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PSM Exam - Complete Answers

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1. Mission Indradhanush

• Launched: December 2014, by Ministry of Health & Family Welfare
• Symbolism: 7 colours of rainbow = 7 vaccines covered initially (BCG, OPV, DPT, Measles, Hepatitis B, DT, TT)
• Aim: Fully immunize 90% of children who are unvaccinated or partially vaccinated by 2020 (later pre-poned to 2018)
• Target beneficiaries: Children under 2 years and pregnant women
• 6 phases completed (April 2015 - Dec 2018), covering 681 districts; 3.39 crore children reached
• Led to 6.7% increase in full immunization coverage in one year (vs. 1% earlier)
• Intensified Mission Indradhanush (IMI): Launched October 2017; focused on 190 districts/urban areas in 24 states; targeted urban slums and areas with slowest progress
• IMI 2.0 and 3.0 were further phases focusing on districts with lowest coverage
• Vaccines now include: BCG, OPV, IPV, DPT, Hepatitis B, Hib, Measles-Rubella (MR), JE (in endemic areas), PCV (in selected states), Rotavirus

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2. Essential Newborn Care (ENC)

• Warmth: Dry and warm the baby immediately; delay bath for at least 24 hours
• Cord care: Clean cut, tie, and keep cord dry (no application of harmful substances)
• Breathing: Stimulate by drying; only suction if airway blocked
• Initiation of breastfeeding within 1 hour of birth
• Eye care: Clean wipes from inner to outer canthus

• Exclusive breastfeeding for 6 months
• Thermal protection - skin-to-skin contact (Kangaroo Mother Care for LBW)
• Vitamin K prophylaxis (to prevent hemorrhagic disease)
• Early identification of danger signs (jaundice, feeding difficulty, respiratory distress, infection signs)
• Immunization: BCG, OPV-0, Hepatitis B at birth

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3. Janani Suraksha Yojana (JSY)

• Launched: 12th April 2005 (modified from National Maternity Benefit Scheme)
• Objective: Reduce maternal and neonatal mortality by encouraging institutional delivery, focusing on BPL families

• 100% centrally sponsored scheme under NHM
• Integrates cash assistance with institutional care (antenatal, delivery, post-partum)
• ASHA is the link worker in Low Performing States (LPS)

• In LPS: All women delivering in govt. health centres or accredited private institutions
• In HPS: Only BPL women + SC/ST women; limited to 2 live births
• ASHA package available in all LPS, NE states, and tribal districts of all states/UTs

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4. Mamata Day (Mamata Diwas)

• Mamata Day (also called VHND - Village Health, Nutrition and Sanitation Day) is held once a month at the Anganwadi Centre
• A platform for provision of maternal and child health services at the village level

1. Antenatal check-up (ANC) of pregnant women
2. Immunization of children and pregnant women
3. Nutrition counselling and supplementation
4. Registration of pregnancies
5. Health education - breastfeeding, complementary feeding, sanitation, hygiene
6. Growth monitoring of children (0-5 years)
7. Distribution of IFA tablets, Calcium, albendazole
8. Identification of high-risk pregnancies
9. Referral services

• ANM (Auxiliary Nurse Midwife)
• AWW (Anganwadi Worker)
• ASHA

• Pregnant women, lactating mothers, children under 5, adolescent girls

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5. HBNC - Role and Responsibility of ASHA

1. Provide essential newborn care and prevent complications
2. Early detection and special care of preterm/LBW babies
3. Early identification of illness and referral
4. Build mother's confidence and skills

1. Mobilize all pregnant mothers for full ANC package
2. Birth planning and birth preparedness with family
3. Home visits providing:
   • Weighing the newborn
   • Measuring temperature
   • Ensuring warmth
   • Supporting exclusive breastfeeding (positioning and attachment)
   • Promoting hand-washing
   • Skin, cord, and eye care
   • Counselling against unhealthy practices (early bathing, bottle feeding)
   • Identifying signs of sepsis
4. Assess high-risk babies (preterm/LBW): increase visits, monitor weight, support warmth and breastfeeding
5. Detect sepsis signs, provide first-level care and refer
6. Recognize postpartum maternal complications and refer
7. Counsel couple for family planning
8. Provide immediate newborn care for home deliveries

• Institutional delivery: 6 visits - Day 3, 7, 14, 21, 28, 42
• Home delivery: 7 visits - Day 1, 3, 7, 14, 21, 28, 42

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6. Rastriya Bal Swasthya Karyakram (RBSK)

• Launched: 2013 under NHM
• Aim: Child health screening and early intervention services from birth to 18 years

1. Defects at birth (30 conditions)
2. Deficiencies (Vitamin A, Iron deficiency, iodine, etc.)
3. Diseases (anemia, dental caries, rheumatic heart disease, reactive airway disease, otitis media)
4. Development delays including disability (vision, hearing, neurodevelopmental)

• Children from 0-18 years (approx. 27 crore children)
• Covers government schools, anganwadi centres (AWCs)

• Mobile Health Teams (MHTs): 2 AYUSH/MBBS doctors per team; 2 teams per block
• Each team covers 100 AWCs or 2-3 schools per day
• Screening twice a year in AWCs, once a year in government schools

• DEICs provide: audiological assessment, corrective surgeries, hearing aids, spectacles, physio/occupational/speech therapy

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7. Components of RMNCH+A

• JSSK (Janani Shishu Suraksha Karyakram) - free services for pregnant women
• MAA programme (breastfeeding promotion)
• Home Based Care for Young Child (HBYC)
• Facility-based Newborn Care (FBNC): NBSUs and SNCUs

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8. Adolescent Schemes

• Target: 10-19 years (253 million adolescents)
• Focus areas: Nutrition, Sexual & Reproductive Health, Mental Health, Non-communicable diseases, Substance misuse, Violence/injury prevention
• Delivery: Peer-led education, Adolescent Friendly Health Clinics (AFHCs)

• School-going girls + out-of-school girls 10-19 years
• Weekly IFA (large blue tablet: 100mg elemental iron + 500mcg folic acid)
• Also includes biannual deworming (albendazole 400mg)

• Girls 11-18 years; 14-18 year group as primary beneficiary
• Nutrition supplementation, iron/folic acid, health check-up, guidance on family welfare and childcare

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9. Health Programme for the Elderly (Geriatric Health)

• Weekly Geriatric OPDs at CHC level
• Free medicines, diagnostics for elderly
• Training of health staff in geriatric care
• Domiciliary care for bed-ridden elderly
• Rashtriya Vayoshri Yojana: Assistive devices (spectacles, hearing aids, wheelchairs, dentures) for BPL elderly

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10. Prevention and Control of Mental Health Problems

1. Prevention and treatment of mental and neurological disorders
2. Rehabilitation of patients
3. Prevention of associated disabilities
4. Reduce stigma

• Started 1996; extended to all districts
• Services: Outpatient, inpatient, follow-up community care, day care, emergency, IEC
• Integration with general health services

• Primary: Health promotion, reduce risk factors (substance abuse, stress, social isolation), school mental health programmes
• Secondary: Early detection, MHGAP (Mental Health Gap Action Programme by WHO), task-sharing with non-specialists
• Tertiary: Rehabilitation, occupational therapy, preventing relapse

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11. Mental Health Act (India - 2017)

1. Right to mental healthcare: Every person has right to access mental healthcare and treatment from government
2. Advance Directive: Person with mental illness can specify how they want to be treated/not treated in future
3. Nominated representative: Can appoint a person to make decisions on their behalf
4. Prohibition of treatments: No ECT without consent (free and informed); no ECT for minors; no chaining
5. Decriminalization of suicide: Attempt to suicide is not a criminal offense; presumed to be under stress
6. Mental Health Review Boards (MHRB): Set up in each district to protect rights of mentally ill
7. Supported admission: Replaces earlier "voluntary/involuntary" with more nuanced 3-category admission
8. Insurance parity: Mental illness to be treated at par with physical illness for insurance
9. Rights of persons with MI: Right to confidentiality, dignity, non-discrimination, free legal aid, right to complain

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12. Definition of Outbreak

• Common source outbreak: All cases exposed to a single source
  • Point source (single exposure event): Bell-shaped epidemic curve
  • Continuous/intermittent source: Prolonged exposure
• Propagated outbreak: Person-to-person spread; gradually rising curve
• Mixed outbreak: Combination of both

• Epidemic: Unusually large or unexpected increase in disease in a defined community/region
• Outbreak is often used interchangeably but may imply more localized/contained event
• Cluster: Aggregation of cases in a place/time, possibly more than expected

1. Confirm the diagnosis
2. Establish case definition
3. Count cases (descriptive epidemiology - Person, Place, Time)
4. Determine epidemic type
5. Identify source and mode of transmission
6. Control measures
7. Report findings

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13. Ayushman Bharat

Component 1: Health and Wellness Centres (HWCs)

• 1.5 lakh centres by 2022 (Sub-Health Centres and PHCs upgraded)
• Provide Comprehensive Primary Health Care (CPHC)
• Services: Maternal & child health, communicable diseases, NCDs (diabetes, hypertension, 3 cancers - oral, breast, cervical), mental health, ENT, ophthalmology, oral health, geriatric, palliative, trauma
• Free essential drugs and diagnostics
• Headed by Community Health Officer (CHO) - BSc/GNM nurse or Ayurveda practitioner
• First HWC inaugurated: 14 April 2018, Bijapur, Chhattisgarh

Component 2: AB-PMJAY (Pradhan Mantri Jan Arogya Yojana)

• Coverage: Rs. 5 lakh per family per year for secondary and tertiary hospitalization
• Beneficiaries: 10.74 crore poor/vulnerable families (based on SECC data) = ~50 crore individuals
• Covers: pre- and post-hospitalization expenses, day-care surgeries, 1350+ medical packages
• Cashless, paperless: At empanelled public and private hospitals
• No cap on family size, no age restriction, pre-existing conditions covered from day 1
• Not covered: OPD, fertility treatment, cosmetic surgeries, drug rehabilitation

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14. Functions of Health and Wellness Centre (HWC)

1. Pregnancy care and maternal health services
2. Neonatal and infant health services
3. Child health
4. Adolescent health
5. Family planning, contraceptive services and other reproductive health care
6. Management of common communicable diseases (malaria, dengue, TB, leprosy)
7. NCDs: Screening, prevention and management of - Hypertension, Diabetes, Oral/Breast/Cervical cancer
8. Mental health (screening, basic management)
9. ENT conditions
10. Ophthalmology (screening for cataract, refractive errors)
11. Oral health
12. Geriatric and palliative care

• Free essential drugs and diagnostics
• Health promotion and wellness activities: Yoga, nutrition counselling, lifestyle modification
• IEC and community outreach
• Teleconsultation support
• Team: CHO + Multi-purpose Workers (Male & Female) + ASHA

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15. Health Problems of the Aged

• Cardiovascular: Hypertension, coronary artery disease, heart failure
• Musculoskeletal: Osteoarthritis, osteoporosis, fractures (hip fracture most dangerous)
• Neurological: Parkinson's disease, stroke, peripheral neuropathy
• Cognitive: Dementia (Alzheimer's most common), delirium
• Sensory: Presbyopia, cataracts, glaucoma, presbycusis (hearing loss)
• Metabolic: Diabetes mellitus, hypothyroidism
• Cancer: Higher incidence in elderly
• Respiratory: COPD, pneumonia
• Urinary: Benign prostatic hyperplasia, urinary incontinence, UTIs
• GI: Constipation, malnutrition, malabsorption

• Depression (most common mental disorder in elderly)
• Anxiety disorders
• Social isolation, loneliness
• Elder abuse and neglect
• Retirement, bereavement

1. Immobility
2. Instability (falls)
3. Incontinence
4. Intellectual impairment (dementia/delirium)
5. Iatrogenic illness (polypharmacy)

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16. Mamata Divas - Service Providers, Beneficiaries, and Services

• Held once a month at every Anganwadi Centre
• A convergence platform of health, ICDS, and drinking water/sanitation departments

1. ANM (Auxiliary Nurse Midwife) - main health functionary
2. ASHA - mobilizes beneficiaries, assists in services
3. AWW (Anganwadi Worker) - arranges venue, maintains records
4. Medical Officer - supervisory, for complicated cases
5. AWH (Anganwadi Helper)

1. Pregnant women (all trimesters)
2. Lactating mothers (upto 6 months of delivery)
3. Children 0-5 years
4. Adolescent girls (11-19 years)
5. Women of reproductive age (15-49 years)

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• Questions 3 and 5 are marked "complete" in your list - focus revision on the others
• For MCQs: Remember key numbers - JSY cash amounts, RBSK 4D's, HBNC visit days (3,7,14,21,28,42), Ayushman Bharat Rs. 5 lakh coverage
• For SAQs: Use structured headings - Definition, Launch/Year, Objectives, Features, Beneficiaries, Service providers, Benefits

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Stages of Disaster Cycle & Triage

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PART 1 - STAGES OF THE DISASTER CYCLE

1. Disaster Response
2. Disaster Preparedness
3. Disaster Mitigation

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The Disaster Cycle - 5 Stages

DISASTER IMPACT
      ↓
  RESPONSE          ← Recovery Phase (after disaster)
      ↓
REHABILITATION
      ↓
RECONSTRUCTION
      ↓
  MITIGATION        ← Risk Reduction Phase (before disaster)
      ↓
PREPAREDNESS
      ↓
DISASTER IMPACT (next cycle)

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Stage-by-Stage Description

1. MITIGATION (Pre-disaster / Risk Reduction Phase)

• Activities to prevent or reduce the effects of a future disaster
• Undertaken during normal times, long before a disaster strikes
• Structural measures: Building earthquake-resistant structures, flood embankments, cyclone shelters, fire-proof construction
• Non-structural measures: Land-use planning, zoning laws, building codes, public education, vulnerability mapping
• Goal: Reduce hazard impact and community vulnerability
• Example: Constructing levees to prevent flood damage

2. PREPAREDNESS (Pre-disaster / Risk Reduction Phase)

• Activities taken in advance to build capacity to respond effectively
• Development of disaster plans (community/hospital emergency plans)
• Training of personnel (search & rescue teams, medical staff, NDRF)
• Stockpiling of emergency supplies (medicines, food, water, tents)
• Early warning systems (cyclone alerts, earthquake sensors)
• Mock drills and simulation exercises
• Establishing communication networks and evacuation routes
• India: National Disaster Management Authority (NDMA), SDMA, DDMA at state/district levels
• Goal: Maximize the ability to rescue lives and minimize damage when disaster strikes

3. RESPONSE (Immediate post-impact phase)

• Actions taken immediately after the disaster strikes
• Begins at time of impact and continues until the emergency is over
• Components:
  • Search and Rescue (SAR) operations
  • Evacuation of affected population
  • First aid and emergency medical care
  • Triage of mass casualties
  • Emergency shelter, food, water supply
  • Epidemiological surveillance
  • Disease control (prevent post-disaster outbreaks)
  • Activation of Emergency Operations Centre (EOC)
• Most injuries occur during impact; greatest need for emergency care is in the first few hours
• "Disaster Response" = immediate life-saving actions

4. REHABILITATION (Recovery Phase)

• Begins when the acute emergency is over; restoring basic services and normal life
• Temporary housing for displaced populations
• Restoration of health services (reopening of hospitals, PHCs)
• Psychosocial support and mental health services for affected population
• Restoration of water supply, sanitation, electricity, communication
• Resumption of livelihoods
• Surveillance for disease outbreaks continues
• Goal: Restore the affected community to pre-disaster functioning as quickly as possible

5. RECONSTRUCTION (Recovery Phase)

• Long-term rebuilding - permanent restoration of physical infrastructure
• Rebuilding homes, schools, hospitals, roads, bridges
• Economic recovery and restoration of livelihoods
• Incorporation of disaster risk reduction measures ("Build Back Better")
• Policy review and strengthening of future preparedness
• Can last months to years
• Goal: Restore or improve on pre-disaster conditions with added resilience

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The Two Broad Phases

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Important Points (MCQ-worthy)

• The disaster cycle is continuous - each disaster feeds into the next cycle
• UNISDR definition: Disaster risk management = systematic process using administrative decisions, operational skills, and policies to lessen impacts of natural hazards
• NDMA (National Disaster Management Authority) - set up under Disaster Management Act 2005 in India; chaired by Prime Minister
• NDRF (National Disaster Response Force) - dedicated force for specialized response
• The Sendai Framework (2015-2030): Global framework for disaster risk reduction
• Disasters most likely to need medical mass-casualty management: earthquakes, building collapse, industrial accidents, terrorist attacks, cyclones

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PART 2 - TRIAGE

Definition

"The principle of first come, first treated is NOT followed in mass emergencies." - Park's PSM

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Purpose / Goals

• In disaster triage: CPR is generally NOT performed (limited resources, poor outcomes at population level)
• Moribund patients requiring excessive resources with questionable benefit receive lowest priority

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Triage Classification - Colour Code System (Internationally Accepted)

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START Triage (Simple Triage and Rapid Treatment)

1. Ask all patients who can walk to move aside → these are GREEN ("walking wounded")
2. For remaining patients, assess in seconds:
   • Respirations - present? rate? (>30/min = RED)
   • Perfusion - capillary refill <2 sec or radial pulse present?
   • Mental status - can follow simple commands?
3. Only interventions at triage: open airway and control external hemorrhage

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Triage Levels - Where It Happens

1. Field/Scene triage - at the disaster site; determines transport priority
2. Transport triage - determines destination hospital
3. Hospital triage - at ED entrance; reassesses and re-triages on arrival (triage is dynamic, must be repeated)

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Triage Tagging

• Name, age, place of origin
• Triage category (colour)
• Diagnosis
• Initial treatment given
• Triage number (bar-coded in modern systems)

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Mass Casualty Incident (MCI) Management Steps

1. Triage - sort all casualties by priority
2. Treatment - stabilize at scene/field hospital (life-saving procedures only)
3. Transport - evacuate in priority order; RED patients leave first
4. Transfer - to definitive care hospitals

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Key Exam Points - Triage

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Epidemiological Surveillance Post-Disaster (Bonus)

• Gastroenteritis (most common post-disaster disease)
• Acute respiratory infections
• Vector-borne diseases (malaria, dengue) - appear after 2-3 weeks
• Leptospirosis (after floods)
• Zoonoses (from displaced animals)

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PSM Exam - Full Easy Explanations 🏥

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Q1. Mission Indradhanush

🌈 Think of it like this:

What is it?

• Launched by Ministry of Health & Family Welfare in December 2014
• Named after the rainbow (Indradhanush) because it covers 7+ vaccines - just like a rainbow has 7 colours
• Main Goal: Fully immunize 90% of children who are unvaccinated or partially vaccinated by 2020 (later changed to 2018)

Who is targeted?

• Children under 2 years of age
• Pregnant women
• Specifically those missed during routine immunization (UIP - Universal Immunization Programme)

Vaccines covered:

Key Facts to Remember:

Simple Memory Trick:

"Rainbow for babies" - 7 colours = 7 vaccines, find every child left behind!

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Q2. Essential Newborn Care (ENC)

🍼 Think of it like this:

Definition:

At Birth - The "ABCDE" of ENC:

• Dry the baby immediately with a clean cloth (stimulates breathing)
• If breathing, no suction needed
• If not breathing → clean mouth, nose gently

• Keep baby warm - skin-to-skin contact with mother immediately
• Delay the first bath for at least 24 hours (early bathing = heat loss = danger!)
• Wrap baby, cover head

• Cut cord with sterile blade
• Tie properly
• Keep cord dry and clean - no paste, no dung, no oil!

• Initiate breastfeeding within 1 hour of birth
• Give colostrum (first yellowish milk) - it is liquid gold! Full of antibodies

• Clean eyes with clean cloth, wiping from inner to outer corner

After Birth:

• Exclusive breastfeeding for 6 months
• Vitamin K injection at birth (prevents bleeding in newborn)
• Immunization: BCG + OPV-0 + Hepatitis B at birth
• Kangaroo Mother Care (KMC) for low birth weight babies

Danger Signs in Newborn (MUST KNOW):

• Not feeding well
• Convulsions
• Fast breathing (>60/min)
• Very high or very low temperature
• Yellow skin (jaundice) spreading to palms and soles
• Pus from umbilicus or eyes

Easy Way to Remember:

"WARM + FEED + CLEAN" = the three pillars of essential newborn care

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Q3. Janani Suraksha Yojana (JSY)

👩‍🍼 Think of it like this:

What is it?

• Full form: Janani = Mother, Suraksha = Protection, Yojana = Scheme
• Launched: 12th April 2005 under NHM
• Modified from the old "National Maternity Benefit Scheme"
• 100% Centrally Sponsored Scheme

Goal:

Two Types of States:

UP, Uttarakhand, MP, Jharkhand, Bihar, Rajasthan, Chhattisgarh, Odisha, Assam, J&K

Cash Benefits (from 2012-13):

Who gets the benefit?

• LPS: ALL women delivering in government health centres
• HPS: Only BPL women + SC/ST women; limited to 2 live births only

Role of ASHA in JSY:

• ASHA is the link worker between poor pregnant woman and health institution
• She escorts the woman to hospital
• She is responsible for ANC, postnatal care follow-up
• She gets her own cash incentive (Rs. 600 rural / Rs. 400 urban in LPS)

Memory Trick:

"LPS = More money, more eligibility" | HPS = Less money, BPL only" Remember the 10 LPS states as: "UU MP JB RC OA J" (UP, Uttarakhand, MP, Jharkhand, Bihar, Rajasthan, Chhattisgarh, Odisha, Assam, J&K)

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Q4. Mamata Day (Mamata Divas / VHND)

📅 Think of it like this:

Full Form:

When & Where?

• Held once a month
• At every Anganwadi Centre (AWC)

The 3 People Who Run It:

1. ANM (Auxiliary Nurse Midwife) - provides health services
2. ASHA - mobilizes people to attend, assists
3. AWW (Anganwadi Worker) - organizes the venue, maintains records

Who Comes (Beneficiaries)?

• Pregnant women
• Lactating mothers (up to 6 months after delivery)
• Children under 5 years
• Adolescent girls (11-19 years)
• Women of reproductive age (15-49 years)

What Services Are Provided?

Simple Summary:

"Mamata Day = Monthly health mela at Anganwadi = ANM + ASHA + AWW serve pregnant women + children + adolescent girls"

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Q5. HBNC - Role & Responsibility of ASHA

🏠 Think of it like this:

Full Form:

Why is HBNC needed?

• Infection (sepsis)
• Low birth weight complications
• Poor breastfeeding
• Hypothermia

ASHA's Main Responsibilities in HBNC:

• Ensure the mother gets full ANC (4 visits minimum)
• Help with birth planning (where to deliver, transport, money)

1. Weigh the baby - to detect Low Birth Weight (LBW)
2. Check temperature - to detect hypothermia or fever
3. Ensure warmth - advise skin-to-skin / proper wrapping
4. Support breastfeeding - teach correct positioning and attachment
5. Promote hand-washing - before touching baby
6. Cord, skin and eye care - teach clean and dry cord care
7. Counsel against bad practices - no early bathing, no bottle feeding
8. Identify sepsis - check for pus, redness, fever, not feeding
9. Manage LBW/preterm babies - increase visits, support warmth + feeding
10. Detect maternal complications - bleeding, fever in mother
11. Family planning counselling - for the couple
12. Home deliveries - provide immediate newborn care if birth happened at home

ASHA's Visit Schedule (Up to 42 days):

ASHA's Incentive:

Memory Trick:

"ASHA visits 6 times for hospital baby (Day 3 onwards), 7 times for home baby (from Day 1)" ASHA = Antenatal prep + Support breastfeeding + Home visits + Alert for danger signs

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Q6. Rastriya Bal Swasthya Karyakram (RBSK)

👶 Think of it like this:

Full Form:

Launched: 2013, under NHM

Target:

The 4 D's of RBSK (Most Important!):

How is it Delivered?

• 2 teams per block
• Each team has 2 doctors (AYUSH or MBBS)
• Plus paramedics and support staff

• AWCs (Anganwadi Centres): Twice a year
• Government Schools: Once a year

Referral System:

What does DEIC provide?

• Audiological assessment (hearing tests)
• Corrective surgeries (for cleft lip, club foot, etc.) - FREE
• Hearing aids - FREE
• Spectacles - FREE
• Physiotherapy, Occupational therapy, Speech therapy

Memory Trick:

"RBSK = 4D programme: Defects, Deficiencies, Diseases, Delays → 0-18 years → MHT teams → DEIC for treatment"

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Q7. Components of RMNCH+A

🔗 Think of it like this:

Full Form:

Launched: 2013, Strategic approach under NHM

The 5 Links of the Chain:

• Family planning services (spacing, limiting births)
• Treatment of RTI/STI (Reproductive Tract Infections, Sexually Transmitted Infections)
• Pre-conception care
• Infertility services

• Antenatal Care: Minimum 4 ANC visits (now 8 recommended by WHO)
• TT vaccination in pregnancy
• IFA (Iron Folic Acid) tablets
• JSY & JSSK (free services at government hospitals)
• Safe/Institutional delivery
• Emergency Obstetric Care (EmOC)
• Postnatal care

• HBNC (Home Based Newborn Care by ASHA)
• ENC (Essential Newborn Care at birth)
• SNCU (Special Newborn Care Unit at district hospitals)
• Kangaroo Mother Care (KMC) for LBW babies
• IMNCI (Integrated Management of Neonatal and Childhood Illness)

• Universal Immunization Programme (UIP)
• RBSK (child health screening)
• Nutrition - ICDS, MAM/SAM management
• ORS + Zinc for diarrhoea
• IMNCI for sick children
• Vitamin A supplementation

• RKSK (Rashtriya Kishor Swasthya Karyakram) - for 10-19 years
• WIFS (Weekly Iron & Folic Acid Supplementation)
• School health programme
• Menstrual hygiene
• ARSH (Adolescent Reproductive and Sexual Health) clinics

The Service Delivery Platform:

Mamata Day (VHND) → ANM/ASHA/AWW → Sub-centre → PHC → CHC → District Hospital → Medical College

Memory Trick:

"R-M-N-C-A = Reproduction-Mother-Newborn-Child-Adolescent = Life stages from womb to youth"

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Q8. Adolescent Schemes

🧒 Think of it like this:

India has 253 million adolescents - the world's largest!

Key Schemes:

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• Meaning: National Adolescent Health Programme
• Target: 10-19 years
• 6 Focus Areas:
  1. Nutrition
  2. Sexual & Reproductive Health
  3. Mental Health
  4. Non-Communicable Diseases prevention
  5. Substance abuse prevention
  6. Violence/injury prevention
• Services through: Adolescent Friendly Health Clinics (AFHCs), peer educators

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• Target: Girls AND boys 10-19 years (school-going + out-of-school)
• Large blue tablet given once a week:
  • 100 mg elemental iron + 500 mcg folic acid
• Also: Biannual deworming (Albendazole 400 mg twice a year)
• Day: Given on fixed day every week (usually Monday)
• Goal: Prevent anaemia in adolescents

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• Target: Girls 11-18 years (primary focus: 14-18 years)
• Provides: Nutritional supplementation, health check-up, IFA, life skills education, guidance on family welfare
• Runs through AWCs

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• Earlier scheme for adolescent girl empowerment (now merged into SABLA/RKSK)

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• Free/subsidized sanitary napkins to rural adolescent girls
• Under RKSK

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• Annual health check-ups in government schools
• Links with RBSK teams

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Memory Table:

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Q9. Health Programme for the Elderly

👴 Think of it like this:

NPHCE = National Programme for Health Care of the Elderly

• Launched: 2010-11
• Target: People 60 years and above
• India's elderly population is rapidly increasing

Health Services at Different Levels:

Key Features:

• Free medicines and diagnostics for elderly
• Domiciliary care - home visits for those who cannot come to clinic
• Training of health staff in geriatric care
• Physiotherapy and rehabilitation services

Rashtriya Vayoshri Yojana (RVY):

• Free assistive devices for BPL elderly:
  • Spectacles (for vision)
  • Hearing aids (for hearing loss)
  • Wheelchairs / walking sticks (for mobility)
  • Dentures (for teeth)

Memory Trick:

"NPHCE = Elderly health from PHC to medical college; RVY = Free devices for poor elderly"

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Q10. Prevention & Control of Mental Health Problems

🧠 Think of it like this:

NMHP = National Mental Health Programme

• Launched: 1982 (one of the oldest health programmes)
• One of the first countries in the developing world to have such a programme

Objectives (4):

1. Prevention and treatment of mental and neurological disorders
2. Rehabilitation of affected patients
3. Prevention of disability associated with mental illness
4. Reduce stigma associated with mental illness

The 3 Levels of Prevention:

• Health promotion and education
• Reduce risk factors: substance abuse, stress, social isolation
• School mental health programmes
• Strengthen community support systems

• Early detection and treatment
• MHGAP (WHO's Mental Health Gap Action Programme) - train non-specialist health workers to identify and manage mental illness at primary level
• Task-sharing - ANM, ASHA, community health workers trained to screen

• Rehabilitation centres
• Occupational therapy
• Prevent relapse with long-term medication
• Community support groups

MHGAP Priority Conditions (8):

DMHP = District Mental Health Programme:

• Started 1996, now extended to all districts
• Services: OPD, inpatient, day care, follow-up, emergency, community outreach, IEC

Helplines:

• iCall, NIMHANS helplines for mental health support
• National Tele Mental Health Programme (Tele-MANAS) - 14416

Memory Trick:

"NMHP 1982 = Prevent + Treat + Rehab + De-stigmatize = MHGAP for early detection = DMHP in every district"

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Q11. Mental Health Act

⚖️ Think of it like this:

Two Important Acts:

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A. Mental Health Act, 1987 (Old Act):

• Established Mental Health Authorities (Central and State)
• Set up procedures for admission and discharge
• Regulated psychiatric hospitals
• But was criticized for not protecting patient rights enough

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B. Mental Healthcare Act, 2017 (New Act - Currently in Force):

• Every person has the RIGHT to access mental healthcare from the government
• Government is responsible to provide this

• A person with mental illness can write instructions in advance about how they want to be treated (or NOT treated) in the future, when they cannot make decisions themselves
• Like a mental health "will"

• Person can appoint someone (family member, friend) to make decisions on their behalf when they are incapacitated

• Attempt to suicide is NO LONGER a crime
• Person who attempts suicide is presumed to be under severe stress
• They need care, not punishment

• ECT (Electroconvulsive Therapy / shock treatment) without consent is BANNED
• ECT for minors (children) is COMPLETELY BANNED
• Must have free and informed consent of patient

• Chaining of mentally ill persons is illegal and punishable

• Set up in every district
• Independent body to protect the rights of mentally ill patients
• Reviews cases of admission, discharge, rights violations

• Mental illness must be treated at par with physical illness for insurance coverage

• Right to confidentiality
• Right to dignity
• Right to non-discrimination
• Right to free legal aid
• Right to complain against ill-treatment

Simple Summary Table:

Memory Trick:

"2017 Act = Rights! No chains, no forced ECT, no punishment for suicide, insurance equality"

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Q12. Define Outbreak

🦠 Think of it like this:

Definition (WHO):

An outbreak is the occurrence of more cases of disease, injury, or other health condition than expected in a given area, among a specific group of persons, during a particular period.

Simple Formula:

Observed cases > Expected cases = Outbreak

Outbreak vs Epidemic vs Pandemic:

Types of Outbreaks:

• All cases exposed to ONE source (e.g., contaminated water supply)
• Two types:
  • Point source: Single, brief exposure (e.g., wedding food poisoning) → Sharp bell-shaped curve
  • Continuous source: Ongoing exposure (e.g., contaminated well over weeks)

• Spread from person to person (e.g., measles, COVID)
• Epidemic curve rises gradually, wave-like pattern

• Starts as common source, then spreads person-to-person

Steps of Outbreak Investigation (9 Steps):

1. Confirm the diagnosis
2. Confirm the outbreak exists
3. Define and identify cases (case definition)
4. Describe data by Person, Place, Time (Descriptive epidemiology)
5. Develop hypotheses (what is the source/cause?)
6. Test hypotheses (analytical study)
7. Implement control measures
8. Evaluate control measures
9. Communicate findings (report)

Memory Trick:

"Outbreak = MORE than expected cases. Point source = one exposure = bell curve. Propagated = person to person = wave curve"

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Q13. Ayushman Bharat

💊 Think of it like this:

1. At the village level - upgrade health centres to provide more services (HWC)
2. At the hospital level - give Rs. 5 lakh insurance to poor families (PMJAY)

Announced: February 2018 (Union Budget); Full launch September 2018

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Component 1: Health and Wellness Centres (HWC)

• 1.5 lakh Sub-Health Centres and PHCs upgraded to HWCs by 2022
• Bring comprehensive primary health care close to home
• First HWC launched: 14 April 2018, Bijapur, Chhattisgarh
• Services: Maternal/child health, NCDs (diabetes, hypertension, cancers), mental health, ENT, eye, oral health, geriatric care
• Free essential drugs + diagnostics
• Headed by CHO (Community Health Officer) - BSc/GNM nurse or Ayurveda practitioner
• Team: CHO + Male MPW + Female MPW (ANM) + ASHA

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Component 2: AB-PMJAY (Pradhan Mantri Jan Arogya Yojana)

What is NOT covered:

• OPD (outpatient) visits
• Cosmetic surgeries
• Fertility/IVF treatment
• Drug rehabilitation
• Self-inflicted injuries

Memory Trick:

"Ayushman Bharat = HWC (village level) + PMJAY (hospital level, Rs 5 lakh, 10.74 crore families)"

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Q14. Functions of Health & Wellness Centre (HWC)

🏥 Think of it like this:

12 Service Packages (MUST MEMORIZE):

Additional Functions:

• Free essential drugs and diagnostics
• Teleconsultation - connect with specialists via phone/video
• Health promotion: Yoga sessions, lifestyle modification counselling, nutrition education
• IEC activities (Information, Education, Communication)
• Community outreach

Staff at HWC:

• CHO (Community Health Officer) - team leader
• MPW Male (Health Worker Male)
• ANM (Female Multipurpose Worker)
• ASHA (Accredited Social Health Activist)

Key Difference - Old vs New:

Memory Trick:

"HWC = 12 packages = Pregnancy + Newborn + Child + Adolescent + Reproductive + Communicable + NCD + Mental + ENT + Eye + Oral + Geriatric" Think of it as: Whole Life Healthcare under one roof

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Q15. Health Problems of the Aged

👵 Think of it like this:

The "5 I's" of Geriatric Problems (CLASSIC EXAM ANSWER!):

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System-wise Common Problems:

• Hypertension (most common)
• Coronary Artery Disease (angina, heart attack)
• Heart failure, stroke

• Osteoarthritis (joint pain, most common)
• Osteoporosis (brittle bones → hip fracture)
• Rheumatoid arthritis

• Dementia (Alzheimer's - most common type)
• Parkinson's disease
• Peripheral neuropathy

• Vision: Cataracts, glaucoma, presbyopia (near vision loss)
• Hearing: Presbycusis (age-related hearing loss) - most common sensory problem

• Diabetes mellitus (Type 2)
• Hypothyroidism

• COPD (Chronic Obstructive Pulmonary Disease)
• Pneumonia (can be fatal in elderly)

• BPH (Benign Prostatic Hyperplasia) in men - urinary difficulty
• UTI (Urinary Tract Infection) - common in women
• Urinary incontinence

• Depression - MOST COMMON mental disorder in elderly
• Anxiety
• Social isolation and loneliness

• Cancer (incidence increases with age)
• Malnutrition
• Elder abuse (physical, financial, emotional)
• Polypharmacy (taking too many medicines)

Memory Trick:

"5 I's: Immobility, Instability, Incontinence, Intellectual impairment, Iatrogenic illness" Most common things to remember:

• Most common mental disorder = Depression
• Most common dementia = Alzheimer's
• Most common sensory problem = Presbycusis
• Most dangerous fracture = Hip fracture

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Q16. Mamata Divas - Service Providers, Beneficiaries & Services

📋 Think of it like this:

What is Mamata Divas?

• Same as VHND = Village Health, Nutrition and Sanitation Day
• Held once a month at every Anganwadi Centre
• A convergence platform bringing health + nutrition + sanitation departments together at village level

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SERVICE PROVIDERS (Who provides services?):

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BENEFICIARIES (Who receives services?):

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SERVICES AVAILABLE (Detailed List):

• ANC check-up: Blood pressure, weight, haemoglobin (Hb) testing
• Abdominal examination (fundal height, foetal heart rate)
• TT (Tetanus Toxoid) vaccination for pregnant women
• IFA (Iron Folic Acid) tablet distribution
• Calcium supplementation
• Registration of new pregnancies
• Identification and referral of high-risk pregnancies

• Immunization: BCG, OPV, DPT, Hepatitis B, MR (as per schedule)
• Growth monitoring: Weighing children; plotting on growth chart
• MUAC (Mid Upper Arm Circumference) to detect malnutrition
• Vitamin A supplementation (children 6 months - 5 years)
• ORS + Zinc for diarrhoea management
• Identification and referral of SAM/MAM (severely/moderately malnourished) children

• Distribution of: IFA tablets, Calcium, Vitamin A, Albendazole
• Nutritional counselling to mothers
• Complementary feeding advice (from 6 months onwards)

• WIFS - Weekly Iron & Folic Acid tablet given on fixed day
• Deworming - Albendazole 400 mg biannually
• Health education on menstrual hygiene, nutrition, reproductive health

• Check-up of recently delivered mothers
• Counselling on exclusive breastfeeding
• Contraceptive counselling and provision (condoms, OCPs)

• Health and hygiene education
• Sanitation promotion (handwashing, ODF - open defecation free)
• Referral for any sick patient to PHC/CHC
• Registration of newborns

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Quick Exam Answer Format for Q16:

Mamata Divas = Monthly VHND at AWC

Providers: ANM, ASHA, AWW (+ AWH, MO for supervision)

Beneficiaries: Pregnant women, Lactating mothers, Children <5 years, Adolescent girls, Women 15-49 years

Services: ANC + Immunization + Nutrition (IFA/Calcium/Vit A) + Growth monitoring + Deworming + WIFS + PNC + Health education + Referral

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📌 Quick Revision - All 16 Topics at a Glance

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🍼 Essential Newborn Care (ENC)

Complete PSM Exam Answer - Easy Explanation

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🎯 What is Essential Newborn Care?

Definition:

Primary Goal:

Reduce perinatal and neonatal mortality

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📊 Why is it Important? (Background)

• Neonatal period = First 28 days of life (most dangerous period for a child)
• Neonatal mortality rate (NMR) in India = about 23 per 1000 live births
• Most neonatal deaths occur in the first 7 days (early neonatal period)
• About 75% of all under-5 deaths occur in the first year of life
• Most of these deaths are preventable with simple, low-cost interventions

Main causes of neonatal death:

1. Birth asphyxia (baby not breathing at birth)
2. Infections/Sepsis
3. Prematurity / Low Birth Weight (LBW)
4. Hypothermia (getting too cold)

ENC directly addresses all 4 of these causes!

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🔑 Main Components of ENC (Park's PSM)

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COMPONENT 1: Resuscitation of Newborn (Handling Birth Asphyxia)

🫁 What is birth asphyxia?

Steps at birth (FIRST 30 SECONDS):

• Immediately wipe the baby with a clean, dry cloth
• This dries the baby AND stimulates it to breathe (touch stimulates breathing reflex)
• Change wet cloth for a dry one immediately

• Is the baby crying? → Breathing well → Continue ENC
• Is the baby NOT crying / breathing weakly? → Start resuscitation

• Suction is needed ONLY if airway is blocked (meconium, blood, mucus)
• Routine suctioning is NOT recommended (it can cause harm)
• If suctioning needed: mouth first, then nose

• Rub the back vigorously
• Flick the soles of the feet (gentle stimulation)

• If baby does not breathe after 30 seconds of stimulation
• Give positive pressure ventilation using bag and mask
• Rate: 40-60 breaths per minute
• Done at the Newborn Care Corner in the labour room

Newborn Care Corner:

• Radiant warmer
• Resuscitation equipment (bag + mask in sizes for newborn)
• Suction device
• Oxygen
• Clock/timer

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COMPONENT 2: Prevention of Hypothermia (Keeping Baby Warm)

🌡️ Why does the newborn get cold so easily?

• Baby comes out wet from amniotic fluid
• Huge surface area compared to body weight
• No shivering mechanism yet
• Cannot generate enough body heat on its own
• Normal baby temperature: 36.5°C - 37.5°C
• Hypothermia = body temperature below 36.5°C

The Warm Chain - 10 Steps:

• Room temperature should be at least 25°C
• No fans, no open windows near the delivery area

• Resuscitation table should be warm (radiant warmer)

• Dry the baby right away with warm, dry cloth
• Remove the wet cloth immediately

• Place baby on mother's bare chest, tummy-to-tummy
• Cover both mother and baby with a blanket
• This is the best way to keep baby warm - uses mother's body heat

• Breastfeeding provides warmth, nutrition, and closeness

• NEVER bathe the baby immediately after birth!
• Delay bath for at least 6 hours (ideally 24 hours)
• Early bathing is a traditional practice that kills babies by causing hypothermia

• Dress baby in clean, warm clothes
• Always cover the head - newborns lose most heat through the head

• If transferring baby, keep warm during transport (wrap well)

• All procedures (injections, weighing) should be done in warm area

• Teach mothers and family not to bathe baby early, not to put baby in cold room

For Low Birth Weight babies → Kangaroo Mother Care (KMC):

1. Skin-to-skin positioning - Baby placed on mother's chest in upright position (like a kangaroo's pouch!)
2. Adequate nutrition - through breastfeeding or expressed breast milk
3. Ambulatory care - mother carries baby, walks around, earlier discharge from hospital
4. Support for the mother and family in caring for the baby

• Maintains normal body temperature (37°C) without incubator
• Promotes breastfeeding
• Reduces infections
• Better weight gain
• Reduces apnoea (breathing pauses)
• Improves mother-baby bonding
• Reduces hospital stay and cost

• All Low Birth Weight babies (< 2500 g)
• All preterm babies
• Stable babies (not needing intensive care)

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COMPONENT 3: Prevention of Infection

🦠 Why are newborns so prone to infection?

• Immune system not yet developed
• Any break in skin/cord can let bacteria in
• Sepsis (blood infection) kills within hours

Clean Delivery:

• Delivery on a clean surface
• Clean hands of delivery attendant (hand washing with soap)
• Clean cord cutting instrument (sterile blade/scissors)
• Clean cord tie (sterile thread/clamp)
• Nothing unclean applied to the cord

Cord Care:

• Keep cord clean and DRY
• Keep cord exposed to air (fold nappy below cord level)
• If soiled, clean with clean water and dry thoroughly

• Apply ghee, mustard oil, cow dung, ash, turmeric, or any substance to cord
• Bandage or cover the cord stump
• These traditional practices CAUSE infection (tetanus, omphalitis)

• Redness around the cord base
• Pus or foul smell from cord
• Swelling → needs immediate referral

Eye Care:

• After birth, clean both eyes gently with a separate clean cloth for each eye
• Wipe from inner corner to outer corner (not the other way)
• Purpose: Remove blood and amniotic fluid, prevent conjunctivitis

Skin Care:

• Vernix caseosa (the white coating on baby) is PROTECTIVE - do not scrub it off
• Gentle cleaning only
• No powders, no oils on skin in first few days

Hand Hygiene:

• Anyone handling the baby must wash hands first
• This is the single most important infection prevention measure

Immunization at Birth:

Vitamin K Injection:

• All newborns should receive Vitamin K 1 mg IM (into thigh muscle) at birth
• Why? Newborns have very little Vitamin K → risk of Haemorrhagic Disease of the Newborn (HDN) - serious internal bleeding
• Vitamin K is needed for blood clotting

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COMPONENT 4: Exclusive Breastfeeding

🤱 What is the BEST food for a newborn?

Breast milk - and ONLY breast milk for the first 6 months!

Early Initiation of Breastfeeding:

• Start breastfeeding within 1 hour of birth - this is critical!
• Early suckling stimulates milk production
• Helps in uterine contraction (reduces maternal bleeding)

Colostrum - The First Milk (Liquid Gold!):

• Thick, yellowish first milk produced in first 3-5 days
• Rich in antibodies (IgA) - protects against infections
• Rich in protein, vitamins, minerals
• Acts as baby's first vaccine
• Traditional practice of throwing away colostrum is WRONG and HARMFUL

Exclusive Breastfeeding for 6 Months:

• No water, no other milk, no other food - ONLY breast milk for 6 months
• Even in hot weather, breast milk has enough water

Benefits of Breastfeeding:

• Complete nutrition (all proteins, fats, vitamins, minerals)
• Antibodies protect against diarrhoea, respiratory infections, otitis media
• Reduces risk of SIDS (Sudden Infant Death Syndrome)
• Better brain development
• Lower risk of obesity and diabetes later in life

• Reduces postpartum bleeding (oxytocin release)
• Natural contraception (LAM - Lactational Amenorrhoea Method)
• Faster return to pre-pregnancy weight
• Reduces risk of breast and ovarian cancer
• Strengthens mother-baby bond

• Saves lives - reduces neonatal and infant mortality
• Saves money - no need to buy formula

Correct Breastfeeding Position (LATCH):

• Baby's whole body facing mother (tummy-to-tummy)
• Baby's mouth wide open
• More areola (dark area) in baby's mouth, not just nipple
• Baby's chin touching breast
• No pain for mother when positioned correctly

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COMPONENT 5: Referral of Sick Newborn

🚨 Danger Signs - When to refer immediately:

Referral Pathway:

Newborn Care Facilities:

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📋 ENC at a Glance - Step by Step at Birth

IMMEDIATELY AT BIRTH (First 30 seconds):

Baby born
    ↓
DRY with warm cloth immediately
    ↓
Is baby crying/breathing?
    ↓              ↓
YES               NO
 ↓                 ↓
Continue ENC   Stimulate (rub back, flick feet)
                   ↓
              Still not breathing?
                   ↓
           Bag-mask ventilation
           (in Newborn Care Corner)

FIRST HOUR OF LIFE:

• ✅ Keep baby warm (skin-to-skin with mother)
• ✅ Initiate breastfeeding within 1 hour
• ✅ Vitamin K injection (1 mg IM)
• ✅ Eye care (clean eyes)
• ✅ BCG + OPV-0 + Hepatitis B vaccines
• ❌ Do NOT bathe baby yet

FIRST DAY:

• ✅ Continue skin-to-skin contact
• ✅ Continue exclusive breastfeeding on demand
• ✅ Cord care - keep dry and clean
• ✅ Watch for danger signs
• ✅ Assess for jaundice (yellowing of skin)
• ❌ Do NOT apply anything to the cord

AFTER DISCHARGE:

• ASHA visits home for HBNC (Day 3, 7, 14, 21, 28, 42)
• Mother counselled on:
  • Exclusive breastfeeding
  • Warmth
  • Cord care
  • Danger signs to watch for
  • Next immunization visits

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📝 Priority Areas to Improve Newborn Health (Park's PSM Summary Table)

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🧠 EASY MEMORY TRICKS for Exam

The "5 C's" of ENC:

Clean birth → Clear airway → Cord care → Colostrum → Check for danger signs

Components in one line:

"RHI-BF-R" = Resuscitation + Hypothermia prevention + Infection prevention + Breastfeeding + Referral

For HBNC visit schedule:

"Hospital baby = 6 visits (Day 3 onwards)" "Home baby = 7 visits (Day 1 onwards)"

Key numbers to remember:

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✍️ How to Write This in Exam (Structure)

1. Definition + Goal (2 lines)
2. Main Components (list the 5) - brief explanation of each
3. Danger signs (list at least 5)

1. Introduction + Definition + Goal + Why important (NMR data)
2. All 5 Components with explanation
3. Warm Chain (10 steps)
4. KMC (4 components + benefits)
5. Danger signs (table)
6. Newborn care facilities (NBCC, NBSU, SNCU, NICU)
7. Conclusion - role of HBNC + ASHA

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