INTRODUCTION TO COMMUNITY HEALTH

1 | P a g e U N I T - I I N T R O D U C T I O N T O C O M M U N I T Y H E A L T H
COMMUNITY HEALTH NURSING-I
UNIT-I
INTRODUCTION TO COMMUNITY HEALTH
FIRST YEAR G.N.M.
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OVERVIEW OF COMMUNITY HEALTH NURSING
 Community has influence on the health status of people. Nurses need to understand
the structure of community, so that appropriate planned section can be taken by
them to achieve the health of the community.
 Before understanding the concept of community health nursing, it is necessary to
understand the community and community health.
 Then there will be discussion on the services provided by the medical and
paramedical personnel to achieve the overall health of people of community.
The term "community health nursing" is composed of three major concepts:
Community - Client
Health - Goal
Nursing -The means
Two Major Fields of Nursing in that:
1. Hospital Nursing
2. Community Health Nursing
 We generally use the terms community health nursing and public health
nursing, and community health nurse and public health nurse interchangeably.
 The community is a social system, where interactions among individual occurs.it
is composes of subsustems such as socio cultural, political, educational,
environmental and religious. All these factors influences the health of
community.so within the community there is need to understand these
subsystem to promote the health of community.
THE COMMUNITY HAS THE FOLLOWING CHARACTERISTICS:
 group of people

 common place
 interaction among members
 common culture
 common language
 same feeling
 common attitude
 more or less same type of life style
 common values and interest
 CHARACTERISTICS OF COMMUNITY
1. Distinctiveness
2. Homogeneity
3. Closeness
4. Sense of belongingness
5. Sense of togetherness
6. Self-sufficiency`
A. Distinctiveness
 Each community has defined as geographical boundaries
having its beginning and end.
 These boundaries are more remarkable in smalller
communities than in larger communities.
B. Homogeneity
 There is similarity in psychological charecteristics of people
living in the defined boundaries of the community
 Example-similarity in language life style, customs, tradition
etc..
C. Closeness
 The people in the community have face to face interaction and
free communication.
 The extent of closeness varies.
 The community people frequently participate in common
activities etc.
D. Sense of belongingness
 The degree and intensity of this feeling may vary among
members in the community.
E. Sense of togetherness

 There is unity and cohesiveness among the members in the
community which is based on their interactions and sense of
belongingness to community.
F. Self-sufficiency
 The community provides all such means and facilities which
help in meeting the basic needs of its people i.e.-space to live,
education, protection and security etc..
 CHARACTERISTICS OF HEALTHY COMMUNITY
 Awareness that we are community
 Conservation of natural resources
 Recognition of and natural resources
 Participation of subgroups in community affairs.
 Preparation to meet crisis
 Ability to solve problems
 Communication through open channels
 Resources available to all
 Setting of disputes through legitimate mechanisms.
 Participation by citizens in decision making.
 Wellness of high degree among its members.
 FUNCTIONS OF HEALTHY COMMUNITY
 It provides space for housing,shelter,for socialization and recreation
 It provides safety and security by protecting the community members.
 Linkage with social system outside the community for meeting needs of its
members.
 Provides opportunity for employment and sustenance.
 Protection, distribution and consumption of goods and services.
 Socialization and education for its members.
 Provides opportunities for interaction amongst members, transmits
information, ideas and belief and provides support system.
THREE TYPES OF COMMUNITIES
1. common place- means geographical location
2. social system-social units and systems with the pattern of interactions
3. group of people

Community
WHO Define
“Community as social group determined by geographical boundaries, common values and
interest”
Health
WHO
"Health is a state of complete physical mental and social well-being, and not merely an absence
of disease or infirmity"
Community Health
WHO’s
“Community health refers to the health status of the community, to the problems, affecting their
health & to the totally health care provided to the community.”
Acc. To AAPH
“The art and science of maintaining, protecting and improving health of the people through
organized efforts.”
Acc. To CEA. Winslow
“Community health is the science and arts of preventing diseases, prolonging life and
promoting health and efficiency through organized efforts”
COMMUNITY HEALTH NURSING
ANA’s
“It is field of practice that synthesizes knowledge & skill from nursing & public health & applied
them toward preventing, promoting, curative & rehabilitative care to family & community.”
Acc. To AAPH
“Public health Nursing synthesizes the body of knowledge from public health sciences and
professional nursing theories for the purpose of improving the health of entire community.”

Acc. to WHO Expert Committee of Nursing
Special field of nursing that combines the skills of nursing, public health and some phases of
social assistance and functions as part of the total public health program for the promotion
of health, the improvement of the conditions in the social and physical environment,
rehabilitation of illness and disability.”
OBJECTIVE OF C.H. NURSING
1) To participate in the development of an over all health plan for the community.
2) To provide quality nursing services to individuals, families & communities.
3) To coordinate nursing services with various members of health team.
4) To participate in and/or conduct researches relevant to community health and
community health nursing services and disseminate their results for improvement
of health.
PURPOSE OF C.H. NURSING
1.To ascertain the nature & extent of disease & disability in the community.
2. To take suitable measures to….
-Promote healthful living.
-Prevent Disabilities.
-Correct re-medical defects.
-Treat illness & Rehabilitate those and handicaps.
3. To evaluate the progress and success of current programmes.
4. To conduct research in community causes and diseases.
5. To provide the medical & nursing care to common ill health.
6. To educate the public in prevention of health hazards.
CONCEPT OF HEALTH
• Good health is a prerequisite of human productive and developmental process.
Health is a condition of being sound by body, mind or spirit especially free from
physical disease or pain.
The concept of health has been defined in a variety of ways. Historically, health and
illness were viewed as extreme on a continuum, with the absence of clinically recognizable
disease
Changing concepts of health
• Biomedical concept
• Ecological concept

• Psychosocial concept
• Holistic concept
Biomedical Concept
• This concept stress on germ theory that is disease or illness is caused due to
disease causing organism.
• The individual was considered to be healthy only if he was free from disease.
• This concept was rejected by other scientist because it will not help to solve
some major health problems which are not occurred by disease causing organism
like malnutrition, accidents, mental illness etc.
Ecological concept
• The ecologists viewed health as a harmonious equilibrium between man and his
environment and disease as a maladjustment of human organism to the
environment.
• This environment includes air, water and other necessary things needed to
human being for their life.
• Example: environmental pollution leads to health problem
Psychosocial concept
• It visualizes health is not only a biomedical phenomena but that it is also
influenced by various factors like social, psychological, cultural, economical and
political. All these factors and status helps to determine and maintain health
status of the population.
Holistic concept
• This concept is a synthesis of the views of all the experts.
• According to this concept health is viewed as a multidimensional process
involving the wellbeing of the whole person in the context of his environment
Concept of Health
 Health: holistic state of well-being, including soundness of mind, body, and spirit
 Wellness: health plus the capacity to develop one’s potential, leading to a fulfilling and
productive life
 Illness: state of being relatively unhealthy
Signs of Good Health
To look for signs of good health, we must examine all the three aspects

• Physical
• Mental
Social
Physical health
A person who enjoys good physical health is one who -
• is energetic
• has good posture
• weighs normal for age and height
• has all body organs functioning normally
• has a clear and clean skin
• has bright eyes
• has good textured and shining hair
• has a clean breath
• has a good appetite
• gets sound sleep
Social heath
A person with good social health -
• gets along well with people around
• has pleasant manners
• helps others
• fulfills responsibility towards others
• A person is socially healthy if he or she can move in the society confidently with
others.
Mental health
Mental health implies -
• control on emotions
• sensitive to the needs of others
• confidence in one’s own abilities
• freedom from unnecessary tensions, anxieties and worries
• A person is mentally healthy if he or she is relaxed and free from any worries

CONCEPT OF DISEASE
 Webster defines disease as “a condition in which body health is impaired, a departure
from a state of health, an alteration of the human body interrupting the performance of
vital functions”.
 The oxford English Dictionary defines disease as “ a condition of the body or some part
or organ of the body in which its functions are disturbed or deranged”.
 Ecological point of view disease is defined as “a maladjustment of the human organism
to the environment.”
 The simplest definition is that disease is just the opposite of health: i.e. any deviation
from normal functioning or state of complete physical or mental well-being.
DISTINCTION BETWEEN DISEASE, ILLNESS AND SICKNESS
 The term disease literally means “without ease” (uneasiness), when something is wrong
with bodily function.
 Illness refers to the presence of a specific disease, and also to the individual’s
perceptions and behavior in response to the disease, as well as the impact of that
disease on the psychosocial environment.
 Sickness refers to a state of social dysfunction.
 Disease is a physiological/psychological dysfunction.
 Illness is a subjective state of the person who feels aware of not being well.
 Sickness is a state of social dysfunction i.e. a role that the individual assumes when ill
(sickness role).
DIMENSIONS OF HEALTH
 Many factors combined together to affect the health of an individual and
community hence we consider health as multidimensional

Physical dimension
 For the physical dimensions the accurate functioning of the body from the
smallest unit like cell of the body to the functioning of a largest organ of the
body and well coordination of all the body organs is considered. It includes:
 Ability to perform daily tasks or self-care activities
 Ability to achieve fitness
 Ability to maintain nutrition
 Ability to avoid abuses
Mental dimension
 It is the ability to deal with energy situation of life whether it is favorable or
unfavorable intelligently and logically or it is a balance the individual and its
surrounding world living harmoniously in the society, accepting reality of
situations and adapt them to situations.
 Characteristics of mental dimensions
 Well adjusted
 Strong sense of self esteem
 Get along with others
 Self actualization
Dimensions of
Health
Physical
Mental
Social
Spiritual
Emotional
Environmental
Occupational
Intellectual

 Good self control
 Cope with stress and anxiety
Social dimension
 social wellbeing implies harmony and integration within the individual as well
as within the Society.
 It refers to the ability to interact with people, respect self and others, develop
meaningful relationships and develop quality communication skills
Spiritual dimension
 Spiritual dimension includes discovering a set of beliefs in some force that serves
to unite and values that brings purpose to life.
 Spirituality can be important factor that helps individual to achieve the balance
needed to maintain health and wellbeing and cope with illness.
Emotional dimension
 It is related with feelings and emotions. It includes the needs of love and
affection, ability to manage stress which affects the body system and anxiety
affects health habits
Occupational dimension
 The ability to achieve balance between work and leisure while managing stress
from relationships with co-workers is essential to occupational health.
 Sudden loss of job affects the psychology and mental health of the person which
eventually affects the physical health status of the person.
Environmental dimension
 Environment helps significant impact on the health status of the individual
Intellectual dimension
 It is the ability to learn and use information effectively
INDICATORS OF HEALTH
 A variable which helps to measure changes, directly or indirectly (WHO, 1981).
 A statistic of direct normative interest which facilitates concise, comprehensive, and
balanced judgments about conditions of major aspects of the society
(H.E.W./USA,1969).

The health indicators are defined as those variables which measures the health status of an
individual and community
INDICATORS OF HEALTH
 Mortality Indicators: Crude Death rate, Life Expectancy, Infant mortality rate, Child
mortality rate, under five mortality rate, maternal mortality ratio, Disease specific
mortality, proportional mortality rate etc.
 Morbidity Indicators: Incidence and prevalence rate, disease notification rate, OPD
attendance rate, Admission, readmission and discharge rate, duration of stay in hospital
and spells of sickness or a Disability Indicators: Sullivan's index, HALE (Health Adjusted
Life Expectancy), DALY (Disability Adjusted Life Year).
 Sullivan's index is a expectation of life free from disability.
 HALE is the equivalent number of years in full health that a newborn can expected to
live based on the current rates of ill health and mortality.
 DALY expresses the years of life lost to premature death and years lived with disability
adjusted for the severity of disability.
 Nutritional Status Indicators: Anthropometric measurement of preschool children,
Prevalence of low birth weight etc.
 Health Care Delivery Indicators: Doctor-population ratio, Bed-nurse ratio,
Population-bed ration, Population per health facility etc.
 Utilization Rates: immunization coverage, ANC coverage, % of Hospital Delivery,
Contraceptives prevalence rate, Bed occupancy rate, average length of stay in
hospital and bed turnover rate etc
 Indicators of social and mental health: Rates of suicides, homicides, violence,
crimes, RTAs, drug abuse, smoking and alcohol consumption etc.
 Environmental indicators: proportion of population having access to safe drinking
water and improved sanitation facility, level of air pollution, water pollution, noise
pollution etc.
 Socio Economic Indicators: rate of population increase, Per capita GNP,
Dependency ratio, Level of unemployment, literacy rate, family size etc.
 Health policy Indicators:

 Proportion of GNP spent on health services, proportion of GNP spent on health related
activities including safe water supply, sanitation, housing, nutrition etc. and proportion of
total health resources devoted to primary health care.
 Indicators of Quality of Life: PQLI, IMR, Literacy rate, Life Expectancy at age one etc.
DETERMINANTS OF HEALTH
Health of an individual and whole community may be considered to be result of many
interaction
Determinants of health
Genetic make up
 The physical and mental traits of human being are at large extend determined
by the nature of genes that are generally transferred from the parents to the
offspring.
 A number of disease result due to transportation of genes or irregular genes eg.:
chromosomal anomalies, errors of metabolism, mental retardation, diabetes etc.
Genetic Make up
Environment
Life style
Socio-economic condition
Education
Occupation
Health Services

Environment
 This is composed of internal and external factors that determines health.
 Internal environment implies to cells tissues, organs and all the body system.
 External environment composed of all the physical, biological, social, cultural
that affects the health both positively and negatively and make a person
susceptible to the illness.
Life style
 Life style is very important determinants of health.
 It is composed of socio-economic status, habits of individual, socio-cultural
factor, customs, religion etc.
 The habit of smoking, alcoholism may affect the health status of an individual.
Good environmental sanitation sanitation, good nutrition, sound sleep, sufficient
physical activities denote the positive side of health status
Socio economic condition
In the developed countries there is less percentage of morbidity and mortality.
Nowadays due to increase in economic, people with good socio economic status can get
better nutrition, have better sanitation conditions that helps influencing the health status
of an individual
Education
 Education determines the health status , as an educated person have more knowledge
about the factors including quality of life than illiterate person
Occupation
Occupation place a very important role in determining the health status. Persons
who are involved in the occupation that require only documentary work are more
susceptible to get obese and hence may develop heart diseases whereas persons involved
in occupation that require more physical activities are more active and healthy
Health Services
 Provision of health services also determines the health status. Better health
services will lower the incidents of illness and improve the health status of the
people.
 Health services are also involved in immunization of children, provision of safe
water supply, care of pregnant women and children, primary health care.


Factors affecting health
 Human biology
 Environment
 Way of living
 Economic status
 Health services
Human biology
 Hereditary characteristics that are height, weight, color of skin, blood group etc.
are determined by the gene passed on from parents.
 The genetic constitution of human body is determined at the time of conception,
therefore the state of health depends on the genetic constitution inherited by
the individual.
 There are inherited disease like diabetes, cleft palate, epilepsy and hypertension
or genetic defects.
Environment
In the environment various living and non-living things surrounding man , place an
important role. The relation between man an environment is called human ecology
 The environment can be divided into three main parts physical environment,
biological environment and social environment.
 physical environment is the part of man’s external environment eg.: air, water,
housing, climate, soil, nutrition etc.
 The biological environment is the living component of man’s external
environment eg: plants, animals, insects, bacteria, viruses etc.
 The social environment is the relationship with the fellow human beings
Way of living
 Health depends upon the way of living level personal hygiene, education and life
style of the people.
 People must maintain the hygiene, eating, balance diet, healthy habits,
immunization and periodic checkups by increasing the living standards as it can
control diseases.
Economic status

 People with good economic status will be able to afford better health services
and maintain health better than the people with poor economic status. Therefore
economic status also affects the health status of the people
Health services
 The health services are provided by physicians, nurses, health assistance, health
workers etc. The services are both curative and preventive. The availability and
quality of health services to the people determines the health status of. the
people
HISTORY AND DEVELOPMENT OF COMMUNITY HEALTH NURSING
 “Health is Not mainly an issue of doctors, social services and hospitals. Health is an
issue of social Justice.
 There is no time to lose. We have the goal of “Health for all by 2000 AD”. This is the
call of the world health organization. and India has taken up the challenge.
 Formerly, Health care has been for those living near enough to a hospital or a doctor
in times of need and for those who could spend money for medicines and treatment.
 The great majority of people stayed in the village when sick and even today many suffer
and die without proper help.
 Attempts have been made to meet the health needs of the people of India by means of
primary health center and the training of Auxiliary Nurse Midwives to go out from these
centre’s to the homes of the people.
The number of ANMS trained was never sufficient and more than half of them after training
went to work in hospitals. In fact, their training was given mainly in the hospitals environment,
with title experience and understanding of health needs of people, families and communities in
rural areas.
 “Community Health Nursing is a synthesis of Nursing practice and public health
practice applied in promoting and preserving the health of populations. The

nature of this practice is general and comprehensive. It is not limited to a
particular age or diagnostic group. It is continuing not episodic. The dominant
responsibility to the population as a whole. Therefore nursing directed to
individuals, family or group contributes to the health of total population. Health
promotion, health maintenance, health education, co-ordination and continuity
of care are utilized in a holistic approach to the management of the health care
of individual, family, group and community.”
History and development of community Health Nursing in India:
 Pre-vedic Period:
 The medical system that are truly Indian origin and development are the Ayurveda
and Siddha system. Ayurveda dy definition implies “Knowledge of Life”. Its origin is
traced far back to the Vedic times, about 5000BC. During this period, medical history
was associated with mythological figures, sages and seers.
 Dhanvantari the Hindu god of Medicine is said to have been born as a result of the
churning of ocean during a tug war between gods and demons. According to some
authorities medical knowledge in the Atharvaveda gradually developed into the
science.
 The experience and concern in health development and public health care dates back
to this Vedic period. In the Indus Vally Civilization (3000 BC) itself, one funds
evidence of well- developed environmental sanitation programmes such as
arrangements of good water supply, underground drainages, Public baths in cities etc.
 In ancient India, the celebrated authorities in Ayurveda medicine were Atreya,
Charaka, Sustra and Vagbhatt. Atreya (about 800 BC) is acknowledged as the firdt
great Indian Physician and Teacher. Charaka a famous Ayuirvedic Medicine, Sustra a
father of Indian Surgery. From this early writings other authers wrote books. From

these writings we learn that surgery had advanced to a high level, also that doctors
and the attendants (Nurse) must be the people of high character, Hospital were large
and well equipped.
 Medical education was introduced in the ancient Universitiesof Taxila and Nalanda.
 During Budha period hospital system was developed for men and women and for
animals.
 This was exapanded during king Ashoka, Moghal Period (1000 AD) Unani Medicine
which (Arabic system) was introudced through Greek medicine which has become a
part of Indian medicine. Nursing and medicine are closely linked together.
 Nursing was regarded on the “Science of Care” and medicine as the “Science of Cure”.
As the science of cure, medicine is concerned with the diagnosis and treatment of
illness.
 As the scienceof care, nursing is concerned with the care of people who are ill. The
care and cure functions are complimentary ; both are necessary and important
aspects of health care for the people.
 King Ashoka (272 BC-236 BC) a convert Buddhism, brought about period of
prosperity.
 Monasteries were built, houses for travelers were provided and hospitals for both
men and women and animals were founded.
 Prevention of disease became a matter of first importance and hygiene practices
were adopted. Cleanliness of the body was religious duty.
 Doctors and midwives were to be trustworthy and skill full. They must wear clean
cloth and keep their nails cut short. Operations were precede by religious
ceremonies and prayers. The nurses were usually men or old women.

 Women of India were favoured though restricted to activities in the home. No doubt
they cared for the sick members in the family.
 By 1 AD superstition and magic had been somewhat replaced by more up to date
practice. But , medicine remained in the hands of priest-physician who refused to
touch blood or pathological tissues. Dissection was forbidden. This together with
religious restrictions probably helped to bring about decline in medicine and
nursing professions.
During this period diagnosis was made on empirical basis and also the given treatment
was according to symptoms. So this era was called symptom oriented oriented era. The health
education was provided by lectures on authoritarian instruction
 This period witnessed the invention of microscope, thermometer, BP apparatus and
other tools for detection and measurement of diseases. Laboratory investigations were
carried out to make This period was called as bacteria- oriented or disease oriented
era.
. Clinical Science Era(1950-1975):
 This is an era which witnessed her individual centered or patient centered approach
for taking care of the health and illness of the people. Clinical instructions abd bed
side teaching started in the field of medical education education. The development of
clinical techniques was initiated in medical science and technology.
 In this period prevention oriented approach started. It was initiated by our ancient
Indians at the time of Indus Valley Civilisation.

 it is being called era of Community centered approach, in which diagnosis and
treatment at community level emerged, clinical public health instructions,
community- side teachings were included in the field of medical education.
 Studies releted to community development, community measurement and criteria
planning techniques also started
 Integration of social sciences, and public health sciences in this era took place.
 In this period the involvement of the community leaders and members of the
community in planning and implementation of the health programmes was practiced
at this stage.
 The national level health planning was established by political authorities of
particular country by involving national and international health agencies to provide
health for all.
 The people-centered approach has been emphasized in this era.
 Community health has now entered an era of individual responsibilities and
community participation.
 The traditional role of medical persons has been shifted from diagnosis and
treatment of individual illness to treatment of all health hazards of community.
 Community diagnosis is based on collection and interpretation of relevant data
related to distribution of population according to age, sex, educational status,
marital status, religion, caste, birthrate, death rate, prevalence of disease etc.
 Definition of Community Health development:

 “Community health nursing development is defined as a nursing intervention that
aims at assisting members of a community to identify a community's health concerns,
mobilize resources, and implement solutions.”
Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier
 Development in the broader sense is not only the improvement or progress in the
community health resources but individual progress in the professional aspect of as
community health nurse.

2009- H1N1 OUTBREAK.NEW ICDS MOTHER AND CHILD PROTECTION CARD CAME IN TO
FORCE.
2010-ICMR ANNOUNCES NUTRIENTS REQUIREMENT FOR RDA FOR INDIANS
PRIMARY HEALTH CARE/ PRIMARY HEALTH CENTRE
Definition:
PHC is the essential care based on practical, scientifically sound and socially acceptable method
and technology made universally accessible to individuals and families in the community
through their full participation and at a cost they and the country can afford to maintain in the
spirit of self reliance and self-determination.
 Primary health care (PHC) is a broad and comprehensive concept approach to
health development.
 It forms an integral part of both the country’s health system
 It is the first level of contact of individuals.

 Primary care refers only to the first level of contact or close-to-client health care.
 In rural areas, this contact is usually with the health centre, health sub centre,
health post or private practitioner (doctor, nurse or midwife).
 In urban areas, a majority of the middle- and upper-income group visit a private
practitioner, who may be a general practitioner or a specialist, or go directly to a
hospital.
In many countries, the so-called family doctor serves as the first point of contact. Primary care is
an integral component of primary health care.
DEFINITION
1. Its essentiality by observing that primary health is essential health care.
2. Its accessibility by observing made universally accessible to individuals and
families in the community.
3. Its acceptability by observing by means acceptable to them.
BASIC PRINCIPLES OF PRIMARY HEALTH CARE
THE BASIC PRINCIPLES OF PRIMARY HEALTH CARE include:
1. Community participation
2. 2. Intersectoral collaboration
3. 3. Integration of health care programmes
4. 4. Equity
5. 5. Self-reliance.
1- COMMUNITY PARTICIPATION
Is the whole mark of primary health care, without which it will not succeed. Community
participation is a process by which individuals and family assume responsibility for their
own health and those of the community and develop the capacity to contribute to
their/and the community development. Participation can be in the area of identification of
needs or during implementation.
The community needs to participate at village, ward, district or local government level.
Participation is easier at the ward or village level because the issue of heterogeneity is
eliminated.
ADVANTAGES
-It addresses the felt health needs of the people
-It ensures social responsibility among the community

-It ensures sustainability
-It ensures cost sharing
-It ensures enhancement of knowledge
-It encourages Intersectoral collaboration
2- INTER SECTORAL COLLBORATION
This is the coordination of health activities with other sectors; such sectors include
Education, Finance, Agriculture, Information etc. There should be a working relationship
these bodies and the health ministry.
ADVANTAGES
-Overall human development
-It ensures economic development
-It ensures affordability
3- INTEGRATON OF HEALTH SERVICES
This is defined as coordination of various primary health care components into a whole
programme and made available at all times including referrals.
ADVANTAGES
-It ensures efficient use of all resources and removes areas of wastage.
-It ensures sustainability of programme
-It ensures bye pass phenomenon
-It reduces opportunity cost
-It grantees clients confidentiality
4- EQUITY
The health care resources available in a given community should not be in the handle of a
few. And resources should be accessible and affordable to all. It is divided in 3
components:
1. Decentralization of health of services into federal state-local government-ward levels.
2. The essential drug services and the national drug formulae. making drugs available at
all levels and at low cost.
3. National health insurance scheme-where people contribute to the health services of
those who don’t have or cannot afford.

5- SELF RELIANCE
This involves the use of technological methods and scientifically sound and maintain by
the community .It can be in terms of human resources, money or materials.
.
ADVANTAGES OF SELF RELIANCE
-Affordability
-Sustainability
-Acceptability
-Authenticity
COMPONENTS OF PRIMRY HEALTH CARE
There are 8 components (elements) of primary health care.
1. Immunization: An increasing number of infectious diseases can be prevented by
vaccinations example-measles, Meningitis, Pertusis, tuberculosis, yellow fever etc
2. Maternal and child care: Pregnant women and women of child bearing age (15-49 years)
are the target group for special care. Children under 5yrs of age are also vulnerable to
childhood killer disease. Maternal and child health clinics are established in Nigeria to
take care of these groups.
3. Essential drugs: The most vital drugs should be available and affordable at all levels.
4. Food and Nutrition: The family’s food should be adequate, affordable and balanced in
nutrients.
5. Education: The community should be informed of health problem and methods of
prevention and control.
6. Illness and injury: Adequate provision of curative services for common ailments and
injuries should be made by the community.
7. Water and sanitation: A safe water supply and the clean disposal of wastes are vital for
health.
8. Vector and reservoirs: Endemic infection diseases can be regulated through the control
or eradication of vectors and animal reservoir.

The Basic Requirements for Sound PHC (the 8 A’s and the 3 C’s)
Appropriateness
Whether the service is needed at all in relation to essential human needs, priorities and
policies.
The service has to be properly selected and carried out by trained personnel in the proper
way.
Adequacy
The service proportionate to requirement.
Sufficient volume of care to meet the need and demand of a community
Affordability
The cost should be within the means and resources of the individual and the country.
Accessibility
Reachable, convenient services
Geographic, economic, cultural accessibility
Acceptability
• Acceptability of care depends on a variety of factors, including satisfactory
communication between health care providers and the patients, whether the patients

trust this care, and whether the patients believe in the confidentiality and privacy of
information shared with the providers.
Availability
Availability of medical care means that care can be obtained whenever people need it.
Assessability
Assessebility means that medical care can be readily evaluated.
Accountability
• Accountability implies the feasibility of regular review of financial records by certified
public accountants.
Completeness
Completeness of care requires adequate attention to all aspects of a medical problem,
including prevention, early detection, diagnosis, treatment, follow up measures, and
rehabilitation
Comprehensiveness
Comprehensiveness of care means that care is provided for all types of health problems.
Continuity
Continuity of care requires that the management of a patient’s care over time be
coordinated among providers
Comprehensive Vs Selective PHC package Comprehensive package of PHC included at
least the following:
1) Education on prevailing health problems and methods for preventing and controlling them
2) Promotion of food supply and proper nutrition
4) Maternal and child health care, including family planning
5) Immunization against major infectious diseases
6) Prevention and control of locally endemic diseases
7) Appropriate treatment of common diseases and injuries
8) Provision of essential drugs.
3) An adequate supply of safe water and basic sanitation
Selective Primary Health Care (1978 to Present)

A “selective” approach attacks the most severe public health problems facing a locality in order
to have the greatest chance to improve health and medical care in less developed countries.
Selective PHC, or the more frequently used term “vertical approach”, refers to the
implementation of a single diseaseprogramme that may have a significant impact on reducing
high morbidity and mortality within a short time frame.
Some examples are polio eradication, making pregnancy safer, immunization programme,
control of HIV/AIDS, tuberculosis and malaria.
Selective Primary Health Care (1978 to Present)
GOBI & GOBI-FFF
The Alma-Ata Declaration was criticized for being too
broad and idealistic, with an unrealistic timetable. A common criticism was that saying Health
for All by 2000 was not feasible.
The term " Selective PHC meant a package of low-cost, technical interventions to tackle the main
disease problems of poor countries.
This interventions were known as GOBI,
Meaning:
Growth monitoring,
Oral rehydration techniques,
Breast feeding, and
Immunizations.
These four interventions appeared easy to monitor and evaluate. Moreover, they were
measurable and had clear targets. Funding appeared easier to obtain because indicators of
success and reporting could be produced more rapidly.
GOBI-FFF
Later, some agencies added FFF to the acronym GOBI, creating GOBI-FFF.
THE MILLENNIUM DEVELOPMENT GOALS (MDGS )
The Millennium Development Goals (MDGs) are eight international development goals that were
officially established following the Millennium Summit of the United Nations in 2000, following
the adoption of the United Nations Millennium Declaration. All 193 United Nations member
states and at least 23 international organizations have agreed to achieve these goals by the year
2015. The goals are:

The 8 MDG are:
1. Eradicating extreme poverty and hunger,
2. Achieving universal primary education,
3. Promoting gender equality and empowering women
4. Reducing child mortality rates,
5. Improving maternal health,
6. Combating HIV/AIDS, malaria, and other diseases,
7. Ensuring environmental sustainability, and
8. Developing a global partnership for development. Each of the goals has specific stated targets
and dates for achieving those targets.
Goal 1: Eradicate extreme poverty and hunger
Quick facts
990 to 24 per
cent in 2008.
ub-Saharan Africa were the hardest hit by the food and financial crises
Nearly one in five children under age five in the developing world is underweight
America and the Caribbean
in 2011
Targets of this goal:
population below $1 per day (PPP values)
Decent Employment for Women, Men, and Young People

-based workers in employed population
Target 1C: Halve the proportion of people who suffer from hunger
consumption .
Goal 2: Achieve universal primary education
Quick Facts
imary school enrolment has slowed since 2004, even as countries with the
toughest challenges have made large strides.
-of-school children are in sub-Saharan Africa
secondary schools
Target 2A: By 2015, all children can complete a full course of primary schooling, girls and boys
primary education
everyone will get into school
Goal 3: Promote gender equality and empower women
Quick Facts
through the education system
and at all levels by 2015

n-agricultural sector
by women in national parliament For girls in some regions, education
remains elusive.
ble forms of employment
-represented in informal employment, with its lack of benefits and security.
-level jobs still go to men — to an overwhelming degree.
quotas and other
special measures
Goal 4: Reduce child mortality rates
Quick Facts
2010.
under-five years old has declined
by 35 percent, from 97 deaths per 1,000 births to 63.
- Saharan Africa has doubled its average rate of child mortality reduction from 1.2 percent
a year during 1990-2000, to 2.4 percent during 2000-2010.
Sub-Saharan Africa suffers though a higher neonatal mortality rate (35 deaths per 1,000 live
births in 2010) than any other region, and has recorded the least improvement over the last two
decades.
die before their fifth
birthday as children in the richest 20 percent of households.
-thirds, between 1990 and 2060, the under-five mortality rate
- ate
-year-old children immunized against measles[16]
-Saharan Africa had a 85 percent drop in measles deaths between 2000 and 2010.
Goal 5: Improve maternal health
Quick Facts
orldwide, a decline of 47 percent
from 1990.

also those with the lowest coverage of births attended by skilled health personnel—less than
half.
-urban gap in skilled care during childbirth has narrowed.
2010, for the developing regions as a whole.
hile Southern Africa reported almost universal coverage in 2010, in West Africa about one-third
of women did not receive antenatal care visits.
form of contraception in 2010 in all regions except sub-Saharan Africa and Oceania.
1990 to 71 percent in 2000, and then to 80 percent in 2010.
sonnel
Goal 6: Combat HIV/AIDS, malaria, and other diseases
Quick facts
-Saharan Africa, annual new infections in 2011 reached 1.7 million people, including
300,000 children. This is 21 percent lower than the 1997 peak and 15 percent lower than in
2001.
- related causes fell to 1.7 million in 2011, a decline of
24% since the peak in 2005.
for HIV or AIDS in low- and middle-income countries, up from 6.6 million people in 2010 and up
from just 400 000 in 2003.

the absolute size of the Asia population means it has the second largest number of people living
with HIV.
-positive pregnant women received treatment to prevent HIV transmission to their
child in 2011.
malaria-specific mortality rates by 25 percent.
–24 years
-risk sex
–24 years with comprehensive correct knowledge of HIV/AIDS
need it
Proportion of population with advanced HIV infection with access to antiretroviral drugs
dence of malaria and other major
diseases
-treated bednets
-malarial drugs
Treatment Short Course).
Goal 7: Ensure environmental sustainability
Quick Facts
net loss worldwide of forests decreased over the last 20 years, from -8.3 million hectares
per year in the 1990s to -5.2 million hectares per year in the last decade.
sure their
sustainability.
by 271 million since 1990. But there remain 1.1 billion people, or 15 percent of the global people
with no sanitation facilities at all.
The number of people using improved drinking water sources reached 6.1 billion in 2010, up by
over 2 billion since 1990.

percent in 1990.
slum residents in the developing world declined from 39 percent in 2000 to
33 percent in 2012.
facilities, or durable or less crowded housing.
mains high in sub-Saharan Africa and increase in countries affected by
conflict.
Target 7A: Integrate the principles of sustainable development into country policies and
programs; reverse loss of environmental resources
7B: Reduce biodiversity loss, achieving, by 2010, a significant reduction in the rate
of loss
-depleting substances
f fish stocks within safe biological limits
Proportion of total water resources used
without sustainable access to safe
drinking water and basic sanitation (for more information see the entry on water supply)
rural
ith access to improved sanitation
million slum-
Goal 8: Develop a global partnership for development
Quick facts
developed countries, still far short of the 0.7 per cent UN target.
remains
below expectations.
Developing countries gain greater access to the markets of developed countries.

regions, up from 59 percent in 2006.
2011, over 160 countries in the world had launched 3G mobile broadband
services and 45 percent of the population worldwide was covered by a high-speed mobile
broadband signal.
2011, when 35
percent of the world was online.
-based, predictable, non-discriminatory trading and
financial system
– both
nationally and internationally
and quota free access for LDC exports; enhanced programme of debt relief for HIPC and
cancellation of official bilateral debt; and more generous ODA (Official Development Assistance)
for countries committed to poverty reduction
Target 8C: developing countries through national and international measures in order to make
debt sustainable in the long term
-operation with pharmaceutical companies, provide access to affordable,
essential drugs in developing countries
on a sustainable basis
-operation with the private sector, make available the benefits of new
technologies, especially information and communications
use per
ROLE OF COMMUNITY HEALTH NURSE IN
PRIMARY HEALTH NURSE
1. Health education
2. Maternal and child health care
3. Prevention of illness
4. Prevention and control of epidemic disease
5. Treatment of minor illness and injuries
6. Adequate and safe water supply
7. Promotion of mental health
8. Adequate nutrition
9. Providing essential drugs
10. Immunisation

 MAJOR ROLE OF CHN IN PHC
 Facilitative role
 Developmental role
 Supportive role
1. Training
2. Management
3. Supervision
4. Programme implementation
5. Programme evaluation
6. Policy making
7. Programme planning
 Clinical role
 SUGGESTED NORMS FOR HEALTH PERSONNEL
1. Doctors- 1 per 3.500 population
2. Nurses- 1 per 5000 population
3. Health worker-1 per 5000 population in plain areas and 3000
population in tribal and hilly area
4. Trained dai-one for each village
5. Health assistant- 1 per 30,000 population in plain area and
20,000 population in tribal and hilly areas
6. Health assistant- provides supportive supervision to 6 health
workers (male/female)
7. Pharmacists-1 per 10,000 population
8. Lab technicians-1 per 10,000 population
HEALTH PROMOTION
WHAT IS HEALTH PROMOTION?

Health promotion is the process of enabling people to increase control over, and to improve their
health.
ACCORDING TO WHO
AIMS
 To improve the health of an individual in respect of physical,mental,social and spiritual
functioning.
PRE-REQUISITES OF HEALTH PROMOTION
1. EDUCATE
2. ENABLE
3. MEDIATE
Education
Education will help people to adopt helthy life style,once they are aware about the merits of
healthy practices and dangerous effect of unhealthy practices.
In this way, education is te way of empowering people to adopt healthy practices to achieve well-
being.
Enable
Individuals need to have control over unhealthy practices which can deter their health.
Conrol over unhealthy and adoption of healthy practices will enable the individual to achieve the
health.
Mediate
Within society, different interests related to health practices prevail.
These different interests in society need to be mediated by health personnel or social groups to
come to compromise for the promotion of health.
Principles of health promotion
GIVEN BY WHO 1984
1. Health promotion involves the population as a whole in the context of their everyday life,
rather than focusing on people at risk for specific disease.
2. Health promotion is directed towards action on the determinants of health.
3. Health promotion combines diverse but complementary method or approaches including
communication, education, legislation,fiscal measures,organisational change,community
development and spontaneous local activities against health hazards.
4. Health promotion aims particularly at effective and concrete public participation.
5. Health promotion is basically an activity in health and social field and not a medical
services,health professionals-particularly in primary health care –have an important role
in nutering and enabling health promotion.

THE OTTAWA CHARTER 1986
The ottawa charter has led to the development of principles and practice of health promotion.
1. Build healthy public policy
2. Create supportive environment
3. Strenghten community action
4. Develop personal skills
5. Re-orient health services
THE BANGKOK CHRTER 2005
1. Advocate for health based on human rights and solidarity.
2. Inves in sustainable polices,action and infrastructure to address determinants of health.
3. Build capacity for policy development, leadership, health promotion practice,knowledge,
transfer and research and health literacy.
4. Regulate the legislate to ensure high level of protection from harm and enable equal
opporunity for health and well being for all people.
5. Partner and build alliance with public,non govermental,intenational organisations and
civil society to create sustainable actions.
Health field concepts-factors affecting health and health promotion
HEALTH
GENETIC COMPOSITION ENVIRONMENT
HEATH SERVICES LIFE STYLE AND INDIVIDUAL
BEHAVIOUR

HEALTH PROMOTION-EMPOWERMENT MODEL
An individual capacity to gain control over the lives and their health is the most important
goal.
People apart from having control at individual level should actively involve themselves in
fostering the health of their communities.
Empowwrment build self confidence and also provide skills in making healthy choices.
Accordidng to empowerment model,how health can be promoted
I.e.-optimum level of functioning is achieved as shown in figure
 Health promotion-a process of community development
 Community development involves working in setting characterised by rural, disadvantage
and deprived with resistant groups.it is particular relevance to health promotion.
HEALTH
EDUCATION
RESTRUCTURING
HEALTH SERVICES
ACCORDING TO NEED
INDIVIDUAL
EMPOWERMENT
THROUGH CONSCIOUS
RAISING
COMMUNITY
EMPOERMENT
THROUGH
CONSCIOUS
RAISING
HEALTH
SAFE ENVIRONMENT
HEALTH
PUBLIC
POLICIES
COMMUNITY
PARTICIPATION

 It is ideology is described in terms of empowerment model.
 Health workers are employed in community to work alongside people.
 The health workers task is to help the community to identify the needs.
 Interventions by health workers through education and also by carrying out activities for
maintaining helath will raise the people,s conscousness and will have control over their
unhealthy beliefs and perceptions,would change the unhealthy practices and will fell more
confident in their abilities to bring social and environment change.
THE PROCESS OF HEALTH PROMOTION

Health promotion-target group
 Workers at workplace
Health promotion activities can be carried out at work place because of following reasons:
 Capitative population
 Well established channel of communication
 Physical facilities
 Availabilities of resources
 Easy to do follow up

 Employer
 Burden on employer of rising cost of health is reduced.
 Develop caring image
 Decreased absenteeism
 Increased productivity
 Employees
 Saves tiime for travelling to locate health services
 Saves money used for transportation and treatment of curing health problems.
 Decreased stress
 Health promotion activities
 Health assessment
 Stress management
 Prevention of accidents
 Prohibiting smoking
 Nutritional education
 Exercise and fitness
 Adolescents
 To reduce behavoural and life style problem.
 To prevent risk taking behaviour such as reckless driving and indulging in sexual
activities etc.
 Education
o Developmental process changes
o Disadvantages of unprotective sexual activities
o Nutrition
o Accident prevention
o Healthy life style
o Emotional and mental health
o Hygienic conditions
o Health assessment
o Physical exercise
o Counselling
 Elderly
To achieve health for all,elderly need to be ignored,so healh of elderly need to be
promoted.

Health promotional activities will help the elderly people to be independeny to carry out
the activities.
Thsese activities are related to
-geriatric health problems due to aging
-chronic non communicable disease and nutritional problems.
-hypertension
Diabetis mellitus
Cancer etc….so there is need to carry out disease specific programmes for them.
 Women and children
Woman.s health espeially reproductive health need to be promoted to optimum level of
functioning through empowwrment.
Children health promotion activities include:
Vaccination
Growth and development monotoring
Weaning
Education of children
Health promotion-through legislative approach
Laws are the rules which everyone has to abide,otherwise punishment will be given.
So framed laws should be implemented and new laws which will be helpful in promoting health
need to be formulated.
There are a number of laws which are related to the promotion of health.
 Law related to prevention of motor vehicle accidents.
Driver need to be fit to drive.example- should drove without consuming alcohol.
 Use of seat belts
 Use of helmets etc..
 Laws related to control of environment pollution.
 Laws related to alcohol use/tobbaco use/ drug abuse
 Laws realed to prevention of accidents at roads by implementing traffic rules etc.
 Health promotion strategies

1. Proper health system
2. Safe environment
3. Public participation
4. Information and education
5. Health research
6. Welfare programme
7. Healthy life style
1. Proper health system
The health system should be well functioning,where health promotion activities can
be carried out.
All the department involved for the promotion of health should be coordinated.
Health insurance companies privae and pblic health care and pharmaceutical
companies need to be coordinated with the public health professionals to achieve
well being.
2. safe environment
Health promotion can be achieved if the environment,i.e.-surrounding of man is
clean.
Health promotion require provision of safe water,control of
rodents,vectors,improvement in housing,clean air, installation of sanitary latrines
and provision of adequate light etc..
Studies have shown that the infectious disease are the result of poor
environment,so efforts need to be taken towards achieving health by providing safe
environment.
3. Public participation
All the interventions carried out without the participation of people are useless.
To achieve the success of any stratrgy,programme or policy invovement of peoples
required.
5) Information and education
People should be empowered through educatio so that decisions regarding healthy
habbits,living and above all healthy life style can be made to them.
Who constitution states about education that education is the extension to all people of
the benefits of medical,psychological and related knowledge essential to the fullest
attainment of health.

6 health research
Research in the field of health example- epidemiological researches helps in identifying
the factors responsible for ill health and how these factors can be manipulated to achieve
health.
7. Welfare programmes
Governmental, non-governmental and voluntary health organisations should be measures
for the welfare of the people.
Welfare programes such as mid day meal programme, reproductive child health, food
fortification,reproductive out for health promotion.
It’s responsibility of these organisations to evaluate the success of the programmes and to
do manipulations if required.
8. Healthy life style
Adoption of healthy life style practices will help in reducing the morbidity and mortality..
MAINTENANCE OF HEALTH
Preventive, protective and promotive measures are required to acieve health.
The measures have to be adopted continuously to remain healthy.
The health can be maintained by exercise,diet,stress management and consultation of doctor.
Health maintaining strategies
Following are health maintaining strategies:
 Nutrition
 Exercise
 Hygiene
 Reduce stress
 Health services
 Safe environment
A. Nutrition
 Nutrition has an impact on health.
 The food or food components if not consumed in proportion to
reqirement,i,e.-eating to less or more nutrients will deteriorate the health.
 Eating too many calories will cause obesity, hypertension and diabettis
mellitus.
 Less intake of calories, proteins in children result in kwashiorkor and
marasmus.

 But some of the foods are used for decreasing the risk of disease, such as
roughage diet decrease the chances of constipation, thereby reducing
chances of cancer.
 So individual have to take well balanced diet to stay healthy.
 This need to be taken throughout the life to prevent the occurrence of
disease and to keep themselves healthy.
B. EXERCISE
 Exercise is directed towards physical fitness.
 Physical exercise strengthen the body muscles, bones and immune
system.
 Exercise in case of heart disease strengthen the heart muscles thereby
reducing the risk of heart attack.
 Exercise like stretching, aerobic, anaerobic helps in keeping the body
physically fit.
 Stretching exercises increase the range of motion muscles and joints
such as adduction, abduction, rotation, flexion and extension.
 While anaerobic exercises such as walking and running exercise
improve the cardiovascular endurance.
C. HYGIENE
 Hygiene here includes personal hygiene and food hygiene.
 Personal hygiene include practices related to keeping the body clean
such as bathing, hair washing,brushing,eye cleaning, ear cleaning
and hand washing etc..
 These hygienic conditions prevent the entry of pathogens and prevent
infections.
 Improper dental hygiene can lead to stomatitis, gingivitis etc..
 Similarly, poor hygiene can cause conjunctivitis.
 Food hygiene is important to prevent the occurrence of disease.

 Food hygiene include hygiene in production,handling,distribution and
serving of all type of food, whether that is fruit,vegetable,meat,milk or
fish etc..
 Disease such as typhoid, diarrhoea ec…are occurring due to improper
food hygiene.
 Proper washing of hands before eating and washing of fruits and
vegetable eating is required to maintain health.
 These hygiene practices are required to maintain health.
 These hygienic practices are required to continuity to keep themselves
healthy.
D. REDUCE STRESS
 Stress can be the result of uncertainty, workload, low income, non-
satisfaction of work.
 It stress remains for a longer time period, then there can be negative impact.
 Simple stress can be easily overruled and homeostasis is maintained.
 In order to cope up with stress, relaxation techniques can be used.
 It can be performed with movement or minimal movement with sitting or
lying.
 The relaxation techniques used are bio feedback.meditation,deep breathing,
walking, gardening,yoga,massage,listening music etc..
 These relaxation techniques increase an individual capability to cope up
with stress.
E. HEALTH SERVICES
 The doctors consultation or health personnel consultation is required
to keep an individual healthy.
 This is requied for regular assessment of health status to find out
early changes related to abnormal health status.
 Minor problems which if not treated can cause major health problems
later on.

 Foe example, a small nodule found in breast can be benign, which
need to be removed early with doctor’s consultation, but if not treated,
can cause cancer of breast.
 So to keep the health of individuals, health services need to be
provided for consultation and follow up.
F. SAFE ENVIRONMENT
 Safe environment means provision of safe and wholesome water, area
should be free from rodents and insects.
 There should be good social interaction and people should be satisfied
at their workplace, home etc..
 Health is maintained by providing safe surrounding to man in which
he lives.

INTRODUCTION TO COMMUNITY HEALTH

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