Curriculum

Acronyms and Abbreviations
ABC Airway Breathing and Circulation
BHU Basic Health Unit
CIDA Canadian International Development Agency
CPR Cardio Pulmonary Resuscitation
CVS Cardio Vascular System
DGHS Director General Health Services
DHIS District Health information System
DHQ Hospital District Headquarters Hospital
DoH Department of Health
EPI Expanded Program of Immunization
GIT Gastro Intestinal Tract
HIV/AIDS Human Immuno-Deficiency Virus/Acquired Immuno-Deficiency Syndrome
I/M Intra-muscular
I/V Intravenous
IT Information technology
MCQs Multiple Choice Questions
MDGs Millennium Development Goals
MIS Management Information System
MO Medical Officer
OPD Outpatient Department
ORS Oral Rehydration Solution
OTAs Operation Theatre Assistants
PHC Primary Health Care
PMF Punjab Medical Faculty
RHC Rural Health Center
S/Cutaneous Sub-cutaneous
SOHIP System s Oriented Health Investment Program
TB Tuberculosis
THQ Hospital Tehsil Headquarters Hospital

Section 1
1. Background and Rationale
Dispensers are one of the most important cadres providing backbone services at health facilities in both public and private sectors. Their contribution is deemed essential for smooth functioning of health services and facilities at all levels, especially at primary and secondary healthcare outlets where they are considered almost indispensible members of health teams. Often, they are the first line health professionals that front healthcare services. In many instances, e.g. in emergencies and after office hours, dispensers provide the all important first line client management. And they manage stores, pharmacies, equipment, buildings and front desks, maintain records and dispense medicines on doctors’ prescriptions. Currently, they form one of the biggest cadres in the Punjab Health Department; approximately 5000 in post in Dec 2007 (source: DGHS). Whilst this large group of dispensers ensures availability of precious human resource at health facilities, its down side is their utilization as a convenient replacement for a number of other paramedical and administrative cadres such as operation theatre assistants and office clerks etc. As dispensers are not trained to do these jobs, the likelihood of client mismanagement and negative impact on the reputation of the Department of Health remains high.
The evolving health needs of the community, exponential advances in medical and allied technologies and changes in health services provision, functions and structure, demand continual and responsive changes in education and training programs meant for health professionals. The job description and training program of dispensers had remained thus far non-respondent to such demands. Therefore, the dispenser cadre had, by virtue of its training and the originally designed role, become irrelevant and archaic in many respects. This lack of responsiveness led to unplanned and possibly unanticipated utilization of dispensers in the healthcare system leading to the already indicated quality, ethical and professional issues.
Increasing episodes of trauma and accidents demand an enhanced state of preparedness on part of health facilities. The level of professional development of staff directly affects performance of health facilities and quality of care offered to clients. Professionalism of dispensers, as the key human resource of a health facility, determines and decides if it would be able to provide quality service or not.
Considering the above issues, a comprehensive exercise was undertaken by the Punjab Health Department through the CIDA funded Systems-Oriented Health Investment Program (SOHIP) in 2007 to explore the contemporary role(s), contextual needs and professional issues of dispensers. This led to the approval of a revised role of the dispenser cadre on 17 November 2007 presented below. It was also decided to revise the dispensers’ curriculum in response to the approved revised role profile and to develop a textbook based on the revised curriculum. The training and examination system for the dispenser cadre will be thus based on this revised curriculum.
2. Curriculum Revision 2008
Revision 2008 of the dispensers’ curriculum is based on the role profile of dispensers agreed by Punjab Health Department in a workshop held on 17 November 2007 in Lahore (please see next section for details of agreed Role Profile of a Dispenser). The revised curriculum carries out the following important functions:
· links pre-service education and training with actual tasks dispensers have to perform after being employed, especially in the public sector
· modernizes dispenser training program by weeding out subjects that have become obsolete and including subjects that are currently considered essential
· provides clarity on subjects and topics to be taught delimiting the breadth and depth of teaching
· gives clarity to examiners on what is to be tested and how
· stimulates critical faculties of both teachers and dispenser students to conceptualize topics rather than memorizing them.
The caveat, however, is that curricula are ever evolving organic documents. Regular reviews and revisions are necessary for their health. Topics that are required now might outlive their utility in a few years. Updating curricula therefore forms the basis for quality teaching as well as professional competence of the product; dispensers in this instance.
3. The Role Profile of a Dispenser
The role profile of dispensers presented below has been defined in view of the contemporary needs and context in which the dispenser has to work. It represents broad areas of agreement on which the dispensers’ training, examination and performance need to be based in order to address dissonance between their training, examination and utilization in the healthcare system.
3.1. Work Activities
3.1.1. Dispensing medicines & maintaining stocks
3.1.2. Administration of injectable medicines to healthcare clients
3.1.3. Minimum required nursing care in secondary and tertiary hospitals and RHCs
3.1.4. Working as first line handlers of emergencies and victims of trauma before the medical officer arrives
3.1.5. Working as dressers in hospitals, RHCs and BHUs
3.1.6. Imparting health education to healthcare clients and their immediate relatives
3.1.7. Linen & instrument sterilization
3.1.8. Supportive role in operation theatres where properly trained OTAs are not present
3.1.9. Working as storekeepers at health facilities for both specialized and general stores
3.1.10. Maintaining health information system records (HMIS/DHIS)
3.1.11. Managing front office & mob control
3.1.12. To assist MOs (non-specific) and cover BHU in case of the absence of MO
3.1.13. Parchi fee collection & maintaining financial records at BHUs and RHCs
3.1.14. Working as caretakers of buildings at RHCs and BHUs
3.2. Behavioral Requirements
3.2.1. Communication skills
3.2.2. Decision making skills
3.2.3. Team-working skills
3.2.4. Client care skills
3.3. Technical Requirements
3.3.1. Skills to operate & maintain medical equipment such as BP apparatus, thermometer, dressing trolley, surgical instruments, autoclave, emergency trays and emergency cupboards etc.
3.3.2. Recordkeeping (stock ledgers etc) skills
3.3.3. Skills to maintain MIS records
3.3.4. Basic knowledge of pharmacology and pharmacy
3.4. Qualifications Required
3.4.1. Matric or FSc (both with science subjects) – for enrolment into the Dispensers Training Progam
3.4.2. Dispenser certification by the PMF.
4. Distribution of Training Time
A typical training day for dispenser students at the public sector dispenser training institutions comprises 5 hours. Roughly, the division of the day is:
· Classroom teaching = 3 hours
· Practical training or field learning = 2 hours
· Total = 5 hours
Keeping a generous allowance of holidays and weekends, an academic year (12 months) for dispenser students would be 200 days.
Therefore, classroom teaching + practical training (field learning) in one academic year (12 months) = (600 + 400) 1000 hrs with the following breakdown:
· Classroom teaching
o Daily classroom teaching = 3 hours
o Teaching days in 12 months = 200 (approximately)
o Teaching hours available in 12 months = 3 x 200= 600 hours
· Practical training (field learning activities)
o Daily practical training (field learning activities) = 2 hours
o Days for practical training (field learning activities) in 12 months = 200 days (approximately)
o Hours for practical training (field learning activities) = 2 x 200 = 400 hours (approximately)
Revision 2008 of dispensers’ curriculum uses the above time allocations for dividing teaching time between various topics, units and sub-units.
5. General Division
Based on the job analysis carried out by CIDA-Systems Oriented Investment Program (SOHIP), dispensers’ curriculum has been divided into the following topics:
1. Dispenser in the Health System
2. Human Body (sub divided into 8 subunits)
3. Pharmacology and Pharmacy
4. Concepts of Management of Common Diseases (EPI-related and with emphasis on health promotion and prevention)
5. First Aid Treatment in Emergencies, Trauma, Overdosage and Poisoning
6. Stores, Records Management & District Health Information System (DHIS)
7. Sterilization and Disinfection
8. Practical Training
The above topics are divided into units that contain details representing curricular aspects of the relevant topic. Generally, each unit represents one topic. However, the unit on human body is further sub-divided into 8 subunits.
In order to avoid ambiguity, each unit follows a harmonized scheme of headings that explain:
· connection of the subject to be taught in the class with dispensers’ role in their work environment, i.e. the work they are expected to do. Thus, establishing a link between the teaching and job requirements
· purpose and reasons for teaching a particular subject in context of primary, secondary and tertiary healthcare delivery systems
· learning outcomes that define boundaries of teaching and examining, thus marking out a clear focus for teachers, examiners and students.
Details in the units and subunits follow the following 9 headings:
· Role
· Rationale
· Scope
· Learning Objectives
· Training requirements/ Instructions
· Practical Learning component
· Assessment Requirements
· Weightage for Assessment


Section 2

Unit 1 & 1.1 Dispenser in the Health System

Learning Focus
The concept of ‘Health’
3 hours
Primary Health Care, Reproductive Health and Health Promotion
· Gender issues in health
9 hours
National Health Policy Priorities and the Millennium Development Goals (MDGs)
3 hours
Introduction to the healthcare system: national, provincial and district
3 hours
The structure of healthcare delivery: primary, secondary and tertiary
3 hours
The role and responsibilities of Dispenser in the Health System
· Approved role profile of the Dispenser (2007)
· Dispenser as a Health Promoter
· Dispenser as a paramedical cadre
3 hours
Basic Communication Skills
6 hours
Total Teaching Time
30 hours
1. Role
Dispensers work in health-related environments performing a broad range of tasks. These include, among other things, patients handling, counseling and guiding. Additionally, dispensers either have close contacts with communities or the opportunity to do so. Often they are the only facility-based healthcare providers who are in continued contact with individuals (patients), families and communities. In this role dispensers have to carry out health promotion and health education. Creating health awareness that would ultimately lead to improvements in the health of individuals and communities is the objective of these activities. Job analysis of dispensers shows that they spend a sizeable amount of their time in activities related to health education and health promotion. However, quantifying tasks to time ratios would be difficult.

2. Rationale
In order to effectively perform as a health promoter, a dispenser needs to have the concept of health, an appreciation of the prevailing organizational environment and an understanding of his or her own job description. MDGs have become a priority national and provincial agenda. The need to familiarize dispenser students with MDGs (gender included), therefore, becomes essential. Communication, especially interpersonal communication and health communication, is the vehicle required for effective interaction with both internal and external clients. Acquiring this skill therefore becomes mandatory.
The goal of this unit, therefore, is to impart an appreciation of the larger operating environment. To acquire this familiarity, dispensers need to have an understanding of the healthcare systems and the health infrastructure. This understanding would help them to relate their own performance with the performance of their parent department.
3. Scope
Learning will focus on developing a basic understanding of the concept of health, health promotion and gender. Teaching will focus on imparting a working knowledge, without much details and not going beyond introduction, of how the healthcare system operates in Pakistan and what its tiers.
4. Learning Objectives
After completing unit 1 dispenser students will be able to:
a. define health, health promotion and gender
b. describe the importance of gender in health
c. appreciate the general organization of the healthcare system and the healthcare delivery system
d. list out national and provincial priorities (MDGs) and understand government prescribed job description for dispensers
e. demonstrate skills required for effective communication.
5. Training Requirements/Instructions
a. Teaching staff for dispensers will be given in-service training as recommended by PMF from time to time
b. Dispenser teachers will use a combination of interactive programmed instructions (non-IT), class teaching with exercises using audiovisual aids, mini-lectures, group discussions, simulations, role plays and case studies as instructional/teaching methodologies
c. IT will be employed for teaching and learning where available
d. A combination of English and Urdu languages will be used as medium of instruction
e. Dispenser teachers will encourage students to ask questions
f. Dispenser teachers will encourage debate and discussion in class to inspire and hone thinking skills of dispenser students.
6. Practical Learning Component
Practical training or field learning will supplement class teaching. It will focus on developing practical skills of dispenser students relevant to this unit, especially developing a practical understanding of the healthcare system and the interrelationship of various components of healthcare system and services. Hospitals, PHC facilities, pharmacies and exposure to administrative units will be used for practical training. Dispenser teachers will ensure that dispenser students are given field learning activities that are relevant to subjects being taught in the class.
Of particular value will be visits to and discussions on various types of housing settlements; a planned housing colony with proper water and sanitation system and an unplanned housing area. A visit to a village would also benefit.
7. Assessment/Examination
a. Classroom evaluations to check learning, understanding and comprehension following completion of each lesson using MCQs, essays and exercises given in the PMF approved textbook.
b. Final certificate examination by PMF following completion of the academic year using MCQs, essay questions and practical examinations. At least 20% assessment in theory papers will be based on MCQs. The questions will be prepared by examiners trained and certified by PMF in examination techniques.
8. Time Allocation
30 hours of class teaching and 4 hours of practical training
9. Weightage for assessment
5%

Unit 2 Human Body
Unit 2 has been further subdivided into the 8 sub units.
Learning Focus
Sub-unit 2.1 Cardiovascular System (Circulatory System)
36 hours
Sub-unit 2.2 Digestive System
36 hours
Sub-unit 2.3 Pulmonary System
36 hours
Sub-unit 2.4 Musculoskeletal System and Skin
36 hours
Sub-unit 2.5 Nervous System
9 hours
Sub-unit 2.6 Excretory System
9 hours
Sub-unit 2.7 Reproductive System
9 hours
Sub-unit 2.8 Endocrine System
9 hours
Total Teaching Time
180 hours
1. Role
Dispensers’ Job analysis shows that they have to perform significant number of tasks related to clinical work and patient handling, especially in the peripheral areas. Given the variety of tasks dispensers carry out in their equally varied places of postings, generalizing tasks to time ratios would be difficult. However, on average a dispenser spends about 50% of time on patient handling. Basic understanding of major parts of human anatomy and physiology, and their application will provide a base to dispensers to build their applied knowledge. Thus, helping them in their work situations where they have to provide first line patient management as well as health promotion and health education.
2. Rationale
Dispenser students will explore human body in order to understand its various systems, major functions performed by these systems and some common disease states affecting them. This knowledge will directly help them in supporting clinical work of medical officers. Basic knowledge of human body is essential for carrying out effective health promotion. Dispensers, while they are dispensing medicine on prescriptions of medical officer, can deliver health promotion messages to health facility clients.
The goal of this unit is to give a broad understanding of human anatomy and physiology to dispenser students so that they are exposed to general functions and structure of the human body using a systems approach. The comprehension thus developed will enable them to confidently use their knowledge and information in their work related to health promotion and prevention of diseases. This unit, along with its sub-units, focuses on breadth of the information and knowledge about human body rather than the depth.
3. Scope
Learning and understanding will focus on gross anatomy, major functions of parts of body and how these are altered in certain common diseased states. The scope of teaching will be less than medical and nursing students.
4. Learning Objectives
After completing unit 2 dispenser students will be able to:
a. identify parts of the human body (gross anatomy only)
b. demonstrate how different parts of human body work and what are their main functions
c. identify abnormal and generic diseased states on gross appearance.
5. Training requirements/instructions
a. Teaching staff for dispensers will be given in-service training as recommended by PMF from time to time
b. Dispenser teachers will use a combination of interactive programmed instructions (non-IT), class teaching with exercises using audiovisual aids, mini-lectures, group discussions, simulations, role plays and case studies as instructional/teaching methodologies
c. IT will be employed for teaching and learning where available
d. A combination of English and Urdu languages will be used as medium of instruction
e. Dispenser teachers will encourage students to ask questions
f. Dispenser teachers will encourage debate and discussion in class to inspire and hone thinking skills of dispenser students.
6. Practical learning component
This will form part of the field learning activities and will focus on developing practical skills of dispenser students. Hospital wards, laboratories, operation theatres, trauma centers, casualty wards, stores and pharmacies will be used for practical training. Dispenser teachers will ensure that dispenser students are given field learning activities that are relevant to subjects being taught in the class.


7. Assessment/Examination
a. Class room evaluations to check learning, understanding and comprehension following completion of each lesson using MCQs, essays and exercises given in the PMF approved textbook
b. Final certificate examination by PMF following completion of the academic year using MCQs, essay questions and practical examinations. At least 20% assessment in theory papers will be based on MCQs. The questions will be prepared by examiners trained and certified by PMF in examination techniques.
8. Time allocation
180 hours of class teaching and 50 hours of practical training
9. Weightage for assessment
30%
Sub-unit 2.1 The Cardiovascular System
1. Rationale
Dispenser students will explore cardiovascular/circulatory system in order to understand its various parts, their major functions and some common diseases affecting the system. In Punjab the pattern of non-communicable diseases has changed over the last 15 years or so. Patients statistics show that approximately 38% of them seek medical advice from public sector health facilities for non-communicable ailments, almost equal to the number of patients reporting with communicable diseases. Hypertension and related complications therefore make this chapter an essential element of curriculum.
2. Scope
Learning and understanding will focus on gross anatomy, major functions of parts of CVS and how they are affected by diseases. The scope of teaching will be limited to giving a general understanding of CVS to dispenser students and developing their skills to measure blood pressure and pulse.
1. Learning Objectives
After completing sub-unit 2 dispenser students will be able to:
a. mark location of the heart on human body and name its coverings
b. name chambers of heart and describe their functions
c. trace pathway of blood through the heart
d. name different types of blood vessels and parts of blood
e. describe the concept of blood pressure
f. identify surface veins for administration of intravenous injections
g. identify key risk factors for developing atherosclerosis and describe conditions associated with atherosclerosis within the coronary blood vessels.
2. Training requirements/instructional methodologies (Process)
a. Teaching staff for dispensers will be given in-service training as recommended by PMF from time to time
b. Dispenser teachers will use a combination of interactive programmed instructions (non-IT), class teaching with exercises using audiovisual aids, mini-lectures, group discussions, simulations and case studies as instructional/teaching methodologies
c. IT will be employed for teaching where available
d. A combination of English and Urdu languages will be used as medium of instruction

e. Dispenser teachers will encourage students to ask questions
f. Dispenser teachers will encourage debate and discussion in class to inspire and hone thinking skills of dispenser students. Students will be given the opportunity to engage in activities that promote divergent thinking skills. Students will be encouraged to work independently, as well as in small groups and as a whole class, to form creative associations of ideas across discipline lines.
3. Practical learning component
Practical training will supplement teaching of CVS. Field learning will be carried out in hospital wards, laboratories, operation theatres, trauma centers, casualty wards, stores and pharmacies. Dispenser teachers will ensure that dispenser students are given field learning activities that are relevant to CVS that is being taught in the class in order for them to develop skills to measure blood pressure, pulse and administer intravenous injections. Teachers will ensure that equipment and procedures such as BP apparatus and blood pressure measurement etc. are included in practical learning activities.
4. Assessment/Examination
a. Class room evaluations to check learning, understanding and comprehension following completion of each lesson using MCQs, essays and exercises given in the PMF approved textbook
b. Final certificate examination by PMF following completion of the academic year will have at least 1 part of an essay question from cardiovascular/circulatory system. At least 1% MCQs will be taken from cardiovascular/circulatory system.
c. Practical examinations will assess skills of dispenser students in measuring blood pressure, counting pulse and marking position of heart on human body. At least 20% assessment in theory paper will be based on MCQs. The questions will be prepared by examiners trained and certified by PMF in examination techniques.
5. Time allocation
36 hours of class teaching and 4 hours of practical training
6. Weightage for assessment
10%


Sub-unit 2.2 The Gastrointestinal System
1. Rationale
In Punjab approximately 38% of the patients reporting at public sector health facilities suffer from communicable disorders. Ailments related to the digestive system such as diarrhea and dysentery form a sizeable portion of these patients. Outbreaks of gastrointestinal diseases are quite common. Contaminated water supply adds another layer of complexity. Dispensers therefore spend a sizeable chunk of their time in tasks related to managing patients with gastrointestinal disorders.
Dispenser students will explore Gastrointestinal System (Digestive System) in order to understand its various parts, their major functions and some common diseases affecting the system. Given its importance, a special reference will be made to oral rehydration therapy. Knowledge of anatomy and physiology of the digestive system will prepare dispensers to understand various curative and preventive interventions that they will be using in their professional lives.
2. Scope
Learning and understanding will focus on gross anatomy, major functions of parts of Gastrointestinal System (Digestive System) and how they are affected by diseases. The scope of teaching will be limited to giving a general understanding of the system to dispenser students and developing their skills to measure dehydration.
3. Learning Objectives
After completing sub-unit 2 dispenser students will be able to:
a. describe gross anatomy of the digestive system
b. describe basic functions of various parts of the digestive system
c. demonstrate an understanding of lower GI tract for administering enemas and suppositories and passing flatus tubes
d. mark location of stomach, liver and appendix on human body
e. identify and recognize signs of dehydration
f. demonstrate how to guide clients about oral rehydration therapy and hygiene
g. demonstrate an understanding of relationship of digestive system with food and water in the context of disease generation and propagation.
4. Training requirements/instructional methodologies (Process)
a. Teaching staff for dispensers will be given in-service training as recommended by PMF from time to time
b. Dispenser teachers will use a combination of interactive programmed instructions (non-IT), class teaching with exercises using audiovisual aids, mini-lectures, group discussions, simulations and case studies as instructional/teaching methodologies
c. IT will be employed for teaching where available
d. A combination of English and Urdu languages will be used as medium of instruction
e. Dispenser teachers will encourage students to ask questions
f. Dispenser teachers will encourage debate and discussion in class to inspire and hone thinking skills of dispenser students. Students will be given the opportunity to engage in activities that promote divergent thinking skills. Students will be encouraged to work independently, as well as in small groups and as a whole class, to form creative associations of ideas across discipline lines.
5. Practical learning component
Field learning will be carried out in hospital wards, laboratories, operation theatres, trauma centers, casualty wards, stores and pharmacies. Dispenser teachers will ensure that dispenser students are given field learning activities that are relevant to the digestive system that is being taught in the class, i.e. demonstrations related to administering enemas and suppositories and passing of flatus tube etc. Practical training will enable them to develop skills to guide patients or their relatives on oral rehydration therapy and basic hygiene such as hand washing.
6. Assessment/Examination
a. Class room evaluations to check learning, understanding and comprehension following completion of each lesson using MCQs, essays and exercises given in the PMF approved textbook
b. Final certificate examination by PMF following completion of the academic year will have at least 1 part of an essay question from the digestive system. At least 20% assessment in theory papers will be based on MCQs.
c. Practical examinations will assess skills of dispenser students in marking position of stomach, liver and appendix on human body. The questions will be prepared by examiners trained and certified by PMF in examination techniques.
7. Time allocation
36 hours of class teaching and 6 hours of practical training
8. Weightage for assessment
20%


Sub-unit 2.3 The Pulmonary System
1. Rationale
Dispenser students will explore the Pulmonary System in order to understand its various parts, their major functions and some common diseases affecting the system. Communicable and non-communicable diseases related to the Pulmonary System form more than a third of the case load of clients reporting at government BHUs and RHCs (Mianwali & Pakpattan MIS reports 2007). Dispensers therefore come across a large number of clients with respiratory problems. Knowledge of this subject will help them support medical officers in effectively managing problems related to the Pulmonary System. Teachers will make a special reference to pneumonia and pulmonary tuberculosis, given the seriousness these carry.
2. Scope
Learning and understanding will focus on gross anatomy, major functions of parts of the Pulmonary System and how they are affected by diseases. The scope of teaching will be limited to giving a general understanding of the system to dispenser students and developing their skills to recognize signs and symptoms of tuberculosis and pneumonia in children and the elderly.
3. Learning Objectives
After completing sub-unit 2.3 dispenser students will be able to:
describe gross anatomy of the pulmonary system
describe basic functions of various parts of the pulmonary system
mark location of lungs on human body
d. identify signs and symptoms of pneumonia and pulmonary tuberculosis
4. Training requirements/instructional methodologies (Process)
a. Teaching staff for dispensers will be given in-service training as recommended by PMF from time to time
b. Dispenser teachers will use a combination of interactive programmed instructions (non-IT), class teaching with exercises using audiovisual aids, mini-lectures, group discussions, simulations and case studies as instructional/teaching methodologies
c. IT will be employed for teaching where available
d. A combination of English and Urdu languages will be used as medium of instruction
e. Dispenser teachers will encourage students to ask questions
f. Dispenser teachers will encourage debate and discussion in class to inspire and hone thinking skills of dispenser students. Students will be given the opportunity to engage in activities that promote divergent thinking skills. Students will be encouraged to work independently, as well as in small groups and as a whole class, to form creative associations of ideas across discipline lines.
Practical learning component:
Field learning will be carried out in hospital wards, laboratories, operation theatres, trauma centers, casualty wards, stores and pharmacies. Dispenser teachers will ensure that dispenser students are given field learning activities that are relevant to the pulmonary system that is being taught in the class. Practical training will enable them to develop skills to recognize signs and symptoms of pneumonia and pulmonary tuberculosis; counseling individuals, families and communities on how to avoid these problems and what to do if someone contracts them..
5. Assessment/Examination
a. Class room evaluations to check learning, understanding and comprehension following completion of each lesson using MCQs, essays and exercises given in the PMF approved textbook
b. Final certificate examination by PMF following completion of the academic year will have at least 1 part of an essay question from the pulmonary system. At least 3% MCQs will be taken from the pulmonary system. At least 20% assessment in theory papers will be based on MCQs.
c. Practical examinations will assess skills of dispenser students in measuring breathing rate and marking position of lungs on human body. The questions will be prepared by examiners trained and certified by PMF in examination techniques.
6. Time allocation
36 hours of class teaching and 6 hours of practical training
7. Weightage for assessment
20%

Sub-unit 2.4 The Musculoskeletal System and Skin
1. Rationale
Dispenser students will explore the musculoskeletal system and skin in order to understand its various parts, their major functions and some common diseases affecting the system with special reference to fractures and their immediate management. Trauma has emerged as an important health problem. Increased numbers of vehicles on roads and problems related to law and order have contributed to accidents. Quite often dispensers are front line health professionals dealing with victims of trauma until these are shifted to trauma centers. Knowledge of this subject will directly help dispensers perform their duties effectively.
2. Scope
Learning and understanding will focus on gross anatomy, major functions of parts of the musculoskeletal system and skin and how they are affected by diseases. The scope of teaching will be limited to giving a general understanding of the musculoskeletal system and skin to dispenser students and developing their skills to recognize and manage fractures (first aid) and other related emergencies. Links of musculoskeletal system and skin will also be explored with other systems of the body such as CVS and gastrointestinal tract.
3. Learning Objective(s)
After completing sub-unit 2.4 dispenser students will be able to:
a. demonstrate basic understanding of the musculoskeletal system and skin (What is the Musculoskeletal System? What comprises the system? What are the major functions of the system? What are the functions of its component parts?)
b. mark location of major parts of the system on human body, e.g. long bones of the body, origin/insertion of muscles of limbs and large joints
c. identify signs and symptoms of fractures
d. carry out immediate (emergency) management of fractures
e. develop a general understanding of anatomy and physiology of skin and recognize skin ailments such as scabies.
4. Training requirements/instructional methodologies (Process)
a. Teaching staff for dispensers will be given in-service training as recommended by PMF from time to time



b. Dispenser teachers will use a combination of interactive programmed instructions (non-IT), class teaching with exercises using audiovisual aids, mini-lectures, group discussions, simulations and case studies as instructional/teaching methodologies
c. IT will be employed for teaching where available
d. A combination of English and Urdu languages will be used as medium of instruction
e. Dispenser teachers will encourage students to ask questions
f. Dispenser teachers will encourage debate and discussion in class to inspire and hone thinking skills of dispenser students. Students will be given the opportunity to engage in activities that promote divergent thinking skills. Students will be encouraged to work independently, as well as in small groups and as a whole class, to form creative associations of ideas across discipline lines.
5. Practical learning component
Field learning will be carried out in hospital wards, laboratories, operation theatres, trauma centers, casualty wards, stores and pharmacies. Dispenser teachers will ensure that dispenser students are given field learning activities that are relevant to the musculoskeletal system and skin that is being taught in the class. Essentially, students will be attached to trauma centers and emergency departments where they will practically participate in managing victims of trauma.
6. Assessment/Examination
a. Classroom evaluations to check learning, understanding and comprehension following completion of each lesson using MCQs, essays and exercises given in the PMF approved textbook
b. Final certificate examination by PMF following completion of the academic year will have at least 1 part of an essay question from the musculoskeletal system. At least 20% assessment in theory papers will be based on MCQs.
c. Practical examinations will assess skills of dispenser students in handling a person with trauma through role plays.

7. Time allocation
36 hours of class teaching and 10 hours of practical training
8. Weightage for assessment
20%


Sub-unit 2.5 The Nervous System
1. Rationale
Dispenser students will explore the nervous system in order to understand its major parts, their major functions and some common diseases affecting the system. Changing economic, social, cultural and demographic patterns have led to an increased number of cases of trauma and stroke. As front line health professionals, dispensers are required to provide initial life saving support to such cases. Knowledge of the nervous system will help them perform these tasks appropriately.
2. Scope
Learning and understanding will focus on gross anatomy, major functions of parts of the nervous system and how they are affected by diseases focusing on head injuries and stroke. The scope of teaching will be limited to giving a general understanding of the nervous system to dispenser students and developing their skills to recognize signs of head injuries and stroke. Links of the nervous system to rest of the human body will also be explored.
3. Learning Objective(s)
After completing sub-unit 2.5 dispenser students will be able to:
a. name major parts of the nervous system and describe their major functions
b. identify signs and symptoms of head injuries, spinal injuries and stroke
c. carry out immediate management (emergency) of head injuries, spinal injuries and stroke.
4. Training requirements/instructional methodologies (Process)
a. Teaching staff for dispensers will be given in-service training as recommended by PMF from time to time
b. Dispenser teachers will use a combination of interactive programmed instructions (non-IT), class teaching with exercises using audiovisual aids, mini-lectures, group discussions, simulations and case studies as instructional/teaching methodologies
c. IT will be employed for teaching where available
d. A combination of English and Urdu languages will be used as medium of instruction
e. Dispenser teachers will encourage students to ask questions
f. Dispenser teachers will encourage debate and discussion in class to inspire and hone thinking skills of dispenser students. Students will be given the opportunity to engage in activities that promote divergent thinking skills. Students will be encouraged to work independently, as well as in small groups and as a whole class, to form creative associations of ideas across discipline lines.



5. Practical learning component
Field learning will be carried out in hospital wards, laboratories, operation theatres, trauma centers, casualty wards, stores and pharmacies. Dispenser teachers will ensure that dispenser students are given field learning activities that are relevant to the nervous system that is being taught in the class.
6. Assessment/Examination
a. Class room evaluations to check learning, understanding and comprehension following completion of each lesson using MCQs, essays and exercises given in the PMF approved textbook.
b. Final certificate examination by PMF following completion of the academic year will have at least 1 part of an essay question from the nervous system. At least 20% assessment in theory papers will be based on MCQs.
c. Practical examinations will assess skills of dispenser students in handling a person with trauma through role plays.
7. Time allocation
9 hours of class teaching and 6 hours of practical training
8. Weightage for assessment
5%


Sub-unit 2.6 The Excretory System
1. Rationale
Dispenser students will explore the excretory system in order to understand its major parts, their major functions and some common diseases affecting the system. Changing demography and patterns of lifestyles have increased the incidence of non-communicable diseases in Punjab. Renal failure has become an important disease entity. These factors necessitate inclusion of excretory system in dispenser’s curriculum. Applied knowledge of various important parts of this system and their important functions will prepare dispensers to effectively support medical officers in managing relevant clients on the one hand and will enable dispensers to deliver health promotion messages effectively to communities, on the other.
2. Scope
Learning and understanding will focus on gross anatomy, major functions of parts of the excretory system and how they are affected by diseases. The scope of teaching will be limited to giving a general understanding of the excretory system to dispenser students and developing their skills to recognize emergencies. Links of the excretory system to rest of the human body will also be explored.
3. Learning Objectives
After completing sub-unit 2.6 dispenser students will be able to:
a. describe routes of excretion of wastes products from human body
b. name major parts of the excretory system and mark their position on human body
c. describe functions of major parts of the excretory system
d. identify common diseases affecting the urinary system.
4. Training requirements/instructional methodologies (Process)
a. Teaching staff for dispensers will be given in-service training as recommended by PMF from time to time
b. Dispenser teachers will use a combination of interactive programmed instructions (non-IT), class teaching with exercises using audiovisual aids, mini-lectures, group discussions, simulations and case studies as instructional/teaching methodologies
c. IT will be employed for teaching where available
d. A combination of English and Urdu languages will be used as medium of instruction
e. Dispenser teachers will encourage students to ask questions
f. Dispenser teachers will encourage debate and discussion in class to inspire and hone thinking skills of dispenser students. Students will be given the opportunity to engage in activities that promote divergent thinking skills. Students will be encouraged to work
independently, as well as in small groups and as a whole class, to form creative associations of ideas across discipline lines.
5. Practical learning component
Field learning will be carried out in hospital wards, laboratories, operation theatres, trauma centers, casualty wards, stores and pharmacies. Dispenser teachers will ensure that dispenser students are given field learning activities that are relevant to the excretory system that is being taught in the class, e.g. identification of catheters, catheterization procedures and passing of flatus tube.
6. Assessment/Examination
a. Class room evaluations to check learning, understanding and comprehension following completion of each lesson using MCQs, essays and exercises given in the PMF approved textbook
b. Final certificate examination by PMF following completion of the academic year will have at least 1 part of an essay question from the excretory system. At least 20% assessment in theory papers will be based on MCQs.
c. Practical examinations will assess skills of dispenser students in identifying catheters and catheterization techniques.
7. Time allocation
9 hours of class teaching and 6 hours of practical training
8. Weightage for assessment
10%
Sub-unit 2.7 The Reproductive System
1. Rationale
Dispenser students will explore the Reproductive System in order to understand its major parts, their major functions and some common diseases affecting the system. A relatively closer relationship of dispensers with communities suitably positions them to assume the role of health counselors. This opportunity needs to be fully capitalized upon in order to improve preventive health interventions. As frontline health workers, dispensers need to have knowledge of the Reproductive System in order to deliver health promotion messages including family planning to individuals and communities in addition to dealing with related emergencies[SA1] .
2. Scope
Learning and understanding will focus on gross anatomy, major functions of parts of the reproductive system and how they are affected by diseases. The scope of teaching will be limited to giving a general understanding of the reproductive system to dispenser students and developing their skills to recognize emergencies. Links of the reproductive system to rest of the human body will also be explored.
3. Learning Objectives
After completing sub-unit 2.7 dispenser students will be able to:
a. identify major parts of the reproductive system
b. describe functions of major parts of the reproductive system
c. identify common disease condition affecting the reproductive system
d. give health promotion messages related to reproductive health.

4. Training requirements/instructional methodologies (Process)
a. Teaching staff for dispensers will be given in-service training as recommended by PMF from time to time
b. Dispenser teachers will use a combination of interactive programmed instructions (non-IT), class teaching with exercises using audiovisual aids, mini-lectures, group discussions, simulations and case studies as instructional/teaching methodologies
c. IT will be employed for teaching where available
d. A combination of English and Urdu languages will be used as medium of instruction
e. Dispenser teachers will encourage students to ask questions
f. Dispenser teachers will encourage debate and discussion in class to inspire and hone thinking skills of dispenser students. Students will be given the opportunity to engage in activities that promote divergent thinking skills. Students will be encouraged to work independently, as well as in small groups and as a whole class, to form creative associations of ideas across discipline lines.

5. Practical learning component
Field learning will be carried out in hospital wards, laboratories, operation theatres, trauma centers, casualty wards, stores and pharmacies. Dispenser teachers will ensure that dispenser students are given field learning activities that are relevant to the reproductive system that is being taught in the class.
6. Assessment/Examination
a. Class room evaluations to check learning, understanding and comprehension following completion of each lesson using MCQs, essays and exercises given in the PMF approved textbook
b. Final certificate examination by PMF following completion of the academic year will have at least 1 part of an essay question from the reproductive system. At least 20% assessment in theory papers will be based on MCQs.
c. Practical examinations will assess skills of dispenser students in identifying catheters and catheterization techniques.

7. Time allocation
9 hours of class teaching and 6 hours of practical training
8. Weightage for Assessment
10%

Sub-unit 2.8 The Endocrine System
1. Rationale
Dispenser students will explore the Endocrine System in order to understand its major parts, their major functions and some common diseases affecting the system. Changing lifestyles and demography have increased the incidence and prevalence of non-communicable diseases in Punjab. Diabetes has become an important disease entity. Inclusion of excretory system in dispenser’s curriculum therefore has become necessary. Knowledge of various important parts of this system and their important functions will prepare dispensers to effectively support health services in managing relevant clients. More importantly, knowledge of the Endocrine System will be enable dispensers to deliver health promotion messages effectively to communities and individuals including those related to hormone-based contraceptives.
2. Scope
Learning and understanding will focus on gross anatomy, major functions of parts of the endocrine system and how they are affected by diseases. The scope of teaching will concentrate on giving a general understanding of the endocrine system to dispenser students and developing their skills to recognize emergencies. Links of the endocrine system to rest of the human body will also be explored.
3. Learning Objective(s)
After completing sub-unit 2.8 dispenser students will be able to:
a. name major parts of the endocrine system
b. describe functions of major parts of the endocrine system
c. identify common diseases affecting the endocrine system
d. deliver health promotion and family planning (family welfare) messages related to this system.
4. Training requirements/instructional methodologies (Process)
a. Teaching staff for dispensers will be given in-service training as recommended by PMF from time to time
b. Dispenser teachers will use a combination of interactive programmed instructions (non-IT), class teaching with exercises using audiovisual aids, mini-lectures, group discussions, simulations and case studies as instructional/teaching methodologies
c. IT will be employed for teaching where available
d. A combination of English and Urdu languages will be used as medium of instruction
e. Dispenser teachers will encourage students to ask questions
f. Dispenser teachers will encourage debate and discussion in class to inspire and hone thinking skills of dispenser students. Students will be given the opportunity to engage in
activities that promote divergent thinking skills. Students will be encouraged to work independently, as well as in small groups and as a whole class, to form creative associations of ideas across discipline lines.
5. Practical learning component
Field learning will be carried out in hospital wards, laboratories, operation theatres, trauma centers, casualty wards, stores and pharmacies. Dispenser teachers will ensure that dispenser students are given field learning activities that are relevant to the endocrine system that is being taught in the class.
6. Assessment/Examination
a. Class room evaluations to check learning, understanding and comprehension following completion of each lesson using MCQs, essays and exercises given in the PMF approved textbook
b. Final certificate examination by PMF following completion of the academic year will have at least 1 part of an essay question from the endocrine system. At least 20% assessment in theory papers will be based on MCQs.
c. Practical examinations will assess skills of dispenser students in identifying enlarged glands such as goiter.
7. Time allocation
9 hours of class teaching and 6 hours of practical training
8. Weightage for assessment
5%

Unit 3 Pharmacy & Pharmacology

Learning Focus
Definition of drugs and their sources, nomenclature (Generic and Brand Names)
9 hours
Incompatibilities
15 hours
Dosage, forms and preparation of drugs, basics of weights and measures, calculation of percentage solutions
15 hours
Compounding and dispensing of pharmaceutical preparations
15 hours
National Formulary and Drug Laws
9 hours
Understanding, reading and writing prescriptions
18 hours
Basic knowledge of commonly used drugs
o Classification
o Generic and brand names
o Preparations, dosage and routes of administration
o Important uses, contraindications and toxic effects of drugs
36 hours
Actions of drugs on human body
o Systemic
o Local

36 hours
Antibiotics and Infections
27 hours
Total Teaching Time
180 hours

1. Role
The range of duties and responsibilities of dispensers includes managing medicine stores, indenting medicines for wards and dispensaries, dispensing medicines in response to doctors’ prescriptions, instructing clients on how to use medicines, managing patients in emergencies and delivering health promotion messages to individuals and communities. Dispensers carry out these duties at all the three levels of health care, i.e. primary level in BHUs and RHCs, secondary level in district and tehsil level hospitals and in tertiary care hospitals. Given the wide range of ‘medicine/drug-related’ functions dispensers are expected to perform, on average 40% of their time is spent in completing tasks related to pharmacology and pharmacy. Basic understanding of
pharmacology and pharmacy, and its application therefore becomes essential ingredient of curriculum.

2. Rationale
Pharmacology is an important integrated science that links disciplines such as physiology and biochemistry and clinical medicine. It deals with drugs and medicines, especially, their origin, effects, use and properties. Actions of drugs on human body, how they behave within human body and how they react with each other form building blocks of the subject. Pharmacy, on the other hand, is preparing, compounding, storing, dispensing and appropriately using drugs and medicines.
Dispensers, in their work situations, are required to manage medicine stores, indent medicines, dispense prescribed medicines to clients, maintain records, prepare simple drug preparations and manage patients in emergency situations. Punjab government-prescribed job description of dispensers and their job analysis also support this aspect.
Viewed against the background of tasks and duties dispensers have to perform, acquisition of basic knowledge and skills of pharmacology and pharmacy form essential part of dispensers’ pre-service training.
3. Scope
Learning and understanding will focus on basic pharmacology and pharmacy. The scope of teaching, training and learning will be less than medical and nursing students. Whilst teaching pharmacology and pharmacy due consideration should always be given to the fact that dispensers cannot independently manage patients, emergency situations being the only exceptions to the rule. The breadth and depth of teaching and training therefore should always be adjusted keeping this fact in mind.
The primary goal of this unit would be to provide basic pharmacologic information that will impart an understanding of action of drugs on human body so that dispenser students can apply this knowledge prior to, during, and after the appropriate use of drugs in their job situations.

Learning and understanding should focus on developing essential concepts such as effects of drugs on human body or incompatibilities of drugs with human body and basic skills such as interpreting doctors’ prescription or storage of drugs, among other things.
Expecting dispensers to independently manage OPDs is a dangerous proposition and works against the proposed “Minimum Service Delivery Standards” of the Government of Punjab.
4. Learning Objectives
After completing unit 3 dispenser students will be able to:
a. define pharmacology and pharmacy
b. name main branches of pharmacology and pharmacy
c. demonstrate an understanding of classification of drugs, their main group actions, their sources, their forms and preparations
d. identify routes of administration of drugs, factors affecting drug absorption and their incompatibilities with human body
e. demonstrate knowledge of drugs acting on different systems of human body (CVS, GIT, Nervous System, Pulmonary/Respiratory System, Excretory System, Endocrine System, Musculoskeletal System)
f. describe generic and trade names of drugs acting on human body in emergencies (angina, asthma, acute pain)
g. define pharmacopeias, their contents and importance, and National Formulary of Pakistan
h. interpret prescriptions, calculate appropriate dosages and understand storage procedures of drugs.

5. Training requirements/instructional methodologies (Process)
a. Teaching staff for dispensers will be given in-service training as recommended by PMF from time to time
b. Dispenser teachers will use a combination of interactive programmed instructions (non-IT), class teaching with exercises using audiovisual aids, mini-lectures, group discussions, simulations and case studies as instructional/teaching methodologies
c. IT will be employed for teaching where available
d. A combination of English and Urdu languages will be used as medium of instruction
e. Dispenser teachers will encourage students to ask questions
f. Dispenser teachers will encourage debate and discussion in class to inspire and hone thinking skills of dispenser students. Students will be given the opportunity to engage in activities that promote divergent thinking skills. Students will be encouraged to work independently, as well as in small groups and as a whole class, to form creative associations of ideas across discipline lines.

6. Practical learning component
Field learning will be carried out in hospital wards, laboratories, operation theatres, trauma centers, casualty wards, stores and pharmacies. Dispenser teachers will ensure that dispenser students are given field learning activities that are relevant to the unit that is being taught in the class.
7. Assessment/Examination
a. Class room evaluations to check learning, understanding and comprehension following completion of each lesson using MCQs, essays and exercises given in the PMF approved textbook
b. Final certificate examination by PMF following completion of the academic year will have at least 1 part of an essay question from pharmacy and pharmacology. At least 20% assessment in theory papers will be based on MCQs.
c. Practical examinations will assess skills of dispenser students in interpreting a doctor’s prescription through role plays.
8. Time allocation
180 hours of class teaching and 50 hours of practical training
9. Weightage for assessment
30%

Unit 4 Concepts of Management of Common Diseases

Learning Focus
Disease and Determinants of Health
9 hours
Principles of Pediatrics
9 hours
EPI-related diseases
Polio
Health Promotion and Prevention Action
Basic Treatment
Tuberculosis
Health Promotion and Prevention Action
Basic Treatment
Diphtheria
Health Promotion and Prevention Action
Basic Treatment
Tetanus
Health Promotion and Prevention Action
Basic Treatment
Pertusis
Health Promotion and Prevention Action
Basic Treatment
Measles
Health Promotion and Prevention Action
Basic Treatment
Hepatitis
Health Promotion and Prevention Action
Basic Treatment
15 hours
Childhood diseases and IMNCI (Integrated Management of Neonatal & Childhood Infections)
Diarrheal Diseases
Health Promotion and Prevention Action
Basic Treatment
Acute Respiratory Tract Infections
Health Promotion and Prevention Action
Basic Treatment
Intestinal Infestations
Health Promotion and Prevention Action
Basic Treatment
15 hours
Principles of Obstetrics and Gynecology
3 hours
Principles of Geriatrics
3 hours
Concept of Management of Diabetes (Health Promotion and Prevention)
3 hours
Concept of Management of Hypertension (Health Promotion and Prevention)
3 hours
Total Teaching Time
60 hours
1. Role
Dispensers play a key role in managing outpatient and inpatients departments at primary, secondary and tertiary levels. Primarily, medical officers and nurses manage patients. However, dispensers act as the first point of contact for patients and their families. A broader view of their role brings them in contact with communities where they practice health promotion or have the opportunity to do so. Knowledge of common diseases will help them to appropriately discharge these duties. Given the variety of this role, on average 40% of their time is spent in completing tasks related acting as the first point of contact for patients and their families and practicing health promotion in communities.
2. Rationale
Information about determinants of health and disease, principles of pediatrics and health promotion provide a context to preventive and promotive actions. Expanded Program on Immunization (EPI) is one of the biggest preventive initiatives of the Government of Pakistan. Familiarity with EPI-related diseases will provide the knowledge base that will enable dispenser students to carry out preventive and promotive activities. Transferring this information to health services clients, families and communities will empower them to exercise control over their health, on the one hand, and will help improve utilization of services offered by the Department of Health, on the other.
Data from health management information system shows that mothers and children are the most vulnerable groups in the province and the country. Relatively high mortality rates for ‘children under five’ and ‘mothers’ are a testimony. Additionally, demography and lifestyles in Pakistan are in the process of transition. The population pyramid is now straightening on the sides with more people in 30- and 40-year age groups compared to their numbers twenty years ago. Continued shift from rural and agrarian lifestyles to urban way of life has contributed to appearance of health problems such as hypertension and diabetes. Emergence of non-communicable health problems as noticeable entities coupled with changing age patterns of population poses new challenges for health services. Education and training of health professionals therefore needs to respond to these emerging realities. Inclusion of this unit will prepare dispensers to effectively respond to these challenges.
3. Scope
Learning and understanding will focus on basic principles of health and disease in order for dispenser students to develop a perspective of these elements. Communicable, non-communicable health problems, EPI-related diseases and health problems special to mother and children will be covered in teaching and training. However, the scope and the main thrust of education and teaching will be on prevention and health promotion rather than details of clinical knowledge. Whilst teaching this unit due consideration should always be given to the fact that dispensers cannot independently manage patients except for emergencies. The breadth and depth of teaching and training therefore should be adjusted with this in mind.
The goal of this unit is to provide basic information and skills that enable dispenser students to become effective health promoters rather than medical practitioners. Expecting dispensers to comprehensively manage health facilities in any case is in conflict with the proposed “Minimum Service Delivery Standards” of the Government of Punjab.
4. Learning Objectives
After completing unit 4 dispenser students will be able to:
a. describe determinants of health and disease
b. demonstrate skills and knowledge related to health promotion and preventive aspects of health
c. demonstrate how to properly advise, counsel and guide individuals, families and communities on how to access and utilize preventive and promotive health services
d. demonstrate knowledge and skills to provide limited and basic first line health care for various diseases
e. demonstrate knowledge and skills to effectively assess and refer to the appropriate healthcare provider or facility, cases of various diseases that merit further treatment and management.
f. define immune system, immunization, antigen and antibody
g. demonstrate an understanding of immunization and how vaccines work
h. demonstrate an understanding of the Expanded Program on Immunization
i. demonstrate an understanding of the immunization schedule followed in Pakistan
j. demonstrate an understanding of diseases covered by the Expanded Program on Immunization - tuberculosis, measles, diphtheria, poliomyelitis, pertussis, tetanus and hepatitis B
k. demonstrate an understanding of hepatitis C.
5. Training requirements/instructional methodologies (Process)
a. Teaching staff for dispensers will be given in-service training as recommended by PMF from time to time
b. Dispenser teachers will use a combination of interactive programmed instructions (non-IT), class teaching with exercises using audiovisual aids, mini-lectures, group discussions, simulations and case studies as instructional/teaching methodologies
c. IT will be employed for teaching where available
d. A combination of English and Urdu languages will be used as medium of instruction
e. Dispenser teachers will encourage students to ask questions
f. Dispenser teachers will encourage debate and discussion in class to inspire and hone thinking skills of dispenser students. Students will be given the opportunity to engage in activities that promote divergent thinking skills. Students will be encouraged to work independently, as well as in small groups and as a whole class, to form creative associations of ideas across discipline lines.
6. Practical learning component
Field learning will supplement class teaching. It will be carried out in hospital wards, health units, laboratories, operation theatres, trauma centers, casualty wards, stores and pharmacies. Dispenser teachers will ensure that dispenser students are given field learning activities that are relevant to prevention and health promotion that is being taught in the class. Attachment of dispenser students with outreach teams such as vaccinators etc. will greatly help in developing understanding of preventive issues.
7. Assessment/Examination
a. Class room evaluations to check learning, understanding and comprehension following completion of each lesson using MCQs, essays and exercises given in the PMF approved textbook
b. Final certificate examination by PMF following completion of the academic year will have at least 1 part of an essay question from this unit. At least 20% assessment in theory papers will be based on MCQs.
c. Practical examinations will assess skills of dispenser students in interpreting a doctor’s prescription through role plays.
8. Time allocation
60 hours of class teaching and 10 hours of practical training
9. Weightage for assessment
10%

Unit 5 First Aid Treatment: Emergencies, Trauma, Over-dosage and Poisoning (including acid poisoning)
Learning Focus
Knowledge of triage
3 hours
Recognizing life threatening conditions, carrying out basic management and referring
9 hours
Keeping airway patent and Cardio-Pulmonary Resuscitation (CPR)
6 hours
Stoppage of bleeding and first line handling of head injuries and fractures
6 hours
Maintaining I/V line
3 hours
Vital Signs and emergency response: Airway, Breathing, Circulation (ABC)
6 hours
Concept of Management of Injuries and Burns
Dressings
Oxygen
Suction
IV line
Catheterization
Positioning
9 hours
Concept of Management of Medical and Surgical Emergencies
Hyper- and Hypo-Glycemia
Hypertensive crisis
Cardiac Emergencies
Bronchospasm
Acute Abdomen
Urinary and Bowel obstructions
6 hours
Concepts of Management of Pediatric Emergencies
3 hours
Concepts of Management of Obstetric Emergencies
3 hours
Concepts of Management of Geriatric Emergencies
3 hours
Medico-legal cases and the Dispenser
3 hours
Total Teaching Time
60 hours

1. Role
As frontline health services staff dispensers have to manage emergencies. Usually, they are the first point of contact for victims of trauma reporting to secondary and primary healthcare facilities. Generally, dispensers are the only healthcare service providers available to attend emergencies after office hours; medical officer being on call. Therefore, they spent a sizeable amount of their time in managing emergencies.
2. Rationale
Increased number of vehicles, rising incidents of violence, natural disasters, cultural & social changes and unregulated sale of drugs have resulted in a proportionate increase in cases of trauma, injuries and drug over-dosage. Dispensers constitute the backbone of emergency and trauma centers in all tertiary, secondary and primary health care facilities. Recognizing life threatening conditions and learning life saving skills therefore are imperatives for their training. In fact their training would not be complete without these topics.
3. Scope
Dispenser students will learn how to recognize life threatening conditions, what are basic life saving measures and how they are carried out. Emphasis will be on referring such patients following initial life saving measures rather than full management. Dispenser students should be given the understanding that professionalism and ethics demand a properly trained doctor or a nurse, when available, managing such patients than dispensers.
Learning emphasis will also be on developing demonstrable skills in carrying out procedures such as keeping a patent airway, recording vital signs, CPR, stoppage of bleeding, shifting/handling patients with head injury, spinal injuries and fractures. All relevant aspects of Minimum Service Delivery Standards, Standard Operating Procedures and Standard Medical Protocols introduced by Punjab’s Department of Health in Jan/Feb 2008 will be part of dispenser’s training package.
4. Learning Objectives
After completing unit 5 dispenser students will be able to:
define triage
record vital signs
elicit life threatening signs
demonstrate skills and knowledge to stop bleeding and maintain I/V line
carry out CPR and manage Airway, Breathing and Circulation (ABC)
carry out first line handling of patients with suspicion of head or spinal injuries
carry out first line handling of patients with fractures.


5. Training requirements/instructional methodologies (Process)
a. Teaching staff for dispensers will be given in-service training as recommended by PMF from time to time
b. Dispenser teachers will use a combination of interactive programmed instructions (non-IT), class teaching with exercises using audiovisual aids, mini-lectures, group discussions, simulations and case studies as instructional/teaching methodologies
c. IT will be employed for teaching where available
d. A combination of English and Urdu languages will be used as medium of instruction
e. Dispenser teachers will encourage students to ask questions
f. Dispenser teachers will encourage debate and discussion in class to inspire and hone thinking skills of dispenser students. Students will be given the opportunity to engage in activities that promote divergent thinking skills. Students will be encouraged to work independently, as well as in small groups and as a whole class, to form creative associations of ideas across discipline lines.
6. Practical learning component
Field learning will be carried out in hospital wards, laboratories, operation theatres, trauma centers, casualty wards, stores and pharmacies. Dispenser teachers will ensure that dispenser students are given field learning activities that are relevant to the unit that is being taught in the class. Demonstrations on dummies will form an essential component of practical training for this unit.
7. Assessment/Examination
a. Class room evaluations to check learning, understanding and comprehension following completion of each lesson using MCQs, essays and exercises given in the PMF approved textbook
b. Final certificate examination by PMF following completion of the academic year will have at least 1 part of an essay question from this unit. At least 20% assessment in theory papers will be based on MCQs.
c. Practical examinations will assess skills of dispenser students in demonstrating life saving skills on dummies or through role plays.
8. Time allocation
60 hours of class teaching and 10 hours of practical training
9. Weightage for assessment
10%


Unit 6 Stores, Record Management & District Health Information System (DHIS)

Learning Focus
Preparing and maintaining chart of vital signs
6 hours
Birth and Death Register
3 hours
DHIS tools and instruments (Registers and forms)
18 hours
Poison Register
3 hours
Medico-legal Register
6 hours
Postmortem Register
6 hours
Inventory and Store Management
18 hors
Total Teaching Time
60 hours

1. Role
Managing stores, general and specialized, and district health management information system (DHIS) are essential components of duties of dispensers. The importance of these services could be gauged from the fact that health facilities, primary, secondary or tertiary, simply cannot work without them. Stores are a vital link in the logistical chain. DHIS provides the all important data that is used or should be used for monitoring, evaluation and planning decisions. Therefore, dispensers not only work at the front end of the healthcare services, they also perform these vital back end tasks.
2. Rationale
Store management and DHIS are specialized support services that need proper education and training. Improperly stored medicines or equipment can quickly deteriorate resulting in financial losses and damage to reputation of healthcare services. Inadequate handling of DHIS data can lead to generation of information which is not congruent with reality. Planning and management decisions based on such information will obviously fail to achieve the desired results leading to wastage of precious resources. Learning these skills on the job without proper pre-service training is risky and fraught with danger. The cost of wasted resources and economic implications of decisions based on faulty information before a dispenser learns to properly manage these two components cannot be ignored. These factors lead to the conclusion that appropriate pre-service education and training in DHIS and store management is essential. Certainly, it will be a lot more economical to spend resources in training dispensers before putting them in the job than doing it the other way round.

3. Learning Objectives
After completing unit 6 dispenser students will be able to:
define different types of stores and their purpose
demonstrate skills and knowledge about how to manage different types of stores, e.g. medicine stores, general stores etc. according to prescribed government procedures
demonstrate skills and knowledge about how to manage store registers, stock ledgers and other accountable records according to prescribed government procedures
define the purpose and importance of DHIS
identify relevant tools and instruments of DHIS (OPD registers, abstract forms, patients records etc.) and their importance
correctly fill out relevant DHIS forms and reports
define the importance of records vis-à-vis audit.
4. Training requirements/instructional methodologies (Process)
a. Teaching staff for dispensers will be given in-service training as recommended by PMF from time to time
b. Dispenser teachers will use a combination of interactive programmed instructions (non-IT), class teaching with exercises using audiovisual aids, mini-lectures, group discussions, simulations and case studies as instructional/teaching methodologies
c. IT will be employed for teaching where available
d. A combination of English and Urdu languages will be used as medium of instruction
e. Dispenser teachers will encourage students to ask questions
f. Dispenser teachers will encourage debate and discussion in class to inspire and hone thinking skills of dispenser students. Students will be given the opportunity to engage in activities that promote divergent thinking skills. Students will be encouraged to work independently, as well as in small groups and as a whole class, to form creative associations of ideas across discipline lines.
5. Practical learning component
Field learning will be carried out in hospital wards, laboratories, operation theatres, trauma centers, casualty wards, stores and pharmacies. Dispenser teachers will ensure that dispenser students are given field learning activities that are relevant to this unit. Attachment with stores and coaching by senior dispensers and DHIS coordinators will form the essential ingredient of teaching.



6. Assessment/Examination
a. Class room evaluations to check learning, understanding and comprehension following completion of each lesson using MCQs, essays and exercises given in the PMF approved textbook
b. Final certificate examination by PMF following completion of the academic year will have at least 1 part of an essay question from this unit. At least 20% assessment in theory papers will be based on MCQs.
c. Practical examinations will assess skills of dispenser students in filling out DHIS forms and interpreting stock registers.
7. Time allocation
60 hours of class teaching and 20 hours of practical training
8. Weightage for assessment
10%
Unit 7 Sterilization and Disinfection

Learning focus
Microorganisms (bacteria, virus, fungi, spores, parasites) & modes of transmission of infections
6
Microbiology & Chemistry related to sterilization and disinfection
3
Infection Control Procedures
3
Principles of Safety
3
Principles, Methods & Controls of Sterilization Processes (cleaning, processing, packaging, distributing, storing, and inventory control of sterile goods, instruments, trays & equipment)
6
Medical terminology related to sterilization and disinfection
Surgical instruments and their handling
3
Blood borne diseases, HIV/AIDS, Hepatitis B & C
3
Infectious diseases TB & leprosy
3
Total Teaching Time
30 hours

1. Role
Sterilization and disinfection start from simple but important aspects such as cleanliness and hand washing and differentiates into technologically complex procedures such as radiation. It is a cross cutting subject which has its application in almost all tasks performed by dispensers whether at hospitals, RHCs, BHUs and rural dispensaries.
Dispensers are an important element of both in- and outdoor patient departments in addition to emergency and trauma centers at tertiary, secondary and primary health care facilities. On average 25% of dispensers’ time is spent on completing tasks related to this unit. Understanding of sterilization and disinfection, and their application therefore becomes essential ingredient of dispensers’ curriculum.
2. Rationale
Concepts and procedures of sterilization and disinfection are the foundational training block which supports the entire edifice of training outcome of dispensers. Improper sterilization and disinfection could have far reaching hazardous impact on clients, families of clients,
communities, health facility staff and dispensers themselves. This unit addresses basic issues related to safety and control of spread of diseases. Understanding of concepts of sterilization and disinfection and learning skills to manage them, therefore forms the essential core of dispenser training program.
3. Scope
Dispenser students will learn about basics of microbes and how infections are transmitted. They will acquire skills related to personal hygiene and sanitation as well as that of their place of duty.
Emphasis will be on developing demonstrable skills in carrying out disinfection and sterilization. All relevant aspects of Minimum Service Delivery Standards, Standard Operating Procedures and Standard Medical Protocols introduced by Punjab Department of Health in Jan/Feb 2008 will be part of dispensers’ training package.
The primary goal of this unit would be to train dispenser students in understanding the relationship between microorganisms and disease, modes of transmission of disease and how to prevent disease by breaking the chain of transmission.
Learning and understanding will also establish the link between sterilization and disinfection and how they support Punjab Government’s efforts in achieving targets related to MDGs.
4. Learning Objectives
After completing unit 7 dispenser students will be able to:
describe & demonstrate personal hygiene and hygiene of their work environment
list rules of general safety
explain the chain of infection
explain the differences between medical asepsis, surgical asepsis, disinfection and sterilization
explain general or universal precaution techniques and isolation precaution techniques
describe nosocomial infections and their risk to clients
describe risk of contracting infection to healthcare professionals
demonstrate proper hand washing methods
prepare and sterilize instruments
carry out safe disposal of instruments (syringes, needles, disposable medical/surgical) equipment.
5. Training requirements/instructional methodologies (Process)
a. Teaching staff for dispensers will be given in-service training as recommended by PMF from time to time

b. Dispenser teachers will use a combination of interactive programmed instructions (non-IT), class teaching with exercises using audiovisual aids, mini-lectures, group discussions, simulations and case studies as instructional/teaching methodologies
c. IT will be employed for teaching where available
d. A combination of English and Urdu languages will be used as medium of instruction
e. Dispenser teachers will encourage students to ask questions
f. Dispenser teachers will encourage debate and discussion in class to inspire and hone thinking skills of dispenser students. Students will be given the opportunity to engage in activities that promote divergent thinking skills. Students will be encouraged to work independently, as well as in small groups and as a whole class, to form creative associations of ideas across discipline lines.
6. Practical learning component
Field learning will be carried out in hospital wards, laboratories, operation theatres, trauma centers, casualty wards, stores, sterilization rooms and pharmacies. Dispenser teachers will ensure that dispenser students are given field learning activities that are relevant to the sterilization and disinfection that is being taught in the class. Practical attachment of dispenser students with sterilization departments or sections is essential for learning sterilization techniques.
7. Assessment/Examination
a. Class room evaluations to check learning, understanding and comprehension following completion of each lesson using MCQs, essays and exercises given in the PMF approved textbook
b. Final certificate examination by PMF following completion of the academic year will have at least 1 part of an essay question from the musculoskeletal system. At least 20% assessment in theory papers will be based on MCQs.
c. Practical examinations will assess practical skills of dispenser students in handling relevant equipment and steps required for sterilization and disinfection.
8. Time allocation
30 hours of class teaching and 15 hours of practical training
9. Weightage for assessment
5%


Unit 8 Practicals

Learning Focus
Pharmacology and Pharmacy Practicals
Measuring systems used in pharmacy
· Metric system
· Imperial system
· Basic units of different systems
· Conversion of temperature measurement (from C to F and vice versa)
30 hours
Labeling (rules, batch number, manufacturing and expiry dates)
15 hours
Solutions, suspensions, emulsions, mixtures, lotions, ointments and powders (Types, percentages of solutions, routes of administration, ORS, dextrose water, dextrose saline etc.)
30 hours
Injectables, sera and vaccines (I/V, I/M, S/Coetaneous and Intra-coetaneous administration of drugs
15 hours
Apparatus in pharmacy
· Drip sets
· Branulas
· Syringes
· Catheters
· Transfusion sets
· Drains
30 hours
Hospital or Ward Practicals
Instruments and equipment used in hospitals
· Preparation of Emergency Cupboard and use of articles in the Cupboard
· Preparation of Emergency Tray and use of articles in the Tray
· Stethoscope
· Blood pressure apparatus
· Sterilizer
· Enema can
· Flatus tube
· Lumber puncture needle
· Splints
· Oxygen cylinder
· Suction tube
· Other specialized ward equipment depending on availability
60 hours
Identification of specimen
Enteric and sugar coated tablets
Spirit and other disinfectants
Copper sulphate
Gention violet
Menthol
Physical examination of drugs (name label, manufacturing and expiry date and other parameters)
90 hours
Records and DHIS
Stock ledgers, DHIS registers, forms and tools, patient recording instruments
130 hours
Total Practical Time
400 hours

1. Role
Practical training forms an extremely important part of pre-service education and training for dispenser students. In fact, it is the practical training that determines the level of professionalism of dispensers after they are employed by health facilities. All tasks that dispensers have to carry out at health facilities require a contribution of this aspect of pre-service training. Therefore, it could be deduced that this unit contributes to the entire job description of a dispenser.
2. Rationale
Technological advances in the field of health in the last three decades have radically changed the scenario of healthcare service provision. Pre-service training of dispensers, especially the practical component, has to keep pace with these developments. The diploma or certificate of a professional qualification is merely a piece of paper with absolutely no value, if the holder lacks purported skills. Hence, practical training will form the basis that will decide the level of quality of dispensers as a product of training. By this analogy, the level of quality of healthcare service
provision will be dependent on dispensers as front line healthcare service providers. Developing skills during practical training therefore forms the essential element.
3. Scope
Dispenser students will learn to recognize the various items, equipment, tools and implements that are commonly used at health facilities. Dispenser students will be trained in their safe use and everyday (unspecialized) maintenance and proper handling. However, specialized maintenance and handling will be left to appropriate persons. Skills development, rather than theoretical aspects, will be the denominator for this unit. Emphasis will be on developing demonstrable skills of elements included in this unit.
4. Learning Objectives
After completing unit 8 dispenser students will be able to:
identify specimen of different forms of drugs and medicines
demonstrate skills and knowledge about how to prepare and maintain emergency tray and emergency cupboard
demonstrate safe and proper use of equipment, tools and implements
Prepare and maintain emergency tray and emergency cupboard
demonstrate proper use of items used for record keeping, e.g. DHIS registers and forms
5. Training requirements/instructional methodologies (Process)
a. Teaching staff for dispensers will be given in-service training as recommended by PMF from time to time
b. Dispenser teachers will use a combination of interactive programmed instructions (non-IT), class teaching with exercises using audiovisual aids, mini-lectures, group discussions, simulations and case studies as instructional/teaching methodologies
c. IT will be employed for teaching where available
d. A combination of English and Urdu languages will be used as medium of instruction
e. Dispenser teachers will encourage students to ask questions
f. Dispenser teachers will encourage debate and discussion during practical sessions to inspire and hone thinking skills of dispenser students. Students will be given the opportunity to engage in activities that promote divergent thinking skills.
g. Students will be encouraged to work independently, as well as in small groups and as a whole class, to form creative associations of ideas across discipline lines.
h. Practical training component given with units 1 to 7 will be effectively utilized to cover unit 8 by creating a learning link between topics taught in classroom with training during practical sessions.
6. Assessment/Examination
a. Teachers will employ post practical training sessions evaluations to check the level of learning, understanding, comprehension and skills acquisition lesson using MCQs and practical exercises.
b. Final certificate examination by PMF following completion of the academic year.
Practical tests will assess skills of dispenser students in handling relevant equipment and proper use of other items given in this curriculum.

7. Time allocation
400 hours of practical training
8. Weightage for assessment
25%