COH-1903-COMMUNITY HEALTH NURSING–SYNOPSIS

Stages of Disease Cycle

1. Incubation Period – Time between exposure and symptom onset (Pathogen multiplies, but no signs).
2. Prodromal Stage – Early, mild symptoms (e.g., fever, fatigue); pathogen spreads.
3. Acute Stage – Severe symptoms, peak infection, high transmission risk.
4. Decline Stage – Symptoms reduce, pathogen count decreases, recovery begins.
5. Convalescence Stage – Recovery phase, immune system repairs, may still be contagious.
6. Chronic/Latent Stage (Optional) – Dormant infection (e.g., TB, HIV), can reactivate later.

🔹 Key for Exams:

• Incubation Period varies (e.g., COVID-19: 2–14 days).
• Carrier State: Asymptomatic but transmits disease (e.g., Typhoid carrier).
• Quarantine (for exposed) vs. Isolation (for infected).
• Helps in outbreak control, vaccination, public health interventions.

Levels of Prevention

1. Primordial Prevention – Prevention of Risk Factors
   • Focus: Policy-making, lifestyle changes to prevent disease risk factors.
   • Example: Banning tobacco ads, promoting healthy diets.
2. Primary Prevention – Preventing Disease Occurrence
   • Focus: Health promotion & specific protection.
   • Example: Vaccination, sanitation, safe drinking water, health education.
3. Secondary Prevention – Early Diagnosis & Treatment
   • Focus: Screening, early detection, preventing complications.
   • Example: Mammography for breast cancer, BP screening for hypertension.
4. Tertiary Prevention – Reducing Disability & Rehabilitation
   • Focus: Managing disease to prevent worsening & improving quality of life.
   • Example: Physiotherapy for stroke patients, insulin therapy for diabetes.
5. Quaternary Prevention – Avoiding Overmedicalization
   • Focus: Preventing unnecessary treatments & interventions.
   • Example: Avoiding excessive antibiotics, reducing unnecessary surgeries.

🔹 Key for Exams:

• Primary = Prevent, Secondary = Detect, Tertiary = Treat, Quaternary = Avoid harm.
• Screening = Secondary Prevention (e.g., Pap smear for cervical cancer).
• Vaccination = Primary Prevention.
• Rehabilitation = Tertiary Prevention.

Iceberg of Disease

🔹 Concept: Diseases exist in a visible (clinical) and hidden (subclinical) form, like an iceberg where only a small part is seen above water.

1. Clinical Cases (Visible Part of Iceberg)
   • Diagnosed, symptomatic cases seen in hospitals.
   • Example: Diagnosed TB, COVID-19 with symptoms.
2. Subclinical Cases (Hidden Part of Iceberg)
   • Undiagnosed, asymptomatic, carriers, latent infections.
   • Example: Asymptomatic COVID-19 cases, latent TB, Hepatitis B carriers.

🔹 Key for Exams:

• Larger hidden burden = Challenges in disease control.
• Screening helps detect subclinical cases (e.g., HIV, TB, cancer screening).
• More subclinical cases = Higher disease transmission.

Spectrum of Disease

🔹 Concept: Diseases progress through various stages, from exposure to outcome.

1. Exposure – Contact with the causative agent.
2. Subclinical Stage – No symptoms, but pathogen present (e.g., HIV before AIDS develops).
3. Clinical Stage – Signs & symptoms appear, may be mild or severe (e.g., Dengue fever).
4. Outcome – Recovery, disability, or death.

🔹 Key for Exams:

• Acute diseases (e.g., flu) → Short duration.
• Chronic diseases (e.g., diabetes, TB) → Long-term effects.
• Spectrum explains disease progression & helps in intervention planning.

Modes of Disease Transmission

🔹 1. Direct Transmission – Person-to-Person Contact

• Droplet infection – Coughing, sneezing (e.g., COVID-19, TB, Influenza)
• Contact transmission – Touching, kissing, sexual contact (e.g., HIV, Herpes, Scabies)
• Transplacental (Vertical) – Mother to child (e.g., HIV, Syphilis, Rubella)

🔹 2. Indirect Transmission – Via Intermediaries

• Fomite transmission – Objects like towels, utensils (e.g., Hepatitis B, MRSA)
• Vector-borne – Through insects/animals
  • Mechanical (Passively carried) – Flies spreading cholera
  • Biological (Inside vector’s body) – Mosquitoes spreading malaria, dengue
• Airborne (Droplet Nuclei) – Suspended particles (e.g., Measles, TB)
• Waterborne/Foodborne – Contaminated food/water (e.g., Cholera, Hepatitis A)
• Zoonotic – From animals to humans (e.g., Rabies, Plague, Brucellosis)

🔹 Key for Exams:

• HIV, Syphilis = Direct (Sexual, Vertical)
• TB, Measles = Airborne
• Malaria, Dengue = Vector-borne (Biological)
• Cholera, Typhoid = Waterborne/Foodborne
• Rabies = Zoonotic
• Prevention Strategies: Hand hygiene, vaccination, vector control, sanitation

Integrated Management of Neonatal and Childhood Illness (IMNCI) –

🔹 Full Form:
IMNCI = Integrated Management of Neonatal and Childhood Illness

🔹 Purpose:
A strategy to reduce neonatal and childhood mortality & morbidity by improving healthcare services at all levels.

Key Components of IMNCI

IMNCI follows a three-pronged approach:

1. Improvement in Case Management Skills of Health Workers
   • Training healthcare workers (ANMs, ASHAs, Nurses, Doctors)
   • Early identification & treatment of childhood illnesses
   • Focus on pneumonia, diarrhea, malaria, measles, and malnutrition
2. Strengthening Health System
   • Ensuring adequate supplies of drugs & equipment
   • Improving referral services
   • Strengthening health facilities
3. Family & Community-Level Interventions
   • Health education to caregivers and mothers
   • Promotion of breastfeeding, nutrition, hygiene
   • Recognition of danger signs (e.g., fast breathing, fever, convulsions)

IMNCI Case Management Process

🔹 1. Assessment

• Check for danger signs (Convulsions, lethargy, inability to feed, vomiting)
• Measure temperature, respiration, weight
• Assess for specific diseases (Diarrhea, Pneumonia, Malaria, Malnutrition)

🔹 2. Classification (Diagnosis)

• Green (Mild): Home care, counseling, follow-up
• Yellow (Moderate): Treat with medicines, refer if needed
• Red (Severe): Immediate referral to a higher facility

🔹 3. Treatment

• Provide antibiotics, ORS, antimalarials, zinc supplementation
• Nutritional support for malnourished children
• Vitamin A, deworming

🔹 4. Referral & Follow-up

• Severe cases referred to hospitals
• Follow-up visits ensure recovery

IMNCI Vs. IMCI

• IMCI (Integrated Management of Childhood Illness) – WHO strategy for children aged 2 months to 5 years
• IMNCI (Integrated Management of Neonatal and Childhood Illness) – Includes neonates (0–2 months) & children (2 months–5 years)
• IMNCI is adapted for India, with greater focus on newborn care

Key for Exams

✅ IMNCI covers 0–5 years, while IMCI covers 2 months–5 years
✅ 3 components: Health workers training, Health system strengthening, Community interventions
✅ Covers pneumonia, diarrhea, malaria, malnutrition, measles
✅ Danger signs: Convulsions, fast breathing, unable to feed, fever
✅ Treatment: ORS, antibiotics, zinc, Vitamin A, nutrition support

Important Child Health Programs in India

1. Navjaat Shishu Suraksha Karyakram (NSSK)

🔹 Full Form: Navjaat Shishu Suraksha Karyakram
🔹 Launch Year: 2009
🔹 Objective: Reduce neonatal mortality by improving newborn care at delivery points.
🔹 Key Components:

• Training of healthcare workers (Doctors, Nurses, ANMs) in essential newborn care.
• Focus on Resuscitation, Prevention of infection, Thermal protection, Breastfeeding.
• Use of Neonatal Resuscitation Devices for birth asphyxia management.
  🔹 Target Group: Newborns (0-28 days)

✅ Key for Exams:

• Focus: Essential newborn care (Golden Hour Concept).
• Trained healthcare workers: Doctors, Nurses, ANMs.
• Main aim: Reduce Neonatal Mortality Rate (NMR).

2. Rashtriya Bal Swasthya Karyakram (RBSK)

🔹 Full Form: Rashtriya Bal Swasthya Karyakram
🔹 Launch Year: 2013
🔹 Objective: Early identification and management of health conditions in children.
🔹 Key Components:

• Screening for 4D’s:
  1. Defects at Birth (Congenital anomalies)
  2. Diseases in Childhood (Anemia, Malnutrition, Skin conditions)
  3. Deficiencies (Iron, Vitamin A, Iodine deficiency)
  4. Developmental Delays and Disabilities (Hearing, Vision, Neuromotor issues)
• Screening at schools & Anganwadi centers.
• Referral services to District Early Intervention Centers (DEICs).
  🔹 Target Group: Children 0-18 years

✅ Key for Exams:

• Focus: 4D’s – Defects, Diseases, Deficiencies, Developmental Delays.
• Screening at: Schools, Anganwadi Centers.
• Referral to: DEIC (District Early Intervention Centers).

3. Bal Sakha Yojana (BSY)

🔹 Full Form: Bal Sakha Yojana
🔹 Launch Year: 2008 (By Gujarat Government)
🔹 Objective: Ensure medical care for neonates born to BPL families.
🔹 Key Components:

• Free neonatal care for BPL families at private hospitals.
• First 30 days of life covered for preterm, low birth weight, birth asphyxia, sepsis, jaundice cases.
• Neonatal Intensive Care Unit (NICU) treatment provided at private hospitals.
  🔹 Target Group: Newborns of BPL families

✅ Key for Exams:

• State-Specific Program (Gujarat).
• Focus: Free neonatal care for BPL families.
• Duration: First 30 days of life.

Quick Comparison Table for Exams

Program	Launch Year	Target Age	Key Focus
NSSK	2009	0-28 days	Essential newborn care (Resuscitation, Infection Prevention)
RBSK	2013	0-18 years	Screening for 4Ds (Defects, Diseases, Deficiencies, Disabilities)
Bal Sakha Yojana	2008 (Gujarat)	Newborns (BPL families)	Free neonatal care in private hospitals

✅ NSSK = Newborn care, Golden Hour, Neonatal resuscitation.
✅ RBSK = 4Ds screening (Defects, Diseases, Deficiencies, Disabilities) + DEIC referrals.
✅ Bal Sakha Yojana = Free neonatal care for BPL newborns in Gujarat.

Occupational Health & Diseases

Occupational diseases are caused due to exposure to physical, chemical, biological, ergonomic, and psychosocial hazards at the workplace.

1. Occupational Diseases Classification & Key Disorders

A. Diseases Due to Physical Hazards

Disease	Cause	High-Risk Occupations
Noise-Induced Hearing Loss (NIHL)	Continuous exposure to loud noise (>85 dB)	Factory workers, Aviation staff, Construction workers
Radiation Sickness	Ionizing radiation (X-rays, UV, gamma rays)	Radiologists, Nuclear plant workers, Astronauts
Vibration White Finger (Hand-Arm Vibration Syndrome – HAVS)	Use of vibrating tools	Jackhammer operators, Miners, Lumberjacks
Heat Stroke & Heat Exhaustion	Prolonged heat exposure	Glass factory workers, Foundry workers, Firefighters
Cold Stress & Frostbite	Exposure to extremely low temperatures	Ice factory workers, Arctic researchers

B. Diseases Due to Chemical Hazards

Disease	Cause	High-Risk Occupations
Lead Poisoning (Plumbism)	Lead exposure	Battery, Paint, Printing workers
Mercury Poisoning	Mercury inhalation	Dentists, Thermometer factory workers
Arsenic Poisoning	Exposure to arsenic compounds	Pesticide industry, Glass manufacturing
Benzene Poisoning (Aplastic Anemia, Leukemia)	Benzene fumes	Petrochemical workers, Paint industry
Carbon Monoxide Poisoning	Inhalation of CO gas	Firefighters, Tunnel workers, Foundry workers
Chromium Toxicity (Nasal Septum Perforation, Lung Cancer)	Chromium dust exposure	Leather tanning, Dye industry workers

C. Pneumoconiosis (Lung Diseases Due to Inhalation of Dust)

Disease	Cause	High-Risk Occupations
Silicosis	Inhalation of silica dust	Miners, Stone cutters, Glass industry
Asbestosis	Inhalation of asbestos fibers	Shipyard workers, Construction workers
Coal Workers’ Pneumoconiosis (Black Lung Disease)	Coal dust	Coal miners
Byssinosis (Brown Lung Disease)	Cotton dust	Textile industry, Cotton mill workers
Bagassosis	Sugarcane dust inhalation	Sugarcane industry
Farmer’s Lung Disease	Mold spores in hay & grain	Farmers, Agricultural workers

D. Diseases Due to Biological Hazards

Disease	Cause	High-Risk Occupations
Anthrax (Wool Sorters’ Disease)	Bacillus anthracis	Farmers, Wool industry workers
Brucellosis (Undulant Fever)	Brucella bacteria from livestock	Dairy farm workers, Veterinarians
Leptospirosis (Weil’s Disease)	Bacteria from contaminated water	Sewer workers, Flood-affected areas
Tuberculosis (TB)	Airborne transmission of Mycobacterium tuberculosis	Healthcare workers, Prison staff
Hepatitis B & C	Bloodborne virus	Healthcare workers, Lab technicians
COVID-19 & SARS	Respiratory virus	Healthcare workers, Airport staff

E. Musculoskeletal & Ergonomic Disorders

Disease	Cause	High-Risk Occupations
Carpal Tunnel Syndrome (CTS)	Repetitive hand movement	IT professionals, Typists
Tennis Elbow (Lateral Epicondylitis)	Repeated wrist & arm motion	Mechanics, Painters
Back Pain & Disc Herniation	Heavy lifting, Poor posture	Construction workers, Nurses
Cervical Spondylosis	Long sitting hours, Poor posture	IT professionals, Office workers
Varicose Veins	Prolonged standing	Nurses, Shopkeepers, Hairdressers

F. Psychological & Social Hazards

Disease	Cause	High-Risk Occupations
Occupational Stress & Depression	Work pressure, Job insecurity	Call centers, IT professionals, Nurses
Burnout Syndrome	Chronic workplace stress	Healthcare workers, Social workers
Workplace Violence & PTSD	Exposure to trauma & abuse	Police officers, Military personnel
Alcoholism & Substance Abuse	Work-related stress	Corporate jobs, Entertainment industry

2. Prevention & Control of Occupational Diseases

A. Primary Prevention (Eliminate Exposure)

• Engineering Controls: Proper ventilation, noise reduction, machine safety.
• Administrative Controls: Reducing work hours, job rotation.
• Personal Protective Equipment (PPE): Gloves, masks, goggles, earplugs.
• Workplace Hygiene: Safe disposal of chemicals, clean environment.

B. Secondary Prevention (Early Detection & Treatment)

• Regular Health Checkups (X-rays for miners, hearing tests for factory workers).
• Medical Surveillance & Screening Programs.

C. Tertiary Prevention (Rehabilitation & Compensation)

• Medical Treatment & Rehabilitation for affected workers.
• Disability Benefits & Compensation (ESIC, Workmen’s Compensation Act).

The Employees’ State Insurance (ESI) Act, 1948 & The Factories Act, 1948

1. The Employees’ State Insurance (ESI) Act, 1948

🔹 Objective:

• To provide social security & health insurance to employees in case of sickness, maternity, disability, or work-related injuries.

🔹 Applicability:

• Applicable to: Factories, Shops, Establishments with ≥ 10 employees.
• Wage Limit: Employees earning up to ₹21,000/month (₹25,000 for disabled workers) are covered.

🔹 Key Benefits Under ESIC:

1. Medical Benefit: Free medical care for insured workers & families.
2. Sickness Benefit: 70% of wages paid for 91 days during certified illness.
3. Maternity Benefit: 100% wages for 26 weeks for pregnancy.
4. Disablement Benefit:
   • Temporary: 90% of wages paid for injury-related leave.
   • Permanent: Pension based on disability percentage.
5. Dependents’ Benefit: Monthly pension for family if worker dies due to occupational injury.
6. Unemployment Allowance: 50% of wages paid for 24 months in case of job loss.

🔹 ESI Fund Contributions:

• Employer: 3.25% of wages
• Employee: 0.75% of wages
• Government: Contributes for specific schemes

🔹 Key Features for Exams:
✅ Covers medical, sickness, maternity, disability, and dependents’ benefits.
✅ Covers factories & establishments with 10+ workers (₹21,000 salary limit).
✅ Employer (3.25%) & Employee (0.75%) contribute to ESIC.
✅ Administered by: Employees’ State Insurance Corporation (ESIC).

2. The Factories Act, 1948

🔹 Objective:

• To ensure worker safety, health, and welfare in industrial settings.

🔹 Applicability:

• Factories with 10+ workers (power-operated) & 20+ workers (non-power).

🔹 Key Provisions of the Act:

A. Health Provisions

✅ Cleanliness – Factories must be kept clean & hygienic.
✅ Ventilation & Temperature Control – Proper airflow to avoid suffocation.
✅ Drinking Water – Safe drinking water must be provided.
✅ Toilets & Washing Facilities – Adequate sanitary provisions.

B. Safety Provisions

✅ Fencing of Machinery – Dangerous machines must be covered.
✅ Precautions Against Fire – Fire safety measures are mandatory.
✅ Worker Training & PPE – Workers must be trained in machinery handling.
✅ Prohibition of Child Labor – Employment of children under 14 years is banned.

C. Welfare Provisions

✅ Canteens – Compulsory in factories with 250+ workers.
✅ Restrooms & Crèche – Mandatory for factories with 30+ women workers.
✅ Working Hours:

• Adults: Max 48 hours/week (9 hrs/day), 1 weekly off.
• Overtime: Extra pay for work beyond 9 hours/day.
• Women Workers: Allowed only 6 AM – 7 PM (No night shifts).

🔹 Key Features for Exams:
✅ Factories with 10+ (power) & 20+ (non-power) workers covered.
✅ 48-hour work week, restrooms, safety measures, no child labor.
✅ Canteens (250+ workers), Crèche (30+ women workers) mandatory.
✅ Ensures worker safety, hygiene, and well-being.

Quick Comparison for Exams

Aspect	ESI Act, 1948	Factories Act, 1948
Objective	Provides social security & medical benefits	Ensures worker health, safety & welfare
Applicability	Factories/establishments with 10+ workers	Factories with 10+ (power) & 20+ (non-power) workers
Coverage	Workers earning ≤ ₹21,000/month	All factory workers
Key Benefits	Medical, Sickness, Maternity, Disability, Pension	Hygiene, Safety, Working hours, Welfare
Contributions	Employer (3.25%), Employee (0.75%)	Not contribution-based
Administering Body	ESIC (Employees’ State Insurance Corporation)	State Labor Departments
Work Hours	48 hours/week	48 hours/week, 9 hours/day
Special Provisions	Cash benefits for sickness, pregnancy, disability	Canteens, Creches, Safety, Fire Precautions

Key Takeaways for Exams:

✅ ESI Act = Social Security, Factories Act = Worker Safety.
✅ ESI applies to ₹21,000 salary workers; Factories Act applies to all workers.
✅ ESI = Medical, Sickness, Maternity Benefits; Factories Act = Health, Safety, Working Hours.
✅ ESI contributions are employer (3.25%) & employee (0.75%); Factories Act has no direct financial contribution.

Primary Health Care (PHC)

1. Elements of Primary Health Care (As per Alma-Ata Declaration, 1978)

🔹 Acronym to Remember: “CHEAP SIR”

Element	Description
C – Community Participation	Encouraging community involvement in healthcare programs.
H – Health Education	Spreading awareness about disease prevention & healthy living.
E – Essential Drug Supply	Availability of basic medicines at PHCs.
A – Adequate Food & Nutrition	Addressing malnutrition & food security.
P – Promotion of Maternal & Child Health	Immunization, safe childbirth, postnatal care.
S – Safe Water & Sanitation	Providing clean drinking water & proper waste disposal.
I – Immunization	Protecting against vaccine-preventable diseases.
R – Rural Health Services	Extending healthcare to remote & rural areas.

✅ Key for Exams:

• 8 essential elements ensure preventive, curative, and promotive care.
• First-level healthcare approach as per Alma-Ata Declaration, WHO 1978.

2. Principles of Primary Health Care

🔹 Acronym to Remember: “EQUITY”

Principle	Description
E – Equitable Distribution	Health services accessible to all, especially rural & underserved areas.
Q – Quality of Care	Services should be effective, evidence-based, and people-centered.
U – Universal Coverage	Ensuring health services for all, irrespective of socio-economic status.
I – Inter-sectoral Coordination	Collaboration between health, education, nutrition, water, and sanitation sectors.
T – Technology that is Appropriate	Using cost-effective, locally suitable health technologies.
Y – Your Community Involvement	Active participation of individuals & communities in their health.

✅ Key for Exams:

• Focus on equity, accessibility, & community participation.
• Multi-sectoral approach for health improvement.

3. Levels of Health Care

Health services are provided at three levels:

Level	Key Features	Example Facilities
Primary Level	First point of contact, Preventive & Basic Curative Care	Sub-Centers, Primary Health Centers (PHCs)
Secondary Level	Referral services, Specialized treatment	Community Health Centers (CHCs), District Hospitals
Tertiary Level	Advanced care, Super-specialty hospitals	Medical Colleges, AIIMS, Corporate Hospitals

✅ Key for Exams:

• Primary (First Contact, Basic Care) → Secondary (Specialized Care) → Tertiary (Super-Specialized Care).
• Primary = PHCs & SCs, Secondary = CHCs & District Hospitals, Tertiary = AIIMS & Medical Colleges.

Quick Summary

Concept	Key Points
Primary Health Care Elements	“CHEAP SIR” – Community Participation, Health Education, Essential Drugs, Nutrition, Maternal & Child Health, Safe Water, Immunization, Rural Health Services
Principles of PHC	“EQUITY” – Equitable Distribution, Quality, Universal Coverage, Inter-sectoral Coordination, Appropriate Technology, Community Participation
Levels of Healthcare	Primary (Basic) → Secondary (Specialist) → Tertiary (Super-Specialty).

Primary Health Care in India with Population Coverage & Levels of Health Care System

1. Primary Health Care in India

🔹 Definition:
Primary Health Care (PHC) in India focuses on providing essential health services to people at the grassroots level, especially in rural and underserved areas.

🔹 Based on:

• Alma-Ata Declaration, 1978 (WHO’s goal of Health for All by 2000).
• National Health Policy, 1983, 2002, 2017 aimed at strengthening PHC.

🔹 Objectives of PHC in India:
✅ Accessible & affordable healthcare for all.
✅ Reduction in Infant & Maternal Mortality Rates (IMR & MMR).
✅ Prevention & control of communicable & non-communicable diseases.
✅ Providing maternal & child healthcare, immunization, family planning.
✅ Improving sanitation, hygiene, & nutrition.

2. Health Care System in India (Three-Tier System)

A. Primary Level (First Contact & Basic Care)

🔹 Population Coverage & Facilities:

Facility	Population Coverage	Staffing	Services Provided
Sub-Center (SC)	5,000 (Plains), 3,000 (Hills/Tribal Areas)	1 ANM, 1 Male Health Worker	Immunization, Antenatal Care, Family Planning, Minor Ailments
Primary Health Center (PHC)	30,000 (Plains), 20,000 (Hills)	Medical Officer, Nurses, Pharmacist	Outpatient Care, Minor Surgeries, MCH Services, Disease Control
Health & Wellness Centers (HWCs)	Same as PHCs/SCs	Community Health Officers (CHOs)	Non-Communicable Disease Care, Telemedicine, Screening

✅ Key for Exams:

• SC = First Contact, Basic Health Needs.
• PHC = Referral Unit for SCs, Basic OPD & Maternal Services.
• HWCs = Upgraded PHCs with focus on Preventive & Chronic Diseases.

B. Secondary Level (Referral & Specialized Care)

🔹 Population Coverage & Facilities:

Facility	Population Coverage	Services Provided
Community Health Center (CHC)	1,20,000 (Plains), 80,000 (Hills)	30-bedded Hospital, General Surgery, Emergency Care
District Hospital (DH)	One per District	Multi-specialty Care, ICU, Surgical & Trauma Care

✅ Key for Exams:

• CHC = Serves as a referral center for PHCs, provides surgical care.
• DH = Highest facility at district level, caters to major health issues.

C. Tertiary Level (Super-Specialty Care & Research)

🔹 Facilities:

Facility	Population Coverage	Services Provided
Medical Colleges & AIIMS	Regional/National	Super-specialty services, Research, Training
Specialty Hospitals	Large Population	Cancer Institutes, Cardiology Centers, Neurology Centers

✅ Key for Exams:

• Medical Colleges = Provide tertiary care & train doctors.
• AIIMS = Apex institute for research & advanced care.

3. Summary Table of Healthcare Levels in India

Level	Facilities	Population Coverage	Services Provided
Primary	SC, PHC, HWC	SC: 5,000 (Plains), 3,000 (Hills) PHC: 30,000 (Plains), 20,000 (Hills)	Preventive, OPD, MCH, Family Planning
Secondary	CHC, District Hospitals	CHC: 1,20,000 (Plains), 80,000 (Hills)	Surgical, Emergency, Specialist Care
Tertiary	Medical Colleges, AIIMS, Specialty Hospitals	Regional/National	Super-specialty care, Research, Teaching

4. Key

✅ Sub-Center (SC) → PHC → CHC → District Hospital → Medical College (3-Tier System).
✅ SC (5,000) → PHC (30,000) → CHC (1,20,000) → District Hospital (Whole District).
✅ PHCs & CHCs = Backbone of rural healthcare.
✅ Tertiary Care = AIIMS, Medical Colleges, Specialized Hospitals.
✅ Health & Wellness Centers (HWCs) = Strengthened PHCs with NCD focus.

Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs)

1. Millennium Development Goals (MDGs)

🔹 Introduction:
Adopted in 2000 by the United Nations, the MDGs aimed at addressing global challenges and improving living standards by 2015.

🔹 8 Key MDGs:

Goal	Objective
MDG 1	Eradicate Extreme Poverty and Hunger
MDG 2	Achieve Universal Primary Education
MDG 3	Promote Gender Equality and Empower Women
MDG 4	Reduce Child Mortality
MDG 5	Improve Maternal Health
MDG 6	Combat HIV/AIDS, Malaria, and Other Diseases
MDG 7	Ensure Environmental Sustainability
MDG 8	Develop a Global Partnership for Development

🔹 Achievements:
✅ Reduced extreme poverty rates by more than half.
✅ Increased primary school enrollment in developing regions.
✅ Reduced child mortality by nearly 50%.
✅ Improved access to drinking water and sanitation.

🔹 Challenges:
🚫 Persistent inequalities in income, gender, and education.
🚫 Incomplete maternal health and disease combat goals.

✅ Key for Exams:

• 8 Goals set in 2000, aimed for 2015.
• Focus on poverty, education, gender equality, health, environment.
• Successful in reducing poverty & improving education.

2. Sustainable Development Goals (SDGs)

🔹 Introduction:
Adopted in 2015, the SDGs are a universal call to end poverty, protect the planet, and ensure peace and prosperity by 2030.

🔹 17 Key SDGs:

Goal	Objective
SDG 1	End Poverty in all forms everywhere
SDG 2	Zero Hunger
SDG 3	Good Health and Well-being
SDG 4	Quality Education
SDG 5	Gender Equality
SDG 6	Clean Water and Sanitation
SDG 7	Affordable and Clean Energy
SDG 8	Decent Work and Economic Growth
SDG 9	Industry, Innovation, and Infrastructure
SDG 10	Reduce Inequality within and among countries
SDG 11	Sustainable Cities and Communities
SDG 12	Responsible Consumption and Production
SDG 13	Climate Action
SDG 14	Life Below Water
SDG 15	Life on Land
SDG 16	Peace, Justice, and Strong Institutions
SDG 17	Partnerships for the Goals

🔹 Targets:

• 169 specific targets across 17 goals.
• Comprehensive focus on economic, social, and environmental sustainability.

🔹 Key Features:
✅ Universal Applicability: Applicable to all countries.
✅ Integrated Approach: Balances economic, social, and environmental dimensions.
✅ Leave No One Behind: Inclusive and equitable growth.

✅ Key for Exams:

• 17 Goals with 169 Targets set in 2015, aimed for 2030.
• Focus on broader issues: Poverty, Health, Education, Environment, Justice, Partnerships.
• SDGs are more comprehensive and interconnected than MDGs.

Comparison: MDGs vs. SDGs

Aspect	MDGs (2000–2015)	SDGs (2015–2030)
Number of Goals	8	17
Number of Targets	21	169
Focus	Poverty, Health, Education, Gender	Poverty, Health, Education, Gender, Environment, Justice, Economy
Scope	Developing Countries	Universal (All Countries)
Approach	Top-Down	Participatory, Inclusive
Monitoring	Limited	Robust, Annual Voluntary Reviews
Key Achievement	Poverty Reduction	Comprehensive Sustainable Development

Key Takeaways for Competitive Exams:

✅ MDGs = 8 Goals (2000–2015) → Focused on Basic Human Rights.
✅ SDGs = 17 Goals (2015–2030) → Comprehensive Global Sustainability Agenda.
✅ SDGs Cover New Areas: Climate Action, Sustainable Cities, Responsible Consumption.
✅ SDGs Encourage Partnerships: Global collaboration for development.
✅ “Leave No One Behind” = Core Principle of SDGs.