HISTORY OF COMMUNITY HEALTH

AND COMMUNITY HEALTH

NURSING
UMA J DEAVER
Asst Professor
MM College of nursing
“The only thing new is the history you
haven’t read”
President Harry S. Truman
A.INFLUENCES OF ANCIENT CULTURES
ON PUBLIC HEALTH:

PUBLIC HEALTH EGYPTIAN CIVILIZATION

(ca 3000 BC) Built irrigation canal and granaries for
storage of food Practice of prophylaxis by the
medicine man and high priest.
Emphasis on personal hygiene, cleanliness within &
outside the body Sanitation measures ( removal of
refuse and crude fumigation in times of epidemics)
Hebrews (c.a. 1400 BC)
Founders of public hygiene
Moses “father of Sanitation”
Mosaic Health Code
pertained to every aspect of
individual, family &
community hygiene,
included:
 a. Principles of personal
hygiene (rest, sleep, hours of
work, cleanliness)
 b. Environmental sanitation
 1. Inspection of food
 2. Methods of disposal of excreta
 3. Detecting and reporting diseases
 4. Practice of isolation, quarantine, fumigation and
disinfection
 5. Detailed instructions on the correct way of hand
washing
Greeks (ca. 600 BC)
 Hippocrates – “Father of
Medicine” > exponent of
the science of preventive
medicine > introduced
the philosophy of the
interrelationship
between physical and
mental health ( “A
healthy mind dwells in a
healthy body”)
Romans (ca. 50 BC)

* Contributed to the field of
sanitation (building of
Aqueducts, purification of
water supply)
* Appointing of public health
medical officers *
Establishment of hospitals
which emphasized both
preventive and curative
aspects of care
B.DEVELOPMENT OF PUBLIC HEALTH
NURSING AS A WORLD MOVEMENT

1. Early Christian Period (1 st

century) * order of Deaconesses-
organized visiting of the sick -
called visiting nurses - forerunner
of CHN - endeavored to practice
the corporal works of mercy
(feeding the hungry, caring for the
sick, burying the dead) Phoebe a
friend of St Paul and the first
Deaconess and visiting nurse
Middle Ages (500-1500)
 * Beguines of Flanders- worked as
nursing sister in the hospital, but also
gave care to the sick in their homes,
staying with the dying and consoling
the families of the bereaved.
Renaissance (1500-1700)
 St Vincent De Paul- introduced modern
principles of visiting nurse and social
services
 * taught that indiscriminate giving was
harmful
 * emphasized the concept of helping people
help themselves
 * organized the daughters of charity
primarily for the care of the sick at home
 * maintained the family is the unit of the
service
 * recognized the importance of supervision
of those who render service to the sick
Early 19 th century

Pastor Theodor Fliedner- German Lutheran
pastor, went tour to raise funds when the
main industry of his community failed, came
back with money and ideas for a program
social work.
 Fredericka Munster Fliedner- a wife pastor
organized women society for visiting nursing
the sick poor in their homes
 Couple recognized the need for preparing
the training those who care for the sick ,
organized a hospital school of nursing in
Germany ( Kaiserswerth Institute for the
training of Deaconesses)
C.Development of Modern PHN
 1 Characterized by clean-up measures in
the control of communicable diseases
 Removal of refuse Clean-up campaign of
prison and asylums
 Improvement of working conditions of
women and children
 William Rathbone father of modern district
nursing with the encouragement of
Florence Nightingale, organized a training
school for nurses in the Liverpool Royal
Infirmary which provided training for
hospital nurses, private duty nurses and
district nurse.
2.Period of Scientific Control of
Communicable Diseases(1890-
1910) -Application of
bacteriology and immunology
3 Period of health education
(1910-present) - Characterized
by education for prevention of
diseases with active cooperation
of the individual in the health
action
 The Future of CHCs
RWHC Eye On Health

Inside CHCs?
Pay them less.
Medicaid They grow their
own vegetables.
COMMUNITY HEALTH NURSING IN INDIA
Pre – Independence Era:
 Pre – Independence Era Early History Indus
Valley Civilization(before 3,000 B.C) –
 planned cities with drainage, houses and
public baths built of backed bricks
(Environmental Sanitation)

 1400 B.C – Invasion of Aryans. Ayurveda and

Siddha medicine came into existence. Manu
Samhita – prescribed rules and regulations
for personal health, dietetics, hygienic rituals,
unity of the physical, mental and spiritual
aspects of life. Sarve Jana Sukhino Bhavatu
– may all men be free from diseases and
may all be healthy

 Post vedic period (600 B.C – 600 A.D) –
 medical education in University of Taxila
and Nalanda leading to the titles of
Pranacharya and Pranavishara . Hospital
system was introduced for men, women
and animals by Rahula Sankirtyana .

 650 – 1850 A.D – Muslim rulers came to

India. Arabic system of medicine ( Unani )
introduced. Due to political changes the
medical education and medical services
became static and ancient universities and
hospitals disappeared

British India
 1757 – British established their rule.
Civil and military services established.
 1825 – Quarantine Act was
promulgated.

 1859 – Royal commission was

appointed. Pointed out the need for the
protection of water supplies,
construction of drains and prevention of
epidemics . Established “Commission of
Public Health”
 1864 – sanitary commission was
appointed in Madras, Bombay & Bengal.


 1869 – Public Health Commissioner &
Statistical Officer appointed.
 1873 – Birth and Death Registration Act
was promulgated.
 1880 – Vaccination Act was passed.
 1881 – Indian Factories Act was passed.
First Indian census was taken.
 1885 – Local Self Government Act was
passed. Local government came into
existence
 1888 – local bodies was directed to look for
sanitation but no local public staff appointed.

.

 1896 – severe epidemic of plague occurred
in India. Plague commission was appointed.
 1897- Epidemic Disease Act
 1904 – plague commission report submitted.
It recommended the reorganization and
expansion of public health department &
establishment of laboratory facilities for
production of vaccines and sera.
 1909 – Central Malaria Bureau at Kausali
 1911 – Indian Research Fund Association
(now called as ICMR) to promote research.
 1912 – Govt. India decided to help the local
bodies. Appointed Deputy Sanitary
Commissioners & Health Officers.

 1918 – Lady Reading Health School,
Delhi & Nutrition Research
Laboratory, Coonoor was
established.
 1919 – First step in decentralization
of health administration. Montague –
Chelmsford Constitutional Reforms –
transfer of public health, sanitation
and vital statistics under the control
of elected minister.
 1920 – 21 – Municipality & Local
Board Acts passed containing legal
provisions for advancement of public
health
 1930 – All India Institute of Hygiene and
Public Health, Calcutta established in aid
with Rockfeller Foundation. The Child
Marriage Restraint Act( Sarda Act) came
into effect. (Girl – 14 yrs and Boys – 18
yrs)
 1931 – Maternity and Child Welfare
Bureau established under IRC.
 1935 – Government of India Act (1919)
revitalized. Health activities in the country
grouped as federal, concurrent, provincial.
 1937 – Central Advisory Board of Health
was set up with Public Health
Commissioner as Secretary and
representatives from provinces and Indian
states as members.


 1939 – Madras Public Health Act was
passed. First Rural Health training
Centre was established at Singur with
the aid from Rockefeller Foundation.
 Tuberculosis Association of India was
established.
 1940 – Drugs Act was passed.
 1943 – The Health Survey and
Development Committee ( Bhore
committee) was appointed – to survey
the existing position with regard to health
conditions and health organization.

 1946 – Bhore committee submitted its report. It
reviewed on the following and recommended short
and long term programme to attain reasonable
health. Public health Medical relief Professional
education. Medical research. International health.

Post independence era:

 1947 – Ministries of health established in state &

center. Post of Director General of Health
Services ( principal advisor to the union
government on both medical & public health
matters) was formed by combining the posts of
Public Health Commissioner& director general of
Indian Medical Service.
 1948 – India joined WHO as a member state.
ESI Act passed in 1948. the report of the
Environmental Hygiene Committee was
published.

 1949 – constituent Assembly adopted the constitution of
India(Article 246 covers all the health subjects). Post of
registrar general of India created in the ministry of home
affairs. SEARO office established in New Delhi. The
Indian Research Fund Association was reconstituted as
ICMR.
 1950 – planning commission was set up.
 1951 – First five year plan begin. BCG vaccination
programme launched.
 1952 – community development block launched. Central
council of health was constituted. Primary health center
was set up.

 1953 – NMCP commenced. National Extension
programme was started for rural development.
Nation wide family programme was started. A
committee was appointed to draft a Model Public
Health Act.
 1954 – Contributory Health Service Scheme was
started at Delhi. The Central Social Welfare Board
was set up. National water supply & sanitation
programme was inaugurated. NLCP was started.
VDRL antigen was set up in Calcutta. The prevention
of Food Adulteration Act was passed.
 1955 – NFCP was commenced. The central
leprosy teaching and research institute
established in chengelpet. A filaria training
centre was established at Ernakulum. The
Hindu marriage act passed. National TB
sample survey commenced.

 1956 – second five year plan launched. The

model public health act published. The central
health education bureau was established.
Director, family planning appointed.
Demographic training & research centre
established in Bombay. The TB chemotherapy
center established in Madras. The immoral
traffic act was passed. Trachoma control pilot
project was established. RCA project was
established with aid from ford foundation.

 1957 – influenza pandmeic swept the country. The
demographic research centers was established in
Calcutta, Delhi & Trivandrum.
 1958 – NMCP converted into NMEP. Leprosy Advisory
committee of the Govt. of India was constituted. The
National Development Council endorsed the
recommendations made by Balwantrai Mehta Committee
on Panchayth Raj. The national Tb survey was
completed.
 1959 – Mudhaliar committee was appointed. Central
expert committee was appointed under ICMR to study
the problems of cholera and chicken pox in India.
Rajasthan was first state to introduce panchayat raj.
National TB institute was established at Bangalore. The
national research laboratory at coonoor was shifted to
Hyderabad.
 1960 – School Health Committee was
constituted. A National Nutrition Advisory
Committee was constituted. Pilot projects for
eradication of small pox was initiated. Vital
statistics was transferred to the Registrar
General of India.
 1961 – third five year plan launched. The
report of Mudhaliar Committee was published.
The Central Bureau of Health Intelligence was
established.
 1962 – Central Family Planning Institute was
established in Delhi. National Small Pox
Eradication Programme was launched. The
School Health Programme was initiated.
National Goiter Control Programme was
launched. The District Tuberculosis
Programme was formulated.

 1963 – Applied Nutrition Programme was launched.
Defense Institute of Physiology and Allied Sciences was
set up.
 National Institute of Communicable Diseases was
inaugurated.
 National Trachoma Control Programme was launched.
Contributory Health Service Scheme was changed into
CGHS. Extended family planning programme was
launched.
 Chadha Committee established a norm of one basic
health worker for every 1000 population. A drinkling water
board was set up.
 1964 – National Institute of Health Administration and
Education was opened in collaboration with Ford
foundation. Committee was set up under the
chairmanship of Shanthilal Shah to study the question for
 1965 –lippes loop was recommended as safe.
Reinforced extended family planning was
launched. BCG vaccination on a house to
house basis introduced.
 1966 – Mukherjee committee was set up.
Minister of health was also appointed for
minister of family planning. A separate
department for family planning was started.
The population council started International
postpartum family planning programme.
 1967 – Modhok committee was constituted. A
small family norm committee was set up. The
central council of health recommended the levy
of a health cases on patient attending hospital.

 1968 – small family committee’s report was
submitted.A bill of registration of birth and death was
passed. The govt. of India appointed medical
education committee.
 1969 – fourth five year plan launched. The name of
the Nutrition Research Laboratory was changed into
National Institute of Nutrition. Comprehensive
legislation for control of river water pollution was
drafted. The central births and deaths registration act
was promulgated. The report of the medical
education committee was submitted.


 1970 – The Drugs Order was promulgated.
All India Post Partum Family Planning
Programme was started. The population
council of India was formed. Chittaranjan
mobile hospitals was installed. The
registration of births and deaths Act came
into force. The name of the Demographic
Training and Research Center, Bombay was
changed into International Institute for
Population studies.
 1971 – The family pension scheme for
industrial workers came into force. MTP bill
passed in parliament. An expert committee
was appointed to draft legislation on air
pollution.


 1972 – MTP act came into force. National service bill
passed. The National Nutrition Monitoring Bureau was
set up under the ICMR.
 1973 – the national programme for minimum needs was
incorporated with the fifth five year plan. The government
envisaged a scheme of setting 30 bedded rural hospitals
one for 4 PHC. Kartar singh committee submitted its
report.
 1974 – fifth five year plan launched. Parliament enacted
the Water Act.

 1975 – India became small pox free. Govt. of India
accepted NMEP. ESI Act amended. Cigarettes
Regulation Act was passed in parliament. Shrivastav
committee submitted its report.
 1976 – Indian Factories Act amended. The
prevention of food adulteration act came into force.
The equal remuneration act was promulgated. New
population policy announced. Central council of
health proposed 3 – tier plan for medical care.
National programme for prevention of blindness was
formulated.

 1977 – National Institute of Health and
Family Planning formed. Rural health
scheme was launched. Revised
modified plan of malaria eradication put
into operation.
 1978 – child marriage restraint bill
approved in parliament. EPI launched.
 1979 – offices of family welfare and
NMEP were merged and named as
Regional Office for health and family
welfare.
 1980 – sixth five year plan launched.
Small pox was officially declared from
entire world.
 1981 – census was taken. The Air Act was enacted. 1982
– new 20 point programme was announced. National
health policy announced.
 1983 – IMPACT India launched (National Plan of Action
Against Avoidable Disablement). NLCP called as NLEP.
Guinea worm eradication programme launched.
 1984 – Bhopal gas tragedy occurred. Workmen’s
compensation act came into force. Juvenile Justice Act
came into force.
 1985 – seventh five year plan launched. UIP launched. A
separate department of women and child development
was set up.

 1986 – The Environment Act promulgated. Mental
health bill was voted in parliament.
 1987 – new 20 point programme was launched. ISI
was renamed as Bureau of Indian Standards. Safe
motherhood campaign was launched. National
diabetes control programme and national AIDS
control programme initiated.
 1989 – blood safety programme was launched.
 1990 – control of ARI programme initiated.
 1991 – decadal census was conducted.

 1992 – eighth five year plan was launched. CSSD was
launched. The Infant Milk Substitute, Feeding Bottles and
Infant Foods Act came into force.
 1993 – RNTCP with DOTS introduced. National Nutrition
policy formulated.
 1994 – Return of plague. Panchayath Raj Act came into
force.
 1995 –ICDS renamed as IMCD. The Legislation on
Transplantation of Human Organs was enacted. Expert
Committee on Malaria submitted its report and
recommended Malaria Action Plan.

 1996 – PPI launched. Family
planning programme made target
free. Yaws eradication programme
came into force.
 1997 – RCH launched. Ninth five
year plan launched.
 1998 – 99 – NFHS II undertaken.
NMEP renamed as National Anti –
Malaria Programme. Phase – II of
National Aids Control Programme
became effective. National Policy for
Older Persons announced.

 2000 – govt. of India announced national population
policy. Declared guinea worm free country. Signatory
of UN millennium declaration. National commission
on population constitute.
 2001 – fist census of the century. National policy for
empowerment of women launched.
 2002 – National Health Policy announced. Govt.
announced National AIDS Prevention and Control
Policy. Tenth five year plan launched. Emergence of
SARS.
 2003 – parliament approves the Cigarette and
Tobacco Products Act. NVBDCP approved.


 2004 – Vandematarum scheme

launched. Revised programme of
National support to primary education
launched. Low osmolality ORS
introduced. National guidelines on
infant and young child feeding
formulated.
 2005 – RCH – II launched. JSY
launched. NRHM launched. IPHS for
community centers formulated. National
plan of Action for children formulated.
India achieved leprosy elimination
target.

 2006 – WHO releases pediatric growth chart. Ban on
child labor. RNTCP covers whole country. NFHS – II
conducted. IMNCI launched.
 2007 – 11 th five year plan launched. NACP –III
launched. IPHS standards for PHC and sub center
formulated. Maintenance and welfare of parents and
senior citizens bill passed.
 2008 – Non communicable diseases programme
was launched.

 2009 – H1N1 outbreak. New
ICDS mother and child
protection card came into force.
2010 – ICMR announces
nutrients requirement for RDA
for Indians.
THANK YOU