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G I P E R , L I M B , S A T A R A
0 5 / 0 6 / 2 0 2 4 1
Prepared by_ Ms. S. R. Dalavi
Assistant professor
SOCIAL &
PREVENTIVE
PHARMACY GIPER, Limb, Satara.
Unit V
 Community Services In
Rural, Urban And School
Health
 Functions Of PHC,
05/06/2024 SOCIAL & PREVENTIVE PAHARMACY 2
COMMUNITY HEALTH
Community Services
In Rural,
Urban And
School Health
4
Community service is a non-payable job performed by one
person or group of people for the benefit of their community.
• To become active members of their community &
• Has a lasting, positive impact on society at large.
Community health- definition as per WHO
“Environmental, social & economic resources to sustain
emotional & physical well-being among people in ways that
advance their aspirations and satisfy their need in their unique
environment.”
COMMUNITY SERVICES
A healthcare center, health
center, or community health
center is one of a network of
clinics staffed by a group of
general practitioners and nurses
providing healthcare services
to people in a certain area.
C O N F E R E N C E P R E S E N T A T I O N 5
The purpose of the health care services is to
improve the health status of a population.
Indian Pharmaceutical Association
Community Pharmacy Division (IPA
CPD) aims to enhance the role of a
pharmacist and raise professional
standards of pharmacy practice through its
activities and aims to improve the public
health through community pharmacists’
services.
INTRODUCTION
Community Pharmacy
A healthcare facility that is
able to provide pharmacy
services to people in a local
area.
A community pharmacy
dispenses medicine, typically
involving a registered
pharmacist with the education,
skills and competence to
deliver professional service to
the community.
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Community Pharmacy Practice
Community pharmacists counsel patients,
Answer questions about prescription and over-the-counter drugs,
such as possible adverse reactions and interactions, and
Give patients health care advice.
They also give advice about durable medical equipment,
Home care and preventive care.
Some community pharmacists offer disease management services
for conditions such as diabetes, asthma, hypertension, etc.
Some community pharmacists offer preventive health programs:
smoking cessation, immunizations, screening for lipid disorders,
etc.
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PROBLEMS IN INDIA
POPULATION
Food scarcity
Maternal illness
Illiteracy
MALNUTRITION
60% Children- Undernutrition
Overnutrition
Protein-energy malnutrition
LACK OF
ENVIRONMENTAL
SANITATION
Excreta disposal
Non-availability of safe
drinking water
HIGH PREVALENCE OF
COMMUNICABLE DISEASES
LACK OF MEDICAL CARE
FACILITIES
8
Communicable diseases Detection, diagnosis & treatment of illness
Prevention of diseases
Improving quality of life
Increasing life expectancy,
9
•Curative
•Basic sanitation, housing
•Prevention of diseases
 COMPREHENSIVE HEALTH CARE
(1946) “integrated promotive, curative &
preventive health services from womb to
tomb”
Criteria for comprehensive health care:
1. Service given at the doorstep of the
community
2. Community participation
3. Available to one & all without considering
their ability to pay
4. Vulnerable & weaker sections are given
preference
5. At family & working place creation of
healthy environment
Health care services
Should reach entire country
with more focus on rural areas.
CONCEPTS OF HEALTH CARE:
A) Comprehensive health care (1946)
B) Basic health care (1965)
C) Total health care (all required health care)
D) Integrated health care (curative +
preventive)
E) Primary health care (First contact care)
• 1. Comprehensive.
• 2. Accessible.
• 3. Acceptable.
• 4.Provide scope for
community participation.
• 5. Available at a cost the country
& community can afford.
1 0
CHARACTERISTICS OF A GOOD HEALTH SERVICE
1 1
• In India it is represented by five major sectors or agencies which
differ from each other by the health technology applied & by the
source of funds for operation.
AGENCIES OF HEALTH CARE
1. PUBLIC HEALTH SECTOR.
2. PRIVATE SECTOR.
3. INDIGENOUS SYSTEM OF MEDICINE.
4. VOLUNTARY HEALTH AGENCIES.
5. NATIONAL HEALTH PROGRAMMES
1 2
1. PRIMARY HEALTH CARE :
A. Primary Health
Centers
B. Sub Centers.
2. Hospitals & Health Centers
A. Community Health Centers.
B. Rural Hospitals.
C. District Hospitals / Health
Centre.
D. Specialist Hospitals.
E. Teaching Hospitals
I. Public Health Sector
3. HEALTH INSURANCE SCHEMES
A. Employees State Insurance.
B. Central Govt. Health
Scheme
4 . OTHER AGENCIES
A. Defense medical
Services.
B. Railways
1 3
A. Private Hospitals, Polyclinics,
Nursing Homes & Dispensaries.
B. General Practitioners & Clinics
II. Private Health Sector
III. Indigenous system of medicine
IV. Voluntary Health
Agencies
NGOs/ social groups
V. National Health
Program
A. Ayurveda (Herbal) & Siddha (Plants &
minerals).
B. Unani & Tibbi_ Perso-Arabic traditional medicine
C. Homeopathy_ Pseudoscientific system of alternative
medicine
D. Unregistered Practitioners
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1 5
o Community Development Programmes (NRHM, midday meals,
women and child welfare, family welfare programmes, etc.,) can be
launched to the village with the voluntary groups which will ensure a
standard of living for the maintenance of the health.
oDais (village health guides) and village guides (Area Nurse or
ANM) can be trained adequately and their services can be utilized.
o Such workers can influence people very easily and deliver
fundamental health services.
o Such health workers can reach the last man of the village often and
deliver health services.
1 6
Community Health Center
(First Referral Unit)
Each CHC covers 1,20,000 population
(plains)
 80,000- hilly/ tribal region.
Total= 3222 CHCs in country.
Covers about 3 to 4 PHCs.
30 beds; x-ray & lab facilities.
Specialist in medicine, surgery &
pediatrics.
•To establish effective
convergence and linkages with
citizen centric services,
•A CHC should be established at
the community development
block/taluka/tehsil/circle level.
•This will also supplement the
three-tier panchayati system (gram
panchayat, block panchayat and
zila panchayat).
Staff for Community Health Centre
1 8
PRIMARY HEALTH CARE IN INDIA
• In 1977 the Govt of India launched a Rural Health Scheme, based on the principles
of “placing people’s health in people's hand".
• It is a three tier system of health care delivery in rural areas based on the
recommendation of the Srivatsav Committee(1975).
• Close on the heels of these recommendations an International Conference at Alma
Ata (1978), set the goal of an acceptable level of Health For All the people of the
world by the year 2000 through Primary health care approach
• As a signatory to the Alma Ata Declaration, the govt of India was committed to
achieving the goal of Health for All through primary health care approach which
seeks to provide universal comprehensive health care at a cost which is affordable.
• Keeping view the WHO goal of “Health For All” by 2000 AD, the govt of India
evolved a National Health Policy based on primary health care approach.
• National Health Policy 2000, 2002 & National Rural Health Mission have been
recently introduced.
Declaration of Alma-Ata
International Conference on Primary Health Care, Alma-Ata, USSR, 6-12
September 1978
The International Conference on Primary Health Care, meeting in Alma-Ata this 12 Sept 978,
expressing the need for urgent action by all governments, all health and development workers, and
the world community to protect and promote the health of all the people of the world.
Primary health care:
1. Reflects and evolves from the economic conditions and sociocultural and political characteristics
of the country and its communities and is based on the application of the relevant results of
social, biomedical and health services research and public health experience;
2. Addresses the main health problems in the community, providing promotive, preventive,
curative and rehabilitative services accordingly;
3. Includes at least: education concerning prevailing health problems and the 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 the major infectious diseases; prevention and control of locally
endemic diseases; appropriate treatment of common diseases and injuries; and provision of
essential drugs;
4. 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, housing, public works, communications and other sectors; and demands the
coordinated efforts of all those sectors;
5. Requires and promotes maximum community and individual self-reliance and
participation in the planning, organization, operation and control of 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;
6. Should be sustained by integrated, functional and mutually supportive referral systems,
leading to the progressive improvement of comprehensive health care for all, and giving
priority to those most in need;
7. Relies, at local and referral levels, on health workers, including physicians, nurses,
midwives, auxiliaries and community workers as applicable, as well as traditional
practitioners as needed, suitably trained socially and technically to work as a health team
and to respond to the expressed health needs of the community.
C O N F E R E N C E P R E S E N T A T I O N 2 1
Primary health center
It is an outcome of Bhore committee report.
538 in Maharashtra. Total 24,855 PHCs in country.
It covers about 5 subcentres.
2 3
1.To provide comprehensive primary health care to
community through PHCs.
2.To achieve & maintain an acceptable standard of
quality of care.
3.To make the healthcare services more responsive
& sensitive to the needs of the community.
OBJECTIVES OF INDIAN PUBLIC HEALTH
STANDARDS FOR PHCs:
2 4
FUNCTIONS OF PHC
1. Medical care
2. Reproductive & child health care
3. Family welfare planning
4. Water supply & sanitation
5. Control of communicable diseases
6. Collection of vital statistics
7. Health education
8. Carry out national health programmes
9. Referral services
10.Training of auxiliary staff like HA, HW, health guides & local dais.
11.Basic laboratory services
12.Provision of essential drugs for PHC
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It is an outpost attached to PHC covering a population
of 5000. Total= 1,50,000 subcentres.
• MPW (M)- 1
• MPW (F)- 1 Health assistant female supervises activity of
MPW (F)
• Voluntary health guide- 1
SUB-CENTER
Community pharmacy- Social and preventive pharmacy UNIT 5
• To implement this policy at the
village level, the following
schemes are in operation.
1. Village Health Guide Scheme.
2. Training of Local Dias.
3. ICDS Scheme.
4. Asha Scheme
Community Health Guide
(VILLAGE LEVEL)- literate volunteer
Primary health care is universal
coverage & equitable distribution
of health resources.
I VILLAGE HEALTH GUIDES
• They act as a link between PHC & Public.
• A Village Health Guide is a person with an aptitude for social service & is not a full
time government functionary.
• The Village Health Guide Scheme was introduces on 2 Oct 1977.
• It provide the first contact between the individual & the health system.
TRAINING
The guidelines for their selection are :
1. Permanent local residents; preferable women.
2. Able to read & write, having minimum formal education at least 6th standard.
3. They should be acceptable to all sections of the society.
4. They should be able to spare at least 2 to 3 hrs every day for community health
work.
 After selection, the Health Guides undergo a short training in primary health care.
 The training is arranges in the nearest PHC, SC for 200 hrs, spread over for a period
of 3 months.
 During the training period they receive a stipend of Rs. 200 per month.
 On completion of their training, they receive a working manual & a kit.
 At present there are 3,24,000 CHG & the national target is to achieve 1 VHG for each
village or 1000 rural population
• Most deliveries in rural are handled by
untrained dais.
II DAIS (Traditional Birth Attendants)
• An extensive programme has been to undertaken under the
Rural Health Scheme, to train all categories of local dais in
the country to develop their knowledge in the elementary
concepts of maternal & child health & sterilization, besides
obstetric skills.
• The training is for 30 working days (1 month).
• Each Dai is paid a stipend of Rs. 300 during her training
period.
• Training is given at the PHC, Sub-centre or Maternal &
Child Health centre for 2 days in a week & on the
remaining 4 days of the week they accompany the Health
Worker to the villages preferably in the dai’s own area.
• During her training each dai is required to conduct at least 2 deliveries under the
guidance & supervision of the HW (F), ANM (Auxiliary nurse midwife) or HA(F).
• The emphasis during training is on asepsis so that home deliveries are conducted
under safe hygienic conditions thereby reducing the maternal & infant mortality.
• After successful completion of training, each dai is provided with a delivery kit
& a certificate.
• These dais are also expected to play a vital role in propagating small family norm
since they are more acceptable to the community.
• The national target is to train one local Dai in each village.
• She undergoes a training in various aspects of health, nutrition & child development
for 4 months.
• She is a part time worker & is paid an honorarium of Rs 1500 per month for the
service rendered, which include health checkups chart, immunization, supplementary
nutrition, health education, non formal pre school education & referral services.
10 rs. for every registered case of pregnancy
3 rs. for every registered infant.
Total trained dais are about 7,00,000 in India.
Each trained Traditional Birth Attendants covers 1000 population.
III. ANGANWADI WORKER
• Under Integrated Child Development
Services (ICDS) scheme, there is
anganwadi worker for a population of
1000.
• There are about 100 such workers in each
ICDS project.
• An anganwadi worker is selected from the
community she is expected to serve
• The beneficiaries are especially nursing
mothers, pregnant women, other women
(15 -45 yrs), children below the age of 6
yrs & adolescent girls.
• Anganwadi workers are the primary link
with the health services & all other services
for young children.
IV. ASHA
• Recognizing the importance of health in the process
of economic & social development & to improve
the quality of life of the citizens, the govt of India
launched “NATIONAL RURAL HEALTH
MISSION” (NRHM) on 5 April 2005.
• The main aim of NRHM is to provide accessible,
affordable, accountable, effective & reliable
primary health care through creation of a cadre of
Accredited Social Health Activist (ASHA).
• ASHA must be a resident of the village.
• A women
(married/widow/divorced) preferably in the age group of 25-45 years with a
formal education upto 8 class
The general norm for selection of ASHA is 1 ASHA/1000 population.
• ASHA will take steps to create awareness & provide information to
the community on
determinants of health, information on existing health services, & the need for
timely utilization of health & family welfare services.
She will counsel women on birth preparedness, importance of safe delivery,
breast feeding & complementary feeding, immunization, contraception &
prevention of common infections including STD/RTI sexually transmitted
Diseases; RTI, reproductive tract infection & care of a young child.
• ASHA will provide primary medical care for minor ailments such as diarrhoea,
fevers & first aid for minor injuries etc.
• She will also act as a depot holder for essential provisions being made available to
every habitation like ORS kit, IFA (Iron folic acid) tab, disposable delivery kit, etc.
• She will inform about the births & deaths in her village, any unusual health
problems in the community to the PHC.
• She will promote the construction of household toilets under total sanitation
campaign.
FUNCTIONS
Panchayat system
The villagers managed their own affairs
through the traditional institution of Panchayat.
With the attainment of freedom now fresh
efforts are being made to strengthen the
Panchayat system and made Panchayat play a
better part in the work of national
reconstruction.
The 73rd Amendment Act, 1993 has led the
foundation of strong and vibrant Panchayat Raj
institution in the country.
3 7
Reason for declining
panchayat raj
1. The coming Zamindari
system
2. Establishment of police and
judicial courts
3. Industrial development and
consequent shifting of rural
population to cities
4. The impact of materialistic
and individualistic
tendencies.
Functions of Panchayat
Construction of village roads and provide for street lights. Extension of health
services.
Look after the property of the Panchayat.
Maintain records of vital statistics, such as birth and death. Organize mela,
exhibition, film shows etc.,
To provide facilities for primary and adult education. Development of agriculture.
Providing facilities for safe drinking water.
Make provision for better quality manure and seeds. Prevention of communicable
diseases.
Maternal and child welfare.
Sanitation of the village.
Through the Panchayat System medical camps can be organized for the early
diagnosis and treatment of the disease
3 8
RURAL HEALTH IN INDIA
• India is in limelight at global front not only in terms of population
burst but also in its health scenario. Even after celebrating its 70 years
of independence, its population is still under the threat of degraded
health system.
• There are approximately 85% of the populations who are still fighting
for basic healthcare services in their area. This situation has been
promoted by worsening living condition of rural habitats.
• The unhygienic and unhealthy conditions of household, unsafe
drinking water, open defecation, magnify expansion of several
diseases in these areas.
• The scenario gets worse through the superstition practiced by ruralites.
The blind faith of tribal that any disease may be cured by magic has
subjugated the minds of rural population of India. Due to this kind of
impression, the rural areas are under the influence of various malpractices
which ultimately seal off the progress of modern pathology here.
• Inadequate human resources in health care system. The health
institutions like Primary Health Centre (PHC), Sub- Centre (SC), and
Community Health Centre (CHC) are facing huge problem because health
professionals are absent. Doctors don’t want to work in rural areas either
because of infrastructure inadequacy or lack of incentives.
• The condition get intensify with not or little qualified practitioner, minimal
amount of expenditure on public healthcare which counts to be 17.9% of
total expenditure.
• About 37% of our under-five children are underweight, 39% are
stunted (height for age), 21% are wasted (weight for height ) and
8% are severely-acutely malnourished, adds the joint study.
• The prevalence of underweight children was higher (38%) in
rural areas compared to urban cities (29%). Only about 10%
children under the age 6-23 months were reported to receive an
adequate diet.
Challenges for Rural Health System in
India-
An Overview
• The poor state of health system in rural areas is a result of
consolidated outgrowth of degraded system. It explains not only
the distance between the existing policy and infrastructure but
obstruction in development too.
• The expenditure on public health system has not only been
ignored by the state but also by the common mass.
• People mostly prefer private practitioners and private
hospitals over government run hospitals.
• Therefore, it is very essential for us to review primary elements
for degradation of Public health system in India.
Challenges for Rural Health
System in India-
• Inadequate human resources
• Inefficacious infrastructure
• Inclination towards Home Based
Deliveries
• Lack of coordination between Medical
Research and Health Service delivery
Institutions
• High Infant Mortality
• Non-preparedness to fight with
Epidemic in rural areas
• Unresponsive attitude of medical
professionals
• Dominance of unregulated Private
medical professionals
Remedies in Rural Health System
• According to the defined norms by the WHO,
the existing infrastructural setup for providing
healthcare in India is far less in terms of required
qualitative and quantitative availability.
• Still, the notion follow up here is ‘something is
better than nothing’.
• There have been various steps taken by
government to improve the health scenario in
rural areas.
• Several strategies and missions have been
initiated for institutionalizing the prevailing rural
health framework to uplift the health standard of
common mass.
National Rural Health Mission (NRHM)
National Rural Health Mission (NRHM) has been one of the central
achievement in the field of rural healthcare. It was first initiated in the
year 2005.
Objective to deal with the problems and weakness across primary
healthcare and enhance the status and system of rural area.
It provides effective, accessible, accountable, inexpensive and reliable
healthcare to the mass and in particular to those sections who are more
poor, vulnerable and prone to health disease.
Healthy Village | Healthy People | Healthy Nation
NRHM seeks to provide equitable,
affordable and quality health care to the
rural population, especially the
vulnerable groups.
Thrust of the mission is on establishing
a fully functional, community owned,
decentralized health delivery system
with inter- sectoral union at all levels,
to ensure simultaneous action on a wide
range of determinants of health such as
water, sanitation, education, nutrition,
social and gender equality.
1. Maternal healthcare- antenatal care, intranatal care & postnatal care
2. Child healthcare- breast feeding, immunization
3. Family planning & contraception
4. Safe abortion services-medical termination of pregnancy, follow up
5. Curative services- minor ailments
6. Adolescent healthcare-education, councelling, prevention & treatment
7. Assistance to school health services
8. Water quality monitoring
9. Promotion of sanitation- use of toilet, waste disposal
46
SUB-CENTERS Services-
12.Field visits by health workers
13.Community needs assessment
14.Control & repairing of endemic diseases- malaria, JE, dengue.
15.Training of traditional birth attendants/ASHA/CHVs.
16.Coordinate services of AWW, ASHA, village health sanitation &
nutrition committee.
17. implementation of national health programs-NACP, IDSP,
NLEP
47
SUB-CENTERS Services-
1. Medical care-OPD services, 24hrs emergency services
2. Maternal & child healthcare including family planning- antenatal care,
intranatal care & postnatal care, newborn care, care of the child, family
welfare
3. Medical termination of pregnancy- safe abortion, using manual vacuum
aspiration (2nd trimester)
4. Management of reproductive tract infections/ sexually transmitted infections-
health education & treatment
5. Nutrition services
6. School health services
7. Adolscent healthcare
8. Disease surveillance & control- endemic diseases
48
PHCs Services-
9. Collection & reporting of vital events
10. Promotion of safe drinking water & sanitation
11. Testing of water quality & disinfection of water sources
12. Participation in national health programmes
13. Referral services
14. Basic laboratory & diagnostic services
15. Record of vital statistics
16. Health workers training
17. Skill-based training to ASHAs.
18. Initial & periodic training of doctors/paramedics
19. Mainstreaming of AYUSH-based preventive, promotive & curative healthcare
49
PHCs Services-
Pradhan Mantri Matritva Vandana Yojana (PMMVY)
• PMMVY, previously known as Indira Gandhi Matritva
Sahyog Yojna (IGMSY), introduced in the year 2010, is a
maternity program run by the government of India.
• Objective to encourage women to follow Infant and Young
Child Feeding (IYCF) practices including early and
exclusive breast feeding for first six months.
• It is a conditional cash transfer scheme which is
implemented through the State for pregnant and lactating
women of 19 years of age or above for first two live births,
from the Ministry of Women and Child Development.
Janani Suraksha Yojana (JSY)
Janani Suraksha Yojana is a flagship program launched in year 2005
under the National Rural Health Mission (NRHM) of Government
of India modifying the National Maternity Benefit Scheme (NMBS).
It is intended to promote institutional delivery to reduce
maternal and neo-natal mortality.
It provide cash incentives to the women for delivering their child in
government or other private medical facility over home-based
deliveries.
Health Insurance through Rashtriya Swasthya Bima
Yojana (RSBY)
Rashtriya Swasthya Bima Yojana (RSBY) is one of the important
schemes in the area of rural health.
It was launched in the year 2008, which was earlier designed to
target only the Below Poverty Line (BPL) households, but has been
expanded to cover other defined categories of unorganized workers.
Its objective is to provide financial aid for household affected by
major health shocks and improve health outcomes.
Swachh Bharat Abhiyan (SBA)
Swachh Bharat Abhiyan or Clean India Mission is a campaign in
India initiated in the year 2014,
Whose objective is to eliminate open defecation through the
construction of household-owned and community owned toilets.
Still in many parts of rural India open defecation is practice which
cause the most common life taking diseases like diarrhea, typhoid,
hepatitis, intestinal worm infections, cholera, etc.
Employment and food in
rural areas to BPL
Good road connectivity Rural development
programme
Continuous power supply
Storage capacity with
facilities to help farmers
Assistance and subsidies to the
villagers for building their houses
LEVELS
OF
HEALTHCARE
Health infrastructure in the
municipalities is divided in four
categories viz.
1. Hospitals, health centres and
sub-centres supported by the
State Health Department.
2. Facilities owned by the other
government departments,
3. Municipality controlled facilities
and
4. Private sector facilities.
Key strategies
•Universal coverage – the entire urban population
including both APL and BPL (Above/Below
Poverty Line) to be covered, while keeping the
focus on BPL.
•™
Strengthening service delivery through a uniform
3-tier service delivery model.
•Strengthening institutional arrangements and
inter departmental union.
•Strengthening monitoring and evaluation.
Urbanization and its impact on
health and health practices
The common diseases among the slum dwellers
are:
Fever, Skin infections, Eye infections,
Malnutrition, Viral infections, Chronic toxicity,
STD (Sexual Transmitted Diseases), Accidents,
Drug abuse, Alcoholism, Crime, Delinquency,
Suicide, prostitution etc.,
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Causes for diseases
Industrial pollution
Over-crowding
Poor hygienic
practices
Food and water
contamination
5 8
1. Encourage local agricultural-based industry
2. Planning of road, office, residence to reduce
traffic
3. Development of green belt, park, trees
4. Plans to reduce pollution
5. Encourage use of biodegradable material for
package.
6. Library & recreation centers in residential
areas
7. Improvement of slum condition
8. Health awareness on habit & lifestyle
Services/welfare actions on urban area:
9. Community participation
10. Urban law implementation
11. Healthy management of urban
wastes.
5 9
1. Theme broadcast in AIR/TV
2. Future articles for good message
3. Exhibitions & display on urban problem
4. Use of folk media for awareness
5. Cultural programmes imbibing urban message
6. Competitions on city improvement activities
Suggested education activity for urban
society
60
1. Slum improvement projects. Agency (ODA) Overseas
Development Administration assisted effort & (UCD)
Urban Community Development efforts- pilot project.
2. World bank assisted Indian population projects (Mumbai,
Chennai, Kolkata, Delhi, Bangalore, Hyderabad)
3. Environmental Improvement Of Urban Slums (EIUS)
4. Urban Basic Services For Poor (UBSP)
SERVICE ON URBAN SLUM AREAS
slum clearance to slum improvement programme
Community pharmacy- Social and preventive pharmacy UNIT 5
WATER SUPPLY AND SANITATION IN
INDIA
➢Drinking water supply and sanitation facilities are very important and
crucial for achieving the goal of “HEALTH FOR ALL”.
➢According to WHO, “poor sanitation and inadequate sewage disposal
the nation’s biggest public health problems.”
➢Approximately 60-70% of untreated sewage is discharged directly into
rivers and streams, the main source water supply in cities.
➢ WATER SUPPLY CONTINUITY
• According to INDIAN NORMS, access to
improved water supply exists if at least 40
liter/ capita / day of safe drinking water are
provided within a distance of 1.6km or 100
meter of elevation difference, to be relaxed as
per field conditions.
• There should be at least one pump per 250
persons.
SERVICE QUALITY
➢ SANITATION
In 2010, the UN estimated based on India statistics that 626 million people practice
open defecation.
In June 2012, minister of rural development JAIRAM RAMESH stated India is the
words largests “ open air toilet.” Of the 2.5 Billion people in the world that defecate
openly in India.
➢ ENVIRONMENT
As of 2003, it was estimated that only 27% of India’s waste water was being treated,
with the remainder flowing into rivers, canals, ground water or the sea.
➢ The lack of adequate sanitation and safe water has significant negative health
impacts including diarrhea, chronic diseases, respiratory problems, skin disorders,
allergies, headaches and eye infections.
RESPONSIBILTY FOR WATER SUPPLY AND SANITATION
➢ Water supply and sanitation is a state responsibility under the INDIAN
CONSTITUTION.
➢ State may give the responsibility to the Panchayati Raj Institutions (PRI) in rural
areas.
➢ In urban areas, - municipalities, called Urban Local Bodies (ULB).
The responsibility for water supply and sanitation at the central and state level is
shared by various ministries.
At the central level three ministries have responsibilities in the sector.
1) The Ministry Of Drinking Water And Sanitation
2) The Ministry Of Housing And Urban Poverty Alleviation
3) The Ministry Of Urban Development.
POLICY AND REGULATION
ROLE OF GOVERNMENT - INDIA
➢1954 – National Water Supply And Sanitation Programme
➢1972 – ARWSP (Accelerated Rural Water Supply Programme)
➢1981 – International Drinking Water Supply And Sanitation
Programme
➢2002 – Swajaldhara
➢2008 – National Urban Sanitation Policy
NATIONAL WATER SUPPLY AND SANITATION
PROGRAMME
➢ It was initiated in 1954.
➢ Objective :
To providing safe water supply and adequate drainage facilities for the entire
urban and rural population of the country.
➢ Targets :
a) 100% urban and rural water supply.
b) 50% urban sanitation.
c) 25% rural sanitation.
ARWSP (ACCELERATED RURAL WATER
SUPPLY PROGRAMME)
➢ In 1972, a special programme known as “ARWSP” was started as supplement to the
national water supply and sanitation programme.
➢ The central government supports the efforts of the states in identifying problem
villages through assistance under ARWSP.
➢ A ‘Problem village’ has been defined as one where no source of safe water is
available within a distance of 1.6 km / 15 m deep, or where source has excess salinity
iron, fluorides & other toxic elements, or where water is exposed to the risk of
cholera.
SWAJALDHARA
➢It was launched in 25th Dec 2002. It has certain reform principles
needed to be adhered by the states governments.
which
➢ AIM -To provide safe drinking water in rural areas, with full ownership of the
community, building awareness among the village community on the
management of drinking water projects, including better hygiene practices
and encouraging water conservation practices along with rainwater
harvesting.
➢ Swajaldhara has two components :
1. Swajaldhara 1 (first dhara) : is for gram panchayat or a group of panchayat (at
block / tehsil level).
2. Swajaldhara 2 (second dhara) : has district as the project area.
ACTIVITIES
➢Plan, implement, operate, maintain and manage all water supply
and sanitation programme.
➢Conservation measures :
A. Rain water harvesting
B. Ground water recharge system
NATIONAL URBAN SANITATION POLICY
➢In November 2008 , the government of India launched a
National Urban Sanitation policy.
➢GOAL:- The main goal of this policy is creating “ totally
sanitized cities” that are
- to treat all waste water
- to make free from open defecation
- to collect and dispose solid waste safety.
School Health Services
School health is an imp aspect of any community health program.
Its basic aim is to provide a comprehensive health care program for children
of school going age (5 to 14 yr).
General prevalence of morbidity:
STATISTICS
 40% students: healthy/ free from defects
24% school children: had disease/ defect
11 % children have such defects had to be referred to a specialist.
Dental ailments 70-90%
Malnutrition 40-75%
Worm infections 20-40%
Skin diseases 10%
Eye diseases 4-8%
Pulmonary TB 4-5%
MILESTONES
1909
First school medical
examination at Baroda
city
1953
Secondary education committee
emphasizes need of examination &
school feeding.
1961
Submitted report;
inadequate inputs.
GOI constituted a task force
“Intensive School Health
Services”
1946
Health survey & development
committee (Bhore committee)
SCHOOL HEALTH SERVICES
practically nonexisted
1960
GOI constituted SCHOOL
HEALTH COMMITTEE
To access stds of health &
nutrition of school children &
suggestive ways for health 7 3
JAN 1982
Task force submitted report
14/22 states made efforts to
establish school health
program (own budget)
Checked PHCs 1337/3614.
2002
2007
Formal document has been
prepared & is waiting for
clearance which include
widened version of school
health care
1997 TO
9th five year plan expected
the progress of school
health care.
2003 TO
74
S
S
7 5
1. Early detection and care of students with health
problems
2. Development of healthy attitudes and healthy
behaviours by students
3. Ensure a healthy environment for children at school
4. Prevention of communicable diseases at school
OBJECTIVES OF SCHOOL HEALTH SERVICES
In School Health Services are occupied:
• Paediatricians and General Practitioners working in the Primary
Health Care
• Health Visitors partially or fully occupied in this service
The main activities of the School Health Service are:
1. Screening Tests
2. Prevention and investigation of Communicable Diseases
3. Vaccination
Community pharmacy- Social and preventive pharmacy UNIT 5
Community pharmacy- Social and preventive pharmacy UNIT 5
School Health Program
Objectives:
•Health consciousness among school children
•Providing health instructions in a healthy environment
•Prevention of disease: early detection, treatment & follow-up of defects
•Promotion of positive health
•Recognizing the child as a “change –agent” in the family.
Components:
1. Health education
2. Healthy environment
3. Health service
Health
Education
Healthy
Environment
Health Care
•Health promotion-
Exercise, nutrition & personal
hygiene.
•Health protection-
Nutrition, immunization,
guidelines.
•Curative services-
Health cards, prompt
treatment of defects, follow
up & referral for special
problems.
•Medical check-ups
(periodic- twice a year)
•Treatments
•Location- Quite place
•Structure- Heat resistant
•Water supply- potable
•Drainage
•Urinals- 1 per 60 students
• latrines- 1 per 100 students
•Waste management
•Ventilation- window: 20%
of floor area
•Playground
•Health lessons
oInsisting high stds of
cleanliness in schools
oImproving water supplies &
latrines; habits for their
proper use.
o healthy practical diets in
school lunch program
oDemonstrating personal
hygiene
•Visits
Observe Community health
services
•Safety education
•Sex education
8 1
Mid-day school meal & other
nutritional service
I. Development of school garden
II. Special nutrients for dental caries, goiter, night blindness,
anemia
III. Mid-day school meal
• It is a supplement
• Provides 1/3rd of energy (daily req.)
• Affordable &
• Simple cooking in acceptable form
IV. Balahar
70% wheat,
25% defatted groundnut meal &
5% skim milk (fat-free milk)
Menu per child per day
Cereal & millet 75 gm
Pulses 30 gm
Oil 8 gm
Leafy vegetables 30 gm
Nonleafy vegetables 30 gm

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Community pharmacy- Social and preventive pharmacy UNIT 5

  • 1. G I P E R , L I M B , S A T A R A 0 5 / 0 6 / 2 0 2 4 1 Prepared by_ Ms. S. R. Dalavi Assistant professor SOCIAL & PREVENTIVE PHARMACY GIPER, Limb, Satara.
  • 2. Unit V  Community Services In Rural, Urban And School Health  Functions Of PHC, 05/06/2024 SOCIAL & PREVENTIVE PAHARMACY 2
  • 3. COMMUNITY HEALTH Community Services In Rural, Urban And School Health
  • 4. 4 Community service is a non-payable job performed by one person or group of people for the benefit of their community. • To become active members of their community & • Has a lasting, positive impact on society at large. Community health- definition as per WHO “Environmental, social & economic resources to sustain emotional & physical well-being among people in ways that advance their aspirations and satisfy their need in their unique environment.”
  • 5. COMMUNITY SERVICES A healthcare center, health center, or community health center is one of a network of clinics staffed by a group of general practitioners and nurses providing healthcare services to people in a certain area. C O N F E R E N C E P R E S E N T A T I O N 5 The purpose of the health care services is to improve the health status of a population. Indian Pharmaceutical Association Community Pharmacy Division (IPA CPD) aims to enhance the role of a pharmacist and raise professional standards of pharmacy practice through its activities and aims to improve the public health through community pharmacists’ services.
  • 6. INTRODUCTION Community Pharmacy A healthcare facility that is able to provide pharmacy services to people in a local area. A community pharmacy dispenses medicine, typically involving a registered pharmacist with the education, skills and competence to deliver professional service to the community. 8 / 0 5 / 2 0 X X 6
  • 7. Community Pharmacy Practice Community pharmacists counsel patients, Answer questions about prescription and over-the-counter drugs, such as possible adverse reactions and interactions, and Give patients health care advice. They also give advice about durable medical equipment, Home care and preventive care. Some community pharmacists offer disease management services for conditions such as diabetes, asthma, hypertension, etc. Some community pharmacists offer preventive health programs: smoking cessation, immunizations, screening for lipid disorders, etc. 8 / 0 5 / 2 0 X X 7
  • 8. PROBLEMS IN INDIA POPULATION Food scarcity Maternal illness Illiteracy MALNUTRITION 60% Children- Undernutrition Overnutrition Protein-energy malnutrition LACK OF ENVIRONMENTAL SANITATION Excreta disposal Non-availability of safe drinking water HIGH PREVALENCE OF COMMUNICABLE DISEASES LACK OF MEDICAL CARE FACILITIES 8 Communicable diseases Detection, diagnosis & treatment of illness Prevention of diseases Improving quality of life Increasing life expectancy,
  • 9. 9 •Curative •Basic sanitation, housing •Prevention of diseases  COMPREHENSIVE HEALTH CARE (1946) “integrated promotive, curative & preventive health services from womb to tomb” Criteria for comprehensive health care: 1. Service given at the doorstep of the community 2. Community participation 3. Available to one & all without considering their ability to pay 4. Vulnerable & weaker sections are given preference 5. At family & working place creation of healthy environment Health care services Should reach entire country with more focus on rural areas. CONCEPTS OF HEALTH CARE: A) Comprehensive health care (1946) B) Basic health care (1965) C) Total health care (all required health care) D) Integrated health care (curative + preventive) E) Primary health care (First contact care)
  • 10. • 1. Comprehensive. • 2. Accessible. • 3. Acceptable. • 4.Provide scope for community participation. • 5. Available at a cost the country & community can afford. 1 0 CHARACTERISTICS OF A GOOD HEALTH SERVICE
  • 11. 1 1 • In India it is represented by five major sectors or agencies which differ from each other by the health technology applied & by the source of funds for operation. AGENCIES OF HEALTH CARE 1. PUBLIC HEALTH SECTOR. 2. PRIVATE SECTOR. 3. INDIGENOUS SYSTEM OF MEDICINE. 4. VOLUNTARY HEALTH AGENCIES. 5. NATIONAL HEALTH PROGRAMMES
  • 12. 1 2 1. PRIMARY HEALTH CARE : A. Primary Health Centers B. Sub Centers. 2. Hospitals & Health Centers A. Community Health Centers. B. Rural Hospitals. C. District Hospitals / Health Centre. D. Specialist Hospitals. E. Teaching Hospitals I. Public Health Sector 3. HEALTH INSURANCE SCHEMES A. Employees State Insurance. B. Central Govt. Health Scheme 4 . OTHER AGENCIES A. Defense medical Services. B. Railways
  • 13. 1 3 A. Private Hospitals, Polyclinics, Nursing Homes & Dispensaries. B. General Practitioners & Clinics II. Private Health Sector III. Indigenous system of medicine IV. Voluntary Health Agencies NGOs/ social groups V. National Health Program A. Ayurveda (Herbal) & Siddha (Plants & minerals). B. Unani & Tibbi_ Perso-Arabic traditional medicine C. Homeopathy_ Pseudoscientific system of alternative medicine D. Unregistered Practitioners
  • 14. 8 / 0 5 / 2 0 X X 1 4
  • 15. 1 5 o Community Development Programmes (NRHM, midday meals, women and child welfare, family welfare programmes, etc.,) can be launched to the village with the voluntary groups which will ensure a standard of living for the maintenance of the health. oDais (village health guides) and village guides (Area Nurse or ANM) can be trained adequately and their services can be utilized. o Such workers can influence people very easily and deliver fundamental health services. o Such health workers can reach the last man of the village often and deliver health services.
  • 16. 1 6 Community Health Center (First Referral Unit) Each CHC covers 1,20,000 population (plains)  80,000- hilly/ tribal region. Total= 3222 CHCs in country. Covers about 3 to 4 PHCs. 30 beds; x-ray & lab facilities. Specialist in medicine, surgery & pediatrics. •To establish effective convergence and linkages with citizen centric services, •A CHC should be established at the community development block/taluka/tehsil/circle level. •This will also supplement the three-tier panchayati system (gram panchayat, block panchayat and zila panchayat).
  • 17. Staff for Community Health Centre
  • 18. 1 8 PRIMARY HEALTH CARE IN INDIA • In 1977 the Govt of India launched a Rural Health Scheme, based on the principles of “placing people’s health in people's hand". • It is a three tier system of health care delivery in rural areas based on the recommendation of the Srivatsav Committee(1975). • Close on the heels of these recommendations an International Conference at Alma Ata (1978), set the goal of an acceptable level of Health For All the people of the world by the year 2000 through Primary health care approach • As a signatory to the Alma Ata Declaration, the govt of India was committed to achieving the goal of Health for All through primary health care approach which seeks to provide universal comprehensive health care at a cost which is affordable. • Keeping view the WHO goal of “Health For All” by 2000 AD, the govt of India evolved a National Health Policy based on primary health care approach. • National Health Policy 2000, 2002 & National Rural Health Mission have been recently introduced.
  • 19. Declaration of Alma-Ata International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978 The International Conference on Primary Health Care, meeting in Alma-Ata this 12 Sept 978, expressing the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world. Primary health care: 1. Reflects and evolves from the economic conditions and sociocultural and political characteristics of the country and its communities and is based on the application of the relevant results of social, biomedical and health services research and public health experience; 2. Addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly; 3. Includes at least: education concerning prevailing health problems and the 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 the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs;
  • 20. 4. 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, housing, public works, communications and other sectors; and demands the coordinated efforts of all those sectors; 5. Requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation and control of 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; 6. Should be sustained by integrated, functional and mutually supportive referral systems, leading to the progressive improvement of comprehensive health care for all, and giving priority to those most in need; 7. Relies, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.
  • 21. C O N F E R E N C E P R E S E N T A T I O N 2 1 Primary health center
  • 22. It is an outcome of Bhore committee report. 538 in Maharashtra. Total 24,855 PHCs in country. It covers about 5 subcentres.
  • 23. 2 3 1.To provide comprehensive primary health care to community through PHCs. 2.To achieve & maintain an acceptable standard of quality of care. 3.To make the healthcare services more responsive & sensitive to the needs of the community. OBJECTIVES OF INDIAN PUBLIC HEALTH STANDARDS FOR PHCs:
  • 24. 2 4 FUNCTIONS OF PHC 1. Medical care 2. Reproductive & child health care 3. Family welfare planning 4. Water supply & sanitation 5. Control of communicable diseases 6. Collection of vital statistics 7. Health education 8. Carry out national health programmes 9. Referral services 10.Training of auxiliary staff like HA, HW, health guides & local dais. 11.Basic laboratory services 12.Provision of essential drugs for PHC
  • 25. 8 / 0 5 / 2 0 X X C O N F E R E N C E P R E S E N T A T I O N 2 5 It is an outpost attached to PHC covering a population of 5000. Total= 1,50,000 subcentres. • MPW (M)- 1 • MPW (F)- 1 Health assistant female supervises activity of MPW (F) • Voluntary health guide- 1 SUB-CENTER
  • 27. • To implement this policy at the village level, the following schemes are in operation. 1. Village Health Guide Scheme. 2. Training of Local Dias. 3. ICDS Scheme. 4. Asha Scheme Community Health Guide (VILLAGE LEVEL)- literate volunteer Primary health care is universal coverage & equitable distribution of health resources.
  • 28. I VILLAGE HEALTH GUIDES • They act as a link between PHC & Public. • A Village Health Guide is a person with an aptitude for social service & is not a full time government functionary. • The Village Health Guide Scheme was introduces on 2 Oct 1977. • It provide the first contact between the individual & the health system. TRAINING
  • 29. The guidelines for their selection are : 1. Permanent local residents; preferable women. 2. Able to read & write, having minimum formal education at least 6th standard. 3. They should be acceptable to all sections of the society. 4. They should be able to spare at least 2 to 3 hrs every day for community health work.  After selection, the Health Guides undergo a short training in primary health care.  The training is arranges in the nearest PHC, SC for 200 hrs, spread over for a period of 3 months.  During the training period they receive a stipend of Rs. 200 per month.  On completion of their training, they receive a working manual & a kit.  At present there are 3,24,000 CHG & the national target is to achieve 1 VHG for each village or 1000 rural population
  • 30. • Most deliveries in rural are handled by untrained dais. II DAIS (Traditional Birth Attendants) • An extensive programme has been to undertaken under the Rural Health Scheme, to train all categories of local dais in the country to develop their knowledge in the elementary concepts of maternal & child health & sterilization, besides obstetric skills. • The training is for 30 working days (1 month). • Each Dai is paid a stipend of Rs. 300 during her training period. • Training is given at the PHC, Sub-centre or Maternal & Child Health centre for 2 days in a week & on the remaining 4 days of the week they accompany the Health Worker to the villages preferably in the dai’s own area.
  • 31. • During her training each dai is required to conduct at least 2 deliveries under the guidance & supervision of the HW (F), ANM (Auxiliary nurse midwife) or HA(F). • The emphasis during training is on asepsis so that home deliveries are conducted under safe hygienic conditions thereby reducing the maternal & infant mortality. • After successful completion of training, each dai is provided with a delivery kit & a certificate. • These dais are also expected to play a vital role in propagating small family norm since they are more acceptable to the community. • The national target is to train one local Dai in each village. • She undergoes a training in various aspects of health, nutrition & child development for 4 months. • She is a part time worker & is paid an honorarium of Rs 1500 per month for the service rendered, which include health checkups chart, immunization, supplementary nutrition, health education, non formal pre school education & referral services.
  • 32. 10 rs. for every registered case of pregnancy 3 rs. for every registered infant. Total trained dais are about 7,00,000 in India. Each trained Traditional Birth Attendants covers 1000 population.
  • 33. III. ANGANWADI WORKER • Under Integrated Child Development Services (ICDS) scheme, there is anganwadi worker for a population of 1000. • There are about 100 such workers in each ICDS project. • An anganwadi worker is selected from the community she is expected to serve • The beneficiaries are especially nursing mothers, pregnant women, other women (15 -45 yrs), children below the age of 6 yrs & adolescent girls. • Anganwadi workers are the primary link with the health services & all other services for young children.
  • 34. IV. ASHA • Recognizing the importance of health in the process of economic & social development & to improve the quality of life of the citizens, the govt of India launched “NATIONAL RURAL HEALTH MISSION” (NRHM) on 5 April 2005. • The main aim of NRHM is to provide accessible, affordable, accountable, effective & reliable primary health care through creation of a cadre of Accredited Social Health Activist (ASHA).
  • 35. • ASHA must be a resident of the village. • A women (married/widow/divorced) preferably in the age group of 25-45 years with a formal education upto 8 class The general norm for selection of ASHA is 1 ASHA/1000 population. • ASHA will take steps to create awareness & provide information to the community on determinants of health, information on existing health services, & the need for timely utilization of health & family welfare services. She will counsel women on birth preparedness, importance of safe delivery, breast feeding & complementary feeding, immunization, contraception & prevention of common infections including STD/RTI sexually transmitted Diseases; RTI, reproductive tract infection & care of a young child.
  • 36. • ASHA will provide primary medical care for minor ailments such as diarrhoea, fevers & first aid for minor injuries etc. • She will also act as a depot holder for essential provisions being made available to every habitation like ORS kit, IFA (Iron folic acid) tab, disposable delivery kit, etc. • She will inform about the births & deaths in her village, any unusual health problems in the community to the PHC. • She will promote the construction of household toilets under total sanitation campaign. FUNCTIONS
  • 37. Panchayat system The villagers managed their own affairs through the traditional institution of Panchayat. With the attainment of freedom now fresh efforts are being made to strengthen the Panchayat system and made Panchayat play a better part in the work of national reconstruction. The 73rd Amendment Act, 1993 has led the foundation of strong and vibrant Panchayat Raj institution in the country. 3 7 Reason for declining panchayat raj 1. The coming Zamindari system 2. Establishment of police and judicial courts 3. Industrial development and consequent shifting of rural population to cities 4. The impact of materialistic and individualistic tendencies.
  • 38. Functions of Panchayat Construction of village roads and provide for street lights. Extension of health services. Look after the property of the Panchayat. Maintain records of vital statistics, such as birth and death. Organize mela, exhibition, film shows etc., To provide facilities for primary and adult education. Development of agriculture. Providing facilities for safe drinking water. Make provision for better quality manure and seeds. Prevention of communicable diseases. Maternal and child welfare. Sanitation of the village. Through the Panchayat System medical camps can be organized for the early diagnosis and treatment of the disease 3 8
  • 39. RURAL HEALTH IN INDIA • India is in limelight at global front not only in terms of population burst but also in its health scenario. Even after celebrating its 70 years of independence, its population is still under the threat of degraded health system. • There are approximately 85% of the populations who are still fighting for basic healthcare services in their area. This situation has been promoted by worsening living condition of rural habitats. • The unhygienic and unhealthy conditions of household, unsafe drinking water, open defecation, magnify expansion of several diseases in these areas.
  • 40. • The scenario gets worse through the superstition practiced by ruralites. The blind faith of tribal that any disease may be cured by magic has subjugated the minds of rural population of India. Due to this kind of impression, the rural areas are under the influence of various malpractices which ultimately seal off the progress of modern pathology here. • Inadequate human resources in health care system. The health institutions like Primary Health Centre (PHC), Sub- Centre (SC), and Community Health Centre (CHC) are facing huge problem because health professionals are absent. Doctors don’t want to work in rural areas either because of infrastructure inadequacy or lack of incentives. • The condition get intensify with not or little qualified practitioner, minimal amount of expenditure on public healthcare which counts to be 17.9% of total expenditure.
  • 41. • About 37% of our under-five children are underweight, 39% are stunted (height for age), 21% are wasted (weight for height ) and 8% are severely-acutely malnourished, adds the joint study. • The prevalence of underweight children was higher (38%) in rural areas compared to urban cities (29%). Only about 10% children under the age 6-23 months were reported to receive an adequate diet.
  • 42. Challenges for Rural Health System in India- An Overview • The poor state of health system in rural areas is a result of consolidated outgrowth of degraded system. It explains not only the distance between the existing policy and infrastructure but obstruction in development too. • The expenditure on public health system has not only been ignored by the state but also by the common mass. • People mostly prefer private practitioners and private hospitals over government run hospitals. • Therefore, it is very essential for us to review primary elements for degradation of Public health system in India.
  • 43. Challenges for Rural Health System in India- • Inadequate human resources • Inefficacious infrastructure • Inclination towards Home Based Deliveries • Lack of coordination between Medical Research and Health Service delivery Institutions • High Infant Mortality • Non-preparedness to fight with Epidemic in rural areas • Unresponsive attitude of medical professionals • Dominance of unregulated Private medical professionals Remedies in Rural Health System • According to the defined norms by the WHO, the existing infrastructural setup for providing healthcare in India is far less in terms of required qualitative and quantitative availability. • Still, the notion follow up here is ‘something is better than nothing’. • There have been various steps taken by government to improve the health scenario in rural areas. • Several strategies and missions have been initiated for institutionalizing the prevailing rural health framework to uplift the health standard of common mass.
  • 44. National Rural Health Mission (NRHM) National Rural Health Mission (NRHM) has been one of the central achievement in the field of rural healthcare. It was first initiated in the year 2005. Objective to deal with the problems and weakness across primary healthcare and enhance the status and system of rural area. It provides effective, accessible, accountable, inexpensive and reliable healthcare to the mass and in particular to those sections who are more poor, vulnerable and prone to health disease. Healthy Village | Healthy People | Healthy Nation
  • 45. NRHM seeks to provide equitable, affordable and quality health care to the rural population, especially the vulnerable groups. Thrust of the mission is on establishing a fully functional, community owned, decentralized health delivery system with inter- sectoral union at all levels, to ensure simultaneous action on a wide range of determinants of health such as water, sanitation, education, nutrition, social and gender equality.
  • 46. 1. Maternal healthcare- antenatal care, intranatal care & postnatal care 2. Child healthcare- breast feeding, immunization 3. Family planning & contraception 4. Safe abortion services-medical termination of pregnancy, follow up 5. Curative services- minor ailments 6. Adolescent healthcare-education, councelling, prevention & treatment 7. Assistance to school health services 8. Water quality monitoring 9. Promotion of sanitation- use of toilet, waste disposal 46 SUB-CENTERS Services-
  • 47. 12.Field visits by health workers 13.Community needs assessment 14.Control & repairing of endemic diseases- malaria, JE, dengue. 15.Training of traditional birth attendants/ASHA/CHVs. 16.Coordinate services of AWW, ASHA, village health sanitation & nutrition committee. 17. implementation of national health programs-NACP, IDSP, NLEP 47 SUB-CENTERS Services-
  • 48. 1. Medical care-OPD services, 24hrs emergency services 2. Maternal & child healthcare including family planning- antenatal care, intranatal care & postnatal care, newborn care, care of the child, family welfare 3. Medical termination of pregnancy- safe abortion, using manual vacuum aspiration (2nd trimester) 4. Management of reproductive tract infections/ sexually transmitted infections- health education & treatment 5. Nutrition services 6. School health services 7. Adolscent healthcare 8. Disease surveillance & control- endemic diseases 48 PHCs Services-
  • 49. 9. Collection & reporting of vital events 10. Promotion of safe drinking water & sanitation 11. Testing of water quality & disinfection of water sources 12. Participation in national health programmes 13. Referral services 14. Basic laboratory & diagnostic services 15. Record of vital statistics 16. Health workers training 17. Skill-based training to ASHAs. 18. Initial & periodic training of doctors/paramedics 19. Mainstreaming of AYUSH-based preventive, promotive & curative healthcare 49 PHCs Services-
  • 50. Pradhan Mantri Matritva Vandana Yojana (PMMVY) • PMMVY, previously known as Indira Gandhi Matritva Sahyog Yojna (IGMSY), introduced in the year 2010, is a maternity program run by the government of India. • Objective to encourage women to follow Infant and Young Child Feeding (IYCF) practices including early and exclusive breast feeding for first six months. • It is a conditional cash transfer scheme which is implemented through the State for pregnant and lactating women of 19 years of age or above for first two live births, from the Ministry of Women and Child Development.
  • 51. Janani Suraksha Yojana (JSY) Janani Suraksha Yojana is a flagship program launched in year 2005 under the National Rural Health Mission (NRHM) of Government of India modifying the National Maternity Benefit Scheme (NMBS). It is intended to promote institutional delivery to reduce maternal and neo-natal mortality. It provide cash incentives to the women for delivering their child in government or other private medical facility over home-based deliveries.
  • 52. Health Insurance through Rashtriya Swasthya Bima Yojana (RSBY) Rashtriya Swasthya Bima Yojana (RSBY) is one of the important schemes in the area of rural health. It was launched in the year 2008, which was earlier designed to target only the Below Poverty Line (BPL) households, but has been expanded to cover other defined categories of unorganized workers. Its objective is to provide financial aid for household affected by major health shocks and improve health outcomes.
  • 53. Swachh Bharat Abhiyan (SBA) Swachh Bharat Abhiyan or Clean India Mission is a campaign in India initiated in the year 2014, Whose objective is to eliminate open defecation through the construction of household-owned and community owned toilets. Still in many parts of rural India open defecation is practice which cause the most common life taking diseases like diarrhea, typhoid, hepatitis, intestinal worm infections, cholera, etc.
  • 54. Employment and food in rural areas to BPL Good road connectivity Rural development programme Continuous power supply Storage capacity with facilities to help farmers Assistance and subsidies to the villagers for building their houses
  • 56. Health infrastructure in the municipalities is divided in four categories viz. 1. Hospitals, health centres and sub-centres supported by the State Health Department. 2. Facilities owned by the other government departments, 3. Municipality controlled facilities and 4. Private sector facilities. Key strategies •Universal coverage – the entire urban population including both APL and BPL (Above/Below Poverty Line) to be covered, while keeping the focus on BPL. •™ Strengthening service delivery through a uniform 3-tier service delivery model. •Strengthening institutional arrangements and inter departmental union. •Strengthening monitoring and evaluation.
  • 57. Urbanization and its impact on health and health practices The common diseases among the slum dwellers are: Fever, Skin infections, Eye infections, Malnutrition, Viral infections, Chronic toxicity, STD (Sexual Transmitted Diseases), Accidents, Drug abuse, Alcoholism, Crime, Delinquency, Suicide, prostitution etc., 8 / 0 5 / 2 0 X X 5 7 Causes for diseases Industrial pollution Over-crowding Poor hygienic practices Food and water contamination
  • 58. 5 8 1. Encourage local agricultural-based industry 2. Planning of road, office, residence to reduce traffic 3. Development of green belt, park, trees 4. Plans to reduce pollution 5. Encourage use of biodegradable material for package. 6. Library & recreation centers in residential areas 7. Improvement of slum condition 8. Health awareness on habit & lifestyle Services/welfare actions on urban area: 9. Community participation 10. Urban law implementation 11. Healthy management of urban wastes.
  • 59. 5 9 1. Theme broadcast in AIR/TV 2. Future articles for good message 3. Exhibitions & display on urban problem 4. Use of folk media for awareness 5. Cultural programmes imbibing urban message 6. Competitions on city improvement activities Suggested education activity for urban society
  • 60. 60 1. Slum improvement projects. Agency (ODA) Overseas Development Administration assisted effort & (UCD) Urban Community Development efforts- pilot project. 2. World bank assisted Indian population projects (Mumbai, Chennai, Kolkata, Delhi, Bangalore, Hyderabad) 3. Environmental Improvement Of Urban Slums (EIUS) 4. Urban Basic Services For Poor (UBSP) SERVICE ON URBAN SLUM AREAS slum clearance to slum improvement programme
  • 62. WATER SUPPLY AND SANITATION IN INDIA ➢Drinking water supply and sanitation facilities are very important and crucial for achieving the goal of “HEALTH FOR ALL”. ➢According to WHO, “poor sanitation and inadequate sewage disposal the nation’s biggest public health problems.” ➢Approximately 60-70% of untreated sewage is discharged directly into rivers and streams, the main source water supply in cities.
  • 63. ➢ WATER SUPPLY CONTINUITY • According to INDIAN NORMS, access to improved water supply exists if at least 40 liter/ capita / day of safe drinking water are provided within a distance of 1.6km or 100 meter of elevation difference, to be relaxed as per field conditions. • There should be at least one pump per 250 persons. SERVICE QUALITY
  • 64. ➢ SANITATION In 2010, the UN estimated based on India statistics that 626 million people practice open defecation. In June 2012, minister of rural development JAIRAM RAMESH stated India is the words largests “ open air toilet.” Of the 2.5 Billion people in the world that defecate openly in India. ➢ ENVIRONMENT As of 2003, it was estimated that only 27% of India’s waste water was being treated, with the remainder flowing into rivers, canals, ground water or the sea. ➢ The lack of adequate sanitation and safe water has significant negative health impacts including diarrhea, chronic diseases, respiratory problems, skin disorders, allergies, headaches and eye infections.
  • 65. RESPONSIBILTY FOR WATER SUPPLY AND SANITATION ➢ Water supply and sanitation is a state responsibility under the INDIAN CONSTITUTION. ➢ State may give the responsibility to the Panchayati Raj Institutions (PRI) in rural areas. ➢ In urban areas, - municipalities, called Urban Local Bodies (ULB). The responsibility for water supply and sanitation at the central and state level is shared by various ministries. At the central level three ministries have responsibilities in the sector. 1) The Ministry Of Drinking Water And Sanitation 2) The Ministry Of Housing And Urban Poverty Alleviation 3) The Ministry Of Urban Development. POLICY AND REGULATION
  • 66. ROLE OF GOVERNMENT - INDIA ➢1954 – National Water Supply And Sanitation Programme ➢1972 – ARWSP (Accelerated Rural Water Supply Programme) ➢1981 – International Drinking Water Supply And Sanitation Programme ➢2002 – Swajaldhara ➢2008 – National Urban Sanitation Policy
  • 67. NATIONAL WATER SUPPLY AND SANITATION PROGRAMME ➢ It was initiated in 1954. ➢ Objective : To providing safe water supply and adequate drainage facilities for the entire urban and rural population of the country. ➢ Targets : a) 100% urban and rural water supply. b) 50% urban sanitation. c) 25% rural sanitation.
  • 68. ARWSP (ACCELERATED RURAL WATER SUPPLY PROGRAMME) ➢ In 1972, a special programme known as “ARWSP” was started as supplement to the national water supply and sanitation programme. ➢ The central government supports the efforts of the states in identifying problem villages through assistance under ARWSP. ➢ A ‘Problem village’ has been defined as one where no source of safe water is available within a distance of 1.6 km / 15 m deep, or where source has excess salinity iron, fluorides & other toxic elements, or where water is exposed to the risk of cholera.
  • 69. SWAJALDHARA ➢It was launched in 25th Dec 2002. It has certain reform principles needed to be adhered by the states governments. which ➢ AIM -To provide safe drinking water in rural areas, with full ownership of the community, building awareness among the village community on the management of drinking water projects, including better hygiene practices and encouraging water conservation practices along with rainwater harvesting. ➢ Swajaldhara has two components : 1. Swajaldhara 1 (first dhara) : is for gram panchayat or a group of panchayat (at block / tehsil level). 2. Swajaldhara 2 (second dhara) : has district as the project area.
  • 70. ACTIVITIES ➢Plan, implement, operate, maintain and manage all water supply and sanitation programme. ➢Conservation measures : A. Rain water harvesting B. Ground water recharge system
  • 71. NATIONAL URBAN SANITATION POLICY ➢In November 2008 , the government of India launched a National Urban Sanitation policy. ➢GOAL:- The main goal of this policy is creating “ totally sanitized cities” that are - to treat all waste water - to make free from open defecation - to collect and dispose solid waste safety.
  • 72. School Health Services School health is an imp aspect of any community health program. Its basic aim is to provide a comprehensive health care program for children of school going age (5 to 14 yr). General prevalence of morbidity: STATISTICS  40% students: healthy/ free from defects 24% school children: had disease/ defect 11 % children have such defects had to be referred to a specialist. Dental ailments 70-90% Malnutrition 40-75% Worm infections 20-40% Skin diseases 10% Eye diseases 4-8% Pulmonary TB 4-5%
  • 73. MILESTONES 1909 First school medical examination at Baroda city 1953 Secondary education committee emphasizes need of examination & school feeding. 1961 Submitted report; inadequate inputs. GOI constituted a task force “Intensive School Health Services” 1946 Health survey & development committee (Bhore committee) SCHOOL HEALTH SERVICES practically nonexisted 1960 GOI constituted SCHOOL HEALTH COMMITTEE To access stds of health & nutrition of school children & suggestive ways for health 7 3
  • 74. JAN 1982 Task force submitted report 14/22 states made efforts to establish school health program (own budget) Checked PHCs 1337/3614. 2002 2007 Formal document has been prepared & is waiting for clearance which include widened version of school health care 1997 TO 9th five year plan expected the progress of school health care. 2003 TO 74 S S
  • 75. 7 5 1. Early detection and care of students with health problems 2. Development of healthy attitudes and healthy behaviours by students 3. Ensure a healthy environment for children at school 4. Prevention of communicable diseases at school OBJECTIVES OF SCHOOL HEALTH SERVICES
  • 76. In School Health Services are occupied: • Paediatricians and General Practitioners working in the Primary Health Care • Health Visitors partially or fully occupied in this service The main activities of the School Health Service are: 1. Screening Tests 2. Prevention and investigation of Communicable Diseases 3. Vaccination
  • 79. School Health Program Objectives: •Health consciousness among school children •Providing health instructions in a healthy environment •Prevention of disease: early detection, treatment & follow-up of defects •Promotion of positive health •Recognizing the child as a “change –agent” in the family. Components: 1. Health education 2. Healthy environment 3. Health service
  • 80. Health Education Healthy Environment Health Care •Health promotion- Exercise, nutrition & personal hygiene. •Health protection- Nutrition, immunization, guidelines. •Curative services- Health cards, prompt treatment of defects, follow up & referral for special problems. •Medical check-ups (periodic- twice a year) •Treatments •Location- Quite place •Structure- Heat resistant •Water supply- potable •Drainage •Urinals- 1 per 60 students • latrines- 1 per 100 students •Waste management •Ventilation- window: 20% of floor area •Playground •Health lessons oInsisting high stds of cleanliness in schools oImproving water supplies & latrines; habits for their proper use. o healthy practical diets in school lunch program oDemonstrating personal hygiene •Visits Observe Community health services •Safety education •Sex education
  • 81. 8 1 Mid-day school meal & other nutritional service I. Development of school garden II. Special nutrients for dental caries, goiter, night blindness, anemia III. Mid-day school meal • It is a supplement • Provides 1/3rd of energy (daily req.) • Affordable & • Simple cooking in acceptable form IV. Balahar 70% wheat, 25% defatted groundnut meal & 5% skim milk (fat-free milk) Menu per child per day Cereal & millet 75 gm Pulses 30 gm Oil 8 gm Leafy vegetables 30 gm Nonleafy vegetables 30 gm