LESSON PLAN

ON
HEALTH CARE DELIVERY
SYSTEM

SUBMITTED TO: SUBMITTED BY:

Dr.Suja suresh, M.SC(N),Ph.D Vinodha.R,M.Sc(N)

Principal Tutor

SRMTCON SRMTCON
Title of lesson plan : Health Care Delivery System

Course : B.sc (Nursing)

Subject : Community Health Nursing-II

Unit III

Duration : 15 Hours

Method of teaching : Lecture cum Discussion

Av aids used : PowerPoint presentation, Blackboard

Name of the Teacher : Ms.Vinodha.R,M.Sc(N)

Previous knowledge of students: The group has previous Knowledge

about the organization , community health care services
GENERAL OBJECTIVES:
The students will be able to gain the adequate Knowledge
regarding health care delivery system in central , state, district wise,
organization, staffing pattern & delivery of community health services
including Health education, vital statistics, Maternal and child health
care, mtp act, female feticide, child adoption, family welfare, services
and defence services, Institutional Allopathy and alternative system of
medicine, Indian system of medicine, Referral system and they will
apply this knowledge to manage the client with delivery of community
health services in community setting.
SPECIFIC OBJECTIVES:

At the end of the class the students will be able to:

• introduce the topic
• define health care delivery system
• elaborate the organization & staffing pattern
• define health education
• discuss in detail about health education.
• explain in detail about vital statistics.
• enumerate maternal and child health services.
• explain in detail about institutional and defense services
• elaborate alternative system of medicine
• explain in detail about Indian system of medicine
• explain in detail about referral system
 HEALTH EDUCATION
INTRODUCTION:
 Health education is the process of imparting information about health in
such a way that the recipient is motivated to use that information for the
protection or advancement of his own, his family’s or his community’s
health.
 Health education is an active learning process, which aims at favorably
changing attitudes and influencing behavior which is related to health.
DEFINITION:
 Health education comprises consciously opportunities for learning involving
some form of communication designed to improve health literacy, including
improving knowledge, and developing skills which are conducive to
individual and community health.
-WHO health promotion
glossary
 Health education is “any combination of learning experiences designed
to facilitate voluntary actions conductive to health.”
-Green and Kreuter, 2005.
OBJECTIVES:
 Informing people:
People are informed about the different diseases, their etiology and how to
prevent them.
 Motivating people:
Concerned with clarifying / changing or forming attitudes, beliefs, values or
opinions. After health information is given it is necessary to motivate them alter
their lifestyles so that it becomes favorable to promoting health and preventing
disease. Motivation is defined as “a combination of forces which initiate, direct
and sustain behavior”.
 Guiding in to action:
 Concerned with development of skills and action. A person who has obtained
health information might be motivated to change his behavior and lifestyle.
However he might need professional help and guidance so as to bring about these
changes and to sustain these altered lifestyles.
APPROACHES TOACHIEVE HEALTH:
Legal or regulatory approach:
 Legal approach forces to control the “human behavior” that may cause
harmful consequences to self and public by using the law and order.
Eg:-Epidemic diseases act
-Pollution act
-Food adulteration act
-Environmental act
 The childhood marriages are prevented in India through
enforcement of “The child marriage Restraint Act, 1929.”
Administrative or service Approach:
 This approach intends to provide all the health facilities to the people with
the hope that they will use it.it becomes a failure if the service is not based
on the felt needs of the people.
 Educational approach:
 Most effective means for achievement of changes in the health practices and
life styles of the community.
 Components – motivation, communication and decision - making
 Result obtained from this approach is slow but permanent and enduring
 Sufficient time should be allowed for the individual to bring about the
desired changes in his behavior
Primary health care approach:
 It involves full participation and active involvement of the people starting
from the planning stage till the delivery of the health services.
  This is based on principles of primary health care-community participation.
 This can be achieved by providing the necessary guidance to help people
identify their health problems and to find solutions to these problems.
PRINCIPLES OF HEALTH EDUCATION:

 Credibility
 Interest
 Participation
 Motivation
 Comprehension
 Reinforcement
 Learning by doing
 Known to unknown
 Setting an example
 Good human relations
 Feedback
 Community leaders
CREDIBILITY:
It is the degree to which the message is perceived as trustworthy by the
receiver. It should be scientifically proven, based on facts and should be
compatible with local culture and goals.
INTEREST:
 If the health education topic is of interest to the people, they will listen to it.
 Health educator should identify the “felt needs” of the people and then
prepare a program that they can actively participate in to make it.
PARTICIPATION
 Health educator should encourage people to participate in the
program.
 Once the people are given a chance to take part in the program it leads to
their acceptance of the program.
 Methods like group discussion, panel discussions etc. provide
opportunities for people’s participation.
MOTIVATION
 The fundamental desire for learning in an individual
 Health education can be facilitated by the motivation provided by the desire
to achieve individual goals
 Eg:-for a teenager, esthetics might be a motive to take care of his teeth
whereas for an adult, the expenses of undergoing restorative care
COMPREHENSION
 Level of understating of the people who receive the health
education
 Should first determine the level of literacy and understanding of the
audience and act accordingly
 words that are strange or new to the people should not be used
 Use of technical terms or medical
 Eg:-A statement saying “Eat food items that are cariogenic” may not be
comprehensive to the layman. A better way of explaining would be
“Avoid food stuffs which are sweet and which stick to your teeth like
toffees and pastries. Eat food items like fruits and raw vegetables which
in addition to being healthy, also help in keeping your teeth clean.
REINFORCEMENT
 This is the principle that refers to the repetition needed in health
education.
 It is not possible for the people to learn new things in a short period of time.
 So repetition is a good idea.
 This can be done at regular intervals and it helps people to
understand new ideas or practice better.
  “Booster dose in health education”.
LEARNING BY DOING
 If the learning process is accompanied by doing new things it is better
instilled in the minds of people
 “if I hear, I forget; if I see, I remember; if I do, I know”
KNOWN TO UNKNOWN
 Before the start of any health education program, the health educator should
find out how much the people already know and then give them the new
knowledge.
 The existing knowledge of the people can be used as the basic step up on
which new knowledge can be placed.
SETTING ANEXAMPLE
 The health educator should follow what he preaches.
 He should set an example to others to follow
 Eg:- A health educator who participate in a program highlighting the ill
effects of tobacco should not be seen smoking since it sends a wrong signal
and seriousness of the situation is lost
GOOD HUMAN RELATIONS
 This principle states that the health educator should have good personal
qualities and should be able to maintain friendly relations with the people
 The health educator should have a kind and sympathetic attitude towards
the people and should always be helpful to them in clarifying doubts or
repeating what is not understood
FEEDBACK
 For any program to be successful it is necessary to collect feedback to find
out if any modifications are needed to make the program more effective
COMMUNITY LEADERS
  Community leaders can be used to reach the people of the community and
to convince them about the need for health education
 Leaders can also be used to educate the people as they will have a rapport
and will be familiar with the people of their community
 The leader will have an understanding of the needs of the community and
advice and guide them
CONTENTS OF HEALTH EDUCATION
 Human biology
 Nutrition
 Hygiene
 Family health care
 Control of communicable and non-communicable diseases
 Prevention of accidents
 Use of health services
HUMAN BIOLOGY
 Training of human biology should start from the kindergarten itself
 Children are taught about the different parts of the human body
and their functions
 They are also taught the importance of good health and methods to keep
physically fit
 Teaching also directed towards the need for exercise, adequate rest and
sleep
 Information about the adverse habits
NUTRITION
 People should be taught about the nutrient value of food stuff and the
effect of nutrients on health
 It is to help people to choose optimum and balanced diets.
HYGIENE
 The people are taught about the importance of hygiene and
methods of maintaining hygiene
 A)personal hygiene-to promote good standards of personal
cleanliness
  B)environmental hygiene-this comprises two aspects-Domestic and
Community
 Domestic hygiene-keeping the house and surroundings clean, proper
ventilation, adequate light and fresh air, proper disposal of waste
materials, avoidance of pests, insects etc.
 Community hygiene-care of the surroundings ensuring proper garbage
disposal, adequate sewage and drainage.
FAMILY HEALTH CARE
 To strengthen and improve the health of family as a unit rather
than as an individual
 Improving maternal oral health to improve the oral health of
child should also be addressed
CONTROL OF COMMUNICABLE & NON COMMUNICABLE DISEASES
To provide elementary common signs and symptoms of disease and prevention
there by promoting health.
PREVENTION OFACCIDENTS
 People have to taught about the basic safety rules and how to prevent
common accidents which takes place in their home, in their work place or
on the road
 Health education programs to educate the students, parents and teachers
about theuse of mouth guards when playing contact sports
USE OF HEALTH SERVICES
People have to be inform about the various health services and preventive
programmes available to them. They also have to be educated on the proper use
of these services. They also be encouraged to participate in the health
programmes.
STAGES IN THE ADOPTION OF NEW IDEAS AND PRACTICE:
 Stage of unawareness:
Stage in which individual not aware of new idea or practice

Stage of awareness:
Stage in which individual has some general information about the new idea or
practice, but does not know much about its usefulness, limitations etc.
Stage of interest:
Stage in which individual showing more about the new idea or practice.
Stage of evaluation:
Stage in which the individual tries to find out he advantages and
disadvantages of the new method. He evaluates whether the new practice will be
beneficial to him and his family
Stage of trial:
Stage in which the individual decides to put the new idea or method into
practice. Additional information and guidance should be given at this stage
Stage of adoption:
Stage in which the individual finally accepts the new idea or practice
as beneficial to him and adopts it.
EDUCATIONAL AIDS USED IN HEALTH EDUCATION
 The aids used for transmitting health education are the main
constituent of the armamentarium of health education process
 Audio aids
 Visual aids
 A combination of audio-visualaids
AUDITORY AIDS
 Based on the principles of sound, electricity and magnetism
 Useful in reproducing any kind of words spoken and also helps in repeating
the same
 Megaphones
 Microphones
  Gramophone records and discs
 Tape records
 Radios
 Sound amplifiers
VISUAL AIDS
 Based on the principles of projection
 Helps individuals to understand better It is
of 2 types
 Projected aids
 Non-projected aids
PROJECTED AIDS
Projected aids
 Needs projection from a source on to the screen
 Films or cinemas
 Film stripes
 Slides
 Overhead projectors
 Transparencies
 Bioscopes
 Video cassettes
 Silent films
Advantages:
 Real life situations can be enacted in films
 Self-explanatory
 Creates a special interest among the audience to watch a film.
 Situational effects can be shown in a film.
NON PROJECTED AIDS
• Black board
 • Pictures,
• cartoons,
• photographs
• Flip charts,
• flashcards
• Flannel boards
• Printed materials- leaflets, pamphlets, folders, booklets,
brochures
• Models, specimens
Advantages:
• Cheapest to produce
• Easy to understand.
• Time saving.
• Easy to create.
MASS MEDIA

Various Mass Media

 Television
 Radio
 Newspapers/press
 Documentary films
 Posters
 Health exhibition
 Health magazines
 Health information booklets
 Internet
Advantages:

• Reaches potentially the largest and widest range.

• Can convey health news /break thoughts.
• Updated and disseminated information.
 • Control information provided.
• Tailor information specifically for intended audience.
• Can be interactive.
• Demonstration can be by audiovisual and graphs.
METHODS IN HEALTH COMMUNICATION

Individual Approach:

The health education must first create an atmosphere of friendship and allow the
individual to talk as much as possible. In this individual teaching we can discuss,
argue and persuade the individual to change his behavior. But by this we can reach
to a small population and who come in contact with us.

Group approach:
Group teaching is an effective way of educating the community.
Chalk & Talk (Lecture):
A lecture may be defined as carefully prepared oral presentation of facts
organized thoughts and ideas by a qualified person. The group should not be more
than 30 and talk should not exceed 15-20 minutes. By using suitable audiovisual
aids.
Demonstration:
A demonstration is a carefully prepared presentation to show how to perform a
skill. This procedure is carried out step by step before an audience.
Discussion method
Group Discussion:
For effective group discussion the group should comprise not less than 6 and not
more than 12 members. There should be a group leader who
initiate the subject and encourage everyone to participate and sum up the
discussion in the end. There must be a recorder who prepares a report on the issues
discussed.
The group members should follow some rules:
• Express the ideas clearly.
• Listen to what others say.
• Do not interrupt when others are speaking.
• Make only relevant remarks.
• Accept criticism gracefully.
• Help to reach conclusion.
Panel Discussion:
In a panel discussion 4-8 qualified persons talk about the topic. Sit and discuss
a given topic in front of a large group/audience. The chairman opens the meeting.
Panel comprises of a chair person and 4-8 speakers. After the main aspects of the
subject are explored, the audience is invited to take part.
Symposium:
It is a series of speeches on a selected subject. Each expert person present it
briefly and at the end of session the chair person makes a comprehensive summary.
Audiences are allowed to raise question f) Workshop: It consists of series of
meetings usually 4 or more with emphasis on an individual work, within the group
and with the help of consultants and response personnel.
Workshop:
It consists of series of meetings usually 4 or more with emphasis on an
individual work, within the group and with the help of consultants and response
personnel.
Role Playing:
This is a brief acting out of an actual situation for the benefit of the audience for
better understanding.
Conference and Seminar:
These programmes are usually held on a regional, state/national level. Where
several experts from different disciplines meet to deliberate on a
particular theme, to apprise others of latest knowledge and research in a particular
field.
MASS APPROACH
Mass media are a “one-way” communication. They are helpful in transmitting
messages to people even in the remote places by TV, Radio, Internet, Newspaper,
Printed material.
Direct mailing, poster, health museum exhibition and folk media.

VITAL STATISTICS

INTRODUCTION:

The process of maintaining vital statistics is a purposeful mechanism of

collecting, processing, analyzing and transmitting the information required for
organizing and operating health services and also for research and training.
DEFINITION:
Vital statistics are conventionally numerical records of marriage, birth,
sickness and death by which the health and growth of community may be studied.

OR
It is a branch of biometry that deals with data and law of human mortality,
morbidity and demography
AIM:
Providing reliable, relevant, up to date, adequate timely and
reasonably complete information to the health authority at all levels.
 Health care providers are able to intervene the health status of the population. It
is the transformation of information through integration and processing with
perception and experience based on social and political value.
WHY VITAL STATISTICS REQUIRE:
•The system should be population based.
•The system should avoid unnecessary agglomeration of data.
•The system should be problem oriented.
•Functional and operational terms.
•Should express information briefly and imaginatively.
PURPOSE:
• To describe the level of community health, diagnose community illness
and solution of health problems.
• To determine success or failure of specific health problems.
• To promote health legislation at local and national level.
• To develop policies and procedure at state and center level
IMPORTANCE:
•To evaluate the impact of various national health programmes.
•To plan for better future measures of disease control.
•To explain hereditary nature of disease.
•To evaluate economic and social development.
•It is primary tool of research activity
COMPONENTS:
• Demography and vital events.
• Environment health statistics.
• Health status: mortality, morbidity, disability and quality of life
• Health resources facilities, beds, manpower.
• Utilization and non-utilization of health services- attendance,
admission
• Health care indices.
• Financial statistics.
SOURCES OF VITAL STATISTICS:
 • Census
• Registration of vital events
• Sample registration system
• Notification of diseases
• Hospital records
• Disease registers
• Record linkage
• Epidemiological surveillance
• Other health records
• Environmental health data
• Health manpower statistics
• Population surveys
• Other routine statistics related to health
• Non quantifiable information
Census:
• It is an important source of health information.
• It is the complete count of a country population. Taken in most
countries of the world at regular intervals, usually of 10 years.
• Census means “to enumerate”. It consists of a sequence of activities
concerned with collection, collation and factual presentation of data
pertaining to social, demographic and health related factors, in respect of
a nation (or large population group), undertaken periodically, and having
some sort of statutory back - up for it to be undertaken.
Registration of Vital Events:
• It keeps a continuous check on demographic changes. If registration of
vital events is complete and accurate, it can serve as a reliable source of
health information. It is the precursor of health statistics and it has
dominated the health information system.
• It is a Legal registration, statistical recording and reporting of the
occurrence of, and the collection, compilation, presentation, analysis and
distribution of statistics pertaining to vital events, i.e., live births, deaths,
foetal deaths, marriages, divorces, adoptions.
Sample Registration System (SRS):
 Objectives:
• To provide annual reliable estimates of birth and death rates at the state and
national levels for rural and urban areas separately.
• To provide other measures like fertility and mortality (TFR, IMR, CMR,
etc).
• To study risk factors and household determinants through causes of deaths.
The main components of SRS
• Base-line survey of the sample unit
• Continuous (longitudinal) enumeration of vital events pertaining to usual
resident population by the enumerator
• Independent retrospective half- yearly surveys
• Matching of events
• Field verification of unmatched and partially matched events.
Notification of Diseases:
• Historically notification of infectious diseases was the first health,
information sub-system to be established.
• The primary purpose of notification is to effect prevention and/or control of
the disease. Notification is also a valuable source of morbidity data i.e., the
incidence and distribution of certain specified diseases which are notifiable
Hospital statistics:
• WHO Expert Committee on Statistics recommended that hospital statistics
be regarded in all countries as an integral and basic part of the national
statistical programme.
• In India, where registration of vital events is defective and notification of
infectious diseases extremely inadequate, hospital data constitute a basic and
primary source of information about diseases prevalent in the community
Disease registers:
• It allow follow-up of patients and provide a continuous account of the
frequency of disease in the community. In the absence of a defined
population base, useful information may be obtained from registers on the
natural course of disease, especially chronic disease in different parts of the
world.
Record Linkage:
• It is the process of bringing together records relating to one individual.
“Medical Record Linkage” is the assembly & maintenance for each
individual in a population, of a file of the more important records relating to
his health. The main drawback is the volume of data it can accumulate.
Epidemiological Surveillance:
Surveillance systems are often set-up in case where a disease is endemic
e.g., Malaria, tuberculosis, leprosy, filariasis, etc.
• To report new cases.
• To know the result of efforts to control the diseases.
• These programmes have yielded considerable morbidity and
mortality data for the specific diseases
Other health service records:
• A lot of information is found in the records of hospital out- patient
departments, primary health centers and subcentres, polyclinics, private
practitioners, mother and child health centers, school health records, diabetic
and hypertensive clinics, etc.
Environmental Health Data:
• It may be the data of air water & noise pollution, industrial intoxicants,
inadequate waste disposal and other aspects of the combination of
population explosion with increased production and consumption of
material goods. Environmental data can be helpful in the identification and
quantification of factors causative of disease.
Health Manpower Statistics:
• Information related to the number of physicians (by age, sex, specialty and
place of work), dentists (classified in the same way), pharmacists,
veterinarians, hospital nurses, medical technicians, etc. Their records are
maintained by the State medical/dental/nursing councils and the Directorates
of Medical Education.
Population Survey:
• A health information system should be population -based. The routine
statistics collected from the above sources do not provide
 all the information about health and disease in the community. The term
"health surveys" is used for surveys relating to any aspect of health -
morbidity, mortality, nutritional status, etc.
Other routine statistics related to health:
• The following list which is not comprehensive merely serves to give
examples of sources of data that have not already been put to good use by
epidemiologist.
Demographic:
Population density, movement &educational level Economic:
Consumption of consumer goods
Social security schemes:
Medical insurance schemes
Non- quantifiable information:
• Information on health policies, health legislation, public attitudes,
programme costs, procedures and technology.
• Health information system has multi-disciplinary inputs.
• There should be proper storage, processing and dissemination of information
as health planners and decision makers require a lot of non-quantifiable
information.
INDICATORS OF VITAL STATISTICS:
• Maternal mortality rate
• Maternal morbidity rate
• Perinatal mortality ,morbidity rate
• Neonatal mortality , morbidity rate
• Infant mortality ,morbidity rate
• Under 5 yr. mortality ,morbidity rate
• Fertility rate
MATERNAL MORTALITY RATE
Number of resident maternal deaths within 42 days of pregnancy termination
due to complications of pregnancy, childbirth, and the puerperium in a specified
geographic area divided by total resident live births for the same geographic area
for a specified time period, usually a calendar year, multiplied by 100,000.
MATERNAL MORBIDITY RATE
It is overarching term that refers to any physical or mental illness or disability
directly related to pregnancy and or child birth, is not necessary for life threatening
CAUSES:
Infection, poor service, hygiene, hemorrhage, anemia, abortion,
difficult labor, hypertension, low socio economic status, living standard.
MEASURES TO PREVENT MMR AND MORBIDITY RATE
• Early registration of pregnancy.
• At least 3 antenatal checkups.
• Dietary supplementation including correct anemia.
• Clean and aseptic delivery practices.
• Prevention of complications eg. Pre- eclampsia and mal
presentation, ruptured uterus.
• Prevention of infection and hemorrhage.
• Treatment of medical conditions.
• Institutional deliveries for women.
• Promotion of family planning.
• Identification of every maternal death and Search for its cause
Perinatal mortality:
Late fetal death (28 weeks of gestation) +
ST
early neonate death (1 Week)
X 1000
Total number of live births at the same year
Causes of perinatal mortality:
ANTENATAL
• Maternal Disease
• Pelvic Disease
• Anatomical Defect
• Malnutrition
• Toxemia Of Pregnancy
INTRANATAL
• Birth Injury
 • Asphyxia
• Prolonged Labor
• Obstetric Complication
POSTNATAL
• Prematurity
• RDS
Measures of reduce perinatal mortality:
• Need to educate community about age of marriage.
• Adequate immunization, prevention of HIV infection, avoidance of drug
abuse.
• Proper nutrition to mother.
• In antenatal period optimum care of mother and need to seek medical
advice in emergency
• In intra natal period use aseptic techniques by skilled person, safe delivery,
control infection and complications.

Neonatal mortality rate:

No. of deaths of neonates under 28 days of age in year
X 1000

Total live births in the same year CAUSES:

• Birth Injury And Difficult
• Prematurity
• Labor
• sepsis
• Fetal Distress
• Congenital Anomalies
• Birth Asphyxia And Tetanus
• Condition Of Placenta And Cord
• Hemolytic Disease
• ARI
INFANT MORTALITYRATE:
 No. of death under 1 year of age

Total no. of live births in year X 1000

IMPORTANCE OF IMR
• It depicts the age related mortality in vulnerable group with in the
society.
• Specific health programme is affected directly and rapidly rather
than the general health problems.
• Improved obstetric and perinatal care.
• Improvement in the quality of life.
• Improvement of nutritional status
• Family planning.
FACTORS AFFECTING IMR
Biological factors:
• Birth weight
• Age of mother
• Birth spacing
• Birth order
• Multiple birth
• Family size
• High fertility

Economic factors Socio

cultural factors
• Breast feeding
• Religion and caste
• Early marriage
• Sex of child
• Maternal education
• Quality of health care and mother care
• Broken families
MEASURE TO REDUCE IMR
• Improve health status of people.
• Raise female literacy.
• Primary health care.
 • Environmental sanitation.
• Prenatal nutrition.
• Socio economic development.
Under 5 year mortality rate:

No. of death of children under 5 yrs of age

X 1000
Total number of children under 5 yrs of age at the same year CAUSES:
• Communicable diseases like diarrhea, measles like diarrhea,
measles, whooping cough diphtheria ARI, malnutrition.
• Accidents
• Congenital anomalies
• Malignant neoplasm
• Pneumonia
• Death PREVENTIVE
MEASURES
• Pre-natal nutrition and routine check ups
• Prevention of infection and aseptic techniques
• Breast feeding
• Family planning
• Sanitation
• PHC and immunization
• Socio economic development
• National health programme
Fertility rate:
General fertility rate:
No. of live birth per in an area during the year X 1000
Midyear female population age (15-49) years in
the same area in same year General
marital fertility rate:
 No. of live birth in a year

Midyear married female population in X 1000

the age group 15-49years
Age - specific fertility rate:
Number of live births in particular age group X 1000
Midyear female population of the same age group
Age – specific marital fertility rate:
Number of live births in particular age group X 1000
Midyear female population of the same age group
Net reproduction rate:
It is defined as the no.of daughters a newborn girl will bear during her life
time assuming fixed age specific fertility and mortality rates.
NRR of India is 1.171(2015) Crude
marriage rate:
Number of marriages in the year X 1000
Midyear population
General marriage rate:
No.of marriages within 1 year X 1000
No.of unmarried persons age 15 – 49 years
Pregnancy rate:
No.of resident pregnancies X 1000
(Live births +induced abortions +fetal deaths)
No.of women aged 15 - 44 years
Pregnancy ratio:
(Live births +induced abortions +fetal deaths) No.of
women in reproductive age (15 -44 years)
Abortion ratio:
It is defined as the number of abortions of all types in a year to number of
live births over the same period.
No.of all types of abortion
No.of live births
World abortion ratio = 32:100 live births .This means for every 100 live births in
the world there are 32 abortions.
MATERNAL AND CHILD HEALTH CARE

INTRODUCTION:
In any community mother and children constitute a priority group. The
problems affecting the health of mother and child are multifactorial. The current
trend in many countries is to provide integrated MCH and family planning services
as compact family welfare services.
OBJECTIVES OF MCH:
⦿ Reduce maternal mortality and morbidity.
⦿ Reduce per natal and neonatal mortality and morbidity.
⦿ Regulate fertility so as to have wanted and healthy children when
desired.
⦿ Provide basic maternal and child health care to all mother and children.
⦿ Promote and protect health of mothers.
⦿ Promote and protect physical growth and psycho-social
development of children.
MATERNAL HEALTH CARE:
Maternal health care include care of women during pregnancy, child birth and
after child birth. It also includes treatment of child-less couples. MATERNAL
RISK FACTOR:
 Maternal risk is defined as the probability of dying or experiencing serious
injury as a result of pregnancy or child birth.
Young primi i.e. below 19 years:
There is grave risk to both mother and the child because the teenage
mother. She still growing and is not adequately equipped to cope with the
pregnancy and labour & is not psychologically prepared for the
responsibilities of marriage.
Elderly primi i.e. 30 years and over:
Having babies too late in life, leads to increased risk of complications in
pregnancy and labour.
Having too many babies:
When the mother bears more than 3 babies, she is at high risk of
developing problems due to repeated pregnancies and labour.
Having too close pregnancies:
When the interval between the two pregnancies is less than three years, it
can create problems during the pregnancy.
Other conditions of mothers
• Mothers with short height i.e. less than 145 cm, having a small and
inadequate pelvis.
• Mothers having less than 40kg of weight: usually underweight mothers are
malnourished and anemic.
• Mothers having more than 70kg of weight have difficulty during child-birth.
• Mothers having malnutrition and anemia. These mothers are weak and find
it difficult to tolerate the stress and strain of pregnancy and child birth.
• Associated medical conditions: These include heart disease, high blood
pressure, kidney disease, tuberculosis, diabetes, repeated attacks of
malaria, hepatic disorder etc.
MCH COMPONENTS:
Maternal healthcare component include
⦿ Antenatal care
⦿ Natal care
⦿ Postnatal care
ANTENATAL CARE:
Antenatal care is care during pregnancy.
Objectives of Antenatal Care:
• To promote, protect and maintain health of mother during
pregnancy.
• To ensure the birth of mature and healthy baby.
• To identify high risk mothers and give the appropriate attention to prevent
complication.
• To prepare the mother for confinement.
• To prepare the mother to care for her baby

Antenatal care services: Registration of

pregnant women:
The mother must be registered within 12 weeks of pregnancy.
Antenatal visit:
Ideally the mother should attend the antenatal clinic once a month during
the first 7 months, twice a month during the second month, and thereafter, once a
week, if everything is normal.
Care during first contact:
Taking health history, Physical examination, general medical
examination, obstetrical examination. Laboratory examination Immunization
against Tetanus:
st nd
2doses of tetanus toxoid should be given. 1 dose at 16-20 weeks and 2
dose at 20-24 weeks of pregnancy.
Iron and folic acid tablet:
Mother is given one tablet of iron and folic acid twice a day for at least 100
days to prevent anemia in mother & to promote proper growth of fetus.
Health education during pregnancy:
Diet during pregnancy:
• A well balanced diet is required during pregnancy for the proper growth
and development of fetus & for optimum health of mother.
 • A pregnant women should be educated regarding personal
hygiene.
Smoking and drinking:
Mother should be advised to avoid smoking and drinking alcohol. It lead to
low birth weight and retardation.
Drugs:
The mother should be advised not to take any medicine unless it is
prescribed by the Doctor.
Radiation:
The mother should be advised to avoid abdominal X-ray it
predisposes child to the risk of leukemia and other cancers
Protection from infections and illnesses:
An expected mother should be instructed to protect herself from the risk of
infection especially measles & syphilis
Sexual activities:
Avoid coitus during the first & last trimester.1st trimester it increases the risk
of abortion & last trimester it predisposes to infection
Travel:
Avoid travel during first and last trimester
Reporting of untoward sign and symptoms:
The mother should be instructed to report to health personal if there is
unusual pain, bleeding from vagina, swelling in the feet, hand or face, headache,
blurred vision, dizziness, high fever baby’s movement not being felt.
Child care:
The mother should be educated on various aspects of child care.
Follow up visits:
Mother must be educated about the need for regular visit and proper care
during pregnancy.
Preparing for confinement:
The preparation for safe delivery is very important. It should be done well
in advance to avoid any type of difficulty or emergency which might occur at the
time of delivery.
Psychological preparation of the mother:
 The expectant mother, especially the primary Para mother has fear and
anxiety about child birth, its outcome, complications etc.
Family planning:
When the mother is pregnant she is more receptive because she is
experiencing the impact and burden of child birth. The mother should be educated
and motivated for small family norm and spacing of children.
INTRANATAL CARE:
Natal care refers to care during confinement /delivery/ birth of
a child.
Objective:
 Toprevent infection,
 To Prevent injury to both mother and baby,
 Todetect and deal with any complications
 Toresuscitate the baby and to provide immediate care to baby. Care
during intranatal period
⦿ Preparation of place and surroundings of confinement.
⦿ Preparation of equipment and supplies required during delivery.
⦿ Physical and psychological preparation of the mother.
⦿ Examination of mother’s physical condition abdominal palpation,
monitoring fetal heart sound, observation of vital signs, labour
pain and uterine extraction etc.
⦿ Conducting delivery, watchful about any problem and helping mother
in taking pains.
⦿ Referral of mother immediately in case of any such problem.
⦿ Giving immediate care to mother and baby after delivery.
⦿ Giving instruction to the mother and family members.
⦿ Maintaining record and reporting of birth to authority.
POST NATAL CARE:
It refer to care which is rendered to both mother and the baby after delivery.
Objectives
 To restore, promote and maintain health of mother and baby.
 To promote breast feeding.
 To prevent complications.
  To establish good nutrition's of the baby.
 To prevent infection and identify any health problem/disorder in the baby.
 To support and strengthen the parents confidence and their role within
their family and cultural environment.
 To motivate for planed and small family norms.
 To educate mother and family on various aspects of mother and child care.
POST NATAL VISIT:
The health worker is expected to follow the under mentioned schedule:-
st nd
◾ 1 visit - within 24 hours (on the 2 of delivery was
conducted by her )
nd th th
◾ 2 visit - 5 or 6 day
rd th
◾ 3 visit - 10 day
th nd th
◾ 4 visit - 2 to 4 week
th th th
◾ 5 visit -6 to 8 week (the visit is done in the clinic).
During these visits, both mother and baby are given care to meet their
health needs.
Care of the mother
• General observation of the mother and the surrounding to assess
overall health status of mother, cleanliness etc.
• Observation temperature, pulse and respiration.
• Examination of breast, involutions of uterus, lochia, perineum for any
kind of abnormality.
• Observation of any abnormality in the abdomen likes painful
and hard abdomen
Care of newborn:
 General observations of the baby and how is he/she.
  Observation of temperature, heart rate and respiration.
 Observation of eyes for any kind of abnormality such as watering
of eyes or any discharge etc.
 Observation of skin for change in colour.
 Observation of cord stump.
 The weight is checked and recorded.
 Observation of any sign of abnormality of abdomen such as
distension, tenderness etc.
IMMEDIATE CARE OF NEWBORN:
Clearing of airway:
Immediately after birth the baby should cry and breathe. In order to promote
breathing the airway needs to be cleared of mucus and any other secretions.
Maintenance of baby temperature:
The new born baby has the risk of hypothermia because of immature heat
regulating system. The risk of hypothermia is greatly reduced if the new born baby
is immediately and carefully dried with towel or clean cloth, wrapped in a clean
cloth, kept close to the mother for skin to skin contact and breast fed as soon as
possible preferably within an hour of birth.
Care of the eyes:
The care of eyes include, wiping of each eye from inside to outside with
boil cooled swabs, one for each eye as the child is born before he opens the eyes.
Care of the umbilical:
The cord should be legated in two places, 6cms and 9cms from the umbilicus
and cut in between with sterilized scissors/blade and tied with sterilized cord tie to
prevent tetanus. The cord should be kept dry.
Apgar scoring:
It is determined by immediate observation of the heart rate, respiration,
muscles tone, reflex response and colour of the infant. The observation is done at
1 minute and again at 5 minutes after birth.
Care of the skin:
The care of the skin is very important to protect the child from any infection
and keep the baby clean and warm.
 Physical examination:
The physical examination of the baby should be done by health worker
assisting mother in delivery soon after the birth to identify any birth injury,
malformations and general health condition of the baby.
Breast feeding:
The breast feeding should be started as soon as possible preferably within an
hour of the birth.
CHILD HEALTH CARE:
Child health care refer to care of children from conception to birth till the age
of five.
Objective:
⦿ Every child receives adequate care and proper nourishment.
⦿ Every child is immunized and protected from diseases.
⦿ Tomonitor growth and development.
⦿ Toidentify ailments and treated without delay.
⦿ To educate the mother and family members to give proper care to their
children.
Care of child:
Personal care of children:
Every child must get proper personal care to protect the child from any kind
of injury. It include maintenance of personal hygiene, maintenance of body
temperature, rest and sleep, exercise, training of child regarding healthy habits etc.
Breast feeding:
For the first few month (6 month) of life, breast feeding is best food which is
made available by nature for healthy growth and development. Supplementary
food:
For the first six month, breast feed alone is sufficient for normal growth and
development. Beyond six month baby require additional food to meet body
requirements.
Monitoring growth and development:
It is very important to monitor growth and development of children regularly.
It indicates health and nutrition status of the child. It helps in identification of any
deviation from normal.
Immunization of children:
 The child needs to be protected from six infectious and vaccine preventable
diseases. There diseases include tuberculosis, tetanus, diphtheria, whooping cough,
measles and poliomyelitis. It is very important that health workers must educate all
the mothers about the importance of immunization.
Safety and security of children:
Safety and security can be ensured by providing clean, safe and
comfortable physical environment.
Early recognition and treatment of ailments:
The most common ailments includes diarrheal diseases, acute respiratory
infection, vaccine- preventable diseases, and nutritional deficiency problems.
ROLE OF NURSE:
Service Provider:
• Provision of ante natal care.
• Monitoring the growth of the fetus & its well being
• Supplementation of requisite vitamins & micro nutrients.
• Provision of health aspects related to new born Promotion of good delivery
practices.
• Promotion of breast feeding & maternal bonding.
• Promotion of optimal new born care
• Ensuring appropriate immunization services.
• Screening for mal formations, congenital anomalies & other
deviations.
• Promotion of child rearing practices.
• Periodic growth, development & mile stone monitoring.
• Promotion of good child rearing practices. Promotion of school
enrollment & Anganwadi enrollment.
• Provision of de-worming services & nutritional supplementation services.
Services for Mothers:
• Assess for feeding difficulties.
• Promote iron & calcium supplementation.
• Monitor & promote balanced diet & good dietary habits.
 • Monitor for post-natal blues.
• Encourage plenty of fluids & roughage diet.
• Promote adoption of contraception & family planning practices.
• Educate the mother on the importance of child rearing & self-care practices
including diet, exercise & sleep.
Role as an Administrator:
• Evolve policy related to MCH.
• Serve as an information provider to policy makers in relation to MCH
services.
• Serve as a liaison with the Govt, community & NGO in organizing &
implementing MCH services.
• Develop counseling & MCH assistance network in the state.
Educationist:
• Organize training programme for health care professionals.
• Conduct workshops & conferences relating to MCH care & sensitize the
community, health care professionals & policy makers.
• Design curriculum in medical & para medical curriculum incorporating
aspects of MCH services.
• Design health education materials & distribute. Develop separate channels
in order to sensitize the public on MCH services.
Researcher:
• Identify researchable areas in MCH & conduct research.
• Pool grant in aids to support research activities in the areas of MCH
services.
• Support research scholars undertaking research in the area of MCH.
• Co-ordinate & network research activities.
• Design models based on research findings.

MTP ACT, FEMALE FETICIDE,

CHILD ADOPTION,FAMILY WELFARE
 MTP ACT:
INTRODCTION:
Abortion is theoretically defined as termination of pregnancy before the fetus
become viable. This has been fixed administratively at 28 weeks, when the fetus
weighs approximately 1000g. In India it has been computed that about 6 million
abortion takes place every year, of which 4 million are induced and 2 million
spontaneous.
REASONS FOR ABORTION:

Unwanted sex sexual

violence unwanted Desire for son
pregnancy

Sex
determination
Abortion

HISTORY:
• The MTP act was passed by the Indian parliament in 1971 and came into
force from April 1, 1972.
• Implementing rules and regulations initially were written in 1971 and were
revised again in 1975.
• MTP act is a health care measure which helps to reduce maternal morbidity
and mortality resulting from illegal abortions.
OBJECTIVES:
Aims to improve the maternal health scenario by preventing large number of
unsafe abortions and consequent high incidence of maternal mortality & morbidity
 Legalizes abortion services
 Promotes access to safe abortion services to women
  Offers protection to medical practitioners who otherwise would be penalized
under the Indian Penal Code (sections 315-316)
LEGAL FRAME WORK:
Medical termination of pregnancy act was passed in the year of 1971.
It includes the following:
1. The condition under which pregnancy can be terminated.
2. The person or persons who can perform termination.
3. The place where termination can be performed.
The condition under which pregnancy can be terminated:
Medical: Conditions of pregnancy may threatens the mother's life. Eugenic: Child
being born with serious physical or mental
abnormalities.
Humanitarian: Pregnancy results in Rape.
Socio Economic: Social or economic background will leads to the injury to
the health of the mother.
Failure of Contraceptive Device: Unwanted pregnancy due to failure of
contraceptive devices can cause mental Injury to the mother.
Person or persons who can perform abortion:
Registered medical practitioner having experience in gynaecology and
obstetrics to perform abortion where the length of pregnancy does not exceed 12
weeks, however where the pregnancy exceeds 12 weeks and is not more than 20
weeks, the opinion of two RMP is necessary to terminate the pregnancy.
Place where abortion can be done:
Abortion can be done Government hospital or Hospitals approved by
Government following this act. Abortion can be strictly confidential where it can
be performed.
MTP RULES:
The rules and regulations framed were altered in October 1975,
 To eliminate the time consuming procedure involved in MTP.
 To make more services readily available.
These changes have occurred in 3 administrative areas
• Approval By Board
• Qualifications Required To Do Abortion
 • The Place Where Abortion Can Be Performed.
Approval by board:
The CHIEF MEDICAL OFFICER of the district is empowered to certified that
the necessary training in Obstetrics and Gynecology to do abortions.
Qualifications required to do abortion:
 The registered medical practitioner has involved in the performance of 25
cases of medical termination of pregnancy in an approved institution
 He also had much experience in old MTP rules.
 6 months housemanship in Obstetrics and Gynecology.
 PG qualifications in Obstetrics and Gynecology.
 3 years practice for Doctors in OBG following the MTP ACT passed
in1971.
Place where abortion can be performed:
Under the new rules the non-Governmental institution may also take up
abortions license from the chief medical officer of the district.
IMPACT OF LIBERALISATION OF ABORTION:
The legal abortions are about 6.1 in 1000 pregnancies.
Although Illegal abortions are about 13. 5 in 1000 pregnancies.
Recent amendment of the MTP in the year of 2003 includes,

1) Spread awareness regarding MTP in the community and available services.

2) Enhance confidential counseling regarding for safe MTP, train ANM, AWW,
and ASHA health workers.
FACILITIES IN MTP:
• To provide vacuum aspiration facilities in CHC.
 • To provide comprehensive and high quality of MTP services in FRUs
• Encourage private and NGO sectors to establish MTP services.

FEMALE FOETICIDE ACT

INTRODUCTION:
• Female foeticide is the aborting of a girl fetus in the womb before its
complete growth. Female foeticide has become a disgraceful and shocking
truth of our nation. In India, there is a strong fondness for sons over
daughter. Several religious, social, financial and emotional factors are the
reason for female foeticide. It is one of the main motives for declining sex
ratio.
• Ultrasonography and foetoscopy helps to determine abnormalities in the
foetus. But it is misused to find out sex of the foetus and abortion is done if
it is a girl child.
DEFINITION:
• It is defined as aborting a female foetus after sex determination test.
• Female foeticide is the procedure of abortion to terminate female fetus from
the womb of the mother before taking birth after the sex recognition.
CAUSES:
• Obsession for son
• Fear of Dowry
• Money: Girls are considered a financial obligations
• Advancement in technology to determine sex
• Poverty
• Illiteracy
• Gender discrimination
• Female is considered as greater responsibility
• Religious faith: Only male child can perform last rites for their
parents
EFFECTS:
 • Decrease in the female sex ratio
• Adverse effect on women’s health physically, mentally and
emotionally
• Women are abused and sexually exploited
• Women trafficking
• Increased suicide among women
MEASURES TO OVERCOME FEMALE FOETICIDE:
Legal Initiatives:
• Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act,
1994
• The Dowry Prohibition Act, 1961
• The Medical Termination of Pregnancy (Amendment) Bill, 2020
• Immoral Traffic Prevention Act
Government Schemes:
• Central Government Schemes:
• Beti Bachao, Beti Padhao
• Sukanya Samriddhi Yojna
• Balika Samridhi Yojna
• Sivagami Ammaiyar Memorial girl child protection scheme by
Government of Tamilnadu.
National Girl Child Day:
Pre-conception and pre-natal diagnostic techniques (pcpndt) act,
1994(amended in 2003):
• Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994
is an act of the parliament of India enacted to stop female foeticide and arrest
the declining sex ratio in India. The act banned prenatal sex determination.
• The main purpose of enacting the act is to ban the use of sex selection
techniques after conception and prevent the misuse of prenatal diagnostic
technique for sex selective abortions.
• The Act provides for the prohibition of sex selection, before or after
conception.
 • It regulates the use of pre-natal diagnostic techniques, like ultrasound and
amniocentesis by allowing them their use only to detect :
• Genetic abnormalities
• Metabolic disorders
• Chromosomal disorders
• Certain congenital malformations
• Hemoglobinopathies
• Sex linked disorders.
• No laboratory or center or clinic will conduct any test including
ultrasonography for the purpose of determining the sex of the foetus.
• No person, including the one who is conducting the procedure as per the
law, will communicate the sex of the foetus to the pregnant woman or her
relatives by words, signs or any other method.
• Any person who puts an advertisement for pre-natal and pre- conception sex
determination facilities in the form of a notice, circular, label, wrapper or
any document, or advertises through interior or other media in electronic or
print form or engages in any visible representation made by means of
hoarding, wall painting, signal, light, sound, smoke or gas, can be
imprisoned for up to three years and fined Rs. 10,000.
Dowry prohibition act:
• Dowry Prohibition Act, Indian law, enacted on May 1, 1961, intended to
prevent the giving or receiving of a dowry. Under the Dowry Prohibition
Act, dowry includes property, goods, or money given by either party to the
marriage, by the parents of either party, or by anyone else in connection with
the marriage.
• If any person, gives or takes or abets the giving or taking of dowry, he shall
be punishable with imprisonment which may extend to six months, or with
fine which may extend to five thousand rupees, or with both.
• If any person, demands, directly or indirectly, from the parents or
guardian of a bride or bridegroom, as the case may be, any
 dowry, he shall be punishable with imprisonment which may extend to six
months, or with fine which may extend to five thousand rupees, or with
both.
The medical termination of pregnancy (amendment) bill, 2020:
• The Bill amends the Medical Termination of Pregnancy Act, 1971 which
provides for the termination of certain pregnancies by registered medical
practitioners.
• Under the Act, a pregnancy may be terminated within 12 weeks, if a
registered medical practitioner is of the opinion that: (i) continuation of the
pregnancy may risk the life of the mother, or cause grave injury to her
health, or (ii) there is a substantial risk that the child, if born, would suffer
physical or mental abnormalities. For termination of a pregnancy between
12 to 20 weeks, two medical practitioners are required to give their opinion.
Immoral traffic (prevention) act, 1956:
The Immoral Traffic (Prevention) Amendment Bill, 2006 amends the Immoral
Traffic (Prevention) Act, 1956 to combat trafficking and sexual exploitation for
commercial purposes.
GOVERNMENT SCHEMES AND POLICIES FOR GIRL CHILD
EMPOWERMENT:
Central Government Schemes:
• Beti Bachao, Beti Padhao
• Sukanya Samriddhi Yojna
• Balika Samridhi Yojna
Sivagami Ammaiyar Memorial girl child protection scheme by
Government of Tamilnadu.
Beti Bachao, Beti Padhao
• Launched with initial funding of ₹100 crore the scheme aims to address the
issue of the declining child sex ratio image (CSR) and is a national initiative
run jointly by the Ministry of Women and Child Development, the Ministry
of Health and Family Welfare and the Ministry of Human Resource
Development.
• Aims at generating awareness about the importance of girl children and
improving the efficiency of welfare services intended for girls in India.
 • Working towards preventing female infanticide.
Sukanya Samriddhi Yojna:
• Part of the ‘Beti Bachao, Beti Padhao’ campaign, the Government of India
backed saving scheme is targeted at the parents of girl children.
• The programme encourages them to build a fund for future education and
marriage expenses for their female child. Parents can start saving early as
the minimum amount of investment required is small, and the account is
active for 14 years from the date of opening the account.
Balika Samridhi Yojna
• This scheme was launched by the Government of India on 15th August 1997
and covered all girls born on or after 15 August 1997 who are below the
poverty line.
• Aimed at offering financial aid to girl children born on or after 15 August
1997, the schemes key objectives include improving the enrolment and
retention of the girl child in schools and helping raise daughters until their
legal age of marriage.
Sivagami ammaiyar memorial girl child protection scheme:
• Sivagami Ammaiyar Memorial girl child protection scheme is being
implemented by the Social Welfare and Nutritious Meal Programme
Department, Government of Tamil Nadu to provide financial assistance to
the girl children in poor families.
Objectives of the scheme are:
• Promote Family Planning
• Eradicate Female Infanticide Promote the welfare of girl children in poor
families and to raise the status of girl children.
National girl child day:
• The National Girl Child Day is celebrated in India every year on January 24.
It was started by the Ministry of Women and Child Development and the
Government of India in 2008.
Objectives:
• To spread awareness among people about all the inequalities faced by girls
in the country.
 • To promote awareness about the rights of a girl child.
• To increase awareness on the importance of girl education, health, and
nutrition.

CHILD ADOPTION ACT

INTRODUCTION:
• Child adoption is seen as an increasing trend in India and across the world.
Most adoptions are either because the parents are not able to have their own
kids or because they want to support and give a new lease of life to a child
who has been left alone in the world.
• Legal adoption confers upon the child and adoptive parents, rights and
responsibilities similar to that of natural parents. The laws of adoption vary
from country to country; the relevant law in India is the “Hindu Adoptions
and Maintenance Act, 1956”.
DEFINITION:
• Adoption is a process where by a person assumes the parenting for another
and in so doing, permanently transfers all rights and responsibilities from the
original parent or parents.
• In simple it is a legal process future parents create a relationship with a child
where it does not exist.
TYPES OF ADOPTION:
Open adoption:
It means that the adoptive parents and the birth parents keep in touch with each
other.
Semi-open adoption:
It doesn’t involve direct contact between the birth parents and the adoptive
parents.
Closed adoption:
Absolutely no contact between the birth parents and the adoptive parents.
Intra family (or) Relative adoption:
It is an adoption that happens with in the family.
Domestic adoption:
 It refers to adoption that happens within the country.
International adoption:
It involves adopting a child from outside the country.
PURPOSES:
• To control population
• To save life of a child
• To provide a good family
• To provide a better future to the existing population
• To avoid any kind of treatment to those who cannot conceive
LEGISLATIONS FOR ADOPTION:
 The Hindu Adoptions and Maintenance Act, 1956
 The Hindu Minority and Guardianship Act, 1956
THE HINDU ADOPTIONS AND MAINTENANCE ACT, 1956:
The Hindu Adoptions and Maintenance Act, 1956 deals with:
• The legal process of adopting children by a Hindu adult.
• With the legal obligations of a Hindu to provide “maintenance” to various
family members including their wife or wives, parents and in-laws.
This Act covers Hindus, Buddhists, Jains or Sikhs. Some relevant parts of
the Act are:
• Married couples or single adults can adopt.
• Legally the man adopts with the consent of his wife.
• A single man or woman can adopt.
• If a biological child already exists in the family, a child of the opposite
sex has to be adopted.
• Children adopted under this Act get the same legal rights as a biological
child might.
• Children under the age of 15 years can be adopted.
• A single man adopting a girl child should be at least 21 years older than the
child.
• A single woman adopting a boy child should be at least 21 years older
than the child.
• Adoption under this Act is irrevocable.
REQUIREMENTS FOR A VALID ADOPTION:
 • The person adopting is lawfully capable of taking in adoption.
• The person giving in adoption is lawfully capable of giving in adoption.
• The person adopted is lawfully capable of being taken in adoption.
• The adoption is completed by an actual giving and taking and the ceremony
called datta homan (oblation to the fire) has been performed.
WHO CAN ADOPT?
• Any male Hindu who is of sound mind, not a minor and is eligible to adopt a
son or a daughter. If such a male has a living spouse, at a time of adoption
then he can adopt a child only with a consent of his wife.
• Any female Hindu who is not married, or if married, whose husband is not
alive or her marriage has been dissolved or her husband has been declared
incompetent by the court has the capacity to take a son or daughter in
adoption.
• In case of adoption, the couple should not have any daughter or son at the
time of adoption.
WHO CAN BE ADOPTED?
• The adopted child can be either male or female.
• The adopted child must fall under the Hindu category.
• The adopter also needs to be unmarried.
• The child cannot be the age of 15 or older.
• Adoption can only occur if there is not a child of the same sex of the
adopted child still residing in the home.
THE HINDU MINORITY AND GUARDIANSHIP ACT, 1956:

• The Hindu Minority and Guardianship Act was established in 1956 as part
of the Hindu Code Bills.
• The Hindu Minority and Guardianship Act of 1956 was meant to enhance
the Guardians and Wards Act of 1890, not serve as its replacement.
• This act specifically serves to define guardianship relationships between
adults and minors, as well as between people of all ages and their respective
property.
 LEGAL IMPLICATIONS:
• From the date of the adoption, the child is under the legal guardianship of
the new adopted parent(s) and thus should enjoy all the benefits from those
family ties.
• This also means that this child, therefore, is cut off from legal benefits
(property, inheritance, etc.) from the family who had given him or her up for
adoption.
ADOPTION PROCEDURE:
• Prospective parents must register at a licensed adoption placement agency
with the entire required document.
• After finding out a suitable child, the agency will call the
prospective parents to meet the child.
• If the parents approve, the agency may hand over the child once a foster care
agreement is signed.
• The agency representative and the parents register the adoption deed as a
proof of a completion of adoption.
FACTS ON ADOPTION:
• To get registered for adoption with an Adoption Coordinating Agency
(ACA) situated at the capital city of every state.
• Be aware of an unauthorized and unlicensed orphanages and institutions
which agree adoptions without much documentation.
• Under the present law, an orphan could also be taken in adoption. In such
cases, the guardian of the orphan can obtain the permission of the court
before giving the adoption.
FAMILY WELFARE
DEFINITION:
FAMILY:
“Family” refers to two or more individuals who depend on one another for
emotional, physical and economical support.”
Introduction:
The ministry of health and family at the center and states plays an important
role in the governmental effort in the delivery of health and family welfare service
to people in the country.
Aim:
 • Welfare of each citizen
• Saving the lives of mother and children.
• Checking the population growth. Service
render under the family welfare are:
• Antenatal registration
• Immunization
• Screening of high risk pregnancy and follow up
• Anemia correction
• Intra natal care, emergency obstetric services, postnatal care.
• Newborn care
• Family welfare services
• Family planning services
• MTP services.
• Micro-surgery: recanalisation and infertility
• Cancer screening: PAP smear test facility.
ROLE OF COMMUNITY HEALTH NURSE IN FAMILY
WELFARE:
• Leadership
• He will be responsible for the proper and successful implementation of the
family welfare services in PHC area including information, education,
communication activities motivation, and delivery of services and after care.
• He will be responsible for giving immediate and sustained attention to the
any complications the acceptors develop due to acceptance of family welfare
method in his area.
• He should carefully watch the morbidity and mortality of acceptors for
immediate action.
• He will extend motivational advice and contraceptives services (temporary
and permanent) to all eligible couples he sees in the clinics conducted by
him at the Ph.C.
• He will trained in service, operation MTP and IUD.
• He will maintain the record of training status of PHC staff on health and
family welfare.
 • He will ensure adequate supplies or equipment, drugs, contraceptive and
educational materials required for the services.
• He will organize monthly staff meetings to review the progress made and to
discuss the problem and future plans.
• He will development and maintain a cooperatives work relationship with
other agencies and opinion leader in PHC area in order to generate and
sustain the family welfare movement.
• He will ensure proper and up-to-date maintenance of eligible couple
registers through spot checking.
INSTITUTIONAL SERVICES & DEFENCE SERVICES
INSTITUTIONAL SERVICES
INTRODUCTION:
Institutional services all services which are not Professional Services including
without limitation, accommodations and use of facility, nursing, technician and
related services, pharmacy services, drugs biological, supplies, appliances and
equipment, diagnostic or therapeutic items or services, administrative services and
housekeeping, durable medical equipment and home health services.
MEANING:
Institutional services means all hospital inpatient and outpatient
services, inpatient hospice care, and services provided by a skilled nursing
facility, provided that all such services are covered services.
DEFINITION:
The institution/hospital is an integral part of a social and medical organization,
the function of which is to provide for the population complete healthcare, both
curative and preventive, and whose out- patient services reach out to the family in
its home environment, the hospital is also a center for the training of health
workers and for bio-social research. TYPES:
1. Based on objective
a. General hospital
b. Special hospital
c. Technical cum Research hospital
2. Based on administration, own ship, control or financial income
a. Governmental or public
b. Non- governmental or private
c. Semi government hospital
d. Voluntary agency hospitals
3. Based on length of stay
a. Short- term or short- stay hospitals (stay less than 30 days)
b. Long- term or long- stay hospitals (stay more than 30 days)
4. Depending on type of medical staff
a. Closed –staff hospital
b. Open –staff hospital
5. Based on bed capacity (size)
a. Small hospital (upto 100 beds)
b. Medium hospital (more than 100 to less than 300 beds)
c. Large hospital (more than 300 beds)
6. Based on type of care
a. Primary care
b. Secondary care
c. Tertiary care
7. By teaching affiliation
a. Teaching hospital
b. Non- teaching hospital
8. Based on system of medicine
a. Allopathic hospital
b. Ayurvedic hospital
c. Homeopathic hospital
d. Unani hospital
e. Hospital of other system of medicine
9. Based on regionality
a. Regional
b. District
c. Upazila health complex
d. Union health and family welfare centers
e. Community clinics
10. As per WHO classification
 a. Regional hospital
b. Intermediate/district hospital
c. Rural hospital BASED
ON OBJECTIVE:
General hospitals
General Hospitals are meant to provide wide-range of various types of
healthcare, but with limited capacity. They care for patients with various- disease
conditions for both sexes to all ages, medical, surgical, pediatrics, obstetrics, eye
and ear etc. Usually, General hospitals are devoid of super- specialist medical care.
Special hospitals
They limit their service to a particular condition orthopedics, maternity,
pediatrics, geriatrics, oncology etc
Teaching cum Research Hospital
College is attached for medical/ nursing/ dental/ pharmacy education. Main
objective is to provide medical care, teaching and research is secondary.
BASED ON ADMINISTRATION, OWN SHIP, CONTROL OR
FINANCIAL INCOME:
Governmental or public hospital:
They are owned, administered and controlled by the government. They provide
free care for patients. The governmental hospitals are owned by:
• The Ministry of Health.
• The University
• Others
Private Hospital
Privately owned or controlled by an individual or group of physicians or citizens
or by private organization. Purpose is to provide services for profit making.
Semi Govt Hospital
Hospitals run both by the govt and private entity. Eg Cantt Board Hospital.
Voluntary Agency Hospital
Not for the profit, hospital run by the voluntary organizations eg, HOPE
Foundation Fistula Hospital.
 BASED ON LENGTH OF STAY:
Short-term or short-stay hospitals
These are hospitals where over 90% of all patients admitted stay less than 30
days.
Long-term or long-stay hospitals
These are hospitals where over 90% of all patients admitted stay 30 days or more,
i.e. mental hospital.
DEPENDING ON TYPE OF MEDICAL STAFF:
Closed-staff hospital
Physicians are held responsible for all medical activities in the hospital including
the diagnosis and treatment of patient fee paying and emergency.
Open-staff hospital
This type of hospital permits other physicians in the community to admit and treat
patients to the hospital' and treat them.
BASED ON BED CAPACITY:
• Teaching Hospital 500 beds (to be increased according to the number of
students).
• District Hospitals - 200 beds, (to be increased up to 300 according to the
population).
• Taluk Hospital – 50 beds (May raised depending upon population to be
served).
• Primary Health Centers -6 (may be raised up to 10)
BASED ON TYPE OF CARE:
Primary health care
• The first level of contact between the individual and the health system.
• Essential health care (PHC) is provided.
• A majority of prevailing health problems can be satisfactorily
managed.
• The closest to the people.
• Provided by the primary health centers.
Secondary health care
• More complex problems are dealt with.
• Comprises curative services Provided by the district hospitals
Tertiary health care
 • Offers super-specialist care
• Provided by regional/central level institution.
• Provide training programs
BASED ON TEACHING AFFILIATION:
Teaching hospital
It is a hospital to which a college is attached for medical/ nursing/ dental/
pharmacy education. The main objective of these hospitals is teaching based on
research & the provision of health care is secondary. AIIMS, JIPMER.
Non-teaching hospital
Non-teaching hospitals serving local communities without federal funding are
known as community hospitals. They can be found in rural or urban settings and
provide vital services to their local populations.
BASED ON SYSTEM OF MEDICINE:
• Allopathic hospital
• Ayurvedic hospital
• Homeopathic hospital
• Unani hospital
• Hospital of other system of medicine
BASED ON REGIONALITY:
• Regional
• District
• Upazila health complex
• Union health and family welfare centers
• Community clinics WHO
CLASSIFICATIONS:
Regional Hospital:
Provides complex range of treatment and highly specialized services. Serves
larger area than a local hospital. Eg Govt Medical College Hospital.
Intermediate/ District Hospital
A district hospital typically is the major health care facility in its locality (For
Bangladesh in a district level). Specialty services in major disciplines (Eg,
Medicine, Surgery, Gynecology etc.)
Rural Hospital
 Remote hospitals with small number of beds and limited service capacity. It
should have 20-100 beds.
FUNCTION:
 Intramural services with in the wall of hospital.
 Extramural services outside the wall of hospital eg OPD, outreach services,
medical camps, immunization program.
PREVENTIVE FUNCTION:
• It is an emerging secondary function for the hospital and concerned with
health promotion.
• It is geared towards providing the preventive services through a
community health center.
• It takes an active role to improve the health of the population.
CURATIVE FUNCTION:
• It is the primary function of the hospital and concerned with
providing patient care
• It refers to any type of care given to the patients by the health team members
eg physicians, nurses…
• Also include health education to patients
TRAINING FUNCTION:
It is a secondary function and concerned with providing training and
educational courses for the professional and technical personnel to provides health
services (eg physician, nurses, dentists, therapists).
RESEARCH FUNCTION:
It is a secondary function and concerned with conducting the health related
researches that focuses on the improvement of the health and /or prevention of
diseases.
Factors led to changing role and function of the hospital:
• Expansion of clientele from dying and destitute to all classes of the people
• Improved socio economic status
• Increased health awareness
• Government duty to provide comprehensive health care
• Improved transportation and communication services
• Rapid advances in medical science and technology
 • Increase in population leading to increase in demand for hospital beds.
• Reorientation of health care system with an emphasis on primary health
care.
ORGANIZATION
Outpatient department:
— Consultation with doctor
— Undergo investigations
— Minor procedures
— Health education
— Receive specialty services
— Rehabilitation services
Emergency/Casualty Department:
— Victims of accidents
— Patients with cardiac arrest
— Patients with breathing difficulty
— located in an area which is Easily accessible to patients
— Should have sufficient medical and nursing personnel
— Supplies and equipments and facilities for meeting
Inpatient service (IP):
— Patient who require continuous medical care and attention
— Stay overnight or for several days or weeks or months for
diagnosis, treatment and therapy
— Patients are given the facilities for lodging, medical and
nursing care
Services:
 Dietary dept.
 Pharmacy
 Other paramedical services (radiology and laboratory)
Nursing department:
— Consist of nursing service and nursing education service
◦ Nursing service
– Most important dept
– Head : nursing officer / nursing superintendent
– Other personnel
 ◦ Assistant nursing supdt
◦ Nursing supervisors
◦ Head nurses
◦ Staff nurses
◦ All nurses should possess registration/license to practice as a nurse
in the hospital.
Nursing education service:
◦ Attached nursing educational institutions
◦ Nursing courses: ANM, GNM, BSc nursing, Post basic BSc
nursing, MSc nursing and Ph.D.
Paramedical department:
— Laboratory : Various investigations are carried out in the
laboratories
– Urine
– Feces
– Blood etc
— Different sessions:
– Hematology
– Biochemistry
– Bacteriology
– Parasitology
– Pathology
– Blood bank
Other departments:
 Administration and accounts
 Housekeeping
 Maintenance
 CSSD
 Laundry department
ADVANTAGES:
• The person is treated as a valued member of the service.
• A person gets the appropriate care.
• The service is built around the person’s needs.
• The service provides the community of support for the person.
 • The institutions of the service provide valued outcomes for the person.
• The person has the opportunity to participate in normal social
activities that are available to others in the society.
DISADVANTAGES:
• A service may not have room for the person.
• A service that is specialized in the needs of the person may not exist.
• The service may not have the skills and resources to provide for the
person’s needs.
• A person may lose his/her existing communities (living,
recreational, education or employment).
• The person has to learn and adjust to the institutions of the service.
DEFENSE SERVICES
INTRODUCTION:
Armed force medical services (AFMS) is an inter-services organization headed
by the director general armed forces medical services who function directly under
the ministry of defense. It is responsible for providing health care services to armed
forces personnel their families and other beneficiaries as mandated.
HISTORY:
In March 1947 a committee named “Armed Forces Medical Services and
Research Integration Committee” headed by Dr BC Roy was appointed by the
Government of India to consider the integration of the three medical services and
medical research in the three services. The Committee recommended that there
should be three branches of the Indian Armed Forces Medical Services i.e. Army,
Navy and Air Force.
There should be a Supreme Controller of all the three Medical Services
designated as Director General of the Armed Forces Medical Services (DGAFMS)
who would be the advisor to the Supreme Commander or the Defense Minister as
the case may be, regarding the medical needs of the Armed Forces. He will be the
administrative head of the Armed Forces Medical Services.
MEANING:
 Armed Forces Medical Services is the first tri-service (Army, Navy and Air
Force) organization and one of the largest organized medical services in the
country. It has state of the art tertiary care hospitals and specialty centers of
excellence.
FUNCTION:
 It provides medical support to the Armed Forces during war as well as
comprehensive health care to all service personnel, ex- servicemen and their
dependents during peace.
 Army Medical Corps provides medical aid during natural calamities both at
national and international levels.
ORGANOGRAM:
DGAFMS (director general of armed force medical services)
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DG (ORG & PERS) AFMS (organizational and personnel matters)
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Add l DGAFMS (HR)
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Dy DGAFMS (HR)
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Director AFMS (P-II)
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Dy Director AFMS
ROLES AND RESPONSIBILITIES OF AFMS:
• To provide comprehensive health care including combat and operational
medical support to the serving armed forces personal their families and
dependents.
• The medical services of the army, navy and air force are headed by the
respective DGsMS who exercise operational control over the medical
infrastructure under them.
• Dental care in armed forces is provided at different dental centers of
army ,navy and air force respectively
• Specialty facilities are provided in service hospitals taking into account the
number of beds in the particular hospitals.
• The AFMS has a well-established referral system where patients needing
specialist and super specialist care are referred or transferred to hospitals
with the requisite facilities when needed.
• Mobile medical treatment facilities are existing in the Indian army.
• Air ambulance – It is pre equipped air craft with intensive care material,
monitors, ventilators etc.
• Artificial limb center- established with the primary objective of managing
the prosthetic and orthotic needs of disabled personnel of the Indian armed
forces.
• AFMS is mandated to follow evidence based medicine as practiced under
“allopathic system of medicine". the AFMS does not practice other alternate
system of medicine like ayurveda and homeopathy.
• The AFMS has been playing a major role in providing medical service in
natural disasters. Hospital of armed forces are also well prepared to provide
specialist medical and surgical teams during disasters. It has collaboration
with international research organization.
• Medical preparedness to contain various types of contagious diseases in
Armed Forces is as under,
a) Armed Forces have formulated policies with regard to contagious diseases in
consonance with the National Health Programmes.
b) Robust mechanism of surveillance and monitoring of the diseases are in
place.
c) Starting from unit level, health education is undertaken for troops and
preventive measures are instituted for communicable diseases.
d) In-built reporting mechanism and updation of health statistics by units,
station health organizations, medical Directorates at various echelons and
DGAFMS ensures monitoring of the cases at all times.
e) Data is held at nodal centers (hospitals, Formation HQ and Service HQrs)
for interpreting, analysis and timely action. Station Health Organizations are
upgraded and equipped for monitoring the cases.
f) Notification of outbreaks is undertaken as per the national and international
health regulations
 g) Armed Forces Central Epidemiological Surveillance Centre (AFCESC) at
AFMC is the specialized nodal center which undertakes surveillance.
h) Constant liaison/interaction with Ministry of Health and Family
Welfare/WHO for any changing new threats.
 Digitization
The committee were informed that digitization is being carried
out in AFMS at 5 levels
 Human resource management
 Patients and clinical processes data
 Medical store procurement
 Military stores
 Recruitment and training
 Minister of defense mandated to conduct research to meet the
requirement of defense sector. AFMS conducts medical research in
all medical fields with an emphasis on military medicine and combat
medicine support.
 Tele-medicine facilities are available.

ALLOPATHY AND ALTERNATIVE HEALTHCARE SYSTEMS LIKE

YOGA, MEDITATION, SOCIAL AND SPIRITUAL
HEALING
ALLOPATHY

INTRODUCTION:
The term Allopathy was invented by German physician Samuel Hahnemann.
He conjoined allos means ‘opposite’ and pathos means “suffering” as a referent
to harsh medical practices of his era which included bleeding, purging, vomiting
and the administration of highly toxic drugs." One example of an allopathic
therapy would be using a laxative to relieve constipation.
DEFINITION:
⚫ It is the treatment of disease by conventional means, i.e. with drugs
having effects opposite to the symptoms.
 OR
⚫ A system of medical practice that aims to combat disease by use
of remedies (as drugs or surgery) producing effects different from or
incompatible with those produced by the disease being treated.
OTHER NAME FOR ALLOPATHIC MEDICINE:
• Conventional medicine
• Mainstream medicine
• Western medicine
• Orthodox medicine
• Bio medicine
FEATURES:
 Allopathy seek fight against body’s natural defense mechanism attacking
symptoms rather than disease.
 Treat the patients according to the disease.
 It helps to identify the organism and select a drug to destroy the specific
germ.
 It opposes the body’s natural defense system and produce germs to
destroy the germ disease.
ADVANTAGE:
 Shortage of time
 Modern curriculum
 Modern technology
 Profitable method
TREATMENT OF ALLOPATHY:
Allopathic medicine doctors and other healthcare professionals use a range
of treatments to treat infection, illness, and disease. These include prescription
drugs like:
• Antibiotics (penicillin, amoxicillin, vancomycin, Augmentin)
• Blood pressure medications (diuretics, beta-blockers, calcium channel
blockers, ace inhibitors).
• Diabetes drugs (metformin, sitagliptin, DPP-4 inhibitors,
thiazolidinediones)
• Migraine medications (ergotamines, triptins, anti nausea drugs)
• Chemotherapy
 • Some types of prescription drugs replace hormones when the body can’t
make enough or any of a certain type, such as:
• Insulin (in diabetes)
• Thyroid hormones (in hypothyroidism)
• Estrogen
• Testosterone
Allopathic medicine professionals may also recommend over-the- counter
(OTC) medications like:
• Pain relievers (acetaminophen, aspirin)
• Muscle relaxers
• Cough suppressants
• Sore throat medications
• Antibiotic ointments
Common allopathic medicine treatments also include:
• Surgery and surgical procedures
• Radiation treatments
PREVENTATIVE CARE:
• Vaccinations to prevent serious life-threatening illness in infants, children,
and adults.
• Prophylactic antibiotics to prevent infection after a surgery, wound, or very
deep cut.
• Pre diabetes care to help prevent diabetes
• Blood pressure medications to help prevent serious complications like heart
disease and stroke.
• Education programs to prevent development of health issues common to at-
risk populations such as heart disease, cancer, and diabetes.
ALTERNATIVE HEALTH CARE SYSTEMS
INTRODUCTION:
Alternative health care systems include various healing approaches that
originate from around the world and that are not based on conventional western
medicine there therapies are called alternative systems of health .They are used
alone and complementary medicine, they are used with conventional medicine.
DEFINITION:
 Alternative system of health defines as the absence of diseases is usually
thought to result from isolated factor and treatment often involves drugs and
surgery.
IMPORTANCE:
Alternative system of health focuses on healing pain and disease by balancing
out other aspects of life. Sleep, nutrition and stress can affect body. So adopting
health plans is important with alternative medicine.
DOMAINS OF ALTERNATE MEDICINE:
Alternative system of health focuses five domains
• Alternative medical system
• Mind body interventions
• Biologically based treatments
• Manipulative and body based methods
• Re-energy therapies
YOGA:
Yoga is the physical, mental and spiritual practices which originated in ancient
India with a view to attain a state of permanent peace of mind in order to
experience one’s true self.
ORIGIN:
Yoga is the stilling of the changing states of mind. The origins of Yoga are a
matter of debate. It may have pre -Vedic origins.
• Gurus from India introduced Yoga to the west following the success of
th th
Swami Vivekananda in the late 19 and early 20 century.
• In 1980’s yoga became popular as a system of physical exercise across the
western world. This form of Yoga is often called Hatha Yoga.
MEANING:
In Vedic Sanskrit, the meaning of word Yoga is “to add”, “to join”, “to unite”
or “to attach”.
PURPOSE:
The ultimate goal of Yoga is Moksha (liberation) through the exact definition
of what form this takes depends on the philosophical or theological system with
which it is conjugated.
• Reduce stress,
• Relieves anxiety,
• Increased flexibility.
• Increased muscle strength and tone.
• Improved respiration, energy and vitality.
• Maintaining a balanced metabolism.
• Weight reduction.
• Cardio and circulatory health.
• Improved athletic performance.
• Protection from injury.
TECHNIQUES:
There are different yoga techniques. The most common among them are
Suryanamaskar Meditation Pranayama.
Suryanamaskar
• It is a salutation to the sun. It is known to ease stress and give the peace of
mind besides increasing the levels of concentration.
Dhyana (meditation):
• It is the state of mind wherein there are no sensor thoughts. It leads to a
deeper level of relaxation, reduces anxiety, decreases muscle tension and
headache.
Pranayama:
• It means a pause in the movement of breath.
• It increases the spiritual power and confers cheerfulness and inner peace.
MEDITATION:
Meditation is an experience of relaxing the body, quieting the mind, and
awakening the spirit. Meditation encourages a deepening of consciousness or
awareness, and also facilitates a deeper understanding of self and others.
CLASSIFICATION:
 Concentrative (The most commonly used form)
  Receptive
 Reflective
 Generative
Concentrative medication:
⚫ Assists with focusing the mind.
⚫ This is done by focusing on the breath image
Objective or sound during meditation.
 This process allows the mind to achieve clarity and awareness.
 Transcendental meditation (TM), based in the Hindu tradition, is a form
of concentrative meditation.
Receptive meditation:
 This is done by being mindful and attentive to feelings, sensation,
thoughts, images, smells and experiences without becoming involved in
judgment, reactions or processes of the experience.
 This helps to gain a calmer, clearer and more non-reactive state of
mind and being. Mindfulness meditation, based on Buddhism, is a form
of receptive meditation.
Reflective meditation:
 Assists with investigating an idea in a systematic way. Uses disciplined
thinking and analysis to reflect upon a compelling.
 Question, challenge, idea or project. Reflects on a verse, a phrase or
inspiring idea. Brings wisdom and insight into all aspects of our lives.
Gerarative meditation:
Assists in consciously cultivating and strengthening specific Qualities such as:
⚫ Patience
⚫ Love
⚫ Appreciation
⚫ Compassion
⚫ Humility
⚫ Gratitude
⚫ Courage
BENEFITS:
• Higher levels of energy, creativity, and
• Spontaneity
• Lower blood pressure
• Increased exercise tolerance
• Better concentration
• Decreased stress, depression and anxiety
• Increased job satisfaction
• Better relationships with others.
HOW CAN MEDITATION HELP STUDENTS?
⚫ Time management
⚫ Assist with addictions
⚫ Mindful eating and body satisfaction
⚫ Athletic performance
⚫ Stress reduction and sleep
⚫ Academic performance
⚫ Enhance immune system
⚫ Developing a deeper sense of compassion and forgiveness for others
SOCIAL AND SPIRITUAL HEALING:
MEANING:
Spirituality derives from Latin word spiritus meaning wind or breath –breath
of life (Webster dictionary) spirituality refers to that part of the being human that
seek meaningfulness through intra, inter and transpersonal connections ( reeds
1991).
DEFINITION:
Spiritual Healing is a process of healing ones soul or body with spiritual
therapies and practices that connect to the spirit. Spiritual healing is the practice
(and experience) of restoring, harmonizing and balancing our Spirit or Soul.
GOAL:
It is to achieve balance and connectedness with the mind, body, and spirit.
 This is reflected in clients experiencing improved physical health, freedom
from chronic pain, relief from insomnia, stress reduction, and improved blood
circulation.
CONCEPTS:
 Religion: Organized system of beliefs and practices
 Provides guidance for life’s questions & challenges.
 Faith: Believe in / be committed to something / someone. Faith gives life
meaning providing the individual with strength.
 Hope: It is a concept that incorporates spirituality “a process of anticipation
that involves the interaction of thinking, acting, feeling and relating and is
directed towards a future fulfillment that is personally meaningful in times
of difficulty.
 Transcendence: It is the capacity to reach out beyond oneself, to extend
oneself beyond personal concerns and to take on broader life perspectives,
activities and purposes.
 Forgiveness: Increased attention among health care professionals assist
client to understand process of forgiveness, clients seek forgiveness during
illness from others as well as God.
IMPORTANCE:
 Meeting spiritual needs
 Coping behavior especially during illness ( acceptance)
 This experience (illness) in life helps the client in their own spiritual
growth.
 Holistic nursing provides care to mind, body & spirit.
 Meeting the clients spiritual needs can decrease suffering and aid in
physical and mental healing
 Helps in approaching death peacefully.
 Being aware of spiritual needs & the process of helping clients, helps the
health professional in their own spiritual growth.
ASPECTS:
The following aspect (mart solf & mickley 1998)
1. Meaning (having purpose making sense of life)
2. Value (having cherished beliefs & standards)
3. Transcendence (appreciating a dimension that is beyond self)
metaphysical.
4. Connecting-(relating to self-others nature & ultimate other)
5. Becoming (which in values reflection, allowing life to unfold,
knowing who one is)
TYPES:
• Physical healing (of the body)
• Emotional healing (of the heart)
• Mental healing (of the mind)
• Soul healing (of the soul)
• Holistic healing (of the body, heart, mind, and soul)
SPIRITUAL NEEDS:
• Need to be respected and valued
• Need for dignity
• Need for meaning to the fullness of life.
• Need for values
• Need for creativity
• Need to connect with god/higher power/or a being greater than oneself.
• Need to belong to a community
INDICATORS OF SPIRITUAL WELL BEING:
• Sense of inner peace.
• Compassion for others
• Reverence for life.
• Gratitude
• Appreciation of both unity & diversity.
• Humor
• Wisdom
• Generosity
• Ability to transcend the self.
• Capacity of unconditional love

INDIAN SYSTEM OF MEDICINE AND

HOMEOPATHY
INTRODUCTION:
The Indian System of Medicine is the culmination of Indian thought of
medicine which represents a way of healthy living valued
with a long and unique cultural history. It also amalgamates the best of influences
that came in from contact with other civilizations. Greece (resulting in Unani
Medicine), Germany (Homeopathy) or our sages (which gave us the science of
Ayush).
HISTORY:
• A separate Department of Indian Systems of Medicine and Homoeopathy
(ISM&H) was set up in 1995 to ensure the optimal development and
propagation of these holistic and traditional system of heath care.
• The Department of ISM&H was re-named as the Department of AYUSH (an
acronym for - Ayurveda, Yoga and Naturopathy, Unani, Siddha,
Homoeopathy) in November 2003.
• The Department of AYUSH under Ministry of Health and Family Welfare,
promotes and propagates Indian systems of Medicine and Homoeopathy.
OBJECTIVES:
• To upgrade the educational standards in the Indian Systems of Medicines and
Homoeopathy colleges in the country.
• To strengthen existing research institutions and ensure a time-bound research
programme on identified diseases for which these systems have an effective
treatment.
• To draw up schemes for promotion, cultivation and regeneration of medicinal
plants used in these systems.
AYURVEDA:
Ayurveda is a classical system of healthcare originating from the Vedas
documented around 5000 years ago. As per the fundamental basis of Ayurveda,
all objects and living bodies are composed of five basic elements, called the
Panchamahabhootas, namely Prithvi (earth), Jalal (water), Agni (fire), Vayu (air)
and Akash (ether).
AIM:
• To keep structural and functional entities in a state of equilibrium, which
signifies good health (Swasthya).
• Any imbalance due to internal or external factors can cause disturbance in the
natural equilibrium giving rise to disease and the
 treatment consists of restoring the equilibrium through various
procedures, regimen, diet, medicines and behavior change.
TREATMENT:
• Panchakarma include 5 detoxification processes, used to treat
diseases, according to Ayurveda.
 Vamana (Medicated emesis),
 Virechana (Medicated purgation),
 Basti (Medicated enema),
 Nasya (medication through the route of nose),
 Raktamokshana (Bloodletting)
• The Panchakarma therapy minimizes the chances of recurrence of the
diseases and promotes positive health by rejuvenating body tissues and bio-
purification.
SURGICAL INTERVENTION:
Kshar Sutra is a Para-surgical intervention using an alkaline thread for
cauterization, which is scientifically validated to be effective in the treatment of
fistula-in-anus and such surgical conditions as require excision of overgrown soft
tissue like polyps, warts, non-healing chronic ulcers, sinuses and papillae.
YOGA:
• The concepts and practices of Yoga originated in India about several
thousand years ago. Its founders were great Saints and Sages.
• Yoga is one of the six systems of Vedic philosophy.
• Maharishi Patanjali, rightly called "The Father of Yoga" compiled "Yoga
Sutras" (aphorisms).
• He advocated the eight folds path of Yoga, popularly known as
"Ashtanga Yoga" for all-round development of human beings. They
are:- Yama, Niyama, Asana, Pranayama, Pratyahara, Dharana, Dhyana
and Samadhi.
• These eight components advocate certain restraints and observances,
physical discipline, breath regulations, restraining the sense organs,
contemplation, meditation and samadhi.
 • These steps helps in improvement of physical health by enhancing
circulation of oxygenated blood in the body, retraining the sense organs
thereby inducing tranquility and serenity of mind.
• The practice of Yoga prevents psychosomatic disorders and improves an
individual’s resistance and ability to endure stressful situations.
DEFINITION OF YOGA:
• Yoga is a discipline to improve or develop one’s inherent power in a
balanced manner. It offers the means to attain complete self- realization.
• The literal meaning of the Sanskrit word Yoga is ’Yoke’. Yoga can be
defined as a means of uniting the individual spirit with the universal spirit of
God.
• According to Maharishi Patanjali, Yoga is the suppression of modifications
of the mind.
SALIENT FEATURES OF YOGA:
• Yoga a universal practical discipline: Yoga is universal in character for
practice and application irrespective of culture, nationality, race, caste,
creed, sex, age and physical condition.
• Yoga as evolutionary process: Yoga is an evolutionary process in the
development of human consciousness. Evolution of total consciousness does
not necessarily begin in any particular man rather it begins only if one
chooses it to begin.
• Yoga as soul therapy: All paths of Yoga (Japa, Karma, and Bhakti etc.) have
healing potential to shelter out the effects of pains.
TYPES OF YOGA:
• Japa Yoga
• Karma Yoga
• Gyana yoga
• Bhakti Yoga
• Raja Yoga
• Swara Yoga
• Kundalini
• Nadi
UNANI:
 As the name indicates, Unani system originated in Greece. The foundation
of Unani system was laid by Hippocrates. It was introduced in India by the
Arabs and Persians sometime around the Eleventh century. During 13th and
17th century A.D. Unani Medicine had its hey-day in India.
• The basic theory of Unani system is based upon the well- known four-
humour theory of Hippocrates.
COMPONENTS:
• The human body is considered to be made up of the following
seven components are:
o Arkan (Elements)
o Mizaj (Temperament)
o Akhlat (Humors)
o Aaza (Organs)
o Arwah (Spirits or vital breaths)
o Quwa (energy)
o Afaal (Functions)
Medical condition to treat:
Unani system of Medicine has been found to be efficacious in
conditions like
o Rheumatoid Arthritis,
o Jaundice,
o Nervous Debility,
o Skin Diseases like Vitiligo & Eczema,
o Sinusitis and Bronchial Asthma.
Essentials of unani:
For the prevention of disease and promotion of health, the unani system
emphasizes six essentials (asbab-e-sitta zarooria):-
a) Pure air
b) Food and water
c) Physical movement and rest
d) Psychic movement and rest
e) Sleep and wakefulness and
f) Retention of useful materials and evacuation of waste
materials from the body.
Treatment in Unani medicine:
o Ilaj bid Dawa (Pharmacotherapy),
o Ilaj bil Ghiza (Diet therapy),
o Ilaj Bid Tadbir (Regimental Therapy) and
o Ilaj bil Jarahat (Surgery).
o Regimental Therapy is a special technique / physical method of treatment to
improve the constitution of body by removing waste materials and
improving the defense mechanism of the body and protect health.
o Some of the special techniques are
o Fasd (Blood-letting) - Withdrawal of often little quantities of blood
from a patient to cure or prevent illness and disease.
o Dalk (Massage)
o Riyazat (Exercise
o Hijama (Cupping) - A partial vacuum is created in cups placed on the skin
either by means of heat or suction. This draws up the underlying tissues.
When the cup is left in place on the skin for a few minutes, blood stasis is
formed and localized healing takes place.
o Taleeq-e-Alaq (Leeching) - application of a living leech to the skin in order
to initiate blood flow or deplete blood from a localized area of the body.
o Hammame- Har (Turkish Bath)
o Amal-e- Kai (Cauterization).
SIDDHA:
The Siddha System of medicine is one of the ancient systems of medicine in
India having its close bend with Dravidian culture. The term Siddha means
achievements and Siddhars are those who have achieved results in medicine. The
Siddha system of Medicine emphasizes on the patient, environment, age, sex, race,
habits, mental frame work, habitat, diet, appetite, physical condition, physiological
constitution of the diseases.
Medical conditions to treat:
The strength of the Siddha system lies in providing very effective therapy in
the case of
  Psoriasis,
 Rheumatic disorders,
 Chronic liver disorders,
 Benign prostate hypertrophy,
 Bleeding piles,
 Peptic ulcer
 Various kinds of Dermatological disorders of non-psoriatic nature.
NATUROPATHY:
• Naturopathy advocates living in harmony with constructive principles of
Nature on the physical, mental, moral and spiritual planes.
• Naturopathy promotes healing by stimulating the body’s inherent power to
regain health with the help of five elements of nature – Earth, Water, Air,
Fire and Ether.
• Naturopathy advocates Better Health without Medicines.
• It is reported to be effective in chronic, allergic autoimmune and stress
related disorders.
Holistic view of naturopathy:
 Simple Eating And Living Habits,
 Fasting,
 Hydrotherapy-body Packs, Baths
 Mud packs, massages,
 Under Water Exercises,
 Air therapy
 Magnet Therapy, Chromo-therapy,
 Acupuncture, Acupressure etc.
HOMOEOPATHY:
• Homoeopathy was brought into India around 1810.
• The Physicians from the time of Hippocrates have observed that certain
substances could produce symptoms of a disease in healthy people similar
to those of people suffering from the disease.
• Dr. Christian Friedrich Samuel Hahnemann, a German physician,
scientifically examined this phenomenon and codified the fundamental
principles of Homoeopathy.
PRINCIPLES:
• Similarity- a medicine which could induce a set of symptoms in healthy
human beings would be capable of curing a similar set of symptoms in
human beings actually suffering from the disease.
• Single Medicine - Single medicine should be administered at a time to a
particular patient during the treatment.
• Minimum Dose - bare minimum dose of a drug which would induce a
curative action without any adverse effect should be administered.
• Many surgical, gynecological and obstetrical and pediatric conditions and
ailments affecting the eyes, nose, ear, teeth, skin, sexual organs etc. are
amenable to homoeopathic treatment.
• Behavioral disorders, neurological problems and metabolic diseases can also
be successfully treated by Homoeopathy.
• Apart from the curative aspects, Homoeopathic medicines are also used in
preventive and promotive health care.
PURPOSES:
• Seek to cure the patients on the physical, mental and
emotional levels.
• Safe treatment, as it uses medicines in extremely
diluted quantities.
• Its non-toxicity makes it a good choice for treatment of
children.
• Homeopathic remedies are inexpensive.
• Colds and flu may be effectively treated with aconite and bryonia.
• Effective in treating many conditions
• Effective in treating infections, circulatory problems, respiratory problems,
heart disease, depression and nervous disorders, migraine headaches,
allergies, arthritis, and diabetes.
• Used to assist the healing process after surgery or chemotherapy.
• Good treatment to explore for acute and chronic illnesses
INDICATION:
• It can be used by pregnant and nursing women.
• It can be used by children and infants.
 • Does not interfere with medications taken by a person.
• If an incorrect remedy is selected, it is completely safe and will not harm the
person at all.
• Very rare side-effects of homeopathic remedies.
• It can be used for chronic or acute conditions
• Individualized system of medicine which treats the person.
• Holistic approach to healing.
• Readily available and can be used by anyone.
• Inexpensive and therefore provide an affordable approach to
healing.
• Can be stored for long periods of time.
• Non-invasive
PRECAUTIONS:
• Remedies should be prescribed by a homeopathic practitioner.
• Those who are taking homeopathic remedies should also avoid taking
antidotes, & other substances.
• Avoid, coffee, peppermint (in toothpaste and mouthwash), camphor (in
salves and lotions), and very spicy foods.
• Should also be handled with care, and should not be touched with the hands
or fingers
SIDE EFFECTS:
• A homeopathic aggravation sometimes occurs during initial
treatment with homeopathic remedies.
• Homeopaths see aggravation as a positive sign that the remedy is a good
match for the patient's symptoms.
• Some patients can experience emotional disturbances.
MAINSTREAMING OF AYUSH UNDER NRHM:
• An initiative has been taken by the department of Health and Family
Welfare and department of AYUSH for strengthening of health care
facilities at all levels by integrating AYUSH systems in national health care
delivery systems under NRHM.
• While constructing new PHC/CHC/DHs as per IPHS, adequate space
should be provided for AYUSH doctor & dispensary within the premises.
 • In PHC- 1 AYUSH doctor & pharmacist (desirable).
• In CHC/DH- 1 AYUSH doctor & pharmacist (essential).
• Qualified AYUSH practitioners may be hired on contractual basis from
NRHM funds.
• The additional supply of generic drugs for common ailments at all levels
shall also include AYUSH formulations.
• ASHA Drug Kit to be expanded to include AYUSH medications with
proven efficacy.
• Training module for ASHA and ANMs have to be updated to
incorporate information of AYUSH.
• AYUSH representatives should be included in the Rogi Kalyan Samities.
TH
THRUST AREAS OF 12 FIVE YEAR PLAN:
Thrust is proposed to be given on the following areas in the 12th
Plan-
 Availability of AYUSH services in 100% of districts through
NABH accredited hospitals.
 Improving quality of education & training and developing centers of
excellence in government and private sectors.
 Promoting quality research to validate the efficacy and safety of AYUSH
remedies.
 Ensuring availability and conservation of medicinal plants.
 Accelerating Pharmacopeias work.
 Ensuring availability of quality drugs.
 Positioning AYUSH National Institutes as leaders in SAARC region.
 Propagation of AYUSH for global acceptance as systems of
medicine.
PUBLIC HEALTH IMPORTANCE OF AYUSH:
• The proposed Public Health Cadre can utilize these human
resources both at the village and community levels.
• Its huge resource of hospitals beds and health workers can be used for safe
delivery under the Janani Suraksha Yojana (JSY) scheme,
 early breastfeeding, ante & post-natal care, growth monitoring of children,
immunization and anemia.
• AYUSH practitioners can be encouraged in taking up public health
programs on project-basis at district, taluk or block level.
• Public health schools in the country have opened their courses to AYUSH
graduates.
• Services of AYUSH doctors with qualifications in Public Health to be
utilized in national health programs, NRHM and public health functionaries
as part of the public health cadre.
• It can play an important role in achieving the National Health Outcome
Goals of reducing MMR, IMR, TFR, Malnutrition, and Anemia.

REFFERAL SYSTEM
DEFINITION:
A referral system is a mechanism that enables a patient’s health needs to be
comprehensively managed using resources beyond those available at the location
they access care from, be it in a community unit, dispensary, health center or a
higher level facility.
REASONS FOR REFERRAL:
• To seek expert opinion.
• To seek additional or different services.
• To seek admission and management
• To seek use of diagnostic& therapeutic tools
• For continuity of care
CHARECTERISTICS:
• Patient should be given optimal care at the right level, right time and right
cost.
• Optimal and cost efficient utilization of health care system.
• Optimal and appropriate utilization of specialist services for needy persons
• Optimal utilization of primary health care services.
RATONALE OF REFERRAL SYSTEM:
 • Most common, most complicated and life threatening diseases requires
different levels.
• Maximize limited resources & avoid duplication of services.
• Ensures a close relationship between all levels of the health system.
• Helps people receive the best possible care closes to home.
• Support primary health centers.
• Helps to build capacity.
• Reduce the high proportion of customers seen at the outpatient clinics at
2nd facilities.
TYPES OF REFERRAL:

STEPS OF REFERRAL PROCESS:

LEVELS OF REFERRAL SYSTEM:
Primary level of care :( PHC)
 Developed to urban and rural areas
 Referral site for the village health worker & basic health units
st
 Usually is the 1 contact level between community & other levels of
health facility.
 Provide management for common & minor alignment requiring simple
uncomplicated intervention.
Secondary level of care :( District Hospital)
• Referral site for the primary care facilities
• Given by physicians with basic health training.
• Usually given in health facilities either private owned or
government operated
• Rural hospitals, state general hospital, out-patient department are main sites
of care.
• Rendered by specialists in health facilities.
Tertiary level of care: (Superspecality Hospitals)
• Referral site for the secondary care facilities.
 • Can be medical centers, regional, provincial hospitals and
specialized hospitals.
• Provide care for complicated, uncommon and serious diseases requiring
highly specialized or high technology interventions.
REFERRAL SYSTEM IN INDIA:
• Sub centres(SC)
• Primary Health Centres(PHC)
• Community Health Centres(CHC)
• Sub District Hospitals
• District Hospitals
• Tertiary Level Facilities In Medical College Hospitals
• Super Speciality Hospitals In India
COMPONENTS:
• Can be adjusted relevant to the local situation.
• Components can include:
 Health system
st
 Referral process at the 1 level of care
 Referral activities
nd
 Referral process at 2 or tertiary level
 Supervision and capacity building
PERSPECTIVES & ISSUES OF ESTABLISHING REFFERAL:
HEALTH SYSTEM ISSUES:
• Service providers & quality of care.
• Performance expectations & involvement of organization.
• All service providers are expected.
• Follow the agreed protocols of care.
REFERRAL PROCESS AT 1ST LEVEL:
• During visits of H.C, it is important that the health worker
• For proper performance the health workers
• Protocols need to include
• Making decision to refer comes after the gathering and analyzing relevant
information using protocols as a guide
• Deciding to refer dose not mean that the health workers is
inadequate or bad.
 REFERRAL ACTIVITIES:
• Adoption of standardized referral forms to ensure equality
whenever a referral is initiated.
• Patients referred out should be accompanied.
• Carefully filled referral card cab helps to get timely attention at the
receiving facility.
ND RD
REFERRAL PROCESS AT 2 OR 3 LEVEL:
• The receiving facility
• The supervisor
SUPERVISION AND CAPACITY BUILDING:
• Facility managers & supervisors at all levels should monitor all referrals
to & from facilities.
• Supervisors should discuss referred cases.
RESPONSIBLITIES OF NURSE:
• Informed consent
• Selection of consultant
• Acceptance
• Task performance
• Feedback
SUMMARY:
Till now we have discuss about delivery of various community health services
like Health education, vital statistics, Maternal and child health care, mtp act,
female feticide, child adoption, family welfare, services and defence services,
Institutional Allopathy and alternative system of medicine, Indian system of
medicine, Referral system.
CONCLUSION:
All conditions can be treated by spiritual healing but not all people. Some
people are more receptive than others to this treatment, due to a number of factors
such as karma and mental outlook. As such the results of healing can vary a great
deal. If the patient has faith in the technique and the healer, this will of course aid
the healing process. Hope that all are gained knowledge regarding various
community health services.
EVALUATION:
I. Short notes: (2x10=20)
1. Explain in detail about Vital Statistics.
2. Elaborate Alternative system of medicine.
II. Short Answers:( 3x5=15)
1. Write in detail about methods of health education
2. Write in detail about referral system
3. Explain in detail about institutional services.
TEACHER REFERENCE:

 Park.k (2017), Textbook of preventive and social medicine, 24th

edition, Banarsidas Bhanat publication, Jabalpur.
 Neelam Kumari (2011), Text book of community health nursing-II, first
editions vikas & company medical publishers.
 Shyamala Manivannan ”Text book of community health nursing”
 Kamalam.S,“Essentials in community health nursing practice”, 1st
edition, 2008 jaypee brothers, new Delhi, page no, 105-110
 B. T. Basavanthappa “community health nursing”, 1st edition, 2008
jaypee brothers, Mumbai, page no 30-35
 Kasturi sundar rao, “community health nursing”, BI publications; 265-270.
STUDENT REFERENCE:

 Park.k (2017), Textbook of preventive and social medicine, 24th

edition, Banarsidas Bhanat publication, Jabalpur.
 Neelam Kumari (2011), Text book of community health nursing-II, first
editions vikas & company medical publishers.
 Shyamala Manivannan ”Text book of community health nursing”
 Kamalam.S,“Essentials in community health nursing practice”, I edition,
2008 jaypee brothers, new Delhi, page no, 105-110
NET REFERENCE:
• https://www.healthline.com/health/allopathic-medicine
• https://www.ncahf.org/articles/a-b/allopathy.html
• https://www.aetherius.org/healing-yourself-and-others/
• http://www.psawa.com/Community_care_Vrs_Institutional_care.ht ml
• https://www.lawinsider.com/dictionary/institutional-services
• http://www.amcsscentry.gov.in/organogram
• https://mod.gov.in/dod/directorate-general-armed-force-medical- services