ST.

Joseph University College of Health and Allied

Health Sciences, Boko Bovya, Dar es Salaam
Community Health Department

MD4 Semester 7& 8 Community Medicine

Rotation
Guide

1
2
 I N D E X

1. 4th year Medical Student’s Rotation in

Community Medicine
2. 4th year Rotation – Community Health
Commentary
3. The Guideline for Dispensary Week
4. The Guideline to Health Centre week
5. The District Health System
6. Functions of a D.M.O.
7. Evaluation of 4th year MD Community
Medicine Rotation

3
ST. Joseph University College of Health and Allied
Health Sciences, Boko Bovya, Dar es Salaam

DEPARTMENT OF COMMUNITY HEALTH

4TH YEAR MEDICAL STUDENTS ROTATION

IN COMMUNITY MEDICINE
Introduction:

Community Health rotation is different from the

other rotations ( [Link], surgery etc.), the
whole emphasis in community medicine will be on
the community as such and not on the individual.
You will be trained in:

1) How to make a community diagnosis.

2) How to provide health to a community with

the participation and help of the community.

3) How to evaluate implemented health

measures in a community (with the community)
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4) How good health will be achieved by the
community if you, as a future DMO, will be able
to initiate and assist in sustaining health related
activities.

- Instead of learning how to diagnose a disease

in a patient you will learn how to diagnose a
health problem of a community.

- Instead of learning which laboratory tests can

help to detect a disease, you will learn which
epidemiologic methods you should apply to
detect the factors that influence the health
status of a community and how to identify and
measure them.

- Instead of learning how to evaluate the

treatment of a patient, you will learn how to
monitor and evaluate the impact of
implemented measures, e.g National control
programmes such as the national T.B. and
leprosy programme, CCD, EPI, RCH, FP-
programme and HIV and AIDS control from
PHC level up to district level.
5
But diagnosing a health problem within the
community, trying to solve it and providing care to the
community, that is acceptable to the community,
needs a different attitude in addition to medical
knowledge, skill and devotion, needed to treat an
individual.
This commitment or attitude towards the community
is the most difficult part of our activities during the 5
weeks. Some of you may have it already, in others we
hope to develop it.

Our broad objective is to prepare you as a future

medical officer who is able to function as a health
(team) leader to provide health for the whole
population with emphasis on the rural population,
which forms over two-thirds of your population. Or to
express it as a behavioral objective:

- “To integrate the theoretical knowledge with

the practical experience in the villages, into
skills which will enable you as a future DMO
to perform your duties as a health team leader
of the district.”

6
- The first week will be an orientation week.
You will be reminded of the epidemiologic
principles involved, which by now you will
have learned in your previous years of
training.

- The second week of the rotation is the

dispensary week. The third week, is the
health center week. In both the second and the
third week, you will participate and gain
experience in providing the health care, which
is carried out at Primary Health Care level.
You will compare that with the theoretical
knowledge you have on Tanzania’s PHC
Strategy, MDGs and now Sustainable
Development Goals (2030). You will be able
to discover whether there are any gaps and if
so, try to think of possible solutions, so that in
the future, as a medical officer, you will know
how to improve the health status of our
communities. You will also discover what
determinants of health in a rural community
are due to all kinds of environmental, socio-
economic, political and culture factors.

7
 practical aspects of rural water supply and
environmental sanitation.

- Immediately after the health center week, you

will travel to the District . In week four you
will learn of some aspects of District Health
system , Council Health Management Team
(CHMT) . You will also learn practically the
public health duties of the DMO and the roles
and functions of a District
Hospital .management of district .

In the 5th week we will discuss you

experiences of the past 5 weeks.
We will finish with a written exam in
community medicine. Assessment of your
performance during the whole rotation in
community health will comprise of
assessment of:
- Dispensary report
- Health center report
- DMO report
- Project paper and presentation
- Written exam

8
 - Presence and participation during
the rotation.

EDUCATIONAL OBJECTIVES OF 4TH YEAR’S

ROTATION COMMUNITY MEDICINE:

During the Community Medicine Rotation 4th year

medical students should acquire a satisfactory level of
competence in the following areas:-

1) Ability to apply epidemiological methods in

studying and diagnosing the health of a rural
community in relation to the specific ecological,
socioeconomic, cultural and political factors.

1.1) Identify, describe and practically utilize

the relevant sources of information.
1.2) Design, undertake and report on a study
of a health aspect in a rural community.
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 1.3) Define the major health determinants of a
rural community.

1.4) Establish the disease pattern in its terms

of incidence, prevalence and severity, and
its potential to epidemics and its control
and preventability and determine its
priority in tackling it.

2) To describe and learn the practical application

of methods and programmes for control of
major health problems of a rural community at
the primary, secondary and tertiary level of
prevention within the framework of the existing
medical care delivery system and according to
the local and national priorities.

2.1) Describe the specific methods of control

of common and
important condition, in terms of:
Primary prevention e.g. environmental
sanitation.

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 Secondary Prevention e.g. effective
treatment, screening methods, growth
monitoring.
Tertiary prevention e.g. proper
management of lameness due to polio.

2.2) To study and appraise to design,

organization and
functioning of the existing health control
programmes in rural areas.

2.3) Practical experience in evaluating the

effectiveness and benefits of a control
program.

3. To acquire practical knowledge and

understanding of the structure and organization
of the Nation’s medical services and the
interrelated function of the medical units at
different levels with particular emphasis on
rural health services.

3.1) To study the national health policy and its

application in practice.

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 3.2) To describe the primary and secondary
level of medical care, as delivered by the
basic health services.

3.3) To identify the medical and health cadres

and study practically their place and
function and co-ordination in medical
care delivery in rural areas.

3.4) To study the community attitude towards

and participation in the existing health
programmes. To identify factors which
enhance community participation or those
that impede community participation in
existing health programmes. To devise
ways of dealing with those factors
appropriately. To identify whether
existing health progrmmes cover felt
needs of the community.

4) To learn to apply practically the appropriate

methods and procedures to administration and
operational managements of basic health services.

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4.1)Administration of medical services in the
general set – up of the decentralized civil
administration; levels of authority, lines of
command, channels of communication etc.

4.2)To study the liaison between the district

offices and other district offices and voluntary
medical services.

4.3)To study the applied administrative

procedures.

4.4)To experience the problems in financing,

budgeting and supplying, the rural medical
services and formulate possible solutions.

4.5)To learn the responsibilities of the DMO and

CHMT in the planning and development of
district health services in relation to the
population to be served, their health needs and
the available resources.

4.6)To acquire experience as a leader to a health

team in:

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 4.6.1) Selection, appraisal and development
of auxiliary medical and health staff.

4.6.2) Assessment and promotion of

knowledge and skills of the medical
health cadres.

4.6.3) Supervision and disciplinary action.

4.7)Evaluation of the effectiveness and benefits of

the basic health services.

These objectives will be further specified and

learning activities defined in order to facilitate
the practical work of the students within the
framework of the weekly programmes.

RULES AND REGULATIONS:

1)Absence of more than two hourly sessions of the

rotation (Whether it be class or practical) will
disqualify you for sitting the exam, unless the
head of the department decides otherwise. See the
university catalogue (under examination
regulations) for conditions of sitting exams.
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2)You are expected to be an example in public
health promoting behaviour.

3)Always make sure that when you screen a

population or do a survey, that you can back up
your findings with advice and treatment if
necessary.

4)Prepare any health education you have to give

thoroughly and well in advance, as to have time
and opportunity to look for suitable education
materials.

5)You are expected to do extensive reading on your

own, both at BOKO DOVYA and in the field.
6.a) When writing a report or research paper, write it
concisely and clear, preferable typed. Follow
the following partition:
1) title
2) acknowledgement if applicable
3) summary
4) introduction and review of literature
5) objectives
6) methodology
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 7) analysis of data
8) discussion
9) recommendations
10) references.

b) Reports and files have to be handed in a the last

Saturday morning of the
rotation before the exam starts.

7) Arrangements for food and other commodities

needed in the field (Dispensary, Health Centre,
Districts, etc.) should be made ahead of time,
while you are still in Dar es Salaam.

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 4TH YEAR ROTATION COMMUNITY

HEALTH COMMENTARY:

You had an exposure to the planning, implementation

and evaluation of different health activities in different
health units of varying size and complexity.

You are in a position now to write a comprehensive

commentary on the following:-

1. Using your knowledge on the definition

of PHC, MDGs and now SDGs -2030
briefly comment on the adequacy of its
implementation at the Dispensary, Health
Centre and District level.

2. Some of the SDG goals have been part of

the National Health Policy even before
the official adoption of Universal Health
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 Coverage strategy . What are your
expectations?
3. It is over 40 years now after the Primary
Health Care Strategy was declared in
Alma-Ata. Is PHC still relevant in
Tanzania?
Using our knowledge of the definition of
PHC, what constraints did you observe in
its implementation at National, Regional,
District, Division, ward and village level.
Suggest practical solutions to the
identified constraints.

4. Having spent 4 years at a Teaching

hospital, briefly discuss the role of
university teaching hospital in the
implementation of Universal Health
Coverage.

INSTRUCTIONS:

To be able to achieve this, you should produce an

individual folder with all the reports you have
prepared while doing Community Health Rotation
including a copy a research paper. This folder should
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be handled in at the ends of your rotation and will
form the basis of individual assessment during 4th
year rotation.

Reference should constantly be made to the contents

of your reports in your commentary. The commentary
should NOT exceed 1000 words and should be typed
double-spaced on A4 size papers.

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 THE GUIDELINE FOR DISPENSARY WEEK DURING THE
COMMUNITY MEDICINE ROTATION

EDUCATIONAL OBJECTIVE:

1. Ability to apply epidemiological methods in studying and

diagnosing the Health disease of rural community in relation
to the specific ecological, socioeconomic, political and
culture factors.

SUBJECT LEARNING LEARNING

CONTENT OBJECTIVE ACTIVITY

A. Interrelation of a) To be able to collect Find sources of

factors, which data on information like
B. influence - Demography, village. Officer.
health. village
population,
catchment area Visit water sources.
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SUBJECT LEARNING LEARNING
CONTENT OBJECTIVE ACTIVITY
Dispensary
population
density.
- Distance from the
first aid post km
or walking hours.
- Distance from the
H.C. in km or
working.

i) Environmental –
identify – different
water sources and
means of
protection.
- Latrine types and
% coverage
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SUBJECT LEARNING LEARNING
CONTENT OBJECTIVE ACTIVITY
- Garbage pits%
coverage.

ii) Agricultural –
Subsistence crops
- Cash crops
- Average
production of
food and cash
crops per family.
- Average
production of
communal
shamba.
- Average income
year per family.
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 SUBJECT LEARNING LEARNING
CONTENT OBJECTIVE ACTIVITY
iii) Social and culture
services.

-
1. Daily attendances - Daily attendance - Visit and sit
rate, no of together with a
deliveries per traditional
year. practitioner or
- No. of traditional traditional
practitioners. midwifes.
- No. of traditional Identify
birth attendars. present of self
- Other means of medication or
getting health medication by
care. family member
or relative.
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 SUBJECT LEARNING LEARNING
CONTENT OBJECTIVE ACTIVITY

2. Survey of Health a) Identify the top ten - Collect data on

status problems of dispensary attendance by
attendances from age sex
registration book. diagnosis made
in last month.
b) Identify the top ten Make a
problems of dispensary random choice
attanders during your of all pts,
stay. visiting the
disp. During
c) Identify the nutritional other two days,
status of the under define the
fives attending a major problem
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SUBJECT LEARNING LEARNING
CONTENT OBJECTIVE ACTIVITY
dispensary and to detect or diagnosis
the at risk children. you can
establish
d) Elaborate on reliability during the
of the above two visit, compile
parameters as your data after
measurement of the 1 day to list the
health status and top ten
elaborate on any compare the
discrepancy between books for any
these two and any bias.
information obtained
from 1a, ii, and iii. - Use: Barker:
epidemiology
use handout.

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EDUCATIONAL OBJECTIVE:

[Link] and learn the practical application of methods and

programmes for control of major health problems of a community at the
primary, secondary and tertiary prevention level within the framework of
the existing medical delivery systems and according to national and local
priorities.

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 SUBJECT LEARNING LEARNING
CONTENT OBJECTIVE ACTIVITY
Primary prevention - To identify Read: Ministers
of disease in the national priorities Budget speech.
community for prevention of Read: Current national
disease. development plan.
Among the top
ten problems you
have identified:

- List the common

preventable health
problems in the
dispensary
- To analyse for
each what should
be done what Read: National plan of
could be done Immunisations WHO
within the paper on vaccination
27
 SUBJECT LEARNING LEARNING
CONTENT OBJECTIVE ACTIVITY
Secondary available schedules observe
prevention of resources and ongoing activities.
disease at what is done to List for example
dispensary implement contact time between
primary patient and person in-
prevention in the charge average length
community the in minutes, adequate
dispensary history and physical
services. examination and any
weakness in the flow
a) Identify limitations to chart.
diagnostic facilities
desirable at the List drug in the
dispensary and discuss Ministry list that are
possibilities of not fast among; and list
improvisation with drugs not on the list but
special reference to TB prescribed by C.O/C.A.
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 SUBJECT LEARNING LEARNING
CONTENT OBJECTIVE ACTIVITY
and Leprosy.

Identify the applicability

of the Ministry of Health
drug list.

Leprosy/TB Control Identify the reattendance List the activities

rate, what are the reasons covered in the NTIP,
for reattendance. which are not carried
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 SUBJECT LEARNING LEARNING
CONTENT OBJECTIVE ACTIVITY
out at the dispensary
and discuss with the in
charge.

EDUCATIONAL OBJECTIVE:

[Link] acquire practical knowledge and understanding the structure

organization of the medical services in the country and the interrelated
function of the medical unit at different levels, with particular emphasis
on rural health services.

SUBJECT LEARNING LEARNING

CONTENT OBJECTIVE ACTIVITY

Structure medical Identify the different Look into problems eg.

service at village types of staff needed at Drug supply, equipment,
30
 SUBJECT LEARNING LEARNING
CONTENT OBJECTIVE ACTIVITY
level. village level according to supply staff, at risk
the national health policy detection contact tracing,
identify the function of self help pregnant etc.
first side and function as how ho they affect the
the same and it start day to day running of the
number according to the health unit.
Organisation of national policy and its Discuss self-referral via
medical services at real function at this stage traditional practitioner?
dispensary level of development. Any referral notes. What
is done ore should be
Identify the major done with –
organization problem - sputa to be
you come across in the stained for AFB
dispensary identify - drug – lab. Test
reason and possible - antennal mothers
solution within the with risk factors.
available resources. - Chargencion.
31
SUBJECT LEARNING LEARNING
CONTENT OBJECTIVE ACTIVITY
- Chronic patients.
Identify the referral - Mother for anti
system and used by conceptive
community first aider discuss what has
and dispensary to been done and its
secondary medical care outcome analysis
(health center, district with RMA and
hospital, regional village leader the
hospital). possible failures.

Describe how to initiates

any self help programme
in improving health
status of the country.

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 GUIDANCE ON DISPENSARY AND ALL
OTHER REPORTS

SOURCE OF INFORMATION: Guidelines of

dispensary/health centre etc week.

The idea of the report is that it reflects the objectives

of the guidelines and put ally our observations and
findings in a framework from where you can deduct
suggestions, recommendations and conclusions. Be
careful that all you suggestions are based on sound
findings, which were quantifiable (e.g.: not the
dispensary was dirty but: the floor was only once
whipped during our 7 day stay, no garbage pits
around, just scattered litter, no cleaning of cupboards,
windows, walls observed).

THE DIFFERENT CHAPTERS:

1. INTRODUCTION:
Give an outline of the need of you, medical students,
and observing dispensary activities in preparing you
as a future D.M.O.
(Maximal 100 ward).

2. OBJECTIVES: See guidelines

33
3. METHODOLOGY: How did you get your
information.
(Maximal 50 wards)

4. RESULTS: Observation following the objectives.

- General description village
- Economic factors related to health status of
village population
- Sociological factors related to health status of
village population
- Out rural factors related to health status of
village population
- Environmental factors related to health status
of village population
- Medical factors related to health status of
village population
- Accessibility, utilization of dispensary.
- Competition by other types of medical
services (stores, traditional).
- Input of health care: staff, equipment, drugs,
and building sitting.
- Output and quality of services:
Qualify and quantify the type of care at each
level of prevention, quality and quantify the
34
 output of each member of staff and of the
whole team as such. Relate this to the internal
organization and administration.
- Health status of the population.

DISCUSSION:
What is your role as a future D.M.O in maintaining
and /or improving the quality of health services at
dispensary level. What is realistic and feeble within
the current constraints to be achieved at short term,
and what is realistic and feasible on a long term
planning. Discuss this in the framework of priorities
based on the public health importance of what you
have observed. For the whole report try to be concise
and precise. Don’t repeat but refer to what you have
earlier said.

35
 GUIDELINE FOR HEALTH CENTER WEEK DURING 4TH YEAR
ROTATION

EDUCATIONAL OBJECTIVE:

During this week practical knowledge will be demonstrated in applying

community health knowledge to a rural community. The week will cover
three main areas of community health
[Link] Health.
[Link] and Child Health (MCH) services.
[Link] Education and Teaching Methods.

Please follow the guideline as per following objectives and learning

activities. For each subject content there are few objectives, which are to be
met with specific learning activities. At the end of activities in each subject,
objectives must be met. If in doubt please discuss with the accompanying
staff or your colleagues.

36
 SUBJECT LEARNING LEARNING ACTIVITY
CONTENT OBJECTIVE
1. [Link] study and [Link] a village and make
ENVIRONMENTA evaluate the notes on water source
L environmental quantity, quality and uses.
HEALTH sanitation status Latrine uses and excreta
of a village. and refuse disposal.
Discuss the findings as a
[Link] discuss the group.
health hazards of
bad [Link] your
environmental observations with
sanitation with villagers and explain to
villagers. them about health hazards
of their environmental
[Link] practically conditions.
demonstrate a
measure to
improve [Link] your
37
 SUBJECT LEARNING LEARNING ACTIVITY
CONTENT OBJECTIVE
environmental discussion put
sanitation. suggestions for
II. Structure of a) Improving
Medical services at environmental
H.C. level conditions.
Out of the
suggestions arrange
for a demonstration
of one-method and
[Link] familiarize assist villagers to
with National understand what they
policy for a health can do and how they
center activity. can do. E.g. Digging
a pit latrine or refuse
pit, burning dry
refuse.
38
SUBJECT LEARNING LEARNING ACTIVITY
CONTENT OBJECTIVE
b) Read – Current
Budget speech and
Minister
of Health and
Social Welfare five-
year plan.
- Other references –
hand out.

[Link] the c) Discuss with your group

functions of a if you are not clear.
health center
in various ares; d) Visit out – patient
1) to study department. Study the
out patient recording
activities. system.
39
SUBJECT LEARNING LEARNING ACTIVITY
CONTENT OBJECTIVE
1) Pattern of patient
flow through out-
patient
services,
2) Visit drug dispensary
and drug stores-note
the availability, types,
ordering, recording,
storeing of drugs.
3) Note catchment area
of the health center
ten
common causes of
out patient
attendance
referrals from
dispensary, referrals
40
SUBJECT LEARNING LEARNING ACTIVITY
CONTENT OBJECTIVE
to district hospital,
transport availability
and distances from
which patients walk.
4) Note on activities
taking place about
National
Health
programmes e.g. T.B.
Leprosy etc.
b) To study B) (i) Study 10
activity in-patient. common causes of
admissions to the
health center.

ii) Assess the in

patient service with regards to
41
SUBJECT LEARNING LEARNING ACTIVITY
CONTENT OBJECTIVE
medical care,
physical facilities (building,
bed,
space etc) and
c) To study RCH staff situation in in-patient.
activities
iii) Study the
procedure of admission,
discharge
and referral from
inpatient service.

c) i) Study how are

records kept in RCH clinics
ii) Study from which
areas mother/children
c) To study antenatal come
42
SUBJECT LEARNING LEARNING ACTIVITY
CONTENT OBJECTIVE
activity. to attend clinic.
iii) Note how many visits
each of them make.
Discuss the reasons
from failure of
subsequent visits both
with mother and RCH
c) (B) To study staff.
Child clinic activities. iv) Study what
immunizations are given at
the
clinic and how are
the vaccines store.
v) Study how is a sick
patient referred for care
(to
3. To study out patient/district
43
SUBJECT LEARNING LEARNING ACTIVITY
CONTENT OBJECTIVE
administrative and hospital/etc)
Managerial
aspects of a H.C. A) i) Discuss with MCH
Aids criteria used for
identifying “at risk”
mothers.
ii) Study what advices
are given to mother about
antenatal, and
postnatal care and delivery.
iii) Talk with mother and
find if they receive help
from traditional birth
attendants.

i) Find out how

frequent and up to what
44
SUBJECT LEARNING LEARNING ACTIVITY
CONTENT OBJECTIVE
age a
child attends the
clinic on average.
ii) Ask mothers if they
carry the cards at each visit
to clinic, to
dispensary or hospital.
iii) Discuss with MCH
Aids whether they have the
opportunity to educate
mothers, to do home
visiting or to arrange
community discussions.

i) Note the staff situation,

equipment availability and
maintenance, building
45
SUBJECT LEARNING LEARNING ACTIVITY
CONTENT OBJECTIVE
maintenance, day to day
working pattern and the
system of ensuring and
maintaining supplies at the
H.C.

ii) Discuss with the I/C of

the H .C and his/her staff
about
above issue and learn as to
how does he solve his daily
problem.

46
SUBJECT LEARNING LEARNING ACTIVITY
CONTENT OBJECTIVE

III. Health 1) To give health 1) Discuss curriculum with

Education education to std. Vi head teacher, find the
Education and vii pupils. objectives of it, prepare a
study plan on a selected topic
and teach a class using
appropriate teaching method
2) To give health and evaluating you teaching
education to a performance.
village
community 2) Discuss with a village
community leader problems
concerning health and illness
and guide them as to how and
3) To be able to what they can do to help
teach health themselves to minimize these
47
SUBJECT LEARNING LEARNING ACTIVITY
CONTENT OBJECTIVE
center staff problems.

3) Hold discussion with H.C.

staff. With them identify
what they would wish to
learn or improve upon. Select
an appropriate method of
teaching and evaluating you
teaching performance.

48
ST. Joseph University College of Health and Allied
Health Sciences, Boko Bovya, Dar es Salaam

COMMUNITY MEDICINE DEPARTMENT

SCHEME FOR MARKING RESEARCH

PAPERS FOR FOURTH AND FIFTH YEAR –
MEDICAL STUDENTS.

MARKING SCHEME

S/NO. SECTION OF THE MAXIMUM

PAPER SCORE
1. Title: in relation to the 5
contents of the
subject matter
2. Summary 5
3. Introduction and 10
Review of Literature
4. Objectives 10
5. Methodology 15
6. Data analysis and 20
presentation

49
 7. Discussion, 30
Conclusion and
Recommendations
8. References 5
9. TOTAL 100

Brief analysis of the criteria to be considered.

1. Title/Heading: - This part must indicate:

a) The key variable in
the study.

b) The proper
relationship between
the variables i.e.
independent variable
followed by
dependant variable.

c) The target population.

2. Summary: This is a brief description of

what the paper is on and
in should include the findings of the
study. This part of the paper should
not be more than 250 wards.

50
3. Introduction and Review of Literature
This section should include:
a)Defining and delimiting specific areas of the
proposed study
b) Identification and discussion of relevant
variables.
c)Hypothesis/Expectations.
d) Significance of the problem.

It should be noted that all materials reviewed

must be relevant to the problem areas and
standars citation should be used throughout.

4. Objectives: - The objectives of a study should

a)Be relevant to the study.
b) Be feasible and observable.
c)Be logical and unequivocal.
d) Meet the purpose of the study.
e)Be clear and expressed in measurable terms.

5. Research Methodology: the part should

include:
a)a brief description of salient characteristics
of the target population.

51
 b) Description of the study sample on
method of selection.
c)Procedure for data collection e.g.
questionnaires, interview schedules, people
who collected the data etc. Definition of the
terms used in the study should also included.

6. Data analysis and presentation:

a)Presentation of data after analysis could be

in the same sequence as the state objectives
for the study.

b) Tables and figures.

[Link] tables must have a number and
title ordinary appear above the table.

[Link] title must be brief and it should

reflect the contents of the table.

[Link] and columns in a table must also

have sub-titles, which reflect their
respective contents.

4.A table have a reasonable number of

rows and columns usually not more than

52
 10. Longer tables should appear in
appendix at the end of the paper.

[Link] should not group all tables/figures

together and their corresponding
explanations somewhere else. Every
table/figure should be preceded or
followed by its corresponding
explanation.

[Link] figures; figure numbers and title

should be indicated and ordinarily these
appear at the bottom of the figure.

[Link] figures should be neatly drawn. It

should be noted that tables represent a
condensed version of the data obtained
from the study.

[Link] comparisons are made appropriate

tests must be done and result indicated.

7. Discussion, Concussion and

Recommendations:

53
 A discussion in NOT a defends of whatever is
revealed by your study or what was expected
when writing the research proposal. It is not
also a transfer of figures from the table into
words BUT rather a commentary on the
findings which the data reflects. This part
represents the authors views on the findings of
the study as revealed by his data in relation to
reviewed literature on the problem area,
possible contribution to the pool of knowledge
and whatever could further by hypothesize in
this field of study.

8. Writing of Quoted References.

It is recommended that in writing quoted

references the Index Medicus style including
pages must be followed.

B O O K S:

For book citations, the students should write

the surname of the author, followed by his/her
initials, title of the book, publisher, place of
publication and year the edition used was
published.

54
 J O U R N A L S:

In the case of articles from journals the

following will be expected: Surname of the
author followed by hi/her initials, (year) title
of the journal preferable underlined, number
of the journal, volume, (year) of publication
and pages where the article can be traced;

Finally all references should be written in

alphabetical order to the surnames cited.

9. NOTE

a)A student should score 50% or more of each

category shown under the marking scheme
for his/her paper to be accepted.

b)Students papers should be marked by at

least two members to staff.

c)Each student should be given the

opportunity to re-write section(s) of her/his
paper until when she/he obtains at least a

55
 minimum pass mark in each category shown
in the marking scheme.

d)Papers should be nearly written and eligibly

written papers will not be accepted for
marking.

56
 THE DISTRICT HEALTH SYSTEM

Structure of District Health System in Tanzania

The Full Council

Vertical Programmes Council Health

Service Board

Council Health
Management Team

District Hospital

Health Centers

Dispensaries

Communities

57
58
Tanzania operates a decentralized health system,
organized around three functional levels: district
(primary level),regional (secondary level), and
referral hospitals (tertiary
Level)
A District Health System consists of a large
variety of inter-related elements which interact
to influence the health status of the population
in the district. The key elements
are the population, resources, health care delivery
and other health related sectors and the output being
health
At the bottom there are the dispensaries found in
every village where the village leaders have a direct
influence in its running. The health centres are found
at ward level and the health centre in charge is
answerable to the ward leaders. At the district there
is a district hospital . . CHMTs are responsible for
provision of services in dispensaries, health centers
and district or ‘district-designated Hospitals
(a)Components of a district health system

59
The following are some of the component of a
district health system:
• .Hospital(s)
• Health centres
• Dispensaries
• Health posts
• Communities and households
• Private health sector/NGO/Faith based
health services
• Other social and economic sectors
• The environment in which all these
components operate.
District Health System Support Services
To function efficiently a district health system
needs the support of the following:
• logistics
• Financial Administration Management
System (FAMS)
• Functioning health Management
Information System (HMIS)
• Functioning referral system
• Availability of drugs and supplies

60
Members of the CHMT are working in the district
office with responsibilities of managing the district
health system. This office with authority is headed
by the District Medical Officer with public health
arid managerial skills, to enable him/her to
effectively manage promotive, preventive, curative
and rehabilitative health care services in the district.

61
(b) City, Municipal, Town, District Council
These are policy bodies consisting of elected
members of the public (councilors) who serve for
a fixed term of office. The elected councilors elect
from among themselves their chairperson who
leads the council.

The council has standing committees, which deal

with specific areas of the operations. The council
has an executive arm which is headed by the
council Director an appointee of the Central
Governments He/she is responsible to the council
and sees that decisions of the council arc
implemented
Functions of the Council include:
• Approval of all district annual plans and
budget
• Approval of quarterly progress reports and
revisions to plans and budgets Approval of
all initiatives for local resource generation

63
 • Ensuring internal and external audits of all
assets, equipment, financial and human
resources in the district
• Attend to appeals, petitions, complaints etc.
from the public and those that may be
relevant to its operations from staff
• Ensuring inter-sectoral co-operation in the
district with relevant government
departments, NGOs and the private sector
• Enacting appropriate by-laws and
instruments
• Human resources management
(c) Council Health Services Board (CHSB)
This is a policy body consisting of elected and
appointed members drawn from the
public and the health sector in the district. They
serve for a fixed term as will be stipulated by the
law

The Council Health Services Boards prime

responsibility is to ensure that the CHMT
facilitates provision of quality cost effective and
sustainable health services taking into account
64
equity concerns- The board is be autonomous.
However, it reports to the social service standing
committee of the council. The Council health
Management Team reports to this board. The
CHMT is supported by the Regional Health
Management Team on technical issues.
Composition
The following is the composition of
the CHSB
(i) Elected members
- service users representative
(half of them are women) -4
- chairperson of the health and
social services committee -1
- representative from private for
profit - 1
- representative from Private not
for profit -1
(ii) Secretariat (Non-elected members)
- DMO - 1
representative from
- council hospital - 1
- DPLO - 1
- representative from - 1
65
 RHMT
Functions of the CHSB.
The CHSB has the following functions
• Give directives and ensure equal
opportunities in the provision of health
services in the district
• Monitor the provision of quality curative,
preventive, promotive and rehabilitative
health services to the district
• Create a conducive environment which will
make sure that health plans set are timely
implemented
• Ensure that the CHMT provides timely health
services to the people
• Make sure that the communities are sensitised
on their health rights and responsibilities and
build confidence in the system arid the
providers
• Supervise the Council Health Management
Team on issues related to the organisation and
66
 provision of health services both public and
private implementation of national policies and
financial management Systems
• Supervise the CHMT in preparing council
health plan ready for approval by the council
• Monitor implementation of the health plans
• Evaluate health services and provide feedback
to CHMT and fine council
• Identify aid mobilise additional funding for the
implementation of the district health plans
• Receive and approve all reports from the
CHMT for submission to the council and
feedback to the Ministry of Health
• Co-ordinate efforts of government private and
non-governmental organisation involved in the
provision of health and health related services
within the council
• Manage, administer district human and other
health resources including hiring and firing of
personnel
67
(d) Council Health Management Team
The CHMT responsible for implementation of the
national health policy a the same time take into
account local council priorities, needs and
available resources.
CHMT will also supervise all hospitals health
centres, dispensaries and other facilities offering
health and health related services both public and
private. The CHMT will be answerable to the
Council Health Service Board, and have a link
with the MOH through the RHMT on technical
issues, and zonal health training centres on
capacity building issues.
The CHMT is comprised of the following core
members:
• District Medical Officer
• District Nursing Officer
• District Health Officer
• District Health Secretary
• District Pharmacist
• District Lab. technologist
• District Dental Surgeon
68
 Note: Particular persons may be co-
opted When required during
discussions/ implementation of
specific issue / activities.
Examples - District Maternal Reproductive
Health Co-ordinator
- Health and Health related
representative NGO
- Private for profit health service
provider - representative etc.

Main functions of the CHMT

• To prepare comprehensive district health plan in
line with the National District Health
• Planning Guidelines
• To ensure that the comprehensive district health
plan is implemented by them, the
• hospitals health centres, dispensaries, village
health posts and communities
• Ensure provision of transport, drugs, vaccines,
medical supplies and equipment to the hospitals,
health centres and dispensaries

69
 • Train and sensitise health workers and
communities to overcome the health problems
• Carry out on job training
• Prepare schedules for outreach and conduct
services
• Explore additional sources of funding, improve
collection and control council health funds
• Oversee that health acts and ethical codes are
adhered to in the district
• Do professional work in the hospital as part time
• Carry out supervisory visits in the health facilities

District Health Planning Team

This team is responsible to prepare a Comprehensive
District Health plan for the District
Composition
DPLO - Chairperson
DMO- Secretary
CHMT members
Representative of the private for profit sector
Representative of NGO
Representative of Faith Based service Providers
(Religious Organisations)
70
Representative from Community Development
department.
The regional secretariat will provide planning
technical support
(e) Hospital Management Team
The hospital management team comprises of the
following members.
• Medical Officer in-charge
• Health Secretary in-charge
• Heads of Department/section
Functions of the hospital management team:
• Ensure provision of quality medical/health
services in the hospital in line with essential
health packages
• Prepare (comprehensive) hospital annual plans
and budget based on HMIS data analysis, and
submit to relevant authorities
• Control and rational use of resources (funds,
drugs, reagents and other supplies)
• Conduct comprehensive need assessment n terms
of personnel, finance, equipment arid supplies
71
 • Procure, store, maintain drugs, supplies and
equipment in the hospitals
• Conduct meetings according to their schedules
• Resolve conflicts among hospital workers
• Compile quarterly/annual progress and financial
reports, and submit to relevant
• authorities
• Assist CHMT in the control of outbreaks and
emergencies
• Ensure adherence of professional ethical codes of
conduct by all health workers in the hospitals.
• Support and strengthen council referral system
and give feedback to lower health facilities on
referred cases.

(f) Health Centre and Dispensary Committee

Composition of the Health Centre Committee
(i
) Elected members
- service user representative I
elected from each ward 3
- representative from dispensary
committees (rotational) 1
- representative from NCO 1
72
 - private for profit 1
- private for non-profit 1
(ii)Non elected members
- representative from ward social
services committee 1
- in-charge of Health Centre 1
Functions of Health Centre Committee
• Receive, analyse and endorses plans and budget of
health centre
• Receive quarterly and annual implementation
and financial reports prepared by health centre
management team
• Explore various sources of revenue and
ensure sufficient resources for provision of
health services in the centre
• Liase with the council health service board and
other partners iii the provision of quality health
care services
• Advise and recommend the council on
employment, deployment, training needs aid
staff motivation
73
 • Support the H/C management team on the day to
day operations
28 Ward health committee
• The councillor of the respective ward
• The ward executive officer
• One head teacher from a primary school
located in the ward who shall be appointed by
the Ward Development Committee
• Two members from the community elected by
the community of which one of whom shall be a
female
• A clinical officer or clinical assistant in-
charge of a health care facility, who shall be
the secretary to the committee
• One member appointed by the Ward
Development Committee from amongst persons
proposed by the village councils within the area
of that Ward
• One representative from a community based
organisation appointed by the Ward
Development Committee

Function of Ward Health Committee

74
• Mobilise the community to be members of the fund
• Prepare the list of members and monitor the number
of members in the community
• Supervise the collectors on annual contributions
• Monitor the level of contributions and use-fee
revenue
• Review fund’s operation, make recommendations
and take remedial actions.
• Initiate and co-ordinate community health plans
• Organize general meetings and any other meetings
of members of the fund

2 9 Village Health Committee

The committee is compised by members of the
community which use the services of the health
facility (Health centre or dispensary).
Composition
• Village executive officer
• Village health workers
• Representative from extension workers
• Religious representative
• TEA representative
• Traditional healers representative
• Women group representative
75
Functions of the committee is as follows:
• Identify community needs and integrate them in
the health facility action plan
• To act as a link between community and nearby
health facility serving the village
• Initiate and participate actively in health related
activities at household and community level
• Develop mechanisms for sustainability of
community based health care workers and
other Community Owned Resource Persons
(CORPs)
• Initiate and strengthen all local development
initiatives with government NGO and private
sectors
• Collect vital health community based data
• Mobilise and account for local health resources

76
 FUNCTIONS OF A DMO/ CHMT

The success of health care activities in the district

depends to a large extent on members of the CHMT
working as an effective team
The most senior local official in the health sector is
the District Medical Officer (DMO). The DMO is
supported by the Council Health Management Team
(CHMT) which is comprised by the DMO and senior
local healthcare administrators

I. Supervision of peripheral health units

Regular supervision by DMO/CHMT will improve

and sustain the quality of care in the peripheral health
facilities. Supervision: an educational process in
which the supervision helps and guides the health
worker to become more competent, to the ultimate
77
benefit of patients and the community.” Supervision is
a way of assisting a health worker, to see if certain
preknown tasks (the job description) are properly
performed of not. It gives a base for which action can
be undertaken either by praising if the tasks have
been performed well or by criticizing if not so. In the
latter case possible corrective measures should be
initiated. By no nears supervision is equal to
negativism. This will only discourage the health
worker.
Supervision should result in a stimulation to perform
better.

Tasks to be performed during supervision

Taking into account the CHMT/DMO’s tight
working-schedule it should be feasible that one day of
the week is spend on supervision of peripheral health
units.
78
Such a day, depending on distance and road
conditions 3 – 5 dispensaries/health centers can be
visited. This leaves in general around ½ - 1 hour per
unit.

Four main topics have to be covered during such

visits:
a) Discuss and advice on current problems in
administration, organization and implementation
of health unit functions as brought to the DMO by
the unit staff.

b) See and advice on “problems patients” with the

medical staff of the unit.
c) A short educational talk to the unit medical staff
on any health topic e.g. treatment schedules: a
certain disease, control aspects: a certain disease,
79
 control aspects: health education versus health
information etc.

d) Evaluation of one aspect of the functions of the

health unit, going through e.g. the drug ordering
and storage system; environmental cleanliness
and maintance of latrines, building, garbage pits
etc; the registration and referral system;
calculation of top ten common medical
conditions; relationship with the community like
village health term meetings, surveillance
activities, self help programmes, relation with
traditional practitioners etc.

II. Public Health duties

i) General: The district Medical Officer is the
Medical Officer of health for

80
the urban district of rural district. The
title “District Medical Officer”
connotes medical responsibility for
both a district hospital. With
emphasis on public health and district
work. As far as public health is
concerned. The first step is to make
a diagnosis of the health situation
and work out priorities of health
problems, with a view to promoting
health and combating major
preventable illness in his district.
The District Medical Officer is also in
charge of all environmental health
work in which his supporting staff
may include at least Health Officer
and one or more health auxillaries.

81
ii) Disease Control:
Specific measures to combat major
communicable disease include meas
treatment schemes. And vaccination
programmes either through the general health
services by special campaigns.
At present such scheme are usually directed
against, tuberculosis, Leprosy, Malaria,
bilharzias, smallpox polliomyelities,
tetanus, whooping cough, measles ,HIV and
AIDS , NCDs, Neglected Diseases and may
be filariasis and some of the important
intestinal helminthes.

The District Medical Officer is responsible for

organizing and directing or c0-ordinationg all
the necessary action against these and similar
diseases of public health importance. At the
82
 same time, special attention and measures are
required to combat the widespread incidence
of protein-calorie malnutrition.

iii) Reproductive l and Child Health

A number of maternal and child health clinics
are operated in each district. The District
Medical Officer must ensure that these clinics
fulfill all the general functions from which
they are established and that the local
maternal and child health problems are
adequately catered for in these clinics. A
formal school health services is not feasible in
nearly all districts, but the District Medical
Officer must supervise the health of school
children as fast as is possible. As part of
Reproductive and Child Health the District

83
 Medical Officer should supervise Family
Planning Activities in the district.

The role of such activities being geared at

child spacing.

III. Hospital:
i) Clinical: In terms of patient care, general
medical duty in Tanzania
means that a medical officer must be
capable or b potentially capable of
pa practicing medicine paediatrics,
surgery and obstetrics and
gynaecology.
The term ‘Medicine’ as used here
must be interpreted fairly liberally. A
general hospital should include
psychiatric care and in that case a
84
working knowledge and skill in
psychiatry are necessary. At the same
time, diseases of local importance
such as tuberculosis, leprosy, malaria,
protein calorie malnutrition, etc.
necessitate postgraduate reading or
study if a medical officer is to cope
competently with the average medical
cases of a district hospital. The term
“surgery” is similarly used to include
simple ophthalmology. Most district
hospitals have waiting lists of hernia
and hydroceles, and at the same time
obstetrical abnormalities, injuries and
fractures, strangulated external
hernias and intestinal obstructions are
common occurrence necessitating
emergency surgery at many district
85
 hospital. The District Medical Officer
must endeavour to be able to cope
with all these confidently and
competently. If the hospital is
equipped with an X-ray machine but
has no qualified radiographer to
operate the machine, the medical
officer must be prepared to operate
the machine himself or supervise the
radiographic auxiliary to whom this
work is delegated.

ii) Medical—legal Duties:

A district Medical Officer is expected to
perform o number of medico-legal
examination and to give evidence in
courts of law as required. Duties
commonly undertaken in this respect are
86
 medico-legal postmortem examinations,
examinations for alleged sexual assault,
assessment of age mental state and
physical fitness of persons for various
medico-legal purposes.

iii) Administrative Duties:

A district Medical Office has overall
responsibility for staff control and
discipline. He is expected to be able to
allocated and delegate duties to other
officers having due regard to the
functions and capabilities of each
cadres of staff and of each individual
staff member within the various cadres.
To do this effectively the District Medical
Officer should familiarize himself with
the level of training and capabilities of
87
 each cadre of staff in his charge. A district
Medical Officer is expected to compile
and to submit objective periodic reports
on staff members in his charge as
required.
As the supervising officer, a District
Medical Officer has to ensure that
finance and stores are properly
managed in accordance with standing
regulations. District Medical Officer is
expected to compile and submit various
periodical returns and reports about health
activities in his district. He is expected to
be able to evaluate such reports and
decide on appropriate action as indicated.

iv) Planning:

88
 A District Medical Officer is expected to
help plan an intergrated health service for
his district. This he will do through
consultations with other interested parties
such as doctors from voluntary Agency.
Hospitals and other local leaders of the
community under the ambit of the District
Development Director.

IV. District:
i) The District Medical Officer is in medical
charge of the district medical services. These
usually consist of health centres, several
dispensaries and other units and public health
services, and they all have to be visited and
supervised regularly for administrative and
professional purposes.

89
 ii) The District Medical Officer is responsible for
visiting and keeping an eye on voluntary
agency (mission) medical services,
particularly those that do not employ a doctor
of their own.

V. Teaching:
It is very important that each District medical
Officer fully appreciated the importance of his
responsibility to teach his staff. It is through such
teaching that a team spirit is established in a place
and it is through continued teaching that
auxiliaries working in dispensaries, etc. can be
intergrated into a district health service or district
health projects. There is another important reason
why a doctor must see teaching as one of his
essential duties. Tanzania is short of doctors and
therefore the use of medical auxiliaries is resorted
90
to freely. These auxiliaries, however will not
function effectively by themselves, and they
require the leadership, activation and example of
doctors to sustain them in their work. In any case,
a medical officer who is not teaching others will
soon cease to teach himself and go from
stagnation to degeneration in his medical
knowledge and skill.

DUTIES OF A DISTRICT MEDICAL

OFFICER:

ORGANIZATION OF HEALTH
SERVICES

91
 D.M.O.
TRAINING HEALTH TEAM MANAGER CONTROL HEALTH

ADMINISTRATION

92
DEFINITIONS:

MANAGEMENT: - Is to make efficient use of

resources and to get people to work
harmoniously together in order to
achieve objectives or management is
getting things done through people or
organizing, implementing and
evaluating.

DELEGATIONS: - Entrusting a task together

with authority and responsibility to
another person.

PLANNING: - A statement of goals and

objectives together with the action
and resources needed to achieve them.

93
SUPERVISION: - On educational process in
which the supervisor helps and
guides the health workers to become
more competent to the ultimate
benefit of patients and the
Community i.e. observation, praising,
criticizing, correcting.

94
 4TH YEAR ROTATION
RCH CLINIC PRACTICALS
SUBJECT LEARNING OBJECTIVE AND LEARNING
CONTENT COMMENTARY ACTIVITTY
General Identity bottlenecks in the running - Observe why
Clinic of the clinic and suggest with a clinic starts late (8
Management diagram how you would improve am is official
patient flow and clinic starting time)
management.
- Observe what staff
do before clinic
and after clinic.

- Observe flow of
patient during
clinic (smooth
flow)
95
SUBJECT LEARNING OBJECTIVE AND LEARNING
CONTENT COMMENTARY ACTIVITTY
- Time spent at each
station

- Any explanations
given to mothers
about findings.

- Reasons for
bringing child to
the clinic.

Heath Identify problems in health - Efforts by Health

Education education and suggest worker to learn the
improvements family perception
of its health needs.

96
SUBJECT LEARNING OBJECTIVE AND LEARNING
CONTENT COMMENTARY ACTIVITTY
- Relevance of topic
and content

- Method of
presentation

- Attention paid by
the audience,
interest by the
audience.

- Feedback from
audience to health
worker.

Growth Observe how the risk factors are - Observe the way
97
 SUBJECT LEARNING OBJECTIVE AND LEARNING
CONTENT COMMENTARY ACTIVITTY
monitoring detected and handled. the wt is taken-
Comment on the growth charts of with all clothing
20 randomly Selected Growth or minimum
Curves. clothing.

- Observe the way

the age is
determined.
Observe if a
discussion of the
growth chart is
done with the
mother and
content.

- Observe if the risk

98
SUBJECT LEARNING OBJECTIVE AND LEARNING
CONTENT COMMENTARY ACTIVITTY
factors in MCH
card are looked for
in the child and
documented and
discussed with the
mother.
Vaccination Identify bottleneckes in the cold - Observe where
chain system from the way the different vaccines
vaccines are stored in the fridge, are kept in the
diluted, kept and administered. fridge and the
temperature of the
fridge at the time
you arrive at the
station.

- Observe
99
SUBJECT LEARNING OBJECTIVE AND LEARNING
CONTENT COMMENTARY ACTIVITTY
sterilization
procedures and
available facilities
for this.

- Observe, learn and

make sure you
actually give at
least two BCG
vaccinations, two
DPT vaccinations

two Measles vaccinations

two Polio vaccinations

- Observe the
100
SUBJECT LEARNING OBJECTIVE AND LEARNING
CONTENT COMMENTARY ACTIVITTY
appropriateness of
syringes and
needles used and
frequency
sterilization and
sharpness and
frequency of
syringe and needle
change between
administrations.

- Note assumed
contraindications
by the health
workers.

- Observe if side
101
SUBJECT LEARNING OBJECTIVE AND LEARNING
CONTENT COMMENTARY ACTIVITTY
effects are
explained to
mother.

- Observe if date of
future
immunization is
explained to
mother.
Maternal Identify problems uncounted in - Record date of
Health for the running the antenatal clinic. first registration
sake of the Comments briefly on how it could for this pregnancy
child be improved, especially risk – 20 mothers
factors. Is the Antenatal Clinic noting the parity.
dealing with mothers health as a
separate entity or is it dealing with - Observe if risk
102
SUBJECT LEARNING OBJECTIVE AND LEARNING
CONTENT COMMENTARY ACTIVITTY
the mother solely for the sake of factors are looked
protecting the unborn child’s for and those
health. found to be
Comment of how you would present if
change the card to cater for both. discussed with
mother eg. BP,
Oedema, anemia
grand multiparity
previous caesarian
section etc.

- Note if 3 tetanus
toxoid were given
and the gestational
age of each.

- Vaccinate your
103
SUBJECT LEARNING OBJECTIVE AND LEARNING
CONTENT COMMENTARY ACTIVITTY
colleague against
tetanus whether or
not previously
vaccinated.

- What routine
investigations
done e.g. Urine for
albumen, test for
syphilis and
haemoglobin.

Maternal Analyse the pattern of family - Register

Health for the planning attendance (use of attendants and
sake of the different methods, age parity etc) look for the
104
 SUBJECT LEARNING OBJECTIVE AND LEARNING
CONTENT COMMENTARY ACTIVITTY
mother using the information in the various risk
family planning register. factors identified
Comment on how well the register on the card.
is kept and suggest ways of
improving. - Observe if and
[Link] keeping how mothers are
[Link] attendance counseled on the
[Link] choice of methods.
compliance Note importance
of privacy.

- Once method is
chosen; apply the
method and
explain it in detail
to the mother.
105
SUBJECT LEARNING OBJECTIVE AND LEARNING
CONTENT COMMENTARY ACTIVITTY
- List the various
methods available.

- Ensure that you

insert at least 5
loops under
supervision. You
must be signed off
by the Family
Planning clinic
nurse for this if
you do not have a
chance on 1st day,
visit the clinic on
any other day
during your spare
time and insert
106
SUBJECT LEARNING OBJECTIVE AND LEARNING
CONTENT COMMENTARY ACTIVITTY
them.

Analysis of Using MCH 6 and various tally Based on clinic data

RCH sheets calculate the rates - Calculate the
Records mentioned on the right hand side maternal mortality
of this paper and comment on rate for Bagamoyo
their monthly or annual variation; district for the
(fluctuation) any seasonality previous 3 years
observed, and point out health 1985 – 1987.
units with the highest rates and
postulate on reasons for this, and - Calculate the still
how one can go about reducing birth rate
them.
- Calculate the live
birth rate
107
SUBJECT LEARNING OBJECTIVE AND LEARNING
CONTENT COMMENTARY ACTIVITTY

- Calculate the
Early Neonatal
mortality rate

- Calculate the
Perinatal mortality
rate

- Calculate any
cause specific
mortality rate e.g.
Neonatal Tetanus.

108
 EVALUATION OF FOURTH YEAR M.D.
COMMUNITY MEDICINE ROTATION PROGRAMME

PROGRAM PROGRAM SUGG

ME WAS ME ESTED
SHOULD IMPR
BE: OVEM
ENTS
1. NO US VE AB IMP K
T EF RY OLI RO EP
INTRODUC
US U US SHE VE T
TION WEEK EF L EF D D S
UL UL A
M
E
2.
DISPENSAR
Y WEEK

3. HEALTH
CENTER
WEEK

110
4.

HOSPITAL

WEEK
5. DISTRICT

WEEK

6. PROJECT

7.
LECTURES
AT DAR

8. FIED
TRIPS –

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A. the basis of community health is a
philosophical framework that relates to the
way in which services are distributed and an
emphasis on prevention.

B. Any further comments about the course.

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