This approach came into existence in 1798, following the international

conference at Alma-Ata (USSR)

The Alma-Ata conference defined primary health care as

Primary health care is essential health care made universally accessible to

individuals and acceptable to them, through their full participation and at the

cost the community and country can afford

The primary health care is equally valid for all the countries from the most to the

least developed. It has been accepted as integral part of the country’s health

system

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 infectious disease

6. Prevention and control of locally endemic disease

7. Appropriate treatment of common disease and injuries

8. Provision of essential drugs

1. Equitable distribution: Health services must be shared equally by all people irrespective of their ability to pay, and all(rich or poor, rural or urban) must have assess to the health services

2. Community participation: Involvement of the individuals, family, communities in the promotion of the their own health and welfare and not merely the government; is essential component of primary health care

There must be continuing effort to secure meaningful involvement of the community in the planning, implementation and maintenance health services

3. Intersectoral coordination: primary health care involves in addition to health sector,

all related sectors and aspects of national and community development, in

particular agriculture, animal husbandry, food, industry, education, housing etc.

An important approach is planning - planning with other sectors to avoid

unnecessary duplication of activities

4. Appropriate technology: It is defined as “technology that is scientifically sound,

adaptable to local needs, and acceptable to those who apply it and those for

whom it is used, and that can be maintained by the people by themselves in keeping

with the principle of self reliance with the resources the community and country can

afford”

Health services in India

1. Public health sector

Primary health care Primary health center

Subcenter

Hospital health center CHC

Rural hospital

District hospital

Specialist hospital

Training hospital

Health insurance scheme ESI

CGHS

Other Railway

Defense

2. Private health sector

Private hospitals, polyclinics,

nursing homes and dispensaries

General practitioners and clinics

3. Indigeneous system of medicine

Ayurveda and Siddha

Unani and Tibbi

Homeopathy

Unregistered practitioners

4. Volantary health agencies

5. National health programme

Village Health GuideStarted in 1977.

Now replaced by ASHA

ASHA Advent with NRHM (per 1000

population)

Imp link between community &

health services

Training of Local Dais

Started under rural health scheme

Training of local dais for 30 days Now not preferred.

AWW

Under ICDS

For every 1000 population

1. Local resident.

2. Preferable Age -25-45 yrs

3. Formal education up to 8th class.

4. Communication & leadership qualities.

5. Adequate representation from disadvantaged

population.

6. Ensured to serve such groups better

AWW & ANM –resource person for ASHA.

Organizing Health day.

Mobilizing beneficiaries

Survey of eligible couples & children < 1 Yr

Weekly/fortnightly meeting of ASHAs by ANM.

Preparation of Village Health plan

One per 5000 population in general & one for every 3000

population in hilly region.

As of 2007, total sub centers in our country –1,45,272, as 2011

1,48,124.

Approved staff – One ANM + One MPW.

One Health Assistant (Male) & One Health Assistant (Female –Lady

Health Visitors) – located at PHC level are entrusted with task of

supervision of six Sub Centers under a PHCs.

1 PHC for every 30,000 population in plain areas

1 PHC for every 20,000 population in hilly, tribal,

backward areas

22370 primary health centers have been established

Types of PHCs

Type A Type B

PHC with delivery load less than 20 per

month

PHC with delivery load more than 20 per

month

I] To provide comprehensive primary health care to the community

through the primary health center.

II] To achieve & maintain an acceptable standard of quality of care.

III] To make the services more responsive & sensitive to the needs of

the community.

Antenatal care: Early registration of all pregnancies ideally in the first trimester (before 12th

week of pregnancy

Indian Public Health Standards (IPHS) Guidelines for Minimum 4 antenatal checkups and provision

of complete package of services.

Suggested schedule for antenatal visits:

1st visit: Within 12 weeks—preferably as soon as pregnancy is suspected—for registration of

pregnancy and first antenatal check-up.

2nd visit: Between 14 and 26 weeks.

3rd visit: Between 28 and 34 weeks.

4th visit: Between 36 weeks and term.

Antenatal care

Minimum laboratory investigations like - Haemoglobin, Urine albumin and sugar, RPR test for syphilis and Blood Grouping and Rh typing.

Nutrition and health counseling.

Identification and management of high risk and alarming signs during pregnancy and labour.

Intra-natal care: (24-hour delivery services both normal and assisted)

Promotion of institutional deliveries.

Management of normal deliveries.

Assisted vaginal deliveries including forceps/vacuum delivery whenever required.

Manual removal of placenta

Minimum 48 hours of stay after delivery.

Managing labour using Partograph.

A fully immunized infant is one who has received BCG, three doses of DPT, three doses of OPV, three doses of Hepatitis B and Measles before one year of age

Access to services:The PHC provides medical care to all patients without any discrimination of gender, cast, or religion. The Medical Officer is responsible for ensuring the delivery of services

Your Rights in the PHC

1. Right to access to all the services provided by the PHC.

2. Right to Information-including information relating to your treatment.

3. Right of making decision regarding treatment.

4. Right for privacy and confidentiality.

5. Right to religious and cultural freedom.

6. Right for Safe and Secure Treatment.

7. Right for grievance redressal.

1. Medical Care2. Maternal & child care

3. Family planning services

4. MTP services

5. Health education & management of

RTI/STI

6. Nutrition Services

7. Basic lab services

8. Selected Surgical procedures

9. School health Services10. Adolescent health care

11. Disease Surveillance & 12. control programme

12. Collection of vital events

13. Promotion of sanitation including use of

toilet & appropriate garbage disposal

14. Water quality monitoring

15. Trainings

16. Mainstreaming of AYUSH17. National health programme

RNTCP

National Programme for blindness (NPCB)

National Leprosy Elimination Programme (NLEP)

NVBDCP

National AIDS Control Programme (NACP)

National Program for Prevention & Control of Cancer, Diabetes, Cardiovascular diseases & Stroke

National Program For Health Care of the Elderly (NPHCE)

Programmes for Iodine Deficiency, Tobacco Control

Integrated Disease Surveillance Project (IDSP)

National Programme for Prevention and Control of Deafness (NPPCD)

National Mental Health Programme (NMHP)

National Programme for Prevention and Control of Fluorosis (NPPCF) Essential in Fluorosis affected

Villages

The CHCs were designed to provide referral health care

For cases from the Primary Health Centres level

For cases in need of specialist care approaching the centre directly.

4 PHCs are included under each CHC thus catering to approximately 80,000 populations in tribal/hilly/desert areas and 1,20,000 population for plain areas.

CHC is a 30-bedded hospital providing specialist care in Medicine, Obstetrics and

Gynecology, Surgery, Paediatrics, Dental and AYUSH.

There are 4535 CHCs functioning in the country as on March 2010 as per Rural

Health Statistics Bulletin 2010.

To provide optimal expert care to the community.

To achieve and maintain an acceptable standard of

quality of care.

To ensure that services at CHC are commensurate with

universal best practices and are responsive and

sensitive to the client needs/expectations.

1. Care of Routine and Emergency Cases in Surgery

2. Care of Routine and Emergency Cases in Medicine

3. Maternal Health

4. Newborn Care and Child Health

5. Family Planning

6. Other National Health Programmes – same as PHCs

7. Others

School health services

Adolescent health services

Blood Storage Facility

Diagnostic Services

Referral (transport) Services

Maternal Death Review (MDR).