Role & responsibilities of mid level healthcare providers Mid-level health providers (MLHPs) are health workers trained at a higher education institution for at least 2-3 years. MLHP is a health provider who: 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 (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.

1. Mid-Level Healthcare
Providers (MLHP)
Presented by:
Harsh Rastogi,
Nursing Tutor,
M. S. Institute of Nursing,
Lucknow

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.

3. Cont…
 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.

4. Cont…
 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.

5. Definition
 Mid-level health providers (MLHPs) 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.

6. Cont…
 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

7. Definition
 MLHP is a health provider who:
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

8. Cont...
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.

9. 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.

10. Cont…
 According to the UN Secretary General
Global Strategy for Women’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.

11. Cont…
 In many settings, however, finding the
resources to train and employ new health
workers is problematic.

12. According to W.H.O.
 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)

13. Cont…
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.

14. Postulation 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.

15. Cont…
 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.

16. Cont…
 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.

17. Cont…
 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.

18. Cont…
 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.

19. Cont…
 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.

20. MLHP in India (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.

22. Cont…
 Government of India has Integrated
Middle-Level Health Provider (MLHP) in
Basic B.Sc. Nursing and Post Basic B.Sc.
Nursing Curriculum in February 2019.
 The total number of hours to incorporate in
the existing Community Health Nursing
subject is around 75 hours (theory +
practical).

23. Cont…
 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.

24. Incorporated topics
 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:
i. Roles and responsibilities of Mid-Level
Healthcare Providers (MLHP)
ii. New national health programmes

25. Cont…
iii. AYUSHMAN BHARAT- The up gradation
of sub-centers into of health and wellness
centres, Concept of Comprehensive
primary health care and key elements of
CPHC. Service delivery and continuum of
care and Roles of Mid-level health care
providers (MLHP)

26. Cont…
iv. Diagnosing and treatment skills essential
at sub-centre level using Standard
treatment protocols as per national health
programmes.
v. Introduction to Rashtriya Bal Sureksha
Karyakaram (RBSK)

27. Cont…
vi. Social mobilization skills
vii. Drug dispensing
viii. Programme management including
supervision and monitoring
ix. Investigation of an outbreak
x. Behavior change communication and soft
skills

28. Cont…
xi. Integrated Disease Surveillance Project
(IDSP)
xii. Mother and Child Tracking System
(MCTS)
xiii. Chikungunya
xiv. Organization of labour room
xv. Safe child birth checklist

29. Cont…
xvi. Postpartum visits by health workers
xvii. Family planning 2020
xviii.National family planning programmes
xix. Food born diseases.

30. Topics to be reviewed
i. Health planning and health care delivery
system in India (IPHS guidelines)
ii. Health Management Information System
HMIS)
iii. Electronic Medical Records(EMR)
iv. Micro birth planning
v. Adolescent counselling
vi. Sources of vital statistics

31. Cont…
vii. Financial Management, Accounts and
Computing at Sub-Centre
viii. Mental health act, drug de-addiction
programmes
ix. Time trends in disease occurrence in
epidemiology
x. Infant and young child feeding and
counselling

32. Cont…
xi. Nutrition across life cycle and update on
national nutritional programmes
xii. Use of Equipment
xiii. Throat problems and febrile seizure in
children
xiv. Transportation of baby and common
accidents and mishaps in labour room

33. Cont…
xv. Counselling-GATHER Approach Update
biomedical waste management by
specifying BMWM rules 2016
xvi. Suturing of superficial wounds
xvii. Postpartum Intra Uterine Contraceptive
Device (PPIUCD)
xviii.All the national health programmes on
Communicable.non communicable

34. Role & responsibilities
of Mid-Level
Healthcare Providers

35. Introduction (MLHP/CHO/CHP)
 The concept of mid-level health providers
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.

36. Cont…
 Mid-level health care providers are new
emerging workforce in healthcare sector.
 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.

37. Cont…
 In order to provide quality primary health
care In 2019, a new Mid-level Health Care
Provider role was introduced in India, also
known as Community Health Officer/
Community Health Provider.
 The role was intended for support the
health and wellness centres in community.

39. Cont…
 Mid-level practitioners, also called
assistant practice clinicians and non-
physician practitioner, are trained health
care providers who have a defined scope
of practice.

40. Cont…
 This means that they are trained and
legally permitted to provide healthcare in
fewer situations than physicians and some
other health professionals, but more than
other health professionals.
 Mid-level providers are cost-effective in
primary care settings, where they can
relieve physicians of the necessity of
providing routine care.

41. Cont…
 Community health officers play a role to
bridge the gap between community people
and health care facilities.
 The services provided by them improve
the quality of life in community and also
empowers the community health care
settings

42. Cont…
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.

43. Definition
 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

44. Need for MLHP
 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 sub- centre, primary
health centre 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.

45. Cont…
 In order to expand access to
comprehensive primary health care
(CPHC), government of India has
launched Ayushman Bharat - Pradhan
Mantri Jan Arogya Yojana (PMJAY) in
Sept, 2018.

46. Cont…
 PMJAY is a centrally sponsored scheme.
Under this scheme - health and wellness
centres (HWCs), sub health centres
(SHCs), and primary health centres
(PHCs) are being strengthened as health
and wellness centres (HWCs).

47. Cont…
 The services in HWCs will be provided
through a mid-level health care provider
(MLHP)/community health officer (CHO)
placed at a HWCs and medical officer at
PHC (rural/urban).
 The MLHP/CHO will undergo a certificate
in community health through IGNOU or
public university.

48. Cont…
 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.
 India is a second most populous nation in
the world and also a developing country.

49. Cont…
 As per WHO, by 2024 the projected
population would be 1,447,560,463.
 With this growing population, India is in a
great demand of doctors and nurses. At
present India has a shortage of an
estimated 600,000 doctors despite of more
than 529 government and private medical
colleges having an annual intake of 70,978
students.

50. Cont…
 Community health officer will bridge the
gap between population and sub-centre,
primary health centre and community
health centre.

51. Cont…
 CHO’s are permitted to serve the
community independently to diagnose,
manage and treat minor ailments and
impairments and also engage in
preventive Expended Service Delivery.
Continuum of Care – Tele-health/ Referral.

52. Cont…
 Their expanding roles are more helpful for
low- and middle-income countries, as a
strategy to overcome the shortage of
health care workforce challenges and
improve access to essential health care
services.

53. Cont…
 So, the MLHP or CHO or mid-level
practioner (MLP) or community health
provider (CHP) are sounds the same and
ultimately it means the majority of nurses
will be in this role.

54. Training
 The curriculum will enable the MLHP to
attain a set of competencies related to
MLHP:
Selection process of candidates for MLHP to
be designed so as to attract competent and
motivated candidates- Preferential Local
Selection.

55. Cont…
MLHPs trained in six month. IGNOU
accredited "Certificate Programme In
Community Health" to build competencies in
public health and primary care theory, soft
skill and experiential learning.
Career progression pathways for MLHPs in
public health functions to be charted at least
up to district level to synergize with Public
Health Cadre.

56. Roles and responsibilities of
MLHP
 CHO roles and responsibilities are purely
population oriented in public health.
 They are expected to provide specific
service delivery, leadership, supervision,
management and take pro-active role in all
the activities at community level, organize
various health program and activity in
health promotion according the need.

57. Cont…
 These roles of CHO help to bridge the gap
between health care facilities and
population seeking health care.
 Roles are:
I. Health care services
II. Administrative and supervision services
III. Other services

58. Roles & responsibilities of
MLHP
MLHP
MCH
Neonatal &
Infant Health
care
Mental
Health
Services
Reproductive
Health care
Child &
adolescent
health care
Care in
illness &
minor
ailment Oral health
Geriatric &
palliative
care
Emergency
services
CDs & NCDs
Eye & ENT
care

59. I. Health care services
 Maternal health care: Prenatal care like
antenatal check-up, screening for high
risk, immunization and supplementation,
child birth, postnatal care and if require
referral to higher centre.

60. Cont…
 Neonate and infant health care:
Management of high-risk newborn,
screening of congenital anomalies, IMNCI
services, immunization.

61. Cont…
 Childhood and adolescent health care:
Adolescent health counselling,
identification of drug abuse, detection of
any deficiency, nutritional supplement and
referral services.

62. Cont…
 Reproductive health care: Family planning,
prevention and management of STI,
identification of gynaecological problems
and referral services.

63. Cont…
 Communicable diseases: Diagnosis and
treatment of vector or water borne
diseases, provision of DOTs and DPMR
(disability prevention and medical
rehabilitation) services for leprosy along
with referral services.

64. Cont…
 Non-communicable diseases: Screening,
prevention, control and management
along with follow up and maintenance of
treatment modalities.

65. Cont…
 Illness and minor ailments: Identification
and management of fever, respiratory
infection, diarrhoea, cholera, skin rashes,
pain, typhoid, etc.

66. Cont…
 Eye and ENT: Screening along with
primary care of ophthalmic and ENT
problem and referral services of any
emergency.

67. Cont…
 Oral health: Regular check-up and
screening of oral health.

68. Cont…
 Geriatric and palliative care: Health camp
organization routine check-up.

69. Cont…
 Emergency services: Burn, injury, trauma
along with first aid management.

70. Cont…
 Mental health care: Screening and
counselling along with referral services.

71. II. Administrative and
supervision services
 Administrative services: Guidance to other
co-health workers and maintain inventory,
report submission.

72. Cont…
 Supervision: Supervision of national health
program, ASHA, home visits, health
promotion activities.

73. Cont…
 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.

74. Cont…
 Disaster and outbreak of disease: Local
response to disease outbreak and early
management of disaster.

75. Cont…
 Fund management: Support the team for
entitling the fund for various projects and
program.

76. Cont…
 Data management: Record population
data with various health indicator and
communicate it.

77. Cont…
 Environmental role: Education to
community, speak about safe water,
sanitation, disposal of waste, pollution
control and identify environmental hazards
and control.

78. III. Other skills
 Communication
skills
 Interpersonal
relationship skills
 Trans-cultural
competence
 Assessment skills
 Training capability
 Professionalism
 Advocacy
 Education and
 Facilitation

79. Conclusion
 Since we have shortage of doctors and
specialists, the shift in role to mid-level
health care provider will relieve the
overburdened doctors and specialists, at
least in rural health setting.

80. Cont…
 Mid-level health care provider has the
limited licence only in primary and
preventive healthcare to practice medicine
at mid-level, who qualify the criteria as
may be specified by regulations which will
have an overwhelming representation of
doctors.

81. Cont…
 This initiative by government of India will
help to provide easy and affordable health
care services to the population which also
play an important role for universal health
coverage in India.

82. References
1. World Health Organization, Global Health
Workforce Alliance. The Kampala
Declaration and Agenda for Global
Action. Geneva: WHO; 2008.
2. International Labour Organization. The
International Standard Classification of
Occupations (ISCO-88). Geneva: ILO;
2004.

83. Cont…
3. World Health Organization, Western
Pacific Region. Mid-level and nurse
practitioners in the Pacific: models and
issues. Manila: WHO/WPRO; 2001
4. Desai S et al. Int J Community Med
Public Health. 2020 Apr;7(4):1610-1617.