3rd Prof. BAMS, Swasthavritta, Community medicine syllabus topic

1. PRIMARY
HEALTH CARE SYSTEM
IN INDIA
Dr. Jasminkumar Viramgami
Reader & H.O.D.,
Dept. of Swasthavritta,
Govt. Akhandanand Ayurved College, Ahmedabad, Gujarat

2. HEALTH
CARE
DELIVERY
CONSUMERS
1015
million
PROVIDERS
Medical officer, Nurses
Pharmacist, Lab
technician
BEE, ANM, HA
SYSTEM
PUBLIC
SECTOR
PRIVATE
SECTOR
INDIGENOUS
SYSTEM OF
MEDICINE
VOLUNTARY
HEALTH
AGENCIESNATIONAL
HEALTH
PROGRAMMESDr. J M Viramgami, HOD Swasthavritta, GAAC

3. • The health care system is intended to deliver
the health care services.
• In India, it is 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.
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

4. HEALTH CARE SYSTEM IN INDIAHEALTHCARESYSTEM
Public Health Sector
Private Sector
Indigenous System Of Medicine
Voluntary Health Agencies
National Health Progs
Dr. J M Viramgami, HOD Swasthavritta, GAAC

5. PUBLIC HEALTH SECTOR
PRIMARY HEALTH CARE
• PHC
• SC.
HOSPITALS / HEALTH CENTERS
• Community Health Centers.
• Rural Hospitals.
• District Hosp.
• Specialist Hosp.
• Teaching Hosp.
HEALTH INSURANCE SCHEMES: ESIS, CGHS.
OTHER AGENCIES: Defence services, RailwaysDr. J M Viramgami, HOD
Swasthavritta, GAAC

6. PRIVATE SECTOR
•Private Hosp, Poly Clinics, Nursing Homes,&
Dispensaries.
•General Practitioners & Clinics.
INDIGENOUS SYSTEM OF MEDICINE
•Ayurveda, Yoga, Unani, siddha & Homeopathy.
(AYUSH)
•Unregistered Practitioners.
VOLUNTARY HEALTH AGENCIES
NATIONAL HEALTH PROGDr. J M Viramgami, HOD
Swasthavritta, GAAC

7. Rural Health care system in India
The health care infrastructure in rural areas is a
three tier system and is based on the population
norms.
Health Facility
Population Norms
Plain Area
Hilly/Tribal/Difficult
Area
Sub-Centre 5000 3000
Primary Health
Centre
30,000 20,000
Community Health
Centre
1,20,000 80,000
Dr. J M Viramgami, HOD Swasthavritta,
GAAC

8. Primary Health Centre (PHC)
Referral unit for 4-6 SC; 4-6 bedded manned with a MO in-
charge and 14 paramedical staff . no. of PHCs with
specialized Health Services
Community Health Centre (CHC)
A 30 bedded Hospital/ Referral unit for 4 no. of PHCs with
specialized Health Services
Sub Centre (SC)
Most peripheral contact point of community with Primary
Health Care system; manned with one MPW(M) and
MPW(F)
Village Level
village level appointed health workers
ASHA, Anganwadi, Dai, local health workerDr. J M Viramgami, HOD Swasthavritta,
GAAC

9. PRIMARY HEALTH CARE IN INDIA
• AT VILLAGE LEVEL:
VILLAGE HEALTH GUIDE
LOCAL DAIS
ANGANWADI WORKER
ASHA
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

10. Village Health Guide
•Started in 1977.
•Now replaced by ASHA
ASHA
• Advent with NRHM
• (per 1000 population)
• link between community &
health services
Local Dais
•Started under rural
health scheme
•Training of local dais for
30 days Now not
preferred.
AWW
•Under ICDS
•For every 1000
population
Dr. J M Viramgami, HOD Swasthavritta, GAAC

11. VILLAGE HEALTH GUIDE SCHEME
• introduced with idea of securing people’s participation
in the care of their own health.
The guidelines for their selection are
• permanent residents of the local community
• able to read and write, having minimum formal
education
• acceptable to all section of the community,
• able to spare at least 2 to 3 hrs every day for health
work
• undergo a short training in PHC
Duties: treatment of simple ailments, activities in first aid,
MCH, family planning ,health education and sanitation.
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

12. LOCAL DAI
• Train all local dais to improve their knowledge in the
maternal and child health and sterilization, besides
obstetric skills.
• Training of 30 days. required to conduct atleast 2
deliveries under the guidance and supervision
• After training Dai is provided with delivery kit and a
certificate
• play a vital role in spreading small family norm because
they are more acceptable to the community.
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

13. ANGANWADI WORKER
• Under the ICDS scheme,
• an anganwadi worker for a population of 1000.
• selected from the local community
• training in various aspects of health, nutrition and child
development for 4 months
• services: health education, non-formal pre-school
education and referral services.
• The beneficiaries are generally nursing mothers, other
women, adolescents and children below the age of 6
years.
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

14. Dr. J M Viramgami, HOD
Swasthavritta, GAAC

15. ASHA = Accredited Social Health Activist
• a health activist in the community to create awareness on
health
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
ASHA
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

16. Responsibilities of ASHA
• create awareness and provide information on health
• counsel women on MCH,
• prevention of CDs including RTI/ STI,
• family planning, care of young child etc
• primary medical care for minor ailments such as
diarrhoea, fevers and first aid for minor injuries
• depot holder for essential provisions like oral
rehydration therapy , iron, folic acid tablets, oral pills
etc
• inform about any unusual health problems in her
village, births and deaths, etc
• promote total sanitation campaignDr. J M Viramgami, HOD
Swasthavritta, GAAC

17. • peripheral outpost of the existing health delivery
system in rural areas
• per 5000 population in general & one for every 3000
population in hilly region.
• MoHFW is providing 100% Central assistance
Approved staff –
• 1 ANM (auxiliary nurse midwife) / FHW + 1 MPW
(male/multipurpose health worker)
• One HA (Male) & One HA (Female –Lady Health
Visitors) – of PHC supervise six Sub Centers under a
PHCs.
SUBCENTRE LEVEL
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

18. Dr. J M Viramgami, HOD
Swasthavritta, GAAC

19. PRIMARY HEALTH CENTRE
PHC provides…
• comprehensive health care
• integrated curative and preventive health care
• preventive and promotive health care
to the rural population in community development
blocks.
• first contact point between village community and
the M.O.
• acts as a referral unit for 6 sub-centres.
• The PHCs are established and maintained by the
State Governments.
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

20. Cont….
• It has 4 - 6 beds for patients.
1 PHC for every
• 30,000 rural population in the plains,
• 20,000 in hilly, tribal and backward areas
• 1 M.O. supported by 14 paramedical and other
staff means a PHC.
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

21. Functions of PHC:
 Medical care
 MCH and family welfare
 MTP services
 Selected Surgical procedures
 Prevention and control of CDs
 Referral services
 Basic laboratory services
 Health education
 School health services
 National health programmes
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

22. Training of health guides, health workers , local
dais and health assistants
Collection and reporting of vital statistics
Safe water supply and basic sanitation
Prevention of food adulteration practices
Mainstreaming of AYUSH
Functions of primary health centres
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

23. Dr. J M Viramgami, HOD
Swasthavritta, GAAC

24. COMMUNITY HEALTH CENTRES
• secondary level of health care, constituting
• First Referral Units (FRU).
• serves as a referral centre for 4 PHCs
CHC covers approximately
• 80,000 population in tribal/ hilly areas
• 1,20,000 population in plain areas.
• 30 bedded hospital with OT, X-ray, Labour Room
and Laboratory facilities
• specialist care in medicine, obstetrics and
gynecology, surgery, paediatrics, Dental and AYUSHDr. J M Viramgami, HOD
Swasthavritta, GAAC

25. (CHC)
• These were established by upgrading the PHC
• established and maintained by the State
Government.
• staffed by four medical specialists i.e. Surgeon,
Physician, Gynecologist and Pediatrician
• and supported by paramedical and other staff.
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

26. Functions of CHC
Care of Routine and Emergency Cases in Surgery
Dressings, I&D, and surgery for Hernia, Hydrocele,
Appendicitis etc.
Emergencies like Intestinal Obstruction, Haemorrhage,
etc.
Other management including nasal packing,
tracheostomy, foreign body removal etc.
Fracture reduction and putting splints/plaster cast.
Conducting daily OPD.
Care of Routine and Emergency Cases in Medicine
Daily OPD
Handling all the emergency and routine cases
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

27. Maternal Health
Minimum 4 ANC check ups including
Registration & associated services
24 hr delivery services including
normal and assisted delivery and
cesarean section
Minimum 48 hours of stay after delivery,
3-7 days stay post delivery for managing
Complications
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

28. Newborn Care and Child Health
Essential Newborn Care and Resuscitation
Counseling on Infant and young child feeding
Routine and emergency care of sick children
Full Immunization of infants and children against
VPDs
Management of Malnutrition cases.
Family Planning
Counseling, provision of Contraceptives, NSV,
Laparoscopic Sterilization Services and their follow up.
Safe Abortion ServicesDr. J M Viramgami, HOD
Swasthavritta, GAAC

29. All National Health Programmes delivered
through CHCs
School health services
Others
Blood storage facility
Essential laboratory services
Referral (transport) services
Maternal Death review (MDR)
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

30. 2. HOSPITALS
Government sector consists of
• rural hospitals,
• sub-divisional/ taluka hospitals,
• district hospitals (DH),
• specialist hospitals and
• teaching institutions.
• RURAL HOSPITALS: a good number of PHCs are located
at Sub-divisional/ taluka headquarters which also have
hospitals.
• DISTRICT HOSPITALS
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

31. • There is no universal health insurance in India.
• at present limited to industrial workers and their
families.
• The Central Govt employees covered by the health
insurance, under "Central Govt. Health Scheme".
• providing reasonable medical care plus some
essential preventive and promotive health services.
• At present “Ayushman Bharat” is similar to
Universal Health Coverage Scheme in India.
HEALTH INSURANCE
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

32. Employees State
Insurance Scheme
• contribution by the employer and employee
• provides for medical care in the form of cash and
kind
• benefits in the contingency of sickness, maternity,
employment, injury
• pension for dependents on the death of worker due
to employment injury.
• covers employees drawing wages not exceeding
Rs.15,000 per month.Dr. J M Viramgami, HOD
Swasthavritta, GAAC

33. Central Government
Health Scheme
• comprehensive medical care to Central Govt
employees.
• co-operative effort by the employee and the
employer, to the mutual advantage of both
• The scheme has dispensaries/ hospitals in
various systems of medicine and
• provides service to about 42.76 lakh
beneficiaries.
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

34. The facilities under the scheme include
• OPD care
• Supply of necessary drugs
• Laboratory , x-ray investigations
• Domiciliary visits
• Hospitalization facilities
• Specialist consultation
• Paediatric services
• Antenatal ,natal, postnatal services
• Emergency treatment
• Supply of optical and dental aids
• Family welfare servicesDr. J M Viramgami, HOD
Swasthavritta, GAAC

35. OTHER AGENCIES
Defense Medical Services:
• Defense services have their own organization for
medical care to defense personnel under the
banner "Armed Forces Medical Services".
Health care of Railway Employees:
• The Railways provide health care services
through the agency of Railway Hospitals, Health
Units and clinics.
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

36. II. PRIVATE SECTOR
• provides a large share of the health services
• general practitioners constitute 10% of the
medical profession.
• Concentrated in urban areas.
• provide mainly curative services.
• services are available to those who can pay.
• it is not organized.
• some statutory bodies regulate private medical
practitioners. Dr. J M Viramgami, HOD
Swasthavritta, GAAC

37. INDIGENEOUS SYSTEMS OF
MEDICINES (ISM)
• provides medical care largely to the rural people.
• In recent years considerable state backing to
promote these systems.
• AYUSH is the new approach, which includes
Ayurveda, Yoga, Unani, Sidhha, Homeopathy
• state run AYUSH dispensaries .
• Central Council of Indian Medicine to prescribe
minimum standards of educationDr. J M Viramgami, HOD
Swasthavritta, GAAC

38. IV. VOLUNTARY HEALTH
AGENCIES

39. INDIAN RED CROSS SOCIETY (IRS)
• established in 1920
• 400 branches in India
ACTIVITIES:
• Relief work
• Milk and Medical supplies
• Armed forces
• Maternal and child welfare services
• Family Planning
• Blood Bank and First Aid
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

40. Hind Kusht Nivaran Sangh
• founded in 1950
• Headquarters in New Delhi
Functions
• financial assistance to leprosy clinics,
• health education, training of medical workers and
physiotherapists,
• conducting research and field investigations,
• organizing All –India Leprosy workers conferences
and publishing journal
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

41. Indian Council for child welfare:
• It was established in 1952
• The services are devoted to secure
India’s children those “Opportunities
And Facilities,by Law And Other
Means” which are necessary to
enable them to develop physically,
mentally, morally, spiritually and
socially in a healthy and normal
manner and in conditions of freedom
and dignity
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

42. Tuberculosis Association Of India:
• It was formed in 1939.
Activities
• organizing TB seal campaign every year to
raise funds
• training of doctors, health visitors and social
workers,
• promotion of health education and promotion
of consultations and conferences.
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

43. Bharat Sevak Samaj
• non political and non official organization
formed in 1952.
• one of the objective of the B.S.S is to help
people to achieve health by their own actions
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

44. Central Social Welfare Board
• Autonomous organization
• under the general administrative
control of the Ministry of Education.
• It was set up by the Government of
India in August 1953.
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

45. Central Social Welfare Board
The functions of the board are:
• Surveying the needs and requirements of
voluntary welfare organizations in the country
• Promoting and setting up of social welfare
organizations
• Rendering of financial and to deserving
existing organizations and institutions
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

46. The Kasturba Memorial Fund
• Created in commemoration of Kasturba
Gandhi, after her death in 1944
• The fund was raised with the main object of
improving the life of women, especially in
the villages, through gram sevikas.
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

47. Family Planning Association Of India
• It was formed in 1949 with its headquarters at
Mumbai .
• It had done pioneering work in propagating
family planning in India
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

48. All India Women’s Conference
• It is only women‘s voluntary welfare
organization in the country .
• It was established in 1926.
• Most of the branches are running M.C.H
clinics, medical centres and adult education
centres, milk centres and family planning
guides.
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

49. All India Blind Relief Society
• It was established in 1946
• with a view to co-ordinate different
institutions working for the blind.
• It organizes eye relief camps and other
measures for the relief of blind.
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

50. Professional bodies:
• The Indian Medical
Association
• All India Licentiates
Association
• All India Dental Association
• The Trained Nurses
Association of India etc
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

51. INTERNATIONAL AGENCIES
• The Rockefeller Foundation,
• Ford Foundation,
• CARE (Co-operative for American Relief
Everywhere)
are examples of voluntary international health
agencies.
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

52. HEALTH PROGRAMMES IN INDIA
• Since India became free, several measures
have been undertaken by the National Govt to
improve the health of the people.
• among these are the national health
programmes
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

53. • launched by the Central Govt
• for the control, improvement of population and rural
health.
• Various international agencies providing technical
and material assistance in the implementation of
these programmes
• like WHO, UNICEF, UNFPA, World Bank, SIDA,
DANIDA, NORAD and USAID
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

54. Some examples…
• National Malaria Eradication Programme
• National Filaria Control Programme
• National Tuberculosis Programme
• National Leprosy Eradication Programme
• Diarrhoeal Disease Control Programme
• National Programme For Control Of Blindness
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

55. • Universal Immunization Programme
• National Family Welfare Programme
• National Water Supply And Sanitation
• National Mental Health Programme
• National AIDS Control Programme
• Minimum Needs Programme
Some examples…
Dr. J M Viramgami, HOD
Swasthavritta, GAAC

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Dr. J M Viramgami, HOD Swasthavritta,
GAAC