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Essential medicines in community health centre - saq strictly from the park textbook spm

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Based on what I've found in Park's textbook, I now have everything needed to write a comprehensive SAQ answer. The Park's textbook chapter on essential medicines uses P/S/T classification (Primary/Secondary/Tertiary healthcare levels), where CHC functions at the Secondary (S) level. Let me compile the full answer from the content already retrieved.

Essential Medicines in Community Health Centre (CHC)

[Short Answer Question — Park's Textbook of Preventive and Social Medicine]

Community Health Centre — Brief Overview

A Community Health Centre (CHC) is established and maintained by state governments. It is manned by four medical specialists (surgeon, physician, gynaecologist, paediatrician), supported by 21 paramedical and other staff. It has 30 indoor beds with one OT, X-ray, labour room, and laboratory facilities, and serves as a referral centre for four PHCs. As of March 2018, 5,624 CHCs are functional in India. According to IPHS norms, the CHC should be manned by 6 specialists (including anaesthetist and eye surgeon) with 24 paramedical staff.
(Park's Textbook of Preventive and Social Medicine, p. 307 approx.)

Concept of Essential Medicines (WHO Definition)

Essential medicines are those that satisfy the priority health care needs of the population. They should be:
  • Available at all times in adequate amounts
  • In appropriate dosage forms
  • With assured quality and adequate information
  • At a price the individual and community can afford
(Park's Textbook, Chapter on Essential Medicines)

National List of Essential Medicines of India - 2015 (NLEMI-2015)

The first NLEMI was prepared in 1996, subsequently revised in 2003, 2011, and 2015.

Criteria for Inclusion in the National List:

  1. Medicine must be approved/licensed in India
  2. Useful in disease that is a public health problem in India
  3. Proven efficacy and safety based on valid scientific evidence
  4. Cost-effective
  5. Aligned with current treatment guidelines
  6. Stable under storage conditions in India
  7. Price of total treatment to be considered, not just unit price
  8. Fixed dose combinations (FDCs) generally not included unless they have unequivocal proven advantage
  9. List is based on level of healthcare - P (Primary), S (Secondary), T (Tertiary)

Level of Healthcare Classification (Key for CHC)

The CHC functions at the Secondary (S) level of care. In the NLEMI-2015:
  • P = Primary health care level (Sub-centre, PHC)
  • S = Secondary level (CHC, District Hospital)
  • T = Tertiary level (Medical College Hospitals)
Medicines marked S and those marked P, S, T are available at the CHC level.

Essential Medicines Available at Secondary (CHC) Level - Selected Examples from Park's Textbook

Section 1: Anaesthetic Agents

MedicineLevelDosage Form
HalothaneS, TInhalation
IsofluraneS, TInhalation
KetamineP, S, TInjection 10 mg/ml, 50 mg/ml
Nitrous oxideP, S, TInhalation
OxygenP, S, TInhalation (medicinal gas)
PropofolP, S, TInjection 10 mg/ml
ThiopentoneP, S, TPowder for injection 0.5g, 1g
SevofluraneT onlyInhalation

Key Points for SAQ:

  1. Park's textbook does NOT give a separate exclusive list for CHC. The NLEMI-2015 uses a three-tier classification (P/S/T), and CHC falls under the Secondary (S) level.
  2. All medicines labelled P, S, T or S, T or P, S are available at the CHC. Medicines labelled "T only" are restricted to tertiary care.
  3. The concept emphasises that careful selection of a limited range of essential medicines results in:
    • Higher quality of care
    • Better medicine management
    • More cost-effective use of health resources
  4. India's list differs from the WHO Model List because it is based on India's own disease burden and includes medicines used in national health programmes and emerging/re-emerging infections.
  5. Pharmacovigilance is an important component - voluntary reporting of adverse effects forms the basis of the International WHO Programme for Drug Monitoring.
Source: Park's Textbook of Preventive and Social Medicine, 25th Edition - Chapter on Essential Medicines (National List of Essential Medicines of India-2015), pp. 546-547 approx.
Note for exam writing: In the SAQ, focus on: (a) definition of essential medicines, (b) criteria for inclusion in the national list, (c) the P/S/T classification system and CHC's place at the Secondary level, and (d) significance/advantages of the essential medicines concept. Park's textbook does not provide a separate "CHC-specific" drug list - the essential medicines chapter uses the three-tier P/S/T classification, and CHC-level medicines are those designated "S" or spanning "P, S, T."
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