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Answers as per K Park PSM book

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Here are comprehensive answers to all questions as per K. Park's Textbook of Preventive and Social Medicine:

SECTION - II

Q.5 Structured Long Questions

Q.5 (1) Define Disaster. Describe the Disaster Planning Cycle for Flood. (2+8)

Definition of Disaster

Disaster is defined as "a sudden, calamitous event bringing great damage, loss, destruction and devastation to life and property and disrupting the social structure of the community; its effects go beyond the coping capacity of the affected community."

According to WHO: "Any occurrence that causes damage, ecological disruption, loss of human life, deterioration of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community or region."
UNDHA defines disaster as: "A serious disruption of the functioning of a society causing widespread human, material or environmental losses which exceed the ability of affected society to cope using its own resources."

Classification of disasters:

Natural disasters: Floods, earthquakes, cyclones, droughts, landslides
Man-made disasters: Industrial accidents, wars, chemical/nuclear accidents, transportation accidents

Disaster Planning Cycle for Flood (The 4-Phase Model)

The disaster planning cycle (also called the Disaster Management Cycle) consists of 4 phases:

Prevention/Mitigation --> Preparedness --> Response --> Recovery
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PHASE 1: PREVENTION / MITIGATION (Pre-flood)

This phase aims to reduce the probability and/or impact of disaster.

Construction of embankments and flood protection walls
Construction of proper drainage and dam systems
Flood-proofing of buildings (raised floors, flood-resistant structures)
Land use regulations - avoiding flood-prone zone settlements
Afforestation to reduce run-off
Regulation of encroachments on river banks
Flood forecasting and early warning systems (IMD, CWC)
Community awareness programmes on flood risks

PHASE 2: PREPAREDNESS (Pre-flood, just before)

This phase ensures readiness to respond when flood strikes.

Formation of Disaster Management Committees at district, block, village levels
Preparation of a flood contingency plan
Training of disaster response teams (NDRF, SDRF)
Pre-positioning of relief materials: food, medicines, rescue boats
Mock drills and rehearsals
Identification of safe routes of evacuation
Identification of high ground areas for relief camps
Stockpiling of vaccines (anti-typhoid, anti-cholera), ORS, chlorine tablets
Setting up of emergency communication systems
Preparation of list of vulnerable groups (elderly, disabled, pregnant women, children)
Training of health personnel in mass casualty management

PHASE 3: RESPONSE (During flood)

This is the immediate response to minimize morbidity and mortality.

Rescue and evacuation:

Search and rescue operations using boats, helicopters
Evacuation of affected population to safer areas/relief camps
Priority to vulnerable groups

Medical relief:

Setting up of mobile health units and medical camps
Treatment of injuries, drowning, hypothermia
Vaccination against typhoid, cholera, hepatitis A
Distribution of ORS for diarrhoeal diseases
Provision of safe drinking water (chlorination, water purification tablets)
Surveillance for epidemic-prone diseases: cholera, typhoid, malaria, leptospirosis, dengue
Mental health support

Logistics:

Food and nutrition relief
Temporary shelter in relief camps
Safe disposal of dead bodies (prevents epidemics)
Sanitation facilities in relief camps

PHASE 4: RECOVERY / REHABILITATION (Post-flood)

This phase aims to restore normalcy and build back better.

Short-term recovery:

Repair of damaged infrastructure (roads, bridges, health facilities)
Restoration of water supply and sanitation
Continued disease surveillance and health camps
Post-flood disease control (vector control for malaria, dengue)

Long-term rehabilitation:

Permanent resettlement of displaced population
Livelihood restoration (agriculture, livestock)
Psychosocial rehabilitation
Strengthening of health systems
Documentation and lessons learned for future preparedness
Incorporation of disaster risk reduction into development planning

Health priorities post-flood:

Diarrhoeal diseases / cholera
Malaria
Leptospirosis
Typhoid
Hepatitis A & E
Acute respiratory infections
Eye infections (conjunctivitis)
Skin diseases

Q.5 (2) Current Progress of India towards Health-related SDG Goals & Strategies to Attain Them (4+6)

Current Progress of India towards Health-related SDGs

The Sustainable Development Goals (SDGs) were adopted by UN member states in September 2015, to be achieved by 2030. There are 17 SDGs with 169 targets. SDG-3: "Ensure healthy lives and promote well-being for all at all ages" is the primary health goal, with 13 sub-targets.

India's Progress on key health SDG indicators:

SDG Target	Indicator	Current Status (India)
SDG 3.1	MMR < 70/lakh live births	MMR: 97/lakh (SRS 2018-20), declining from 254 in 2004-06
SDG 3.2	NMR ≤ 12/1000; U5MR ≤ 25/1000	NMR: 20/1000 (2020); U5MR: 32/1000 (2020)
SDG 3.3	End AIDS, TB, malaria, NTDs	TB incidence declining; malaria cases reduced significantly
SDG 3.4	Reduce NCD premature mortality by 1/3	NCDs still major burden; rising cardiovascular and cancer deaths
SDG 3.5	Prevent substance abuse	Rising alcohol and tobacco use, especially youth
SDG 3.6	Halve road traffic deaths	India has highest road traffic deaths globally
SDG 3.7	Universal access to sexual/reproductive health	Unmet need for family planning still exists (9.4% - NFHS-5)
SDG 3.8	Universal Health Coverage (UHC)	UHC index improving with PM-JAY launch; still gaps in rural areas
SDG 3.9	Reduce deaths from air/water/soil pollution	Air pollution a major killer; Ganga/Yamuna still polluted

Other health-related SDGs:

SDG 1 (No poverty) - Poverty linked to malnutrition and disease burden
SDG 2 (Zero hunger) - Stunting 35.5%, wasting 19.3% (NFHS-5)
SDG 6 (Clean water & sanitation) - Coverage improved; ODF India declared 2019
SDG 11 (Sustainable cities) - Urban health infrastructure gaps remain

NITI Aayog SDG India Index (2020-21): India scored 66/100 (Performer category). States like Kerala, Himachal Pradesh, Andhra Pradesh lead; Jharkhand, Bihar lag behind.

Strategies Implemented by India to Attain Health-related SDGs

1. National Health Policy 2017 (NHP-2017)

Provides the overarching framework for achieving SDG-3
Aims for Universal Health Coverage (UHC)
Targets: MMR < 100, NMR < 20, U5MR < 23, IMR < 28 by 2025
Progressive realization of the right to health

2. Ayushman Bharat Programme (2018)

Two components:
- (a) Health & Wellness Centres (HWC): 1.5 lakh sub-centres/PHCs upgraded for comprehensive primary care (CPHC) - addresses SDG 3.8
- (b) PM-JAY (Pradhan Mantri Jan Arogya Yojana): Health insurance cover of Rs 5 lakh/family/year for 10 crore poor families

3. National Health Mission (NHM)

NRHM (rural) + NUHM (urban)
Strengthening of health infrastructure (SCs, PHCs, CHCs)
ASHA workers for community mobilization
Free essential medicines and diagnostics

4. Reproductive, Maternal, Newborn, Child & Adolescent Health (RMNCH+A) strategy - addresses SDG 3.1, 3.2, 3.7

Janani Suraksha Yojana (JSY) - safe delivery
Janani Shishu Suraksha Karyakram (JSSK) - free maternity services
PMSMA - Pradhan Mantri Surakshit Matritva Abhiyan
LaQshya programme for quality labour rooms
Mission Parivar Vikas for family planning

5. National Programmes for Disease Control - addresses SDG 3.3

RNTCP/National TB Elimination Programme (NTEP) - End TB by 2025
National Malaria Elimination Programme - Malaria elimination by 2027
National AIDS Control Programme (NACP IV)
National Vector Borne Disease Control Programme (NVBDCP)
Universal Immunization Programme (Mission Indradhanush)

6. NCD Control - addresses SDG 3.4

National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS)
National Tobacco Control Programme (NTCP)
National Mental Health Programme (NMHP)

7. Swachh Bharat Mission (SBM, 2014) - addresses SDG 6

Open defecation free India
Household toilet construction
Solid and liquid waste management

8. Jal Jeevan Mission (2019) - addresses SDG 6

Functional household tap connections to every rural household by 2024

9. Poshan Abhiyan (National Nutrition Mission, 2018) - addresses SDG 2

Reduce stunting, wasting, anaemia in children and women

10. Research and Monitoring: NITI Aayog publishes annual SDG India Index to track progress

Q.6 Short Notes (Any 2 out of 3)

Q.6 (1) Anti-larval Measures against Mosquito

[As per K. Park, Textbook of PSM]

The ideal method of vector control is elimination of breeding places by adequate sanitation and underground waste-water disposal. In India, anti-larval measures are restricted mainly to urban areas (including a 3-km peripheral belt) due to operational and financial constraints. The urban areas focus on Culex quinquefasciatus (C. fatigans) which has a flight range of about 3 km.

Anti-larval activities are divided into:

A. Anti-larval Measures Against Malaria Mosquito (Anopheles)

(i) Larvicides (Chemical Control):

Oiling: Spreading thin film of oil (e.g., Mosquito Larvicidal Oil - MLO) on breeding water surfaces - prevents larval breathing
Paris green (copper acetoarsenite): Applied as powder, 3% dust at 5.6 kg/ha, oldest larvicide still used in some areas
Pyrethrum oil (Pyrosene oil-E): Pyrethrum-based emulsifiable larvicide; diluted 1:4 with water before use
Organophosphorus larvicides:
- Temephos (Abate) - WHO recommended, safe, low mammalian toxicity, applied weekly
- Fenthion - used at 0.1 mg/L
Bacillus thuringiensis israelensis (Bti): Biological larvicide; safe, effective, no resistance reported
Bacillus sphaericus: Another biological agent

(ii) Source Reduction (Environmental Measures):

Drainage of stagnant water
Filling up of ditches, cesspools, low-lying areas
Deepening or flushing of water bodies
Management of water level fluctuations
Changing salt content of water
Intermittent irrigation (malaria control in paddy fields)
Minor engineering operations: maintenance of septic tanks, soakage pits

(iii) Biological Control:

Introduction of larvivorous fish: Gambusia affinis, Lebistes reticulatus (guppy fish), Aplocheilus blocki in breeding places
These fish feed on mosquito larvae and are an eco-friendly method

(iv) Integrated Control:

Combination of chemical, biological, and environmental measures
Reduces dependence on residual insecticides
Prevents development of insecticide resistance

B. Anti-larval Measures Against Culex (Filariasis vector)

Mosquito Larvicidal Oil (MLO): Active against all pre-adult stages; being replaced by pyrethrum oil, temephos, fenthion
Pyrosene oil-E: Emulsion diluted 1:4 with water
Organophosphorus larvicides: Temephos, fenthion - applied weekly on all breeding places
Pistia plant removal: For Mansonia mosquitoes - removing aquatic vegetation (pistia plant) from water bodies; alternatively herbicides like phenoxylene 30 or Shell Weed Killer D
Minor environmental measures: Filling ditches, cesspools, drainage of stagnant water

C. Anti-larval Measures Against Aedes (Dengue/Yellow fever vector)

Aedes breeds in clean, stagnant water in and around houses
Elimination of man-made containers: flower vases, tyres, coolers, overhead tanks
Source reduction is most important - "Tip, toss, cover, and clean" campaign
Regular cleaning and covering of water storage containers
Temephos in drinking water containers at 1 mg/L
Abatement campaigns: Community mobilization

Q.6 (2) Pre-Conception and Pre-Natal Diagnostic Techniques (PC-PNDT) Act

Background:

The Pre-Natal Diagnostic Techniques (PNDT) Act was enacted in 1994 to prevent misuse of prenatal diagnostic techniques for sex determination leading to female foeticide
Amended and renamed as Pre-Conception and Pre-Natal Diagnostic Techniques (PC-PNDT) Act, 2003 - extended scope to include pre-conception sex selection

Objectives of the Act:

Prevention of sex-selective abortions
Regulation of prenatal diagnostic techniques
Prevention of misuse of technology for determination of sex of foetus
Ensure availability of these techniques only for detection of genetic abnormalities/disorders

Key Provisions:

Prohibition:

No person can conduct sex determination tests before or after conception
No person can communicate the sex of the foetus to the pregnant woman or her relatives by words, signs, or any other method
No advertisement of sex determination tests is permitted (newspapers, magazines, electronic media)

Regulation of Genetic Clinics/Laboratories/Counselling Centres:

Every genetic clinic, genetic laboratory, or genetic counselling centre must be registered under the Act
Registration is mandatory and must be renewed periodically
Registration authority: Appropriate Authority (Central/State/UT level)

Conditions for using Prenatal Diagnostic Techniques: Prenatal diagnostic procedures shall only be used for detection of:

Chromosomal abnormalities
Genetic metabolic diseases
Haemoglobinopathies (e.g., sickle cell disease, thalassaemia)
Sex-linked genetic diseases
Congenital anomalies
Any other abnormalities/diseases as may be specified

Conditions for pregnant woman: Prenatal tests can be performed only if the woman is:

Age > 35 years
History of 2 or more spontaneous abortions/foetal loss
History of stillbirth or neonatal death due to chromosomal abnormalities
Family history of chromosomal disorder/sex-linked genetic disease
Known exposure to radiation/infection/drugs (teratogens)

Mandatory Form F:

Before conducting any prenatal test, a written consent from the pregnant woman and a signed declaration by the doctor is required in Form F
Form F includes the indication for the test

Penalties:

Conducting sex determination: Imprisonment up to 3 years + fine up to Rs 10,000 (first offence); up to 5 years + Rs 50,000 (subsequent offences)
Advertising sex determination: Imprisonment up to 3 years + fine up to Rs 10,000
Failure to maintain records: Rs 25,000 fine

Advisory Committees:

Central Supervisory Board (CSB) under the Ministry of Health
State Supervisory Boards
Appropriate Authorities at district level

Awareness Programmes: "Beti Bachao, Beti Padhao" (2015) complements the legal framework

Significance: India's Child Sex Ratio (CSR, 0-6 years) declined from 945 (1991) to 914 (2011) per 1000 males, triggering stronger enforcement. NFHS-5 (2019-21) showed CSR improved to 929.

Q.6 (3) Network Analysis (PERT/CPM)

Definition: Network analysis is a planning tool that uses graphical networks to plan, schedule, and control complex projects. It helps identify the most efficient way to complete a project on time and within budget.

Types:

PERT - Programme Evaluation and Review Technique
CPM - Critical Path Method

Basic Concepts:

Activity: A specific task or job that consumes time and resources; represented by an arrow (→)
Event (Node): A point in time marking the start or end of an activity; represented by a circle
Network/Arrow diagram: A graphical representation showing sequence of activities
Critical Path: The longest path through the network - determines the minimum project duration. Activities on this path are "critical" - any delay delays the whole project
Float/Slack: The time by which a non-critical activity can be delayed without delaying the project

PERT vs CPM:

Feature	PERT	CPM
Time estimates	3 estimates (optimistic, pessimistic, most likely)	1 estimate (deterministic)
Nature	Probabilistic	Deterministic
Focus	Time	Time and Cost
Application	New, uncertain projects (R&D)	Repetitive, well-known projects (construction)

PERT Time Formula:

Optimistic time (a)
Most likely time (m)
Pessimistic time (b)
Expected time (te) = (a + 4m + b) / 6

Example (Immunization Campaign):

Suppose a polio immunization camp is to be organized. The activities are:

A: Training of health workers (2 days)
B: Procurement of vaccines (3 days, can start simultaneously with A)
C: Mobilization of community (3 days, after A)
D: Setting up booths (1 day, after B)
E: Conducting the camp (1 day, after C and D)
F: Documentation and reporting (1 day, after E)

Network diagram would show paths:

Path 1: A → C → E → F = 2+3+1+1 = 7 days
Path 2: B → D → E → F = 3+1+1+1 = 6 days

Critical Path = A → C → E → F = 7 days (longest path)

Activities on critical path must finish on time; any delay will delay the whole camp.

Applications in Health Administration:

Planning new hospital construction
Organizing immunization campaigns
Planning disease control programmes
Hospital administration and project management
Monitoring National Health Programmes

Advantages:

Identifies critical activities requiring close monitoring
Improves planning and coordination
Helps in resource allocation
Identifies time-saving opportunities
Useful for complex, multi-activity health projects

Q.7 Short Notes (Any 3 out of 4)

Q.7 (1) Treatment and Disposal Methods for Yellow Category Waste

[From K. Park + BMW Rules 2016, Schedule 1, Part 1]

Yellow Category waste is placed in yellow-coloured non-chlorinated plastic bags or containers.

Yellow category includes 8 sub-types (a to h):

Sub-type	Waste Type	Treatment & Disposal
(a)	Human anatomical waste: tissues, organs, body parts, foetus below viability	Incineration or Plasma Pyrolysis or Deep Burial
(b)	Animal anatomical waste: carcasses, body parts from animal experiments	Incineration or Plasma Pyrolysis or Deep Burial
(c)	Soiled waste: blood/body fluid-contaminated dressings, plaster casts, cotton swabs, blood bags	Incineration or Plasma Pyrolysis or Deep Burial; in absence - Autoclaving or Microwaving/Hydroclaving + shredding; treated waste for energy recovery
(d)	Expired/discarded medicines: antibiotics, cytotoxic drugs, glass/plastic ampoules	Cytotoxic drugs: return to manufacturer or incineration at >1200°C, or Encapsulation or Plasma Pyrolysis >1200°C; Other medicines: returned to manufacturer or incineration
(e)	Chemical waste: chemicals used in production of biologicals, discarded disinfectants	Incineration or Plasma Pyrolysis or Encapsulation in hazardous waste treatment facility
(f)	Chemical liquid waste: X-ray developing liquids, discarded formalin, floor washings	After resource recovery, pre-treatment before mixing with wastewater; discharge to comply with Schedule-III norms
(g)	Discarded linen, mattresses, beddings contaminated with blood/body fluids	Non-chlorinated chemical disinfection + Incineration or Plasma Pyrolysis or energy recovery; in absence - shredding/mutilation + sterilization
(h)	Microbiology/biotechnology/clinical lab waste: blood bags, cultures, live vaccines, cell cultures, toxins	Pre-treat with non-chlorinated chemicals (as per NACO/WHO guidelines) on-site, then Incineration

Treatment Methods defined:

Incineration: Thermal destruction at high temperature (>850°C); most effective for anatomical waste; reduces volume to ash; must comply with CPCB emission norms

Plasma Pyrolysis: High-temperature (1200-1400°C) gasification; superior to incineration; no dioxins/furans; ash is non-hazardous

Deep Burial: Pit lined with lime; used where incineration is unavailable (CHCs, PHCs in rural areas); foetuses, anatomical waste; pit depth 2 metres, away from water bodies

Autoclaving/Microwaving/Hydroclaving: Steam sterilization methods; effective for non-anatomical solid waste; followed by shredding for waste reduction

Encapsulation: For sharps and small-quantity waste; encased in concrete/plastic containers then sent to land-fill

Bag colour coding summary:

Yellow = anatomical, soiled, chemical, pharmaceutical waste
Red = contaminated recyclable waste
White/translucent = sharps
Blue = glassware

Q.7 (2) Methods of Health Communication and Group Discussion

Methods of Health Communication

Health communication refers to the study and use of communication strategies to inform and influence individual and community decisions to enhance health.

Classification:

A. Based on the number of people reached:

1. Individual/Interpersonal Methods:

Face-to-face individual conversation
Home visits (by ASHA, ANM)
Counselling sessions
Most effective for attitude and behaviour change
Two-way communication possible

2. Group Methods:

Group discussion
Lecture/talk
Symposium
Panel discussion
Workshop/seminar
Role play/drama
Exhibition
Film shows

3. Mass/Community Methods:

Radio and television broadcasts
Newspaper and magazine articles
Posters, leaflets, pamphlets, booklets, flipcharts
Loudspeakers/public address systems
Folk media (street plays, puppet shows, songs)
Social media (WhatsApp, Facebook, YouTube)
Reach large population but one-way communication

B. Based on the type of media used:

Audio aids: Radio, tape recorder, gramophone, audio cassettes
Visual aids: Posters, charts, flannel graphs, flashcards, photographs, slides
Audio-visual aids: TV, films, video, LCD projector
Print media: Booklets, pamphlets, leaflets, newspapers
Folk media: Puppetry, ballads, street plays

Group Discussion

Definition: Group discussion is a democratic educational technique in which a group of people (usually 8-15 persons) discuss a topic under the guidance of a leader/facilitator. It is an interactive, participatory method.

Characteristics:

Group size: 8-15 persons (ideal)
Time: 45 minutes to 1 hour
Needs a skilled group leader/facilitator
Topic is pre-decided and participants are informed in advance
Participants sit in a circle (or U-shape) to ensure eye contact

Role of the Group Leader/Facilitator:

Introduces the topic
Ensures all members participate
Prevents monopolization by few members
Summarizes points at intervals
Maintains a permissive, non-threatening atmosphere
Summarizes conclusions at the end

Steps in Group Discussion:

Preparation (inform group, arrange seating)
Introduction of topic by leader
Open discussion - free participation
Summarization and conclusion

Advantages:

Two-way communication - ideas flow in both directions
Promotes active participation and involvement
Changes attitudes effectively (peer group influence)
Group decisions are more acceptable
Useful when individual practices/beliefs need to be changed
Respects cultural norms and values
Useful for health education in villages (VHSNCs, SHGs)

Disadvantages:

Can be time-consuming
Requires a skilled leader
May be dominated by a few vocal members
Not suitable for large groups

Applications in Health Education:

Antenatal/postnatal care groups
Tobacco cessation, alcohol de-addiction
Family planning counselling
Nutrition education (pregnant/lactating mothers)
Adolescent health education

Q.7 (3) Medical Measures to Prevent Occupational Diseases

Medical measures are one of the three broad approaches to occupational health (the others being engineering measures and legislative measures).

Medical measures include:

1. Pre-employment Medical Examination

Conducted before placing a worker in a job
Detects pre-existing conditions that may be aggravated by work exposure
Identifies physically or mentally unfit workers for certain tasks
Prevents placement of susceptible individuals in hazardous work
Example: Workers with pre-existing respiratory disease should not work in dusty environments

2. Periodic Medical Examination

Conducted at regular intervals (annually or as required by law) during employment
Detects early signs of occupational diseases (medical surveillance)
Allows early treatment and change of job before permanent damage
Example: Annual chest X-ray and lung function tests for miners (silicosis detection)
Blood lead levels for workers exposed to lead
Audiometry for workers exposed to noise (noise-induced hearing loss)
Liver function tests for workers handling hepatotoxic chemicals

3. Biological Monitoring (Biological Surveillance)

Measurement of toxic substances or their metabolites in body fluids (blood, urine, exhaled air)
Reflects actual internal dose absorbed by the worker
Examples:
- Lead: blood lead levels
- Mercury: urinary mercury levels
- Pesticide (organophosphorus): blood cholinesterase levels
- Benzene: urinary phenol

4. Immunization / Prophylaxis

Protection against biological hazards
Anti-tetanus immunization for agricultural/industrial workers
Hepatitis B vaccination for healthcare workers
BCG for workers exposed to tuberculosis
Anti-rabies for veterinary workers and animal handlers
Typhoid vaccine for sewage/sanitation workers

5. Nutrition and Physical Fitness

Adequate nutrition prevents susceptibility to hazards
Good general health reduces vulnerability
Physical fitness programmes for heavy manual workers

6. First Aid and Emergency Care

Trained first aid personnel and first aid boxes at workplace
Emergency care for accidents, chemical burns, electric shocks
Treatment of work-related injuries before referral

7. Treatment of Occupational Diseases

Early detection → early treatment → prevention of disability
Silicosis: No definitive cure; remove from exposure, prevent TB co-infection
Lead poisoning: Chelation therapy (EDTA, BAL, D-penicillamine)
Organophosphate poisoning: Atropine + pralidoxime (PAM)
Asbestosis: Symptomatic treatment, oxygen therapy

8. Health Promotion and Education

Educating workers about occupational hazards
Proper use of PPE (personal protective equipment)
Reporting of symptoms early
Lifestyle modification (no smoking in dusty environments)

9. Workers' Compensation and Rehabilitation

Workers' Compensation Acts ensure financial security
Vocational rehabilitation for disabled workers
Job placement in safer roles

Legislative framework for medical measures in India:

Factories Act 1948: Mandates medical examination of workers in hazardous industries
Mines Act 1952: Periodic medical examinations for miners
Plantation Labour Act 1951
Employees State Insurance (ESI) Act 1948: Medical benefits for workers

Q.7 (4) Functions of Health Worker Female (ANM) at Sub-centre

The Sub-centre is the peripheral-most outpost of the health delivery system. Each sub-centre is staffed by one Health Worker Female (HWF) / Auxiliary Nurse Midwife (ANM) and one Health Worker Male. As per revised norms (2012), one sub-centre serves 5000 population (3000 in hilly/tribal areas).

Functions of ANM (Health Worker Female) at Sub-centre:

1. Maternal and Child Health (MCH) Services:

Registration of all pregnant women in her area
Provision of antenatal care (ANC): BP measurement, weight, fundal height, detection of danger signs
Administration of TT (Tetanus Toxoid) immunization
Distribution of iron-folic acid (IFA) tablets
Nutritional counselling during pregnancy
Identification and referral of high-risk pregnancies
Conducting deliveries (normal deliveries in sub-centre or homes)
Postnatal care visits (mother and newborn)
Care of the newborn: weighing, cord care, warmth
Promotion of exclusive breastfeeding (EBF) for 6 months
Referral of sick newborns (SNCU/NBSU)

2. Family Planning Services:

Motivation for adoption of family planning methods
Distribution of oral contraceptive pills (OCPs) and condoms
Insertion of IUDs (Copper-T) - if trained
Referral for sterilization operations
Counselling on spacing methods

3. Immunization Services:

Conducting immunization sessions as per UIP schedule
Cold chain maintenance at village level
Immunization of children: BCG, OPV, DPT, Hepatitis B, Hib, IPV, measles/MR, JE, Vitamin A
Immunization of pregnant women: TT/Td vaccine
Recording and reporting of immunization coverage
Tracking defaulters

4. Nutritional Services:

Identification of malnourished children (weight monitoring)
Nutritional supplementation: distribution of iron/folic acid, Vitamin A
Referral of severe acute malnourished (SAM) children
Nutrition education to mothers and families
Coordination with ICDS (Anganwadi Workers)

5. Disease Surveillance and Control:

Surveillance for communicable diseases (malaria, TB, dengue, diarrhoea)
Collection of blood smears for malaria
DOTS (directly observed treatment, short course) for TB patients
Reporting of disease outbreaks
Collection of stool samples for polio surveillance
Conduct health education on disease prevention

6. Environmental Sanitation:

Health education on personal hygiene and environmental sanitation
Promotion of safe drinking water practices
Promotion of ODF (open defecation free) behaviour
Source reduction for vector-borne diseases

7. School Health:

Medical examination of school children
Detection of deficiencies (nutritional, sensory)
Deworming activities
Health education in schools

8. Record Keeping and Reporting:

Maintenance of registers: birth and death register, ANC register, immunization register, eligible couple register, family planning register
Preparation and submission of monthly reports (HMIS)
Population enumeration and survey

9. Referral Services:

Identification of cases needing referral
Ensuring transport and accompanied referral for emergencies (with ASHA)

10. Community Involvement:

Conducting Village Health, Sanitation and Nutrition Committee (VHSNC) meetings
Coordination with ASHA, AWW, village panchayat
Facilitating Mahila Arogya Samiti

11. Other Functions:

First aid services
Care of the elderly and disabled
Mental health awareness
Adolescent health (RKSK programme - Rashtriya Kishor Swasthya Karyakram)

Q.8 Short Answers (Any 5 out of 6) - 2-3 Sentences Each

Q.8 (1) Current Year Theme of World Health Day

World Health Day is celebrated on 7th April every year (marking the founding of WHO in 1948).

World Health Day 2025 theme: "Healthy Beginnings, Hopeful Futures" (focus on maternal and newborn health, reducing preventable deaths of mothers and babies)
World Health Day 2024 theme: "My Health, My Right" (every person's right to quality health services, education, and information)
World Health Day 2026 theme: To be announced by WHO

(Note: If the exam refers to 2025-26 academic year, the relevant theme is "Healthy Beginnings, Hopeful Futures" - 2025.)

Q.8 (2) Cultural Barriers of Communication

Cultural barriers are obstacles to effective health communication arising from differences in cultural beliefs, values, practices, and norms between communicator and audience.

Cultural barriers include:

Language and dialect differences - terminology not understood by community
Religious beliefs and taboos - e.g., refusal of blood transfusion by Jehovah's Witnesses; pork-based vaccines rejected by Muslims
Caste and social hierarchy - health worker from different caste not accepted
Gender norms - male health worker unable to examine female patients in conservative communities
Traditional beliefs and superstitions - disease attributed to evil spirits, not accepting biomedical explanation
Folk medicine preferences - preference for traditional healers (faith healers, ojha, witch doctors) over modern medicine
Concept of illness - illness seen as divine punishment; fate (kismet) attitude; fatalism
Practices around food - food taboos during illness/pregnancy (avoiding nutritious foods)
Social distance - lack of trust between educated health worker and illiterate community
Non-verbal communication differences - gestures having different meanings in different cultures

Q.8 (3) Four Social Securities for Industrial Workers

Social security measures for industrial workers in India:

Employees' State Insurance (ESI) Act, 1948: Provides medical care, sickness benefit, maternity benefit, disablement benefit, and dependants' benefit. Applicable to factories with 10 or more workers. Funded by contributions from employer (3.25%), employee (0.75%), and government.
Employees' Provident Fund (EPF) Act, 1952: Compulsory savings scheme for retirement; both employer and employee contribute 12% each of basic wages. Provides provident fund, pension, and life insurance.
Workmen's Compensation Act, 1923 (now Employees' Compensation Act, 1923): Provides compensation to workers or their dependants for employment injury, occupational disease, or death. Employer is liable to pay compensation.
Maternity Benefit Act, 1961: Provides paid maternity leave (26 weeks for first two children; 12 weeks thereafter), nursing breaks, medical bonus, and protection from dismissal during maternity. Applicable to establishments not covered by ESI.

(Others: Payment of Gratuity Act 1972, Payment of Wages Act 1936)

Q.8 (4) Bacteriological Indicators to Assess Efficiency of Water Treatment

Bacteriological indicators are used to assess microbiological quality of treated water:

Coliform Count (Total Coliforms): Most Probable Number (MPN) method; WHO standard: 0 coliforms per 100 mL of piped water. Presence of coliforms indicates faecal contamination and treatment failure.
Faecal Coliforms (Thermotolerant Coliforms) / E. coli: More specific indicator of recent faecal contamination; must be 0 per 100 mL in treated water; E. coli is the gold standard bacteriological indicator.
Faecal Streptococci (Enterococci): Indicates human and animal faecal contamination; more resistant to chlorine than E. coli, hence a supplementary indicator; 0 per 100 mL in treated water.
Standard Plate Count (Total Viable Count): Count of all bacteria growing at 37°C in 24 hours; should be <10 CFU/mL in treated piped water; rise indicates treatment failure.

(Note: Residual chlorine >0.2 mg/L at the consumer's end is the chemical indicator of treatment efficiency.)

Q.8 (5) Panchayati Raj

Panchayati Raj is India's three-tier system of local self-government in rural areas, established to decentralize administration and involve communities in development and health.

Three tiers (as recommended by Balwant Rai Mehta Committee, 1957):

Gram Panchayat - Village level (Gram Sabha = all eligible voters of village)
Panchayat Samiti - Block/Taluk level
Zila Parishad - District level

Constitutional basis: 73rd Constitutional Amendment Act, 1992 (came into force 24 April 1993) - made Panchayati Raj a constitutional body (Part IX, Articles 243-243O); 11th Schedule lists 29 subjects including health and sanitation.

Role in health:

Village Health, Sanitation and Nutrition Committee (VHSNC) works under Gram Panchayat
Untied funds (Rs 10,000/year) to VHSNC for community health activities
Oversight of sub-centre functions
Monitoring of ASHA workers
Sanitation and safe water supply
Management of village health infrastructure

Q.8 (6) Non-Governmental Agencies Working for Health

Non-Governmental Organizations (NGOs) are voluntary, non-profit bodies not owned or operated by the government that contribute to health promotion and service delivery.

Major NGOs working for health in India:

International NGOs:

WHO (World Health Organization) - Technical assistance, disease surveillance, standard-setting
UNICEF - Child health, nutrition, immunization, water and sanitation
Rotary International - Pulse Polio programme, eradication of polio
Red Cross Society - Emergency relief, blood transfusion services
PATH (Programme for Appropriate Technology in Health) - Vaccines, maternal health
Population Services International (PSI) - Family planning, HIV

National NGOs / Voluntary Organizations:

Bhore Committee (1946) recommended involvement of voluntary organizations
Kasturba Health Society - Rural health in tribal areas
Comprehensive Rural Health Project (CRHP), Jamkhed - Dr. Raj and Mabelle Arole; model of community-based health
Indian Red Cross Society - First aid, blood banking
Voluntary Health Association of India (VHAI) - Policy advocacy, community health
Central Social Welfare Board - Health and social welfare schemes
Family Planning Association of India (FPAI)
Tuberculosis Association of India (TAI)
Indian Council for Child Welfare (ICCW)
Cancer Patients Aid Association (CPAA)
Helpage India - Old age health
SEWA (Self Employed Women's Association) - Women's health in informal sector

Roles of NGOs in health:

Bridging gap between government services and community
Health education and awareness
Supplementary preventive and curative services
Research and training
Advocacy and policy influence
Reaching underserved populations

All answers based on K. Park's Textbook of Preventive and Social Medicine (25th Edition). - Park's Textbook of Preventive and Social Medicine

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