Levels of Health Care

Decentralised approach
REF: Park 20′ edition page 792

Principles of primary health care:

1. Equitable distribution
2. Community participation
3. Intersectoral coordination
4. Appropriate technology

Decentralised approach

Among all the options listed above, community participation is the current trend followed as far as Health care is concerned.

The whole concept to protect health is possible only with the participation of the community whose health is being protected.

Primary health care is that health care being provided at the level individuals, family and community.

Equitable distribution is one of the principles of primary health care as per Alma – Ata Declaration. 

Ref: Park’s Textbook of Preventive and Social Medicine, 19th Edition, Pages 20, 21.

• Dependency ratio
• Rate of population increase
• Literacy rate
• Level of unemployment
• Family size
• Housing
• Per capita GNP

Life expectancy is one of the mortality indicators.

At the conference held in 1978, the Alma-Ata Declaration has defined public health care as “Primary Health Care” is essential healthcare made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and country can afford.

Bhore Committee Comprehensive Health Care

Ans is ‘b’ i.e., Community participation

Responsibility for health

• Individuals health is almost inseparable from the health of larger community and the health of every community in every state and territory determines the overall health status of the Nation.
• Therefore, it involves the joint efforts of the whole social fabric (the individual, the community, and the state) to protect and promote health.

1. Individual responsibility (Self Care)

             Health has to be earned and maintained by the individuals by ‘Self Care’, a recent trend in health care.

             Self care refers to those activities individuals undertake in promoting their own health, preventing their own disease, limiting their own illness, and restoring their own health. For example, measuring self BP, doing exercise, taking nutritious diet etc.

2. Community responsibilty (Community participation)

             Health can never be adequately protected by health services without active understanding and involvement of the communities whose health is at stake. This makes community participation a very important aspect of health care.

             Therefore, emphasis has shifted from health care for the people to health care by the people.

3. State responsibility

             Responsibility for health does not end with the individual and community effort.

             The state assumes responsibility for the health and welfare of its citizen

             State shall make proper state health policy.

4. International responsibility

The health of mankind requires, the cooperation of governments, the people, national and international organization both within and outside the united nations system.

Ans. is ‘c’ i.e., Infant mortality rate

o IMR is considered a sensitive index of health services as it reflects maternal care, perinatal care, child rearing practices, nutritional practices, and socioeconomic conditions in which people live as well as availability, effectiveness and utilization of health care services.

“IMR is universally regarded not only as a most important indicator of health status of a community but also of the level of living of people in general and effectiveness of MCH services in particular. ” 

Ans. is ‘b’ i.e., Primary health care practice 

The practice of primary health care involves a good deal of deprofessionalization of medicine.

Ans. is ‘b’ i.e., Alma ata Declaration 

o The Bhore committee in 1946 gave the concept of Primary Health Centre as basic health unit.

o But in the view of limited resources, the committee recommendations could not implemented even after the lapse of 60 years.

o The deceleration of Alma ata conference in 1978 setting the goal of health for all by 2000 AD, has ushered as a new philosophy of equity, and a new approach – the primary health care approach.

o The national health plan (1983) proposed the reorganization of PHC for more effective coverage. As on 22370 PHC has been established in the country.

Ans. is ‘b’ i.e., Effectiveness 

Ans. is ‘a’ i.e., Treatment by doctor 

Primary heath care

o “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.”

o There are 4 main principles of primary health care :

1. Equitable distribution

Community participation

1. intersectorial coordination
2. Appropriate technology

o Primary health care involves: health care of mother and child, immunization, prevention and control of locally endemic diseases, as well as appropriate treatment of common diseases and injuries. However, it is not essential to deliver these elements throught the agencies of doctors under the primary health care. Root level workers, such as village health guides. are appropriately trained to deliver these elements, at the village level.

Ans. is “b’ i.e. Health services are taken to the doors of people

Principles of primary health care

1. Equitable distribution

          It means, health services must he shared equally by all people irrespective of their ability to pay and all people (urban or rural, rich or poor) have access to health services.

2. Com m unity participation

          The local community is involved in planning and implementation of health services.

          Primary health care is thus described as – Health by the people, placing people’s health in people hands.

         Village health guides and trained dais are perfect examples of community participation. They belong to the community they serve

3.Intersectorai coordination

          The primary health care is not provided by health sector alone.

        It involves all other related sectors of national and community development, in particular agriculture, animal husbandry. food, industry, education, housing, public works, communication and other sectors.

4. Appropriate technology

Appropriate technology is defined as ‘technology that is scientifically sound, adaptable to local needs, and acceptable to those who apply it and those for whom it is used, and that can be maintained by the people themselves in keeping with the principles of set r reliance with the resources the community and country can afford.’

Ans. is ‘c’ i.e., Sound Referral System 

Elements of Primary health care –

1)Education concerning prevailing health problems and the methods of

preventing and controlling them

2)  Promotion offrod supply and proper nutrition

3)  An adequate supply of safe water and basic sanitation

4) Maternal and child healths care including family planning.

5)Immunization against major infectious disease

6) Prevention and control of locally endemic disease. 7)Appropriate tIt of common disease and injuries. 8) Provision of essential drugs.

Ans. is `b’ i.e., Adequate housing

Ans. is ‘c’ i.e., Multipurpose health worker 

Ans. is ‘c’ i.e., Speciality_, services 

Ans. is ‘d’ i.e., Information, Education and Communication 

Ans. is ‘C’ i.e., Disability prevalence 

Ans. B: Specialised surgeries

Primary health care is provided by city and district hospitals and rural primary health centers (PHCs). These hospitals provide treatment free of cost.

Primary care is focused on:

• Immunization against major infectious disease
• Promotion of food supply, proper nutrition and prevention of malnutrition
• Maternal and child health care, including family planning
• Treatment of common illnesses and injuries
• Provision of essential drugs
• Education concerning prevailing health problems and methods of preventing and controlling them.
• Prevention and control of locally endemic diseases.
• Adequate supply of safe water and basic sanitation

Patients who receive specialized care or have complicated illnesses are referred to secondary (often located in district and taluk headquarters) and tertiary care hospitals (located in district and state headquarters or those that are teaching hospitals).

Ans. A: Treatment is done by doctor

Primary health care

• The Alma Ata Conference defines Primary Health Care as essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally, accessible to individuals and families in the community by means of acceptable to them, through their full participation and at a cost that community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.

• It forms an integral part of both the country’s health system, of which it is the central function and the main focus and of the overall social and economic development of the community
• Goal

The global goal as stated in the Alma Ata Declaration is Health for All by the year 2000 through self-reliance.

– Health begins at home, in schools and in the workplace because it is there where people live and work that health is made or broken.

– It also means that people will use better approaches than they do now for preventing diseases and alleviating
unavoidable disease and disability and have better ways of growing up, growing old and dying gracefully.

– It also means that here will be even distribution among the population of whatever resources for health are available.

– It means that essential health services will be accessible to all individuals and families in an acceptable and affordable way.

• Principles and Strategies:
• Accessibility, Availability, Affordability and Acceptability of Health Services Strategies:

– Health services delivered where the people are

– Use of indigenous/resident volunteer health worker as a health care provider with a ratio of one community health worker per 10-20 households

– Use of traditional (herbal medicine) with essential drugs.

• Provision of quality, basic and essential health services Strategies:

– Training design and curriculum based on community needs and priorities.

– Attitudes, knowledge and skills developed are on promotive, preventive, curative and rehabilitative health care.

–  Regular monitoring and periodic evaluation of community health workers performance by the community and health staff.

• Community Participation Strategies:

– Awareness, building and consciousness raising on health and health-related issues.

– Planning, implementation, monitoring and evaluation done through small group meetings (10-20 households cluster)

Selection of community health workers by the community.

– Formation of health committees.

Establishment of a community health organization at the parish or municipal level.

– Mass health campaigns and mobilization to combat health problems.

• Self-reliance Strategies

Community generates support (cash, labor) for health programs.

– Use of local resources (human, financial, material)

– Training of community in leadership and management skills.

– Incorporation of income generating projects, cooperatives and small scale industries.

• Recognition of interrelationship of health and development Strategies:

– Convergence of health, food, nutrition, water, sanitation and population services.

Integration of PHC into national, regional, provincial, municipal and barangay development plans.

–  Coordination of activities with economic planning, education, agriculture, industry, housing, public works, communication and social services.

Establishment of an effective health referral system.

• Social Mobilization Strategies

–  Establishment of an effective health referral system.

– Multi-sectoral and interdisciplinary linkage.

–  Information, education, communication support using multi-media.

– Collaboration between government and non-governmental organizations.

• Decentralization Strategies

– Reallocation of budgetary resources.

– Reorientation of health professional and PHC.

Advocacy for political and support from the national leadership down to the barangay level.

• 8 Essential Health Services in Primary Health Care

– E – Education for Health

– L – Locally endemic disease control

– C – Expanded program for immunization

M – Maternal and Child Health including responsible parenthood

– E – Essential drugs

–     N – Nutrition

– T – Treatment of communicable and non-communicable diseases

– S – Safe water and sanitation

• Remember ELEMENTS

Ans. C: Supervising sample registration system

Sample registration system is a dual record system, consisting of a continuous enumeration of births and deaths by an enumerator and an independent survey every 6 months by an investigator supervisor.

Ans. B: Primary health care

Ans. is ‘a’ i.e., Proper housing

Primary heath care

• “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.” 
• There are 4 main principles of primary health care :

1. Equitable distribution
2. Community participation
3. Intersectorial coordination
4. Appropriate technology

• Primary health care involves: health care of mother and child, immunization, prevention and control of locally endemic diseases, as well as appropriate treatment of common diseases and injuries. However, it is not essential to deliver these elements throught the agencies of doctors under the primary health care. Root level workers, such as village health guides, are appropriately trained to deliver these elements, at the village level.

Ans. is ‘d’ i.e., Best approach for health for al is basic health care

The Declaration of Alma-Ata (1978) by emphasizing the need for “individual and community participation” gave a new meaning and direction to the practice of health education.

In 1978, the Alma-Ata International conference on Primary Health Care reaffirmed Health for All as the major social goal fo governments, and stated that the best approach to achieve the goal of HFA is by providing primary health care, especially to the vast majority of underserved rural people and urban poor.

It was envisaged that by the year 2000, at least essential health care should be accessible to all individuals and families in an acceptable and affordable way, with their full participation.

The Alma-Ata Conference called on all governments to formulate national policies, strategies and plans of action to launch and sustain primary health care as part of a national health system.

It is left to each country to develop its norms and indicators for providing primary health care according to its own circumstances.

Ans. is ‘c’ i.e., Tertirary health care 

Levels of health care

• It is customary to describe health care service at 3 levels, viz. primary, secondary and tertiary care levels. o These levels represent different types of care involving varying degrees of complexity.

1. Primary care level

• It is the first level of contact of individuals, the family and community with the national health system, where “primary health care”, (“essential” health care) is provided.
• As a level of care, it is close to the people, where most of their health problems can be dealt with and resolved.
• It is at this level that health care will be most effective within the context of the area’s needs and limitations.
• In India, primary health care is provided by PHC and their subcentres through the agency of multipurose health workers, village health guides and trained dais.

2. Secondary care level

• The next higher level of care is the secondary (intermediate) health care level.
• At this level more complex problems are dealth with.
• In India, this kind of care is generally provided in district hospitals and community health centres which also serve as the first referral level.

3. Tertiary care level

• The tertiary level is a more specialized level than secondary care level and requires specific facilities and attention of highly specialized health workers.
• This care is provided by the regional or central level institutions, e.g,. Medical College Hospitals, All India Institutes, Regional Hospitals, Specialized Hospitals and other Apex Institutions

Ans. is ‘a’ i.e., Primary health care