health promotion and primary prevention: Mamta Suryavanshi

Seminar on Primary
Health care and
Health Promotion
Presented by – Mamta Suryavanshi
M.Sc. Nursing
NINE,PGIMER,CHD

AAM ADMI,CHHOTA
ADMI,BEKAR ADMI, HEALTH
IS RIGHT OF EVERYONE

Content
• BACKGROUND:PHC
• FACTS AND FIGURES RELATED TO PHC
• WHAT IS PRIMARY HEALTH CARE
• DEFINITION OF PHC
• PRINCIPLES OF PRIMARY HEALTH CARE
• CPHC AND HWC
• ROLE OF NURSE IN PRIMARY HEALTH CARE
• PROBLEMS IN IMPLEMENTING PRIMARY HEALTH
CARE IN INDIA

Contd...
• HEALTH PROMOTION
– BRIEF HISTORY OF HEALTH PROMOTION
– INTRODUCTION : HEALTH PROMOTION
– EXACT DEFINITION OF HEALTH PROMOTION
– WHO’s GOAL OF HEALTH PROMOTION
– IMPORTANCE OF HEALTH PROMOTION
– HEALTH PROMOTION APPROACHES
– PUBLIC HEALTH PROMOTION AND LAWS
– LATEST GOVERNMENT INITIATIVES
• SUMMARY
• CONCLUSION

LEARNING OBJECTIVE
• At the end of the class students of M.Sc. I Year
will be able to :
• Define the modern concept of Primary health
care(PHC) and Health promotion.
• Recall the facts and updates related to PHC.
• State the principles of PHC.

Contd….
• Describe the role of nursing officers in PHC.
• Enumerate the problems in implementation of
PHC in india.
• Recognize the importance of health promotion
• Relate the legislation and health promotion
• Apply the concept of PHC and health promotion
to empower the public and deliver quality care to
community people everywhere.

BACKGROUND : PHC
Caring for people rather than
treatment of specific disease[1]
First point of contact people[1]

BACKGROUND : PHC
1978 Alma ata declaration 2018- Astana declaration
• Chance to commemorate the
1978 Alma-Ata Declaration on
Primary Health Care
• reflect on how far we have
come and the work that still
lies ahead.
• Aims to refocus efforts on
primary health care to ensure
that everyone everywhere is
able to enjoy the highest
possible attainable standard of
health. [1]

The declaration of ALMA- ATA stated the Primary
Health Care includes at least:
• Education about prevailing health problems and
methods of preventing and controlling them.
• Promotion of food supply and proper nutrition.
• An adequate supply of safe water and basic
sanitation.
• Maternal and child health care including family
planning.
• Immunization against infectious diseases.
• Prevention and control of endemic diseases.
• Appropriate treatment of common diseases and
injuries.
• Provision of essential drugs.

The PHC approach is foundational to achieve UHC AND
SDG-3
Universal Health Coverage (UHC) Health-related Sustainable Goals

FACTS AND FIGURES RELATED TO PHC
•
50% PEOPLE OF THE WORLD
STILL LACK FULL COVERAGE
OF ESSENTIAL HEALTH
SERVICES
Countries are spending more
on health, but people are still
paying too much out of their
own pockets
25% of patients experience
harm in the primary care
setting

Contd…
• Avoidable harm caused to patients as a result of
their health care is unacceptable, yet in many
settings it is widespread.
• Patient harm is the 14th leading cause of
morbidity and mortality globally, comparable to
diseases such a tuberculosis and malaria.[18]
• An estimated 25% of patients experience harm in
the primary care setting in lower middle-income
countries and up to 80% of events leading to
harm are thought to be preventable.[19]

WHAT IS CHANGED IN 40 YEARS
1946,51-55,78,83,2002,2005
• Bhore commitee-1946-failed
• Community Development
Programme, 1951‐55-failed
• Concept of PHC :Alma Ata
Deceleration, 1978 and
• First National Health Policy,
1983:Strategy to achieve ʹHealth
for All by the year 2000
ADʹ failed
• Second National Health Policy,
2002-failed
• National Rural Health Mission,
2005.
• GDP -0.9-1.5(FY-1978-2019)
2012-2020
• Universal Health Coverage
Report, 2012
• National Health policy -
2017
• Concept of CPHC ,Health
and wellness centre
• Health promotion
• GDP-1.6%(FY20)
• Plan to increase GDP -
2.5%(FY22)

CHANGED 40 YEARS LATER
• In February 2018, the Government of India
announced that 1,50,000 Health & Wellness
Centres (HWCs) would be created by
transforming existing Sub Health Centres and
Primary Health Centres to deliver
Comprehensive Primary Health Care and
declared this as one of the two components of
Ayushman Bharat.

WHAT IS PRIMARY HEALTH CARE?
• Primary health care is care for all at all ages.
All people, everywhere, deserve the right
care, right in their community.
• a whole-of-society approach to health and
well-being centred on the needs and
preferences of individuals, families and
communities

Contd…
• It provides whole-person care for health
needs throughout the lifespan, not just for a
set of specific diseases.

DEFINITION : PHC
• Essential health care made universally
accessible to individuals and families in the
community by means acceptable to them,
through their full participation and at a cost
that the community and country can afford. It
forms an integral part both of the country's
health system of which it is the nucleus and of
the overall social and economic development
of the community.’(Alma –ata delcaration-
1978)

ASTANA –DECLARATION-2018(40
YEARS LATER): HIGHLIGHTS
1. We reaffirm our commitment to all its values
and principles, in particular to justice and
solidarity, and we underline the importance
of health for peace, security and
socioeconomic development, and their
interdependence.

Contd.. Highlights of astana
declaration
2. We will each pursue our paths to achieving
UHC so that all people have equitable access
to the quality and effective health care they
need, ensuring that the use of these services
does not expose them to financial hardship.

Contd..
3. Address the growing burden of NCDs , which lead to
 Poor health
 Premature deaths due to tobacco use
 Harmful use of alcohol
 Unhealthy lifestyles and behaviours,
 Insufficient physical activity and Unhealthy diets.
We must not lose opportunities to halt disease
outbreaks and global health threats such as
antimicrobial resistance that spread beyond countries’
boundaries

Contd..
Promotive, preventive, curative, rehabilitative services and
palliative care must be accessible to all.
 Save millions of extreme poverty, caused by
disproportionate out-of-pocket spending on health.
 No longer underemphasize the crucial importance of health
promotion and disease prevention, nor tolerate
fragmented, unsafe or poor-quality care.
 Must address the shortage and uneven distribution of
health workers.
 Must act on the growing costs of health care and
medicines and vaccines.
 Cannot afford waste in health care spending due to
inefficiency

Contd..
4. Commit to make bold political choices for
health across all sectors
5. Build sustainable primary health care .

• The primary health care approach has been
described as “health by the people” and placing
people’s health in people’s hands”.
• This approach integrates at the community level, all
the factors required for improving the health status
of the community.
• Primary health care was accepted by member
countries of WHO as the key in achieving the goals of
“Health for All”.

THREE (3) PILLARS OF PHC
WHO: A vision for primary health care in the 21st century. 2018
Empowered
people and
engaged
communities
Multisectoral
and
intersectoral
action for
health
Health services
that deliver
both high-
quality primary
care and
essential public
health functions

PRINCIPLES OF
PRIMARY
HEALTH CARE

PRINCIPLES OF PRIMARY HEALTH CARE
EQUITABLE PARTICIPATION
COMMUNITY
PARTICIPATION
INTERSECTORAL
COORDINATION
APPROPRIATE TECHNOLOGY
HEALTH MAN POWER
RESOURCES

• Equal distribution of health
services i.e., without any
discrimination.
• Aim is to readdress the
imbalance by shifting the
centre of gravity of health
care` system from cities to the
rural areas and bring these
services as near people’s
homes as possible.
1. EQUITABLE PARTICIPATION

2. COMMUNITY PARTICIPATION:
• Now the involvement of the individuals, families and
communities in promotion of their own health and
welfare, is an essential ingredient of primary health
care.
• Involvement of the community in the planning,
implementation and maintenance of health services,
besides maximum reliance on local resources such as
man power, money and materials.

Cont…
• One approach that has
been tried successfully in
India is the use of village
health guides and trained
dais. They are selected by
the local community and
trained locally in the
delivery of primary health
care to the community
they belong, free of
charge.

The declaration of the ALMA-
ATA states that primary health
care involves in addition to the
health sector, all related
sectors and aspects of national
and community development,
in particular agriculture,
animal husbandry, food
industry, education, public
works, communication and
other sectors.
3. INTERSECTORAL COORDINATION:

• An important element of intersectoral approach is
planning- Planning with other sectors to avoid
unnecessary duplication of activities.
• This approach requires strong political will to
translate values into actions, introduction of suitable
legislation to insure, that coordination can take
place.
Cont…

4. APPROPRIATE TECHNOLOGY:
• The use of appropriate technology will enable the
health care system to use the best treatment for
caring the people in our country.

• Appropriate technology has been defined as
“technology that is scientifically sound, adaptable, to
local needs and acceptable to those who apply it and
those for whom it is used, and that can be
maintained by the people themselves in keeping with
principles of self reliance with the resources that the
community and the country can afford.
Cont…

• The no. of personnel needed
for providing the appropriate
care is very less compared to
felt health needs of our
society.
• So, the health care system
has to monitor the strength
of the staffs available and
should recruit new staff if
needed and allocate specific
jobs to them.
5. HEALTH MAN POWER RESOURCES:

NEW CONCEPT –CPHC, HWC
• In order to ensure delivery of Comprehensive
Primary Health Care (CPHC) services, existing
Sub Health Centres covering a population of
3000-5000 would be converted to Health and
Wellness Centres (HWC), with the principle
being “time to care” to be no more than 30
minutes.

Expanded Range of Services in HWC
1. Care in pregnancy and child-birth.
2. Neonatal and infant health care services.
3. Childhood and adolescent health care services.
4. Family planning, Contraceptive services and
other Reproductive Health Care services.
5. Management of Communicable diseases
including National Health Programmes.
6. Management of Common Communicable
Diseases and Outpatient care for acute simple
illnesses and minor ailments.

Expanded Range of Services in HWC
7. Screening, Prevention, Control and Management
of Non-Communicable diseases.
8. Care for Common Ophthalmic and ENT problems.
9. Basic Oral health care.
10. Elderly and Palliative health care services.
11. Emergency Medical Services.
12. Screening and Basic management of Mental
health ailments.

1. Care in pregnancy and child birth
• Early registration of pregnancy and issuing of ID number
and Mother and Child protection card
• Antenatal check-up including screening of Hypertension,
Diabetes, Anaemia, Immunization for pregnant woman-TT,
IFA and Calcium supplementation
• Screening, referral and follow up care in cases of
Gestational Diabetes, and Syphilis during pregnancy
• Normal vaginal delivery in specified delivery sites as per
state context - where Mid-level provider or MPW (F) is
trained as Skill Birth Attendant .
• Provide first aid treatment and referral for obstetric
emergencies, e.g. eclampsia, PPH, Sepsis, and prompt
referral .

2.Neonatal and infant Health
• Identification and management of high risk
newborn - low birth weight/ preterm/ sick
newborn and sepsis (with referral as required)
• Management of birth asphyxia (Type B SHC)
• Identification, appropriate referral and follow up
of congenital anomalies
• Management of ARI/Diarrhoea and other
common illness and referral of severe cases
• Screening, referral and follow up for disabilities
and developmental delays

Contd...
• Complete immunization
• Vitamin A supplementation
• Identification and follow up, referral
• Reporting of Adverse Events Following
Immunization (AEFI)

3. Childhood and Adolescent health
care services including immunization
• Complete immunization
• Detection and treatment of Anaemia and other
deficiencies in children and adolescents
• Identification and management of vaccine preventable
diseases in children such as Diphtheria, Pertussis and
Measles
• Early detection of growth abnormalities, delays in
development and disability and referral
• Prompt Management of ARI, acute diarrhoea and
fever with referral as needed

Contd..
• Management (with timely referral as needed) of ear,
eye and throat problems, skin infections, worm
infestations, febrile seizure, poisoning,
injuries/accidents, insect and animal bites
• Detection of SAM, referral and follow up care for SAM.
• Adolescent health- counselling
• Detection for cases of substance abuse, referral and
follow up
• Detection and Treatment of Anaemia and other
deficiencies in adolescents
• Detection and referral for growth abnormality and
disabilities, with referral as required

4. Family planning, contraceptive services and
other reproductive care services
• Insertion of IUCD
• Removal of IUCD
• Provision of condoms, oral contraceptive pills and
emergency contraceptive pills
• Provision of Injectable Contraceptives in MPV districts
• Counselling and facilitation for safe abortion services
• Medical methods of abortion (up to 7 weeks of
pregnancy) on fix days at the HWC by PHC MO
•

Contd.
• Post abortion contraceptive counselling
• Follow up for any complication after abortion and
appropriate referral if needed
• First aid for GBV related injuries - link to referral
centre and legal support centre
• Identification and management of RTIs/STIs
• Identification, management (with referral as
needed) in cases of dysmenorrhoea, vaginal
discharge, mastitis, breast lump, pelvic pain,
pelvic organ prolapse

5. Management of Communicable diseases and General
Outpatient care for acute simple illness and minor
ailments
• Identification and management of common
fevers, ARIs, diarrhoea, and skin infections.
(scabies and abscess)
• Identification and management (with referral
as needed) in cases of cholera, dysentery,
typhoid, hepatitis and helminthiasis
• Management of common aches, joint pains,
and common skin conditions, (rash/urticaria)

6. Management of Communicable diseases: National Health Programmes
(Tuberculosis, Leprosy, Hepatitis, HIVAIDS, Malaria, Kala-azar, Filariasis and
Other vector borne diseases)
• Diagnosis, (or sample collection) treatment (as
appropriate for that level of care) and follow
up care for vector borne diseases – Malaria,
Dengue, Chikungunya, Filaria, Kalazar,
Japanese Encephalitis, TB and Leprosy.
• Provision of DOTS for TB and MDT for leprosy
• HIV Screening (in Type B SHC), appropriate
referral and support for HIV treatment.
• Referral of complicated cases

Contd..
• Community awareness about mental disorders (Psychosis,
Depression, Neurosis, Dementia, Mental Retardation,
Autism, Epilepsy and Substance Abuse related disorders)
• Identification and referral to the HWC/ PHC for diagnosis.
• Ensure treatment compliance and follow up of patients
with Severe Mental Disorders
• Support home based care by regular home visits to patients
of Severe Mental Disorders
• Facilitate access to support groups, day care centres and
higher education/ vocational skills
• Detection and referral

7. Prevention, Screening and Management of
Non Communicable diseases
• Screening and treatment compliance for Hypertension
and Diabetes, with referral if needed Screening and
follow up care for occupational diseases
(Pneumoconiosis, dermatitis, lead poisoning);
fluorosis; respiratory disorders (COPD and asthma) and
epilepsy.
• Cancer – screening for oral, breast and cervical cancer
and referral for suspected cases of other cancers
Confirmation and referral for deaddiction –
tobacco/alcohol/ substance abuseTreatment
compliance and follow up for all diagnose cases Linking
with specialists and undertaking two-way referral for
complication

8. Care for Common Ophthalmic and
ENT problems
• Diagnosis of Screening for blindness and refractive errors.
• Identification and treatment of common eye problems –
conjunctivitis, acute red eye, trachoma; spring catarrh,
xeropthalmia as per the STG
• Screening for visual acuity, cataract and for refractive errors
• Management of common colds, Acute Suppurative Otitis
Media, injuries, pharyngitis, laryngitis, rhinitis, URI,
sinusitis, epistaxis
• Early detection of hearing impairment and deafness with
referral.
• Diagnosis and treatment services for common diseases like
otomycosis, otitis externa, ear discharge etc.

Contd..
• Manage common throat complaints
(tonsillitis, pharyngitis, laryngitis, sinusitis)
• First aid for injuries/ stabilization and then
referral.
• Removal of Foreign Body. (Eye, Ear, Nose and
throat)
• Identification and referral of thyroid swelling,
discharging ear, blocked nose, hoarseness and
dysphagia

9. Basic oral health care
• Screening for gingivitis, periodontitis, malocclusion,
dental caries, dental fluorosis and oral cancers, with
referral
• Oral health education about dental caries, periodontal
diseases, malocclusion and oral cancers
• Management of conditions like apthous ulcers,
candidiasis and glossitis, with referral for underlying
disease
• Symptomatic care for tooth ache and first aid for tooth
trauma, with referral
• Counselling for tobacco cessation and referral to
Tobacco Cessation Centres

10. Elderly and palliative healtthem h
care services
• Arrange for suitable supportive devices from
higher centres to the elderly /disabled persons
to make ambulatory
• Referral for diseases needing further
investigation and treatment, to PHC/CHC/DH
• Management of common geriatric ailments;
counselling, supportive treatment
• Pain Management and provision of palliative
care with support of ASHA

11. Emergency Medical Services,
including for Trauma and Burns
• Stabilization care and first aid before referral in cases of
- poisoning, trauma, minor injury, burns, respiratory
arrest and cardiac arrest, fractures, shock, chocking,
fits, drowning, animal bites and haemorrhage,
infections (abscess and cellulitis), acute gastro
intestinal conditions and acute genito urinary condition
• Identify and refer cases for surgical correction - lumps
and bumps (cysts/ lipoma/ haemangioma/ganglion);
anorectal problems, haemorrhoids, rectal prolapse,
hernia, hydrocele, varicoele, epidymo-orchitis,
lymphedema, varicose veins, genital ulcers, bed ulcers,
lower urinary tract symptoms (Phimosis,
paraphimosis), and atrophic vaginitis.

12. Screening and Basic management
of Mental health ailments
• Detection and referral of patients with severe
mental disorders
• Confirmation and referral to deaddiction centres
• Dispense follow up medication as prescribed by
the Medical officer at PHC/ CHC or by the
Psychiatrist at DH
• Counselling and follow up of patients with Severe
Mental Disorders
• Management of Violence related concerns

ROLE OF NURSE IN PRIMARY
HEALTH CARE

• It is an integral part of all health services and hence all
health personnel, including nurses are responsible for
educating people as to how they can improve their own
health.
• The community health nurse has to play an important role
in organizing appropriate health education programmes
according to needs of community with the help of
coordination.
1. HEALTH EDUCATION:

HEALTH EDUCATION
• Most cost effective interventions.
• The target of educational efforts may include the
general public, patients, priority groups, health
providers, community leaders and decision makers.
• If people were adequately informed about disease
condition and if they were encouraged to take
necessary precautions in time then it helps in the
attainment of the fullest health.

• The community health nurse has to provide essential
health services.
• It includes growth charts in children, making provision for
supply of iodized salt, vitamin A supplements,
supplementary food for malnourished child in
collaboration with other members of the health team.
2. FOOD SUPPLY AND PROPER NUTRITION:

• Prevention and treatment of diarrhoeal diseases.
• Education regarding promotion of breast feeding, and
safe weaning practices.
Cont… FOOD SUPPLY AND PROPER NUTRITION:

3. WATER SUPPLY AND BASIC SANITATION:
• Educate people regarding Hand hygiene, hygienic
practices, menstrual hygiene,personal habits, safe
drinking water, germ theory, causes of insanitation,
garbage disposal etc.

Community health
nurses are assigned
to carry out
maternal and child
health care, which
includes antenatal,
perinatal and post
natal care.
4. MATERNAL AND CHILD HEALTH CARE
INCLUDING FAMILY PLANNING:

5. IMMUNIZATION:
• Education regarding importance and schedule of
immunization for children and pregnant ladies.
• Regular monitoring of implementation of
immunization programmes.

6. PREVENTION AND CONTROL OF ENDEMIC
DISEASES:
Proper collection of
data
Visit and follow up
care and provide
surveillance over
the target
population.

7. TREATMENT OF MINOR AILMENT:
• Nurses have been trained to treat patient under a
doctor’s standing order.
• The emergency treatment and primary care
provided by nurse’s help to reduce morbidity and
mortality rate.

• Nurse should be aware of the resources and facilities
for getting essential drugs to inform the client within a
short distance.
• With regards to the role of nurse and primary health
care WHO identified four self explanatory roles of the
nurses as given below:
-Nurse as a direct care provider.
-Nurse as a teacher and educator.
-Nurse as a supervisor and manager.
-Nurse as a researcher and evaluator.
8. PROVISION OF ESSENTIAL DRUGS:

Cont…
• These self explanatory roles enable the nurses to
contribute to the better establishment of the
primary health care to the people of the country.

• According to NMC bill 2019, nurses are the first
choice for CHO and this will also pave the way for
professional development. Since there is global
shortage of healthcare professionals and raising
need of health care facilities especially in community
setting, CHO is new evolving role which will promote
the health care in access to community public. CHO
being Midlevel health care provider will reduce the
burden of other healthcare professionals and also
contribute to achieve the aim of ‘health for all’.

PROBLEMS IN
IMPLEMENTING PRIMARY
HEALTH CARE IN INDIA

1. RESOURCES
• The basic resources are
a. Health, manpower
b. Money, material and time
• Lack of resources leads to poor performance of
primary health care system. In poor states spending
levels are low while an expectation for coverage
remains high.

2. POPULATION PROBLEM
Because of increased population, development of
country faces many problems. Increased population
affects the education, employment, housing, health
care sanitation of environment.

3. ABSENCE OF POLITICAL SUPPORT AND LACK
OF INTEREST IN THE PROBLEMS OF RURAL
AREAS.

4. MEDICAL CARE PROBLEMS:
This is due to the unequal distribution of available
health resources between below and rural areas.

5. OTHER FACTORS
STAFF
SHORTAGE
RISING COST OF
HEALTH CARE

cont… (OTHER FACTORS)
Natural and
manmade
disasters

POVERTY

5. OTHER FACTORS
• Failure to restore medical supplies on a higher basis.
• Lack of cooperation on the part of health services.
• Communicable and non communicable diseases.
• Illiteracy, life span, overcrowding etc.

Brief History of Health promotion
 The first International Conference on Health
Promotion was held in Ottawa in 1986.
 The basic strategies for health promotion
identified in the Ottawa Charter were:
1. Advocate (to boost the factors which encourage
health),
2. Enable (allowing all people to achieve health
equity) and
3. Mediate (through collaboration across all
sectors).

Contd…
• Most recently, the 9th global conference
(Shanghai 2016), titled ‘Promoting health in
the Sustainable Development Goals:
 Health for all and all for health’, highlighted
the critical links between promoting health
and the 2030 Agenda for Sustainable
Development

Health promotion :Introduction
• Health promotion is a set of principles involving
equity and participation and a practice that
encompasses communication, capacity building
and politically orientated activities.

A process that empowers people to change their
personal behavior and lifestyle and creates and
supports environments that contribute to healthy living
(Nutbeam,1986;Simons-Morton,2013)
Health promotion is the process of enabling
people to increase control over, and to
improve their health. (WHO:1986)

PURPOSES:
• To positively influence the health behavior of
individuals and communities as well as the
living and working condition that influence
their health.

WHO’s GOAL OF HEALTH PROMOTION
• To promote equity in health, reduce health risks,
enhance healthy lifestyles and work sites and respond
to core determinants of health.
• The WHO conducted the 1ST International Conference
on Health promotion at OTTAWA in Nov. 1986.
Following which a document titled the Ottawa Charter
for Health Promotion was released.

Cont…
The Charter provides the framework for the
implementation of health promotion in 5 specific
areas:
• Develop personal skills.
• Create supportive environment.
• Strength community action.
• Reorient health services.
• Build healthy public policy.

IMPORTANCE OF
HEALTH
PROMOTION

IMPORTANCE OF HEALTH PROMOTION
• Health promotion
improves the health
status of individuals,
families, communities,
states and the nation.
• Enhances the quality of
life for all people.
• It reduces premature
deaths.

Cont…
• By focusing in prevention, health promotion reduces
the costs (both financial and human) that individuals,
employers, families, insurance companies, medical
facilities, communities, the state and nation would
spend on medical treatment.

Cont…
• Adequate knowledge is essential about the following to
prevent the occurrence of diseases:
 Causation
 Dynamic of transmission.
 Identification of risk factors and risk groups.
 Availability of prophylactic or early detection and
treatment measures.
 An organization for applying these measures to
appropriate persons/groups, and continuous
evaluation and development of procedures applied.

Cont…
• The main objective of prevention is to intercept the
“cause” and thereby the disease process.

HEALTH PROMOTION APPROACHES:
CREATING
HEALTHY
CITIES
MAKING EVERY
SCHOOL A HEALTH
PROMOTING SCHOOL
PROMOTIN
G HEALTH
AND WELL
BEING
IMPROVING
HEALTH
LITERACY
•Creating healthy cities:
•Creating healthy cities:
ALT
H
GO
VER
NA
NC
E
PROMOTING
HEALTH
THROUGH
GOOD
GOVERNANCE

Downie et al has identified seven different types of activities
(Glass & Schmidt 1987) that can involve health promotion
activities, which includes:
• 1. Preventive services (e.g., immunization,
screening for cancer, etc).
• 2. Preventive health education (e.g., efforts to
influence life-style and to increase the use of
preventive services).
• 3. Preventive health protection (e.g., the
fluoridation of water, iodization of salt, etc).
• 4. Health education for preventive health
protection (e.g., lobbying for seat-beat legislation
and shifting of polluting industries from
residential areas).

Contd..
• 5. Positive health education (e.g., encouraging
people for productive use of their leisure time
and helping people developing health-related life
skills)
• 6. Positive health protection (e.g.,
implementation of workplace anti-smoking
policies and anti-sexual harassment policies).
• 7. Health education for positive health
protection (e.g., obtaining support for positive
health promotion activities –anti-smoking
legislation, etc[13]

1. CREATING HEALTHY CITIES
• A Healthy City aims to:
• create a health-supportive environment,
• achieve a good quality of life,
• provide basic sanitation and hygiene needs,
• supply access to health care

• Most cost effective interventions.
• Health literacy means more than being able to read
pamphlets and make appointments.
• By improving people’s access to health information, and their
capacity to use it effectively
• Meeting the health literacy needs of the most disadvantaged
and marginalized societies will particularly accelerate progress
in reducing inequities in health and beyond
2. IMPROVING HEALTH LITERACY

3. MAKING EVERY SCHOOL A HEALTH PROMOTING
SCHOOL
• Globally, over 90% of children in the primary school age, and over
80% of children in the lower secondary school age are enrolled in
school, where they spend one third of their time.
• Schools are a unique setting for creating health and cover an
important time period for establishing healthy behaviours.

4. PROMOTING HEALTH AND WELL BEING
 Growing power of social mobilization for health promotion is
tremendous.
 Because health touches the lives of everyone, everywhere,
and since health inequities stem from and contribute to other
inequities, integrating health promotion into various efforts
for change can push the SDGs forward.

5. PROMOTING THROUGH GOOD GOVERNANCE
• Health is determined by multiple factors outside the direct
control of the health sector (e.g. education, income, and
individual living conditions) and that decisions made in other
sectors can affect the health of individuals and shape patterns of
disease distribution and mortality.

.
Cont…LIFE STYLE AND BEHAVIOURAL CHANGES:
• It involves organizational, social, political and economic
interventions designed to facilitate environmental and
behavioral adaptations that will improve to protect health.
• Lifestyle changes include the modification in daily
activities of client to make the healthy life pattern.

Public Health Promotion and Law
• Law has to prohibit individuals who create the
situation for others suffering.
• Applications of prohibitory power on
individual autonomy would be unwelcome in
democratic world. For this reason, public
health must maintain the balance between
individual autonomy and community
protection.

Indian Constitution and Health
Promotion
• Asoka the Great, a Buddhist king is well known
for his edicts describing the state
responsibility for providing safe water, shelter,
trees implantation at the road side, care for
sick human beings and animals, suitable place
for moral and spiritual education to the
people without any discrimination and kind
treatment for slaves and servants (Kishore &
Ray 2001).

Contd…
• Right to Equality Article 15
• Article 17: Abolition of untouchability
• Right for Freedom Article 21:
• Right against Exploitation Article 23:
Prohibition of traffic of human beings and
forced labor
• Article 24: Prohibition of employment of
children (below 14 years) in factories, etc.

Contd..
• Cultural and educational Rights.
• Directive Principles of State Policy Article 38:
• Article 39: securing equal pay for equal work to man
and woman; and securing the health and strength of
workers, men and women, and the tender age of
children.
• Article 42: Provision for just and humane conditions of
work and maternity relief.
• Article 43: living wages, etc. for workers: state shall
secure a decent standard of life and full enjoyment of
leisure and social and cultural opportunities.

Contd..
• Article 45: Provision for free and compulsory education
for children
• Article 46: Promotion of educational and economic
interests of scheduled castes, scheduled tribes and
other weaker sections.
• Article 47: Duty of the state to raise the level of
nutrition and the standard of living and to improve
public health.
• Article 48 A: Protection and improvement of
environment and safeguard of forest and wild life.
• Article 51: Promotion of International Peace and
Security.

Contd..
• B. Protection of Human Rights and Dignity:
• There are many instances when people’s health
is suffered due to violation of human rights and
restoring such rights ensure better health.
• b) The Scheduled Castes and The Scheduled
Tribes (Prevention of Atrocities) Act 1989:
Incidences of physical and mental torture of
Scheduled Castes (SCs) & Scheduled Tribes (STs)
are common in Indian society that lead to high
morbidity and mortality.

Contd..
C. Epidemic Diseases Act, 1897
• The Mental Health Act 1987
D. To Prevent the use of tobacco and other
substance use:
a) The Cigarette and Other Tobacco (Prohibition of
Advertisement and Regulation of Trade and
Commerce, Production, Supply and Distribution)
Act 2003:
• b) The Narcotic Drugs and Psychotropic
Substances Act, 1985:

Contd..
• The Drugs and Cosmetics Act, 1940:
E. Promotion of health through safe nutrition:
The Prevention of Food Adulteration Act,
1954: Enrichment of flour, bread, or other
cereals with vitamins or minerals, iodization of
salt, fortification with vitamin of vanaspati oil,
addition of vitamin “C” in certain foods can be
done under the provision made in this Act.

AYUSHMAN BHARAT
Ayushman Bharat for a new India -2022, announced
Two major initiatives in health sector announced
-Rs. 1200 Crore allocated for 1.5 Lakh health and
wellness Centres.
-National health protection Scheme to provide
Hospitalisation cover to over 10 Crore poor and
vulnerable families.

• The Government announced two major initiatives in
health sector , as part of Ayushman Bharat programme.
The Union Minister for Finance and Corporate Affairs,
Shri Arun Jaitely while presenting the General Budget
2018-19 in Parliament said that this was aimed at
making path breaking interventions to address health
holistically, in primary, secondary and tertiary care
systems, covering both prevention and health
promotion.
Cont…(AYUSHMAN BHARAT)

THE INITIATIVES ARE AS FOLLOWS:-
(i) Health and Wellness Centre:-
 The National Health Policy, 2017 has envisioned
Health and Wellness Centres as the foundation of India’s
health system.
 Under this 1.5 lakh centres will bring health care system
closer to the homes of people.
 These centres will provide comprehensive health care,
including for non-communicable diseases and maternal
and child health services.

 These centres will also provide free essential drugs and
diagnostic services. The Budget has allocated Rs.1200 crore
for this flagship programme. Contribution of private sector
through CSR and philanthropic institutions in adopting
these centres is also envisaged.

ii) National Health Protection Scheme:-
• The second flagship programme under Ayushman
Bharat is National Health Protection Scheme, which will
cover over 10 crore poor and vulnerable families
(approximately 50 crore beneficiaries) providing
coverage upto 5 lakh rupees per family per year for
secondary and tertiary care hospitalization.
• This will be the world’s largest government funded
health care programme. Adequate funds will be
provided for smooth implementation of this
programme.

• The Finance Minister further said, that these two
health sector initiatives under Ayushman Bharat
Programme will build a New India 2022 and ensure
enhanced productivity, well being and avert wage
loss. These Schemes will also generate lakhs of jobs,
particularly for women.

• The Finance Minister said, that in order to further
enhance accessibility of quality medical education
and health care, 24 new Government Medical
Colleges and Hospitals will be set up, by up-grading
existing district hospitals in the country. This would
ensure that there is at least 1 Medical College for
every 3 Parliamentary Constituencies and at least 1
Government Medical College in each State of the
country.

OTHER INITIATIVE
• SWACHH BHARAT MISSION-2014
• ANEMIA MUKTA BHARAT(2018-2022):POSHAN
ABHIYAN(8TH MARCH -2018)REDUCING
PREVALENCE OF ANEMIA BY 3% PER YEAR
AMONG CHILDREN,ADOLESCENTS
• 6X6X6 STRATEGY( 6 BENEFICIARY,6
INTERVENTION,6 INSTITUTIONAL MECHANISM
• SEPTEMBER 2018 -RASHTRIYA POSHAN MAAH

Summary
• PHC is usually the first point of contact people have
with the health care system. It provides
comprehensive, accessible, community-based care that
meets the health needs of individuals throughout their
life .Health promotion is actually about ensuring that
individuals and communities are able to assume the
power to which they are entitled. There are many
govt. initiatives for health promotion like goals stated
in SDG, Ayushman Bharat program 2018, Swachh
Bharat Mission -2014,Anemia Mukta Bharat and
legislation for health protection and health promotion.

CONCLUSION:
• Primary care is qualitatively a different approach to deal
with the health problems of a community. This approach
signifies a new dynamism in health care and has been
described as Health by the people, placing people’s hands.
Action is required to strengthen the three pillars of primary
health care, that is, primary care and essential public health
functions as the core of integrated health services;
empowered people and communities; and multisectoral
policy and action.
• Health promotion need multisectoral support and it
should be priority for resurgent country like India.

Contd..
• IF PEOPLE IS EMPOWERED….EDUCATED,,,IT
BECOMES VERY EASY TO PROMOTE HEALTH
e.g. KERELA HAS PROVED ITSELF IN TERMS OF
DEVELOPMENT AND HEALTH PROMOTION.

REFERENCES
1. https://www.who.int/primary-health/conference-phc,info:retrieved on
25-09-2020
2. https://www.who.int/news-room/fact-sheets/detail/primary-health-
care,updated on27feb2019,info:retrieved on 25-09-202
3. P.Basheer ,Advanced nursing practice,2nd Edition, reprint: 2019 EMMESS
Pubisher,page no-622-655
4. Perry Potter, Fundamentals of nursing; Elsevior publication; 8th edition; Pp
66, 70.
5. https://www.who.int/healthpromotion/conferences/previous/ottawa/en/
retrieved on 25-09-2020
6. file:///C:/Users/Adminpc/Downloads/2016_Book_HealthPromotionForChi
ldrenAndA.pdf ,K.Maya Ram,e-book-Health promotion for children and
adolescent, database springer 20
7. http://www.taylorfrancis.com.elibpgimer.remotexs.in/books/9781315106
885
8. Laverack . Glenn, Health Promotion in Disease Outbreaks and Health
Emergencies CRC Press [2018] Taylor & Francis Group

REFERENCES
9. https://www.who.int/activities/creating-healthy-
cities,info:retrieved on 27-09-202
10. https://www.who.int/activities/improving-health literacy
info: retrieved on 27-09-20
11. https://www.who.int/activities/making-every-school-a-
health-promoting-school info: retrieved on 27-09-2020
12. https://www.who.int/activities/promoting-health-and-well-
being info: retrieved on 27-09-2020
13. https://www.who.int/activities/promoting-health-through-
good-governance info: retrieved on 27-09-2020
14. Glass, K., Schmidt, W. (1987). Law and health promotion with
particular reference to lifestyles: A comparative research
study in Europe. Health Promotion International, 2(1), 85-90
World Health Organization (1986). Ottawa Charter for Health
Promotion. World Health Organization, Copenhagen

REFERENCES
15. Netbean, D. (1985). Health promotion glossary. Copenhagen WHO
Regional office of Europe. (Document ICP/HBI 503 (GO4).
16. K. Jugal, review of legislation and health promotion in India vol.3 No-2
2012 ,page-75-87
www.researchgate.net/publication/237332236_Legislation_and_Health_
Promotion_in_India
17. https://www.india.gov.in/spotlight/ayushman-bharat-national-health-
protection-mission; cited on 17.12.2018.
18. facts on patient safety. Geneva: World Health Organization; 2018
(http://www.who.int/features/ factfiles/patient_safety/en/, accessed 24
September 2018).
19. The economics of patient safety in primary and ambulatory care. Paris:
OECD; 2018 (https://www. oecd.org/health/health-systems/The-
Economics-of-Patient-Safety-in-Primary-and-Ambulatory-
CareApril2018.pdf, accessed 24 September 2018).
20. Desai S, Bishnoi RK, Punjot P. Community health officer: the concept of
mid-level health care providers. Int J Community Med Public Health
2020;7: 1610

21.http://nhsrcindia.org/sites/default/files/Operational%20Guidelines%20For
%20Comprehensive%20Primary%20Health%20Care%20through%20Health%2
0and%20Wellness%20Centers.pdf.Operational guidelines: NHSRC,AYUSHMAN
BHARAT: Comprehensive Primary Health Care through Health and Wellness
Centers ,17-09-2018
22 .https://anemiamuktbharat.info/home/6x6x6-strategy

QUESTIONS
1. What are the 4 As in PHC
2. Enlist the pillars of PHC
3. Enlist the pillars of Ayushman Bharat.
4. Alma ata declaration held in ...... Year
5. Astana declaration held in.........year
6. Ottawa charter is for........
7. SDG-.........is for health promotion

Answers
1.affordability, accessability, acceptability, availability
2.Appropriate technology, intersectoral co-ordination,
community participation, Human resources
3.CPHC,HWC
4. 1978
5. 2018
6. 1986

8. The public heath nurse who does Blood Pressure
screening and related health education is
conducting activities in the level of
• a. primary prevention
• b. secondary prevention
• c. tertiary prevention
• d. focused prevention

• Ans 8 . B secondary prevention

9. The nurse educator planning a smoking
cessation program understands that the most
basic type of health promotion program is
• a. utilizing a variety of media for information
dissemination
• b. conducting health risk surveys
• c. providing counseling for lifestyle and
behavior change
• d. facilitating environmental control programs

• Ans9. A. utilizing a variety of media for
information dissemination

10.Community groups who monitor changes in
water and air quality are examples of
• a. information dissemination
• b. health risk appraisal and wellness
assessment
• c. lifestyle and behavior change
• d. environmental control program

• Ans10. d. environmental control program

11. A home health nurse who provides skin care
and repositioning of a client on bedrest is
conducting activities in
• a. health promotion
• b. health protection
• c. health prevention
• d. rehabilitation

• Ans11. b. health protection

health promotion and primary prevention: Mamta Suryavanshi

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to health promotion and primary prevention: Mamta Suryavanshi

Similar to health promotion and primary prevention: Mamta Suryavanshi (20)

Recently uploaded

Recently uploaded (20)

health promotion and primary prevention: Mamta Suryavanshi