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India is a large country which has a seventh place in area and second place in population in the world. Thus providing health care facilities to all people is important work for the government. Therefore health care delivery system must be according to the needs of people, which can promote the health status of people. Attention should be focused on vulnerable groups of society. Health services should be provided without discrimination and avoid physical, social, cultural, and economic barriers. In India, a gap is found in urban and rural areas. In which most health care facilities are focused on urban areas, and rural areas have a lack these facilities. After the independence government is making continuous attempts to improve the deficiency condition, and more attention is giving to rural areas.
In India, only government is not able to provide health care facilities to the whole population so private, government and voluntary health agencies are combined to provide these services. Through these attempts, effective health care services are provided to improve the health status of the country.
Health subject is affected by various factors such as infections disease, availability of health services, adequate nutrition, sanitation, environment, daily habits. So “health care” subject is broader than “medical care” subject which helps in maintaining the health status of people.
“Health care services” are the services provided to individuals or community by an agent of the health services or professions for the purpose of promoting, maintaining, monitoring, or restoring health. “Medical care” refers chiefly to those personal services that are provided directly by physicians or rendered as the result of physician’s instructions. It ranges from domiciliary care to resident hospital care. Medical care is a subset of the health care system in which mostly therapeutic care is provided.
Health is the most valuable property of the person in the world; thus, good health is essential for a good life. Healthy people could contribute to the development of the nation by doing productive work with full capacity. So it is the right of every person to use the available health facilities to maintain health status. In the whole world, most countries make special provisions for health services in the constitution. In India, the government made special attention to health services in the constitution, and health services were put on a concurrent list under the 7th article of the constitution. Under the concurrent list, the main responsibility of health services is afforded by the state government, and the central government is responsible for only supervision and guidance in health services.
Every nation in the world is trying to develop the health sector by increasing health knowledge and technical knowledge from time to time. Every profession is trying to maintain self-importance in its own field by continuous change or development. Thus continuous changes are bringing in the health care system and concepts for providing better health care services according to the needs of people.
Bhore Committee in 1946 firstly used the term “comprehensive health care” and suggested the provision of integrated preventive, curative and promotional health service from “Womb to tomb” to every individual residing in a defined geographic area.
The Bhore Committee defined comprehensive health care as following-
1. To provide adequate preventive, curative, and promotive health care services.
2. To provide services without care of cost and as close to the beneficiaries as possible.
3. These services are provided by the widest cooperation between professional workers and the people.
4. To create and maintain a healthy environment in the home, hospital and workplace.
5. These services are provided mostly to weak and vulnerable groups of society.
The Indian government is started to developed health care infrastructure in rural areas during the first five-year plan after independence. But due to the lack of adequate health workers and medicines, these services failed to provide effective health care services.
UNICEF and World Health Organization in 1965 firstly used the term “Basic health services” under joint health policy.
“Basic health services are understood to be the network of coordinated, peripheral and intermediate health units capable of performing a selected group of functions essential to the health of an area effectively and assuring the availability of competent professional and auxiliary personnel to perform these activities.”
The main deficiency in basic health services is lack of active participation of people, lack of inter-sectorial coordination, and dissociation from the socio-economic aspect of health.
A new approach to health care came into existence in 1978 during the International Conference at Alma Ata by WHO. It is known as “Primary health care”. Firstly Bhore Committee proposed this approach in 1946, and today, it is accepted by mainly national and international agencies.
Before the Alma Ata Conference in 1978, Primary Health Care was known as “basic health care,” “first contact care,” “easily accessible care,” “services provided by generalists,” etc.
Primary Care Health can be defined as essential health care made universally accessible to individual and acceptable to them through their full participation and at the cost the community and country can afford.
Primary health care is equally valid for all countries in the world. All countries accepted it as a key to achieving health for all by 2000 AD. It is accepted as an integral part of the health system in the country.
Health care is defined as “services provided to individuals or communities by agents of the health services or professionals for the purpose of promoting, maintaining, monitoring or restoring health.”
1. Health promotion
2. Health maintaining
3. Health monitoring
4. Health restoring
1. Appropriateness: Health care services should be according to the people’s needs, priorities and policies.
2. Comprehensiveness: Health care services should be a mixture of preventive, therapeutic, promotive, and rehabilitative services.
3. Adequacy: Health care services should be provided according to the needs and quantity of people.
4. Easy accessibility: Health care services should be easily available from geographical, economic, social, and cultural aspects.
5. Cost-effectiveness: Health care services should be according to the economic capacity of person and state.
6. Feasibility: Health care services should be planned and implemented according to available resources and material. It enhances the effectiveness of health services.
1. Primary health care level: It is the first contact level between the health system and the people. On this level, “essential health care” or “Primary health care” services are provided. On this level, mainly preventive type services are provided. It has close contact with the people. Mainly sub-centre, primary health centre provide these services. On this level, the cultural and communication gap is bridged between the health system and rural people. These services are provided by multipurpose health workers, dais, village health guide, nurse, etc.
2. Secondary health care level: This level is the second-highest level of health care. The more complex health problem is resolved at this level. It is generally known as the first referral level. These services are provided at the community health centre and district hospital. At this level, mainly diagnostic and therapeutic services are provided. These services are provided by health workers and doctors who do not come in contact on the first level.
3. Tertiary health care level: The tertiary level is more specialized level than the secondary care level and required more specific facilities and attention from highly specialized health workers. These services are provided on regional and central level institutions. It is known as the second referral level and included modern diagnostic, therapeutic, rehabilitative services. Example: plastic surgery, cancer treatment, cardiac surgery, burn surgery, etc.
The Alma-Ata international conference gave primary health care a wider meaning. The Alma-Ata Conference defined primary health care as follows :-
“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”.
Although specific health services provided by every country is different, according to Alma Ata declaration, eight essential components of primary health care are as follows-
1. Education concerning prevailing health problems and the methods of preventing and controlling them.
2. Promotion of food supply and proper nutrition.
3. An adequate supply of safe water and basic sanitation.
4. Maternal and child health care, including family planning.
5. Immunization against major infections disease.
6. Prevention and control of the locally endemic disease.
7. Appropriate treatment of common diseases and injuries.
8. Provision of essential drugs.
The functions of the primary health centre in India cover all the 8 “essential” elements of primary health care as outlined in the Alma-Ata Declaration. They are:
1. Medical care
2. MCH including family planning
3. Safe water supply and basic sanitation
4. Prevention and control of locally endemic diseases
5. Collection and reporting of vital statistics
6. Education about health
7. National Health Programmes – as relevant
8. Referral services
9. Training of health guides, health workers, local dais and health assistants
10. Basic laboratory services
1. Equitable distribution: The first principle in providing primary health care services is equitable distribution of health services. These health services are provided without discrimination of economic, social, cultural, racial aspects. Today most health care services are centred in cities and towns. Thus these services are not easily available for vulnerable groups in cities and rural populations. It is called social injustice. The main objective of primary health care services is to bridge the gap between the health services in urban and rural areas. So by these services, social justice is done to vulnerable groups and populations. It also brings the rural population closer to the health system, and these services are provided near to people’s homes.
2. Community participation: Although the responsibility of health services is performed by both state and central government. But without the active participation of individuals and the community, it is impossible to provide these services effectively. Local community participation is essential for providing these services in every part of the country. So it is essential to involve the local community people in the planning, implementation, and evaluation of health programmes. The government also attempts to use the locally available resources, manpower, and material in health programmes.
This concept is kept in mind, and the plan is made to train the local people and used it in health programmes. Under this concept, village, health guide, and dai are trained on the local level and use in local services under the various programme. The benefits of local health workers are reducing the social, cultural, and communication barriers in the community and getting better results in the health programme.
3. Intersectoral coordination: It is the real fact that only primary health centre is not capable of providing primary health care services. So health and other related sectors such as agriculture, animal husbandry, food, education, housing, communication, sanitation are working in a coordinated manner to provide services. For proper coordination, various sectors may have to review their administrative system, reallocate their resources and introduce suitable legislation. For all these measures, strong political will and better planning are needed to avoid duplication of efforts and implement the plan effectively.
4. Appropriate technology: Appropriate technology term can be defined as “technology that is scientifically sound, acceptable to those who apply it and who used it adaptable to local needs and that can be maintained by the people themselves in keeping with the principle of self-reliance with the resources the community and country can afford.” The term “appropriate” means health services are available according to the needs and budget of people. So, cheaper, valid, acceptable procedures and techniques are used in health services to more utilization of services among poor and rural people. Example: If the doctor prescribes the costly treatment of diarrhoea in rural areas, people could not afford it, but if he prescribes the ORS therapy, maximum people could afford it as it is cheap, effective, easy in administration, and can be prepared at home.
5. Focus on prevention: The main focus of the primary health care approach is on prevention from disease and promotion of health which leads to improvement in health status and reduces the chance of disease occurrence. These services are mainly provided before the disease onset. For this purpose best tool which is used is health education among people.
Figure 2.1: Health Care Services System in India
Today all the countries in the world attempt to provide adequate health care facilities to its population. In India, most of the big hospitals provide services in urban areas. But in rural areas, they are not able to provide adequate health services. Most of the hospitals are providing only therapeutic health services. But these hospitals are not providing comprehensive health care facilities. In modern times the cost of maintenance of hospitals is continuously increasing, so these centres have failed to provide comprehensive health care facilities in the community. So, the Indian government is trying to develop an optional management route for providing cheap, acceptable and appropriate health services in rural areas.
The health care system is utilized for providing health care facilities to people who are in need actually. The health care system consists of administrative and organization matter in its structure. This system is operating according to the social, economic, and political situation of the country. It is completely different on the basis of technique and money sources for operational activities.
The health care system is intended to deliver the health care services. It constitutes the management sector and involves organizational matters. It operates in the context of the socioeconomic and political framework of the country. In India, it is represented by five major sectors or agencies which differ from each other by the health technology applied and by the source of funds for operation. These are:
1. Public Health Sector
a. Primary Health Care
i. Primary health centres (PHC)
ii. Sub- centres
b. Hospitals/Health Centres
i. Community health centres (CHC)
ii. Health centres at Urban areas
iii.Rural hospitals
iv. District hospital/health centre
v. Specialist hospitals
vi. Teaching hospitals
c. Health Insurance Schemes
i. Employees State Insurance
ii. Central Government Health Scheme
d. Other agencies
i. Defence services
ii.Railways
2. Private Sector
a. Private hospitals, polyclinics, Nursing homes, and dispensaries
b. General practitioners and clinics
3. Indigenous Systems of Medicine
a. Ayurveda
b. Yoga
c. Siddha
d. Unani and Tibbi
e. Homoeopathy
f. Unregistered practitioners
g. Voluntary Health Agencies
h. National Health Programmes
The primary health centre is the first level of direct contact between the doctor and community people because in the health system, firstly, the doctor is appointed on this level. The primary health centre is generally established on 30,000 population, but in hilly areas, it is established on 20,000 population. On PHC doctor, nurse grade second, female health worker, female health assistant, male health assistant, pharmacist, lab technician, and other support staff is available. Every PHC is working for the supervision of 6 sub-centres. It provides diagnostic, therapeutic, and family planning services in the community. At present, about 25,308 PHCs are operational in the country. Every PHC is having 6 beds capacity for IPD services.
Following services are provided at the primary health centre:
1. Medical services:
a. Outpatient department services (OPD)
b. 24 hours emergency services.
c. Referral services.
d. In-patient care services.
2. Maternal and Child Health Services (MCH services)
3. Antenatal care:
a. Early registration of pregnancy and minimum 3 antenatal checkups.
b. Essential laboratory investigation example-Hb, sugar, urine albumin, B.P, BPR for syphilis disease.
c. Health and nutritional consultation services.
d. Providing folic acid, iron tablets, and vaccination for tetanus toxoid.
e. High-risk pregnancy refers to a high level.
i. Intranatal care
1. Promotion of 24 hours normal delivery facilities and institutional delivery.
2. Assisted deliveries, including forceps and vacuum deliveries.
3. Actively removal of the placenta by the nurse.
4. Refer adequate but high-risk cases to specialized doctors.
ii. Postnatal care:
1. At least a minimum of two postnatal home visits on 48 hours and 7 days after the delivery.
2. Initiating breastfeeding after 30 minutes of delivery.
3. Provide education to mothers on nutrition, sanitation, and contraception.
4. Providing benefits and facilities under the Janani Suraksha Yojana.
iii. Newborn care:
1. Essential newborn care.
2. Providing care and facilities to newborns for restitution.
3. Management of newborn for hypothermia and jaundice.
iv. Children care:
1. Providing emergency care services to sick children.
2. Providing daily care facilities to children during sickness.
3. Promotion of exclusive breastfeeding in the first six months of life.
4. Complete vaccination of children against preventable disease in early life according to available facilities.
5. Blindness is preventing by providing vitamin A prophylactic dose in children.
v. Other services
1. Providing all types of family planning services, including consultation and referral services for sterilization complications.
2. Safe abortion is performed in MTP by using a manual vacuum aspiration technique by trained health workers.
3. Providing diagnosis, treatment, and consultation services in conditions related to deficiency of vitamin A, anemia, and malnutrition.
4. Providing health education for preventing respiratory and sexually transmitted disease
5. Providing school health services.
6. Providing adolescent health services.
7. Disease surveillance and control of the endemic disease.
8. Collection and reporting of vital statistics events.
9. Promotion of sanitation, including uses of latrines and proper disposal of excreta.
10. Investigate the quality of water and disinfection of water sources.
11. Assist in national health programmes.
12. Training of health workers Example: dais, LHV, ASHA, ANM, etc.
13. Supervision of the work of health workers.
14. Promotion of AYUSH system.
15. Providing facilities of some basic surgical procedures like vasectomy, tubectomy, MTP, cataract surgery, hydrocoele, etc
16. Providing the facilities of basic laboratory investigation Example: urine, stool, blood smear, RPR syphilis, sputum test for TB, etc.
It is generally established on 5,000 population and on 3,000 population in hilly areas. Till 2014 about 1,53,655 sub-centres have been established in-country. At present, one male health worker (MHW) and one female health worker (FHW) are appointed at the sub-centre for services. By the primary health centre, one female health assistant and one male health assistant, 6 subcentres are supervised. Subcentres provide antenatal care, vaccination, nutritional, child care, family planning, and various consultation-related health services in rural areas.
Following services are provided at the sub-centre according to Indian public health standards.
1. Maternal health care services:
2. Antenatal care:
a. Early registration of pregnancy and doing minimum 3 antenatal visits.
b. Pregnancy-related normal investigation example: weight, blood pressure, sugar, urine, blood group test, etc.
c. Providing folic acid and iron tablets to pregnant women.
d. Identification and refer high-risk pregnant women.
e. Immunization by tetanus toxoid.
f. Special care and nutritional advice to pregnant women.
2. Intranatal care:
a. Promotion of institutional deliveries.
b. Deliveries are attended by trained workers.
3. Postnatal care:
a. Minimum 2 postnatal visits after delivery.
b. Initiating breastfeeding after 30 minutes of delivery.
c. Complete vaccination of children from prevention of disease.
d. Consultation services for nutritional, sanitation, and contraception.
e. Providing health services according to Janani Suraksha Yojana.
4. Child health care services:
a. Providing essential child health care services.
b. Promotion of breastfeeding
c. Vaccination of children according to the immunization schedule.
d. Providing a preventive dose of vitamin-A.
e. Prevention of malnutrition, diarrhoea, and other communicable diseases in children.
5. Other services
a. Providing family planning and contraceptive services.
b. Providing referral and consultation services for safe abortion.
c. Providing education and consultation services to adolescent persons.
d. Assist in school health services.
e. Monitoring of quality of water.
f. Identification of community needs.
g. Providing area visits facilities for health workers for disease surveillance.
h. Providing first aid facilities for minor diseases like fever, diarrhoea, worm infection.
i. Providing training to the dais, ASHA, and voluntary health workers.
j. Increase cooperation and coordination among various health workers.
k. Providing cooperation in national health programmes:
The community health centre is usually established on 1,20,000 population and 80,000 population in hilly areas. In 2014, In India, about 5,396 community health centres were established. It is mainly established at the block or tehsil level. CHC consists of 30 beds capacity with four specialist doctors in surgery, medicine, gynaecology and obstetrics, and paediatric services. They are assisted by nurse grade first, nurse grade second, lab technician, X-Ray specialist, pharmacist, and other support staff.
These centres mainly provide promotive, preventive, therapeutic health care facilities. One non-medical post community health officer is also created at this level for providing the services. It is known as the first level of referral system. It can refer the patient directly into a medical college or specialized hospital without referring to the district hospital.
1. One anesthesia specialist assisting the surgeon on a contract or voluntary basis.
2. One public health manager on a contract basis.
3. One ANM, one PHN, and under the family planning programs, one ASHA is appointed for providing services.
1. Providing surgical care facilities in a general and emergency condition.
2. Providing vaccination facilities in community health centres.
3. Providing medicine-related facilities in a general and emergency condition.
4. Providing all types of diagnostic and therapeutic health care facilities.
5. Providing all types of family planning and surgery facilities.
6. Providing consultation, follow-up, and supervision facilities for primary health centres.
7. Providing safe delivery, abortion, and newborn care-related facilities.
8. Providing health benefits to the people by organizing all national health programmes on the block level.
9. Providing referral services as a first level of referral system.
10. Providing donating and storage facilities for blood donors
11. Treatment and prevention of communicable disease.
12. Organizing health education-related programmes in the community.
13. Providing training to health workers and students.
1. Routine and emergency care service of surgery.
2. Routine and emergency care by medicine, dengue, malaria, etc., case management should be done according to the established guideline for emergency conditions related to national health programmes.
3. 24 hours facilities of normal and assisted labour on centre.
4. Safe abortion facilities.
5. Essential and emergency delivery-related care services included surgical procedure, surgical delivery and medicine procedure, etc.
6. Complete family planning services, including laparoscopic services.
7. Newborn care services.
8. Routine and emergency services for sick infants.
9. Other services including tracheostomy, nasal packing, and expulsion of foreign particles from the nose, etc.
10. Providing services of national health programme by the community health centre.
11. Establishment of microscopic centre on CHC under the revised National Tuberculosis Control Programme.
12. Providing diagnostic and therapeutic health services at community health centres under the National Vector Borne Disease Control Programme.
13. Providing diagnostic, therapeutic, and rehabilitative health services at CHC under the National Leprosy Elimination Programme.
14. Under the National Blindness Control Programme, eye care services and surgical procedure services are provided at CHC. On every 5 lakh population, one eye specialist is appointed.
15. Under the integrated disease surveillance programme, CHC is working for the collection of information related to endemic disease and send to district-level authorities. It also assists in the management of disease when disease prevails on a mass scale.
16. Providing transportation facilities in referral services.
17. Provide essential laboratory services.
18. Blood storage facilities.
Urban Health Centres provide health services at a small or big level in the form of general or specialized health services. Following Institutes are established in urban areas for providing these services:
1. Dispensaries: Dispensaries are established in urban areas for the diagnosis and treatment of minor diseases. These services are provided for reducing the load from district hospitals and medical college hospitals. Mainly outdoor health facilities are provided in these dispensaries.
2. Urban health post: This scheme was started in 1983. Under this scheme, urban health centres are established in slums of urban areas. These centres are established under the family planning and RCH programmes. At present, about 871 urban health posts are operational in the country, mainly RCH, family planning, contraceptive, and first where aid health care services are provided.
3. Urban family welfare centre: These centres are working since 1950 in the country to provide family welfare services in the urban areas. On the basis of the population, these are divided into Type – I, Type – II, and Type–III centres. Type – I, on 10,000, Type– On 10,000 to 25,000, and Type–III more than 50,000 population working for providing family welfare services. At present, about 1083 centres are operational for providing family welfare services and distribution of contraceptive material.
4. Satellite hospital: Satellite hospital is established and occupied with modern techniques and facilities in urban areas for reducing the pressure on district hospitals and medical college hospitals. In these centres, trauma centres, I.C.U, and other emergency services are provided. These centres are working as secondary health centres and referral services centres.
5. Maternal and child health centres: These centres are established for providing maternal and child health care services in urban areas. The main objectives of these services to reduce the mortality and morbidity rate and promotion of health status in mothers and children.
These hospitals are established at the district level. At present, district hospitals are converted into district health centres. In these centres, specialized IPD and OPD health care facilities are provided. These hospitals act as a receptor for referral patients from rural areas.
Super specialty hospitals are established under the special act by parliament. These hospitals are providing super-specialty health services and participate in health-related research.
Examples:
1. NIMHANS Neurosurgery health services
2. Tata Memorial Hospital (TMH): Cancer treatment.
3. AIIMS Delhi – All types of services.
There is no universal health insurance in India. Health insurance is at present limited to industrial workers and their families. The Central Government employees are also covered by the health insurance, under the banner “Central Govt. Health Scheme”.
The ESI scheme, introduced by an Act of Parliament in 1948, is a unique piece of social legislation in India. It has introduced for the first time in India the principle of contribution by the employer and employee. The Act provides for medical care in cash and kind, benefits in the contingency of sickness, maternity, employment injury, and pension for dependents on the death of worker because of employment injury. The Act covers employees drawing wages not exceeding Rs. 15,000 per month
The Central Government Health Scheme (previously known as Contributory Health Service Scheme) for the Central Government employees was first introduced in New Delhi in 1954 to provide comprehensive medical care to Central Government employees. The scheme is based on the principle of cooperative effort by the employee and the employer, to the mutual advantage of both.
The facilities under the scheme include:
1. Out-patient care through a network of dispensaries
2. Supply of necessary drugs
3. Laboratory and x-ray investigations
4. Domiciliary visits
5. Hospitalization facilities at government as well as private hospitals recognized for the purpose
6. Specialist consultation
7. Paediatric services including immunization
8. Antenatal, natal and postnatal services
9. Emergency treatment
10. Supply of optical and dental aids at reasonable rate, and
11. Family welfare services.
Defense services have their own organization for medical care to defence personnel under the banner “Armed Forces Medical Services”. The services provided are integrated and comprehensive embracing preventive, promotive and curative services.
The Railways provide comprehensive health care services through the agency of Railway Hospitals, Health Units and clinics. Environmental sanitation is taken care of by Health Inspectors in big stations. A chief Health Inspector supervises the division’s work. Heath check-up of employees is provided at the time of entry into service, and thereafter at yearly intervals. There are lady medical officers, health visitors and midwives who look after the MCH and School Health Services. Specialists’ services are also available at the Divisional Hospitals.
In a mixed economy such as India’s, private practice of medicine provides a large share of the health services available. There has been a rapid expansion in the number of qualified allopathic physicians from about 50,000 at the time of Independence to about 7.67 lakhs in 2005 and the doctor-population ratio for the country as a whole is 1 : 1428. The general practitioners constitute 70 per cent of the medical profession. Most of them tend to congregate in urban areas. They provide mainly curative services. Their services are available to those who can pay. The private sector of the health care services is not organized. Some statutory bodies like the Medical Council of India and the Indian Medical Association regulate some of the functions and activities of the large body of private registered medical practitioners.
The practitioners of indigenous systems of medicine (e.g., Ayurveda, Siddha, Homoeopathy, etc.) provide the bulk of medical care to the rural people. Ayurvedic physicians alone are estimated to be about 4.38 lakh. Studies indicate that nearly 90 per cent of Ayurvedic physicians serve the rural areas. Most of them are local residents and remain very close to the people socially and culturally. In recent years there has been considerable state patronage to foster these systems of medicine. Many Ayurvedic dispensaries are state- run. The Govt, of India has established a National Institute of Ayurveda in Jaipur and a National Institute of Homoeopathy in Kolkata. A Central Council of Indian Medicine was established in 1971 to prescribe minimum standards of education in Indian medicine. The Govt, of India is studying the question of how indigenous systems of medicine could best be utilized for more effective or total health coverage.
The voluntary health agencies occupy an important place in community health programmes. “A voluntary health agency may be defined as an organisation that is administered by an autonomous board which holds meetings, collects funds for its support chiefly from private sources and expends money, whether with or without paid workers, in conducting a programme directed primarily to furthering the public health by providing health services or health education, or by advancing research or legislation for health, or by a combination of these activities”. The one country where voluntary health agencies have developed and flourished to an enormous extent is the United States. Even in 1945, it was estimated that there were more than 20,000 voluntary agencies in the United States. The voluntary health agencies have been compared to “motor trucks” which can penetrate the by-ways, and the official agencies to “Railway Trunk Lines” which must run on tracks established by law.
1. Supplementing The Work Of Government Agencies :
It is well known that government agencies cannot provide complete service because they operate under financial and statutory restrictions. The voluntary health agencies can help strengthen the work of government agencies by lending personnel, or by contributing funds for special equipment, supplies or services,
2. Pioneering:
The voluntary health agencies are in a position to explore ways and means of doing new things. Research is one form of pioneering. When the efforts succeed and bear fruit, the government agencies can step in and take over the project for the benefit of the larger numbers. The family planning programme in India is an example of pioneering by the voluntary agencies which first spearheaded the movement, in the face of much opposition. When the importance of family planning was realised, the government accepted family planning as a national policy,
3. Education:
There is unlimited scope for health education in India. The government agencies cannot cope with the problem, unless it is supplemented by voluntary effort on the part of the people.
4. Demonstration:
By putting up demonstrations and experimental projects, the voluntary health agencies have advanced the cause of public health. The demonstration of bore hole latrines by the Rockefeller Foundation to solve the problem of hookworm in India is a case in point. The borehole latrine and its modifications have since become an essential part of the environmental sanitation programme in India.
5. Guarding the work of government agencies:
By setting a good example the voluntary health agencies can always guide and criticize the work of government agencies.
6. Advancing health legislation:
The voluntary agencies can also mobilize public opinion and advance legislation on health matters for the benefit of the whole community.
Since India became free, several measures have been undertaken by the National Government to improve the health of the people. Prominent among these measures are the NATIONAL HEALTH PROGRAMMES, which have been launched by the Central Government for the control/ eradication of communicable diseases, improvement of environmental sanitation, nutrition, control of population and rural health. Various international agencies like WHO, UNICEF, UNFPA, World Bank, as also a number of foreign agencies like SIDA, DANIDA, NORAD and USAID have been providing technical and material assistance in the implementation of these programmes.
1. Providing maternal and child health care services.
2. Providing family planning and contraception services.
3. Organise health education-related programmes
4. Organise nutrition-related consultation programmes.
5. Provide essential nutritional substance.
6. Complete vaccination of pregnant women and children.
7.Provide training to the dais and voluntary health workers.
8. Prevention and treatment of communicable disease.
9. Collection and reporting of vital statistic data.
10. Prepare various types of records and reports at the subcentre.
11. Providing treatment facilities for minor diseases.
12. Cooperative working with workers on sub-centre.
13. Increase awareness in people by information, education, and communication activities.
14. Complete own work with responsibility as a member of the health team.
1. Prepare various types of records and reports on sub-centre.
2. Assist in the national health programme.
3. Help in maintaining environmental sanitation.
4. Providing health education in the community.
5. Providing nutrition and nutrition-related advice to people in the community.
6. Collection of vital statistic data and educate the people about the importance of vital statistic data.
7. Assist in the family planning programme.
8. Prevention of communicable disease.
9. Assist in referral services.
1. Providing consultation and guidance services to people for health programmes in the community and supervision of national health programmes.
2. Working with team spirit between PHC and subcentres organises meetings and coordinates various programmes.
3. Supply and management of equipment on sub centre.
4. Prepare various types of records and reports.
5. Screening of 10% suspected homes affected by kala-azar, lymphatic filariasis, Japanese encephalitis, prepared records; provide treatment and spray the affected area.
6. Provide training to the dais, ASHA, health workers, voluntary workers.
7. Provide folic acid, iron tablets, identifying and treatment of malnourished children, and educate the mothers about breastfeeding.
8. Provide family planning and MTP services.
9. Provide complete vaccination according to immunization schedule for mother and children.
10. Treatment and refer the case according to need in acute respiratory disease.
11. Assist in school health services.
12. Provides primary health care services.
13. Provide health education to people in the community.
1. Screening of homes for malaria disease, investigate the blood smear slides, supervise the work of health workers, treatment of the patient, and spray the insecticide solution in affected areas.
2. Surveillance of communicable disease, apply control measures for the treatment of disease.
3. Identifying, treatment and prepare the record for leprosy and tuberculosis patients.
4. Maintenance and promotion of environmental sanitation.
5. Assist in the immunization programme.
6. Assist in the family planning programme.
7. Provide nutrition and consultation related to nutrition.
8. Provide preventive measures for blindness and provide treatment.
1. Provide health education to community people.
2. Assist in vaccination programme at village level.
3. Assist in maternal and child health programmes in the village.
4. Providing primary health care services.
5. Provide treatment for the minor disease.
6. Assist in the family planning programme.
7. Promotion of environmental sanitation.
8. Providing consultation services related to health.
9. Assist in emergency referral services.
10. Surveillance and prevention of communicable disease.
1. Conducting safe, hygienic, and asepsis delivery at the local level.
2. Providing antenatal, intranatal, and postnatal health facilities to pregnant women.
3. Vaccination of pregnant women with tetanus toxoid.
4. Provide iron and folic acid tablets to pregnant women.
5. Assist in referring the abnormal and high-risk pregnant women.
6. Providing consultation services in pregnancy related to nutrition, sanitation, and health.
7. Provide knowledge about the importance of breastfeeding to mothers and early initiation of breastfeeding.
8. Provide complete vaccination to newborns according to the immunization schedule.
9. Motivate the people about contraceptive and permanent sterilization, organize family planning-related health programmes in rural areas.
10. Promotion of environmental sanitation.
11. Reporting to a female health worker about health programmes and vital statistics events held in the community.
To bridge the gap between urban and rural health services, a new post is created under the NRHM programme known as ASHA. This post is created at the village level on 1000 population for providing health services locally.
1. Priority is given to women who are divorced / widows / married.
2. Women must be the resident of the village.
3. Women must be the age of 25 to 45 years.
4. Minimum qualification of VIII class and able to read and write.
5. She is acceptable to all sections of the village.
6. Women are having the quality of communication and leadership.
7. Women must represent the disadvantaged population groups in society.
8. Normal ASHA is selected on 1,000 population, but hilly and desert areas have some relaxation in population.
1. Selection of ASHA is made by a nodal officer with the help of the district health committee.
2. Block nodal officer gives 10 possible names of female candidates to district nodal officer. They may be an Anganwadi worker, voluntary health worker, or any other woman.
3. At the district level, 2 days workshop is organized for these candidates for discussion about the selection of ASHA, role, and responsibilities of ASHA.
4. All the ASHA candidates dose close discussions about given topics.
5. Among these candidates minimum, 3 candidates name is proposed in Gram Sabha, and Gram Sabha agrees on one name of the candidate.
6. Name of the selected candidate by Gram Sabha is sent to the district nodal officer for permission, and the district nodal officer accepts the name.
7. After this selection candidate starts the training procedure for improvement in communication and leadership skills.
8. ASHA gets the training at the block level, district level, and state level.
9. Local training is provided by Anganwadi workers and ANM at Panchayat Bhawan.
10. After the completion of training, she was permitted to work in the rural community and assisted by ANM and Anganwadi workers.
1. ASHA creates awareness in rural areas about health determinant factors, including nutrition, sanitation, family planning, living and working conditions.
2. ASHA prepares the women for the birth of the baby. Give the knowledge about the importance of safe delivery, breastfeeding, immunisation, nutrition, and prevention from pelvic infection and also provide consultation services.
3. ASHA helps the community people to get health services on sub centre, PHC, and Anganwadi centre, including immunization, antenatal care, intranatal care, postnatal care, supplementary nutrition, sanitation, etc.
4. ASHA arrange the nearest identify health centre for admission and treatment of pregnant women and small children.
5. ASHA provides treatment facilities for minor diseases Example: fever, diarrhoea, first aid. She also provides DOTS therapy under the RNTCP programme.
6. ASHA work as a depot holder of essential health services provided for people. Example: ORS therapy, Iron tablets, folic acid tablets, Chloroquine tablets, disposable delivery kit, contraceptive pill and devices, and condom, etc. For this purpose, one drug kit is provided to ASHA.
7. ASHA work with rural health and sanitation committee for the development of health scheme on the village level.
8. ASHA motivate the people for the construction of latrines in homes under a complete sanitation programme.
9. ASHA submitted the report to the sub centre and PHC of vital events held in the community.
10.ASHA is working to provide health facilities to people. ASHA get more training and promote to care of the newborn, sick child, and sick people in rural areas.
1. Organized health day once or twice a month. On this day, the knowledge of the importance of women, adolescent girls, and child-related health aspects is provided. Example: nutritious food, personal hygiene care in pregnancy, antenatal care, institutional delivery, immunization, treatment of minor disease, etc.
2. Anganwadi worker informs ANM about health day who assist and give guidance in health day organization.
3. Anganwadi workers and ANM work as source persons for the training of ASHA.
4. ASHA educates the people about health services by using information, education, and communication activities in the poster, folk dance, and puppet shows.
5. Anganwadi workers act as depot holders for drugs. These drugs were issued and replaced for ASHA in health services.
6. Anganwadi worker prepares the list of the eligible couple and infant child to assist ASHA.
7. ASHA will support the Anganwadi worker to promote pregnant and lactating women for supplementary nutrition.
8. ASHA also supports the Anganwadi worker to bring the beneficiary people on the special day of immunization and health check up day.
1. ANM organises meeting with ASHA once or twice a week. In this meeting. She discusses the activities held during the week and provides guidance for ASHA if she has any problem at work.
2. ANM and Anganwadi workers act as sources person for the training of ASHA.
3. ANM informs ASHA about outreach session time and date and provides guidance for bringing the beneficiary people to outreach sessions.
4. ANM coordinates and participates in organizing health day at Anganwadi centre.
5. ANM also helps ASHA in the registration of eligible couples and infant children.
6. ANM motivates pregnant women by ASHA for the antenatal check, iron, and folic acid tablet intake, and checkup at the sub-centre level.
7. ANM also motivates the eligible couple to adopt contraceptive methods from sub-centres.
8. ANM provides iron and folic acid tablets to pregnant women and immunized with tetanus toxoid.
9. ANM also guides ASHA about dose schedule and side effects of oral pills for contraception.
10. ANM guides ASHA about serious symptoms in pregnancy and the side effects of hard work during pregnancy and also provides adequate treatment facilities to pregnant women.
11. ANM informs the ASHA about the date and time of training and provides the suitable TA/DA for attending training.
A new post is created under the integrated child development scheme known as Anganwadi worker. Under this scheme, health services are provided to pregnant women, lactating women, and 0–6 years of children. On every 1,000 population, one Anganwadi worker is appointed. About 100 Anganwadi workers are appointed at one ICDS block level. At present, about 6,719 ICDS blocks are functional in the country.
Anganwadi workers are selected from the rural population and then provided 4 months of training about nutrition, health education, and child development aspects. She is a part-time health worker paid Rs 1500 per month for her services. Anganwadi workers provide health checkups, immunization, supplementary nutrition, health education, informal health education, referral services to people. Anganwadi workers and village health guides act as the primary contact between health services and the health system.
1. Providing supplementary nutrition to pregnant women, lactating women, and adolescent girls.
2. Providing health education to women.
3. Providing essential investigation and health care facilities of antenatal, intranatal, and postnatal care for pregnant women.
4. Participation in immunization programmes.
5. Providing training to ASHA.
6. Organises the meetings of health workers and peoples.
7. Organises the health day at Anganwadi centre.
8. Providing referral services.
9. Providing informal health education to people.
10. Distribution of iron and folic acid to pregnant women.
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Phone : +91-941-111-4532 / +91-914-935-2988
Email : info@shahealthcare.org
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