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Welcome to online class by the
Department of Community Medicine
All students can communicate with the facilitator in chat which is
being continuously monitored
Note:
1. All students will rename your devise with UNID & name which will be utilized for attendance
2. All students will mute your microphone and video till the class ends.
10-Jun-20 Occupational Diseases 1
Health care of the community –
Primary health care in India
Dr. Jayaramachandran S
Associate Professor
Department of Community Medicine
05.06.2020
The student shall be able to
• Classify the existing health care system in India
• Explain primary health care delivery in India
Health care systems
• Public health sector
• Private sector
• Indigenous system of medicine
• Voluntary health agencies
• National health programmes
1. Primary Health care
• PHC / SC
2. Hospitals / Health centres
• CHC
• Rural hospitals
• District hospitals
• Specialist hospitals
• Teaching hospitals
3. Health insurance schemes
• CGHS / ESI
4. Other agencies
• Defence / railway services
1. Private hospitals
2. Polyclinics
3. Nursing homes
4. Dispensaries
5. General practitioners &
Clinics
1. Ayurveda & Siddha
2. Unani & Tibbi
3. Homoeopathy
4. Unregistered
practitioners
Primary Health Care in India
Primary Health Care in India
Primary Health care approach
1978 : Alma Ata Conference – Health for All by 2000
3 tier system based on Shrivastav committee
1977 : Rural Health scheme – people’s health in people’s hand
10-Jun-20 Health care of the community 6
Primary Health Care in India
NRHM – NUHM – National Health Mission
2000 : National Population Policy
Five Year Plans – Planning commission – Niti Aayog
1983 : National Health Policy – 2017
10-Jun-20 Health care of the community 7
Primary Health Care in India
• The primary health care infrastructure has been developed as a
three-tier system.
• consists of Sub Centre, PHC and CHC based on the population
norms.
• Over 72 % of population of India lives in rural areas.
Primary Health Care in India
Village level
• ASHA
• AWW
• Trained dais
Sub-Centre
• Type A
• Type B
PHC
8 elements
of primary
health care
CHC
• upgraded /
block PHC
10-Jun-20 Health care of the community 9
At Village Level
10-Jun-20 Health care of the community 10
At Village level
A. ASHA scheme
B. ICDS scheme – Anganwadi Worker
C. Training of Local Dais
A. ASHA Scheme
10-Jun-20 Health care of the community 12
ASHA
• Accredited social health activist
• A women (married / widowed / divorced)
• 25 – 45 yrs / formal education - 8th class
• Communication / leadership skills
• 1 / 1000 population
• Hilly – 1 ASHA / habitat
ASHA – roles & responsibilities
• Create awareness – common health issues
• MCH care – birth preparedness / safe delivery / breast feeding
• Facilitate them to access health care for basic health care like
immunisation, AN check up, etc
• VHSC – village health & sanitation committee
• DOTS provider
10-Jun-20 Health care of the community 14
ASHA – roles & responsibilities
• Medical care for minor aliments
• Escort patients to health care provider
• Promote sanitation
• Inform births / deaths
• Construct toilets under total sanitation campaign
10-Jun-20 Health care of the community 15
Role & integration with AWW
• Organize health day 1-2/month
• AWWs & ANMs will act as resource person for training ASHA
• IEC activity
• AWW will issue the drug kits
• AWW will update the field registers with the help of ASHAs
10-Jun-20 Health care of the community 16
Role & integration with ANM
• ANMs will discuss the work done by the ASHAs every week
• ANMs will inform the time and date of outreach session
• ANM will guide in organizing health days
• Will utilize ASHAs to motivate the pregnant mothers
• ANMs will orient ASHAs on the dose / side effects of drugs like
OCPs, etc
10-Jun-20 Health care of the community 17
B. Anganwadi Worker (AWW)
10-Jun-20 Health care of the community 18
Anganwadi Worker (AWW)
• Integrated Child Development Services(ICDS), chosen by village
people.
• One AWW worker
– for 400-800 population in plain area
– 300-500 in tribal and difficult areas
• Undergoes training in health, nutrition and child development
• Part time worker: paid Rs. 1500 / month as honorarium
• Provide heath checkup
10-Jun-20 Health care of the community 19
AWW – roles & responsibilities
• Maintain growth chart
• Immunization
• Supplementary nutrition
• Health education
• Non-formal pre-school education
• Referral services
• Beneficiaries: under6, pregnant, adolescent, women (15-45)
10-Jun-20 Health care of the community 20
C. Local Dais
10-Jun-20 Health care of the community 21
Local Dais
• 1 dai / village
• Safe deliveries where no one is available (places where safe
delivery rate is < 30 %)
• All EAG states
Primary Health Care Infrastructure
Level
Population Size
Functionaries
Plain area
Tribal, hilly
desert areas
Village 1000
-Health volunteers or health guides (Female)
-Anganwadi workers
-Trained birth attendants
-Accredited Social Health Activist (ASHA)
Sub
Centre
5000 3000
Multipurpose health workers (Male and
Female)
PHC 30,000 20,000 Health professionals (Doctors)
CHC 120,000 80,000 Specialists
At Sub-centre Level
10-Jun-20 Health care of the community 24
Sub-centres (SC)
• It is community based first level of primary health care system
in rural area.
• It is maintained by one multipurpose health worker(female)
and one multipurpose worker(male), who are skilled
paramedical trained workers, having undergone one year(male
worker) and one year and a half training(female worker).
• 1 LHV & 1 HA (male) – will be entrusted for supervision of 6
sub-centre under 1 PHC
Sub-centres (SC)
• For every 5000 population in plain area
• 3000 in tribal, hilly and desert area.
• Promotive, preventive & curative services
• Site of service delivery:
– In the village : village health & nutrition day / immunisation sessions
– During house visits
– House to house surveys
– Meeting & events in the community
– At the facility for 1-2 hrs / day if 1 ANM or 6 hrs / day if 2 ANMs
1 SC
Services provided by Sub-centres (SC)
• MCH (ante/intra/postnatal)
• Family planning & contraception
• Counselling
• Adolescent health care
• Assistance
• Water quality monitoring
• Promotion of hygiene
• Field visits
• Community need assessment
• Curative services
• Training of TBA / ASHA
• Co-ordinate services of AWW /
ASHA
• Disease surveillance
• National health programs
10-Jun-20 Health care of the community 27
At primary health centre Level
10-Jun-20 Health care of the community 28
Primary Health Centre (PHC)
• The Bhore Committee gave the concept of a PHC as a basic
health unit, to provide, as close to the people as possible, an
integrated curative and preventive health care to the rural
population.
• The Bhore Committee aimed at having a health centre to serve
a population of 10,000 to 20,000 with 6 medical officers, 6
public health nurses and other supporting staff.
PHC
• Now, each PHC covers 30,000 population in plain rural area
and 20,000 in tribal , hilly, desert and difficult areas.
• These PHCs are established and maintained by the State
Governments.
• One PHC acts as a referral unit for 6 sub-centres.
• Each PHC has 4-6 indoor observation beds for patients, it has
operation theatre complex and a labour room.
Staffing Pattern in PHC
Category Existing Recommended
Medical officer 1 3 (at least 1 female)
AYUSH practitioner 0 1
Accounts Manager 0 1
Health Assistant Male 1 1
Health Assistant Female 1 1
Health Educator 1 1
Health worker female 1 1
Staffing Pattern of PHC
Category Existing Recommended
Nurse midwives(Staff nurses) 1 5
Pharmacists 1 2
Lab. Technician 1 2
Clerks 2 2
Driver 1 1
Class IV 4 4
Total Staffs 15 25
Functions of a PHC
1. Medical Care
2. MCH including Family Planning
3. Prevention and control of locally endemic diseases
4. Training of health guides, health workers, local dais and
health assistants
5. Arrange referral transport
Functions of a PHC
6. Safe water supply and basic sanitation
7. Collection and reporting of vital statistics
8. Education about health
9. National Health Programmes
10.Basic laboratory services
Functions of a PHC
• School and adolescent health
• Promotion of safe drinking water and basic sanitation
• Prevention and control of locally endemic diseases like Malaria,
Kala-Azar and Japanese Encephalitis.
• Integrated diseases surveillance and control of
epidemics/outbreaks
• Collecting and reporting of vital events.
Role of Medical officer of a PHC
• Medical Officer is the leader of health team at the PHC.
• He is responsible for planning, organizing, implementation,
coordination, monitoring and supervision of services at sub-
centres.
• Holding of staff meetings to get information and give
information to staff and also to solve their problems.
• Planning of work in sector meeting with AWWs and health
workers and their supervisions is also an essential function.
At Community health centre Level
10-Jun-20 Health care of the community 37
Community Health Centre(CHC)
• Was designed to provide referral as well as specialist care to the
rural population.
• A CHC is referral centre for four PHCs.
• A CHC is responsible for 1,20,000 population in plain and 80,000 in
tribal area.
• CHCs were established and maintained by the State Government.
• CHC is a 30 bedded hospital providing specialist care in Medicine,
Obstetrics and Gynecology, Surgery and Pediatrics.
• It has facility of labour room, operation theatre, X-ray and
laboratory.
Staffing pattern
• Each CHC is manned by six specialists namely- surgeon,
physician, obstetrician and gynecologist, pediatrician,
anesthetist and public health programme manager.
• One eye specialist has been provided for every 5 CHCs.
• The anesthetist and public health programme manager are
provided on contractual basis.
• The senior-most specialist will be designated as Block Health
Officer and made responsible for overall
administration/management of CHC.
Staffing pattern in a CHC
Category Existing As per IPHS(NRHM)2007
Medical specialists 4 6
Dental surgeon 0 1
Eye surgeon 0 1(for every 5 CHCs)
General Duty Medical Officer 0 6( with at lest 2 Lady MOs)
Specialist of AYUSH 0 1
GDMO of AYUSH 0 1
Nurse Midwives 7 19(Staff Nurses)
Public Health Nurse 1 1
ANM 1 1
Block Extension Educator 1 0
Category Existing Recommended
Pharmacist 1 0
Radiographer 1 2
Pharmacist AYUSH 0 1
Lab. Technician 1 3
Ophthalmic Assistant 0 1
Dressers 1 2
Accountant 1 1
Registration Clerks 0 2
Computer/Statistical Assist. 1 2
OT. Technician 0 1
Driver 1 1
Others 11 24
Functions of CHC
• Routine and emergency care in surgery, medicine, obstetrics and
gynecology, and pediatrics, in addition to services for the National
Health Programmes.
• To provide specialist services and referral services to four PHCs
area.
• 24 hour delivery services.
• Full range of family planning services.
• RTI/STI services and ICTC for HIV/AIDS.
• MTP services
• School health services/ Adolescent health.
Functions of CHC
• Referral transport services - round the clock
• Cold chain maintenance for vaccines.
• Designated microscopy centre for TB.
• Essential laboratory and X-ray services.
• In-patient services.
• Dental health services.
Functions of CHC
• Blood storage facility.
• Training and continuing education of health teams.
• Integrated disease surveillance and control of outbreaks.
• To elicit community participation.
• To enhance public private partnership.
• To organize behaviour change communication activities.
10-Jun-20 Health care of the community 44
First referral Unit (FRU)
• 24 hours delivery services
• Emergency obstetric care
• Newborn care
• Emergency care of sick children
• Full range of family planning services.
• MTP services
• Treatment of RTI/STI
• Blood storage facility
• Referral transport services
• Comprehensive Emergency Obstetric and Neonatal Care Centre
Think ….
How can community
health be improved in
India?
Thank you…
Next class on 11.09.2018
• Indian Public Health Standards
• Voluntary Health agencies in India
• Health insurance
10-Jun-20 Health care of the community 47

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Primary Health Care in India

  • 1. Welcome to online class by the Department of Community Medicine All students can communicate with the facilitator in chat which is being continuously monitored Note: 1. All students will rename your devise with UNID & name which will be utilized for attendance 2. All students will mute your microphone and video till the class ends. 10-Jun-20 Occupational Diseases 1
  • 2. Health care of the community – Primary health care in India Dr. Jayaramachandran S Associate Professor Department of Community Medicine 05.06.2020
  • 3. The student shall be able to • Classify the existing health care system in India • Explain primary health care delivery in India
  • 4. Health care systems • Public health sector • Private sector • Indigenous system of medicine • Voluntary health agencies • National health programmes 1. Primary Health care • PHC / SC 2. Hospitals / Health centres • CHC • Rural hospitals • District hospitals • Specialist hospitals • Teaching hospitals 3. Health insurance schemes • CGHS / ESI 4. Other agencies • Defence / railway services 1. Private hospitals 2. Polyclinics 3. Nursing homes 4. Dispensaries 5. General practitioners & Clinics 1. Ayurveda & Siddha 2. Unani & Tibbi 3. Homoeopathy 4. Unregistered practitioners
  • 6. Primary Health Care in India Primary Health care approach 1978 : Alma Ata Conference – Health for All by 2000 3 tier system based on Shrivastav committee 1977 : Rural Health scheme – people’s health in people’s hand 10-Jun-20 Health care of the community 6
  • 7. Primary Health Care in India NRHM – NUHM – National Health Mission 2000 : National Population Policy Five Year Plans – Planning commission – Niti Aayog 1983 : National Health Policy – 2017 10-Jun-20 Health care of the community 7
  • 8. Primary Health Care in India • The primary health care infrastructure has been developed as a three-tier system. • consists of Sub Centre, PHC and CHC based on the population norms. • Over 72 % of population of India lives in rural areas.
  • 9. Primary Health Care in India Village level • ASHA • AWW • Trained dais Sub-Centre • Type A • Type B PHC 8 elements of primary health care CHC • upgraded / block PHC 10-Jun-20 Health care of the community 9
  • 10. At Village Level 10-Jun-20 Health care of the community 10
  • 11. At Village level A. ASHA scheme B. ICDS scheme – Anganwadi Worker C. Training of Local Dais
  • 12. A. ASHA Scheme 10-Jun-20 Health care of the community 12
  • 13. ASHA • Accredited social health activist • A women (married / widowed / divorced) • 25 – 45 yrs / formal education - 8th class • Communication / leadership skills • 1 / 1000 population • Hilly – 1 ASHA / habitat
  • 14. ASHA – roles & responsibilities • Create awareness – common health issues • MCH care – birth preparedness / safe delivery / breast feeding • Facilitate them to access health care for basic health care like immunisation, AN check up, etc • VHSC – village health & sanitation committee • DOTS provider 10-Jun-20 Health care of the community 14
  • 15. ASHA – roles & responsibilities • Medical care for minor aliments • Escort patients to health care provider • Promote sanitation • Inform births / deaths • Construct toilets under total sanitation campaign 10-Jun-20 Health care of the community 15
  • 16. Role & integration with AWW • Organize health day 1-2/month • AWWs & ANMs will act as resource person for training ASHA • IEC activity • AWW will issue the drug kits • AWW will update the field registers with the help of ASHAs 10-Jun-20 Health care of the community 16
  • 17. Role & integration with ANM • ANMs will discuss the work done by the ASHAs every week • ANMs will inform the time and date of outreach session • ANM will guide in organizing health days • Will utilize ASHAs to motivate the pregnant mothers • ANMs will orient ASHAs on the dose / side effects of drugs like OCPs, etc 10-Jun-20 Health care of the community 17
  • 18. B. Anganwadi Worker (AWW) 10-Jun-20 Health care of the community 18
  • 19. Anganwadi Worker (AWW) • Integrated Child Development Services(ICDS), chosen by village people. • One AWW worker – for 400-800 population in plain area – 300-500 in tribal and difficult areas • Undergoes training in health, nutrition and child development • Part time worker: paid Rs. 1500 / month as honorarium • Provide heath checkup 10-Jun-20 Health care of the community 19
  • 20. AWW – roles & responsibilities • Maintain growth chart • Immunization • Supplementary nutrition • Health education • Non-formal pre-school education • Referral services • Beneficiaries: under6, pregnant, adolescent, women (15-45) 10-Jun-20 Health care of the community 20
  • 21. C. Local Dais 10-Jun-20 Health care of the community 21
  • 22. Local Dais • 1 dai / village • Safe deliveries where no one is available (places where safe delivery rate is < 30 %) • All EAG states
  • 23. Primary Health Care Infrastructure Level Population Size Functionaries Plain area Tribal, hilly desert areas Village 1000 -Health volunteers or health guides (Female) -Anganwadi workers -Trained birth attendants -Accredited Social Health Activist (ASHA) Sub Centre 5000 3000 Multipurpose health workers (Male and Female) PHC 30,000 20,000 Health professionals (Doctors) CHC 120,000 80,000 Specialists
  • 24. At Sub-centre Level 10-Jun-20 Health care of the community 24
  • 25. Sub-centres (SC) • It is community based first level of primary health care system in rural area. • It is maintained by one multipurpose health worker(female) and one multipurpose worker(male), who are skilled paramedical trained workers, having undergone one year(male worker) and one year and a half training(female worker). • 1 LHV & 1 HA (male) – will be entrusted for supervision of 6 sub-centre under 1 PHC
  • 26. Sub-centres (SC) • For every 5000 population in plain area • 3000 in tribal, hilly and desert area. • Promotive, preventive & curative services • Site of service delivery: – In the village : village health & nutrition day / immunisation sessions – During house visits – House to house surveys – Meeting & events in the community – At the facility for 1-2 hrs / day if 1 ANM or 6 hrs / day if 2 ANMs 1 SC
  • 27. Services provided by Sub-centres (SC) • MCH (ante/intra/postnatal) • Family planning & contraception • Counselling • Adolescent health care • Assistance • Water quality monitoring • Promotion of hygiene • Field visits • Community need assessment • Curative services • Training of TBA / ASHA • Co-ordinate services of AWW / ASHA • Disease surveillance • National health programs 10-Jun-20 Health care of the community 27
  • 28. At primary health centre Level 10-Jun-20 Health care of the community 28
  • 29. Primary Health Centre (PHC) • The Bhore Committee gave the concept of a PHC as a basic health unit, to provide, as close to the people as possible, an integrated curative and preventive health care to the rural population. • The Bhore Committee aimed at having a health centre to serve a population of 10,000 to 20,000 with 6 medical officers, 6 public health nurses and other supporting staff.
  • 30. PHC • Now, each PHC covers 30,000 population in plain rural area and 20,000 in tribal , hilly, desert and difficult areas. • These PHCs are established and maintained by the State Governments. • One PHC acts as a referral unit for 6 sub-centres. • Each PHC has 4-6 indoor observation beds for patients, it has operation theatre complex and a labour room.
  • 31. Staffing Pattern in PHC Category Existing Recommended Medical officer 1 3 (at least 1 female) AYUSH practitioner 0 1 Accounts Manager 0 1 Health Assistant Male 1 1 Health Assistant Female 1 1 Health Educator 1 1 Health worker female 1 1
  • 32. Staffing Pattern of PHC Category Existing Recommended Nurse midwives(Staff nurses) 1 5 Pharmacists 1 2 Lab. Technician 1 2 Clerks 2 2 Driver 1 1 Class IV 4 4 Total Staffs 15 25
  • 33. Functions of a PHC 1. Medical Care 2. MCH including Family Planning 3. Prevention and control of locally endemic diseases 4. Training of health guides, health workers, local dais and health assistants 5. Arrange referral transport
  • 34. Functions of a PHC 6. Safe water supply and basic sanitation 7. Collection and reporting of vital statistics 8. Education about health 9. National Health Programmes 10.Basic laboratory services
  • 35. Functions of a PHC • School and adolescent health • Promotion of safe drinking water and basic sanitation • Prevention and control of locally endemic diseases like Malaria, Kala-Azar and Japanese Encephalitis. • Integrated diseases surveillance and control of epidemics/outbreaks • Collecting and reporting of vital events.
  • 36. Role of Medical officer of a PHC • Medical Officer is the leader of health team at the PHC. • He is responsible for planning, organizing, implementation, coordination, monitoring and supervision of services at sub- centres. • Holding of staff meetings to get information and give information to staff and also to solve their problems. • Planning of work in sector meeting with AWWs and health workers and their supervisions is also an essential function.
  • 37. At Community health centre Level 10-Jun-20 Health care of the community 37
  • 38. Community Health Centre(CHC) • Was designed to provide referral as well as specialist care to the rural population. • A CHC is referral centre for four PHCs. • A CHC is responsible for 1,20,000 population in plain and 80,000 in tribal area. • CHCs were established and maintained by the State Government. • CHC is a 30 bedded hospital providing specialist care in Medicine, Obstetrics and Gynecology, Surgery and Pediatrics. • It has facility of labour room, operation theatre, X-ray and laboratory.
  • 39. Staffing pattern • Each CHC is manned by six specialists namely- surgeon, physician, obstetrician and gynecologist, pediatrician, anesthetist and public health programme manager. • One eye specialist has been provided for every 5 CHCs. • The anesthetist and public health programme manager are provided on contractual basis. • The senior-most specialist will be designated as Block Health Officer and made responsible for overall administration/management of CHC.
  • 40. Staffing pattern in a CHC Category Existing As per IPHS(NRHM)2007 Medical specialists 4 6 Dental surgeon 0 1 Eye surgeon 0 1(for every 5 CHCs) General Duty Medical Officer 0 6( with at lest 2 Lady MOs) Specialist of AYUSH 0 1 GDMO of AYUSH 0 1 Nurse Midwives 7 19(Staff Nurses) Public Health Nurse 1 1 ANM 1 1 Block Extension Educator 1 0
  • 41. Category Existing Recommended Pharmacist 1 0 Radiographer 1 2 Pharmacist AYUSH 0 1 Lab. Technician 1 3 Ophthalmic Assistant 0 1 Dressers 1 2 Accountant 1 1 Registration Clerks 0 2 Computer/Statistical Assist. 1 2 OT. Technician 0 1 Driver 1 1 Others 11 24
  • 42. Functions of CHC • Routine and emergency care in surgery, medicine, obstetrics and gynecology, and pediatrics, in addition to services for the National Health Programmes. • To provide specialist services and referral services to four PHCs area. • 24 hour delivery services. • Full range of family planning services. • RTI/STI services and ICTC for HIV/AIDS. • MTP services • School health services/ Adolescent health.
  • 43. Functions of CHC • Referral transport services - round the clock • Cold chain maintenance for vaccines. • Designated microscopy centre for TB. • Essential laboratory and X-ray services. • In-patient services. • Dental health services.
  • 44. Functions of CHC • Blood storage facility. • Training and continuing education of health teams. • Integrated disease surveillance and control of outbreaks. • To elicit community participation. • To enhance public private partnership. • To organize behaviour change communication activities. 10-Jun-20 Health care of the community 44
  • 45. First referral Unit (FRU) • 24 hours delivery services • Emergency obstetric care • Newborn care • Emergency care of sick children • Full range of family planning services. • MTP services • Treatment of RTI/STI • Blood storage facility • Referral transport services • Comprehensive Emergency Obstetric and Neonatal Care Centre
  • 46. Think …. How can community health be improved in India? Thank you…
  • 47. Next class on 11.09.2018 • Indian Public Health Standards • Voluntary Health agencies in India • Health insurance 10-Jun-20 Health care of the community 47