Unit-V

Community Services in Rural, Urban and School Health

The primary hospital (PHC) is that the basic structural and functional unit of the general public
health services in developing countries, to supply accessible, affordable, and available primary
health care to people. OR "Primary health centres sometimes said as public health centers.

Primary Health Centre (PHCs), sometimes brought up as public health centres, are state-owned
rural health care facilities in India. They're essentially single-physician clinics usually with
facilities for minor surgeries, too. They are a part of the government-funded public health
system in India and are the foremost basic units of this technique. As on 31 March 2019, there
are 30,045 PHCs in India in which 24,855 are located on rural areas and 5,190 are on urban
areas.

PRIMARY HEALTH CENTRE (PHC)

PHC is that the first contact point between village community and also the medic. The PHCs
were envisaged to produce an integrated curative and preventive health care to the rural
population with emphasis on preventive and promotive aspects of health care. The PHCs are
established and maintained by the State governments under the Minimum Needs Programme
(MNP)/ Basic Minimum Services (BMS) Programme.

As per minimum requirement, a PHC is to be manned by a medical practitioner supported by

14 paramedical and other staff. Under NRHM, there's a provision for two additional staff nurses
at PHCs on contract basis. It acts as a referral unit for six Sub Centres and has 4-6 beds for
patients. The activities of PHC involve curative, preventive, promotive and family welfare
services.

There were 25,650 PHCs functioning within the country as on 31st March, 2017. At the
national level, there's a rise of 2414 PHCs by 2017 as compared thereto existed in 2005.
Significant increase is observed within the number of PHCs within the States of Karnataka
(678), Assam (404), Rajasthan (366), Jammu & Kashmir (303) and Chhattisgarh (268) and
Bihar (251).

Percentage of PHCs functioning in government buildings has increased significantly from 78%
in 2005 to 90.9% in 2017. This can be mainly because of increase within the government
buildings within the States of province (1681), Karnataka (841), Gujarat (450), Assam (403),
Madhya Pradesh (410), Maharashtra (232) and Chhattisgarh (336).

The number of allopathic doctors at PHCs has increased from 20308 in 2005 to 27124 in 2017,
which is about 33.6% increase. Shortfall of allopathic doctors in PHCs was 11.8% of the whole
requirement for existing infrastructure.

GOALS AND PRINCIPLES

➢ To reducing exclusion and social disparities in health.

➢ To organizing health services around people's needs and expectations.
➢ To integrating health into all sectors.
➢ To pursuing collaborative models of policy dialogue (leadership reforms).
➢ Health workforce developments.
➢ Community participation.

OBJECTIVES

➢ To provide comprehensive primary health care to the community at PHCs.

➢ To achieve and maintain an appropriate standard of quality of care.
➢ To make the services more responsive and sensitive to the necessity of the community.

FUNCTIONS OF PHC

The Indian government initiative to create and expand the presences of Primary Health Centres
throughout the country is consistent with the eight elements of primary health care outlined in
the Alma-Ata declaration. These are listed below:

➢ Provision of medical care

➢ Maternal-child health including family planning
➢ Safe water supply and basic sanitation
➢ Prevention and control of locally endemic diseases
➢ Collection and reporting of vital statistics
➢ Education about health
➢ National health programmes, as relevant
➢ Referral services
➢ Training of health guides, health workers, local dais and health assistants
➢ Basic laboratory workers
COMMUNITY HEALTH CENTRE (CHC)

CHCs are being established and maintained by the regime under MNP/BMS programme.

As per minimum norms, a CHC is required to be manned by four medical specialists i.e.
surgeon, physician, gynaecologist and paediatrician supported by 21 paramedical and other
staff. It's 30 in-door beds with one OT, X-ray, labour room and laboratory facilities.

It is a referral centre for 4 PHCs and also provides facilities for obstetric care and specialist
consultations.

As on 31st March, 2017, there have been 5,624 CHCs functioning within the country.
Significant increase is observed within the number of CHCs within the States of province (436),
state (350), and state (254), Rajasthan (253), Odisha (139), Jharkhand (141), Kerala (126),
Gujarat (91) and Madhya Pradesh (80).

Number of CHCs functioning in government buildings has also increased during the amount
2005-2017. The proportion of CHCs in Govt. buildings has increased from 91.6% in 2005 to
96.7% in 2017.

In addition to 4156 Specialists, 14350 General Duty Medical Officers (GDMOs) are available
at CHCs as on 31st March, 2017 There was huge shortfall of surgeons (86.5%), obstetricians
& gynaecologists (74.1%), physicians (84.6%) and paediatricians (81%). Overall, there was a
shortfall of 81.6% specialists at the CHCs vis-a-vis the necessity for existing CHCS.

FIRST REFERRAL UNIT (FRU)

An existing facility (District Hospital, Sub-divisional Hospital, Community Health Centre etc.)
may be declared a completely operational First Referral Unit (FRU) on condition that it's
equipped to supply round-the-clock services for emergency obstetric and New Born Care,
additionally to all or any emergencies that any hospital is required to produce. It should be
noted that there are three critical determinants of a facility being declared as a FRU:

Emergency Obstetric Care including surgical interventions like caesarean sections, New-born
care; and Blood storage facility on a 24-hour basis.

At present there are 3, 076 FRUs functioning within the country. Out of those total 94.2% of
the FRUs are having Operation Theatre facilities, 96.3% of the FRUs are having functional
Labour Room while 68.9% of the FRUs are having Blood Storage/ linkage facility.
Improvement in Rural Sanitation

CENTRAL RURAL SANITATION PROGRAMME (TOTAL SANITATION CAMPAIGN)

1. Individual health and hygiene depend largely on adequate availability of potable water and
proper sanitation. There is, therefore, an instantaneous relationship between water, sanitation
and health. Consumption of unsafe potable water, improper disposal of human excreta,
improper high infant mortality rate is additionally attributed largely to poor sanitation. It
absolutely was during this context that the Central Rural Sanitation Programme (CRSP) was
launched in 1986 with the target of improving the standard of lifetime of rural people and to
produce privacy and dignity to women.

2. The concept of sanitation was earlier limited to disposal of human excreta by oases pools,
open ditches, pit latrines, bucket system, etc. Today, it connotes a comprehensive concept,
which has liquid and solid waste disposal, food hygiene and personal, domestic still as
environmental hygiene.

Proper sanitation is important not only from the general health point of view but it's a
significant role to play in our individual and social life too. Sanitation is one in every of the
essential amenities people must have because it includes a direct link to food hygiene. Good
sanitation practices prevent contamination of water and soil, and thereby, prevent diseases. The
concept of sanitation was, therefore, expanded to incorporate personal hygiene, home
sanitation, safe water, disposal, excreta disposal and waste water disposal.

3. A comprehensive baseline survey on knowledge, attitudes and practices in rural facility and
sanitation was conducted during 1996-97 by the Indian Institute of Mass Communication,
which showed that 55 per cent of these with private latrines were self-motivated. Only 2 percent
of the respondents claimed the existence of subsidy because the major motivating factor, while
54 per cent claimed to possess gone sure sanitary latrines because of convenience and privacy.
The study also showed that 51 per cent of the beneficiaries were willing to spend up to 1,000
to accumulate sanitary toilets.

4. Keeping in sight the above facts, the Central Rural Sanitation Programme has been
improved. Thus, CRSP moves towards a 'demand-driven approach. The revised approach
within the Programme titled 'Total Sanitation Campaign (TSC) emphasizes more on
Information, Education and Communication (IEC), Human Resource Development, Capacity
Development activities to extend awareness and demand generation for sanitary facilities. This
may enhance people's capacity to decide on appropriate options through alternate delivery
mechanisms with beneficiary participation to fulfill their demands. The programme is being
implemented with target community-led and other people centred initiatives.

Objectives

The main objectives of the full Sanitation Campaign are as follows:

1. Bringing about an improvement within the general quality of life within the rural areas.

2. Accelerating sanitation coverage in rural areas.

3. Generating felt demand for sanitation facilities through awareness creation and health
education.

4. Covering schools in rural areas with sanitation facilities and promote sanitary habits among
students.

5. Encouraging cost-effective and appropriate technologies in sanitation.

6. Marketing endeavour to scale back the incidence of water and sanitation-related diseases.

Activities of Total Sanitation Campaign

1. The start-up activities include initial publicity, motivational campaign, conducting of

preliminary survey to assess the demand with the aim to arrange the District TSC project
proposals for seeking Government of India assistance.

2. Information, Education and Communication are the important components of the

Programme. These intend to create the demand for sanitary facilities within the rural areas for
households, schools, anganwadis and balwadies and ladies complexes. The activities disbursed
under this component should be area-specific and will also involve all sections of rural
population in an exceedingly manner, where willingness of the people to construct latrines is
generated.

RURAL SANITARY MARTS AND PRODUCTION CENTRES

The Rural Sanitary Mart (RSM) is, an outlet coping with the materials required for the
development of not only sanitary latrines but also other sanitary facilities required for people,
families and also the environment within the rural areas. The RSM should have those items,
which are required as an element of sanitation package. It's an advertisement enterprise with a
social objective.
The main aim of getting a RSM is to supply materials and guidance needed for constructing
different varieties of latrines and other sanitary facilities, which are technologically and
financially suitable to the agricultural areas. Production centres are the means to boost
production of cost effective affordable sanitary materials.

CONSTRUCTION OF INDIVIDUAL HOUSEHOLD LATRINES

A duly completed household sanitary latrine shall comprise a basic low-cost unit (without the
super structure). Within the first phase, the programme is aimed toward covering all the
families subsisting below the personal income. Subsidy disbursement shall be subject to shut
supervision and monitoring, and linked with the development activity so on ensure sincere
participation and full involvement of the community.

WOMEN SANITARY COMPLEX

Village Sanitary Complex for ladies is a very important component of the TSC. These
complexes is founded in an exceedingly place within the village acceptable to and accessible
to women. The upkeep of such complexes is extremely essential that Gram Panchayat should
own the responsibility or make alternative arrangements at the village level.

SCHOOL SANITATION

Children are more receptive to new ideas and faculty is an appropriate institution for changing
their behaviour, mindset and habits of open defecation to the utilization of bathroom through
motivation and education. The experience gained by children through use of toilets at school
and sanitation education imparted by teachers would reach home and influence parents to adopt
good sanitary habits.

School sanitation, therefore, forms an integral part of every TSC project. Toilets should be
constructed all told styles of government schools, i.e., primary, upper primary, secondary and
higher secondary.
National Urban Health Mission

The National Urban Health Mission (NUHM) as a sub-mission of National Health Mission
(NHM) has been approved by the cabinet on 1st May 2013.

NUHM envisages to satisfy health care needs of the urban population with the main target on
urban poor, by making available to them essential primary health care services and reducing
their out-of-pocket expenses for treatment. This can be achieved by strengthening the
prevailing health care service delivery system, targeting the people living in slums and
converging with various schemes referring to wider determinants of health like potable water,
sanitation, school education, etc. implemented by the Ministries of Urban Development,
Housing & Urban Poverty Alleviation, Human Resource Development and women & Child
Development.

OBJECTIVES

The National Urban Health Mission aims to enhance the health status of the urban population
with attention on disadvantaged and poor population. The mission aims to produce equitable
access to quality health care through a revamped public health system, partnerships (public-
public and public-private) and community-based mechanism.

The expected outcomes of the program are:

➢ Reducing infant death rate (IMR) in urban areas by 40% to 20 per 1000 population (if
you're comparing in percentage then keep it consistent).
➢ Reduce Maternal fatality rate (MMR) in urban areas by 50 you must 1 per 1000.
➢ Achieve universal access to reproductive health including 100% institutional delivery.
➢ Achieve Total birth rate of 2.1.

Achieve all targets of Disease Control Programmes (such as National Iodine Deficiency
Disorders Control Programme, National Vector Borne Disease Control Programme, Revised
National TB Control Programme, etc.).

NUHM FRAMEWORK FOR IMPLEMENTATION

In order to effectively address the health concerns of the urban poor population, the Ministry
has launched the sub-mission National Urban Health Mission (NUHM) under NHM. The
Mission Steering Group of the NHM is expanded to figure because the apex body for NUHM
also every Municipal Corporation, Municipality, Notified Area Committee, and city Panchayat
will become a unit of designing with its own approved broad norms for putting in place of
health facilities. The separate plans for Notified Area Committees, Town Panchayats and
Municipalities are a part of the District Health Plan immersed for a separate plan of action as
per broad norms for urban areas. The prevailing structures and mechanisms of governance
under NHM are going to be suitably adapted to fulfil the requirements of sub-mission NUHM
also.

National Level

Mission Steering Group- under the chairmanship of Minister, Health and Family Welfare. It
provides policy direction to the mission. It is empowered to approve financial norms of all
components of the mission.

Empowered Programme Committee- under the Secretary, Health and Family Welfare. It has
been given the flexibility to change financial norms approved by the mission steering group by
25%, with larger variations being approved by the mission steering group.

National Programme Coordination Committee- it is headed by the Mission Director, who

is of the rank of Additional Secretary. It is responsible for the appraisal of State programme
implementation plans.

State Health Mission- It is chaired by the Chief Minister and includes nominated public
representatives such as the MPs and MLAs in the state. It deals with policy matters related with
the health sector at the state level and insures inter-sectoral coordination.

State Level

State Health Society- It is chaired by the Chief Secretary and is the executive organ of the
State health mission. It is responsible for the approval of the state health plan and
implementation of the mission in the state.

State Program Management Support Unit- It will provide technical assistance to the state
health mission and society. It will have experts and skilled professionals like management
information system (MIS) specialists, consultants recruited.

City and community Level

States may either decide to constitute a separate City urban health mission and City urban
health society or use the existing structure of the District health mission and District health
society under the NRHM. The District health mission would be headed by the head of the urban
local body and would deal with policy related matters, whereas the District health society
would be headed by the Municipal commissioner/District collector and would be the executive
wing of the district health mission.

Mahilla Arogya Samiti-It will act as a community group involved in awareness generation,
community-based monitoring and linkages with services. It will comprise of 10-12 women and
would function as a community group, preferably at the slum level.

NUHM would Endeavour to Achieve its Goal Through

i. Need based city specific urban health care system to fulfil the varied health care needs of the
urban poor and other vulnerable sections.

ii. Institutional mechanism and management systems to fulfil the health-related challenges of
a rapidly growing urban population.

iii. Partnership with community and native bodies for a more proactive involvement in
planning, implementation, and monitoring of health activities.

iv. Availability of resources for providing essential primary health care to urban poor.

v. Partnerships with NGOs, for profit and not for profit health service providers and other
stakeholders.

NUHM would cover all State capitals, district headquarters and cities/towns with a population
of over 50000. It might primarily concentrate on slum dwellers and other marginalized groups
like rickshaw pullers, street vendors, railway and bus terminal coolies, homeless people, street
children, construction site workers.

The centre-state funding pattern are going to be 75:25 for all the States except North-Eastern
states including Sikkim and other special category states of Jammu & Kashmir, Himachal
Pradesh and Uttarakhand, for whom the centre-state funding pattern are going to be 90:10. The
Programme Implementation Plans (PIPs) sent by the states are apprised and approved by the
Ministry.

NUHM

The National Urban Health Mission (NUHM) as a sub-mission of National Health Mission
(NHM) has been approved by the cabinet on 1st May 2013.
NUHM envisages to fulfill health care needs of the urban population with the main target on
urban poor, by making available to them essential primary health care services and reducing
their out of pocket expenses for treatment. This may be achieved by strengthening the present
health care service delivery system, targeting the people living in slums and converging with
various schemes regarding wider determinants 251 of health like water, sanitation, school
education, etc. implemented by the Ministries of Urban Development, Housing & Urban
Poverty Alleviation, Human Resource Development and women & Child Development.

NUHM seeks to enhance the health status of the urban population particularly slum dwellers
and other vulnerable sections by facilitating their access to quality primary health care. NUHM
would cover all state capitals, district headquarters and other cities/towns with a population of
50,000 and above (as per census 2011) in an exceedingly phased manner. Cities and towns with
population below 50,000 are going to be covered under NRHM.

GOALS OF NUHM

➢ Need based city specific urban health care system to fulfil the various health care needs
of the urban poor and other vulnerable sections.
➢ Institutional mechanism and management systems to fulfill the health-related
challenges of a rapidly growing urban population.
➢ Partnership with community and local bodies for a more proactive involvement in
planning, implementation, and monitoring of health activities.
➢ Availability of resources for providing essential primary health care to urban poor.
➢ Partnerships with NGOs, for profit and not for profit health service providers and other
stakeholders

COVER OF NUHM

NUHM would cover all State capitals, district headquarters and cities/towns with a population
of quite 50000. it might primarily specialize in slum dwellers and other marginalized groups
like rickshaw pullers, street vendors, railway and bus terminal coolies, homeless people, street
children, construction site workers.

The mission seeks to attain its goals through interventions at different levels-

Urban Social Health Activist (USHA)- Each slum/community will wear frontline community
worker called USHA on the lines of ASHA under NRHM, for delivery of services at the
doorstep. She is going to cover around 1000-2500 beneficiaries across 250-500 households.
She should be a women resident of the slum, preferably within the people of 25-45 years. She
would be chosen through a community driven process involving urban local body counsellors,
self-help groups, anganwadis, etc. She would maintain interpersonal communication with du
beneficiary families and would function a link between the treatment rooms (Urban Primary
Health Centre) and also the urban slum populations.

Auxiliary Nurse Midwife (ANM): 4-5 ANMs would be posted in each primary health centre
reckoning on the population. The ANM would be liable for outreach sessions at the community
level. The sessions will include check-ups, drug dispensing and counselling. Outreach sessions
are planned to focus special attention for reaching bent on the vulnerable sections like slum
population, rag pickers, sex workers, brick kiln workers, street children and rickshaw pullers.

Urban Primary Health Centre(U-PHC)- it should be located within a slum or near a slum
within half a kilometre radius. At the U-PHC level, services provided will include Outpatient
department (OPD) consultation, basic lab diagnosis, drug/contraceptive dispensing and
distribution of health education material and counselling for all communicable and non-
communicable diseases. One U-PHC must be present for each 50,000 population.

State Level

State Health Mission: it's chaired by the Chief Minister and includes nominated public
representatives like the MPs and MLAs within the state. It deals with policy matters related
with the health sector at the state level and insures inter-sectoral coordination.

State Health Society- it's chaired by the Chief Secretary and is that the executive organ of the
State health mission. It's liable for the approval of the state health plan and implementation of
the mission within the state.

State Program Management Support Unit-It'll provide technical assistance to the state
health mission and society. It'll have experts and skilled professionals like management
information system (MIS) specialists, consultants recruited from the open market.

City and Community Level

States may either arrange to constitute a separate City urban health mission and City urban
health society or use the present structure of the District health mission and District health
society under the NRHM. The District health mission would be headed by the pinnacle of the
urban local body and would house policy related matters, whereas the District health society
would be headed by the Municipal commissioner/District collector and would be the manager
wing of the District health mission.

Mahilla Arogya Samiti- It'll act as a community group involved in awareness generation,
community-based monitoring and linkages with services. it'll comprise of 10-12 women and
would function as a community group, preferably at the slum level.

Urban Community Health Centre (U-CHC)-It should be founded as a satellite hospital for
each 4-5 U-PHCs. It'd provide in-patient services (30-50 bedded facility) and would be founded
in cities with quite 5 lakh population. One U-CHC must be present for each 2,50,000
population. Flow of Funds the flow of funds needs to root.

FLOW OF FUNDS

The flow of funds needs to root from community demand. As shows in diagram 2. City/District
Health Society prepares the community program implementation plans (CPIP) and sent
through the ranks. The CPIP's would be consolidated at state level as State Programme
Implementation Plan (SPIP). Release of funds would depend upon the SPIP which is able to
should be approved by Chairman of Empowered Programme Committee (Union Secretary of
Health & Family Welfare) supported appraisal by National Programme Coordination
Committee chaired by Mission Director (rank of Additional Secretary). The Centre-State
funding pattern are 75:25 for all States except North Eastern States including Sikkim and other
special category states of Jamonu & Kashmir, Himachal Pradesh & Uttarakhand, for whom it'll
be 90:10.

City programme implementation plan

State programme implementation plan

National programme coordination committee

Empowered programme committee

Flow of Fund
STRATEGIES

To ensure efficient implementation of NUHM and achievement of its goals, it might be

essential to include innovative practices & strategies, so as to enhance the provisions of the
scheme.

Public Private Partnerships-in sight of the big number of personal providers in urban areas,
partnerships particularly with not for profit should be encouraged. A number of the NGOs
working within the Health Sector are LEPRA Society, Uday Foundation, Smile Foundation,
Udaan, etc. The NGOs may additionally support in undertaking situational analysis,
identification and mapping of slums, identification and capacity building of Link Volunteers.

Community based groups- Groups like the Mahila Arogya Samiti will be to blame for health
& hygiene behaviour change promotion further community wolle risk pooling mechanism. The
urban poor incur high out-of-pocket expenditure often resulting in indebtedness and
impoverishment. To mitigate this risk, it's proposed to encourage Mahila Arogya Samitis to
pool monetary resources and "save for a rainy day" thereby lowing financial risks of the
community.

Convergence with other schemes- Geographic Information System (GIS) based physical
mapping of the slums being undertaken under national leader National rehabilitation Mission
(JNNURM); and therefore, the spatial representation of socio-economic profile of slums being
undertaken under Rajiv Awas Yojana (RAY) are often useful City programme implementation
plan, State programme implementation plan, National programme coordination committee,
Empowered programme committee 4 within the development of City Level Plans under
NUHM. Women groups mandated under Swarna Jayanti Shahri Rozgar Yojana (SJSRY) could
also be federated into Mahila Arogya Samitis.

Member of Parliament Local Area Development Scheme (MPLADS)- All members of

parliament (MPs), members of legislative assemblies (MLAs) and municipal councillor's
(MCs) receive area development fund which may be mobilized for creation of health facilities
in underserved urban areas and also for procurement of equipment's, Mobile Medical Units and
ambulances etc. This fund will be utilized to accomplish goals of the mission.

Corporate Social Responsibility (CSR)- Around 2 per cent of the entire profit of all corporate
sector companies is earmarked for social development under CSR This fund may also be
mobilized for health sector through efforts of Ministry of Health & Family Welfare and,
therefore, the State Government's Department of Public Enterprise (DPE) for public sector and
Ministry of Corporate Affairs for the private sector. The Community Development Programme
by Indian Oil Corporation Ltd. (IOCL), Mobile Health Outreach Programme by Gas Authority
of India Ltd. (GAIL) and also the Ranbaxy Community Healthcare Society are samples of such
initiatives.
 Health Promotion and Education in School

Health promotion has been the main target of health care providers. Health education in schools
is one in every of the methods to make awareness among the community. World Health
Organization (WHO) because the process of enabling people to extend control over, and to
enhance, their health, has defined health promotion. It moves beyond a spotlight on individual
behaviour towards a large range of social and environmental interventions (WHO, Health
Promotion, 2016). Health promotion in an exceedingly school setting involves educating the
kids about health-related matters that reflect on the health in a very more holistic way. These
activities aim at strengthening its capacity for learning and leading a healthy life.

Health Promoting School is one that promotes health and learning, involves teachers and
leaders within the community to interact in activities to form the college a healthy one. The
aim of this programme is to produce opportunity for education, nutrition, good environment,
etc. It helps in implementing policies and practices regarding individual's wellbeing. The HPS
strives for improving the health of teachers, children, and other personnel, families and
community members, and aims at bringing awareness among the community leaders about the
contribution of community towards people's health (WHO, School and youth health, 2015).
The most focus of HPSs are to create healthy decisions about self et al. look after self et al.
creating policies, services that are conducive to health and building capacity for food, shelter,
education, etc. To endorse health and support, lifelong learning, living and wellbeing, WHO
identified the requirement for a world health promotion and education initiative as a component
of the Ottawa Charter for Health promotion? The framework of HPSs was developed supported
this initiative

Health promoting schools focus on:

Caring for oneself et al.

Making healthy decisions and taking control over life's circumstances

Creating conditions that are conducive to health (through policies, services, physical/social
conditions)

Building capacities for peace, shelter, education, food, income, a stable ecosystem, equity,
social justice, sustainable development.
Preventing leading causes of death, disease and disability: helminths, tobacco use,
HIV/AIDS/STDs, sedentary lifestyle, drugs and alcohol, violence and injuries, unhealthy
nutrition.

Influencing health-related behaviours: knowledge, beliefs, skills, attitudes, values, support.

PROMOTION OF SCHOOL HEALTH AND ITS MAINTENANCE

One of the two major goals of Healthy People is to assist individuals of all ages increase
lifetime and improve their quality of life. The concepts of health promotion and health
maintenance provide interventions that contribute to meeting this goal. Many students in health
professions begin their studies with a powerful interest in care of ill individuals. However, as
time progresses, they learn that "well" people need care also. They have teaching to boost diet,
reduce stress, and procure immunizations. They'll seek information about a way to exercise
properly or ensure a secure environment for his or her children. These samples of care and
teaching are components of health promotion and health maintenance.

Health care management may be a holistic profession that examines and works with all aspects
of individuals' lives, and features a strong specialise in family and community similarly.
Therefore, it should be uniquely positioned to produce health promotion and health
maintenance activities. In fact, these activities should be an element of every encounter with
families.

The family's role in children's health is critical. A radical understanding of the healthcare
conditions that affect children is required in order that health promotion and health maintenance
may be integrated within the framework of comprehensive health care. Some children have
special healthcare needs and these are integrated into the supply of health promotion and health
maintenance.

GENERAL CONCEPT

In order to know health promotion and health maintenance, it's important to know the definition
of health first. The planet Health Organization defines health as a state of complete physical,
mental, and social well-being and not merely the absence of disease and infirmity (World
Health Organization, 1996). Health is viewed as dynamic, changing, and unfolding; it's the
belief of a state of actualization or potential (Pender, Murdaugh, & Parsons, 2006). This basic
right is critical for development of societies.
Health promotion refers to activities that increase well-being and enhance wellness or health
(Pender, Murdaugh, & Parsons, 2006). These activities cause actualization of positive health
potential for all individuals, even those with chronic or acute conditions.

Examples include providing information and resources so as to:

➢ Enhance nutrition at each developmental stage

➢ Integrate physical activity into the child's daily events
➢ Provide adequate housing
➢ Promote oral health
➢ Foster positive personality development

Health promotion is worried with developing sets of strategies that seek to foster conditions
that allow populations to be healthy and to form healthy choices (World Health Organization,
2001).

Health maintenance (or health protection) refers to activities that preserve an individual's
present state of health which prevent disease or injury occurrence. Samples of these activities
include developmental screening or surveillance to spot early deviations from normal
development, providing immunizations to forestall illnesses, and teaching about common
childhood safety hazards.

Health promotion and health maintenance activities are closely linked and infrequently overlap,
but there are some differences. Health maintenance focuses on known potential health risks
and seeks to forestall them, or identify them early in order that intervention can occur. Health
promotion looks at the strengths and goals of people, families, and populations, and seeks to
use them to help in reaching higher levels of wellness.

COMPONENTS OF HEALTH PROMOTION/HEALTH MAINTENANCE VISITS

Growth and Developmental Surveillance in Schools

Growth and developmental surveillance provides important clues about the child's condition
and environment. Evaluation of growth, child height, weight, and body mass index are should
be calculated at each health supervision visit. Parents should incline the data in written form
and interpreted for them. Physical assessment is performed to take the kid is growing of course
and has no abnormal or unexplained physical findings. Developmental surveillance could be a
flexible, continuous process of skilled observations that also provides data about the child's
capabilities, allows for learly identification of any neurological problems, and helps to verify
that the house Environment is stimulating. Information is also collected from several sources;
for example, a questionnaire that the parent completes, trigger questions asked during the
interview, or observation of the kid during the visit. Parents may also be interviewed to spot
any developmental concerns they'll have about the kid or adolescent. When talking with
parents, review physical, social, and communication milestones for infants, young children,
older children, or adolescents.

Development could be a fragile process determined by both innate conditions and

environmental influences. Developmental screening of all children employing a regular and
arranged approach is required, since about 16% of kids have some sort of developmental delay
or disability (Earls & Hay, 2006).

NUTRITION

Nutrition may be a vital part of each health supervision visit. It makes important contributions
to general health and fosters growth and development. Include observations and screening
relevant to nutritional intake at each health supervision visit. Eating proper foods for age and
activity ensures that children have the energy for correct growth, physical activity, cognition,
and immune function. Nutrition is closely linked to both health promotion and health
maintenance.

PHYSICAL ACTIVITY

Physical activity provides many physical and psychological health benefits. However, there's
growing disparity between recommendations and reality among most of our kids. Research by
the Centres for Disease Control and Prevention (CDC) using the Youth Media Campaign
Longitudinal Survey (YMCLS) of oldsters and kids found that 61.5% of 9- to 13-year old
children report that they do not participate in any organized physical activity during hours
outside of college. While organized activities are important and consistent styles of exercise,
not all children can participate or desire to try and do so. However, 22.6% of those children
reported that they do not engage in ANY physical activity outside of college. Parents noted that
barriers to physical activities included transportation problems, lack of opportunities in area,
expenses, lack of parental time, and lack of neighbourhood safety (CDC, 2003). Because the
child grows older, insert questions about sedentary activities like number of hours spent
watching television or playing computer games. See if the kid plays sports at college or within
the community. Ask about activities during a typical day to live amount of activity

ORAL HEALTH

While oral health could appear to want the knowledge of a specialist, many implications relate
to general health care. Oral health is very important because teeth assist in language
development, impacted or infected teeth result in systemic illness, and teeth are associated with
positive self-image formation. Children are affected by cavity and pain that interfere with
activities of daily living like eating, sleeping, attending school, and speaking. Health promotion
to dental health by teaching about oral care and access to dental visits should be done. Health
maintenance activities relate to prevention of caries and illness associated with dental disease.

EYE AND VISION

Eye exams for youngsters are extremely important, because 5 to 10 per cent of preschoolers
and 25 percent of school-aged children have vision problems. Early identification of a child's
vision problem is crucial because children often are more attentive to treatment when problems
are diagnosed early.

Infants should have their first comprehensive eye exam at 6 months old. Children then should
have additional eye exams at age 3, and just before they enter the primary grade at about age 5
or 6. For school-aged children, an eye fixed exam every two years is suggested if no vision
correction is required. Children who need eyeglasses or contact lenses should be examined
annually or as recommended by the optometrist.

MENTAL AND SPIRITUAL HEALTH

Mental and spiritual health is vital concepts to deal with in health promotion and Health
Promotion and Education in School health maintenance visits. Parents are encouraged to stay
a record of psychological state issues to bring around health supervision visits. This helps them
understand that the healthcare professional is willing to partner with them to help in addressing
psychological state. Suggest topics like child and parental mood, child temperament, stresses
and ways in which members of the family manage stress, or sleep patterns. Be alert for signs
of depression, stress, anxiety, and child abuse/neglect. Both health promotion and health
maintenance goals associated with child and family mental state should be established. Health
promotion goals relate to adequate resources to fulfill family challenges, protective factors like
involvement in clan and also the community. Teaching stress reduction techniques like
meditation, relaxation, and imagery, similarly as providing resources for yoga or other
techniques, is helpful. Health maintenance goals relate to prevention of psychological state
problems.

The spiritual dimension may be a reference to a greater power than that within the self, and
guides someone to strive for inspiration, respect, meaning, and purpose in life (Murray,
Zentner, Pangman, & Pangman, 2005). Spiritual health is seen within the large context as those
entities that provide meaning in life.

DISEASE PREVENTION STRATEGIES

Disease prevention strategies focus mainly on health maintenance, or prevention of disease.

Some health disruptions will be detected early and treatment for the condition can begin.
Screening may be a procedure accustomed detects the possible presence of a health condition
before symptoms are apparent. It usually conducted on large groups of people in danger for a
condition and represents the secondary level of prevention. Examples include developmental
screening, vital sign screening, and vision/hearing screening. Most screening tests aren't
diagnostic by them but are followed by further diagnostic tests if the screening result's positive.
Once a screening test identifies the existence of a health condition, early intervention can begin,
with the goal of reducing the severity or complications of the condition.

VACCINATION

Like eating well and exercising, immunization could be a foundation for a healthy life. Getting
vaccinated may be a safe and necessary part of keeping you and your family healthy.
Vaccinations are incredibly important, because immunization doesn't just protect you, it also
protects everyone around you. After you get vaccinated against a disease, you build up your
system, making you stronger and more immune to that disease. Regardless of how healthy
you're, if you haven't had the vaccine, you do not have the antibodies to safeguard you if you're
ever exposed to the disease.

Immunization is a crucial component of public health because it prevents many folks from
becoming sick with a disease, reducing the chance to them et al. Immunization is differently to
stop children against common communicable diseases. Getting vaccinated not only prevents
children from getting sick but also reduces the chance to those with less protection; like infants
or people with chronic diseases.
ENCOURAGE HEALTH PROMOTION ACTIVITIES

Families often need health education and counselling to market healthy behaviours in their own
child. Samples of focused health education and counselling could also be information about
environmental control to limit sedentary behaviours, dietary changes to extend fruit and
vegetable intake, and switching to low-fat dairy products. Patient education and counselling
are best when the family understands the link between a behaviour change and also the resulting
health outcome. When identifying that a family would have the benefit of a change in health
behaviour, consider the family members perceptions about the health change, barriers and
benefits to alter, and plan interventions to reinforce the chance for change.

Steps in promoting patient education and counselling include:

➢ Clarifying learning needs of kid and family

➢ Setting a limited agenda
➢ Prioritizing needs with family
➢ Selecting-teaching strategy (explaining, showing, providing resources, questioning,
practicing, giving feedback)
➢ Evaluating effectiveness (Green & Palfrey, 2002)
➢ Periodic Health Check-up

Periodic health check-ups and screenings with health care provider are key to maximizing the
possibility of living an extended and healthier life. Not only can they assist prevent health
problems before they begin, but regular check-ups can also help discover health problems early
enough to extend chances of successful treatment and recovery. Regular health checkups can
help to spot the chance factors for common moreover as rare diseases, both acute and chronic.
Getting examined periodically can help within the detection of diseases that might be
asymptomatic within the initial stages.