healthcare of communityhealthcare of communityhealthcare of community

1. UNIT – 7
Healthcare of Community

2. Health Planning and
Management

3. Introduction
Health planning is a process of
• defining objectives, goals, and priorities in
health sector and
• developing strategies to achieve them.
• ensures optimal use of resources, and
• equitable access to healthcare.

4. Steps in Health Planning
• 1. Situational analysis
• 2. Setting goals and objectives
• 3. Resource analysis
• 4. Prioritization
• 5. Formulation of plan
• 6. Implementation
• 7. Monitoring and evaluation

5. Situational Analysis
• Assessment of existing health problems,
resources, and determinants of health.
• Includes epidemiological, demographic, and
socio-economic analysis.

6. Setting Goals and Objectives
• Goals are broad targets,
• while objectives are specific, measurable,
achievable, relevant, and time-bound
(SMART).
• Helps in focusing resources and efforts.

7. Resource Analysis
• Analysis of available manpower, money,
materials, and methods.
• Identification of gaps in resources.

8. Prioritization
• Determining which health problems need
immediate attention.
• Criteria: magnitude, severity, feasibility, and
cost-effectiveness.

9. Formulation of Plan
• Designing detailed interventions, allocation of
resources, and assigning responsibilities.

10. Implementation
• Execution of planned health programs and
policies.
• Requires coordination, communication, and
supervision.

11. Monitoring and Evaluation
• Monitoring: continuous assessment of
progress.
• Evaluation: periodic assessment of outcomes
and impact.
• Helps in improving future planning.

12. Health Management
• Application of management principles to
health services.
• Functions: Planning, Organizing, Staffing,
Directing, Coordinating, Reporting, Budgeting.

13. Challenges in Health Planning
• - Limited resources
• - Inequity in distribution of health services
• - Lack of coordination
• - Political and administrative barriers

14. Conclusion
• Health planning and management are
essential for effective delivery of health care
services.
• They ensure optimum use of resources and
improved health outcomes.

15. National Health Policy (India)

16. Evolution of National Health Policy
• NHP 1983 → Primary health care focus;
community participation.
• NHP 2002 → Strengthening health systems;
public–private partnerships; human resources.
• NHP 2017 → UHC orientation; financial
protection; quality & patient-centred care;
measurable targets.

17. Vision / Goal
• Attain the highest possible level of health &
well being for all at all ages.
‑
• Preventive & promotive care orientation
across sectors; universal access to quality
services.
• No financial hardship due to health care;
improve access, quality and reduce costs.

18. Key Policy Principles (I–V)
• Professionalism, Integrity & Ethics.
• Equity: affirmative action for poorest; reduce
geographic & social disparities.
• Affordability: reduce catastrophic household
health expenditure.
• Universality: design services for the entire
population, including special groups.
• Patient centred quality of care: standards, safety,
‑
dignity and confidentiality.

19. Key Policy Principles (VI–X)
• Accountability: financial & performance transparency;
anti corruption.
‑
• Inclusive partnerships: academia, not for profit and
‑ ‑
industry with communities.
• Pluralism: appropriate integration of AYUSH with
documented practices.
• Decentralization: community participation in local
health planning.
• Dynamism & adaptiveness: evidence informed
‑
learning health system.

20. Core Objectives
• Progressively achieve Universal Health
Coverage (UHC).
• Reinforce trust in public health services via
predictable, efficient, patient centric care.
‑
• Align the growth of private sector and
technologies with public health goals (ethical,
effective, affordable).

21. Policy Thrust – Adequate Investment
• Raise public health expenditure to 2.5% of
GDP (time bound).
‑
• Link central resource allocation to state
indicators and absorptive capacity.
• Consider selective taxes (tobacco, alcohol,
unhealthy foods, extractive industries) and
leverage CSR funds.

22. Preventive & Promotive Health –
Intersectoral Actions
• Create Swasth Nagrik Abhiyan across seven
priority areas:
– Swachh Bharat Abhiyan (WASH)
– Balanced diets & physical activity
– Control tobacco, alcohol & substance abuse
– Yatri Suraksha – reduce transport injuries
– Nirbhaya Nari – action against gender violence
– Workplace stress reduction & safety
– Reduce indoor & outdoor air pollution

23. Organization of Public Health Care
• Comprehensive Primary Health Care (CPHC)
through Health & Wellness Centres (HWCs).
• Continuity of care with robust referral linkages
to secondary & tertiary levels.
• Re orient public hospitals towards quality,
‑
responsiveness and efficiency.

24. Urban Health Strategy
• Prioritize primary health care for urban poor
in listed/unlisted slums and vulnerable groups.
• Leverage partnerships (for profit &
‑
not for profit) for service delivery; address
‑ ‑
social determinants.
• Early detection & secondary prevention for
NCDs; strengthen referral and community
organisations.

25. Quantitative Goals – Life Expectancy &
Fertility
• Increase life expectancy at birth: 67.5 → 70 by
2025.
• Track DALY index for major disease categories
by 2022.
• Reduce Total Fertility Rate (TFR) to 2.1 at
national and sub national levels by 2025.
‑

26. Quantitative Goals – Mortality
• Under five mortality: reduce to 23 by 2025.
‑
• Maternal mortality ratio: reduce to 100 by
2020.
• Infant mortality rate: reduce to 28 by 2019.
• Neonatal mortality: reduce to 16 by 2025;
stillbirth rate to single digit by 2025.
‑

27. Quantitative Goals – Diseases
• HIV 90 90 90 by 2020 (status knowledge, ART
‑ ‑
coverage, viral suppression).
• Elimination status: Leprosy (2018), Kala azar (2017),
‑
Lymphatic filariasis (endemic pockets by 2017).
• Tuberculosis: >85% cure in new sputum positive;
‑
reduce incidence to reach elimination by 2025.
• Blindness prevalence: reduce to 0.25 per 1000 by 2025;
reduce overall disease burden by one third.
‑
• Premature mortality from CVDs, cancer, diabetes or
chronic respiratory diseases: reduce by 25% by 2025.

28. Health Systems Performance – Coverage
• Increase utilization of public facilities by 50% by
2025.
• ANC coverage >90% and skilled birth attendance
>90% by 2025.
• Full immunization >90% by 1 year of age by 2025.
• Meet family planning need >90% at national and
sub national levels by 2025.
‑
• 80% of known hypertensive & diabetic individuals
achieve controlled status by 2025.

29. Cross sectoral Goals Related to Health
‑
• Relative reduction in current tobacco use by 15%
(2020) and 30% (2025).
• Reduce stunting in under five children by 40% by
‑
2025.
• Universal access to safe water & sanitation by
2020 (alignment with Swachh Bharat).
• Halve occupational injuries among agricultural
workers by 2020; state level tracking of key
‑
health behaviours.

30. Health System Strengthening – Finance
• Public health expenditure to 2.5% of GDP by
2025.
• State health spending >8% of state budgets by
2020.
• Reduce households facing catastrophic health
expenditure by 25% by 2025.
• Strategic purchasing to fill service gaps;
prioritise primary care in allocations.

31. Health Information & Surveillance
• District level electronic health databases by
‑
2020; strengthen surveillance and disease
registries.
• Establish federated, integrated health
information architecture, HIEs and a National
Health Information Network by 2025.
• Use digital tools for epidemiological surveys
and programme monitoring.

32. Digital Health Ecosystem – Policy Directions
• Use unique ID for identification; create
provider, patient, service and disease
registries.
• Build national health information exchange
platforms and networks.
• Leverage mobile/Cloud/NOFN; real time data
‑
capture; support AYUSH data systems.

33. Regulation, HTA & Technologies
• Develop institutional framework for Health
Technology Assessment (HTA).
• Strengthen regulation for quality, safety, ethics
across public & private sectors.
• Incentivize domestic manufacturing of drugs,
APIs and medical devices; strengthen public
procurement.

34. Implementation & Governance
• Clarify roles of Centre & States; equity sensitive
‑
resource allocation.
• Strengthen Panchayati Raj Institutions; mandate
Community Based Monitoring & Planning.
• Increase horizontal & vertical accountability;
robust grievance redressal.
• Progressive, assurance based pathway towards
‑
Right to Health.

35. Health Systems in India

36. Centre (MoHFW & National Agencies)
• Ministry of Health & Family Welfare (MoHFW)
– Departments: Health & Family Welfare; Health
Research (ICMR); NACO under DoHFW
– DGHS: technical directorate; standards & programs
• Institutions / Missions
– National Health Mission (NHM) – rural & urban
(NUHM)
– Ayushman Bharat: AAM/HWCs & PM-JAY (NHA)
– ABDM (digital health), PM-ABHIM (infrastructure)

37. State Level
• State Health Mission & State Health Society (SHS)
– Headed by CM/Health Minister; implements NHM via
SHS
– SPMU, SHSRC, SIHFW support policy, planning, HR &
capacity building
• Directorate of Health Services & Program
Directorates
– Public health programs, disease control, HRH,
procurement & quality

38. District & Below
• District Health Society (DHS)
– Planning & management of all health & family
welfare programmes
– District Programme Management Unit (DPMU):
planning, M&E, finance
• Facility & Community Platforms
– Rogi Kalyan Samiti (RKS) at PHC/CHC/SDH/DH
– Village Health, Sanitation & Nutrition Committee
(VHSNC) at GP/ward

39. Referral Pyramid (Rural & Urban)
Apex / Tertiary (Medical College)
District Hospital / SDH
CHC / UCHC
PHC / UPHC
Sub-centre (AAM-SC) / MAS
Community Platforms

40. Governance Flow – NHM
MoHFW / NHM Policy, Funds
State Health Mission & State Health
Society
District Health Society (DHS)
Health Facilities (PHC/CHC/DH)
with RKS
Community Platforms
VHSNC / MAS / PRI

41. Panchayati Raj & Health
• Three-tier PRIs
– Gram Panchayat → Panchayat Samiti (Block) → Zila
Parishad (District)
– Eleventh Schedule includes health, sanitation, water
supply, nutrition
• Community Action Mechanisms
– VHSNC at village/ward level for planning, monitoring,
social accountability
– RKS for facility-level governance, patient-centred
services

42. PRI–Health Interface
Zila Parishad Panchayat Samiti Gram Panchayat
Devolution & Planning
District Health Society VHSNC & ASHA / AWW / ANM
Community
Feedback
Facility RKS (APHC/CHC/DH)

43. Rural Development Schemes – Determinants
of Health
• MGNREGA (MoRD)
– 100 days wage employment; assets for water conservation; supports incomes
• DAY-NRLM (MoRD)
– Women SHGs; livelihoods; nutrition & social development through community
institutions
• PMAY-G (MoRD)
– Pucca housing with basic amenities; convergence with toilets, water, LPG
• PMGSY (MoRD)
– Rural road connectivity → access to health & markets
• Jal Jeevan Mission (MoJS-DDWS)
– Household tap water; water quality & source sustainability
• Swachh Bharat Mission – Gramin (MoJS-DDWS)
– ODF sustainability, SLWM, fecal sludge & greywater management

44. Social Determinants Linked to Schemes
IncoAAme & Livelihoods
MGNREGA / NRLM
HousinAg
PMAY-G
Roads & Access
PMGSY
Water Supply
JJM
Sanitation & Hygiene
SBM-G
Improved Health Outcomes
(communicable & NCD risk reduction)

45. Urban Health (NUHM)
• Urban Primary/Community Health Centres;
MAS; linkages with ULBs
• Focus on slum & vulnerable populations; NCD
screening; community processes

46. Facility Standards (IPHS 2022)
• Updated benchmarks for
SC/PHC/CHC/SDH/DH across services, HR,
diagnostics, drugs, quality & patient safety
• Alignment with AAM/HWCs and PM-ABHIM
infrastructure investments

47. Ayushman Arogya Mandir (AB-HWC)
• Comprehensive primary care: preventive,
promotive, curative, rehabilitative & palliative
services
• SCs/PHCs transformed as AAMs; empanelled
diagnostics & essential drugs; digital health
registries

48. District Planning, M&E & Accountability
• District Health Action Plan (DHAP)
– Gap analysis, resource mapping, strategies &
budgeting
• Accountability mechanisms
– RKS at facilities; community-based monitoring;
social audits (VHSNC)
• HMIS & surveillance
– Timely reporting, dashboards; use of data for
decisions

49. Health Planning in India

50. Introduction
• Health planning: systematic approach to
define objectives, mobilize resources, and
implement strategies for health improvement.
• India: health planning integrated with national
economic development through Five-Year
Plans.
• Framework: Central, State, District levels with
PRI and community participation.

51. Evolution of Health Planning in India
• First Five-Year Plan (1951-56)
– Focused on agriculture, community development, basic health services.
• Second Plan (1956-61)
– Expansion of hospitals and dispensaries, training health professionals.
• Third Plan (1961-66)
– Emphasis on prevention of communicable diseases, malaria eradication.
• Fourth Plan (1969-74)
– Family planning, maternal and child health, rural health services.
• Fifth Plan (1974-79)
– Minimum Needs Programme; rural health infrastructure.
.

52. Evolution of Health Planning in India
• Sixth Plan (1980-85)
– Technology mission for immunization, MCH programs.
• Seventh Plan (1985-90)
– Universal Immunization Programme, strengthening PHCs.
• Eighth Plan (1992-97)
– Child survival, safe motherhood, RCH approach.
• Ninth Plan (1997-2002)
– National Population Policy, NHP 2002.
• Tenth Plan (2002-07)
– NHM conceptualized; focus on outcomes.
• Eleventh Plan (2007-12)
– NRHM implementation, ICDS expansion.
• Twelfth Plan (2012-17)
– Inclusive growth; Universal Health Coverage.

53. National Health Programs & Missions
• National Health Mission (NHM): NRHM +
NUHM.
• Ayushman Bharat: Health & Wellness Centres,
PM-JAY.
• Disease-specific programs: RNTCP (TB), NACP
(HIV), NVBDCP (vector-borne), NCD Control.
• Family planning, immunization, MCH
programs.

54. Health System Structure
• Centre
– MoHFW, DGHS, NHA, ICMR; National policies, financing,
programs.
• State
– State Health Societies, Directorates, SHSRC, SIHFW.
• District
– District Health Society, DPMU, RKS, VHSNC.
• Service Tiers
– Sub-Centre (AAM-SC), PHC, CHC/SDH, District Hospital,
Tertiary (Medical College).

55. Panchayati Raj & Community Action
• 73rd Amendment
– Health, sanitation, water, nutrition in Eleventh
Schedule.
• Village Health Sanitation & Nutrition
Committee (VHSNC)
– Local planning, social audits, monitoring.
• Rogi Kalyan Samiti (RKS)
– Facility-level governance and accountability.

56. Rural Development Schemes – Health
Linkages
• MGNREGA
– Income & assets for water conservation; livelihood security.
• PMAY-G
– Housing with basic amenities.
• PMGSY
– Rural road connectivity → health access.
• Jal Jeevan Mission
– Safe tap water to households.
• Swachh Bharat Mission – Gramin
– ODF sustainability, waste management.

57. Challenges & Way Forward
• Resource constraints, inequities, urban-rural
disparities.
• Integration of services and intersectoral
convergence.
• Strengthening primary care and HRH.
• Digital health and surveillance.
• Towards Universal Health Coverage and SDG
targets.

58. International Health Agencies

59. Introduction
• Global health agencies play a vital role in
disease prevention, health promotion, and
humanitarian aid.
• Three key agencies: WHO, UNICEF, and
International Red Cross & Red Crescent
Movement.

60. World Health Organization (WHO)
• Background
– Founded: 7 April 1948, HQ Geneva
– Specialized UN agency, directing & coordinating
authority for global health
• Roles & Functions
– Disease prevention & eradication (smallpox, polio)
– Health systems strengthening, universal health
coverage
– Research, guidelines, health statistics

61. UNICEF
• Background
– Established 1946, permanent UN agency since
1953
– Works in 192 countries; HQ New York
• Functions
– Child health & nutrition, immunization, MCH
programs
– Education, sanitation, emergency relief

62. International Red Cross & Red Crescent
Movement
• Background
– Founded: ICRC 1863; IFRC 1919
– Components: ICRC, IFRC, 192 National Societies
• Functions
– ICRC: humanitarian assistance in conflict zones
– IFRC: disaster relief, health emergencies, capacity
building
– National Societies: first aid, community health,
blood donation

63. Comparative Roles of WHO, UNICEF & Red Cross
WHO
Global health policy
& disease control
UNICEF
Child health, nutrition
& education
Red Cross
Humanitarian aid
& disaster relief

64. Collaboration & Impact Cycle
Health Policy (WHO)
Child Care & Relief
(UNICEF)
Humanitarian
Response (Red Cross)
Joint Programs &
Emergencies
Core
Coordination

65. Major Achievements
• WHO: Eradication of smallpox; Global Polio
Eradication Initiative
• UNICEF: Immunization campaigns, education
& nutrition programs
• Red Cross: Humanitarian relief in wars &
disasters, first aid, blood services

66. Challenges & Future Directions
• Funding constraints & political influences
• Global inequities, refugee crises, pandemics
• Future: SDGs, climate resilience, digital health,
universal access

67. Voluntary Health Agencies
(VHAs)

68. Definition & Essence
• Non profit, non governmental organizations providing health services and
‑ ‑
advocacy.
• Driven by voluntarism, philanthropy, and community participation.
• Operate at local, national, or international levels; complement public
health systems.

69. Key Roles & Functions
• Service delivery: clinics, camps, outreach for MCH, NCDs, communicable
diseases.
• Health promotion & IEC/Behaviour Change Communication.
• Training & capacity building for community health workers and volunteers.
• Advocacy & policy engagement; research and pilots; emergency relief.

70. Typical VHA Organization Flow
Governing Board
Executive Director/CEO
Programs Division Operations/Admin Finance & Compliance
Monitoring & Evaluation HR & Capacity Building Communications/IEC

71. Program Cycle for VHAs
Community Needs
Assessment
Design & Resource
Mobilization
Implementation
Monitoring
Evaluation & Learning
Scale/Replication
Continuous
Improvement

72. Funding Streams & Accountability
Grants & Philanthropy Govt Contracts/PPP CSR & Donors
Membership/Fees Crowdfunding & Events
Transparent Finance
& Impact Reporting

73. Partnerships with Government & Others
• Service delivery MoUs under NHM/NUHM, outreach in hard to reach
‑ ‑
areas.
• Community processes (VHSNC support, ASHA training, PRI interface).
• Collaborations with academic institutions & private sector for innovation.

74. Legal & Compliance Snapshot
• Registration: Societies Registration Act / Indian Trusts Act / Companies Act
(Section 8).
• FCRA (for foreign contributions), 12AB & 80G (income tax exemptions),
CSR alignment.
• Safeguarding, quality standards, data protection and ethics policies.

75. Measuring Impact (KPIs)
• Coverage & reach (people served, geographies).
• Health outcomes (e.g., immunization completion, BP control).
• Quality & satisfaction indices; cost effectiveness.
‑
• Sustainability: retention, scale-up, partnerships.

76. Best Practices for VHAs
• Community co design; inclusive and gender sensitive approaches.
‑ ‑
• Strong M&E with real time dashboards; open data where feasible.
‑
• Ethical fundraising; transparency; periodic social audits.
• Leverage digital health tools and interoperable registries.

77. How to Engage/Collaborate
• Map local needs and existing VHAs; define complementary roles.
• Draft outcomes based MoUs; align with district & state health plans.
‑
• Plan for knowledge transfer, capacity building and sustainability.

78. Indian Red Cross Society (IRCS)
• Established: 1920 under Indian Red Cross Society Act.
• Focus: disaster relief, blood banking, MCH programs, HIV/AIDS awareness.
• Nationwide network of branches providing first aid, ambulance, and
health camps.
• Recognized for its disaster relief and humanitarian services.

79. Hind Kusht Nivaran Sangh (HKNS)
• Founded: 1950 to control and eliminate leprosy in India.
• Runs treatment centres, leprosy homes, awareness programs.
• Advocates against stigma; works on rehabilitation of cured patients.
• Collaborates with National Leprosy Eradication Programme.

80. Voluntary Health Association of India (VHAI)
• Established: 1970s; umbrella network of state VHAs.
• Advocacy on public health policies, tobacco control, rational drug use.
• Community health programs, capacity building, health research.
• Publishes health literature and awareness materials.

81. Tuberculosis Association of India (TAI)
• Founded: 1939; pioneer NGO in TB control.
• Runs TB clinics, awareness campaigns, professional training.
• Supports RNTCP/NTEP programs in India.
• Publishes the 'Indian Journal of Tuberculosis'.

82. Family Planning Association of India (FPAI)
• Established: 1949; affiliate of International Planned Parenthood
Federation.
• Focus: reproductive health, family planning, HIV/AIDS prevention.
• Operates clinics, counselling centres, advocacy and education programs.
• Promotes youth empowerment and sexual health education.

83. Kasturba Gandhi Trust (KGT)
• Founded: 1945 in memory of Kasturba Gandhi.
• Focus: maternal & child health, rural development, women
empowerment.
• Runs hospitals, schools, training centres in rural areas.
• Promotes Gandhian principles of self-reliance and community
participation.

84. Contributions & Partnerships
• VHAs extend health services to underserved populations.
• Work in partnership with government health programs like NHM, RNTCP,
NACP.
• Mobilize volunteers and community participation in health initiatives.
• Advocate for equitable policies and health system strengthening.

85. Thank You

88. Healthcare of the Community

89. Introduction
• Community healthcare delivers preventive, promotive, curative, and
rehabilitative services.
• India’s healthcare system is structured at primary, secondary, and tertiary
levels.
• National health programs address key public health issues.

90. Levels of Healthcare
• Primary: Sub-Centres, PHCs, HWCs – first contact, essential services.
• Secondary: CHCs, Sub-District Hospitals – referral care, specialist services.
• Tertiary: District Hospitals, Medical Colleges, Apex Institutions – advanced
diagnostic and treatment facilities.

91. Health for All
• Origin: Alma-Ata Declaration (1978) – health as a human right.
• India’s approach: strengthen primary healthcare, achieve UHC.
• National Health Policy 2017: quality healthcare for all without financial
hardship.

92. Primary Healthcare – Principles
• Equitable distribution of services.
• Community participation in planning and implementation.
• Use of appropriate technology suited to local needs.
• Intersectoral coordination – education, water, sanitation, nutrition.

93. Healthcare Delivery in India
• Public Sector: Sub-Centre → PHC → CHC → District Hospital → Medical
College.
• Private Sector: dominant in urban/semi-urban areas.
• Voluntary Health Agencies: NGOs and charities complementing public
services.
• Ayushman Bharat: HWCs and PM-JAY health insurance scheme.

94. Major Health Problems in India
• Communicable diseases: TB, malaria, HIV/AIDS, dengue.
• Non-communicable diseases: diabetes, hypertension, cancers, CVDs.
• Maternal and child health: high MMR, IMR, malnutrition, anaemia.
• Environmental/lifestyle factors: sanitation, pollution, tobacco, alcohol use.

95. Healthcare Services & Systems
• Preventive: immunization, antenatal care, family planning, health
education.
• Promotive: nutrition, safe water, sanitation, lifestyle modification.
• Curative: diagnosis and treatment at all levels.
• Rehabilitative: disability care, mental health, rehab centres.

96. Voluntary Health Agencies
• Indian Red Cross Society – disaster relief, blood banking, health camps.
• Voluntary Health Association of India – advocacy, awareness, tobacco
control.
• Tuberculosis Association of India – TB clinics, training, publications.
• Family Planning Association of India – reproductive health, HIV
prevention.
• Kasturba Gandhi Trust – rural health, women empowerment.

97. National Health Programs
• National Tuberculosis Elimination Program (NTEP).
• National AIDS Control Program (NACP).
• National Vector Borne Disease Control Program (NVBDCP).
• RMNCH+A – reproductive, maternal, newborn, child and adolescent
health.
• NPCDCS – NCDs: cancer, diabetes, CVD, stroke.
• National Leprosy Eradication Program (NLEP).
• Universal Immunization Program (UIP).

98. Contributions of National Programs
• Reduced maternal and infant mortality.
• Expanded immunization coverage, eradicated smallpox, near-elimination
of polio.
• Strengthened TB, HIV, malaria, leprosy control.
• Improved health infrastructure and human resources.
• Enhanced community participation and awareness.