🔰 Levels of Prevention in Public Health

The concept was given by Leavell and Clark in 1965 and includes four levels:

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1️⃣ Primordial Prevention 🧬

🔹 Focus: Preventing the emergence of risk factors

🧠 Meaning: Action taken before risk factors develop in a population.

💡 Examples:

• Promoting healthy lifestyle in children
• Discouraging junk food, smoking
• Urban planning to promote physical activity 🏃‍♀️
• School health education 📚

👩‍⚕️ Nursing Role:

• Counseling parents
• Community awareness campaigns

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2️⃣ Primary Prevention 🚫🦠

🔹 Focus: Preventing disease before it occurs

🧠 Meaning: Action taken when person is apparently healthy, but exposed to risk factors.

🧰 Methods:

• Health Promotion (education, nutrition, hygiene, etc.)
• Specific Protection (immunization, prophylaxis)

💡 Examples:

• DPT vaccination 💉
• Using mosquito nets for malaria
• Wearing helmets and seatbelts 🪖

👩‍⚕️ Nursing Role:

• Immunization drives
• IEC (Information, Education & Communication) sessions

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3️⃣ Secondary Prevention 🔍🧪

🔹 Focus: Early diagnosis and prompt treatment

🧠 Meaning: Action taken to detect and treat disease in early stages.

🧰 Methods:

• Screening (cancer, hypertension, diabetes)
• Case finding
• Early treatment

💡 Examples:

• Mammography for breast cancer 🎗️
• Pap smear test for cervical cancer
• BP & blood sugar checks 🩸

👩‍⚕️ Nursing Role:

• Conducting health check-up camps
• Referring patients for treatment

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4️⃣ Tertiary Prevention 🏥♿

🔹 Focus: Limiting disability and rehabilitation

🧠 Meaning: Actions taken after disease has caused damage, to restore function and prevent complications.

🧰 Methods:

• Disability limitation
• Rehabilitation (physical, social, vocational)

💡 Examples:

• Physiotherapy for stroke survivors 🧠
• Cardiac rehab after heart attack ❤️
• Use of prosthesis after amputation

👩‍⚕️ Nursing Role:

• Rehabilitation nursing
• Home care and support

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📝 Mnemonic for Levels of Prevention

“Please Pray Someone Tries”
🔹 Primordial
🔹 Primary
🔹 Secondary
🔹 Tertiary

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📌 Common MCQ-Style Review:

✅ Q: Pap smear test is an example of which level of prevention?
🅰️ Secondary Prevention

✅ Q: Immunization is an example of —
🅰️ Primary Prevention

✅ Q: Rehabilitation after stroke falls under —
🅰️ Tertiary Prevention

✅ Q: Health education to prevent onset of obesity in school children is —
🅰️ Primordial Prevention

🩺🔰 Levels of Health Care

Health care services are organized at three major levels to provide comprehensive health care based on need, severity, and accessibility.

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1️⃣ Primary Health Care (PHC) 🏡

✅ First level of contact between individual & health system
✅ Focus: Prevention, Promotion & Basic Care

🔹 Provided through:

• Sub-Centres (SC) 🏠
• Primary Health Centres (PHC) 🏥
• Village Health & Wellness Centres

🔹 Key Services:

• Immunization 💉
• ANC checkups 🤰
• Health education 🧠
• Minor ailments treatment 🩹
• Family planning services 👨‍👩‍👧‍👦
• Nutrition education 🍎

🔹 Health Workers:

• ANMs, MPWs, ASHA, Community Health Officers

🎯 Goal: Universal, accessible, and affordable care for all

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2️⃣ Secondary Health Care 🏨

✅ More advanced care than PHC
✅ Focus: Specialist care & referral services

🔹 Provided through:

• Community Health Centres (CHCs)
• District Hospitals 🏥

🔹 Key Services:

• Emergency care 🚑
• Basic surgeries 🩼
• Specialist OPDs (ENT, Gynae, Ortho, etc.) 🩻
• Hospitalization facilities 🛏️
• Diagnostic services 🔬

🔹 Health Personnel:

• General physicians, surgeons, obstetricians, pediatricians, lab technicians

🎯 Goal: Support and strengthen PHC with expertise & hospitalization

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3️⃣ Tertiary Health Care 🏥🔬

✅ Most advanced and specialized care
✅ Focus: Super-specialty and intensive care

🔹 Provided through:

• Medical Colleges
• Super-specialty Hospitals (AIIMS, NIMHANS, etc.) 🧠❤️🫁

🔹 Key Services:

• Organ transplant 🧬
• Cardiac surgery 🫀
• Neurosurgery 🧠
• Cancer treatment 🎗️
• ICU, NICU, PICU care 🧑‍⚕️

🔹 Health Personnel:

• Super-specialists, intensivists, advanced surgical teams

🎯 Goal: Manage complex health conditions requiring high-level care

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🧠 Comparison Chart Summary

Level	Services	Facilities	Providers	Example Conditions
Primary	Preventive, Basic	SC, PHC	ANM, MPW, ASHA	Cough, Fever, Immunization
Secondary	Curative, Referral	CHC, District Hosp.	Doctors, Surgeons	Fracture, Childbirth
Tertiary	Super-specialty	AIIMS, Medical Coll	Super-specialists	Cancer, Transplants

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📌 MCQ-Style Review

✅ Q: First level of contact between people and health system is —
🅰️ Primary Health Care

✅ Q: CHC provides what level of health care?
🅰️ Secondary

✅ Q: Neurosurgery is provided at which level of health care?
🅰️ Tertiary Health Care

✅ Q: Health care level provided at PHC and SC includes —
🅰️ Immunization, nutrition, family planning

👥📈 Population & Health Care Services with Required Health Workers

The Government of India provides guidelines based on population norms for the deployment of health infrastructure & human resources in rural and urban areas to ensure equitable and accessible healthcare.

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🌾 Rural Health Care Services (as per population norms)

🚩 Level	👥 Population Coverage	🏥 Facility/Worker
Sub-Centre (SC)	5,000 (plain) / 3,000 (tribal)	ANM, MPW (F/M), ASHA
Primary Health Centre	30,000 (plain) / 20,000 (tribal)	MO (1), Nurse (2), Pharmacist, Lab Tech
Community Health Centre	1,20,000 (plain)/80,000 (tribal)	Specialist Doctors (4), Nurses, Lab, OT techs
District Hospital	~10–12 lakh	Specialists, Superintendents, Nursing & Tech team

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🏙️ Urban Health Care Services (NUHM norms)

🏢 Facility	👥 Population Norm	👨‍⚕️ Required Workers
Urban Primary Health Centre (UPHC)	50,000	MO (1), Staff Nurse (2), ANM, Pharmacist, Lab Tech
Urban Community Health Centre	2,50,000	Specialist team (Gynae, Pediatrician, Physician)
Urban ASHA	1,000–2,500 population	1 Urban ASHA per 1,000–2,500 people

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💉 Workers Required at Each Level (Rural Setup)

🏠 Sub-Centre (SC)

• 1 Female Health Worker (ANM)
• 1 Male Health Worker (MPW-M)
• 1 ASHA per 1,000 population
• Health Supervisor (LHV) for every 6 SCs

🏥 Primary Health Centre (PHC)

• 1 Medical Officer (MBBS)
• 1 AYUSH MO (optional)
• 2 Staff Nurses
• 1 Pharmacist
• 1 Lab Technician
• 1 Health Worker (M/F)

🏨 Community Health Centre (CHC)

• 4 Specialists (Physician, Surgeon, Obstetrician/Gynecologist, Pediatrician)
• 6 Staff Nurses
• 1 Radiographer
• 1 Pharmacist
• 1 Lab Technician
• 1 OT Assistant

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🎯 GOALS of This Norm-Based System

✅ Ensure equity in access
✅ Adequate workforce-to-population ratio
✅ Better referral linkage
✅ Comprehensive primary health care delivery
✅ Reduce maternal & infant mortality

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🧠 Golden One-Liners for Exams

🟩 Q: Population norm for establishing a Sub-Centre in plain areas?
🅰️ 5,000 population

🟩 Q: Who is the first contact health worker in a village?
🅰️ ASHA (Accredited Social Health Activist)

🟩 Q: How many people does one PHC cover in tribal areas?
🅰️ 20,000

🟩 Q: How many specialists are there in a CHC?
🅰️ 4 (Physician, Surgeon, OBG, Pediatrician)

🟩 Q: District Hospital serves a population of approximately?
🅰️ 10–12 lakh