its a presentation for dental students in subject to Public Health Dentistry conttaing Levels of Health Care In India Characteristics of primary health care Components of health care Principles of primary health care Health care sectors in India Village level workers Sub-Centre level Primary health care Community health centre

1. PRIMARY HEALTH CARE
Presented by:-
Dr. Surbhit Singh
Senior Lecturer
Public Health Dentistry
1

2. Contents:
• History
• Introduction
• Levels of Health Care In India
• Characteristics of primary health care
• Components of health care
• Principles of primary health care
• Health care sectors in India
• Village level workers
• Sub-Centre level
• Primary health care
• Community health centre 2

3. History :
• The concept of primary health care came into existence,
following a joint WHO – UNICEF International conference at
Alma Ata USSR on 12th september 1978.
• The Alma Ata conference called for acceptance of the WHO
goal of Health for all by 2000 AD and proclaimed primary
health care as a way to achieving Health for all.
3

4. ModificationsinPHCinIndia:
• Bhore committee (1946):
• The government of India in 1943 appointed the “Health Survey and
Development Committee” with Sir Joseph Bhore as chairman.
• The committee which had among its member some of the pioneers of
public health, met regularly for 2 years and submitted in 1946 its famous
report which runs into 4 volumes.
• The committee put forward, for the first time , comprehensive proposal for
the development of a National Programme of Health Services for the
country.
4

5. Some of the important recommendations of Bohre committee were:
1. Integration of Preventive and curative services at all administrative levels.
2. The committee visualized development of PHCs in two stage –
• I. Short-term measure - i.e. one PHC for the population of 40,000 with a
secondary health centre to serve as supervisory, coordinating and referral
unit. Each PHC , 2 Medical officers, 4 public health nurses, 1 nurse, 4
midwives, 4 trained dais, 2 sanitary inspectors, 1 pharmacist, and 15 other
class IV employees were recommended.
• II. A long-term program – (also called as 3 million plan) of setting up PHC
with 75-bedded hospital for each 10,000 to 20,000, population and
secondary units with 650-bedded hospital, again regionalized around district
hospital with 2,500 beds.
3. Major changes in medical education which includes 3 month training in
preventive and social medicine to prepare “social Physicians”.
5

6. • Mudliar committee (1962) (Chairman, A.L. Mudliar)
• (Also called as Health Survey and Planning Committee).
• It felt that the quality of services provided by PHCs was inadequate, and
advised strengthening of the existing PHCs.
• The main recommendations of the Mudaliar Committee were:
1. Consolidation of advances made in the first two five year plans.
2. Strengthening of district hospital with special services to serve as central
base of regional services.
3. Regional organizations in each state between the headquarters
organization and the district incharge of a regional deputy or assistant
directors- each to supervise 2 or 3 district medical and health officers.
6

7. 4. Each primary health centre not to serve more than
40,000 population.
5. To improve the quality of health care provided by
primary health centres.
6. Integration of medical and health services as
recommended by Bhore committee.
7. Consideration of an all India health service on the
pattern of Indian administrative service 7

8. • Chadah committee (1963) (Chairman- Dr. M.S. Chadah)
• Recommended that the “vigilance” operations in respect of NMEP
(National Malaria Eradiation Program) should be a responsibility of
general health services, i.e. PHC at block level.
• One basic health worker, Multi purpose worker (MPW) per population of
10,000 was recommended.
• The Family Planning Health Assistant were to supervise 3 or 4 of these
basic health workers. At the district level, the general health services were
to take the responsibility for the maintenance phase.
8

9. • Kartar singh committee, (1973) (The committee on the Multipurpose
Workers under Health and Family Planning – chairman – Kartar singh).
• The committee submitted its report in september 1973. its main
recommendations were:
• Recommended replacement of present Auxiliary Nurse Midwife (ANM) by
Female Health Workers and the Family Planning Health Assistant by Male
Health Workers.
• Recommended that for proper coverage there should be one PHC for a
population of 50,000.
• Each PHC should be divided into 16 sub- centers each having a population of
about 3,000 to 3,500 depending up on the topography and means of
communication. 9

10. • Each sub centre should be staffed by team of one males and one
female health worker.
• There should be a male health supervisor to supervise the work of
3-4 Male Health Worker, and a female health supervisor to supervise
the work of 4 Female Health Workers.
• The Doctor incharge of PHC should have the overall charge of the
supervisors and health workers in this area.
10

11. • Shrivastav committee (1975) –
• Recommended the creation of bands of para-professional and semi-
professional health workers from within the community itself (e.g. teachers,
gram sevaks, post masters) to provide simple promotive, preventive and
curative health services needed by the community.
• Establishment of 2 cadres of health workers namely Multipurpose Health
Workers (MPWs) and Health Assistant between the community level
workers and the doctors at the PHC.
• Development of a Referral Service Complex by establishing proper linkage
between PHC and higher level of referral and service centre. 11

12. 4. Establishment of a Medical and Health Education
Commission for Planning and implementing the reforms
needed in health and Medical education on the lines of
University Grand commission.
The committee felt that by the end of the sixth plan , one male
and one female worker should be available for every 50,000
population.
12

13. • Rural health scheme, (1977) - the program of training of the
community health workers was initiated during 1977-78.
• Steps were initiated
• (a) For involvement of medical colleges in the total health care of
selected PHCs with the objective of reorienting medical education to
the needs of rural people. Training of MPWs for control of
communicable diseases.
• (b) reorientation training of multipurpose workers engaged in the
control of various communicable disease Programs into unipurpose
workers.
• This “Plan of action” was adopted by the joint Meeting of the Central
Council of Health and Central Family Planning Council held in New Delhi
in April 1976”
13

14. • Five year plans – the five year plans were conceived to re-build the
rural area. Recognizing health as an important contributory factor in
the utilization of manpower and uplifting the economic condition of
the country, the planning commissions gave considerable
importance to the health programs in the five year plans
14

15. • Tenth five year plan- the approach during the tenth five
year plan was to improve access to and enhance the
quality of primary health care in urban and rural areas by
providing an optimally functioning PHC system as a part
of the BMS scheme to improve the efficiency of existing
health care infrastructure at primary, secondary and
tertiary care settings through appropriate institutional
strengthening, and improvement of referral linkage.
15

16. Introduction:
• Primary health care is an approach to health care, which
integrates at the community level all the factors required for
improving the health status of the population.
• The services provided are :
1. simple and efficient with regard to cost, techniques and
organization.
2. Readily accessible to those concerned and contributes of
individuals families and the community as a whole.
16

17. • Primary health care is the first level of contact of individuals,
the family and the community with the national health
system, where essential health care is provided.
• Definition:
• It is defined as “ essential health care based on practical,
scientifically sound and socially acceptable methods and
technology made universally accessible to individuals and
families in the community through their full participation
and at a cost that the community and the country can afford
to maintain at every stage of their development in the spirit
of self determination”. 17

18. 18
Level of Health Care in India
Primary care Level
Secondary care Level
Tertiary Care Level

19. CHANGINGCONCEPTS–(Approaches)
19
Comprehensive
health care
Basic health
services
Primary health
care

20. Comprehensive health care
• Provide adequate preventive, curative and promotive health services.
• Be as close to the beneficiaries as possible
• Is available to all irrespective of their ability to pay.
• It has the widest cooperation between the people, the service and the
profession
• Look after specifically the vulnerable and weaker sections of the community 20

21. Basic health services
• The term was used by UNICEF/WHO in their joint
health policy.
• This concept formed the basis of National
Health Planning in INDIA and led to the
establishment of a network of primary health
centers and sub centers.
21

22. Primary Health Care :
• A new approach to healthcare came into existence in 1978
following an international conference at Alma –Ata
(USSR)
• First proposed by the Bhore Committee in 1946.
22

23. Characteristics of Primary Health Care
• It is essential health care , which is based on practical, scientifically
sound and socially acceptable method and technology.
• It should be rendered universally acceptable to individuals and the
families in the community through their full participation.
• Its availability should be at a cost which the community and country
can afford to maintain at every stage of their development in a spirit
of self reliance and self development.
• It requires joint efforts of the health sectors and other health related
sectors like, education food and agriculture, social welfare, animal
husbandary, housing, etc. 23

24. According to Alma Ata Declaration:
• Reflects and evolves from the economic conditions and sociocultural
and political characteristics of the country and is based on the
application of the relevant results of social, biomedical and health
services research and public experiences.
• Addresses the main Health problems in the community, providing,
promotive, preventive, curative and rehabilitative services
accordingly.
24

25. • Involves in addition to the health sectors and aspects of
national and community development, in particular
agriculture, animal husbandry, food industry, education,
housing, public workers, communication and other sectors;
and demands the coordinated efforts of all those sectors.
• Should be sustained by integrated functional and mutually
supportive referral systems leading to the progressive priority
to those most in need.
25

26. • Requires and promotes maximum community and individual
self-reliance and participation in the planning, organization
operation and control primary health care, making fullest use
of local, national and other available resources and to this end
develops, through appropriate education, the ability of
communities to participate
• Relies, at local and referral levels, on health workers, including
physician, nurses, midwives, auxiliaries, community workers,
as well as traditional practitioners, suitably trained socially and
technically to work as a health team and to respond to the
expressed health needs of the community
26

27. Components of Primary Health
Care:
• The Alma Ata declaration has outlined 8 essential components
of Primary Health Care.
1. Education about prevailing health problems and methods of
prevention and controlling them.
2. Promotion of food supply and proper nutrition.
3. An adequate supply of safe water and basic sanitation.
27

28. 4. Maternal and child health care, including family planning.
5. Immunization against infectious diseases.
6. Prevention and control of endemic diseases.
7. Appropriate treatment of common diseases and injuries.
8. Provision of essential drugs.
28

29. Principles of Primary Health Care:
Equitable
distribution
Community
Participation
Intersectoral
coordination
{Multisectoral
approach}
Appropriate
Technology
Focus on
Prevention
29

30. Equitable distribution:
• The first key in the primary health care strategy is equity or equitable
distribution of health services.
• At present, health services are mainly concentrated in major towns
and cities, and the worst hit are the needy and vulnerable group of
population in rural areas and slum and this is termed as social
injustice.
• Primary health care aims to redress this by shifting the centre of
gravity of health care system from cities to rural areas and bring
these services to as near the people’s homes as possible.
30

31. Community Participation
• The involvement of individuals, families, and communities in
promotion of their own health and welfare is an essential
ingredient of primary health care.
• The community must involve in the planning, implementation
and maintenance of health services besides maximum reliance
on local resources such as manpower, money and materials.
31

32. 32

33. Inter-sectoral coordination
(Multi-sectoral Approach)
• An important element of intersectoral coordination is planning, i.e.
planning with the other sectors to avoid unnecessary duplication of
activities.
• In order to achieve such cooperation, the administrative system of a
country has to be reviewed, their resources reallocation and suitable
legislation introduced to ensure that coordination can take place.
33

34. • The major reason for lack of success of many oral health
programs is the isolation separate from general health care
structure.
• Oral health could better be integrated into general health
programs by tackling common cause, by including oral health
in general health education.
• If oral health is to improve, more attention must be given to
policies and strategies that requires multisectoral co-operation
and action.
34

35. Appropriate Technology:
• Defined as technology that is scientifically sound, adaptable to
local needs and acceptable to those who apply to it and those
for whom it is used, and that can be maintained by the people
themselves in keeping with the principle of self reliance with
the resources the community and country can afford.
35

36. Focus on Prevention:
• Treatment of illness and rehabilitation are important since
communities rightly except treatment services and may be less
interested in other services unless accompanied by curative services.
• Health services should however not only be curative but should also
promote health and healthy lifestyle with emphasis on prevention.
36

37. Health care sectors in India:
37
Community
health center
Primary health
center
Sub-center
Village- level
Dai
168,418 (2019)
33,476 (2019)
5510 (2017)
https://data.gov.in/catalog/rural-
health-statistics-2017

38. Village Level Workers
Village health guides
Local Dias
Anganwadi workers
Accredited social
health activist (ASHA)
38

39. Village Health guide:
• Introduced on 2nd October 1977 under the integrated rural
Health Program with the nomenclature of Community Health
Workers (CHW). Two years later the name changed to
Commumity Health Volunteers in 1979. Once again in 1981
re-designed as Health Guide.
• The main objective was to provide preventive, promotive and
curative health services to people of the village through a
volunteer from the village itself.
• A village health guide is a person with an aptitude for social
service and is not a government functionary. 39

40. • They should be permanent resident of the local community.
• They should be able to read and write and have a minimum
formal education of at least upto VI standard.
• Be acceptable to all sections of the community.
• Be able to spare at least 2-3 hours every day for community
health work.
• Trainning:
• 200hrs in 3months
• Received Rs 200/month as a stipend.
40

41. • Duties:
• Treatment of simple ailments and activities in first aid.
• Mother and child health including family planning.
• Health education and sanitation.
• They do community health work of about -3 hr daily and get paid an
honorarium of Rs 50/month and durgs worth Rs600/annum.
• 1 village health Guide = 1 village/ 1000 rural population.
41

42. Local Dais:
• Under the Rural Health Scheme, extensive program was
undertaken to train all categories of local dais (Traditional
birth attendants) to Improve knowledge in elementary
concepts of maternal & child health & sterilization.
42

43. • Training:
• At PHC or Sub centre or MCH centre.
• For 2days in a week & rest 4 days accompanies Health Workers to
villages.
• Conduct at least 2deliveries under guidance of Health Workers.
• Dai is paid a stipend of Rs 300 during her Training.
• After training she is provided with a delivery kit & is entitled to
receive monetary compensation per delivery and for each infant
registered.
43

44. Anganwadi Workers:
• The Integrated Child Development Services Scheme (ICDS)
was started on 2nd October 1975.
• Anganwadi covers a population of 1000 in rural and urban
and 700 in tribal areas.
• Anganwadi is run by anganwadi worker who is selected from
the same community and is trained for 4 months.
• Training includes
• Health
• Nutrition
• Child development 44

45. • Anganwadi Workers is paid about Rs 1500 per month as
honorarium for services.
• Anganwadi helpers get about Rs 750/month.
• The work of an anganwadi worker is supervised by Mukhya
Sevikas who cover 20 – 25 anganwadis.
45

46. • Services are:
• Supplementary nutrition for children below 6 years and
pregnant & Lactating Mother.
• Immunization.
• Health Checkup.
• Referral services.
• Pre- school education for children aged 3 – 6 years.
• Nutrition and health education for women aged 15 – 45 years.
46

47. Accredited social health activist
(ASHA)
• ASHA must be resident of the village – a women
(married/widow/divorced).
• Must have formal education upto eight class.
• Having communication skill and leadership quality.
• Generally the norm of selection is 1 ASHA for 1000
population.
• In tribal or hilly areas 1 ASHA per habitation. 47

48. Role and Responsibilities of ASHA:
1. Creates awareness and provide information to community on
determinants of health such as nutrition, sanitation and hygiene
practices.
2. She will counsel women on birth preparedness, importance of safe
delivery, breast feeding, immunization, contraception and prevention
of common infection.
3. ASHA will mobilize the community and facilitates them in accessing
health and health related services available at the Anganwadi/sub-
centre / PHC.
4. She will work with the village health and sanitation committee of the
gram panchayat to develop a comprehensive village health program.
48

49. 5. She will arrange escort/accompany pregnant women and children
requiring treatment/admission to the nearest health facility.
6. ASHA will provide primary medical care for minor aliments such as
diarrohea, fever, DOTS, and first aid for minor injuries.
7. She will also act as depot holder for essential provisions like oral
rehydration therapy, iron and follic acid Tablets, disposable delivery
kits, oral pills etc.
49

50. 8. Graded training for providing newborn care and
management of childhood illnesses.
9. She will give information about birth and deaths
in her village and any unusual health problem/
disease outbreak in the community to sub-
centre/ PHC.
10. She will promote construction of household
toilets under total sanitation campaign.
50

51. Sub Centre Level:
• A sub-health centre is most peripheral and first contact point
between the primary health care system and the community
• .
• 1 sub-centre = 5000 population in plain Or 3000 in
hilly/tribal/desert areas.
• A sub-centre provides all the primary health care services like
Mother and Child Care, Family Planning and Immunization,
adolescent health care water quality monitoring, field visits
etc.
51

52. 52
https://data.gov.in/catalog/rural-health-statistics-2017

53. Staffing Pattern for a sub centre No.
Female Health Worker 1
Male Multipurpose Health Worker 1
Female Health Assistant
(Lady Health Visitor)
1
Voluntary worker to Assist ANM 1
53

54. Primary health Centres :
• Bhore Committee in 1946 gave Concept of ‘Primary Health
Centre’ as a “Basic Health unit” to provide integrated curative,
preventive & promotive activities in rural areas to the people
at their doorstep.
• 1PHC=30,000 rural population in plains, 20,000 in hilly, tribal
and backward areas.
54

55. 55
https://data.gov.in/catalog/rural-health-statistics-2017

56. • FUNCTIONS:
• Medical care
• MCH&FP
• Safe water supply& Basic sanitation
• Prevention & Control of locally endemic diseases
• Collection & Reporting of vital statistics
• Education about Health
• National health programmes
• Training of health guides, local dais etc
• Basic Laboratory services
• Selected surgical procedures 56

57. • Indian Public Health Standard (IPHS)for PHC
• Revised in 2012.
• The standard are prescribed are for a PHC covering 20000 –
30000 population with six beds, as all the block level PHCs are
ultimately upgraded as CHC with 30 beds of providing
specialized services.
57

58. • The objective of IPHS for PHC are:
1. To provide comprehensive primary health care to the community
through the Primary Health Centre.
2. To achieve and maintain an acceptable standard of quality of care.
3. To make the service more responsive and sensitive to the need of the
community.
From the delivery angle, PHC may be of two types:
Type A PHC = PHC with less than 20 deliveries/month.
Type B PHC = PHC with 20 or more deliveries/month.
58

59. Staffing Pattern for PHC No.
Medical Officer 1
Pharmacist 1
Nurse Midwife 1
Female Health Worker 1
Block Extension Educator 1
Male Health Assistant 1
Female Health Assistant 1
Upper Division Clerk 1
Lower Division Clerk 1
Laboratory Technician 1
Driver 1
Class IV Workers 1
59

60. STATUSOFPHC,CHCANDSUBCENTERS
60

61. 61

62. 62

63. 63

64. COMMUNITY HEALTH CENTERS :
• Each community Health Centre covering a population of
80000 – 1.20 lakh.
• CHC Have :
• - 30 beds
• Specialists in surgery.
• Medicine
• Obstetrics
• Gynaecology
• Paediatrics
• X-ray facilities 64

65. 65
https://data.gov.in/catalog/rural-health-statistics-2017

66. Functions of CHC
• Care of routine and emergency cases in surgery.
• Care of routine and emergency cases in Medicine.
• 24 hour delivery services including normal and assisted
deliveries.
• Full Range of family Planning services including laproscopic
services.
• New born care.
• Routine and emergency care of sick children.
66

67. Staffing Pattern of CHC No.
Block health Officer 1
General surgeon 1
Physician 1
Obstetrician/Gynaecologist 1
Pediatrician 1
Anesthetist 1
Public health Manager 1
Eye Surgeon 1 for ever 5 CHCs
Dental surgeon 1
General Duty Medical Officer 6
AYUSH Specialist 1
General duty medical officer of AYUSH 1
Staff Nurse 19
Public Health Nurse 1
Auxiliary Nurse Midwife 9
67

68. Staffing Pattern of CHC No.
Pharmacist 3
Pharmacist AYUSH 1
Laboratory Technician 3
Radiographer 2
Ophthalmic assistant 1
Dresser 2
Ward boys 5
Sweepers 5
Chowkidar 5
Dhobi 1
Mali 1
Ayah 5
Peon 2
OPD attendant 1
Data entry operator 2
68

69. References:
• PARK’S TEXTBOOK OF PREVENTIVE AND SOCIAL
MEDICINE 24TH EDITION.
• PINE CYNTHIA, TEXTBOOK OF COMMUNITY ORAL HEALTH,
REED EDUCATIONAL & PROFESSIONAL PUBLISHING LTD.
1997; 1ST EDITION: 10- 15.
• SOBEN PETER ESSENTIALS OF PUBLIC HEALTH
DENTISTRY 5TH EDITION
• https://data.gov.in/catalog/rural-health-statistics-2017
69

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