Primary health care in India

2.  This approach came into existence in 1798, following the international
conference at Alma-Ata (USSR)
 The Alma-Ata conference defined primary health care as
Primary health care is essential health care made universally accessible to
individuals and acceptable to them, through their full participation and at the
cost the community and country can afford
 The primary health care is equally valid for all the countries from the most to the
least developed. It has been accepted as integral part of the country’s health
system

3. 1. Education concerning prevailing health problems and the
methods of preventing and controlling them
2. Promotion of food supply and proper nutrition
3. An adequate supply of safe water and basic sanitation
4. Maternal and child health care, including family planning
5. Immunization against major infectious disease
6. Prevention and control of locally endemic disease
7. Appropriate treatment of common disease and injuries
8. Provision of essential drugs

4. 1. Equitable distribution: Health services must be shared equally by
all people irrespective of their ability to pay, and all(rich or poor,
rural or urban) must have assess to the health services
2. Community participation: Involvement of the individuals, family,
communities in the promotion of the their own health and
welfare and not merely the government; is essential component
of primary health care
There must be continuing effort to secure meaningful
involvement of the community in the planning, implementation
and maintenance health services

5. 3. Intersectoral coordination: primary health care involves in addition to health sector,
all related sectors and aspects of national and community development, in
particular agriculture, animal husbandry, food, industry, education, housing etc.
An important approach is planning - planning with other sectors to avoid
unnecessary duplication of activities
4. Appropriate technology: It is defined as “technology that is scientifically sound,
adaptable to local needs, and acceptable to those who apply it and those for
whom it is used, and that can be maintained by the people by themselves in keeping
with the principle of self reliance with the resources the community and country can
afford”

6. Health services in India
1. Public health sector
 Primary health care
 Primary health center
 Subcenter
 Hospital health center
 CHC
 Rural hospital
 District hospital
 Specialist hospital
 Training hospital
 Health insurance scheme
 ESI
 CGHS
 Other
 Railway
 Defense
2. Private health sector
 Private hospitals, polyclinics,
nursing homes and dispensaries
 General practitioners and clinics
3. Indigeneous system of medicine
 Ayurveda and Siddha
 Unani and Tibbi
 Homeopathy
 Unregistered practitioners
4. Volantary health agencies
5. National health programme

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

8. 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

10.  AWW & ANM –resource person for ASHA.
 Organizing Health day.
 Mobilizing beneficiaries
 Survey of eligible couples & children < 1 Yr
 Weekly/fortnightly meeting of ASHAs by ANM.
 Preparation of Village Health plan

12.  One per 5000 population in general & one for every 3000
population in hilly region.
 As of 2007, total sub centers in our country –1,45,272, as 2011
1,48,124.
 Approved staff – One ANM + One MPW.
 One Health Assistant (Male) & One Health Assistant (Female –Lady
Health Visitors) – located at PHC level are entrusted with task of
supervision of six Sub Centers under a PHCs.

14.  1 PHC for every 30,000 population in plain areas
 1 PHC for every 20,000 population in hilly, tribal,
backward areas
 22370 primary health centers have been established
Types of PHCs
Type A Type B
PHC with delivery load less than 20 per
month
PHC with delivery load more than 20 per
month

16. 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.

17.  Antenatal care: Early registration of all pregnancies ideally in the first trimester (before 12th
week of pregnancy
 Indian Public Health Standards (IPHS) Guidelines for Minimum 4 antenatal checkups and provision
of complete package of services.
 Suggested schedule for antenatal visits:
 1st visit: Within 12 weeks—preferably as soon as pregnancy is suspected—for registration of
pregnancy and first antenatal check-up.
 2nd visit: Between 14 and 26 weeks.
 3rd visit: Between 28 and 34 weeks.
 4th visit: Between 36 weeks and term.

18. Antenatal care
 Minimum laboratory investigations like - Haemoglobin, Urine albumin and sugar, RPR test for
syphilis and Blood Grouping and Rh typing.
 Nutrition and health counseling.
 Identification and management of high risk and alarming signs during pregnancy and labour.
 Intra-natal care: (24-hour delivery services both normal and assisted)
 Promotion of institutional deliveries.
 Management of normal deliveries.
 Assisted vaginal deliveries including forceps/vacuum delivery whenever required.
 Manual removal of placenta
 Minimum 48 hours of stay after delivery.
 Managing labour using Partograph.

22. A fully immunized infant is one who has received BCG, three doses of DPT, three doses of
OPV, three doses of Hepatitis B and Measles before one year of age

25.  Access to services:The PHC provides medical care to all patients without any
discrimination of gender, cast, or religion. The Medical Officer is responsible for
ensuring the delivery of services
 Your Rights in the PHC
1. Right to access to all the services provided by the PHC.
2. Right to Information-including information relating to your treatment.
3. Right of making decision regarding treatment.
4. Right for privacy and confidentiality.
5. Right to religious and cultural freedom.
6. Right for Safe and Secure Treatment.
7. Right for grievance redressal.

26. 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 &
12. control programme
12. Collection of vital events
13. Promotion of sanitation including use of
toilet & appropriate garbage disposal
14. Water quality monitoring
15. Trainings
16. Mainstreaming of AYUSH
17. National health programme

27.  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
 Integrated Disease Surveillance Project (IDSP)
 National Programme for Prevention and Control of Deafness (NPPCD)
 National Mental Health Programme (NMHP)
 National Programme for Prevention and Control of Fluorosis (NPPCF) Essential in Fluorosis affected
Villages

28.  The CHCs were designed to provide referral health care
 For cases from the Primary Health Centres level
 For cases in need of specialist care approaching the centre directly.
 4 PHCs are included under each CHC thus catering to approximately 80,000
populations in tribal/hilly/desert areas and 1,20,000 population for plain areas.
 CHC is a 30-bedded hospital providing specialist care in Medicine, Obstetrics and
Gynecology, Surgery, Paediatrics, Dental and AYUSH.
 There are 4535 CHCs functioning in the country as on March 2010 as per Rural
Health Statistics Bulletin 2010.

29.  To provide optimal expert care to the community.
 To achieve and maintain an acceptable standard of
quality of care.
 To ensure that services at CHC are commensurate with
universal best practices and are responsive and
sensitive to the client needs/expectations.

30. 1. Care of Routine and Emergency Cases in Surgery
2. Care of Routine and Emergency Cases in Medicine
3. Maternal Health
4. Newborn Care and Child Health
5. Family Planning
6. Other National Health Programmes – same as PHCs
7. Others
 School health services
 Adolescent health services
 Blood Storage Facility
 Diagnostic Services
 Referral (transport) Services
 Maternal Death Review (MDR).