Community Diagnosis » W.H:O. defines Community Diagnosis as A qualitative and quantitative description of the health of the citizens and factors influencing health and the perception of citizens about health : Main purpose of community diagnosis is to identify health status and health problems and health determinants of the community Community diagnosis may be a) comprehensive -gathers general information —_ based-related to particular problemRelevant information for community Diagnosis » Demographic data- » Socioeconomic strata » Housing, sanitation,water supply etc. » Nutritional status _ » Morbidity data,mortality data » Reproductive and child health » Health care seeking behaviour » Available health resourcesMethods of data collection for community diagnosis >» Primary data collection techniques-key information interview, cross sectional survey jlongitudinal survey » Secondary Data Collection techniques Census, hospital records, health management information systems ,integrated disease surveillance project, National family health surveys » Data is compiled and analyzed in terms of 7 ate,ratio and health needs analyzed and actions are takenCommunity |1reatment » Community treatment or action means steps taken to fulfill community needs considering the available resources and health needs of the people » It includes improvement in water supply ,immunization,health education etc. » Characterisitics of community health action program > leffective utilization of available resources > 2.It must coordinate the the efforts of all encies full participation of community» Allthe countries accepted primary health care approach to attain Health for All by 2000A.D. and also as a integral part of country’s health system. > Definition - » Alma-Ata international conference defined it as: ’ “primary health care is essential health care made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and country can afford” —"Three tire health care system ~~ - Delivered by Subcenter Primary iL _— a - Delivered by superspeciality hospitals, medical college hospitalssaan a Levels of health care 1. ‘Primary care level > Primary health care is the 1% and foremost link between the people and national health system, where majority of their health problems are dealt with and resolved. » — It is provided by the primary health centers, their sub-centers, multipurpose health workers, village : health guides and trained dais.2. Secondary care level >» It includes district hospitals and community health centers which also serve as the first referral level. 3. Tertiary care level >» It is much more specialized. » It has specific facilities and highly specialized health workers provided by the regional or central level institutions. To provide a sound referral system is the major problem and major need of the developing countries including india. For the betterment of the society, the concept of healthcare has been changing day by day. ———Elements of primary health care w uw ~ Health education about -prevention and control of prevalent diseases and promotion of health Promotion of food supply and proper nutrition Supply of safe water and basic sanitation Maternal and child health care including family planning Immunization Prevention and control of locally endemic diseases Appropriate treatment Provision of essential drugsPrinciples of primary health care 1. Equitable distribution -Health services must be shared equally % by all irrespective of their ability to fi pay,sex,religion ,cast etc. 2. Egof equitable distribution—population covered by Sc and PHC are different for hilly tribal areas and plain areas2. Community participation - Primary health care cannot be achieved without the involvement of the local community. Passive participation-utilization of health services Active participation-Actual participation in health care delivery eg village health guides and trained dais,ASHA AWW a3. Inter sectoral coordination i 3, ¢ - The health sector alone cannot fulfill the health a needs of the society. - Hence it needs support from other sectors agriculture, animal husbandry, food, industry, | education, housing, public works, communication and other sectors. - All the sectors must be coordinated by planned reallocation of resources by the administrative system.4. Appropriate technology - scientifically sound - adaptable to local needs - acceptable to those who apply it and to those whom it is used -can be maintained by people themselves - Appropriate technology doesn’t mean the use of costly equipment, procedures and techniques when cheaper, scientifically valid and acceptable ones are available. = chart,ORS- , Health care providers at village » 1)LOCAL DAIS -An extensive programme has been under taken under the rural health scheme, to train all categories of local dais (traditional birth attendants ) to improve their knowledge in the concepts of maternal and child health and sterilization besides obstetric skills. The training is for 30 working days. During her training each dai is requested to conductat least 2 deliveries under guidance of health worker. te» Each dai is provide by a delivery kit and certificate. v 2)ANGANWADI WORKER- there is one Anganwadi worker for a population of 400-800. Anganwadi worker is selected from community, s SERVICES - health check-ups immunization supplementary nutrition, health education, non - formal pre school education and referral services. 3)ASHA Under NRHM scheme ASHA is a voluntary worker Duties-Escort women for availing MCH services distribution of contraceptives,health education 4) Village Health Guide-first contact between individual and health system.Female worker from the community.After training she provides the services-treatment of simple ; ilements,MCH, family planning,first aid ,health vy ~yvyCENTER LEVEL » Population covered-3000 in hilly and tribal area & 5000 in plain areas » Staff-Each sub center is manned by one male and one female multipurpose health workers. » FUNCTIONS-MCH care, family planning, immunization, » The work is supervised by male and female health assistants.PRIMARY HEALTH CENTER LEVEL >» The BHORE committee in 1946 gave the concept of a primary health center as a basic health unit, to provide, as close to the people as possible, an integrated curative and preventive health care to rural population with emphasis on preventive and promotive aspects of health care. Population covered-30,000 In plains and 20,000 in hilly tribal areas v anFUNCTIONS OF PHC awn es CP enay Medical care MCH and family planning Safe water supply and basic sanitation Prevention and control of locally endemic diseases Collection and reporting of vital statistics Health education National health programmes -as relevant Referral services Training of health guides and workers local dais health assistants 10. Basic lab servicesCommunity Health Center » Population covered is 80,000-1,20000 » First Referral Unit » Routine and emergency services of Medicine Surgery Pediatrics Obst and GuynacImportant SAQs /LAQs > Definition of primary health care and levels of health care >» Principles of primary health care » Elements of primary health care » Functions of PHC E » Community Diagnosis and treatment