Guidelines on Referral System in CGHS



Guidelines on Referral System in CGHS



The referral system in CGHS is based on the following set of guidelines-

Treatment at CGHS empanelled hospitals


I.                   Treatment under medical emergency:

No referral is required and beneficiary can directly go to any private empanelled hospital for availing treatment.


II.               Elective treatment at Empanelled  hospitals in Delhi/NCR :

-         CGHS/Government Specialist advises specific treatment procedure required. Permission letter has to be obtained from CGHS Wellness centre /Addl. Director of CGHS in case of pensioners, ex-MPs, etc., and from the department in case of serving employees for undergoing the treatment at any of the CGHS empanelled   hospitals of his /her choice.

-         In satellite towns of NCR, viz., Faridabad, Ghaziabad, Gurgaon and Noida, CMO i/c of CGHS Wellness centres can refer the CGHS beneficiaries directly to private empanelled hospitals for treatment and management. In such cases permission for specific treatment procedure is to be obtained from competent authority i.e., from CGHS in case of pensioners, etc., and from the department in case of serving employees.

III.            Treatment at Empanelled hospitals in other CGHS covered cities outside Delhi/NCR :

-         CGHS beneficiaries must compulsorily be referred to Polyclinics wherever set up by the CGHS.  On the advice/opinion of the Specialists/ Post graduate GDMOs, CMO In-charge, AD/ JDs may refer CGHS beneficiary to private empanelled hospitals of the choice of the beneficiary.

-         In those cities which do not have polyclinics and if GDMOs who are post Graduate are available, their services as specialist may be utilized and patients may be referred to the dispensary in which such PG. GDMOs are posted or if space is available in a centrally located dispensary, the PG GDMOs may be posted there.


-         In the event of neither a specialist nor PG GDMO is available in a city CMO In-charge shall make a provisional diagnosis and refer the patients to private empanelled hospital for specialist consultation. If any specific treatment/ procedure is advised (except in emergency) by private empanelled hospital, It must be counter-signed by CMO I/c before the services are availed to check possible misuse.


The processes of referral through Government/ CGHS specialists provide a check and balance in the system, so far as correct diagnosis and treatment is concerned.

The MoS, Ministry of Health and Family Welfare, ShriShripadYessoNaikstated this in a written reply in the LokSabha here today.


                                                       *****
Several Interventions Made Under NHM to Improve the Health Condition of Children

According to UNICEF, the concluding observation made by the Committee on Child Rights in 2014 included the following:

High level of neonatal mortality.

High level of chronic malnutrition (stunting), wasting (acute malnutrition) and underweight among children, in particular children under age 5 years.

Low level of breastfeeding within one-hour of the birth of the child and exclusive breastfeeding of children below 6 months;

Low level of immunization among the children;

High prevalence of communicable diseases among children, such as acute respiratory infections, diarrhoea and fever, including fever linked to malaria.

Several interventions have been made by the Government under National Health Mission to improve the health condition of the Children. These include:

1. Focussed attention in 184 High Priority Districts for implementation of Reproductive Maternal Newborn Child Health+ Adolescent (RMNCH+A) interventions for achieving improved maternal and child health outcomes.

2. Name Based Web enabled Tracking of Pregnant Women to ensure antenatal, intranatal and postnatal care and Children for immunization to all the children.

3. Mother and Child Protection Card in collaboration with the Ministry of Women and Child Development to monitor service delivery for mothers and children.

4. Engagement of more than 8.9 lakhs Accredited Social Health Activists (ASHAs) to generate demand and facilitate accessing of health care services by the community including those for children.

5. Village Health and Nutrition Days in rural areas as an outreach activity, for provision of maternal and child health services.

6. Health and nutrition education to promote dietary diversification, inclusion of iron and folate rich food as well as food items that promote iron absorption.

7. Put in place similar entitlements for all sick infants accessing public health institutions for treatment.

8. Establishment of Newborn care corners at all health facilities where deliveries take place; Setting up of Special New Born Care Units and New Born Stabilization Units at appropriate facilities for the care of sick newborn including preterm babies.

9. Promotion of appropriate Infant and young child feeding practices such as early initiation of breastfeeding, exclusive breastfeeding and age appropriate complementary feeding among young children.

10. Launched India Newborn Action Plan to reduce neonatal mortality and stillbirths.

11. Intensified Diarrhoea Control Fortnight was observed in August 2014 focussing on ORS and Zinc distribution for management of diarrhoea and feeding practices.

12. Integrated Action Plan for Pneumonia and Diarrhoea launched in four States (Uttar Pradesh, Madhya Pradesh, Bihar and Rajasthan) with highest Child Mortality.

The MoS, Ministry of Health and Family Welfare, Shri Shripad Yesso Naik stated this in a written reply in the Lok Sabha here today.

*****

Steps Taken to Improve Health Condition of Children


The Government has been conducting surveys like, National Family Health Surveys (NFHS), District Level Household Surveys (DLHS), Annual Health Survey (AHS), Sample Registration System (SRS) etc., to assess the performance of various health indicators including those for children.
Performance of some of the health indicators relating to children is given below.

 Indicator
 Value
Source (Year)
Neonatal Mortality Rate
29
SRS (2012)
Infant Mortality Rate
40
SRS (2013)
Under  five Mortality Rate 
52
SRS(2012)
 Fully Immunized (%)  Children aged 12-23 months
53.5
DLHS – 3 (2007-08)
 % of  Children aged under 3 years whose mother started breastfeeding within one hour of birth
40.5
DLHS – 3 (2007-08)
 % of Children Under  age 5 years  classified as  Underweight
42.5
NFHS -3 (2005-06)


The steps taken by the Government to further improve the health condition of childreninclude the following:

1.      Focussed attention in 184 High Priority Districts for implementation of Reproductive Maternal Newborn Child Health+ Adolescent (RMNCH+A) interventions for achieving improved maternal and child health outcomes.
2.      Name Based Web enabled Tracking of Pregnant Women to ensure antenatal, intranatal and postnatal care and children for immunization to all the children.
3.      Mother and Child Protection Card in collaboration with the Ministry of Women and Child Development to monitor service delivery for mothers and children.
4.      Engagement of more than 8.9 lakhs Accredited Social Health Activists (ASHAs) to generate demand and facilitate accessing of health care services by the community including those for children.
5.      Village Health and Nutrition Days in rural areas as an outreach activity, for provision of maternal and child health services.
6.      Health and nutrition education to promote dietary diversification, inclusion of iron and folate rich food as well as food items that promote iron absorption.
7.      Put in place similar entitlements for all sick infants accessing public health institutions for treatment.
8.       Establishment of Newborn care corners  at all health facilities where deliveries take place; Setting up of Special New Born Care Units  and New Born Stabilization Units at appropriate facilities for the care of sick newborn including preterm babies.
9.      Promotion of appropriate Infant and young child feeding practices such as early initiation of breastfeeding, exclusive breastfeeding and age appropriate complementary feeding among young children.
10. Launched India Newborn Action Plan to reduce neonatal mortality and stillbirths.
11. Intensified Diarrhoea Control Fortnight was observed in August 2014 focussing on ORS and Zinc distribution for management of diarrhoea and feeding practices.
12. Integrated Action Plan for Pneumonia and Diarrhoea launched in four States (Uttar Pradesh, Madhya Pradesh, Bihar and Rajasthan) with highest Child Mortality.


The MoS, Ministry of Health and Family Welfare, ShriShripadYessoNaikstated this in a written reply in the LokSabha here today.


                                                       *****

Guidelines on Referral System in CGHS Guidelines on Referral System in CGHS Reviewed by Ajit Kumar on 12:19 PM Rating: 5

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