History and development of Community Health Nursing in India
History and development of Community Health NursingGuided by: Mr. Ramakant GaikwadPresented by : Mr. Ajay MagarPresented on: 09/02/11
“Health is Not mainly an issue of doctors, social services and hospitals. Health is an issue of social Justice. There is no time to lose. We have the goal of “Health for all by 2000 AD”. This is the call of the world health organization. and India has taken up the challenge. Formerly, Health care has been for those living near enough to a hospital or a doctor in times of need and for those who could spend money for medicines and treatment.
The great majority of people stayed in the village when sick and even today many suffer and die without proper help. Attempts have been made to meet the health needs of the people of India by means of primary health center and the training of Auxiliary Nurse Midwives to go out from these centre’s to the homes of the people. The number of ANMS trained was never sufficient and more than half of them after training went to work in hospitals. In fact, their training was given mainly in the hospitals environment, with title experience and understanding of health needs of people, families and communities in rural areas.
Community health nursing is one of the professions/disciplines which operates within the realms/domain of community health and helps in meeting health and nursing needs of the community. It plays a very important and challenging role in promoting and protecting health of people. Unlike other specialties of nursing, community health nursing lays major emphasis on primary level prevention and focuses on the entire community. Before further discussion let us see the definition of Community Health Nursing
“Community Health Nursing is a synthesis of Nursing practice and public health practice applied in promoting and preserving the health of populations. The nature of this practice is general and comprehensive. It is not limited to a particular age or diagnostic group. It is continuing not episodic. The dominant responsibility to the population as a whole. Therefore nursing directed to individuals, family or group contributes to the health of total population. Health promotion, health maintenance, health education, co- ordination and continuity of care are utilized in a holistic approach to the management of the health care of individual, family, group and community.”
Pre-vedic Period: The medical system that are truly Indian origin and development are the Ayurveda and Siddha system. Ayurveda dy definition implies “ Knowledge of Life”. Its origin is traced far back to the Vedic times, about 5000BC. During this period, medical history was associated with mythological figures, sages and seers. Dhanvantari the Hindu god of Medicine is said to have been born as a result of the churning of ocean during a tug war between gods and demons. According to some authorities medical knowledge in the Atharvaveda gradually developed into the science.
The experience and concern in health development and public health care dates back to this Vedic period. In the Indus Vally Civilization (3000 BC) itself, one funds evidence of well- developed environmental sanitation programmes such as arrangements of good water supply, underground drainages, Public baths in cities etc.
In ancient India, the celebrated authorities in Ayurveda medicine were Atreya, Charaka, Sustra and Vagbhatt. Atreya (about 800 BC) is acknowledged as the firdt great Indian Physician and Teacher. Charaka a famous Ayuirvedic Medicine, Sustra a father of Indian Surgery. From this early writings other authers wrote books. From these writings we learn that surgery had advanced to a high level, also that doctors and the attendants (Nurse) must be the people of high character, Hospital were large and well equipped.
Medical education was introduced in the ancient Universitiesof Taxila and Nalanda. During Budha period hospital system was developed for men and women and for animals. This was exapanded during king Ashoka, Moghal Period (1000 AD) Unani Medicine which (Arabic system) was introudced through Greek medicine which has become a part of Indian medicine. Nursing and medicine are closely linked together. Nursing was regarded on the “Science of Care” and medicine as the “Science of Cure”. As the science of cure, medicine is concerned with the diagnosis and treatment of illness. As the scienceof care, nursing is concerned with the care of people who are ill. The care and cure functions are complimentary ; both are necessary and important aspects of health care for the people.
King Ashoka (272 BC-236 BC) a convert Buddhism, brought about period of prosperity. Monasteries were built, houses for travelers were provided and hospitals for both men and women and animals were founded. Prevention of disease became a matter of first importance and hygiene practices were adopted. Cleanliness of the body was religious duty. Doctors and midwives were to be trustworthy and skill full. They must wear clean cloth and keep their nails cut short. Operations were precede by religious ceremonies and prayers. The nurses were usually men or old women.
Women of India were favoured though restricted to activities in the home. No doubt they cared for the sick members in the family. By 1 AD superstition and magic had been somewhat replaced by more up to date practice. But , medicine remained in the hands of priest-physician who refused to touch blood or pathological tissues. Dissection was forbidden. This together with religious restrictions probably helped to bring about decline in medicine and nursing professions.
During this period diagnosis was made on empirical basis and also the given treatment was according to symptoms. So this era was called symptom oriented oriented era. The health education was provided by lectures on authoritarian instruction.
This period witnessed the invention of microscope, thermometer, BP apparatus and other tools for detection and measurement of diseases. Laboratory investigations were carried out to make This period was called as bacteria- oriented or disease oriented era.
This is an era which witnessed her individual centered or patient centered approach for taking care of the health and illness of the people. Clinical instructions abd bed side teaching started in the field of medical education education. The development of clinical techniques was initiated in medical science and technology.
In this period prevention oriented approach started. It was initiated by our ancient Indians at the time of Indus Valley Civilisation. it is being called era of Community centered approach, in which diagnosis and treatment at community level emerged, clinical public health instructions, community- side teachings were included in the field of medical education. Studies releted to community development, community measurement and criteria planning techniques also started Integration of social sciences, and public health sciences in this era took place.
In this period the involvement of the community leaders and members of the community in planning and implementation of the health programmes was practiced at this stage. The national level health planning was established by political authorities of particular country by involving national and international health agencies to provide health for all. The people-centered approach has been emphasized in this era.
Community health has now entered an era of individual responsibilities and community participation. The traditional role of medical persons has been shifted from diagnosis and treatment of individual illness to treatment of all health hazards of community. Community diagnosis is based on collection and interpretation of relevant data related to distribution of population according to age, sex, educational status, marital status, religion, caste, birthrate, death rate, prevalence of disease etc.
Development in the broader sense is not only the improvement or progress in the community health resources but individual progress in the professional aspect of as community health nurse.
Sr.No Year Events1 1918 The preparation of Nursing workers for public health work started in Delhi, Lady Reading Health School2 1930 At Calcutta All India Institute of Hygiene and Public Health was started3 1931 A Maternal and Child Welfare Bureau was established by the Indian Red Cross Society.4 1939 Indian Tuberculosis Association was started5 1943 Health Survey and Development Committee was appointed by GOI under the Chairmanship of Sir Joseph Bhore.
Sr.No Year Events6 1918 The preparation of Nursing workers for public health work started in Delhi, Lady Reading Health School7 1930 At Calcutta All India Institute of Hygiene and Public Health was started8 1931 A Maternal and Child Welfare Bureau was established by the Indian Red Cross Society.9 1939 Indian Tuberculosis Association was started10 1943 Health Survey and Development Committee was appointed by GOI under the Chairmanship of Sir Joseph Bhore.
11 1952 Community Development Programme was launched on 2nd October for overall development of rural areas. Central Council of Health constituted.12 1954 National water supply and sanitation scheme was inaugurated. National Leprosy Control Programme was started. Food Adulteration Act was passed.13 1955 National Filaria Control Programme started14 1958 National Malaria Control Programme was changed to Eradication Programme15 1959 Mudaliar Committee was appointed to review the progress made in health sector
16 1961 Mudaliar Committee report was published17 1962 Central Family Planning Institute was established18 1971 MTP Act was passed, In 1972 came in force.19 1973 Multipurpose Health Workers Scheme was introduced by Kartar Singh committee report20 1975 India declared as FREE from Smallpox21 1977 Rural Health Scheme was introduced
22 1978 The slogan “Health for All by 2000 AD came in force at Alma Atta declaration in USSR underlined the primary health care approach.23 1982 GOI framed National Health Policy. School Health Services started at trial bases24 1985 Universal Immunization Programme was launched on 19th November Indira Gandi’s Birthday.25 1992 CSSM programme was launched on 20th August26 1995 Pulse Polio Immunization Programme launched in December and January.26 1996 RCH in place of CSSM with slight modification,launched in 199727 2000 GOI announced National Population Policy28 2002 GOI announces Nationational AIDS Prevention controlpolicy
29 2003 Launching of ART centres at MetroCentres,e.g. Sasoon30 2004 NTCP Inclucated DOTS31 2007 Revision of National Population32 2008 , revised in 2009 Swine Flu awareness Programme and control Programme
Books Park K, Parks Textbook of Preventive and Social Medicine, 20th Edition, Banarasidas Bhanot, Jabalpur, 2010, Page No.1- 11,644-648. Kamalam.S, Essentials in Community Health Nursing Practice, First Edition, 2008,Jaypee Brothers, New Delhi, Page No. 3- 10, 12-15. Basavanthappa.B.T, Community Health Nursing,First Edition,Jaypee Brothers, Mumbai, 2008, Page No. 10-12. Marsije.L.M, A new textbook for nurses in India, CMAI, B.I. Publication, Chennai,1997, Volume I, Page No. 3- 68. Journals e Journal of Community Medicine, http://www.ijcm.org.in/ Websites and Links http://www.peopletree.co.in/infoemployer.htm. http://en.wikipedia.org/wiki/Nursing_in_India#mw-head