PRIMARY HEALTH CARE IN
INDIA / HEALTH PROBLEMS IN
INDIA & ROLE OF A NURSE.
DR. MAHESWARI JAIKUMAR
PRINCIPLES OF PRIMARY HEALT CARE.
•A FOCUS ON HEALTH PROMOTION / DISEASE PREVENTION.
•COMMUNITY PARTICIPATION.A MULTISECTORAL APPROACH.
•MAN POWER PLANNING.
ELEMENTS OF PRIMARY HEALTH CARE.
•Education concerning prevailing health problems &
methods of preventing & controlling them.
•Promotion of food supply & proper nutrition.
•Adequate supply of safe drinking water & basic
•Maternal & child health care , including family planning.
•Immunization against major infectious diseases.
•Prevention & control of locally endemic disease.
•Appropriate treatment of common diseases & injuries.
•Provision of essential drugs.
CURRENT HEALTH PROBLEMS IN INDIA.
COMMUNITY DIAGNOSIS. Refers to the assessment of
health status & health problems to design health services.
The following are the components Indicators decisive of
•Morbidity & mortality statistics.
•Demographic conditions of the population.
•Environmental factors influencing health.
•Socio – Economic factors influencing health.
•Culture & its components.
•Medical & Health services available.
•Other services available.
HEALTH PROBLEMS IN INDIA.
•COMMUNICABLE DISEASE PROBLEM.
•ENVIRONMENTAL SANITATION PROBLEM.
•MEDICAL CARE PROBLEM.
COMMUNICABLES DISEASE PROBLEM.
•The incidence of disease is 2.32 %.
•P.falciparum cases have increased than the previous
•30 % 0f the total population is affected with TB.
•1.5 % have radio logically active disease.
•0.4 % of the cases are sputum positive.
•India has 12.7 million cases of pulmonary TB ( 3.4 million
are sputum +ve.
•Death due to TB – 500000 every yr.
Commonly encountered with children,
•Diarrhoeal disease contribute 7.1 lakh deaths / yr.
•The disease is attributed to un hygienic feeding
practices & poor environmental conditions.
•Causes major morbidity 7 mortality among U5.
•ARI constitutes 13.6 % hospital admissions.
•13 % in patient deaths in pediatric wards is due to
•2003 – 2004 – 2.20 lakh new cases were detected.
•The prevalence rate of leprosy is 2.3 / 10000 pop.
•The proportion of infectious case varies between 6 – 8
•India accounts for 60 % of leprosy cases in the world.
•About 6 million cases / yr.
•45 million persons have one or more chronic filarial
•AIDS was first detected in 1986.
•No: of AIDS cases have risen to 86028 by 2004.
•By 2003 – 5.1 million HIV +ve cases.
Kala – azar, meningitis, viral encephalitis, entric
fever, helminthic infestations.
PROTEIN ENERGY MALNUTRITION.
•80% OF Indian children have mild – moderate PEM.
•The incidence is 1-2% in pre school children.
•PEM includes marasmus & kwashiorkor.
•India has the highest prevalence of nutritional anemia
among women & children.
•60 -80% of pregnant women are anemic.
•20-40% of maternal deaths are attributed to anemia.
•Fe+ deficiency anemia is widely prevalent
•30% of babies born are LBW.
•Maternal malnutrition is responsible for LBW.
0.04% of blindness is attributed to Vit A deficiency.
Keratomalacia is considered to be a major cause of
nutritional blindness in 1-3 yrs.
Vit A deficiency also predisposes to frequent GI infections.
IODINE DEFICIENCY DISORDERS
Widely prevalent in India.
Lathyrism, endemic flurosis, food adulteration.
•Increased urbanization & industrialization leads to
hazards to human health , air, water, & food chain.
•1981-1990 International Water Supply & Sanitation
Decade was observed.
•As of 2000 – safe Water is available to almost 85% of
the rural population.
•Excreta disposal facility (1994)------- Urban – 70%,
Rural – 14%, Combined – 29%.
MEDICAL CARE PROBLEMS
•India does not have a National Health Service.
•80% of the health services are concentrated in the
•India does not meet the suggested manpower norms.
•India is the second populest country in the world.
•Population explosion has detrimental effect on
housing, health care, sanitation, & environment.
•The Annual Growth Rate of India is high 2.1.
THE HEALTH CARE SYSTEMS – INDIA.
•The care system is the structure of the country’s
pattern of delivery of the health services.
•The health care system operates within the context of
socio-economic & political framework of the country.
HEALTH CARE SYSTEM IN INDIA.
Public Health Sector
Indigenous System Of Medicine
Voluntary Health Agencies
National Health Progs
PUBLIC HEALTH SECTOR
•HOSPITALS / HEALTH CENTERS
•PRIMARY HEALTH CARE – PHC, HSC.
•Community Health Centers.
•HEALTH INSURANCE SCHEMES.- ESI, CGHS.
•OTHER AGENCIES.---- Defence services, Railways.
•Private Hosp, Poly Clinics, Nursing Homes,& Dispensaries.
•General Practitioners & Clinics.
INDIGENOUS SYSTEM OF MEDICINE.
•Ayurveda & sidda.
•Unani & Tibbi.
VOLUNTARY HEALTH AGENCIES.
NATIONAL HEALTH PROGS.
MODEL OF HEALTH CARE SYSTEM.
Health Services Health Care Systems
Health problems •Preventive
ROLE OF A NURSE IN HCDS.
PUBLIC & PRIVATE
ROLE OF A NURSE IN HCDS
EDUCATION CONCERNING HEALTH PROBLEMS.
•The nurse in various capacities
designs health education progs,
materials & disseminates the same to
the policy makers, educationists,
general public, & to various
categories of health personnel.
•The nurse designs health education contents according
to the health needs & problems, according to the
beneficiary & according to the context.
•The nurse undertakes necessary precautionary
measures, primordial prevention strategies, specific
preventive measures to promote the health of the
•Devise necessary surveillance measures, control
measures, control measures to check the disease load
in the community.
•Involve mass media & relevant other personnel in
preventing preventable diseases.
PROMOTE FOOD SUPPLY & NUTRITION.
•Undertake measures to carry out
•Maintain epidemiological profile of the
•Assess the extent of nutritional
problems & categorize them depending
on the intervention required.
•Organize & carry out nutritional supplementation &
rehabilitation services to the target group.
•Co-ordinate with the state’s initiative in the
implementation of relevant nutritional programmes.
(ANP, ICDS, Vit A Porg,SNP, School Feeding Prog, Fe+
deficiency anemia Prog.)
•Co-Ordinate with like minded agencies FAO, WHO,
UNICEF & Voluntary health sectors to promote the
nutritional status of the community.
•Promote optimal food production & storage &
distribution system & an efficient public distribution
PROVISION OF SAFE WATER & SANITATION.
•The nurse, translates the
components of water & sanitation
•The nurse co –odinates with
agencies that are involved in the
provision of safe water (Water Plants,
Sewerage treatment Plants.)
•Educate the community regarding
importance of safe drinking water &
PROVISION OF MATERNAL &
CHILD HEALTH SERVICES.
•Translate the relevant MCH elements
of the various governmental policies &
•Involve similar agencies (SHAKTHI,
NGO, VHAI) in the designing &
implementation of MCH initiatives.
•Implement U5 initiatives incorporating
ICDS Anganwadi, SNP,ANP,& related
Plan & carry out AN,PN care.
•Registration, investigation, TT, weight monitoring,IFA
& calcium supplementation,Essential perinatal care.
•Impart Essential New Born Care.
•Implement adolescent health initiatives.
•Implement initiatives for control of STD & AIDS.
IMMUNIZATION AGAINST VPD.
•Implement the National Immunization Prog.
•Plan & design immunization services at all
•Maintain statistical details of the
immunization status of India.
•Co-ordinate with agencies & industries
•Design & disseminate H/E materials relevant to
Vaccine Preventable Diseases.
PREVENTION & CONTROL OF LOCALLY
•Implement relevant national control &
prevention, eradication prog.
•Co-ordinate the state & center’s initiatives in
controlling communicable diseases.
•Plan & implement control & eradication
•Advocate & sensitize the community to practice
•Undertake primordial prevention measures & focus to
prevent endemic disease.
•Implement prophylactic measures during the period of
APPROPRIATE TREATMENT FOR
Undertake & implement appropriate treatment
PROVISION OF ESSENTIAL DRUGS.
•Co-ordinate with the Drug Control
•Monitor the manufacture & supply of drugs
in the market.
•Maintain inventory--- stock of drugs as per
•Indent required drug for various levels of