Community Medicine
Health Care of the Community
Community medicine health care of the community for MBBS: primary health care principles, Alma-Ata, rural three-tier infrastructure, ASHA and community diagnosis, mapped to NMC codes CM17.1 to CM17.5.
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Health Care of the Community
Community medicine health care of the community for MBBS: primary health care principles, Alma-Ata, rural three-tier infrastructure, ASHA and community diagnosis, mapped to NMC codes CM17.1 to CM17.5.
This chapter covers the delivery of health care to the community through the concept and principles of primary health care and the Alma-Ata Declaration. It details the three-tier rural health infrastructure of sub-centre, primary health centre and community health centre, the role of the ASHA and the process of community diagnosis.
High-yield: Health Care of the Community
- Primary health care is essential care made universally accessible at a cost the community and country can afford.
- The Alma-Ata Declaration of 1978 set the goal of Health for All and made primary health care its key strategy.
- The four principles of primary health care are equitable distribution, community participation, intersectoral coordination and appropriate technology.
- The eight essential components of primary health care include health education, nutrition, safe water, maternal and child health and essential drugs.
- In rural India the three-tier structure comprises the sub-centre, the primary health centre and the community health centre.
- A sub-centre serves about five thousand people in the plains and three thousand in hilly or tribal areas.
- A primary health centre serves about thirty thousand people in the plains and twenty thousand in difficult areas.
- A community health centre serves about one hundred and twenty thousand people and provides specialist care.
- The accredited social health activist, or ASHA, is a trained community volunteer linking villages to the health system.
- Community diagnosis identifies the major health problems and needs of a defined population.
- The Indian Public Health Standards define the minimum services and staffing for each level of facility.
- Health and wellness centres under Ayushman Bharat expand the package of primary care services.
- The Sustainable Development Goals succeeded the Millennium Development Goals and include universal health coverage.
- Referral linkages between the three tiers ensure continuity of care from village to hospital.
Rural health infrastructure tiers
- **Sub-centre:** Serves about 5,000 people (3,000 in hilly or tribal areas). Staffed by an ANM and a male health worker.
- **Primary health centre:** Serves about 30,000 people (20,000 in difficult areas). Referral unit for six sub-centres.
- **Community health centre:** Serves about 120,000 people. Provides specialist care in medicine, surgery, obstetrics and paediatrics.
- **ASHA:** Trained female community volunteer linking the village to health services and promoting institutional care.
NMC competencies in this chapter
- **CM17.1:** Concept of health care to the community
- **CM17.2:** Community diagnosis
- **CM17.3:** Primary health care, its components and principles
- **CM17.4:** National health policies and the Sustainable Development Goals
- **CM17.5:** Health care delivery in India
Frequently Asked Questions
What are the four principles of primary health care?
The four principles set out at Alma-Ata are equitable distribution of services, community participation, intersectoral coordination, and the use of appropriate and affordable technology, all directed at achieving Health for All.
What population does each rural health facility serve?
A sub-centre serves about five thousand people, a primary health centre about thirty thousand and a community health centre about one hundred and twenty thousand, with lower thresholds in hilly, tribal and difficult areas.
Who is an ASHA and what does she do?
An accredited social health activist, or ASHA, is a trained female community health volunteer who acts as the first link between the village and the health system, promoting institutional delivery, immunisation and health awareness.
What is community diagnosis?
Community diagnosis is the process of identifying and quantifying the major health problems and their determinants in a defined population, so that services and resources can be planned to meet the community's actual needs.
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