This document introduces mid-level health providers (MLHPs) as an emerging workforce in developing countries to address shortages of trained healthcare professionals. MLHPs are health workers trained for 2-3 years who can diagnose, treat illnesses and perform basic medical tasks autonomously, especially in rural areas with limited access to doctors and nurses. The document defines MLHPs according to the WHO and discusses their concept, including how adequately trained MLHPs can deliver essential health services with quality comparable to physicians. It also outlines India's introduction of a new MLHP role called Community Health Officers in 2019 to support primary health centers, and changes being integrated to nursing curriculums to incorporate MLHP training.

1. MID LEVEL HEALTH PROVIDER
(MLHP)
Introduction
By
Mrs. Nagamani.T
Dept of Community Health Nursing
Quality Health Care College of Nursing

2. INTRODUCTION
Health care burden of developing countries is rapidly increasing day by day. Most of the
population belongs to below poverty line and are unable to avail health care services.
Health facilities of developing countries are inadequate to meet the demands of vast
population.
To get over with health issues the country requires health care professionals and
healthcare facilities for providing required healthcare support.On the other hand
shortage of trained health care professionals also directly creates extra burden on the
government.
In India, the government is working towards easy access of healthcare services for all.
The community health officer is the new step by Indian government which comes under
mid-level healthcare providers. Mid-level health care providers are new emerging
workforce in healthcare sector.

3. DEFINITION
Mid-level health providers (MLPs) are health workers trained at a higher
education institution for at least 2-3 years.They are authorized to work
autonomously to diagnose, manage and treat illness, disease and impairments,
as well as engage in preventive and promotive care.
They are increasingly being used to render services autonomously, particularly
in rural and remote areas to make up for the gaps in health workers with higher
qualifications.
Mid-level health providers; a promising resource to achieve the health
Millennium Development Goals

4. DEFINITION. ACCTO W.H.O..
MLHP is a health provider:
a.Who is trained, authorized and regulated to work autonomously,
b.Who receives pre-service training at a higher education institution for at least 2-3
years, and
c.Whose scope of practice includes (but is not restricted to) being able to diagnose,
manage and treat illness, disease and impairments (including perform surgery,
where appropriately trained), prescribe medicines, as well as engage in preventive
and promotive care.

5. CONCEPT OF MLHP
Many countries are facing critical shortages of health workers, in particular in rural areas,
which hinder the provision of essential health services.
According to the UN Secretary General Global Strategy forWomen’s and Children’s
health, up to 3.5 million additional health workers are needed in 49 low-income countries
in order to achieve the health Millennium Development Goals targets
In many settings, however, finding the resources to train and employ new health workers
is problematic;

6. ACCTOWHO..
What do we mean by quality of care?
Quality of care should:
● Fit the needs of the patient;
● Cause no harm to the patient;
● Be right for the patient (correct diagnosis and
treatment, i.e. evidence based);
● Be given without unnecessary delays;
● Include only the necessary medical tests and
procedures for the specific diagnosis and
treatment;
● Be fair and not affected by gender, religion,
language, age or income.

7. CONCEPT OF MLHP
Mid-level providers are health workers with 2-3 years of post- secondary school
healthcare training who undertake tasks usually carried out by doctors and nurses,
such as clinical or diagnostic functions.
They are increasingly being used to render services autonomously, particularly in
rural and remote areas to make up for the gaps in health workers with higher
qualifications.
Experience demonstrates that, where these mid-level providers are adequately
trained, supported and supervised, they can deliver essential health services
including maternal and child health, HIV and other priority conditions with similar
quality standards as physicians, and often for a fraction of the cost.

8. CONCEPT OF MLHP
Mid-level health workers should therefore be included as part of the general planning and
management of the health system, and equally benefit from support, supervision, regulation,
quality control, and opportunities for professional development and career progression.
Their role has been progressively expanding and receiving attention, in particular in low- and
middle income countries, as a strategy to overcome health workforce challenges and improve
access to essential health services.
Finally, there is a clear need for establishing procedures and systems that can integrate core HR
management functions, such as accreditation, regulation, professional development and career
progression for MLP, in the planning and management of the health system.

9. MLHP IN INDIA
In 2019, a new mid level health care provider role was introduced in India, known as Community
Health Officer (CHO).The role was intended to support the Health and Wellness Centres in
community level in India.
Govt of India has Integrated Middle-Level Health Provider (MLHP) in Basic B.Sc Nursing and Post
Basic B.Sc Nursing Curriculum in Feb 2019.
The total number of hours to incorporate in the existing Community Health Nursing subject is around
75 hours (theory + practical). It will be feasible to accommodate in the 195 hours already allocated in
the B.Sc Nursing Syllabus (internship period) & P.B.B.Sc.(N) in CHN.
The following areas to be incorporated in the Community Health Nursing subject of B.Sc Nursing
Syllabus and also in Post Basic B.Sc Nursing:-
1. Roles and responsibilities of Mid-Level Healthcare Providers (MLHP)
2. New national health programmes

10. 3. AYUSHMÄN BHARAT-The up gradation of sub-centers into of health and
wellness centers, Concept of Comprehensive primary health care and key
elements of CPI-IC, Service delivery and continuum of care and Roles of Mid-level
health care providers(MLHP)
4. Diagnosing and treatment skills essential at sub-centre level using Standard
treatment protocols as per national health programmes
5. Introduction to Rashtriya Bal Sureksha Karyakaram (RBSK)
6. .Social mobilization skills
7. Drug dispensing
8. Programme management including supervision and monitoring
9. Investigation of an outbreak
10. Behavior change communication and soft skills
11 Integrated Disease Surveillance Project (IDSP)
12. Mother and ChildTracking System (MCT S)

11. 13. Chikungunya
14. Organization of labour room
15. Safe child birth checklist
16. Postpartum visits by health workers
17. Family planning 2020
18. National family planning programmes
19. Food Borne diseases

12. Following topics to be reviewed:-
 Health planning and health care delivery system in India (IPHS guidelines)
 Health Management Information System(HMIS)
 Electronic Medical Records(EMR)
 Micro birth planning
 Adolescent counseling
 Sources of vital statistics
 Financial Management, Accounts and Computing at Sub - Centre Mental
health act, drug de-addiction programmes

13.  Time trends in disease occurrence in epidemiology
 Infant and young child feeding and counseling
 Nutrition across life cycle and update on national nutritional programmes Use of
Equipment
 Throat problems and febrile seizure in children
 Transportation of baby and common accidents and mishaps 111 labour room
Counselling-GATHERApproach
 Update biomedical waste management by specifying biomedical waste
management rules 2016
 Suturing of superficial wounds
 Postpartum Intra Uterine Contraceptive Device (PPIUCD)
 All the national health programmes on Communicable,non communicable

14. WILL CONTINUE WITH THE NEXT CLASS ABOUT EACH TOPIC
GIVEN UNDER MLHP.
** THANK YOU **