58 287

INTRODUCTION, BARRIERS &IUD

Introduction
00:02:04

Planned foamily
Family which has -

The child birth is aHer a0urs of the

mother's age
-

minimum of 3
uyears between a children
-

Limited size of children (a or 3)

objectives of family planning

Prevent unuwarted preananecies

Limit the no of children
Limit the age ot temale (at the child birthd

Couple Protection Rate [cPR

Percentage ot eligible couples efectively protected aqainst

child birth by one/ the other tamiluy planning methods

CPR of o0% TFR 0f al NRR of

Required tor stable populotion

TFR: Total Fertility Rate

NRR: Net Reproduction Rate

eliqible couple: Couple in which the temale is in reproductive aqe

group
Any contraceptive method is used

in uwhich the ¥emale is in reproductive aqe

Tarqet couple: COuple
group and

Has achieved the desired family size or

- Has at least a to 3 live birth

Sterilisation is preterred

in India I5-18%
Eliaible couples

Community Medicine v2.0 Marrow 4.0 2020

288 Demography & 58
Family Planning Contraceptive methods

P 00:10:08

Permanent
Temporory

Barr ier Tubectomuy

Natural methods
Vasectomu
Other methods
Pills (OCPs)
Oral contraceptive

devices (lUD)
I n t r a u t e r ine

Injectables

Implants
methods
LOther / Newer

Barrier methods 00:11:50p

I. Condoms:

male condoms

made p ot lateBx

Transmitted
Etective in preventing preonancy, Sexually
infections
Infections (STD, reproductive tract
Failure rate a or 3 to 40 HwY (Hundred women Years)

most common cause ot Bailure: Ineorrect usage

manutactured in Hindustan Latex (Trivandrum)

London Rubber Industry (Chennai)

Female condoms

made up of polyurethane

Prelubricated with silicone Spermicidal is not required)

Failure rate: 4 or 5 to aO HUUY

Less eective in preventing preanancy, STIS compared to ale

condoms

a. Diaphraqm:
- Dutch cap

Community Medicine v2.0 . Marrow 4.0 2020

 58 Introduction, 289
Barriers&lUD
-

Not recommended
under the National
family planning
proaramme
-

used beBore inter course

and left for (ohrs
postcoital
Chance of Toxic shock sundrome
Failure rate: o to la HuJY

3. Vaginal sponge:
-
Brand name: Today
-

Impreanated uhile spermicidal: Nonoxunol9

-

Failure rate: a0 to 40 HuJY

Intra Uterine Devices (IUD) 00:20:38

TYPES
qeneration luD' Lippes Loop, Grattenbera's ring (Insert luD

generation luD
CuT-aa0
used nouwadaus
CuT-38oJ
L
Applicable for 1o urs

Nova T Surs
CUT aso Applicablefor
multiload device 3-5 urs
CUT 375

I qeneration lud (Hormonal)

mirena (LNG-a0) (7-0 yrs) Progestasert(1y

- Noturol progesteronee
- Levonorqesterol

-
a0 meg proqesterone / Day
-

Loadinoq dose: 38 mg
- LOwest tailure rate
65 mea Day
LOwest expulsion rote

Community Medicine v2.0 Marrow 4.0 2020

 59 293

OCP AND OTHER CONTRACEPTIVE METHODS

Classification of hormonal contraceptives 00:00:15

Chemical classitcation
Pregnoane: medroxy proqesterone acetate
meqestrol
estrane Norethisterone

Lynestrenol
Ethunodiol diacetate

GGonane : Levonorqestrel

Phusicoal classitcotion
Oral Pills

Combined Oral Pills

Proqesterone Onlu Pills
Post Coital Pills

Long acting Pills

male Pills

Depot Formulations

Injectables
Implants

Combined oral pills 00:03:20

Types
mala N National proaram free al Tablets

mala D Social marketing scheme al+7Tablets

Both tupes contain: Levonorqestrel O . S ma

ethinl estradiol> O.03 mq

I n mola D, 7 tablets of Ferrous tumarate 6 0 mg used

Community Medicine v2.0 Marrow 4.0 2020

294 Demography& 59
Family Planning
mechanism ot Action

Disrupts the Hupothalamus Pituitary axis

Stoppage ot oCP atter, a days lead to 'wtndraual bleed

dess amount of bleeding)
Less chance o+ Anemia

etectiveness: 99.9 more etective than IuDs)

Adverse effects of OCPs 00:10:30

Adverse eftects

metobolc Cardiovascular Careinooenc Others

ueigt gan Ptireroselerosis Ca Cerv Liver aseases

Obesity Ca Breast Siaht nhiatien

Hepatocelular lactatcn
Huperternsion - Thromboembolsm

- DVT carenoma
Dyslipidemia - CAD
- Stroke

HTN

ectopic pregnancu is seen n

Proaesterone Oniy Pilis (POP)

Benefits of OCPs 00:18:10

I. Reqularisation ot menstrual cycleS

a. Contraceptive beneRts

3. Benian ereast disease Fibroadenoma

4.Ca OvaryCaEndometrium, ovarian cust

5.PevicInlammatory Diseases
.Iron Deiciency Anemia
Contraindications of OCPs 00:21:20

Absolute contraindications

L. Ca Sreast, Genital cancers

a. Preanancy

3. Sever Liver disease

Communty Medicine v2.0 Marow 4.0 2020

 90 483

PRIMARY HEALTH CARE, MDG, SDG

I n t r o d u c t i o n
00:00:43

The health care in India is divided into 3 section

health care
. Primary
level of contact
- Sub centre, primary health centres
arass root level workers: ASHA
USHA
Anganuwadi visitors
Health visitors
Trained dais.

Secondory health care

- Intermediate health care
- Communitu health centre , district hospital, Arst referral units

Tertiaru health care

- Specialised health care

-
medical colleges, speciolisedhospitoal

Primary health care 00:03:21

- Basic health care

- Provicdes

Health promotion
Disease prevention
Holistic heath care
Curative core
Rehabilitotive care
Elements ot health care:
Education
Locallu endemic diseases core
ESsentiol drugs
mCH ond family ploanning
Expanded immunisation proaramme ( universal Immunisation
Proaram/ National Immunisation Schedule / mission Indradhanush)
Nutrition supply
Treatment of common diseases
Sate water and sanitation

v2.0 Marrow 4.0 2020

Community medicine
484 Healthcare
of the 90
community Principles of health care:

I.Equitable distribution

to the patients uwho requires the care most

-

Prior ity qiven

. Community participation
3.
Intersectoral coordnation
of Health and Familu uwella re
Ea: ICDS proaran>ministry
(nOHFUU) + ministry or uiomen and Chii
Md
1Development
mOHFu)t ministry of Food
Poshan yojano
>
minstry of Heath and Family Ujelt.
Biomedical waste ore
ministry of Forest and Environinent

4. Appropriate Technoloqy
Eq: IT enabled sustem in Te
2n based ORS

J a i viqyan missior) (Rheumatic tever)

RKS and Mahila Arogya Samiti 00:07:52

RKS
- Roqi kalyan samiti

manaqement ot health care tacility

mahila Aroqya samiti

- In urban a r e a s

- manaqement ot urban health centres

Responsible for so100houses ( as0 500 population)

-
-

IPHS 00:09:25

Indian public health standards

Standards for the qovernment
NABH (Notional Accredition Boord for Hospitals)
NABL (National Accredition Board for Laboratories )

Stafts KITS (A P)
. Subcentre- a A,6,C

a. PHC 1a 18
14 a
3. CHC 4o- Sa e-P

Community medicine v2.0 Marrow 4.0 2020

 487
91
HEALTH CARE SYSTEM IN INDIA - NHM

National

ueath mission CNHm) >

Health

aO4
components:
s a
t NRHm(Nationol
(
Rural Health
( Notional ur ban Heolthmission)>
a005
m
mission)- aol

HM

Basedon 4 principle Equity

Equality
Etectivity
s approaches to this proqrams
Eticiencu
Communitize

manaaement capacity
.Flexible financin
HR management
.quality IPHS ( Indian Public Health Standards) DPSE

NHM is oan umbrela proaranm, all health

proarams ot the country
comes under this.

Thelogo- has I daughter

1ONAL
HEALTH M
in a tamilu.
Stating- NRR =

Net Reproductive Rate)

Organisation of NHM 00:05:24

DIShrict
Digtel Hospital ( DH)- Administration
Plain Area ( PA) = \,a0,000

Community Heath Centre ( CHC)

Hilly/forest/tribal = 80,o00
area ( HFTA)

itnary Heath centre ( PHC)PPA: 30,000

HFTA a0,o00

Sub centre ( se )- PASO00

HFTA 3000

SHA uWorkers I ASHA is tor lo00 population at vliage level.

v2.0 Marrow 4.0

Community medicine
488 Healthcare
of the 91
Community Ctalt at varou ehy
ASHA > Village level

SC> mPu) -male female (multi purpose worKer)

PHC medical oFficer in char qe (mo ),Auush ( Ajur veda, uouo.
unani, Siddha, Homoeopathy , AAIm, Pharmacist,
Health assistant.
CHC Specialists (General medicine, surgery, qynecooqist
Pediatrician Anaesthesiologist +Ophthalinologist +ANim+
Pharmacist +OT technician+lah technicon)
District Hospital > All Clinical specialites +speciolzed labs+
Program managersS

Asha Worker 00:11:40

should be marrmed
as-39
ur of age, at least loth pass
Prelerably a mother (Not > a children

Function
work for all NHP
members of village Health sanitation and nutrition committee.
ASHA will
Once a month Nutrition Day"is celebroted
"

coordinate it.
Family planning: Home delivery of condoms.
Responsible for the health coare of the communituy
Drug depot holders in community ( Drugs are kept in
Anganwadi, ASHA worker is responsible for issuing the Drug
ASHA-Implementotion of proaram at the louwest level.

Multi purpose worker 00:16:21

mPu worK at Gram ponchauot level

male mPuw : Functions

-NVBDCP Implementation
uwater Quality in the area
Take port in OPD everydou conductsurvey
maintain record/ Register in sub centre
-

Procurement of Druas from PHC to ASHA worker

Female mPuw: unctions

-

mCH, ANC, PNC, Immunization, Family lanning

OPD+dailysurvey
maintenance of sub centre.

Community medicine v2.0 Marrow 4.0 2020

 91 Health care 489
system in
H e a l t hP s s i s t o n t :

India NHM
rant link betueen Doctor of PHC arnd qross ront level
myo
workers.

odical oYicer wll have 3 mPu), 30 ASHA under himn.

The management is done by health assistont.

ole for moa intenance of records.

R e s p o n s i b l e

. Procurementtof druas i stock Keeping

v/s number of beds 00:22:48

C e n t
res

RKS-CHC
Ambnulance
Telephone
obrielric/surgical Medieal
Lmergences 24 X 7
Round the Clock Services

3
HDC/RKS-PHC LEVEL
Staff Nurses, 1LV for 45 SHCs
Ambulonce/hired vebvcle, Fxed Day MCH/Immunization
Clinics, Telephone, MO Vc, Ayush Doctor,
Emeroencies that can be handled by Nurees - 24X 7,
Round the Clock Serices, Drugs, TB/ Malaria etc. fests

GRAM PANCHAYAT SUB HEALTH CENTRE LEVEL

Skill up-oradatlon of educated RMP/ 2 ANMa, 1 male MPW FOR 56 Villages,
elephone Link, MCH/Immunization Daye; Drugs, MCH CHnic

VILLAGE LEVEL - ASHA, AWW, VH &SC

1 ASHA, AWa In every village. Vilage Health Doy

Drug Kt Referral choins

A No delivery service
.Villa.ge- No beds Sub centre
No beds.
PHC 4-6 beds
e-Deliveryservice
CHC 30 beds
k/a mcH- Sc
DH- 80 beds
a beds.

B
Sub centres: a tupes: A j
louw load
deliveries/month.
hioh load - a 0
centre
34x7 functioninq heoth
PHC
- a 0 deliveries/douy
E 3 0 deliveries/dauy
- Month
a0 30 delivery/deu
Less load
mh
230 delivery/do
Heavy load

Roq Koluan somiti

health centre.
¥or management ot
participation
Community

Community m 2.0 Marrow 4.0 2020

490 Healthcare
of the 91
Community Heath Personnels in var ious centres

norms for health personnel

Suggested
Norms suggested
Category of personnel
1 per 5,000 population
1. Nurses
1 per 5,000 population in plain
2. Heallh worker area and 3,000 population
female and male In tribal and hilly areas.
One for each village
3. Trained dai
1 per 30,000 population in plain
4. Health assistant area and 20,000 populatlon
(male and female) in tribal and hilly areas.
Provides supportive super-
vision to 6 health workers
(male /female).
1 per 10,000 population
5. Pharmacists
1 per 10,000 population
6. Lab. technlcians
1 per 1,000 population
7. ASHA

R K S - CHC 46 5a

PHC13 a
S u B Health centre > a - o

Village >1. ASHA

worker > under 1CDS; ¥or 400 -

800 population
IAnganwadi
Receive 4 month training
villaqe health quide 300hrs ot training

ASHA worker a3 days training

Targets 00:30:57

to be achieved bu aoao
.Reduce MMRto 1/1000 live births
A Reduce IMRto 25/1000 live births
Reduce TFR to 2.1
Prevention and reduction of anemia in women aged 15-49
years

Prevent and reduce mortality and morbidity from

communicable, non-communicable; injuries and emerging
diseases
Reduce household out-of-pocket expenditure on total health
care expenditure
Reduce annual incidence and mortality from tuberculosis by
half
Reduce prevalence of leprosy to <1/10000 population and
incidence to zero in all districts
Annual Malaria Incidence to be<1/1000
Less than1 per cent
microfilaria
prevalence in all districts
Kala-azar elimination by 2015<1 case per 10000 population
in all blocks.

Community medicine v2.0 Marrow 4.0 2020

 91 Health care 491
system in
00:32:40 India - NHM
N U H M

Populationn SI2e
Structure2

DH

urban - CHC a,50,000 population

I n In metro cities 5,00,000

urban - PHC SO,000

urban - ANM l0,000

a00-500 households
uSHA
l e : 1000 - a500 population.

dicine v2.0 Marrow 4.0 2020