Post Basic BSC Nursing Book

A TEXTBOOK of
COMMUNITY HEALTH NURSING

for
POST-BASIC B.Sc. NURSING STUDENTS
AS PER SYLLABUS BY INDIAN NURSING COUNCIL
HEAVEN DAHIYA
B.Sc. (Hons) Nursing;
Lady Hardinge College of Nursing, University of Delhi,
Master of Science in Community Health Nursing;
Post Graduate Institute of Medical Sciences,
University of Health Sciences, Rohtak, Haryana
Master of Arts in Adult Education, IGNOU, Delhi
KUMAR PUBLISHING HOUSE

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First Edition : 2017
© Publisher
Price : ` XXX.00
ISBN: 978-93-82428-XX-X
HEAVEN DAHIYA
B.Sc. (Hons) Nursing;
Lady Hardinge College of Nursing, University of Delhi,
Master of Science in Community Health Nursing;
Typesetting by Satendra Singh Post Graduate Institute of Medical Sciences,
Edited by Mr. Prashant Gupta University of Health Sciences, Rohtak, Haryana
Mr. Asit Kumar Master of Arts in Adult Education, IGNOU, Delhi
Dr. Neetu Manoj Bhatia (P.T.)
All Rights reserved. No part of this publication may be reproduced, stored in retrieval
system or transmitted in any form or by any means, i.e. electro-mechanical, photocopying,
recording or otherwise without the prior written permission of the publisher.
The book has been published in good faith as per the manuscript provided by the
author. However the publisher, the printer, the author and the editors will not be held
responsible for any inadvertent error(s). All disputes will be subject to the jurisdiction
of Delhi under the Constitution of India.
Published by :
NEELAM KUMAR
KUMAR PUBLISHING HOUSE
PD 11 & 12B, Vishakha Enclave, Opposite Maurya Enclave Police Quarters,
Near N.D. Market, Pitampura, Delhi - 110034 (India)
E-Mail: kphnursingbooks@gmail.com | Website: www.kphnursingbooks.com
,
DEDICATED
to
MY PARENTS
and
LOVED ONES....
I can never pay them back for
all they have done for me,
but I can try .....
PREFACE
First and foremost, I would like to thank the Almighty God in the form of
my parents and loved ones for their immeasurable and abundant blessings
for giving me an opportunity to surpass this subject as my book. As I come
to the completion of this book, I realize that I owe a huge debt of gratitude
to my respected parents, teachers, supervisors, friends and well-wishers
who have supported me throughout this endeavour by providing me with
the gems of creative insights and critical thinking at every step of this book.
Special words of cheer are extended to my close friends and well-wishers
who believed, encouraged, supported and guided me, whenever needed
throughout the period of this book.
Words seem inadequate to my constant supporters who are my inner
strength, my parents and loved ones and my deep sense of love to my little
star Pratham, friends and relatives—the ineffable gifts of my life. To them
I dedicate this book.
This book covers the latest syllabus, documented by INDIAN NURSING
COUNCIL for the Post-Basic B.Sc. Nursing Students and I hope, this book
will help nursing students establish not only a clear background but also
in the implementation of better and quality nursing services in respective
communities.
I wish to thank Mrs. Neelam Kumar (Publisher) and Mr. Ashok Kumar
(Director) for encouraging, co-operating, being so kind and positive to
publish my book ‘A Textbook of Community Health Nursing for
Post-Basic B.Sc. Nursing Students’ and also the whole staff of KUMAR
PUBLISHING HOUSE, Delhi, for their outstanding efforts.
— HEAVEN DAHIYA
vi
vii
SYLLABUS
COMMUNITY HEALTH NURSING

COURSE CONTENTS
Unit - I Unit - III

F Introduction F Organisation and administration of health
F Introduction to community health— services in India.
concepts, principles and elements of F National health policy.
primary health care. F Health care delivery system in India.
F Introduction to community health nursing. F Health team concept.
F Concepts of community health nursing— F Centre, state, district, urban health services,
community nursing process. rural health services.
F Objectives, scope and principles of F System of medicines.
community health nursing. F Centrally sponsored health schemes.
F Role of voluntary health organizations
Unit - II and international health agencies.
F Family health services. F Role of health personnel in the community.
F Concepts, objectives, scope and principles. F Public health legislation.
F Individual family and community as a
Unit - IV
unit of service.
F Principles and techniques of home visiting. F Health education.
F Establishing working relationship with F Aims, concepts and scope of the health
the family. education.
F Working with families in relation to pre- F National plan for health education.
vention of disease, promotion of health. F Communication techniques.
F Care of the sick in the home, physically F Methods and media for health education
handicapped and mentally challenged. programmes.
F Surveillance and monitoring. F Planning for health education and role
of nurse.
viii
Unit - V F Epidemiology—theories and models.

F Application of epidemiology, principles
F Role of the community health nurse.
and concepts in community health.
F National health programmes.
F Maternal and child health programmes. Unit VII
F Family welfare and school health services.
F Occupational health services. F Bio-statistics and vital statistics.
F As a member of the health team. F Introduction, definition, scope and legis-
F Training and supervision of health care lation.
workers. F Report, recording and compiling of vital
statistics at the local, state, national and
Unit - VI international level.
F Definitions and methods of computing
F Epidemiology
vital statistics.
F Definition—concepts, aims, objectives,
F Methods of presenting data.
methods, principles.
F Management information system.
CONTENTS
Chapter Title Page No.

Chapter 1 INTRODUCTION 01–03
n Community Health 1 n Community Health Nursing/ 2
Public Health Nurse
Chapter 2 FAMILY HEALTH SERVICES 04–13

n Introduction to Family Health Services 05 n
Care of Sick in the Home, Physically 11
n Family Health Nursing Process 07 Handicapped and Mentally Challenged
n Home Visiting 08 n Surveillance and Monitoring 12
n Establishing Working Relationship with 10
the Family
Chapter 3 ORGANIZATION AND ADMINISTRATION OF HEALTH 15–88

SERVICE IN INDIA
n Health Organization in India 15 n
System of Medicines 69
n Planning and Organizing Nursing Services 19 n
Centrally Sponsored Health Schemes 73
at Various Levels: National, State and District n
Role of Voluntary Health Organizations 75
n National Health Policy, 2000 21 and International Agencies
n Health Care Delivery System in India 22 n Non-Governmental Voluntary Agencies 81
n Health Care Delivery System 24 n National Voluntary Health Agencies 83
n Health Team Concept 32 in India
n Roles and Responsibilities of Nursing 34 n Public Health Legislation 86
Personnel in Hospital, Community and
Educational Settings
Chapter 4 HEALTH EDUCATION 89–98

n Introduction to Health Education 89 n Roles and Responsibilities of Community 97
Health Nurse In Health Education
x
Chapter Title Page No.

Chapter 5 ROLES OF COMMUNITY HEALTH NURSE 99–165
n
Introduction to Role of Community 99 n As a Member of the Health Team 163
Health Nurse n Training and Supervision of Health 164
n National Health Programmes 102 Care Workers
n National Health Mission 149
Chapter 6 EPIDEMIOLOGY 167–176

n Introduction to Epidemiology 167 n Application of Epidemiology in 175
Community Health Nursing
Chapter 7 DEMOGRAPHIC STUDIES 176–197

n Introduction 177 n Methods of Presenting Data 180
n Biostatistics 177 n Management Information System (MIS) 188
n Vital Statistics 177 n Health Management Information System 194
C
INTRODUCTION H
A
P
T 1
E
R
COMMUNITY HEALTH certain norms, values and social

institutions.
According to World Health Organization
A EURO symposium in 1966 has defined
Expert Committee, a community is a social
community health as including “all the personal
group having following characteristics:
health and environmental services in any human
1. Determined by geographical boundaries. community, irrespective of whether such services
2. Common values and interests. were public or private ones”.
3. Its members know and interact with Community health nursing is a compre-
each other. hensive branch of nursing, which is based on
4. It functions within a particular social RAIOE i.e.:
structure and exhibits and creates
R: Recognition
A: Assessment
I: Intervention
O: Organization
E: Evaluation
FIG. 1.1: RAIOE

2 A Textbook of Community Health Nursing for Post-Basic B.Sc. Nursing Students
3. It supports the entire community as well

COMMUNITY HEALTH NURSING/
as individual, families and aggregates is
PUBLIC HEALTH NURSE a focus for community health nursing
1. According to Harden Mailer (1985), practice.
formal director of World Health 4. It believes in overall development and
Organization, “Basic element of com- well-being of individuals, families,
munity health nursing is expansion communities and nation.
of primary care of health and faith of
patients in nurse”. Objectives, Scopes and Principles
2. According to WHO Expert Committee, of Community Health Nursing
“Community health nursing/Public
Goals and Objectives
C health nursing combines the skills of
nursing, public health and some phases n To assess the need and priorities of
H
of social assistance and function as a vulnerable group like pregnant mother,
A
part of total public health program for children and old age persons.
P
the promotion of health, improvement n To provide health care services at every
T
of conditions in social and physical level of community.
E
environment, prevention of illness, n To make community diagnosis.
R
disability and rehabilitation”. n To evaluate the health programmes and
1 3. According to European Conference make further plans.
on Nursing Administration (1959), n To prevent disabilities and providing
Introduction
“The Nurse is most directly concerned rehabilitation services.

with giving health education and n To provide referral services at various
care to individual and family in the health care levels.

community”. n To increase life expectancy.
n To enhance the standard of nursing
Concepts of Community Health profession through:

Nursing l Conducting nursing research.
l Provide quality assurance in
1. Community health nursing identifies community health nursing.
the need of holistic care approach. l Performing the role of nurse
2. Community health nursing supports epidemiologist.
that community based efforts and
involvement is essential for the risk Scopes
reduction.
3. It realizes that health promotion and n Rural areas and slums of cities.
primary prevention are major activities n Special clinics.
in community health nursing practice.

Introduction 3
n Mobile camps. n Community health nursing should be

n Health centres. provided continuously, without any
n Schools interruption.
n Industrial organizations. n Preparation and maintenance of records
n Outdoor patient departments of big and reports is very important in com-
hospitals. munity health nursing.
n Fairs and other places of social functions/ n Community health nurses and other
gathering. health workers should be guided and
n Rural and poor urban families etc. supervised by highly educated and
skilled professionals.
Principles n Community health nurse should be
n Health services should be based on the responsible for: C
needs of individuals and the community. l Responsible for professional H
n Health services should be suitable to development. A
the budget; workers and the resources. l Should continuously receive in- P
n Family should be recognized as a unit and service training and continuing T
the health services should be provided education. E
to its members. l Should follow professional ethics
R
n Health services should be equally avail- and standards in her work and
able to all without any discrimination of behaviour. 1
age, sex, caste religion, political leaning l Should have job satisfaction.
Introduction
and social or economic level etc.
n Health education is an important part of
n Must have effective team spirit while
community health nursing. It should working in the community.
be preplanned, suitable to conditions, n Timely evaluation is must for community
scientifically true and effective. services.

C
H
A
P
T
E
R
1
Introduction
C
FAMILY HEALTH H
A
SERVICES P
T 2
E
R
2. Family health services act as a problem

INTRODUCTION TO FAMILY
solving process in which family health
HEALTH SERVICES nurse provides services irrespective of
Family health services are the central point of socio-economic level of families.
health services. It is an important component 3. Comprehensive health care (preventive,
of “Health for All” goal. Health of each individual promotive and rehabilitative care) can
affects the health of other members of family. It be provided to community and family
is essential for community health nurse to have through health care services.
a sound knowledge of family. Family health 4. Family planning, nutrition, maternal
can be defined as continuing ability to meet and child health and geriatric care are
defined functions in interaction with other the important aspects of family health
social, political, economical and health system. services.
Definition Objectives
Family Health Services can be defined as possessing 1. To identify and appraise health problems
abilities and resources to accomplish family of family.
development tasks. It is a special attention 2. Ensure family’s understanding and
which is given to family members to promote acceptance of problem.
their health, prevent from health problems and 3. Provide nursing services according to
for the welfare of family. health needs of the family.
4. To help to develop competence in
Concepts members to take care of their family.
5. Promote utilization of available resources
1. Family is the basic unit of any health to maintain all aspects of health of family.
care system. Without family care 6. To provide health education for leading
services, the target of health services healthy and fruitful life.
cannot be achieved.
7. To provide health services to the family Scopes

members at cost effective level.
8. To assist the family members in The goals of individual and community’s
achieving their health goals. health and growth in national health level can
be achieved through family health services:
Aims 1. Reproductive Health
1. Reducing maternal mortality, morbidity 2. Child Health
and infant mortality rate. 3. Adolescent Health
2. Spacing birth of children. 4. Mental Health
C 3. Solve problem of malnutrition in the 5. Gender Issues
family. 6. Aging
H
A 4. Health education.
Principles
P
T
E
Establish Good Professional Relationship with Family
R
2 Knowledge of Basic Facts e.g. Size, Occupation,
Customs, Rituals and Education Standards
Family Health Services
Problem Identication and Priority
Need Based Support and Services to Family
Problem Discussion with Family and Possible Solution
Encourage Family to be Self-sufcient to Fulll

their Needs
Health Services should be Irrespective of Sex, Age,

Income and Religion
Participation of Family Members
FIG. 2.1: Principles

Family Health Services 7
Individual, Family and Community 7. Family plays an important role in

supporting health care need.
as a Unit of Service 8. Individual health problem can be tackled
1. Family is supposed to be the basic and solved easily through family health
biological, cultural and epidemiological care.
unit of society. Also, Health resources 9. Successful family life cycle can be
are utilized through family. Hence, achieved by family health care services.
family is the basic unit of health care 10. The goal of community health nursing
services. can be achieved through effective and
2. Health of individual depends on health most available channel for mobilizing
C
of family. the health needs of the society.
H
3. Interdependence and interpersonal
A
relationship create awareness about FAMILY HEALTH NURSING
P
health among family members.
4. Family size, structure, income, education, PROCESS T
environment affect health standard of It is a systematic, problem solving, logical and E
family. R
deliberate process to help family to develop
5. In health care needs, family plays and strengthen their capabilities to meet their 2
important role. health needs and to solve their health problems.

6. Illness of one family member affect It facilitates standardized nursing actions to
total health care of family.
A Delicious Pie
A: Assessment D: Diagnosis P: Planning I: Implementation E: Evaluation
FIG. 2.2: A Delicious Pie
Planning: It involves establishing

achieve family health nursing goals and objectives.
3.
It is a logical sequence of data collection to priorities, setting goals and objectives
family health care. It consists of five phases: and formulating family health nursing
Assessment: It involves Observation,
1. care plan.
Nursing history, Consultation review Implementation: It consists of mobi-
4.
of Literature, Interview, Clinical records, lization of resources facilitating work
Physical and Psycho-social history. environment, implementation and
Diagnosis: Consists of family diagnosis.
2. documentation.
Evaluation: Involves summative and

5. Qualities of Family Health Nurse
formative evaluation of family health
nursing care plan.
Family Centred Holistic Approach Non-Judgemental Accepting Different

Approach (Wellness) During Approach Self-Awareness
Values and Beliefs
Able to Work Sensitive Towards Independent and

in Adverse Flexible Skillful
Time and Efforts Positive Attitude
Conditions
C Able to Cope Terminate

Able to Handle Relationship
H and Manage Situation
Stress with Family
A
P FIG. 2.3: Qualities of Family Health Nurse
T
E
R health due to illiteracy and unemployment,
HOME VISITING
therefore, home health services are provided
2
Can be defined as an evidence based program to community for their well-being of health.
that include home visiting as a primary service
delivery strategy and is offered on voluntary Aims

basis to pregnant women or children up to
n Protection against diseases.
5 years. It also includes improved maternal
n Providing possible nursing care at home.
and child health, prevention of child injuries
n Improving the health standard of family.
or maltreatment and reduction emergency
n Monitoring the health problems, diseases
department visit, improvement in family
and providing follow up treatment.
economic, self-sufficiency and improvement
n Assessing health, immunization and
in the co-ordination and referral for other
nutrition level of family.
community resources and support.
n Reducing the IMR and MMR.
It is an important activity of community
n Identification of sources of communi-
health services. A large part of population is
cable diseases.
confined to their homes due to illness and is
n Providing health education during
not able to take advantages of institutional
home visiting.
Principles of Home Visiting
Planning and
Purposeful
Evaluative Regularity
C
H
Educative
Principles of Flexibility A
Home Visiting
P
T
E
Scientic and Up-to- Voluntary and R
Date Technique Convenient
2

Development
Relationship
FIG. 2.4: Principles of Home Visiting
Techniques of Home Visiting n Do not scold the family members for

not following the advices.
n Introduce yourself and state the cause n Home visiting should be planned
of your visit. according to the domestic conditions.
n Develop good interpersonal relationship n Observe the following while communi-
and try to win the confidence of the cating:
family.
l Physical and ecological environ-
n Motivate the individual to explore their
ment.
problems.
l Health level of pregnant mother
n Maintain confidentiality.
and infants.
n Don’t criticize habits, culture and tradition
l Health level of children below
of the family. Without criticizing, take
5 years and their immunization.
rectifying measures, if necessary.
l Any sign of malnutrition in the n Home visiting should be planned and

family. conducted as per the requirements of
l Their way of living, cleanliness the community.
and personal hygiene. n A community health nurse should
categorize her/his area, then visit the
n Provide follow up treatment.
selected units. There should be definite
n Provide health education to the family
aim of home visiting i.e. to conduct
members.
survey, statistics collection, maternal
and child health services and nursing
ESTABLISHING WORKING services at home.
C
H
RELATIONSHIP WITH THE FAMILY n Class session should be pre-planned to
increase active participation of family
A n To develop an effective working relation- in home nursing.
P ship with the family, the community
T health nurse should focus on the Working with Families in Relation
E following objectives:
to Prevention of Disease,
R l To collect complete information
Promotion of Health
2 about the family and their environ-
ment, family health needs and n According to Florence Nightingale,
available resources. “the secret of national health lies in the

l To provide comprehensive nursing homes of the people”.
services to the family. n Family acts as a focal point of health care,
l To encourage family to become as it is the right place for integrating

independent in taking care of preventive, promotive and curative
their health. services.
l To remove all those shortcomings n Family health services consider family
of cleanliness, which can cause as a unit which starts from first contact
the illness or death. to the ongoing care of chronic problems
(from prevention to rehabilitation).
n Home visiting helps in establishing good
n The family health services are designed
relationship between nurse and family
to delivery “primary care” to the family.
members, in understanding the problems
n Health behaviour of family members can
and collecting the facts.
be modified through health education
n It also increases the faith of community
during implementation of family
in nursing and health services. So, the
health services.
community health nurse should make
n Family health services create awareness
optimum use of her/his complete
about inter-dependency and health
knowledge, positive attitude and profes-
among family members.
sional skills in home visiting.
n Maintain Input Output charting.

CARE OF SICK IN THE HOME,
n Frequent changing of position to
PHYSICALLY HANDICAPPED prevent pressure ulcer.
AND MENTALLY CHALLENGED n In case of emergency, seek medical help.
Care of Sick at Home Care of Physically Handicapped

n Sick person should be placed in a room n Prevention of disability at all level of care.
separated from the common areas of n Early identification of risk factors and
the house. impairment/disability.
n The door of the sick person’s room
n Assessment of extend of handicapped. C
should be kept closed, if possible to n Assessment of activities of daily living H
limit the visits. (ADL’s). A
n The mouth of the sick person should be
n Help to achieve the activities of daily P
covered while coughing and sneezing living. T
and should wash their hands with soap n Referral to specialist of consulting E
and water. discipline, seeking advice. R
n Always wear face mask to the sick
n Co-ordination between the efforts and
person. team members, NGO’s and agencies. 2
n One family member should be there to
n IEC activities for handicapped.

provide assistance to the sick person. n Prevention for contractures and com-
n Avoid sharing of utensils, clothes etc.
plications.
of the sick person. n Arrangement for helping device, aids
n Maintain quiet and calm room with
and minor repairment.
adequate lightening and proper venti- n Check for further complications.
lation to the sick person. n Keen observation over any sign of
n Discard the disposable items used by
pressure sore.
the sick person. n Rehabilitation—physical, social, mental,
n Maintain personal hygiene of the sick
psycho-social and vocational.
person and of his/her surroundings. n Nursing research for care of handi-
n Provide plenty of fluids.
capped.
n A sick person should be bathed or washed
with sponge/cotton cloth with luke- Care of Mentally Challenged
warm water everyday.
n Provide a small and frequent diet n Assessing the extend of problem and
(according to disease condition) to the informing the reality to relatives.
sick person and encourage him/her n Innovative teaching methodology for
to drink plenty of sweetened drinks, providing special education for mentally

especially if he/she does not eat much. challenged.
n Psychotherapeutic intervention, as practices and other factors that may

when needed. affect health.
n Strengthen the family system of mentally n Surveillance, if properly pursued, can
challenged person. provide the health agencies with
n Taking the help of NGO’s, voluntary an overall intelligence and disease-
agencies in care of mentally challenged accounting capability.
patients. n It is an essential prerequisite to the
n Creating a positive attitude in the society rational design and evaluation of any
towards mentally challenged persons. disease control programme.
n Loving tender care at all levels of health n It requires professional analysis and
C
system. sophisticated judgement of data lead-
H
n Proper rehabilitation according to ing to recommendations for control
A
individual need, including vocational activities.
P
rehabilitation of mentally challenged.
T
n Full participation of community people
Objectives of Surveillance
E in mental health programme to make n Prevention.
R society aware about prevention of mental n To detect changes in trend or distribution
2 illness. in order to initiate investigative or control
measures.
SURVEILLANCE AND MONITORING n To provide feedback which may be

expected to modify the policy and the
Surveillance system itself and lead to redefinition of
objectives.
Surveillance has been as “the continuous scrutiny
n Provide timely warning of public health
of the factors that determine the occurrence and
disasters so that interventions can be
distribution of disease and other conditions of
mobilized.
ill health”.
Or
Monitoring
“The continuous scrutiny of all aspects of
occurrence and spread of disease that are pertinent Monitoring is “the performance and analysis
to effective control”: of routine measurements aimed at detecting
n Surveillance is essential for effective
changes in the environment or health status
control, prevention and includes the of population”:
collection, analysis, interpretation and n Monitoring is the day-to-day follow-up of
distribution of relevant data for action. activities during their implementation
n It connotes exercise of continuous to ensure that they are proceeding, as
scrutiny of health indices, nutritional planned and are on schedule.
status, environmental hazards, health n It refers to on-going measurement of
performance of a health service or a
health professional or of the extent to time by technicians and automated

which patients comply with or adhere instrumentation.
to advice from health professionals. n It is a continuous process of observing,
n It becomes one more specific and recording and reporting on the activities
essential part of the broader concept of the organization or project.
embraced by surveillance. n It consists of keeping track of the course
n It requires careful planning and the of activities and identifying deviations
use of standardized procedures and and taking corrective action, if excessive
methods of data collection and can then deviations occur.
be carried out over extended periods of
C
H
A
P
T
E
R
2

C
H
A
P
T
E
R
2
C
ORGANIZATION AND H
A
ADMINISTRATION OF P
T 3
HEALTH SERVICES IN INDIA E
R
n Promotion of research through

HEALTH ORGANIZATION IN INDIA
research centres.
1. Central Level n Regulation of medical, pharma-
2. State Level ceutical, dental and nursing
3. Peripheral Level professions.
n Establishment of drug standards.
1. At the Central Level n Census and collection and publi-
n The Union Ministry of Health and cation of other statistical data.

Family Welfare. n Co-ordination with other states
n Directorate General of Health Services.

for promotion of health.
n Central Council of Health and Family
n Regulating labour in mines and
Welfare. oil mines.

n Immigration and emigration.
The Union Ministry of Health and Family (b)

Concurrent list:
Welfare
n Prevention of extension of commu-
Central list: International health:
(i) nicable diseases from one unit to
n
Port health research another.
n Technical and scientific education n Prevention of adulteration of food.
Functions of Union Ministry of Health and n Control drugs and poisons.
Family Welfare n Population control and family

planning.
Union list:
(a) n Economic and social planning.
n International health relations; n Administration of ports other
administration of port quarantine. than major.
n Administration of central institutes. n Labour welfare.
Directorate General of Health Functions of Central Council of Health and

Services (DGHS) Family Welfare
Functions of Directorate General of Health (a) To consider and recommend broad
C outlines of policy with regard to matters
Services
H of health, such as:
A
n General functions
n Surveys n Provision of remedial and preven-
P
n Planning tive care.
T
n Co-ordination n Environment hygiene
E
n Programming n Nutrition
R n Health education
n Appraisal of all health matters
3 n Specific Functions n Promotion of facilities for training
n International health relations and research.

Organization and Administration of Health Services in India
n Control of drug standards

(b) To make proposals for legislation in
n Medical store depots
the fields of medical and public health
n Post-graduate training
matters and to lie down.
n Medical education
(c) To make recommendations to the central
n Medical research
government regarding the health.
n Central government health schemes
(d) To establish any organization with
n National health programmes
appropriate functions for promoting
n Central health education bureau
and maintaining co-operation between
n Health intelligence
central and state health administrations.
The Central Council of Health and
2. At the State Level
Family Welfare
The central council of health was set up by the History
presidential order on 9th August, 1952 under This started from the year 1919, when the states
article 263 of the constitution of India for (then known as provinces) obtained autonomy,
promoting co-ordinated and concerted action from the central government, in matters of
between the centre and the state for the imple- public health. This was the first milestone in
mentation of all the programmes and measures state health organization. By 1921–22, all the
pirating to the health of the nation. The Union states had created some form of public health
Health minister is the chairman and the State organization.
Health ministers are the members.
Organization and Administration of Health Services in India 17
The State List n Major functions of the secretariat includes:

The Government of India Act, 1935 gave further l Formulation, review and modifi-
autonomy to the states. The health subjects cation of board policy outlines.
were divided into 3 lists under the 7th schedule l Execution of policies programs etc. C
of the India the constitution. They are: l Co-ordination with government of H
India and other state governments. A
(i) The Union list
l Control for smooth and efficient P
(ii) The State list
functioning of administrative T
(iii) The Concurrent list
machinery. E
Functions under State List R
State Health Directorate and Family Welfare
n Public health sanitation, hospitals and
n Principle advisor in matters relating to 3
dispensaries.
n Local government, that is, the constitutions
medicine and public health.

and powers of municipal corporations, n Assisted by joint director, regional joint
district boards, mining settlement, director and assistant directors.

authorities for the purpose of local self- Functions of state health directorate
government of village administration. n Providing curative and preventive
n Intoxicating liquors that is production, services.
manufacture, possession, transport, n Provision for control of milk and food
purchase and sale of intoxicating liquors. sanitation.
n Relief of the disabled and unemployable. n Assumes for total responsibility for
n Burials and burial grounds, cremation taking all steps in the prevention of any
grounds. outbreak of communicable diseases,
n Markets and fairs. especially during festivals and special
seasons.
State Health Administration n Establishment and maintenance of
n State Ministry of Health and Family central laboratories for preparation of
Welfare. vaccines, etc.
n State Health Directorate and Family n Promotion of health education.
Welfare. n Collection, tabulation and publication
State Ministry of Health and Family Welfare of vital statistics.

n Apart from governmental actions, it
l Headed: Cabinet minister and deputy
will be organized by State Nursing
minister (Political head).
Councils and Universities. Functions of
n Responsibility: Formulating policies.
University are: organize the courses, plan
n Monitoring the implementation of
for the examinations, setting question
these policies and programmes.
papers, planning the examination date
n The health secretariat: Is the official
and plan for the curriculum.
organ of the state ministry of health.
3. At the District Level District Health Organization

n Most districts in India are divided into
n Principal unit of administration in
two or more sub-division (in-charge is
C India.
assistant collector or sub-collector).
H n District health organization identifies and
n Each division is again divided into
A provides the needs of expanding rural
tehsils (talukas), in-charge is a Tehsildar.
P health and family welfare programme.
n A tehsil usually comprises between
T n Within each district again, there are
200–600 villages.
E 6 types of administrative areas.
R n No uniform model of district health
organization.
3
District
Rural Urban
Community Sub-Division Corporations

Development Blocks
Tahsil (Taluka)
Villages Municipal Boards
Panchayats Town Area Committees
FIG. 3.1: District Health Organization
Panchayati Raj n The nyaya panchayat

The Panchayati Raj is a 3-tier structure of rural n The gram sabha: It is comprised of all
local self-government in India, linking the the adult men and women of the village.
village to the district. The 3 institutions are: This body meets at least twice in a year
and discusses important issues. They
(i) Panchayat: At the village level.
elect members of panchayat.
(ii) Panchayat Samiti: At the block level.
n The gram panchayat: Consists of 15–
(iii) Zila Parishad: At the district level.
30 elected members.
(i) At the village level n Covers the population of 5000–20000.
This consists of: n Chaired by the president i.e. Sarpanch/
n The gram sabha Mukhiya/Sabhapati.

n The gram panchayat n There is a vice-president and a secretary.
n Responsible for overall planning and n Representatives of women, SC/ST,

development of the villages. two persons who have experience
n The panchayat secretary has been given in administration, rural develop-
powers to functions for wide areas, such ment officer etc. C
as maintenance of sanitation and public H
health, socio-economic development
of the villages etc.
PLANNING AND ORGANIZING A
P
n The nyaya panchayat: It is comprised of NURSING SERVICES AT
T
5 members from the panchayat. It tries VARIOUS LEVELS: NATIONAL, E
to solve the dispute between two parties/ STATE AND DISTRICT R
groups/individuals over certain matters
on mutual consent. Placement of Nurses in the 3
(ii) At the block level Healthcare Organization

It is known as Panchayat Samiti: A high power committee on nursing and nursing
n Members of panchayat samiti are: profession was set up by the Government of
l Sarpanches from all the gram India in July, 1987, under the chairmanship of
panchayats in the block. Smt. Sarojini Varadappan, an eminent social
l MLAs and MPs residing in the area. worker and former chairperson of Central
l Representative of women, schedule Social Welfare Board with Smt. Rajkumari Sood,
castes, schedule tribes and co- Nursing Advisor to Government of India, as
operative societies. the member secretary. The terms of reference
n The funds for the development activities of the committee were as follows:
are processed through panchayat samiti. 1. Looking into the existing working condi-
n The block development officer is the ex- tions of nurses with particular reference
officio secretary of the panchayat samiti. to the status of the nursing care services,
n The panchayat samiti is responsible both in the rural and urban areas.
for the block developmental activities 2. To study and recommend the staffing
under the community development norms necessary for providing adequate
programme. nursing personnel to give the best
(iii) At the district level possible care, both in the hospitals and
n The panchayati raj institution at the community.
district level is known as Zila Parishad. 3. To look into the training of all categories,
n It is headed by the chairman, also known levels of nursing, midwifery personnel
as Adhikshak. to meet the nursing manpower needs at
n It includes the following members: all levels of health service and education.
l The heads of all the gram samiti in 4. To study and clarify the role of nursing
the district, MLA and MPs from personnel in the healthcare delivery
the district. system including their interaction with
other members of the health team at every the committee will hold consultations
level of health services management. with the state governments.
5. To examine the need for organization
The findings of this committee give a grim
C of the nursing services at the national,
state, district and lower levels with picture of the existing working condition of
H
particular reference to the need for nurses, staffing norms for providing adequate
A
planning, implementing the compre- nursing personnel and education of nursing
P
hensive nursing care services with the personnel to meet the nursing manpower needs
T
overall healthcare system of the country at all levels and the role of nursing personnel in
E the healthcare delivery system. Their recommen-
at their respective levels.
R 6. To look into all other aspects which the dations on the organization of nursing services
3 committee may consider relevant with at central, state and district levels and the
reference to their terms of reference. norms of nursing service and education are
7. While considering the various issues given below:

under the above norms of reference,
Directorate General of Health Services (DGHS)
Central Level
Addl DDG (Public Health) Addl DDG (Nursing) Addl DDG (Medical)
State Level
ADG (Community ADG (Nursing Education ADG (Hospital
Nursing Services) and Research) Nursing Services)
District Public Health Nurse Ofcer Principal Nursing Superintendent
Public Health Nurse Supervisor Vice-Principal Deputy Nursing Superintendent

District Level
Public Health Nurse Lecturer/Senior Tutor Assisstant Nursing Superintendent
Lady Health Visitor Tutor Ward Sister
Auxiliary Nurse Midwifery Clinical Instructor Staff Nurse
FIG. 3.2: Placement of Nurses at the Central, State and District Level
Note: At central level: Directorate General of Health Services (DGHS) and Additional Deputy Directorate General of Health
Services (Addl DDG).
At state level: Assistant Directorate General of Health Services (ADG) (Nursing Services) in Community, Education and
Hospital settings.
3. Ensure equitable access to health services

NATIONAL HEALTH POLICY, 2000
across the social and geographical expanse
The Ministry of Health and Family Welfare, of the country.
Government of India, evolved a National 4. Primacy will be given to preventive and C
Health Policy in 1983, keeping in view the first line curative initiatives at primary H
national commitment to attain the goal of health level. A
health for all by the year 2000. 5. Focus on those diseases, which are P
principally contributing to disease T
Main Objectives burden, such as TB, HIV/AIDS, E
1. To achieve and acceptable standard Malaria, Blindness etc. R
of good health among the general 6. Emphasis will be laid on rational use
3
population of the country. of drugs within the allopathic system.

2. The approach would be increase access
to decentralize public health system Goals
by establishing new infrastructure in
the existing institutes.
S. No. Goals By the Year to
be Achieved
1. Eliminate Lymphatic Filariasis. 2015
2. Eliminate Kala-Azar. 2010
3. Eliminate malaria and vector and water borne diseases. 2010
4. Reduce prevalence of blindness to 0.5 per cent. 2010
5. Reduce IMR to 30/1000 and MMR to 100/1 Lakh. 2010
6. Increase utilization of public health facilities from current level of <20–>75 per cent. 2010
7. Increase health expenditure by government as a per cent of GDP from the 2010
existing 0.9–2 per cent.
8. Increase share of central grants to constitute at least 25 per cent of total 2010
health spending.
9. Further increase to 8 per cent of the budget. 2010
10. Achieve zero level growth of HIV/AIDS. 2007
11. Eradicate Polio and Yaws. 2005
12. Eliminate Leprosy.
13. Establish an integrated system of surveillance, National health accounts 2005
and health statistics.
14. Increase state sector health spending from 5.5–7 per cent of the budget. 2005
womb to tomb and continuing in the state of

HEALTH CARE DELIVERY
health as well as disease.”
SYSTEM IN INDIA
C
Definition Model of Health Care System
H
According to World Health Organization, Health Status or Health Problems
A
P “Health Care Delivery System is an integrated An assessment of the health status and health
T care containing promotive, preventive and problems is the first requisite for any planned
E curative elements that bear the longitudinal effort to develop health care services. This is
R association with an individual, extending from also known as Community Diagnosis. The data
3
Inputs Health Care Services Health Care System Outputs
Health Status or
Health Problems Curative, Public,
Preventive Private, Changes in
and Voluntary and Health Status
Resources Promotive Indigenous
FIG. 3.3: Placement of Nurses at the Central, State and District Level
required for analyzing the health situation and Health Problems of India
for defining the health problems comprise the
following: Indirectly Related Directly Affecting
to Health Health
1. Morbidity and mortality statistics.
Environmental Diseases:
2. Demographic conditions of the Communicable
population. Non-communicable
New Emerging
3. Environmental conditions which have
a bearing on health. Education Fertility:
4. Socio-economic factors which have a Population
Growth Rate
direct effect on health.
Total Fertility
5. Cultural background, attitudes, beliefs
and practices which affect health. Empowerment Nutrition:
6. Medical and health services available. Mal-nutrition
Obesity
7. Other services available.
FIG. 3.4: Health Problem in India

Resources n It constitutes the management sector

The basic resources for providing health care and involves organizational matters.
are: n It operates in the context of the socio-
economic and political framework of C
the country. H
Health Money and Time
n In India, the health care system is A
Manpower Material represented by five major sectors/ P
agencies: T
FIG. 3.5: Resources E
Public Health R
Sector
Health Care Services 3
n The purpose of health care services

is to improve the health status of the National Private
Health Health Sector
population. Programmes Care
n The goals to be achieved have been fixed Systems
in terms of mortality and morbidity
reduction, increase in expectation of life, Voluntary Indigenous
decrease in population growth rate, Health System of
improvements in nutritional status, Agencies Medicine
provision of basic sanitation, health
manpower requirements and resources FIG. 3.6: Health Care Systems
development and certain other para-
metres, such as food production, literacy
rate, reduced level of poverty etc. Public Health Sector
n The health care services should be:
Public Health Sector consists of:
l Comprehensive
Primary Health Care: Involves Primary
(a)
l Accessible
Health Centres and Sub-Centres.
l Acceptable
Hospitals/Health Centres: Involves
(b)
l Provide scope for community
Community Health Centres, Rural
participation.
Hospitals, District Hospitals/Health
l Available at a cost community and
Centres, Specialist Hospitals and
country can afford.
Teaching Hospitals.
Health Care Systems Health Insurance Schemes: Involves
(c)
Employee State Insurance, Central
n The health care system is intended to
Government Health Scheme.
deliver the health care services.
(d) Other Agencies: Involves Defence of health resources i.e. health care must penetrate
Services and Railways. into the farthest reaches of rural areas and
Private Sector everyone should have access to them. To imple-
C ment this policy at village level, the following
H
Private Sector consists of:
schemes are in operation:
A (a) Private hospitals, polyclinics, nursing
1. Village Health Guides Scheme
P homes and dispensaries.
2. Training of Local Dais
T (b) General practitioners and clinics.
3. ICDS Scheme
E Indigenous System of Medicine 4. ASHA Scheme
R Indigenous System of Medicine consists of
1. Village Health Guides Scheme
3 AYUSH and Unregistered practitioners.
n The Village Health Guides Scheme
was introduced in 1977 with the idea

HEALTH CARE DELIVERY SYSTEM of securing people’s participation in the
1. In 1977, the Government of India care of their own health.
launched a Rural Health Scheme based n The Village Health Guide serves as a
on the principle of “placing people’s link between the community and the
health in people’s hands”. government infrastructure.
2. It is three-tier system of health care n They provide the first contact between
delivery in rural areas, based on the the individual and the health system.
recommendations of the Srivastava n The guidelines for the selection of
Committee in 1975. Village Health Guide:
4. Keeping in view the WHO goal of l They should be permanent residents
“Health for All” by 2000, the Govern- of the local community, preferably
ment of India evolved a National women.
Health Policy, based on primary health l They should be able to read and
care approach in 1983. write, having minimum formal
5. Further development of rural health education at least upto the VI
infrastructure took place in view to standard.
implement National Health Policy, l They should be acceptable to all
National Population Policy and more sections of the community.
recently National Health Mission with l They should be able to spare
formulation of Indian Public Health at least 2–3 hours everyday for
Standards. community health work.
Village Level n After selection, the Health Guides

undergo a short training of 3 months
One of the basic tenets of primary health care in primary health care.
is universal coverage and equitable distribution
n The duties assigned to health guides 3. ICDS Scheme

include treatment of simple ailments n Under the Integrated Child Develop-
and activities in first-aid, maternal and ment Scheme, there is an Anganwadi
child health including family planning, worker for a population of 1000. C
health education and sanitation. n The Anganwadi worker is selected from H
n The national target is to achieve 1 health
the community, she is expected to serve. A
guide for each village or 1000 rural n The Anganwadi worker undergoes P
population. training in various aspects of health, T
2. Training of Local Dais nutrition and child development for E

4 months. R
n An extensive programme has been n The services rendered by Anganwadi
undertaken, under the Rural Health 3
worker include maintenance of growth
Scheme, to train all categories of local

chart, immunization, supplementary
dais (Traditional Birth Attendants) nutrition, health education, non-formal
for 30 working days in the country preschool education and referral services.
to improve their knowledge in the n The beneficiaries are especially nurs-
elementary concepts of maternal and ing mothers, pregnant women, other
child health and sterilization, besides women (15–45 years), children below
obstetric skills. the age of 6 years and adolescent girls.
n Training is given at PHC/Sub-centre
or MCH centre for 2 days in a week 4. ASHA Scheme
and on the remaining four days, they n The main aim of National Rural Health
accompany the health workers to the Mission is to provide accessible,
villages preferably in the dai’s own area. affordable, accountable, effective
n During the training period, each dai is
and reliable primary health care and
required to conduct at least 2 deliveries bridging the gap in rural health care
under the guidance and supervision of through creation of a cadre of Accredited
the health workers. Social Health Activist (ASHA).
n The emphasis during training is on asepsis
n The guidelines for the selection
so that home deliveries are conducted of ASHA:
under safe hygienic conditions, there-
l Must be resident of the village.
by reducing the maternal and infant
l A woman (married/widow/
mortality.
divorced) preferably in the age
n After successful completion of training,
group of 25–45 years with formal
each dai is provided with a delivery kit
education upto 8th standard, having
and a certificate.
communication skills and leader-
n The national target is to train 1 local dai
ship qualities.
in each village.
n The general norm of selection will be Responsibilities of ASHA Worker

one ASHA for 1000 population. The ASHA will be a health activist in the
community, who will create awareness on health.
C
H
Create Awareness and Provide Information to the Community on
A Determinants of Health
P
T Counsel Women on Birth Preparedness, Importance of Safe
Delivery, Breastfeeding and Complementary Feeding,
E Contraception and Prevention of Sexually Transmitted Diseases/
R Reproductive Tract Diseases and Care of the Young Child
3 Mobilize the Community in Accessing Health and Health Related

Services Available at Anganwadi/Sub-Centre/PHC
Work with the Village Health and Sanitation Committee of the Gram
Panchayat to Develop a Comprehensive Village Health Plan
Accompany Pregnant Women and Children Requiring Treatment/

Admission to the Nearest Pre-Identied Health Facility.
Provide Primary Medical Care for Minor Ailments
Provider of DOTS under Revised National Tuberculosis Control

Programme
Act as a Depot Holder for Essential Provisions being Made Available

to Every Habitat like Folic Acid Tablet, Oral Rehydration Therapy etc.
Inform About the Births and Deaths and any Unusual Health
Problems/Disease Outbreaks in the Community to the
Sub-Centre/PHC
Promote Construction of Household Toilets under Total Sanitation

Campaign
FIG. 3.7: Responsibilities of ASHA Worker
Sub-Centre Level n Most peripheral and first contact point

between the primary health care system
n The Sub-Centre is the peripheral and the community.
outpost of the existing health delivery
system in rural areas.
n Manned by at least 1 ANM/Female Centre Plain Hilly/Tribal/

Health Worker and 1 Male Health Area Difficult Area
Worker. Community Health Centre 1,20,000 80,000
n Under NRHM, one additional second Primary Health Centre 30,000 20,000 C
ANM on contract basis. Sub-Centre 5,000 3,000 H
n Provide services in relation to maternal A
and child health, family welfare, nutrition, n According to Indian Public Health
P
immunization and control of communi- Standards for Sub-Centres, the following T
cable diseases. services are being prescribed to provide
E
n Ministry of Health and Family Welfare
basic promotive, preventive and few
R
is providing 100 per cent Central curative primary health care services to
assistance to all the Sub-Centre’s. the community and achieve an acceptable 3
standard of quality of care:

Maternal Health Care
Child Health Care
Family Planning and Contraception
Counseling and Appropriate Referral for Safe Abortion Service
Adolescent Health Care
Assistance to School Health Services
Water Quality Monitroing
Promotion of Sanitation Including Use of Toilet and Appropriate

Garbage Disposal
Field Visits by Appropriate Health Workers for Disease Surveillance

and Family Welfare Services
Community Need Assessment
Curative Services for Minor Ailments
Training of Traditional Birth Attendants and ASHA/Community

Health Volunteers
Co-ordinate Services of Anganwadi Workers, ASHA, Village

Health and Sanitation Committee etc.
National Health Programmes
FIG. 3.8: Sub-Centre Level

Primary Health Centre Level universally accessible to individuals and accept-

able to them, through their full participation
Primary Health Care and at a cost the community and the country
C The Alma-Ata Conference has defined “Primary can afford”.
H Health Care is essential health care made Elements of Primary Health Care
A
P
T Health Education
E Nutrition
R
Water and Sanitation
3
Maternal and Child Health
Immunization
Prevention of Endemic Diseases
Treatment
Drug Availability
FIG. 3.9: Elements of Primary Health Care
Principles of Primary Health Care integrated curative and preventive

n The Bhore Committee, in 1946, gave health care to the rural population with
the concept of primary health centre emphasis on preventive and promotive
as a basic health unit, to provide an aspects of health care.
Equitable Community Appropriate Focus on Multi-Sectoral

Distribution Participation Technology Prevention Co-Ordination
FIG. 3.10: Principles of Primary Health Care

n The National Health Plan (1983) n Established and maintained by the State
proposed reorganization of primary Governments under the Minimum
health centres on the basis of one PHC Need Programme.
for every 30,0000 rural population n Manned by a Medical Officer supported C
in the plains, and one PHC for every by 14 paramedical and other staff. H
20,000 population in hilly, tribal and n NRHM two additional Staff Nurses at A
backward areas for more effective PHCs (contractual). P
coverage. n It acts as a referral unit for 6 Sub-Centre’s T
n First contact point between village and has 4–6 beds for patients. E
community and the Medical Officer. R
3

Community Health Centre (CHC): A 30 Bedded Hospital/Referral Unit
for 4 PHCs with Specialized Services
Primary Health Centre (PHC): A Referral Unit for 6 Sub-Centre 4–6 Bedded
manned with a Medical Ofcer Incharge and 14 Subordinate Paramedical Staff
Sub-Centre (SC: Most Peripheral Contact Point Between Primary Health

Care System and Community Manned with One HW (F)/ANM and One HW(M)
FIG. 3.11: Primary Health Care
According to Indian Public Health Standards n To make the services more responsive
for PHCs, the objectives for PHCs are: and sensitive to the needs of the
n To provide comprehensive primary community.
health care to the community through According to Indian Public Health Standards
the Primary Health Centres. for Public Health Centres, the following services
n To achieve and maintain an acceptable are being prescribed to provide basic promotive,
standard of quality of care. preventive and curative primary health care
services to the community and achieve an

acceptable standard of quality of care:
C
Medical Care
H
A Maternal and Child Health Care
P
Family Planning and Contraception
T
E Counselling and Appropriate Referral for Safe Abortion Service
R
3
Assistance to School Health Services
Water Quality Monitroing
Promotion of Sanitation Including Use of Toilet and Appropriate

Garbage Disposal
Field Visits by Appropriate Health Workers for Disease Surveillance

and Family Welfare Services
Community Need Assessment
Curative Services for Minor Ailments
Training of Traditional Birth Attendants and ASHA/Community

Health Volunteers
Co-ordinate Services of Anganwadi Workers, ASHA, Village

Health and Sanitation Committee etc.
Collection and Reporting of Vital Events
Basic Laboratory Services
Monitoring and Supervision
Selected Surgical Procedures
Mainstreaming of AYUSH
FIG. 3.12: Primary Health Centre

Community Health Centre Level n It has 30 indoor beds with 1 OT,

X-ray, Labour Room and Laboratory
n Established and maintained by the facilities.
State Government under Minimum n It serves as a referral centre for 4 PHCs C
Need Programme. and also provides facilities for obstetric H
n Each CHC covers a population of care and specialist consultations. A
80,000–1.20 lakh. n According to Indian Public Health P
n As per minimum norms, a CHC is Standards for CHCs, the following T
required to be manned by four Medical services are being prescribed to provide E
Specialists i.e. Surgeon, Physician, optimal expert care to the community R
Gynecologist and Pediatrician supported and achieve an acceptable standard of
by 21 paramedical and other staff. quality of care: 3

Care of Routine and Emergency Cases in Surgery
Care of Routine and Emergency Cases in Medicine
24 hours Delivery Services Including Normal and Assisted Deliveries
Essential and Emergency Obstetric Care
Full Range of Family Planning Services
Safe Abortion Service
Newborn Care
Routine and Emergency Care of Sick Children
Other Management Including Nasal Packing, Tracheostomy etc.
Blood Storage Facility
Essential Laboratory Services
Referral (Transport) Services
FIG. 3.13: Community Health Centre Level

n Medical termination of pregnancy.

HEALTH TEAM CONCEPT
n Nutrition
Definition n Prevention, control of communicable

C and non-communicable diseases.
H Health Team has been defined as “a group of
n Dai training.
persons who share a common health goal and
A n Registration of vital events.
common objectives, determined by community
P n Maintenance of records.
needs and towards the achievement of which each
T n Provision of primary medical records.
member of the team contributes in accordance
E n Team activities.
with his/her competence and skills and respecting
R n To conduct survey.
the functions of the other”.
n Organization and implementation of
3 Or
immunization programme.
Health team is a group of people working
n Identification of reports about com-
together for common goal in order to provide

municable diseases.
preventive, promotive, curative, rehabilitative,
n To provide control services.
restorative services to the individual, family
n Follow up/referrals.
and community:
n Guiding the health workers for planning
n The health team concept has taken programmes.
a firm root in the delivery of health n Conducting group meetings.
services, both in the developing and n Organization of health programmes.
developed countries. n Supervision and guidance.
n The health team approach aims to n Team work
produce the right ‘mix’ of health personnel n Supplies, equipment and maintenance.
for providing full health coverage of the n Training and supervision.
entire population. n Primary medical care.
n The auxiliary is an essential member n Continuing education.
of the team. n Co-operate activities within the team
n The team must have a leader. The members and village persons.
leader should be able to evaluate the n Home visiting.
team adequately and should know n Administration in primary and sub-
the motivations of each member in centres and districts levels.
order to stimulate and enhance their n Education
potentialities.
l Orientation
l In-service education.
Functions of Health Team l Dai training.
n Maternal and child health activities. l Training of student nurses.
n Family planning.
n Team will work together for achieving n Encourages in community involvement

their objectives. and decision-making.
n Records and reports. n Conducting laboratory investigations
n Provision of school health services. and procedures. C
n Educates about environmental sanita- H
tion. Characteristics of Effective Health A
Team P
T
E
R
Proper Leadership and Condence in the Leader
3
Clarity of Health Targets

Full Knowledge of Objectives Among the Health Team
High but Achievable and Measurable Objectives
Clear Knowledge of Work and Role
Team should Relate Welfare and Professional Progress
Maximum Utilization of Skill and Knowledge of Members
Members should be Qualied Enough to Achieve Objectives
Clear Open and Effective Communication
Clear Denition of Priorities
Co-operation and Co-ordination Among Members
Resolves Conicts and Problems by Team Problem-Solving Techniques
Having a Time Table/Schedule
Evaluation of Results from Time-To-Time
FIG. 3.14: Characteristics of Effective Health Team

profession within the organization. Chief

ROLES AND RESPONSIBILITIES
Nursing Officer 1:500 beds.
OF NURSING PERSONNEL IN
Educational Qualifications and Experience
C HOSPITAL, COMMUNITY AND
(i) General: As prescribed for staff nurse.
H EDUCATIONAL SETTINGS (ii) Professionals: M.Sc. Nursing or
A
Organization of Nursing Services equivalent Master degree in Nursing
P
recognized by INC.
T in Hospital Settings Or
E
B.Sc. or equivalent degree in Nursing
R
Chief Nursing Ofcer
recognized by INC.
3 Registration: Registered with State
(iii)
Nursing Council.
Nursing Superintendent
(iv) Experience: Should have minimum

15 years experience in nursing service
Deputy Nursing Superintendent
of which 5 years in administration
and education/as Assistant Director
Assistant Nursing Superintendent
of Nursing or 3 years as a Director of
Nursing.
Ward Sister
(v) Standard norms: As per Indian Nursing
Council.
Staff Nurse
Skills
FIG. 3.15: Organization Services in Hospital n To advice the Ministry of Health on all
nursing matters and provides leadership
for the nursing profession in order to
1. Chief Nursing Officer (CNO) achieve the highest standard of nursing
service and education.
A CNO is the head of the nursing department
n Understands national nursing issues.
and in-charge of developing programs, policies
n Understands the process of policy
and procedures to ensure high quality patient
formulation and implementation.
care. She is accountable for creating a nursing
environment, which is based on excellent clinical Behaviours and Qualities
care services, education and supported by research n Inclination for policy and regulatory work.
knowledge and evidence based practices. The n Good team facilitating skills.
duty of the CNO is to work towards the constant n Ability to gain the respect of nursing
enhancement and advancement of the Nursing leaders in the public and private sector.
Duties and Responsibilities Related to

Nursing Services
C
Planning Directing Controlling Evaluating Co-Coordinating H
A
P
FIG. 3.16: Duties and Responsibilities Related to Nursing Services T
E
R
Planning for n Number of patients.
n Kinds and amounts of equip-
3
(i) An organization of nursing services
which provides for effective functioning ment and the effect of the

of all nursing service personnel: physical plan on the nursing
(a) Define lines of authority and areas workload.
of responsibility. (b) Determine nursing service activities
(b) Delegate responsibility and authority consistent with sound utilization
consistent with position assign- of personnel and accepted nursing
ment. practice.
(ii) Appropriate numbers and categories of (c) Establish quantitative standards
personnel to meet nursing needs: of nursing care to patients.
(d) Analyze personnel abilities in the
(a) Analyze with personnel concerned, light of activities to be performed.
nursing service needs of all areas, in
which nursing service personnel (iii) Promotion of the personal and pro-
are assigned and considering: fessional growth of all nursing service
n Plan of medical therapy.
employees:
n Physical, emotional, rehabili- (a) Provide for and participate; in
tative and teaching needs of education and training programs
patients. for all professional and non-pro-
n Length of stay of patients. fessional nursing service personnel.
n Post-hospital needs of patient. (b) Provide for:
n Nursing service responsibility n Counseling and guidance
for assisting in medical research programs.
programs and orientation of n Regularly scheduled group
medical personnel. conferences.
n Preparation and abilities of n Special committees and work
nursing service personnel. groups.
(c) Provide opportunity for addi- (ii) Establishing channels of communica-

tional experience and encourage tions and means for reporting nursing
advances study. service activities:
C
Directing by (a) Devise a systematic plan for dis-
H
Utilizing sound personnel management practices seminate of information up and
A down the nursing service organi-
in administering the nursing service:
P zation.
T (i) Select for employment qualified profes-
(b) Participate in inter-divisional and
E
sional and non-professional personnel.
intra-divisional planning for
(ii) Provide for assignment of personnel on
R effective communications which
the basis of qualifications and ability.
3 affect nursing service, including
(iii) Provide professional nurse supervision
communications; with regional
of personnel which promotes develop-
office clinics and community

ment to their highest potential and
nursing agencies.
which contributes to efficiency and
(c) Prepare comprehensive reports
economy in providing nursing care.
on all phases of nursing service.
(iv) Establish performance requirements
for all the employees which permit: Co-ordinating by
(a) Identification of substandard Inter-relating nursing service activities with all
performance and form the basis other hospital services:
for appropriate action. (i) With services concerned, develop work-
(b) Identification of outstanding ing arrangements which are mutually
performance and form the basis for acceptable and which facilitate operational
recognition and reward. activities in providing nursing care.
Controlling by (ii) Establish and maintain co-operative
relationships with all hospital services.
(i) Planning budgetary requests for nursing
service and participating in planning for Evaluating by
equipment and supplies, which affect Conducting continuous review and analysis of
nursing service programs: nursing service programs:
(a) Submit budgetary estimate for (i) Initiate studies of local problems in nursing
nursing service personnel. service activities and co-ordinate plans
(b) With appropriate personnel, parti- of action for their execution.
cipate in budgetary planning for (ii) Interpret findings of studies and initiate
equipment and supplies, which appropriate actions.
increase efficiency and economy (iii) Review functions of nursing service
of nursing service activities. personnel to determine whether or
not they are consistent with changes in Educational Qualifications and Experience
therapeutic programs and professional (i) General: As prescribed for staff nurse.
practices. (ii) Professionals: M.Sc. Nursing or
Major Responsibilities equivalent Master degree in Nursing C
recognized by INC. H
(i) Overall administration of the department
Or A
of the nursing.
(ii) Assistance to the hospital administrator: B.Sc. or equivalent degree in Nursing P
recognized by INC. T
(a) Direct reporting about patients (iii) Registration: Registered with State E
and her departmental activities Nursing Council. R
(b) Responsibility for delegated tasks (iv) Experience: Should have minimum
in her absence 3
15 years experience in nursing services
(iii) Intra-departmental “TOP-LEVEL” decision of which 5 years in administration and

maker and describer of jobs of nursing education.
personnel. (v) Standard norms: As per Indian Nursing
(iv) Inter-departmental “TOP-LEVEL” rela- Council.
tionships: Functions
(a) Morale setter. Supervising nursing staff
(b) Determiner of boundary lines of (i) The top priority of a Nursing Superin-
departmental responsibility. tendent is to ensure that the nursing
(v) Personnel administration: staff members are providing the best
(a) Appointment care to the patients.
(b) Evaluation (ii) She makes sure that individual nurses
(c) Problem-solving and nurses aids are carrying out care
(d) Staff development plans and ensures that communication
between shifts happens smoothly and
2. Nursing Superintendent thoroughly.
The Nursing Superintendent, who is also called (iii) The Superintendent also monitors
the Director of Nursing, is responsible for the stock and supplies to make sure that
running and supervision of a nursing department. nurses have the equipment, they need
Depending on the size of the facility, she may to provide quality care.
control subsidiary departments, such as house- Overseed hiring and training
keeping. Nursing Superintendents generally (i) The Nursing Superintendent is respon-
report to the hospital director or medical director sible for the hiring and training of new
of their facility. Nursing Superintendent 1:300 staff.
beds (wherever beds are over 200).
(ii) She must search for nurses that comple- (ii) In extreme cases like patient abuse
ment the existing team, design training or staff coming to work under the
programs and make sure that nursing influence, the Nursing Superintendent
C instructors and trainers are adequately is responsible for terminating contracts,
H preparing new staff for the workplace. as needed.
A (iii) Often this includes hearing an evalua- Manage other department
P tion of new nurses from the floor staff (i) In a large facility, the Nursing Superin-
T during the training period. tendent may be responsible for directing
E Patient care the activities of the housekeeping, linen
R (i) Although the nursing superintendent and kitchen facilities.
3 does not have a high level of direct (ii) She must handle any problems that arise,
patient care, she is responsible for the communicate with department leaders
well-being of patients at the facility. and address any supply issues.

This means that the superintendent Negotiate with vendors
must monitor nurses’ care and the (i) Because the Nursing Superintendent is
attitude and health of the patients. responsible for the supply of equipment
(ii) In cases, where the family requests alter- and medical necessities, she often
nate care, the Nursing Superintendent negotiates with vendors for the new
must hear the request and make the contracts.
final decision. (ii) In large facilities, a purchasing manager
Create work schedules may handle these duties and report to
(i) Each pay period, the Nursing Superin- the Superintendent.
tendent is responsible for setting the work
schedules for the entire department. 3. Deputy Nursing Superintendent
(ii) She must take into account holidays, The Deputy Nursing Superintendent (in hospital
hear requests for time off, and create with =/< than 150 beds) is responsible to the Chief
a schedule that gives the appropriate Nursing Officer/Nursing Superintendent.
number of hours to each nurse. Educational Qualifications and Experience
(iii) As a part of the process, the Nursing
(i) General: As prescribed for staff nurse.
Superintendent assigns duties and
(ii) Professionals: M.Sc. Nursing or
responsibilities to each nurse.
equivalent Master degree in Nursing,
Make disciplinary action recognized by INC with 6 years experience,
(i) In situations where a nurse, nurse’s aid of which 3 years in administration.
or other staff member is involved in a Or
dispute, the Nursing Superintendent B.Sc. or equivalent degree in Nursing
must handle disciplinary actions. recognized by INC with 10 years total
professional experience.
Or (i) Planning and organizing nursing services

RN, RM with Diploma in Hospital in hospital
administration preferable with 10 years Deputy Nursing Superintendent will assist
experience in administration. the Nursing Superintendent on planning and C
Registration: Registered with State
(iii) organizing nursing services in the hospital for: H
Nursing Council. n
Preparing a philosophy and objectives for A
(iv) Experience: Should have about 10 years the nursing department in accordance P
experience in nursing service of which with those of the hospital. T
3 years in administration. n To see that all services areas are managed, E
(v) Standard norms: Since, it is the second as per their needs. R
level nursing supervisory role; it needs n Utilizing specially trained nurses in
at least the Deputy Nursing Superin- 3
that particular area only.
tendent for three Assistant Nursing

n Planning and putting up of proposals
Superintendents (1:3). to the authorities for increase of staff
Skills in different categories so as to fulfill the
(i) Responsible for developing and supervis- INC recommendations.
ing nursing services in order to achieve n Co-operating with the authorities
highest standard of nursing services. during emergencies in setting up special

(ii) Responsible for smooth management nursing squads, ward or any other
of the nursing services in the hospital machinery required.
at all times and every time. n Preparing an organizational chart showing
channels of communication.
Functions
(ii) General administration
n Assist the Nursing Superintendent in
Planning and Organizing
Nursing Services in Hospital framing policies, keeping within the
framework of government rules and
regulations.
Miscellaneous General n Interpreting and implementing the
Administration policies and procedure of the govern-
Functions ment body, the hospital and the INC
to sub-ordinate staff and others.
n Carrying out correspondence with the
Educational General Duties
Activities
hospital with nurses and others.
n Attending to the correspondence from
outside agencies and individuals.
n Submitting proposal for special equip-
FIG. 3.17: Functions
ments required for nursing services
giving specifications.
n Supervise the nursing care given to the adjustment in duty schedule, if found
patients in various departments by necessary.
taking regular rounds of her area. n Act as a liaison officer between Nursing
C n Preparing job descriptions, where none Superintendent and the nursing staff of
H are available and seeing that each staff the hospital.
A member gets one. n Receive evening and night reports from
P n Investigating complaints, preparing ANS/Supervisors.
T reports and taking disciplinary action n Conduct regular physical verification
E or recommending the same. of hospital stocks i.e. drugs, equip-
R n Preparing annual statistics and project- ments etc.
ing manpower needs. n Initiate procedure for condemnation and
3
n Handling grievances and solving procurement of hospital equipment/
problems frequently. linen etc.
n Holding departmental meetings allowing n Assist the nursing superintendent in

free exchange of ideas and reviewing making master duty roster of nursing
ward staffing. personnel.
n Guiding subordinate and delegating n Assist the nursing superintendent in
powers depending upon the person’s recruitment of nursing staff.
ability to carry out the responsibilities n Officiate in the absence of nursing
alongwith commensurate authority. superintendent.
n To see that ward procedure manual n Keep the senior nursing officials (CNO
(nursing procedure) is maintained in and NS) informed of the happenings
all wards. in the wards.
n Sanctioning or recommending leave to (iii) Educational activities
nursing personnel. n Assist in planning/organizing and
n Maintaining individual cumulative
implementing staff development
records of all nursing staff. programmes.
n Writing reports—annual report of nurs-
n Ensure clinical experience facilities for
ing department, confidential report of student nurses in various clinical areas
nursing staff etc. that may be required of the hospital.
to be submitted. n Provide guidance and counselling to
n Reading and analyzing daily reports of
nursing staff.
hospital situation. n Arrange orientation programmes for
n Making of a routine to have 6 monthly
new nursing staff.
or yearly health check-up for all nurses n Maintain discipline among nursing
and 6 weekly for those working in personnel.
Tuberculosis department, to enable
n
Organize educational programmes for n Any other activity concerned with the
graduate/post-graduate students from profession.
different hospitals with the co-ordina-
tion of clinical instructor/lecturer. 4. Assistant Nursing Superintendent C
n Encouraging, recommending interested Assistant Nursing Superintendent is responsible H
nurses to get further training and higher to the Deputy Nursing Superintendent/Nursing A
education. Superintendent. She/he is responsible for P
n Experimenting with newer duty and developing and supervising nursing services of T
staffing patterns. a department specific unit/floor consisting of E
(iv) General duties two or more wards or units managed by nursing R
n Escorts special visitors, NS, MS for
sisters. For every additional 50 beds, one more
Assistant Nursing Superintendent. 3
hospital rounds.
Educational Qualifications and Experience

n Arranges and participates in professional
and social functions of the staff and (i) General: As prescribed for staff nurse.
students. (ii) Professionals: M.Sc. Nursing or
n Maintains good public relations. equivalent Master degree in Nursing,
n Any other duties assigned to her from recognized by INC with 6 years experience,
time-to-time. of which 3 years in administration.
(v) Miscellaneous Or
n Giving leadership to the nursing B.Sc. or equivalent degree in Nursing,
department. recognized by INC with 10 years total
n Encouraging nursing personnel to professional experience.
become members of the professional Or
association. RN, RM with Diploma in Hospital
n Participating in meeting, workshop and administration preferable with 10 years
seminars of local, state or national level experience in administration.
and representing the profession. Registration: Registered with State
(iii)
n Proving counseling services to nursing Nursing Council.
personnel. (iv) Experience: Should have about 10 years
n Carrying out research or co-operating experience in nursing service of which
with others, who may be doing it. 3 years in administration.
Wards Staff Nurse : Patient Ward Sister : Bed ANS

Medical Ward 1:3 1 : 25 each shift 1 for 3–4 wards
Surgical Ward 1:3 1 : 25 each shift 1 for 3–4 wards
Orthopaedic Ward 1:3 1 : 25 each shift 1 for 3–4 wards
Paediatric Ward 1:3 1 : 25 each shift 1 for 3–4 wards
Contd.....
Wards Staff Nurse : Patient Ward Sister : Bed ANS

Gynaecology Ward 1:3 1 : 25 each shift 1 for 3–4 wards
Maternity Ward 1:3 1 : 25 each shift 1 for 3–4 wards
C Intensive Care Unit 1:1 1 each shift ANS for 3–4 units
H Coronary Care Unit 1:1 1 each shift -do-
A Nephrology Unit 1:1 1 each shift -do-
P Neurosurgery Unit 1:1 1 each shift -do-
T Special Wards, ENT and Eye etc. 1:1 1 each shift -do-
E Operation Theatre 3 for 24 hours per Table 1 ANS 4–5 OT
R Casualty and Emergency Unit 2–3 Depending on the 1 ANS
Number of Days
3
Line of Authority n Acts as Public Relations Officer of the

n Organize and plan nursing care activities unit and deal with the problems faced
of the departments, according to hospital by the Nursing Sister.
policies and service needs. n Keep the Deputy Nursing Superinten-
n Plan staffing pattern and other necessary dent’s/Nursing Superintendent’s Office

requirements of her/his department. informed of the needs of the Nursing
n Conduct and attend departmental Units/Ward under his/her charge of
and inter-departmental meetings and any special problems.
conferences from time-to-time. n Arrange classes and clinical teaching
n Look after the safety and general clean- of nursing students in the department
liness of the department. related to the speciality experiences.
n Look after general comforts of the n Implement the ward teaching programme
patients. and clinical experience of students with

n Evaluate the nature and quantum of the help of Tutors and Nursing Sisters.
care required in each unit/ward. n Counsel and guide staff and students.
n Plan ward management with the nursing n Arrange and conduct staff development
sister of each unit/ward. programme of the department.

n Re-enforce the principle of good ward n Update her/his knowledge and skills
management in each ward. by attending staff development and

n Help ward/unit nursing sister to procure continuing education programmes
their ward/unit supplies. time-to-time.
n Supervise the proper use and care n Encourage and participate in medical
of equipments and supplies in the and nursing research.

departments. n Accompany Deputy Nursing Superin-
tendent/Nursing Superintendent/
Director and Special visitors in the clinical and domestic staff, as the case may be.
department/unit. The main aim of the ward sister should be to
n Participate in various professional foster team spirit in her area of work.
activities, e.g. staff education, staff Educational Qualifications and Experience C
meetings etc. H
(i) General: As prescribed for staff nurse
n Act as liaison officer between the Nursing A
(i) Professionals: B.Sc. or equivalent
Superintendent and higher hospital P
degree in Nursing, recognized by INC
authorities. T
or RN, RM with Diploma in Hospital
n Carry out any other duties delegated by E
administration.
the Deputy Nursing Superintendent/ R
(i) Registration: Registered with State
Nursing Superintendent/Director.
n She will assist the Nursing Superintendent
Nursing Council. 3
(i) Experience: Should have about 5 years
for maintenance of cleanliness and

experience in nursing service as staff
general sanitation in the wards. She
nurse.
will make the roster duty of nursing
staff and will hold the nursing sisters Purposes
administrative work. She will make (i) To supervise staff nurse and their
rounds in all wards and see whether administration and to provide continuing
the wards staff is performing their responsibility for the management and
duties properly or not. leadership of a designated area by effective
n Sundays and Holidays—She/he is utilisation of staff and resources.
responsible for the call duties on (ii) Provide and maintain effective manage-
Sundays and Holidays. She will sign ment and leadership promoting a high
the night report and see that all the standard of safely delivered evidence
Nursing Staff are on duty as well as see based clinical care.
that all categories of staff are present (iii) Create and maintain effective commu-
on their duty hours. She has to attend nication within the multi-disciplinary
emergency call too. team.
n She has to do duty in Matron’s Office, (iv) Act as lead practitioner for specific
whenever required or needed. speciality/specialities co-ordinating
staff, resources and management skills
5. Ward Sister in an efficient manner, whilst providing
Ward Sister is responsible to the Assistant expert skilled assistance.
Nursing Superintendent for the management (v) Demonstrate the ability to manage
of the wards and supervisions of the nursing or delegate the duties effectively and
and domestic staff. She would be assisted in efficiently meeting the service require-
carrying out the following duties by staff nurse ments.
Roles and Responsibilities n Making list for condemnation of articles

Administration and supervision and submitting it to the concerned
n To be able to manage own workload
authorities.
C n Delegate the responsibility for ordering
alongwith that of others, by ensuring
H and the maintenance of specific stock
appropriate delegation of their skills
A and capabilities. levels in her absence.
P n Maintaining plans for maintaining
n Writing out the weekly duty schedule.
T discipline in the ward. n Promoting high staff morale by inspiring
E n Manage the daily ward routine ensuring
a shared vision and common goal.
R effective time management. n Promote and practice effective forms of
n Define levels of responsibility and role

communication between the patient,
3
boundaries of junior staff, providing their family and all other healthcare
professionals.
adequate opportunities for them to

develop their roles. n Participate in and manage team meetings,
n Improve service provided by updating

promoting and maintaining effective
and implementing new practices and communications between all staff
products in accordance with institutional members and departmental.
guidelines. n Ensure accurate and adequate record
n To initiate and take responsibility for

keeping alongwith maintaining confi-
the reporting of critical incidents and dentiality at all times.
complaints, ensuring action is taken n Supervise the cleanliness of the ward
and the process is communicated and laundry work.

appropriately. n Ensure all faults are reported and rectified
n Writing confidential report of staff

effectively and efficiently.
nurses. n Act as a liaison between ward staff and
n Demonstrate the ability to contribute to

administration.
and challenge current practice, by actively Clinical professional responsibilities
promoting change, along with acting as n Ensure all equipment and resources
a change agent, where required. are available to perform procedures
n Maintaining inventory of the consum- according to the individual needs of
able, non-consumable items and ensuring the patient.
uninterrupted supply of materials by n Participate as a specialist practitioner
timely indent and maintaining stocks. with regard to patient care.
n Manage ordering, stock levels and n Be acquainted with the physical condi-
be responsible for safe handling and tions of patients and any special nursing
storage of all drugs in accordance with problems and see that patients receive
institutional policies. good nursing care.
n Co-ordinates patient care with other Education and training

departments. n Attend in-service courses relevant to grade
n Prepare for ward rounds and accompany and needs as identified and encourages
the head of the unit on rounds and other staff nurses to do the same. C
bring to the doctor’s attention any n Participate as a clinical expert in the H
point of importance. education and training of all grades of A
n To lead, delegate and liaise with all staff, within the multidisciplinary team, P
members of the multi-disciplinary in accordance with their individual T
team ensuring appropriate skill levels objectives, promoting an ethos of life- E
and experience are available to ensure long learning. R
a safe patient journey through the n To be involved in the initiation of nursing
department. research and co-operate with nurses
3
n Ensure policies/protocols are updated, carrying out research studies.

monitored and maintained with regard n Demonstrate a working knowledge
to continually improving patient care. of and work within the INC Code of
n Promote high standards of care by Professional Conduct.
demonstrating the ability to develop n Demonstrate continuing knowledge and
and empower the team, alongwith skill development providing enhanced
acting as a role model at all times. and improved standards of patient care.
n To maintain standards of infection n Help student nurses in understanding
control within the ward area and during the patient illness and the type of care
clinical care. that is to be given.
Communication n Co-operate with the clinical instructors
n Ensure that identified lines of commu-

by arranging clinical teaching and
nication are maintained with patients, supervising he practical work.
colleagues and external agencies. n Give incidental teaching to patients,
n Be actively involved in team meetings

relatives and staff.
and facilitate own team meetings and n Plan and implement orientation
inter-team meetings to ensure flexible programme for new staff nurses.

working and service provisions. n Encourage staff development programme
n Play an integral role in ensuring that all

in her ward.
team members are aware of local and
6. Staff Nurse
general Health and Safety matters and
other on-going issues, which arise Staff nurse is a first level professional nurse, who
including patient safety issues. provides direct care to one patient or group of
n Demonstrate the ability to be able to
patients assigned to her/him during duty shift
motivate and persuade others through and assist in management of wards/units/special
advanced communication skills. departments. She is directly responsible to Sister
In-charge/Ward Sister in the ward.
Qualification n See
that all investigation specimen
n GNM or Basic B.Sc. or Post-Basic B.Sc. are sent to the proper laboratory with
Nursing from a recognized university forms.
C n Registered with Indian Nursing Council/ n Keep Intravenous or Blood Transfusion
H Respective State Nursing Council. tray ready and help the doctor with the
A procedure.
Duties and Responsibilities
P n Observe all patients condition and
T report changes to Ward In-charge or
E the doctors.
R n Carry out nursing procedure for all
R: Recognition
Nursing Care serious patients.
3
n Check for new admissions.
n Read case properly and carry out orders
A: Assessment
Administration
carefully.
I: Intervention
Teaching n Give expert bedside care to serious
patients.
n Maintain case papers, investigation
reports etc. in the proper file or board.
FIG. 3.18: Duties and Responsibilities
n Write day, night orders and maintain
statistics.
(i) Nursing care n Talk to the pre-operative patients to
reduce their tension and give them
n Take over from duty nurse of the
confidence.
previous new and serious patient’s
n Discharged patients should be sending
instruments, supplies, drugs etc.
with proper instructions regarding
n Carry out the procedures of admission
follow up, diet and medicines etc.
and discharge of the patient.
n Makes beds of serious patients and 2. Administrative
help students to make beds, supplying n Help the Ward In-charge to carry out
necessary linen. her work.
n Administer medication properly. n Work instead of the Ward In-charge in
n Prepare patients for operations and case of his/ her absence.
see that he/she is sent to OT with all n Maintain general cleanliness of the
necessary papers and medications. ward and sanitary annexure.
n Take rounds with doctors and document n Write the diet register and supervise
each and every instruction. distribution of the diet.
n Maintain poisonous (scheduled) drug Organization of Nursing Services

registers.
n Supervise medicine given by students
in Community Settings
or do it herself, in case there are no C
students. District Public Health Nurse Ofcer H
n Supervise nursing care given by nursing A
students. Public Health Nurse (Supervisor) P
n Maintain duty room trays, sterilizer and T
instruments in working condition by Public Health Nurse E
getting indents from sisters. R
n Maintain good IPR with all other staffs.
n Supervise sub-ordinates work.
Lady Health Visitor
3
n Maintain all procedure trays in readiness.

Auxiliary Nurse Midwife
n Maintain all the records and reports
of the ward.
FIG. 3.19: Organization Service in Community
3. Teaching
n Instruct students in their work.
n Orient newly posted students and
1. District Public Health Nurse Officer
new staffs. The District Public Health Nurse Officer
n Carry out health teaching for individual (DPHNO) is directly responsible to the District
or group of patients. Health Officer and has relegated responsibility
n Instruct orderlies and the sweepers for all nursing personnel in the District Public
especially the newly appointed ones in Health field. She is guided by the Deputy/
the correct way of handling bed pans, Assistant Director of Health Services (Nursing)
urinals, sputum cups, kidney trays, of District level.
oiled linen. Roles/Functions
n Provide for and demonstrate methods
of disinfection and cleaning.
n Extends co-operation and participates
R: Recognition
General
in clinical teaching.
n Participates in in-service education A: Assessment
Administrative
programs.
n Plans and implements formal and I: Intervention
Supervisory
informal health education program
I: Intervention
Educational
and teaching program.
n Assists and extends co-operation in
FIG. 3.20: Roles/Functions
medical and nursing research program.
(i) General functions n Improving the standard of patient care

Organises, directs and develops all community in the district.
health nursing and midwifery services within (iv) Educational functions
C the district: n The DPHNO will initiate and assist
H
n
Participation in all relevant discussions with:
A
of health services in the district. l In-service educational programmes.
P
n Interpretation of the needs of the nursing
l Orientation training programmes.
T and midwifery services to the DHO
E
l Dais training programmes.
and to the Zila Parishad. l Health workers training pro-
R
(ii) Administrative functions grammes.
3 Responsible for the implementation of policies l Training of student nurses in rural
and programmes relating to nursing and field health centres.
midwifery services in the district: n Observation of nursing educational

n
Recommendations to the DHO regarding institutions (GNMTC/ANMTC or
the Nursing administration (selection, FHWTC/DTC) of the district from
appointment, leave, transfers, further time-to-time.
education and possible promotion of n Improving standard of nursing students
nursing staff ). and nursing education.
n Participation in budget planning for n Organizing orientation training pro-
nursing services, material, equipment gramme for nursing personnel/health
and reasonable for indenting of supplies workers.
and equipment for nursing section. n Making programme for Dai (TBA’s)
n Evaluation of all reports from nursing training and training of nursing staff.
staff of the district sent to DHO. n Arranging for in-service training.
n Will submit monthly and annual reports
Other functions
on the work done by DPHNO to the
n Organizing nursing workshops, seminars,
DHO.
discussion, etc.
(iii) Supervisory functions n Participation at state level, as a nursing
Aim to promote harmony and efficiency within representative of the district.
the health teams to improve the quality of n Getting co-operation from other insti-
work: tutions/organizations to improve the
n Supervising the work of nursing personnel/ quality of nursing services.
health workers from time-to-time. n Encouraging nursing researches.
n Taking disciplinary actions.

2. Public Health Nurse Supervisor
n Encouraging the qualities of co-operation
and co-ordination among nursing Public Health Nurse Supervisor guides and
personnel/health workers. supervises the functions of public health nurses,
health workers, working in her assigned field. (vi) Environmental sanitation: Supervises

She is responsible to District Public Health and guides the health assistants and health
Nurse (DPHN) or District Public Health workers in the effective implementation
Nurse Officer (DPHNO) for the provision, of the environmental sanitation and C
supervision and improvement of community provision of safe drinking water in the H
health care. village. A
Roles of Public Health Nurse Supervisor (vii) Treatment of minor ailments: Provides P
guidance to the health assistants and T
(i) Control of communicable diseases:
health workers, health guides, primary E
l Ensures that all necessary steps school teachers in the treatment of R
are being taken for the control of minor ailments and early referral to
the communicable diseases in the the Medical Officer. 3
village. (viii) Community involvement and health

l Should report any outbreak of education:
an epidemic to medical officer
n Maintains a close liaison with the
in-charge to take the necessary
block development officer and
actions in the PHC area.
other developmental programme
(ii) Maternal and child health: Supervises workers, community leaders for
and guides the health assistants effective implementation of national
and health workers in the effective health programmes.
implementation of the programme for n Participates in the village health
maternal and child health. committee/village panchayat meet-
(iii) School health: Visits schools in the PHC ing to assess the health needs of the
area at regular intervals and arranges community, to discuss the health
for medical check up (primary health programmes with the community
care, immunization, environmental and to enlist their co-operation in
sanitation and health education), treat- the health programmes.
ment and follow up by the Medical n Organises camps, meetings, health
Officer. education talks, demonstrations,
(iv) Family planning: Supervises and guides display of posters, exhibitions
the health assistants and health workers and films for active participation
in the effective implementation of the of community in various health
family planning programmes. programmes.
(v) Nutrition: Supervises and guides the
(ix) Training of health personnel and
health assistants and health workers
community level workers
in the effective implementation of the
nutrition programmes. n Primarily responsible for field
training, in-service and continuing
education of the health workers n Providing leadership in the planning

in the PHC area. of total health care to all individuals,
n Assists the Medical Officer, PHC families and community in her assigned
C in the monthly group activities area.
H at the PHC, Sub-Centre and n Carrying out preventive, promotive,
A community levels. curative and rehabilitative care.
P n Assisting in development of the
Management and supervision:
(x)
T standard of health care with the
E
n Assists the Medical Officer, PHC accepted philosophy, objectives and
in conducting field investigations health policies.
R
to delineate local health problems n Assisting in the preparation of budget
3 for effective delivery of health for the Community Health department.
services. n Utilizing the budget allotted to the
n Ensures that supplies and equip-

Community Health department.
ments are supplied in time to n Supervision and guidance of Public
sub-centres to enable the health Health Nurse/Lady Health Visitor/
workers to carry out their functions Female health Worker/Female Health
effectively. Worker/Male Health Worker working
n Scrutinizes the work plans of the
in her field.
health workers. n Organizing educational programmes
n Supervises the maintenance of the
for community members including
prescribed records at sub-centre school children, RCH group or other
level. interested/targeted groups in her area.
n Obtains the records from the
n Supervision of records/reports prepared
periphery, analyses and utilises by health workers working under her
the findings for improving the jurisdiction.
implementation of the health n Assisting the District Public Health Nurse/
programmes in the PHC area. District Public Health Nurse Officer
n Organize monthly staff meetings
for the preparation of job description
as a means of discussion, improve- and assignment of responsibilities for
ment and staff development and other community health workers.
continuing education.
n Maintenance of records and reports. Public Health Nursing
Responsibilities of Public Health Nurse According to Dr. C.E. Winslow, Public Health
Supervisor Nursing is defined as science and art of preventing
n Assisting in determination of the philo- disease, prolonging life, promoting health and
sophy and objectives of the community efficiency, through organized community effort
health programmes.
for the sanitation of the environment, control Essential Qualification

of communicable diseases, the education of B.Sc. Degree in Nursing from any recognized
individuals in personal hygiene, the organization university or institute or certificate in public
of medical and nursing services for the early health nursing from any recognized institution. C
diagnosis and preventive treatment of disease, H
Roles and Responsibilities of the Public
and the development of the social machinery to A
Health Nurse
ensure everyone a standard of living adequate P
for the maintenance of health, so organizing The District public health nurse is responsible
T
these benefits as to enable every citizen to for planning organization and directing the
E
realize his birthright of health and longevity: public health program of jurisdiction, where
R
she is appointed:
(i) According to WHO, it is an art of 3
applying science in the context of n Participates in policy-making activities
in regards to health care. She needs to

politics, so as to reduce inequalities in
health while ensuring the best health learn and understand the organization,
for the greatest number. administration and states public health
(ii) Special field of nursing that combines program are effected by quantity of
the skills of nursing, public health and public health nursing services available
some phases of social assistance and in rural areas.
functions as part of the total public n Evaluation of nursing services is done
health programme for the promotion by District public nurse, who plans for
of health, the improvement of the continuously improving the quality of
conditions in the social and physical client care.
environment, rehabilitation of illness n The district public health nurse is
and disability. attached to the District health office.

She is directly responsible to the District
3. Public Health Nurse health officer and delegates the responsi-
n A consensus conference report in bilities to all nursing personnel in the
1985 has defined community health District community health field i.e.
nurses as any nurses working in the PHC, Sub-Centre, family planning
community, whether or not, they had and all national health programs. She
preparation in public health nursing. is supervised by nursing officer at
n Public health nurses were nurses with directorate level.
speciality education and clinical practice n District public health nurse works in close
either bachelor’s, master’s or doctoral, co-ordination with community health

with an emphasis on public health. nursing, nursing tutors and hospital
administration and other health workers.
(i) Responsibilities as manager policies and re-engineering of the physical

n Planning environment for healthier actions.
n Organizing n Provides clients with information that
C n Staffing allows them to make healthier choices
H n Directing and practices.
A n Controlling n Health education activities is a major
P (ii) Supervisory responsibilities component of any public health program.
T n Participates in community health field
n Supervisor of midwives and other
E experience organized for nursing students
auxiliary health workers.
R of schools or colleges.
n Formulates a supervisory plan and
n Suggest in selection of areas for practical
3 conducts supervisory visits to implement
experience.
the plan.
n Provide facilities and resources to students
n Conducts supervisory visits using a

of staff.
supervisory checklist.
n Guide students during field experience.
(iii) Nursing care responsibilities
(vi) Training responsibilities
n Based on the science and art of caring.
n Initiates the formulation of staff develop-
n Uses knowledge and skill in the nursing
ment and training programs for midwives
process.
and other auxiliary workers.
n Establishes rapport with the client
n Does training needs assessment, designs
to ensure good quality data and to
training program and conducts them
facilitate.
in collaboration with other resource
n Enhance partnership in addressing
persons and evaluates training outcomes.
identified health needs and problems.
n Community organizing is a means of
n Home visiting is a must activity for a
mobilizing people to solve their own
PHN.
problems.
(iv) Collaborating and co-ordinating n Participates in community health field
responsibilities experience and organized for nursing
Establishes linkages and collaborative relation- students of schools or colleges:
ships with other health professionals, government
l Suggests in selection of areas for
agencies, the private sector, non-government
practical experience.
organizations and people’s organizations to
l Provides facilities and resources
address health problems.
to students of staff.
(v) Health promotion and educational l Guides students during field
responsibilities experience.
n Uses skills in advocacy for the creation
of supportive environment through
(vii) Responsibilities as a researcher hilly areas), in which there are 6 sub-centres,

n Disease surveillance is a research activity each with the health worker female.
of a public health nurse. Essential Qualification and Experience
n Surveillance is an integral part of many C
12th standard with 2 years Multi-Purpose
programs. H
Health Worker training course with 5 years
A
4. Lady Health Visitor/Health experience.
P
Assistant/Health Supervisor Roles and Responsibilities of Lady Health T
A Health Assistant is expected to cover a Visitor/Health Assistant/Health Supervisor E
population of 30,000 (20,000 in tribal and R
3

Supervise and Guidance
Team Work
Supplies, Equipment and Maintenance of Sub-Centres
Records and Reports
Training
Family Planning and Medical Termination of Pregnancy (MTP)
Nutrition
Universal Immunization Programme
Acute Respiratory Infection
School Health
Primary Medical Care
Health Education
FIG. 3.21: Roles and Responsibilities of Lady Health Visitor

(i) Supervise and guidance in the procurement of supplies and

n Supervise and guide the health workers equipment.
in the delivery of health care services n Check that the drugs at sub-centre are
C to the community. properly stored and that the equipments
H n Strengthen the knowledge and skills of are well-maintained.
A the health workers for working in the n Ensure that the health workers maintains
P community, in planning and organizing general kit, midwifery kit and dai kit in
T the health programmes. the proper way and sub-centre is kept
E n Visit each sub-centre at least once a clean and properly maintained.
R week on a fixed day. (iv) Records and reports
3 n Assess fortnightly the progress of work
n Scrutinize the maintenance of records
of the health workers. by the health workers and guide them
n Carry out supervisory home visits in
in proper maintenance.
the area of the health workers and n Review reports received from health
supervise referral. workers, consolidate them and submit
(ii) Teamwork monthly reports to the Medical officer
n Help the workers to work as a part of of the PHC.
the health team. (v) Training
n Co-ordinate the health activities with
n Organize and conduct training for Dais/
the activities of workers of other depart- Accredited Social Health Activist with
ment and agencies. the assistance of the health workers.
n Conduct regular staff meetings with the
n Assist the Medical officer of the primary
health workers in co-ordination with health centre in conducting training
the Health Assistants. programme for various categories of
n Attend staff meetings at the primary
health personnel.
health centres.
(vi) Maternal and child health
n Assist the Medical Officer of the primary
health centre in the organization of the n Conduct weekly Maternal and Child
different health services in the area. Health clinics at each sub-centre with
the assistance of the health workers.
(iii) Supplies, equipment and maintenance
n Respond to calls from the health workers
of sub-centres
and render the necessary help.
n In collaboration with the health assistants,
n Conduct deliveries, when required at
check the regular intervals the stores PHC level and provide domiciliary
available at the sub-centre and help and midwifery services.
(vii) Family planning and medical (x) Acute respiratory infection (ARI)
termination of pregnancy (MTP) n Ensure early diagnosis of pneumonia
n Ensure through spot checking that the cases.
health workers maintains up-to-date n Provide suitable treatment to mild/ C
eligible couple registers all the time. moderate cases of ARI. H
n Conduct weekly family planning clinics n Ensure early referral in doubtful/severe A
alongwith the MCH clinics at each sub- cases. P
centre with the assistance of the health (xi) School health T
workers. E
Help medical officers in school health services.
n Provide information on the available R
services for MTP and sterilization. (xii) Primary medical care
n Guide the health workers in establishing n Ensure treatment for minor ailments. 3
female depot holder. n Provide ORS, first-aid for accidents,

n Provide intra-uterine devices services emergencies and refer cases beyond
and their follow up. the competence to the primary health
n Assist Medical officer and PHC in centre or nearest hospital.
organization of family planning camps (xiii) Health education
and drives. n Carry out educational activities for
(viii) Nutrition MCH, Family planning, Nutrition and
n Ensure that all cases of malnutrition among Immunization, Control of Blindness,
infants and young children (0–5 years) Dental care and other National health
are given necessary treatment and advice programmes with the assistance of
and refer serious cases to the primary health workers.
health centre. n Arrange group meetings with the leaders
n Ensure that iron and folic acid, vitamin A and involve them in spreading the
are distributed to the beneficiaries, as message for various health programmes.
prescribed. n Organize and utilize women leaders,
n Educate the expectant mother regarding Mahila Mandal, teachers and other
breastfeeding. women in the community in the
family welfare programmes, includ-
(ix) Universal immunization programme
ing Integrated Child Development
n Supervise the immunization of all pregnant
Scheme personnel.
women and children (0–5 years).
n Guide the health workers to procure 5. Auxiliary Nurse Midwife/Multi-
supplies, organize immunization camps, Purpose Health Worker
provide guidance for maintaining cold
Qualification
chain, storage of vaccine, health education
and immunizations. 12th standard with 2 years training in Multi-
Purpose Health Worker vocational course.
Line of Authority Duties and Responsibilities of ANM

ANM is directly under the supervision of
Health Assistance/LHV.
C
H
A
P
T Family Planning
E
Medical Termination of Pregnancy
R
3 Nutrition
Universal Immunization Program

Diarrohea Control Program
Dai Training
Communicable Diseases
Vital Events
Record Keeping
Primary Medical Care
School Health
Disease Control Program
Preventive Health Care
FIG. 3.22: Duties and Responsibilities of ANM
(i) Maternal and child health n Test urine of pregnant women for
n Register and provide care to pregnant albumin, sugar and estimate haemo-
women throughout the period of globin.
pregnancy.
n Ensure all pregnant women get VDRL n Provide follow-up services for acceptors
and HIV test done. of male sterilization and also motivate
n Refer cases with complications and any males for sterilization and spacing
medical and gynecological abnormality. methods based on ANMs eligible C
n Conduct 50 per cent of deliveries in the couple register. H
assigned area. n Assist the ANMs and ASHAs in distri- A
n Supervise deliveries conducted by dais bution of conventional contraceptives P
and assist in need. to eligible couples. T
n Make at least 3 postnatal visits for each (iii) Medical termination of pregnancy E
delivery conducted in the assigned area. n Identify the women requiring help for R
n Assess the growth and development of
medical termination of pregnancy and
the infant. 3
refer to nearest approved institutions.
n Educate mother individually and in

n Educate community of the consequences
group regarding better child care, family of septic abortion and inform about
planning, nutrition and environmental availability of services.
hygiene.
n Assist MO and LHVs in conducting
(iv) Nutrition
ante-natal and post-natal clinics at n Identify cases of malnutrition among
sub-centers. infants and young children (0–5 years).

n Assist in ensuring timely referral transport n Distribute iron and folic acids tablets,
for pregnant women at the time of as prescribed to pregnant women and

delivery. nursing mothers, infants and young
children (0–5 years) and family planning
(ii) Family planning
acceptors.
n Utilize the information from the eligible
n Administer vitamin A solution, as
couple and child register to the family prescribed to children from 1–5 years.
planning program. n Educate community about nutritious
n Spread message of family planning to
diet for mothers and children.
the couples and motivate them.
n Assist the ANMs and ASHAs in distri-
(v) Universal immunisation programme
bution of conventional contraceptives n Administer DPT vaccine, oral polio-
to eligible couples. myelitis vaccine, measles vaccine and

n Provide follow up services to female BCG vaccines to all infants and children.
planning acceptors, identify any side n Maintain report of all eligible, those
effects and refer for treatment. vaccinated and follow-up defaulters.

n Identify women leaders and help the n Assist the Health Workers in adminis-
health assistants to train them. tering TT to all the pregnant women.

n Participate in Mahila Mandal meetings. n Assist the Health Assistants in the
school immunization program.
n Educate the community about the and about the importance of taking
importance of immunization against regular and complete treatment.
the various communicable diseases. (ix) Vital events
C
(vi) Diarrhoea control programme Record births and deaths occurring in the
H
n Educate mothers regarding home assigned area in the birth and death registers
A
management of diarrhoea with ORT. and report to health workers.
P
n Provide and indent ORS. (x) Record keeping
T
n Monitoring of cases of diarrhoea, if any
n Register:
E increase, report to medical officer.
R n Records deaths due to diarrhoea and
l Pregnant women from 3 months
of pregnancy onward.
3 give monthly report.
n Arrange for mother’s meeting and work
l Infants 0–1 year of age.
l Women aged 15–44 years.
closely with Anganwadi and other

health workers. n Maintain the prenatal and maternity
(vii) Dai training records and child care records.
n List Dais in the assigned area and involve
n Assist the health workers in preparing
them in promoting family welfare. eligible couple and child register and
n Help the health assistants in training
maintaining it up-to-date.
programme of Dais. (xi) Primary medical care
(viii) Communicable disease Provide treatment for minor ailments, provide
n Notify the MO, PHC immediately
first-aid for accidents and emergencies and
about any abnormal increase in cases refer cases beyond her/his competence to the
of diarrhoea/dysentery, poliomyelitis, primary health centre or nearest.
neonatal tetanus, fever with rigours, fever (xii) School health
with rash and fever with jaundice. n Visit all the schools in the assigned area
n Identify cases of skin patches, especially and advocate personal hygiene, nutrition,
if accompanied by loss of sensation safe drinking water and sanitation and
and bring them to the notice of health other public health measures.
workers for skin smears. n Undertake awareness generation of
n Assist the health workers in maintaining national health programmes (Malaria,
a record of cases in the assigned area, who TB, and Leprosy etc.) for early detection
are under treatment for communicable of communicable and non-communicable
diseases. diseases.
n Educate the community about the n Ensure completion of immunization
importance of control and preventive schedules including Injection TT, as
measures against communicable diseases per guidelines.
n Assist Ophthalmic Assistant for eye provider to ensure that all confirmed
screening of children for detection of cases are on regular treatment and
visual defects. motivate defaulters for regular
n Identify cases of malnutrition in school treatment. C
children and refer cases to PHC Medical l Improve community awareness on H
Officer. signs and symptoms of tuberculosis A
n Guide teachers, parents on nutrition and guide the suspected TB cases P
and anaemia. for referral. T
n Help the MO in School Health Services. l Ensure that follow-up smear E
(xiii) Disease control program examinations of sputum are R
n Malaria:
carried out, as per the schedules.
l Maintain the treatment cards
3
l Conduct domiciliary house-
and transmit the data weekly to

to-house visits covering all the the PHC.
assigned population, as per the
schedules approved by the PHC n Leprosy:
Medical Officer. l Identify leprosy suspected cases of
l Collect blood smears and perform skin patches with loss of sensation
Random Diagnostic Tests from and refer to PHC.
suspected fever cases and maintain l Provide Multi Drug Treatment
records. (MDT) to confirmed cases and
l Ensure immediate dispatch ensure completion of treatment
of collected blood smears for including retrieval of defaulters.
laboratory investigations and l Guide leprosy patients with
provide treatment to positive deformities for management at
cases, as per the guidelines. appropriate health facilities.
l Educate the community on the l Assist and supervise the ASHAs/
importance of blood smear exami- Anganwadi Workers/Village Health
nation for fever cases, insecticidal Guides/local health volunteers for
spraying of houses and treatment early detection of Leprosy cases
of fever cases. and treatment.
n Tuberculosis:
l Improve community awareness on
signs and symptoms of Leprosy for
l Identify all cases of fever for over early detection.
two weeks with prolonged cough l Maintain the treatment cards and
or spitting of blood and refer to transmit the data to the PHC.
PHC for further investigation. l Maintain the records of domiciliary
l Function as Direct Observation
visits and records of patients on
Short-term course Therapy (DOTS) treatment.
(xiv) Preventive health care 1. Nursing Advisor

n Surveillance for unusually high incidence n Nursing Advisor being the Head of
of cases of diarrhoea, dysentery, fever, the Nursing Services in the country is
C jaundice, diphtheria, whooping cough, responsible for advising the Government
H tetanus, polio and other communicable of India on all matters concerning
A disease and notify PHC. nursing service, nursing education and
P n Ensure regular chlorination of all the specialization in nursing, etc.
T drinking water sources. n She/he guides, supervises and co-ordinates
E n Generate community awareness regard- nursing services and nursing education
R ing safe drinking water, sanitation, in the States.
3 waste disposal and personal hygiene. n She/he plans total nursing manpower
n Carry out control measures until the requirements of the country in the area
arrival of the health assistants and assist
of nursing service, nursing education

them in carrying out effective measures. and continuing education, etc., in co-
operation and co-ordination with State
Organization of Nursing Services Government units and Voluntary
in Educational Settings agencies.
n Responsible for developing the National
and International Projects concerning
Nursing Advisor
nursing in India.
n She/he is a program officer for nursing
Principal
section in the office of the Director
General of Health Services, which
Vice-Principal
involves components of all the National
Health Program.
Professor
n Maintains liaison with all professional
bodies concerned with improving the
Assistant Professor
standards of nursing services and nursing
education in the country.
Lecturer
Educational Qualification
Senior Tutor M. Sc. Nursing or equivalent is preferred.
Registration
Tutor Registered in any State Nursing Council.
Experience
Clinical Instructor
Should have more than 15 years of experience
FIG. 3.23: Organization in Nursing Education in nursing services including administration
and education.
Roles and Responsibilities of Nursing Advisor (ii) Education and specialization in nursing
(i) Administrator n Develops policies, procedures regarding
n Serves as manager, communicator, qualifications and employment of

participator in institutional policy nursing staff members. C
development and planning and as n She/he is program officer to conduct and H
evaluator of nursing care. develop various educational programs A
n Develops policies and procedures regard- for up-gradation of nursing services. P
ing qualifications and employment of n Collaborate with WHO and implement T
nursing staff members. WHO fellowship and certificate course. E
n Establishes the department philosophy, n Plan and establishes various schools R
goals, objectives, standards and policies and colleges of nursing to increase the
qualified nursing personnel.
3
and procedures to achieve high quality
n Plan and submit the budget to the

nursing care.
n Develops a system for evaluation of higher authority for implementation
work performance and evaluates the of various nursing courses.
performance of management personnel n Attend workshops at International level
accordingly. like WHO, UNICEF, etc.

n Plan ways to improve leadership skills n Develop policies to conduct specializa-
and to anticipate and minimize problems tion courses for nursing personnel.
and ways to identify these problems n Supervises various schools and colleges
and to plan their resolution. about the formulation and implemen-

n Directs the formulation and imple- tation of quality patient care.
mentation of policies, procedures and (iii) Services
standards of practice. n Organizes department structure, interprets
n Prepares and submits budget information this relationship to nursing personnel;
to administration. plans, directs and supervises the nursing
n She/he attend meeting at national and service.
international level regarding development n Plans ways to promote the growth and
of nursing standard. development of personnel through in-
n Organizes plans and directs department service programs, workshops, seminars
functions and activities to comply with and other continuing educational
short-and long-term objectives and programs.
with hospital philosophy and policies. n Implements activities necessary to meet
n Serves as a member of different nursing objectives.
professional organization like TNAI, n Establishes a system for regular monthly
INC, etc. meeting.
n Assists management personnel in n Selects and organizes learning

developing objectives, planned change, experience.
policy and procedure development and (ii) Organizing
C monitoring of standards of nursing n Determines the number of position,
H care. scope and responsibility of each faculty
A n Maintains contact and communication
and staff.
P with administrator, department heads n Analyses the job to be done in terms
T and medical staff concerning all areas of needs of education program.
E of direct and indirect patient care and n Prepares the job description, indicate
R hospital matters. line of authority, responsibility in the
3 2. Principal relationship and channels of communi-
cation by means of organizational chart
Principal, College of Nursing is the admini-
and other methods.

strative head of the College of Nursing will n Considers preparation, ability and interest
be directly responsible to the Director of the personally in equating responsibility.
Medical Education/Director of Health and n Delegate’s authority commensurate with
Family Welfare services and responsible for responsibility.
implementation and revision of curriculum n Maintains a plan of workload among
for various courses and research activities of staff members.
the College of Nursing. n Provides an organizational framework
Educational Qualification and Experience for effective staff functioning, such as
M.Sc. Nursing with 15 years of experience, meeting of the staff etc.
out of which 12 years should be teaching (iii) Directing
experience with minimum of 5 years in collegiate n Recommends appointment and promo-
programme. Ph.D in Nursing is desirable. tion based on qualification and experience
Registration of the individual staff, scope of job and
Registered in any State Nursing Council. total staff composition.
n Subscribes and encourages develop-
Roles and Responsibilities of Principal mental aspects with reference to welfare
(i) Planning of staff and students.
n Develops philosophy and objectives n Provides adequate orientation of staff
for educational program. members.
n Identifies the present needs related to n Guides and encourages staff members
educational program. in their job activities.
n Investigates, evaluates and secures n Consistently makes administrative
resources. decision-based on established policies.
n Formulates the plan of action. n Facilitates participation in community,
professional and institutional activities
by providing time, opportunity for (vi) Instruction (teaching)

support for such participation. n Plans for participating in educational
n Creates involvement in designing programs for further development.
educationally sound program. n Recognizes the needs for continuing C
n Maintenance of attitude rightly accept- education for self and staff provide H
able to staff and learners. stimulation of opportunities for such A
n Provides for utilization in the develop- development. P
ment of total program and encourages n Participates as a teacher in the educa- T
their contribution. tional program. E
n Provides freedom for staff to develop
(vii) Guiding R
active training course within the frame-
n Provides for systematic guidance program 3
work for curriculum.
for staff members and students.
n Promotes staff participation in research.

n Encourages studies, research and writing
n Procures and maintains physical
for publication.
facilities, which are of a standard.
n Provides and maintains a program for
(iv) Co-ordinating recruitment, selection and promotion
n Co-ordinates activities relating to the of students.
programs, such as regular meetings,
time schedule, maintaining effective 3. Vice- Principal
communication, etc. Educational Qualification and Experience
n Initiates ways of co-operation.
M.Sc. Nursing with 12 years of experience, out of
n Interprets nursing education to other
which 10 years should be teaching experience
related disciplines and to the public. with minimum of 5 years in collegiate programme.
(v) Controlling Ph.D in Nursing is desirable.
n Provides for continuous follow-up and Registration
revision of education program.
Registered in any State Nursing Council.
n Maintains recognition of the educational
program by accrediting bodies. Roles and Responsibilities of Vice-Principal
n Maintains a comprehensive system of (i) Financial
records. n Assists Principal in carrying out financial
n Prepares periodic report which revives activities.
the progress and problems of the entire n Planning and revising budget.
program and presents plans for its n Monitoring college expenditure.
continuous development. n In the absence of Principal, performs
n Prepares, secures approval and adminis- all the functions.
trates the budget.
(ii) Educational (iv) Establishment

n Assists Principal in planning, implementa- n Assists Principal in maintaining rules
tion and evaluation of the programmes. and regulations in college campus.
C n Assists Principal in identifying needs for n Supervises overall functioning of staff
H professional development of faculty and students’ hostel.
A and conducting staff development n Assists Principal in maintaining discipline
P programme. in the college.
T n Supervises post-graduate students in n Assists Principal in reviewing recruitment
E conducting research. and promotion policies of teaching and
R n Participates in teaching of various educa- non-teaching staff.
3 tional programmes. (v) Interpersonal
n In the absence of Principal, chairs the
n Assists Principal in maintaining human
assigned committee meetings.
relation and communication.

n Supervises all educational programmes
n Identifies conflict among staff members,
in co-ordination with the co-ordinators. initiates solution and reports to Principal,
n Guides faculty in day-to-day academic
when necessary.
activities. n Communicates with staff in explaining
(iii) Supervisory administrative constraints.
n Shares responsibility with Principal and n Facilitates guidance and counselling
Professor in supervision of teaching students and staff, as per need.
and non-teaching staff. n Any other responsibility assigned by the
n Plans academic staff assignments in Principal.
consultation with Principal.
n Participates in conduct of orientation
4. Professor
programme. The Professor is overall in charge of the depart-
n Supervises and guides staff in conducting ment and thereby responsible for administration
their activities. and teaching activities and guidance of the
n Writes staff performance report and department.
reviews evaluation report of assigned Educational Qualification and Experience
staff.
M.Sc. Nursing with 10 years of experience, out
n Assists Principal in monitoring students
of which 7 years should be teaching experience.
welfare activities e.g. Mess, Hostel,
Ph.D in Nursing is desirable.
Health, Sports, SNA etc.
n Assists Principal in administration and Registration
supervision of library. Registered in any State Nursing Council.
Duties and Responsibilities of Professor (iii) Helping the learners to acquire

(i) Administration desirable attitudes, knowledge and skill
n Participating in determination of educa- n Seeks to create a climate conducive to
tional purposes and policies. learning. C

n Contributes to the development and n Assists learners in using problem- H
implementation of the philosophy and solving techniques. A
purposes of the educational program. n Uses varied and appropriate teaching P
n Utilizes opportunities through group methods effectively. T
action to initiate improvement of the n Uses incidental and planned opportu- E
educational program. nities for teaching. R
n Interprets educational philosophy and n Encourages learners to assume increasing
responsibility for own development. 3
policy to others.
(iv) Evaluating learner’s progress

n Directs the activities of staff working
in the department. n Recognizes individual differences in
(ii) Instruction appraising the learner’s progress.
n Identifies needs of learners. n Uses appropriate devices for evaluation.
n Identifies the needs of the learners in terms n Measures and describes quality of
of objectives of the program and utilizing performance objectively.

records of previous experience, personal n Helps learners for self-evaluation.
interviews, tests and observations. n Participates in staff evaluation of learner’s
n Assists learners and identify their needs. progress.

n Develops plan for learning experience. (v) Recording and reporting
n Participates in the formulation and n Maintains, uses adequate and accurate
implementation of the philosophy and records.
objectives program. n Prepares, channels clear and concise
n Selects and organizes learning expe- reports.
riences, which are in accordance with n Shares information about learner’s needs
their objectives. and achievements with other concerned
n Participates in the continuous develop- with instruction and guidance.
ment and the evaluation of the n Participates in the formulation and
curriculum. maintenance of comprehensive record
n Plans within the educational unit, with system.
the nursing services and allied groups. (vi) Investigative ways to improving teaching
n Ascertains, selects, organizes facilities,
n Measures effectiveness of instructions
equipment and materials necessary for
by use of appropriate devices.
learning.
n Increases knowledge and skill in own
curriculum area.
n
Analyzes and evaluates resources material. Registration
n
Devices teaching methods appropriate Registered in any State Nursing Council.
to objectives and contents.
C Duties and Responsibilities of Assistant
(vii) Guidance Professor
H
n Co-operating in guidance program.
(i) Administration
A
n Shares in planning, developing and
P n Participates in determination of educa-
using guidance programme.
T tional purposes and policies.
n Gives guidance within own field of
E n Contributes to the development and
competence.
R implementation of the philosophy
n Helps the learner with special problems
and purposes of the total educational
3 to seek and use additional helps, as
program.
indicated.
n Utilizes opportunities through group
(viii) Counselling action to initiate improvement of the

n Helps the learner to grow in self-under- total educational program.
standing. n Interprets educational philosophy and
n Promotes continuous growth and policy to others.
development towards maturity. n Directs the activities of staff working
n Continues to develop competence in in the department.
problem solving process. (ii) Instruction
n Co-operates in and/or initiates group
n Identifies the needs of learners.
activities in development and evaluation
n Identifies the needs of the learners in
of studies.
terms of the objectives of the program
n Utilizes findings of research.
by utilizing records of previous experience,
n Makes data available concerning learners
personal records of previous experience,
and concerning methods of teaching
personal interviews, tests and observa-
and evaluation.
tions.
5. Assistant Professor n Assists learners in identifying their needs.
n Develops plan for learning experience.
The Assistant Professor usually works under
n Participates in the formulation and
Professor/Head of the Department of the
implementation of the philosophy and
particular department of speciality and assists
objectives of the program.
him/her in administration, teaching, guidance
n Selects and organizes learning experiences,
and counselling and research activities.
which are in accordance with their
Educational Qualification and Experience objectives.
M.Sc. Nursing with 8 years of experience, out of n Participates in the continue development
which 5 years should be teaching experience. and evaluation of the curriculum.
Ph.D in Nursing is desirable.
n Plans within the educational, with the (vi) Investigating ways improving teaching
nursing services and allied groups. n Measures effectiveness of instruction
n Ascertains, selects and organizes facilities, by use of appropriate devices.
equipment and materials necessary for n Increases knowledge and skill in own C
learning. curriculum area. H
(iii) Helping the learners to acquire n Analyzes and evaluates resource material. A
desirable attitudes, knowledge and skill n Devices teaching methods appropriate P
n Seeks to create a climate conductive to to objectives and contents. T
learning. (vii) Guidance E
n Assists learners using problem-solving n Co-operating in guidance program. R
techniques. n Shares in planning, developing and 3
n Uses varied and appropriate teaching using guidance program.

methods effectively. n Gives guidance within own field of
n Uses incidental and planned opportunities competence.
for teaching. n Helps the learners with special problems
n Encourages learners to assume increas- to seek and use additional help, as
ing responsibility for own development. indicated.
(iv) Evaluating learning progress (viii) Counselling
n Recognize individual differences in n Helps the learner to grow in self-under-
appraising the learner’s progress. standing.
n Uses appropriate devices for evaluation. n Promotes continuous growth and
n Measures and describes quality of perfor- development towards maturity.
mance objectively. (ix) Assisting in selection and promotion
n Helps learners for self-evaluation.
of learners
n Participates in staff evaluation of learner’s
Participates in development of criteria for
progress.
selection and promotion of learners.
(v) Recording and reporting
(x) Research
n Maintains, uses adequate and accurate
n Imitates and participates in studies for the
records.
improvement of educational programs.
n Prepares channels for clear and concise
n Identifies problems in which research
reports.
is indicated or potentially desirable.
n Shares information about learner’s needs
n Continues to develop competence in
and achievement with others concerned
problem-solving process.
with instruction and guidance.
n Co-operates in and/or initiates group
n Participates in the formulation and
activity in development and evaluation
maintenance of comprehensive record
of studies.
system.
n Utilizes findings of research. n Prepares clear and concise reports.

n Makes data available concerning learners n Share information about learner’s needs
and concerning methods of teaching and achievements with others concerned.
C and evaluation. n Measures effectiveness of instruction
H by use of appropriate devices.
A 6. Lecturer n Increases knowledge and skill in own
P He/she works under the direction of the depart- curriculum area.
T ment head and assists him/her in administration, n Devices leaching methods appropriate
E instruction and guidance activities. to objectives and contents.
R Educational Qualification and Experience (ii) Guidance and counselling
3 M.Sc. Nursing with 3 years of experience. n Gives guidance with own field of
competence.
Registration
n Helps the learner to grow in self-under-

Registered in any State Nursing Council. standing.
Duties and Responsibilities of Lecturer (iii) Research
(i) Instruction n Assists in initiating and participating
n Identifies the needs of the learners in in studies for the improvement of
terms of the program by utilizing the educational program.
records of previous experience, personal n Identifies the problems in which research
interviews, tests and observation. is indicated or potentially desirable.
n Assists the learners in identifying their n Make data available concerning learners
needs. and concerning methods of teaching
n Participates in formulation and imple- and evaluation.
mentation of the philosophies and n Continues to develop competence in
objectives of the post. problem-solving process.
n Selects and organizes learning experiences n Co-operate in and/or initiates group
which are in accordance with these activity in development and evaluation
objectives. of studies.
n Plans with the educational unit with n Utilizes the findings of research.
nursing service and allied groups.
n Ascertains, selects and organizes facilities
7. Senior Tutor
equipment and materials necessary for Educational Qualification and Experience
learning. M.Sc. Nursing or B.Sc. Nursing/Post-Basic
n Assists the learners in using problem- B.Sc. Nursing with 3 years of experience.
solving process.
Registration
n Measures and describes quality of
performance objectively. Registered in any State Nursing Council.
Responsibilities of Senior Tutor Registration

n Participates in teaching and supervising Registered in any State Nursing Council.
the courses of undergraduate students. Responsibilities of Clinical Instructor
n Participates in curriculum development, C
n Demonstrate standards for nursing
H
evaluation and revision.
practice. A
n Guide in research projects for under-
n Supervise and teach the students in the
graduate students. P
clinical fields.
n Acts as a counsellor for staff and T
n Participate in evaluation of students.
students. E
n Assist the students in conducting
n Maintains various educational records. R
health education programme.
n Conducting and participating in depart-
n Maintain students’ records. 3
ment meetings and attending various
n Participate in the student counseling
meetings.

programmes.
n Participates in administration activities
n Participate and promote student welfare
of department.
activities.
8. Tutor
Educational Qualification and Experience SYSTEM OF MEDICINES
M.Sc. Nursing or B.Sc. Nursing/Post-Basic
AYUSH—The Indian System of
B.Sc. Nursing with 1 year of experience.
Medicine
Registration
The medical systems that are truly Indian in origin
Registered in any State Nursing Council.
and development are Ayurveda and Siddha.
Responsibilities of Tutor AYUSH comes under the heading of
n Participates in teaching and supervising Indigenous System of Medicine.
the courses of undergraduate students.
n Co-ordinates with the external lecturer
A Ayurveda
for various courses, as assigned.
n Participate in the evaluation of students.
Y Yoga and Naturopathy
n Guide the students in conducting seminars,
discussions and presentations etc. U Unani
n Maintain students’ records.
n Participate in student counselling S Siddha
programmes.
H Homeopathy
9. Clinical Instructor
Educational Qualification and Experience
FIG. 3.24: AYUSH
B.Sc. Nursing/Post-Basic B.Sc. Nursing.
1. Ayurveda (A) n The treatment of ayurveda involves:

Implies science of life. Around 1000 bc compre- l Preventive measures: Include
hensive documentation of the knowledge of personal hygiene, daily routing,
C
ayurveda was done by Charaka (Father of rejuvenating materials/food, drugs
H
Medicine) in Charaka Samhita and Sushruta and rasayanas.
A l Curative measures: Includes
(Father of Surgery) in Sushruta Samhita:
P 3 major measures: Aushadhi means
n The National Institute of Ayurveda was
T Drugs, Anna means Diets and
established in 1976.
E Vihara means exercises and general
n A 5 year degree programme (BAMS) is
R mode of life.
planned, organized and administered with
3 an additional 6 months of compulsory n Ayurveda deals with problems related
internship. to Nervous system, Respiratory system,
n The uniformity and standards of Under Gastrointestinal system, Integumentary

Graduates and Post-Graduates education system and Musculoskeletal system.
are maintained by the Central Council n Ayurveda is most popular in Kerala,
of Indian Medicine (CCIM) established Himachal Pradesh, Gujarat, Karnataka,
in 1971, under Indian Medicine Central Madhya Pradesh, Rajasthan, Uttar
Council Act, 1970. Pradesh and Odisha.
n Health is considered as pre-requisite
Eight Specialities in Ayurveda
for achieving goal of life for Dharmas,
Artha, Kama and Moksha. (i) Kayachikitsa: Internal Medicine.
n Body of knowledge of ayurveda is
(ii) Kumar Bhartiya: Paediatrics.
derived from darshanas (Science) which (iii) Graha Chikitsa: Psychiatry.
encompass physically, biologically and (iv) Shalakya: Eye and ENT.
spiritual sciences. (v) Shalya Tantra: Surgery.
n Practice of ayurveda is based on theory
(vi) Vishwa Tantra: Toxicology.
of Pancha Mahabhutas (5 elements). (vii) Rasayana: Geriatrics.
n They are classified in form of Tridosha.
(viii) Vagi Karna: Science of Virility.
2. Yoga and Naturopathy (Y)

Pitta (Fire
Vata (Ether Kaph (Water Yoga is a science which helps to co-ordinate
and Air) and Earth) body and mind more effectively:
n It helps in prevention and cure of various
Tri Dosha psychosomatic disorders, psychic and
physical disorders.
n National Institute of Naturopathy (NIN)
was established in Pune (1984).
FIG. 3.25: Tri Dosha
n Every year 21st June is celebrated as n Ministry of Human Resource Department

International Yoga Day. plans to introduce yoga in schools,
n It was propounded by Patanjali. hospitals or short term course for stress
n Components of Yoga. management by leading yoga institutions. C
H
A
Meditation
P
T
E
R
Breathing Exercises Contemplation
3

Yoga
Physical Posture Restraining of Sense Organs
Austerity Smadhi
Restraint
FIG. 3.26: Yoga
Naturopathy 3. Unani System of Medicine (U)

n It is holistic system, which helps to The National Institute of Unani Medicine was
promote physical, mental/emotional, established jointly by Government of Karnataka
social and spiritual health. in 1984, at Bangalore:
n It is based mainly on application of
n A 5 years degree programme (BUMS)
simple laws of nature. is planned, organized and administered
with an additional 6 months of n It uses ingredients of animal and

compulsory internship. marine origin.
n It is based on 4 humour theory of n The diagnosis of a disease is done by
C Hippocrates i.e. blood, phlegm, yellow feeling pulse, observation of urine,
H bile and black bile. stool, colour of skin and gait etc.
A n Treatment is carried out in 4 forms:
P
T
E
R Pharmco Therapy Diet Therapy Regimental Therapy Surgery
3
FIG. 3.27: Treatment of Unani System of Medicine
n Unani system of medicine specializes on 3 Doshas, 7 Dhatus and 3 Malas.

rheumatic arthritis, jaundice, filariasis, Equilibrium between 3 is considered to
eczema, sinusitis and bronchial asthma. be ‘Health’ and disequilibrium results
n It emphasis on developing defence in disease or sickness.
mechanism of the body. n Causative factors are identified by
examination of pulse, eyes, body colour,
4. Siddha System of Medicine (S) tongue, digestive system, urine and
It is one of the oldest system of medicine: study of voice.
n A 5 years degree programme is planned, n Consider patient as a whole: Age,
organized and administered with an sex, race, habits, mental frame, diet,
additional 6 months of compulsory appetite, physical condition, physiological
internship. constitution, habitat, environment and
n National Institute of Siddha (NIS) was meteorological conditions.
proposed and approved during 9th Five n Siddha medicine makes use of mercury,
year plan. silver, arsenic, lead, sulphur etc. minerals,

n The researches in Siddha are done plants and animal parts.
by Central Council for Research in n It is effective in treating chronic cases of
Ayurveda and Siddha set up in 1970. rheumatic problems, anaemia, peptic

n Philosophy: There is an intimate link ulcer, bleeding piles, liver and skin
between man and environment. diseases.
n Food is the basic building material n Siddha system of medicine is most
in the body, which gets processed into popular in South India, especially
in Tamil Nadu.
5. Homeopathic System of Medicine (H) CENTRALLY SPONSORED

A 5 year degree programme (BHMS) is planned, HEALTH SCHEMES
organized and administered with an additional
C
6 months of compulsory internship registered Employees State Insurance (ESI)
by Central Council of Health: H
Act, 1948
A
n It is based on theory “Similia Similibus n The ESI scheme is administered by an P
Curentur” means any substance capable autonomous body called Employees T
of producing artificial symptoms on State Insurance Corporation (ESIC),
healthy individuals can cure the same E
which meets at least twice a year. R
symptoms in a natural disease. n The 1975 amendment extended the
n Basic laws, diagnosis and treatment
Act to the following: 3
methods in Homeopathy:
l Non-power using factories employ-

l Law of direction of cure: During
ing 20 or more persons.
curative process, the symptoms l Power using factories employing
disappear in the reverse direction 10 or more persons.
from centre to periphery. l Road transport establishments.
l Law of single remedy: Uses only
l Newspaper establishments.
a single medicine based on indi- l Cinemas and theatres
vidualization. The physician l Hotels and restaurants
adopts a detailed case study by l Shops
exploring the physical, psycho-
logical, biomedical constitution n At present, the employees drawing
of the individual. wages upto ` 15000/- per month purview

l Law of minimum doses: Minimum of the ESI Act.
possible doses to correct diseased Benefits to Employee
state. n Medical benefit: Includes ambulance
l Theory of chronic diseases: Homeo-
services, domiciliary treatment facility
pathy is highly individualizing and provisions of drugs, dressings and
process. some appliances.
n Homeopathy system of medicine deals n Sickness benefits: Include paid in
with chronic diseases, such as diabetes, cash (50 per cent of the wages) to the
arthritis, bronchial asthma, skin allergic, insured persons (admissible to 91 days
immunological disorders, behavioural in a year) to compensate their loss of
disorders and mental diseases. wages in the event of sickness certified
by an authorized medical officer.
n Maternity benefit: It is payable (equal n Saves from the imposition of interest/

to wage) to insured women in case of damages/compensation/prosecution.
confinement for 12 weeks and 6 weeks n Employers get rebate under Income
C in case of miscarriage. Tax Act on contribution to ESIC.
H n Disablement benefit: Payable (72 per n Exempted from liability of organizing
A cent of the wages) for temporary or health care services for employees.
P permanent, partial or total disablement
T as a result of employment injury 2. Central Government Health
E (including occupational diseases) Scheme (CGHS)
R n Dependents benefit: It is payable to
Central Government Health Scheme (CGHS)
dependents of insured person dying as a
3 was started in 1954.
result of employment injury. Widow of
the deceased gets the benefit throughout Objectives of the Scheme
her life or until remarriage and legitimate

(i) To give extensive medical facilities to
or adopted children are paid till 18 years
central government employees and
of age.
their family members.
n Funeral expenses: On the death of an
(ii) To save government from heavy expenses
insured person, a sum of a maximum
on medical refund.
` 2500 is payable to the family member
to meet the funeral expense from local Coverage Under the Scheme
offices.
Scheme was started in Delhi and at present, it
n Rehabilitation benefit: Workers
is functioning in 25 cities: Nagpur, Hyderabad,
entitled to receive an artificial limb are
Bengaluru, Kolkata, Jaipur, Lucknow, Mumbai,
awarded a rehabilitation allowance,
Chandigarh etc.
for each day of their admission at the
artificial limb centre, for provision or Beneficiaries of Scheme
replacement of an artificial limb.
(i) Central Government employees and
n Other benefits: Involves free supply of
their family members.
physical aids and appliances, preventive
(ii) Member of Parliament.
health care services etc.
(iii) Judges of Supreme Court and High
Benefits to Employers Court.
Compliance under the Act brings about healthy (iv) Freedom fighters.
work force and augmentation in production: (v) Pensioners of Central Government, semi,
n Discharge the employer from liability autonomous units and employees of
under other labour enactments, such Semi-Government Organization.
as Workmen’s Compensation Act, (vi) Journalists
Maternity Benefit Act, etc. (vii) Governors and Ex-Vice Presidents.
Facilities Under the Scheme i.e. attainment by all people of the world by
(i) Outdoor treatment facilities in all the year 2000 ad of a level of health that will
medical systems. permit them to lead a productive life—also
(ii) Emergency services in Allopathy system. known as Health for All by 2000 ad. C
(iii) Free medicines. H
Membership A
(iv) Facilities for laboratory tests and
radiological investigations. Open to all countries P
(v) Treatment for serious patients at their WHO Work T
homes. E
(vi) Specialist consultation. WHO’s first Constitutional function is to act as R
(vii) Family welfare services. the directing and co-ordinating authority on
3
(viii) Facilities for 90 per cent advanced all international health work. The WHO also
has specific responsibilities for establishing

payment in case of need.
(ix) According to 2009 report, 9.34 lakhs are and promoting international standards in the
card holder and 31.81 lakhs beneficiaries. field of health, which comprise the following
Under CGHS, there are 247 allopathic broad areas:
hospitals, 82 dispensaries of AYUSH, (i) Prevention and control of specific diseases.
19 polyclinics, 65 laboratories, 21 dental (ii) Development of comprehensive health
units and 4 yoga centres. services.
(iii) Family health.
ROLE OF VOLUNTARY HEALTH (iv) Environmental health.
(v) Health statistics.
ORGANIZATIONS AND (vi) Biomedical research.
INTERNATIONAL AGENCIES (vii) Health literature and information.
(viii) Co-operation with other organizations.
1. World Health Organization
The world health organization (WHO) is a Structure
specialized, non-political, health agency of the The WHO consists of three principal organs:
United Nations, with headquarters at Geneva. (i) The World Health Assembly
The constitution came into force on 7th April, (ii) The Executive Board
1948, which is celebrated every year as “World (iii) The Secretariat
Health Day”. A World Health Day theme is
(i) The World Health Assembly
chosen each year to focus attention on a specific
aspect of public health. It is the supreme governing body of the organi-
zation. It meets annually at Geneva. The main
Objective functions of the Health Assembly are:
The objective of the WHO is “the attainment n To determine international health policy
by all people’s of the highest level of health” and programmes.
n To review the work of the past year. l Division of public information

n To approve the budget needed for the and education for health.
following year. l Division of mental health.
C n To elect Member States to designate a l Division of diagnostic, therapeutic
H person to serve for three years on the and rehabilitative technology.
A Executive Board and to replace the l Division of strengthening of health
P retiring members. services.
T (ii) The Executive Board l Division of family health.
E l Division of non-communicable
The executive board has 30–31 members:
R diseases.
n Minimum 3 member from each l Division of health manpower
3 WHO region. development.
n Meet twice a year. l Division of information systems
n The main work of the Board is to give support.

effect to the decisions and policies of l Division of personnel and general
the Assembly. services.
n The Board also has power to take l Division of budget and finance.
action itself in an emergency, such as
epidemics, earthquakes and floods, WHO Regional Organizations
where immediate action is needed. S. No. Region Headquarters
(iii) The Secretariat 1. South-East Asia New Delhi (India)

2. Africa Brazzaville Congo
The Secretariat headed by the Director
3. The Americas Washington DC (USA)
General:
4. Europe Copenhagen (Denmark)
n The primary function of the WHO 5. Eastern Alexandria (Egypt)
secretariat is to provide Member States Mediterranean
with technical and managerial support 6. Western Pacific Manila (Philippines)
for their national health development
programmes.
n The WHO Secretariat comprised of 2. United Nations International
the following divisions: Children’s Emergency Fund
l Division of epidemiological surveil- (i) Established in 1946 by the United
lance and health situation and Nations General Assembly to deal
trend assessment. with rehabilitation of children in war
l Division of communicable diseases.
ravaged countries.
l Division of vector biology and
(ii) The headquarters of the United Nations
control. International Children’s Emergency
l Division of environmental health.
Fund (UNICEF) is at United Nations,
New York. UNICEF’s regional office is (d) Education: Emphasis is placed on

in New Delhi, the region is known as the kind of schooling relevant to
the South Central Asian Region, which the environment and future life
covers Afghanistan, Sri Lanka, India, of the children. C
The Maldives, Mongolia and Nepal. H
Currently, UNICEF is promoting
(iii) UNICEF works in close collaboration A
a campaign known as GOBI campaign
with WHO and the other specialized P
to encourage 4 strategies for a “child
agencies of the United Nations like T
health revolution”:
UNDP, FAO and UNESCO. E
G : For growth charts to better monitor
Contents of Services: R
child development.
(a) Child health: UNICEF is focussing O : For oral rehydration to treat all 3
attention on providing primary mild and moderate dehydration.

health care to mothers and children. B : For breast feeding.
Emphasis is placed on immuniza- I : For immunization against measles,
tion, infant and young child care, diphtheria, polio, pertussis, tetanus
family planning aspects of family and tuberculosis.
health, safe water and adequate (iv) Since 1976, UNICEF has been partici-
sanitation. pating in Urban Basic Services (UBS).
(b) Child nutrition: UNICEF gives The aim of the UBS projects is to
high priority to improving child upgrade basic services (e.g., health,
nutrition. Specific aid given for nutrition, water supply, sanitation and
intervention against nutritional education) especially for women and
deficiency diseases through pro- children. The overall objective is to
vision of large doses of vitamin improve the degree and quality of
A in areas, where xerophthalmia survival and development of the children
is prevalent, enrichment of salt of urban low-income families.
with iodine in areas of endemic
goiter, provision of iron and folate 3. United Nations Educational,
supplements to combat anemia’s
and enrichment of foods. Scientific and Cultural
(c) Family and child welfare: To improve Organization (UNESCO)
the acre of children, both within (i) It is a specialized agency of United
and outside their homes through Nations established on 16th November,
such means as parent education, 1945.
day care centres, child welfare (ii) It has 193 member states and 7 associate
and youth agencies and women’s members.
clubs.
(iii) This organization is based in Paris with living and working conditions of workers
over 50 field offices and many institutes all over the world.
throughout the world. (iv) The ILO also provides assistance to
C organizations interested in the betterment
H Objectives of UNESCO of living and employment standards.
A (a) To maintain peace and security by
P promoting international collaboration 5. United Nations Development
T through education and sciences. Programme (UNDP)
E (b) To protect human rights, universal
respect for justice. (i) Established in 1966.
R
(c) To improve educational, social and human (ii) It is the main source of funds for
3 technical assistance.
sciences with better communication
and information. (iii) The basic objective of the UNDP is to
help poorer nations to develop their

4. International Labour human and natural resources more fully.
(iv) The UNDP projects cover virtually every
Organization (ILO) economic and social sector: agriculture,
(i) It was established in 1919 to improve industry, education and science, health,
the working and living conditions of social welfare, etc.
the working population all over the
world. WHO and ILO are co-partners 6. United Nations for Population
in the field of health and labour. Activities (UNFPA)
(ii) Head quarters: Geneva, Switzerland.
(i) UNFPA has been providing assistance
Objectives to India since 1974. In addition to
(a) To improve the working and funding national level schemes, area
living conditions of workers/ projects for intensive development of
labourers through international health and family welfare infrastructure
efforts. and improvement in the availability
(b) To co-operate in maintaining peace of services in the rural areas have been
in establishment by promoting under implementation in 11 districts
special justice. of Bihar and 4 districts of Rajasthan.
(c) To promote economic and social (ii) The UNFPA inputs are designed:
stability. (a) To develop national capability for
(iii) The International Labour Code is a the manufacture of contraceptives.
collection of international minimum (b) To develop population education
standards related to health, welfare and programmes.
(c) To undertake organized sector (vi) The main object of the Campaign is to
projects. combat malnutrition and to disseminate
(d) To strengthen programme manage- information and education.
ment as well as to improve output (vii) The joint WHO/FAO expert committees C
of grass-root level health workers. have provided the basis for many co- H
(e) Introduction of innovative appro- operative activities: nutritional surveys, A
aches to family planning and training courses, seminars and the co- P
MCH care. ordination of research programmes on T
brucellosis and other zoonoses. E
7. Food and Agriculture R
Organization (FAO) 8. World Bank (WB)
3
(i) FAO was formed in 1945 with World Bank is a specialized agency of the

Headquarters in Rome. United Nations:
(ii) Chief aims of FAO are: (i) It was established in 1944 with the
(a) To help nations to raise living purpose of helping less developed
standards. countries to raise their living standards.
(b) To improve nutrition of the people (ii) The powers of the bank are vested in
of all countries. a Board of Governors.
(c) To increase the efficiency of (iii) The Bank gives loans for projects that
farming, forestry and fisheries. will lead to economic growth.
(d) To better the condition of rural (iv) The projects are usually concerned
people. with electric power, roads, railways,
(e) To widen the opportunity of all agriculture, water supply, education,
people for productive work. family planning etc.
(v) Health and environmental components
(iii) FAO’s prime concern is the increased have been added to many projects.
production of food to keep pace with (vi) Co-operative programmes exist between
the ever-growing world population. WHO and the Bank e.g. projects for
(iv) The most important aspect of FAO’s Water Supply, World Food Programme,
work is towards ensuring that the food Population Control etc.
is consumed by the people, who need
it, in sufficient quantities and in right 9. United States Agency for
proportions, to develop and maintain
a better state of nutrition throughout International Development
the world. (i) The US Government presently extends
(v) FAO has organized a World Freedom aid to India through three agencies:
from Hunger Campaign (FFHC) (a) United States Agency for Inter-
in 1960. national Development (USAID).
(b) The Public Law, 480 (Food for (iv) The plan provides for visits to countries
Peace) Programme. by experts, who can offer advice on local
(c) The US Export-Import Bank. problems and train the local people.
C
(ii) It was created in 1961. A USAID (v) The contribution of Canada in supply-
H ing Cobalt Therapy Units to medical
mission functions in New Delhi.
A institutions in India was an important
(iii) It is in-charge of activities previously
P item of aid under the Colombo Plan.
administered by the Technical Co-
T (vi) Colombo Plan seeks to improve living
operation Mission (TCM).
E standards of the people of the area by
(iv) The US has been assisting in a number
R reviewing developmental plans and
of projects designed to improve the
co-ordinating development assistance.
3 health of India’s people. These are:
(a) Malaria eradication 11. Swedish International
(b) Medical education

Development Agency (SIDA)
(c) Nursing education
(d) Health education
(i) The Swedish International Develop-
(e) Water supply and sanitation ment Agency is assisting the National
(f ) Control of communicable diseases Tuberculosis Control Programme
(g) Nutrition since 1979.
(h) Family planning (ii) The SIDA assistance is usually spent
on procurement of supplies like X-ray
(v) The recent trend in assistance from
units, microscopes and anti-tuberculosis
the USA is increasingly in the support
drugs.
of agricultural and family planning
(iii) SIDA authorities are also supporting
programmes, with some reduction in
the Short Course Chemotherapy Drug
aid in the general public health field.
Regimens under Pilot study, which
were introduced in 18 districts of the
10. The Colombo Plan country during 1983–84 and pilot
(i) Established in 1950 for co-operative phase I of the revised strategy of NTP
economic development in South and in 5 sites namely Delhi, Bengaluru,
South-East Asia. Mumbai, Kolkata and Mehsana (Gujarat)
(ii) Membership comprises 20 developing sine 1993.
countries within the region and 6 non-
regional members: Australia, Canada, 12. Danish International
Japan, New Zealand, UK and USA. Development Agency (DANIDA)
(iii) The bulk of Colombo plan assistance
goes into industrial and agricultural (i) Denmark is one of the 5 countries
development. in the world that meets the United
Nation’s target of granting 0.7 per cent (ii) It was established by Henry Dunant
of gross national income (GNI) in in 1919.
development assistance. (iii) International Committee of the Red
(ii) The Danish International Development Cross (ICRC), an independent, neutral C
Agency is the section of the Danish institution, the founder organization of H
Ministry of Foreign Affairs dedicated the Red Cross. A
to providing aid and financing pro- (iv) The work of the Red Cross was extended P
development activities in developing to other programmes, which comprise T
countries. services to armed forces, service to war E
(iii) The Government of Denmark is pro- veterans, disaster service, first-aid and R
viding assistance for the development nursing, health education and maternity
of services under National Blindness and child welfare services, which would 3
Control Programme since 1978. prevent human suffering.

(iv) The new strategy for Denmark’s develop-
ment co-operation, “The Right to 2. Rockefeller Foundation
a better life” creates the foundation (i) Rockefeller foundation was established
for an effective Danish Development in 1913 by John D Rockefeller.
Co-operation, which aims to combat (ii) The purpose to promote it is the well
poverty and promote human rights. being of mankind throughout the
(v) Economic growth is central to the world.
strategy, but growth should be green (iii) The activities of the foundation, where
and promote social progress in order more in the field of community health
to contribute to improve the lives of and medicine.
poor people and their ability to create (iv) The work of Rockefeller foundation
a better life for themselves. started from 1920 in India with the
scheme for the control of hookworm
NON-GOVERNMENTAL disease in the Madras Presidency.
VOLUNTARY AGENCIES (v) Established of the All India Institute of
Hygiene and Public Health at Kolkata
1. International Red Cross was in large measure due to the co-
Red Cross is Non-Governmental, Non-Political, operation of the Rockefeller Foundation.
International Humanitarian Voluntary Organi- (vi) The foundation’s programmes included:
zation devoted to the service of mankind in (a) The training of competent teachers
peace and war: and research workers.
(i) The headquarters of International Red (b) Training abroad of candidates
Cross Society is in Geneva. from India through fellowships
and travel grants.
(c) Sponsoring of visit of a large (c) Pilot project in rural health

number of medical specialist services: At Gandhigram, Tamil
from the USA. Nadu to develop and operate a co-
C (d) Providing grants in aid to some ordinated type of health service,
H selective institutions. which will provide a useful model
A (e) Development of medical college for health administrators in the
P libraries. country.
T (f ) Population studies. (d) Establishment of NIHAE: The
E (g) Assistance to research projects and Ford Foundation has supported
R institutions (for example: National the establishment of the National
Institute of Virology at Pune). Institute of Health Administration
3
(h) Helps in the development of and Education at Delhi. The
agriculture. Institute provides senior staff-
(i) Helps in the development of college type training for health

family planning. administrators.
(j) Provides rural training and (e) Calcutta water supply and drain-
medical education. age system: The Foundation
has helped in the preparation of
3. Ford Foundation a master plan for water supply,
sewerage and drainage for the city
(i) Ford foundation is an organization
of kolkata in collaboration with
which is dedicated to the field of rural
other international agencies.
health services and family planning.
Family planning programme: The
(ii) The Ford Foundation has helped India (f )
Foundation is supporting research
in the following projects:
in reproductive biology and in
(a) Orientation training centres: At the family planning fellowship
Singur, Poonamallee and Najafgarh programmes.
to provide training courses in
public health for medical and (iii) In India, the foundation provides help
paramedical personnel from all in short-term training programmes in
over India. community health, pilot projects of health
(b) Research-cum-action projects: services, RCA projects and research
Were aimed at solving some of the programmes in family planning.
basic problems in environmental (iv) The Ford Foundation has provided
sanitation e.g. designing and help in the water supply and drainage
construction of hand-flushed of sewage systems in Kolkata and the
acceptable sanitary latrines in establishment of National Health and
the rural areas. Family Welfare Institute in Delhi.
4. Co-Operative for Assistance (h) Konkan integrated development

project.
and Relief Everywhere
(ix) CARE India works in partnership
(i) It was founded in North America C
with the Government of India, State
in 1945. H
Governments and NGO’s.
(ii) It is one of the world’s largest independent, A
(x) It undertakes projects in Andhra Pradesh,
non-profit, non-sectarian international P
Bihar, Madhya Pradesh, Maharashtra,
relief and developmental organization. T
Odisha, Rajasthan, Uttar Pradesh and
(iii) CARE provides: E
West Bengal.
(a) Emergency aid R
(b) Health education 5. Asian Development Bank 3
(c) Co-operation in agriculture
(d) Professional training (i) Asian Development Bank established on

(e) Long-term developmental assistance 19 December, 1966 to promote social
and economic development in Asia.
(iv) CARE begins its operation in India (ii) Social development organization
in 1950. dedicated to reduce poverty in Asia
(v) 1971: CARE is assisting in Mid-Meal and Pacific through inclusive economic
Scheme. growth, environmental sustainable
(vi) Till the end of 1980’s, the primary growth and regional integration.
objective of CARE: To provide food (iii) Asian Development Bank assistance
for children in the age group of supports the Government of India’s
6–11 years. evolving priorities.
(vii) CARE also supports the ICDS (iv) Asian Development Bank’s country
Programme and developmental pro- partnership strategy, 2013–2017 for
grammes in the area of health and India aims to support the government’s
income supplementation. Twelfth Five-year plan priorities of
(viii) CARE helped in the following projects: “faster, more inclusive and sustainable
(a) Integrated nutrition and health growth”.
project.
(b) Better health and nutrition project. NATIONAL VOLUNTARY HEALTH
(c) Anaemia control project.
(d) Improving women’s health project.
AGENCIES IN INDIA
(e) Improved health care for adolescent 1. Indian Red Cross Society
girls project.
(f ) Child survival project. (i) The Red Cross Society of India was
(g) Improving women’s reproductive established by an Act of the Indian
health and family spacing project. Legislature in 1920.
(ii) The National headquarters of Indian health care. Some of the non-govern-
Red Cross Society (IRCS) is at Delhi. mental organizations are: Voluntary
(iii) Objectives of Indian Red Cross Society: Health Association of India, Trained
C Nurses Association of India, World
(a) Improvement of health.
H Federation of Medical Education and
(b) Disaster relief.
A (c) Prevention of disease. International Union against Cancer etc.
P (d) Promotion of voluntary blood
T donation. 2. Kasturba Memorial Fund
E (e) Collection of blood for transfusion. (i) The Kasturba Memorial Fund was
R (f ) Hospital services. established in the memory of Kasturba
3 (g) Maternal and child welfare. Gandhi after her death in 1944.
(h) Family planning. (ii) Attempt is made to raise the standard
(i) Community services. of Indian women.

(j) Ambulance services.
(k) Nursing services. 3. Tuberculosis Association of India
(l) Mitigation of suffering.
(i) The Tuberculosis Association of India
(iv) The Red Cross Home at Bengaluru for was established in 1939.
disabled ex-servicemen is one of the (ii) Headquarters: Delhi
pioneer institutions of its kind in Asia. (iii) The association conducts a drive for
(v) Indian Red Cross has work in the direc- fund collection every year.
tion of reducing human suffering by (iv) It helps in training health professionals
providing health services like disaster in anti-tuberculosis programmes and
services, maternity and child welfare health education.
services etc. (v) Some institutions run by the association:
(vi) Indian Red Cross Society is a national (a) Lady Linlithgow Sanatorium,
organization with more than 655 branches, Kasauli.
which are spread throughout the state, (b) King Edward VII Sanatorium,
district and sub-division of the country. Dharampur.
(vii) The Junior Red Cross is one of the most (c) Tuberculosis Centre, New Delhi.
active sections of the Society. It gives (d) TB Hospital, Mehrauli.
an opportunity to lakhs of boys and
girls all over India to be associated with 4. Bharat Sevak Samaj (BSS)
activities like the village uplift, first
aid, anti-epidemic work and building (i) Bharat Sevak Samaj was formed
up of an international friendliness, in 1952.
understanding and co-operation. (ii) It is non-political, non-governmental
(viii) Non-governmental organizations con- and non-voluntary organization.
stitute a valuable resource in promoting
(iii) The main objective of BSS is to help (iv) Functions of the Board:
people to achieve health through their (a) Serving the need and importance
efforts. of voluntary welfare agencies.
(iv) The main activity of the organization— (b) Setting up voluntary social welfare C
improvement in environmental sanita- agencies and to promote their H
tion in rural area is included. growth. A
(v) The branches of BSS are functioning (c) Providing financial aid to deserving P
in almost all districts of all states. agencies and organizations. T
E
5. Hind Kusht Nivaran Sangh 7. Family Planning Association of R
(i) The Hind Kusht Nivaran Sangh was India 3
founded in 1950.
(i) It was formed in 1949 with Headquarters

(ii) Headquarters: New Delhi and the Sangh
in Mumbai.
has branches throughout India, which
(ii) The association promotes activities
are active in Leprosy Eradication
related to family planning throughout
Programme in India with the help of
the country with aid from Government
voluntary and government agencies.
of India.
(iii) The main activities of Sangh are:
(iii) The activities include:
(a) To help leprosy homes and clinics.
(a) Conducting family planning clinics.
(b) Health education through publi-
(b) Training of health professionals.
cation and publicity.
(c) Providing information related to
(c) Training of health personnel.
family planning.
(d) Field diagnosis and research.
(e) Arranging leprosy worker’s confe-
8. All India Blind Relief Society
rence and publication of quarterly
“Leprosy India”. (i) It was established in 1946 with objective
of co-ordinating the various organiza-
6. Central Social Welfare Board tions working for the blind people.
(ii) It also conducts eye camps, works for
(i) This organization is semi-government,
social and economic help to the blind.
autonomous organization, which was
(iii) It helps in prevention and control of
formed by Government of India in 1953.
blindness.
(ii) The board has started the family and
child welfare services since 1968.
9. All India Women’s Conference
(iii) It plays an important role in social
education, craft training, maternity, (i) It is voluntary organization of women,
milk distribution, establishment and which was formed in 1926.
running of Balwadi and play centres. (ii) Its branches are functioning all over the
country.
(iii) It gives special contribution in running (v) In the Brigade wing trained workers
of maternal, child health clinics, health perform field duties.
centres and family planning clinics. (vi) Apart from emergencies, the association
C (iv) It also arranges for adult education. provides first-aid services in public
H functions, festivals, games, factories.
A 10. Indian Council For Child Mines and other public places.
P Welfare (ICCW) (vii) It also involves training to teachers,
T students, factory and mine workers,
(i) Indian Council for Child Welfare was
E NCC, Scouts and guide girls, aviation
formed in 1952.
R stuff and general public.
(ii) This organization is concerned with (viii) It has trained approximately 10 million
3 International Children’s Welfare Council. people.
(iii) The main objective was to promote Composition: The President of India is
the opportunities and facilities for the President of Saint John Ambulance
development of children through legal Association.
or any other means. (ix) The Chairman of Saint John Ambulance
(iv) It also helps in promotion of physical, Association is nominated by the President.
social and mental health of children. (x) The National Executive Committee
is headed by the Union Minister for
11. Saint John Ambulance Health and Family Welfare.
Association (xi) The Secretary General of the Indian
(i) Headquarters: Delhi. Red Cross Society is also the Secretary
(ii) The objective of Saint John Ambulance General of this association.
Association is: (xii) The organization functions through its
association and brigade wings.
(a) To create an army like organization:
n for delivering first-aid.
n to take care of the sick and PUBLIC HEALTH LEGISLATION
injured.
Definition
(b) To give better home nursing.
It is a study of legal powers and duties of the
(c) To train publics for first-aid services.
state to assure the conditions for people to
(iii) Saint John Ambulance Association has be healthy and limitations on the power of
more than 52000 trained workers. the state to constraint the autonomy, privacy,
(iv) It comprises 2470 divisions, 680 regional/ liberty, propriety or other legally protected
district/local centres, apart from 28 brigade interests on the individual for the protection
districts, 17 state centres, 8 railway of promotion of community health.
centres and 2 Union Territories centres.
Public Health Act, 2010, commenced on (v) To achieve maternal health and to
1st September, 2012. The objectives of the empower the women:
Public Health Act are to: n The Pre-conception and Prenatal
(i) Protect and promote public health. Diagnostic Technique Act, 1994. C
(ii) Control the risk to public health. n Domestic Violence Act, 2005. H
(iii) Promote the control of infectious disease. n Indecent Representation of A
(iv) Prevent the spread of infectious disease. Women (Prohibition) Act, 1986. P
(v) Recognize the role of local governments n The Medical Termination of T
in protecting public health. Pregnancy Act, 1971. E
n The Maternity Benefit Act, 1961. R
Categories of Public Health legislation n The Dowry Prohibition Act, 1961.
3
(i) To protect the rights of health and n The Immoral Traffic (Prevention)

improve the health of nation in Act, 1956.
comprehensive manner: (vi) To safeguard the children and young:
n National Health Bill, 2009. n The Infant Milk Substitutes,
(ii) To improve and maintain high standards Feeding Bottles and Infant Foods
in the medical education and services: (Regulation of Production, Supply
and Distribution) Act, 1992.
n The Indian Medical Council Act,
n The Child Labour (Prohibition
1956 and Regulation, 2002.
and Regulation) Act, 1986.
n The Indian Nursing Council
n The Child Marriage Restraint
Act, 1947.
Act, 1929.
n The Consumer Protection
Act, 1986. (vii) To rehabilitate and provide equal
(iii) Public registration to assess mortality opportunity to disabled and dis-
and enumeration of population: advantaged groups:
n The Census Act, 1948.
n The Persons with Disabilities
n The Registration of Births and (Equal Opportunity, Protection
Deaths Act, 1969. of Rights and Full Participation)
Act, 1995.
(iv) To prevent public health problems: n The Mental Health Act, 1987.
n The International Health Regula-
(viii) To prevent drug addiction and substance
tion, 2005.
abuse and safe manufacturing of drugs,
n The Transplantation of Human
Organ Act, 1994. distribution and storage:
n The Prevention of Food Adultera- n The Narcotic Drugs and Psycho-
tion Act, 1954. tropic Substances Act, 1985.
n The Epidemic Diseases Act, 1897.
n The Cigarettes and Other Tobacco (x) Environmental legislations:

Products Act, 2003. n The Environment (Protection)
n The Drugs and Cosmetics Act, 1986.
C Act, 1940. n The Biomedical Waste (Manage-
H n The Drugs and Magic Remedies ment and Handling) Rules, 1998.
A Act, 1948. n The Municipal Solid Waste
P (ix) To protect workers and to provide (Management and Handling)
T social security: Rules, 2000.
E n The Hazardous Waste (Manage-
n The Minimum Wages Act, 1948.
R ment and Handling) Rules, 1989.
n The Factories Act, 1948.
3 n The Air (Prevention and Control
n The Mines Act, 1952.
of Pollution) Act, 1974.
n The Employees State Insurance
n The Motor Vehicle Act, 1988.
Act, 1948.
n The Workmen’s Compensation (xi) To promote voluntary work:
Act, 1923. n The Red Cross Society Act, 1936.
C
HEALTH EDUCATION H
A
P
T 4
E
R
and helps people to adopt and maintain

INTRODUCTION TO HEALTH
healthy practices and lifestyle, advocates
EDUCATION environmental changes”.
Health Education is one of the most cost effective
intervention. A large number of diseases to be Aims and Objectives
prevented with little or no medical intervention, 1. To ensure the belief that “Health is
if people were adequately informed about them Wealth”.
and if they were encouraged to take necessary 2. To encourage people to adopt and sustain
precautions in time. World Health Organiza- health promoting lifestyle and practices.
tion Constitution states that “Extension to all 3. To promote the proper use of health
people of the benefits of medical, psychological services.
and related knowledge is essential to the fullest 4. To arouse interest and provide new
attainment of health.” Health Education is knowledge, improve skills and change
a part of health care that is concerned with attitudes in making rationale decisions
promoting healthy behaviour. to solve their own problems.
5. To make awareness regarding health
Definition and health issues in people, groups and
1. According to John M Last, “The process communities.
by which individuals and groups of people
learn to behave in a manner conducive Concepts
to the promotion, maintenance or Following the Alma-Ata Declaration adopted
restoration of health”. in 1978, the concept of health education are
2. According to National Conference on as follows:
Preventive Medicine in United States,
1. Prevention of disease to promote healthy
“It is a process that informs, motivates
lifestyle.
2. The modification of individual behaviour 3. Community participation to community

to modification of “social environment”, involvement.
in which the individual lives. 4. Promotion of individual and community
“self-reliance”.
Scopes
Human Biology
C Nutrition
H
Hygiene
A
P Family Planning and Maternal and Child Health
T
Prevention of Diseases
E
R Prevention of Accidents
4 Mental Health
Health Education
Utilization of Health Services
Sex Education
Health Statistics
FIG. 4.1: Scopes
National Plan for Health Education co-ordinate health education work in

country.
Government has a responsibility for assisting 2. Many state governments in India have
and guiding the health education of general now health education bureau in their
public: health directorates.
1. At National level, the Government of 3. Some other official agencies, DAVP
India, in 1956, established a Central (Directorate of Advertising and Visual
Health Education Bureau in Ministry Publicity), Press information bureau,
of Health, New Delhi to promote and Doordarshan and All India Radio are
active in health education work.
Health Education 91
4. Some voluntary agencies, such as health education was established in

Indian Red Cross are also engaged 1983 with headquarters at Bengaluru.
in health education.
5. South East Asia Regional Bureau Communication Techniques
(SEARB) of International Union for
R: Recognition
Listening
A: Assessment
Broad Openings
C
H
I: Intervention
Restating A
P
I: Intervention
Clarication
T
E
R
R: Recognition
Reection
4
A: Assessment
Focusing
Health Education
I: Intervention
Sharing Perceptions
I: Intervention
Silence
A: Assessment
Humor
I: Intervention
Informing
I: Intervention
Suggesting
FIG. 4.2: Communication Techniques

Methods and Media for Health 2. Group Approach

Education Programmes It is an effective way of educating the community.
It involves the following:
1. Individual Approach
(i) Lecture Method/Chalk and Talk Method
It is given in personal interviews by Health
Special form of communication with proper
professionals to clients. A Community Health
voice, gesture, movement, facial expression
Nurse uses individual approach through home
and eye contact:
visits, personal contact and personal letters.
n Most frequently used method of teaching.
C
Health Communication
H
A
P
Individual Approach: Group Approach: Mass Approach:
T
Personal Contact Lectures Television
E Home Visits Demonstrations Radio
Personal Letters Discussion Methods
R Newspaper
Printed Material
4 Posters
Direct Mailing
Health Museums
Health Education
Exhibition
Folk Methods
Internet
FIG. 4.3: Health Communication
Advantages (ii) Demonstration
n Factual material is presented in a directed Demonstration is an instance of somebody
and logical manner. showing and explaining how something work
n May provide experience that inspire. or done.
n Useful for large groups. — Oxford Advanced Learner’s Dictionary
Disadvantages Advantages
n Proficient oral skills are required. n It provides an opportunity for observa-
n Audience is often passive. tional learning.
n Communication is one way. n The demonstration method is adaptable
n Learning is difficult to guage. to both, group and individual teaching.
Health Education 93
n
It correlates theory with practice. (b) Panel discussion
n It clarifies the underlying principle by It is a method in which 4–8 qualified persons
demonstrating the ‘why’ of the procedure. talk about the topic and discuss a given problem
Disadvantages in front of a large group of audience. Panel
n It provides no scope for ‘learning by
comprises a chairperson/moderator, who opens
doing’ for students, as students just the meeting, welcome the group and introduces
observe what the teacher is performing. the panel members.
n If method is not student-centred, it Advantages
makes no provision for individual n Different point of views in the subject
differences. are presented by experts.
n Since, the teacher performs, the experi- n Quick exchange of facts, opinions and C
ment in his own pace, many students plans. H
cannot comprehended the concept n Student learn to discuss a topic in A
being clarified. conversational form in a small group P
n It is time consuming process/method. in front of a large group. T
(iii) Discussion Methods Disadvantages E
Involves the following methods: n Panel method require more time in R
(a) Group discussion planning, organizing and presentation 4

for teaching selected topics.
Provides a wider interaction among members
Health Education
n Discussion may be superficial, if presenter
then is possible with other methods. For
lack mastery on their subject.
effective group discussion, there should be
6–12 members in a group. The participants (c) Symposium
are all seated in a circle and there should be a It consist series of lecture on a selected topic.
group leader to initiates the subject. Experts present their views on a subject in
Advantages brief, but no discussion among experts. In the
end, audience can contribute in symposium
n It helps in changing the attitude and
by asking questions. Towards the end of the
health behaviour of people.
session, the chairperson presents the gist of
n Decision taken by group more easily
the symposium.
than decision taken by solitary one.
n It is very effective in reaching decisions, Advantages
based on ideas of all people. n Coverage of topic by several experts in
Disadvantages depth and broader sense.

n It provides broader scope for general
n All members are not equal in group,
discussion.
some may dominant in group.
n Greater feedback and contribution
n Many irrelevant discussion may be there.
from the audience because the topic is
n Not suitable for all the topics.
presented from several points of views.
Disadvantages Advantages
n Limited time (15–20 minutes) to present n It supplements the lecture by asking
the topic. the questions, clarifying doubts.
n Audience participation is also limited. n It provides the opportunity to direct
n Time consuming. and guide the individual student, assist
(d) Workshop slow learner.
A novel experiment in education is called as Disadvantages
workshop. It consists series of meetings, usually n Time consuming.
4 or more than 4 with emphasis on individual n Require multiple skills.
work. The total workshop may be divided (f) Seminar
C into small groups and each group will choose It is a method of group discussion, is similar to
H a chairperson and a recorder. One group is symposium in many ways. It is usually used in
A allotted one topic only. Each individual has colleges and university students. It is usually
P important role. Education is carried out in the held on regional, state or national level. It
T guidance of experts and at last, small groups ranges from 1day to 1 week in length and may
E combine to study the subject in detail and find cover a single topic in depth.
R out the solution of the problem and conclusions
are presented at the end of the workshop. Advantages
4 n It gives training in self-learning.
Advantages
n It promote independent thinking.
Health Education
n Comprehensive knowledge
n It promotes team spirits and co-
n Certification
operative attitude.
n Updation
n Development of inter-personal relation-
Disadvantages
ship n Time consuming
n Expensive
Disadvantages
n Time consuming
(g) Role play
n Expensive The spontaneous acting of role in context of clean
n Unable to cover large topics defined social situation by 2 or more persons
for subsequent discussion. It is a medium to
(e) Conference
express one’s opinion and about certain social
This method is similar to class discussion but situations.
number of students is limited. Usually, the
teacher assign large class into small conference Advantages
groups in order to provide opportunity for n Develop leadership skill, interviewing
discussion usually after formal lecture that and social interaction.

deals with a selected problem. n Provide an opportunity for the student
to put herself in another’s place and to
become more sensitive to another’s feeling.
Health Education 95
n Develop skills in group in problem-solving. setting norms, delivering technical messages,

n Develop the ability to observe and popularizing health knowledge and fostering
analyze the situation. community involvement are well-recognized.
Disadvantages Public health methodologies should be culturally
n Time consuming
appropriate; they should be carefully thought-out
n Language barrier
before use. The commonly used mass media are:
n Lack of active participation (i) Television
(ii) Radio
3. Mass Approach (iii) Newspaper
It is “Education of the General Public”. No (iv) Printed Material
health worker or health team can mount an (v) Posters C
effective health education programme for (vi) Direct Mailing H
the whole community, except through mass (vii) Health Museums A
media of communication. Mass media are a (viii) Exhibition P
“one-way” communication. They are useful (ix) Folk Methods T
in transmitting messages to people even in (x) Internet E
the remotest places. The power of mass media
in creating a political will in favour of health, R
Principles of Health Education
raising the health consciousness of the people, 4
Health Education
Motivation
Interest
Participation
Comprehension
Learning by Doing
Repetition
Simple to Complex, Normal to Abnormal and Known to Unknown
Good Human Relation
Communication
Capable Leadership
Planning
Evaluation
FIG. 4.4: Principles of Health Education

Planning for Health Education
R:
Need
Recognition
Assessment
A: Assessment
Content
C I: Intervention
Process
H
A
P I: Intervention
Evaluation
T
E
R FIG. 4.5: Planning of Health Education
4
1. Need Assessment 2. Content
Health Education
It is the most important step in planning that Content should be emphasis in things
may be quiet complex or as simple as asking concerned to the patient:
a question. Different techniques are used for (i) Look at the result of the need assessment.
assessment: (ii) Seek the resources like literature, audio-
(i) Questionnaire: The most commonly visual aids and educational material.
used tool for assessment.
(ii) Delphi technique: Opinion is achieved 3. Process
from a pool of experts. It involves a series of skills that need to be
Salient belief assessment: Usually we
(iii) practiced just as any other nursing skill.
have 5–8 salient beliefs about any The techniques used for health education
subject. These beliefs are so influential process:
on behaviour; health teaching should (i) Content to be taught
be based on awareness of the patient (ii) Need of the client
salient belief. (iii) Skills of the professional nurse
Health Education 97
Some other techniques are also used: planning and to increase efficiency and also,
(a) Giving information/Questionnaire. used to assess the goals and objectives of health
(b) Contracting education.
(c) Demonstration and returned demon-
stration. ROLES AND RESPONSIBILITIES
(d) Environmental cueing OF COMMUNITY HEALTH NURSE
(e) Group norms
(f ) System change IN HEALTH EDUCATION
4. Evaluation Roles

It is the last step of health education in which C
process evaluation is used for further programme H
A
P
Educator T
E
R
Change Agent Advocator
4
Health Education
Care Provider Evaluator
Roles
Researcher Advisor
Liasion Communicator
Co-ordinator
FIG. 4.6: Roles of Community Health Nurse in Health Education

Responsibilities
To Gain Condence of People
To Arouse Interest in People About Good Health
To Motivate them for Healthy Habits
To Prepare them for Utilization of Available Resources and

Health Services
C
To Develop a Sense of Responsibility Towards Good Health
H and Community
A
P To Induce Co-operative Feeling during Health Education
T
To Provide an Opportunity for Participation
E
R To Make Aware People Regarding Prevention of Communicable
and Non-Communicable Diseases
4
To Use of Appropriate Audio-Visual Aids to Enhance the Effect
Health Education
of Health Education
To Participation and Co-operation of Government and Voluntary

Agencies, State Health Education Bureau, Central Health
Education Bureau, Local Leaders and Teachers
To Know the Basic Difference between Health Education

and Propaganda
Periodical Evaluation and Accepted Correction of Health Education

Programmes with various Tools and Observations
To Remove various Obstacles for Effective Communication
Health Education should be Planned and Continuous
FIG. 4.7: Responsibilities of Community Health Nurse in Health Education

C
ROLES OF COMMUNITY H
A
HEALTH NURSE P
T 5
E
R
nurse is expected to perform the following

INTRODUCTION TO ROLE OF
roles:
COMMUNITY HEALTH NURSE
There are enumerable roles which are performed 1. Care Provider
by community health nurses working in various (i) The Community Health Nurse provides
community health settings. Considering the comprehensive and continuous care i.e.
conceptual aspects and nature of community care along the entire range of health
health nursing practice, the community health and disease continuum to entire family,
Care Provider Planner Organizer
Sensitive Sensitive Director

Sensitive
and
Manager
Observer Observer Co-Ordinator
Observer
Educator Change Agent Controller and Researcher

Evaluator
Concerned Leadership
Advocator Collaborator
Advisor Role
FIG. 5.1: Roles of Community Health Nurse

group of people and even the community health problems/medical conditions,

at large: medical prescription, nursing needs/
(ii) The Community Health Nurse appro- nursing problems, competence of
aches the client for providing promotive individual, family member etc.
and preventive services.
(iii) The care encompasses all the dimensions 2. Sensitive Observer
of health with efficient and effective (i) It is very essential for a community health
C professional skills, adequate knowledge
H nurse to observe, react and take action
and positive attitude of community
A with respect to determinants of health
health nurse.
P
of individual, family and community
(iv) The care is provided in the clinic, home, at large:
T school and at work place depending upon
E
R
5 Any Evidence of Ill health, Abnormal Behaviour, Poor Growth and
Development, Response to Treatment etc.
Roles of the Community Health Nurses
Any Evidence of Poor Health Knowledge, Health Attitude, Health

Behaviour and Practices
Physical, Biological and Psychosocial Aspects which Affect Health

and Welfare of the Family and Community at Large
Observation of Available Resources
FIG. 5.2: Sensitive Observer
(ii) It includes observation of people, their 3. Educator

lifestyle and environmental conditions
with respect to: (i) The ultimate aim of community health
nursing is to help people to gain health
(a) The observation can be planned and
knowledge, modify health attitude, health
incidental but must be recorded.
behaviour and develop competence to
(b) Making skillful observation is
become self-dependent, self-reliant in
integral to the care provider role
dealing their health matters, etc.
of community health nurse.
Roles of the Community Health Nurses 101
(ii) The major emphasis is on health pro- (ii) As a manager, the community health
motion and disease prevention. nurse plans, organizes, co-ordinates,
supervises, guides, directs, reports and
4. Advocator evaluates.
(i) As an advocate, the community health
nurse stands between the individual/ 8. Planner
family/community and various specialized (i) Planning is the foremost function of C
health services. community health nurse. H
(ii) As an effective advocate, the community (ii) The community health nurse involves A
health nurse needs to possess various in overall planning of community health P
qualities: care or in planning of any specific T
(a) Risk taking behaviour programme for any particular group
E
(b) Assertiveness or for the whole community.
R
(c) Communicability
(d) Resourcefulness 9. Organizer 5
(i) Organizing is the second function of

5. Concerned Advisor management.
The community health nurse acts as an advisor (ii) As an organizer, the community health
while giving suggestions and advises on practical nurse tries to provide infrastructure for
situations which require immediate actions and people to function to achieve the desired
where there is no scope of health education. objectives i.e. she/he has to decide who
will do what, who will report to whom,
6. Change Agent where and how decisions will be made.
The community health nurse acts as a change 10. Director and Co-ordinator
agent i.e. she serves as a potentiater or catalyst
to develop individuals/families/communities (i) The Director and Co-ordinator role are
capabilities and to effect change in their attitude the part of community health nurse’s
and health behaviour. manager role which will help in getting
the work done and achieving the goals
7. Manager and objectives.
(ii) She/he ensures effective byway commu-
(i) Community health nurses are expected nication between her/his as a manager
to function as a manager of family health and the personnel and also among the
care, school health care, community personnel themselves about their job
health care, any specific programme responsibilities to be performed, direct,
or project, etc. motivate, supervise and guide them to
reach the desired objectives.
11. Controller and Evaluator (ii) The community health nurse makes
use of investigate approach in giving
(i) Once any service programme is planned care to individual, family and people
and implemented, it is essential for the at large.
community health nurse to monitor
(iii) The practice of community health
the service programme to make sure,
implies involving epidemiologic
whether it is proceeding in its direction
C
approach to deal with health problems.
or not.
It may range from the simplest inquiry
H (ii) The community health nurse acts as
to most complex epidemiological
A an evaluator and judge the outcome
studies. Therefore, community health
P of performance against the intended
nurse does perform a researcher role
T goals and objectives.
in community health nursing practice.
E
R 12. Leadership Role
NATIONAL HEALTH
5 The community health nurse takes leadership
role in persuading people to solve their health PROGRAMMES
problems and become self-reliant in their health National health programmes emphasize to
matters by persuation. primary, secondary and tertiary health care
services to people all over the country.
13. Collaborator Following measures are important in
(i) The community health nurse collabo- effective implementation of national health
rates with other health team members, programmes:
voluntary organization, outside the 1. Identifying the shortcomings of pro-
agency and community people to meet grammes and removing the same.
their health needs. 2. Filling the gap between infrastructure
(ii) The community health nurse needs to and the health personnel.
be assertive while collaborating with 3. Improving the quality of services.
the health team. 4. Proper implementation of integrated
disease surveillance project (IDSP).
14. Researcher 5. Increasing the utility of programmes
(i) The community health nurse helps in for clients.
generation and collection of data by 6. Arranging appropriate training for the
maintaining accurate and legible data workers to increase their capabilities
about individual, family, specific com- and skill.
munity groups and community at large. 7. Ensuring the supply of required resources
for the implementation of programme.
8. Increasing the awareness about national was estimated to 2.3 million people were newly
health programmes through information, infected with HIV and 1.6 million people
education and communication (IEC) died from AIDS. There are about 2.4 million
and behaviour change communication people living with HIV/AIDS in India. Most
(BCC). infections occur through heterosexual route of
9. Procuring the international co-operation transmission. However, in North-East region,
for the programmes and strengthening Injecting Drug Use (IDU) is the major cause
C
the monitoring system. for the epidemic spread.
The World AIDS Day is celebrated on H
National Aids Control Programme 1st December and voluntary Blood Donation A
Day on 1st of October every year. In Haryana, P
Human Immunodeficiency Virus (HIV) is a T
lentivirus (member of slowly replicating retrovirus 1st case of HIV was reported in Rohtak in 1986.
According to Haryana State AIDS Control E
family) that causes Acquired Immunodeficiency
Society (registered in 1998), the total estimated R
Syndrome (AIDS), a condition in humans in
HIV positive cases in Haryana (upto February, 5
which progressive failure of the immune system
2013) were 42000 and the highest number
life threatening opportunistic infections to

of AIDS cases (590) were reported from District
thrive. HIV that causes AIDS has precipitated
Rohtak. It is transmissible and so far no curative
a global pandemic. It is a global problem that
drug/immunization has been discovered.
requires a global response.
HIV infection, nearly always progresses to
History AIDS over a course of 5–20 years. AIDS does
AIDS was 1st recognized in 1981 among ho- not itself cause death but instead extensively
mosexual men in the United States of America damages the immune system because of which
and rapidly established itself throughout the the body cannot protect itself from infection
world. In India, HIV was first reported in 1986 and become the cause of death. As there is
among commercial sex workers in Tamil Nadu no known cure for AIDS, the entire burden
and AIDS in Mumbai in the year 1987. of prevention has to be done by the program
of education which would limit the spread of
— Facilitators guide by NACO and the disease.
Indian Nursing Council National Aids Control Programme (NACP)
Demographically, the second largest launched in India, in the year 1987. The
country in the world, India has also the third Ministry of Health and Family Welfare has
largest number of people living with HIV/ set up National AIDS Control Organization
AIDS. According to the INTERNATIONAL (NACO) as a separate wing to implement and
STATISTICS (HIV), more than 35 million closely monitor the various components of
people now live with HIV/AIDS. In 2012, it the programme.
Aims (iii) To minimize the socio-economic

(i) To prevent further transmission of HIV. impact, resulting from HIV infection.
(ii) To decrease morbidity and mortality Milestones of the Programme
associated with HIV infection.
C First Case of HIV Detected

1986 AIDS Task Force Set up by the ICMR
H National AIDS Committee Established Under the Ministry of Health
A
P
1990 Medium Plan Term Launched for four States and the four Metros
T
E
R 1992
NACP - I: Launched to Slow Down the Spread of HIV Infection
National AIDS Control Board Constituted and NACO Setup
5
NACP - II: Begins, Focussing on Behaviour Change, Increased

1999 Decentralization and NGO Involvement
State AIDS Control Societies Established
National AIDS Control Policy Adopted

2002
National Blood Policy Adopted
2004 Anti-retroviral Treatment Initiated
National Council on AIDS Constituted Under Chairmanship of

2006 Prime Minister
National Policy on Paediatric ART Formulated
2007 NACP- III: Launched for 5 Years (2007–2012)
FIG. 5.3: Milestones of the Programme

Activities Under NACP Phase - I

(September, 1992 To March, 1999)
100 per cent centrally sponsored project for
all the States and UTs.
C
Establishment of Surveillance Centres
H
A
Identication of High Risk Groups and Their Screening P
T
E
Clinical Management of Detected Cases
R
5
Control of Sexually Transmitted Diseases (STD) and

Condom Programme
Information Education and Communication
Blood Safety
FIG. 5.4: Activities Under NACP Phase - I
Activities Under Phase - II (iii) United States Agency for International

(i) Adequate infrastructure has been provided Development (USAID).
to the societies for implementation of (iv) Department for International Develop-
the programme components. ment (DFID).
(ii) Computerized Management System
has been developed to monitor the
programme.
Nation Wide HIV Sentinel Surveillance
Family Health Awareness Campaigns and Blood Safety Measures
Voluntary Counselling and Testing Centres (VCTC)
Information Education and Communication

C
Targeted Interventions, Training of Medical and Paramedical Workers
H
A STD Control Programme and Post-Exposure Prophylaxis (PEP)
P
Prevention of HIV Transmission from Mother to Child (MTCT)
T
E Multi-sectoral Co-ordination and Care and Support Initiatives
R USAID Assisted Andhra Pradesh AIDS Control Project in

5 Tamil Nadu (APAC)
DFID Assisted Sexual Partnership Project in Andhra Pradesh,

Gujarat, Kerala and Odisha
National External Quality Assurance Scheme (EQAS)
FIG. 5.5: Activities Under Phase - II
Goal of NACP - III programmes for prevention, care, support and

To halt and reverse the epidemic in India treatment.
over the 5 years (2007–2012) by integrating Programme components of NACP - III
Prevention Care, Support and Treatment Capacity Building Strategic
Information
Management
Targeted interventions ART Establishment support and Monitoring and
among High Risk Groups capacity strengthening. evaluation.
(IDUs, FSW and MSW).
Other interventions Paediatric ART Training Surveillance
(Truckers, migrants etc.)
Integrated counselling Centre of excellence Managing programme Research
and testing centres. implementation and contracts.
Blood safety (including Care and support (Community care Mainstreaming/private
mobile blood banks). centres and impact mitigation) sector partnerships.
Communication, advocacy
and social mobilization.
n AIDS surveillance centre was established 5. To secure participation of voluntary

in the department of Microbiology at organizations in eye care.
Pt. B.D. Sharma PGIMS, Rohtak, in
September, 1986. Also, ART Centre Strategies
and ICTC were established by the State 1. To make National Programme for Control
Government at PGIMS, Rohtak. of Blindness more comprehensive by
n Suraksha Clinics are associated with strengthening services for other causes
dermatology department. of blindness like corneal blindness, C
n “Suraksha Clinic” Formation, 1992 refractive errors in school going children, H
(Ministry of Health and Family Welfare): improving follow-up services of cataract A
operated persons etc. P
l Are a chain of STI/RTI clinics,
2. To shift from the eye camp approach to T
established by NACO for better
a fixed facility surgical approach. E
health services and for prevention
of HIV/ AIDS in India. 3. To expand the World Bank project R
l Provide syndromic case manage-
activities like construction of dedicated 5
ment to STI/RTI patients which is eye operation theatres, eye wards at
district level.

comprehensive approach consisting
of history, examination, treatment, 4. To strengthen participation of voluntary
counseling, follow-up and referral. organization in the programme and
to earmark geographic areas to NGOs
National Programme for Control and government hospitals to avoid
duplication of effort and improve the
of Blindness
performance of government units.
The National Programme for Control of 5. To enhance the coverage of eye care
Blindness was launched in the year 1976 as a services in tribal and other under-
100 per cent centrally sponsored programme served areas.
with the goal to reduce the prevalence of
blindness from 1–0.3 per cent. Administration
Objectives Central: Ophthalmology Section, Directorate

General of Health Services, Ministry of
1. To reduce the backlog of blindness Health and Family Welfare, New Delhi
through identification and treatment
of blind. State: State Ophthalalmic Cell, Directorate of
2. To develop eye care facilities in every Health Services and State Health Societies
district.
3. To develop human resources for provid- District: District Blindness Control Society
ing eye care services.
4. To improve quality of service delivery. FIG. 5.6: Administration
Service Delivery and Referral System/ implementation of National Blindness

Organizational Structure Control Programme.
1. Community health education is a 2. The programme also includes regular
built-in component at all levels of eye check-up and provision of vitamin
A prophylaxis and service facilities in
rural areas.
C
H
A Tertiary
P Level Regional Institutes of Ophthalmology and Centres
T of Excellence in Eye Care Medical Colleges
E
R Secondary
District Hospital and NGO Eye Hospital
Level
5
Sub-district Level Hospitals/ CHCs

Primary Mobile Ophthalmic Units
Level Upgraded PHCs
Link Workers/ Panchayats
FIG. 5.7: Service Delivery and Referral System
Vision 2020: The Right-To-Sight (ii) Human resource development as

1. It is a global initiative launched by well as infrastructure and technol-
WHO on 18th February, 1999 to reduce ogy development at various levels
avoidable (preventable and curable) of health system.
blindness by the year 2020. (iii) The proposed four tier structure
2. The plan of action for the country has includes:
been developed with the following (a) Centre of excellence (20):
main features: Ø Professional leadership.
(i) Target diseases are cataract and Ø Strategy development.
refractive errors, childhood blind- Ø Continued medical educa-
ness, corneal blindness, glaucoma tion.

and diabetic retinopathy.
Ø Laying
of standards and Ø Facilities for refraction
quality assurance. Ø Referral services
Ø Research (d)
Vision Centres (20000)
(b)
Training Centres (200): Ø Refraction and prescription
Ø Tertiary eye care including of glasses.
retinal surgery, corneal Ø Primary eye care.
transplantation, glaucoma Ø School eye screening C
surgery etc. programme. H
Ø Training and continued Ø Screening and referral
A
medical education. services. P
(c)
Services Centres (2000): Centre of Excellence and Training
3. T
Ø Cataract surgery Centres: Tertiary Level. E
Service Centres: Secondary Level.
Ø Other common eye surgeries 4. R
Vision Centres: Primary Level.
5.
5

Centre of
Excellence
(20)
Training Centres (200)
Service Centres (2000)
Vision Centres (20000)
FIG. 5.8: Vision 2020

National Cancer Control Programme 2. According to the latest World Cancer

Report from the WHO, more women
The Cancer Control Programme was started in India are being newly diagnosed with
in 1975–76 as a central sector project. The cancer annually. As against 4.77 lakh
programme was renamed to National Cancer men, 5.37 lakh women were diagnosed
Control Programme (NCCP) in 1985 and with cancer in India, in 2012. Cancer of
revised in 2004. lip and oral cavity has emerged as the
C deadliest among Indian men while
H Cancer Epidemiology
for women, it is breast cancer. The top
A History 5 cancers in men are lip/oral cavity, lung,
P First cancer statistics was collected in the mid stomach, colorectal and pharynx while
T 19th century. Genetic explanation of cancer was among women they are breast, cervix,
E put forward in early 20th century by Professor colorectal, ovary and lip/oral cavity.
R of Zoology Theodor Boveri of Germany. — A report by Kounteya Sinha,
5 National Cancer Institute Act was passed in 1937. Times of India, 2013
Chemotherapy, radiotherapy and surgery became
According to National Cancer Registries
3.
an integral part of anticancer therapy. Preventive

and Atlas of Cancer in India, current
aspects gained prime position i.e. 1993–1997
projections suggest that the total cancer
e.g. educating people on lifestyle factors like
burden in India for all sites will double
nutrition and cancer, regular exercises, etc.
by 2026 because of increase longevity,
Screening the susceptible groups with respect
greater exposure to environmental
to the age, nature of job, family history of
carcinogens due to wide variety of chemical
cancer, controlling environment etc.
agents in industry and agriculture and
Burden of Cancer the continued use of tobacco.
According to International Agency for
1. Objectives
Research on Cancer (IARC), 2012,
Primary prevention: Health education
1.
an estimated 14.1 million new cancer
on prevention of cancer.
cases and 8.2 million cancer-related
Secondary prevention: Early detection
2.
deaths occurred in 2012, compared
and diagnosis of common cancer, such
with 12.7 million and 7.6 million
as cancer of cervix, mouth breast and
respectively in 2008.
tobacco related cancer by screening and
Nearly 7 lakh Indians die of cancer
self-examination methods.
every year. Lungs cancer (1.8 million,
Tertiary prevention: Strengthening
3.
13 per cent of the total) is the most
of the existing institution for compre-
commonly diagnosed cancer world-
hensive therapy including palliative
wide followed by breast (1.7 million,
care.
11.9 per cent).
Strategies Schemes Under the Program

1. Prevention and early detection of cancers Recognition of New Regional Cancer
1.
through district cancer control activities and Strengthening of Existing Regional
and strengthened IEC campaign. Cancer Centres. Main functions:
2. To promote ‘centres of excellence’ in (i) Cancer detection and diagnosis.
the field of cancer management with (ii) Provision of therapy.
support to existing RCC of 20 years (iii) After care and rehabilitation. C
of proven track record by providing (iv) Preventive measures with emphasis H
financial assistance. on health education, especially A
3. To augment comprehensive cancer care for tobacco related cancers. P
facilities across the country through (v) Training of paramedical and T
institutional capacity building in new, medical staff. E
existing regional cancer centres and (vi) Research R
through new and existing oncology (vii) Co-ordination with the medical
wings. colleges and the general health 5
4. Development of early diagnostic structure is the essential feature.

capabilities in district hospitals.
5. Encouraging public private partnership. Oncology Wings in Medical Colleges:
2.
6. Increase capacity for palliative care in (i) Main target of NCCP—to develop
cancer. oncology wings in all medical
7. Promote research in cancer that would colleges.
be relevant to control cancer in India. (ii) Medical colleges would form an
8. Capacity building and training of all important link between the regional
personnel in cancer prevention and early centres on one hand and the more
detection to be done for all categories peripheral health infrastructure
in phased manner. (District hospitals, Tehsil hospitals,
9. Health education of the general public PHCs) on the other hand.
through use of audio, video and print District Cancer Control Program:
3.
media regarding prevention and early
detection of cancers. The District program has five
(i)
10. Promote innovations in cancers care elements:
and indigenization of cancer treatment (a) Health education
equipments. (b) Early detection
(c) Training of medical and para- 4. Voluntary Organization:

medical personnel’s. (i) Financial assistance has been
(d) Palliative treatment and pain provided to NGOs for the purpose
relief. of undertaking IEC and early
(e) Co-ordination and monitoring. detection activities in cancer.
(ii) The District programs are linked (ii) NGOs will implement IEC and
C with Regional Cancer Centres/ early detection activities under
H Government Hospitals/Medical the co-ordination of the nodal
Colleges. agency, which will be regional
A
(iii) Pt. B.D. Sharma PGIMS, Rohtak, centre or oncology wing.
P
Haryana is one of the Regional
Cancer Centre out of the 19 Regional Implementation
T
E
Cancer Research and Treatment 1. The pilot project was started in the states
R
Centres recognized by Government of Bihar, Tamil Nadu, Uttar Pradesh
5 of India. A grant of ` 75 lakh and West Bengal under the direct
every year is being given to these supervision of the state Regional
19 Regional Cancer Centres by Cancer Centres.

the Government of India. 2. 20 rural blocks in each of the states of
(iv) For effective functioning, each Bihar and Uttar Pradesh and 10 rural
district, where program is started blocks in each of the states of Tamil
has 1 District Cancer Society that Nadu and West Bengal were selected
is chaired by Local Collector/ to implement the pilot project.
Chief Medical Officer. 3. For each block, 20 female non-commu-
(v) Other members: Dean/Principal nicable diseases (NCD) workers have
of Medical College, Zila Parishad been selected to play a pivotal role in
representative, NGO representa- the success of the project.
tive etc. 4. The workers had cleared their secondary
Ø Research and Training: Train- level of education and are mostly from
ing Manuals for health profes- the villages or the localities, where the
sionals, cytology, palliative project is being implemented.
care and tobacco cessation 5. The survey questionnaire was designed
have been developed under and translated into the respective regional
the program for capacity languages to obtain demographic data,
building in cancer control at knowledge, attitude and practice about
the district level. cancer and information about the
accessibility of the population to primary anti-tobacco items under the agreement

health care and quality of services with Prasar Bharati and MOHFW.
rendered by the centres. 7. Broadcast of health education audio
6. For every 10 blocks, 5 medical officers material developed by CNCI, Kolkata,
and 1 consultant doctor have been through FM Radio.
recruited to guide and supervise the 8. Community Based Cancer Control
NCD workers. Program carried out with the help of
C
7. The charitable and private sector has WHO:
H
been mobilized to participate in cancer (i) Training of health care personnel
control activities through recognition of A
at district level in early detection
NGOs or private health care facilities in P
and awareness of cancer.
cancer care. T
(ii) Telemedicine in cancer.
8. However, National Integrated Surveillance E
Program has included the risks of cancer National Cancer Registry Program R
for surveillance. NCCP now comes Cancer registration is the process of systematically 5
under NRHM. and continuously collecting information on

malignant neoplasm.
New Initiatives
Two types of cancer registries:
1. India has become the member of
Hospital based registries: At Chandigarh,
1.
International Agency for Research
Dibrugarh, Thiruvananthapuram,
on Cancer (IARC).
Bengaluru, Mumbai and Chennai,
2. Onconet India: Telemedicine project
6 hospital based registries are maintained.
to connect 27 RCCs and each RCC
Population based registries: Five in
2.
with 4–5 peripheral centres is being
urban areas (Delhi, Bhopal, Mumbai,
operationalized.
Bengaluru and Chennai) and one in
3. Participation in Health Melas and distri-
rural area (Barshi in Maharashtra).
bution of health education material.
4. National Cancer Awareness Day is National Cancer Registry Program was
celebrated on the birth anniversary launched in 1982, by Indian Council of Medical
of Nobel Laureate Madam Curie, Research (ICMR) to provide true information
7th November. on cancer prevalence and incidence.
5. International Childhood Cancer Day is Objectives
held annually on 15th February to raise
1. To generate authentic data on the
awareness about childhood cancer to
magnitude of cancer problem in India.
express support for children, adolescents
2. To undertake epidemiological investi-
with cancer, survivors and their families.
gations and advise control measures.
6. Telecast of a health magazine ‘KALYANI’
3. Promote human resource development
in the current year with cancer and
in cancer epidemiology.
Cancer Vaccine The main components of the vaccine

Cancer vaccines have the potential to reduce the are glycoproteins, which imitate particular
burden of cancer. Cancer vaccines are intended fragments of tumour antigens. Example:
either to treat existing cancers (therapeutic Resan Vaccine.
vaccines) or to prevent the development of cancer Resan vaccine
(prophylactic vaccines). Anti-tumoral agent.
C Treatment or therapeutic vaccines:
1. Indications
H (i) Are administered to cancer patients. 1. Preventing the formation of tumours
A (ii) Are designed to strengthen the in healthy people.
P body’s natural defenses against 2. For preventing relapses of malignant
T cancers that have already developed. tumours after radical operation.
E (iii) Prevent further growth of existing 3. Usage as anti-metastatic drug.
R cancers. 4. Usage as an immunotherapy of benign
5 (iv) Prevent the recurrence of treated tumours.
cancers.
(v) Eliminate cancer cells not killed National Program for Prevention,
by prior treatments. Control of Diabetes, Cardiovascular

Prevention or prophylactic vaccines:
2. Diseases and Stroke (NPDCS)
(i) Administered to healthy individuals. Magnitude of the Problem
(ii) Are designed to target cancer-
1. During the year 2005, NCD accounted
causing viruses.
for 53 per cent of all the deaths in the
(iii) Prevent viral infection.
age group of 30–59 years in India. Of
The vaccine possesses the vast and strong these, 29 per cent were due to cardio-
anti-tumoral properties due to a unique combi- vascular (CV) diseases. It is estimated
nation of telomerase antigen imitators together that by the year 2020, CV diseases
with more than 40 other tumour specific antigen will be the largest cause for disability
imitators in its composition. and death, as a proportion of all
The chances of the complete destruction deaths in India.
of a tumour depend on: 2. According to Diabetes Atlas, 2006,
(a) Number of tumour cells (size of a tumour) published by International Diabetes
and their mitotic activities. Federation, the number of diabetics in
(b) Type of tumour histological structures, India is currently around 40.9 million
antigen structures, the number of HLA-A and is expected to rise to 69.9 million
class molecules on tumour cells. by 2025, unless preventive steps are
(c) Initial state of the immune system. taken.
3. Similarly, 118 million people were 5. To train human resource within the
estimated to have high BP during 2000, public health set up, viz. doctors,
which is expected to go upto 213 million paramedics and nursing staff to cope up
by 2025. with the increasing burden of NCDs.
4. Not only this, Indians succumb to 6. To establish and develop capacity for
diabetes, high BP and heart attacks palliative and rehabilitative care.
5–10 years earlier than their western
counterparts, during their most produc- Components C
tive years. This leads to considerable The following components are envisaged in H
loss of productive years to country, the program: A
leading to huge economic loss as high P
1. District NPCDCS program (626 districts).
as 237 billion dollars by the year 2015. T
2. NCD focal centres at medical colleges
5. The pilot program was launched on E
(54 medical colleges).
4th January, 2008 in 7 states with 1 district R
3. State/UT NCD cell (35).
each from Assam (Kamrup), Punjab 4. National NCD cell at centre. 5
(Jalandhar), Rajasthan (Bhilwara), 5. IEC/BCC.

Karnataka (Shimoga), Tamil Nadu 6. Capacity building and research.
(Kancheepuram), Kerala (Thiruvanan- 7. Inter sectoral convergence.
thapuram), Andhra Pradesh (Nellore) 8. Monitoring (including MIS) and
with objective of providing integrated evaluation.
action plan for prevention and control
of these chronic diseases. Financial outlay In the program, it is envisaged is providing
for the pilot phase was ` 5 crore. preventive, promotive, curative and supportive
services (core and integrated) for Cancer, Diabetes,
Objectives CV diseases and Stroke at various government
1. To prevent and control common NCDs health facilities with provision for expanding
through behaviour and lifestyle changes. the diseases covered under the program to
2. To generate awareness on lifestyle chronic lungs diseases, geriatric diseases etc. The
changes. program interventions have been grouped into
3. To provide early diagnosis and manage- the following three components:
ment of common NCDs. (i) Health promotion for general population.
4. To build capacity at various levels of (ii) Disease prevention for the high risk
health care for prevention, diagnosis group.
and treatment of common NCDs. (iii) Assessment of prevalence of risk factors.
Services Available under NPCDCS

at Different Levels
Institutional Framework Public Health Intrastructure Service
C
H
State NCD Cell Test Level Tertiary Cancer Care Centres
A Medical Colleges/RCC
P
Health Promotion: Early
T District Hospital,
Diagnosis and Management
NCD Clinic,
Referral
E District NCD Cell
Cardiac Care Unit and
Home Based Care (Day
Care Facility Referral)
R Cancer Care Facility
5 CHC, NCD Clinic and Early

Diagnosis and Management;
Block CHC (Rogi Laboratory (Investigation,
Kalyan Samiti) Home Based Care), Referral
Sub-center and Screening Facility

Village Health (Health Promotion; Opportunistic
Committee Screening; referral)
FIG. 5.9: Vision 2020
National Iodine Deficiency Disorder of them were suffered from goitre i.e. about
32 per cent.
Control Programme (NIDDCP) The National Goitre Control Programme
The Problem of Iodine Deficiency came into existence during second five year
Disorder (IDD) plan (1956–1962), iodized salt was used in
Surveys, conducted by the central goitre survey Kangra valley for mass prophylaxis of Goitre.
teams of the Directorate General of Health The success of this experiment leads to initiation
Services and also reassessment surveys by ICMR of centrally sponsored national programme.
during the period from 1959–1982 revealed National Goitre Control Programme was
that no country is free from goitre. It was launched in 1962 i.e. towards the end of second
estimated that 140 million people were living five year plan with the following objectives:
in goitre endemic areas and nearly 45 million 1. Identification of the goitre endemic
regions.
2. To supply iodized salt in place of ordinary 3. To 0 per cent of cretins among the
common salt to the goitre endemic newborns by the year 2000.
areas.
3. To assess the impact of goitre control Objectives
measures over a period of time. 1. To undertake surveys to assess the
magnitude of iodine deficiency
In order to control the problem of Goitre
disorders (IDDs).
the supply of iodized salt was co-ordinated to 2. To supply iodized salt in place of C
be available to the people living in the goitre common salt. H
endemic areas of the Himalayan region. The 3. To conduct re-surveys to assess the A
Ministry of Health provides extra cost of impact of control measures after every P
iodination of salt to remove financial burden 5 years. T
on the consumers. Only 30 per cent of people 4. To undertake monitoring of the quality E
could be covered due to inadequate production of iodized salt and urinary iodine R
of iodized salt, but the requirement is about excretion.
60 per cent. However, there was some reduction 5. To conduct health education and 5
in the prevalence rate of goitre as a result of publicity.

distribution of iodized salt in goitre endemic areas.
Administrative Set-up
National Iodine Deficiency Disorder
1. Salt Commissioner, central office
Control Programme (NIDDCP) of Government of India, supervises
It was realized that iodine is an essential micro- universal iodization. He issues license to
nutrient for normal growth and development. salt manufacturers to produce iodized
Its deficiency not only causes goitre but also salt liberally containing 15 ppm of
other disorders, such as abortions, stillbirths, iodine.
mental retardation, deafness, mutism, squint 2. A national reference laboratory for
and neuromotor defects. Considering these monitoring IDD has been set-up at
various factors, the National Goitre Control the biochemistry division of national
Programme was renamed to National Iodine institute of communicable diseases
Deficiency Disorder Control Programme in (NICD), Delhi for training medical
1992 to have a wide coverage. and paramedical personnel.
3. About 100 IDD control cells and IDD
Aims monitoring laboratories have been
To reduce the prevalence of IDD: established in the states to monitor the
quality of iodinated salt and urinary
1. To less than 10 per cent among adults iodine excretion pattern.
by 2010. 4. UNICEF has donated testing kits to
2. To less than 5 per cent among children district officers to test the quality of
of 10–14 years. iodized salt at the consumer level.
5. To encourage the consumption of iodized n To assess the magnitude of dental carries

salt and directorate of field publicity, and to prevent and control the same.
Doordarshan, All India Radio have n To launch the extensive IEC campaign
conducted IEC program. through mass media in order to improve
the dietary habits.
Achievements n To co-ordinate with similar on-going
1. Consequent upon liberalization of iodized programmes being implemented in
C salt production, the salt commissioner the country.
H has issued license to 930 salt manu-
A
Information Education Communication (IEC)
facturers, out of which 552 units have
P n Activities through song and drama
commenced production. These units
T division.
have an annual production of 130 lakh
E n Activities through Directorate field
metric tons of iodized salt.
R
publicity.
2. An all time high production of iodinated
n Activities through Doordarshan.
5 salt of 46 lakh MT was recorded in
n Activities through All India Radio.
2000–01 and it increase 50 lakh by
n Activities through the Directorate of
2007–08 banning on non-iodized salt

advertisement and visual publicity.
production by ministry of health and
n Activities through the state health
family welfare on 17th May, 2006 for
Directorate.
effective implementation of NIDDCP
at state level. Future Plans
3. IDD control cells were established for n The states to complete surveys in the
effective implementation. remaining districts to assess the exact
4. IDD monitoring laboratories have been magnitude of IDD.
set-up. n To further strengthen the IEC activities
with focus on remote rural, backward
Pilot Project NIDDCP tribal areas as well as urban slums using
Objectives appropriate channels of communication
n To assess and improve the iron and to promote consumption of iodinated
vitamin A deficiency status of school salt.
children, adolescent girls and boys, no- n To strengthen existing system of IDD
pregnant ladies and elderly population monitoring to ensure supply of good
who suffered, by supplementing iron quality iodized salt at reasonable rate
and folic acid tablets and vitamin A. preferably through the public distribution
n To assess zinc, zinc deficiency at some system.
level specially soil and different foods.
n To control the problem of IDD through UNICEF and many other agencies, institutions
sustained reduction in its prevalence. and individuals, responded to this challenge by
developing a strategy known as the Integrated
Integrated Management of Management of Childhood Illness (IMCI).
Neonatal and Child Illness (IMNCI) An integrated approach is needed to manage
sick children to achieve better outcomes. Child
Every year more than 9 million children die in health programmes need to move beyond
developing countries before they reach their C
tackling single diseases in order to address
fifth birthday, many of them during the first H
the overall health and well-being of the child.
year of life. More than 70 per cent of these child A
Improvements in child health are not necessarily
deaths are due to 5 diseases, namely pneumonia, P
dependent on the use of sophisticated and
diarrhoea, measles, malaria and malnutrition, T
expensive technologies. Although the major
and often to a combination of these illnesses. E
reason for developing the IMCI strategy
These diseases are also the reasons for seeking R
stemmed from the needs of curative care, the
care for at least three out of four children strategy also addresses aspects of nutrition, 5
who come to health facilities. Child health immunization, and other important elements
programmes need to move beyond single

of disease prevention and health promotion.
diseases to addressing the overall health and The objectives of the strategy are to reduce
well-being of the child. Because many children death and the frequency and severity of illness
present with overlapping signs and symptoms and disability, and to contribute to improved
of diseases, a single diagnosis can be difficult, growth and development. This strategy has
and may not be feasible or appropriate. This been expanded in India to include all neonates
is especially true for first level health facilities,and renamed as ‘Integrated Management of
where examinations involve few instruments, Neonatal and Childhood Illness (IMNCI).
negligible laboratory tests, and no X-ray.
According to SRS Bulletin, 2011, in India, Definition
Children (0–6 years) consist of 13.12 per cent It is an integrated approach to child health that
of the total population. focusses on the well-being of the whole child. It
Indicators India Sources focussed primarily on the most common causes
Neonatal Mortality Rate 33 SRS Bulletin 2012 of child mortality: diarrhoea, pneumonia,
IMR 44 SRS Bulletin 2012 measles, malaria and malnutrition, illness
Under-5 Mortality Rate 59 SRS Bulletin 2012 affecting child from birth to 2 months, 2 months
to 5 years including both, preventive and curative
During the mid-1990s, the World Health elements to be implemented by families and
Organization (WHO), in collaboration with communities as well as by health facilities.
Measles 4 per cent Other 2 per cent

AIDS 1 per cent
Diarrhoea 20 per cent Neonatal 25 per cent
C
H
A Malnutrition 20 per cent
P
T
E
HIV/AIDS 20 per cent
R
5 Pneumonia 28 per cent Malaria 20 per cent
FIG. 5.10: Child Health in Ethiopia, Background Document for the National Child Survival Conference,
April, 2004, Family Health Department, Ministry of Health.
The Integrated Management of Neonatal within the family and community. It mainly
and Childhood Illness (IMNCI) is the Indian includes 3 components:
adaptation of the WHO—UNICEF generic 1. Improving case management skills of
Integrated Management of Childhood Illness healthcare staff.
(IMCI) strategy and is the centre piece of 2. Improving health systems.
newborn and child health strategy under 3. Improving family and community
Reproductive Child Health II and National health practices.
Rural Health Mission. Implementation of
IMNCI was started in India, in the year 2003. Aims
To reduce death, illness and disability and to
Strategy
promote improved growth and development
Its is a strategy that integrates all available among children under five years of age.
measures for health promotion, prevention and
integrated management of childhood diseases Goals
through their early detection and effective To assess current status of child survival indicators
treatment and promotion of healthy habits and process indicators for existing programme
activities in intervention and compassion districts.
Objectives which indicate the need for referral or

1. To determine baseline mortality among admission to a hospital.
children under 5 years of age (NMR, 3. All young infants and child 2 months to
IMR and U5MR). 5 years of age must be routinely assessed
2. To determine prevalence of diseases for nutritional and immunization status,
(morbidity density) among children feeding problems and other potential
under 5 years of age. problems.
C
3. To assess effective programme coverage 4. Only a limited number of carefully
selected clinical signs are used, based H
for specified disease condition. A
4. Causes of under 5 mortality and pathway on evidence of drugs sensitivity and
specificity to detect disease. P
analysis of events prior to death and
5. A combination of individual signs leads T
recovery of sick under 5 children.
to an infant or child classification rather E
5. Sickness management practices at
than diagnosis. R
household, community level and health
facility level. 5
The IMNCI Case Management Process
6. Sickness and care providing competencies
1. Assessment

of health care provider.
Assess a child by checking first for danger signs
7. Health system support for manpower,
(or possible bacterial infection in a young
logistics, referral mechanism, intersectoral
infant), asking questions about the common
co-ordination, social mobilization,
monitoring and supervision. conditions, examining the child and checking
nutrition and immunization status. Assessment
Components includes checking the child for other health
1. Health Worker Component: Case problems.
management skills. 2. Classification
2. Health Service Component: Improve-
Classify a child’s illnesses using a colour-coded
ment in overall health.
triage system. Because many children have more
3. Community Component: Improve-
than one condition, each illness is classified
ments in family and community health
according to whether it requires:
care practices.
Classification According to Colour Code
Principles Colour Classification
1. All sick young infant upto 2 months must Pink Urgent Pre-Referral Treatment and Referral
(Hospital Referral or Admission).
be assessed for bacterial infection/jaundice
Yellow Specific Medical Treatment and Advice
and major symptoms of diarrhoea. (Initiation of Special Treatment).
2. All sick children 2 months to 5 years Green Simple Advice on Home Management.
must examine for general danger signs
3. Identification a specific date and teach her how to recognize

Identify specific treatments for the child. If the signs that indicate the child should return
child requires urgent referral, give essential immediately to the health facility.
treatment before the patient is transferred. If 5. Counselling
a child needs treatment at home, develop an Assess feeding, including assessment of breast
integrated treatment plan for the child and give feeding practices and counsel to solve any
the first dose of drugs in the clinic. If a child feeding problems found. Then, counsel the
C
should be immunized, give immunizations. mother about her own health.
H
A 4. Treatment 6. Follow-up Care
P Provide practical treatment instructions, includ- When a child is brought back to the clinic as
T ing teaching the caretaker how to give oral requested, give follow up care and if necessary,
E drugs, how to feed and give fluids during illness re-assess the child for new problems.
R and how to treat local infections at home.
Ask the caretaker to return for follow-up on Outpatient Health Facility
5
Check for Danger Signs: Convulsions/Lethagy/Unconsicousness/Inability to Drink/

Breastfeed/Vomiting.
Assess Main Symptoms: Cough/Difculty in Breathing/Diarrhoea/Fever/Ear Problems.
Assess Nutrition, Immunization Status and Potential Feeding Problems.
Check for Other Problems
Classify Conditions and Identify Treatment Actions: According to Colour-Coded

Treatment
Urgent Referral: Out Treatment at Outpatient Home Management:

Patient Facility: Health Facility: Out Home:
Pre-referral Treatments Patient Health Facility: Caretaker is
Advise Parents Counselled on How to:
Treat Local Infection
Refer Child
Give Oral Drugs Give Oral Drugs
Advise and Teach Treat Local Infections
Care-Taker at Home
Referral Facility: Follow-up Continuing Feeding
Emergency Triage and When to Return
Treatment (ETAT) Immediately
Diagnosis Follow-up
Treatment
Monitoring and
Follow-up
FIG. 5.11: Outpatient Health Facility

Care of Children According to IMNCI of leprosy in the country by the year 2000,
0–2 Months thereby reducing the case load to 1 in 10,000
populations or less”.
n Keeping the child warm.
At the outset, the objective of NLEP was to
n Initiation of breast feeding.
achieve elimination of leprosy in the country
n Counselling for exclusive breast feeding.
by the year 2000, by reducing the case load of
n Cord, skin and eye care.
the disease to 1 or less per 10,000 populations
n Recognition of illness in newborn and C
with following strategies:
management and/referral. H
n Immunization. 1. Intensification of early case detection
A
n Home visit in the post-natal period. by population survey, school survey,
P
contact survey etc.
2 Months to 5 Years T
2. Multidrug chemotherapy (MTD).
n Management of diarrhoea, ARI, malaria, E
3. Health education.
measles, acute ear infection, malnutrition R
4. Rehabilitation services.
and anaemia. 5
n Recognition of illness and risk. Components

n Prevention and management of iron The components of program are as follows:
and vitamin A deficiency.
1. Decentralized integrated leprosy services
n Counselling on feeding for all children
through general health care system.
below 2 years.
2. Capacity building of all general health
n Counselling on feeding for malnourished.
services functionaries.
n Immunization
3. Intensified information, education and
communication.
National Leprosy Eradication 4. Prevention of disability and medical
Program (NLEP) rehabilitation.
The government started the National Leprosy 5. Intensified monitoring and supervision.
Control Program in 1955. The objective was to
“to control the spread of disease and to render Multidrug Treatment
modern treatment facilities to patients”. In MDT used to be initiated only after confirmation
1983, the program was re-designed as National of the disease and classified as multibacillary
Leprosy Eradication Program and the goal set (infectious) and paucibacillary (non-infectious)
was “to achieve arrest of disease activity in all categories. The treatment used to be given in
the known leprosy cases in the country by the a phased manner as follows:
year 2000”. 1. Multibacillary Leprosy
After the World Health Assembly resolu-
(i) Intensive phase (lasting for 14 days):
tion in 1991, the objective of the program
was redefined as “to achieve the elimination (a) Rifampicin 600 mg daily (super-
vised).
(b) Clofazimine 300 mg daily (super-

vised).
(c) Dapsone 100 mg daily (super-
vised). R:
Leprosy
Recognition
Control Units
Continuation phase (lasting for 2 or

(ii) A: Assessment
Survey Education
Treatment Centers
more years):
C (a) Rifampicin 600 mg once a month I: Intervention
Urban Leprosy Centers
H (supervised) (pulse dose).
Mobile Leprosy
A (b) Clofazimine 50 mg daily and 300 Treatment Units
P mg (supervised) once a month.
T (c) Dapsone 100 mg daily (unsuper-
E vised). FIG. 5.11: Outpatient Health Facility
R Duration of treatment used to be for a
5 minimum of 2 years or until 2 consecutive
skin smears taken at monthly interval become population, each unit serving a
population of 4.5 lakh.
negative, whichever is later.

The follow-up was done once in 6 months (b) Each unit had a staff pattern of:
for 5 years. 1 MO, 2 Non-medical Supervisors
and 20 Paramedical workers
2. Paucibacillary Leprosy (PMW), each PMW covering a
(i) Rifampicin 600 mg once a month population of 15,000–20,000 and
(supervised). is expected to examine 8000 persons
(ii) Dapsone 100 mg daily (unsupervised). per year by house-to-house survey
MDT is very effective with high cure rate in his areas of jurisdiction.
and zero relapses. It prevents deformities and (c) Each PMW was specially trained
lepra reactions. Duration of treatment was for to institute domiciliary treatment.
one year and follow-up was once in 6 months Thus, it was a ‘vertical program’.
for 2 years. Survey Education Treatment Centres
(ii)
Infrastructure (a) One Survey education treatment
(SET) centre is established for a
NPLS was implemented through the establish-
population of 25,000 in those
ment of following infrastructures:
endemic areas, where the preva-
Leprosy Control Unit (LCU):
(i) lence rate of leprosy is less than
(a) This is established in leprosy 5 per 1000 population. They are
endemic areas with the preva- attached to PHC.
lence rate of 5 or more per 1000 (b) Each centre is manned by one
PMW, 1 Non-medical supervisor
for every 4–5 PMWs and the (iii) Urban Leprosy Centres: Such ULC were
MO of the attached PHC is the established in urban endemic areas,
administrative, controlling officer. one for every 50,000 population. It is
(c) Only one PMW is attached to a manned by a non-medical supervisor,
SET centre. Thus, ‘Horizontal who functions under the supervision
Program’ is recommended for low of MO.
endemic districts. (iv) Mobile Leprosy Treatment Unit: Such
unit provides services to leprosy patients C
Activities Under SET: H
in non-endemic areas. Each such unit
n Survey: The whole population is A
consists of 1 MO, 1 Non-MO, 1 non-
surveyed by the PMW to detect medical supervisor, 2 PMWs and a P
cases of leprosy. The school children driver: T
also surveyed. During the survey, E
the investigator (PMW) looks n All these organizations work
under the administrative control R
for hypo pigmented patches for
loss of sensation over the body, of the State Program Officer 5
(SPO), placed in the Directorate
in good daylight, with minimum

of Health Services. The SPO is
clothes and palpates peripheral
chief co-ordinator and technical
nerves for thickening. Such cases
advisor to the concerned state
are then referred to MO for further
government.
confirmation.
n At centre level, the Leprosy
n Education: The PMW gives
Division of the DGHS, New
health education to the patient
Delhi is responsible for planning,
that leprosy is curable and he
supervision and monitoring of
should take treatment correctly
the program. The division is
and completely. He educates
under the control of a Deputy
the family that not all cases are
Director General, who advises the
infectious, it is caused by bacteria,
Government on all anti-leprosy
there is a treatment and that the
activities.
patient should be shown sympathy
and should not be thrown out of Progress of NLEP
the family.
1. With the introduction of MDT, it opened
n Treatment: All paucibacillary
a new avenue in the control of leprosy
cases are treated with combination
in the country. With MDT services
of dapsone (DDS) and rifampicin
under the NLEP, a large number of
and all multibacillary cases with
leprosy cases are being discharged as
dapsone, rifampicin and clofazi-
‘Disease cured’.
mine. This is called MDT.
2. For the first time in 1987, the number progress at national level, it was uneven in some
of MDT cured cases are 10 per cent states. So, it was decided to launch leprosy
more than the number of new cases elimination campaign.
detected and this percentage of cured The multi-drug treatment (MDT) regimen
cases gradually increased subsequently. for leprosy was modified under elimination
It became 25 in 1988, 38 per cent in campaign with effect from November 1, 1997, as
1989 and over 90 per cent in 1991–92. recommended by WHO Leprosy Elimination
C 3. The annual case load, which was Advisory Group of Expert Committee.
H 4.29 lakh during 1994, was reduced to The MDT is given free of cost in all the
A 2.2 lakh during 2004. The prevalence Government Hospitals, PHCs and CHCs. The
P rate which was 57.6 per 10,000 popula- drugs are available in blister packs. Each blister
T tions during 1981, brought down to pack contains drug required for 1 month. The
E 2.3 per 10,000 populations by 2004. blister packs are different for Paucibacillary,
R multi-bacillary leprosy and for adults and
Program Assistance children.
5
NGOs also have contributed on functioning Regimen for Paucibacillary Cases
of the program. More than 290 NGOs are
(i) Single skin lesion—single dose:

working in the field of leprosy throughout the
country. Adults: Rifampicin 600 mg
Besides the NGOs, several international Ofloxacin 400 mg
agencies contribute to the leprosy, elimination Minocycline 100 mg
effort in the country. Among these, WHO Children: Half the adult dose
extends money, man-power and material Follow-up: Once in a year for 2 years
assistance to NLEP. It supplies drugs in the Note: If there is no improvement,
form of blister packs separately for multi- treatment to be extended for 6 months,
bacillary and paucibacillary leprosy cases and with Dapsone daily and Rifampicin
made available free of cost in all the PHCs. once a month, as below.
World Bank has offered financial assistance Single Nerve Lesion with 2–5 Skin
2.
to the program. Support also comes from Lesions.
Danish International Development Agency Adults: Dapsone 100 mg daily
(DANIDA) and International Federation of self-administered.
Leprosy Elimination (IFLE). Rifampicin 600 mg once
Modified Leprosy Elimination a month, supervised.
Children: Proportionately less.
Campaign (MLEC)
Duration of 6 months.
The NLEP was appraised in April, 1997 and treatment:
observed that even though there was good Follow-up: Once a year for 2 years.
Regimen for Multi-bacillary Cases fourth campaign was different from

n Adults: first three campaigns in that states are
l Dapsone 100 mg daily. Self- divided into three categories:
administered. l Category I: Eight states were taken
l Clofazimine 50 mg daily or 100 mg up. In the areas with prevalence
on alternate days. Self-administered. rate of more than 5/10,000 popu-
l Clofazimine 300 mg monthly lations, active search by house-to- C
(pulse) dose supervised. house visit was taken.
H
Rifampicin 600 mg monthly (pulse) l Categor y II: This includes
A
dose supervised. 14 moderate to low endemic states,
P
n Children: Proportionately less. where extensive IEC activities
n Duration of treatment: 12 months.
T
were taken up alongwith training
n Follow-up: Once a year for 5 years.
E
of health personnel and active
search for new cases. R
Campaign Comprises a Package of Activities
This campaign comprises a package of four
l Category III: This includes 13 very 5
low endemic states, where extensive
activities, namely:

IEC activities and passive detection
n Teaching and training to all health staff. of leprosy cases in health centres
n Intensified IEC activities. were carried out.
n Case detection by house-to-house visits
to detect new leprosy case. n The fifth campaign was carried out
n Correct and complete treatment.
during December, 2003 to March, 2004
in 6 high priority areas namely Bihar,
Goals Chhattisgarh, UP and Maharashtra,
The goal was to eliminate leprosy by the year Andhra Pradesh and West Bengal
2005. Several such rounds of campaigns have states. The activities carried out in
been executed: these areas, as follows:
n First round of campaign lead to detection l Four Urban Areas.
of 4.63 lakh cases. l Four Rural Areas.
n Second campaign was carried out from
January to March, 2000 with detection Leprosy Elimination Monitoring (LEM)
of 2.13 lakh cases. LEM consists of assessing the performance of
n Third campaign was carried out from elimination campaign on various issues like case
October, 2001 to February, 2002 with detection, quality of services like treatment, IEC
detection of 1.65 lakh cases. activities, drug supply, management, etc. This
n Fourth campaign carried out from is carried out by National Institute of Health
August, 2002 to March, 2003 leading and Family Welfare (NIHFW), New Delhi,
to detection of 1.04 lakh cases. The every year in 12 endemic states, for 3 years
since June, 2002.
So far 15 states have reached the goal of Objectives

elimination of leprosy, i.e. prevalence rate is n To ensure availability and accessibility
reduced to less than 1 per 10,000 populations. of minimum mental care for all in the
In March, 2014, NLEP in Haryana eradicated foreseeable future, particularly to the
Leprosy by 0.27/10,000 populations. most vulnerable and under privileged
sections of population.
National Mental Health Programme n To encourage application of mental
C
The Government of India has launched the health knowledge in general health care
H
National Mental Health Program in 1982, with and in social development.
A
a view to ensure availability of Mental Health n To promote community participation
P
Care Services for all, especially the community in the mental health services develop-
T
at risk and under privileged section of the ment and to stimulate efforts towards
E
population, to encourage application of mental self-help in the community.
R
health knowledge in general health care and
5 social development: Components
1. A National Advisory Group on n Treatment of mentally ill patients.
mental health was constituted under n Rehabilitation of disabled mental
the Chairmanship of the Secretary, patients.

Ministry of Health and Family Welfare n Prevention and promotion of positive
for the effective implementation of mental health.

the NMHP. Personnel Involved in the Program
2. Eleven institutions have been identified
n The health guides at village level will
for imparting training in basic knowledge
participate in case identification and
and skills in the field of mental health
referral of patients and will help to
to PHC physicians and paramedical
supervise the follow-up of patients in
personnel.
need of long term maintenance therapy.
Aims n The health workers at sub-centres level
(a) Prevention, treatment of mental, neuro- provide first-aid care and follow-up
logical disorders and their associated services.
disabilities. n The health assistants are entrusted the
(b) Use of mental health technology to task of early recognition and manage-
improve general health services. ment of priority psychiatric conditions,
(c) Application of mental health principles carried out under the supervision of
in total national development to improve medical officer.
quality of life.
n The PHC medical officer is vested with problems. Later on, addictions, juvenile delin-
overall responsibility of organizing and quency and acute adjustment problems will be
supervising the primary level mental brought into the ambit. Community leaders
health care for population under PHC and PHC MOs would be actively involved in
jurisdiction. this activity.
Services District Mental Health Program (DMHP)

The service component includes three activities: The Government of India launched DMHP as C
per 100 per cent centrally sponsored scheme H
1. Treatment
for the first five years at the national level in A
The focus is on the following morbidity P
1996–97, during ninth five year plan as a pilot
conditions: T
project.
(i) Acute psychoses of schizophrenia, E
Objectives of DMHP
affective or unknown etiology, paranoid R
reactions and psychosis, resulting from (a) To provide sustainable basic mental
health services to the community and 5
cerebral involvement (e.g. Alcoholic,
malaria and epileptic psychosis). to integrate these services with other

(ii) Chronic or frequently recurring mental health services.
illness, such as some cases of schizophrenia, (b) Early detection and treatment of these
cyclic affective psychosis, epileptic patients within the community itself.
psychosis, dementia and encephalopathy (c) To provide mental health care at primary
associated with intoxication and chronic level only.
organic diseases. (d) To reduce stigma attached towards mental
(iii) Emotional illness like anxiety, hysteria illness through public awareness.
and neurotic depression. (e) To treat and rehabilitate mental patients
within the community after their discharge
2. Rehabilitation from the hospital.
Maintenance treatment of epileptics and
Components of DMHP
psychotics at community level is an important
rehabilitative activity. Wherever practical, the (i) Training programs of all workers in the
rehabilitation centres would be developed at the mental health team at the identified
district level as well as at higher referral centres. Nodal institute in the state.
(ii) Education of the public regarding mental
3. Prevention health to increase the awareness and
In the initial phase, the main focus will be upon reduce stigma.
prevention and control of alcohol related
(iii) For early detection and treatment, out- Components of RCH - I

patient services and in-patient services 1. Family Planning: Child Survival and
are provided. Safe Motherhood (CSSM) component.
(iv) Providing valuable data and experience 2. Client Approach to Health Care:
at the level of community to the state and Prevention/Management of RTI/
centre for future planning, improvement STDS/AIDS.
in service and research.
C Highlights of RCH Programme
H
Thrust Areas
n DMHP will be covering the entire 1. The programme integrates all interven-
A
country in phased manner. tions of fertility regulation, maternal
P
n Modernization of mental hospitals to and child health with reproductive
T
modify their present custodian role. health for both, men and women.
E
n Upgrading the department of psychiatry 2. The services to be provided are client
R oriented, demand driven, high quality
in medical colleges and enhancing the
5 curriculum of psychiatry at both, under- and based on needs of community
graduate and post-graduate level. through decentralized participatory
n Strengthening the Central and State planning and target free approach.
Mental Health authorities with a 3. The programme envisages upgradation
permanent secretariat to make their of the level of facilities for providing
monitoring role more effective. quality of care by setting up First Referral
n Research and training in the field of Units (FRUs) at sub-centre level to provide
community mental health, substance comprehensive emergency obstetric
abuse and child/adolescent psychiatric. and newborn care.
4. Facilities of obstetric care, MTP and
Reproductive and Child Health IUD insertion in the PHCs level are
improved.
Programme
5. Specialist facilities for STD and RTI
Definition are available in all district hospitals.
The Reproductive and Child health approach 6. The programme aims at improving
has been defined as “people have the ability to the outreach services primarily for the
reproduce and regulate their fertility, women are vulnerable group of population.
able to go through pregnancy and child birth
Child Survival and Safe Motherhood
safely, the outcome of pregnancies is successful
in terms of maternal and infant survival and
Programme
well being, and couples are able to have sexual In 1992, the Child Survival and Safe Mother-
relations, free of fear of pregnancy and of hood Programme component of RCH - I
contracting disease”.
programme was implemented with the follow-

ing components:
Early Registration of Pregnancy
To Provide Minimum 3 Antenatal Check-Ups
Universal Coverage of all Pregnant Women with TT Immunization C

H
Advice on Food, Nutrition and Rest
A
Detection of High Risk Pregnancies and Prompt Referral P
Clean Deliveries by Trained Personnel T
E
Birth Spacing
R
Promotion of Institutional Deliveries 5

FIG. 5.11: Out-patient Health Facility
Services Under RCH - I Programme 14. RCH Out-reach scheme.

1. Essential Obstetric Care. 15. Border District Cluster Strategy.
2. Emergency Obstetric Care. 16. Introduction of Hepatitis B vaccination
3. 24 hours delivery services at PHCs/ project.
CHCs. 17. Training of Dais.
4. Medical Termination of Pregnancy. Empowered Action Group (EAG)
5. Control of Reproductive Tract Infections
(RTI) and Sexually Transmitted Diseases 1. An Empowered Action Group has been
(STD). constituted in the Ministry of Health
6. Immunization and Family Welfare, with Union
7. Drug and equipment kits. Minister for Health and Family Welfare
8. Essential newborn care. as Chairman on 20th March, 2001.
9. Diarrhoeal disease control. 2. As 55 per cent of the increase in the
10. Acute respiratory disease control. population of India is anticipated in the
11. Prevention and control of Vitamin A states of Uttar Pradesh, Bihar, Madhya
deficiency in children. Pradesh, Rajasthan, Odisha, Chhattisgarh,
12. Prevention and control of anaemia in Jharkhand and Uttaranchal, these states
children. are perceived to be more deficient in
13. RCH camps. critical socio-demographic indices.
3. Through EAG, these states will get Strategies

focused attention foe different health Essential Obstetric Care:
1.
and family welfare programmes.
(a) Institutional delivery
4. The RCH programme conducts district
(b) Skilled attendance at delivery
based rapid household survey to assess
the reproductive health status of women. Emergency Obstetric Care:
2.
(a) Operationalizing 1st Referral Units.
C RCH Phase - II
H
(b) Operationalizing PHCs and CHCs
RCH phase II began from 1st April, 2005 with for round the clock deliver services.
A the focus on reducing maternal and child
P morbidity and mortality with emphasis on Strengthening referral system: The
3.
T rural health care. minimum services to be provided by a
E fully functional FRU are:
R
5
24 hours Delivery Services Including Normal and Assisted Deliveries
Emergency Obstetric Care Including Surgical Interventions Like

Caesarean Section
Newborn Care
Emergency Care of Sick Children
Full Range of Family Planning Services including Laparoscopic Services
Safe Abortion Services
Treatment of STI/RTI
Blood Storage Facility
Essential Laboratory Services
Referral (Transport) Services
FIG. 5.12: Strengthening Referral System
New Initiatives n Setting up of blood storage centres at

n Training of MBBS doctors in life saving FRUs according to Government of
anaesthetic skills for emergency obstetric India guidelines.
care.
n Janani Suraksha Yojana: The National ASHA Package in Low Performing

Maternity Benefit scheme has been States (LPS) and High Performance
modified into a new scheme called States (HPS)
Janani Suraksha Yojana (JSY) launched
Package ASHA Mother ASHA Mother
on 12th April, 2005. (Urban) (Urban) (Rural) (Rural)
l Objectives of JSY: Reducing HPS 200 800 200 1000
maternal mortality and infant LPS 200 800 600 1400
C
mortality through encouraging
H
delivery at health institutions and The eligibility of cash assistance is as follows: A
focussing at institutional care
n In Low Performance States (LPS): All P
among women in below poverty
line families. women, including those from SC and T
l Features of JSY:
ST families, delivering in government E
health centres like sub-centre, PHC, R
Ø It is a 100 per cent centrally
CHC, FRU, District and State hospitals
sponsored scheme. 5
or accredited private institutions.
Ø Under National Rural Health
n In High Performance States (HPS):

Mission, it integrates the Below poverty line women, aged 19 years
benefit of cash assistance with and above and the SC and ST pregnant
institutional care during ante- women.
natal, delivery and immediate
post-partum care. This benefit The limitation of cash assistance for institu-
will be given to all women, both tional delivery is as follows:
rural and urban, belonging to n In Low Performance States (LPS): All
below poverty line household births, delivered in health centre
and aged 19 years or above, government or accredited private health
upto first two live births. institutions will get the benefit.
Ø The ASHA would work as a n In High Performance States (HPS): The
link health worker between benefit is only upto 2 live births:
the poor pregnant women and l Vande Mataram Scheme is a
public sector health institution voluntary scheme, wherein any
in the 10 low performing states obstetric and Gynae specialist,
(Uttar Pradesh, Uttaranchal, maternity home, nursing home,
Madhya Pradesh, Jharkhand, lady doctor/MBBS doctor can
Bihar, Rajasthan, Chhattisgarh, volunteer themselves for providing
Odisha, Assam and Jammu & safe motherhood services. Iron,
Kashmir). folic acid tablets, oral pills, TT
injections etc. will be provided (49 days) of amenorrhoea in a

by the respective District medical facility with provision for safe
officers to the ‘Vande Mataram abortion services and blood
clinics’ for free distribution to transfusion.
beneficiaries. Ø Manual Vacuum Aspiration
l Safe abortion services: Under (MVA) is a safe and simple
RCH phase II, following facilities technique for termination of
C
are provided: early pregnancy, makes it
H feasible to be used in PHCs or
Ø Medical method of abortion:
A comparable facilities, there-
Termination of early pregnancy
P by increasing access to safe
with two drugs: Mifepristone
T abortion services.
(RU 486) followed by Miso-
E
prostol. They are considered l The quality indicators used to
R
safe under supervision, with monitor and evaluate RCH
5 appropriate counseling and programme through monthly
recommended upto 7 weeks reports are:
Number of Antenatal Cases Registered
Number of Pregnant Women Who had 3 Antenatal Check-ups
Number of High-Risk Pregnant Women Referred
Number of Pregnant Women Who had two Doses of TT Injection
Number of Pregnant Women Under Prophylaxis and Treatment for Anaemia
Number of Deliveries by Trained and Untrained Birth Attendant
Number of Cases with Complications Referred to PHC/FRU
Number of Newborn with Birth Weight Recorded
Number of STI/RTI Cases Detected, Treated and Referred
Number of Children Fully Immunized
Number of Adverse Reactions Reported after Immunization
Number of Cases of ARI and Diarrhoea under 5 years Treated,

Referred PHC/FRU and Deaths
Number of Cases Motivated and Followed up for Contraception
FIG. 5.13: Quality Indicators to RCH

Revised National Tuberculosis (v) Microscopy centres and treatment

centres.
Control Programme
(vi) DOTS providers.
The Government of India, WHO and World Bank
2. Direct Observation Therapy Short
together reviewed the National Tuberculosis
term (DOTS) is a community based
Programme (1962) in the year 1992. Based on
tuberculosis treatment and care strategy
the findings of a revised strategy for National
which combines the benefits of super- C
Tuberculosis Programme was evolved. The salient
vised treatment and the benefits of H
features of the strategy are:
community based care and support. A
1. Achievement of 85 per cent cure rate 3. DOTS ensures high cure rates through P
of infectious cases through supervised its three components: T
Short Course Chemotherapy involving
(i) Appropriate medical treatment. E
peripheral health functionaries.
(ii) Supervision and motivation. R
2. Augmentation of case finding activities
(iii) Monitoring of disease status by
through quality sputum microscopy to 5
health services.
detect at least 70 per cent estimated cases.

3. Involvement of NGOs, Information, 4. The success of DOTS depends on five
Education and Communication and components:
Improved Operational Research. (i) Political commitment
The revised strategy was introduced in the (ii) Good quality sputum microscopy
country as a Pilot Project since 1993 in a phased (iii) Directly observed treatment
manner as Pilot Project I, Pilot Project II, (iv) Uninterrupted supply of good
Pilot Project III. quality drugs
(v) Accountability
Organization
5. DOTS plus is a strategy currently under
1. The profile of RNTCP in a state is as development for the management of
follows: multi-drug resistant TB (MDR-TB).
(i) State Tuberculosis Office: State 6. The RNTCP views the treatment of
Tuberculosis Officer. MDR-TB patients as a ‘standard of care’
(ii) State Tuberculosis Training and issue.
Demonstration Centre: Director. 7. A nation-wide network of RNTCP
District Tuberculosis Centre:
(iii) quality assured designated sputum
District Tuberculosis Officer. smear microscopy laboratories has
(iv) Tuberculosis Unit: been set up, providing appropriate,
(a) Medical Officer TB Control available, affordable and accessible
(b) Senior Treatment Supervisor diagnostic services for TB suspects
(c) Senior TB Laboratory Supervisor and cases.
8. In view of the new and focussed activities, Diagnostic Method of TB

institutional strengthening at national, Tuberculin Test or Mantoux Test:
state and district level is being taken up
1. It detects whether the person is infected
by RNTCP.
with tubercle bacilli.
9. The positions of TB-HIV co-ordinator,
2. One Tuberculin Unit (TU) of Purified
urban co-ordinator and communication
Protein Derivative (PPD) 0.1 ml, route
facilitator have been introduced at
C intradermal and site is flexor aspect of
state, district and sub-district levels.
H left arm.
10. A major recommendation was that the
A 3. Mantoux test is read 72 hours (3rd day)
drugs for paediatric TB cases under
P and marks the induration (never redness)
RNTCP should be supplied in patient-
T with pen on 2 sites, take median of
wise boxes (PWBs), treatment will
E 2 reading.
be based on the child’s body weight
R
4. Interpretations:
and there will be 2 generic paediatric
PWBs: one for the 6–10 kg weight (i) If induration > 10 mm is positive.
5
band and second for the 11–17 kg (ii) If induration < 6 mm is negative.
(iii) If induration 6–10 mm test is
weight band. Children, weighing less

than 6 kg, will be treated with loose doubtful.
anti-TB drugs.
TABLE 5.1: DOTS Medicine Treatment Categorization

Category Types of TB Patients Drugs
I l Seriously ill new sputum smear negative. 2 (HRZE) 3 + 4 (HR) 3
l Seriously ill new extra pulmonary.
l New sputum smear positive.
II l Sputum smear positive relapse. 2 (HRZEs) 3 + 1 (HRZE) 3 + 5 (HRE) 3
l Sputum smear positive failure.
l Sputum smear positive treatment after default.
l Others.
III l New sputum smear negative not seriously ill. 2 (HRZ) 3 + 4 (HR) 3
l New extra pulmonary not seriously ill.
1. 2 (HRZE) 3, here 2 indicates time 2. 4 (HR) 3, here 4 indicates time duration

duration of intensive phase i.e. 2 months of continuous phase i.e. 4 months.
and 3 indicates frequency of TB 3. Drugs are supplied in patient wise boxes
medicines to be taken by the patient (PWBs) containing the full course of
i.e. 3 alternate days in a week.
treatment and packaged in blister pack. Dosage Strength

PWBs have colour code indicating Isoniazid (H) 600 mg 2 pills
category as: Rifampicin (R) 450 mg 1 pills
(i) Red: Category 1 Pyrazinamide (Z) 1500 mg 2 pills
(ii) Blue: Category 2 Ethambutol (E) 1200 mg 2 pills
Green: Category 3
(iii) Streptomycin (S) 750 mg
C
Diagnosis of Tuberculosis in RNTCP H
A
P
Cough for 3 weeks of more 3 Sputum Smears
T
E
R
3 or 2 Positives 1 Positive 3 Negatives
5

Smear Positive TB X-Ray Antibiotics 1–2 weeks
Anti-TB Treatment Symptoms Persist
Repeat Smear Examination

Positive Negative for TB
Negative
Non-TB
Negative for TB Positive
Smear Negative TB
Anti-TB Treatment
FIG. 5.14: Diagnosis of TB in RNTCP

Universal Immunization Aims

Programme 1. To achieve 100 per cent coverage of
pregnant women, with 2 doses of tetanus
1. In 1974, the WHO launched its toxoid and at least 85 per cent coverage
‘Expanded Programme on Immuniza- of infants with 3 doses each of DPT,
tion’ against six killer, most common, OPV, 1 dose of BCG and 1 dose of
preventable and childhood diseases measles vaccine by 1990.
C i.e. diphtheria, pertussis (whooping
H
2. To strengthen routine immunization,
cough), tetanus, polio, tuberculosis the Government of India has planned
A and measles. the State Programme Implementation
P 2. “Expanded” in the WHO definition Plan (PIP). It consists of:
T meant adding more disease controlling
E antigens of vaccination schedules, (i) Support for alternate vaccine
R extending coverage to all corners of a delivery from PHC to sub-centre
country and spreading services to reach and outreach sessions.
5 (ii) Developing retired manpower to
the less privileged sectors of the society.
3. The Government of India launched its carry out immunization activities
Expanded Programme on Immunization in urban slums and underserved

(EPI) in 1978, with the objective of areas, where services are deficient.
reducing the mortality and morbidity (iii) Mobility support to district immu-
resulting from vaccine-preventable nization officer, as per state plan
diseases of childhood and to achieve self- for monitoring and supportive
sufficiency in the production of vaccines. supervision.
4. “Universal” immunization is best inter- (iv) Review meeting at the state level
preted as implying the ideal that no with the districts at 6 monthly
child should be denied immunization intervals.
against tuberculosis, diphtheria, pertussis (v) Training of ANM, cold chain
(whooping cough), tetanus, polio and handlers, mid-level managers,
measles. refrigerator mechanics etc.
5. Universal Immunization Programme (vi) Support for mobilization of children
was started in India, in 1985 and has to immunization session sites
two vital components: by ASHA, women self-help
groups etc.
(i) Immunization of pregnant women (vii) Printing of immunization cards,
against tetanus. monitoring sheet, cold chain chart,
(ii) Immunization of children in their vaccine inventory charts etc.
first year of life against the six
EPI target diseases.
TABLE 5.2: Vaccine Under UIP

Age Vaccines Route Dosage
FOR INFANTS
At Birth BCG, OPV ID, Oral 0.05 ml, 2 drops
1.5 months OPV, Pentavalent (DPT, Hepatitis B, HiB) – I Oral, IM 2 drops, 0.5 ml
2.5 months OPV, Pentavalent (DPT, Hepatitis B, HiB) – II Oral, IM 2 drops, 0.5 ml
3.5 months OPV, Pentavalent (DPT, Hepatitis B, HiB) – III Oral, IM 2 drops, 0.5 ml
C
9 months Measles, Vitamin A S/c, Oral 0.5 ml, 2 Lakh IU
H
16–24 months DPT (Booster), OPV, Measles – II, Vitamin A IM, Oral, SC 0.5 ml, 2 drops,
and Oral SC, 1 Lakh IU
A
5 years DPT IM 0.5 ml P
10 years TT IM 0.5 ml T
16 years TT IM 0.5 ml E
FOR PREGNANT WOMEN R
Early in Pregnancy TT-1 IM 0.5 ml 5
1 month after TT-1 TT-2 IM 0.5 ml

National Vector Borne Disease 3. The NVBDC is one of the most compre-
hensive and multifaceted public health
Control Program activities in the country.
1. The Directorate of National Vector 4. Factors increasing the risk of vector
Borne Disease Control (NVBDC) borne disease outbreaks:
Program is the national nodal agency (i) Increasing urban population.
for prevention and control of major (ii) Shortage of water supply.
vector borne diseases of public health (iii) Traditional water storage.
importance, namely: (iv) Poor garbage collection.
n Malaria (v) Changing lifestyle (use of water
n Filaria coolers etc.)
n Japanese Encephalitis (JE) (vi) Rapid transportation.
n Kala Azar
5. According to the Ninth Five year plan,
n Dengue/Dengue Haemorrhagic
following has been set up for NVBDCP:
Fever (DHF)
n Chikungunya Fever (i) Vision: A well-informed and self-
sustained, healthy India free from
2. This program now comes under the vector borne diseases with equitable
umbrella of National Rural Health access to quality health care.
Mission (NHRM).
Mission: An integrated and

(ii) 4. Involvement of NGOs/Private Sector/
accelerated action towards reducing Community/Local self-government.
mortality on account of Malaria, 5. Quality assurance on laboratory diagnosis.
Dengue and Japanese Encephalitis 6. Long lasting insecticide treated nets.
by half, elimination of Kala-Azar by 7. Supportive interventions including
2010 and elimination of Lymphatic behaviour change communication
Filariasis by 2015. (BCC), Public private partnership and
C inter-sectoral convergence, human
H Objectives resource development through capacity
A 1. To prevent mortality due to vector building, operational research includ-
P borne diseases. ing studies on drug resistance and
T 2. To reduce morbidity due to vector insecticide susceptibility, monitoring
E borne diseases. and evaluation through periodic reviews/
R 3. Elimination of Kala-Azar and Lymphatic field visits and web based management
5 Filariasis. information system.
Goals Burden of Vector Borne Diseases in India

1. To reduce the case incidence including1. Malaria

morbidity on account of Malaria and Malaria cases have consistently declined from
Dengue, Chikungunya and Japanese 2.8 million to 1.31 million during the year
Encephalitis by 50 per cent by 2017. 2001 to 2011. Similarly, Pf cases have declined
2. To achieve elimination of Kala-Azar from 1 to 0.6 million cases during the same
and Lymphatic Filariasis by 2015. period. This indicates declining trend of overall
endemicity of malaria in the country. The
Strategies
analysis of the state wise data of year 2011
1. Disease Management: shows that 90 per cent of malaria cases in the
(i) Early case detection and complete country are reported in 12 states, namely
treatment. Odisha, Jharkhand, Chhattisgarh, Maharashtra,
(ii) Strengthening of referral services. Madhya Pradesh, Gujarat, West Bengal, Uttar
(iii) Epidemic preparedness and rapid Pradesh, Assam, Rajasthan, Andhra Pradesh and
response. Haryana. A total of 1221008 cases of Lymphatic
Filariasis were reported during the year 2011.
2. Insecticide resistance in vector: More
research will be supported to under- S. Vector Borne Year Cases Deaths
No. Diseases
stand the causes of resistance and its
1. Dengue 2011 18860 169
management.
2. Chikungunya 2011 20402 −
3. Legislative measures: Civics bye-laws
3. Japanese Encephalitis 2011 8247 1169
and building bye-laws will be enforced.
4. Kala- Azar 2011 33043 80
According to Annual Report on Implemen- have been reported in the State, showing the
tation of NVBCDP in Haryana (2010), during declining position as compare to the 32,272 cases
the year 2010, 18,921 cases with 763 Pf cases reported during the year 2009:
Year/VBD Malaria Dengue Chikungunya Japanese Encephalitis
Total Pf Deaths Conf. Deaths Conf. Deaths Conf. Deaths
State (Haryana)
Cases cases Cases Cases Cases
2010 18921 763 − 866 21 1 − 1 1
C
District (Rohtak) Cases Deaths Cases Deaths Cases Deaths Cases Deaths
H
2010 825 − 20 2 1 − – −
A
P
CHC Wise Epidemiological Data of T
Malaria in District Rohtak for the Year 2010: E
R
Name of District Name of CHC Population Total +Ve Cases
Rohtak (U) 383563 124 5
Kiloi 151100 206

Chiri 103971 64
Rohtak
Kalanaur 163291 210
Meham 167184 211
Sampla 110909 11
Total 1080018 825
Malaria began originally as National Programme in 1958. Milestones of Malaria

Malaria Control Programme in 1953. The Control Activities in India:
Control Programme converted into Eradication
1993 Launching of National Malaria Control Progrmme (NMCP).
1958 NMCP was Changed to National Malaria Eradication Programme (MNEP).
1977 Modied Plan of Operations Implemented.
1997 World Bank assisted Enahnced Malria Control Project (EMCP) launched.
FIG. 5.17: Milestones of Malaria Control Activities in India

Fig. 5.17 Contd.......
1999 Renaming of Programme to National Anti-Malaria Programme (NAMP).
2002 Renaming of NAMP to National Vector Borne Control Programme.
Global Fund Assisted Intensied Malaria Control Project (IMCP)

2005 Launched
C Introduction of RDT (Rapid Diagnostic Tests) in the Programme
H
Artesunate Combination Therapy (ACT) Introduced in Areas Showing
A 2006
Chloroquine Resistance in Falciparum Malaria
P
T ACT Extended to High Pf Predominant Districts Covering about
E 2008 95 per cent Pf Cases.
World Bank Supported National Malaria Control Project Launched.
R
5 2009 Introduction of Long Lasting Insecticidal Nets (LLINs).
2010 New Drug Policy, 2010.
FIG. 5.17: Malaria
Activities n Training
The main activities of the programme are: n
Facilitating research through NCDC,
n Formulating policies and guidelines
NIMR and Regional Medical Research
n Technical guidance
Centres, etc.
n Planning
n Co-ordinating control activities in the
n Logistics
inter-state and inter-country border
n Monitoring and evaluation
areas.
n Co-ordination of activities through Organization
the States/Union Territories and in n There are 19 regional offices for Health
consultation with national organi- and Family Welfare under Directorate
zations, such as National Cadre for General of Health Services, Ministry
Diseases Control (NCDC), National of Health and Family Welfare, located
Institute of Malaria Research (NIMR). in 19 states, which play a crucial role
n Collaboration with international organi-
in monitoring the activities under
zations like the WHO, World Bank, NVBDCP.
GFATM and other donor agencies.
n Every state has a Vector Borne Disease (DHO) has the overall responsibility of
Control Division under its Department the programme.
of Health and Family Welfare. It is headed n Spray operations are the direct responsi-
by State Programme Officer (SPO), who bility of DMO/DVBDC officer in the
is responsible for supervision, guidance entire district under overall supervision
and effective implementation of the of CMO and collaborative supervision/
programme and for co-ordination of monitoring by PHC’s Medical Officer.
There is one Assistant Malaria Officer C
the activities with the neighbouring
(AMO) and Malaria Inspectors (MIs) H
States/UTs.
n States are responsible for the procurement to assist him. A
certain insecticides for indoor residual n The laboratories have been decentralized P
spray (IRS), Spray equipment and certain and positioned at PHCs. The medical T
anti-malarias, the central government officer—PHC has the overall responsi- E
supplies DDT and larvicides. bility for surveillance and laboratory R
n At the divisional level, zonal officers services and also supervises the spray. 5
have technical and administrative n Case detection management and com-

responsibilities of the programme in munity outreach services are carried
their areas under the overall supervision out by MPWs as well as ASHAs and
of Senior Divisional Officers (SDOs). other community health volunteers.
n At the district level, the Chief Medical Classification of endemic areas
Officer (CMO)/District Health Officer The classification of areas, according to Annual
Parasite Incidence:
S. No. Components Areas with API more than 2 Areas with API Less than 2
1. Spraying l Regular Insecticidal Spray with 2 rounds of Focal Spraying is to be
DDT, unless the vector is refractory. undertaken only around
l Where the vector is refractory to DDT, P. falciparum cases detected
3 rounds of malathion are recommended. during surveillance.
l Areas refractory both to DDT and malathion
are to be treated with 2 rounds of synthetic
pyrethroids spray at intervals of 6 weeks.
l DDT, malathion and pyrethroids dosage applied
are 1, 2 and 0.25g per sq. metre surface area
respectively.
2. Entomological l Done by entomological teams
Assessment l Carry out susceptibility tests and suggest appro-
priate insecticide to be used in particular areas.
3. Surveillance l Collection and examination of blood smears. Active and passive surveillance
l Active and passive surveillance activities are operations will have to be
carried out fortnightly carried out vigorously every
fortnight.
Contd...........
S. No. Components Areas with API more than 2 Areas with API Less than 2
4. Treatment l DDT Radical treatment Radical treatment
5. Follow-Up Follow-up blood smears are to
be collected from all positive
cases on completion of the
radical treatment and there-
after at monthly intervals for
12 months.
C 6. Epidemiological All malaria cases are to be
H Investigation investigated. This may be
A including mass surveys.
P
T Urban malaria scheme n The Expert Committee on Malaria
E had recommended under the Urban
n Launched in 1971 to reduce or interrupt
R Malaria Scheme:
malaria transmission in town and cities.
5 n The methodology comprises vector l
Inclusion of all urban areas with
control by intensive anti-larval measures more than 50,000 population.
and drug treatment. l Reporting slides positivity rate of

n About 7.4 per cent of the total cases of 5 per cent and above.
malaria and 10.95 of deaths due to l Introduction of active surveillance.
malaria are reported from urban areas.
Goals for the strategic plan, 2007–2012
n Control of urban malaria lies primarily
The main national goals for malaria control are:
in the implementation of civil bye laws
to prevent mosquito breeding in the n Atleast 50 per cent reduction in
domestic and peridomestic areas. mortality due to malaria by the year
n The urban malaria scheme under 2010, as per National Health policy
national vector borne disease control document 2002.
programme is presently protecting n Atleast 80 per cent of those suffering
115.5 million population from malaria from malaria get correct, affordable
and other mosquito borne diseases and appropriate treatment within
in 131 towns in 19 states and Union 244 hours of reporting to the health
Territories. system, by the year 2012.
n The civil bye laws are enacted and n Atleast 80 per cent of those at high risk
implemented in Delhi, Mumbai, of malaria get protected by effective

Kolkata, Chandigarh, bengaluru preventive measures, such as ITNs/
Chennai, Ahmedabad and Goa etc. LLINs or IRS by 2012.
Strategic action plan for malaria control in l The total financial outlay
India (2007–2012) ` 277.20 crores.
(a) Surveillance and case management: l New project supported by Global
n Case detection (active and passive). Fund IMCP-II has started since
n Early diagnosis and complete October, 2010 in 7 North-East
treatment. states (except Sikkim) for a period
n Sentinel surveillance. of 5 years (2010–2015).
C
(b) Integrated vector management (IVM): n World Bank supported Project on H
n Indoor residual spray (IRS).
Malaria Control and Kala-Azar A
n Insecticide treated bed nets
Elimination: P
(ITNs)/Long Lasting Insecticidal l Approved for 5 years effective T
Nets (LLINs). from March, 2009 to December, E
n Anti-larval measures including 2013. R
source reduction. l Total financial outlay `1000 crores.
l Initiated in 93 malarious districts
5
(c) Epidemic preparedness and early
of eight states, namely Andhra

response.
Pradesh, Chhattisgarh, Gujarat,
(d) Supportive interventions:
Jharkhand, Madhya Pradesh,
n
Capacity building. Maharashtra, Odisha and Karnataka
n Behaviour change communica- and 46 kala-azar districts in three
tion (BCC). states, namely Bihar, Jharkhand
n Inter-sectoral collaboration. and West Bengal.
n Monitoring and evaluation.
2. Lymphatic Filariasis
n Operational research and applied
field research. n The National Filaria Control Programme
has been in operation since 1955.
The major externally supported projects
n In June, 1978, the operational component
n Global Fund supported Intensified
of the NFCP was merged with the
Malaria Control Project (IMCP): urban malaria scheme for maximum
l Implemented in 106 districts in utilization of available resources.
10 states, namely 7 North Eastern n The training and research components,
states and in selected high risk however, continue to be with the Director,
areas of Odisha, Jharkhand and National Institute of Communicable
West Bengal covering a population Diseases, Delhi.
of about 100 million. n Training in filariology under National
l For a period of 5 years starting Institute of Communicable Diseases,
from July, 2005 to June, 2010. Delhi is being given at three regional
Filaria training and research centres covered with co-administration of

situated at: single dose of DEC+ albendazole.
l Calicut (Kerala). n The Mass Drug Administration (MDA)
l Rajahmundry (Andhra Pradesh). coverage was 86 per cent in 2009 and

l Varanasi (Uttar Pradesh). 85 per cent in 2010.
Mass drug administration
n Filaria control strategy includes:
C
DEC single dose is given to everyone in
l Vector control through anti-larval community except children under 2 years,
H operations. pregnant women and very sick persons.
A l Source reduction.
P l Detection and treatment of micro-
Advantages of single dose mass therapy
T filariasis carriers. n Cost-effective.
E l Morbidity treatment. n Enhance compliance for persons, who
R l IEC receive treatment.

n Doesn’t require complex management
5 n National Filaria Control Programme is infrastructure.
being implemented through 206 Filaria n Integrated with existing primary health
control units, 199 Filaria clinics and care system.

27 survey units primarily in endemic
Age (in Dose Number
urban towns.
Years) of DEC of Tablets
n In rural areas, anti-Filaria medicines
<2 Nil Nil
and morbidity management services
2–5 100Mg 1
are provided through primary health
6–14 200Mg 2
care system.
15 and above 300Mg 3
n In India, the National Health Policy, 2002
envisages elimination of Lymphatic
n DEC is now supplied to all MDA
Filariasis by 2015.
districts as 100 mg tablets.
n The elimination is defined as “lymphatic
filariasis ceases to be public health Drug delivery strategies
problem, when the number of micro- n House to House administration.
filaria carriers is less than 1 per cent n Booth administration (within 1 km area).
and the children born after initiation n Special population groups in places like
of ELF are free from circulating anti- schools, hospitals, industries, prisons etc.
genaemia (presence of adult Filarial n Community aggregations like market
worm in human body). places, bus stand, railway stations,

n During 2010, 18 States/UTs except fairs etc.
Tamil Nadu and West Bengal were
Drug requirement of Kala-Azar and to ensure complete

Drug requirement is estimated as follows: treatment after confirmation.
n DEC = 100 mg tablets, multiply the n World Bank is providing assistance in
total population by 2.5. 46 districts in 3 states, namely Bihar,

n Albendazole = 400 mg tabs. Multiply
Jharkhand and West Bengal.
the total population by 1: 4. Japanese Encephalitis
l NGO’s, community based organi- n Japanese Encephalitis is the leading C
zations, faith based organizations cause of viral encephalitis. H
and Panchayats should also be n It mainly attacks children younger than A
involved in the elimination of 15 years of age. P
lymphatic filariasis programme. n The first evidence of JE transmission
T
l Low compliance: Coverage 40– in India in 1952, in district Vellore E
46 per cent is due to fear of side (Tamil Nadu). R
reaction. n The role of Culex tritaeniorhynchus as
a vector and the involvement of wading 5
New strategy to achieve lymphatic filariasis
elimination ardeidae and pigs as reservoirs hosts

were demonstrated in 1938.
n Lowering the dose of DEC tabs, may
n The major endemic states affected due to
help to reduce the side reactions.
Acute Encephalitis Syndrome (AES)/
n Increasing the dose of Albendazole
JE were Andhra Pradesh, Assam, Bihar,
800 mg tabs.
Delhi, Goa, Haryana, Jharkhand,
3. Kala-Azar Karnataka, Kerala, Maharashtra,
n A centrally sponsored programme was Manipur, Nagaland, Tamil Nadu,
launched in 1990–91. Uttar Pradesh and West Bengal.
n The active case searches are carried out
5. Dengue/Dengue Haemorrhagic Fever
during a fortnight, designated as “Kala-
n Dengue is an outbreak prone seasonal
Azar Fortnight”, during which the
viral disease caused by anyone of 4 strains
peripheral health workers and volunteers
of Dengue virus (DEN-1, DEN-2,
are engaged to make door-to-door
DEN-3 and DEN-4).
search and refer the cases conforming
n The virus is transmitted to humans by the
to the case definition of Kala-Azar and
bite of an infected AEDES Mosquito.
PKDL to the treatment centres for
n Dengue is as self-limiting acute disease
definitive diagnosis and treatment.
characterized by fever, headache, muscle,
n National Health Policy (2002) envisaged
joint pains, rash, nausea and vomiting.
Kala-Azar elimination by the year 2010.
n Dengue was first isolated in Kolkata, in
n An incentive of an amount of ` 100 is
1945 and dengue fever was reported
being provided to the health worker/
1st time in 1956 from Vellore town of
ASHA for referring a suspected case
Tamil Nadu.
6. Chikungunya 2. Dengue and Chikungunya

n Chikungunya is a debilitating non-fatal n Strengthening of monitoring and
viral illness. vector surveillance.
n It resembles Dengue fever and is charac- n Strengthening of Apex Referral laboratories
terized by severe, sometimes persistent, and sentinel surveillance hospitals.
joint pain (arthralgia), as well as fever n Training/re-orientation of medical
and rash. officers on dengue/DHF case manage-
C
n Chikungunya is transmitted by the Aedes ment.
H
albopictus and Aedes aegypti mosquitoes. n Intensive IEC/BCC activities by involv-
A
n Humans are considered to be the major ing community and village health and
P
source or reservoir of Chikungunya virus. sanitation committee/local municipal
T bodies.
E Strategies n Follow-up wit States and municipal
R The strategies for prevention and control of bodies for enactment and implemen-
5 vector borne diseases are: tation of legislative measures against
1. Malaria breeding of vector (mosquitoes).
n Inter-sectoral convergence for prevent-

n Focussed interventions in high malaria
ing vector mosquito breeding.
endemic areas.
n Periodic reviews, focussed and intensive
n Early diagnosis and treatment by:
supervision.
l Strengthening of human resources
for surveillance and laboratory 3. Japanese Encephalitis
support. n Strengthening of referral services,
l Use and scale up of rapid diagnostic diagnostic facilities, monitoring and
test (RDT). surveillance activities.
l Introduction, scale of artemisinin- n Capacity building for proper case
based combination therapy (ACT) management at PHC/CHC/District
for Pf cases. Hospitals.
n Up-scaling use of long lasting insecticidal n Targeted vaccination, with single dose
nets (LLINs). live attenuated SA-14-14-2 vaccine,
n Indoor Residual Spray (IRS). for children between 1–15 years of age,
n Intensive monitoring and supervision. under Universal Immunization Programme
n Intensified Information, Education and (UIP) in a phased manner and inclusion
Communication (IEC) and Behaviour of JE vaccine in routine immunization
Change Communication (BCC) activities in affected districts.
involving community. n BCC for personal hygiene and sanita-
tion in affected communities.
n Strengthening of PHCs/CHCs for n Hydrocele operations for relief of the

early case management. patients.
n Involvement of ASHAs in early case n Training on home based care for
referrals and dissemination of informa- morbidity management.
tion to general public on prevention
and control of AES/JE. NATIONAL HEALTH MISSION
4. Kala-Azar C
The Union Cabinet vide its decision dated
n Expansion of new tools i.e. Rapid,
1st May, 2013 has approved the launch of H
Diagnostic Kits (RDK) and oral drug National Urban Health Mission (NUHM) A
Miltefosine to increase acceptable and as a Sub-mission of an over-arching National P
compliance of treatment. Health Mission (NHM), with National Rural T
n Free diet to all the Kala-Azar patients
Health Mission (NHRM) being the other E
(including old, new) and one attendant Sub-mission of National Health Mission. R
and incentive to patient towards loss of The National Health Mission encompasses
wages during the full period of treatment. 5
its two sub-missions:
n Incentive to ASHA/Volunteer for refer-

ring suspected cases of Kala-Azar and 1. National Rural Health Mission
ensuring complete treatment after (NHRM).
confirmation by Rapid Diagnostic 2. National Urban Health Mission
Kit (RDK) for Kala-Azar. (NUHM).
n Two rounds of focused indoor residual The NHM envisages achievement of
spraying (IRS) under strict supervision universal access to equitable, affordable and
and monitoring, using NRHM insti- quality health care services that are accountable
tutions.
5. Lymphatic Filariasis
n Implementation of Mass Drug Admini-
stration with two drug combination
(DEC+ Albendazole) in Filaria endemic NUHM
districts (Mf rate>1 per cent) for inter-
ruption of transmission. NRHM
n Specific intensive Behaviour Change
Communication (BCC) Campaign for
NHM
mass drug administration
n Training/re-orientation for mass drug
administration for health personnel
at different levels, including drug
distributors, medical officers and FIG. 5.18: National Health Mission
paramedical staff.
and responsive to people’s needs. Outcomes n Reduce MMR to 100/100000 live births
for NHM in the 12th plan are synonymous n Reduce TFR to 2.1.
with those of the 12th plan and are part of the n Annual Malaria Incidence to be
overall vision. <1/1000.
n Kala-Azar Elimination by 2015, <1 case
Components per 10000 population in all blocks.
n Reduce prevalence of Leprosy to
C The main programmatic components include
<1/10000 population and incidence
H Health System Strengthening in rural and
to zero in all districts.
A urban areas:
n Prevention and reduction of anaemia
P 1. Reproductive, Maternal, Neonatal, in women aged 15–49 years.
T Child Health and Adolescent Health n Prevent, reduce mortality and morbidity
E (RMNCH + A) from communicable, non-communicable,
R 2. Communicable and Non-Communi- injuries and emerging diseases.
cable Diseases n Reduce household out-of-pocket
5
NHM has six financing components: expenditure on total health care
expenditure.
n Reduce annual incidence and mortality
from Tuberculosis by half.
R:
NRHM-RCH
RecognitionFlexipool
n Less than 1 per cent micro-filaria
prevalence in all districts.
NUHM Flexipool
NRHM
Flexible Pool for
Communicable Diseases The Government of India launched National
Flexible Pool for Non- Rural Health Mission (NRHM) on 5th April,
Communicable Diseases 2005 for a period of 7 years (2005–2012). The
mission seeks to improve rural health care
Infrastructure Maintenance
delivery system. The thrust of the mission is on
Family Welfare Central establishing a fully functional, community
Sector Component owned, decentralized health delivery system
with inter-sectoral convergence at all levels, to
ensure simultaneous action on a wide range of
FIG. 5.19: Components of NHM determinants of health, such as water, sanitation,
education, nutrition social and gender equality.
Targets of NHM Main Aim

The main aim of NRHM is to provide equitable,
n Reduce IMR to 30/1000 live births.
accessible, affordable, accountable, effective and
reliable primary health care and bridging the n Filaria reduction rate is 70 per cent by
gap in rural health care through ASHA. 2010 and elimination by 2015.
n Dengue mortality reduction rate is
Targets of NHRM 50 per cent by 2010.
n IMR reduced to 30/1000 live births n Cataract operation increases up to
by 2012. 45 lacs per annum.
n MMR reduced to 100/100000 live n Leprosy prevalence rate reduce from
C
births by 2012 1.8/10000 in 2005.
n TFR reduced to 2.1 by 2012. n TB DOTS series maintain 85 per cent
H
n Malaria mortality reduction rate is cure through mission period. A
100 per cent by 2010. P
n Kala-Azar reduction rate is 50 per cent NHRM—Health Systems Strengthening T
by 2010. E
R
Reproductive, Maternal,
5
Child HealthScreening
New Born, Child Health Gender Based
and Early Intervention

and Adolescent Violence
Services
(RMNCH + A) Services
Prevention and Adolescent Health

Maternal Health and
Management of and Addressing the
Family Planning
STI and RTI Declining Sex Ratio
Access to Safe Leadership Role

Concerned Advisor
Abortion Services
FIG. 5.20: NHRM Health Systems Strengthening
NUHM NUHM seeks to improve the health status

of the urban population (50,000 and above)
The Union Cabinet vide its decision dated particularly slum dwellers and other vulnerable
1st May, 2013 has approved the launch of sections by facilitating their access to quality
National Urban Health Mission (NUHM) primary health care.
as a sub-mission of an over-arching National
Health Mission (NHM).
Flexible Pool for Control of Communicable

Diseases:
National Vector Borne Diseases Control Programme (NVBDCP)
Revised National Tuberculosis Control Programme (RNTCP)

C
National Leprosy Control Programme (NLCP)
H
A Integrated Disease Survelliance Programme (IDSP)
P
T
FIG. 5.21: Flexible Pool for Control of Communicable Disease
E
R
5 Flexible Pool for Control of Non-
Communicable Diseases:
National Programme for Prevention and Control of Cancer,

Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)
National Programme for the Control of Blindness (NPCB)
National Mental Health Programme (NMHP)
National Programme for the Healthcare of the Elderly (NPHCE)
National Programme for the Prevention and Control of

Deafness (NPPCD)
National Tobacco Control Programme (NTCP)
National Oral Health Programme (NOHP)
National Programme for Palliative Care (NPPC)
National Programme for the Prevention and Management of

Burn Injuries (NPPMBI)
National Programme for Prevention and Control of Fluorosis (NPPCF)
FIG. 5.22: Flexible Pool for Control of Non-Communicable Disease

Critical Areas for Concerted Action l Equipment

Towards Health Systems Strengthening l Human resources
l Drugs and supplies
l Quality assurance systems
l Service provisioning
Outreach Services
n With the launch of NUHM, primary
health care in urban areas would be C
strengthened, and district hospitals H
Facility Based would be enabled to provide multi A
Service Delivery
speciality referral care. P
n All district hospitals would have a quality
T
management system that would be
Decentralized E
Health Planning certified against set standards.
R
n An approach to quality certification
would be developed, based on learning 5
from the pilots in quality management

FIG. 5.23: Critical Areas for Concerted Action systems undertaken in the XI plan
period.
3. Outreach Services
1. Decentralized Health Planning n Sub-centres are the hub for delivering
n The District Health Plan is an important effective outreach services in rural

institutional structure for enabling areas.
decentralization, convergence and n Most outreach activities will take place
integration and is also the vehicle for at the village level, with the Anganwadi
promoting equity and prioritizing Centre being the usual platform for
the needs of the most socially and service delivery.
economically vulnerable groups in a n For facilitating access to the community
district. and for the safety of the providers, new

n The District Health Action Plan will be construction of sub-centres must be
developed as an instrument of progress located in well-populated and frequented
towards the provision of universal health parts of the village.
care in a phased manner. n Health care delivery facilities should be
within 30 minutes of walking distance,
2. Facility Based Service Delivery
from habitation, implying that additional
n A Facility Development Plan has the sub-centres population is dispersed,
following components: would need to be created.
l Infrastructure
n The drugs and supplies provided to Five Year Plans (1951–2002)

the sub-centres would be integrated 1. First Five Year Plan (1951–56)
with the state drug procurement and
n The National Family Planning Pro-
logistics system.
gramme was launched in 1952.
n The pattern of Medical Mobile Units
n The services were rendered through
(MMUs) will depend on the geography
clinic approach.
and could provide package of services
C n Contraceptive supplies and educational
equivalent to a primary health centre,
H material were distributed.
and have the necessary HR, equipment
A n Training and research was conducted.
and supplies.
P 2. Second Five Year Plan (1956–61)
T National Family Welfare Suggested to integrate family planning and
E Programme health education activities with community
R development to systematize the programme.
Historical Developments
5 3. Third Five Year Plan (1961–66)
1. The concerns about fertility levels and
n The Family planning programme was
population growth were initially voiced

during the second decade of 20th century considered as the centre of planned
in India. approach for overall development.
2. An excess of population was considered n There was a shift from clinic approach
as the major factor interfering with to extension education approach.

combating and overcoming evils of ill n The services were extended to community
health, illiteracy and ignorance, death level in the villages and urban areas,
and poverty from the society. both through extension educators to
3. The First Family Planning Clinic was motivate people for small family norm
opened at Poona by Prof. R.D. Karve and provide contraceptives.
in 1923. n In 1965, Lippes loop was introduced.
4. In 1946, a Health Survey and Develop- n A separate department of family plan-
ment Committee chaired by Sir Joseph ning was set up in 1966 in the Ministry
Bhore, advised for deliberate limitation of Health.
of family size and recommended the Period (1966–69)
provision of integrated preventive, n Family planning programmes although
promotive and curative primary health voluntary in nature but became time
care services with high priority for bound and target oriented.
improving nutritional and health n The family planning infrastructure,
status of mother and child. which included urban family planning
centres, district and state bureaus, was n The National health policy had also
strengthened. laid emphasis on reorganization and
4. Fourth Five Year Plan (1969–74) strengthening of health care delivery
system.
n Family planning programme was given
top priority by the Government of India. 7. Seventh Five Year Plan (1985–90)
n The family planning services were Various maternal and child health related
rendered through sub-centres, primary programmes were started and strengthened C
health centres and MCH and family such as Universal Immunization Programme, H
welfare centres as integral part of MCH Oral Rehydration Therapy and various other A
services. MCH programmes were brought together P
n All India Hospital Post Partum Programme under Child Survival and Safe Motherhood T
was started in 1970 to motivate mother Programme (CSSM) during this plan period E
for family planning soon after delivery. for effectively tackling the issue of population R
stabilization.
n In 1972, Medical Termination of 5
Pregnancy Act, 71 was implemented. 8. Eighth Five Year Plan (1992–97)

5. Fifth Five Year Plan (1974–79) n The major thrust areas included focus
on delivery of quality services and
n The department of family planning
integration with other sectors.
was renamed as Department of Family
n In April, 1996 target approach was
Welfare.
renounced and target free approach
n The population control and family
was adopted.
planning were made as concurrent
n The target free approach emphasized on
subject in January, 1977 by the 42nd
providing quality services on demand
amendment of the constitution.
based on needs of the people.
6. Sixth Five Year Plan (1980–85) n The Reproductive Child Health (RCH)
n Through Primary health care approach was launched and the scope of family
the Government of India accepted a welfare programme was widened.
National Health Policy in 1983 which n The RCH programme included:
had laid down long term demographic
l All the components of the safe
goals to be achieved by year 2000 ad.
motherhood programme with the
n Goals:
added component of Reproductive
l Net reproductive rate 1 (2 child
tract infection/Sexually transmitted
norm). infection (RTI/STI).
l Crude birth rate 21/1000 live births.
l All the components of child survival.
l Crude death rate 9/1000 popula-
l Fertility regulation with a focus
tion. on quality care.
l Couple protection rate 60 per cent.
RCH Programme emotional and social development make up a

n Aims to improve the management of school’s health program”.
services at the central, state, district and School health is an important branch of
block level. community health. According to modern
n Seeks to attain holistic approach in concepts, school health service is an economical
implementation of the programme. and powerful means of raising community
n Focuses on neglected geographical health. It is a personal health service. Also, it
C
areas. Example: area projects in poorly is a forum for the improvement of the health
H of the nation.
performing states and district integrated
A
projects in remote/border districts.
P n Also, focusses on previously neglected
Health Problems of School Children
T segments of population, such as urban 1. Malnutrition
E slums, men, adolescents etc. 2. Infectious diseases
R 3. Intestinal parasites
9. Ninth Five Year Plan (1997–2002)
5 4. Diseases of skin, eye and ear
n The target free approach has been
5. Dental caries
renamed as Community Need Assess-
ment Approach (CNAA) from 1997. Objectives of School Health

n According to this approach, Annual action
1. Health promotion: The promotion
plans are to be prepared in the beginning of positive health.
of each year by the concerned State 2. Health protection: The prevention
Health and Family Welfare authorities of diseases.
at various levels, starting with the grass 3. Health restoration: Early diagnosis,
root level workers at periphery. treatment and follow-up of defects.
n A comprehensive National Population
4. Health education: Awakening health
Policy, 2000 has been formulated to consciousness in children.
promote family welfare programme 6. Healthy living: The provision of
and achieve the set goals and objectives. healthful environment
School Health Services Role of Community Health Nurse

School Health in School Health
According to American School Health Associa- On the basis of the aspects of the school health
tion, “All the strategies, activities and services services, the role of Community Health Nurse
offered by, in or in association with schools that in School Health are as follows:
are designed to promote student’s physical, Health appraisal of school children and
1.
school personnel: Health appraisal
consists of periodic medical examina- personal health of the pupils. The

tions and observation of children by following minimum standards for
class teacher: sanitation of the school and its environs
(i) Periodical medical examination: in India are:
The School Health Committee (i) Location: The school premises
(1961) in India, recommended should be properly fenced and
medical examination of children kept free from all hazards. C
at the time of entry and thereafter (ii) Site: The School Health Committee H
every 4 years. (1961) recommends that 10 acres A
(ii) School personnel: Medical of land be provided for higher
P
examination should be given elementary schools and 5 acres
T
to teachers and other school of land for primary schools.
E
personnel, as they form part of (iii) Structure: School should be single
R
the environment to which the storied with minimum exterior
child is exposed. wall thickness of 10 inches and 5
Daily morning inspection: The
(iii) should be heat resistant.

teacher is a familiar with the (iv) Classrooms: No classroom should
children and can detect changes in accommodate more than 40 students.
the child’s appearance or behaviour Per capita space for students in a
that suggest illness or improper classroom should not be less than
growth and development. 10 sq. ft.
(v) Furniture: Furniture should suit
Remedial measures and follow up:
2.
the age group of students. Desks
Special clinics should be conducted
should be of “minus” type and
exclusively for school children at PHCs
chairs should be provided with
in the rural areas and in one of the
proper back rest with facilities
selected schools or dispensaries for a
for desk work.
group of about 5000 children in the
(vi) Doors and windows: The windows
urban areas.
should be broad with the bottom
Prevention of communicable diseases:
3.
sill, at a height of 2–6 inch from
A well-planned immunization pro-
the floor level; combined door
gramme should be drawn up against
and window area should be atleast
the communicable diseases and a
25 per cent of the floor space.
record of all immunizations should
(vii) Colour: Inside colour of the class
be maintained as part of the school
room should be white and should
health records.
be periodically white-washed.
Healthful school environment: A
4.
(viii) Lighting: Classrooms should have
healthful school environment is necessary
sufficient natural light.
for the best emotional and social and
(ix) Water supply: There should be dental examination, atleast once a year.
an independent source of safe Dental hygienists make preliminary
and potable water supply, which inspection of the teeth and do prophy-
should be continuous and distri- lactic cleansing which is of great value
buted from the taps. in preventing gum troubles and in
(x) Eating facilities: There should improving personal appearance.
be a separate room provided for 9. Eye health: Basic eye health services
C mid-day meals. should be provided in schools for
H (xi) Lavatory: Privies and urinals early detection and treatment of eye
A should be provided—one urinal disorders and also, administration of
P for 60 students and one latrine Vitamin A to children at risk.
T for 100 students. Arrangements 10. Health education: The most important
E should be separately made for element of the school health programme
R boys and girls. is health education. The goal of health
5 education should be to bring about
Nutritional services: The School Health
5.
desirable changes in health knowledge,
Committee (1961) recommended that
in attitudes and in practice and not
school children should be assured of at

merely to teach the children a set of
least one nourishing meal by the school
rules of hygiene.
through their own cafeteria on a ‘no
Education of handicapped children:
11.
profit no loss’ basis.
The ultimate goal is to assist the handi-
First aid and emergency care: A fully
6.
capped child and his family so that the
equipped First-Aid post should be
child will be able to reach his maximum
provided as per regulations of St. John
potential, to lead as normal a life as
Ambulance Association of India with
possible, to become as independent as
the responsibility of giving first-aid and
possible, and to become a productive and
emergency care to pupils who become
self-supporting member of society.
sick or injured on school premises.
Proper maintenance and use of school
Mental health: The school is the most 12.
7.
health records: The purpose of main-
strategic place for shaping the child’s
taining school health records is to have
behaviour and promoting mental health.
cumulative information on the health
Every effort should be made to relieve
aspects of school children in order
the tedium of the classroom and no
to give continuing intelligent health
distinction should be made between
supervision. A cumulative school health
race, religion, caste or community etc.
record will be useful in analyzing and
Dental health: A school health pro-
8.
evaluating school health programmes
gramme should have provision for
and providing a useful link between the (iv) Biological hazards: Hazards related
home, school and the community. to exposure to infective and parasitic
agents at the workplace.
Occupational Health Services Psychological hazards: Hazards
(v)
arise from the workers failure to
1. Occupational health is the health science
adapt to an alien psychological
which is related to human work, work-
environment.
place and work environment. C
2. The chief objective of occupational 5. Occupational diseases are usually H
health is the safety of workers in all defined as diseases arising out of or A
occupations from injuries and diseases in the course of employment. P
and to improve their health status. (i) Diseases due to physical agents: T
3. According to joint committee of WHO Cancer, occupational deafness, E
and ILO (1950), Occupational health burns, frost bite, etc. R
in all occupations should be: (ii) Diseases due to chemical agents:
(i) Care and improve the physical, Dusts (Pneumoconiosis) due to 5
mental and social well-being of inorganic dust:

workers. n Coal Dust—Anthracosis,
(ii) Prevent hindrances to health Silica—Silicosis, Asbestos—
including those which occur due Asbestosis and Iron—Siderosis.
to workplace. n Due to organic dust.
(iii) Protect the workers engaged in n Cane fibre—Bagassosis, Cotton
occupations. dust—Byssinosis, Tobacco—
(vi) Provide them a healthy environ- Tobacossis, Hay or Grain
ment. dust—Farmers lung.
4. Types of occupational hazards: n Diseases due to biological agents:
(i) Ergonomic hazards: Hazards Brucellosis, anthrax, tetanus, fungal
related to job environment. infections, etc.
(ii) Physical hazards: Hazards related n Occupational cancers: Cancer of
to physical environment (light, skin, lungs and bladder.
heat, noise, radiation etc.) n Diseases of psychological origin:
Chemical hazards: Hazards related
(iii) Industrial neurosis, Hypertension,
to exposure to chemicals. peptic ulcer, etc.
Health Problems Due to Industrialization
Environmental Sanitation
Communicable Diseases
C Food Sanitation
H
A Mental Health
P
Accidents
T
E Social Problems
R
5 Morbidity and Mortality
FIG. 5.24: Health Problems due to Industrialization
Measures for Health Protection of Environmental sanitation: It includes

(iii)
Workers sufficient supply of wholesome water,
The measures for the general health protection proper sanitary preparation, storage and
of workers was the subject of discussion by handling of food, sanitary convenience
the WHO/ILO Committee on Occupational for every 25 employees, sufficient floor
Health in 1953: and cubic space, proper lightening,
adequate ventilation with suitable
(i) Nutrition: The aim is to provide balanced temperature and adequate environmental
diets or snacks at reasonable cost under controls against occupational hazards.
sanitary control. (iv) Mental health: The goals of mental
(ii) Communicable disease control: There health in industry are:
should be an adequate immunization
programme against preventable com- (a) To promote the health and
municable diseases. happiness of the workers.
Nutrition
Communicable Disease Control
Environmental Sanitation
C
Mental Health
H
Measures for Women and Children A
P
Health Education T
Family Planning E
R
5
FIG. 5.25: Measures for Health Protection of Workers

(b) To detect signs of emotional stress (e) The Factories Act, 1976 provides
and strain and to secure relief of for crèches in factories, where
stress and strain where possible. more than 30 women workers are
(c) The treatment of employees suffer- employed. Regarding protection
ing from mental illness. of children, the Constitution of
(d) The rehabilitation of those who India declared: “No Child below
become ill. the age of 14 shall be employed
Measures for women and children:
(v) to work in any factory or mine or
The following types of protection are engaged in any other hazardous
available for women workers in India: employment”.
(a) Expectant mothers are given (vi) Health education: The health content
maternity leave for 12 weeks varies from matters of personal hygiene
under the ESI Act, 1948. and protection to participation of the
(b) Provision of free antenatal, intra workers in the planning and operation
natal and postnatal services. of the total health service programme
(c) The Factories Act prohibits night in industry.
work between 7 pm and 6 am. (vii) Family planning: Family planning
(d) The Indian Mines Act prohibits is recognized a decisive factor for the
work underground. quality of life. The workers must adopt
the small family norm.
Prevention of Occupational Diseases

The various measures for the prevention of
Isolation
occupational diseases may be grouped under
three heads: Local Exhaust Ventilation
1. Medical Measures Protective Devices
C Pre-placement Examination
Environmental Monitoring
H
Periodical Examination Statistical Monitoring
A
P Medical and Health Care Services Research
T
E Notication
FIG. 5.27: Engineering Measures
R
Supervision of Working Environment
5
Maintenance and Analysis of Records
3. Legislation
Health Education and Counselling
FIG. 5.26: Medical Measures The Factories The ESI

Act, 1948 Act, 1948
2. Engineering Measures

FIG. 5.26: Legislation
Design of Building
The factories Act, 1948
Good House-Keeping
n Scope: The Act defines factory as an
General Ventilation establishment employing 10 or more
workers, where power is used and 20 or
Mechanization
more workers, where power is not used.
n Health, safety and welfare: Elaborate
Substitution
provisions have been made in the Act
Dusts with regard to health, safety and welfare
of the workers.
Enclosure
n The 1976 amendment provides for
the appointment of ‘Safety Officers’
FIG. 5.27: Engineering Measures in every factory, wherein 1000 or more
Contd....... Fig. 5.27 workers are ordinarily employed.
n The 1976 amendment provides for

crèches in every factory, wherein more
AS A MEMBER OF THE HEALTH
than 30 women workers are ordinarily TEAM
employed. Community Health Nurse as a member of
n Employment of young persons: The Act
health team is closely related with all national
prohibits employment of children below health programmes. She/he should know the
the age of 14 years and adolescent aims of participation, needed equipment and
employee (age between 15–18 and C
resources, programme activities, actions and
above) is allowed to work only between H
general instructions related to each national
6 am to 7 pm. A
health programme.
n Hours of work: The Act has prescribed P
a maximum of 48 working hours per T
Aims of Participation
week, not exceeding 9 hours per day E
with rest for at least ½ hour after n To understand and identify the feelings, R
5 hours of continuous work. The total attitude and adaptability of community
towards specific health programmes. 5
number of hours of work in a week
including overtime shall not exceed 60. n To implement the policies and programmes

n Leave with wages: The Act lays down related to the health of the people and to
that besides weekly holidays, every worker get the co-operation of the community.
will be entitled to leave with wages after n To assist in changing the bad habits
12 month’s continuous service at the and adopting the good ones.

following rate: adult: 1 day for every n To convert a local person into an effective
20 days of work, children: 1 day for health worker through good training
every 15 days of work. and assisting the people in identifying
n Occupational diseases: Provision has also and solving their problems.
been made in the 1976 amendment for n To motivate local people.
safety and occupational health surveys n To keep the relevant and latest informa-
in factories and industries. tion about national health programmes.

n Employment in hazardous processes:
Specific responsibilities of the occupier Resources Needed for Participating
in relation to hazardous processes were in the Programme
also made with workers’ participation n To identify the problem:
in safety management.
l It is essential to maintain morbidity
The Employees State Insurance Act, 1948 register, clinical register, survey
The Employees State Insurance (ESI) Act, 1948
refer Chapter 3, page no. 73.
register, personal card and family n Try to change unhealthy religious faiths
card. and superstitions, which are resisting
n Making arrangements for the the programme.
laboratory tests. n Exchange knowledge and information,
n Temperature, pulse and respiration so that receptivity for the programme
tray, weighing scale and immuniza- can increase.
tion tray, blood pressure apparatus n Health programmes should be beneficial
C and other devices, as needed. to the majority of people.
H n Medicines (as per the requirement). n Time and implementation of the
A n Health education material (cards, programme should be convenient
P film etc.) for the community.
T n Availability of doctor/any other n Health education should be provided to
E specialist/assistant worker/health public regarding the health programme.
R workers/vaccinator etc. for the n It is essential to get political support
5 examination of patients. and help in implementation of national

programmes.
Actions
n Quick identification of patients. TRAINING AND SUPERVISION

n Assisting in diagnosis and laboratory OF HEALTH CARE WORKERS
examination.
n Giving treatment to patients.
n Providing care to patients at home. Training of Health Care Workers
n Health education. 1. Lady Health Visitor/ Health Assistant/
n Assisting in achieving the targets. Health Supervisor (Refer page no. 53).
n Providing supervision and training. 2. Auxiliary Nurse Midwife/Multi-Purpose
n Preparation and maintenance of reports. Health Worker (Refer page no. 55).
n Evaluation of health programmes.
Supervision of Health Care Workers

General Instructions
All aspects like administration, management,
Community health nurse should pay attention education, guidance, organization and evaluation
to the following facts, while implementing are included in supervisory responsibility of
the health programmes: community health nurse.
n Ensuring participation of community It is necessary to delegate proper authorities
and its leaders for the success of the to the community health nurse through
programme. decentralization of power.
The supervisory functions of community 4. Supervision of field work:

health nurse are: (i) Observation of actual home visits
1. Examining the work of health assistant and the prescribed home visits
and health workers employed at the of health workers and health
PHCs and sub-centres. assistants.
(i) Ensuring and certifying their (ii) Observation of technique of home
attendance at the sub-centre. visit. C
(ii) Looking after their job charts (iii) Supervising the nursing services
H
and roles. provided through home visits.
A
(iii) Personal guidance and advice. (iv) Achievement of home visits.
P
(v) Giving guidance for home visiting.
2. Educational function: T
Personnel evaluation:
(i) Arranging for continuing nursing 5. E
education (CNE) and in service (i) Comparing the job chart and R
training of nursing personnel actual work done. 5
employed at the health centres. (ii) Evaluating the achievement of
workers employed at the health

(ii) Arranging training of local dais
(TBAs). centres in the field of reproductive
and child health (including family
Observation of records:
3.
planning), control of communicable
(i) Observing the records collected diseases and in other national
and maintained at the sub-centres programmes.
and PHCs. Making necessary (iii) Preparing checklist for evaluation.
correction and giving guidance. (iv) Sending reports or recommenda-
(ii) Examining the reporting system. tions regarding achievements/
failures of health workers.
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6. Epidemiology is more concerned with

INTRODUCTION TO EPIDEMIOLOGY
the well-being of society as a whole, than
Definition with the well- being of individuals.
According to World Health Organization,
Aims
“Epidemiology is the study of the distribution
and determinants of health-related states or events According to the International Epidemiological
(including disease) in specified populations, Association (IEA):
and the application of this study to the control 1. To describe the distribution and
of diseases and other health problems”. magnitude of health and disease
problems in human populations.
Concepts 2. To identify etiological factors (risk factors)
1. Epidemiology is derived from the word in the pathogenesis of disease.
“epidemic” (Epi = among; demos = 3. To provide the data essential to the plan-
people; logos = study). ning, implementation and evaluation
2. In 1927, W.H. Frost became the first of services for the prevention, control
professor of epidemiology in US. and treatment of disease and to the
3. Epidemiology has now become firmly setting up of priorities among those
established in medical education. services.
4. Modern epidemiology has also taken
within its scope, the study of health Objectives
related states, events and “facts of life” 1. To prevent, control, eradicate health
occurring in human population. and health-related problems.
5. It includes study of health services, used 2. To reduce/minimize the impact of
by the population and to measure their health-related problems.
impact.
3. To promote health and quality of life It is used to measure the change in

of people at large. population size over a specified period.
4. To provide database for planning, It is an indicator of community health
providing and evaluating the health in a particular place.
services. n Infant Mortality Rate (IMR): Infant
5. To evaluate the trends in health sector. mortality rate includes number of
6. To identify the problems for further infant deaths under 1 year of age per
analysis. 1000 live births.
n Maternal Mortality Rate (MMR): Refers
Tools and Methods to number of deaths of pregnant women
due to any pregnancy related cause within
1. Tools
C 42 days of termination of pregnancy
H
Data are organized, categorized to comparison per 1,00,000 live births.
and evaluation of study results. The most n Neonatal Mortality Rate (NMR): It is
A
common basic tools are used in epidemiology: the number of neonatal deaths in a given
P
T Rate year per 1000 live births in that year.
n Total Fertility Rate (TFR): Average
E It is defined as “specific event, condition or disease
R in a given population within a specific time number of children that would be
period”. Rate demonstrates the quantitative born to a woman if she experiences the
6 current fertility pattern throughout her
characteristics like amount of disease or number
of affected person in a particular population. reproductive period span (15–49 years).
Epidemiology
Number Affected in a Time Period

It is useful indicator for analyzing the
Rate = Total Population in Same Area prospects for population stabilization.

n Age Specific Death Rate: Number of
n Rate may be used for comparison between
deaths in a particular age group per
groups.
1000 mid-year population of that age
n Rate presents demographic data and
group in a year in a particular area.
morbidity data.
Morbidity rates
Demographic rates
Morbidity are presented generally as incidence
It involves the following rates:
and prevalence rates:
n Crude Birth Rate (CBR): Refers to
n Incidence rate: Number of new cases
number of live births per 1000 on
of a disease during a given time period
estimated mid-year population in a
per 1000 population at risk during that
defined area per year. It is the simplest
period.
indicator of fertility.
n Prevalence rate: Number of existing
n Crude Death Rate (CDR): Number of
cases (new + old cases) of a disease in
deaths per 1000 estimated midyear
total population at a particular point
population in a year, in a defined area.
of time.
Epidemiology 169
Frequency Distribution l Income
Demonstrates the qualitative characteristics l Social class

such as height, weight or investigation values. l Dietary pattern
It is an another way of organizing the data. l Habits
n Provides data for describing the nature

2. Methods
of diseases or problems and measuring
(i) Descriptive Method their extent in terms of incidence/
(ii) Analytical Method prevalence rate, ratios, mortality rates
(iii) Experimental Method etc. by age, sex, occupation and social
(i) Descriptive Method class etc. helps in making Community
Concerned with the study of frequency and Diagnosis.
n Clues to the etiology of diseases for
C
distribution of disease and health related events H
in population, in terms of person, place and time: further rigorous investigation and
confirmation of the causes. A
n Its
purpose is to provide an overview n Background information for plan- P
of the extent of health problems and to ning, organizing, implementation and T
give clue to possible etiological factors evaluating preventive, curative services E
involved. to deal with the health problems. R
n The data is collected about:
Designs in descriptive method 6
(a) Time:
n Cross-sectional studies: Cross-sectional
l Year
Epidemiology
study is like a snapshot and provides
l Season
information about the prevalence of
l Month
a disease. It is also called as Prevalence
l Week
Study. The data is collected from a
l Day
cross-section of population at a one
l Hour of onset of the disease
point in time. The result of the study is
Place:
(b) applied on the whole population. Useful
l Areas of high concentration for detailed community assessment,
l Areas of low concentration study of morbidity and underlying
l Spotting of cases in the map factors, especially chronic diseases are
Person:
(c) economical and comparatively quick
l Age
to perform.
n Longitudinal studies: Data is collected
l Sex
l Race
from the same population repeatedly over
l Marital status
a continuous period of time by follow
l Occupation
up of contacts and their examination.
l Education
Useful for studying the natural history
of diseases, finding out incidence rates estimating incidence rates and

of diseases and identifying risk factors risk of developing disease. It also
of diseases. More expensive and time helps to identify the relationship
consuming. of the risk factor under study to
(ii) Analytical Method other diseases or problems.
2. Retrospective cohort: It is called
More specific in focus, test hypothesis and
as Historical Cohort Study. The
attempt to determine casual factors of disease.
event has already occurred and
Types of analytical methods: the investigator goes back in time
(a) Case control study: It has retrospective 10–30 years and identifies the
approach. It is also called as retrospective cases from existing record to be
C method/case comparison design. Group included in the study group. It is
H of people who have been diagnosed as useful for determining the effect
A having a particular problem (cases) are of occupational hazards. Hospital
P compared with a group of people, who records can help in designing
T are similar in characteristics to that cohort studies. It can be done in
E cases but they are free from the problem short period and are economical.
R
(controls). Easy to organize and are less 3. A combination of retrospective and
expensive. Very effective in determining prospective cohort-Characteristics
6 the risk factors. Drawback—difficulty of both, retrospective and pros-
in selecting the control group. pective studies. The investigator
Epidemiology
(b) Cohort study: A cohort is a specific identifies the cohort from past
group of people, at a certain time, sharing record and traces forward till date.
common characteristics or experience The same cohort is followed up
e.g. people born on the same day or the further for assessment prospectively
same year (birth cohort), people with upto desired period.
same occupation (occupation cohort) (iii) Experimental Method
etc. Cohort studies can be designed in
3 ways: It is done to confirm the etiology of diseases,
establish the efficacy of preventive or therapeutic
1. Prospective cohort: Prospective in measures and evaluate health care services. It
nature (the group under study is is done under controlled conditions. It is very
free from the disease but exposed expensive. Community health nurse conduct
to risk factor and epidemiologist experimental studies to determine the effective-
study the development of a condi- ness of community health practices e.g. efficacy
tion over time). It is expensive and of different health education methods and
time consuming. It helps in study- motivation techniques, communication methods,
ing the natural history of disease, self-help model etc.
+
Epidemiology 171
Experimental Experimental
Group Group
Treatment
Control Control
No Treatment
Group Group
C
FIG. 6.1: Experimental Methods H
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Principles (v) An important outcome of this study is
formulation of aetiological hypothesis E
Disease Frequency
known as “Descriptive Epidemiology”. R
The basic measure of disease frequency is a
rate or ratio. It is a vital step in the develop- Determinants 6
ment of strategies for prevention or control of Real substance of epidemiology known as
Epidemiology
health problems. Biostatistics is a basic tool of “analytical epidemiology”. Analytical strategies
epidemiology. help in developing scientifically sound health
Distribution of Disease programmes, interventions and policies.
It occurs in patterns, in a community leading to
Theories and Models
generation of hypotheses about causative factors.
The epidemiologist examines whether: 1. Germ Theory of Disease
(i) There has been an increase or decrease Referred as one-to-one relationship between
of disease over time span. casual agent and disease.
(ii) There is a higher concentration of disease
in one geographic area than in others.
(iii) The disease occurs more often in males Disease Agent Man Disease
or in a particular age group.
(iv) More characteristics or behaviour of
those affected are different from those FIG. 6.2: Germ Theory of Disease
who are not affected.
2. Epidemiological Triad n Absence or insufficiency or excess of a

The causative factors of disease may be classified factor necessary to health
as Agent, Host and Environment referred to as n Social agents
Epidemiological Triad. (ii) Host

Host factors play a major role in determining
the outcome of an individual’s exposure to
infection (e.g. tuberculosis). The host factors
may be classified as:
Environment
n Demographic characteristics
n Biological characteristics
C n Social and economic characteristics
H (iii) Environment
A Epidemiological Defined as “all that which is external to the
P Triad individual human host, living and non-living,
T and with which he is in constant interaction”.
E For descriptive purposes, the environment of
R Agent Host man has been divided into three components:
6 physical, biological and psychosocial.
3. Multi-Factorial Causation

Epidemiology
FIG. 6.3: Epidemiological Triad New models of disease causation have been
developed (e.g. multifactorial causation, web
of causation) which de-emphasize the concept
(i) Agent of disease “agent” and stress multiplicity of
Defined as a substance, living or a non-living interactions between host and environment.
or a force tangible or intangible, the excessive The purpose of knowing the multiple factors
presence or relative lack of which may initiate, of disease is to quantify and arrange them in
or perpetuate a disease process. priority sequence (prioritization) for modification
Disease agents may be classified broadly or amelioration to prevent or control disease.
into the following groups: The multifactorial concept offers multiple
n Biological agents approaches for the prevention/control of disease.
n Nutrient agents
n Physical agents
4. Web of Causation
n Chemical agents The “web of causation” considers all the predis-
n Mechanical agents posing factors of any type and their complex
Epidemiology 173
inter-relationship with each other. The basic disease, provided that link is sufficiently important
tenet of epidemiology is to study the clusters in the pathogenic process.
of causes and combinations of effects and how
they relate to each other. The web of causation 5. Natural History of Disease
does not imply that the disease cannot be It is the principle model in epidemiology. It is
controlled unless all the multiple causes or the key concept in epidemiology. It signifies the
chains of causation or at least a number of way in which a disease evolves over time from
them are appropriately controlled or removed. earliest stage of its pre-pathogenesis phase to
Sometimes removal or elimination of just only termination as recovery, disability or death. It
one link or chain may be sufficient to control is best established by cohort study.
C
PERIOD OF PRE-PATHOGENESIS PERIOD OF PATHOGENESIS H
A
DISEASE PROCESS Before Man is Involved The Course of the Disease in Man
Death P
Agent Host
Chronic State T
Defect E
Disability
R
Illness
Environment Factors
(Known and Unknown)
Clinical Horizon Signs and Symptoms
6
Immunity and
Resistance
Epidemiology
Bring Agent and
Host Together or
Stimulus or Agent becomes Established
Procedure a Disease
and Increases by Multiplication Recovery
Provoking Stimulus
In the Interaction of
Human Host and Stimulus Host Reaction
Host
Early Discernible Advanced
Pathogenesis Early Lesions Diseases Convalescence
Secondary
Level of Prevention Primary Prevention Prevention Tertiary Prevention
Modes of Health Specic Early Diagnosis Disability

Rehabilitation
Intervention Promotion Protection and Treatment Limitation
FIG. 6.4: Natural History of Diseases
(i) Pre-pathogenesis Phase is known as “Man in midst of disease”. The

It is the period preliminary to the onset of disease, agent, host and environment operating in a
agent has not yet entered in man but the factors combination determine not only the onset
which favours its interaction with human host of disease which may range from a single case
are already existing in the environment. This to epidemics. Primary prevention (health
promotion and specific protection) is very tertiary prevention (disability limitation and
effective in period of pre-pathogenesis. rehabilitation) as effective levels of prevention
in period of pathogenesis phase.
(ii) Pathogenesis Phase
It begins with entry of disease “agent” in susceptible 6. Health Sickness Spectrum
host. Further, events in pathogenesis phase are Health and disease lie along a continuum, the
clear in infectious/communicable diseases. This lowest point on the health-disease spectrum
stage may be modified by intervention measures, is death and the highest point corresponds to
such as immunization and chemotherapy. The the World Health Organization definition of
infection may be clinical or subclinical, typical positive health. The spectral concept of health
or atypical or host may become a carrier with emphasizes that the health of an individual is
or without having developed clinical diseases not static; it is dynamic phenomenon and a
C
as in case of diphtheria or poliomyelitis. In process of continuous change, subject to frequent
H
chronic diseases, the early pathogenesis phase is subtle variations. It implies that health is a state
A
less dramatic, that’s why disease is preferred as not to be attained once and for all, but ever to
P
pre-symptomatic phase. It involves secondary be renewed.
T
prevention (early diagnosis and treatment) and
E
R
Positive Freedom from Mild Death
6 Health Sickness Sickness
Epidemiology
Better Unrecognized Severe

Health Sickness Sickness
FIG. 6.5: Health Sickness Spectrum
7. Iceberg Phenomenon represents the hidden mass of disease i.e. latent,
According to Iceberg Phenomena, disease in a inapparent, pre-symptomatic and undiagnosed
community may be compared to an iceberg. cases and carriers in the community. The “water-
The floating tip of the iceberg represents what line” represents the demarcation between apparent
the physician sees in the community i.e. clinical and inapparent disease.
cases, the vast submerged portion of the iceberg
Epidemiology 175
Death
Hospitalized Symptomatic
Patients Disease
What the
Surface of Detection Diagnosis Physician Sees
General Practitioner
Self-Reported Practitioner What the Pre-Symptomatic

Physician Disease
Population Screening does not Sees C
H
A
FIG. 6.6: Iceberg Phenomenon
P
T
mutually helpful, inseparable and have E
APPLICATION OF EPIDEMIOLOGY R
co-existence.
IN COMMUNITY HEALTH NURSING 3. Community health nurse makes use of 6
“Morris” identified seven distinct uses of nursing process, which is comparable
Epidemiology
epidemiology: to epidemiological process in solving
various health problems.
1. To study historically the rise and fall of
4. Nurses in the community have an
disease in the population.
important role in prevention and control
2. Community diagnosis.
of chronic and non-infectious diseases
3. Planning and evaluation.
through health education and helping
4. Evaluation of individual’s risks and
people to change their lifestyle.
chances.
5. Community health nurses help in
5. Syndrome identification.
restoring and maintaining optimum
6. Completing the natural history of
health.
disease.
6. Epidemiologic concepts and methods
7. Searching for causes and risk factors.
must be included as an integral part of
both, theory and practical of nursing
Epidemiology and Nursing curriculum.
1. Epidemiology is one of the basic 7. Nursing students must be given an
sciences applicable to nursing. opportunity to apply epidemiologic
2. Epidemiology and nursing are not concepts during their clinical and
antagonistic but both are closely related, field practice.
8. Epidemiology evaluates the outcome community health nursing, enabling the

of preventive and therapeutic measures community health nurses to act as a key
and provides feedback for effective person in health information system as
health management. The evaluation well as in health management.
is an on-going process in the field of
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INTRODUCTION Importance of Biostatistics

Demographic studies have two parts: 1. To improve health status of population.
2. To clarify the relationship between
Population statistics: It includes the
1.
factors and diseases.
indicators and measures of population
3. To enumerate the occurrence of disease.
size, sex ratio, density and dependency
4. To explain the etiology of disease
ratio.
(causative factors).
Vital statistics: It is an important part
2.
5. To predict the number of disease
of demographic studies.
occurrence.
It is quantitative data, concerning
6. To read, understand and criticize the
the population, such as birth rates, death
medical literature.
rates, natural growth rates, mortality
7. To plan, conduct and interpretation
and fertility rates etc.
of medical research.
BIOSTATISTICS VITAL STATISTICS

Definition
Definition
Biostatistics is the application of statistical
Branch of biometry which deals with data
methods to health sciences.
and law of human mortality, morbidity and
Or
demography.
It includes statistical processes and methods
It is the statistics, concerning human life
applied to the collection, analysis and inter-
or the conditions affecting human life and
pretation of biological data and especially data
maintenance of population as birth rates,
relating to human biology, health and medicine.
death rates, etc.
Scopes 4. Making entries is a must for specific

time period.
1. To evaluate the impact of various
national health programmes. Report, Recording and Compiling
2. To plan for better future measures of of Vital Statistics at the Local, State,
disease control.
3. To plan, evaluate social and economical
National and International Level
development Civil registration and vital statistics system are
4. It acts as a primary tool in research considered the optimum source of mortality
activity. statistics and birth statistics because death rate
C 5. To compare health status of one nation and birth rate of any country are likely to be
H with other. compared with the help of civil registration
A 6. To promote health legislation. and vital statistics system.
P 7. To assess the attitude and degree of Assessment of vital registration system should
T satisfaction of beneficiaries with the be based on a comprehensive framework that
E health system. covers key aspect of their operation.
R The assessment framework we used, explores
7
Legislation administrative, technical and societal issues
that influence civil registration system.
1. The most common way of collecting
Demographic Studies
information on demographic events is The World Population

through civil registration, an adminis-
According to the United States:
trative system used by governments to
record vital events, which occur in the n World population reached 7 Billion on
populations. October 31, 2011.
2. Civil registration is the continuous, n Population in the world is currently
permanent, compulsory and universal growing at a rate of around 1.14 per

recording of the occurrence and cent per year.
characteristics of vital events and other n The average population change is
civil status events pertaining to the currently estimated at around 80 million

population as provided by decree, law per year.
or regulation, in accordance with the National vital statistics system (NVSS)
legal requirements in each country. provides nation’s official and vital statistics
3. General legislation include compulsion data, based on the collection and registration of
of registration, collection of statistical birth and death events at state and local level.
items, confidentiality, privacy and safe It provides the most complete and conti-
keeping, storage and reservation of nuous data available to public health officials
records. at national, state and local level and in also,
private sector.
Demography Studies 179
Vital statistics are critical component of our n Age Specific Mortality Rate Lowest for
national health information system, allowing Males and Females 10–14 years age
us to monitor progress towards achieving group.
important health goals. n Mean Age at Effective Marriage for
Females 21.2 years.
Vital Statistics of India n The workforce participation rate for
According to Sample Registration System of females at national level stands at
India in the year 2011: 25.51 per cent compared with 53.26 per
n Total Population 1210.19 Million cent for males.
n Crude Birth Rate 21.4 (per thousand) C
State Level (Haryana)
n Crude Death Rate 7 (per thousand). H
n Males 623.12 Million (51.5 per cent). According to Sample Registration System of
A
n Females 587.45 Million (48.5 per cent). India in the year 2011:
P
n Total Sex Ratio 943. n Total Population 253.51 lakh. T
n Urban Sex Ratio 929. n Crude Birth Rate 21.8 (per thousand). E
n Rural Sex Ratio 949. n Crude Death Rate 6.5 (per thousand).
R
n Highest Sex Ratio (Kerala) 1084. n Males 134.95 lakh.
n Lowest Sex Ratio (Daman & Diu) 618. n Females 118.56 lakh. 7
n Infant Mortality Rate (IMR) 44. n Sex Ratio 877.
Demographic Studies
n Highest IMR (Madhya Pradesh) 59. n Infant Mortality Rate (IMR) 44.
n Lowest IMR (Kerala) 12. n Maternal Mortality Rate (MMR) 13.5.
n Maternal Mortality Ratio 16.3. n Maternal Mortality Ratio 146.
n Maternal Mortality Rate (MMR) 178. n Total Literacy Rate 76.64 per cent.
n Highest MMR (Assam) 390. n Literacy Rate (Males) 84.1 per cent.
n Total Literacy Rate 74 per cent. n Literacy Rate (Females) 65.9 per cent.
n Literacy Rate (Males) 80.9 per cent. n 4,833 CHCs are functioning in the
n Literacy Rate (Females) 64.6 per cent. country (2013).
n Highest Literacy Rate (Kerala) 94 per n There are 109 CHCs functioning in
cent. Haryana (2013).
n Highest Age Specific Fertility Rate n 24,049 PHCs are functioning in the
20–24 years age group. country (2013).
n Total Fertility Rate 2.4. n There were 447 PHCs functioning in
n General Fertility Rate 81.2. Haryana (2013).
n Mortality Rate Across All Ages 6.3 for n 1,48,366 sub-centre are functioning in
Females and 7.8 for Males. the country (2013).
n There were 2520 SCs are functioning
in Haryana (2013).
Local Level (Rohtak) vital records with legal value are prepared and
According to Sample Registration System of vital statistics are based.
India in the year 2011: Demographic Sample Surveys
n Total Population 10.6 lakh. Conducted by National Sample Surveys
n Crude Birth Rate 26.9 (per thousand). Organization (NSSO) attempted to provide
n Crude Death Rate 7.5 (per thousand).
reliable estimates of birth and death rates
n Males 5.68 lakh.
through its regular rates.
n Females 4.92 lakh.
n Sex Ratio 868. Sample Registration System
C n Infant Mortality Rate (IMR) 67.
Based on a Dual Recording System. It provides
H n Literacy Rate 80 per cent.
reliable annual data on fertility and mortality
A at the state and national levels for rural and
P Definition of Computing Vital urban areas separately.
T Statistics
E Health Surveys
A vital statistics system is defined by the United
R Nations as the total process of: National Family Health Surveys (NFHS) and
7 the District Level Household Surveys (DLHS)
1. Collecting information by civil registra-
conducted for the evaluation of reproductive
tion or enumeration on the frequency or
Demographic Studies
and child health programmes. NFHS provide

occurrence of specified and defined vital
information on the availability of health and
events, as well as relevant characteristics
family planning services to pregnant mothers
of the events themselves and the person
and other women in reproductive ages.
or persons concerned.
2. Compiling and processing, analyzing, District Level Household Surveys (DLHS)
evaluating, presenting and disseminating
The DLHS provide information at the district
these data in statistical form.
level on a number of indicators relating to
child health, reproductive health problems and
Methods of Computing Vital
quality of services available to them.
Statistics
The methods of computing vital statistics are: METHODS OF PRESENTING DATA
Civil Registration System Frequency Distribution
The civil registration method is the procedure
An appropriate presentation of data involves
employed to gather the basic observations on the
organization of data in such a manner that mean-
incidence of vital events and their characteristics
ingful conclusions and inferences can be drawn
which occur to the population of a country
to answer the research question. Quantitative
within a specified time period and upon which
data are generally condensed and frequency n Reference symbols can be directly placed
distribution is presented through tables, charts, beneath the table for any explanatory
graphs and diagrams. footnotes.
n Two or three small tables should be
Tables preferred to one large one.
n A table presents data in a concise, 2. Parts of a Table
systematic manner from masses of
Depending upon the nature of the data and
statistical data.
purpose of investigation:
n Tabulation is the first step before data
is used for further statistical analysis n Table number: Table number should
C
and interpretation. be placed at the top of the table.
H
n Tabulation means a systematic presenta- n Title: Title should be brief, concise
and describe the contents of the table. A
tion of information contained in the
n Head notes: It is given just below the
P
data in rows and columns, in accordance
title in a prominent type, usually T
with some features and characteristics.
enclosed in brackets for further E
n Rows are horizontal and columns are
vertical arrangements. description of the contents of the table. R
n Caption and stubs: Captions are the 7
1. General Principles of Tabulation
headings designated for vertical columns
n A table should be precise, understandable
Demographic Studies
and stubs are the headings for horizontal
and self-explanatory. rows.
n Every table should have title, placed at
n Body of table: arrangement of the data
the top of the table and must describe according to description given in the
the content clearly and precisely. form of captions and stubs form the
n Items should be arranged alphabetically
body of the table.
or according to size, importance or casual n Footnotes: Used to explain the items
relationship to facilitate comparison. which are not adequately explained.
n Rows and columns to be compared with
n Source note: Used, when the table
one another should be brought together. itself is retrieved.
n The unit of measurement must be clearly
stated. 3. Types of Tables
n Also, figures can be in the form of (i) Frequency distribution table
percentage. Present the frequency and percentage distribution
n Totals can be placed at the bottom of of the information collected, where an attribute
the columns. is grouped in number of classes.
The class or group intervals are kept constant. (ii) Contingency table
For example: n Frequency distribution of two nominal
TABLE 7.1: Description of Sample variables simultaneously and include

Characteristics totals.
S. Demographic Frequency Percentage n The categories considered should be
No. Data (per cent) mutually exclusive as well as exhaustive
1. Age (N = 20) (i.e. observations cannot be beyond
25–30 11 55 these categories).
31–36 4 20 n Contingency tables are also known as
37–42 1 5 cross tables, which present the frequency
C
43–48 1 5 distribution of two or more variables to
H 49–54 3 15 establish the relationship or association
A 2. Qualification (N = 20) among them.
P GNM 10 50 n The number of subjects in a cell is
T B.Sc. Nursing 10 50 called the cell frequency.
E n These tables are generally used in
R chi- ( χ ) square test. For example:
7
TABLE 7.2: Types of Ventilation and Daily Bowel Movements Among Patients
Demographic Studies
Bowel Movements Mode of Ventilation Total f χ 2 Value

Spontaneous Ventilation Mechanical Ventilation
f (per cent) f (per cent)
Present 391 (64) 32 (29.4) 423
Absent 220 (36) 77 (70.6) 297 45.87 × Df = 1
Total 611 109 720
(iii) Multiple-response table TABLE 7.3: Factors Contributing to Sleep

When classification of the cases is done into Deprivation Among Patients
categories that are neither exclusive nor Factors* Frequency f (%) (N = 60)
exhaustive. Blood Sampling 35 (58.3)
The total number of subjects in case of Diagnostic Tests 33 (55)
multiple responses is given as base and from Medication 33 (55)
this, we calculate the percentages. Vital Signs Monitoring 32 (53.3)
Noise 32 (53.3)
Bright Lights 30 (50)
*Each patient has more than one factor.
(iv) Miscellaneous table Constructing Diagrams/Graphs

Used present data other than frequency or n They must have a title and index.
percentage distributions, such as mean, median, n The proportion between width and
mode, range or standard deviation and so on. height should be balanced.
A table is called as miscellaneous, when n The selection of scale must be appropriate.
presentation of data cannot be classified under n Footnotes may be included, wherever
the frequency distribution table, contingency it is needed.
table or multiple response tables. n Principle of simplicity must be kept
TABLE 7.4: Mean, Median, Mode and Range in mind.
of Scores of Nurses n Neatness and cleanliness in construction C
Measures Knowledge Attitude Skill of graph must be ensured. H
Mean 8.6 16.5 9.1 A
Types of Diagrams and Graphs
Median 9.1 17.3 9.8 P
Mode 9.6 17.6 10 The commonly used diagrams and graphs in the T
Range of 12 – 4 = 8 21 – 10 = 11 11 – 6 = 5 presentation of data of the research studies are E
Obtained Scores bar diagram, pie diagram, histogram, frequency
Range of 0–15 1–25 0–14
R
Possible Scores
polygon, line graphs, cumulative frequency
curve, scattered diagrams, pictograms and map 7
diagrams.
Demographic Studies
Graphical Presentation of Data 1. Bar Diagram
Main Reasons for using the n Convenient graphical device is parti-
cularly useful for displaying nominal
Diagrammatic and Graphic
or ordinal data.
Representation of Data
n Easy method adopted for visual
n They are the most convenient and comparison of the magnitude of different
appealing ways, in which statistical frequencies.
results may be presented. n Length of the bars drawn vertically or
n They give an overall view of entire data. horizontally indicates the frequency of
n They are visually more attractive than a character.
other ways of representing data. n The bar charts are called vertical bar
n It is easier to understand and memorize charts (or column charts), if bar charts
data through graphical representation. are placed vertically. When the bars are
n They facilitate comparison of data placed horizontally, called horizontal
relating to different periods of time of bar charts.
different origins.
Constructing bar diagram
n
The width of bars should be uniform 3. Proportion bar diagram
throughout the diagram.
n The gap between the bars should be
uniform throughout. Whispering
n Bars may be vertical or horizontal.
Types of bar diagram Arriving Late
(i) Simple bar diagram

Sneezing
(ii) Multiple bar diagram

Flash
Photography
C
H 0 10 20 30 40 50 60
100
A Whispering Sneezing
P 0
Vegetarian Non-
T Vegetarian Arriving Late Flash Photography
E
R FIG. 7.1: Type of Dietary Pattern
FIG. 7.2: Number of Theatre Performances
7
Demographic Studies
2. Pie Diagram
20
16.4
15
17.3
10 9.6
8
9.1
05 8.7
Workshop
Attended
Workshop
Knowledge Attitude Skill no t Attended
FIG. 7.3: Proportion

n Useful pictorial device for presenting n Size of each angle is calculated by multiple
discrete data of qualitative characteristics, class percentages with 360
such as age groups, genders and occu- Class Frequency
pational groups in a population. or = × 100
Total Observation
n The total area of the circle represents
the entire data under consideration. 3. Histogram
n It gives comparative at a glance.
C
H
A
P
T
E
R
7
Demographic Studies
FIG. 7.4: Pie Diagram
n Most commonly used graphical representa-

tion of grouped frequency distribution. 50
n Frequency of each group forms a 40
rectangle or column. 30
15–20
n The area of rectangle is proportional

20
25–25
to the frequency of the correspondence 25–30

class interval and the total area of the 10
histogram, being proportional to the 0

Number of Males
total frequency of all the class intervals.
FIG. 7.5: Histogram
Construction of Histogram
n Set of vertical bars, the areas of which are n Used, where data is collected over a
proportional to frequencies represented. long-period of time.
n The difference of histogram from bar n On x-axis, values of independent variables
diagram—bar diagram is one dimensional are taken and values of dependent
and only the length of the bar has its variables are taken on y-axis.
significance, while in histograms, both 6. Cumulative Frequency Curve or Ogive
length and width matters.
n When class intervals are equal, frequency
500
is taken on y-axis, the variables on x-axis
and adjacent rectangles are constructed. 400
C n When the class intervals are unequal, 300

H a correction for unequal class intervals 200
A must be made. 100
P
4. Frequency Polygon
T 0
2001 2002 2003 2004
E n Curve obtained by joining the mid-
R
points of the tops of the rectangles in Number of Sold in Delhi
Number of Sold in Mumbai
a histogram by straight lines.
7 n The two end points of the line drawn are FIG. 7.7: Line Graph
joined to the horizontal axis at the mid-
Demographic Studies
point of the empty class-intervals at both

ends of the frequency distribution. n Represents the data of a cumulative
n Frequency polygons are simple and frequency distribution.
sketch an outline of data pattern more n Plotted to the upper limits of the classes.
clearly than histograms. n The points corresponding to cumulative

frequency at each upper limit of the
5. Line Graphs
classes are joined by a free-hand curve.
50 7. Map Diagram or Spot Map
40
15–20 150
30
25–25 100
20
25–30 50
10
Linear
(20–25) 0
0 15–20 20–25 25–30 30–35
Number of Males
FIG. 7.6: Frequency Polygon FIG. 7.8: Cumulative Frequency Curve or Ogive
Prepared to show geographical distribution of

frequencies of characteristics.
8. Scattered or Dotted Diagram
Maternal Mortality Ratio Per 100000 Live Births
C
H
A
P
T
E
R
7
Less than 10 death per 100000.
10–199 deaths per 100000.
Demographic Studies
200–499 death per 100000.
500–999 deaths per 100000.
Greater than or equal to 1000 deaths per 100000.
Data not available.
FIG. 7.9: Map Diagram or Spot Map
n Shows the nature of correlation between

two variables characters x and y on the 6
similar features or characteristics. 4
n It is also called correlation diagram. 2
9. Pictograms or Picture Diagram 0

0 1 2 3 4 5 6
FIG. 7.10: Scattered or Dotted Diagram

Used to impress the frequency of the occurrence system is not only to reduce the risk of wrong
of events to common people, such as attacks, decisions but also to work as an effective controlling
deaths, no of operations, admissions, accidents technique. Managers at every level require
and discharges in a population. important information with speed, brevity and
economy in order to discharge their functions
effectively. Due to the complexity of business
≤ 20 years and industrial operations, the management
(20.2 per cent) information system (MIS) gets more importance.
Government regulations are to also create the
need of supply of more reliable information
C
accurately within short span of time. This
H
21–35 Years clearly shows that the management is entering
A (53.3 per cent) into an “Information Age”.
P
T Meaning
E 36–50 Years (19.4 per cent)
Management information system is a planned,
R
≥ 51 Years (7.1 per cent) organized and systematic collection of relevant,
7 accurate, precise and timely information which
FIG. 7.11: Pictograms or Picture Diagram are properly processed and supplied to required
Demographic Studies
persons economically for the purpose of achieving

organizational objectives.
Limitations of Graph
n Confusing (may be false or true). Definition
n Present only quantitative aspect. 1. Hanson defines a management informa-
n Get information only on one aspect or tion system as an array components
on limited characteristics. designed to transform a collective set
n They can present only approximate of data into knowledge that is directly
values. useful and applicable in the process of
directing and controlling resources and
MANAGEMENT INFORMATION their application to the achievement of
specific objectives.
SYSTEM (MIS) 2. Walter J. Kennevan defined management
Management requires complete reliable information system as, “a formal method
information to solve any problem and exercise of collecting timely information in a
effective control by taking a timely decision. presentable form in order to carry out
The complete reliable information is received organizational operations for the purpose
in time. The proper management information of achieving the organizational goals”.
Objectives of Management resources in order to achieve the objective of

organization. Managers can prepare the plan in
Information System order to achieve the objective by selecting best
Facilitates decision making: Manage-
1. course of action. He can identify the task, which
ment executives at all levels are taking are emerged under the operation of an organi-
large number of decision by receiving zation and organized into the homogeneous
the best possible current information. groups. The completion of task is to be controlled
Accurate, reliable, precise and information by the setting performance standard and avoid
facilitates the decision-making process deviations from such standards. In this place,
very easy. management facilitates the executives for
C
Avoid duplication of work: Major
2. taking number of valued decisions with regard
H
portion of the organizational operations to planning, organizing and controlling the
A
are computerized and procedure are performance task and function of business.
P
simplified.
Saving of time: Standard time is fixed
3. 2. Information T
for each work separately. E
Information can be defined as tangible or
Establish uniform procedures: Uniform
4. intangible facts, which are used to reduce or R
procedures ensure proper flow of data avoid uncertainty of future events. Information 7
from concerned department of section. is necessary to every management to plan and
Demographic Studies
Fixing responsibility: It is the respon-
5. control the business operation effectively.
sibility of concerned executives to Information is derived from the data out of
provide data. the available data, information is developed
Improving service: Improved service
6. and used for decision making purpose. There
is rendered by the executive in an must be proper transformation of data into
organization. information. The presentation of information
is in such a way that is current and in a readily
Elements of Management usable and easily understood format.
Information System (MIS) Types of Information
The term ‘management information system’ (i) Operating information: It includes
consists of three words. They are management, various operation of unit. Detail of
information and system. If one understands production and sales, number of persons
the meaning and nature of these three words, employed, overtime worked in terms of
properly, he/she can have thorough under- production and man hours, wastage in
standing the concept of MIS: term of unit of measurement etc. are
the examples of operation information.
1. Management (ii) Status information: The status of
Management is the process of planning, organi- certain work on a particular point of
zing and controlling of physical and human time is given. Work is the progress in
the term of unit of measurement, stage community wise etc. are social informa-
of major project, stage of construction tion.
work etc. is the example of status (viii) Economic information: It includes
information. economic condition of the nation. Rate
(iii) Resource information: It includes of inflation, rate of interest, cost of
the resources of an organization. Own inflation index, money value standard
capital, borrowed capital, skilled human of living, per capita income, GNP, etc.
resources, semi-skilled human resources, are the economic information.
unskilled human resources, material (ix) Technology information: The technology
power etc. are the examples of resources adopted by the organization for each
C
information. activity is kept in separate file. Besides,
H
(iv) Resource allocation information: It the technology available in the market,
A includes allocation of available resources technology adopted by other similar units
P within organization own capital used and the gap between latest technology
T for purchase of fixed assets and current available and technology adopted by the
E assets, borrowed capital used for purchase organization are included in technology
R of fixed assets and current assets or information.
7 clean of old debts, employment of (x) Competition information: Competition
personnel in department wise etc. are with regard to sales, labour force and
Demographic Studies
the example of examples of resource raw material suppliers are included in

allocation information. competition information. The list of
(v) Planning and control information: competitors and their strength and
Top management can prepare the plan weaknesses are also collected as informa-
and control for each activity production tion for taking sound decisions.
and sales budget, cash budget production 3. System
schedule, capital budgeting, zero base
System can be defined as a set of inter-related
budgeting etc. are examples of planning
elements working towards for achieving
and control information.
general objectives of an organization. There
(vi) Government information: It includes
may be sub-system in organization and all
The Fiscal Policies of the Government.
such systems are part of large systems. There
The Government presents the budget
is a need of application of principle of system
every year, which affect the business to
in the business organization. If so, there is a
some extent. The extent of affect and ways
possibility of integration of the sub-system
of affect are to be accessed and presented
through information inter proper change. The
to the government information.
system concept of MIS is, therefore, one of the
(vii) Social information: It includes demo-
optimizing the output of the organization by
graphic details, population in urban
connecting the operating sub-systems through
area wise and rural area wise, sex wise,
the medium of information exchange.
industrial workers wise, religion wise,
Designing the Management be properly noted to avoid duplication

and waste of efforts. It means that a
Information System pool is created to collect the data from
Under management information system, a such units and department.
set of procedures is systematically followed to Information in summarized form:
5.
collect relevant data, processing the data and Information is presented in such manner
presented in a required format as information. that action can be initiated and or
A well-developed system should be designed in decision can be taken without further
the following manner: interpretation and analysis. It reduces
Supplies complete, accurate and timely
1. the time, efforts and volume of infor- C
data: Effective planning and decision mation. Management by exception
H
making is possible by availing complete, principle is followed here by the top
A
accurate and timely data. The MIS management.
P
would solve the problems connected Flexibility: The MIS should be flexible
6.
T
with inconsistent, incomplete and as much as possible so that the system
E
inaccurate data. can be changed or revised whenever
R
Identify and quantify inter-related
2. necessary.
operation: Production and sales 7
are independent variables, but these Process of Management
Demographic Studies
variables have close relationship within Information System
each other. Production is depending The transformation from data to information
upon the demand for the product that involves six stages:
is sales volume. So, the information
of production develops a relationship 1. Assembling: It means finding and
with sales. This can be projected to collection of data and recorded in a
forecast future trends. set of files. The well-defined sources
Measure and control the performance:
3. of information facilitate the collection
Production data can be presented in of data.
monetary terms. If so, production 2. Processing: It means that collected
costs can be measured and control the data has been summarized, edited and
performance, which can be closely processed. During editing, the irrelevant
monitored. and inaccurate data have been eliminated
Identify need of decentralized organi-
4. from the records.
zation: In large scale enterprise, there 3. Analyzing: It means that the data has
is a decentralization of authority and been analyzed to develop or calculate
departmentation. The need of such percentages, ratios etc. Percentage and
decentralized units and departments can ratios are providing useful information
to the decision-maker.
4. Storage and retrieval: Indexing, coding, functional area of business. Management

filing and location of information are should have well-organized system to
coming under the process of storage. collect information and maintain upto
Provisions have been made to quick date information to take prompt and
relocation of such information and timely decision.
retrieval, when it is necessary. 2. Planning: Top management want
5. Evaluation: It means determinations information for planning purpose.
of usefulness of information in term Planning is the primary function of
of accuracy, precise and relevance. management. The primary function is
The degree of accuracy, precise and effectively carried on by the managers
C
relevance is based upon the needs of under well-designed management
H
the decision-maker. information system. The MIS can be
A 6. Dissemination: It means supplying hooked upto various corporate models
P the required information in the specified for planning. The uncertainty can be
T format at the right time to the decision converted into a certainty through
E maker. proper planning.
R 3. Control: The MIS informs the
The following process for establishing
7 decision maker about the performance
any MIS:
of work with standards set of them. If the
1. State the management objective clearly.
Demographic Studies
information is better, more complete,

2. Identify the actions required to meet more reliable and timely, it is easier for
the objective. manager to exercise effective control.
3. Identify the responsible position in the
organization. Importance of Management
4. Identify the information required to
Information System
meet the objective.
5. Determine the data required to produce 1. Complexity of business opera-
the needed information. tions: The business operations will
6. Determine the system‘s requirement be changed into complexity due to
for processing the data. dynamics of the environment. The MIS
7. Develop a flowchart. helps the managers in this situation,
to look upon the business operations
Areas of Management Information without much difficulty.
System 2. Size of business unit: Most of the
business units have grown in size. This
1. Decision-making: MIS is designed to results in management being removed
generate and free flow of information from the scene of the operations.
collected from internal and external Now MIS plays a vital role to solve
source for sound decision-making in all operational problems.
Changes in economic structure: Rate

3. capacity to store and supply more
of inflation and unemployment, changes information. This has made informa-
in interest rate GNP and the like are tion handling easier.
affecting the smooth functioning of a
business unit. Hence, these types of Factors Affecting the Management
information should be collected and help Information System
the manager to take a valid decision.
There must be a free flow of information from
Technological changes: These include
4.
one place to another place within organization.
the changes in the operations of business
Even though, some factors affecting the free
unit. Whenever there is a change in
flow of information. They are listed below: C
technology, there is a problem to the
H
management. This type of problem Availability: Availability of informa-
1.
A
can be easily solved with the help of tion refers more accurate and relevant
information. All decisions are made P
effective MIS.
out of available information, if the T
Social changes: It includes higher level
5.
decisions are highly uncertain. But, E
of education, changes in consumer
tastes, usage of computer at home, there is no parameter available to access R
preference of job etc. this type of the information as accurate or inaccurate 7
information is maintained upto date. If and adequate or inadequate. Hence, the
Demographic Studies
so, running of business unit is very easy. managers are forced to take decisions
Determination of training needs: In
6. out of available information.
large scale enterprise, the operations are Quality: Quality of information describes
2.
decentralized so that more information its compactness and accuracy. Sound
is needed about the operations units. decisions are taken only out of quality
The performance of all units should information. Accordingly, the informa-
be closely watched and steps must be tion should be precise and highly reliable.
taken, if there is a poor performance Quantity: Too much information
3.
of units. It means that training needs cannot be processed very easily by the
can be found out in order to improve management within stipulated time
the performance of units. Here, MIS and difficult to get accurate informa-
can be effectively used for measuring tion. On the other hand, too little
performance and decide the training information may leave relevant, reliable
needs for better performance and and accurate information, which are
achieve organizational goals or plans. necessary to take useful decisions.
Wide use of computer: The computers
7. Timeliness: Information must be
4.
are widely used since the operation available when needed. Sometimes,
requires less expenses and have more some important decision can be delayed
due to non-availability of necessary Objectives of Health Management

information properly in time and the
results missed opportunities. At the
Information System
same time, the time gap between the 1. To provide reliable, latest and useful
collection of data and the presentation health information to all levels of health
of the proposed information should be officers and administrators.
reduced as much as possible. Besides, 2. To amend health policies and work-
the information should be presented ing system on the basis of feedback,
before the decision-maker, when needed received from health management
and not on a periodic and cyclic basis. information system.
C
3. To provide information about periodically
H
HEALTH MANAGEMENT and time bound programmes and for
A midterm evaluation.
P INFORMATION SYSTEM 4. To contribute towards achievement
T of objectives of health policies and
E
Definition
programmes.
R Health Management Information System is a 5. To increase efficiency and quality in
7 system in which collection, utilization, analysis health management.
and transmission of information is done for
conducting health services, training and research Characteristics of Health
Demographic Studies
to improve and protect population health. Management Information System

Health Management Information System
is a process, whereby health data (input) are
(Recommended by WHO)
recorded, stored, retrieved and processed for 1. The information should be problem
decision making (output). Decision-making oriented.
broadly involves two aspects: managerial and 2. Information should be population
clinical. Managerial aspects include planning, based.
organizing and control of health care facilities 3. Functional and directorial wording
at the national, state and district level. Clinical should be used.
aspects, can be divided into: 4. Information should be expressed in
1. Providing optional care. short and in imaginative form (graph,
2. Training of medical personnel to generate chart, table etc.)
appropriate human resource and facilitate 5. Facility for data feedback must be present
research and development activities in in health management information
various fields of health/medicine. system.
6. Advanced technology should be used 8. For information management, organiza-

in health management information tion structure must be present.
system.
7. Unnecessary figures or data should Sources of Health Management
not be present in health management Information System
information system.
Census
C
Registration of Vital Statistics
H
Notications of Diseases and Disease Registers A
P
Records and Reports of Hospitals
T
Statistics Regarding Environmental Health E
R
Statistics Regarding Health Resources and Service
7
Sample Survey
Demographic Studies
Pollution Survey
School Record
Economic Planning
Plans of Social Security
Statistics Regarding Efforts to Check Epidemiological Diseases

and Researches
FIG. 7.12: Sources of Health Management Information System
Problems of Health Management facilities for storage and maintenance

of records.
Information System in India Procedural: Involves excessive infor-
2.
Structural: It includes multiplicity of
1. mation, hidden issues, exhaustive
institutions and departments, fragmen- information, overburden of collection
tation of data, lack of infrastructural and recording of data along with
General Health Care, incomplete, 4. Related to human resources: It

unreliable and intentionally managed includes absence or skilled medical
information, inappropriate forms/ record professionals, lack of opportu-
cards/reports, less interest of users in nity for in service training for the staff,
information, time consuming procedure, health providers are collecting and
confusing coding, long list, if indices, preparing the data, lack of motivation.
absence of feedback to information 5. Technological: It involves much manual
suppliers. paper based system, absence or lack of
Related to content: Mostly service
3. computerized data base system.
utilization statistics, only summarized
C
information reaches at higher level, less Sub-Components of Health
H
emphasis on socio-economic informa- Management Information System
A
tion, no user friendly.
P
T
E
Epidemiological Identication/Notication of Diseases and Risk Factors, Investigation,
R Surveillance Follow-up and Control Measures
7
Demographic Studies
Routine Service Hospital/health Centre Based Indicators on Performance of

Reporting the Various Services
Specic Program Various Programs in Operation Like RCH, AIDS, Malaria, TB, Leprosy
Reporting Control and Eradication Programs etc. Under Different Departments
Administrative Account and Financial Systems, Drugs Management, Personnel

Systems Management, Asset Management, Maintenance System
Vital Registration Births, Deaths, Migration etc.
FIG. 7.13: Sources of Health Management Information System

Challenges of Health Management

Information System
Low Levels of Public will, About Vital Registration System
Inadequate Government’s Capacity and Lack of Firm Political Decision
Gender Issue in Vital Events Registration
Fragmentation of Health Information C

H
Establishing a Unied Information System within Country (Need of
Integrating Public and Private Sector Health Informations) A
P
T
FIG. 7.14: Challenges of Health Management Information System
E
R
Benefits of Health Management 7

Information System
Demographic Studies
According to WHO, the benefits of Management
Information System are:
Helping Decision Makers to Detect and Control Emerging and

Endemic Health Problems
Help in Monitroing Progress Towards Health Goals and Promote Equity
Empowering Individuals and Communities with Timely and

Understandable Health Related Information
Improving in Quality of Services
Strengthening the Evidence Base for Effective Health Policies
Permitting Evaluation of Scale up Efforts and Enabling Innovation

through Research
Mobilising New Resources and Ensuring Accountability in the

way they are used
Improving Governance
FIG. 7.15: Benefits of Health Management Information System

C
H
A
P
T
E
R
7
Demographic Studies
INDEX
A At the village level 18

Auxiliary nurse midwife/multipurpose health worker 55
Achievements 118
Ayurveda (A) 70
Actions 164
AYUSH—the Indian system of medicine 69
Activities under NACP phase – I (September, 1992
to March, 1999) 105
Activities under phase - II 105
B
Activities 142 Bar diagram 183
Acute respiratory infection (ARI) 55 Behaviours and qualities 34
Administration and supervision 44 Beneficiaries of scheme 74
Administration 65–66, 107 Benefits of health management 197
Administrative functions 48 Benefits to employee 73–74
Administrative set-up 117 Bharat sevak samaj (BSS) 84
Administrative 46 Burden of cancer 110
Administrator 61 Burden of vector borne diseases in India 140
Advantages of single dose mass therapy 146
Advantages 92–94 C
Advocator 101 Campaign comprises a package of activities 127
Agent 172 Cancer epidemiology 110
Aims and objectives 89 Cancer vaccine 114
Aims of participation 163 Care of children according to IMNCI 123
Aims 6, 8, 104, 117, 120, 128, 138, 167 Care of mentally challenged 11
All India blind relief society 85 Care of physically handicapped 11
All India women’s conference 85 Care of sick at home 11
Analytical method 170 Care provider 99
Areas of management information 192 Categories of public health legislation 87
ASHA package in low performing states (LPS) and Central government health scheme (CGHS) 74
high performance states (HPS) 133 Central social welfare board 85
ASHA scheme 25 Challenges of health management information
Asian development bank 83 system 197
Assessment 121 Change agent 101
Assistant nursing superintendent 41 Characteristics of effective health 33
Assistant professor 66 Characteristics of health 194
Assisting in selection and promotion of learners 67 Chief nursing officer (CNO) 34
At the block level 19 Chikungunya 148
At the central level 15 Child survival and safe motherhood programme 130
At the district level 18 Civil registration system 180
At the district level 19 Classification according to colour code 121
At the state level 16
200 Index
Classification of endemic areas 143 Diarrhoea control programme 58

Clinical instructor 69 Directing 36, 62
Clinical professional responsibilities 44 Director and co-ordinator 101
Collaborating and co-ordinating responsibilities 52 Directorate general of health services (DGHS) 16
Collaborator 102 Discussion methods 93
Communicable disease 58 Disease control program 59
Communication techniques 91 Disease frequency 171
Communication 45 Distribution of disease 171
Community health centre level 31 District health organization 18
Components of DMHP 129 District level household surveys 180
Components of RCH - I 130 District mental health program (DMHP) 129
Concepts of community health nursing 2 District public health nurse officer 47
Concerned advisor 101 Dosage strength 137
Conference 94 Dots medicine treatment categorization 136
Constructing bar diagram 184 Drug delivery strategies 146
Constructing diagrams/graphs 183 Drug requirement 147
Construction of histogram 186 Duties and responsibilities of ANM 56
Contingency table 182 Duties and responsibilities of assistant professor 66
Control programme 135 Duties and responsibilities of lecturer 68
Controller and evaluator 102 Duties and responsibilities of professor 65
Controlling 36, 63 Duties and responsibilities related to nursing
Co-operative for assistance and relief everywhere 83 services 35
Co-ordinating 36, 63 Duties and responsibilities 46
Counselling 66–67, 122
Index
Coverage under the scheme 74 E

Create work schedules 38
Education and specialization in nursing 61
Critical areas for concerted action 153
Education and training 45
Cumulative frequency curve or ogive 186
Educational activities 40
Educational functions 48
D Educational qualification and experience 34, 37–38,
Dai training 58 41, 43, 62–64, 66, 68–69
Danish international development agency Educational qualification 60
(DANIDA) 80 Educational 64
Decentralized health planning 153 Educator 100
Definition of computing vital statistics 180 Eight specialities in Ayurveda 70
Definition 5, 22, 32, 86, 89, 119, 130, 167, 177, 188, 194 Eighth five year plan (1992–97) 155
Demographic rates 168 Elements of management 189
Demographic sample surveys 180 Elements of primary health care 28
Demonstration 92 Employees state insurance (ESI) act, 1948 73
Dengue and chikungunya 148 Empowered action group (EAG) 131
Dengue/dengue haemorrhagic fever 147 Engineering measures 162
Deputy nursing superintendent 38 Environment 172
Descriptive method 169 Epidemiological triad 172
Designing the management 191 Epidemiology and nursing 175
Designs in descriptive method 169 Essential qualification and experience 53
Determinants 171 Establishment 64
Diagnosis of tuberculosis in RNTCP 137 Evaluating 36
Diagnostic method of TB 136 Evaluating learner’s progress 65, 67
Index 201
Evaluation 97 Guidance 66, 67

Experience 60 Guiding 63
Experimental method 170
H
F Health care services 23
Facilities under the scheme 75 Health care systems 23
Facility based service delivery 153 Health education 55
Factors affecting the management 193 Health problems due to industrialization 160
Family planning and medical termination of Health problems of India 22
pregnancy (MTP) 55 Health problems of school children 156
Family planning association of India 85 Health promotion and educational responsibilities 52
Family planning 57 Health sickness spectrum 174
Fifth five year plan (1974–79) 155 Health status or health problems 22
Financial 63 Health surveys 180
First five year plan (1951–56) 154 Helping the learners to acquire desirable attitudes,
Five year plans (1951–2002) 154 knowledge and skill 65, 67
Follow-up care 122 Highlights of RCH programme 130
Food and agriculture organization (FAO) 79 Hind kusht nivaran sangh 85
Ford foundation 82 Historical developments 154
Fourth five year plan (1969–74) 155 History 16, 103
Frequency distribution table 181 Homaeopathic system of medicine (H) 73
Frequency distribution 169, 180 Host 172
Frequency polygon 186
I
Index
Functions of central council of health and family
welfare 16
ICDS scheme 25
Functions of directorate general of health services 16
Iceberg phenomenon 174
Functions of health team 32
Implementation 112
Functions of state health directorate 17
Importance of biostatistics 177
Functions of union ministry of health and family
Importance of management 192
welfare 15
Indian council for child welfare (ICCW) 86
Functions under state list 17
Indian red cross society 83
Future plans 118
Indigenous system of medicine 24
Individual approach 92
G Individual, family and community as a unit of service 7
General administration 39 Information education communication (IEC) 118
General duties 41 Information system (MIS) 189
General functions 48 Information system in India 195
General instructions 164 Information system 189, 191–195, 197
General principles of tabulation 181 Infrastructure 124
Germ theory of disease 171 Instruction (teaching) 63
Goal of NACP - III 106 Integrated management of neonatal and child illness
Goals for the strategic plan, 2007–2012 144 (IMNCI) 119
Graphical presentation of data 183 International labour organization (ILO) 78
Group approach 92 International red cross 81
Group discussion 93 Interpersonal 64
Guidance and counselling 68 Investigating ways improving teaching 65, 67
202 Index
J Morbidity rates 168

Multibacillary leprosy 123
Japanese encephalitis 147–148
Multidrug treatment 123
Multi-factorial causation 172
K Multiple bar diagram 184
Kala-azar 147, 149 Multiple-response table 182
Kasturba memorial fund 84
N
L National aids control programme 103
Lady health visitor/health assistant/health National cancer control programme 110
supervisor 53 National cancer registry program 113
Leadership role 102 National family welfare programme 154
Lecture method/chalk and talk method 92 National iodine deficiency disorder control
Lecturer 68 programme (NIDDCP) 116–117
Legislation 162, 178 National iodine deficiency disorder 116
Leprosy elimination monitoring (LEM) 127 National leprosy eradication program (NLEP) 123
Limitations of graph 188 National mental health programme 128
Line graphs 186 National plan for health education 90
Line of authority 42, 56 National program for prevention, control of diabetes,
Local level (Rohtak) 180 cardiovascular diseases and stroke (NPDCS) 114
Lymphatic filariasis 145, 149 National programme for control of blindness 107
National vector borne disease control program 139
M Natural history of disease 173
Index
Naturopathy 71
Magnitude of the problem 114
Need assessment 96
Main aim 150
Negotiate with vendors 38
Main objectives 21
New initiatives 113, 132
Main reasons for using the diagrammatic and graphic
New strategy to achieve lymphatic filariasis
representation of data 183
elimination 147
Major responsibilities 37
NHRM—health systems strengthening 151
Make disciplinary action 38
Ninth five year plan (1997–2002) 156
Malaria 140, 148
NRHM 150
Manage other department 38
NUHM 151
Management information system (recommended
Nursing advisor 60
by WHO) 194, 196
Nursing care responsibilities 52
Manager 101
Nursing care 46
Map diagram or spot map 187
Nursing superintendent 37
Mass drug administration 146
Nutrition 55, 57
Maternal and child health 54, 56
Measures for health protection of workers 160
Medical measures 162 O
Medical termination of pregnancy 57 Objectives of DMHP 129
Methods and media for health education Objectives of health management 194
programmes 92 Objectives of management 189
Methods of computing vital 180 Objectives of school health 156
Milestones of the programme 104 Objectives of surveillance 12
Miscellaneous 41 Objectives of the scheme 74
Miscellaneous table 183 Objectives of UNESCO 78
Model of health care system 22 Objectives, scopes and principles of community
Modified leprosy elimination campaign (MLEC) 126 health nursing 2
Monitoring 12 Occupational health services 159
Index 203
Organization of nursing services in community Public health nurse supervisor 48

settings 47 Public health nurse 51
Organization of nursing services in educational Public health nursing 50
settings 60 Public health sector 23
Organization of nursing services in hospital
settings 34 Q
Organization 135, 142
Qualification 46, 55
Organizer 101
Qualities of family health nurse 8
Organizing 62
Outpatient health facility 122
Outreach services 153
R
Overseed hiring and training 37 Rate 168
RCH phase - II 132
P RCH programme 156
Record keeping 58
Panchayati raj 18
Recording and reporting 65, 67
Panel discussion 93
Records and reports 54
Parts of a table 181
Regimen for multi-bacillary cases 127
Pathogenesis phase 174
Regimen for paucibacillary cases 126
Patient care 38
Registration 60, 62–64, 66-69
Paucibacillary leprosy 124
Rehabilitation 129
Personnel involved in the program 128
Report, recording and compiling of vital statistics at the
Pictograms or picture diagram 188
local, state, national and international level 178
Pie diagram 185
Reproductive and child health programme 130
Index
Pilot project NIDDCP 118
Resan vaccine 114
Placement of nurses in the healthcare organization 19
Research 67–68
Planner 101
Researcher 102
Planning and organizing nursing services in
Resources needed for participating in the
hospital 39
programme 163
Planning for health education 96
Responsibilities as a researcher 53
Planning 35, 62
Responsibilities as manager 52
Pre-pathogenesis phase 173
Responsibilities of ASHA worker 26
Prevention of occupational diseases 162
Responsibilities of clinical instructor 69
Preventive health care 60
Responsibilities of public health nurse supervisor 50
Primary health care 28
Responsibilities of senior tutor 69
Primary health centre level 28
Responsibilities of tutor 69
Primary medical care 55, 58
Responsibilities 98
Principles of health education 95
Revised national tuberculosis 135
Principles of home visiting 9
Rockefeller foundation 81
Principles of primary health care 28
Role of community health nurse in school health 156
Principle 3, 6, 62, 121
Role play 94
Private sector 24
Roles and responsibilities of lady health visitor/health
Problems of health management 195
assistant/health supervisor 53
Process of management 191
Roles and responsibilities of nursing advisor 61
Process 96
Roles and responsibilities of principal 62
Professor 64
Roles and responsibilities of the public health nurse 51
Program assistance 126
Roles and responsibilities of vice-principal 63
Programme components of NACP - III 106
Roles and responsibilities 44
Progress of NLEP 125
Roles of public health nurse supervisor 49
Promotion of health 10
Roles 97
Proportion bar diagram 84
Roles/functions 47
204 Index
S Team 33
Teamwork 54
Saint John ambulance association 86
Techniques of home visiting 9
Sample registration system 180
The central council of health and family welfare 16
Scattered or dotted diagram 187
The colombo plan 80
Schemes under the program 111
The employees state insurance act, 1948 163
School health services 156
The executive board 76
School health 55, 58, 156
The factories act, 1948 162
Scopes 2, 6, 90, 178
The IMNCI case management process 121
Second five year plan (1956–61) 154
The major externally supported projects 145
Seminar 94
The problem of iodine deficiency disorder (IDD) 116
Senior tutor 68
The secretariat 76
Sensitive observer 100
The state list 17
Service delivery and referral system/organizational
The union ministry of health and family welfare 15
structure 108
The world health assembly 75
Services available under NPCDCS at different
The world population 178
levels 116
Theories and models 171
Services under RCH - I programme 131
Third five year plan (1961–66) 154
Seventh five year plan (1985–90) 155
Thrust areas 130
Siddha system of medicine (s) 72
Tools and methods 168
Simple bar diagram 184
Tools 168
Sixth five year plan (1980–85) 155
Towards health systems strengthening 153
Skills 34, 39
Training of health care workers 164
Sources of health management 195
Training of local dais 25
Index
Staff nurse 45
Training responsibilities 52
State health administration 17
Training 54
State health directorate and family welfare 17
Treatment 122
State level (Haryana) 179
Treatment 129
State ministry of health and family welfare 17
Tuberculosis association of India 84
Statistics 180
Tutor 69
Strategic action plan for malaria control in India
Types of analytical methods 170
(2007–2012) 145
Types of bar diagram 184
Sub-centre level 26
Types of diagrams and graphs 183
Sub-components of health 196
Types of information 189
Supervise and guidance 54
Types of tables 181
Supervising nursing staff 37
Supervision of health care workers 164
Supervisory functions 48
U
Supervisory responsibilities 52 Unani system of medicine (U) 71
Supervisory 64 United nations development programme (UNDP) 78
Supplies, equipment and maintenance of sub- United nations educational, scientific and cultural
centres 54 organization (UNESCO) 77
Surveillance 12 United nations for population activities (UNFPA) 78
Swedish international development agency (SIDA) 80 United nations international children’s emergency
Symposium 93 fund 76
United states agency for international development 79
T Universal immunisation programme 57
Universal immunization programme 55
Tables 181
Universal immunization 138
Targets of NHM 150
Urban malaria scheme 144
Targets of NHRM 151
Teaching 47
Index 205
V X
Vaccine under UIP 139 X-axis 186
Vice- principal 63 X-ray 31, 80, 119
Village health guides scheme 24
Village level 24 Y
Vision 2020: the right-to-sight 108
Yaws 21
Vital events 58
Y-axis 186
Vital statistics of India 179
Yoga and naturopathy (Y) 70
W Z
Ward sister 43
Zila parishad 19, 48
Web of causation 172
Zoology theodor boveri of germany 110
Who regional organizations 76
Zoonoses 79
Who work 75
Working with families in relation to prevention
of disease 10
Workshop 94
World bank (WB) 79
World health organization 75
Index
206 Index
Index

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A TEXTBOOK of

COMMUNITY HEALTH NURSING

KUMAR PUBLISHING HOUSE

COMMUNITY HEALTH NURSING

Unit - I Unit - III

Unit - V F Epidemiology—theories and models.

Chapter Title Page No.

Chapter 2 FAMILY HEALTH SERVICES 04–13

Chapter 3 ORGANIZATION AND ADMINISTRATION OF HEALTH 15–88

Chapter 4 HEALTH EDUCATION 89–98

Chapter Title Page No.

Chapter 6 EPIDEMIOLOGY 167–176

Chapter 7 DEMOGRAPHIC STUDIES 176–197

COMMUNITY HEALTH certain norms, values and social

FIG. 1.1: RAIOE

3. It supports the entire community as well

“The Nurse is most directly concerned rehabilitation services.

care to individual and family in the health care levels.

Concepts of Community Health profession through:

primary prevention are major activities n Special clinics.

in community health nursing practice.

n Mobile camps. n Community health nursing should be

scientifically true and effective. services.

2. Family health services act as a problem

7. To provide health services to the family Scopes

Problem Identication and Priority

Need Based Support and Services to Family

Problem Discussion with Family and Possible Solution

Encourage Family to be Self-sufcient to Fulll

Health Services should be Irrespective of Sex, Age,

Participation of Family Members

FIG. 2.1: Principles

Individual, Family and Community 7. Family plays an important role in

Family Health Services

A: Assessment D: Diagnosis P: Planning I: Implementation E: Evaluation

FIG. 2.2: A Delicious Pie

Planning: It involves establishing

Evaluation: Involves summative and

Family Centred Holistic Approach Non-Judgemental Accepting Different

Able to Work Sensitive Towards Independent and

C Able to Cope Terminate

delivery strategy and is offered on voluntary Aims

Principles of Home Visiting

Family Health Services

FIG. 2.4: Principles of Home Visiting

Techniques of Home Visiting n Do not scold the family members for

l Any sign of malnutrition in the n Home visiting should be planned and

available resources. “the secret of national health lies in the

l To encourage family to become as it is the right place for integrating

n Maintain Input Output charting.

Care of Sick at Home Care of Physically Handicapped

Family Health Services

to drink plenty of sweetened drinks, providing special education for mentally

n Psychotherapeutic intervention, as practices and other factors that may

SURVEILLANCE AND MONITORING n To provide feedback which may be

health professional or of the extent to time by technicians and automated

Family Health Services

n Promotion of research through

Problem Identication and Priority

Encourage Family to be Self-sufcient to Fulll

District Public Health Nurse Ofcer Principal Nursing Superintendent