health is a state of complete physical, mental, social well- being and not merely the absence of disease or infirmity. to reduce the consequences of ill- health.

1. HEALTH AND HEALTH CARE
SERVICES
PRESENTED BY: -
SAMIKSHA KURIYAL
M. Sc NURSING 1st YEAR

2. HEALTH: -
ACCORDING TO WHO-
“Health is a state of complete physical, mental and
social well- being and not merely the absence of
disease or infirmity”.

3. HEALTH INDICATORS: -
Health indicators are the various factors (variables) which
indicate or give clue to the health status of the people living in a
defined area. Most of these indicators measures lack of health,
i.e. illness (morbidity), consequences of ill- health, i.e. disability
and mortality. The indicators are classified as under:

4. 1. MORTALITY INDICATORS
Mortality indicators give information about deaths which occur in different age-
groups and due to specific diseases. These include:
i. Infant mortality rate (IMR): Deaths in under 1 year age- group.
ii. Child mortality rate (CMR): Deaths in under 5 year age- group.
iii. Maternal mortality rate (MMR): Deaths of pregnant women due to
pregnancy related causes.
iv. Cured death rate (CDR): Death in total population.
v. Diseases specific mortality rate (DSMR): Deaths due to any particular
diseases, e.g. deaths due to tuberculosis, infective hepatitis, etc.

5. Mortality indicators differ from place to place and increase or
decrease over time in the same place. Decrease in mortality indicators
indicates improvement in the health status of people.
2. Morbidity Indicators: - Morbidity indicators give information
about the people who are suffering from various diseases in the
community. The morbidity indicators include incidence and
prevalence rates of various communicable and non- communicable
diseases. These will vary from place to place and time to time.
The decreasing morbidity indicators indicate improving the health
status of people.

6. 3. DISABILITY INDICATORS: -
Disability indicators give information about the people who are not
able to perform full range of activities due to any disease or any
such problem.
The disability indicates include absenteeism rates at school and
place of work, prevalence of blindness, deafness, dumbness, etc.
Decrease in disability indicators indicates the better health of
people.

7. 4. LIFE EXPECTANCY AT BIRTH: -
This indicator gives information about the number of years the
new- born babies are expected to live. The increasing life
expectancy at birth indicates improving the health status of people.
This is a positive health indicator as it does not deal with lack of
health.

8. 5. NUTRITIONAL STATUS INDICTORS: -
These indictors give information about the growth of under five and
school going children in terms of their weights, mid- arm
circumference and heights. This is also a positive health indicator.

9. 6. SOCIAL AND MENTAL HEALTH
INDICATORS: -
These indicators give information about social and mental health
problems. These include the prevalence of drug and alcohol
abuse, child and women abuse, juvenile delinquency, suicide,
homicide, road accidents, etc.

10. 7. OTHER INDICATORS: -
i. Health Care Delivery Indicators- These indicators give information about
availability and distribution of health care services in the community. These
include doctor- population ratio, nurse- population ratio, nurse- bed ratio,
nurse- doctor ratio, etc.
ii. Health Care Utilization Indicators- These indicators will give
information about the services being used by people, e.g. number of users
of contraceptives, number of immunized children, number of deliveries
conducted by trained personnel, antenatal clinic attendance etc.

11. III. SOCIO- ECONOMIC INDICATORS-
These indicators gives information about the living standard of
people. These indicators include family size, literacy, population
growth, per capita income etc. these indicators affect the health
status of people directly or indirectly.

12. HEALTH CARE SERVICES
INTRODUCTION: -
Health is very precious to all. People try to practice health
behaviors to promote, protect, regain and maintain their
health.
But often they lack optimal health and well- being due to
various reasons such as lack of knowledge, positive attitude,
health behavior, facilities, etc.

13. HEALTH CARE
MEANING: - Health care means “to feel concerned about health, to
be attentive about health, to be cautious about health, to protect
health”.
DEFINITION: - According to WHO- “Multiple services rendered
to individuals, families or communities by the agents of health
services or health professionals for the purposes of promoting,
maintaining or restoring health”.

14. HEALTH CARE SERVICES
The term health care services refers to as “system of providing
health care to individuals, families and people at large through the
various levels of health institutions”.
 The health institution include sub- centers, primary health
centers, community health centers, general and specialized
hospitals, training and research institution.

15. PURPOSES OF HEALTH CARE SERVICES
The purpose of health care services is to meet health needs and
health demands of people
To improve their health status by helping people to promote,
protect, regain and maintain their health.

16. OBJECTIVES OF HEALTH CARE SERVICES
Reduce morbidity and mortality rates.
Increase expectation of life.
Improve nutrition status of people.
Improve environmental sanitation.
Develop health manpower and health resources.
Bring in change in health knowledge, health attitude and health behavior
of people of people through well- planned and organized information,
education and communication program (IEC).

17. PRINCIPLES OF HEALTH CARE SERVICES
In order to achieve the purpose and objectives of health care services,
certain principles are considered by the Government for providing
services to the people. These are under:
1. The health care services must be relevant.
2. The services must be comprehensive.
3. The services must be adequate and available to all.
4. The services must be accessible.
5. The services must be acceptable to the people.
6. The service must be feasible.
7. The services must be continuous services.
8. The services must be of desired standards.

18. LEVELS OF HEALTH CARE
There are three levels (or tiers) of health care. These are primary level,
secondary level and tertiary level.
1. Primary level health care- The primary level health care is rendered at
the grassroot level, i.e., at the community level.
In Rural areas- The primary health care services are rendered from sub-
centers, primary health centers and community health centers. The services
are provided by a team-
Medical officers
Health supervisors
Multi- purpose health workers (female and male)
Sanitary inspectors
Extension health educators etc.

19. CONT….
There is active participation of village level health workers such as-
Village health volunteers/ guides
ASHA
Village (trained) dais
Anganwadi workers
In Urban areas- the primary health care services are given in maternal
and child health and family welfare centers (MCH and FW centers), out
patient departments (OPDs), health clinics run by hospitals, etc.

20. SECONDARY LEVEL HEALTH CARE
The secondary level of health care is rendered at the district level
from district health Centre/ hospital. This level deals with complex
health problems and requires to have facilities to provide diagnostic
and curative services. Those case which cannot be handled at PHC/
CHC are referred to district health Centre/ hospital.

21. TERTIARY LEVEL HEALTH CARE
The tertiary level of health care is provided at the state/ regional/ central
level hospital. These hospitals provide super- specialist services and serve
as referral Centre's for secondary and primary level health care Centre’s.
These hospitals conduct education and training program for the various
categories of health personnel.

22. HEALTH FOR ALL (HFA)
The “Health For All” (HFA) by 2000 AD as the goal was decided by
World Health Organization in 1977 in its 30th World Assembly meeting.
This decision was taken to overcome the existing problems of:
inaccessibility of essential and life- saving health care services in rural
areas and urban slums, unresolved emerging health problems in developed
countries and major problems of infectious diseases, sanitation and basic
health services, poor living standards etc.

23. DEFINITION AND MEANING OF HFA
The “HFA” was defined as:
“The attainment of a level of health that will permit every individual to
lead socially and economically productive life”.

24. HFA GOALS
The HFA goals calls for efforts not only in public health and medical
aspects but also in education, agriculture, industry, housing,
communication, etc. to provide an acceptable level of healthful living
to all people.

25. PRIMARY HEALTH CARE APPROACH FOR HFA
 In 1978, WHO and UNICEF together sponsored International
Conference on Primary Health Care in Alma- Ata in Russia.
The conference reaffirmed the goal of “Health For All”.
 It declared “PRIMARY HEALTH CARE” (PHC) as the key approach
to achieve this goal by the year 2000AD and was accepted by the
member countries.

26. NATIONAL STRATEGY FOR HFA
The Government of India, being signatory to Alma- Ata Declaration
committed itself to achieve the goal of HFA by 2000AD through
Primary Health Care approach. The Government of India recognized
and strengthened the Infrastructure to implement primary health care.

27. 1. VILLAGE HEALTH POST
In plain area, there is 1 village health post for a population of 1000 and
in hilly and tribal areas for 500. Each village health post is manned by 1
trained birth attendant (TBA) and 1 village health guide (VHG). There
is also 1 Anganwadi worker.

28. 2. SUB- CENTRE
In plain area, there is provision of one sub- centre for a population of
5000 and in hilly/ tribal areas for 2500- 3000. Each sub- centre is
manned by 1 health worker(F) i.e., Auxiliary Nurse Midwife (ANM)
and 1 health worker (M) and one part time attendant.

29. 3. PRIMARY HEALTH CENTRE (PHC)
There is provision of 1 PHC for a population of 3000 in plain areas and for 25000 in
hilly/ tribal areas. It has 4- 6 beds and some diagnostic facilities.
STAFF RECOMMDATION
Medical Officer 1
Nurse Midwife 1
Pharmacist 1
Health Assistant (M) 1
Health Assistant (F) 1
Block Extension Educator 1
Health Worker (F) (ANM) 1
Lab Technician 1
UDC and LDC 2 (1each)
Driver 1
Class IV 4
TOTAL 15

30. 4. COMMUNITY HEALTH CENTRES (CHC)
There is provision of 1 CHC foe each block with a population of 80,000- 1,20,000. The
centre has 30 beds and provides medical, surgical, obstetrical and gynecology and pediatric
services. STAFF RECOMMENDATION
Medical Officer 4
Nurse- Midwife 7
Pharmacists/ Compounder 1
Dresser 1
Lab- Technician 1
Radiographer 1
Ward Boys 2
Dhobi 1
Sweepers 3
Mali 1
Chowkidar 1
Aya 1
Peon 1

31. 5. HEALTH POST IN URBAN SLUMS
There is provision of one health post for a population of 5000 in urban
slums.
6. THE PRIMARY HEALTH CARE PACKAGE
Primary health care package which is considered suitable and accepted
for health for all by 2000AD is as under:
Universal provision of promotive, preventive and basic curative
services.
Health education of people.
Health care services to vulnerable group of people, i.e., children,
women and eligible couples.

32. Prevention and control of endemic communicable and non-
communicable disease.
Promotion of food supply and improvement of nutritional status.
Provision of protected water supply and sanitary disposal of excreta.
Family welfare services.
7. THE REQUISITES FOR HFA
The requisites for HFA which are considered are as under:
The political commitment.
Community participation.
Support of health related sectors.

33. CONCEPT OF PRIMARY HEALTH CARE
Primary health care is the peripheral level care which is rendered at he
community level where people live. It is the primary, i.e., first level
contact of the people with the national health care delivery system. Its
brings health care closer to the people.
ESSENTIAL ELEMENTS
According to primary health care framework declared by WHO and
UNICEF jointly at Alma- Ata Conference in 1978, primary health care
is essential health care and includes eight essential elements. These are
as under:

34. Education of people concerning prevailing health problems and
methods of preventing and controlling them.
Promotion of food supply and proper nutrition.
Provision of safe water and basic sanitation.
Maternal and child health care including family planning.
Immunization against the major infectious diseases.
Prevention and control of locally endemic diseases.
Appropriate treatment of common diseases and injury.
Provision of essential drugs.

35. PRINCIPLES OF PRIMARY HEALTH CARE
1. EQUITABLE DISTRIBUTION- It means that health care services
should be equally accessible to all, irrespective of their socio-
economic status, castes, religious, etc.
2. COMMUNITY PARTICIPATION- Primary health care is
community based to help people take care of their own health needs
and health problems.
3. APPROPRIATE TECHNOLOGY- Appropriate technology means
that the methods, techniques and equipment which are used must be
simple, scientifically sound, in accordance with local needs and
acceptable to users and to those for whom they are used.

36. 4. FOCUS ON PREVENTION- This implies that emphasis must be on
the prevention of diseases and promotion of health. It must form part and
parcel of primary health care.
5. MULTI- SECTORAL APPROACH- Health For All through
primary health care cannot be achieved without the support of other
socio- economic sectors such as education, housing, nutrition, safe water
supply, communication, mass media etc.

37. NURSE’S ROLE IN PRIMARY HEALTH CARE
The Trained Nurse Association of India (TNAI) affirmed its commitment
to HFA through Primary Health Care in its conference on Nursing
Education in 1979. WHO study group in 1985 highlighted the following
roles and functions of nurses in primary health care.
1. DIRECT CARE PROVIDER- The nurse provides direct care to an
individual, families and community with reference to eight elements
of primary health care.
2. HEALTH EDUCATOR AND ATEACHER- In order to promote
health, prevent diseases, regain and maintain health, the nurse
educates individuals, families and community at large about healthful
behavior, sanitary environment, prevention of diseases, etc.

38. 3. PLANNER AND CARE MANAGER- The nurse working for
primary health care makes an assessment of health needs, health
problems of individuals, families and community. She plans care
accordingly for them and implements the planned care. She makes
referrals when required. She maintains the record of care given and
evaluates the effectiveness of the same.
4. GUIDE AND SUPERVISOR- As a nurses engaged in providing
primary health care, she is expected to supervise, guide and help other
personnel in providing care, planning health services for families and
for the community.