Part B :

Primary health care –

Definition, principle, elements, levels of health care. Structure at village,

sub-centre, PHC, CHC, rural hospital levels. Health insurance, private
angencies, voluntary health agencies, NGOs and AYUSH sector. Role of
Ayurveda in primary health care.

Primary health care

In 1978, following an international conference at Alma-Ata(USSR)
primary health care was defined. The concept of primary health care has
been accepted by all countries to achieve the goal HFA-2000AD.

Definition:

“ 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.”

PRINCIPLES OF PRIMARY HEALTH CARE

Consists 4 principles:
1. Equitable distribution
2. Community participation
3. Intersectoral co-ordination
4. Appropriate technology

[1] Equitable distribution

 It means equity or equitable distribution of health services. i.e.

health services must be shared equally by all people irrespective of
the cast, creed, community and their ability to pay, and thus these
services must be accessible to all (rich or poor, urban or rural).
 Primary health care aims to correct this imbalance by shifting the
centre of the health care system from cities to the rural areas and
bring these services as near people’s homes as possible.

[2] Community participation

 This consists of active participation of the individuals, families and

communities in promotion of their own health and welfare and
providing primary health care.
  Community participation promotes social awareness of the
community. It increases the community acceptance of the primary
health care programmes and reduces the distance between the
providers and the consumers of the health care.
 It is by the people, of the people and for the people.
 The use of village guides and dais is successful in India. They are
selected by the local community and trained locally in the delivery of
primary health care to the community they belong, free of charge.
 They provide primary health care in ways that are acceptable to the
community. It is now considered that ASHA and anganwadi workers
are an essential feature of primary health care in India.

Advantages of community participation:

 Cost effective
 Easy acceptance by people
 Greater commitment of people results in success of health care
 Health awareness increases
 Health workers get greater support for their activities
 Less dependent on the government
 Quality of health improves

[3] Intersectoral co-ordination

 Primary health care cannot be provided by the health sector alone.

 It requires the co-ordination of other health related sectors also such
as education, communication, fisheries, animal husbandry, housing,
food and agriculture department, social welfare, public works,
voluntary organizations, etc.

[4] Appropriate technology

 Technology that is scientifically sound, adaptable to local needs and

acceptable to those who apply it and those for whom it is used
 Appropriate technologies that have been developed and introduced in
the country are oral rehydration therapy, distribution of IFA tablets,
biogas plants for cooking etc.

ELEMENTS OF PRIMARY HEALTH CARE

8 essential components of primary health care:

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 diseases;
6) Prevention and control of locally endemic diseases;
7) Appropriate treatment of common diseases and injuries;
8) Provision of essential drugs.

LEVELS OF HEALTH CARE

Mainly 3 levels:
A. Primary level of health care
B. Secondary level of health care
C. Tertiary level of health care

[A] Primary level of health care

 It is the first level of contact of individuals, the family and community

with the national health system, where the primary health services
are provided.
 Health services are provided even at the individual door level.
 This care is provided by primary health centres and their sub-
centres through the agencies of multipurpose health workers,
ANM, ASHA, anganwadi workers, village health guides and trained
dais.

[B] Secondary level of health care

 The next higher level of care is the secondary (intermediate) health

care level.
 At this level, services of the specialists are made available to the
people, to deal with more complex problems.
 In India, this kind of curative services are provided in district
hospitals and community health centres which also serve as the
first referral level.

[C] Tertiary level of health care

 It is more specialized level than secondary care level.

 Services of specialists & super specialists and specific facilities are
made to available to the people.
 This care is provided by the regional or central level institutions.
E.g. medical college hospitals, all India institutes, regional
hospitals, specialized hospitals and other apex institutions.
 These institutions not only provide high-tech diagnostic and highly
specialized care, but also planning and managerial skills. Conduct
training programmes also.
 HEALTH FOR ALL
The principle of HFA strategy is equity means equal health status for
people and countries, ensured by an equitable distribution of health
resources.

Definition of HFA: (nice to know)

“Attainment of a level of health that will enable every individual to

lead a socially and economically productive life.”

The best approach to achieve the goal of HFA is by providing primary

health care, to the vast majority of underserved rural people and urban
poor by the year 2000, families in an acceptable and affordable way, with
their full participation.

National strategies for HFA/2000

Goals to be achieved by 2000 Ad were:
1) Reduction of infant mortality from the level of 125(1978) to below
60.
2) To raise the expectation of life at birth from the level of 52 years to
64.
3) To reduce the crude death rate from the level of 14 per 1000
population to 9 per 1000.
4) To reduce the crude birth rate from the level of 33 per 1000
population to 21.
5) To achieve a net reproduction rate of one.
6) To provide potable water to the entire rural population.

HEALTH CARE SYSTEMS

The health care system is proposed to deliver health care services. It
constitutes the management sector and involves organisational matters.
In India, it is represented by five major sectors or agencies. These
are:

[1] Public health sectors

1) Primary health care

a) Primary health centres

b) Sub-centres

2) Hospitals/Health centres
 a) Community health centres
b) Rural hospitals
c) District hospitals/ health centres
d) Specialist hospitals
e) Teaching hospitals

3) Health Insurance schemes

a) Employes state insurance (ESI)

b) Central government health scheme (CGHS)

4) Other agencies

a) Defence services (AFMC)

b) Railways

[2] Private sector

1) Private hospitals, polyclinics, nursing homes and dispensaries
2) General practitioners and clinics

[3] Indigenous systems of medicine

1) Ayurveda
2) Siddha
3) Unani
4) Tibbi
5) Homeopathy
6) Yoga
7) Unqualified and unregistered practitioners

[4] Voluntary health agencies

[5] National health programmes

PRIMARY HEALTH CARE IN INDIA

It is a strategy to achieve the WHO’s global, social target “Health for all
by 2000 AD”, in the International Health Conference, held at Alma-Ata,
during 1978.
The concept was to provide the services at the individual doors. But
under primary health care, it was felt to start the health service from the
community and place their health in their own hands. i.e. by
community participation.
It is three tier system of health.

1. VILLAGE LEVEL
Basic object of primary health care is universal coverage and
equitable distribution of health resources.
Health care should reach to rural areas and everyone should have access
to it.
To implement this policy at village level, the following schemes are in
operation:
Schemes: A. ASHA scheme
B. ICDS scheme
C. Training of local Dais

[A] ASHA: Accredited Social Health Activist

 ASHA must be resident of village – a woman
(married/widow/divorced) preferably in the age group of 25 to 45
years, having formal education upto 8th class, having
communication skills and leadership qualities.
 Generally one ASHA for 1000 population is activated.

Role and Responsibilities of ASHA:

ASHA will be a health activist in the community who will create awareness
on health.

1) ASHA will create awareness and provide information to the

community about nutrition, basic sanitation and hygienic practises,
healthy living and working condition, information of existing health
services
2) She will counsel women on importance of safe delivery, breast
feeding and complementary feeding, immunization, contraception
and prevention of common infections including reproductive tract
infection/ sexually transmitted infection and care of the young child.
3) ASHA will aware the community about services available at the
Anganwadi/Sub-centre/Primary health centres, such as
immunization, antenatal check-up and other services provided by
government.
4) She will arrange escort/accompany pregnant women and children
requiring treatment to the nearest health facility. i.e. primary
health centre/ community health centre/ first referral unit.
5) ASHA will provide primary health care for minor ailments such as
diarrhoea, fevers, and first-aid for minor injuries.
6) She will be a provider of Directly Observed Treatment Short-course
(DOTS) under revised national tuberculosis control programme.
7) She will also provide oral rehydration therapy, iron folic acid
tablet, chloroquine, disposable delivery kits, oral pills and condoms,
etc.
8) She will inform about births and deaths in her village and any
unusual health problems/ disease outbreaks in the community to the
sub-centre/primary health centre.
9) She will promote construction of household toilets under total
sanitation campaign.

[B] Anganwadi workers (ICDS Scheme)

 Angan literally means a courtyard.
 Under the Integrated Child Development Services(ICDS) scheme,
there is an anganwadi worker for a population of 400-800.
 There are about 100 such workers in each ICDS project.
 An anganwadi worker is selected from the community. She undergoes
training in various aspects such as health, nutrition and child
development for 4 months.
 She is part-time worker and is paid an honorarium of Rs.1500 per
month for the services which include health check-ups including
maintenance of growth chart, immunization, supplementary
nutrition, health education and referral services.
 The benefits are for nursing mothers, pregnant women, other
women(15-45 years), children below age of 6 years and adolescent
girls.

[C] Local Dais

 A scheme for training of Dais was initiated during 2001-02.
 The aim was to train at least one Dai in every village with the
objective of making deliveries safe.
 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.
 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.
2. SUB-CENTRE LEVEL
The sub-centre is for developing health care in rural areas.
One sub-centre for every 5000 population in general and one for every
3000 population in hilly, tribal and backward areas.
A sub-centre provides interface with the community at grass-root level,
providing all the primary health care.

Building:

 Each sub-centre has one male and one female health worker.

 The centre has 2 portions – a clinic portion and a residential portion.

 In the residential portion, only the HWF resides and the HWM resides
outside.

 The clinic portion is meant for providing mainly MCH and Family
welfare services such as care of expectant mothers, including routine
investigations like Hb percent and urine examinations, conducting
deliveries, IUD insertion and immunizations.

 The health worker female (HWF) is supervised by health assistant

female (HAF). One HAF supervises 6 HWFs. There is no medical officer
and no in-patient or out-patient facilities.

Categorization of subcentres:

Mainly 2 categories: [1] Type A [2] Type B

[1] Type A

 Facilities for conducting delivery will not be available here.

 But, in case of need, the ANMs have been trained in midwifery to
conduct normal delivery.
 Sub-centres where at present, no delivery or occasional delivery is
taking place. i.e. very low case load of deliveries. If the case load
increases, these sub-centres should be considered for upgradation to
Type B.

[2] Type B

 These would include following types of sub-centres:

a) Centrally or better located sub-centres with good connectivity to
catchment areas.
b) They have good physical infrastructure with own building,
adequate space, residential accommodation and labour room
facilities.
 c) They have good case load of deliveries from the catchment
areas.
d) There are no nearby higher level delivery facilities.
 They will be expected to conduct 20 deliveries per month.
 They should provide all labour room facilities and equipments along
with newborn care corner.
 These centres may provide extra equipment, drugs, supplies,
materials, 2 beds and budget for smooth functioning.

Manpower of sub-centre

Total - 3
Type of Sub-Centre A Sub-Centre B
sub-centre (MCH sub-centre)
Staff Essential Desirable Essential Desirable
ANM/Health 1 +1 2
Worker (Female)
Health Worker 1 1
(Male)
Staff Nurse 1**
(or ANM, if Staff
Nurse is not available)
Safai-Karamchari* 1(Part-time) 1(Full-time)

Services to be provided in a sub-centre:

sub-centre mainly provides outreach facilities, where most services are not
delivered in the sub-centre building itself, the site of service delivery is at
following places:

a) In the village: village health and nutrition day/ immunization

session.

b) During house visits.

c) During house to house surveys.

d) During meetings and events with the community.

e) At the facility premises, it is desirable, that the sub-centre should

provide minimum of 6 hours of routine OPD services in a day for six
days in a week. Wherever 2 ANMs are provided, ensure that one
ANM is available at sub-centre and sub-centre remains open for
providing OPD services on working days. Only one of them may
provide outreach services at a time.
 3. PRIMARY HEALTH CENTRE LEVEL
The Bhore committee in 1946 gave the concept of a primary health centre
as a basic health unit, to provide, as close to the people, an integrated
curative and preventive health care to the rural population with emphasis
on preventive and promotive aspects of health care.
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.

Functions of PHC (imp)

8 essential elements of primary health care as out-lined in the Alma-Ata
Declaration.

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;
8. Referral services;
9. Training of health guides, health workers, local dais and health
assistants;
10. Basic laboratory services.

Types
Mainly 2 types:

1) Type A PHC: PHC with less than 20 deliveries per month.

2) Type B PHC: PHC with 20 or more deliveries per month.

Services to be provided in PHC: (nice to know)

All the services have been classified in essential or desirable.

1. Medical care
a) OPD services
b) 24 hour emergency services
c) Referral services
d) In-patient services
2. Maternal and child health care
a) Antenatal care
 b) Intranatal care
c) Postnatal care
d) Newborn care
e) Care of the child
3. Full range of family planning services including counselling and
appropriate referral for couples having infertility.
4. Medical termination of pregnancy using manual vacuum aspiration
technique, wherever trained personal and facility exists.
5. Health education for prevention and management of RTI/STI.
6. Nutrition services: diagnosis and management of malnutrition,
anaemia and vitamin A deficiency and co-ordination with ICDS.
7. School health services
8. Adolescent health care
9. Prevention and control of locally endemic diseases like malaria,
kala-azar, Japanese encephalitis etc.
10. Health education and behavioural change communication.
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 by PHC vehicle or other
available referral transport.
15. Record of vital events
16. Training
a) Health workers and traditional birth attendants
b) Training of ASHAs
c) Periodic training of doctors through education, conferences, skill
development training etc
d) Training of ANM and LHV in antenatal care and skilled birth
attendance
e) Training under integrated management of neonatal and childhood
illness(IMNCI)
f) Training of pharmacist on AYUSH component with standard
modules
g) Training of AYUSH doctor in imparting health services related to
national health and family welfare programme
17. Basic laboratory services
18. Monitoring and supervision
a) Monitoring and supervision of activities of sub-centres through
regular meetings/periodic visits etc
b) Monitoring of all national health programmes
c) Monitoring activities of ASHAs
d) Medical officer should visit all sub-centres at least once in a month
 e) Health assistants male and LHV (Lady Health Visitor) should visit
sub-centres once a week.
19. Selected surgical procedures like vasectomy, tubectomy, MTP,
hydrocelectomy and cataract surgeries as a camp/fixed day approach
have to be carried out in a PHC having facilities of O.T.
20. Mainstreaming of AYUSH
21. Physical medicine and rehabilitation(PMR) services
22. Maternal death review(MDR): facilities based MDR shall be
conducted at the PHC.
23. Functional linkages with sub-centres

Total staff- 13/14

Staffing Pattern of PHC: (nice to know)

Staff Essential
Type A Type B
Medical Officer – MBBS 1 1
Medical Officer – AYUSH -
Accountant cum data entry 1 1
operator
Pharmacist 1 1
Pharmacist AYUSH
Nurse -midwife (Staff-nurse) 3 4
Health worker (Female) 1* 1*
Health assistant (Male) 1 1
Health assistant (Female) / 1 1
Lady health visitor
Health educator
Laboratory technician 1 1
Cold chain & vaccine logistic -
assistant
Multi-skilled group D worker 2 2
Sanitary worker cum watchman 1 1
Total 13 14

4. COMMUNITY HEALTH CENTRES LEVEL

On 31st March 2014, community health centres were established by
upgrading the primary health centres.
Each community health centre covering a population of 80,000 to1.2
lakh with 30 beds and specialists in surgery, medicine, obstetrics
and gynaecology and paediatrics with X-rays and laboratory facilities.
For strengthening preventive and promotive aspects of health care, a
new non-medical post called community health officer has been
created at each community centre.
 Services to be provided at CHC: (nice to Know)
Every CHC has to provide following services which are indicated as
essential or desirable.
1. Care of routine and emergency cases in surgery
a) This includes dressings, incision and drainage, surgery for hernia,
hydrocele, appendicitis, haemorrhoids, fistula, stitching of injuries.
b) Handling of emergencies like intestinal obstruction, haemorrhage, etc.
c) Other managements like nasal packing, tracheostomy, foreign body
removal, etc.
d) Fracture reduction and putting plaster cast.
e) Conducting daily OPD.
2. Care of routine and emergency cases in medicine
a) Handling of all emergencies like dengue haemorrhoids fever, cerebral
malaria and others like dog & snake bites cases, poisoning, congestive
heart failure, left ventricular failure, pneumonias,
meningoencephalitis, acute respiratory conditions, status epilepticus,
burns, shock, acute dehydration etc.
b) Conducting daily OPD.
3. Maternal health
a) 24 hours delivery services
b) Managing labour using partographs
c) All referred cases of complications in pregnancy, labour and postnatal
period must be adequate treated.
d) Minimum 48 hours of stay after delivery
e) Management of all complications including PPH, eclampsia, sepsis etc
during PNC
f) Essential and emergency obstetrics care
g) Provisions of JananiSurakshaYojana(JSY) and
JananiShishuSurakshaKaryakram(JSSK) as per guidelines.
4. Newborn care and child health
a) Essential newborn care and resuscitation by providing newborn corner
in the labour room and operation theatre
b) Newborn stabilization unit and counselling on infant and young child
feeding
c) Routine and emergency care of sick children
d) Immunization of infants and children
e) Prevention and management of routine childhood diseases, infections
and anaemia
f) Management of malnutritional cases
g) Provision of JSSK as per guidelines
5. Family planning
a) Full range of family planning services including IEC, counselling,
provision of contraceptives, non-scalpel vasectomy(NSV), leproscopic
sterilization services
b) Safe abortion services as per MTP act and abortion care guidelines.
6. National health programmes(NHP)
7. Physical medicine and rehabilitation(PMR)
8. Oral health: dental care and dental health education
9. School health services: doctors from CHC/PHC will also visit one
school per week based on the screening reports submitted by the
teams.
a) Screening, health care and referral
b) Immunization
c) Micronutrient(vitamin A& IFA) management
d) De-worming
e) Capacity building
f) Monitoring and evaluation
g) Mid day meal

10. Blood storage facility

11. Diagnostic services
12. Referral(transport) services
13. Maternal death review(MDR)

Manpower for CHC:

 Medical staff – 15/16 & Non medical staff - 64

Personnel Strength Desirable Qualifications

Block Health - Senior most specialists among the
Officer below mentioned speciality
(Physician/General Surgeon/Paed.
/Obs & Gyne Anaesthesia/Public
Health/Ophthalmology
General Surgeon 1 MS/DNB, (General Surgery)
Physician 1 MD/DNB (General Medicine)
Obstetrician & 1 MD/DNB/DGO (OBG)
Gynaecologist
Paediatrics 1 MD (Paediatrics)/DNB/DCH
Anaesthetist 1 MD
(Anaesthesia)/DNB/DA/Certificate
course in anaesthesia for one year
 Public Health 1 MD (PSM)/MD (CHA)/MD
Manager Community Medicine or Post
Graduation Degree with MBA
Eye surgeon 1 (1 for every MD/MS/DOMS/DNB/(Ophthal)
five CHCs)
Dental Surgeon 1 BDS
General Duty 6 (at least 2 MBBD
Medical Officer female doctors)
Specialist of 1 Post Graduate in AYUSH
AYUSH
General Duty 1 Graduate in AYUSH
Medical Officer of
AYUSH
Total 15/16
Conclusion -

Sub centre PHC CHC

Level of I I II
health care
Population in 5000 30000 120000
plain
Population in 3000 20000 80000
hills
Staff 3 13/14 80
maintainance Center State state

JOB DESCRPTION OF MEMBERS OF THE HEALTH

TEAM

Category of personnel Norms

suggested

1. Nurses 1 per 5,000 population

2. Health worker 1 per 5,000 population in plain
female and male area and 3,000 population in
tribal and hilly areas.
3. Trained dai One for each village
4. Health assistant 1 per 30,000 population in plain
(male and female) area and 20,000 population
Provides supportive in tribal and hilly areas.
supervision to 6 health
workers (male / female).
5. ASHA 1 per 1,000 population
1. Medical Officer, PHC (imp)
1. He is the captain of the health team at the primary health centre. He
should spend morning hours attending to patients in out-door; in
afternoon he supervises the field work.
2. His tour programme should cover all basic health services
including family planning.
3. He will plan and implement UIP as per guidelines and ensure
maximum possible coverage of population in the PHC. He will ensure
proper storage of vaccine and maintenance of cold chain
equipment.
4. He will ensure proper implementation of IMNCI as per guidelines.
5. He will visit schools in the PHC area at regular intervals and arrange
for medical check-up and immunization.
6. He will organize and conduct tubectomy and vasectomy camps.
7. Organize training of all health personal like ASHA, anganwadi
worker, Dais, etc.
8. He ensures that national health programmes are being
implemented in his area properly
9. He visits each sub-centre regularly on fixed days and hours and
provides guidance, supervision and leadership to health team.
10. He spends one day in each month organising staff meetings at the
primary health centre to discuss the problems and review the progress
of health activities.
11. The success of PHC depends on the team leadership which the
medical officer is able to provide. The medical officer must be the
planner, the promoter, the director, the supervisor, the co-
ordinator and the evaluator.

2. Health Worker Male and Female:

Under the multipurpose worker scheme, one health worker female and
one health worker male are posted at each sub-centre and are expected
to cover a population of 5000 (3000 in tribal and hilly areas). Health
worker female limits her activities among 350-500 families.

[A] Health worker female (ANM)

1) Maternal and child health

2) Family planning
3) Medical termination of pregnancy(MTP)
4) Nutrition
5) Universal programme on immunization(UIP)
6) Dai training
7) Management of communicable diseases
8) Management of non-communicable diseases
9) Record and report of vital events
10) Record keeping
11) Treatment for minor ailments
12) Team activities

[B] Health worker male (HWM)

1) National health programmes

a) National vector borne disease control programme(NVBDCP)
b) National leprosy eradication programme(NLEP)
c) Revised national tuberculosis control programme(RNTCP)
d) National blindness control programme(NBCP)
e) Expanded programme on immunization
f) Reproductive and child health programme(RCH)
2) Management of communicable diseases
3) Environmental sanitation
4) Nutrition
5) Record and report of vital events
6) Record keeping

3. Job Responsibilities of Health Assistant

Under the multipurpose workers scheme, a health assistant is expected
to cover a population of 30,000 (20,000 in tribal and hilly areas) in which
there are 6 sub-centres, each with one health worker.

[A] Female

1) Supervision and guidance

2) Team work
3) Supplies, equipment and maintenance of sub-centre
4) Records and reports
5) Where kala-azar, lymphatic filariasis, Japanese encephalitis are
endemic, additional duties should be performed.
6) Training
7) Maternal and child health
8) Family welfare and medical termination of pregnancy(MTP)
9) Nutrition
10) Immunization
11) Acute respiratory infection
12) School health
13) Primary medical care
14) Health education

[B] Male

1) Supervision and guidance

2) Team work
 3) Supplies, equipment and maintenance of sub-centres
4) Records and reports
5) Malaria
6) Where kala-azar, Japanese encephalitis, lymphatic filariasis are
endemic, specific duties should be performed.
7) Management of communicable diseases
8) Leprosy management
9) Tuberculosis management
10) Environmental sanitation
11) Expanded programme on immunization
12) Family planning
13) Nutrition
14) Control of blindness

HOSPITALS
Apart from primary health centre, the present organization of health services
of the government sector consists of rural hospitals, sub-
divisional/tahsil/taluka hospitals, district hospitals, specialist hospitals and
teaching institutions.

A hospital differs from a health centres in the following respects:

 In a hospital, services provided are mostly curative. In a health

centre, the services are preventive, promotive and curative.
 A hospital has no catchment areas. A health centre is responsible for
definite area and population.
 The health team in health centre is made of medical and paramedical
workers. In a hospital, the team consist only a curative staff. i.e.
doctors, compounders, nurses, etc.

HEALTH INSURANCE
 Health insurance is at present limited to industrial worker and their
facilities.
 The central government employees are also covered by the health
insurance, under the banner “Central Govt. Health Scheme”.
 Employees State Insurance Scheme(ESI):
 In ESI scheme, introduced by an Act of parliament in 1948, is a unique
piece of social law in India.
 The principle is contribution by the employer and the employee.
 The act provides medical care in cash and kind, benefits in the
contingency of sickness, maternity, employment injuries and pension
for dependents on the death of worker because of employment injury.
 The act covers employees drawing wages not exceeding Rs. 15,000
per month.
  Central Government Health Scheme:
 The Central Government health Scheme for the central government
employees was first introduced in New Delhi in 1954 to provide
comprehensive medical care to central government employees.
 The principle of co-operative efforts by the employee and the
employer, to the mutual advantage of both.

 Facilities under the scheme:

 Out patient care
 Supply of necessary drugs
 Laboratory and X-rays investigations
 Domiciliary visits
 Hospitalization facilities at government as well as private hospitals
 Specialist consultation
 Paediatric services including immunization
 Antenatal, natal and postnatal services
 Emergency treatment
 Supply of optical and dental aids at reasonable rate
 Family welfare services

OTHER AGENCIES

Defence Medical Services:

 Defence services have their own organization for medical care to defence
personnel under the banner “Armed Forces Medical Services”.
 The services provided are integrated and comprehensive providing
preventive, promotive and curative services.

Health Care of Railway Employees:

 The railway provides health care services through the agency of Railway
hospitals, Health units and clinics.
 Health check-up of employees is provided at the time of entry into service
and at yearly intervals.
 There are lady medical officer, health visitors and midwives who look after
the MCH and school health services.
 Specialist’ services are also available at the divisional hospitals.

PRIVATE AGENCIES

 Private practise of medicine provides health services.

 There has been rapid expansion in the number of qualified allopathic
physicians from about 50,000 at the time of Independence to about
7.67 lakhs in 2005.
 The doctor-population ratio is 1 : 1428 now.
  Most of medical practitioners provide mainly curative services to urban
areas.
 The private sector of the health care services is not organized.
 Some statutory bodies like the Medical Council of India and the Indian
Medicine Association regulate some of the functions and activities of
private registered medical practitioners.

INDIGENOUS SYSTEMS OF MEDICINE

 This constitutes Ayurveda, Yoga, Unani, Siddhi, Homeopathy (AYUSH).
 These practitioners provide medical care to rural areas.
 Most of them are local residents. They remain close to the people socially
and culturally.
 Govt. Of India is studying to avail the services of these medicines for
effective and total health coverage.

Voluntary Health Agencies:

Definition:

“A voluntary health agency is defined as an organization that is administered

by an autonomous board which hold meetings and expends money,
whether with or without paid workers, in conducting a programme directed
primarily to promoting the public health by providing health services or
health education, or by making research or law for health, or by a
combination of these activities”.

Functions:

 Supplementing the work of government agencies

 Pioneering
 Education
 Demonstration
 Guarding the work of government agencies
 Advancing health legislation(law)

Voluntary Health Agencies in India:

 Indian Red Cross Society

 Hind KushtNivaranSangh
 Indian Council For Child Welfare
 Tuberculosis Association Of India
 Bharat Sevak Samaj
 Central Social Welfare Board
 The Kasturba Memorial Fund
 Family Planning Association Of India
 All India Women’s Conference
 The All-India Blind Relief Society
 Professional Bodies
 International Agencies

Health Programmes in India.

 Revised national tuberculosis control programme(RNTCP)

 National vector borne disease control programme(NVBDCP)
 HIV/AIDS control programme
 National leprosy eradication programme(NLEP)
 National programme for control of blindness(NPCB)
 National programme for prevention and control of deafness(NPPCD)
 National mental health programme(NMHP)
 National programme for prevention and control of cancer, diabetes,
CVD and stroke(NPCDCS)
 National iodine deficiency disorders control programme(NIDDCP)
 National programme for prevention and control of fluorosis(NPPCF)
 National tobacco control programme(NTCP)
 National programme for health care of elderly(NPHCE)

AYUSH SECTOR

(AYUSH- AYURVEDA, UNANI, SIDDHA, YOGA & NATUROPATHY, HOMEOPATHY AND

SOWA RIGPA)

About the Ministry

The Ministry of AYUSH was formed on 9th November 2014 to

ensure the optimal development and propagation of AYUSH systems of
health care. Earlier it was known as the Department of Indian System of
Medicine and Homeopathy (ISM&H) which was created in March 1995 and
renamed as Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha,
and Homoeopathy (AYUSH) in November 2003, with focused attention for
development of Education and Research in Ayurveda, Yoga and Naturopathy,
Unani, Siddha, and Homoeopathy.

Objectives:

1. To upgrade the educational standards of Indian Systems of Medicines

and Homoeopathy colleges in the country.

2. To strengthen existing research institutions and to ensure a time-

bound research programme on identified diseases for which these
systems have an effective treatment.

3. To draw up schemes for promotion, cultivation and regeneration of

medicinal plants used in these systems.
 4. To evolve Pharmacopoeial standards for Indian Systems of Medicine
and Homoeopathy drugs

5. To provide cost effective and equitable AYUSH Services, with a universal

access through upgrading AYUSH Hospitals and Dispensaries, co-location
of AYUSH facilities at Primary Health Centres (PHCs), Community Health
Centres (CHCs) and District Hospitals (DHs).

6. To strengthen the AYUSH systems by making them as prominent

medical streams for institutional capacity at the state level through
upgrading AYUSH educational institutions, State Govt. ASU&H
Pharmacies, Drug Testing Laboratories and ASU & H enforcement
mechanism.

7. Support cultivation of medicinal plants by adopting Good Agricultural

Practices (GAPs) so as to provide sustained supply of quality raw
materials and support certification mechanism for quality standards,
Good Agricultural/Collection/Storage Practices.

8. Support setting up of clusters through convergence of cultivation,

warehousing, value addition and marketing and development of
infrastructure for entrepreneurs.

9. To improve educational institutions capable of imparting quality AYUSH

education.

10. To promote the adoption of Quality standards of AYUSH drugs and

making available the sustained supply of AYUSH raw-materials.

Actions:

1. Encouragement to scientific research and education

2. Laying down pharmacopoeial standards to ensure quality drugs
3. Evolving good laboratory practises
4. Following good manufacturing practises
5. Regulating education standards
6. Supplementing the efforts of state Government in setting up speciality
clinics of AYUSH in allopathic hospitals and AYUSH wing in district
allopathic hospitals
7. Creating awareness through organization of Health Melas and other
information, education and communication

Statutory Regulatory Councils:

 The central council of Indian medicine (CCIM)

 The central council for homeopathy (CCH)

Research Councils:
Four apex of research council:

 Central council for research in Ayurveda and Siddha (CCRAS)

 Central council for research in Unani medicines (CCRUM)
 Central council for research in homeopathy (CCRH)
 Central council for research in Yoga and Naturopathy (CCRYN)

National Institutions:

8 apex educational institutions are established to promote excellence in

Indian Systems of medicine and homeopathy education. Of each system,
there is national institute;

 National Institute of Unani Medicines, Banglore.

 Morarji Desai National Institute of Yoga, New Delhi.
 National Institute of Naturopathy, Pune.
 National Institute of Homeopathy, Kolkata.
 Rashtriya Ayurveda Vidyapeeth, New Delhi.
 Institute of Post Graduate Training & Research in Ayurveda,
Jamnagar.
 National Institute of Ayurveda (NIA), Jaipur.
 National Institute of Siddha (NIS), Chennai.

ROLE OF AYURVEDA IN PRIMARY HEALTH CARE

1. Ayurveda have a great role in primary health care of people in India.

2. There are more than 3 lakhs Ayurvedic physicians in India.
3. More then 90% of Ayurvedic physicians serve the rural areas where
the medical facilities are rare.
4. Most of these doctors are local residents and remain very close to the
people socially and culturally.
5. After the establishment of CCIM in 1971, the practise of Ayurveda is
regulated under government authority.
6. The Ayurvedic doctors are trained in Ayurveda as well as in allopathy
so they can serve the people according to need.
7. Ayurveda has unique concepts and methodologies to address health
care throughout the course of life, from pregnancy and infant care to
geriatric disorders.
8. Besides doctors, Indian people have the traditional knowledge of
Ayurveda. They know the concept on prevention in Ayurveda. i.e. daily
regimen(dinacharya), seasonal regimen(rutucharya) and concept of
diet.
9. Common spices are utilized, as well as herbs, herbal mixtures, and
special preparations known as Rasayanas. Purification procedures
known as Panchakarma remove toxins from the physiology.
10. Thus Ayurveda has the major role in prevention of diseases by
using its principles in day to day life. Many ayurvedic drugs are used as
home remedies in many ailments like cough, cold, fever, pain in
abdomen etc.
11. Research has been conducted worldwide on Ayurveda. There are
encouraging results for its effectiveness in treating various ailments,
including chronic disorders associated with the aging process.
12. gave positive results and provide a basis for conducting larger,
more rigorous clinical trials. Conducting research that compares
Ayurveda's comprehensive treatment approach, Western allopathic
treatment, and an integrated approach combining the Ayurvedic and
allopathic treatments would shed light on which treatment approach is
the most effective for the benefit of the patient.
13. Ayurveda is flourishing in India. In future it will serve the public
better when the people understand the Ayurveda and its utility.