By Dr. Ravi Prakash

1. Presented by
Dr Ravi Prakash
Junior Resident-I
Department of Community Medicine

2. 1. Introduction
2. Definition
3. Elements
4. Principles
5. Primary health care system in rural, urban & tribal areas
6. References

3.  First level of contact between the individual and the health system
where essential health care i.e. primary health care is provided.
 Alma-Ata conference called for acceptance of the WHO goal of
Health for All by 2000 AD and proclaimed primary health care as
way to achieving “Health for All”
 Based on principles of equity, wider coverage, individual &
community involvement and intersectoral coordination.
 It integrates promotive, preventive and curative services.

4.  Alma-Ata declaration called on all governments to formulate national
policies, strategies, and plan of action to launch and sustain primary
health care as part of a national health system.
 It also conceived as an integral part of the country’s plan for socio-
economic development.
 In Indian context, this care is provided mainly by primary health centres
and their sub centres with community participation.

5.  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 the country can
afford.
• Essential health care –means basic essential services
• Universally accessible-means those services should be reachable to all
segments of population
• Acceptable-provided in such a way that people should accept them
• Their full participation-should start from the people of community to
make them successful
• Affordability-services must be economical & cost effective

6.  Affordability - Means that the services must be economical and cost-
effective so that Government can provide the services.
 Adaptability- Means the services provided should be flexible to suit the
given situation (should be implemented).
 Availability - Refers to ‘Round the clock’ presence of the service.
 Appropriateness - Means the service should be relevant to the needs
and demands of the people.
 Closeness - Refers to the proximity between the health provider and the
consumer, in other words, the services are made available to the
individual doors.
 Continuity - Refers to the service provided from ‘Womb to tomb’.
 Comprehensiveness - Means the services should be preventive,
promotive, curative and rehabilitative/restorative to the community.
 Coordinativeness - Means these basic services requires the cooperation
of various health related departments.

8.  Education concerning prevailing health problems and methods of
preventing and controlling them;
 Promotion of adequate food supply and proper nutrition;
 An adequate supply of safe water and basic sanitation;
 Maternal and child health care, including family planning;
 Immunization against infectious diseases;
 Prevention and control of endemic diseases;
 Appropriate treatment of common diseases and injuries; and
 Provision of essential drugs.

10. 1. Equitable distribution-
 Health services must be shared equally by all people irrespective of
their ability to pay and all must have access to health services.
 At present health care services are concentrated in town and cities
( where 25% people live & 75% budget spent). On the other hand
needy and vulnerable group reside in rural and urban slum (where
75% live & 25% budget spent). This social injustice must be
removed.

11. 2. Community participation-
 Active involvement of people of community is providing primary
health care.
 Involvement includes planning, implementation, and
maintenance.
 It promote the social awareness, and reduce the distance
between providers & consumer.
 Health care should start by the people, of the people, and for the
people.
 Training of anganwadi workers, dais, village health guide, they
should be selected locally, trained locally and provide services
locally.

12.  Village Health Guide-
 She must be a permanent, local resident of that village, (That
means she is selected from the village where she is going to work)
 She must be literate, as to read, write and maintain records
 She must be acceptable to all sections of society
 She must be willing to do community health work for 2 to 3 hours a
day.

13.  Importance of TBAs-
 Age old-practice of conducting delivery by dais is prevalent.
 Their skills are accepted by the people. Not only rural people but
also some of urban areas also take their help.
 Female health worker may not be available all the time to
conduct all the deliveries in her area.
 About 90 percent of the deliveries are normal and do not require
the services of specialists.
 Dais can be trained locally in PHCs.
 Their training would improve the quality of MCH services.
 This helps in community participation.

14. Advantage-
 Cost effective method
 Greater commitment by the people resulting more success
 Promote health awareness
 Health worker would get greater support for their activities
 More relevant to health need of the people
 Less dependence of the government
 Improvement of quality

15. 3. Intersectoral coordination-
 It requires coordination of other sector like education,
communication department, animal husbandry, food and
agricultural department, social welfare, public works,
voluntary organisations etc. These coordination also require
strong political will.
 Planning and implementation should be in such a way to
avoid the duplication of activities.

17. 4. Appropriate technology-
 Technology must be simple, scientifically sound, practically
adaptable, culturally acceptable, economically cheaper and
operationally convenient.
 E.g. oral rehydration therapy, immunization program,
nutritional supplementation, DOTS, distribution of IFA tablets,
smokeless chulha etc.

18.  It include following in order to successfully implement primary
health care. WHO identified following supportive activities:
 Community involvement & participation
 Intra and inter-sectoral coordination
 Provision of effective referral support

19.  Development and mobilization of resources
 Managerial processes i.e. policy, goals and objectives.
 Medical and health services research, including innovative
approaches
 Development and application of appropriate technology
 Health manpower development

20. Three tier system
Community
health centre
Primary
health
centre
Sub-
centre

21. Level Population size Functionaries
Village 1000 Health volunteers or
health guide(female)
Anganwadi workers
Trained birth attendants
Accredited social health
activist (ASHA)
Sub-centre 5000 Multipurpose health
workers (male & female)
PHC 30000 Health
professionals(Doctors)
CHC 1,20000 Specialists

22.  First level of primary health care in rural areas.
 Manpower-
• one multipurpose health worker(female-trained for 1.5 years)
• one multipurpose health worker(male-trained for 1 year).
• one voluntary worker(optional)-preferably a TBA
 Population-5000 in plain areas and 3000 in hilly, tribal & desert areas.
 Delivery huts under RCH-2
 Drug kit A and B, Midwifery kit, BP apparatus, stethoscope, weighing
machine, pressure cooker and auto-disable syringes.

23.  Function/services at Sub-centre-
 Maternal and child health services
 Adolescent health and counselling
 Referral of suspected TB cases to PHC/CHC
 Opportunistic screening and education about prevention of cancers and
other noncommunicable diseases.
 Success of all national health programmes depend largely on the well-
functioning sub-centres providing services of acceptable standards to
people. NRHM has also laid down Indian public health standard (IPHS) for
subcentres .

24.  Designed to provide comprehensive primary health care i.e. promotive,
preventive and curative health services to rural population.
 Population-
• 30000 in plain rural areas
• 20000 in tribal, hilly, desert & difficult areas
 Manpower-
• Medical officer
• Nursing professionals
• Pharmacist
• Other support staff

25.  Functions of PHC-
 Technical functions (clinical functions)
 Medical care
 Monitoring & supervision of subcentres
 MCH Services
 MTP
 Management of RTI/STI
 Essential newborn care
 IMNCI
 School health
 Adolescent health
 Prevention & control of locally endemic diseases
 Basic laboratory services
 Collection & reporting of vital events
 Services for all national health programmes of communicable &
noncommunicable diseases

26.  Rogi kalyan samiti-
 It’s a primary health centre’s management committee for
improvement of management and service provision at the
PHC.
 It has power to generate own funds and utilize the same for
service improvement of the PHC besides monitoring the
function of PHC.

27.  Designed to provide referral health care for the cases from PHC & cases
in need of specialist care approaching the centre directly.
 Population-
• 1,20,000 in plain and 80,000 in tribal areas.
 Manpower-
• Qualified or specially trained medical specialists i.e. surgeon, physician,
obstetrician & gynaecologist, paediatrician, supported by paramedical
and other staff.

28.  Functions/Assured services-
 Routine/emergency care
 Services for national health programmes
 Specialist services & referral services
 24 hour delivery services
 Full range of family planning services
 RTI/STI services and ICTC for HIV/AIDS
 MTP (safe abortion services)
 Newborn care
 School health/Adolescent health services
 Cold chain maintenance

29.  Essential laboratory & x-ray services
 Indoor services
 Dental services
 Blood storage facility
 Training of health professionals
 To enhance public-private partnership
 First and foremost manager of extensive resources
 Trainer of continuing education
 Clinical care

30. Public or
empanelled
secondary/tertiary
private providers
Urban health centre( 1
for 50000) including 25-
30000 slum population
Strengthened existing public health
care facility for extending services
to unserved areas
Community outreach service( outreach points in
govt/public domain empanelled private service
providers) school health services

31.  Medical care—OPD services. 4 hours in the morning and 2 hours in the
evening
 RCH—II services
 National Health Program
 Collection and reporting of vital events
 IDSP (Integrated disease surveillance project)
 Referral services
 Basic laboratory services
 Counseling services

32.  Tribal population constitute about 8.2% of the country’s total populations.
 Most vulnerable & disadvantaged group.
 Norms for population coverage have been relaxed for tribal areas.
 Access to and utilization of health care is suboptimal and health &
nutrition indices in the tribal population is very poor.

33.  Park’s Text book of Preventive & Social Medicine.
 Community medicine with Recent advances by
A.H.Suryakantha
 Textbook of Community Medicine by Sunder Lal,
Adarsh, Pankaj.