Dr.

Rajesh Kumar Konduru

Professor
Community Medicine
Introduction:
The basis for organization of health services
in India through the primary health care
approach in modern time was laid by
recommendations of Bhore committee in
1946.
Bhore Committee suggested an establishment
of a Primary Health Center for every 40,000
Population.
Over the next three decades the health service
organization and infrastructure have undergone
extensive changes by a number of expert
committees namely
– The Mudaliar committee (1961)
- The Mukherjee committee (1966)
- The Kartar Singh committee(1974)
In the 30th world health assembly in 1977 it was
decided that the main social goal of the
governments and of the WHO should be
the attainment by all the people of the
world by the year 2000 of a level of health
that will permit them to work
productively and to participate actively in the
social life of their community.
Before 1978, primary health care was
synonymous with -
Basic health care
First contact care
Easily accessible care

But after Alma Ata conference in1978 it got a

wider meaning and has been accepted as an
integral part of countries health system.
Definition:

Primary health care is the essential health

care made universally accessible to
individuals and acceptable to them,
through their full participation and at a
cost the community and country can
afford.
Primary health care is the first level of contact of the - individuals
- Family
- Community

Thus brings health care as close as possible

to where the people live & work

It constitutes the first element of the process

of continuing health care and this should
get full support from the rest of health
system.
The support should be in the following areas -

a. Consultation on health problems

b. Referral of patients to local or other
specialized institutions.
c. Supportive supervision & guidance
d. Logistic support & supplies
 Element of Primary Health Care
There are 8 elements of primary care :-

1.Education concerning prevailing health

problems and the methods of preventing
and controlling them.

2. Promotion of food supply and proper

nutrition

3. An adequate supply of safe water and

basic sanitation.
4. Maternal and child health care including
family planning.

5. Immunization against major infectious

diseases

6. Prevention and control of locally endemic

diseases

7. Appropriate treatment of common diseases

and injuries

8. Provision of essential drugs

 STATUS OF VARIOUS ELEMENTS OF PRIMARY
HEALTH CARE IN INDIA AND REMEDIAL
MEASURES

Education of people about health matters

Knowledge regarding health matters is lacking

among people of rural areas & urban slums.

Reasons – Socio-economic backwardness

Ignorance
Traditions
Superstitions
Remedial measures- Appropriate Health
education programmes on common/endemic
diseases are to be conducted regularly

Involvement of the following sectors will

contribute significantly
- Social & women’s welfare
- Education
- Agriculture
- Animal husbandry
- Panchayats
- Voluntary agencies
Promotion of food supply and nutrition

Problems:

Nutritional deficiency states of varying

degree with regards to malnutrition, vit.A
Iodine deficiency & nutritional anemia are
prevalent in a wide section of the
population.
Remedial measures -

- Organizing & conducting nutrition education

programs in the community

- Education on food hygiene

- Encourage growing of foods locally

- Income generation schemes

Supply of safe water and basic sanitation
measures -

Safe & potable water is not available to all

section of the population

Environmental sanitation is poor, particularly

in rural areas & urban slums
Remedial measures -

Systematic approach should be made to

survey and identify resources of safe
water

Arrangements for regular purification of

water

Emphasis on personal hygienic practices

Maternal & child health care

- MMR is high in India at 301/100000 live births

- IMR is 54 / 1000 live births
Remedial measures -

- Systematic efforts to increase antenatal

registration and care of pregnant level

- Promote institutional deliveries

- Proper post natal check up & health

education
- Training of Health workers in proper
prenatal & neonatal care

- Prevention and treatment of malnutrition

Family planning :-

Family planning is a means to curtail population

explosion

Present crude birth rate is 23/1000 MYP

Remedial measures:

-Small family norm has to become a way of life

- Continuous education of the community and

the individual couples using coordinated use
of mass media, group orientation and
interpersonal communication is important.

-Strengthen the knowledge and skills of grass

root level workers
- Service agency should be properly geared
for effective implementation

- To promote increase acceptance of family

planning, IMR has to be reduced

- Enforcement of universal primary education and

prevention of drop outs

- Women empowerment will be an important step

Immunization against major infectious diseases:

- Immunization coverage varies from 40% in some

backward state to 90% in well performing states

- There is a problem of incomplete immunization

 Remedial measures:

- Regular supply a proper storage of vaccines

with effective maintenance of cold chains

- Health education regarding immunization

against vaccine preventable diseases

- Motivating active community involvement

and participation
Prevention and control of locally endemic
diseases

- Endemic diseases vary from one region to

another, some of the important one are –
TB, Malaria, Filaria, Scabies, Rabies, Polio etc.,

- Chronic disease like diabetes, HTN are also

on the rise
Remedial measures:

- Effective implementation of the national

programme

- Increase the fund allocation to health services

- Strengthen public health system

- Formation of a timely surveillance network

Principles of Primary health care

1. Equitable distribution

2. Community participation

3. Intersectoral co-ordination

4. Appropriate technology
1. Equitable distribution:

- First key principle

- Health services must be shared equally by all
people irrespective of their ability to pay and
all must have access to health services.
- Presently health services are concentrated in
urban areas
- Primary care aims to redress this imbalance
and bring the services as near to peoples
homes as possible
2. Community participation:

- Corner stone for the success of PHC

- Meaningful community participation not to

the expected level, except in certain parts of
the country.

- These must be a continuing effort to secure

meaningful involvement of the community in
planning, implementation and maintenance
of health services.
Contd…..

- The approaches tried in India are- village

guides, trained dais and recently accredited
social health activist (ASHA)

- Decentralization of power and involvement

of elected representatives in health
committees at all levels is beneficial
3. Intra & Intersectoral coordination:

a. Intra sectoral coordination:

Within the health sector, besides the

national health system, a number of non-
government agencies are functioning &
catering to the health needs of a large
proportion of the population.
These includes -

Voluntary organization, NGOs, professional

bodies, private practitioners of modern
medicine and indigenous system of medicine,
many university departments and speicialised
institutions.

Draw back: No effective linkage with the

national health care delivery system for
ensuring coverage of all sections of the
population through primary health care
b. Intersectoral co ordination:

- PHC approach can’t stand on its own in

an isolated manner

- Has to be a part of overall socio economic

development process
4. Appropriate technology:

- Review existing technologies and identify

those that are appropriate

- Promotes research to develop alternatives

to replace inappropriate technologies

- Promote participation of the government

departments, research & academic
institution industry & NGOs.