Community Health Services

8th sem
Social & Preventive Pharmacy
 • The Constitution of India clearly recognizes
the government’s responsibility for health,
and states that “The state should regard the
raising of the level of nutrition, the standard
of living of its people and the improvement of
public health as its primary duties."
• The preamble to the WHO constitution states
that “The enjoyment of the highest attainable
standard of health is one of the fundamental
World Health rights of every human being without
distinction of race, religion, political belief,
Day 2009: Make economic or social condition" (Article 47).

Hospitals Safe in • The 1948 UN Universal Declaration of Human

Rights proclaims: "Everyone has right to a
Emergencies standard of living adequate for health and
well-being of himself and of his family,
including food, clothing, housing and medical
care and necessary social services, and the
right to security in the event of
unemployment, sickness, disability,
widowhood, old age or other lack of
livelihood in circumstances beyond his
control. Motherhood and childhood are
entitled to special care and assistance"
(Article 25).
 Imbalance in Health Care
and its Causes
• The present-day health care system in India unfairly inclines
in favor of the wealthy urban population. Not only is it
mainly cure-oriented, but it is not accessible to the vast
rural population. This situation is the result of three basic
causes as follows:
1. Lack of a Positive, Dynamic and Multidimensional Concept
of Health.
2. Social Injustice.
3. Other Socioeconomic, Cultural, Religious and Political
Factors.
 Lack of a Positive, Dynamic and
Multidimensional Concept of Health

• The WHO definition of health has two components. The first is a positive statement,
affirming that "Health is a state of complete physical, mental and social well-being.
• The second is a negative statement that "it is not merely an absence of disease and
infirmity." However, in practice, the majority of health professionals continue to
concentrate only upon the second component with utter disregard for the far more
important first component.
• This has resulted in a situation when health is understood by the health
professionals predominantly in biological, individualistic, clinical and curative terms.
• A holistic approach to health is essential to grasp the full relevance of community
health care and to reduce the exaggerated importance usually given to medical
professionals and costly drugs.
 • Justice is a central issue in
health care. According to the
World Bank, "present health
policies are not only
inefficient but also
inequitable in most
developing countries."
Social injustice • A primarily hospital-oriented
health care system is
ineffective, inefficient, and
unjust since it does not lead
to an equitable distribution of
resources. Moreover, there is
an unfair and uneven
distribution of health care.
Other Socioeconomic, Cultural,
Religious and Political Factors
• Health is not an independent system, but it is a subsystem in society and basically
reflects the socioeconomic, political and ideological systems.
• It has been said that “Health is not mainly an issue of doctors, medical services and
hospitals but it is an issue of who gets the available resources. If poor health patterns
are to be changed, then changes must be made in the entire socioeconomic political
system in any given community."
• In connection with the impact of politics on health care, two points have been
emphasized: The initial national commitment to tackle the public health problems,
such as communicable diseases, and to direct the national resources towards providing
health benefits to the rural poor, has given place to a tendency towards providing
expensive, urban hospital-based, and curative medicine for diseases like cancer and
heart disease, for which little is achieved at much expense; (ii) There is an
"involvement of politicians in the conversion of medicine into a highly lucrative health
industry in an area where consumer resistance is at its weakest.“
• Examples cited therein are: (a) Establishment of capitation fee in medical colleges by
politicians; (b) Excessive production of drugs; (c) Import of expensive medical
equipment.
 Health care

• Levels of health care

• Health care is traditionally categorized as a three-tier pattern, which is given below:
1. Primary health care:
• This is the essential health care provided at the first level of contact of the
individual or the family with the National Health System. It is provided at the
level of the primary health center and subcenter by the medical officer and
the health worker. At the village level, it is provided by the village health
guide and a trained dai. The anganwadi worker in the ICDS (Integrated Child
Development Scheme) also provides important health-related services at
village level.
2. Secondary health care: This refers to an intermediate level of health care, in
which special facilities are available to deal with complex health problems
referred from the primary level.
3. Tertiary level: It is the highest level in which super specialties are available, and
sophisticated investigations along with therapeutic procedures are performed.
 • Primary Health Care (PHC) has been
defined as essential health care
made universally accessible to
individuals and acceptable to them,
including full participation of people
and affordable health services.
• It is an integral part of the country's
health system and plays a vital role in
Primary the community's social and
economic development.
health care
(PHC) • Moreover, it is the first level of
contact of an individual, the family,
and the community with the national
health system in order to bring
health care as close as possible
where people live and work.
• It constitutes the first element of a
continuing health care process.
 CHARACTERISTICS OF
PRIMARY HEALTH CARE
• It is essential health-care based on practical, scientifically
sound, and socially acceptable methods and technology.
• It should be rendered universally acceptable to individuals
and the families in the community through their full
participation.
• PHC’s availability should be at a cost which the community
and country can afford at every stage of their development.
• It requires joint efforts of the health sector and other health-
related factors, viz., education, food and agri­culture, social
welfare, animal husbandry, housing, rural reconstruction,
etc.
 • Primary Health Care should, at least, must
include the following:
1. Education concerning the prevailing
health problems and the methods of
Components preventing and controlling them.
2. Promotion of food supply and proper
of Primary nutrition.
3. Basic sanitation and adequate supply
Health Care of safe water.
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.
 • The Bhore Committee
recommended that an integrated
health service comprising primary
health units, secondary health
Rural units and district health units
primary should be established.
health care • This service should provide all
facilities of medical and health
care including ambulance,
hospitals, laboratories and various
specialists. This recommendation
had to be implemented through a
long-term program over a period
of 30 to 40 years and through an
immediate short-term program
over a period of 10 years.
Rural primary health care

• The long-term program envisaged a three-tier system of health units as

follows:
1. A 75 bed Primary Health Unit or Centre (PHU or PHC) for 10 to 20,000
population. The recommended staff consisted of 6 medical officers,
sanitary inspectors, 6 public health nurses. 2 health assistants and 11
ancillary staff.
2. A 550-bed secondary health unit to cover about 30 PHU was
proposed. The staff included an adminis­trative officer and full-time
heads of departments of medicine, surgery, maternity, tuberculosis
and pathology.
3. A 2500 bed district health unit at the district head quarter to provide
cover to 10 to 30 lakh population was proposed.
• A primary health center was intended provide health care, both curative and
preventive, and to serve as an epicenter from which health services radiate
into the area covered by the Community Development Block. Now, these
PHCs form the core of National Health Planning.
Functions of the PHC
• The Primary health center is responsible for performing a
number of functions as given below:
1. Medical care, including referral and laboratory services.
2. Control of communicable diseases.
3. Environmental sanitation with priority for provision of
safe water supply and sanitary disposal of human excreta.
4. Maternal and Child health services (MCH).
5. Family planning, School health services, Health education,
and Training of personnel.
6. Implementing national health programs and collection of
vital statistics.