rural health care

1. PRIMARY HEALTH CARE
 PRESENTED BY:
Mrs.krishnaveni Murugesh

2. Introduction:
 In 1977, theWorld Health Assembly gave the
call of “Health For All by 2000 AD”.
 Primary Health Care was organized at Alma
Ata,The capital of Kazakh Soviet Socialist
Republic from 6-12th September 1978.
 Thus Primary Health Care forms an integral
part of the country’s health system and of the
overall social and economic development of
the community.

3. Three tier system
 The health care infrastructure in rural areas
has been developed as a three tier system
 Sub-Centre
 Primary Health Centre
 Community Health Centre

4. Rural health care services-
Three tier system

5. Population Norms
.
Centre
Plain Area Hilly/Tribal/Difficul
t Area
Sub-Centre 5000 3000
Primary Health
Centre
30,000 20,000
Community Health
Centre
1,20,000 80,000

6. Introduction PHC :
 The primary health centre, it is not new to
India.
 The Bhore Committee in 1946 gave the
concept of a Primary Health centre as a basic
health unit, to provide, as close to the people
as possible, an integrated curative and
preventive health care to the rural population
with emphasis on preventive and promotive
aspects of health care.

7. Introduction:
 It is the first level of contact of the individual,
the family and the community with the
national health system, bringing health care
as close as possible to where people live and
work.


8. Primary Health Centres (PHCs
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 with emphasis on preventive
and promotive aspects of health care.
The PHCs are established and maintained by the
State Governments under the Minimum Needs
Programme (MNP)/ Basic Minimum Services
(BMS) Programme. As per minimum
requirement

9. definition
Primary health care as defined jointly by
WHO and UNICEF at AlmaAta conference
in 1978 is as:-
Essential health care, made universally
accessible to individuals and families in the
community by means acceptable to them,
through their fullest participation and at a
cast, that community and country can afford.

10. Primary health care approach
a) Primary health care approach functions best through intersect oral
coordination.
b) Mainly preventive and promotive.
c) Emphasises common conditions, e.g. reduction of IMR, MMR.
d) Helps healthy people to prevent sickness and treat sickness.
e) Auxiliaries are one of the main agents of health promotion and change.
f) Health promotion is a family and community activity.
g) It is less expensive.
h) Encourages positive health aspects of traditional medicine and culture.
i) Partly supported by the community and partly by international agencies along
with govt.
j) Helps the individual and community to look after themselves.

11. CRITERIA PRE REQUISITES
 The scope, the purpose and the mode of
delivery of primary health care is different from
country to country, the health problems of which
differ from time to time and place to place.
 The Primary Health Care, hence depends on,
 The types of illnesses prevalent
 Availability of qualified personnel
 Priorities set up in health field
 Need and extent of active community
participation.

12. PRINCIPLES OF PRIMARY HEALTH
CARE:
 Equitable Distribution
 Inter- Sectoral Co-
ordination
 Appropriate
Technology
 Community
Participation
 Focus on prevention
 Cultural Sensitivity
 Self Determinism
 Empowerment
 Folds of “A”
 access
AFFORD
ACCEPT
AVAILABLE

13. 1.Equitabte distribution:- It means that
primary health care services must be shared
equally by all the people irrespective of their
ability to pay belonging to urban or rural
areas and to any segment of the community
but giving priority to the underprivileged and
underserved sections of the society.
PRINCIPLES OF PRIMARY HEALTH
CARE

14. 3. Community participation:- Community
participation is the process by which individuals
and families assume responsibilities for their
own health and welfare. Since primary health
care is for the people, by the people the local
community must participate in the planning,
implementation and maintenance of health
services.

15. 4. Multisectoral Approach:-The basic tenet
of primary health care is that health cannot be
achieved by the health sector alone. It requires
the joint efforts of the health-related sectors
such as agriculture, education, social welfare,
sanitation, water supply etc.

16. 5. Appropriate health technology:-
Appropriate health technology is very important
factor for successful primary health care. It
implies the use of methods, techniques and
equipments which are scientifically sound but
simple, understood and acceptable by the
people.

17. COMPONENTS (ELEMENTS) OF
PRIMARY HEALTH CARE:

18. ELEMENTS
 E- ENSURE SAFEWATER SUPPLY
 L- LOCALLY CONTROL ENDEMIC DISEASES
 E- EDUCATION
 M- MCH
 E- ENVIRONMENTAL SANITATION
 N- NUTRITIONAL SERVICES
 T-TREATMENT OF MINOR ALLINMENTS
 S- SCHOOL HEALTH SERVICES

19. SUPPORTIVE ACTIVITIES:
 S- sectoral
collobaration
 U-utilization of
technology
 P-participation
 P-provision of
resources
 O-organization
&managemenrt
 R-research
 T-training &
manpower
development

20. MAJOR CONSTRAINTS AND
PROBLEMS IN CARRYING OUT
PHC ACTIVITIES IN INDIA:
 A . Health Aspects
 B.MCH & FW ASPECTS
 C . Operational aspects

21. A . Health Aspects:
 A . Health Aspects:
 High incidence of communicable diseases
 Wide spread prevalence of malnutrition
 Scarcity of water and safe water
 Poor environmental sanitation
 Problems closely linked with life styles

22. B.MCH & FW ASPECTS:
 B.MCH & FW ASPECTS:
 High infant and maternal mortality
 Wide prevalence of nutritional deficiencies
 Poor antenatal care
 High birth rate and poor effective couple
protection
 Low acceptance of contraceptive methods

23. C.Operational aspects:
 C.Operational aspects:
 Inaccessibility – geographic, financial, cultural and functional.
 Limited out reach services
 Poor utilization of health service
 High illiteracy and superstitions
 Low health educational activities
 Low impetus to integrated development
 Poorly developed infrastructure
 Less public sector expenditure on health
 More expenditure for urban area
 Poor community involvement
 Drastically inadequate managerial skills

24. Functions of Primary Health
Centre:
 Medical care including Referral and laboratory services.
 Control communicable disease
 Safe water supply and basic sanitation
 Maternal and child health services
 Family planning
 School Health services
 Health education
 Collection of vital statistics
 Carrying out the National Health Programme
 Training of Personnel

25. Staffing Pattern:
 Staffing Pattern of Primary Health Centre:
 1. Medical Officer
 2. Community Health Officer
 3. Pharmacist
 4. Nurse Midwife
 5. ANM
 6. Health Educator
 7. Health Assistant (Male)
 8. Health Assistant (Female)
 9. UDC
 10. LDC
 11. LabTechnician
 12. Driver
 13. Class IV
 -------
 total 15
 Population served : 30,000

26. SUB-CENTRE COVERAGE BY PHC
 6-SUBCENTRE COVERGE
1PHC
SC
SC
SC
SC
SC
SC

27. I.Functions of Medical
Officer:
Medical Officer:
General
Supervisory
Administrative

28. General:
 He is responsible for all curative and preventive health work in his
area, ie. for the functions of the PHC described above. His clinical
duties includes,
 Organizing and conducting the out patients clinics at PHC.
 Organisation of the indoor service
 Attending to medico-legal cuses
 Attending to emergency cues
 Organising the laboratory service at the PHC.
 Referring cases to hospital

29. Supervisory:
 He supervises and guides the work of
other members the staff. He visits sub
centres and other villages for this purpose.

30. Administrative:
 -Co-ordinate and co-operate with other health agencies and
voluntary organizations working in the area.
 -He enlists co-operation of other departments such as revenue,
agriculture, education and public health engineering for
promotion of health and prevention of disease.
 -Guiding and preparation and checking the preparation of tour
programmes of staff.
 -All matters relating to indents, receipts and maintenance of
supplies.
 -Reporting the progress of activities under all programmes to the
Chief Medical Officer.

31. II.Health Worker Female:
 1.Registration:
 2.Care at Home:
 3.Care at the Clinic:
 4.Care of Community:
 5.Others:

32. 1.Registration:
 -Pregnant women from 3 months of
pregnancy onwards
 -Married women in reproductive period
 -Children through systematic home and at
clinics.
 -Maintain maternity card


33. 2.Care at Home:
-She will provide care to all
pregnant women
-Distribute folic acid
-Immunization
-Family Planning
-Record and Report birth and
death.

34. Care at the Clinic:
 -Arrange and help MO and Health Assistant in
conducting MCH and Family Planning Clinics
at the sub centre.
 -Conduct urine examination and
 estimate Hb%.

35. Care of Community:
 -She will identify women leaders and help the
health assistant (f) 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 others for promoting family welfare
programme.

36. Others:
 5.Others:
 -Cleanliness of the centre
 -Attend staff meeting at PHC, CD block or
both

37. III.Male Health Workers:
 Record keeping
 Malaria
 Communicable disease
 Leprosy
 Tuberculosis
 Environmental sanitation
 Expanded programme on immunization
 Family Planning

38. IV.Health Assistant (Male &
Female):
 Supervise the health workers
 -Control of blindness, vital statistics (Male)
 The health assistant supervise the health care services to the
community.
 Strengthen the knowledge and skills of health workers in their
different areas.
 Help the health workers in improving their human relations skill.
 Help and guide the health workers in planning and organizing
their programme.
 Promote team work among the health workers
 Coordinate activities with other workers and agencies
 Visit each worker periodically
 Arrange group meetings with leaders and involve them in
spreading the message for various.

39. V.Function of Pharmacist:
 V.Function of Pharmacist:
 Distribution of medical drugs prescribed by
MO
 Equipment storage
 Maintain stock register


40. VI. Staff Nurse:
 Conducting delivery
 Administration of injection
 Medication distribution

41. VII.ANM:
 Conducting delivery
 Administration of injection
 Medication distribution

42. The WHO study group (1985)
identified four main self-
explanatory roles in primary
health care.
 Nurse as a direct care provider
 Nurse as a teacher and educator
 Nurse as a supervisor and manager
 Nurse as a researcher and evaluator

43. Major Roles of Nurses in
PHC:
 Facilitator Role
 Developmental Role
 Supportive Role
 Advocate
 Counsellor
 Resource person
 Change agent
 Observer

44. Major Roles of Nurses in
PHC:
 Advicer
 Manager
 Leader
 Collaborator
 Researcher

45. Role of nurse in primary health
care:-
1. collaborator:-The primary health care nurse
works collaborately with the member of the
health team in assessing the health status,
planning of intervention, implementing and
evaluating of health care services.

46. 2. Adviser:- She develops a good rapport with
the family and people in the community and
advises them, how to handle the problematic
situation that relates to health in a proper way.

47. 3. consultant:- As a consultant, the community
health nurses share nursing knowledge and
experiences with the health authorities in
planning a program and organizing camps.

48. 4.Advocate :She acts as an advocate, she
encourages and supports people to take right
decision in maintaining their health and
protect patient’s and individual’s rights in
relation to health care.

49. 5. Preventer of illness :-The primary health
care nurse practices disease prevention through
conducting immunization clinics, organizing
“pulse polio” immunization mass campaigns,
counseling on nutrition and other disease
prevention.

50. 6.Promotor of health :-The community
health nurse acts as an educator who teaches
the importance of breast-feeding, nutrition,
weaning, environmental sanitation as a package
to the individual, families and groups. She has to
act, as a promoter according to the felt needs of
the community.

51. 7. Care provider :- Nurse who work in the
community are authorized to provide required
care according to the felt needs of the people.
The nurses have to provide skilled care in all
stages of development, she carries standing
orders and care in emergencies.

52. 8.Team leader:- In this absence of medical
officers, the community health nurse is the
leader of the health team at the PHC level. By
working alone she cannot meet the health needs
of the people. But by using a team of health
personnel he/she can provide more and better
health services.

53. 9. Observer :- She is expected to alert and active
in many situations, and the community health
nurse is supposed to be aware of his
surrounding, occurrence of disease,
environmental threats and natural calamities in
seasons may cause threat to the health of the
community. Hence, constant observations
should be made in the community.

54. 10. Manager :-The community health nurse is
expected to organize and manage various
planned programs of health and assume
leadership in organizing, implementing and
monitoring of health activities.

55. 11. Participant :-The community health nurse
have to participate in conferences, meeting,
workshops, seminars, orientation of training
camps, and in implementation of health
programs, not only as a participant and also she
delivers her suggestions and ideas for the
promotion of primary health care.

56. 12. Practitioner :-The CHN has play many roles
according to health situation in the community.
- She creates awareness in health that would promote
their general well-being of the people.
- She encourages people to take active participation
in the community health programme.
- She develop rapport with other sector for the
successful implementation of primary health care.

57. Required Skillfor nurses:
 a.Social Process Skills:
 b.Problem solving skills:
 c.Other Skills:

58. Functions of Nurses in PHC:
 Maintaining records and reports
 Conducting camp
 Area visit
 Immunization
 Conducting school health programme
 Verification
 Over all supervision
 Immunization

59. Functions of Nurses in PHC
 Health Education
 .Food Supply and Proper Nutrition
 Maternal and Child Health including
F.P.
 Water Supply and Basic Sanitation
 Prevention and Control of Locally
Endemic Diseases:
 Treatment of Minor Ailments:
 Provision of Essential Drugs:

60. Functions of Nurses in PHC
 Supervision
 Training
 Management
 Programme Planning
 Policy Making
 Programme Implementation
 Programme Evaluation

61. Norms
s.no Indicator
populatio
n
National
norms
rural
National
norms
Hill area
Present
average
coverage
1 population
Coverage
Sc
Phc
chc
2 No of sc
per 1 phc
6 6
3 No of phc
per chc
4 4

62. The level of health care refers to the tiers of
health care.These are primary level,
secondary level and tertiary level.
Level of Health care:-

63. 1. Primary level health care:- primary level
health care is rendered at the grassroots level.
This is the first level of contact between the
recipient of care and the health care delivery
system. In rural area of India, it is the sub-centre,
primary health centre, and community health
centre which provide primary level health care.

64. 2. Secondary level health care:-At this level
more complex problems are taken care which
require secondary level of prevention service.
The services are provided at district health
centre/hospital.Those case which cannot be
handed at PHC or CHC are referred to district
health centre/hospital.

65. 3.Tertiary level health care:- this level of
health care is provided at the
state/regional/central level institutions.These
institutions provide super specialty care.These
institutions serve as referral units for units of
primary and secondary level of care.

66. THANK U……..