Health is a state of complete physical Mental
and Social well being and not merely an
absence of disease of infirmity.
Illness is a State which
emotional , intellectual,
a person ‘s physical
social or spiritual
functioning is diminished or impaired..
LEVELS OF HEALTHCARE
Provided at the community level
Secondary health care
Provided at PHC, CHC, DH etc.
Tertiary health care
Provided at hospitals
• 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.
WHATIS THEREIN PRIMARYHEALTH CARE..
Primary Health Care includes:
– Primary Care (physicians, midwives & nurses);
– Health promotion, illness prevention;
– Health maintenance & home support;
– Community rehabilitation;
– Pre-hospital emergency medical services… and…
– Coordination and referral to other areas of health care.
1. Education about prevailing health conditions and methods
to prevent and control them
2. Promotion of food supply and proper nutrition
3. Adequate water supply and basic sanitation
4. Maternal and child health care with 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.
Most deliveries in rural areas by untrained dais.
Training given for 30 working days. Stipend of Rs
300 during the training period.
The training is at PHC, Sub centers or MCH
centers for two days in a week and on the
remaining four days of the week accompany the
health worker female to the village.
conduct at least two deliveries under the
1. MCH care
2. Family planning
4. Education about health
5. Referral services
6. safe water basic sanitation
Under the ICDS scheme there is an
Anganwadi worker for a population of 1000. There
are about 100 such workers in each ICDS project.
The Anganwadi worker is selected from the
community and she undergoes training in various
aspect of health, nutrition and child development
for 4 months. She is a part time worker and paid
an honorarium of Rs. 200 to 250 per month for the
Function of anganwadi worker
2. Family Planning
4. Education About Health
5. Referral Services
6. Safe Water And Basic Sanitation
7. Supplementary Nutrition
8. Non Formal Education Of Children.
• One of the key components of the National Rural
Health Mission is to provide every village in the
country with a trained ASHA or Accredited
Social Health Activist. Selected from the village
itself and accountable to it .
• ASHA must primarily be a women resident of the
village- Married / Widowed /Divorced preferably
in the age group of 25 to 45 years.
• she should be a literate woman with formal
education upto class 8.
• ASHA will be chosen through a rigorous process
of selection involving various community groups,
self- help groups, Anganwadi institution, The
black Nodal Officer, District Nodal Officer, The
village health committee and the Gram sabha.
• ASHA will have to undergo services of training
episodes to acquire the necessary knowledge.
• The ASHAs will receive performance-based
• ASHAs empowered with drug-kit
• ASHA will create awareness in health and
The most peripheral and first contact point
between the primary health care system and the
of Health &
They are established on the basis of
One SC for every 5,000 pop in general and…
One SC for every 3,000 pop in hilly, tribal and
Each Sub-Centre is manned by one Male and
one female Health.
PHC is the first contact point between village
community and the Medical Officer.
The PHCs were envisaged to provide an
integrated curative and preventive health care to
the rural population
The PHCs are established and maintained by the
At present, a PHC is manned by a Medical Officer
supported by 14 paramedical and other staff.
It acts as a referral unit for 6 SubCentres.
It has 4 - 6 beds for patients.
The activities of PHC involve curative, preventive,
promotive and Family Welfare Services.
National Health Plan (1983) proposed
One PHC for every…..30,000 pop in Rural areas
One PHC for every…..50,000 pop in Urban areas
One PHC for every…..20,000 pop in hilly and
MCH care and family planning
Health education and training
Safe water supply and basic sanitation
Prevention and control of locally endemic diseases
Collection and reporting of vital events
Basic laboratory services..
Staffing Pattern of PHC:
1. Medical officer : 1
2. Community health officer : 1
3. Pharmacist : 1
4. Nurse Midwife : 1
5. ANM : 1
6. Health educator :1
7. Health assistant (Male) : 1
8. Health assistant(Female) : 1
1. UDC : 1
2. LDC : 1
3. Lab Technician: 1
4. Driver : 1
5. Class 4: 1
• He is responsible for all curative and preventive
health work in his area …. Clinical duty… OPD
• Organization of the Indoor services .
• Attending medico-legal cases .
• Attending to emergency cases .
• Organizing The laboratory service at the PHC
• Referring cases to hospital.
• Co-ordinate and co-operate with other health
• He entwists co-operation of other department
Such as revenue, agriculture, education, Public
Health engineering, etc..
• preparation of tour programs of staff .
• all matters relating to Indents, receipts and
maintenance of supplies.
• Reporting the progress of activities under all
program to the Chief Medical Officer .
FUNCTIONS OF FEMALE HEALTHWORKER
2. Care At Home
3. Care Of Community
4. Care At The Clinic
She will provide care to all pregnant women
Distribute Folic acid
Initiation family planning
Record and report birth and death..
Care at the clinic
• Arrange and help HO and health assistant in
conducting MCH and family planning clinics at
the sub centre
• Conduct Urine Examination and estimate Hb%
Care of community
• She will identify women leaders and participate in
the training of women leaders
• Set up women depot holder for condom
• Participate in meetings
• Utilize satisfied customers, village leaders, dais and
the others for promoting Family Welfare programme
• Record keeping
• Communicable disease
• Expanded programme on immunization
• Family planning
HEALTHASSISTANT ( MALE &FEMALE)
• Supervise the health workers
• Supervise the health care services..
• Strengthen the knowledge and skills of health
workers in the different areas
• Help the health workers in the human relation
• Help and guide health workers in planning and
organizing their program
• Promote learning of the health worker
The WHO Study Group (1985)
Identified Main self Explanatory Roles
In Primary Health Care
• Nurses as Direct care provider
• Nurse as a Teacher and Educator
• Nurse as a Supervisor and
• Nurse as Researcher and Evaluator
ROLE OF NURSES IN PHC
• Maintaining records and reports
• Conducting camp
• Area visit
• Food supply and proper nutrition
• Maternal and child health including FP
• water supply and basic sanitation
• Prevention and control of locally endemic disease
• Treatment of minor ailments
• Provision of essential drugs drugs
• Conducting school health programmes
• Health education
COMMUNITY HEALTH CENTRE :
• Health care delivery in india has 3 levels- primary,
secondary and tertiary.
• The secondary level of health care essentially includes
community health centres(CHCs) with First referral
• CHCs designed to provide referral health care for cases
from the primary health centres.
• 4 PHC are included under each CHCs
• One CHC – 80000 population in hilly/ tribal areas
1,20,000 population in plain areas.
• CHC is a 30 bedded hospitals providing specialist
care in medicine, obstetrics and gynecology ,
surgery, paediatrics, dental and AYUSH.
• In 2022 total CHCs = 15,363
• To provide optimal , expert care to the community .
• To achieve and maintain an acceptable standards of
quality of care.
• To make the services more responsive and sensitive
to the need of the community.
SERVICES PROVIDED AT CHC:
• Care of routine and emergency cases in surgery :
• A) This includes incision and drainage , and surgery
for hernia , hydrocele, appendicitis, haemorrhoids,
fistula , etc.
• Handling of emergencies like intestinal
obstruction, haemorrhage etc.
• Care of routine and emergency cases in medicine:
• Handling of all emergencies in relation to the
national health programmes as per guidelines like
dengue / DHF , cerebral malaria etc,
• 24 – hours delivery services , including normal and
• Essential and emergency obstetric care including
surgical intervention like caesarean sections and
other medical interventions.
• Full range of family planning services including
• Other management , including nasal packing, tracheostomy,
foreign body removal etc.
• All the national health programmes(NHP) should be
delivered through the CHCs.
• Safe abortion services.
• Newborn care
• Routine and emergency care of sick children
• A. blood storage facility
• B. essential laboratory services.
• C. Referral transport services.
MANPOWER AT CHC:
Medical officers, pediatic , gynaecologist, physician
Nurse mid wives 7
Pharmacist/ compounder 1
Lab technician 1
Ward boys 2
AT DISTRICT LEVEL:
• The principal unit of administarion in india is the district under a
• There are 967 ( year 2020) districts in india .
• Within each district again there are 6 types of administrative
• Community development blocks
• Most districts in india are divided into 2 or more sub
divisions, each in charge of an assistant collector or sub
• Each division is again divided into talukas , in charge of a
• A talukas usually comprises between 200 to 600 villages.
• The rural areas of the district have been organized into
blocks, known as community development blocks.
• The block is a unit of rural planning and development , and
comprises approximately 100 villages and about 80,000 to
1,20, 000 population , in charge of a block development
• Finally there are the village panchayats , which are
institutions of a local self government.
HEALTH ORGANIZATION AT
• URBAN ADMINISTRATION
• Municipal corporation
• Town area committee
• Panchayat at village level
• Gram sabha
• Gram panchayat
• Naya panchayat
• Panchayat samiti ( at block
• Zilla parishad (at district
• PANCHAYATI RAJ INSTITUTION:
• The panchayati raj is a 3 – tier structure of rural local self government in
india , linking the village to the district.
• The three institutions are:
• Panchayat – at the village level.
• Panchayat samiti – at the block level.
• Zila parishad – at the district level .
• Panchayat ( at village level) :
• The gram sabha
• The gram panchayat
• The Nyay panchayat
• GRAM SABHA :
• The assembly of all the adults of the village , which meets atleast twice
• It condsiders proposals for taxation, discuss the annual programme and
elects members of itself.
• GRAM PANCHAYAT :
• An Agency for planning and development at the village level.
• Its strength varies from 15 to 30 and population covered varies widely
from 5000 to 15000 0r more
• The members hold office for a period of 3 to 4 years.
• Every panchayat has an elected president ,a vice president and a
• They cover the entire field of civic administration , including sanitation and public
health and social and economic development of the village.
PANCHAYAT SAMITI :
• It consist of about 100 villages and a population of about 80,000
• The panchayat raj agency at the block level is the panchayat
samiti / janpada panchayat.
• It consists of all sarpanchas of the village panchayat in tha block
MLA, MPs residing in the block area ; representatives of women
scheduled castes, scheduled tribes and cooperative societies.
• The block development officer is the ex – officio secretary of it
and his staff give assistant to the village panchayats engaged in
• Execution of the community development programme in the block
FUNCTIONS OF PRs
• Supply of safe and clean drinking water
• Women and child development
• Adult and formal education
• Poverty alleviation programme
• Rural electrification
• Health and sanitation
• Water management
• Rural housing
• Roads and other means of communication
HEALTHORGANIZATION AT STATE LEVEL
• STATE HEALTH ADMINISTRATION:
• At present there was 29 states in india, with each state
having its own health administration.
• In all states , the management sector comprises the state
ministry of health and a directorate of health or state health
STATE MINISTRY OF HEALTH
• The state ministry of health is headed by a minister of health
and family welfare and a deputy minister of health and
family welfare .
• The healh secretariast is the official organ of the state
ministry of health and is headed by a secretary who is
assisted by deputy secretaries. Under secretaries, a large
STATE MINISTRY OF HEALTH
Ministry of health and family welfare
state health minister
Deputy minister of health and family welfare
Health secretariat, Health secretary
Administrative staff members
• For a long time two departments medical and public health , were
functioning in the states.
• The heads of these departments were known as,
• surgeon general and inspector general of civil hospitals.
• Director of public health respectively.
• The director of health services is the chief medical adviser to the
state government on all matters related to medicine and public
• He is also responsible for the organization and direction of all health
• The director of health and family welfare is assisted by a suitable
number of deputies and assistants.
• The deputies and assistants director of health may be two types;
Regional and functional.
• The director of health and family welfare is assisted by a
suitable number of deputies and assistants.
• The deputies and assistants director of health may be two
Regional and functional.
The regional directors inspect all the branches of public
The functional directors are usually specialist in a particular
branch of public health such MCH, family planning, nutrition,
TB, leprosy and health education.
HEALTH ORGANIZATION AT
• AT THE CENTRAL:
• The official ‘organs’ of the health system at the central
level consists of;
• The union ministry of health and family welfare
• The directorate general of health services (DGHS).
• The central council of health and family welfare.
UNION MINISTRY OF HEALTH AND
• 1) ORGANIZATION:
• the union ministry of health and family welfare is headed by
cabinet minister, a minister of state and a deputy health
• These are political appoinments.
• Department of health
• Department of welfare
• The secretary to the government of india in the ministry of
health and family welfare is in over all in charge of the
department of family welfare.
• UNION LIST ( central govt only)
• International health relation and administration
• Administration of central institutes
• Promotion of research
• Regulation and development of medical, pharmaceutical , dental
and nursing professions.
• Collecting census and publication of statistical data.
CONCURRENT LIST ( both central and
• prevention of communicable disease.
• Prevention of food adulteration
• Control of drug and poison
• Vital statistics
• Labour welfare
• Economic and social planning