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📚 RGUHS BSc NURSING 5th SEMESTER

COMMUNITY HEALTH NURSING - I

UNIT 4: NUTRITION ASSESSMENT, NUTRITION EDUCATION & FOOD SAFETY

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SECTION A: NUTRITION - CONCEPTS & REVIEW

1. CONCEPTS OF NUTRITION

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2. MEAL PLANNING

1. To meet nutritional requirements of the individual/family
2. To use available food resources economically
3. To prevent nutritional deficiency diseases
4. To satisfy appetite and provide satiety
5. To consider food preferences, culture, religion, and habits
6. To maintain health and prevent disease

1. Assess the nutritional needs (age, sex, physiological state, activity)
2. Identify available foods in the locality and their costs
3. Plan menus using food groups (cereals, pulses, vegetables, fruits, milk, fats)
4. Ensure variety, color, texture, and palatability
5. Check against Recommended Daily Allowances (RDA) by ICMR
6. Consider cooking methods to preserve nutrients
7. Evaluate and revise the plan

• Adult male (moderate work): 2,875 kcal/day
• Adult female (moderate work): 2,225 kcal/day
• Pregnancy: +300 kcal/day
• Lactation: +550 kcal/day
• Protein: 0.8-1 g/kg body weight/day for adults

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3. NUTRITION ASSESSMENT

A - Anthropometric Assessment

B - Biochemical Assessment

C - Clinical Assessment

D - Dietary Assessment

1. 24-hour dietary recall - Subject recalls all food/drinks in past 24 hours; simple, quick, but relies on memory
2. Food frequency questionnaire (FFQ) - How often certain foods are consumed weekly/monthly
3. Weighed food record - Actual weighing of food for 3-7 days; most accurate but laborious
4. Diet history - Detailed past dietary habits; used for long-term assessment
5. Food balance sheets - National/community level assessment

• Growth monitoring (weight charting in children)
• Ecological surveys (food availability, soil quality)
• Vital statistics (mortality, morbidity data)

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4. PLANNING SUITABLE DIET FOR INDIVIDUALS AND FAMILIES

1. Local availability of foods - Use seasonal, locally grown foods; reduce cost
2. Dietary habits - Cultural, religious food preferences (vegetarian, halal, etc.)
3. Economic status - Low-cost nutritious foods: millets, pulses, green leafy vegetables (GLV), eggs
4. Age and physiological state - Adjust for pregnancy, lactation, illness, old age
5. Food groups - Ensure representation from all groups daily

• Group 1: Cereals, millets, pulses (energy and protein)
• Group 2: Vegetables and fruits (vitamins, minerals, fiber)
• Group 3: Milk and milk products (calcium, protein)
• Group 4: Oils, fats, sugar (energy)
• Group 5: Flesh foods (meat, fish, eggs) - protein, iron

• Millets (ragi, jowar, bajra) - iron, calcium
• Green leafy vegetables - iron, folic acid, Vit A
• Pulses (dal) - protein, iron
• Eggs - complete protein
• Groundnuts - protein, fat

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5. GENERAL NUTRITIONAL ADVICE

1. Eat from all food groups daily
2. Include green leafy vegetables at every meal
3. Consume adequate water (6-8 glasses/day)
4. Avoid excess salt, sugar, and saturated fats
5. Breastfeed exclusively for 6 months
6. Use iodized salt for all cooking
7. Expose to sunlight for Vitamin D
8. Avoid junk food and packaged foods
9. Supplement iron and folic acid during pregnancy
10. Maintain proper food hygiene and safe water

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6. NUTRITION EDUCATION

• To create awareness about nutritional needs
• To motivate people to adopt healthy eating habits
• To prevent and control nutritional deficiency diseases
• To bring positive behavioral changes

1. Start with what the people know and believe
2. Use simple, local language
3. Teach through demonstration (practical)
4. Involve community leaders and family members
5. Be culturally sensitive
6. Emphasize positive messages (what TO eat)
7. Use appropriate audiovisual aids
8. Ensure continuous and repeated exposure

• Flannel graphs, flip charts, flash cards
• Food models (plastic/rubber replicas)
• Posters, pamphlets, leaflets
• Puppet shows, folk songs, nukkad nataks
• Digital media and social media

• Nutritional rehabilitation centers (NRC) for SAM children
• Therapeutic feeding programs
• RUTF (Ready-to-Use Therapeutic Food) for SAM
• Community-based management of malnutrition

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SECTION B: NUTRITIONAL DEFICIENCY DISORDERS

Key Nutritional Deficiency Disorders (Review for Exam)

1. Protein-Energy Malnutrition (PEM)

• Phase 1 (Stabilization): Treat hypoglycemia, hypothermia, dehydration, infections
• Phase 2 (Rehabilitation): F-100 therapeutic diet, RUTF
• Follow-up and nutritional counseling of mother

2. Anaemia (Iron Deficiency)

• Most common nutritional deficiency in India
• Hb < 11 g/dL (children, pregnant), < 12 g/dL (adult women), < 13 g/dL (adult men)
• Signs: pallor, fatigue, dyspnea, koilonychia, angular stomatitis
• Treatment: Iron supplementation (IFA tablets), dietary advice, treat worm infestation

3. Vitamin A Deficiency (VAD)

• Bitot's spots, night blindness, xerophthalmia, keratomalacia (leading to blindness)
• Prevention: Vit A supplementation (National Programme - 2 lakh IU every 6 months for children 9 months - 5 years)

4. Iodine Deficiency Disorders (IDD)

• Goitre, cretinism (mental retardation + deaf-mutism in infants)
• Prevention: Iodized salt, iodized oil injection in severe endemic areas
• Goitre Belt: Sub-Himalayan region (Jammu-Kashmir, Assam, U.P. hills)

5. Vitamin D Deficiency

• Rickets in children (soft bones, bow legs, frontal bossing, Harrison's sulcus)
• Osteomalacia in adults (bone pain, muscle weakness)
• Prevention: Sun exposure, dietary sources (egg yolk, fish, fortified milk)

6. Pellagra (Niacin/B3 Deficiency)

• "3 Ds" - Dermatitis (casal's necklace - sun-exposed areas), Diarrhoea, Dementia
• Common in maize-eating populations (tryptophan-poor diet)
• Treatment: Nicotinamide/Niacin supplementation

7. Scurvy (Vitamin C Deficiency)

• Bleeding gums, perifollicular hemorrhages, poor wound healing, corkscrew hair
• Infants: Subperiosteal hemorrhage (frog leg position), Trummerfeld zone on X-ray
• Treatment: Ascorbic acid 100 mg TDS, dietary citrus fruits

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SECTION C: NATIONAL NUTRITIONAL POLICY & PROGRAMS IN INDIA

National Nutrition Policy (NNP), 1993

• Reduce severe and moderate malnutrition by half
• Achieve universal salt iodization
• Eliminate Vitamin A deficiency causing blindness
• Reduce anemia among women by 25%
• Reduce iodine deficiency disorders

• Short-term: Direct intervention (supplementation, fortification)
• Long-term: Diet diversification, food security, income generation, nutrition education

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Key National Nutritional Programs

• Started: 1975
• Objective: Overall development of children under 6 years
• 6 Services (mnemonic: SINPRE): Supplementary nutrition, Immunization, Nutrition & health education, Preschool education, Referral services, Health check-up
• Implemented through: Anganwadi centers (AWC) by Anganwadi Workers (AWW)

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SECTION D: FOOD BORNE DISEASES AND FOOD SAFETY

1. FOOD BORNE DISEASES - DEFINITION & BURDEN

• WHO estimates 600 million people fall ill and 420,000 die each year from foodborne diseases
• Children under 5 years bear 40% of the foodborne disease burden
• Leading cause: Diarrheal diseases (most commonly due to contaminated food and water)
• Developing countries most affected due to poor sanitation, inadequate food hygiene

• Biological: Bacteria, viruses, parasites, fungi
• Chemical: Pesticides, heavy metals, food additives (aflatoxins)
• Physical: Glass pieces, metal fragments

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2. SIGNS & SYMPTOMS OF FOOD BORNE DISEASES

• Nausea, vomiting
• Diarrhoea (watery or bloody)
• Abdominal cramps and pain
• Fever (usually low grade)
• Dehydration

• High fever with rigors
• Bloody diarrhoea
• Signs of dehydration (sunken eyes, dry mouth, decreased urine output, poor skin turgor)
• Neurological symptoms (double vision, difficulty swallowing - botulism!)
• Jaundice (hepatitis A)
• Shock, hypotension
• Confusion/altered sensorium

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3. TRANSMISSION OF FOOD BORNE PATHOGENS & TOXINS

1. Fecal-oral route - Contaminated food/water (most common)
2. Person-to-person - Infected food handlers
3. Animal-to-human (zoonotic) - Contaminated meat, milk, eggs
4. Environmental contamination - Soil (Cl. perfringens), water
5. Cross-contamination - Raw to cooked food during preparation

• Water (cholera, typhoid)
• Milk and dairy products (brucellosis, staphylococcal poisoning, salmonella)
• Meat and poultry (salmonella, Cl. perfringens, E. coli O157:H7)
• Eggs and egg products (salmonella)
• Shellfish (hepatitis A, Vibrio species)
• Canned foods (botulism)

• Improper temperature storage (bacteria multiply between 5-60°C = "danger zone")
• Inadequate cooking
• Poor personal hygiene of food handlers
• Cross-contamination (raw vs cooked)
• Unsafe water for washing

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4. EARLY IDENTIFICATION, INITIAL MANAGEMENT, AND REFERRAL

• Detailed food history (what was eaten, when, how many people affected)
• Epidemiological link (common meal, same food item consumed)
• Onset and type of symptoms
• Time between eating and onset (incubation period clues the causative agent)

1. Assess hydration status - check skin turgor, eyes, mouth, urine output
2. Oral Rehydration Solution (ORS) for mild-moderate dehydration
3. IV fluids for severe dehydration or inability to tolerate oral intake
4. Antipyretics for fever
5. Anti-emetics if needed
6. Do NOT give antidiarrheal drugs routinely (can prolong illness)
7. Continue feeding (BRAT diet not required - normal diet as tolerated)
8. Collect stool sample before antibiotics if needed

• Children < 2 years with diarrhea and vomiting
• Severe dehydration or shock
• Bloody diarrhea with high fever
• Neurological symptoms (botulism suspicion)
• Suspected typhoid or hepatitis A
• Outbreak involving multiple cases
• Immunocompromised patients
• No improvement in 48-72 hours

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SECTION E: FOOD POISONING & FOOD INTOXICATION

FOOD POISONING

1. History of ingestion of a common food
2. Attack of many persons at the same time
3. Similarity of signs and symptoms in majority

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TYPES OF FOOD POISONING

A. NON-BACTERIAL FOOD POISONING

B. BACTERIAL FOOD POISONING

1. Salmonella Food Poisoning (Most Common Bacterial Type)

• Agent: S. typhimurium, S. cholerae-suis, S. enteritidis
• Source: Farm animals, poultry, eggs, contaminated meat, milk; also rats/mice
• Incubation period: 12-24 hours (commonly)
• Mechanism: Organisms multiply in intestine → acute enteritis + colitis
• Symptoms: Sudden onset, chills, fever, nausea, vomiting, profuse watery diarrhoea (2-3 days)
• Mortality: ~1%
• Prevention: Proper cooking, refrigeration, avoid cross-contamination

2. Staphylococcal Food Poisoning

• Agent: Enterotoxins of Staphylococcus aureus (coagulase-positive); heat-stable toxins (resist boiling for 30 min)
• Source: Skin, nose, throat of food handlers; custards, salads, milk products
• Incubation period: 1-8 hours (short because toxin is PREFORMED in food)
• Mechanism: "Intradietic" toxins - preformed in food; toxin acts on intestine and CNS
• Symptoms: Sudden violent nausea, vomiting, abdominal cramps, prostration; diarrhoea; low-grade fever or no fever; recovery in 24 hours
• Exam Note: Very short IP because toxin is already in the food

3. Clostridium botulinum Food Poisoning (Botulism)

• Agent: Cl. botulinum produces one of the most potent toxins known (neurotoxin type A, B, E most common in humans)
• Source: Home-canned vegetables and meats (anaerobic, improperly preserved)
• Incubation period: 12-36 hours (range 2 hours to 8 days)
• Mechanism: Toxin absorbed from intestine → reaches CNS → blocks acetylcholine release at neuromuscular junction → flaccid paralysis
• Symptoms: NEUROLOGICAL (NO fever, NO diarrhoea) - diplopia (double vision), dysarthria, dysphagia, descending flaccid paralysis; respiratory failure can cause death
• Key feature: Descending symmetrical paralysis; patient remains conscious
• Treatment: Antitoxin (50,000-100,000 units IV); ventilatory support; Guanidine hydrochloride
• Prevention: Proper canning (autoclaving), not consuming home-canned food with bulging lids

4. Clostridium perfringens Food Poisoning

• Agent: Cl. perfringens (welchii); spores survive cooking
• Source: Cooked meat and poultry stored at room temperature
• Incubation period: 6-24 hours (peak 10-14 hours)
• Mechanism: Spores survive cooking; germinate during cooling; organisms multiply and produce toxins (alpha, theta toxins)
• Symptoms: Diarrhoea, abdominal cramps; NO fever; little/no vomiting; short duration (1 day); no deaths
• Prevention: Cook meat just before consumption; rapid and adequate cooling if stored

5. Bacillus cereus Food Poisoning

• Agent: B. cereus (gram-positive spore-bearer, ubiquitous in soil)
• Source: Rice dishes (fried/boiled rice left at room temp), cereals, spices
• Two syndromes:
  • Diarrhoeal syndrome (IP 6-15 hours) - watery diarrhoea, abdominal cramps (like Cl. perfringens)
  • Emetic syndrome (IP 1-5 hours) - nausea and vomiting (like Staph. aureus) - associated with fried rice
• Prevention: Refrigerate cooked rice, consume promptly

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FOOD INTOXICATION

• Food infection: ingestion of live organisms which then multiply in the body
• Food intoxication: ingestion of preformed toxin in the food (e.g., botulism, staphylococcal)

• Short incubation period (toxin already present)
• No fever usually (except rare cases)
• Symptoms predominantly GI (vomiting, diarrhoea) or neurological (botulism)
• Not transmissible person-to-person

1. Proper food storage (refrigeration, <5°C)
2. Adequate cooking temperature (>70°C core temp)
3. No consumption of food in bulging/dented cans
4. Proper personal hygiene of food handlers
5. Avoid leaving food at room temperature for >2 hours
6. Safe water supply
7. Proper waste disposal
8. Health education of food handlers

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5. PUBLIC HEALTH RESPONSE TO FOOD BORNE DISEASES

1. Case finding and case definition - Identify all affected persons
2. Notify authorities - Report to CDMO, PHO, state health department
3. Epidemiological investigation:
   • Attack rate calculation
   • Spot map
   • Epidemic curve (source-common point or propagated)
   • Food specific attack rates to identify vehicle
4. Laboratory investigation:
   • Collect stool/vomit/blood samples from cases
   • Collect food samples from suspected source
   • Culture and sensitivity
5. Control measures:
   • Remove and destroy contaminated food
   • Treat cases (ORS, antibiotics if indicated)
   • Close contaminated food establishment if necessary
   • Decontaminate premises
6. Prevention of further cases:
   • Public health advisory
   • Inspecting food handling practices
   • Safe water supply
   • Health education to community and food handlers
7. Reporting and documentation:
   • Submit outbreak investigation report
   • Notifiable disease (Food poisoning is notifiable under Epidemic Diseases Act, 1897)

• Food Safety and Standards Act (FSSA), 2006 - Main law governing food safety; replaced PFA Act 1954
• FSSAI (Food Safety and Standards Authority of India) - Regulatory body under FSSA 2006
• Prevention of Food Adulteration Act (PFA), 1954 - Now replaced by FSSA 2006
• Essential Commodities Act, 1955 - Controls supply of essential food items

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QUICK REVISION - EXAM TABLE: FOOD POISONING COMPARISON

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HIGH-YIELD MNEMONICS FOR EXAM

• Kwashiorkor = Kids aged 1-5, Kids have edema, Kids have adequate Calories (protein deficient)
• Marasmus = very Meagre food (both protein + calorie), looks like a Mummy (wasted)

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LIKELY EXAM QUESTIONS

1. Describe the ABCD methods of nutritional assessment at community level with their significance.
2. Explain the types of food poisoning with their causative agents, incubation periods, clinical features, and prevention.
3. Describe the ICDS scheme - objectives, services, and the role of community health nurse.

1. Write short notes on Kwashiorkor and Marasmus.
2. Explain National Nutrition Policy, 1993.
3. Describe the public health response to a food-borne disease outbreak.
4. Write about food safety legislation in India.
5. What is meal planning? State its aims and steps.
6. Describe the principles and methods of nutrition education.

1. Define food poisoning. Give two examples.
2. Differentiate between food infection and food intoxication.
3. What is MUAC? What are the cut-off values?
4. What is FSSAI?
5. Name two programs for control of anaemia in India.

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📚 RGUHS BSc NURSING 5th SEMESTER

COMMUNITY HEALTH NURSING - I

HEALTH CARE DELIVERY SYSTEM IN INDIA

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INTRODUCTION

1. Central Level - Ministry of Health and Family Welfare (MoHFW), New Delhi
2. State Level - State Health Department/Directorate
3. District/Peripheral Level - District Hospital → CHC → PHC → Sub-centre → Village level

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LEVEL 1: CENTRAL LEVEL

A. Ministry of Health and Family Welfare (MoHFW)

• Minister of State for Health
• Secretary (Health & Family Welfare) - Senior IAS officer
• Additional Secretaries, Joint Secretaries

Functions of MoHFW (Union List)

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B. Directorate General of Health Services (DGHS)

Organizational Structure Under DGHS:

DGHS (Director General of Health Services)
│
├── Deputy DGHSs (multiple, specialized wings)
│   ├── Medical Education
│   ├── Family Welfare
│   ├── Hospital Services
│   ├── Disease Control
│   └── Nursing
│
├── Central Government Health Scheme (CGHS)
├── Central Drug Standard Control Organization (CDSCO)
├── National Institute of Communicable Diseases (NICD/NCDC)
├── Central Health Education Bureau (CHEB)
└── Central Bureau of Health Intelligence (CBHI)

Functions of DGHS:

1. Medical care - Supervision of Central Govt hospitals, dispensaries, CGHS
2. Medical education - Advising on standards of medical colleges
3. Disease control - Policy guidance on National Health Programs
4. Drug control - Drug Controller General of India (DCGI) under DGHS
5. Research - Coordination with ICMR
6. International health - Liaison with WHO, UNICEF, other agencies
7. Vital statistics - Collection and analysis through CBHI
8. Health manpower - Standards for medical/nursing/paramedical education

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C. Central Council of Health and Family Welfare

• Constituted under Article 263 of the Constitution
• Chairman: Union Minister of Health and Family Welfare
• Members: State Health Ministers + Central Health Minister
• Acts as advisory body for laying down broad policy

Functions:

1. Consider and recommend broad policy on health matters
2. Make recommendations on measures for preventing infectious diseases
3. Coordinate between central and state health activities
4. Advise on distribution of grants-in-aid to states
5. Make recommendations on medical education

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D. Central Government Health Scheme (CGHS)

• Established 1954 in New Delhi; now in ~25 cities
• Provides comprehensive healthcare to Central Govt employees and pensioners and their dependents
• Services: OPD, indoor treatment, specialist consultations, medicines, lab investigations
• Implemented through Wellness Centres (formerly called dispensaries)

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E. Key Central Bodies/Institutions

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LEVEL 2: STATE LEVEL

A. State Health Ministry

• Assisted by Minister of State for Health
• Principal Secretary / Secretary (Health) - Senior IAS officer

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B. Directorate of Health Services (DHS) / Directorate of Medical Education (DME)

1. Directorate of Health Services - Public health programs, primary care, disease control
2. Directorate of Medical Education - Medical colleges, specialist hospitals

Functions of State Directorate of Health Services:

1. Implementation of National Health Programs at state level
2. Planning and supervision of all district health activities
3. Maintenance of State hospitals and dispensaries
4. Health education and IEC activities
5. Training of health personnel
6. Supervision of PHCs, CHCs, sub-centres
7. Maternal and Child Health (MCH) programs
8. Disease surveillance and outbreak investigation
9. Vital registration and health statistics
10. Coordination with MOHFW and other departments

Officers Under State Directorate:

Director of Health Services (State HQ)
│
├── Joint Director of Health Services (Regional level)
│   (In charge of a region/zone - covers several districts)
│
├── Deputy Director of Health Services
│   (Specialized: Malaria, TB, Leprosy, FW, etc.)
│
└── District Health Officer (DHO) / Chief Medical Officer (CMO)
    (District level - see below)

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C. State Health Bodies

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D. State-Level Hospitals

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LEVEL 3: DISTRICT & PERIPHERAL LEVEL

DISTRICT LEVEL

A. District Health Officer (DHO) / Chief Medical Officer (CMO) / CMHO

• Head of health services at district level
• Also known as: District Medical Officer (DMO), Civil Surgeon (older states)
• Reports to: Director of Health Services (State)

Functions of DHO/CMO:

1. Overall supervision of all health services in the district
2. Implementation of National Health Programs
3. Monitoring of PHCs, CHCs, Sub-centres
4. Outbreak investigation and epidemic control
5. Coordination with other departments (Education, ICDS, Water Supply)
6. Health statistics and vital events reporting
7. Training and supervision of peripheral health workers
8. Budget management and supply chain (drugs, vaccines, equipment)

District Health Team:

• District Epidemiologist - Disease surveillance
• District Immunization Officer - UIP coordination
• District TB Officer - NTEP
• District Leprosy Officer - NLEP
• District Programme Officer (FW) - Family welfare
• District Malaria Officer - NVBDCP
• District Health Education Officer (DHEO) - IEC activities
• District Nursing Superintendent - Nursing services

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B. District Hospital (DH)

• Located at district headquarters
• Beds: 75-300 or more depending on population
• Head: Civil Surgeon / Superintendent
• Provides: Secondary level care - general medicine, surgery, obstetrics & gynecology, pediatrics, orthopedics, ophthalmology, ENT, radiology, pathology
• Acts as referral centre for CHCs and PHCs

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SUB-DISTRICT / TALUK LEVEL

Taluk/Sub-Divisional Hospital

• Each district is divided into Taluks/Blocks
• Beds: 30-50 beds
• Headed by Deputy/Assistant Director of Health or Medical Officer In-charge
• Provides primary-level specialist care; acts as referral for PHCs

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BLOCK / PHC LEVEL

Primary Health Centre (PHC)

"The primary health centre is the cornerstone of rural health services, providing preventive, promotive, and curative care at the grassroots."

• 4-6 bedded facility
• OPD, minor OT, labour room, laboratory
• Referral unit for 4-6 Sub-Centres

Staffing of PHC (IPHS norms):

Functions of PHC:

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Community Health Centre (CHC)

• 30 bedded hospital
• 1 Operation Theatre (OT)
• X-ray facility
• Labour room
• Laboratory
• Serves as referral centre for 4 PHCs

Staffing of CHC (IPHS norms):

• 4 Specialists: General Surgeon, General Physician, Obstetrician & Gynecologist, Pediatrician
• Supported by: Anesthesiologist/Anesthesia facility
• Staff Nurses, Pharmacist, Lab Technician, Radiographer
• Administrative staff

Functions of CHC:

1. Emergency surgical care - Hernia, hydrocele, appendicitis; intestinal obstruction, hemorrhage
2. Obstetric care - Normal and complicated deliveries, C-section (FRU)
3. Specialist consultations - Medicine, Surgery, Gynecology, Pediatrics
4. Referral services - Refer cases requiring tertiary care to District Hospital
5. In-patient care - 30 beds
6. OPD daily
7. Blood storage unit - For emergency obstetric care
8. Newborn stabilization unit

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Sub-Centre (SC)

Staffing of Sub-Centre:

Functions of Sub-Centre (ANM's role):

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Village Level

Anganwadi Worker (AWW) - Under ICDS

• Serves a population of ~1000 (1 AWW per 1000 population in tribal areas, 1 per 400-800 in urban slums)
• 6 services: supplementary nutrition, immunization, health checkup, referral, preschool education, nutrition & health education
• Supervised by Lady Supervisor and Child Development Project Officer (CDPO)

ASHA (Accredited Social Health Activist) - Under NHM

• Introduced under National Rural Health Mission (NRHM), 2005 - now National Health Mission (NHM)
• 1 ASHA per 1000 population (village level)
• A female resident of the village, 10th pass, married/widow/divorced, aged 25-45 years
• Link between community and health system
• Key functions:
  • Mobilize community for health services
  • Escort pregnant women for ANC and institutional delivery (JSY/PMMVY)
  • Facilitate child immunization
  • Distribute ORS, iron-folic acid, oral contraceptive pills, condoms
  • Maintain household register and provide information on health entitlements
  • First responder for illness
  • Incentive-based worker (not a regular Govt. employee)

Panchayati Raj Institution (PRI)

• Village Panchayat, Block Panchayat, Zilla Panchayat
• Play important role in village-level planning, monitoring of health services
• Village Health Sanitation & Nutrition Committee (VHSNC) - Plans and monitors village health activities

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LEVELS OF HEALTH CARE

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SUMMARY DIAGRAM: HIERARCHY

CENTRAL LEVEL
MoHFW → DGHS → Central Council of Health
        ↓
STATE LEVEL
State Health Ministry → Director of Health Services
                      → Joint Director (Regional)
                      → Deputy Director
                        ↓
DISTRICT LEVEL
District Health Officer / CMO
        ↓
Taluk/Sub-District Hospital
        ↓
PRIMARY HEALTH CENTRE (PHC) [30,000 pop]
(Covers 4-6 Sub-Centres)
        ↓
COMMUNITY HEALTH CENTRE (CHC) [1,20,000 pop]
(Covers 4 PHCs - First Referral Unit)
        ↓
SUB-CENTRE [5,000 pop]
ANM + MPW(M)
        ↓
VILLAGE LEVEL
ASHA + AWW + Village Panchayat

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POPULATION NORMS - QUICK REVISION TABLE

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NATIONAL HEALTH MISSION (NHM)

1. Reduce MMR, IMR, TFR
2. Prevent and control communicable and non-communicable diseases
3. Strengthen infrastructure, human resources
4. Ensure universal access to free and quality health services

• ASHA workers
• Mobile Medical Units (MMU)
• Janani Suraksha Yojana (JSY) - Cash incentive for institutional delivery
• Janani Shishu Suraksha Karyakram (JSSK) - Free services for mothers and newborns
• Rashtriya Bal Swasthya Karyakram (RBSK) - Child health screening
• IPHS standards for PHC/CHC
• Indian Public Health Standards (IPHS) - Quality norms

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LIKELY EXAM QUESTIONS

1. Describe the health care delivery system in India at central, state, and district levels with a suitable diagram.
2. Describe the organization, staffing, and functions of a Primary Health Centre. What is the role of a community health nurse at PHC level?
3. Explain the functions and responsibilities of ASHA in the delivery of primary health care.

1. Write short notes on Sub-centre - population norms, staffing and functions.
2. Describe the functions of DGHS.
3. What is CHC? Describe its staffing and functions (First Referral Unit).
4. What is NHM? State its objectives and key components.
5. Write the role of Panchayati Raj Institutions in health care.

1. Expand: DGHS, CDSCO, ICMR, CBHI, NIHFW, ASHA, ANM, LHV, IPHS
2. What is the population norm for PHC in hilly areas?
3. What are the beds in a CHC?
4. Who heads the district health team?
5. What is CGHS?

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MNEMONICS

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