Primary Health Care services provided before the establishment of Ayushman Arogya Mandirs in 2018
Reading File
Searching the Web
Primary Health Care services India before Ayushman Arogya Mandirs 2018 Sub Health Centre PHC CHC
Finding Sources
Reading Web Page
Primary Health Care services India before 2018 Sub Health Centre PHC CHC services provided
Finding Sources
Searching the Web
services provided at Sub Health Centre Primary Health Centre India before 2018 NHM maternal child health RCH
Finding Sources
Reading Web Page
services provided before Ayushman Arogya Mandir sub health centre PHC pre-2018
Finding Sources
Searching the Web
India Sub Health Centre services list ANM 12 basic services before 2018 NHM IPHS norms
Reading Web Page
services provided at sub health centre PHC before 2018 RCH maternal child health immunization family planning
Here is a comprehensive overview of Primary Health Care (PHC) services provided in India before the establishment of Ayushman Arogya Mandirs (then called Health and Wellness Centres) in April 2018.
Primary Health Care Services in India — Pre-2018
Background
Before 2018, India's primary health care (PHC) delivery was organized through a three-tier rural health infrastructure under the National Health Mission (NHM):
| Facility | Population Served | Level |
|---|---|---|
| Sub Health Centre (SHC) | 3,000–5,000 (plains) / 1,000–3,000 (hilly/tribal) | First contact point |
| Primary Health Centre (PHC) | 20,000–30,000 (plains) / 10,000–20,000 (hilly/tribal) | Referral for SHCs |
| Community Health Centre (CHC) | 80,000–1,20,000 | First referral unit |
The governing norms were laid out in the Indian Public Health Standards (IPHS) 2012, and services were primarily focused on selective primary health care — centred on Reproductive and Child Health (RCH) and communicable disease control.
I. Sub-Health Centre (SHC) Services
The SHC was the most peripheral and first point of contact between the community and the health system, staffed by an ANM (Auxiliary Nurse Midwife) / Health Worker (Female) and a Health Worker (Male).
A. Maternal Health
- Antenatal care (ANC): registration, check-ups, iron & folic acid supplementation, TT injections
- Identification and referral of high-risk pregnancies
- Safe delivery services (Type B / MCH sub-centres): intranatal care and assisted delivery
- Home delivery attendance and management of uncomplicated births
- Postnatal care (PNC) for mother and newborn
- Prevention of Parent-to-Child Transmission (PPTCT) of HIV
B. Child Health
- Newborn care (essential newborn care, early breastfeeding counselling)
- Growth monitoring of infants and under-5 children
- Management of diarrhoea, ARI/pneumonia, and minor ailments (per IMNCI guidelines)
- Referral of severe acute malnutrition and serious illness
- Vitamin A prophylaxis
C. Universal Immunization Programme (UIP)
- Administration of all UIP vaccines: OPV, BCG, DPT, TT, Measles, Hepatitis B, JE
- Village Health and Nutrition (VHN) Days
- School health programme support
D. Family Planning
- Counselling and provision of contraceptives: OCP, condoms, IUCD insertion
- Spacing and limiting methods education
- Eligible couple registration
E. Nutrition
- Identification of malnutrition (SAM/MAM)
- IFA supplementation
- Coordination with Anganwadi centres (ICDS)
F. Communicable Disease Control
- Surveillance and reporting of communicable diseases
- Malaria blood smear collection and treatment
- Tuberculosis (RNTCP): sputum collection, DOTS
- Leprosy (NLEP): case identification and treatment
- Kala-azar and other vector-borne diseases (NVBDCP)
- STI/RTI management and counselling
G. Limited NCD Screening (included in IPHS 2012)
- Basic screening for hypertension and diabetes (though not systematically implemented)
H. Primary Medical Care
- Treatment of minor ailments and first aid
- Referral of cases beyond competence to PHC/CHC
I. Environmental Health & Sanitation
- Safe water supply information, sanitation education
- Coordination with Village Health Sanitation & Nutrition Committees (VHSNCs)
II. Primary Health Centre (PHC) Services
The PHC served as the first referral unit for SHCs, staffed by a Medical Officer (MBBS) and supportive staff.
Additional services over and above SHC:
- OPD (general curative care) by Medical Officer
- 24-hour delivery services at operationalized PHCs (50% PHCs made 24×7 under NRHM/NHM)
- Emergency obstetric care and neonatal care
- Inpatient care (4–6 beds)
- Laboratory services: blood smear, urine, stool, Hb testing
- AYUSH integration (in many states)
- Adolescent Health Clinics (weekly, under RKSK programme)
- National programmes: RNTCP, NLEP, NVBDCP, National Mental Health Programme (basic level)
III. Key National Programmes Delivered Through PHC Tier (Pre-2018)
| Programme | Services |
|---|---|
| RMNCH+A (Reproductive, Maternal, Newborn, Child & Adolescent Health) | Continuum of care from preconception to adolescence |
| JSY (Janani Suraksha Yojana) | Cash incentives for institutional delivery |
| JSSK (Janani Shishu Suraksha Karyakram) | Free delivery, drugs, diagnostics for pregnant women & sick newborns |
| PMMVY | Maternity benefit for first live birth |
| Rashtriya Bal Swasthya Karyakram (RBSK) | Child health screening (0–18 yrs) for 4Ds: defects, diseases, deficiencies, developmental delays |
| RKSK | Adolescent health services |
| RNTCP | Revised National TB Control Programme |
| NVBDCP | Vector-borne disease control (malaria, dengue, filaria, kala-azar) |
IV. What Was Missing / The Gap That Led to Ayushman Arogya Mandirs
The NHM-era PHC framework was explicitly selective — focused on RCH and communicable diseases. The National Health Policy 2017 and the Primary Health Care Task Force identified critical gaps:
- No systematic NCD management at primary level (hypertension, diabetes, cancer screening, mental health, COPD)
- No palliative or rehabilitative care
- No oral, eye, or ENT services at peripheral level
- Fragmented care with weak referral linkages
- No formal care for geriatric health
These gaps prompted the Ayushman Bharat - Comprehensive Primary Health Care (AB-CPHC) programme, which launched the first Health and Wellness Centre (now renamed Ayushman Arogya Mandir) on 14 April 2018 at Jaangla, Bijapur, Chhattisgarh — transforming existing SHCs and PHCs into platforms for comprehensive primary care, adding 12 expanded service packages including NCDs, mental health, oral health, and palliative care.
Sources: IPHS Guidelines for Sub-Centres (NHM, 2012); RMNCH+A Strategy Document (NHM); Ayushman Bharat - Health and Wellness Centres Operational Guidelines (MoHFW, 2018); National Health Systems Resource Centre (NHSRC).
CHCS do not provide primary health care please make that correction
You are correct. Community Health Centres (CHCs) function as First Referral Units (FRUs) — they provide secondary-level care (specialist services, surgery, blood transfusion, specialist OPD), not primary health care. They sit above the PHC tier and are not part of the primary health care delivery chain.
Here is the corrected table:
Primary Health Care Infrastructure in India — Pre-2018
Three-Tier Rural Health Infrastructure
| Facility | Population Served | Level |
|---|---|---|
| Sub Health Centre (SHC) | 3,000–5,000 (plains) / 1,000–3,000 (hilly/tribal) | First contact point — primary health care |
| Primary Health Centre (PHC) | 20,000–30,000 (plains) / 10,000–20,000 (hilly/tribal) | Referral unit for SHCs — primary health care |
| Community Health Centre (CHC) | 80,000–1,20,000 | First Referral Unit (FRU) — secondary care, not primary health care |
The PHC was the highest tier delivering primary health care. The CHC, staffed by specialists (surgeon, physician, obstetrician, paediatrician), provided secondary-level services — specialist OPD, surgical care, blood transfusion, 30-bed inpatient care — and received referrals from the PHC. It falls outside the scope of primary health care delivery.
All other content in the previous response remains accurate. Thank you for the correction.
Define Primary Health Care. Principles of Primary Health Care with suitable examples
Finding Sources
Searching the Web
Definition and principles of Primary Health Care Alma Ata declaration 1978
Finding Sources
Reading Web Page
definition and principles of primary health care Alma Ata 1978 examples
Finding Sources
Searching the Web
8 principles of primary health care equity community participation intersectoral coordination appropriate technology examples
Reading Web Page
principles of primary health care equitable distribution community participation intersectoral coordination appropriate technology examples India
Primary Health Care (PHC)
Definition
The Declaration of Alma-Ata (1978) — adopted at the International Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September 1978 — provides the internationally accepted definition:
"Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination."
Key elements of the definition:
- It is the first level of contact between individuals, family, and community with the national health system
- It brings health care as close as possible to where people live and work
- It constitutes the first element of a continuing health care process
- It is the central function and main focus of a country's health system
- It addresses promotive, preventive, curative and rehabilitative health needs
Principles of Primary Health Care
The Alma-Ata Declaration established four core principles of PHC (as accepted in community medicine/PSM):
1. Equitable Distribution
What it means: Health services must be distributed fairly across all sections of society — regardless of geography, income, caste, gender, or social status. Resources should reach those who need them most, particularly the rural poor and disadvantaged groups.
Examples:
- Establishing Sub Health Centres in tribal and hilly areas at a population norm of 1:3,000 (vs. 1:5,000 in plains) to compensate for geographic disadvantage
- Mobile health units reaching remote villages not served by fixed facilities
- India's Janani Suraksha Yojana (JSY) — cash incentives specifically for Below Poverty Line (BPL) women to encourage institutional delivery, addressing the equity gap in maternal care
- Free drugs and diagnostics under Ayushman Bharat targeted at the most underserved populations
2. Community Participation
What it means: The community must be actively involved in planning, implementing, and evaluating health programmes. Health is not merely delivered to people — it is achieved with them. Communities should contribute resources, decision-making, and feedback.
Examples:
- Village Health Sanitation and Nutrition Committees (VHSNCs) — village-level committees that plan local health activities, manage untied funds, and oversee health workers
- ASHA (Accredited Social Health Activist) — a community member selected by the village community itself, trained as the link between the community and the health system
- Rogi Kalyan Samiti (RKS) — patient welfare committees at hospitals with community representation that manage hospital funds
- Community-based oral rehydration therapy (ORT) training for mothers to manage childhood diarrhoea at home
3. Intersectoral Coordination
What it means: Health is determined by factors outside the health sector — nutrition, safe water, sanitation, education, agriculture, housing, and income. Achieving PHC requires coordinated action across multiple government departments and sectors, not health alone.
Examples:
- Safe water supply (Department of Drinking Water & Sanitation) + chlorination education (Health) — combined to prevent water-borne diseases
- Swachh Bharat Mission (Ministry of Jal Shakti) + health sector working together to build toilets and reduce open defecation, thereby reducing diarrhoeal diseases
- ICDS (Integrated Child Development Services) run by the Women & Child Development Ministry — Anganwadi workers coordinate with ANMs for nutrition supplementation, growth monitoring, and immunization
- Agriculture department promoting fortified crops + health department promoting dietary counselling to combat anaemia and malnutrition
- Mid-Day Meal Scheme (Education Ministry) + health sector — addressing child malnutrition through school feeding
4. Appropriate Technology
What it means: Technology used in PHC must be scientifically valid, practically usable in local settings, affordable, acceptable to the community, and sustainable with locally available resources. It should not be expensive, complex, or dependent on scarce expertise.
Examples:
- Oral Rehydration Salt (ORS) solution — a simple, cheap, and effective treatment for diarrhoeal dehydration that can be prepared and administered by mothers at home
- Cold chain maintenance for vaccines using simple ice-lined refrigerators and cold boxes, with the shake test to check vaccine potency in the field (instead of laboratory testing)
- Pot chlorination (NEERI method) and chlorine tablets for purifying drinking water at household or community level — instead of expensive water treatment plants
- Simple splinting using bamboo sticks and cloth for fracture first aid in remote areas
- Hand centrifuge for PCV/haemoglobin estimation in settings with unreliable electricity
- Biogas systems at community level for clean fuel, instead of piped natural gas
- Rapid Diagnostic Tests (RDTs) for malaria — replacing microscopy in remote areas where trained microscopists are unavailable
Summary Table
| Principle | Core Idea | Indian Example |
|---|---|---|
| Equitable Distribution | Services reach all, especially the marginalised | SHC norms for tribal areas; JSY for BPL women |
| Community Participation | Community plans, implements, monitors | ASHA, VHSNCs, Rogi Kalyan Samiti |
| Intersectoral Coordination | Health requires action beyond health sector | ICDS + ANM coordination; Swachh Bharat + health |
| Appropriate Technology | Simple, affordable, locally sustainable technology | ORS, shake test for vaccines, pot chlorination |
Source: Declaration of Alma-Ata, WHO/UNICEF, 1978; IPHS Guidelines (NHM, 2012); ICMR Workshop on Appropriate Technology for PHC, 1981.
This is a shared conversation. Sign in to Orris to start your own chat.