COMMUNITY HEALTH
NURSING II
UNIT III
RURAL HEALTH CARE
SERVICES
• PREPARED BY,
MRS,M.JOSEPHIN,
TUTOR

INTRODUCTION
 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..

Cont….
Health care is...
Promoting
Restoring and
Maintaining health
Embraces all the goods and services designed
for "prevention, promotion and rehabilitation
interventions” includes Medical Care

CHARACTERISTICSOFAGOODHEALTHCARE
SERVICE
1. Comprehensive
2.Accessible
3. Acceptable
4.Provide scope for community participate
5.Cost-effective

LEVELS OF HEALTHCARE
Primary Healthcare
Provided at the community level
Secondary health care
Provided at PHC, CHC, DH etc.
Tertiary health care
Provided at hospitals

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.

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.

ELEMENTSOF PRIMARYHEALTHCARE
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.

PRINCIPLESOF HEALTHCARE CENTRE

VILLAGELEVEL

I
(2)LOCALDAIS
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
supervision

Functionsof dais
1. MCH care
2. Family planning
3. Immunization
4. Education about health
5. Referral services
6. safe water basic sanitation
7. Nutrition.

(3)ANGANWADIWORKER:
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
services.

Function of anganwadi worker
1. MCH
2. Family Planning
3. Immunization
4. Education About Health
5. Referral Services
6. Safe Water And Basic Sanitation
7. Supplementary Nutrition
8. Non Formal Education Of Children.

ASHA SCHEME:
• 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.

Cont…..
• 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
incentives.
• ASHAs empowered with drug-kit
• ASHA will create awareness in health and
Nutrition.

SUBCENTRE
The most peripheral and first contact point
between the primary health care system and the
community.
The Ministry
Welfare
of Health &
is providing
Family
100%
Central assistance
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
backward areas
Each Sub-Centre is manned by one Male and
one female Health.

CONT…
• .
Family welfare,
Nutrition,
Immunization,
Diarrhea control and
Control of communicable diseases
programmes.
Maternal and child health,
The sub centre are provided with basic
drugs for minor ailments.

STAFFFORSUB CENTRE
S.N
O
STAFF FOR SUB
CENTRE
NUMBER
OF POSTS
1 Health Worker (Female)
/ANM
1
2 Health worker (Male) /
MPW
1
3 Voluntary Worker 1
TOTAL 3

PRIMARYHEALTHCENTRE
 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
State Governments.
At present, a PHC is manned by a Medical Officer
supported by 14 paramedical and other staff.

CONT….
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
tribal areas..

PHC

FUNCTIONSOFPHCS
Health programmes
MCH care and family planning
Medical care
Health education and training
Referral services
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

NJ

Functions of medicalofficers
1. GENERAL
2.SUPERVISORY
3.ADMINISTRATIVE

General
• 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.

Supervisory
• He supervisors and Guides the work of
other members of the staff .
• He visits sub centers and other villages
for this purpose.

Administrative
• Co-ordinate and co-operate with other health
agencies
• 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
1. Registration
2. Care At Home
3. Care Of Community
4. Care At The Clinic
5. Others

Registration
• Pregnant woman from 3 month of pregnancy
onwards
• Married women in reproductive period
• Children
• Maintain Maternity card..

Careat home
She will provide care to all pregnant women
Distribute Folic acid
Immunization
 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
distributions
• Participate in meetings
• Utilize satisfied customers, village leaders, dais and
the others for promoting Family Welfare programme

Others
• Cleanliness Of The Centre
• Staff Meeting At PHC CD Block Or Both

MALE HEALTHWORKERS
• Record keeping
• Malaria
• Communicable disease
• Leprosy
• Tuberculosis
• Environmental
• Sanitation
• 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

FUNCTIONSOF PHARMACIST
• Distribution of medical program
• Equipment storage
• Maintenance of stock register

STAFF NURSE :
• Conducting delivery
• Administration of injection
• Medication distribution..

ANM:
• Conducting delivery
• Administration of injection
• Medication distribution..

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
Manager
• 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
• Immunization
• 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
units(FRUs).
• 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

OBJECTIVES:
• 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
assisted deliveries.
• Essential and emergency obstetric care including
surgical intervention like caesarean sections and
other medical interventions.
• Full range of family planning services including
laprascopic services.

• 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
• Others,
• A. blood storage facility
• B. essential laboratory services.
• C. Referral transport services.

MANPOWER AT CHC:
PERSONNEL EXISTING
Medical officers, pediatic , gynaecologist, physician
and surgeon
4
Nurse mid wives 7
Dresser 1
Pharmacist/ compounder 1
Lab technician 1
Radiographer 1
Ward boys 2
Sweepers 3
Dhobi 1
Aya 1
Peon 1
Security 1

AT DISTRICT LEVEL:
• The principal unit of administarion in india is the district under a
collector.
• There are 967 ( year 2020) districts in india .
• Within each district again there are 6 types of administrative
areas.
• Sub-divcisions
• Talukas
• Community development blocks
• Villages
• Panchayat.

• Most districts in india are divided into 2 or more sub
divisions, each in charge of an assistant collector or sub
collector .
• Each division is again divided into talukas , in charge of a
tahsildar.
• 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
officer.
• Finally there are the village panchayats , which are
institutions of a local self government.

HEALTH ORGANIZATION AT
DISTRICT LEVEL:
• URBAN ADMINISTRATION
• Municipal corporation
• Town area committee
• RURAL
ADMINISTRATION
• Panchayat at village level
• Gram sabha
• Gram panchayat
• Naya panchayat
• Panchayat samiti ( at block
level)
• Zilla parishad (at district
level)

RURALADMINISTRATION
• 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
a year.
• 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
panchayat secretary.

THE FUNCTIONS
• 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
to 1,20,000.
• 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
development programmes.
FUNCTION
• Execution of the community development programme in the block

FUNCTIONS OF PRs
• Agriculture
• 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
directorate

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
administrative staff.

STATE MINISTRY OF HEALTH
(ORGANIZATIONSTRUCTURE)
Ministry of health and family welfare
state health minister
Deputy minister of health and family welfare
Health secretariat, Health secretary
Deputy secretaries
Administrative staff members

STATE HEALTHDIRECTORATE
• 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
health.
• He is also responsible for the organization and direction of all health
activities.
• 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
types;
Regional and functional.
The regional directors inspect all the branches of public
health.
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
CENTRAL LEVEL
• 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
FAMILY WELFARE
• 1) ORGANIZATION:
• the union ministry of health and family welfare is headed by
cabinet minister, a minister of state and a deputy health
minister.
• 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.

ORGANIZATION STRUCTURE
Directorate general of health services
Director general of health services
Additional director general of health services
Deputy director general of health services
Administrative staff

FUNCTIONS
• 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
state govt)
• prevention of communicable disease.
• Prevention of food adulteration
• Control of drug and poison
• Vital statistics
• Labour welfare
• Economic and social planning

THANK YOU