The student shall be able to 1. Classify the existing health care system in India 2. Explain primary health care delivery in India

1. Welcome to online class by the
Department of Community Medicine
All students can communicate with the facilitator in chat which is
being continuously monitored
Note:
1. All students will rename your devise with UNID & name which will be utilized for attendance
2. All students will mute your microphone and video till the class ends.
10-Jun-20 Occupational Diseases 1

2. Health care of the community –
Primary health care in India
Dr. Jayaramachandran S
Associate Professor
Department of Community Medicine
05.06.2020

3. The student shall be able to
• Classify the existing health care system in India
• Explain primary health care delivery in India

4. Health care systems
• Public health sector
• Private sector
• Indigenous system of medicine
• Voluntary health agencies
• National health programmes
1. Primary Health care
• PHC / SC
2. Hospitals / Health centres
• CHC
• Rural hospitals
• District hospitals
• Specialist hospitals
• Teaching hospitals
3. Health insurance schemes
• CGHS / ESI
4. Other agencies
• Defence / railway services
1. Private hospitals
2. Polyclinics
3. Nursing homes
4. Dispensaries
5. General practitioners &
Clinics
1. Ayurveda & Siddha
2. Unani & Tibbi
3. Homoeopathy
4. Unregistered
practitioners

5. Primary Health Care in India

6. Primary Health Care in India
Primary Health care approach
1978 : Alma Ata Conference – Health for All by 2000
3 tier system based on Shrivastav committee
1977 : Rural Health scheme – people’s health in people’s hand
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7. Primary Health Care in India
NRHM – NUHM – National Health Mission
2000 : National Population Policy
Five Year Plans – Planning commission – Niti Aayog
1983 : National Health Policy – 2017
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8. Primary Health Care in India
• The primary health care infrastructure has been developed as a
three-tier system.
• consists of Sub Centre, PHC and CHC based on the population
norms.
• Over 72 % of population of India lives in rural areas.

9. Primary Health Care in India
Village level
• ASHA
• AWW
• Trained dais
Sub-Centre
• Type A
• Type B
PHC
8 elements
of primary
health care
CHC
• upgraded /
block PHC
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10. At Village Level
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11. At Village level
A. ASHA scheme
B. ICDS scheme – Anganwadi Worker
C. Training of Local Dais

12. A. ASHA Scheme
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13. ASHA
• Accredited social health activist
• A women (married / widowed / divorced)
• 25 – 45 yrs / formal education - 8th class
• Communication / leadership skills
• 1 / 1000 population
• Hilly – 1 ASHA / habitat

14. ASHA – roles & responsibilities
• Create awareness – common health issues
• MCH care – birth preparedness / safe delivery / breast feeding
• Facilitate them to access health care for basic health care like
immunisation, AN check up, etc
• VHSC – village health & sanitation committee
• DOTS provider
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15. ASHA – roles & responsibilities
• Medical care for minor aliments
• Escort patients to health care provider
• Promote sanitation
• Inform births / deaths
• Construct toilets under total sanitation campaign
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16. Role & integration with AWW
• Organize health day 1-2/month
• AWWs & ANMs will act as resource person for training ASHA
• IEC activity
• AWW will issue the drug kits
• AWW will update the field registers with the help of ASHAs
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17. Role & integration with ANM
• ANMs will discuss the work done by the ASHAs every week
• ANMs will inform the time and date of outreach session
• ANM will guide in organizing health days
• Will utilize ASHAs to motivate the pregnant mothers
• ANMs will orient ASHAs on the dose / side effects of drugs like
OCPs, etc
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18. B. Anganwadi Worker (AWW)
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19. Anganwadi Worker (AWW)
• Integrated Child Development Services(ICDS), chosen by village
people.
• One AWW worker
– for 400-800 population in plain area
– 300-500 in tribal and difficult areas
• Undergoes training in health, nutrition and child development
• Part time worker: paid Rs. 1500 / month as honorarium
• Provide heath checkup
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20. AWW – roles & responsibilities
• Maintain growth chart
• Immunization
• Supplementary nutrition
• Health education
• Non-formal pre-school education
• Referral services
• Beneficiaries: under6, pregnant, adolescent, women (15-45)
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21. C. Local Dais
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22. Local Dais
• 1 dai / village
• Safe deliveries where no one is available (places where safe
delivery rate is < 30 %)
• All EAG states

23. Primary Health Care Infrastructure
Level
Population Size
Functionaries
Plain area
Tribal, hilly
desert areas
Village 1000
-Health volunteers or health guides (Female)
-Anganwadi workers
-Trained birth attendants
-Accredited Social Health Activist (ASHA)
Sub
Centre
5000 3000
Multipurpose health workers (Male and
Female)
PHC 30,000 20,000 Health professionals (Doctors)
CHC 120,000 80,000 Specialists

24. At Sub-centre Level
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25. Sub-centres (SC)
• It is community based first level of primary health care system
in rural area.
• It is maintained by one multipurpose health worker(female)
and one multipurpose worker(male), who are skilled
paramedical trained workers, having undergone one year(male
worker) and one year and a half training(female worker).
• 1 LHV & 1 HA (male) – will be entrusted for supervision of 6
sub-centre under 1 PHC

26. Sub-centres (SC)
• For every 5000 population in plain area
• 3000 in tribal, hilly and desert area.
• Promotive, preventive & curative services
• Site of service delivery:
– In the village : village health & nutrition day / immunisation sessions
– During house visits
– House to house surveys
– Meeting & events in the community
– At the facility for 1-2 hrs / day if 1 ANM or 6 hrs / day if 2 ANMs
1 SC

27. Services provided by Sub-centres (SC)
• MCH (ante/intra/postnatal)
• Family planning & contraception
• Counselling
• Adolescent health care
• Assistance
• Water quality monitoring
• Promotion of hygiene
• Field visits
• Community need assessment
• Curative services
• Training of TBA / ASHA
• Co-ordinate services of AWW /
ASHA
• Disease surveillance
• National health programs
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28. At primary health centre Level
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29. Primary Health Centre (PHC)
• The Bhore Committee gave the concept of a PHC as a basic
health unit, to provide, as close to the people as possible, an
integrated curative and preventive health care to the rural
population.
• The Bhore Committee aimed at having a health centre to serve
a population of 10,000 to 20,000 with 6 medical officers, 6
public health nurses and other supporting staff.

30. PHC
• Now, each PHC covers 30,000 population in plain rural area
and 20,000 in tribal , hilly, desert and difficult areas.
• These PHCs are established and maintained by the State
Governments.
• One PHC acts as a referral unit for 6 sub-centres.
• Each PHC has 4-6 indoor observation beds for patients, it has
operation theatre complex and a labour room.

31. Staffing Pattern in PHC
Category Existing Recommended
Medical officer 1 3 (at least 1 female)
AYUSH practitioner 0 1
Accounts Manager 0 1
Health Assistant Male 1 1
Health Assistant Female 1 1
Health Educator 1 1
Health worker female 1 1

32. Staffing Pattern of PHC
Category Existing Recommended
Nurse midwives(Staff nurses) 1 5
Pharmacists 1 2
Lab. Technician 1 2
Clerks 2 2
Driver 1 1
Class IV 4 4
Total Staffs 15 25

33. Functions of a PHC
1. Medical Care
2. MCH including Family Planning
3. Prevention and control of locally endemic diseases
4. Training of health guides, health workers, local dais and
health assistants
5. Arrange referral transport

34. Functions of a PHC
6. Safe water supply and basic sanitation
7. Collection and reporting of vital statistics
8. Education about health
9. National Health Programmes
10.Basic laboratory services

35. Functions of a PHC
• School and adolescent health
• Promotion of safe drinking water and basic sanitation
• Prevention and control of locally endemic diseases like Malaria,
Kala-Azar and Japanese Encephalitis.
• Integrated diseases surveillance and control of
epidemics/outbreaks
• Collecting and reporting of vital events.

36. Role of Medical officer of a PHC
• Medical Officer is the leader of health team at the PHC.
• He is responsible for planning, organizing, implementation,
coordination, monitoring and supervision of services at sub-
centres.
• Holding of staff meetings to get information and give
information to staff and also to solve their problems.
• Planning of work in sector meeting with AWWs and health
workers and their supervisions is also an essential function.

37. At Community health centre Level
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38. Community Health Centre(CHC)
• Was designed to provide referral as well as specialist care to the
rural population.
• A CHC is referral centre for four PHCs.
• A CHC is responsible for 1,20,000 population in plain and 80,000 in
tribal area.
• CHCs were established and maintained by the State Government.
• CHC is a 30 bedded hospital providing specialist care in Medicine,
Obstetrics and Gynecology, Surgery and Pediatrics.
• It has facility of labour room, operation theatre, X-ray and
laboratory.

39. Staffing pattern
• Each CHC is manned by six specialists namely- surgeon,
physician, obstetrician and gynecologist, pediatrician,
anesthetist and public health programme manager.
• One eye specialist has been provided for every 5 CHCs.
• The anesthetist and public health programme manager are
provided on contractual basis.
• The senior-most specialist will be designated as Block Health
Officer and made responsible for overall
administration/management of CHC.

40. Staffing pattern in a CHC
Category Existing As per IPHS(NRHM)2007
Medical specialists 4 6
Dental surgeon 0 1
Eye surgeon 0 1(for every 5 CHCs)
General Duty Medical Officer 0 6( with at lest 2 Lady MOs)
Specialist of AYUSH 0 1
GDMO of AYUSH 0 1
Nurse Midwives 7 19(Staff Nurses)
Public Health Nurse 1 1
ANM 1 1
Block Extension Educator 1 0

41. Category Existing Recommended
Pharmacist 1 0
Radiographer 1 2
Pharmacist AYUSH 0 1
Lab. Technician 1 3
Ophthalmic Assistant 0 1
Dressers 1 2
Accountant 1 1
Registration Clerks 0 2
Computer/Statistical Assist. 1 2
OT. Technician 0 1
Driver 1 1
Others 11 24

42. Functions of CHC
• Routine and emergency care in surgery, medicine, obstetrics and
gynecology, and pediatrics, in addition to services for the National
Health Programmes.
• To provide specialist services and referral services to four PHCs
area.
• 24 hour delivery services.
• Full range of family planning services.
• RTI/STI services and ICTC for HIV/AIDS.
• MTP services
• School health services/ Adolescent health.

43. Functions of CHC
• Referral transport services - round the clock
• Cold chain maintenance for vaccines.
• Designated microscopy centre for TB.
• Essential laboratory and X-ray services.
• In-patient services.
• Dental health services.

44. Functions of CHC
• Blood storage facility.
• Training and continuing education of health teams.
• Integrated disease surveillance and control of outbreaks.
• To elicit community participation.
• To enhance public private partnership.
• To organize behaviour change communication activities.
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45. First referral Unit (FRU)
• 24 hours delivery services
• Emergency obstetric care
• Newborn care
• Emergency care of sick children
• Full range of family planning services.
• MTP services
• Treatment of RTI/STI
• Blood storage facility
• Referral transport services
• Comprehensive Emergency Obstetric and Neonatal Care Centre

46. Think ….
How can community
health be improved in
India?
Thank you…

47. Next class on 11.09.2018
• Indian Public Health Standards
• Voluntary Health agencies in India
• Health insurance
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