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Biodiversity: Community Health Nursing Notes

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1. What is Biodiversity?

Simple definition: Biodiversity = all the different forms of life on Earth and the places where they live.

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2. Levels of Biodiversity

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3. Classification of Biodiversity

A. Based on Habitat (Where They Live)

1. Terrestrial Biodiversity - found on land (forests, grasslands, deserts)
2. Aquatic Biodiversity - found in water (freshwater rivers/lakes; marine/ocean)
3. Microbial Biodiversity - microscopic organisms (bacteria, fungi, viruses in soil, water, and gut)

B. Based on Type of Organism

1. Flora - all plants (trees, shrubs, herbs, algae)
2. Fauna - all animals (mammals, birds, reptiles, insects, fish)
3. Microorganisms - bacteria, fungi, viruses, protozoa
4. Fungi & others - mushrooms, lichens, mosses

C. Based on Conservation Status (IUCN Red List)

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4. Importance of Biodiversity to Human Health

• Clean air and water - forests and wetlands filter air and water, reducing respiratory and waterborne diseases
• Food and nutrition - diverse crops and species ensure food security and adequate micronutrients in diet
• Medicines - over 25% of modern medicines come from plants and animals (e.g., aspirin from willow bark, morphine from poppy)
• Disease regulation - healthy ecosystems control pests and disease vectors (mosquitoes, rodents)
• Mental health - exposure to biodiverse environments reduces stress, anxiety, and improves mental well-being
• Immune regulation - diverse microbial environments (in soil, forests) strengthen the human immune system ("Biodiversity Hypothesis")
• Climate stability - forests absorb over 2.6 billion tonnes of CO2 every year, reducing climate-related diseases

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5. Threats to Biodiversity

Major Threats (Remember as "D-H-P-C-I"):

Health Consequences of Biodiversity Loss:

• 35% decline in global wetlands since 1970 → increased waterborne diseases
• Decline in bees → reduced crop pollination → food insecurity and malnutrition
• Deforestation → increased malaria, Ebola, COVID-19 type zoonotic diseases
• Loss of plant diversity → fewer raw materials for new medicines

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6. Conservation of Biodiversity

Types of Conservation:

A. In-Situ Conservation (Protection in Natural Habitat - "On-site")

Protecting species where they naturally live.

• National Parks - areas where wildlife is fully protected (e.g., Jim Corbett, Ranthambore)
• Wildlife Sanctuaries - protected areas allowing some human activity
• Biosphere Reserves - large protected areas that include surrounding human communities
• Sacred Groves - forests protected by local/tribal communities for religious reasons

B. Ex-Situ Conservation (Protection outside Natural Habitat - "Off-site")

Protecting species by moving them to a controlled environment.

• Zoos - protect endangered animals
• Botanical Gardens - protect rare plants (e.g., National Botanical Research Institute, Lucknow)
• Seed Banks - store seeds of rare and threatened plants (e.g., National Gene Bank, New Delhi)
• Cryopreservation - freezing embryos/sperms/eggs of endangered species

C. Community-Based Conservation

• Local communities protecting their nearby forests, water bodies, and wildlife
• Examples: Van Panchayats (India), community forests, community fishing rules

Important International Agreements:

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7. Role of Community Health Nurse in Biodiversity Conservation

1. Health Education - teach community members about how biodiversity affects their health
2. Advocacy - support policies that protect green spaces, forests, and clean water
3. Disease Prevention - educate about zoonotic diseases linked to deforestation
4. Nutrition Counseling - promote diverse, locally grown food for better nutrition
5. Environmental Health Assessment - identify environmental risks (polluted water, loss of forest) in the community
6. Community Mobilization - involve community in tree planting, waste reduction, and protecting local ecosystems
7. Research & Reporting - document health problems linked to environmental degradation

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8. Quick Summary (Exam Points)

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• WHO Biodiversity Fact Sheet - key statistics on biodiversity and health
• IUCN Biodiversity and Health - conservation and health connections
• Centring Biodiversity in Nursing - PMC - nursing's role in biodiversity and planetary health

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Committees and Commissions on Health and Family Welfare in India

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Overview

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1. Bhore Committee (1946)

Background:

Key Observations:

• India had very poor health indicators
• Life expectancy at birth was only ~32 years
• Only 43 medical colleges existed
• Lack of integration between curative and preventive services

Major Recommendations:

1. Integration of preventive and curative services at all administrative levels
2. 3-tier healthcare system:
   • Primary Health Centre (PHC) - 1 PHC for 10,000-20,000 population (75 beds)
   • Secondary/District Hospital - 650 beds for 15-25 PHCs
   • Regional/Central Hospital - 2,500 beds at district level
3. 1 PHC per 10,000-20,000 population with 75 beds and 6 doctors
4. Modification of medical education to produce "social physicians"
5. Increase Bed-Population Ratio to 1.03 beds/1,000 population in 10 years
6. Emphasis on preventive, promotive, and rehabilitative health care
7. All health services should be free to all citizens

Memory tip: "Bhore = Base of India's health system - PHC concept"

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2. Mudaliar Committee (1962)

Background:

Key Observations:

• Government spending on health had decreased from 5.9% (1st Five Year Plan) to 4.25% (3rd Five Year Plan)
• Bed-Population ratio was only 0.4/1,000 population
• Life expectancy at birth had risen to about 42 years
• 61 medical colleges existed (more than Bhore's target of 43)
• PHCs were overcrowded and understaffed

Major Recommendations:

1. Strengthen and consolidate existing PHCs rather than creating new ones
2. Each PHC should not serve more than 40,000 population
3. Improve the quality of care at PHCs
4. Strengthen District Hospitals as referral centers
5. Establish sub-centres: minimum 1 per 10,000 population; ideally 1 per 5,000
6. All India Health Service (on the pattern of IAS) should be created to replace the Indian Medical Service
7. Integration of medical and health services at all levels (as recommended by Bhore Committee)
8. Regional organizations in each state to supervise District Medical/Health Officers
9. Basic health workers to work as Multipurpose Workers (MPW) - 1 per 10,000 population
10. PHC to have microscope and laboratory technician

Memory tip: "Mudaliar = Quality & Consolidation of PHCs; All India Health Service"

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3. Chadha Committee (1963)

Background:

Major Recommendations:

1. Basic Health Workers should function as multipurpose workers - handling both malaria AND family planning duties
2. One basic health worker per 10,000 population (ideally 1/5,000)
3. PHC should have a microscope and lab technician
4. General health services should be responsible for the maintenance phase of NMEP
5. Integration of malaria and family planning workers into one multipurpose role

Problem with implementation:

Memory tip: "Chadha = First attempt at Multipurpose Workers (MPW)"

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4. Mukherjee Committee (1965-66)

Background:

Key Observations:

• Great shortage of staff for Family Planning Programme
• Doctors reluctant to take up FP duties
• Training and infrastructure lacking
• Community leaders unhappy with too many workers visiting homes separately

Major Recommendations:

1. Delink Family Planning activities from other health activities - separate staff for FP
2. Family Planning Assistants to undertake FP duties only
3. Basic health workers to be utilized for purposes other than FP
4. Delink malaria activities from family planning so FP gets undivided staff attention
5. Strengthening of District Family Planning Bureaus
6. Provision of FP allowance to doctors
7. Training in FP methods to be provided to all relevant health workers
8. Basic Health Service to be provided at the Block level

Memory tip: "Mukherjee = Delink FP from other programmes; Separate FP staff"

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5. Jungalwalla Committee (1967)

Background:

Definition Given:

Major Recommendations:

1. No private practice by government doctors - recommended abolition
2. Unified cadre for health workers
3. Common seniority list across departments
4. Equal pay for equal work
5. Special pay for specialized work
6. Good service conditions as a substitute for private practice
7. Having multipurpose workers is desirable and feasible
8. Integration of health services at all levels
9. Recognition of extra qualifications for pay purposes
10. Non-practice allowance should be reasonable and realistic to prevent private practice

Memory tip: "Jungalwalla = Integration of services + No private practice + Equal pay"

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6. Kartar Singh Committee (1973)

Background:

Key Observations:

• Individual disease programmes (malaria, FP, smallpox) each had separate workers visiting homes - community was unhappy
• Workers providing treatment for minor ailments were more acceptable in community
• Poor supervision was the main cause of peripheral worker underperformance

Major Recommendations:

1. Sub-Centre concept - 1 Sub-Centre per 3,000-3,500 population (rural)
2. 1 PHC for every 50,000 population, divided into 16 sub-centres
3. Each sub-centre staffed by 1 Male Multipurpose Worker (MPW-M) and 1 Female Multipurpose Worker (MPW-F)
4. Work of 3-4 MPWs to be supervised by 1 Health Supervisor (male or female)
5. Lady Health Visitors (LHV) to be redesignated as Female Health Supervisors
6. Doctor in charge of PHC to have overall charge of supervisors and health workers
7. Various categories of peripheral workers to be amalgamated into a single cadre of multipurpose workers
8. Existing ANMs to be converted into MPW(F); basic health workers and malaria surveillance workers to be converted to MPW(M)

This committee's recommendations formed the basis of the current sub-centre structure in India.

Memory tip: "Kartar Singh = Sub-Centre + MPHW (Male Multipurpose Health Worker) scheme"

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7. Shrivastav Committee (1975)

Background:

• (a) Reorient medical education according to national needs and priorities
• (b) Suggest steps for improving existing medical educational processes with emphasis on community health

Major Recommendations:

1. Village Health Guide (VHG) scheme - train local village volunteers as health guides
2. Emphasis on community participation in health services
3. Trained Dai (traditional birth attendant) - local dais to be trained for safe deliveries
4. Reorientation of medical education towards community/rural health needs
5. Doctors should be trained to work in rural and community settings
6. Establishment of a Medical and Health Education Commission (on lines of UGC) for planning and implementing reforms in health and medical education
7. Integration of health services at all levels
8. 30-bedded hospital for every 1 lakh population
9. PHC and District Health Centers to be under control of three-tier Panchayat Raj System
10. Redefined the role of doctor in the community

Outcome:

Memory tip: "Shrivastav = Village Health Guide (VHG) + Rural Health Scheme + Community participation"

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8. ICMR-ICSSR Joint Study Group (1980)

Major Recommendations:

1. Attain "Health for All by 2000 AD" (aligned with Alma Ata Declaration 1978)
2. Primary Health Care (PHC) approach as the main strategy
3. Health services must be community-based and people-centered
4. 30-bedded hospital for every 1 lakh population
5. Integration of health services at all levels
6. PHC and District Health Centers under the Panchayat Raj System (three-tier)
7. Redefined the role of doctors - focus on community health

Memory tip: "ICMR-ICSSR = Health for All 2000 + Primary Health Care approach"

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9. Bajaj Committee (1986)

Background:

Major Recommendations:

1. National Health Manpower Policy - formulate a policy based on realistic survey of needs
2. Educational Commission for Health Sciences - to be developed on lines of UGC (University Grants Commission)
3. Restructure medical education to produce doctors suited for rural and community health
4. Reorientation of nursing education - nursing to have its own council and educational standards
5. Rational deployment of health manpower across rural and urban areas
6. Community health workers to be trained and deployed at village level
7. Strengthening of preventive and social medicine in medical curriculum
8. Task shifting - allow trained paramedics and nurses to perform more clinical tasks in rural areas
9. A National Health Manpower Database to be created
10. Continuing Medical Education (CME) to be made mandatory

Memory tip: "Bajaj = Health Manpower Planning + Educational Commission for Health Sciences"

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10. Krishnan Committee (2019)

Major Recommendations:

1. Separate Public Health Cadre - dedicated cadre of public health professionals distinct from clinical doctors
2. Strengthening disease surveillance systems across India
3. Digital health initiatives - use of technology for health record keeping and telemedicine
4. Strengthen Ayushman Bharat - Primary Health Centres transformed into Health and Wellness Centres
5. Universal Health Coverage as a national goal

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Quick Comparison Table - All Committees at a Glance

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Important One-Line Exam Tips

• Bhore Committee = "Father of PHC in India" / Magna Carta of Indian Health
• Mudaliar Committee = "Quality control of PHCs"
• Chadha Committee = "First MPW idea" (failed in practice)
• Mukherjee Committee = "Separated FP staff from other health workers"
• Jungalwalla Committee = "Integration + No private practice"
• Kartar Singh Committee = "Sub-centre + Male MPW (MPHW)"
• Shrivastav Committee = "Village Health Guide (VHG) + Rural Health Service"
• ICMR-ICSSR = "Health for All 2000 AD"
• Bajaj Committee = "Health Manpower Planning"
• Krishnan Committee = "Public Health Cadre + Digital Health"

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• NIHFW - National Institute of Health and Family Welfare (official)
• Community Medicine Reference - Health Committees Comparison PDF