Development of COMMUNITY HEALTH NURSING in India

1. HISTORICAL
DEVELOPMENT OF
COMMUNITY HEALTH
NURSING IN INDIA
PRESENTED BY- Harsh Rastogi
M.Sc. Nursing 1st year
K.G.M.U. I.O.N.

2.  “Health is not mainly an issue of doctors, social
services and hospitals. Health is an issue of Social
Justice.
 There is no time to lose. We have the goal of “Health
for all by 2000 AD”. This is the call of the world health
organization. And India has taken up the challenge.
Formerly, Health care has been for those living near
enough to a hospital or a doctor in times of need and
for those who could spend money for medicines and
treatment.

3.  The great majority of people stayed in the village when sick
and even today many suffer and die without proper help.
 Attempts have been made to meet the health needs of the
people of India by means of primary health center and the
training of Auxiliary Nurse.
 Midwives to go out from these centre’s to the homes of the
people.
 The number of ANMS trained was never sufficient and more
than half of them after training went to work in hospitals. In
fact, their training was given mainly in the hospitals
environment, with title experience and understanding of health
needs of people, families and communities in rural areas.

4.  Community health nursing is one of the
professions/disciplines which operates within the
realms/domain of community health and helps in
meeting health and nursing needs of the community.
 It plays a very important and challenging role in
promoting and protecting health of people. Unlike other
specialties of nursing, Community Health Nursing lays
major emphasis on primary level prevention and
focuses on the entire community.
 Before further discussion let us see the definition of
Community Health Nursing

5.  “Community Health Nursing is a synthesis of Nursing
practice and public health practice applied in promoting
and preserving the health of populations. The nature of
this practice is general and comprehensive. It is not
limited to a particular age or diagnostic group. It is
continuing not episodic. The dominant responsibility to
the population as a whole. Therefore nursing directed to
individuals, family or group contributes to the health of
total population. Health promotion, health maintenance,
health education, coordination and continuity of care
are utilized in a holistic approach to the management of
the health care of individual, family, group and
community.”

6. DEVELOPMENT OF
COMMUNITY HEALTH
NURSING IN INDIA

7.  The medical system that are truly Indian origin and
development are the Ayurveda and Siddha System.
Ayurveda by definition implies “Knowledge of Life”.
Its origin is traced far back to the Vedic times, about
5000 BC. During this period, medical history was
associated with mythological figures, sages and seers.

8.  Dhanvantari the Hindu god of Medicine is said to have
been born as a result of the churning of ocean during a
tug war between gods and demons.
 According to some authorities medical knowledge in
the Atharvaveda gradually developed into the science.

9.  The experience and concern in health development and
public health care dates back to this Vedic period.
 In the Indus Valley Civilization (3000 BC) itself, one
funds evidence of well- developed environmental
sanitation programme such as arrangements of good
water supply, underground drainages, Public baths in
cities etc.

10.  In ancient India, the celebrated authorities in Ayurveda
Medicine were Atreya, Charaka, Sustra and Vagbhatt.
 Atreya (about 800 BC) is acknowledged as the first great
Indian Physician and Teacher.
 Charaka a famous Ayurvedic Medicine.
 Sustra a father of Indian Surgery.
 From this early writings other authors wrote books.
 From these writings we learn that surgery had advanced to a
high level, also that doctors and the attendants (Nurse) must be
the people of high character, Hospital were large and well
equipped.

11.  Medical education was introduced in the ancient Universities
of Taxila and Nalanda.
 During Buddha period hospital system was developed for
men and women and for animals.
 This was expanded during king Ashoka, Moghal Period
(1000 AD) Yunani Medicine which (Arabic system) was
introduced through Greek medicine which has become a part
of Indian medicine. Nursing and medicine are closely linked
together.

12.  Nursing was regarded on the “Science of Care” and
medicine as the “Science of Cure”. As the science of
cure, medicine is concerned with the diagnosis and
treatment of illness.
 As the science of care, nursing is concerned with the
care of people who are ill. The care and cure functions
are complimentary ; both are necessary and important
aspects of health care for the people.

13.  King Ashoka (272 BC-236 BC) a convert Buddhism, brought
about period of prosperity.
 Monasteries were built, houses for travelers were provided
and hospitals for both men and women and animals were
founded.
 Prevention of disease became a matter of first importance and
hygiene practices were adopted.
 Cleanliness of the body was religious duty.
 Doctors and midwives were to be trustworthy and skill full.
They must wear clean cloth and keep their nails cut short.
Operations were precede by religious ceremonies and prayers.
 The nurses were usually men or old women.

14.  Women of India were favored though restricted to activities in
the home. No doubt they cared for the sick members in the
family.
 By 1 AD superstition and magic had been somewhat replaced
by more up to date practice. But , medicine remained in the
hands of priest-physician who refused to touch blood or
pathological tissues.
 Dissection was forbidden.
 This together with religious restrictions probably helped to
bring about decline in medicine and nursing professions.

15.  During this period diagnosis was made on empirical
basis and also the given treatment was according to
symptoms. So this era was called symptom oriented
era. The health education was provided by lectures on
authoritarian instruction.

16.  This period witnessed the invention of microscope,
thermometer, B.P. apparatus and other tools for
detection and measurement of diseases. Laboratory
investigations were carried out to make This period was
called as bacteria- oriented or disease oriented era.

17.  This is an era which witnessed her individual centered
or patient centered approach for taking care of the
health and illness of the people. Clinical instructions at
bed side teaching started in the field of medical
education education. The development of clinical
techniques was initiated in medical science and
technology.

18.  In this period prevention oriented approach started. It was
initiated by our ancient Indians at the time of Indus Valley
Civilization.
 It is being called era of Community centered approach, in
which diagnosis and treatment at community level emerged,
clinical public health instructions, community- side teachings
were included in the field of medical education.
 Studies related to community development, community
measurement and criteria planning techniques also started
 Integration of social sciences, and public health sciences in
this era took place.

19.  In this period the involvement of the community
leaders and members of the community in planning
and implementation of the health programmes was
practiced at this stage.
 The national level health planning was established by
political authorities of particular country by involving
national and international health agencies to provide
health for all.
 The people-centered approach has been emphasized
in this era.

20.  Community health has now entered an era of individual
responsibilities and community participation.
 The traditional role of medical persons has been shifted
from diagnosis and treatment of individual illness to
treatment of all health hazards of community.
 Community diagnosis is based on collection and
interpretation of relevant data related to distribution of
population according to age, sex, educational status,
marital status, religion, caste, birthrate, death rate,
prevalence of disease etc.

21.  Definition of Community Health development:
 “Community health nursing development is defined as
a nursing intervention that aims at assisting members of
a community to identify a community's health
concerns, mobilize resources, and implement
solutions.”
Mosby's Medical Dictionary, 8th Edition.© 2009,
Elsevier.

22.  Development in the broader sense is not only the
improvement or progress in the community health
resources but individual progress in the professional
aspect of as community health nurse.

23.  1918: The preparation of Nursing workers for public
health work started in Delhi, Lady Reading Health
School.
 1930: At Calcutta All India Institute of Hygiene and
Public Health was started.
 1931: A Maternal and Child Welfare Bureau was
established by the Indian Red Cross Society.
 1939: Indian Tuberculosis Association was started.
 1943: Health Survey and Development Committee was
appointed by Government of India under the
Chairmanship of Sir Joseph Bhore.

24.  1952: Community Development Programme was launched
on 2nd October for overall development of rural areas.
Central Council of Health constituted.
 1954: National water supply and sanitation scheme was
inaugurated.
 1954: National Leprosy Control Programme was started.
 1954: Food Adulteration Act was passed.
 1955: National Filarial Control Programme started.
 1958: National Malaria Control Programme was changed to
Eradication Programme.
 1959: Mudaliar Committee was appointed to review the
progress made in health sector.

25.  1961: Mudaliar Committee report was published
 1962: Central Family Planning Institute was
established
 1971: MTP Act was passed, In 1972 came in force.
 1973: Multipurpose Health Workers Scheme was
introduced by Kartar Singh committee report
 1975: India declared as FREE from Smallpox
 1977: Rural Health Scheme was introduced

26.  1978: The slogan “Health for All by 2000 AD came in force at Alma
Atta declaration in USSR underlined the primary health care approach.
 1982: GOI framed National Health Policy. School Health Services
started at trial bases
 1985: Universal Immunization Programme was launched on 19th
November Indira Gandhi's Birthday.
 1992: CSSM programme was launched on 20th August
 1995: Pulse Polio Immunization Programme launched in December
and January.
 1996: RCH in place of CSSM with slight modification was launched in
1997.
 2000: Government of India announced National Population Policy
 2002: Government of announces National AIDS Prevention Control
Policy

27.  2003: Launching of ART centers at Metro Centers, e.g.
Sassoon
 2004: NTCP Inculcated DOTS
 2007: Revision of National Population
 2008: Revised in 2009 Swine Flu awareness
Programme and Control Programme