This presentation deals with Primary Health Care in India. It describes in detail concept & characteristics of PHC. It focuses on structure, service delivery & challanges in front of Primary Health Care in India.

1. PRIMARY HEALTH CARE
SYSTEM IN INDIA -
STRUCTURE & SERVICES
DR PRADIP AWATE,
ASSISTANT DIRECTOR OF HEALTH SERVICES, MAHARASHTRA

2. Scheme of Presentation
 Concept & Importance of Primary Health Care
(PHC)
 Brief history of PHC in India
 Evolution of PHC in India
 Current structure of PHC
 Services provided through PHC
 Issues, Challenges & Opportunities in front of PHC

3. Concept of PHC

5. Characteristics of PHC I
1. PHC reflects and evolves from the economic
conditions and sociocultural and political
characteristics of the country and its communities
and
2. PHC is based on the application of the relevant
results of social, biomedical and health services
research and public health experience;
3. PHC addresses the main health problems in
the community, providing promotive,
preventive, curative and rehabilitative
services accordingly;

6. 4. PHC 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;
Characteristics of PHC II

7. 6. PHC 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. PHC 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.
Characteristics of PHC III

8. History & Evolution of PHC

9. ‘If it were possible to evaluate the loss, which this country annually
suffers through the avoidable waste of valuable human material
and the lowering of human efficiency through malnutrition and
preventable morbidity,
we feel that the result would be so startling that the whole country
would be aroused and
would not rest until a radical change had been brought about‘
(Bhore Committee Report 1946)
सव सु खनः संतु l
सव संतु नरामया ll
'Let all be free
from disease/let
all be healthy',

10. History
 1946 – put forward concept
of Primary Health Care.
 1974- Integrated
cadre of MPWs.
 In 1977, GoI launched a
based on principle of ‘ placing people’s health in
people’s hand.’ ( Recommendation of
1975)
 1978 – – Health for All
through Primary Health Care.

11. Population Norms for PHC
 Bhore Committee – PHC/ 10- 20,000 population.
( But ….resources???)
 Mudaliar Committee (1962) – PHC/ 40,000
population.
 By Fifth Plan (1975-80) – PHC was catering health
needs of 1,00,000 population.
 Alma Ata – New philosophy of Primary Health Care
 1983- National Health Plan – PHC/ 30,000 in plain
areas & per 20,000 in hilly region.

12. Number of PHCs
725
5484
23,887
I Five Year Plan V Five Year Plan Mar-11

13. Current Structure of PHC in India

14. The Ultimate Goal of PHC
1. Reducing exclusion & social disparities in health. (
Universal Health Coverage Reform)
2. Organizing health services around people’s needs.
( Service delivery reforms)
3. Integrated health in to all sectors ( Public Policy
Reforms)
4. Pursuing collaborative models of policy dialogue (
Leadership reform)
5. Increasing stake holder participation

15. Structure of Health Care In India
District
Hospital
RH/SDH/CHC
Primary Health
Center
Subcenter
Village
Subcenter
Village Village Village
Subcener
Village Village
Subcenter

16. Services Provided Through PHC

17. Octagon of PHC
1. Education of the people about prevailing health
problems and methods of preventing and controlling
them.
2. Promotion of food supply and proper nutrition.
3. Adequate supply of safe water and basic sanitation.
4. Maternal and child health care and family planning.
5. Immunization against major infectious diseases.
6. Prevention and control of locally endemic diseases.
7. Appropriate treatment of common diseases and
injuries.
8. Provision of essential drugs.

18. Octagon
of PHC
Health
Education
Food Supply
& Nutrition
Safe Water
& Sanitation
Mother &
Child Health
& Family
Welfare
Immunization
Prevention &
Control of
Diseases
Appropriate
Treatment of
Common
Diseases &
Injuries
Provision of
Essential
drugs

19. Spectrum of Primary Health Care

20. Village Level
• Started in 1977.
• Now replaced by ASHA
Village
Health Guide
• Started under rural health scheme
• Training of local dais for 30 days
• Now not preferred.
Training of
Local Dais
• Advent with NRHM (per 1000 population)
• Imp link between community & health servicesASHA
AWW
•Under ICDS
•For every 400-800 population

21. ASHA
–
1. Local resident.
2. Preferable Age -25-45 yrs
3. Formal education up to 8th class.
4. Communication & leadership qualities.
5. Adequate representation from disadvantaged
population.
6. Ensured to serve such groups better

22. Role of ASHA
1. Awareness & info to
community about
determinants of health.
2. Counseling of women
3. Mobilization &
facilitation of community
to access health care.
4. Work with VHSNC.
5. Accompany women &
children in need of health
care.
6) T/t minor ailments &
DOTS provider.
7) Depot holder of essential
drugs, ORS, IFA, DDK, Anti
malaria
drugs, condoms, Oral pills.
8) T/t of childhood illnesses
9) Inform about vital events.
10) Promote household toilets
under total sanitation
campaign.

23. Integration of ASHA with AWW &
ANM
 AWW & ANM –
resource person for
ASHA.
 Organizing Health
day.
 Mobilizing
beneficiaries
 Survey of eligible
couples & children < 1
yr
 Wkly/fortnightly
meeting of ASHAs by
ANM.
 IEC activity
 Preparation of Village
Health plan

24. Anganwadi Worker (ICDS)
1. Health check up including maintenance of growth charts.
2. Immunization
3. Supplementary nutrition
4. Health education
5. Non formal pre primary education
6. Referral services
 Nursing & pregnant women
 Other women (15-45 years)
 Children below 6 years

25. Composition of VHSNC
 50% members should be women.
 Every hamlet should have adequate representation
along with representative from weaker sections.
 30% representation for Non Government Sectors.
 Representation to women’s self help group.

26. Village Health Sanitation & Nutrition
Committee (VHSNC)
 Create awareness about nutritional issues
 Carry out survey on nutritional status and nutritional deficiencies in the village
 Identify locally available food stuffs of high nutrient value as well as disseminate
and promote best practices (traditional wisdom) congruent with local
culture, capabilities and physical environment through a process of community
consultation.
 Inclusion of Nutritional needs in the Village Health Planand facilitate its working in
improving nutritional status of women and children. .
 Monitoring and Supervision of Village Health and Nutrition Day to ensure that it is
organized every month in the village with the active participation of the whole
village.
 Facilitate early detection of malnourished children in the community, tie up referral
to the nearest Nutritional Rehabilitation Centre (NRC) as well as follow up for
sustained outcome.
 Supervise the functioning of Anganwadi Centre (AWC) in the village
 Act as a grievances redressal forum on health and nutrition issues

27. Sub center
 One per 5000 population in general & one for
every 3000 population in hilly region.
 As of 2011, total sub centers in our country –
1,48,124.
 Approved staff – One ANM + One MPW.
 One Health Assistant (Male) & One Health Assistant
(Female –LHV) –located at PHC HQ are entrusted
with supervision of six SCs under PHCs.

28. Rogi Kalyan Samiti
(Patient Welfare Committee)
 Simple yet effective management structure
 A registered society, acts as a group of trustees for the hospitals
to manage the affairs of the hospital.
 It consists of members from
1. local Panchayati Raj Institutions (PRIs),
2. NGOs,
3. local elected representatives and
4. officials from Government sector who are responsible for
proper functioning and management of the hospital /
Community Health Centre / FRUs.
 RKS / HMS is free to prescribe, generate and use the funds with it as per its
best judgment for smooth functioning and maintaining the quality of services.

29. Package of Services at Sub Center
 Immunization
 Antenatal, natal & postnatal care
 Prevention of malnutrition
 Common Childhood Diseases
 Family Welfare Services
 Counseling
 Elementary drugs for minor ailments
 Community Needs Assessment
 Various National Health Programmes

30. Objectives of IPHS for PHCs
I] To provide comprehensive primary health
care to the community through the
primary health center.
II] To achieve & maintain an acceptable
standard of quality of care.
III]To make the services more responsive &
sensitive to the needs of the community.

31. PRIMARY
HEALTH
CARE
Preventive
Promotive
Curative
Rehabilitative

32. IPHS for PHCs
1. Medical Care
2. Maternal & child care
3. Family planning services
4. MTP services
5. Health education &
management of RTI/STI
6. Nutrition Services
7. Basic lab services
8. Selected Surgical
procedures
9. School health Services
10. Adolescent health care
11. Disease Surveillance &
control programme
12. Collection of vital events
13. Promotion of sanitation
including use of toilet &
appropriate garbage
disposal
14. Water quality monitoring
15. M & E

33. Main National Health Programmes
Through PHC
 RNTCP
 National Programme for blindness (NPCB)
 National Leprosy Elimination Programme (NLEP)
 NVBDCP
 National AIDS Control Programme (NACP)
 National Program for Prevention & Control of
Cancer, Diabetes, Cardiovascular diseases & Stroke
 National Program For Health Care of the Elderly
(NPHCE)
 Programmes for Iodine Deficiency, Tobacco Control

34. INTEGRATED HEALTH APPROACH
Content Activities Ministries/Agencies involved
Focused activities for
marginalized
population Employment, Food security Tribal Welfare, Social welfare
Food Supply
Grains, Cereal, Tuber, Vegetables and Fruit
production
Agriculture,Animal Husbandry, Fisheries, Social
Welfare
Proper Nutrition Milk and dairy products, meat and fish Animal Husbandry, Dairies - pvt/cooperatives, FDA
Food supply Agricultural Produce Markets Ration Shops PDS
Food quality, safety FDA
ICDS, Women and Child Development Women & Child Welfare
Safe Water
Drinking Water Resources, Sewage drainage
and disposal, Water purification, Forest and
Water Conservation, Irrigation
Water Supply & Sanitation , PWD, Rural Development,
Public Health Labs
Sanitation Solid waste disposal PWDs, Urban Planning, Environmental
Mother (Women) Care
Marriage registration,ANC, PNC, CaCx
detection, family planning
Public Health and Family welfare, Registrar of Vital
events
Child care
Trained Birth Attendant, Institutional delivery,
Birth registration, early Breast feeding,
Immunization, treatment of illnesses, early
child care
Public Health and Family welfare, FDA, Pharmaceutical
and Health device industry, Paediatric clinics/hospitals,
vaccine industry
Communicable Diseases Prevention & Control activities
Water Supply & Sanitation, Urban Development, Rural
Development, Agriculture, Forest, Animal Husbandry

35. Challenges In Providing Effective
PHC

36. Challenges ???
 Infrastructure for rising population Size & diversity
 Rapid urbanization
 Changing demographic profile – Ageing
population
 Triple burden of diseases
 Man power crisis
 Quality care & client satisfaction
 Quality research in PHC

37. The woods are lovely, dark & deep
But I have promises to keep…
And miles to go before I sleep…!
--- Robert Frost.