COMMUNITY HEALTH NURSING

UNIT I

Define community health nursing?

Community health Nursing is the synthesis of nursing and public health practice
applied to promote and protect the health of population. It combines all the basic
elements of professional, clinical nursing with public health and community
practice.

Define community health?

It is a discipline which concerns itself with the study and
improvement
of
the health
characteristics
of
biological communities. While the term community can be broadly
defined, community health tends to focus on geographical areas
rather than people with shared characteristics.

Describe the scope of nursing practice?

According to the International Council of Nurses (ICN), the scope

of nursing practice encompasses autonomous and collaborative
care of individuals of all ages, families, groups, and communities,
sick or well and in all settings. National nursing associations
further clarify the scope of nursing practice by establishing
particular practice standards and codes of ethics. National and
state agencies also regulate the scope of nursing practice.
Together, these bodies set forth legal parameters and guidelines

for the practice of nurses as clinicians, educators, administrators,

or researchers

Community Health Nursing Practice

Community health nursing incorporates varying titles to describe the work of
nurses in community settings. Over the past centuries and in different parts of the
world, community health nurses were called district nurses, visiting nurses, public
health nurses, home-care nurses, and community health nurses. Today community
health nursing and public health nursing are the most common titles used by nurses
whose practices focus on promoting and protecting the health of populations.
Knowledge from nursing, social, and public health sciences informs community
health nursing practices. In many countries, ensuring that needed health services
are provided to the most vulnerable and disadvantaged groups is central to
community health nursing practice. In the United States, community health nurses
work in a variety of settings, including state and local health departments, school
health programs, migrant health clinics, neighborhood health centers, senior
centers, occupational health programs, nursing centres, and home care programs.
Care at home is often seen as a preferred alternative for caring for the sick. Today
home-care nurses provide very sophisticated, complex care in patients homes.
Globally, home care is being examined as a solution to the needs of the growing
numbers of elderly requiring care.

Historical development of community health nursing in India?

Pre Independence Era:
Pre Independence Era Early History Indus Valley Civilization(before 3,000 B.C)
planned cities with drainage, houses and public baths built of backed bricks
(Environmental Sanitation) 1400 B.C Invasion of Aryans. Ayurveda and Siddha
medicine came into existence. Manu Samhita prescribed rules and regulations for
personal health, dietetics, hygienic rituals, unity of eh physical, mental and

spiritual aspects of life. Sarve Jana Sukhino Bhavatu may all men be free from
diseases and may all be healthy
Post vedic period (600 B.C 600 A.D) medical education in University of Taxila
and Nalanda leading to the titles of Pranacharya and Pranavishara . Hospital
system was introduced for men, women and animals by Rahula Sankirtyana . 650
1850 A.D Muslim rulers came to India. Arabic system of medicine ( Unani )
introduced. Due to political changes the medical education and medical services
became static and ancient universities and hospitals disappeared

British India 1757 British established their rule. Civil and military services
established. 1825 Quarantine Act was promulgated. 1859 Royal commission
was appointed. Pointed out the need for the protection of water supplies,
construction of drains and prevention of epidemics . Established Commission of
Public Health 1864 sanitary commission was appointed in Madras, Bombay &
Bengal.
1869 Public Health Commissioner & Statistical Officer appointed. 1873 Birth
and Death Registration Act was promulgated. 1880 Vaccination Act was passed.
1881 Indian Factories Act was passed. First Indian census was taken. 1885
Local Self Government Act was passed. Local government came into existence.
1888 local bodies was directed to look for sanitation but no local public staff
appointed.
1896 severe epidemic of plague occurred in India. Plague commission was
appointed. 1897- Epidemic Disease Act 1904 plague commission report
submitted. It recommended the reorganization and expansion of public health
department & establishment of laboratory facilities for production of vaccines and
sera. 1909 Central Malaria Bureau at Kausali 1911 Indian Research Fund
Association (now called as ICMR) to promote research. 1912 Govt. India

decided to help the local bodies. Appointed Deputy Sanitary Commissioners &
Health Officers.
1918 Lady Reading Health School, Delhi & Nutrition Research Laboratory,
Coonoor was established. 1919 First step in decentralization of health
administration. Montague Chelmsford Constitutional Reforms transfer of
public health, sanitation and vital statistics under the control of elected minister.
1920 21 Municipality & Local Board Acts passed containing legal provisions
for advancement of public health.
1930 All India Institute of Hygiene and Public Health, Calcutta established in aid
with Rockfeller Foundation. The Child Marriage Restraint Act( Sarda Act) came
into effect. (Girl 14 yrs and Boys 18 yrs) 1931 Maternity and Child Welfare
Bureau established under IRC. 1935 Government of India Act (1919) revitalized.
Health activities in the country grouped as federal, concurrent, provincial. 1937
Central Advisory Board of Health was set up with Public Health Commissioner as
Secretary and representatives from provinces and Indian states as members.
1939 Madras Public Health Act was passed. First Rural Health training Centre
was established at Singur with the aid from Rockefeller Foundation. Tuberculosis
Association of India was established. 1940 Drugs Act was passed. 1943 The
Health Survey and Development Committee ( Bhore committee) was appointed
to survey the existing position with regard to health conditions and health
organization.
1946 Bhore committee submitted its report. It reviewed on the following and
recommended short and long term programme to attain reasonable health. Public
health Medical relief Professional education. Medical research. International
health.

Post independence era:

Post independence era 1947 Ministries of health established in state & center.
Post of Director General of Health Services ( principal advisor to the union
government on both medical & public health matters) was formed by combining
the posts of Public Health Commissioner& director general of Indian Medical
Service. 1948 India joined WHO as a member state. ESI Act passed in 1948. the
report of the Environmental Hygiene Committee was published.

1949 constituent Assembly adopted the constitution of India(Article 246 covers

all the health subjects). Post of registrar general of India created in the ministry of
home affairs. SEARO office established in New Delhi. The Indian Research Fund
Association was reconstituted as ICMR. 1950 planning commission was set up.
1951 First five year plan begin. BCG vaccination programme launched. 1952
community development block launched. Central council of health was constituted.
Primary health center was set up.

1953 NMCP commenced. National Extension programme was started for rural
development. Nation wide family programme was started. A committee was
appointed to draft a Model Public Health Act. 1954 Contributory Health Service
Scheme was started at Delhi. The Central Social Welfare Board was set up.
National water supply & sanitation programme was inaugurated. NLCP was
started. VDRL antigen was set up in Calcutta. The prevention of Food Adulteration
Act was passed.
1955 NFCP was commenced. The central leprosy teaching and research institute
established in chengelpet. A filaria training centre was established at Ernakulum.
The Hindu marriage act passed. National TB sample survey commenced. 1956
second five year plan launched. The model public health act published. The central
health education bureau was established. Director, family planning appointed.
Demographic training & research centre established in Bombay. The TB

chemotherapy center established in Madras. The immoral traffic act was passed.
Trachoma control pilot project was established. RCA project was established with
aid from ford foundation.

1957 influenza pandmeic swept the country. The demographic research centers
was established in Calcutta, Delhi & Trivandrum. 1958 NMCP converted into
NMEP. Leprosy Advisory committee of the Govt. of India was constituted. The
National Development Council endorsed the recommendations made by
Balwantrai Mehta Committee on Panchayth Raj. The national Tb survey was
completed. 1959 Mudhaliar committee was appointed. Central expert committee
was appointed under ICMR to study the problems of cholera and chicken pox in
India. Rajasthan was first state to introduce panchayath raj. National TB institute
was established at Bangalore. The national research laboratory at coonoor was
shifted to Hyderabad.
1960 School Health Committee was constituted. A National Nutrition Advisory
Committee was constituted. Pilot projects for eradication of small pox was
initiated. Vital statistics was transferred to the Registrar General of India. 1961
third five year plan launched. The report of Mudhaliar Committee was published.
The Central Bureau of Health Intelligence was established. 1962 Central Family
Planning Institute was established in Delhi. National Small Pox Eradication
Programme was launched. The School Health Programme was initiated. National
Goiter Control Programme was launched. The District Tuberculosis Programme
was formulated.
1963 Applied Nutrition Programme was launched. Defense Institute of
Physiology and Allied Sciences was set up. National Institute of Communicable
Diseases was inaugurated. National Trachoma Control Programme was launched.
Contributory Health Service Scheme was changed into CGHS. Extended family
planning programme was launched. Chadha Committee established a norm of one
basic health worker for every 1000 population. A drinkling water board was set up.

1964 National Institute of Health Administration and Education was opened in

collaboration with Ford foundation. Committee was set up under the chairmanship
of Shanthilal Shah to study the question for legal abortion.

1965 lippes loop was recommended as safe. Reinforced extended family planning
was launched. BCG vaccination on a house to house basis introduced. 1966
Mukherjee committee was set up. Minister of health was also appointed for
minister of family planning. A separate department for family planning was started.
The population council started International postpartum family planning
programme. 1967 Modhok committee was constituted. A small family norm
committee was set up. The central council of health recommended the levy of a
health cess on patient attending hospital.
1968 small family committees report was submitted.A bill of registration of birth
and death was passed. The govt. of India appointed medical education committee.
1969 fourth five year plan launched. The name of the Nutrition Research
Laboratory was changed into National Institute of Nutrition. Comprehensive
legislation for control of river water pollution was drafted. The central births and
deaths registration act was promulgated. The report of the medical education
committee was submitted.
1970 The Drugs Order was promulgated. All India Post Partum Family Planning
Programme was started. The population council of India was formed. Chittaranjan
mobile hospitals was installed. The registration of births and deaths Act came into
force. The name of the Demographic Training and Research Center, Bombay was
changed into International Institute for Population studies. 1971 The family
pension scheme for industrial workers came into force. MTP bill passed in
parliament. An expert committee was appointed to draft legislation on air pollution.
1972 MTP act came into force. National service bill passed. The National
Nutrition Monitoring Bureau was set up under the ICMR. 1973 the national
programme for minimum needs was incorporated with the fifth five year plan. The
government envisaged a scheme of setting 30 bedded rural hospitals one for 4

PHC. Kartar singh committee submitted its report. 1974 fifth five year plan
launched. Parliament enacted the Water Act.
1975 India became small pox free. Govt. of India accepted NMEP. ESI Act
amended. Cigarettes Regulation Act was passed in parliament. Shrivastav
committee submitted its report. 1976 Indian Factories Act amended. The
prevention of food adulteration act came into force. The equal remuneration act
was promulgated. New population policy announced. Central council of health
proposed 3 tier plan for medical care. National programme for prevention of
blindness was formulated.
1977 National Institute of Health and Family Planning formed. Rural health
scheme was launched. Revised modified plan of malaria eradication put into
operation. 1978 child marriage restraint bill approved in parliament. EPI
launched. 1979 offices of family welfare and NMEP were merged and named as
Regional Office for health and family welfare. 1980 sixth five year plan
launched. Small pox was officially declared from entire world.
1981 census was taken. The Air Act was enacted. 1982 new 20 point
programme was announced. National health policy announced. 1983 IMPACT
India launched (National Plan of Action Against Avoidable Disablement). NLCP
called as NLEP. Guinea worm eradication programme launched. 1984 Bhopal
gas tragedy occurred. Workmens compensation act came into force. Juvenile
Justice Act came into force. 1985 seventh five year plan launched. UIP launched.
A separate department of women and child development was set up.
1986 The Environment Act promulgated. Mental health bill was voted in
parliament. 1987 new 20 point programme was launched. ISI was renamed as
Bureau of Indian Standards. Safe motherhood campaign was launched. National
diabetes control programme and national AIDS control programme initiated. 1989
blood safety programme was launched. 1990 control of ARI programme
initiated. 1991 decadal census was conducted.

1992 eighth five year plan was launched. CSSD was launched. The Infant Milk
Substitute, Feeding Bottles and Infant Foods Act came into force. 1993 RNTCP
with DOTS introduced. National Nutrition policy formulated. 1994 Return of
plague. Panchayath Raj Act came into force. 1995 ICDS renamed as IMCD. The
Legislation on Transplantation of Human Organs was enacted. Expert Committee
on Malaria submitted its report and recommended Malaria Action Plan.
1996 PPI launched. Family planning programme made target free. PNDT came
into force. Yaws eradication programme came into force. 1997 RCH launched.
Ninth five year plan launched. 1998 99 NFHS II undertaken. NMEP renamed
as National Anti Malaria Programme. Phase II of National Aids Control
Programme became effective. National Policy for Older Persons announced
2000 govt. of India announced national population policy. Declared guinea worm
free country. Signatory of UN millennium declaration. National commission on
population constitute. 2001 fist census of the century. National policy for
empowerment of women launched. 2002 National Health Policy announced.
Govt. announced National AIDS Prevention and Control Policy. Tenth five year
plan launched. Emergence of SARS. 2003 parliament approves the Cigarette and
Tobacco Products Act. NVBDCP approved.
2004 Vandematarum scheme launched. Revised programme of National support
to primary education launched. Low osmolality Ors introduced. IDSP launched.
National guidelines on infant and young child feeding formulated. 2005 RCH
II launched. JSY launched. NRHM launched. IPHS for community centers
formulated. National plan of Action for children formulated. India achieved
leprosy elimination target
2006 WHO releases pediatric growth chart. Ban on child labor. RNTCP covers
whole country. NFHS II conducted. IMNCI launched. 2007 11 th five year plan
launched. NACP III launched. IPHS standards for PHC and sub center

formulated. Maintenance and welfare of parents and senior citizens bill passed.
2008 Non communicable diseases programme was launched.
2009 H1N1 outbreak. New ICDS mother and child protection card came into
force.
2010 ICMR announces nutrients requirement for RDA for Indians.
UNITII
DESCRIBE HEALTH PLANNING IN INDIA
Health planning:
(i) the orderly process of defining health problems, identifying unmet needs and
surveying the resources to meet them, establishing priority goals that are realistic
and feasible, and projecting administrative action, concerned not only with the
adequacy, efficacy and efficiency of health services but also with those factors of
ecology and of social and individual behavior that affect the health of the
individual and the community
(ii) the process of organizing decisions and actions to achieve particular ends, set
within a policy.
(iii) a code word for public decision making towards the future often used
interchangeably with policy formation or developing strategies and programmers
Establishing health planning in India is a key to improving the health of the
Indian Population. The Ministry of Health and Family Welfare has been facilitating
Health needs in India by establishing various schemes and organizations.
The Government is conscious of the need for dynamic Indian health planning and
management. Innovative healthcare and development programs are the need of the
hour. For this, major organizations like the National AIDS Control organization
have been established by the Health Ministry. The areas to focus on in Health
Planning have been laid down by the Ministry's National Health Policy.

Some of them are mentioned below:

Increasing Healthcare programs: To be implemented in various socioeconomic settings of different States of India.

Increasing Public Health infrastructure: More hospitals, Outdoor medical

facilities, Medical equipments.

Efficient doctors and nurses: To ensure minimum standards of Patient care.

Family Medicine: Establishing more personnel for family healthcare.

Low cost drugs and vaccines: Keeping in view of the possible globalization
induced high costs.

Mental health: Need for increase in hospitals and professionals.

Health research: Medical innovation and specialization is needed.

Disease control: More database needs to be collected in this regard in order

treat and prevent diseases.

Women's health: Adequate access to public healthcare facilities is a

necessity which in turn will improve family health as well.
List of National Health Programs organized by the health ministry are National
Vector Borne Disease Control Program (NVBDCP) , National Iodine Deficiency
Disorders Control Program, National Leprosy Eradication Program, National
Program for Control of Blindness, National Filarial Control Program, National
Program for Prevention and Control of Deafness, National Cancer Control
Program,NationalAidsControlProgram, Universal Immunization Program (RTI
ACT, 2005),Revised National TB Control Program, and National Mental Health
Program.
Some more endeavors for health planning in India are Medical Health Division,
Hospital Services Consultancy Corporation, SC/ST facilities, Central Government

Health Schemes, Prevention of food adulteration, establishment of food and drug

testing laboratories, L.R.S. Institute of Tuberculosis and Respiratory Diseases,
National rural health mission
Good health planning in India will enable the country to establish a Healthcare
system which will be socially acceptable, medically sound, and cost-effective
enough
for
every
Indian.

India Planning
India Planning Commission
First Five Year Plan India
Second Five Year Plan India
Third Five Year Plan India
Fourth Five Year Plan India
Sixth Five Year Plan India
Seventh Five Year Plan India
Eighth Five Year Plan India
Ninth Five Year Plan India
Tenth Five Year Plan India
Education Planning in India
Sports Planning in India
Health Planning in India
Social & Cultural Plan.in India
Rural Planning in India
Agriculture in India Planning
Village Industry Plan. in India
Urban Planning in India
Industry in India Planning
Info. Technology Planning in India
Tourism Planning in India
Real Estate Planning in India
Infrastructure in India Plan.
Forest & Environment Plan. in India
Investment & Financial plan in India.

Describe the main features of five year plan

1. Democratic:
The first important feature of Indian planning is that it is totally democratic. India
being the largest democratic country in the world has been maintaining such a
planning set up where every basic issue related to its Five Year Plan is determined
by a democratically elected Government. Moreover, while formulating a Five Year
Plan, opinions of various tiers of Government, various organisations, institutions,
experts etc. are being given due considerations.
2. Decentralised Planning:
Although since the inception of First Plan, the importance of decentralised
planning was emphasized so as to achieve active peoples participation in the
planning process, but the real introduction of decentralised planning was made in
India for the first time during the Seventh Plan. Thus decentralised planning is a
kind of planning at the grass root level or planning from below. Under
decentralised planning in India, emphasis has been given on the introduction of
district planning, sub-divisional planning and block-level planning so as to reach
finally the village level planning successfully.
3. Regulatory Mechanism:
Another important feature of Indian planning is that it is being directed by a central
planning authority, i.e., the Planning Commission of India which plays the role of
regulatory mechanism, so as to provide necessary direction and regulation over the
planning system.

Thus under the present regulatory mechanism, every planning decision in India
originates from the Planning Commission and being finally approved by the
National Development Council. Moreover, the Planning Commission of India is
also having adequate regulatory mechanism over the successful implementation of
planning.
4. Existence of Central Plan and State Plan:
Another important feature of Indian planning is that there is the co-existence of
both the Central Plan and State Plans. In every Five Year Plan of the country,
separate outlay is earmarked both for the Central Plan and also for the State Plans.
Central Plan is under the exclusive control of the Planning Commission and the
Central Government, whereas the State Plan is under the exclusive control of State
Planning Board and State Government which also requires usual approval from the
Planning Commission.
5. Public Sector and Private Sector Plan:
Another notable feature of Indias Five Year Plan is that in each plan, a separate
outlay is earmarked both for public sector and the private sector. In each five year
plan of the country, public sector investment and private sector investment amount
is separately fixed, which comprises the total investment in each plan. India, being
a mixed economy, it is quite natural that a separate investment outlay for public as
well as the private sector is being maintained in each plan.
6. Periodic Plan:
One of the important features of Indian planning is that it has adopted a periodic
plan of 5-year period having five depurate Annual Plan components. This type of
periodic plan approach is quite suitable for realizing its definite targets.

7. Basic Objectives:
One of salient features of Indian Five Year Plan is that each and every plan is
guided by certain basic or fundamental objectives which are almost common in
most of our plans.

The major objectives of economic planning in India mostly consist:

(a) Attainment of higher rate of economic growth
(b) Reduction of economic inequalities
Achieving full employment
(d) Attaining economic self reliance
(e) Modernisation of various sectors
(f) Redressing the imbalances in the economy.
In general, Growth with social justice is the main objective of economic planning
in India.
8. Unchanging Priorities:
Five year plans in India are determining its priorities considering the needs of the
country. It is being observed that Indian Five Year Plans have been giving too
many priorities on the development of industry, power and agriculture with minor
modifications. Thus there is no remarkable changes in the priority pattern of Indian

planning, although in recent years increasing priorities are also being laid on
poverty eradication programmes and on employment generating schemes.
9. Balanced Regional Development:
Another salient feature of Indias Five Year Plan is that it constantly attaches much
importance on balanced regional development. Development of backward regions
is one of the important objectives of Indian planning. Indias planning system has
even isolated some states under special category states so as to channelize
additional resources to these backward states for their rapid development. Special
budgetary relief in the form of tax holiday or tax relief for establishing industries
into back-ward regions of the country.
10. Perspective Planning on Basic Issues or Problems:
Another important feature of Indian planning is that it has adopted the system of
perspective planning on some basic issues or problems of the country, for a period
of 15 to 20 years on the basis of necessary projections.
11. Programme Implementation and Evaluation:
Indian planning system is broadly supported by programme implementation
machinery, which used to play a very important role. Programme implementation
machinery includes various Government departments which are usually involved
for the implementation of the plan. More there is an evaluation machinery which
usually conducts pre-project evaluation and post-project evaluation of every
planning project of the country.

12. Shortfalls in Target Realization:

Another notable feature of Indias Five Year Plan is its shortfalls in target
realization. Although targets are fixed for every plans in respect of rate of growth
of national income, employment, population, production of some important items
etc. But in most of the cases these targets are not fulfilled to the fullest extent,
excluding certain specific cases.
Such shortfalls in target realization lead to the problems of spill over of projects
into next five year plans and cost over-runs. Thus we have seen that salient features
of Indias Five Year Plans, although numerous but some of these are quite common
to that of other countries while some are very much uncommon even.
DISCUSS HEALTH PROBLEMS IN INDIA
India is a country which is quite infamous for its sanitation and
cleanliness. The chaotic waste management system and urban planning is
responsible for the overflowing gutters and scattered waste.

The common man has to suffer a lot because of this mismanagement. To add
to the poor sanitary conditions, the population load is increasing each day. This has
resulted in slums and poverty. The poor and unhealthy living is the primary cause
for many health disorders.

India does not have the provision of clean water and food in many areas,
especially the rural parts. The contaminated water and food increase the chances of
getting infected through waterborne or food borne diseases. Another major cause
for common health issues in India is the pollution. Pollution of air, water and soil
has affected the health of many citizens. Airborne diseases are mainly caused
because of polluted air. There are many diseases or health issues that commonly

occur among Indians. The disorders can be quite severe and precautions should be
taken to avoid them.

1.Diarrhoea

This is a common health problem encountered in India. The main reason is

consumption of contaminated food and water. The disease affects the working of
stomach and intestines. The digestion system has troubles, leading to dysentery,
vomiting, nausea and dehydration. It is estimated that diarrhoea occurs more in
kids and can be very serious with them. Diarrhoea can be avoided by drinking
boiled water and home-cooked food. Snacks served by the roadside should be
avoided.
2. Malaria

The mosquito-transmitted disease is common in areas that have a poor drainage

system. Mosquitoes breed at places with piles of rotting garbage, open faeces, and
wastewater puddles. Malaria can cause fever, fatigue and queasiness. The
mosquitoes that cause malaria usually bite during the night time. To avoid getting
infected by Malaria, keep the house and surroundings clean and use a mosquito
repellent
cream.

3.Hepatitis

Hepatitis is divided in two types - A and B. Both the types are quite common in
India. Type A is waterborne or foodborne and Type B is hereditary, spread by
infected body fluids. These diseases can be fatal if not given proper attention.

There are oral as well as intravenous vaccinations available for preventing

Hepatitis.

4. AIDS/HIV

India has increasing patients of AIDS, which is an extremely dangerous disease.

AIDS, caused by the Human Immunodeficiency Virus (HIV), hampers the working
of the body which eventually results in multiple organ failure. AIDS is caused by
various reasons like unsafe sex, contact of fluids with an infected patient and using
the same needle for injection, tattoos, etc. There are many myths related to
transferring of HIV/AIDS.

5. Typhoid

Typhoid is one of the major health problems in India. This disease is waterborne
and can be transferred if in contact with somebody affected by it. Typhoid causes
high fever, nausea, dehydration and fatigue. This disease can be treated by using
antibiotics, vaccinations, eating healthy and drinking good quality water.

DESCRIBE VARIOUS COMMITTEES AND THEIR RECOMMENDATIONS

1. BHORE COMMITTEE. 1946.

This committee, known as the Health Survey & Development Committee, was
appointed in 1943 with Sir Joseph Bhore as its Chairman. It laid emphasis on
integrationof curative and preventive medicine at all levels. It made comprehensive
recommendations for remodeling of health services in India. The report, submitted
in 1946, had some important recommendations like :-

1.Integration of preventive and curative services of all administrative levels.

2. Development of Primary Health Centres in 2 stages :
a. Short-term measure one primary health centre as suggested for a population of
40,000. Each PHC was to be manned by 2 doctors, one nurse, four public health
nurses, four midwives, four trained dais, two sanitary inspectors, two health
assistants, one pharmacist and fifteen other class IV employees. Secondary health
centre was also envisaged to provide support to PHC, and to coordinate and
supervise their functioning.

b. A long-term programme (also called the 3 million plan) of setting up primary

health units with 75 bedded hospitals for each 10,000 to 20,000 population and
secondary units with 650 bedded hospital, again regionalised around district
hospitals with 2500 beds.

3. Major changes in medical education which includes 3 - month

training in preventive and social medicine

MUDALIAR COMMITTEE. 1962.

This committee known as the Health Survey and Planning Committee, headed
by Dr. A.L. Mudaliar, was appointed to assess the performance in health sector
since the submission of Bhore Committee report. This committee found the
conditions in PHCs to be unsatisfactory and suggested that the PHC, already
established should be strengthened before new ones are opened.
Strengthening of sub divisional and district hospitals was also advised. It was
emphasised that a PHC should not be made to cater to more than 40,000 population
and that the curative, preventive and promotive services should be all provided at
the PHC. The Mudaliar Committee also recommended that an All India Health
service should be created to replace the erstwhile Indian Medical service.

3. CHADHA COMMITTEE, 1963.

This committee was appointed under chairmanship of Dr. M.S. Chadha, the then
Director General of Health Services, to advise about the necessary arrangements
forthe maintenance phase of National Malaria Eradication Programme. The
committee suggested that the vigilance activity in the NMEP should be carried out
by basichealth workers (one per 10,000 population), who would function as
multipurpose workers and would perform, in addition to malaria work, the duties
of family planningand vital statistics data collection under supervision of family
planning health assistants.

4. MUKHERJEE COMMITTEE. 1965.

The recommendations of the Chadha Committee, when implemented, were found
to be impracticable because the basic health workers, with their multiple
functionscould do justice neither to malaria work nor to family planning work. The
Mukherjee committee headed by the then Secretary of Health Shri Mukherjee, was

appointedto review the performance in the area of family planning. The committee
recommended separate staff for the family planning programme. The family
planningassistants were to undertake family planning duties only. The basic health
workers were to be utilised for purposes other than family planning. The
committeealso recommended to delink the malaria activities from family planning
so that the latter would received undivided attention of its staff.

5. MUKHERJEE COMMITTEE. 1966.

Multiple activities of the mass programmes like family planning, small pox,
leprosy, trachoma, NMEP (maintenance phase), etc. were making it difficult for the
statesto undertake these effectively because of shortage of funds. A committee of
state health secretaries, headed by the Union Health Secretary, Shri Mukherjee,
was set
up to look into this problem. The committee worked out the details of the Basic
Health Service which should be provided at the Block level, and some
consequential strengthening required at higher levels of administration.

6. JUNGALWALLA COMMITTEE, 1967.

This committee, known as the Committee on Integration of Health Services was
set up in 1964 under the chairmanship of Dr. N Jungalwalla, the then Director of
National Institute of Health Administration and Education (currently NIHFW). It
was asked to look into various problems related to integration of health services,
abolition of private practice by doctors in government services, and the service
conditions of Doctors. The committee defined integrated health services as :-

a.

A service with a unified approach for all problems instead of a segmented

approach for different problems.

b Medical care and public health programmes should be put under charge of a
. single administrator at all levels of hierarchy.

Following steps were recommended for the integration at all levels of health
organisation in the country

Unified Cadre

Common Seniority

Recognition of extra qualifications

Equal pay for equal work

Special pay for special work

Abolition of private practice by government doctors

Improvement in their service conditions

7. KARTAR SINGH COMMITTEE. 1973.

This committee, headed by the Additional Secretary of Health and titled the
"Committee on multipurpose workers under Health and Family Planning" was
constituted toform a framework for integration of health and medical services at
peripheral and supervisory levels. Its main recommendations were :-

a. Various categories of peripheral workers should be amalgamated into a single

cadre of multipurpose workers (male and female). The erstwhile auxiliary
nursemidwives were to be converted into MPW(F) and the basic health workers,
malaria surveillance workers etc. were to be converted to MPW(M). The work of
3-4 maleand female MPWs was to be supervised by one health supervisor (male or
female respectively). The existing lady health visitors were to be converted into
female health supervisor.

b One Primary Health Centre should cover a population of 50,000. It should be

divided into 16 subcentres (one for 3000 to 3500 population) each to be staffed by
a male and a female health worker.

8. SHRIVASTAV COMMITTEE. 1975.

This committee was set up in 1974 as "Group on Medical Education and Support
Manpower" to determine steps needed to (i) reorient medical education in
accordancewith national needs & priorities and (ii) develop a curriculum for health
assistants who were to function as a link between medical officers and MPWs. It
recommended immediate action for :

1. Creation of bonds of paraprofessional and semiprofessional health workers from

within the community itself.

2. Establishment of 3 cadres of health workers namely multipurpose health

workers and health assistants between the community level workers and doctors at
PHC.

3. Development of a Referral Services Complex

4. Establishment of a Medical and Health Education Commission for planning and

implementing the reforms needed in health and medical education on the lines of
Universal Grants Commission.
Acceptance of the recommendations of the Shrivastava Committee in 1977 led to
the launching of the Rural Health Service.

9. BAJAJ COMMITTEE, 1986.

An "Expert Committee for Health Manpower Planning, Production and

Management" was
constituted in 1985 under Dr. J.S. Bajaj, the then professor at AIIMS. Major
recommendations
are :-

1
Formulation of National Medical & Health Education Policy.
.

2
Formulation of National Health Manpower Policy.
.

3 Establishment of an Educational Commission for Health Sciences (ECHS) on

. the lines of UGC.

4 Establishment of Health Science Universities in various states and union

. territories.

5
Establishment of health manpower cells at centre and in the states.
.

6 Vocationalisation of education at 10+2 levels as regards health related fields

. with appropriate incentives, so that good quality paramedical personnel may

be
available in adequate numbers.

7
Carrying out a realistic health manpower survey.
.
Central Council Of Health:
Central Council Of Health It as set by presidential order on 9 th Aug 1952 Purpose
is to promote the coordination between the Centre and States in the implementation
of national programmes and measures pertaining to health Union Minister of
Health is the chairman and State Health Ministers are its members
Functions of CCH
Preparing proposals for making laws in areas of medicine and health Making plans
for development of health in entire nation
Preparing recommendations for providing grants and financial assistance to state
for medical services and also review the activities in the light of grants provided
Considering policies and recommendations related to medical care, environment,
nutrition and medical education and preparing draft Encouragement of medical
education and training Cooperation between centre and state in health
administration and also to establish necessary organizations for better functioning
Family welfare
1. 1. Family Welfare Programmes Submitted By: Pathan Karimulla, Prahlad
Kamsani.
2. What is Family Welfare? Steps for development of wellbeings of a family
as of they can maintain a family with peace and love.
3. In response to our phenomenal population growth,india seriously took up
an effective family planning program which was renamed as family welfare
programmes.
4. It however has taken several decades to become effective.

5. At the global level by the year 2000,600 million , or 57% of women in the
reproductive age group , were using some method of contraception.
6. However the use of contraceptive measures is higher in developed
countries-68% -lower in developing countries-55%.
7. Female sterilization is the most popular method of contraception In
developing countries at present.
8. Informing the public about various contraceptive measures that are available
is of primary importance. It must be done affectively by Government
agencies such as health and family welfare, as well as education and
extension workers. It is of great importance for policy makers and elected
representatives of people-Ministers ,MPs ,MLAs at central and state Levelsto understand the great and urgent need to support family welfare. The
media must keep people informed about the need to limit family size and the
ill effects of growing population on the worlds resources.
9. The greatest challenge the world faces is how to supply its exploding human
population with the resources it needs. It is evident that without controlling
human numbers, the earths resources will be rapidly exhausted. In addition,
economically advanced countries and rich people in poorer countries uses
more resources than they need. Energy use is growing both due to an
increasing population ,and a more energy hungry lifestyle that increasingly
uses consumer goods that require larger amounts of energy for their
production, packaging, and transportation. Our growing population also
adds enormous amount of waste.
10.With all these linkages between population growth and the environment,
Family Welfare Programs have become critical to human existence. The
most effective measure is the couple once they been offered all the various
options that are available. The Family Welfare Program advocates a variety
of measures to control population. Permanent methods are done by a minor
surgery. Tubectomy in females is done by tying the tubes that carry the
ovum to the uterus. Vasectomy is done by the tubes that carry the sperm.
Both are very simple procedures,done under local anesthesia,are painless
and doesnt have post operative problems.
11.There are several methods of temporary birth control. There are also
traditional but less reliable methods of contraception. Methods Of
Sterilization Indias Family welfare program has been fairly successful but
still needs to be achieved to stabilize over population.
National Health Policy 2002

 Achieving an acceptable standard of good health of Indian Population,

Decentralizing public health system by upgrading infrastructure in existing
institutions,
Ensuring a more equitable access to health service across the social and
geographical expanse of India
Enhancing the contribution of private sector in providing health service for
people who can afford to pay.
Giving primacy for prevention and first line curative initiative.
Emphasizing rational use of drugs.
Increasing access to tried systems of Traditional Medicine
Goals NHP 2002
. Eradication of Polio & Yaws

2005

2. Elimination of Leprosy

2005

3. Elimination of Kala-azar

2010

4. Elimination of lymphatic Filariasis 2015

5. Achieve of Zero level growth

2007

of HIV/AIDS

6.Reduction of mortality by 50% 2010 on account of Tuberculosis,

Malaria, Other vector and water borne Diseases
7.Reduce prevalence of blindness 2010 to 0.5%.

Reduction of IMR to 30/1000 & 2010 MMR to 100/lakh

9. Increase utilisation of public 2010 health facilities from current

of <20% to > 75%

level

10. Establishment of an integrated

2007 system of surveillance,
National Health Accounts and Health Statistics

 11.Increase health expenditure 2010 by government as a % of GDP from

the existing 0.9% to 2.0%
12. Increase share of Central 2010 grants to constitute at least25% of total
health spending13. Increase State Sector 2005 Health spending from 5.5%
to 7% of the budget
14. Further increase of

2010 State sector Health spending from 7% to 8%

NATIONAL POPULATION POLICY

It reiterated the governments resolve to push for voluntary and informed choice
and agreeability of citizens to get maximum benefit from reproductive health
services.
It embarks on a policy outline for the government for next ten years to improve
the reproductive and child health needs of people of India which include issues like
child survival, maternal health, contraception, etc.
School education upto age of 14, to be made free and mandatory.
This will also include plan to check drop-out rate of boys and girls.
The policy also aims at curbing the IMR to less than 30 per 1000 live births.
The Maternal Mortality Rate will also be brought down to less than 100 per 1,
00,000 live births.
A high MMR is a symbol of economic and social disparity of the fairer sex.
It also points to heightened inequities in terms of healthcare and nutrition.
Another important feature of the policy is to attain universal immunisation of all
children against preventable diseases.
The policy will also act against child marriage and promote 20 years as the right
marriageable age for girls. The legal age for same is 18 years.

The policy will actively support a target of 80% institutional deliveries and 100 %
deliveries by trained persons. It also seeks to achieve 100 % registration of births,
deaths, marriages and pregnancies. Preventing and controlling all communicable
diseases.
It will also strive to Integrate Indian Systems of Medicine to provide reproductive
and child health services by reaching out to households. It thus will seek to
integrate and converge all related social sector programmes so that complete
family welfare and health can be taken care of and properly maintained. NPP 2000
also emphasizes the role of Ayurveda, Yoga, Unani, Siddh and Homeopathy
(AYUSH) medicine system to serve the goals of public health. The NPP 2000
strived to change the mindsets of people from base level. Its intense focus on
women empowerment has led to improvement in many national statistics.
However, there has been a great upsurge in the number of institutional deliveries
but there has not been a parallel increase in the healthcare staff. This has led to
immense pressure on health facilities and officials and an obvious degradation of
quality of services. Also, at many places there is an acute shortage of medicines,
staff
and
other
related
materials.

Unit iii
Describe the delivery of community services in India.
Health is a state of complete Physical, Mental and Social well being and
not merely an absence of disease or infirmity which allows a person to live a
socio-economically productive life
Illness is a state in which a person s physical, emotional, intellectual, social
or spiritual functioning is diminished or impaired.
Health care ismultitude of services rendered to individuals or communities
by the agents of health services or professional for the purpose of
Promoting
Restoring and Maintaining health
Embraces all the goods and services designed for prevention,
promotion and rehabilitation interventions includes Medical Care

A person or organization that provides services and/or health care

personnel to deliver proper health care in a systematic way to any
individual in need of health care services.
Could be a governmentor
.the health care industry,
.a health care equipment company,
.an institution such as a hospital or laboratory.
Health care professionals may include physicians, dentists, and other
support staff

Health services
Permanent countrywide system of estabilished institutions with the
objective of
.coping with the various health needs and demands of
population
thereby provide health care to individuals and community with
preventive and curative activities
.utilizing health care workers
System
Includes concepts ( e.g health and diseases)
Ideas(e.g equity)
Objects(e.g hospitals, health centres)
Persons (health care workers viz. physician, nurses)
Together these forms a system interacting with each other,
supporting and controlling each other
Explain the components of health care delivery system

1. Structure of health system

Aspects of the design of health services that influences the way in which
they are delivered Includes.
Number and type of personnel and staff
Way of these personnel organized to work
Nature and extend of facility and equipment
Range of services offered

 System of management and amenities

Financing
Enumeration and determination of the eligible population for
these services
Governance and decision making
2. Process of health care delivery
Consists of two parts
Behavior of professionals
Recognition of the problem i.e diagnosis
Diagnostic procedure
Recommendation of treatment or management
Appropiate follow up
Participation of people
Utilization of services
Understanding the recommendations
Satisfaction with the services
Participation in decision making
3. Outcomes of health care
Aspects of health that results from interventions
provided by the health system
4. Flow of patients in health care system
Varies from country to country

 India harbors a multistage (three tier) system, where majority of health

care is delivered by community health care worker

Indian system is more cost effective if health workers are skilled and
effectively supervised
Such system could one of the reason to reduced cost of health care in
developing countries

LEVELS OF HEALTH CARE

Primary Health care
Provided at the community level
Secondary health care
Provided at PHC, CHC, DH etc.
Tertiary health care
Provided at hospitals

Primary health care

Primary Health Care as defined by the World Health Organization (WHO) in

1978 is
Essential health care; based on

 practical,
scientifically sound, and
socially acceptable method and technology.
made universally accessible to individuals and families of the
community through their full participation at a cost that community
and country can afford to maintain every stage of their development in
the spirit of self determination.
Definition
Primary health care is essential health care made universally accessible to
individuals and acceptable to them through their full participation and at a
cost the community and country can afford
Primary Health Care includes:
Primary Care (physicians, midwives & nurses);
Health promotion, illness prevention;
Health maintenance & home support;
Community rehabilitation;
Pre-hospital emergency medical services and
Coordination and referral to other areas of health care.
It is the first level of contact with the health system to promote health,
prevent illness, care for common illnesses, and manage ongoing health
problems.
Primary Health Care involves concerted effort to provide rural population
of developing countries with least bare minimum of health services.
Some services are also provided community and hospitals
Primary Health Care is different in each community depending upon:

 Needs of the residents;

Availability of health care providers;
The communities geographic location; &
Proximity to other health care services in the area

Elements of primary health care

1. Education about prevailing health conditions and methods to prevent and
control them
Promotion of food supply and proper nutrition
Adequate water supply and basic sanitation
Maternal and child health care with family planning
Immunization against major infectious diseases
Prevention and control of locally endemic diseases
Appropriate treatment of common diseases and injuries
Provision of essential drugs
Principles of primary health care
-Equitable distribution
-Community participation
-Intersectoral coordination
-Appropriate technology
Health Care Delivery System in India
India is a union of 28 states and 7 union territories.

 States are largely independent in matters relating to the delivery of health

care to the people.
Each state has developed its own system of health care delivery, independent
of the Central Government.
The Central Governments responsibility consists mainly of policy making ,
planning , guiding, assisting, evaluating and coordinating the work of the
State
Health
Ministries.

Ministry of Health and Family Welfare

Functions of MoHFW
Union list
International health relations and administration of port quarintine
Administration of Central Institutes
Promotion of research
Regulation and development of medical, pharmaceutical, dental and nursing
professions
Establishment and maintenance of drug standards
Census and collection and publication of other statistical data
Coordination with states

Concurrent List:

Prevention of Communicable disease

Prevention of food adulteration
Control of drug and poison
Vital statistics
Labor welfare
Economic and social planning
Population control and family planning

Directorate General of Health Services

Functions of Directorate General of Health servicesGeneral functions

Surveys
Planning
Coordination
Programming and appraisal of all health matters
Specific function
International health relations and quarantine of all major ports in country and
international airport.
Control of drug standards
Maintain medical store depots
Administration of post graduate training programmes
Administration of certain medical colleges in India

 Conducting medical research through Indian Council of Medical Research

( ICMR )
Central Government Health Schemes.
Implementation of national health programmes
Preparation of health education material for creating health awareness
through Health Education Bureau
Collection, compilation, analysis, evaluation and dissemination of
information
National Medical Library

Central Council of health

Functions
To consider and recommend broad outlines of policy related to matters
concerning health like environment hygiene, nutrition and health education.
To make proposals for legislation relating to medical and public health
matters.

 To make recommendations to the Central Government regarding distribution

of grants-in-aid.

At District level
There are 593 ( year 2001 census) districts in India. Within each district,
there are 6 types of administrative areas.
1. Sub division
2. Tehsils ( Talukas )
3. Community Development Blocks
4. Municipalities and Corporations
5. Villages and
6. Panchayats

 Health Services Outpatient services -Patients who dont require

hospitalization can receive health care in a clinic. An out patient setting is
designed to be convenient and easily accessible to the patient.
Clinics Clinics involve a department in a
hospital
where
patients
not
requiring
hospitalization, receive medical care.
Institutions Hospitals Hospital have been the
major agency of health care system.
In broad sense the health services should be
b. Comprehensive
c. Accessible
d. Acceptable
e. Provide scope of community participation and.

f. Available at an affordable cost by country and community

Health care systems Intended to delivery healthcare services and represented

by five major sectors different from each other by health technology
1. Public health sector
a. Primary health care
Primary health centres
Sub centres
b.Hospitals/Health centres
Community health centres
Rural hospitals
District hospitals/health centres
Specialist hospitals
Teaching hospitals
c.Health insurance schemes
Employees State Insurance
Central Govt. Health Schemes
d.Otheragencies
defense services.
Railways .
2. Private sector
a. Private hospitals, polyclinic, nursing homes and dispensaries
b. General practitioners and clinics

3. Indigenous system of medicine

c. Ayurveda and Siddha
d. Unani and Tibbi
e. Homeopathy
f. Unregistered practitioners
4. Voluntary health agencies
5. National health programme
Primary health care in India
In 1977, Government of India launched Rural Health Scheme based on the
principle of placing peoples health in peoples hand
Subsequently in the international conference of Alma-Ata(1978)the goal of
Health for all by 2000 through primary health care approach was set.
Keeping in view WHO Health for all by 2000 Government of India
formulated National health policy 2002.

Sub Center

 The most peripheral and first contact point between the primary health care
system and the community.
The Ministry of Health & Family Welfare is providing 100% Central assistance
They are established on the basis of
One SC for every 5,000 population in general and
One SC for every 3,000 pop in hilly, tribal and backward areas
Each Sub-Centre is manned by one Male and one female Health Worker.
One Lady Health Worker (LHV) is entrusted with the task of supervision of
six Sub-Centers. Sub Centre are assigned tasks relating to interpersonal
communication
In order to bring about behavioral change and provide services in relation
to.
Maternal and child health,
Family welfare,
Nutrition,
Immunization,
Diarrhea control and
Control of communicable diseases programmes.
The sub centre are provided with basic drugs for minor ailments.
Primary Health Center
PHC is the first contact point between village community and the Medical
Officer.

 The PHCs were envisaged to provide an integrated

curative and preventive health care to the rural
population with emphasis on preventive and promotive
aspects of health care.

The PHCs are established and maintained by the State Governments.

At present, a PHC is manned by a Medical Officer supported by

14 paramedical and other staff. It acts as a referral unit for 6 Sub Centres.

It has 4 - 6 beds for patients.

The activities of PHC involve curative, preventive, primitive and Family
Welfare Services.
National Health Plan (1983) proposed reorganization of PHCs on the basis
of.
One PHC for every..30,000 pop in Rural areas
One PHC for every..50,000 pop in Urban areas
Functions of PHCs Medical care
Health programmes
MCH care and family planning
Health education and training
Referral services
Safe water supply and basic sanitation
Prevention and control of locally endemic diseases

 Collection and reporting of vital events

Basic laboratory services

Community Health Center (CHC)

These were established by upgrading the primary health centers
CHCs are being established and maintained by the State Government.
centers,each community health center should cover a population of 8000 to 1.2
lakh
It is manned by four medical specialists i.e. Surgeon, Physician, Gynecologist and
Pediatrician and supported by paramedical and other staff.
Functions of CHCs Care of Routine and Emergency Cases in Surgery
Dressings, I&D, and surgery for Hernia, Hydrocele, Appendicitis etc.
Emergencies like Intestinal Obstruction, Haemorrhage, etc.

 Other management including nasal packing, tracheostomy, foreign

body removal etc.
Fracture reduction and putting splints/plaster cast.
Conducting daily OPD.
Care of Routine and Emergency Cases in Medicine
Daily OPD
Handling all the emergency and routine cases
Maternal Health
Minimum 4 ANC check ups including Registration & associated
services
1st visit: Within 12 weekspreferably as soon as pregnancy
2nd visit: Between 14 and 26 weeks
3rd visit: Between 28 and 34 weeks
4th visit: Between 36 weeks and term
24 hr delivery services including normal and assisted delivery and
cesarean section
Managing labour using Partograph.
Minimum 48 hours of stay after delivery, 3-7 days stay post delivery
for managing Complications
Newborn Care and Child Health
Essential Newborn Care and Resuscitation
Counseling on Infant and young child feeding
Routine and emergency care of sick children

 Full Immunization of infants and children against VPDs

Management of Malnutrition cases.
Family Planning
Counseling, provision of Contraceptives,
Sterilization Services and their follow up.

NSV, Laparoscopic

Safe Abortion Services

All National Health Programmes delivered through CHCs
School health services
Others
Blood storage facility
Essential laboratory services
Referral (transport) services

 Maternal

Death

review

(MDR)

It has 30 in-door beds with one OT, X-ray, Labour Room and Laboratory
facilities.
It serves as a referral centre for 4 PHCs and
also provides facilities for obstetric care and
specialist consultations.

ENVIRONMENTAL SANITATION

Environmental sanitation comprises a set of actions geared towards improving

living conditions, health conditions and the overall quality of life. Environmental
sanitation includes treatment and disposal of human, industrial and animal waste,
along with the control of disease vectors and the provision of restroom facilities for
personal hygiene. For environmental sanitation to be effective, these practices must
be instituted on a community and individual basis.
On a broad scale, environmental sanitation involves limiting the environmental
contributors that spread disease, commercial food safety practices in public
facilities such as farms and restaurants, hospital safety and efficient waste removal.
On a smaller scale, it is the responsibility of the individual or head of household to
instill effective personal hygiene practices.
Environmental sanitation is a critical public health issue in developing nations and
impoverished urban areas. Areas that do not have access to clean water and/or do
not engage in efficient waste removal and treatment practices are susceptible to
widespread pollution and the proliferation of infectious diseases..

HEALTH EDUCATION
Health education can be defined as the principle by which individuals and
groups of people, learn to behave in a manner conducive to the promotion,
maintenance, or restoration of health.
The World Health Organization defined Health Education as "compris[ing]
[of] consciously constructed opportunities for learning involving some form of
communication designed to improve health literacy, including improving
knowledge, and developing life skills which are conducive to individual and
community health."
Purpose/Aims

of

Health

To ensure that health is an assets in the community.

To equip the people with skills, knowledge and attitude.

Education:

 To promote the development and proper use of health service.

Principles

of

Health

Education

Interest
It is a psychological principle that people are unlikely to listen to those things
which
are
not
to
their
interest.
Participation
It should aim at encouraging people to work actively with health workers and
others identifying their own health problems and also in developing solution and
plans
to
work
them
out.
Known
to
unknown
Start where the people are and with what they understand and then proceed to new
knowledge
Comprehension
In Health Education, we must know the level of understanding, education and
literacy
of
people
to
whom
the
teaching
is
directed.
Re-enforcement
Repetition at interval is extremely useful for understanding all the news.
Motivation
Every individual has a fundamental desire to learn. Stimulation or awakening of
desire
of
learning
called
motivation.
Communication
Health educators must be aware of the various barriers of communication and
cultural
background
of
the
community.
Learning
by
doing
The Chinese proverb if I hear, I forget. If I see, I remember. If I do, I know
illustrate the importance of learning by doing.

VITAL STATISTICS
Definition:
Vital statistics are conventionally numerical records of marriage births,
sickness, and death by which the health and growth of community may be studied.
Or
It is a branch of biometry deals with data and law of human mortality,
morbidity,& demography.
Purpose:1) Community Health: To describe the level of community health, to diagnose
community illness & to discover solutions to health problems.
2) Administrative purpose: It provides clues for administrative action to create
administrative standards of health activities.
3) Health programmed organization: To determine success or failure of
specific health programmed or undertake overall evaluation of public health
work.
4) Legislation purpose: To promote health legislation at local, state,& national
level.
5) Government Purpose: To develope, policies, procedure at state and central
level.
Uses: To evaluate the impact of various National Health Programmes.
To plan for better future measures of disease control.
To explain the heridetary nature of the disease.
To plan and evaluate economic and social development.

 It is a primary tool in research activities.

To determine the health status of individual.
To compare the health status of individual one nation with others.
SOURCES OF VITAL STATISTICS
. Civil Registration System:
It is defined as the continous permanent and compulsory recording of the
occurrence of vital events like live births, deaths, fetal deaths, marriages, divorces,
as well as annulments, judicial separation, adoption. Civil registration is performed
under a law and regulation so as to provide legal basis to the records and certificate
made from system.
National Sample Survey:
The data collected from the census are not very reliable and available only once in
10 years. In absence of reliable data from the civil registration system(SRS), the
need for reliable statistics at national and state levels is being met through sample
surveys launched from time to time.
Sample Registration System:
In this system, there is continous enumeration of births and deaths in a sample of
villages/urban blocks by a resident parttime enumerator and then an independent
six monthly retrospective survey by a full time supervisor.
Health Surveys:
A few important sources for demographic data have emerged. These are National
Family Health Surveys(NFHS) and the District Levels Household Surveys(DLHS)
conducted for evaluation of reproductive and child health programmes.
NFHS provide estimates of fertility, child mortality and a no. of fertility,
child mortality and a no. of health parameters relating to infants and children at
state level.

The DLHS provide information at the district level on a no. of indicators

relating to child health, reproductive health problems and quality of services
availability to them.
(a)Important Vital Statistics.
Crude Death Rate (CDR)
= Total death in a given year

X 1000

Average or mid year population of a year

(b) Age-specific Death rate (ASDR)
Nos. of death at age a _X 1000
Mid-yrs pop. of a given year at age a
Crude rate is based on total population while a specific rate is based on the
basis of age, sex, cause etc
C) Infant Mortality rate (IMR)
= Nos. of infant death in a year

X1000

Nos. of live birth in the year

d) Neonatal Mortality Rate d) Post-neonates Mortality Rate
= Death between 1st and 11 complete months x 1000
Nos. of live birth
(e) Maternal Mortality Rate (MMR)

Number of death of mother due to the cause related

to maternity
Total nos. of live birth

X 1000

= Death under one months

X 1000

Nos. of live birth

MTP Act

MTP Act - an enabling act which

Aims to improve the maternal health scenario by preventing large
number of unsafe abortions and consequent high incidence of maternal
mortality & morbidity
Legalizes abortion services
Promotes access to safe abortion services to women
De-criminalizes the abortion seeker
Offers protection to medical practitioners who otherwise would be
penalized under the Indian Penal Code (sections 315-316)

MTP Act
lays down when & where pregnancies can be terminated
Grants the central govt. power to make rules and the state govt.
power to frame regulations
MTP Rules
lays down who can terminate the pregnancy,
requirements, approval process for place, etc.
MTP Regulations

training

 lays down forms for opinion, maintenance of records

custody of forms and reporting of cases
Legal abortions
Abortions are termed legal only when all the following conditions are met:
Termination done by a medical practitioner approved by the Act
Termination done at a place approved under the Act
Termination done for conditions and within the gestation
prescribed by the Act
Other requirements of the rules & regulations are complied with
When can pregnancies be terminated
Up to 20 weeks gestation
With the consent of the women. If the women is below 18 years or is
mentally ill, then with consent of a guardian
With the opinion of a registered medical practitioner, formed in good
faith, under certain circumstances
Opinion of two RMPs required for termination of pregnancy between
12 and 20 weeks
MTP Act: Indications
Continuation of pregnancy constitutes risk to the life or grave
injury to the physical or mental health of woman
Substantial risk of physical or mental abnormalities in the fetus as
to render it seriously handicapped
Pregnancy caused by rape (presumed grave injury to mental
health)

 Contraceptive failure in married couple (presumed grave injury

to mental health)
In determining whether the continuance of pregnancy would
involve such risk of injury to the health (as mentioned above),
account may be taken of the pregnant womans actual or reasonable
foreseeable environment
MTP Act: Place for conducting MTP

A hospital established or maintained by Government

or
A place approved for the purpose of this Act by a District-level
Committee constituted by the government with the CMHO as
Chairperson
MTP Act amendment 2002
Decentralizes site registration to a 3-5 member district level committee
chaired by the CMO/DHO
Approval of sites that can perform MTPs under the act can now be done
at the district level
Stricter penalties for MTPs being done in a un-approved site or by a
persons not permitted by the act
Medical Abortion
MTP using Mifepristrone (RU 486) & Misoprostol approved for up to 7
weeks termination
Only an RMP (as defined by the MTP Act) can prescribe the drugs
Has to follow MTP Act, Rules & Regulations

 Can prescribe in his/her clinic, provided he/she has access to an

approved place
Should display a certificate from owner of approved place agreeing to
provide access

Implications of amendments
Simplifies registration of sites which can be done at district level now
Providers can get their sites approved for providing abortions under the
MTP Act for 1st trimester only or up to 20 weeks and thereby come under
the protective cover of the MTP Act
MTP rules: what are they for?

Enable proper implementation of the provisions of the Act

Ensure that MTP services are provided by qualified persons in safe and
hygienic settings
Help to monitor quality of services
MTP rules: what do they cover?
Experience & training required for providers
Approval of a place for terminating pregnancy under the Act
Composition & tenure of District Level Committee
Inspection, cancellation or suspension of approval; review
Consent form
MTP rules: Who can perform?
MTP rules: training requirement 1
For termination up to 12 weeks:

 A practitioner who has assisted a registered medical practitioner in

performing 25 cases of MTP of which at least 5 were performed
independently in a hospital established or maintained or a training
institute approved for this purpose by the Government
For termination up to 20 weeks
A practitioner who holds a post-graduate degree or diploma in
Obstetrics and Gynecology
A practitioner who has completed six months house job in Obstetrics
and Gynecology
A practitioner who has at least one-year experience in practice of
Obstetrics and Gynecology at a hospital which has all facilities
A practitioner registered in state medical register immediately before
commencement of the Act, experience in practice of Obstetrics and
Gynecology for a period not less than three years.
Approval of a place by trimester
For sites up to 12 weeks (1st trimester)
Gynecology examination/ labor table
Resuscitation and sterilization equipment
Drugs & parental fluids
B ack up facilities for treatment of shock
Facilities for transportation
Approval of a place by trimester
For sites up to 20 weeks (1st and 2nd trimester):
All requirements for up to 12 weeks +
Operation table and instruments for performing abdominal
gynecological surgery

or

 Anesthetic equipment, resuscitation equipment and sterilization equipment

Drugs & parental fluids notified for emergency use, notified by
Government of India from time to time

Regulatory body: D L C
District level MTP Committee
Minimum of 3 & Maximum of 5 members including chairperson
(CM H O)
Composition of the committee:
One medical person (Gyne/Surgeon/Anestheist)
One member from local medical profession; NGO & Panchayati
Raj Institution of the district.
At least one member shall be a woman.
Tenure 2 calendar years
NGO members shall not have more than 2 terms
Approval Process
Application in Form A to be addressed to CMHO by place seeking
approval
CMHO verifies or inspects the place to satisfy that termination can be
done under safe & hygienic conditions
CMHO recommends approval to the committee
Committee considers application & recommendation and approve and
issue certificate of approval in Form B
Place to be inspected within 2 months of receiving application
Certificate to be issued within 2 months of inspection

 If deficiency found, within 2 months of deficiency having been rectified

Inspection
CMHOs to inspect to ensure safe & hygienic conditions for conduction of
MTPs.
Call for information and seize in case found otherwise
Cancellation/ Suspension
CMHO to report the committee for unsafe and unhygienic conditions.
Committee can suspend or cancel approval after giving the owner an
opportunity for representation
Owner can reapply to the committee after making additions and
improvements.
During suspension the place be deemed as non-approved
MTP regulations
Power to states to make regulations regarding MTP services
Regulations for Union Territories by Central Govt.
Application of central govt. regulations in the absence of state regulations

MTP regulations: What do they cover?

Forms to be required for making opinion, admission register and
reporting of MTPs
Custody of forms
Prevention of disclosure of information
F or an MTP, opinion of an approved RMP
(2 RMPs for 2nd trimester) is required.

 The provider(s) is required to certify his/her opinion in Form I within

three hours of terminating a pregnancy.
Declining sex ratios
Census 2001 confirmed apprehensions of declining juvenile sex ratios.
Parallel with steep increase in availability of ultrasound machines and use
during pregnancy
Sex determination testing followed by second trimester abortion- major
pathway for sex selection
Public interest litigation triggered amendments in Act of 1994
Focus on female feticide as having attained endemic proportions

The problem solution

The recent incidents in India have shown that the distinction between two
public policy issues sex selection (female feticide) and safe abortion
have become extremely blurred
Choices along the thin edge separating the two are:
Restricting access to abortion to prevent sex selection
Dealing with the two issues separately
Developing a integrated strategy to address both sex selection and
unsafe abortion together .

Short notes on female foeticide

Introduction: Female infanticide has been a common practice in our country since
centuries. Indian census has always shown a gendered imbalance. This marked gap
between boys and girls, which has nationwide implications, is the result of
decisions made at the most local level- the family. Sex selective abortion is a fairly
recent phenomena but its root can be traced back to the age old practice of female
infanticide.

One of the greatest threats to our contemporary civilization is the menace of

skewed sex ratio. The increasing imbalance between men and women is leading to
many crimes such as illegal trafficking of women, sexual assaults, polygamy and

dehumanization of society. These acts have been increasing making this world
unsafe for women. Female foeticide is one of the most nefarious crimes on this
earth; perhaps what is detestable is that the people who commit crime belong to the
educated class. To this menace our ancestral and biased view about male child,
lack of education, ever increasing population and dowry have been good
propellants. Some measures and their enforcement have to happen immediately.
The ineffectiveness of the Pre-Natal Diagnostics Techniques (Regulation and
Prevention of Misuse) Act is very much evident. Hence there needs to be quick
reformation in the attitude of people to look beyond the legacy and transform this
world as a better place to live in.

What is female foeticide?

Female foeticide is a practice that involves the detection of the sex of the unborn
baby in the womb of the mother and the decision to abort it if the sex of the child is
detected as a girl. This could be done at the behest of the mother, or father, or both
or under family pressure. This detection of the sex of the baby is done through
three methods:
(a) amniocentesis;
(b) chronic villus sampling and
(c) ultrasonography.

Legislative actions:
To arrest this evil, the Forum against Sex Determination and Sex Preselection
(FASDSP) a broad forum of feminist and human rights groups, was formed in
1984, and it has been lobbying for legislation to ban the practice. In 1988, the state
of Maharashtra passed an Act banning prenatal diagnostic practices. In September
20, 1994 the Parliament had enacted the Pre-Natal Diagnostic Techniques
(Regulation & Prevention of Misuse) Act, which came into force from January

1996. Later, the Act was amended with effect from February 14 2003 and was
renamed the Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of
Sex Selection) Act, 1994 (PCPNDT Act).

Ground reality:
The ban on the government hospitals and clinics at the centre and in the states,
making use of pre-natal sex determination for the purpose of abortion a penal
offence led to the commercialization of the technology; private clinics
providing sex determination tests through amniocentesis multiplied rapidly and
widely. These tests are made available in areas that do not even have potable water,
with marginal farmers willing to take loans at 25 per cent interest to have the test.
People are encouraged to abort their female fetuses through advertisements in
order to save the future cost of dowry. The portable ultrasound
machine has facilitated doctors to go from house to house in towns and villages.4
Despite the law being there, due to lack of proper implementation, very few cases
are registered. Under the two main laws (Medical Termination of Pregnancy
(MTP) Act 1971 and the Pre Natal Diagnostic Techniques (PNDT) Act 1994, the
Indian government has conceded that abortion may be carried out if there is
(a) danger to the life of the mother in child birth,
(b) if the child is at risk of being born handicapped, or
(c) if the women has conceived the child as a result of rape.
Women are also allowed the right to abortion if they wish to do so in the interest of
keeping the family small. PNDT Act only focuses on regulation and control is
techniques of pre-natal sex determination, not the access to abortion in any form.
That is, the Act does not concern itself with selective abortion of female fetuses as
such, but rather, with medical procedures to detect the sex of the foetus,

which can lead to femicide. However, it is often seen that the decision of abortion
is taken after the detection that the unborn child is female, especially if it is the
second or third female child. It must be mentioned here that abortion has entered
the lexicon of feminist struggle through a very different trajectory from that
followed in the West. Here, the right to abortion has never been at the centre of
much debate since it is seen as a measure to control population growth.5 Since
poverty is seen as a by -product of rising population, for developing countries like
India, population control measures has been a central focus of government
programmes for economic development. The Medical Termination Act was passed
in 1971 amidst Parliamentary rhetoric of choice and womens rights, but it was
clearly intended as a population measure, as several MPs pointed out during the
debate on the Bill.6 Here, it is worth mentioning that a vocal and influential school
of thought still justifies the selective abortion of female fetuses as a
form of population control. Their argument is that to permit abortion of female
fetuses would stop couples from continuing to have children until the desired son
was produced.

Indeed, the statistics are startling. Numerous studies analyzing the

skewed sex ratio demonstrate the extent of this shocking practice. At birth, there
ought to be around 105 or 106 male children for every 100 female children, and
this proportion is about the same everywhere in the world. The ratio then slowly
changes and women, who are much healthier and more likely to survive than
men, end up outnumbering the men. In places like in Europe and North
America, the ratio of women to men is typically around 1.05 or 1.06, or higher.5

In India, the 2001 census reveals that the overall sex ratio is 933 females
for every 1000 males, showing a marginal increase of 6 points from the 1991
census of 927. However, this is a very sorry state indeed and we are doing

much worse than over a hundred years ago when the sex ratio was 972 in 1901,
946 in 1951 till the 933 today. This deterioration in women's position results
largely from their unequal sharing in the advantages of medical and social
progress.6

The child sex ratio is another story altogether. This child sex ratio has
shown a steady decrease since 1961 and shows no signs of improving. From
the 976 in 1961, we moved to 964 in 1971. In 1981, we evidenced a further
decline to 962 and even further to 945 in 1991. Today the child sex ratio is 927,
a full 18 points drop. This can only mean one thing. More and more baby girls
have either been aborted or killed as infants since 1961 and that this trend
continues strong even today. Indeed, an improvement in the child sex ratio has
only been marked in one state, Kerala, and two Union Territories, Lakshwadeep
and Pondicherry. Everywhere else, there is a decrease in the number of girls.
The greatest offenders in this area are the northern and the western
states, with Punjab and Haryana leading the pack. In Punjab, the child sex ratio
has decreased by 77 points to a new and horrifying low of 798 females to a 1000
males, and Haryana has seen a decrease of 60 points, meaning there are now
only 819 females to a 1000 males. Other offenders high on this list are Himachal
Pradesh, Delhi, Chandigarh and Gujarat. What is also disturbing is that this
trend is also noticeable in other states, which evidenced a relatively healthy child
sex ratio in 1991 and has now radically decreased.

Eradication of Situation:
Unfortunately, various schemes to counter this situation brought out by many
states as well as at the central level have been ineffective in reducing the extent
of this problem. However, we cannot let our despair or the extent of the problem
be the justification for inaction. At this stage, removal of this practice must
involve:

Focus on the humanist, as well as scientific and rational approach and a

move away from the traditional teachings which support such a practice;

Empowerment of women and measures to deal with other discriminatory

practices such as dowry, etc.;
Ensuring development of and access to good health care services;
A strong ethical code for doctors;
Simpler methods for complaint registration for all women, particularly
those who are most vulnerable;
Publicity for the cause through the media and increasing awareness
amongst the people through NGOs and other organizations;
Regular appraisal and assessment of the indicators of the status of
women such as sex ratio, female mortality, literacy and economic
participation.

Of course, we must recognize that infanticide is a crime of murder and

punishment should be given to both parents. There ought to be stricter control
over clinics that offer to identify the sex of a fetus and stronger check on
abortions to ensure that they are not performed for the wrong reasons. Doctors
must also be sensitized and strong punitive measures must be taken against

those who violate the law. To conclude, I would just like to say that this is not so
much a legal problem as it is a social disease. We need to truly rid ourselves of
this son-obsession and understand that our lives would be just as fulfilling, if not
more, if our children were to be girls. This is not to say that the law can play no
role. We must all work together to ensure that each and every baby girl is given
her due.

Conclusion
Female feticide is one extreme manifestation of violence against women.
Unfortunately, as Kerala High Court Chief Justice K K Usha mentioned in a
seminar that genderspecific laws like MTP Act 1971 which aims at
empowering women has been grossly misused for female foeticide after
carrying out legally banned pre-natal sex determination tests to meet the
desire of the family to have a male child.10 Misuse of law, wrong
implementation of law has added to the woe of female foeticide. Firstly, it
must be realized that even a full proof law is just beginning of a struggle to
curb notorious practice like female foeticide. As Haksar points out that law
reform cannot be divorced from the more fundamental struggle to transform
social values. Moreover, it is necessary to understand that.
Write short notes on Child adoption act ?
Adoption is the legal act of permanently placing a child with a
parent or parents other than the birth parents. Adoption results in the severing
of the parental responsibilities and rights of the biological parents and the
placing of those responsibilities and rights onto the adoptive parents. After the
finalization of an adoption, there is generally no legal difference between
biological and adopted children, though in some jurisdictions, some
exceptions may apply.
Basic rules for adopting a child

In India, an Indian, Non Resident Indian (NRI), or a foreign citizen may

adopt a child. There are specific guidelines and documentation for each group of
prospective adoptive parents.
A single female or a married couple can adopt a child. In India, a single male is
usually not eligible to be an adoptive parent.
A single man desiring to adopt a child may be eligible if he applies through a
registered agency. However, he will still only be able to adopt a male child.
An adoptive parent should be medically fit and financially able to care for a child.
A person wishing to adopt a child must be at least 21 years old.
There is no legal upper age limit for parents but most adoptive agencies set their
own benchmarks with regard to age.
For a child who is less than a year old, the adoptive parents can have a maximum
combined age of 90 years. Also, neither parent must be older than45years.
In the case of adoption of older children, the age of the parents may be relaxed
accordingly. For example, for a one-year-old child, the age limit is 46 years, for a
two-year-old child, it is 47 years and so on.
The upper age limit for an adopted child is 12 years while for an adoptive parent it
is 55 years. In the case of an adopted child with special needs, the age limit may be
relaxed marginally by the state government, depending on the evaluation of the
case. However, in all cases, the age of the parent cannot exceed 55 years.

Indian citizens who are Hindus, Jains, Sikhs, or Buddhists are allowed to
formally adopt a child.
The adoption is under the Hindu Adoption and Maintenance Act of 1956.
Under this act, a single parent or married couple are not permitted to adopt more
than one child of the same sex.

Foreign citizens, NRIs, and those Indian nationals who are Muslims, Parsis,
Christians or Jews are subject to the Guardian and Wards Act of 1890. Under this
act, the adoptive parent is only the guardian of the child until she reaches 18 years .
Foreign citizens and NRIs are supposed to formally adopt their child
according to the adoption laws and procedures in the country of their residence.
This must be carried out within two years of the individual becoming a child's
guardian. There is also a Juvenile Justice Act of 2000, a part of which deals with
adoption of children by non-Hindu parents. However, this act is applicable only to
children who have been abandoned or abused and not to those children who have
been voluntarily put up for adoption.

An adoptive parent is allowed to ask for a child, as per her preferences.

For example a parent may ask for a child of a certain age, gender (if it is the
first child in the family), skin colour, religion, special features, health condition,
etc. However, greater the specifications, more difficult it is to find a child who
conforms to them. This restricts the pool of children available for adoption.
Depending on the adoptive parent's desired details, children are scrutinised to
find a suitable match. When a child with the desired characteristics is found, she is
shown to the prospective parents. In case the parents are unhappy with the
selection, about two more children with the same characteristics may be presented
to the parents.

The entire adoption process takes some months to complete. However, when
all the hurdles are cleared, you are ready to welcome your new child to the family
SCHOOL HEALTH SERVICES
Define School Health

School health refers to a state of complete physical, mental, social and spiritual
wellbeing and not merely the absence of disease or infirmity among pupils,
teachers and others school personnel.
Define School Health services
It refers to need based comprehensive services rendered to pupils ,teachers and
other personnel in the school to promote, protect their health, prevent and control
diseases and maintain their health.
Aims and Objectives of School Health service
Aim: To promote, to protect and maintain health of school children and reduce
morbidity and mortality in them

Specific Objectives:
1) To create health consciousness among school children, parents and teachers.
2) To provide healthy and safe environment which is conducive to comprehensive
development of children
3) Impart health information and conduct health education on various aspects of
healthful living in school, home and community.
4) Prevent communicable and non-communicable diseases
. 5) Identify and treat any abnormalities/defects/diseases as early as possible and do
the referral and follow up
6)Involve teachers, students and their parents in the management of health aspects

Principles:
1) School health services should be based on health needs of children
2) School health services should be planned in coordination with school,
health personnel ,parents and community people
3) School health services should be pa part of community health services
4) School health services should emphasize on promotive and preventive
aspects
5) School health services should emphasise on health education to
promote,protect,improve and maintain health of children and staff.
6) School health services should emphasise on learning through active and
desirable participation.
7) School health services should be continuos and ongoing process.
8) School health services should be ongoing and continuous programme.
9) School health services should have an effective system of record keeping
and reporting.
Components of school health Services:
1) Health promotive and Protective services
2) Wholesome school environment
3) Maintainence of personal hygiene
4) Nutritional services
5) Physical and recreational activities
6) Promotion of mental health Health education Immunization

7) Therapeutic Services Health appraisal Treatment and follow-up

First aid and emergency care Specialized health care services
8) Rehabilitative services Care of the handicapped
9) School health Records Components of school health Services
10)

Health promotive and Protective services

Wholesome school environment

It is essential for holistic development of children coming from varying
socioeconomic and cultural backgrounds.It comprises of the site,location,the
building structure and its surroundings, the sanitary and other facilities.
i)Location; School should be located away from the nuisance of noise, traffic, dust
and easily approachable. Site should be dry on a raised surface with proper
drainage system and with a proper play ground.
ii) Building structure It should be single storeyed building Construction should
be heat proof. Well ventilated and attached to verandas and there should be
cross ventilation. Classroom should be spacious enough with a space of 10.sq
feet for each student. It is better to to have trees, plantations etc to keep the
environments cleanand fresh. iii) Furnishing of classrooms It is desirable to have a
single desk with chair for each student.
iv) Sanitary and other Facilities Water supply- It should be continuous, potable
and safe water supply from the tap. Water should be chlorinated periodically for
safety. Drinking water should be handled properly with long handle and a tumbler
kept along with it.
Lavatory- Each School must have school urinals and latrines with adequate
water supply. The habit of micturition should not be allowed anywhere. Disposal
of waste water and refuse-Each school should have a proper system of drainage
of waste water.

In rural areas drainage comprised of dust,paper,dirt,peelings of fruit,vegetables

and left out of vegetables should be disposed off in a dustbin. v) Canteen and
Eating-School should have its own sanitary canteen facility on subsidy basis. water
can be drained in soak pit or garden or nearby agricultural field. Food items should
be prepared and maintained in a hygienic manner by the food handlers
2)Maintainence of personal hygiene
It is important on the part of the teachers to explain the
importance of personal hygiene among children and promote it.
They can be a role model of personal hygiene. Daily inspection
of personal hygiene(eg: checking nails, daily baths, Proper care
of the body should be explained to te students(eg:care of
hair,nails,eyes,ears)
3)Nutritional services
A good nutritional intake is very important in the growth and development
of a child and also for his educational achievement. A nutritious mid-day meal is
considered a very practical solution to combat malnutrition.In view to curb
malnutrition,in the year 1961 the mid-day meal committee had started the mid-day
meal programme which caters atleast the 1/3rd of the caloric requirements of the
child
4)Physical and recreational activities
Physical activities and recreational activities in the school promote
musculoskeletal development inculcate team-spirit and help release physical and
mental stress. This helps to achieve optimal health and promote growth and
development.
5)Promotion of mental health
Wholesome mental health and behavior of the child is making sound
adjustmen with overall environment around him/her in the school and with the
studies expected. Maladjustment may lead to untoward behavior such as
truancy,juvenile delinquency, drug addiction etc.

6)Health education
Health education creates awareness, makes them regarding health matter;
develops motivation and promotes change in health behavior and health attitudes in
them. It consists of areas including personal hygiene, environmental health,
nutrition, prevention and control of communicable and non-communicable
diseases.
7)Immunization
Immunization of children against specific communicable diseases is
necessary to prevent the occurrence of diseases like tuberculosis, diphtheria,
tetanus, measles and polio. Immunization schedule is complete by the time the
child is 5-6 years old. A proper record of immunization should be maintained as
part of comprehensive health record which should be handed over to the child at
the time of leaving school
2) Therapeutic Services
1) Health appraisal Regular periodical appraisal of health of
school children is very necessary to identify the deviation from
normal body parts and systems. It requires complete physical
and medical check-ups. Initial appraisal should be done at the
time of entry of the child which includes history taking,
physical and medical examination. Physical examination
includes observation of child from head to toe, measurement of
height, weight, arm and chest circumference. Testing of
vision,hearing and speech,observations such as vital signs as
pulse, respiratory rate and temperature. A routine examination
of blood, urine and stool should be carried out. Screening for
tuberculosis should be done at the tuberculosis clinic A
minimum of three health check-ups need to be carried out at
i)on school entry at the age of 5-6yrs ii)on passing out from
primary school at the age of 10-11 years. iii)on passing out
from middle school at the age of 13-14 years

2 Treatment and follow-up

*Treatment and follow-up of children who are found to have
any illness or defect is essential for their cure. *It is therefore
very important to have such arrangements exclusively for
children in the rural area specifically at the primary health
centers. First aid and emergency care *The school should make
arrangements for providing first-aid and emergency care to
children who get injured and sick at school. *Teachers who are
available at the spot can provide such care. Specialized health
care services *School children often suffer from problems like
dental carries,periodontal diseases;eye problems like defective
vision,squint, eye infection.
3) Rehabilitative services
Rehabilitative services are required for those candidates who
are born with or and acquire any disability or handicap due to
road accident/infection some serious diseases, burns, injury etc.
Children with special disabilities like autism, blindness,
deafness should be trained in special institutions for
rehabilitation.
4) School health Records
It is essential to maintain complete, accurate and continuous
records of school children. Such health records are very useful
in monitoring the health status of the children They are used for
i) identification and personal aspect ii) findings of physical and
medical examination iii) findings of physical and medical
examination iv) findings of routine examination and screening
v) services rendered and the progress School health Team
The concept of school health team has evolved with generalized
family and community services. The services to the children in

school is in continuation of the services which are rendered to

age of under five children. It consists of the several members
like:

1.The School Principal

2) The School Teacher
3) The Parents
4) The Community
5) The Children
6) The Medical Officer
7) The School Health Nurse

Occupational health
Define occupational health
The promotion and maintenance of the highest degree of physical, mental and
social well-being of workers in all occupations" .
Health promotion of workers
Prevention of occupational diseases
Roles and responsibilities of occupational health nurse
Administration of occupational health services
International organizations

 Women and occupational health

Child labour and prevention
Values at workplace

HEALTH PROMOTION OF WORKERS

Recommendations by ILO / WHO committee on occupational health in 1953
HEALTH PROMOTION OF WORKERS
Nutrition
Communicable disease control
Environmental sanitation
Mental health
Measures for women and children
Health education
Family planning
COMMUNICABLE DISEASE CONTROL
Early diagnosis
Cases isolated from working environment
Protective measures
Regular Medical checkup & Immunisation
TB,Typhoid,hepatitis,malaria, venereal diseases

ENVIRONMENTAL SANITATION
Water supply
Food
Toilet
General cleanliness
Space
Lighting
Ventillation/Temperature
Protection from hazards
Housing
MENTAL HEALTH
Promote health and happiness
Detect signs of emotional stress
Identify the cause
Treatment
Rehabilitation of the ill
MEASURES FOR WOMEN &CHILDREN
Maternity leave for 12 weeks with cash benefit under ESI act
Ante/Intra/Postnatal services
Prohibition of night work

 Prohibits of work underground

Crches
No child below 14 shall be employed
Health education
Important health promotional measure
Provided whenever necessary
Content
Hygiene, participation
At all levels
Management
Supervisors
Workers
Trade union leaders
Family planning
Encouraged to adopt small family norm
Health education
Prevention of occupational diseases
Medical measures
Engineering measures
Legislative measures

Medical measures
Pre placement examination
Periodical examination
Medical & health care service
Notification
Supervision of working environment
Maintenance & analysis of records
Health education & counseling
Engineering measures
Design of building
Good housekeeping
General ventilation
Mechanization
Substitution
Dusts
Enclosure
Isolation
Local exhaust ventilation
Protective devices
Research

 Statistical monitoring
Environmental monitoring
LEGISLATIVE MEASURES
The Factories Act, 1948
The Employees State Insurance Act, 1948
Mine & Mineral Act, (Development & Regulation) Act, 1957
Noise Pollution (Regulation & Control ) Rules, 2000
The Child Labour (Prohibition & Regulation) Act, 1986
The Air (Prevention & Control of Pollution ) Act, 1981
Maternity Benefit Act (1961)
Minimum wages Act
THE FACTORIES ACT, 1948
Factories act enacted in 1881
The act amended in 1911, 1934, 1948, 1976, 1987
Factory: establishment employing 10 or more workers where power is used,
and 20 or more workers where power is not used.
Prescribed working hours, holidays and employment of young men and
women.
Prohibits employment of children under 14 years
Adolescents should be duly certified by certifying surgeons regarding fitness
to work

THE FACTORIES ACT, 1948

Chapter III (Section 11-20) deals with health aspects
Chapter IV (Section 21-40) deals with safety aspects
Chapter V deals with welfare aspects
Chapter VI deals with work hours holidays interval
Chapter VII deals with employment of young person
The Employees State Insurance Act, 1948

Provides cash and medical benefits to industrial employees in case of

sickness, maternity and employment injury.

Administration by ESI Corporation

The Union minister for labour :chairman Secretary Ministry of labour : vice
chairman
4 principal officers
Insurance commissioner
Medical commissioner
Finance commissioner
Actuary
The Employees State Insurance Act, 1948
Benefits to employees
Medical benefit

 Sickness benefit
Maternity benefit
Disablement benefit
Dependent benefit
Funeral expense
Rehabilitation allowance
Benefits to employers
Exemption from the applicability of Workmen's Compensation Act
1923
Exemption from Maternity Benefit Act 1961
Exemption from payment of Medical allowance to employees and
their dependants or arranging for their medical care
Rebate under the Income Tax Act on contribution deposited in the ESI
Account
Healthy work-force.

The Child Labour (Prohibition & Regulation) Act, 1986

Child (under 14 years) labour is prohibited in India under The Child

Labour (Prohibition And Regulation) Act, 1986.

It includes work in a shop, commercial establishment, work-shop, farm,

residential hotel, restaurant, eating-house, theatre or other place of public
amusement or entertainment

ROLES AND RESPOSIBILITIES OF OCCUPATIONAL HEALTH NURSESE

Prevention of occupational injury and disease
Promotion of health and work ability
Improving environmental health management
ROLES AND RESPONSIBILITIES OF OCCUPATIONAL HEALTH NURSE
Clinician
Specialist
Manager
Coordinator
Adviser
Health educator
Counselor
Researcher

ADMINISTRATION OF OCCUPATIONAL HEALTH SERVICES

CENTRAL LEVEL
STATE LEVEL
VOLUNTARY ORGANIZATIONS

CENTRAL LEVEL
The director general for factory inspection and advisory services
The government departments of labour and health and the Board of
mines
The atomic energy commission
Central labour institute at Mumbai and regional labour institutes in
Kanpur, Kolkata and Chennai.

STATE LEVEL
No occupational health division in state health directorate except Uttar
Pradesh
State responsibilities are vested in Chief inspector of factories
VOLUNTARY ORGANIZATIONS
Tata institute of industrial hygiene
Society of Industrial Medicine.

 Also certain political association work for the welfare of workers like,

INTERNATIONAL ORGANIZATIONS

The International Labour Organization

Canadian Centre for Occupational Health and Safety (Canada)
Congressional Office of Compliance (US)
European Agency for Safety and Health at Work (EU)
Government & Educational OHS Resources (Australia)
Health and Safety Executive (UK)
Health for Work Adviceline for small businesses (UK)
Information Center of Occupational Safety and Health (Israel)
Workplace Safety & Health Council, Singapore

The International Labour Organization

The International Labour Organization is a specialized agency in

relationship with the United Nations,
Comprises the International Labour Conference, the Governing Body, and
the International Labour Office.

 Conference meets annually, is composed of national representatives of

government, management, and labour
Principal function is to formulate international labour standards in the form
of Conventions and of Recommendations. It may also record its decisions in
the form of resolutions which is accepted by member countries
WELFARE ORGANISATION OF EMPLOYEES
Indian National Trade Union Congress (INTUC)
Centre of Indian trade unions (CITU)
WOMEN AND OCCUPATIONAL HEALTH
Women's jobs have specific characteristics
Equipment and schedules designed in relation to the average male body
Low wages
Sexual harassment at work place
Discrimination against women
Excluded from many health-promoting benefits
Increased responsibility on household works
The laws of labour are male oriented
Global Commission Report

Issues should be examined within the context of gender specific analyses

identify the specific occupational health risks of particular industries,

 Women's work in the informal sector, in agriculture and in the home has to
be conceptualized and measured
specific occupational health risks of women are to be addressed.
studies to identify and assess occupational health risks should be extended.
Legislation addressing women's occupational health needs should be
reassessed
International agreement about the classification of reproductive hazards
(such as chemicals) and on the precautions needed to protect both men and
women from those hazards, should be developed.
collaboration on the part of the various international agencies concerned,
such as WHO and ILO.
Interdisciplinary research with a strong social science component.
VALUES AT WORKPLACE
Characteristics of people at a work place
Different genders
Diverse ethnic, racial and cultural backgrounds
Different ages and experiences
Different abilities
Different religions
Different languages
Different family structures
Different educational backgrounds

 Different work and life experiences

VALUES AT WORKPLACE
1. Believe in yourself and your values.
2. Know your rights as well as duties
3. Be responsible, sincere and honest in your work.
4. Be acknowledgeable to superiors and kind towards subordinates.
5. Dont compromise justice
6. Be a learner.
7. Be an advocate for others when situation calls.
8. Be sensitive to the impact you have on others.
9. Respect others dignity, values , beliefs and feelings.
10.Communicate honestly.
11.Never harass or accept the harassment of others.
12.Confront prejudices and stereotypes that demean or exclude people
13.Accept our mistakes and dont blame it on others.
14.Excuse others mistake, all are humans
UNIT 4
APPROACHES OF COMMUNITY HEALTH NURSING
NURSING THEORIES IN COMMUNITY HEALTH NURSING.

NURSING PROCESS
The nursing process is a modified scientific method.[1] Nursing practise was first
described as a four stage nursing process by Ida Jean Orlando in 1958,[2]. It should
not be confused with nursing theories or Health informatics. The diagnosis phase
was added later.
The nursing process uses clinical judgement to strike a balance
of Epistomology between personal interpretation and research evidence in
which critical thinking may play a part to categorize the clients issue and course of
action. Nursing offers diverse patterns of knowing.

Phases of the nursing process

The nursing process is goal-oriented method of caring that provides a framework
to nursing care. It involves five major steps:
A - Assess (what data is collected?)
D - Diagnose (what is the patients problem)
P - Plan (how to manage the problem)
I - Implement (putting plan into action)
E - Evaluate (did the plan work?)
Assessing phase
The nurse completes an holistic nursing assessment of the needs of the
individual/family/community, regardless of the reason for the encounter. The nurse
collects subjective data and objective datausing a nursing framework, such as
Marjory Gordon's functional health patterns.
Models for data collection

Nursing assessments provide the starting point for determining nursing diagnoses.
It is vital that a recognized nursing assessment framework is used in practice to
identify the patients* problems, risks and outcomes for enhancing health. The use
of an evidence-based nursing framework such as Gordons Functional Health
Pattern Assessment should guide assessments that support nurses in determination
of NANDA-I nursing diagnoses. For accurate determination of nursing diagnoses,
a useful, evidence-based assessment framework is best practice.

How to collect data

Client Interview
Physical Examination
Obtaining a health history (including dietary data)
Family history/report
Diagnostic Data
Observation
Diagnosing phase
Nursing diagnoses represent the nurse's clinical judgment about actual or potential
health problems/life process occurring with the individual, family, group or
community. The accuracy of the nursing diagnosis is validated when a nurse is able
to clearly identify and link to the defining characteristics, related factors and/or risk
factors found within the patients assessment. Multiple nursing diagnoses may be
made for one client.
Characteristics of the nursing process
The nursing process is a cyclical and ongoing process that can end at any stage if
the problem is solved. The nursing process exists for every problem that the

individual/family/community has. The nursing process not only focuses on ways to

improve physical needs, but also on social and emotional needs as well.

Cyclic and dynamic

Goal directed and client centered
Interpersonal and collaborative
Universally applicable
Systematic[7]
The entire process is recorded or documented in order to inform all members of the
health care team.

NURSING THEORIES
A nursing theory is a conceptualization of some aspects pf nursing
communicated for the purpose of describing,explaining,predicting,&
or prescribing nursing care
PEPLAUS THEORY(1952)
Hilgegard Peplau focuses on the individual,the nuirse & interactive
processes;the result is the nurse patient relationship.For e.g the when
the client seeks help ,the nurse & the client discusses the nature of the
problem & the nurse explains the services available.As the clientnurse relationship develops,the nurse & the client mutually defines the
problem & potienal solutions.
HENDERSONS THEORY(1955)

Virgina hinderson defines nursing as assisting individual,sick or

well,in performance of those activities that will contribute to
health,recovery,or a peaceful death & that the individual would
perform unaided if he or she had necessary strength,will or
knowledge.According to this theory nurses help the client to perform
his basic needs.
ABDELLAHS THEORY(1960)
The theory was developed by Faye Abdellah & others emphasizes
delivering nursing care for the whole person to meet
physical,emotional,intellectual,social,& spiritual needs of the client &
family.

ROGERSS THEORY(1970)
Martha Rogers considered individual (unitary human being) as an
energy field coexisting within the universe.
OREMS THEORY(1971)
This is self care deficit theory.Nursing care becomes necessary when
client is unable to fulfill biological,psychological,developmental or
social needs.
KINGS THEORY(1971)
Nursing theory is defined as dynamic interpersonal process between
the nurse, patient & health care system.The goal of nursing is to use
communication to assist client in restablishing or maintaining a
positive adaptation to the environment.
NEUMANS THEORY(1972)

Stress reduction is goal of systems model of nursing practice.nursing

actions are in primary,secondary & tertiary level of prevention.
LEININGERS THEORY(1978)
Leiningers cultural care diversity & universality theory states that
care is the essence of nursing & dominant,distinctive &unifying
feature of nursing.To provide care to clients of unique cultures the
nurse selects interventions from one of the following:a)culture care preservation & maintainance
b)culture care accommodation &negociation or both
c)cuture care restructuring & repatterning
ROYS
THEORY(1979)
Sister Callister Roys adaptative system.According to this theory the
goal of nursing is to help the person adapt to changes in physiological
needs,self concept,role function & interdependence relations during
health & illness.The need for nursing arises when the client cannot
adapt to internal or external environment.
WATSONS THEORY(1979)
This theory involves philosophy & science of caring;is interpersonal
process comprising interventions that result in meeting human
needs.In addition,the nurse comforts & offers compassion & empathy
to clients & families.
BENNER & WRUBELS THEORY(1989)
This theory states caring is central to the essence of nursing.Caring
creates of coping & enables possibilities for connecting with &
concern for others

APPROACHES IN COMMUNITY HEALTH NURSING

EPIDEMIOLOGICAL APPROACHES
Epidemiological analysis & measurement allow reaearchers to measure health
status & measurement of disease occurences in a population.Surviellance of
disease yields epidemiological intelligence data by providing systematic count of
disease frequency. these data can be in turn used to estimate the magnitude of
health problems in the community,detect epidemics & understand natural history of
a disease or detect potienal emerging
infectious disease threats.
EVIDENCE BASED PRACTICE
Evidence-based practice (EBP) "entails making decisions about how to promote
health or provide care by integrating the best available evidence with practitioner
expertise and other resources, and with the characteristics, state, needs, values and
preferences of those who will be affected. This is done in a manner that is
compatible with the environmental and organizational context. Evidence is
comprised of research findings derived from the systematic collection of data
through observation and experiment and the formulation of questions and testing of
hypotheses
PROBLEM SOLVING APPROACH
Community health is a problem solving process and a team approach is very
necessary to deal with varied and complex health needs & problems at large. It
is just not possible for any one profession or discipline to provide such care.
community health nursing is one of the professions & community health nurses
along with auxiliary nurses and female health supervisors help to meet nursing

needs of the community as a whole. other members of the team who are usually
there include physicians, clinical specialists, public health engineers, health
statistians, epidemiologists, health educationalists, counselors, social workers,
clinical psychologists, pharmacologists, lab technicians, village health
workers..community health nurses working in the community health settings
needs to identify the health teams and their roles, functions and team dynamics
so as to participate effectively in providing compressive health care services to
people in the community & accomplish community health goals and aims.
Community empowerment refers to the process of enabling communities to
increase control over their lives. "Communities" are groups of people that may
or may not be spatially connected, but who share common interests, concerns or
identities. These communities could be local, national or international, with
specific or broad interests. 'Empowerment' refers to the process by which people
gain control over the factors and decisions that shape their lives. It is the process
by which they increase their assets and attributes and build capacities to gain
access, partners, networks and/or a voice, in order to gain control. "Enabling"
implies that people cannot "be empowered" by others; they can only empower
themselves by acquiring more of power's different forms (Laverack, 2008). It
assumes that people are their own assets, and the role of the external agent is to
catalyse, facilitate or "accompany" the community in acquiring power.
Community empowerment, therefore, is more than the involvement,
participation or engagement of communities. It implies community ownership
and action that explicitly aims at social and political change. Community
empowerment is a process of re-negotiating power in order to gain more control.
It recognizes that if some people are going to be empowered, then others will be
sharing their existing power and giving some of it up (Baum, 2008). Power is a
central concept in community empowerment and health promotion invariably
operates within the arena of a power struggle.
Community empowerment necessarily addresses the social, cultural, political
and economic determinants that underpin health, and seeks to build partnerships
with other sectors in finding solutions.
Globalization adds another dimension to the process of community
empowerment. In todays world, the local and global are inextricably linked.
Action on one cannot ignore the influence of or impact on the other. Community
empowerment recognizes and strategically acts upon this inter-linkage and
ensures that power is shared at both local and global levels.

Communication plays a vital role in ensuring community

Participatory approaches in communication that encourage
debate result in increased knowledge and awareness, and a
critical thinking. Critical thinking enables communities to
interplay of forces operating on their lives, and helps them
decisions.

empowerment.
discussion and
higher level of
understand the
take their own

This track of the conference will focus on the conceptual and practical issues in
building empowered communities. Through examples and case studies it will
analyse how successful partnerships with communities can be forged even in the
environment of vertical health programming. It will examine how empowerment
oriented health promotion can be practiced both in local and global settings.

DISCUSS THE CONCEPTS OF PRIMARY HEALTH CARE

EQUITABLE DISTRIBUTION OF HEALTH CARE
According to this principle, primary care and other services to meet the
main health problems in a community must be provided equally to all individuals
irrespective of their gender, age, caste, color, urban/rural location and social class.
COMMUNITY PARTICIPATION
Effective health promotion practice places people at the heart of all
activities. Health promotion needs to be carried outby people and with people,
rather than on people or topeople. This requires us to engage with communities in
ways that allow people to have ownership of and involvement in all stages of
health promotion activities.
Community participation is also known as community engagement or community
action.

There are four different levels of community engagement and it's important to be
honest with communities about which level is being applied at any one time.
The most basic level is to provide information to individuals or the community
about decisions and activities underway this is a one-way flow of information.
This may involve communication in the form of fact sheets, websites and
information kits. The second level is to consult with individuals and the
community and get feedback on the proposed activities. This is a limited two-way
communication flow; however, it can be used effectively when community input is
required to influence a decision on a preferred option. This level may involve
communication in the form of focus groups, public submissions or comments and
surveys.
The third level of engagement is involvement; by working with the community to
explore issues it may be possible to progress discussions to policy development
and program responses. This level can be used when community issues are more
complex. Examples of community engagement at this level include working
groups, committees and workshops involving community members.
The fourth and highest level of engagement is collaboration, where there is a
partnership with the community. This level is used where there is a substantial
timeframe involved and there is a chance to set the agenda together. Examples of
engagement at this level include strategic advisory boards and committees. At this
level of engagement the community can define their own goals and contribute to
decision-making to address a collective health issue.
An engaged and empowered community is one in which individuals and
organisations apply their skills and resources to gain increased influence over the
determinants of health, address health priorities and meet their respective health
needs.
Effective community participation needs a good understanding of our communities
or the groups and individuals we work with. We need to get to know their needs,
priorities, capacity and any barriers to taking action before launching into any
interventions.

Community participation also requires skills that recognise we don't all have the
same life experiences. Enabling, mediating and advocacy, the ability to listen,
empathise and respond are important for effective community participation.
Practitioners can find more information on how to decide on the appropriate level
of engagement to use and ideas for different types of engagement techniques in the
Department of Health and Human Services Your Care Your Sayresources.
The National Safety and Quality Health Service Standards, and
FOCUS ON PREVENTION
Preventative health care has become an increasingly popular area of the
health care sector. Using a variety of methods to educate populations and avoid
illnesses, this type of health care works to improve the overall wellness of
Americans. Preventative health care informs populations, promotes healthy
lifestyles and provides early treatment for illnesses. In the industry, the emergence
of health care reform and an increased number of individuals suffering from
chronic conditions has led to an amplified role for nurses in disease prevention.
Appropriate Technology
Appropriate Technology for Primary Health Care is the proceedings
of the national workshop on Appropriate Technology for Primary Health Care held
at the Indian Council of Medical Research (ICMR) New Delhi from 23-26 April.
Appropriate technology has been comprehended as a combination of social
imagination and technology innovation and simply, any technology that makes the
most economical use of the country's natural resources and its relative proportion
of capital labour and skills that contribute to national and social goals. Where
Machinery and/or equipment is involved, it should be simple to run and repair. It
should be locally produced as far as possible. It does not require any great depth of
understanding to apply these general precepts to the field of health- and from there
to the area of primary health care.

Multi-sectional approach recognition that health cannot be improved by

intervention within just the formal health sector; other sectors are equally
important in promoting the health and self-reliance of communities. These
sectors include, at least: agriculture (e.g. food security); education;

communication (e.g. concerning prevailing health problems and the methods of

preventing and controlling them); housing; public works (e.g. ensuring an
adequate supply of safe water and basic sanitation); rural development;
industry;
community
organizations
(including Panchayats or local
governments, voluntary organizations, etc.).
Roles and responsibility of nurses in Information Education Communication.
INFORMATION EDUCATION AND COMMUNICATION
Information:
Facts about situation, persons, and events are called as information.
Health information:
It is an integral part of the national health system. It is a basic tool of management
and a key input for the progress of any society.
Health information system:
A mechanism for the collection, processing, analysis and transmission of
information required for organizing and operating health services and also for
research and training.
Objectives:
(1) To provide reliable, relevant, up-to-date, adequate, timely and reasonably
complete
information for health managers at all levels (central, intermediate and local)
(2) To provide at periodic intervals, data that will show the general performance of
the
health services.
(3) To assist planners in studying their current functioning and trends in demand
and workload.
Information and its requirements:
A WHO Expert Committee identified the following requirements to be satisfied by
the health information system.
(1) The system should be population based.
(2) The system should avoid the unnecessary agglomeration of data.
(3) The system should be problem oriented.

(4) The system should employ functional and operational terms (e.g. episode of
illness, treatment regimens, laboratory test)
(5) The system should express information briefly and imaginatively
(6) The system should make provision for the feed-back of data.
Components of health information system: The health information system is
composed of several related subsystem. A comprehensive health information
system requires information and indicators on the following subjects:
(1) Demography and vital events
(2) Environmental health statistics
(3) Health status: mortality, morbidity, disability and quality of life
(4) Health resources: facilities, beds, manpower
(5) Utilization and non-utilization of health services: attendance, admission,
waiting list
(6) Indices of outcome of medical care
(7) Financial statistics related to the particular objective
Uses of health information:
The important uses to which health information may be applied are:
(1) To measure the health status of the people and to quantify their health problems
and
Medical and health care needs.
(2) For local, national and international comparison of health status
(3) For planning, administration and management of health services and
programmes
(4) For assessing whether health services are accomplishing their objectives in
terms of
Their effectiveness and efficiency
(5) For assessing the attitude and degree of satisfaction of the beneficiary with the
health
system
(6) For research into particular problems of health and disease

Management information system:

Management information system means a formal system that provides timely and
necessary information to the manager for making decisions.
Health management information system:
It is a part of Management information system which is a formal system that
supplies timely and necessary information to the health planners through
surveillance for monitoring and making decisions in the area of health care
delivery system.
Surveillance:
Surveillance is an integral part of the Management information system. One of the
modules of the child survival and safe motherhood programme states: An
effective surveillance system is essential to achieve the goals as reliable
epidemiological data are necessary for effective planning, monitoring the quality
services and documentation of impact
Importance of surveillance:
The data generated through surveillance are important in planning health services
because they are:
(1) Highlight the magnitude of an illness as a public health problem.
(2) Help in planning appropriate program me interventions based on
epidemiological data.
(3) Monitor the quality of community and institutional health services being
rendered.
(4) Estimate programme needs for drugs(in terms of the countrys national policy)
(5) Document impact of health services, reduction in mortality and morbidity rates,
declining trends of diseases, prevention of cases, complication and death etc.
Types of surveillance:
Surveillance is of two types
(1) Active
(2) Passive
(1) Active surveillance

This type of surveillance, where active participation of the concerned personnel

come into play is known as active surveillance.
Eg. Collecting information on fever cases and blood slides for detection of malaria.
(2) Passive surveillance:
Passive surveillance on the contrary is that type of surveillance, where health data
are available from hospital and other health facilities, where consumers come on
their own seeking necessary health related interventions.
Health education
Definition
Health education is a process that informs motivates and helps people to adopt
and maintain healthy practices and lifestyles, advocates environmental changes as
needed to facilitate this goal and conducts, professional training and research to the
same end
Objectives of health education
(a) Informing people:
The first objective of health education is to inform people or disseminate scientific
knowledge about prevention of disease and promotion of health. Exposure to
knowledge will melt away the barriers of ignorance, prejudices and
misconceptions, people may have about health and disease.
(b) Motivating people:
The second objective is more important than the first. Simply telling people about
health is not enough. They must be motivated to change their habits and ways of
living, since many present day problems of community health require alteration of
human behavior

changes in the health practices which are detrimental to health, viz. pollution of
water, out-door defecation, indulgence in alcohol, cigarette smoking, drug
addiction, physical inactivity, family planning, etc.
(c) Guiding into action:
Under the above definition, health education can and should be conducted by a
variety of health, education and communication personnel, in a variety of settings,
starting with the physician. People need help to adopt and maintain healthy
practices and life-styles, which may be totally new to them.
Describe the approaches to public health
There are three well known approaches to public health:
(1) REGULATORY APPROACH:
The regulatory or legal approach seeks to protect the health of the public through
the enforcement of laws and regulations, e.g., Epidemic diseases Act, Food
Adulteration Act, etc. The best laws are but waste of paper if they are not
appreciated and understood by the people(4). They may be useful in times of
emergency or in limited situations, e.g., fairs, festivals and epidemics; but they are
not likely to change human behavior. In areas involving personal choice (e.g.,
giving up smoking, family planning) laws have little place in a democratic society.
The legal approach has also the disadvantage that it requires vast administrative
machinery to enforce laws and also involves considerable expenditure.
(2) SERVICE APPROACH:
The service or administrative approach aims at providing all the health facilities
needed by the community in the hope that people would use them to improve their
own health. The service approach proved a failure when it was not based on the
felt needs of the people. For example, when water seal latrines were provided,
free of cost, in some villages in India under the Community Development
Programme, people did not use them. This serves to illustrate that we may provide
free service to the people, but there is no guarantee that the service will be used by
them.

(3) EDUCATIONAL APPROACH:

The educational approach is a major means today for achieving change in health
practices and the recognition of health needs; It involves motivation,
communication and decision-making. The results, although slow, are permanent
and enduring. Sufficient time should be allowed to have the desired change
brought about. There are certain problems which can be solved only through
education, e.g., nutritional problems, infant and child care, personal hygiene,
family planning. The educational approach is used widely today in the solution of
community health problems. It is consistent with democratic philosophy which
does not order the individual..
Principles of health education
(1) INTEREST:
It is a psychological principle that people are unlikely to listen to those things
which are not to their interest. It is salutary to remind ourselves that health teaching
should relate to the interests of the people. The public is not interested in health
slogans such as Take care of your health or be healthy. A health education
programme of this kind would be as useless as asking people to be healthy, as a
nutrition programme asking people to eat good food. Health educators must find
out the real health needs of the people. Psychologists call them felt-needs, that
is needs the people feel about themselves. If a health programme is based on felt
needs people will gladly participate in the programme; and only then it will be a
peoples programme. Very often, there are groups, who may have health needs of
which they are not aware. This is especially true in India where about 70 per cent
of the people are illiterate. The health educator will have to bring about recognition
of the needs before he proceeds to tackle them.
(2) PARTICIPATION:
It is a key word in health education. Participation is based on the psychological
principle of active learning; it is better than passive learning. Group discussion,
panel

discussion, workshop all provides opportunities for active learning. Personal

involvement is more likely to lead to personal acceptance.
(3) KNOWN TO UNKNOWN:
In health education work, we proceed from the known to the unknown i.e., start
where the people are and with what they understand and then proceed to new
knowledge. We use the existing knowledge of the people as pegs on which to hang
new knowledge. In this way systematic knowledge is built up. New knowledge
will bring about a new, enlarged understanding which can give rise to an insight
into the problem. The way in which medicine has developed from religion to
modern medicine serves us as an illustration, the growth of knowledge from the
unknown to the known. It is a long process full of obstacles and resistance, and we
must not expect quick results.
(4) COMPREHENSION:
In health education we must know the level of understanding, education and
literacy of people to whom the teaching is directed. One barrier to communication
is using words which cannot be understood. A doctor asked the diabetic to cut
down starchy foods; the patient had no idea of starchy foods. A doctor prescribed
medicine in the familiar jargon one teaspoonful three times a day; the patient, a
village woman, had never seen a teaspoon, and could not follow the doctor s
directions. In health education, we should always communicate in the language
people understand, and never use works which are strange and new to the people.
Teaching should be within the mental capacity of the audience.
(5) REINFORCEMENT:
Few people can learn all that is new in a single contact. Repetition at intervals is
extremely useful. It assists comprehension and understanding. Every health
campaign needs reinforcement; we may call it a booster dose.

(6) MOTIVATION:

In every person, there is a fundamental desire to learn. Awakening this desire is

called motivation. There are two types of motives primary and secondary.
Primary motives (e.g., sex, hunger, survival) are driving forces initiating people
into action; these motives are inborn desires. Secondary motives are based on
desires created by outside forces or incentives. Some of the secondary motives are
praise, love, rivalry, rewards and punishment, and recognition. In health education,
motivation is an important factor; that is, the need for incentives is a first step in
learning to change. The incentives may be positive or negative. To tell a lady, faced
with the problem of overweight, to reduce her weight because she might develop
cardiovascular disease or it might reduce her life span, may have little effect; but to
tell her that by reducing her weight she might look more charming and beautiful,
she might accept health advice. When a father promises his child a reward for
getting up early every day, he is motivating the child to inculcate a good habit. In
health education, we make use of motivation.
(7) LEARNING BY DOING:
Learning is an action-process; not a memorizing one in the narrow sense. The
Chinese proverb: If I hear, I forget; if I see, I remember, if I do, I know illustrates
the importance of learning by doing.
(8) SOIL, SEED AND SOWER:
The people are the soil, the health facts the seed and the transmitting media the
sower. Prior knowledge of the people-customs, habits, taboos, beliefs, health
needs- is essential for successful health education. The seed or the health facts
must be truthful and based on scientific knowledge. The transmitting media must
be attractive, palatable and acceptable. Unless these three elements are carefully
and satisfactorily interrelated the message will not have the desired effect.
(10) SETTING AN EXAMPLE:
The health educator should set a good example in the things he is teaching
If he is explaining the hazards of smoking, he will not be very successful if he
himself smokes.

If he is talking about the Small family norm, he will not get very far if his own
family size is big.
(11) GOOD HUMAN RELATIONS:
Studies have shown that friendliness and good personal qualities of the health
educator are more important than his technical qualifications. Good human
relations are of utmost importance in learning. The health educator must be kind
and sympathetic. People must accept him as their real friend.
(12) LEADERS:
Psychologists have shown and established that we learn best from people whom
we respect and regard. In the work of health education, we try to penetrate the
community through the local leaders-the village headman, the school teacher or the
political worker. Leaders are agents of change and they can be made use of in
health education work. If the leaders are convinced first about a given programme,
the rest of the task of implementing the programme will be easy. The attributes of a
leader are: he understands the needs and demands of the community; provides
proper guidance, takes the initiative, is receptive to the views and suggestions of
the people; identifies himself with the community; self-less, honest, impartial,
considerate and sincere; easily accessible to the people; able to control and
compromise the various factions in the community; possesses the requisite skill
and knowledge of eliciting cooperation and achieving coordination of the various
official and non-official organizations.
METHODS OF HEALTH EDUCATION
Health education is carried out at three main levels individual, group and general
public through mass media of communication. For effecting changes in attitudes
and behaviors, we rely on individual and group approach.
(1) Individual and family health education
There are plenty of opportunities for individual health education. It may be given
in personal interviews in the consultation room of the doctor or in the health center
or in 10

the homes of the people. The individual comes to the doctor or health center
because of illness. Opportunity is taken in educating him on matters of interest
diet, causation and nature of illness and its prevention, personal hygiene,
environmental hygiene, etc. Topics for health counseling may be selected
according to the relevance of the situation. By such individual health teaching, we
will be equipping the individual ad the family to deal more effectively with the
health problems. The responsibility of the attending physician in this regard, is
very great because he has the confidence of the patient. The patient will listen more
readily to the physicians health counseling. A hint from the doctor may have a
more lasting effect than volumes of printed word. The nursing staff has also ample
opportunities for undertaking health education. Florence Nightingale said that the
nurse can do more good in the home than in the hospital. Public health nurses,
health visitors and health inspectors are visiting hundreds of homes; they have
plenty of opportunities for individual health teaching. In working with individuals,
the health educator must first create an atmosphere of friendship and allow the
individual to talk as much as possible. It is useful to remember; Give everyone
thing ear, but few thy words. The biggest advantage of individual health teaching
is that we can discuss, argue and persuade the individual to change his behavior. It
provides opportunities to ask questions in terms of specific interests. The limitation
of individual health teaching is that the numbers we reach are small, and health
education is given only to those who come in contact with us.
(2) Group health education
Our society contains groups of many kinds school children, mothers, industrial
workers, patients, etc. Group teaching is an effective way of educating the
community. The choice of subject in group health teaching is very important; it
must relate directly to the interest of the group. For example, we should not broach
the subject of tuberculosis control to a mother who has come for delivery; we
should talk to her about child-birth and baby care. Similarly, school children may
be taught about oral hygiene; tuberculosis patients about tuberculosis, and
industrial workers about accidents. We have to select also the suitable method of
health education including audio-visual aids for successful group health education.
A brief account of the methods of group teaching is given below:

(1) Lectures:
Lectures are the most widely used method of teaching, including health education.
It is not a good method because communication mostly one-way. There is no
opportunity for the group to participate actively in learning. The lecture should be
on a topic of current health interest, based on the needs of the group; it should not
exceed 15 to 20 minutes; the subject matter should not deal with more than 5 or 6
points; the group should not be more than 30. The effect of the lecture depends
upon the personality and performance of the speaker. Lecture may arouse interest
in a subject. It may stimulate a group and give them basic information upon which
to act.
Used alone, the lecture method may fail to influence the health behaviour of
people. The lecture method can be made effective by combining with the following
audio-visual aids.
(a) Films and charts:
These are mass media of communication. If used with discrimination, they can be
of value in educating small groups.
(b) Flannel graphs:
A piece of rough flannel or khaki fixed over a wooden board provides an excellent
background for displaying cut-out pictures, graphs, drawings and other
illustrations. The cut-out pictures and other illustrations are provided with a rough
surface at the back by pasting pieces of sand paper, felt or rough cloth and they
adhere at once when put on the flannel. Flannel graph offers the advantage that
pre-arranged sequence of pictures displayed one after another helps maintain
continuity and adds much to the presentation. The other advantages are that the
flannel graph is a very cheap medium easy to transport and promotes thought and
criticism.
(c) Exhibits:
Objects, models, specimens, etc. convey a specific message to the viewer. They are
essentially mass media of communication, which can also be used in group
teaching.

(d) Flash Cards:

They consist of a series of cards, approximately 10 by 12 inches, each with an
illustration pertaining to the story or talk to be given. Each card is flashed or
displayed before a group as the talk is being given. The message on the cards must
be brief and to the point. Flash cards are primarily designed to hold the attention of
the group.
(2) Group discussions:
Group discussion is considered a very effective method of health teaching. It is a
two way communication; people learn by exchanging their views and
experiences. This method is useful when the groups have common interests and
similar problems. For an effective group discussion, the group should comprise not
less than 6 and not more than 20 people. There should be a group leader who
initiates the subject, helps the discussion in the proper manner, prevents sideconversations, encourages everyone to participate and sums up the discussion in
the end. If the discussion goes well, the group may arrive at decisions which no
individual member would have been able to make alone. It is also desirable to have
a person to record whatever is discussed. The recorder prepares a report on the
issues discussed and agreements reached. In a group discussion, the members
should observe the following rules: (a) express ideas clearly and concisely (b)
listen to what others say (c) do not interrupt when others are speaking (d) make
only relevant remarks (e) accept criticism gratefully and (f) help to reach
conclusions (9). Group discussion is successful if the members know each other
beforehand, when they can discuss freely. There is a good deal of evidence that
group discussion is a very effective method of bringing about changes in the health
behavior of people. Further, when a group of people decide collectively to accept
an idea and act on it, the group acceptance strengthens and reinforces and gives the
individual member courage to do the same. A well conducted group discussion is
usually effective in reaching the right decisions and securing desirable action.
(3) Panel discussions:
In a panel discussion, 4 to 8 persons who are qualified to talk about the topic sit
and discuss a given problem, or the topic, in front of a large group or audience. The
pane 13

comprises, a chairman or moderator and from 4 to 8 speakers. The chairman opens

the meeting, welcomes the group and introduces the panel speakers. He introduces
the topic briefly and invites the panel speakers to present their point of view. There
is no specific agenda, no order of speaking and not set speeches (9). The success of
the pane depends upon the chairman; he has to keep the discussion going and
develop the train of thought. After the main aspects of the subject are explored by
the panel speakers, the audience is invited to take part. The discussion should be
spontaneous and natural. If members of the panel are unacquainted with this
method, they may have a preliminary meeting, prepare the material on the subject
and decide upon the method and plan of presentation. Panel discussion can be an
extremely effective method of education, provided it is properly planned and
guided.
(4) Symposium:
A symposium is a series of speeches on a selected subject. Each person or expert
presents an aspect of the subject briefly. There is no discussion among the
symposium members unlike in panel discussion. In the end, the audience may raise
questions. The chairman makes a comprehensive summary at the end of entire
session.
(5) Workshop:
The workshop is the name given to a novel experiment in education. It consists of
a series of meetings, usually four or more, with emphasis on individual work,
within the group, with the help of consultants and resource personnel. The total
workshop may be divided into small groups and each group will choose a chairman
and a recorder. The individuals work, solve a part of the problem through their
personal effort with the help of consultants, contribute to group work and group
discussion and leave the workshop with a plan of action on the problem. Learning
takes place in a friendly, happy and democratic atmosphere, under expert guidance.
The workshop provides each participant opportunities to improve his effectiveness
as a professional worker
(6) Role playing:
Role playing or sociodrama is based on the assumption that many values in a
situation cannot be expressed in words, and the communication can be more
effective if the situation.

Dramatized by the group. The group members who take part in the socidrama enact
their roles as they have observed or experienced them. The audience is not passive
but actively concerned with the drama. They are supposed to pay sympathetic
attention to what is going on, suggest alternative solutions at the request of the
leader and if requested come up and take an active part by demonstrating how they
feel a particular role should be handled, or the like. The size of the group is thought
to be best at about 25. Role playing is a useful technique to use in providing
discussion of problems of human relationship. It is a particularly useful educational
device for school children. Role playing is followed by a discussion of the
problem.
(7) Demonstrations:
Practical demonstration is an important technique of health education. We show
people how a particular thing is done using a tooth brush, bathing a child, feeding
of an infant, cooking, etc. A demonstration leaves a visual impression on the minds
of the people and is more effective than the printed word.
3. Education of the general pubic
For education of the general public, we employ mass media of communication.
These are:
(a) Television:
Television bids fair to become the most potent of all media. We can mould public
attitudes through television. Television has now become the cheapest media of
mass education.
(b) Radio:
It is found nearly in every home, and has penetrated into even the remotest
villages. It is a potent instrument of education. Radio talks should not exceed 15
minutes.

(c) Press:
Newspapers are the most widely disseminated of all forms of literature. They are
an important channel of communication to the people. The local health department
ought to establish good relationship with the local press.
(d) Health Magazines:
Some are good and some not so good. Good magazines can be an important
channel of communication. The material needs expert presentation. The Swasth
Hind from Delhi and the Herald of Health from Pune are good health magazines
published in India.
(e) Posters:
Posters are widely used for dissemination of information to the general public. The
first job of a poster is to attract attention; therefore, the material needs artistic
preparation. Motives such as humor and fear are introduced into the posters in
order to hold the attention of the public. In places where the exposure time is short
(e.g., streets), the message of the poster should be short, simple, direct and one that
can be taken at a glance and easy to understand immediately. In places where
people have some time to spend (e.g., bus stops, railway stations, hospitals, health
centers) the poster can present more information. The right amount of matter
should be put up in the right place and at the right time. That is, when there is an
epidemic of viral hepatitis, there should be posters displayed on viral jaundice, but
not on cholera. The life of a poster is usually short; posters should be changed
frequently, otherwise they will lose their effect. As a media of health education,
posters have much less effect in changing behavior than its enthusiastic users
would hope. Indiscriminate use of posters by pasting them on walls serves no other
useful purpose than covering the wall.
(f) Health exhibition:
Health exhibitions, if properly organized and published, attract are numbers of
people who might otherwise never come in contact with the variety of new ideas in
health .

matters. Small mobile exhibitions are effective if used at key points of interest,
e.g., fairs and festivals. Health exhibitions enable the local health service to arouse
public consciousness.
(g) Health museums:
Health museum display material covering various aspects of health. A good
museum can be a very effective mass media of education, such as the one at
Hyderabad in Andhra Pradesh:
Mass media are generally less effective in changing human behavior than
individual or group methods because communication is one-way. Nevertheless,
they do have quite an important value in reaching large numbers of people with
whom there is no contact. The continuous dissemination of information and views
about health through all the media contribute in no small degree to the raising of
the general level of knowledge in the community. For effective health education,
mass media should preferably not be used alone, but in combination with other
methods.
COMMUNICATION
Definition of communication:
Communication is the process of exchanging the information, and the process of
generating and transmitting meanings, between two or more individuals.
Communication process:
(1) Communicator or Sender:
Sender is the originator of the message. To be effective, a communicator must
know (a) his objectives clearly defined; (b) his audience its needs, interests and
abilities; (c) his message its content, validity and usefulness; and (d) channels of
communication.

It is the information a communicator wishes his audience to receive, understand,

accept and act upon. A good message must be (a) in line with the objectives (b)
carefully chosen, i.e., oriented to the needs of the audience (c) clear and
understandable (d) specific (e) timely and (f) appealing. The message must fit into
the existing framework of attitudes, and interests of the people.
(3) Audience or receiver:
They are the consumers of the message. The audience may be the total population
or specific group within the population.
(4) Channels of communication:
By channel is implied the medium of communication. The choice of the medium is
an important factor in the effectiveness of communication. It has to be carefully
selected bearing in mind its ability to deliver the message, its cost and availability.
An attempt should be made to provide variety in selecting channels so as to keep
the teaching process interesting and entertaining. A two-way communication is
more likely to influence behavior than one-way communication. Wherever
possible, communication should be adjusted to the local cultural patterns (folk
media) of the people.
Types of communication:
(1) One way communication:
The flow of communication is one way from the communicator to audience.
The familiar example is the lecture method in the class room.
(2) Two way communication:
Communication in which both the communicator and audience take part. The
Audience may raise question, and add their own information, ideas and opinions
to the subject.
(3) Verbal communicationis exchange of information using words, including both spoken and written
Words. Nurses use verbal communication extensively when providing patient care.
They also speak with patients family members, other nurses about patients
report. Common verbal communications in health care setup are:
1. Discussion,
2. Meetings,
3. Suggestions,

4. Advice
5. Announcements
6. Periodical talk between employer and employee,
7. Staff conferences
8. Social gatherings.
9. Employee counseling's
10. Records and reports
(4) Non-verbal communication:
Communication can occur even without words. It includes a whole range of bodily
movements, posture, gesture, facial expression (smile, raised eye brows, touch, eye
contact etc.)
(5) Visual communication:
The visual forms of communication comprise: charts and graphs, pictograms,
tables, maps, posters etc.
Barriers of communication
These can be:
1. Physiological - difficulties in hearing, expression
2. Psychological - emotional disturbances, neurosis, level of intelligence
3. Environmental - noise, invisibility, congestion
4. Cultural - levels of knowledge and understanding, customs, beliefs,
Religion, attitudes, economic and social class differences, cultural difficulties
between foreigners and nationals, between urban education and rural population.
The barriers should be identified and removed for achieving effective
communication.
HOME VISITING
The home visit:
A home visit is conducted to visit clients where they live in order to assist them in
their efforts to achieve a high level of wellness as possible (Empower).
To visit families in their home is a privilege.
-Home is a private space. (you are a stranger).
-You are the guest and they are the experts.
Work with families where they live, (streets, homeless shelter, with relatives).

Use of expert nursing skills.

- Use of non judgmental approach. -Work with families where they live,
(streets, homeless shelter, with relatives).
- Use of expert nursing skills.
- Use of non judgmental approach. Therapeutic Relationship With the Client /
Family.
AIM OF HOME VISIT
-To improve health and the quality of life (health promotion).
-Initiate and maintain relationship.
-Assessment of family (environment).

Source for data.

-Follow-up care.
(Implementation Of Nursing Process In The Home).

Advantages of home visiting.

Control over interaction.
Family accepts change (more amenable) to health education
Able to observe factors that influence family health.
Able to observe family interaction.

Allows for early intervention. Facilitates family participation in health care.

Facilitates family focus and individualized care
Change in value system and style of practice. (not compatible with providing
services at home).
Less coverage in proportion to time spent.
No easy access to emergency equipment or consultation.
Personal safety concerns.
Work individually, (cannot work with groups).
Distraction difficult to control.
Family resents intrusion into home and/or prefers health care setting.
Can be exhausting to the care giver

Pre visit Preparation

Factors to be considered in planning a home visit:

- Geographic lay-out of the area.
- Number of houses to be visited.
- Number of families needing close supervision-reason for visit (referral).
- Yearly plan schedule for a visit in a year.
- Distance (further the home, lesser the no. of home visited).

- Transport.
- Time spent in a home.
Activities performed- H/V
Assessment of home environmental conditions.
-reveals important assessment & information.(guide planning and
intervention with families).
-gather information about resources/difficulties encountered by families.
Assessment of household members.

Planning to meet the health needs of families during home visit.

Lack of planning & preparation greatest barrier to successful family

health visit.

Successful family visit Good planning & preparation, accurate

documentation & follow-up.

PHASES OF HOME VISIT.

Contacting Phase:
When the nurse becomes aware of an individual/family who is desiring or
needing a visit.
Referral- self / agency (e.g. social welfare).

 Clarify reason for referral.

Contacting phase

Clarify purpose of h/visit, who ref. family & why.

Know where to go.
Determine whether any special equip. is needed or is available in the home.
Entry Phase.
Observe and interact with families.
Learn about them and their life situation .
Provide health education. Complete treatment if required.
Reviewing plans of care with the family.
Identifying health needs of all household members.
Referring family members to app. Resources.
Conduct all visits in a caring way, providing comfort, support, information,
and counseling, as indicated.
Complete treatment if required.
Reviewing plans of care with the family.
Identifying health needs of all household members.

 Referring family members to app. Resources.

Conduct all visits in a caring way, providing comfort, support,
information, and counseling, as indicated.
Termination Phase.
Summarize accomplishments of the visit, and with the family.
Discuss plans for the next home visit.
Discuss referrals with the family if any.
Reinforce family strengths.
Documentation
Clean up.
Thank the family for their time.
Discuss referrals with the family if any.
Reinforce family strengths.
Documentation
Clean up.
Thank the family for their time.
Implementation of the nursing process in the home
Assessment involves all family members both as individual and family as a unit.
Family nursing diagnosis is important in developing appropriate plans &
intervention, in collaboration w Use of acute observation skill.

Assessment..
Use of acute observation skill.
Purpose of the 1st. H/visit begin to identify family strengths & health
needs, coping abilities, home environment
Use of assessment tools, (interviewing, observation, questionares, or
checklist).

(assessment tools - remind the nurse about areas to explore with the
family).

assessment -- health education (same time). **(teaching h/promotion

activities to the family may begin only after members express an interest &
recognize a need).

Nursing diagnosis & planning care.

On the basis of assessment establish the nursing diagnosis. for the entire
family/ individuals within the family. long term/short term goals established within
the family strengths/weakness expected outcomes, including measurable results
within a specific time frame are established.

Cultural health practices

Influence all aspects of nursing process.
Understand them understand client behavior.
Plan interventions that are consistent with client health beliefs.

Qualities of community health nurse.

Community health nurse play an important role in the overall health and
well-being of the community. You will find opportunities in a variety of
settings including government agencies, hospitals, educational and research
institutions as well as nonprofit organizations. Your job profile and salary
package will depend on a several factors such as.
1 Communication skills (verbal & written)
Communication skills are crucial for your success as a public health professional.
Most organizations employ public health professionals to design, develop and
implement health education programs and support services for their members.
Strong communication skills will help you understand the core values of your
employees and interact efficiently with the members.
2 Strong work ethic
A strong work ethic will help you make the best of the situation and deliver best
results under the circumstances. Employees wish to employ professionals who are
responsible and work hard to achieve the ultimate goal of the organization.
3 Teamwork skills
Public health professionals cannot work in isolation. It is practically impossible to
implement programs independently. You collaborate with other staff members such
as social workers, healthcare professionals and the managers for the success of
your program.
4 Initiative
Most employers expect their public health professionals to be self-starters. You
should take the initiative and a proactive approach to organize the public health
programs and solve everyday problems associated with them.

5 Interpersonal skills
Interpersonal skills are essential for your success at any organization. A healthy
relationship with management, colleagues and clients is the basis of a successful
program.
6 Problem-solving skills
The implementation of a public health initiative is associated with a variety of
problems including budgeting, operation, and customer satisfaction. You must
demonstrate good problem-solving skills which will help overcome these issues.
7 Analytical skills
Analytical skills are closely linked to your ability to manage day-to-day
responsibilities related to the project and problem-solving skills. Your employers
expect you to analyze the situations and act as per the norms of the organization.
8 Flexibility/adaptability
The field of public health is changing constantly. You should work proactively to
keep track of current developments in the field and adapt or change your program
accordingly. You should also accommodate the feedbacks and requirements of the
clients. Some employers may also be looking for flexible schedules or hours of
work.
9 Computer skills
Basic computer skills such as MS Office and the Internet are important in todays
era of technology.
10 Technical skills
Your ultimate success as a public health professional will depend on your technical
skills specifically related to your field, and your ability to implement your
education in a real world scenario. It is your responsibility to demonstrate how

your technical knowledge will help the prospective employers achieve their
organizational goals.

Public Health Nurse Job Responsibilities:

Maintains the public's health by providing health services and information.

Public Health Nurse Job Duties:

Serves patients by visiting homes; determining patient and family needs;
developing health care plans; providing nursing services and treatments;
referring patients with social and emotional problems to other community
agencies.
Helps the community health care team by coordinating assessment,
planning, and providing of needed health and related services; participating
in case conferences with physicians, hospital and rehabilitative personnel,
and representative of other agencies.
Provides health information by instructing family in care and rehabilitation
of patient; maintaining health and prevention of disease for family members;
teaching home nursing, maternal and child care; providing instructions in
other subjects related to individual and community welfare.
Safeguards health of children by participating in child health conferences,
school health; providing group instruction for parents; conducting
immunization programs.
Arranges convalescent and rehabilitative care of sick or injured persons by
cooperating with families, community agencies, and medical personnel.
Improves quality results by studying, evaluating, and recommending
changes in processes; implementing changes.

 Keeps vehicle and equipment operating by following operating instructions;

troubleshooting breakdowns; maintaining supplies; performing preventive
maintenance; calling for repairs.
Keeps supplies ready by inventorying stock; placing orders; verifying
receipt.
Documents actions by completing forms, reports, logs, and patient records.
Avoids legal challenges by complying with legal requirements; keeping
patient information confidential.
Updates public health job knowledge by participating in educational
opportunities; reading professional publications; maintaining personal
networks; participating in professional organizations.
Enhances public health department and city reputation by accepting
ownership for accomplishing new and different requests; exploring
opportunities to add value to job accomplishments.
Public Health Nurse Skills and Qualifications:
Verbal Communication, Health Promotion and Maintenance, Listening, Quality
Management, Energy Level, Integrity, Infection Control, Informing Others,
Nursing Skills, Medical Teamwork, Multi-tasking

Unit v
Assisting individuals and groups to promote and maintain their health

List down the mile stones for 4 to 6 months baby

Recognizes familiar sounds

Reaches for objects but often misjudge distance
Full control of head movement
Sits its propped
Sits in high chair
Rolls from prone to supine
Begins to differentiates likes and dislikes of food

Waste management in community

Waste means any waste which is generated by human being or animal
TYPES OF WASTE IN COMMUNITY
Solid wastes
Sewage
Excreta wastes

MANAGEMENT OF WASTE
(A)SOLID WASTE MANAGEMENT
Storage :- dust bin ,public bin ,paper sack
Collection :- collection facility is available mainly in urban area
:-Majority of places in india people are expected to dump the refuse in
the nearest public bin

:-Public bin are emptied mechanically by lorries fitted with cranes.

Methods of solid waste disposal
1. Dumping 2.Controlled Tipping 3.Incineration 4.Composting
5.Manure pits 6.Burial
(B) METHOD OF SWEGE DISPOSAL
1.Swage purification
:- Primary treatment
:-Secondary treatment
2.River outfall
3.Land treatment
4.Oxidation pond
5.Oxidation ditches
( C ) METHOD OF EXCRETA DISPOSAL
1.Service type latrine
:-Burying
:-Composting
2.Sanitry latrine
:- Bore hole latrine
:- Dug well latrine
:- Water seal latrine
:- Septic tank
:- Aqua privy
3.Water carriage system and swage treatment

UNIT -6TH
Elaborate the role of community health nurse in training and supervision of
ASHA workers
o Community health nurse will select ASHA must be the resident of the
village preferably in the age group of 25-45 years
o Community health nurse will assess the communication skills and leadership
qualities for the selection of ASHA
o Community health nurse will assist medical officer while giving training to
the ASHA
o Community health nurse educate ASHA on danger sign of pregnancy labour
o Community health nurse will orient ASHA on the dose schedule and side
effect of oral pills
o Community health nurse will inform ASHA on date, time and place for
initial and periodic training schedule
o Community health nurse will also ensure that during the training ASHA gets
the compensation for the performance and also TA/DA for attending
training.
o Community health nurse should hold weekly/fortnightly meeting with
ASHA and discus the activities undertaken during the week /fortnight.
o Community health nurse should inform ASHA regarding date and time of
the outreach session
o Community health nurse guide ASHA for bringing beneficiary to the
outreach session
o Community health nurse take help of ASHA to updating eligible couple
register of the village concerned
o Community health nurse should ensure ASHA is motivating pregnant
women for taking full course of iron and folic acid tab. And TT injection .
o Community health nurse should ensure that is she promoting people
construction of household toilets
o Community health nurse should ensure that is she providing DOTS under
RNTCP
o Community health nurse should ensure that is she working with village
health and sanitation committee
o Community health nurse should ensure that is she counseling women on
birth preparedness.

Explain National Anti Malaria Programme and roll of nurse in prevention

and treatment of malaria .
NATIONAL ANTI MALARIA PROGRAMME
The programme began originally as national malaria control programme in 1953
National malaria control programme changed to national malaria eradication
programme in 1958
renaming of programme national anti malaria programme in 1999
OBJECTIVES OF MALARIA CONTROL PROGRAMME
1.managment of serious and complicated malaria cases .
2.prevention of mortality with particular reference to high risk group.
3.reduction of morbidity
4. control of out breaks and epidemics
5.incidence and containment resistance malaria .

MALARIA CONTROL STRATEGIES

1. SURVEILLANCE AND CASE MANAGEMENT
-Case detection ( passive and active )
-Early diagnosis and treatment
-Sentinel surveillance
2.

INTEGRATED VECTOR MANAGEMENT

- indoor residual spray
-insecticide treated bed nets
-long lasting insecticidal nets
-anti larval measures including source reduction

3.

EPIDEMIC PREPAREDNESS AND EARLY RESPONSE

4.

SUPPORTIVE INTERVENTION
-capacity building
-behavior change communication
-intersectoral collaboration
-monitoring and evaluation
-operational and applied field research

ROLE OF NURSE TO PREVENT AND TREATMENT THE MALARIA

CASE FINDER
o Prepare a blood smear of a patient with fever and other sign
/symptoms of malaria to confirm the diagnosis.
o Assist MPW in active case detection is carried out in rural area with
blood smear
o Direct ASHA in passive case detection
DIRECT CARE PROVIDER
o
o
o
o

On confirmation start anti malarial therapy

Monitor the patient for one after administration of anti malarial drug.
Fluid and electrolyte balance should be maintained
Ensuring protection of children and pregnant women.

EDUCATER
o Educate the community regarding vector control.
o Educate the community to kept environment clean outside the
residential area.
ADVISER
o Advise the family to use bed nets

o Advise the family for indoor residual spray to control adult

mosquitoes
o Advise the family member to wear full sleeves dress
o Advise the family to use apply anti mosquitoes ointment during
night
o Advise the family to clean the home and not to kept unwanted thing
inside the home
.
SUPERVISOR
o Supervise ANM , MPW and ASHA worker in implementing malaria
control programme
o Provide health workers with updates on policies or new
recommended policies
o Check the stocks & condition of equipments
COORDINATOR
o inter-sectoral coordination with other government dept. corporate
and voluntary agencies at national ,state and district level to prevent
malaria .
RESEARCHER AND EVALUATOR
Discuss the impact of ICDS programme on health of school going children .
The impact of ICDS programme on health of school going children are:Lay the foundation for psychological ,physical and social development of the
children
Improved the nutritional and health status of the children
Reduced the incidence of mortality
Reduced the incidence of morbidity
Reduced the incidence of malnutrition
Reduced the drop out due to health problems

Describe role of community health nurse in national AIDS control

programme
Care provider
she should take the help from community nursing officer for the implementation of
programme
Community nurse play key role at the ART Centre
Dispensing of ARV drugs (till a pharmacist is added to the team)
Responsible for the HIV test
Counselor
Community health nurse recognize the problem of HIV patient
Counseling of patients regarding ART
counseling the community people regarding cope with HIV patient
counseling the family member regarding patient care
Help HIV patient learn to make use of problem solving process and make decision
to solve their problems
Health educator
Whatever care She provides to individual , family and group she provide
them by educating
She should provide health education to most vulnerable group to HIV
infection
Modify attitude of people towards AIDS patient
AN Advocate
She should speak in favorer of policies regarding HIV/AIDS
She should speak for those who can not speak for themselves
Educate AIDS patient regarding services are available for them
Observer
She is responsible to any change in her patient and their surrounding
Adviser
Advise to client regarding ART Centre
Streamlining and guiding patients at the ART centre and helping the
centre to run efficiently and in an
orderly fashion

advise the community people regarding Use of condom to

prevent HIV/AIDS
Use of aseptic technique while handling HIV client to other
health workers
Advise ANM to Implementation of programme
Manager
As a manager she follows the following role
Planner role regarding NACP
organizer roll
director roll
co-coordinator roll :- Coordinating and tracking the referrals made within the
hospital
COLABRATOR :-collaborate with all other sector to prevent
AIDS/HIV
LEADER Play a roll of leader in planning ,implementing and
evaluating national AIDS control progarmme
RESEARCHER: participate in studies to control and prevent AI/HIV
EVALUATOR
Describe role of community health nurse in integrated management of
neonatal and childhood disease .
Role of community health nurse in integrated management of neonatal and
childhood disease
1. PRIMARY HEALTH CARE GIVER
Community health nurse. should provide preventive , promotive
,curative care to every children in community
2. COORDINATOR & COLLABORATOR
The nurse play an extremely important role with the combination of
health care team member .
Nurse maintain good IPR with the child family
The nurse coordinate nursing care with other services for meeting the
need of the child ex. Physician, social worker, community leader,
ASHA , AWW
3. ADVOCATOR

 Nurse act as an advocate to safe guard the child right

Assist and provide best care
Nurse acts as a representative for the child ,family and other health
care provider
4. HEALTH EDUCATOR
Provide health information to child parents and significant other
about prevention of illness, promotion, promotion and health
maintenance
5. CASE MANAGER
Nurse should organize care ,monitor, and evaluate childrens
treatment for successful outcome
Act as manager IMNCI in community

6. SOCIAL WORKER
Nurse should participate in chil7 family welfare agencies for
necessary support
7. NURSE RESEARCHER
Nurse should participate or perform research activities to provide
basis for change in nursing practice ,improvement in the IMNCI care
EPI
EXPANDED PROGRAMME ON IMMUNIZATIOM
In 1974 the WHO launched its EPI against six most common preventable
childhood diseases viz. diphtheria ,pertussis , tetanus , polio , tuberculosis ,and
measles .
From the beginning of the programme UNICEF has been providing significant
support to EPI
The govt of india launched EPI in Indian on 1978
OBJECTIVES OF EPI IN INDIA
1. To reduced the mortality and morbidity resulting from vaccine- preventable
disease of childhood
2 To achieve self sufficiency in the production of vaccine

The immunization services are being provided through MCH centres, PHC , sub
centre, hospitals ,dispensaries ,and ICD units
There is not seprate cadre of staff for EPI
ACHIEVEMENT HAVE BEEN MADE IN INDIA
1985-86 , vaccine coverage ranged between 29% for BCG 41% for DPT
Bye the end 2008 coverage level had gone up about 80% for tetanus toxoid for
pregnant women about 87% for BCG, 66% for DPT 3 doses, 70% for measles and
67% for OPV 3 doses.
Yaws Eradication Programme (YEP)
The programme was started in 19996-97 in Koraput district of Orrissa then
extended to endemic state or a centrally sponsored health scheme.
OBJECTIVES
Interrupting the transmission of Yaws infection ( no case ) in the
country.
Eradication of yaws
STRATEGY

Man power development

Detection of cases
Treatment of cases and contact
IEC involving multi Sectors approach

Components of district mental health Programme

COMPONENTS
Training programme of all workers in the mental health team at the
identified Nodal Institute in the state .

 Public education in the mental health to increase awareness and reduce

stigma
For early detection and treatment the OPD and indoor services provided
Providing valuable data and experience at the level of community to the
state and centre for future planning , improvement in service and research .