public health dentistry

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3. CONCEPT OF HEALTH CARE
Health care?
A multitude of services rendered by agents of
health services or professions, for the purpose of
promoting, maintaining, monitoring or restoring
health.
“The enjoyment of the highest attainable standard of
health is one of the fundamental rights of every
human being without distinction of race, religion,
political belief, economic or social condition”.
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4. HEALTH SYSTEM
The delivery of health services takes place through
health system
Mainly by:
1. It should cover the entire populations not
just the selected group.
2. Through primary health care services
supported by adequate referral system
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5. HEALTH PROBLEMS IN INDIAHEALTH PROBLEMS IN INDIA
1. Communicable disease problems
2. Nutritional problems
3. Environmental sanitation problems
4. Medical care problems
5. Population problems
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6. HEALTH CARE SERVICES
 The purpose of health care services is to improve
the health status of the population.
 Health services should be:
Comprehensive
Accessible
Acceptable
Provide scope for community participation
Available at a cost the community and country can afford
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7. HEALTH CARE SYSTEMS
 In India, it represented by five major sectors or agencies
which differ from each other by the health technology
applied and by the source of funds for operation.
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8. 1. PUBLIC HEALTH SECTOR
(a) Primary health care
Primary health centers
sub-centers
(b) Hospitals/Health centers
Community health centers
Rural hospitals
District hospital/health center
Specialist hospitals
Teaching hospitals
(c) Health Insurances schemes
Employees state insurance
Central Govt. Health Scheme
(d) Other agencies
Defense services
Railways 8

9. 2. Private Sector
(a) Private Hospitals, polyclinics, Nursing homes and
Dispensaries.
(b) General practitioners and clinics
3.Indigenous system of Medicine
Ayurveda, Siddha, Unani and Tibbi, Homeopathy
4.Voluntary Health Agencies
5.National Health Programmes
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10. PRIMARY HEALTH CARE
Primary health care is essential health care
made universally accessible to individuals
and acceptable to them, through their full
participation and at a cost the country and
community can afford.
-Alma-Ata International Conference 1978
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11. ELEMENTS OF PRIMARY HEALTH CARE
There are eight essential components of primary
health care:
1) Education concerning prevailing health
problems and the methods of preventing and
controlling them;
2) Promotion of food supply and proper
nutrition;
3) An adequate supply of safe water and
sanitation;
4) Maternal and child health care including
family planning 11

12. 5) Immunization against major infectious
diseases;
6) Prevention and control of major endemic
diseases;
7) Appropriate treatment of common diseases
and injuries; and
8) Provision of essential drugs.
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13. Principles of Primary Health Care
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14. Equitable distributionEquitable distribution
The first key principle
Health services must be shared equally by all people
irrespective of their ability to pay
All rich/poor and urban/rural must have access to
health services
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 service to as near the
people`s homes as possible.
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15. Community participationCommunity participation
The involvement of individuals, families and
communities in promotion of their own health and
welfare is an essential.
The community must involve in planning,
implementation and maintenance of health services.
In India, village health guide and trained dais
In China, bare foot doctor
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16. Inter sectoral co-ordinationInter sectoral co-ordination
Planning with the other sectors to avoid unnecessary
duplication of activities.
Primary health care involves in addition to the health
sectore, all related sectors and aspects of national and
community development, in particular agriculture,
animal husbandry, food industry, public work,
communication and other sectors.
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17. The major reason for lack of success of many oral
health programms is the fact that they operate in
isolation, separate from general health care structure.
Oral health could better be integrated into general
health programms by trackling common causes, by
including oral health in general health education.
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18. Appropriate technologyAppropriate technology
Technology that is scientifically sound, adaptable to
local needs, and acceptable to those who apply it and
those for whom it is used, and that can be maintained
by the people themselves in keeping with the principle
of self reliance with resources the community and
country can afford.
Neem stick, mango leaf for tooth brushing are
effective when used in proper way.
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19. PRIMARY HEALTH CARE IN INDIA:
Launched by Govt of India in 1977 based on the
principle of “placing people’s health in people’s
hands”
It’s a three-tier system of health care delivery in rural
areas based on the recommendation of Srivastav
Committee.
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20.  The Bhore committee in 1946 gave the concept of a
primary health center as a basic health unit to
provide, as close to the people as possible, an
integrated curative and preventivecurative and preventive health care to
the ruralrural population with emphasis on preventive
and promotive aspects of health care.
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21. PRIMARY HEALTH CENTRE LEVEL:
The National Health Plan (1983) proposed
 one PHC = every 30,000 rural population
one PHC = every 20,000 population in hilly, tribal
and backward areas
for more effective coverage.
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22. Functions of PHC In IndiaFunctions of PHC In India
1. Medical care
2. MCH including family planning
3. Safe water supply and basic sanitation
4. Prevention and control of locally endemic diseases.
5. Collection and reporting of vital statistics
6. Education about health
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23. 7. National health programs
8. Referral services
9. Training of health guides, health workers, local
dais and health assistant
10. Basic laboratory services
Staff patterns
PHC - 15
Sub centers - 03
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Staff Recommended
Medical officer 3
AYUSH 1
Pharmacist 2
Nurse-midwife 5
Health worker 1
Health educator 1
Helth asstt (M/F) 2

25. Primary Health Care at:
1)Village level:
One of the basic contents of Primary health Care
is Universal coverage and equitable
distribution of health resources. To implement
this at the village level the following schemes
are in operation:
a) Village health Guides Scheme
b) Training of local dais
c) ICDS scheme
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26. VILLAGE HEALTH GUIDES
Introduced on 2nd
October 1977
Health guides are mostly women
They should be the permanent residents of the
local community.
Able to read and write, with a minimum education
of at least up to 6th
std.
Acceptable to all the sections of the society
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27. A village health guide is a person with an aptitude for
social service and is not a full time government
functionary.
The health guide are now mostly women. A circular
was issued by government of India in may 1986 that
male health guides would be replaced by female health
guides.
They serve as links between the community and the
governmental infrastructure. They provide the first
contact between the individual and health system.
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28. LOCAL DAIS
Most deliveries in rural areas are still handled by
untrained dais
An extensive program has been undertaken, under
the Rural health scheme, to train all categories of
local dais (traditional birth attendants) in the country
to improve their knowledge in the elementary
concepts of maternal and child health and
sterilization, besides obstetric skills.
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29.  The training is for 30 working days. She is paid a
stipend of Rs. 300 during her training period.
Training is given at the PHC, sub-center or MCH
center for 2 days in a week, and on the remaining four
days of the week they accompany the health worker.
 After successful completion of training, each dai is
provided with a delivery kit and a certificate. She is
entitled to receive an amount of Rs. 10 per delivery
provided the case is registered with the sub-
center/PHC.
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30. ICDS SCHEME:
Under this scheme, there is an anganwadi worker
for a population of 1000. There are about 100 such
workers in each ICDS project.
Anganwadi worker is selected from the community
she is expected to serve. The services she provides
include health check-up, immunization,
supplementary nutrition, health education, non-
formal pre-school education and referral services.
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31.  She undergoes training in various aspects of health,
nutrition, and child development for 4 months.
 She is a part-time worker and is paid an honorarium
of RS.200-250 per month for the services rendered,
which include health check-up, immunization,
supplementary nutrition, health education, non-
formal pre-school education and referral services.
 The beneficiaries are especially nursing mothers,
other women (15-45years) and children below the
age of 6 years.
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32. 2) SUB-CENTRE LEVEL
one sub-centre = every 5000 general population
one sub-centre = every 3000 population in hilly,
tribal and backward areas
The functions of the subcentre include mother and
child health care, family planning and immunization.
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33. COMMUNITY HEALTH CENTRES
There is one CHC for a population ranging from
80,000 to 1.20 lakh.
Each CHC is equipped with 30 beds and
specialists in surgery medicine, obstetrics,
gynaecology and pediatrics with X-Ray and lab
facilities.
CHC staffing = 25 personnel
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34. Population norms for each centre
Plain area Hilly/Tribal/Difficult
area
Sub centre 5,000 3,000
Primary health
centre
30,000 20,000
Community
health centre
1,20,000 80,000
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35. Community Health Centre (CHC)
A 30 bedded hospital / Referral
Primary health centre (PHC)
A Referral Unit for 6 Sub Centres 4-6 bedded
manned with a Medical Officer in charge and 14
subordinate paramedical staff
Sub Centre (SC)
Most peripheral contact point between Primary Health Care
System
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36. Hospitals
Apart from primary health centres, the present
organization of health services of Government sector
consists of
(a) Rural Hospitals
(b) Sub-divisional/tehsil/talika Hospital
(c) District Hospitals
(d) Specialist Hospitals
(e) Teaching Institutuions
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37. (c) Health Insurances schemes(c) Health Insurances schemes
There is no universal health insurance in India. At
present it is limited to industrial workers and their
families. The central government employees are also
covered by the health insurance, under the banner
“central govt. health scheme”
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38. Employees State Insurance SchemeEmployees State Insurance Scheme
 Introduced by an act of Parliament in 1948, is a unique
piece of social legislation in India.
 The act provides for medical care in cash and kind,
benefits in the contingency of sickness, maternity,
employment injury, and pension for dependents on the
death of worker because of employment injury.
 The act covers employees drawing wages not exceeding
Rs. 15000 per month.
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39. Central Government Health SchemeCentral Government Health Scheme
 It was first introduced in New Delhi in 1954 to provide
comprehensive medical care to central government
employees.
 The scheme is based on the principle of co-operative
effort by the employee and the employer, to the mutual
advantage of both.
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40.  The facilities under the scheme include
a) Out-patient care through network of dispensaries
b) Supply of necessary drugs
c) Laboratory and X-ray investigation
d) Hospitalization facilities at government as well as
private hospitals recognized for the purpose
e) Specialist consultation
f) Pediatric services including immunization
g) Antenatal, natal and postnatal services
h) Emergency treatment
i) Supply of optical and dental aids at reasonable rate
j) Family welfare services.
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41. (d) Other Agencies(d) Other Agencies
(a)Defence Medical Services: Defence services have their
own organization for medical care to defence personnel
under the banner “Armed forces medical services”.
(b)Health care of Railway Employees: Comprehensive
health care services through the agency of railway
hospitals, health units and clinics.
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42. (2) Private Agencies(2) Private Agencies
In a mixed economy such as India's private practice of
medicine provides a large share of the health services
available.
Most of them tend to congregate in in urban areas. They
provide mainly curative services. Their services are
available to those who can pay.
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43. (3) Indigenous Systems of Medicine(3) Indigenous Systems of Medicine
The practitioners of indigenous systems of medicine (eg,
Ayurveda, Siddha, Homeopathy, etc.) provide the bulk of
medical care to the rural people.
Most of them are local residents and remain very close to
the people socially and culturally.
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44. (4) Voluntary Health Agencies(4) Voluntary Health Agencies
“A voluntary health agency may be defined as an
organization that is administered by an autonomous board
which holds meetings, collects funds for its support
chiefly from private sources and expends money, whether
with or without paid workers, in conducting a programme
directed primarily to furthering the public health by
providing health services or health education, or by
advancing research or legislation for health, or by a
combination of these activities”.
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45. Voluntary health agencies in IndiaVoluntary health agencies in India
1. Indian Red Cross Society
2. Hind Kusht nivaran sangh
3. Indian council for child welfare
4. Tuberculosis association of India
5. Bharat sevak samaj
6. Central social welfare board
7. The kasturba memorial fund
8. Family plannin association of India
9. The All-India blind relief society
10. International agencies
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46. (5) National health programmes(5) National health programmes
1. Anti-malaria programme
2. National filaria control programme
3. Kala-azar control programme
4. Dengue control
5. National Leprosy-eradication programme
6. National tuberculosis programme
7. National AIDS control programme
8. National programme for control of blindness
9. Iodine deficiency programme
10. Universal immunization programme
11. Reproductive and child health programme
12. National caner control programme
13. National family welfare programme
14. National water supply and sanitation programme 46

47. Thank u
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