PRIMARY HEALTH CARE IN INDIA / HEALTH PROBLEMS IN

INDIA & ROLE OF A NURSE.

DR. MAHESWARI JAIKUMAR

PRINCIPLES OF PRIMARY HEALT CARE.

•EQUITABLE DISTRIBUTION.

•APPROPRIATE TECHNOLOGY.

•A FOCUS ON HEALTH PROMOTION / DISEASE PREVENTION.

•COMMUNITY PARTICIPATION.A MULTISECTORAL APPROACH.

•MAN POWER PLANNING.

ELEMENTS OF PRIMARY HEALTH CARE.

•Education concerning prevailing health problems & methods of preventing & controlling them.

•Promotion of food supply & proper nutrition.

•Adequate supply of safe drinking water & basic sanitation.

•Maternal & child health care , including family planning.

•Immunization against major infectious diseases.

•Prevention & control of locally endemic disease.

•Appropriate treatment of common diseases & injuries.

•Provision of essential drugs.

•.

CURRENT HEALTH PROBLEMS IN INDIA.

COMMUNITY DIAGNOSIS. Refers to the assessment of health status & health problems to design health services. The following are the components Indicators decisive of health problems.

•Morbidity & mortality statistics.

•Demographic conditions of the population.

•Environmental factors influencing health.

•Socio – Economic factors influencing health.

•Culture & its components.

•Medical & Health services available.

•Other services available.

HEALTH PROBLEMS IN INDIA.

•COMMUNICABLE DISEASE PROBLEM.

•NUTRITION PROBLEMS.

•ENVIRONMENTAL SANITATION PROBLEM.

•MEDICAL CARE PROBLEM.

•POPULATION PROBLEMS.

COMMUNICABLES DISEASE PROBLEM.MALARIA :

•The incidence of disease is 2.32 %.

•P.falciparum cases have increased than the previous years.

TUBERCULOSIS :

•30 % 0f the total population is affected with TB.

•1.5 % have radio logically active disease.

•0.4 % of the cases are sputum positive.

•India has 12.7 million cases of pulmonary TB ( 3.4 million are sputum +ve.

•Death due to TB – 500000 every yr.

DIARRHOEAL DISEASECommonly encountered with children,

•Diarrhoeal disease contribute 7.1 lakh deaths / yr.

•The disease is attributed to un hygienic feeding practices & poor environmental conditions.

ARI•Causes major morbidity 7 mortality among U5.

•ARI constitutes 13.6 % hospital admissions.

•13 % in patient deaths in pediatric wards is due to ARI.

LEPROSY.•2003 – 2004 – 2.20 lakh new cases were detected.

•The prevalence rate of leprosy is 2.3 / 10000 pop.

•The proportion of infectious case varies between 6 – 8 % .

•India accounts for 60 % of leprosy cases in the world.

FILARIA.

•About 6 million cases / yr.

•45 million persons have one or more chronic filarial lesion.

AIDS.•AIDS was first detected in 1986.

•No: of AIDS cases have risen to 86028 by 2004.

•By 2003 – 5.1 million HIV +ve cases.

OTHERS.

Kala – azar, meningitis, viral encephalitis, entric fever, helminthic infestations.

NUTRITIONAL PROBLEMS.

PROTEIN ENERGY MALNUTRITION.

•80% OF Indian children have mild – moderate PEM.

•The incidence is 1-2% in pre school children.

•PEM includes marasmus & kwashiorkor.

NUTRITIONAL ANEMIA.

•India has the highest prevalence of nutritional anemia among women & children.

•60 -80% of pregnant women are anemic.

•20-40% of maternal deaths are attributed to anemia.

•Fe+ deficiency anemia is widely prevalent

LBW

•30% of babies born are LBW.

•Maternal malnutrition is responsible for LBW.

XEROPHTHALMIA0.04% of blindness is attributed to Vit A deficiency.

Keratomalacia is considered to be a major cause of nutritional blindness in 1-3 yrs.

Vit A deficiency also predisposes to frequent GI infections.

IODINE DEFICIENCY DISORDERS

Widely prevalent in India.

OTHERS

Lathyrism, endemic flurosis, food adulteration.

ENVIRONMENTAL SANITATION

•Increased urbanization & industrialization leads to hazards to human health , air, water, & food chain.

•1981-1990 International Water Supply & Sanitation Decade was observed.

•As of 2000 – safe Water is available to almost 85% of the rural population.

•Excreta disposal facility (1994)------- Urban – 70%, Rural – 14%, Combined – 29%.

MEDICAL CARE PROBLEMS

•India does not have a National Health Service.

•80% of the health services are concentrated in the urban areas.

•India does not meet the suggested manpower norms.

POPULATION PROBLEMS

•India is the second populest country in the world.

•Population explosion has detrimental effect on housing, health care, sanitation, & environment.

•The Annual Growth Rate of India is high 2.1.

THE HEALTH CARE SYSTEMS – INDIA.

•The care system is the structure of the country’s pattern of delivery of the health services.

•The health care system operates within the context of socio-economic & political framework of the country.

HEALTH CARE SYSTEM IN INDIA.

HCS

Public Health Sector

Private Sector

Indigenous System Of Medicine

Voluntary Health Agencies

National Health Progs

PUBLIC HEALTH SECTOR

•HOSPITALS / HEALTH CENTERS

•PRIMARY HEALTH CARE – PHC, HSC.

•HEALTH INSURANCE SCHEMES.- ESI, CGHS.

•OTHER AGENCIES.---- Defence services, Railways.

•Community Health Centers.

•Rural Hospitals.

•Dt Hosp.

•Specialist Hosp.

•Teaching Hosp.

PRIVATE SECTOR

•Private Hosp, Poly Clinics, Nursing Homes,& Dispensaries.

•General Practitioners & Clinics.

INDIGENOUS SYSTEM OF MEDICINE.

•Ayurveda & sidda.

•Unani & Tibbi.

•Homeopathy.

•Unregistered Practitioners.

VOLUNTARY HEALTH AGENCIES.

NATIONAL HEALTH PROGS.

MODEL OF HEALTH CARE SYSTEM.

Inputs Health Services Health Care Systems Output

OUTPUT

Health status

Health problems

Resources

•Promotive

•Preventive

•Curative

•Rehabilitative

•Public

•Private

•Voluntary

•Indigenous

Changes in health status

ROLE OF A NURSE IN HCDS.

Nurse

Administrator

Service provider

HCDS

HCDS HCDS

HCDS

PUBLIC & PRIVATE SECTORS

INDIGENOUS SYSTEM OF MEDICINE

NATIONAL HEALTH PROG

VOLUNTARY HEALTH AGENCIES

RESEARCHER

Preventive

curative

Rehabilitative

Promotive

FUNCTIONAL ROLES

Educationist

Research

ROLE OF A NURSE IN HCDSEDUCATION CONCERNING HEALTH PROBLEMS.

•The nurse in various capacities designs health education progs, materials & disseminates the same to the policy makers, educationists, general public, & to various categories of health personnel.

•The nurse designs health education contents according to the health needs & problems, according to the beneficiary & according to the context.

•The nurse undertakes necessary precautionary measures, primordial prevention strategies, specific preventive measures to promote the health of the community.

•Devise necessary surveillance measures, control measures, control measures to check the disease load in the community.

•Involve mass media & relevant other personnel in preventing preventable diseases.

PROMOTE FOOD SUPPLY & NUTRITION.

•Undertake measures to carry out nutritional surveillance.

•Maintain epidemiological profile of the nutritional disease.

•Assess the extent of nutritional problems & categorize them depending on the intervention required.

•Organize & carry out nutritional supplementation & rehabilitation services to the target group.

•Co-ordinate with the state’s initiative in the implementation of relevant nutritional programmes.(ANP, ICDS, Vit A Porg,SNP, School Feeding Prog, Fe+ deficiency anemia Prog.)

•Co-Ordinate with like minded agencies FAO, WHO, UNICEF & Voluntary health sectors to promote the nutritional status of the community.

•Promote optimal food production & storage & distribution system & an efficient public distribution system.

PROVISION OF SAFE WATER & SANITATION.

•The nurse, translates the components of water & sanitation decade.

•The nurse co –odinates with agencies that are involved in the provision of safe water (Water Plants, Sewerage treatment Plants.)

•Educate the community regarding importance of safe drinking water & sanitation measures.

PROVISION OF MATERNAL & CHILD HEALTH SERVICES.

•Translate the relevant MCH elements of the various governmental policies & programs.

•Involve similar agencies (SHAKTHI, NGO, VHAI) in the designing & implementation of MCH initiatives.

•Implement U5 initiatives incorporating ICDS Anganwadi, SNP,ANP,& related components.

Plan & carry out AN,PN care.

•Registration, investigation, TT, weight monitoring,IFA & calcium supplementation,Essential perinatal care.

•Impart Essential New Born Care.

•Implement adolescent health initiatives.

•Implement initiatives for control of STD & AIDS.

IMMUNIZATION AGAINST VPD.•Implement the National Immunization Prog.

•Plan & design immunization services at all levels.

•Maintain statistical details of the immunization status of India.

•Co-ordinate with agencies & industries manufacturing vaccines.

•Design & disseminate H/E materials relevant to Vaccine Preventable Diseases.

PREVENTION & CONTROL OF LOCALLY ENDEMIC DISEASES.

•Implement relevant national control & prevention, eradication prog.

•Co-ordinate the state & center’s initiatives in controlling communicable diseases.

•Plan & implement control & eradication measures locally.

•Advocate & sensitize the community to practice preventive strategies.

•Undertake primordial prevention measures & focus to prevent endemic disease.

•Implement prophylactic measures during the period of endemicity.

APPROPRIATE TREATMENT FOR COMMON INJURIES.

Undertake & implement appropriate treatment strategies.

PROVISION OF ESSENTIAL DRUGS.

•Co-ordinate with the Drug Control Organization.

•Monitor the manufacture & supply of drugs in the market.

•Maintain inventory--- stock of drugs as per requisites.

•Indent required drug for various levels of care settings.