The document summarizes the history of community health and community health nursing in Nepal and worldwide. It discusses how in Nepal, community health nursing began with a few nurses being sent for training in India in the early 20th century. It established the first community health programs in the 1970s and developed national policies in the 1990s. Globally, it evolved from early religious care of the sick at home, to district nursing focusing on health education, to public health nursing addressing populations, and now community health nursing serving communities. The document provides an overview of the key developments and individuals that helped establish community health nursing as a critical part of healthcare.

1. Ms. Sakun Rasaily
PAEDIATRIC WARD
BPKIHS
sakunrasaily@gmail.com
PRESENTATOR
HISTORYOFCOMMUNITYHEALTH&COMMUNITYHEALTHNURSING
INNEPAL
INWORL

2. PRESENTATION OUTLINES
 INTRODUCTION TO…..
History
Community
Health
Community Health
Community Health Nurse
Community Health Nursing
 HISTORY OF COMMUNITY HEALTH NURSING IN NEPAL
 SCOPE OF COMMUNITY HEALTH NURSING
 HISTORY OF COMMUNITY HEALTH NURSING IN THE WORLD
 REFERENCES
 SUMMARY

3. History
 Thedisciplinethatstudiesthechronologicalrecordof events(as
affectinganationorpeople),basedonacriticalexaminationof
sourcematerialsandusuallypresentinganexplanationof their
causes.
Thebranchof knowledgedealingwithpastevents.
acontinuous,systematicnarrativeof pasteventsasrelatingtoaparticular
people,country,period,person,etc.,usuallywrittenasachronologicalaccount;
chronicle:ahistoryof france;amedicalhistoryof thepatient.
theaggregateof pastevents.
therecordof pasteventsandtimes,especiallyinconnectionwiththehuman
race.

4.  A group of people with a common characteristic or interest
living together within a larger society
 A body of persons or nations having a common history or
common social, economic, and political interests
 A social, religious, occupational, or other group sharing
common characteristics or interests and perceived or
perceiving itself as distinct in some respect from the larger
society within which it exists:

5.  Health is a state of complete physical, mental,
and social well-being and not merely the
absence of disease or infirmity.” WHO
 The condition of being sound in body, mind, or
spirit.She is the picture
of health.especially : freedom from physical
disease or pain

6.  The term "community health" refers to the health status of a
defined group of people, or community, and the actions and
conditions that protect and improve the health of the
community.
 A community is a group of people who might have different
characteristics but share geographical location, settings, goals,
or social interest. Examples of communities include people
living in the same town, members of a church, or members of
a sports team. Community health is a field of public health
that focuses on studying, protecting, or improving health
within a community. It does not focus on a group of people
with the same shared characteristics, like age or diagnosis, but
on all people within a geographical location or involved in
specific activity.

7.  Community health nurses serve the public in their own
environments to promote wellness and improve
healthcare. They are educators and advocates.
 A community health nurse or public health nurse identifies
people in need and reaches out to them. Whether they are
helping young pregnant women, the elderly or victims of
crime, community health nurses spearhead efforts to aid
vulnerable groups of people. They may also apply their
medical expertise to specialize in a variety of fields:
 Case management.
 Clinical practice.
 Corporate or school nursing.
 Home care.
 Pharmaceutical sales.
COMMUNITY HEALTH

8.  Community health nursing involves a holistic
approach to patient care. Interventions are aimed at
individuals, families and groups within a geographic
area. Nursing care focuses on managing and
preventing diseases as well as educating a community
about maintaining well-being.
 To determine how to educate and treat a community,
nurses should consider the following:
 Cultural beliefs
 Environment
 Lifestyle
 Socioeconomic factors

9. BEFORE 1972 AD
 History of communuty health nursing in nepal isnot more
longer.
 In the beginning when mankind needed nursing services was
given by the mother & any other women.they give nursing care
to the sick injured & sick people.
 At that time peoples attitude towards nursing wasnot good in
the beginning people said to refuse care from nures.
 Before & during RANA period from 1903 to 2002 BS there were
not public health nursing services available in Nepal.
 At that time four neplease girls were sent to Allahabad India for
18 month midwifery course along with their
History Community Health Nursing In Nepal

10.  Guardians in 1985 BS.
 During the rule of Jung bahadur Rana, Royal
Family,got immunization against small pox.
 At the time of Prithivinaran Narayan shahallopathic
medicine used to apply to cure injury & injured
people of Kritipur.
 Dr. warfied was Allopathoc doctor in royal family.
 The record shows that one post was created as
Director of local health service {Dr raghubir Vaidhya}.
 Later on this local health service was changed in to
public health services.but malaria eradication,small
pox,leprosy ,TB eradication,FP,MCH remained
seperately as vertical project by the support of donoar
agencies.

11.  After complection of foue ladies training all of them
were posted at Bir hospital in the year 2010/2011 Bs.
 One post was created for the director general for local
health assigned to take that post.
 Ms Laxmi Malla was appointed by MOH in 2012 Bs to
work as a public health Nurse.
 Later she dis M.sc. In community health from womens
university Bombay.
 Then she started her Nursing Profession as an
SN/PHN in Bharatpur in the ANM training centre.

12.  In thr central level Kathmandu PHN were assigned in
MCH/FP projects to provide community health
nursing focusing on mother & child health care and
FP services.
 In second plan period {1962-1965 }…..
 Treatment plan was shifed in preventive & curative
medicine.
 In the third plan {1956-1970 }…
 Emphasis on preventive & promotivr health care
services gained further attention.
 At that time there were epidemic of various
communicable disease like Malaria,small
pox,Cholera,TB,Leprosy etc.

13.  Separate individual health workers from each
organization use to be managed in each level of health
care system {HP level ? Central level } for provoding
those services.
 Integrated Community Health Service development
Project established by the MOH was made responsible to
integrate all vertical health programmes & ran under one
umbrella as Distric Health Office.

14. After 1972 AD {2028 /2029 ]…
 In 2028 /2029 Bs, the new approach of integrated health
servises was developed.
 All health services provided through various projects were put
together umbrella of government of Nepal community hwalth
servicea as a pilot project.
 In 2029/2030 Bs two district Bara & Kaski were selected to run
the programme as a pilot test.
 At the Same year an organization of Integrated Health Service
pilot projrct was established in central level,last it was upgrated
as Community Health Division after the success of pilot project
in to Bara & kaski districts it was implemented in all districts in
phase wise.

15.  The programme of distric hospitals & health post were midified.
 The health post run under the distric public health office.
 First Long Term Health Plan {1975-1990 }…
 Emphasized on the revision of comprehensive basic Health Service to
majority op population as the concept of HEALTH FOR ALL by 2000 WHO.
 In 2033/2034 {1976 Ad }….
 Post basic bachlor in community health nursing was started in Mahabuddha
Nursing Campus & prepared for communuty health nusre to work in
community according to the plan of Nepal government.
 In 2046 {1989 }….
 Changed the political system from autocratic to democratic in the country &
also changed the health care system from centra to peripheral level i.e from
Ministry to Sub Health level.
 New hwalth care system defined the health care service to be provided by each
level of health system.

16. In 2048 {1991 }…..
National Health Service Policy was developed for health sector
development.The principle objective of National Policy formulated
to upgrade health standard of rural population strengthening PHC.
National Health Policy mainly addressed…..
 Preventive primitive health services.
 Basic primary health services.
 Curative health services.
 Ayurveda & other traditional health services.
 Community participation in the health services.
 Organization & management.
 Human resourses development { training job description
change}
 Drug supply { community drug scheme }
 Resource mobilization.
 Health search.
 Private – NGO & Public partnership inter sectirial co-
ordination
 12 Decentralization { district health approach }

17.  In 2050 Bs {1993 Ad }…..
 Organization was changed.
 Various division including Nursing Division &
Community Health Division were dissolved &
developed within the department of Health Service.
 All programme were implemented within thw DOHS.
 In 1996 AD established Malaria resesrch & training
centre in Hetauda later on converted to Vector Born
Disease research & training centre.
 At the same time job description of PHN of various
health care system was prepared by National Health
Trainint Centre.

18.  Later in 1997 – 2002 focused on poverty alleviation
programme that people could be engaged in productive
activity in daily living.
 At present many PHN & ANM are working in various
areas like Government Of nepal.educational Institutes,
INGO,NGO,& local NGO from central to grass roots
level to provide the various communities health nursing
services in Nepal.

19. Responsibilities of ANMs in Integrated Health
Services
 Run FP/MCH clinics
 Home Visit to identify ANC/PNC women's
 Motivate/Distribute FP methods
 Treatment of simple diseases
 Motivate people to seek health care and facilities
 Coordinate with TBAs for safe delivery
 Run outreach/mobile clinic
 Keep record up to 2 hr walking distance once a week
 Keep record/ Report FP/MCH activities
 Referral of any high risk and complicated mothers

20. Scope of community health nursing
 Home care
 Nursing homes
 MCH and family planning
services
 School health nursing
 Domiciliary Care
 Rehabilitative centers
 Mental health nursing services
 Geriatric nursing care
 Family planning centre
 Industrial nursing services

21.  Community health nursing is the product of centuries of responsiveness and
growth.
 Its practice was adapted to accommodate the needs of a changing society, yet
it has always maintained its initial goal of improved community health.
 Community health nursing development has been influenced by changes in
nursing, public health and society that is traced through several stages.
HISTORY OF COMMUNITY HEALTH
NURSING IN THE WORLD

22. The specialty of community health nursing
developed historically through four stages.
1 The early homecare stage (before the mid-1800s) :- emphasized care to the sick poor in their
homes by various lay and religious orders.
2 The district nursing stage (mid-1800s) :- included voluntary home nursing care
for the poor
by specialists or "health nurses" who treated the sick and taught wholesome
living to
patients.
3 The public health nursing stage (1900-1970):- was characterized by an increased concern for
the health of the general public.
4 The community health nursing stage (1970 to the present) :- includes increased recognition of
community health nursing as a specialty field, with focus on communities and populations

23.  Community health nursing development has been influenced by changes in nursing, public
health and society that is traced through several stages.Early Home Care Stage (Before Mid
1800s) For many centuries female family members and friends attended the sick at home.
 The focus of this care was to reduce suffering and promote healing (Kalish and Kalish,
1986).
 The early roots of home care nursing began with religious and charitable groups
 This stage was in the midst of these deplorable conditions and response to them that
Florence Nightingale began her work.

 Much of the foundation for modern community health nursing practice was laid through
Florence Nightingale's remarkable accomplishments.
 Nightingale’s concern for population at risk as well as her vision and successful efforts at
health reform provided a model for community health nursing today.

24. District Nursing (Mid 1800s to 1900)

The next stage in the development of community health nursing was the formal organization of visiting
nursing (Phoebe, 58AD) or district nursing.
 Although district nurses primarily care for the sick, they also thought cleanliness and wholesome living to
their patients, even in that early period.
 Nightingale referred to them as “health nurse”. This early emphasis on prevention and health nursing
became one of the distinguishing features of district nursing and later of public health nursing as a
specialty.
Problems of district nursing:

Increased number of immigrants Increased crowded city slums Inadequate sanitation practicesUnsafe.
 Unhealthy working conditionsNevertheless, nursing educational programs at that time did not truly
prepare district nurses to cope with their patients, multiple health, and social problems.

25. Public Health Nursing Training (1900-1970)

By the turn of the century, district nursing had broadened its focus to include the health and welfare of
the general public, not just the poor.Lillian D. Wald’s ( ) contributions to public health nursing were
enormous.
 Her driving commitment was to serve needy populations.
 Wald’s emphasis on illness prevention and health promotion through health teaching and nursing
intervention as well as her use of epidemiological methodology established these actions as hallmarks of
public health nursing practice .
Community Health Nursing (1970 to present)

The emergence of the term community health nursing heralded a new era while public health nurses continued
their work in public health by the late 1960s and early 1970s.
 Many other nurses, not necessarily practicing public health, were based in the community.
 Their practice settings included community based clinics, doctor’s office, work sites, schools, etc, to provide a
label that encompassed all nurses in the community

26.  Public health nursing, viewed as a part of community health nursing, was described as generalist practice
for nurses prepared with basic public health content at the baccalaureate level and a specialized practice for
nurses prepared in the public health at the master's level or beyond.
 The first district nurses in England undertook 12 months of training at St Thomas’s Hospital and six
months of training in district nursing.
 According to Baly (16) they had “lectures on subjects that general training omitted, such as the care of
mothers and their infants after childbirth, sanitary reforms, drainage, water supply, infectious diseases,
and the teaching of health care”.
 In the United States, Lillian Wald’s work at Henry Street has inspired many to pursue the role of the
public health nurse.
 The following quote by her, cited in Anderson (17), illustrates her thinking at the turn of the 20th
century.

27. REFERENCES
 https://www.google.com/search?q=historical+development+of+community+health+in+world
 https://www.slideshare.net/drjayeshpatidar/historical-developments-of-community-health-nur
 https://www.cartercenter.org/resources/pdfs/health/ephti/library/lectu
 https://www.cartercenter.org/resources/pdfs/health/ephti/library/lectu
 https://slideplayer.com/slide/10734355/
 A text book of community health nursing. { BINDA GHIMIRE }
 Government Of Nepal.Ministry of Health % Population. Annual Report.
 Park K, Parks text book of preventive & social medicine.