This document discusses primary health care in India and the role of nurses. It outlines the principles of primary health care as equitable distribution, appropriate technology, health promotion/prevention, and community participation. It then examines current health problems in India such as communicable diseases, nutrition problems, environmental sanitation issues, lack of medical care, and population issues. Specifically, it analyzes problems like malaria, tuberculosis, diarrhea, ARI, leprosy, and HIV/AIDS. Finally, it discusses the role of nurses in addressing these problems through various activities like health education, nutrition promotion, provision of water/sanitation, maternal/child services, immunization, disease control, and ensuring access to treatment and essential drugs.

1. PRIMARY HEALTH CARE IN
INDIA / HEALTH PROBLEMS IN
INDIA & ROLE OF A NURSE.
DR. MAHESWARI JAIKUMAR

2. PRINCIPLES OF PRIMARY HEALT CARE.
•EQUITABLE DISTRIBUTION.
•APPROPRIATE TECHNOLOGY.
•A FOCUS ON HEALTH PROMOTION / DISEASE PREVENTION.
•COMMUNITY PARTICIPATION.A MULTISECTORAL APPROACH.
•MAN POWER PLANNING.

3. ELEMENTS OF PRIMARY HEALTH CARE.
•Education concerning prevailing health problems &
methods of preventing & controlling them.
•Promotion of food supply & proper nutrition.
•Adequate supply of safe drinking water & basic
sanitation.
•Maternal & child health care , including family planning.
•Immunization against major infectious diseases.
•Prevention & control of locally endemic disease.
•Appropriate treatment of common diseases & injuries.
•Provision of essential drugs.
•.

4. CURRENT HEALTH PROBLEMS IN INDIA.
COMMUNITY DIAGNOSIS. Refers to the assessment of
health status & health problems to design health services.
The following are the components Indicators decisive of
health problems.
•Morbidity & mortality statistics.
•Demographic conditions of the population.
•Environmental factors influencing health.
•Socio – Economic factors influencing health.
•Culture & its components.
•Medical & Health services available.
•Other services available.

5. HEALTH PROBLEMS IN INDIA.
•COMMUNICABLE DISEASE PROBLEM.
•NUTRITION PROBLEMS.
•ENVIRONMENTAL SANITATION PROBLEM.
•MEDICAL CARE PROBLEM.
•POPULATION PROBLEMS.

6. COMMUNICABLES DISEASE PROBLEM.
MALARIA :
•The incidence of disease is 2.32 %.
•P.falciparum cases have increased than the previous
years.
TUBERCULOSIS :
•30 % 0f the total population is affected with TB.
•1.5 % have radio logically active disease.
•0.4 % of the cases are sputum positive.
•India has 12.7 million cases of pulmonary TB ( 3.4 million
are sputum +ve.
•Death due to TB – 500000 every yr.

7. DIARRHOEAL DISEASE
Commonly encountered with children,
•Diarrhoeal disease contribute 7.1 lakh deaths / yr.
•The disease is attributed to un hygienic feeding
practices & poor environmental conditions.
ARI
•Causes major morbidity 7 mortality among U5.
•ARI constitutes 13.6 % hospital admissions.
•13 % in patient deaths in pediatric wards is due to
ARI.

8. LEPROSY.
•2003 – 2004 – 2.20 lakh new cases were detected.
•The prevalence rate of leprosy is 2.3 / 10000 pop.
•The proportion of infectious case varies between 6 – 8
% .
•India accounts for 60 % of leprosy cases in the world.
FILARIA.
•About 6 million cases / yr.
•45 million persons have one or more chronic filarial
lesion.

9. AIDS.
•AIDS was first detected in 1986.
•No: of AIDS cases have risen to 86028 by 2004.
•By 2003 – 5.1 million HIV +ve cases.
OTHERS.
Kala – azar, meningitis, viral encephalitis, entric fever,
helminthic infestations.

10. NUTRITIONAL PROBLEMS.
PROTEIN ENERGY MALNUTRITION.
•80% OF Indian children have mild – moderate PEM.
•The incidence is 1-2% in pre school children.
•PEM includes marasmus & kwashiorkor.

11. NUTRITIONAL ANEMIA.
•India has the highest prevalence of nutritional anemia
among women & children.
•60 -80% of pregnant women are anemic.
•20-40% of maternal deaths are attributed to anemia.
•Fe+ deficiency anemia is widely prevalent
LBW
•30% of babies born are LBW.
•Maternal malnutrition is responsible for LBW.

12. XEROPHTHALMIA
0.04% of blindness is attributed to Vit A deficiency.
Keratomalacia is considered to be a major cause of
nutritional blindness in 1-3 yrs.
Vit A deficiency also predisposes to frequent GI infections.
IODINE DEFICIENCY DISORDERS
Widely prevalent in India.
OTHERS
Lathyrism, endemic flurosis, food adulteration.

13. ENVIRONMENTAL SANITATION
•Increased urbanization & industrialization leads to
hazards to human health , air, water, & food chain.
•1981-1990 International Water Supply & Sanitation
Decade was observed.
•As of 2000 – safe Water is available to almost 85% of
the rural population.
•Excreta disposal facility (1994)------- Urban – 70%,
Rural – 14%, Combined – 29%.

14. MEDICAL CARE PROBLEMS
•India does not have a National Health Service.
•80% of the health services are concentrated in the
urban areas.
•India does not meet the suggested manpower norms.

15. POPULATION PROBLEMS
•India is the second populest country in the world.
•Population explosion has detrimental effect on
housing, health care, sanitation, & environment.
•The Annual Growth Rate of India is high 2.1.

16. THE HEALTH CARE SYSTEMS – INDIA.
•The care system is the structure of the country’s
pattern of delivery of the health services.
•The health care system operates within the context of
socio-economic & political framework of the country.

17. HEALTH CARE SYSTEM IN INDIA.
HCS
Public Health Sector
Private Sector
Indigenous System Of Medicine
Voluntary Health Agencies
National Health Progs

18. PUBLIC HEALTH SECTOR
•HOSPITALS / HEALTH CENTERS
•PRIMARY HEALTH CARE – PHC, HSC.
•HEALTH INSURANCE SCHEMES.- ESI, CGHS.
•OTHER AGENCIES.---- Defence services, Railways.
•Community Health Centers.
•Rural Hospitals.
•Dt Hosp.
•Specialist Hosp.
•Teaching Hosp.

19. PRIVATE SECTOR
•Private Hosp, Poly Clinics, Nursing Homes,& Dispensaries.
•General Practitioners & Clinics.
INDIGENOUS SYSTEM OF MEDICINE.
•Ayurveda & sidda.
•Unani & Tibbi.
•Homeopathy.
•Unregistered Practitioners.
VOLUNTARY HEALTH AGENCIES.
NATIONAL HEALTH PROGS.

20. MODEL OF HEALTH CARE SYSTEM.
Inputs Health Services Health Care Systems Output
OUTPUT
Health status
Health problems
Resources
•Promotive
•Preventive
•Curative
•Rehabilitative
•Public
•Private
•Voluntary
•Indigenous
Changes
in health
status

21. ROLE OF A NURSE IN HCDS.
Nurse
Administrator
Service provider
HCDS
HCDS HCDS
HCDS
PUBLIC & PRIVATE
SECTORS
INDIGENOUS SYSTEM
OF MEDICINE
NATIONAL HEALTH
PROG
VOLUNTARY HEALTH
AGENCIES
Preventive
curative
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22. ROLE OF A NURSE IN HCDS
EDUCATION CONCERNING HEALTH PROBLEMS.
•The nurse in various capacities
designs health education progs,
materials & disseminates the same to
the policy makers, educationists,
general public, & to various
categories of health personnel.
•The nurse designs health education contents according
to the health needs & problems, according to the
beneficiary & according to the context.

23. •The nurse undertakes necessary precautionary
measures, primordial prevention strategies, specific
preventive measures to promote the health of the
community.
•Devise necessary surveillance measures, control
measures, control measures to check the disease load
in the community.
•Involve mass media & relevant other personnel in
preventing preventable diseases.

24. PROMOTE FOOD SUPPLY & NUTRITION.
•Undertake measures to carry out
nutritional surveillance.
•Maintain epidemiological profile of the
nutritional disease.
•Assess the extent of nutritional
problems & categorize them depending
on the intervention required.
•Organize & carry out nutritional supplementation &
rehabilitation services to the target group.

25. •Co-ordinate with the state’s initiative in the
implementation of relevant nutritional programmes.(ANP,
ICDS, Vit A Porg,SNP, School Feeding Prog, Fe+
deficiency anemia Prog.)
•Co-Ordinate with like minded agencies FAO, WHO,
UNICEF & Voluntary health sectors to promote the
nutritional status of the community.
•Promote optimal food production & storage &
distribution system & an efficient public distribution
system.

26. PROVISION OF SAFE WATER & SANITATION.
•The nurse, translates the
components of water & sanitation
decade.
•The nurse co –odinates with
agencies that are involved in the
provision of safe water (Water Plants,
Sewerage treatment Plants.)
•Educate the community regarding
importance of safe drinking water &
sanitation measures.

27. PROVISION OF MATERNAL &
CHILD HEALTH SERVICES.
•Translate the relevant MCH elements
of the various governmental policies &
programs.
•Involve similar agencies (SHAKTHI,
NGO, VHAI) in the designing &
implementation of MCH initiatives.
•Implement U5 initiatives incorporating
ICDS Anganwadi, SNP,ANP,& related
components.

28. Plan & carry out AN,PN care.
•Registration, investigation, TT, weight monitoring,IFA &
calcium supplementation,Essential perinatal care.
•Impart Essential New Born Care.
•Implement adolescent health initiatives.
•Implement initiatives for control of STD & AIDS.

29. IMMUNIZATION AGAINST VPD.
•Implement the National Immunization Prog.
•Plan & design immunization services at all
levels.
•Maintain statistical details of the
immunization status of India.
•Co-ordinate with agencies & industries
manufacturing vaccines.
•Design & disseminate H/E materials relevant to
Vaccine Preventable Diseases.

30. PREVENTION & CONTROL OF LOCALLY
ENDEMIC DISEASES.
•Implement relevant national control &
prevention, eradication prog.
•Co-ordinate the state & center’s initiatives in
controlling communicable diseases.
•Plan & implement control & eradication
measures locally.
•Advocate & sensitize the community to practice
preventive strategies.
•Undertake primordial prevention measures & focus to
prevent endemic disease.
•Implement prophylactic measures during the period of
endemicity.

31. APPROPRIATE TREATMENT FOR
COMMON INJURIES.
Undertake & implement appropriate treatment
strategies.

32. PROVISION OF ESSENTIAL DRUGS.
•Co-ordinate with the Drug Control
Organization.
•Monitor the manufacture & supply of drugs
in the market.
•Maintain inventory--- stock of drugs as per
requisites.
•Indent required drug for various levels of
care settings.