Ist yr Bsc Nursing

1. UNIT I : INTRODUCTION
CONCEPTS OF HEALTH
Prepared By :Mrs Bemina JA
Assistant Professor
ESIC College of Nursing
Kalaburagi

2.  By the end of the lectures on the Concept of Health and
Disease you should know and understand the following
 • Changing concepts of Health;
 • Definitions of Health; New Philosophy of Health;
 • Dimensions of Health; Positive Health;
 • Concept of Wellbeing; Physical Quality of Life Index
(PQLI); By the end of the lecture the students should know
and understand the following
 • Determinants of Health; Ecology of Health;
Responsibility for Health; Health and Development;
 • Indicators of Health

3.  Biomedical Concept (Health has been viewed as an “absence of
disease”, and if one was free from disease the person was considered
healthy)
 Ecological Concept (Health implies the relative absence of pain and
discomfort and a continuous adaptation and adjustment to the
environment to ensure optimal function)
 Psychosocial Concept (Health is both a biological and social
phenomenon)
 Holistic Concept (A sound mind in a sound body, in a sound family, in
a sound environment; All sectors of society like agriculture, animal
husbandry, food, industry, education, housing, public works,
communication & other sectors have an effect on health)
 It recognizes the strength of social, economic, political and
environmental influences on health. Implies that all sectors of society
have an effect on health Ancient view: Sound mind, in a sound body,
in a sound family, in sound environment Emphasis is on promotion
and protection of health

4.  WHO Definition: “ Health is a state of complete
physical, mental and social wellbeing and not merely
an absence of disease or infirmity and the ability to lead
a socially and economically productive life”.
 Operational Definition of Health: “ A condition or
quality of the human organism expressing the adequate
functioning of the organism in given conditions,
genetic or environmental”.
 Thus Health means
 (a) No obvious evidence of disease and that the person
is functioning normally
 (b) Several organs of the body are functioning
adequately as well as in relation to one another
(Equilibrium or Homeostasis).

5.  • Health is a fundamental Human Right
 • Health is the essence of productive life
 • Health is inter sectorial
 • Health is an integral part of development
 • Health is central to the concept of quality of life
 • Health involves individuals, state and international
responsibility
 • Health & its maintenance is a major social investment
 • Health is a worldwide social goal

6.  • Health is multidimensional,
 WHO definition envisages three (3) specific dimensions, however there are
many more dimensions: •
 Physical
What does physical health mean?
 Perfect functioning of the body in which each organ is working in harmony
with the maximum capacity
How is it achieved?
 By exercise, healthy diet, adequate rest & sleep, and no addictions.
What are the signs of good physical health?
 A healthy skin texture
 Bright eyes
 Not too thin or fat
 A good appetite
 Regular bowel and bladder activities
 Smooth and easy coordinated movements
 The resting, pulse rate, blood pressure and exercise tolerance are all within the
range of "normality" for the individual's age and sex.
 Steady gain in weight till 25 years and constant thereafter

7.  i) Self assessment of overall health
 ii) Inquiry into symptoms of ill health and risk factors
 iii) Inquiry into medications
 iv) Inquiry into level of activity
 v) Inquiry into use of medical services
 vi) Standardized questionnaires for cardiovascular diseases
vii) Standardized questionnaires for respiratory diseases
viii) Clinical examination
 ix) Nutrition and dietary assessment and
 x) Biochemical and laboratory investigations
 Community Assessment: At the Community Level, state of
health may be assessed by such indicators as:
 • Death Rate; Infant Mortality Rate and Expectation of Life

8.  What is good mental health?
The ability to respond to the many varied experiences of life
with flexibility and a sense of purpose
 Definition: "A state of balance between the individual and
the surrounding world, a state of harmony between oneself
and others, a coexistence between the realities of the self and
that of other people and that of the environment"
 Psychological factors can induce all kinds of illness not
simply mental ones which may include:
 Essential Hypertension;
 Peptic Ulcer and Bronchial Asthma • Some major Psychiatric
Illnesses like Depression and Schizophrenia have biological
component

9.  A) Free from internal conflicts, is not at war with him or
herself
 B) Well adjusted: Is able to get along well with others.
Accepts criticism and is not easily upset
 C) Searches for Identity
 D) Has a strong sense of self esteem
 E) Knows oneself, ones needs, problems and goals (this is
known as self actualization)
 F) Has good self control, balances rationality and
emotionality
 G) Faces problems and tries to solve them intelligently, i.e.,
coping with stress and anxiety
One of the keys to good health is Positive Mental Health.

10.  Harmony and integration within the individual, between
each individual and other members of society and between
individuals and the world in which they live
 Definition: "Quantity and quality of an individual's
interpersonal ties and the extent of involvement with the
community"
 • Social health takes into account that every individual is a
part of a family and a wider community and focuses on social
and economic conditions and well being of the “Whole
Person” in the context of his social network.
 • Social Health is rooted in “Positive material
environment” (focusing on financial and residential matters)
and “Positive human environment” which is concerned with
social network of the individual.

11.  It includes integrity, principles and ethics, the
purpose in life, commitment to some higher being and
belief in concepts that are not subject to "state of the
art" explanation
 (Spiritual health in this context, refers to that part of the
individual which reaches out and strives for meaning
and purpose in life)

12.  Mental health can be seen as "knowing" or "cognition"
while emotional health relates to "feeling"
 (Initially mental and emotional dimensions were seen
one in the same thing but as more research becomes
available a definite difference is emerging.

13.  When work is fully adapted to human goals, capacities
and limitations, work often plays a role in promoting both
physical and mental health the culmination of the efforts of
other dimensions as they function together to produce what
the individual considers life "success"
 (Importance of this dimension is exposed when individuals
suddenly loose their jobs or are faced with mandatory
retirement.
 For some this dimension may merely be a source of income
but for others it may be source of self worth and life
success.
 Goal achievement and self realization in work are source
of satisfaction and enhanced self esteem)

14.  Philosophical,
 Cultural,
 Socioeconomic,
 Environmental,
 Educational,
 Nutritional,
 Curative
 Preventive.

15.  A variable which helps to measure changes , directly or
indirectly (WHO,1981).
 The health indicators are defined as those variables which
measures the health status of an individual and
community.
 Mortality Indicators: Crude Death rate, Life Expectancy,
Infant mortality rate, Child mortality rate, Under five
mortality rate, Maternal mortality ratio, Disease specific
mortality, proportional mortality rate etc.
 Morbidity Indicators: Incidence and prevalence rate,
disease notification rate, OPD attendance rate, Admission,
readmission and discharge rate, duration of stay in hospital
and spells of sickness or absence from work or school.

16.  Nutritional Status Indicators: Anthropometric
measurement of preschool children, Prevalence of low
birth weight etc.
 Health Care Delivery Indicators: Doctor- population
ratio, Bed-nurse ratio, Population- bed ration,
Population per health facility etc.
 Utilization Rates: immunization coverage, ANC
coverage, % of Hospital Delivery, Contraceptives
prevalence rate, Bed occupancy rate, average length of
stay in hospital and bed turnover rate etc. 16

17.  Indicators of social and mental health:
Rates of suicides, homicides, violence, crimes, RTAs,
drug abuse, smoking and alcohol consumption etc.
 Environmental indicators:
Proportion of population having access to safe
drinking water and improved sanitation facility, level of
air pollution, water pollution, noise pollution etc.

18.  Socio Economic Indicators: rate of population
increase, Per capita GNP, Dependency ratio, Level of
unemployment, literacy rate, family size etc.
 Health policy Indicators: proportion of GNP spent on
health services, proportion of GNP spent on health
related activities including safe water supply,
sanitation, housing, nutrition etc. and proportion of
total health resources devoted to primary health care.
 • Indicators of Quality of Life: PQLI physical quality of
life index , IMR, Literacy rate, Life Expectancy at age
one etc.

19.  WHO definition of health introduces the concept of
“well being”.
 It has both subjective and objective components.
 Standard of Living (Spiritual , educational, recreational
and other services may be used individually as
measures of socioeconomic status and collectively as
an index of the standard of living”.
 The standard of living depends on the per capita GNP)

20.  It consists of nine components: health, food consumption,
education, occupation and working conditions, housing,
social security, clothing, recreation and leisure and human
rights.
 These objective characteristics are believed to influence
human well being
 Quality of Life
 It is a subjective component and is defined by WHO as “
The condition of life resulting from the combination of the
effects of the complete range of factors such as those
determining health, happiness (including comfort in the
physical environment and a satisfying occupation,
education, social and intellectual attainments, freedom
of action, justice and freedom of expression.”)

23.  According to Betty Newman (1990) "Health on a
continuum is the degree of client wellness that exists at
any point in time, ranging from an optimal wellness
condition with available energy at its maximum to
death, which represents total energy depletion.
 “ According to Health-illness continuum model,
 'Health is a dynamic state that continuously alters as a
person adapts to changes in the internal and external
environments to maintain a state of physical, emotional,
intellectual, social, developmental and spiritual well-being.
Illness is a process in which the functioning of a person is
diminished or impaired in one or more dimensions when
compared with the person's previous condition'.

24.  Because health and illness are relative qualities existing
in varying degrees it may be more useful to consider
health and illness in terms of a point on a scale or
continuum rather than a absolute state.
 High level of wellness and sever illness are at opposite
ends of the continuum
 A nurse can determine a clients level of health at any
point of time on the health illness continuum
 Center to health illness continuum model are risk factors

28.  The health illness continuum is a graphic illustration
of a well being , concept first proposed by John. W.
Travis in 1972.
 It describes how wellbeing is more than simply an
absence of illness , but also incorporates the
individuals mental and emotional health.
 Travis believed that the standard approach to
medicines , which assumes a person is well when
there are no signs or symptoms of disease , was
insufficient.

29.  Composed of two arrows pointing in opposite
direction and joined at a neutral point.
 Movement to the right to the arrows (toward the high
level of wellness) equals an increase in level of health
and wellbeing
 • Achieved in three steps , • Awareness • Education •
Growth
 Movement to the left to the arrows (towards
premature death) equates a progressively decreasing
state of health.
 • Achieved in three steps, • Signs • Symptoms •
Disability

30.  Most important is the direction is the individual facing
on the pathway
 A. If towards high level of health , a person has
genuinely optimistic or positive out look despite his/
her health status.
 B. If towards premature death , a person has a
genuinely pessimistic or negative out look about his or
health status.

31.  Compares treatment model with a wellness model, If
treatment model is used , an individual can move right
only to the neutral point.
 Eg: A hypertensive client who only takes his
medications without making any other life style
changes.
 If wellness model is used , an individual can move right
past the neutral point.
 Eg : As hypertensive client not only takes medications
but stops smoking , looses weight , starts an exercise
programme etc

32.  – To help the client to identify their place on the health-
continuum.
 – To assist the clients to adopt some measures in order
to reach a well state of health.

33.  The factors determining health are many
 Some factors are inside the body genetics and some
fact are out side the body environment .
 Genetic
 Environment
 Biological
 Social
 Psychological
 Others

34.  Genetic Influences
Race
Sex
Genetically Transmitted Diseases
 Behavioral Influences
Tobacco use
Unhealthy diet
Inadequate activity
Alcohol and drug use
Risky sexual behaviors
Behaviors leading to intentional/unintentional injury
Personal hygiene

35.  Internal environment (organs )
 External environment (air ,water, soil ,climate )
 Indirect Health Risks
Adequate housing
Family composition
Education level of parents
Economic status of parents
Direct Health Risks
Infectious disease exposure
Toxic substance exposure
Radiation exposure
Violence exposure

36.  Biological
Plants and Animals and pathogenic microorganism
 Social
Cultural
Beliefs
Traditions
Psychological
Mental disorder
Psychological symptoms
Personality trait
Coping styles
Maladaptive health behavior
Stress related physiological response

37.  Others
Life style
Socio economic conditions
Education
Occupation
Income
Health services
Exercise
Rest and sleep
Posture
Clean home environment
Safety measures at play and work

39. INTRODUCTION
 Illness : An illness is the response ,the person has to
disease .
 It is an abnormal process in which the persons level of
functioning is changed compared with a previous level.
 Persons physical ,emotional, intellectual , social,
developmental or spiritual functioning is diminished.
 Illness is highly subjective ; only the individual person
can say he or she is ill.

41.  ILLNESS BEHAVIOR
A coping mechanism , involves ways individual
describes ,monitor ,interpret their symptoms ,take
remedial actions , and the use of health care system.
 DETERMINANTS OF ILLNESS BEHAVIOR
 Recognisability of illness symptoms.
 The extent the person perceives symptoms as serious.
 Information, knowledge and cultural assumption.
 Disruption in family work and social activity.
 Frequency of appearance.
 Toleration level.
 Physical proximity of treatment resources

42.  Biological factors [infection /pathogenic organisms ]
 Physical factors [cold heat radiation pollution]
 Psychological factors [stress, tensions,fear, anxiety and emotions]
 Genetic /heredity factor
 Idiopathic [unknown factors]
 Traumatic [falls,injuries,accidents]
 Iatrogenic [hospital induced ]
 Neoplastic [cancers]
 Congenital [by birth ,development of embryo growth of fetus]
 Community causes
 Epidemic [sudden out break of disease in a particular population ]eg
Nipah,SARS
 Endemic
 Pandemic
 Sporadic

43.  Any condition that increases the chances of developing a
diseases
 Family history
 Age
 Gender
 Lifestyle practices
 Habits
 Sedentary life style
 Physical inactivity
 Diet
 Culture
 Beliefs
 Religious

44.  Impact on family
 Family dynamics is the process by which the family
functions, makes decision, give support to individual
members and copes with everyday changes and
challenges which were reluctant to assume the ill role
or responsibilities due to frequent hospitalization
,economic problems.

45.  Family factors such as member of the family who is ill
 Serious and length of illness
 Cultural and social customs the family follows
 Roles changes
 Task reassignment and increased demands on time
 Stress
 Financial problems
 Loneliness
 Change in social customs

46.  Impact on clients
 Leads to behavioral and emotional changes such as
 Irritable
 Anger
 Withdrawal
 Denial
 Hopelessness
 Powerlessness
 Lack of energy
 Fear
 Anxiety
 Change in body image /physical appearance depending on the type of change
Short term [they will accept] permanent [show reactions ]
 Shock
 Withdrawal
 Acknowledgement
 Acceptance
 Rehabilitation
 Use of prosthesis
 Change in life style [diet ,exercise ,activity rest and sleep ]

47.  Body defense or immunity is defined as action
produced against infection may be local, systemic, non
specific, specific, humoral and cellular.
 Any antigen entering in body may stimulate single or
generally multiple defense mechanisms.
 It is a specific protective antibodies or cellular
immunity as a result of previous infection
 ACTIVE IMMUNITY: Individual naturally resistant to
certain microorganisms
 PASSIVE IMMUNITY: Individual develops as a result
of previous contact with an organism

48. Active Immunity
 • Humoral Immunity
 • Cellular Immunity
 • Combination of humoral and cellular immunity
Passive Immunity
 • Normal human Ig
 • Specific human Ig
 • Animal antigen

50. VACCINES
 Live Vacine
 Inactivated Vaccine
 Toxoids
IMMUNOGLOBULINS:
 IgG IgM IgA IgD IgE
ANTISERA OR ANTITOXINS

52.  Currently health care system has five levels of care for
which health care providers offers services:
 Disease Prevention
 Health Promotion
 Primary Care
 Secondary Care
 Tertiary Care

53.  It is defined as main social targets of governments and
WHO in the coming decades should attainment of all
citizens of the world by the year of 2000 of a level of
health that will enable every individual to lead a
socially and economically productive life

54.  Realization of highest possible of health
 Attainment of minimum level of health
 Removal of obstacles to health such as unemployment,
ignorance, poor living conditions, malnutrition etc
 Health care services are within the reach of all in the
country

55.  The Alma Ata Declaration called for global strategy to provide
guidelines for member countries to refer.
 In 1981, Who global strategy for HFA is based on the following
principles:
 Health is a fundamental human right People have right and duty
of participate individually and collectively in the planning and
implementation of their health care
 Existing gross inequality in the health strategies concern of all
countries and must be drastically reduced
 Government has responsibility for the health of their people
 Countries and people must become self reliant in health matters
 Governments and health professionals have the responsibility of
providing health information
 Equitable distribution of resources should be allocated most to
those who need most
 Primary health care would be the key to the success of HFA
 Development and application of appropriate technology to health
care system
 Research in the field of biomedical and health care services

56.  Reduction of infant mortality from the level of 125
to below 60
 To raise the expectation of life at birth from the level
of 52 years to 64
 To reduce the crude death rate from the level of 14
per 1000 population to 21
 To reduce the crude birth rate from the level of 33
per 1000 population to 21
 To achieve a net production rate of one rural
population

57.  Health promotion refers to efforts are focused on
promoting self actualization and integrated functioning
among individuals, families, groups and communities
 Health promotion programme lower the over all costs
of health care by reducing the incidence of disease,
minimizing complications and thus reducing the need
to use more expensive health care resources.

58.  DEFINITION: Health promotion is a process of
helping people improve their health to reach an optimal
state of physical, mental and social well being.

59.  ACTIVE STRATEGIES OF HEALTH PROMOTION:
Individuals are motivated to adopt specific health
programme such as weight reduction and smoking
cessation programme to improve the present & future
level of illness while decreasing risk of disease
 PASSIVE STRATEGIES OF HEALTH PROMOTION:
Individuals gain from the activities of others with out
acting themselves.
 Eg: Fluoridation of municipal drinking water and
fortification of homogenized milk with vitamin-D

60.  Wellness is given in form of education teaches people
how to care themselves in a healthy way and it can be
achieved by awareness education, stress management
and self responsibility.
 Preventive care is more disease oriented and focused
on reducing and controlling risk factors for disease
through activities such as immunization and
occupational health programmes
 It means avoiding or removal or elimination of
single known essential cause which produce illness

61.  Primary prevention
 Secondary prevention
 Tertiary prevention
Primary prevention
 It can be defined as action taken prior to the onset of
disease which removes the possibility that a disease
will ever occur.
 It includes health promotion and specific protection

62.  HEALTH PROMOTION: First level of prevention is
by promoting and maintaining the health of the host by
nutrition, health education, good heredity and other
health promotion activities
 SPECIFIC PROTECTION: May be directed towards
the agent like disinfection of contaminated particles,
materials, water, food and other particles on the
assumption that the agent has escaped into these
vehicles or environment Specific protection can be
achieved by immunization

63.  Secondary prevention done by early diagnosis and
treatment
 It can be defined as action which halts the progress of
the disease at its incipient stage and prevents
complication.
 Early detection of the disease ensures prompt
treatment so that the disease will not progress further
 Early detection of the disease is possible by periodic
examination of population groups like antenatal
mothers, growing children, industrial workers

64. DIAGNOSIS
 It can be defined as the detection of disturbances of homeostatic and
compensatory mechanism while biochemical, morphological and
functional changes are still reversible – WHO
TREATMENT
 It means measures directed at removing or relieving the cause of a
disease
 TYPES OF TREATMENTS:
 Causal Treatment
 Conservative Treatment
 Curative Treatment
 Empirical Treatment
 Heroic Treatment
 Palliative Treatment
 Radical Treatment
 Rationale Treatment
 Specific Treatment
 Symptomatic Treatment

65.  It can be defined as all measures available to reduce or
limit impairment and disabilities, minimize suffering
caused by existing departures and disabilities, minimize
suffering caused by existing departures from good
health and to promote the patients adjustments to
irremedial conditions.
 Activities are directed at rehabilitation rather than
diagnosis and treatment

66. Rehabilitation
 It has been defined as the combined and co ordinated use of medical,
social, educational and vocational measures for training and retraining
the individual to the highest possible level of functional ability – WHO
AIMS:
 To reduce the impact of disability and handicapping condition
 To achieve social integration
 Rehabilitation occurs in many health care settings including special
rehabilitation agencies, out patient settings and home Rehabilitation
services includes physical, occupational, speech therapy and social
services
 Specialized rehabilitation services such as cardiovascular, neurological,
musculoskeletal, pulmonary and mental health rehabilitation
programmes help patients and families adjust to necessary changes in
life style and learn to function with the limitations of their disease
 It restores a person to the fullest physical, mental, social, vocational
and economic potential

67.  MEANING: The word hospital comes from “hospes”
which means host or guest Hospitals are organized
institution for the care of the sick and injured
 It is defined as an integral part of the social and
medical organization, the function of which is to
provide for the population, complete health care, both
curative and preventive and whose outpatient services
reach out to the families and its environment; the
hospital is also a centre for the training of health
workers and biosocial research - WHO

68. Based on the ownership
 Public hospitals
 Voluntary hospitals
 Private/ charitable/ nursing homes
 Corporate hospitals
Based on the length of stay
 Short term stay – acute illness
 Long term stay – chronic illness
Based on the license to treat
 General hospitals
 Specialty hospitals
 Based on the size
 Teaching hospitals – 500 beds
 District hospitals - 200 beds
 Taluka hospitals -50 beds
 Primary health centers – 4 – 30 beds
Based on the system
Allopathic Ayurvedic Homeopathic Unani Sidha
Naturopathy Yoga

69.  RECEPTION: it receives patients with illness and
directs to OPD
 Members: receptionist and nurse
 Functions:
 clarify the enquiry –
 Guide the patients to various departments
 Maintain various registers and records

70. OUTPATIENT DEPARTMENT:
 Registration
 History collection and physical examination
 Consultation with the doctor
 References
 Referral system
 Initial admission procedures
INPATIENT DEPARTMENT:
 Admission and discharge of patients
 Provision of medical and nursing care
 Investigations
 Health education
 Infection control
 Material management
 Staff development

71.  DIAGNOSTIC: Provide the diagnostic services for the early and
prompt diagnosis of illness
 THERAPEUTIC: Provide the curative services to the sick people
 EMERGENCY CARE: Provide the emergency care to the patients for
acute illness
 CRITICAL CARE SERVICES: Provide the advanced tertiary care for
the patients suffering from life threatening illness
 REHABILITATION: Provides facilities for rehabilitative services such
physical, occupational and speech therapy
 PREVENTIVE SERVICES: Provide preventive services such as
antenatal care, immunization, well baby clinic etc
 HEALTH PROMOTION: Should actively participate in health
promotion activities such as health education and family welfare clinics
 EDUCATION AND TRAINING: Provide platform to offer the
education for medical, nursing and paramedical students
 RESEARCH: Research carried out to expand body of knowledge in the
field of health sciences

72. ADMINISTRATIVE DEPARTMENT:
 Administrative officer
 Assistant officers
 Manager
 Secretary
 Treasury
 Clerks
 Accountants
 Class IV workers
Functions
Staffing
Maintenance of the hospital building
Budgeting for the hospital
Supervision
Controlling and coordination among various functionaries
Medical and nursing audit
Performance appraisal
Patient welfare activites
Quality assurance
Accreditation
Reporting

73.  Health care team work has been defined as a dynamic process involving two or more health care
professionals with complementary backgrounds and skills, sharing common health goals, exercising
concerted physical and mental effort in assessing, planning or evaluating patient care
 Physicians
 Nurses
 Dieticians
 Pharmacists
 Laboratory Technician
 Radiology Technician
 Respiratory Technologist
 Physiotherapist
 Occupational Therapist
 Social Workers
 Psychiatrist
 paramedical workers
 health educators
 health visitors
 public health engineers

75. DEFINITION: Activities directed toward increasing the level of well being – PENDER (1996)

 HEALTH EDUCATION: A large number of diseases could be prevented through proper health
education and awareness programme. Eg: Aids awarness programme, hygienic measures, cancer
prevention, cessation of smoking, tobacco prevention, prevention of water borne diseases
 ENVIRONMENTAL MODIFICATION: A comprehensive approach to health promotion requires
environmental modification. Eg: Provision of safe water, Installation of sanitary latrines, Control of
insects and rodents, Improvement of housing
 NUTRITIONAL INTERVENTIONS: These comprises of food distribution and nutrition
improvement of vulnerable groups such as under five children's and women's. Eg: Child feeding
programme, Mid day meal programme, Prevention of anemia and vitamin – A deficiency
 LIFESTYLE AND BEHAVIORAL CHANGE: It can be achieved through health education
programme. Eg: Cessation of smoking, Tobacco prevention, Stress reduction programme
Make changes in life style and attitude of people towards health related activities Facilitate patients
involvement in the assessment, implementation and evaluation of health goals

76.  Primary health care is an 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
 Health education
 Maternal and child health care
 Prevention of illness
 Prevention and control of epidemic diseases
 Treatment of minor illness and injuries
 Adequate safe water and supply
 Promotion of mental health
 Adequate nutrition
 Provision of essential drugs Immunization

77.  ACCESSIBILITY: Permeates uniformly reach equitably to all segments of
population
 ACCEPTABILITY: Achieves accepts through cultural assimilation of its
policies and programs
 ADAPTABILITY: PHC system is highly flexible and adaptable
 AFFORDABILITY: Affordable to consumer as well as providers
 AVAILABILITY: Always to ready to respond to any demand at any time
 APPROPRIATENESS: Evolves from the socio economic conditions, social
values and health situation of a community
 CLOSENESS: Health centre is close at hand to people at their door steps
 CONTINUITY: Continuous service which extends from womb to tomb
 COMPREHENSIVENESS: Comprehensive and curative needs of the
community
 COORDINATIVENESS: Dependent on inter sectoral coordination and
community participation

78.  EQUITABLE DISTRIBUTION: Shared equally by all
peoples irrespective of their ability to pay (rich, poor, urban
or rural)
 COMMUNITY PARTICIPATION: Involvement of
community in planning, implementation and maintenance
of health services
 COVERAGE AND ACCESSIBILITY: Cover the entire
population and acceptable within easy reach of them
 INTERSECTORAL COORDINATION: Requires joint
efforts with other sectors such as agriculture, animal
husbandry, housing, social welfare, public works,
communication and other sectors

79.  APPROPRIATE HEALTH TECHNOLOGY: Scientific
adaptable to local need and socially acceptable instead of
costly methods, equipment and technology
 HUMAN RESOURCE: Very essential to make full use of
all the available resources including human potential of the
entire community
 REFERRAL SYSTEM: Desirable to develop referring
from one level to another with laid down procedures and
policies
 LOGISTICS TO SUPPLY: Include planning and budgeting
for the supplies required manufacture, storage distribution
and control
 PHYSICAL FACILITIES: Need to be simple and clean,
should have specious waiting area with toilet facility
 CONTROL AND EVALUATION: Assess the relevance,
progress, efficiency, effectiveness and impact of the
services