COMMUNITY HEALTH CARE

Prof.A.I.Chitra
Vice Principal
GRT College of Nursing
 Definition
Health
The World Health Organization (WHO) defines health as a state
of complete physical, mental, and social well-being.
Community Health
Community health is the health of a community, including the
health of its members, the health care it receives, and the factors that
impact its health.-WHO
Primary Health Care
Primary Health Care is essential health care made universally
accessible to individuals and families in the community by means
acceptable to them, through their full participation and at a cost that the
community and country can afford.
 Principles of health care services

Principles of health care services include access, quality, safety, and equity. They also
include ethical and rights-based approaches, and sustainability.
Principles of health care services
• Access: Healthcare should be accessible and easy to use. This can include extended
clinic hours, online consultations, and shorter wait times.
• Quality: The health system should continuously improve the quality of services.
• Safety: Healthcare organizations can reduce variability in care and improve patient
outcomes by standardizing processes.
• Equity: Health services should be equitable and provide coverage to
everyone
• Ethics: Healthcare services should be ethical and rights-based. This
includes principles like beneficence, nonmaleficence, autonomy, and
justice.
• Sustainability: The health system should be sustainable.
• Coordination: Care should be properly coordinated to reduce feelings
of vulnerability and powerlessness for patients.
• Standardization: Healthcare organizations can improve patient
outcomes by consistently applying evidence-based practices and
protocols
Levels of Health Care Services
 Levels of Health Care Services
The levels of health care services are primary, secondary, and tertiary
Primary care
Usually the first point of contact for medical care, primary care focuses on health
promotion and prevention. Primary care providers include general practitioners,
pediatricians, and family physicians.
Secondary care
Secondary care is provided at district hospitals and focuses on more complex
issues. Secondary care providers include specialists and surgeons who work with primary
care providers to deliver comprehensive care
Tertiary care
Tertiary care is provided at medical college hospitals and specialized institutions. It
focuses on specialized care and attention from highly trained workers for complex medical
procedures and treatments.
Other types of health care services include:
Hospice care
Provides medical, emotional, and spiritual support for patients and
their families
Long-term care
Long-term care facilities provide medical care for patients with
serious conditions who require constant treatment. They also provide a
social support network for patients.
Clinical preventive services
Clinical preventive services are medical procedures, tests, or
counseling that health professionals deliver to prevent disease and promote
health.
 Concepts of Prevention
Actions aimed at eradicating, eliminating or minimizing
the impact of disease and disability, or if none of these are
feasible, retarding the progress of the disease and disability.

Primodial Primary
Prevention Prevention

Levels of
Prevention

Secondary Tertiary
Prevention Prevention
Primordial prevention:
Prevents the development of risk factors in a population
group or country where they haven't yet appeared. For
example, childhood is a time when lifestyles are formed,
which can lead to adult health problems like obesity and
hypertension.
Primary prevention:
Prevents disease or injury from occurring by: Preventing
exposure to hazards ,Altering unhealthy behaviors ,Increasing
resistance to disease or injury
Examples include legislation, education, and immunization
Secondary Prevention
It is a health strategy that aims to reduce the impact of a disease or
injury by detecting and treating it early. The goal is to minimize serious
consequences and prevent long-term problems.
Eg-Lifestyle changes=Diet and exercise programs, or taking low-dose aspirin
daily to prevent further heart attacks or strokes
Tertiary Prevention
It is a type of healthcare intervention that focuses on reducing the
impact of a disease or injury that has already been established. The goal of
tertiary prevention is to:
Reduce disability, Minimize suffering, Maximize quality of life, Prevent
relapses, Prevent chronicity, and Prevent hospitalization.
 CONTROL AND MODES OF
INTERVENTION
Control conditions and modes of intervention are used in
research to assess the efficacy of interventions.
Control conditions
Randomized controlled trials
Researchers use control conditions to ensure the
methodological rigor of their trials. This allows them to draw
conclusions about the efficacy of the intervention.
Opt-out settings
In games, players can opt out of interventions, which
allows them to control whether the intervention is applied to
their game.
Modes of Intervention

HEALTH
PROMOTION

PSYCHOMOG
ICAL SPECIFIC
INTERVENTI PROTECTION
ON

MULTICOMPONE
NT
INTERVENTION

EARLY
REHABLITATI DIAGNOSIS
ON AND
TREATMENT

DISABILITY
LIMITATION
 Modes of Intervention
Health promotion:
`` This mode aims to strengthen individuals through education,
lifestyle changes, and environmental modifications.
Specific protection:
This mode uses techniques like immunization, chemoprophylaxis,
and avoiding hazards.
Early diagnosis and treatment:
This mode aims to prevent impairment by identifying diseases
early.
.
Disability limitation:
This mode aims to prevent further progression of a disability.
Rehabilitation:
This mode aims to reintegrate individuals by coordinating medical,
social, and vocational support.
Psychological interventions:
These interventions can be used to manage atopic dermatitis, for
example.
Multicomponent interventions:
These interventions combine physical exercises and cognitive
training. They can be effective in improving cognition in elderly people.
 Health Care Systems
Introduction
Primary Health Centre (PHCs), sometimes referred to
as public health centres are state-owned rural and urban health
care facilities in India.
They are essentially single-physician clinics usually with
facilities for minor surgeries. They are part of the government-
funded public health system in India and are the most basic
units of this system. As on 31 March 2019 there are 30,045
PHCs in India in which 24,855 are located on rural areas and
5,190 are on urban areas The idea of creating PHCs in India
was set forward by Bhore committee in 1946.
 Health Care Systems

Primary Health Centre

A primary health center (PHC) is a health care facility that offers a range of
services to the community. PHCs are a key part of the health care system in
India. They are also known as public health centers.
Services offered
Preventive care: Screenings, immunizations, and lifestyle counseling
Chronic disease management: Personalized treatment plans for ongoing
health concerns
Emergency care: Prompt treatment for urgent medical needs
Diagnostic and curative services: Minor surgeries and other medical
Staff
Medical Officer: An MBBS degree holder who runs the PHC
and acts as the primary administrator
Accredited Social Health Activist (ASHA): A primary field staff
member who provides outreach services
Village health nurse: A primary field staff member who provides
service at the point of care, often in the patient's home

Accessibility
PHCs are designed to be accessible to people with disabilities,
with wheelchair accessible entrances, exits, and parking
 Primary Health Centres programmes :

Primary Health Centres programmes are:

• Provision of medical care
• Maternal-child health including family planning
• Safe water supply and basic sanitation
• Prevention and control of locally endemic diseases
• Collection and reporting of vital statistics
• Education about health
• National health programmes, as relevant
• Referral services
• Training of health guides, health workers, local dais and health assistants
• Basic laboratory workers
 Private Health Systems
A private health system is a healthcare system where individuals and
organizations that are not owned by the government provide health
services. Private health systems can be for-profit or not-for-profit, formal or
informal, and domestic or international.
How it works
Individuals or organizations pay for medical services directly or through private
insurance.
Private healthcare providers include hospitals, clinics, and individual medical
professionals.
Private healthcare systems operate on the principles of supply and demand,
competition, and cost efficiency.
 How to access private healthcare
You can pay for private healthcare yourself.
You can access it through your employer if they provide cover.
You can access it through your own private health insurance plan.
You can take a medical loan at some private hospitals.
 Challenges with private healthcare
The cost of care can be substantial, making it inaccessible to many.
There are concerns about transparency in pricing and quality of care.
There is no mandate for universal coverage, either for people or for
services.
 Indigenous Systems
Indigenous systems include knowledge systems, health care systems, and
governance systems that are developed by indigenous people. These systems are
based on the knowledge, practices, and beliefs of indigenous people, who have
developed them over thousands of years.
Indigenous knowledge systems
Traditional knowledge
A body of knowledge that includes observations, practices, and beliefs that
help people understand and steward their natural and cultural resources.
Indigenous pedagogies
Teaching methods that help people understand their place in the world and
the interconnectedness of all things.
Indigenous languages
Contain information about the history and culture of indigenous people,
including place names, songs, and stories.
Indigenous health care systems
AYUSH
A system of medicine in India that includes Ayurveda, Yoga,
Unani, Siddha, and Homeopathy.
Indigenous health care strategies
These strategies include increasing the number of Indigenous
people in health roles, creating cultural spaces for patients, and
providing cultural support staff.
Indigenous governance systems
Indigenous peoples' rights: These rights include the right to self-
determination, the right to practice their culture, and the right to
participate in decision-making.
 Voluntary Health System
Voluntary health agencies (VHA) are non-profit organizations that
provide health services, education, and research. They are an important part
of community health programs and work to improve public health.
Raise funds: VHA raise funds through private donations and membership
fees.
Provide services: VHA provide health services, education, and research.
Advocate for legislation: VHA advocate for legislation to improve health.
Pioneer new approaches: VHA pioneer new approaches to health care.
Examples of VHA in India
Tuberculosis Association of India: A VHA that works on tuberculosis
Hind Kusht Nivaran Sangh: A VHA that works on leprosy control
Family Planning Association of India: A VHA that works on family
planning
Bharat Sevak Samaj (BSS): A non-political, non-official organization that
works on improving sanitation in villages
Examples of VHA programs
Eye relief camps: VHA organize eye relief camps and other measures for
the relief of the blind
Primary health care: VHA provide health services at the home of village
people
Health education: VHA provide health education to vulnerable groups
Role of Professional Social Worker in
Community Health Ststem
Social workers play a vital role in community health systems by helping
people cope with illness, disability, and other health concerns. They also
advocate for patient rights and help patients and their families access resources.
Responsibilities
Direct services
Social workers provide counseling, home visits, and other direct services
to individuals, families, and small groups
Teamwork
Social workers participate in diagnosing and treating patients, and work
with doctors and nurses to ensure patients receive the right care
Community health activities
Social workers educate the community about health and wellness, and help
prevent health issues
Administrative tasks
Social workers plan programs, report on activities, and supervise other staff
Advocacy
Social workers advocate for patient rights and ensure patients are treated with
respect
Education
Social workers educate patients and their families about their condition and
treatment plan
Case management
Social workers work with physicians, nurses, and pharmacists to manage
cases
Organization and Administration of
Health Care
The organization and administration of health care involves
planning, policymaking, and implementation of health programs. Health
care systems are organized at the central, state, and local levels.
Central level
The Union Ministry of Health and Family Welfare is the main
organization at the central level.
The Ministry has three departments: Health & Family Welfare, Indian
system of Medicine and Homeopathy, and Health Research.
The Directorate General of Health Services provides technical guidance
to the Ministry.
State level
The State Ministry of Health and Family Welfare is the main
organization at the state level.
State health departments implement national programs and oversee
district organizations.
Local level
Districts are administered by Chief Medical Officers.
Districts have facilities like community health centers, primary health
centers, and sub-centers.
 Health Planning in India
Health planning in India has evolved through a
series of systematic efforts since its independence in
1947. The country's health planning framework is
characterized by centralized policies, state-level
implementation, and an emphasis on addressing the
health needs of a vast and diverse population. Here’s an
overview of health planning in India:
Key Milestones in Health Planning
Bhore Committee (1946):
1. Proposed a comprehensive public health system.
2. Advocated for the integration of preventive and curative services.
3. Recommended a three-tier health infrastructure with primary, secondary, and tertiary levels.
National Health Policy (1983, Revised in 2002 and 2017):
4. 1983: Emphasized health equity, primary health care, and disease control programs.
5. 2002: Focused on decentralization, public-private partnerships, and addressing emerging
health challenges.
6. 2017: Prioritized universal health coverage, reducing out-of-pocket expenditures, and
achieving Sustainable Development Goals (SDGs).
Five-Year Plans:
7. Health was a prominent focus across India’s Five-Year Plans.
8. The First Plan (1951–56) prioritized public health and family planning.
9. Subsequent plans emphasized rural health infrastructure, control of communicable diseases,
and healthcare financing.
•.
National Rural Health Mission (NRHM, 2005):
Focused on rural healthcare delivery.
Strengthened health infrastructure and services, especially in underserved areas.
Introduced Accredited Social Health Activists (ASHAs) for community-level
engagement.
National Health Mission (NHM, 2013):
Combined NRHM and the National Urban Health Mission (NUHM).
Addressed both rural and urban health challenges.
Ayushman Bharat (2018):
Two components: Health and Wellness Centers (HWCs) and Pradhan Mantri Jan
Arogya Yojana (PM-JAY).
HWCs focus on primary healthcare and preventive services.
PM-JAY provides financial protection for secondary and tertiary healthcare to
vulnerable populations.
Current Health Planning Initiatives
Digital Health Mission:
Promotes digitalization of health records and telemedicine.
Focus on Non-Communicable Diseases (NCDs):
Strategies to address diabetes, hypertension, and cancer.
Universal Immunization Program (UIP):
Expanded vaccination coverage, including newer vaccines.
Maternal and Child Health Programs:
Janani Suraksha Yojana (JSY) and Mission Indradhanush.
Challenges in Health Planning
1.Funding Constraints:
1. Low public health expenditure (around 2% of GDP).
2. Heavy reliance on out-of-pocket spending.
2.Infrastructure Gaps:
1. Shortages of hospitals, clinics, and medical professionals, especially in rural
areas.
3.Inequalities:
1. Disparities in health outcomes across states and socio-economic groups.
4.Emerging Health Threats:
1. Rising burden of NCDs and pandemics like COVID-19.
 Health Committees
Health committees in India have played a pivotal role in shaping the
country’s health policy and planning. These committees, formed at various points
in time, were established to address specific health challenges, assess existing
infrastructure, and recommend strategies for improvement.
Below is a summary of the most notable health committees in India:
Bhore Committee (1943–1946)
Chairperson: Sir Joseph Bhore
Key Contributions:
• Emphasized the integration of preventive and curative healthcare services.
• Proposed a three-tier healthcare system: primary, secondary, and tertiary.
• Recommended the establishment of Primary Health Centers (PHCs) for every 40,000
people.
• Advocated free and universal health care.
• Pioneered the concept of comprehensive public health planning in India.
Mudaliar Committee (1961)
Chairperson: Dr. A. Lakshmanaswami Mudaliar
Key Contributions:
Evaluated the progress of recommendations from the Bhore Committee.
Suggested strengthening district hospitals and regional health infrastructure
. Recommended the establishment of separate medical and health services cadres
. Highlighted the need for improving quality over quantity in health services.

Chadha Committee (1963)

Chairperson: Dr. M.S. Chadha
Key Contributions:
Focused on integrating family planning with general health services.
Proposed the involvement of multipurpose health workers in rural healthcare.
Recommended the deployment of one Basic Health Worker per 10,000
population.
.
Jungalwalla Committee (1967)
Chairperson: Dr. Jungalwalla
Key Contributions:
Focused on the integration of health services
. Recommended the unification of medical, health, and family planning services under a single
administration.
. Kartar Singh Committee (1973)
Chairperson: Kartar Singh
Key Contributions:
Proposed creating a more efficient system of rural health services
. Recommended a team approach at the PHC level with health assistants and workers.
Suggested a health assistant for every 5,000 population and a health worker for every 3,000
population.
Shrivastav Committee (1975
)Chairperson: Dr. Shrivastav
Key Contributions
:Emphasized the importance of community participation in health programs
.Recommended creating a cadre of community health workers (CHWs).
Proposed a referral system to link primary, secondary, and tertiary care levels.
Bajaj Committee (1986)
Chairperson: Dr. J.S. Bajaj
Key Contributions:
Focused on postgraduate medical education.
Recommended enhancing training for medical professionals to meet
emerging health challenges.
Mashelkar Committee (2003)
Chairperson: Dr. R.A. Mashelkar
Key Contributions:
Addressed the regulation of drugs, diagnostics, and other medical
products.
Advocated for strengthening the Central Drugs Standard Control
Organization (CDSCO).
 National Health Policy Committees
These committees periodically review and draft National Health
Policies (1983, 2002, 2017) to address evolving health priorities and
align with global goals such as the Sustainable Development Goals
(SDGs).
NITI Aayog Health Initiatives
Established: 2015 (as a successor to the Planning Commission)
.Key Contributions:
Acts as a think tank for health policy
.Develops strategies for universal health coverage, Ayushman
Bharat, and other health missions.
 Health Programmes
• India has implemented numerous health programs to
address the diverse health needs of its population.
These programs target various aspects of healthcare,
including maternal and child health, communicable
diseases, non-communicable diseases, nutrition, and
mental health
Below is a detailed overview of key health programs in
India:
Maternal and Child Health Programs
Janani Suraksha Yojana (JSY):
• Launched under the National Health Mission (NHM) in 2005.
• Aimed at reducing maternal and neonatal mortality by promoting institutional
deliveries.
• Provides cash incentives to pregnant women for accessing healthcare facilities.
Janani Shishu Suraksha Karyakram (JSSK):
• Ensures free delivery services, including C-sections, medications, and transportation
for pregnant women and newborns.
Rashtriya Bal Swasthya Karyakram (RBSK):
• Focuses on early identification and intervention for 4Ds: Defects at birth,
Deficiencies, Diseases, and Developmental delays.
Mission Indradhanush:
• Launched in 2014 to increase vaccination coverage for children and pregnant
women.
• Targets diseases such as polio, diphtheria, tetanus, and measles.
Communicable Disease Control Programs
National Tuberculosis Elimination Programme (NTEP):
• Aims to eliminate TB in India by 2025.
• Includes free diagnostics, treatment, and nutritional support for TB patients.
National AIDS Control Programme (NACP):
• Focuses on preventing the spread of HIV/AIDS and providing care to affected
individuals.
• Includes programs for education, testing, and access to antiretroviral therapy.
Revised National Malaria Control Programme (RNMCP):
• Targets malaria elimination through early diagnosis, treatment, and vector control
measures.
National Leprosy Eradication Programme (NLEP):
• Aims to eliminate leprosy by early detection and free treatment under Multi-Drug
Therapy (MDT).
Integrated Disease Surveillance Programme (IDSP):
• Monitors outbreaks of epidemic-prone diseases and provides early warning signals.
Non-Communicable Disease (NCD) Programs
National Programme for Prevention and Control of Cancer,
Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS):
• Focuses on screening, early diagnosis, and treatment of major NCDs.
National Tobacco Control Programme (NTCP):
• Aims to reduce tobacco consumption and its health consequences through
awareness and enforcement of anti-tobacco laws.
National Mental Health Programme (NMHP):
• Provides community-based mental health services and integrates mental
health with general healthcare.
Nutrition Programs
Integrated Child Development Services (ICDS):
• Provides supplementary nutrition, health education, and preschool education to
children under six and pregnant and lactating women.
Mid-Day Meal Scheme:
• Ensures nutritional support to school-going children to reduce malnutrition and
increase enrollment.
Poshan Abhiyaan (National Nutrition Mission):
• Launched in 2018 to reduce stunting, undernutrition, and anemia among
children, adolescent girls, and women
Universal Healthcare Programs
Ayushman Bharat:
Two components: Health and Wellness Centers (HWCs) and Pradhan Mantri
Jan Arogya Yojana (PM-JAY).
HWCs focus on preventive, promotive, and primary care.PM-JAY provides
financial protection for secondary and tertiary healthcare for economically
vulnerable families.
Urban Health Programs
National Urban Health Mission (NUHM):
Targets urban poor populations by strengthening primary healthcare delivery
in urban areas.
Reproductive and Adolescent Health Programs
Rashtriya Kishor Swasthya Karyakram (RKSK):
Focuses on adolescent health, addressing issues like nutrition,
reproductive health, mental health, and substance abuse.
Health Insurance Programs
Rashtriya Swasthya Bima Yojana (RSBY):
Provides health insurance coverage to workers in the unorganized
sector.
Offers cashless hospitalization services.
Employees’ State Insurance Scheme (ESIS):
Offers medical and financial benefits to workers in organized
sectors.
Other Notable Programs
Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA):
• Provides free antenatal care to pregnant women on the 9th of every month.
National Programme for Control of Blindness (NPCB):
• Focuses on reducing preventable blindness through screening and treatment
services.
Ayush Mission:
• Promotes traditional Indian systems of medicine like Ayurveda, Yoga, Unani,
Siddha, and Homeopathy.
 Health Problems in India
• India faces numerous health challenges, stemming from its large and
diverse population, socio-economic disparities, and a rapidly evolving
healthcare landscape. These challenges can be broadly categorized into
communicable diseases, non-communicable diseases, maternal and
child health issues, nutritional deficiencies, mental health disorders,
and healthcare infrastructure gaps.
• Here’s an overview:
Communicable Diseases
Tuberculosis (TB):
• India accounts for the highest global TB burden.
• Drug-resistant TB is an emerging concern.
HIV/AIDS:
• Despite progress, certain high-risk groups face stigma and limited access to treatment.
Vector-borne Diseases:
• Diseases like malaria, dengue, chikungunya, and Japanese encephalitis remain endemic in
several regions.
COVID-19 and Emerging Pandemics:
• The COVID-19 pandemic highlighted gaps in healthcare infrastructure and the need for
pandemic preparedness.
Diarrheal Diseases:
• A leading cause of child mortality, especially in areas with poor sanitation and unsafe
drinking water.
Non-Communicable Diseases (NCDs)
Cardiovascular Diseases (CVDs):
• Rising prevalence due to sedentary lifestyles, unhealthy diets, and increasing obesity
rates.
Diabetes:
• India is often referred to as the "Diabetes Capital of the World."
• A growing challenge, especially in urban areas.
Cancers:
• Increasing cases of breast, cervical, and oral cancers, with late-stage diagnosis being
common.
Chronic Respiratory Diseases:
• Conditions like asthma and chronic obstructive pulmonary disease (COPD) are
aggravated by air pollution and smoking.
Mental Health Disorders:
• Depression, anxiety, and suicide rates are high, but mental health services remain under-
resourced and stigmatized.
Maternal and Child Health Issues
Maternal Mortality:
• High rates of maternal deaths due to complications like hemorrhage, sepsis,
and eclampsia.
Infant and Child Mortality:
• Issues like malnutrition, low birth weight, and lack of access to neonatal care
contribute to high mortality rates.
Adolescent Health:
• High rates of teenage pregnancies, anemia, and substance abuse among
adolescents.
Nutritional Deficiencies
Malnutrition:
• A significant public health issue, particularly in children under five, leading to
stunting and wasting.
Micronutrient Deficiencies:
• High prevalence of anemia, especially among women and children, due to
iron, vitamin A, and iodine deficiencies.
Obesity:
• Rising obesity rates, especially in urban areas, due to lifestyle changes and
unhealthy eating habits.
Environmental and Occupational Health Issues
Air Pollution:
• A leading cause of respiratory and cardiovascular diseases.
• Cities like Delhi frequently experience hazardous air quality.
Waterborne Diseases:
• Contaminated water sources contribute to diseases like cholera, typhoid, and
hepatitis.
Occupational Hazards:
• Workers in unregulated industries face risks like respiratory illnesses, injuries,
and chemical exposure.
 Mental Health Disorders
Prevalence:
High rates of depression, anxiety, schizophrenia, and bipolar disorders.
Barriers to Care:
Limited mental health infrastructure, stigma, and lack of trained
professionals.
Lifestyle-Related Health Problems
Tobacco Use:
A significant contributor to cancers, respiratory diseases, and
cardiovascular conditions.
Substance Abuse:
Rising cases of drug and alcohol addiction, particularly among youth.
Healthcare Infrastructure Challenges
Access to Healthcare:
• Rural areas often lack adequate healthcare facilities and trained professionals.
Healthcare Financing:
• High out-of-pocket expenditures lead to financial hardships for many
families.
Quality of Care:
• Variability in the quality of services across public and private sectors.
Population and Demographic Challenges
Overpopulation:
• Strains healthcare resources and infrastructure.
Aging Population:
• Increasing prevalence of age-related diseases like Alzheimer’s and
osteoporosis.
Public Health Emergencies
Natural Disasters:
• Floods, earthquakes, and cyclones often disrupt healthcare services.
Antimicrobial Resistance (AMR):
• Misuse of antibiotics has led to rising cases of drug-resistant
infections.
 Strategies to Address Health Problems
Strengthen Primary Healthcare:
1. Expand the network of Health and Wellness Centers (HWCs).
Public-Private Partnerships:
2. Collaborate to improve healthcare infrastructure and services.
Focus on Preventive Care:
3. Promote vaccination, health education, and regular screenings.
Increase Healthcare Expenditure:
4. Allocate more resources to public health programs and research.
Digital Health Integration:
5. Utilize telemedicine and electronic health records to improve access and
efficiency.