HEALTH PROBLEMS IN INDIA

INTRODUCTION:

Problems is the first requisite for any planned effort to develop health care.
The data required for the analysis of health situation and health services. Problems
comprise of mortality, morbidity, demographic conditions, socioeconomic factors etc.,

According to WHO health as a state of complete physical, mental, and social

well-being and not merely the absence of disease or infirmity. Health problem is a
state in which we are unable to function normally (state of ill health, unhealthiness)

MAJOR HEALTH PROBLEMS : communicable disease problem,

o medical care problem,
o environmental sanitation problem
o nutritional problem
o population problem

COMMUNICABLE DISEASE PROBLEMS

Communicable diseases are continue to be the major health problem in India. The
diseases continue to be of greater importance are

MALARIA

Malaria is caused by a parasite that is Anopheles . Symptoms: Anemia, Bloody

stools,Chills, Coma, Convulsion, Fever, Headache, Jaundice, Muscle pain, Nausea,
Sweating, Vomiting

SIGNS AND TESTS: During a physical examination, the doctor may find an enlarged
liver or enlarged spleen. A complete blood count (CBC) will identify anemia if it is
present.
Treatment: Chloroquine, for chloroquine-resistant infections(quinine plus doxycycline,
tetracycline, or clindamycin)

TUBERCULOSIS:

Pulmonary tuberculosis (TB) is a contagious bacterial infection that involves the lungs,
but may spread to other organs.
Causes:
Mycobacterium tuberculosis (M.tuberculosis)
Symptoms:- Cough (usually cough up mucus), Coughing up blood,- Excessive sweating,
especially at night,- Fatigue, Fever, Unintentional weight loss,- Breathing difficulty,-
Chest pain,- Wheezing
Tests:
 Sputum examination and cultures, Bronchoscopy, Chest CT scan, Chest x-ray,
Biopsy of the affected tissue (rare), Tuberculin skin test, Thoracentesis.

Treatment: Isoniazid, Rifampin, Pyrazinamide, Ethambutol , Amikacin, Ethionamide,

Moxifloxacin, Para-aminosalicylic acid, Streptomycin.

DIARRHOEAL DISEASE:

Diarrhoeal disease is the second leading cause of death in children under five years old.
Causes: Infection(bacterial,malnutrition in children under five years old. viral and
parasitic organisms),
Prevention and treatment:- access to safe drinking-water- improved sanitation,-
exclusive breastfeeding or the first six months of life,- good personal and food hygiene,-
health education about how infections spread rotavirus vaccination.- Rehydration, Zinc
supplements, Nutrient-rich foods, Consulting a health worker if there are signs of
dehydration.

ACUTE RESPIRATORY TRACT INFECTIONS

Acute respiratory infections: are causes of mortality and morbidity in children below
5yrs of age. It is estimated that about 13.6% hospital admissions and 13% inpatient
deaths in paediatric ward are due to ARI. Acc. To 2009, Around two million deaths each
year with the incidence of 0.29 and , 0.05 episodes per child-year occurs.
Causes: Streptococcus pneumonia Haemophilus influenzae, Staphylococcus aureus and
other bacterial species, measles virus, human parainfluenza viruses, influenza virus and
varicella virus.

LEPROSY

Leprosy is another major public health problem in India. During the year 2003-2004:
2.20 lakh leprosy cases in the world. In 2002: 0.44 million cases were there. New cases
were detected out of which child cases were 14.91%, all the states and India accounts for
the 60% of the union territories reported cases of leprosy.

AIDS:

Since AIDS was first detected in year 1986, In 2009 cumulative number of cases has
risen to 124995 by the end of Aug 2007, Total cases-2.4 million, 1.7 lakh HIV/AIDS
related deaths were reported. 41% of new cases were reported from Orissa, Bihar, West
bangal,U.P, Rajsthan, M.P, and Gujrat.

OTHERS:

Kala-azar, Meningitis, viral hepatitis, Japanese encephalitis, Enteric fever, and

helmenthic infestations are among the other important communicable disease problems in
India.
 NUTRITIONAL PROBLEMS

PROTEIN ENERGY MALNUTRITION:

PEM refers to the deficiency of energy and protein in the body. 1-2% of preschool
children in India suffer from PEM. In 1998, India is ranked 2nd in the world of the
number of children from PEM. In 1991, it has around 150 million children, suffering
from malnutrition. The constituting 17.5% of Indias population, who are below the age
of 6 years. 2011 Global Hunger Index (GHI) Report ranked India 15th, amongst leading
countries with hunger situation
CAUSES: Inadequate intake of food both in quantity and quality, Infections (Diarrhea,
Respiratory infections, measles, intestinal worms)
TYPES: MARASMUS, KWASHIORKER

NUTRITIONAL ANEMIA:

India has probably the highest about one half of the prevalence of nutritional anaemia in
women and children. 60-80% of non-pregnant women and children are estimated to
suffer from anaemia. 20-40% of maternal deaths are attributed to pregnant women are
anaemic. Mostly the anaemia is of iron deficiency and less frequently is of folate and
vitamin B12 deficiency.
LOW BIRTH WEIGHT: This is the major public health problem. About 30% of the
babies are born of low birth weight in developing countries.
Cause : Maternal malnutrition and anaemia as compared to about 4% in some
developed countries. Inadequate nutritional intake during pregnancy.

XEROPHTHALMIA:

About 0.04% of total blindness in India are DRYNESS BITOT SPOT, keratomalacia,
BILATERAL BLINDNESS
Keramalacia has been the major attributed to nutritional deficiency of Vit. A. cause of
nutritional blindness in children usually between 1-3 years of age.

IODINE DEFICIENCY DISORDER: (Goitre)

The prevalence rate in some parts of Himachal Pradesh was 28.7%(Sirmor) and
34.5%(Mandi) ,45.8% in According to 2011 census, 64.4% in bihar;27% in Arunachal
Pradesh. million people in India suffer from this, 1.3 crore people in UP, M.P-0.82 crore,
Bihar-0.62 crore.

ENVIRONMENTAL SANITATION

The two main problems1.) lack of safe water in many areas of the country2.) primitive
methods of excreta disposal. Beside these, there has been a growing concern about the
impact of new problems resulting from population explosion, urbanization and
industrialization leading to hazards to human health in the air, in water, and in food chain.
 MEDICAL CARE PROBLEMS

Thus the major health care problem is inequitable distribution and inadequate services.

Inadequate financial sources

health benefits to the urban population.
Uneven distribution
Migration to the urban areas, health problems have been
Aggravated like overcrowding in hospitals, inadequate staffing
Scarcity of certain drugs and medicines.

POPULATION PROBLEM
 SCHOOL HEATH SERVICE

NEED FOR SCHOOL HEATH:

1.1951- 209671 PRIMARY SCHOOLS.

2.1995- 581305 PRIMARY SCHOOLS

3.1951- 19.2 MILLION-SCHOOL ENROLLMENT.

4.1995- 108 MILLION-SCHOOL ENROLLMENT.

MAJOR HEALTH PROBLEMS ENCOUNTERED:

1. Malnutrition.

2. Infectious diseases

3. Intestinal parasites.

4. Diseases of skin, eye, & ear

5. Dental carries...

DEVELOPMENT OF SCHOOL HEALTH IN INDIA

1. 1909-Medical examination for school children.

2. 1946-Bhore committee report on non existence of adequate school health facilities.

3. 1953-The secondary education committee stressed on the need for regular examination
& school feeding programme.

4. II FYP Initiatives for school health feeding prog.

5.1960-Constitution of school health committee

OTHER SUPPORTIVE PROGS 1974-75-ICDS 1980-83-ADDCP,ARI Cont prog.

Welfare programme are linked with school health prog.

OBJECTIVES

1. To promote health of the school children through health supervision, health care &
nutrition progs.

2. To prevent communicable & non communicable diseases.

 3. To inculcate healthy habits by proper health instruction.

4. To create health consciousness in children, parent & teacher.

5. To prepare the child for education &for good citizenship

6. To provide healthful school environment

COMPONENTS OF SCHOOL HEALTH PROG

1. The task of school health are multidimensional

2. The interventions vary according to the context of the society, however broadly

The following are some aspects, components of SHP:

1. Health appraisal of school children & school personnel

2. Remedial measures & follow-up

3. Prevention of communicable diseases.

4. Healthful school environment

5. Nutrition serves

6. First aid & emergency care.

7. Mental health

8. Dental health

9. Eye health.

10. Health education.

11. Education of the handicapped children

12. Maintenance & use of school health records..

COMPONENTS OF SCHOOL HEALTH

1. Periodical medical examination schoolchildren, teachers, health personnel

2. Medical examination on entry- 4 yrs

 3. Routine Physical Examination needs to be done

4. Clinical examination for nutritional deficiency, examination of feces.

5. Tuberculin testing/screening for Hansen's annual testing of vision, regular & quarterly
Wt/Ht checking

6. Daily morning inspection by the teachers unusually flushed face, rashes, spots, s/s
acute cold, coughing & sneezing, sore throat, rigid neck, nausea, vomiting, watery eyes,
headache, chills, fever, sleepiness, disinclination to play, diarrhea, skin conditions-
scabies or ringworm..

REMEDIAL MEASURES & FOLLOW UP

1. Following the regular examination, respective referral services

2. Special clinics should be conducted in the health units.

3. Specialist should be employed in schools for the same.

4. Referral hospital must provide for beds for children who are admitted & provide
relevant treatment.

PREVENTION OF COMMUNICABLE DISEASE:

1. By means of immunization.

2. The above should be maintained in the school health records.

HEALTHFUL SCHOOL ENVIRONMENT:

1. An optimal school environment location, building & equipment are important pre-
requisites for a school health.

2. A good school environment promotes physical, social & emotional health of the
pupils.

3. Schools should serve as exemplary places to reflect sanitation.

SUGGESTED STANDARDS:

1. Location-Centrally situated, fairly away from busy places, roads, cinema theatre,
houses, factory, railway tracks & market places.

2. The school premises should be fenced.

 SITE-1.on high land. SHC-10 Acre-higher elementary school. 5 Acre-primary school.
Additional.- with 1 acre land- 100 students.

STRUCTURE: Nursery & Secondary schools must be single Ext walls should be 10
inches thick & should be heat resistant.
CLASS ROOMS: Verandas should be attached to class rooms. A class should
comfortably accommodate 40 students. The per capita space for student should be 10 sq
ft & more.
FURNITURE: Furniture should suit the age group. Single desks & chairs should be
provided to the students & The chairs should have proper back rest.
DOORS & WINDOWS:

1.The combined door & window should be >25% of the floor space

2.The class should have cross ventilation

3.Class rooms should have ventilators.>2% of the floor area.

4.The windows should be broad located at 2-6 Ft from the floor level.

COLOUR: White & the class room should be periodically white washed.
LIGHTING: The class room should have sufficient natural lighting (room left).
WATER SUPPLY: There should be an independent, safe & portable water supply
distributed from taps.
EATING FACILITIES: There should be separate room for dining purposes. Only
approved vendors should be allowed.
LAVATORY: Privies &urinals should be provided. 1 urinal/ 60 students. 1 urinals/ 100
students. Facilities should be separate for boys & girls.
NUTRITIONAL SERVICES: Studies in India have revealed that 1961-SHC
recommended nutritional deficiency is prevalent among school children. one nourishing
meal 1/3 of protein & calorie requirement.
Implementation of ANP with the assistance of UNICEF Maintenance of school kitchen
& Measures should be taken to veg gardens. combat nutritional deficiencies.
FIRST AID & EMERGENCY CARE: The first aid management for sick children
rests with the teachers & the teachers could be trained during teachers training
programme. First aid box should be made available.
MENTAL HEALTH: The teachers in the school have a Positive & preventive role in
fostering a positive mental health among the learners. Suitably modify learning strategies,
incentives.- rest, relaxation.
DENTAL HELTH: School children usually suffer from dental diseases & School
health should incorporate dental health, Dental hygienist components too. & dentist are
to be employed.
During the dental check up should focus on prophylactic cleansing & dental hygiene
classes.
 EYE HEALTH: Teachers are in key position to detect refractive errors, refer for
treatment of squints, ambylopia & to Vit A administration could be done.detect eye
infections.
HEALTH EDUCATION: The health education is an important component in the
school health prog. The H/E should aim at imparting desirable changes among students.
H/E- focus on, personal hygiene, environmental health.
EDUCATION OF HANDICAPPED: Every child irrespective of the disability, should
be encouraged to become productive & self supporting.
SCHOOL HEALTH RECORDS: The schools should have cumulative health records
providing pertinent information and serve as tools to evaluate the school health services.

ROLE OF A NURSE:
RESEARCHER
EDUCATIONIST
ADMINISTRATOR
SERVICE PROVIDER
ADMINISTRATOR : Organize school health progs at all levels. Co-ordinate the SHP
initiatives of the state with school administration. Serve as liaison between the
community & the school in organizing & implementing SHP
Co-ordinate with the state in mobilizing funds & Organize Evolve relevant policy for
implementation of SHP. grant in aids & conduct workshop, conferences & Co-ordinate
meetings on SHP. & serve as liaison for the NGOs & voluntary agencies.
Incorporate the aspects & elements of SHP in PHC Organize school health camps,
involving community & Design mass media. & Co-ordinate with disseminate health
education materials relevant to SHP. allied sectors in promoting & implementing school
health initiatives
Maintain epidemiological profile of school going & Serve as information providers to
the policy makers on school related maters. school health & its related aspects.
EDUCATIONIST: Design a curriculum for schools & health Implement science
subjects incorporating SH aspects. & monitor the implementation of school curriculum
in the educational settings.
Organize Training programme & educational preparation for nurses to be placed in
schools & Evaluate the educational institutions. Refer appropriate cases to referral
center.
school health programme implementation.
SERVICE PROVIDER: Conduct SHP in the area of employment. Co-ordinate with
NGO/VHAI in implementing SHP. Supply & monitor articles, drugs & equipments for
SHP
Co-ordinate /implement the various health prog of the community, ICDS, SHP, Anemia
Prevention Prog, Mid Day Meal Prog, Vit A prophylaxis prog. Periodically conduct SH
surveys & maintain health status of the children

RESEARCHER: as school health nurse Identify researchable area in SH Create data

base in SH for research. & disseminate the finding.
 HEALTH CAREDELIVERYSYSTEMwww.drjayeshpatidar.blogspot.com
2. HEALTH CARE DELIVERY SYSTEMIntroduction:India is a union of 28 states and
7 union territories.States are largely independent in matters relating to thedelivery of
health care to the people. Each state hasdeveloped its own system of health caredelivery,
independent of the Central Government. TheCentral Government responsibility consists
mainly ofpolicy making, planning, guiding, assisting, evaluatingand coordinating the
work of the State Health Ministries.The health system in India has 3 main links1.
Central2. State and3. Local or peripheralwww.drjayeshpatidar.blogspot.in
3. At the central The official organs of the health system at thenational level consist
of 1. Ministry of Health and Family Welfare 2. The Directorate General of Health
Services 3. The Central Council of Health and Family
Welfarewww.drjayeshpatidar.blogspot.in
4. Union Ministry of Health and FamilyWelfare.Organization PatternCabinet
MinisterDepartment of Health Department of Family Welfare Joint Secretary
 Additional Secretary Deputy Secretary Commissioner Administrative staff Joint
SecretaryAdministrative staffwww.drjayeshpatidar.blogspot.in
5. Functions: Ministry of Health and Family Welfare.Union list1. International health
relations and administration of portquarantine2. Administration of Central Institutes such
as All IndiaInstitute of Hygiene and Public Health, Kolkata.3. Promotion of research
through research centers4. Regulation and development ofmedical, pharmaceutical,
dental and nursing Professions5. Establishment and maintenance of drug standards6.
Census and collection and publication of other statisticaldata7. Immigration and
emigration8.Regulation of labor in the working of mines and oil fields9. Coordination
with states and with other ministries forpromotion of health
www.drjayeshpatidar.blogspot.in
6. Concurrent listThe functions listed under the concurrent list are the responsibilityof
both the union and state governments.1. Prevention and extension of communicable
diseases2. Prevention of adulteration of food stuffs3. Control of drugs and poisons4. Vital
statistics5. Labor welfare6. Ports other than major7. Economic and social planning8.
Population control and Family Planning9. Preparation of health education material for
creating healthawareness through Central Health Education Bureau.10. Collection,
compilation, analysis, evaluation an dissemination ofinformation through the Central
Bureau of Health Intelligence11. National Medical
Librarywww.drjayeshpatidar.blogspot.in
7. Directorate General of Health ServicesOrganization PatternDirectorate General of
health servicesDirector General of health servicesAdditional Director General of health
serviceDeputy Directorate General of health servicesAdministrative
staffwww.drjayeshpatidar.blogspot.in
8. FUNCTIONS OF D.G.H.S1. International health relations and quarantine of all
majorports in country and International airport2. Control of drug standards3. Maintain
medical store depots4. Administration of post graduate training programmes5.
Administration of certain medical colleges in India6. Conducting medical research
through Indian Council ofMedical Research7. Central Government Health Schemes.8.
Implementation of national health programmes9. Preparation of health education material
for creating healthawareness through Central Health Education Bureau.10. Collection,
compilation, analysis, evaluation anddissemination of information through the Central
Bureau ofHealth Intelligence11. National Medical
Librarywww.drjayeshpatidar.blogspot.in
9. Central Council of HealthOrganization PatternChairman(Union health
Minister)Members(State health Minister)www.drjayeshpatidar.blogspot.in
10. Functions Of Central Council Of Health1. To consider and recommend broad outlines
ofpolicy regard to matters concerning health likeenvironment hygiene, nutrition and
healtheducation.2. To make proposals for legislation relating tomedical and public health
matters.3. To make recommendations to the centralgovernment regarding distribution of
grants-in-aid.www.drjayeshpatidar.blogspot.in
11. AT THE STATE LEVELOrganization Pattern(1) State Ministry of Health & family
welfareDeputy Minister of Health and Family WelfareHealth SecretaryDeputy
SecretariesAdministrative staffwww.drjayeshpatidar.blogspot.in
12. (2) State Director of healthDirector of Medical Education Director of Health
Services Dean of medical college Additional Director of Health Services State
 nursing superintendent Deputy Director of Health Services Hospital Education
Regional Function Nsg Superintendent Nsg Officer MCH, TB, Leprosy,
Immunization Ward Incharge Senior tutor Nsg Staff Junior
tutorwww.drjayeshpatidar.blogspot.in
13. Functions of state health Director:(1) Studies in depth the health problem and needs
in the state andplans scheme to Solve them.(2) Providing curative &preventive
services.(3) Provision for control of milk and food sanitation.(4) Prevention of any
outbreak of communicable diseases.(5) Promotion of health education(6) Promotion of
health programmes such as school health, familyplanning, occupational health(7)
Supervision of PHC(8) Establishing training courses for health personnel(9) Co-
ordination of all health services with other minister of statesuch as minister of education,
central health minister&voluntary agencywww.drjayeshpatidar.blogspot.in
14. At the district levelThere are 593 ( year 2001 ) districts in India.Within each district,
there are 6 types ofadministrative areas.1. Sub division2. Tehsils( Talukas )3.
Community Development Blocks4. Municipalities and Corporations5. Villages and6.
Panchayatswww.drjayeshpatidar.blogspot.in
15. Most district in India are divided into two ormore subdivision, each incharge of an
AssistantCollector or Sub Collector Each division is again divided intotalukas, incharge
of a tahsildhar. A talukausually comprises between 200 to 600 villages The community
development block comprisesapproximately 100 villages and about 80000 to1,20,000
population, in charge of a BlockDevelopment Officer. Finally, there are the village
panchayats, whichare institutions of rural local self-
government.www.drjayeshpatidar.blogspot.in
16. The urban areas of the district are organized into Town Area Committees (in areas
withpopulation ranging between 5,000 to10,000 Municipal Boards (in areas with
populationranging between 10,000 and 2,00,000) Corporations (with population above
2,00,000) The Town Area Committees are like panchayats.They provide sanitary
services. The Municipal Boards are headed by Chairmen/President, elected by
members.www.drjayeshpatidar.blogspot.in
17. The functions of Municipal Board: Construction and maintenance of roads
Sanitation and drainage Street lighting Water supply Maintenance of hospitals and
dispensaries Education and Registration of births and deaths
etcwww.drjayeshpatidar.blogspot.in
18. Panchayat Raj -The panchayat raj is a 3-tier structure of rurallocal self-government in
India linking the villageto the district.It includes Panchayat (at the village level)
Panchayat Samiti( at the block level) Zila Parishad(at the district
levelwww.drjayeshpatidar.blogspot.in
19. Panchayat (at the village level):The Panchayat Raj at the village level consists of
The Gram Sabha The Gram PanchayatThe Gram Sabha:It is the assembly of all the
adults of the village, whichmeets at least twice a year.The gram sabha considersproposals
for taxation,and elect members of TheGram Panchayat.www.drjayeshpatidar.blogspot.in
20. The Gram Panchayat It is the executive organ of the gram sabha and anagency for
planning and development at thevillage level. The population covered varies from5000 to
15000 or more. The members ofpanchayat hold offices for a period of 3to4 years.Every
panchayat has an elected president(Sarpanch or Sabhapati or Mukhia), a vicepresident
and panchayat secretary. It covers thecivic administration including sanitation andpublic
 health and work for the social andeconomic development of the
villagewww.drjayeshpatidar.blogspot.in
21. Panchayat Samiti (at the block level): The block consists of about 100 villages and
apopulation of about 80,000 to 1,20,000. Thepanchayat samiti consists ofSarpanch,
MLAs, MPs residing in blockarea, representative of women, SC, ST andcooperative
societies. The primary function ofThe Panchayat Samiti is the execute thecommunity
development programme in theblock. The Block development Officer and hisstaff give
technical assistance and guidance indevelopment work.www.drjayeshpatidar.blogspot.in
22. Zila Parishad (at the district level): The Zila Parishad is the agency of rural local
selfgovernment at the district level . The membersof Zila parishad include all heads of
panchayatsamiti in the district,MPs, MLAs, representativeof SC, ST and women and 2
persons ofexperience in administration, public life or ruraldevelopment. Its functions and
powers varyfrom state to state.www.drjayeshpatidar.blogspot.in
23. Health care system:(1) At village level(2) At sub center level(3) At PHC level(4) At
CHC levelwww.drjayeshpatidar.blogspot.in
24. At village level: At the village level, elementary services arerendered by(a) Village
health guides(b) Local dais(c) Anganwadi workers(d)
ASHAwww.drjayeshpatidar.blogspot.in
25. Village health guides: Village health guide is a person with anaptitude for social
service and is not full timegovt. functionary. Village health guides schemewas introduced
on 2nd oct. 1977.www.drjayeshpatidar.blogspot.in
26. Guidelines for their selection:(1) They should be permanent resident of the
localcommunity, preferably women(2) They should be able to read and write, having
minimumformal education at least up to the VI std.(3) They should be acceptable to all
sections of community(4) They should be able spare at least 2 to 3 hours every dayfor
community health work.After selection the health guide undergo a shorttraining in
primary health care. The training is arranged inthe nearest PHC, subcenter or other
suitable place for theduration of 200 hours, spread over a period of 3 months.During the
training period they receive a stipend of Rs.200 per
month.www.drjayeshpatidar.blogspot.in
27. Functions of Village health guides:(1) Provide treatment for common
minorailments(2) First aid during accidents and emergency(3) MCH care(4) Family
planning(5) Health educationwww.drjayeshpatidar.blogspot.in
28. Local dais: Most deliveries in rural areas are handled byuntrained dais. The training
for dais given for 30working days. Each dai is paid stipend of Rs. 300during the training
period. The training is given atPHC,subcenters or MCH center for 2 days in a weekand
on the remaining four days of the week theyaccompany the health worker(female) to the
village.During her training each dai is required to conductat least 2 deliveries under the
supervision andguidance of health worker (female), ANM,healthassistant
(female).www.drjayeshpatidar.blogspot.in
29. Functions of dais:(1) MCH care(2) Family planning(3) Immunization(4) Education
about health(5) Referral services(6) Safe water and basic sanitation(7)
Nutritionwww.drjayeshpatidar.blogspot.in
30. Anganwadi worker: Under the ICDS scheme there is an anganwadiworker for a
population of 1000.There are about100 such workers in each ICDS project.
Theanganwadi worker is selected from thecommunity and she undergoes training
 invarious aspect of health, nutrition and childdevelopment for 4 months. She is a part
timeworker and paid an honorarium of Rs.200-250per month for the
services.www.drjayeshpatidar.blogspot.in
31. Functions of anganwadi worker(1) MCH care(2) Family planning(3) Immunization(4)
Education about health(5) Referral services(6) Safe water and basic sanitation(7)
Supplementary nutrition(8) Nonformal education of
childrenwww.drjayeshpatidar.blogspot.in
32. Accredited Social Health Activist(ASHA) One of the key components of the
National RuralHealth Mission is to provide every village in thecountry with a trained
female community healthactivist ASHA or Accredited Social HealthActivist. Selected
from the village itself andaccountable to it, the ASHA will be trained towork as an
interface between the community andthe public health system. Following are the
keycomponents of ASHAwww.drjayeshpatidar.blogspot.in
33. SELECTION OF ASHA The general norm will be One ASHA per
1000population. In tribal, hilly, desert areas the normcould be relaxed to one ASHA
perhabitation, dependant on workload etc. The States will also need to work out the
district andblock-wise coverage/phasing for selection of ASHAs. It is envisaged that the
selection and training processof ASHA will be given due attention by the concernedState
to ensure that at least 40 percent of the ASHAsin the State are selected and given
induction trainingin the first year as per the norms given in theguidelines. Rest of the
ASHAs can subsequently beselected and trained during second and third
year.www.drjayeshpatidar.blogspot.in
34. Criteria for Selection ASHA must be primarily a woman resident of thevillage
Married/Widow/Divorced andpreferably in the age group of 25 to 45 yrs. ASHA
should have effective communicationskills, leadership qualities and be able to reachout to
the community. She should be a literatewoman with formal education up to
EighthClass.www.drjayeshpatidar.blogspot.in
35. Roles and responsibilities of ASHA: provide information to the community
ondeterminants of health such as nutrition, basicsanitation & hygienic practices, healthy
living. She will counsel women on birthpreparedness, importance of safe delivery,
breast-feeding and complementaryfeeding, immunization, contraception andprevention of
common infections includingReproductive Tract Infection/Sexually TransmittedInfection
(RTIs/STIs) and care of the young child.www.drjayeshpatidar.blogspot.in
36. ASHA will mobilize the community and facilitatethem in accessing health and
health relatedservices available at the village/sub-center/primary health centers, such
asImmunization, Ante Natal Check-up (ANC), PostNatal Check-up (PNC), ICDS,
sanitation and otherservices being provided by the government. ASHA will provide
primary medical care forminor ailments such as diarrhea, fevers, andfirst aid for minor
injurieswww.drjayeshpatidar.blogspot.in
37. She will also act as a depot holder for essentialprovisions being made available to
everyhabitation like Oral Rehydration Therapy(ORS), Iron Folic Acid Tablet(IFA),
chloroquine, Disposable Delivery Kits(DDK), Oral Pills & Condoms, etc.She will inform
about the births and deaths inher village and any unusual healthproblems/disease
outbreaks in the community tothe Sub-Centers/Primary Health Centre. She will promote
construction of householdtoilets under Total Sanitation
Campaign.www.drjayeshpatidar.blogspot.in
 38. Comparison of health care delivery system inRajasthan and Maharashtra:(1)
Subcenter:Topics Maharashtra Rajasthan(1) Population covered(2) Functions5000 in
general3000 in tribal & hillyareas(1) MCH care(2) Family planning(3) Immunization(4)
Education about health(5) Referral services3600 in general2800 in tribal & hillyareas(1)
MCH care(2) Family planning(3) Immunization(4) Education about health(5) Safe water
and basicsanitation(6) Prevention and controlof locally
endemicdiseaseswww.drjayeshpatidar.blogspot.in
39. Topics Maharashtra Rajasthan(3) StaffingpatternHealth worker female 1Health
worker male 1Voluntary worker 1(paid Rs 100 per month asHonorarium)Health worker
female 1Health worker male 1ANM 1www.drjayeshpatidar.blogspot.in
40. (2) Primary health center:TOPICS Maharashtra Rajasthan(1) Population covered(2)
Functions30,000 rural population in plains20,000 population in hilly, tribal(1) MCH
care(2) Family planning(3) Immunization(4) Education about health(5) Referral
services(6) Safe water and basic sanitation(7) Prevention and control oflocally endemic
diseases(8) Collection and reporting of vitalstatistics(9) National health programmes(10)
Training of health guides, healthworkers, local dais and healthassistant(11) Basic
laboratory services48000 population in plains30000 population in tribal and hilly(1)
MCH care(2) Family planning(3) Immunization(4) Education about health(5) Referral
services(6) Safe water and basic sanitation(7) Prevention and control oflocally endemic
diseases(8) Collection and reporting Of vitalstatistics(9) National health
programmes(10)Training of health guides, healthworkers, local dais and
healthassistant(11)Basic laboratory serviceswww.drjayeshpatidar.blogspot.in
41. TOPICS Maharashtra Rajasthan(3) Staffing pattern Medical officer 2Pharmacist
1Nurse midwife 1Health worker female 1Block extension educator 1Health assistant
(female) 1Health assistant male 1U.D.C 1L.D.C 1Driver 1Class IV 4Medical officer
1Pharmacist 1Nurse midwife 1Health worker female 1Health worker male 1Block
extension educator 1Health assistant (female) 1Health assistant male 1U.D.C 1L.D.C
1Driver 1Class IV 2www.drjayeshpatidar.blogspot.in
42. (3) Community health center:TOPICS Maharashtra Rajasthan(1)
Populationcovered(2) Bed capacity(3) Specialty80,000 to 1.20 lakhs30 BedsSurgery,
medicine,obstetrics andgynecologist andpediatrics with X-rayand lab facilities.74,000 to
1.5 lakhs24 BedsSurgery, medicine,obstetrics andgynecologist andpediatrics with X-
rayand lab facilities.www.drjayeshpatidar.blogspot.in
43. TOPICS MAHARASHTRA RAJASTHAN(1) Population covered(2) Bed capacity(3)
Specialty(3) Functions80,000 to 1.20 lakhs30 BedsSurgery, medicine, obstetrics
andgynecologist and pediatrics withX-ray and lab facilities.Care of routine andemergency
cases in surgeryCare of routine andemergency cases in medicine24 hours delivery
servicesincluding normal andassisted deliveriesEssential and emergencyobstetric care
includingcaesarean sections andotherMedical interventions.74,000 to 1.5 lakhs24
BedsSurgery, medicine, obstetricsand gynecologist and pediatricswith X-ray and lab
facilities.(1) MCH care(2) Family planning(3) Immunization(4) Education about
health(5) Referral services(6) Safe water and basicsanitation(7) Prevention and control
oflocally endemic diseaseswww.drjayeshpatidar.blogspot.in
44. TOPICS MAHARASHTRA RAJASTHAN Full range of family planning
servicesincluding laparoscopic services Safe abortion service Newborn care Routine
and emergency care ofchildren Other management including
 Nasalpacking,tracheostomy,foreign bodyremoval(10) All national healthprogrammes
delivered throughCHCOther services(a) Blood storagefacility(b) Essential lab.Services(c
) Referral(transport) services(8) Collection and report in ofvital statistics(9) 24 hours
delivery servicesincluding normal and assisteddeliveries(10) Essential and
emergencyobstetric care includingcaesarean sections and otherMedical interventions.(11)
Full range of family planningservices including laparoscopicservices(12) Safe abortion
service(13) Newborn care(14) Routine and emergency careof childrens.(15) ) All
national healthprogrammes delivered throughCHCwww.drjayeshpatidar.blogspot.in
45. TOPICS MAHARASHTRA RAJASTHAN(4) Staffing pattern Existing clinical
manpowerGeneral surgeon 1Physician 1Obstetrics/ gynecologist 1Pediatrician 1Proposed
clinical man powerAnesthetics 1Eye surgeon 1Public health programme
1managerExisting clinical manpowerGeneral surgeon 1Physician 1Obstetrics/
gynecologist 1Pediatrician 1Proposed clinical man powerAnesthetic 1Public health
programme 1managerwww.drjayeshpatidar.blogspot.in
46. TOPICS MAHARASHTRA RAJASTHANExisting support manpowerNurse
midwife 9Dresser 1Pharmacist 1Lab. Technician 1Radiographer 1Ophthalmic 1Ward boy
2Sweeper 3Chowkidar 1OPD attendant 1Statistical assistant 1OT attendant 1Registration
clerk 1Existing support manpowerNurse midwife 12Dresser 1Pharmacist 2Lab.
Technician 1Radiographer 1Ophthalmic 1Ward boy 2Sweeper 3Chowkidar 2OPD
attendant 1Statistical assistant 1OT attendant 1Registration clerk
2www.drjayeshpatidar.blogspot.in
47. (1) Medical officer: He is the captain of the health team at the primaryhealth center.
He devotes the morning hours attending to patientsin the outdoor,in the afternoon and
supervises thefield work. He visits each subcenter regularly on fixed days andhours and
provides guidance, supervision andleadership to the health team. He spends one day in
each month organizing staffmeetings at PHC to discuss the problems and reviewthe
progress of health activities.Job description of the members of the health
team:www.drjayeshpatidar.blogspot.in
48. He ensures that national health programmes arebeing implemented in in his area
properly. The success of PHC depends largely on the teamleadership which the medical
officer is able toprovide. The medical officer must be a planner, thepromoter, the
director, the supervisor, thecoordinator as well as the
evaluator.www.drjayeshpatidar.blogspot.in
49. Health worker female: She will register pregnant women from three monthsof
pregnancies onwards. Maintain maternity record, register of antenatal cases,eligible
couple register, children register up to date. She will provide care to pregnant women
especiallyregistered mother throughout the period of pregnancy; Give advice on
nutrition to expectant and nursingmothers about storage, preparation and distribution
offood. Immunize pregnant mothers with tetanus toxoid. Conduct about 50% of total
deliveries at home. Supervise deliveries conducted by Dais and whenevercall
in.www.drjayeshpatidar.blogspot.in
50. Spread the message of family planning to the couples;motivate them for family
planning individually and ingroups. Distribute conventional contraceptives to the
couples. Assess the growth and development of the infant andtake necessary action.
Records and reports births and deaths in her area. Test urine for albumin and sugar and
do Hb during herhome visit. Arrange and help M.O and health assistant inconducting
 MCH and family planning clinics at subcenters. Maintain the cleanliness of subcenter.
Attend staff meetings at PHC, CD block or both.www.drjayeshpatidar.blogspot.in
51. Health worker male: He will survey all the families in his area and collectall the
information about each village/ locality in hisarea. Identify the cases of communicable
diseases andnotify the health assistant male and M.O PHCimmediately. Educate the
community about importance ofcontrol and preventive measures againstcommunicable
diseases. Assist the village health guide in undertaking theactivities under TB
programme properly.www.drjayeshpatidar.blogspot.in
52. Educate community on the method of liquid and solidwaste, home sanitation,
advantage and use of sanitarylatrines. Assist the health assistant male in the school
healthprogramme. Utilize the information from the eligible couple andchild register for
the family planning programme. Spread the message of family planning to the
couples;motivate them for family planning individually and ingroups. Distribute
conventional contraceptives to the couples. Provide follow-up services to male family
planningacceptors. www.drjayeshpatidar.blogspot.in
53. Health assistant female: Supervise and guide the health workers in thedelivery of
health care services to the community. Carry out supervisory home visiting. Guide the
health workers (female) in Distributionof conventional contraceptives to the couples.Visit
each of the 4 subcenters at least once in aweek on fixed days. Respond to urgent calls
from the health workersand trained dais and render necessary
help.www.drjayeshpatidar.blogspot.in
54. Organize and utilize the mahila mandal, teachersetc., in the family welfare
programme. Provide information on the availability of servicesfor MTPs and refer
suitable cases to the approvedinstitution. Supervise the immunization of all pregnant
womenand children (0-5 years) Collect and compile the weekly reports of birthsand
deaths occurring in his area. Educate the community regarding the need ofregistration of
vital events.www.drjayeshpatidar.blogspot.in
55. Health assistant male: Supervise the work of Health worker male duringconcurrent
visit. Check minimum 10% of houses in village. Supervise the spraying of insecticides
during localspraying along with the health worker (male). Conduct immunization of all
school going children withthe help of health worker (male). Supervise the immunization
of all childrens (0-5 years). Assist M.O.PHC in organization of family planningcamps
and drives. . Provide information on the availability of services forMTPs and refer
suitable cases to the approvedinstitution.www.drjayeshpatidar.blogspot.in
56. Ensures follow-up of all cases of vasectomy, tubectomyIUD and other family
planning acceptors. Ensure that all the cases of malnutrition infants andyoung childrens
(0-5years) are given the necessarytreatment and advice and refer serious cases to PHC.
Ensure that Iron and folic acid and Vitamin A aredistributed to the beneficiaries. Conduct
MCH andfamily planning clinics and carry out educationalactivities. Organize and
conduct training for dais women leaderswith the help of health workers Collect and
compile the weekly reports of births anddeaths occurring in his area. Educate the
community regarding the need ofregistration of vital events.
www.drjayeshpatidar.blogspot.in