Q7. Sub Centre - Staff & Functions (Park's SPM)

• Sub-centre A: 1 ANM/Health Worker (Female) + 1 Health Worker (Male) + 1 Safai Karamchari (part-time)
• Sub-centre B (MCH Sub-centre): 2 ANM/HW (Female) + 1 Health Worker (Male) + 1 Safai Karamchari (full-time) + 1 Staff Nurse (desirable)

• Maternal & Child Health (ANC, natal, postnatal care)
• Family planning services
• Nutrition and immunization
• Management of common illnesses/first aid
• School health, IEC (health education)
• National Health Programme activities (TB, leprosy, malaria, etc.)
• Record keeping and reporting of vital events
• Field services: VHND, house-to-house surveys, home visits

Q8. Public Private Partnership (PPP) (Park's SPM)

• PPP is a collaboration between the government (public sector) and private sector to improve health care delivery.
• About 75% of health services in India are currently provided by the private sector.
• Under RCH II (NRHM), PPP was set up to make the programme better and ensure availability of preventive and curative reproductive and child health services.
• PPP helps expand coverage to underserved areas (e.g., eye care services under NPCB).
• Private sector contributes laboratory investigations, specialist services, and diagnostic facilities (biochemical, pathological, mammography, etc.).
• Goal: bridge gaps in public health infrastructure by utilizing private sector resources efficiently.

Q9. Healthcare Delivery Indicators (Park's SPM)

1. Doctor-population ratio
2. Doctor-nurse ratio
3. Population-bed ratio
4. Population per health/sub-centre
5. Population per trained birth attendant

Q10. Functions of a Physician (Park's SPM)

• Assess health status through clinical and laboratory diagnosis
• Provide treatment, prevention, and referral to higher levels
• Expert in common conditions, first-aid, and acute emergencies
• Delegate work appropriately to auxiliaries

• Leader of the "health team"
• Provide primary health care at grass-root level
• Community diagnosis, prioritization of health problems, community treatment
• Focus on the 8 essential elements of primary health care (Alma-Ata Declaration)

• The word "doctor" by derivation means "to teach"
• Role in health education of individuals, families, and communities
• Generate and mobilize community participation in health programmes
• Propagate relevant health information

Q11. Health For All (HFA) Goals (Park's SPM)

• 1977: World Health Assembly launched "Health for All by the year 2000" (HFA/2000)
• Definition (30th WHA): "Attainment of a level of health that will enable every individual to lead a socially and economically productive life."
• Fundamental principle: Equity - equal health status ensured by equitable distribution of health resources

1. Reduce infant mortality from 125 to below 60
2. Raise life expectancy at birth from 52 years to 64 years
3. Reduce crude death rate from 14 to 9 per 1000 population
4. Reduce crude birth rate from 33 to 21 per 1000 population
5. Achieve net reproduction rate of one
6. Provide potable water to the entire rural population

Primary Health Care (PHC) - Components & Elements

(Park's Textbook of Preventive and Social Medicine)

Definition (Alma-Ata, 1978)

"Primary health care is essential health care made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and country can afford."

8 Essential Elements / Components of PHC

Note: The list can be modified to fit local circumstances. Some countries include mental health, physical handicaps, and care of the elderly.

4 Principles of PHC

1. Equitable Distribution

• Health services must be shared equally by ALL, irrespective of ability to pay
• Redresses imbalance between urban (3/4 of health budget) and rural (3/4 of population) areas
• Health services brought as near to people's homes as possible
• Targets vulnerable groups - rural poor and urban slum dwellers

2. Community Participation

• Individuals, families, and communities must be involved in planning, implementation, and maintenance of health services
• Maximum reliance on local resources (manpower, money, materials)
• In India: Village Health Guides, trained Dais, ASHA and Anganwadi workers are essential features
• Concept of "Health by the people" and "placing people's health in people's hands"

3. Intersectoral Coordination

• Components of PHC cannot be provided by the health sector alone
• Involves: agriculture, animal husbandry, food, industry, education, housing, public works, communication, and others
• Requires strong political will and planning to avoid duplication
• An important element is joint planning with other sectors

4. Appropriate Technology

• Technology that is scientifically sound, adaptable to local needs, acceptable to users, and can be maintained by people themselves
• Emphasizes affordable, valid alternatives over costly procedures (e.g., ORS instead of IV fluids, standpipes instead of house-to-house water connections)
• Avoids inappropriate large hospitals that absorb major national health budget

Memory tip (4 principles): Equitable distribution - Community participation - Intersectoral coordination - Appropriate technology → "ECIA"

Memory tip (8 elements): "E-P-W-M-I-P-A-P" → Education, Proper nutrition, Water & sanitation, MCH+FP, Immunization, Prevention of endemic diseases, Appropriate treatment, Provision of essential drugs