Primary health care system in India =. ppt

primary health care in india

1. INTRODUCTION
The primary health centre occupies a key
position in the nation’s health care system. It
provide an integrated curative and preventive
health care to the rural population with emphasis
on preventive and promotive aspects of health
care.

2. INTRODUCTION …CONT
Population covered by one PHC
Rural populations in the plains - 30,000
In hilly, tribal & backward areas- 20,000

3. DEFINITIONS
HEALTH
Acc to WHO (1946), Health is defined as "a
state of complete physical, mental, and
social
 well-being and not merely the absence
of disease or infirmity."

4. DEFINITIONS …CONT
PRIMARY HEALTH CARE:1978
Alma-Ate defined the “primary health care is
essential health care made universally
accessible to individuals and acceptable to
them through their full participation and at a
cost the community and country can afford.

5. DEFINITIONS …CONT
PRIMARY HEALTH CENTRE
Primary Health Centre is an
institution for providing
comprehensives health care
viz., preventive, promotive and
curative services, to the people
living in a defined geographical
area.

7. PRIMARY HEALTH CARE
The “first” level of contact between the
individual and the health system.
Essential health care (PHC) is provided.
A majority of prevailing health problems can
be satisfactorily managed.
The closest to the people.
Provided by the primary health centers.

8. SECONDARY HEALTH CARE
More complex problems are dealt with.
Comprises curative services
Provided by the district hospitals
The 1
st
referral level
TERTIARY HEALTH CARE
Offers super-specialist care
Provided by regional/central level institution.
Provide training programs

9. PRINCIPLES OF PRIMARY
HEALTH CARE

10. STATISTICS
Total PHC in India - 23,109
Total PHC in UP - 3560

11. The Basic Requirements for
Sound PHC (the 8 A’s and the 3
C’s)
Appropriateness
Availability
Adequacy
Accessibility
Acceptability
Affordability
Assessability
Accountability
Completeness
Comprehensiveness
Continuity

12. HISTORY AND EVOLUTION OF
PRIMARY HEALTH CENTRE in
INDIA
In 1977, the government of India had launched a
Rural Health Mission, based on the principle of
“placing the people health in people hands”.

13. PRIMARY HEALTH CENTRE in
INDIA …CONT
BHORE COMMITTEE 1946:
 PHC a basic health unit to provide
integrated preventive and curative
services to rural population.
one PHC/10 to 20,000 populations with 6
medical officers and 6 public health nurses
and other supporting staff.

14. PRIMARY HEALTH CENTRE in
INDIA …CONT
CENTRAL COUNCIL OF HEALTH:
In 1953 ,recommended for establishment of
PHCs in community development blocks to
provide comprehensive health care to rural
population.
One PHC is for 1,00,000 population with little
or no community involvement.
Poorly staffed and equipped, inadequately for
covering the population.

15. PRIMARY HEALTH CENTRE in
INDIA …CONT
MUDALIAR COMMITTEE,1962:
1. Strengthening of existing PHCs and
2. One PHC for 40,000 populations.
SHRIVASTAV COMMITTEE-1975:
Community health care should be provided by
health workers who are from the same
community after proper training. So that people
health is placed in people hands.

16. PRIMARY HEALTH CENTRE in
INDIA …CONT
NATIONAL HEALTH PLAN:
As a signatory to the Alma-Ata declaration ,
India has proposed
reorganization of primary health centers on
the basis of one PHC for 30,000 populations
in plain areas and 20,000 populations in
tribal and hilly areas for more effective
coverage.

17. STAFFING PATTERN
Medical officer -1
Pharmacist -1
Nurse midwife - 1
Health worker F (ANM) -1
Block extension Educator-1
Health Assistant (F)/LHV-1

18. STAFFING PATTERN
Health Assistant (M) -1
UDC and LDC -2 (1 each)
Lab technician -1
Driver (if vehicle is there) -1
Class IV -4
Total 15

20. MEDICAL CARE
OPD services: 4 hours in the morning and
2 hours in the afternoon/evening. Time
schedule will vary from state to state.
Minimum OPD attendance should be 40
patients per doctor per day.
24 hours emergency services : appropriate
management of injuries and accident,

21. MEDICAL CARE …cont
First-aid, stabilization of the condition of
patient before referral.
dog bite/ snake bite/scorpion bite cases,
and other emergency conditions;
Referral services;
In-patient services (6 beds).

22. MCH including family
planning
ANTENATAL CARE
Early registration of pregnancy and
minimum 3 antenatal check-up;
Minimum laboratory investigations such as
hemoglobin, urine albumin and sugar.
Nutrition and health counseling;

23. Antenatal care …cont
Supplementation of folic acid and iron tablets
and tetanus toxoid immunization.
 Identification of high risk pregnancies and
appropriate management;
Refer to other hospital in case of high
pregnancy beyond the management
capability of medical officer in PHC.

24. INTRANATAL CARE
24 hours services for normal delivery;
Promotion of institutional delivery;
Conducting assisted deliveries including
forceps and vacuum delivery whenever
required;
Manual removal of placenta and
Appropriate and prompt referral for cases
needing specialist care.

25. POST –NATAL CARE
Within 48 hours of delivery and 2
nd
within 7
days through sub centers staff;
Initiation of breast-feeding of delivery within
half-hour of delivery;
Education on nutrition, hygiene and
contraction and
Provision of facilities under Janani Suraksha
Yojana.

26. NEW BORN CARE
Essential new born care;
Facilities and care for neonatal resuscitation
and
Management of neonatal hypothermia and
jaundice.

27. CARE OF THE CHILD
Emergency care of sick child including Integrated
Management of Neonatal and childhood Illness
(IMNCI);
Care of routine childhood illness;
Promotion of breast-feeding for 6 months;
Full immunization of all infants and children
against vaccine preventable diseases as per
guidelines and ;
Vitamin A prophylaxis.

28. TRAINING
Initial and periodic training of paramedics in
treatment of minor ailments.
Training of ASHAs.
Training of ANM and LHV in antenatal care
and skilled birth attendance.
Training of AYUSH doctor in imparting health
services related to National Health and
Family Welfare programme.

29. NUTRITION SERVICES
Diagnosis and
management of
malnutrition ,
anemia and vitamin
A deficiency and
coordination with
ICDS.

30. MONITORING AND
SUPERVISION
Monitoring and supervision of activities of
sub-centers through regular meetings/
periodic visits, etc.
Monitoring of all National Health
Programmes.
Monitoring activities of ASHAs.
Health assistant’s male and LHV should visit
sub-centers once a week.

31. 1. Village level
One of the basic tenets of primary health care
is universal coverage and equitable
distribution of health resources. That is health
care must penetrate into the farthest reaches
of rural areas and that everyone should have
access to it. To implement this policy at the
village level the following schemes are in
operation
a. Village Health Guides Scheme
b. Training of Local Dais
c. ICDS Scheme.
d. ASHA Scheme
31

32. a. Village Health Guides (now MPHW M/F)
- A Village Health Guide is a person with an
aptitude for social service and is not a full
time government functionary.
- The Health Guides are now mostly women.
- The Health Guides come from and are
chosen by the community in which they
work.
- They serve as links between the community
and the governmental infrastructure.
- They provide the first contact between the
individual and the health system.
Village Health guide cont….32

33. The guidelines for their selection are
(a) They should be permanent residents of the local
community preferably women
(b) They should he able to read and write having minimum
formal education at least up to the VI standard
(c) They should be acceptable to all sections of the
community and
(d) They should be able to spare at least 2 to 3 hours every
day for community health work.
After selection, the Health Guides undergo a short training in
primary health care.
The training is arranged in the nearest primary health centre,
subcentre or any other suitable place for the duration of 200
hours, spread over a period of 3 months.
Village Health guide cont….
33

34. Broadly the duties assigned to health guides
are
- treatment of simple ailments and activities in first aid
- Mother and child health including family planning
- Health education and sanitation.
They are expected to do community health work in their
spare time of about 2 to 3 hours daily for which they are
paid an honorarium of Rs. 50 per month and drugs worth Rs.
600 per annum.
As the training involves expenditure, the
Government will not train another Health Guide from the
same village before three years. As of date, there are 3.23
lakh village Health Guides functioning in the country
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35. b. Local dais
Most deliveries in rural areas are still handled
by untrained dais who are often the only
people immediately available to women
during the Perinatal period.
An extensive programme has been
undertaken under the Rural Health Scheme to
train all categories of local dais (traditional
birth attendants) in the country to improve
their knowledge in the elementary concepts of
- Maternal and Child Health and sterilization,
- besides obstetric skills.
Local dais cont……35

36. The training is for 30 working days.
Each dai is paid a stipend of Rs. 300 during her
training period.
Training is given at the PHC, subcentre or MCH
centre for 2 days in a week, and on the remaining
four days of the week they accompany the Health
worker (Female) to the villages preferably in the dai's
own area. During her training each dai is required to
conduct at least 2 deliveries under the guidance and
supervision of the HW (F), ANM or HA (F).
After successful completion of training, each dai is
provided with a delivery kit and a certificate.
The national target is to train one local dai in each
village.
36

37. C. Anganwadi worker
Under the ICDS (Integrated Child Development
Services) Scheme there is an anganwadi worker for
a population of 400-800.
There are about 100 such workers in each ICDS
Project.
As of date over 6,719 ICDS blocks are functioning in
the country.
-The anganwadi worker is selected from the
community she is expected to serve.
- She undergoes training in various aspects of
health, nutrition, and child development for 4
months.
- She is a part-time worker and is paid an
honorarium of Rs. 7500 per month
Nnganwadi worker cont...37

38. Duties of Anganwadi Workers
1. Health check-up including maintenance of
growth
chart
2.Immunization
3 Supplementary nutrition
4.Health education
5 Non formal pre-school education and
6. Referral services.
The beneficiaries are. Especially nursing mothers,
pregnant women, other women (15-45 years)
children below the age of 6 years and adolescent
girls.
Along with Village Health Guides the anganwadi
workers are the community’s primary link with the
health services and all other services for young
children.
.
38

39. (d) Accredited Social Health Activist .
(ASHA).
Major initiatives under NRHM
1. Selection of ASHA:
1. ASHA: - must be the resident of the village
between
25 to 45 years of age, with formal education
up to eighth class, having communication
skills and leadership qualities.
The general norm of selection is one ASHA
for 1000 population. In tribal, hilly and desert
areas the norm could be relaxed to one ASHA
per habitation.
ASHA cont………….
39

40. Role and responsibilities of ASHA
ASHA will be a health activist in the
community
1. ASHA will take steps to create awareness
and provide information to the community on
determinants of health such as nutrition,
basic sanitation.
2. She will counsel women on birth
preparedness, importance of safe delivery,
breast-feeding and complementary feeding,
immunization, Contraception
ASHA cont…………. 40

41. 3. ASHA will mobilize the community and facilitate them in
accessing health and health related services
4. She will work with the village health and sanitation
committee of the gram panchayat
5. She will arrange escort/accompany pregnant women and
children requiring treatment/admission
6. ASHA will provide primary medical care for minor
ailments
7. She will also act as a depot holder for essential
provisions
8. Her role as a provider can be enhanced subsequently.
9. She will inform about the births and deaths in her village
and any unusual health problems/disease outbreaks in the
community to the sub-centre/primary health centre.
10. She will promote construction of household toilets under
total sanitation campaign.
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42. 2. Sub – center level
It is a peripharal out post of health system.
One Sub center for 5000 population in plains and 3000 in
hilly area. At present 152326 in country.
Services
Immunization, antenatal, natal and postnatal care,
prevention of malnutrition and common childhood
diseases, family planning services and counseling.
They also provide elementary drugs for minor ailments
such as ARI, diarrhoea, fever, worm infestation etc. and
carryout community needs assessment.
Besides the above, the government implements several
national health and family welfare programmes through
these frontline workers
42

43. 43
Currently, a sub-centre is staffed by –
1.One Female Health Worker known as
Auxiliary Nurse Midwife (ANM)
2. One Male Health Worker known as
Multi Purpose Worker (Male).
One Health Assistant (Female) known
as Lady Health Visitor (LHV)
One Health Assistant (Male) located at
the PHC level are entrusted with the
task of supervision of six sub-centres
under a PHC.

44. 3.Primary health centre level
The National Health Plan (1983) proposed
reorganization of primary health centres on the
basis of
- One PHC for every 30,000 rural population in the
plains, and
- One PHC for every 20,000 population in hilly,
tribal and backward areas for more effective
coverage.
-6 Bed indoor facilities
As on March 2014, 25,020 primary health centres
have been established in the country.

-
44

45. Functions of the PHC
The functions of the primary health center in India cover all the 8
"essential" elements of primary health care as outlined in the Alma-Ata
Declaration. They are :
1. Medical care
2. MCH including family planning
3. Safe water supply and basic sanitation
4. Prevention and control of locally endemic diseases
5. Collection and reporting of vital statistics
6. Education about health
7. National Health Programmes - as relevant
8. Referral services
9. Training of health guides, health workers, local dais and health
assistants
10. Basic laboratory services
It is proposed to equip the primary health centres with facilities for
selected surgical procedures (e.g., vasectomy, tubectomy, MTP and
minor surgical procedures) and for paediatric care. In order to reorient
medical education (ROME Programme) towards the needs of the country
and community care, three primary health centres have been attached to
each of the 148 medical colleges.
45

46. It is proposed to equip the primary
health centres with facilities like
- Selected surgical procedures (e.g.,
vasectomy, tubectomy, MTP and minor
surgical procedures) and for paediatric
care. In order to reorient medical
education (ROME Programme) towards
the needs of the country and community
care, three primary health centres have
been attached to each of the 148 medical
colleges.
46

47. Functions of PHC
1. MEDICAL CARE : (a) OPD services : 4
hours in the morning and 2 hours in the
afternoon/evening. Time schedule will vary
from state to state. Minimum OPD attendance
should be 40 patients per doctor per day; (b)
24 hours emergency services: appropriate
management of injuries and accident, First-
aid, stabilization of the condition of patient
before referral, dog bite/snake bite/ scorpion
bite cases, and other emergency conditions;
(c) Referral services; and
(d) In-patient services (6 beds).
47

48. 2. MATERNAL AND CHILD HEALTH CARE:

- Antenatal care
- Intranatal care
- Postnatal care
- New born care
- Care of the child
48

49. 3. Full range of family planning services
4. Medical termination of pregnancy
5. Health education.
6. Nutrition Services : Diagnosis ·and management
of
malnutrition, anaemia and vitamin A deficiency
and
coordination with ICDS.
7. School health services.
8. Adolescent health care.
9. Disease surveillance and control of epidemics.
10. Collection and reporting of vital event.
49

50. 11. Promotion of sanitation including use of toilet
and appropriate garbage disposal.
12. Testing of water quality and disinfection of water
sources.
13. National health programmes.
14. Appropriate and prompt referral of cases
needing special care and providing transport
facilities either
15. Record of vital events
16. Training : Health workers
17. Basic laboratory services
18. Monitoring and supervision : Monitoring and
supervision of activities of sub- centres
19. Selected surgical procedures
20. Mainstreaming of AYUSH
50

51. STAFFING PATTERN The manpower that should be
available in the PHC is as follows:
1. Medical Officer - 1 (3 at least one female)
2. Pharmacist -1 (2)
3. Nurse-midwife (Staff Nurse) -1 (5)
4. Health workers (F) - 1
5. Health Educator - 1
6. Health Asstt. - 2 (Male & Female).
7. Clerks - 2
8. Laboratory Technician - 1
9. Driver - 1
10. Class IV – 4
11. Account manager – NIL (1)
12. AYUSH practioner (1)
51

52. 4. Community Health Centres
As on 31st March 2014, 5363 community
health centres were established by upgrading
the primary health centres
- Each community health centre covering a
population of 80,000 to 1.20 lakh (one in each
community development block) with 30 beds
Capacity with Specialists in
- Surgery,
- Medicine,
- Obstetrics and gynaecology, and
- Paediatrics with
- X-ray and laboratory facilities.
52

53. Manpower for community health centres
The existing staff for CHC is as follows :
1. General Surgeon - 1
2. Physician - 1
3. Obstetrician and Gynaecologist - 1
4. Paediatrician - 1
Existing support manpower
- Nurse - midwife - 7 + 2
- Dresser - 1
- Pharmacist I compounder - 1
- Lab. Technician - 1
- Radiographer - 1
- Ophthalmic assistant -1
- Ward boy - I
- nursing orderly - 2
- Sweepers - 3
- Chowkidar - 2
- OPD attendant Statistical assistant - I
- Data entry operator - 5
- OT attendant Registration clerk Total essential 21-22+2
1 ANM and 1 PHN for family welfare will be appointed under the ASHA scheme.
Ophthalmic assistant may be placed wherever it does not exist through
redeployment or contract basis. Flexibility may rest with the state for recruitment
of personnel as per requirements.
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