Mid level health provider

2. AIM:
At the end of seminar students will get to know about the detail knowledge of Mid level
health providers.
OBJECTIVES:
At the end of the seminar students will be able to –
• Introduction of Mid- level health providers.
• Define the Mid- level health providers.
• Explain the need of Mid- level health providers.
• Discuss the training of Mid – level health providers.
• Describe the roles and responsibility of Mid- level health providers.

3. • The concept of mid-level health provider started 100 years ago in
many countries and showed a remarkable change in their health
indicators. Since last 10 years, the growth of health professionals
is in rise with its new emerging roles.
• India is alarming country for disease burden and to cover the huge
gap in providing health care facilities, it requires the mid-level
health care providers at different settings of the country.

4. • Mid-level practitioners, also called assistant practice
clinicians, non-physician practitioners are trained health care
providers who have a defined scope of practice. This means
that they are trained and legally permitted to provide
healthcare in fewer situations than physicians and some other
heath professionals, but more than other health professionals
• Community health officers play a role to bridge the gap
between community people and health care facilities.

5. According to WHO, mid-level health provider is:
A health provider:
• Who is trained, authorized and regulated to work autonomously,
• Who receives pre service training at a higher education institution for at
least 2-3 years, and
• Whose scope of practice includes being able to diagnose, manage and
treat illness, diseases and impairments, prescribed medicines, as well as
engage in preventive and promotive care.

6. • In 2019, a new Mid-level Health Care Provider role was
introduced in India, known as Community Health Officer.
The role was intended for support the health and wellness
centres in community level in India.

7. • Studies reported around 11.5% households, in rural areas and about only 4% in urban
areas, are not receiving any form of OPD care at subcenter, primary health care centers
and CHC level. This indicates the low utilization of primary health care for minor
ailments or it may be because of inefficient health care services or unavailability of
healthcare providers.
• In order to expand access to comprehensive primary health care government of India
has launched Ayushman Bharat- Pradhan mantra jan Arogya yojana in sept 2018.
PMJAY is a centrally sponsored scheme. Under this sub health centers, and primary
health centers are being strengthened as health and wellness centers.

8. • The services in HWCs will be provided through a midlevel health
providers / community health officer placed at a PHC, The MLHP will
undergo a certificate in community health through IGNOU or public
university.
• Community health officers are health care workers with training less
than that of a physician but greater than that of more ordinary nurses
and other medical assistants.
• CHOs are permitted to serve the community independently to
diagnose, manage and treat minor ailments and impairments and also
engage in preventive Expended Service Delivery.

10. MLHP
MPW
• 2 Female
• 1 male

12. • Selection process of candidates for MLHP to be designed so as to attract
competent and motivated candidates preferential local candidates.
• MLHPs trained in a six-month IGNOU accredited ‘Certificate Program in
Community Health” to build competencies in public health and primary care
theory, skill and experimental earning.
• Programme approach by Ministry of Health and Family Welfare on 16th March,
2016. It is a six months programme of 18 credits (8 credits in theory and 10 credits
in practical). It has 2 theory and 1 practical course. The programme was designed
and developed with the funding of Ministry of Health and Family Welfare, GOI
(NHM) and the programme has been launched by IGNOU in January, 2017.
• Nursing and AYUSH Practitioner are eligible.

13. CHO roles and responsibilities are purely population oriented in public health.
They are expected to provide specific service delivery, leadership, supervision,
management and take proactive role in all the activities at community level,
organize various health program and activity in health promotion according the
need These roles of CHO help to bridge the gap between heath care facilities and
population seeking health care.
ROLES ARE:
• Health care services
• Administrative and supervision services
• Other services

15. • Maternal health care: Prenatal care like antenatal checkup, screening for high risk,
immunization and supplementation, child birth, postnatal care and if require referral to
higher center.
• Neonate and infant health care: Management of high-risk newborn, screening of
congenital anomalies, IMNCI services, immunization.
• Childhood and adolescent health care: Adolescent health counseling, identification
of drug abuse, detection of any deficiency, nutritional supplement and referral services.
• Reproductive health care: Family planning, prevention and management of STI,
identification of gynecological problems and referral services,

16. • Communicable diseases: Diagnosis and treatment of vector or water
borne diseases, provision of DOTs and DPMR services for leprosy
along with referral services.
• Illness and minor ailments: Identification and management of fever,
respiratory infection, diarrhea, cholera, skin rashes, pain, typhoid.
• Non communicable diseases: Screening, prevention, control and
management along with follow up and maintenance of treatment
modalities.
• Eye and ENT: Screening along with primary care of ophthalmic and
ENT problem and referral services of any emergency.

17. • Oral health: regular checkup and screening of oral health.
• Geriatric and palliative care: Health camp organization
routine checkup.
• Emergency services: Burn, injury, trauma an along with
first aid management.
• Mental health care: Screening and counseling along with
referral services

18. • Administrative services: Guidance to other co health workers and maintain
inventory, report submission.
• Supervision: Supervision of national health program, ASHA, home visit,
health promotion activities.
• Care pathway: Provide specific care according to standard treatment
guidelines.
• Case coordinator and manager: Provide communication to higher
authority regarding specific case, coordinate in care and management of
care.

19. • Disaster and outbreak of diseases: Local response to disease
outbreak and early management of disaster.
• Fund management: Support the team for entitling the fund for
various projects and program.
• Data management: Record population data with various health
indicator and communicate it.
• Environmental role: education to community, speak about safe
water, sanitation, disposal of waste, pollution control and identity
environmental hazard and control.

21. Communication skills, interpersonal relationship skills,
transcultural competence, assessment skills, training
capability, professionalism, advocacy and education.

22. Measuring and managing the work environment of the mid-level provider
Eilish McAuliffe, Cameron Bowie, Human Resources for Health volume 7,Article number: 13 (2009)
• Background
Countries having lost most of their highly qualified health care professionals to migration
increasingly rely on mid-level providers as the mainstay for health services delivery. Mid-level
providers are health workers who perform tasks conventionally associated with more highly trained
and internationally mobile workers. Their training usually has lower entry requirements and is for
shorter periods (usually two to four years). This paper explores the work environment of mid-level
providers in Malawi, and contributes to the validation of an instrument to measure the work
environment of mid-level providers in low-income countries.

23. • Conclusion
The Healthcare Provider Work Index identifies factors salient to improving job
satisfaction and work performance among mid-level cadres in resource-poor settings.
The extent to which these results can be generalized beyond the current sample must
be established. The poor motivational environment in which clinical officers and
medical assistants work in comparison to that of nurses is of concern, as these staff
members are increasingly being asked to take on leadership roles and greater levels of
clinical responsibility. More research on mid-level providers is needed, as they are the
mainstay of health service delivery in many low-income countries. This paper
contributes to a methodology for exploring the work environment of mid-level
providers in low-income countries and identifies several areas needing further
research.

24. Enlist health care services ?

25. • https://ab-hwc.nhp.gov.in/home/aboutus
• https://www.who.int/workforcealliance/knowledge/resources/Final_
MLP_web_2.pdf
• http://svnc.co.in/wp-content/uploads/2020/04/Mid-Level-Health-Providers-
MLHP_R1.pdf
• https://link.springer.com/article/10.1186/1478-4491-7-13