Scope of Community health

Scope of Community health:

Community health may be studied within three broad categories:

Primary healthcare: Primary healthcare refers to interventions that focus on the individual or family such as hand‐washing, immunization, circumcision. Traditionally, a population health approach has been a public health focus. More recently. However, the Primary Health Care Strategy set a new direction for primary health care, which traditionally provided treatment services focusing on individuals, not communities or populations. Primary health care services are now to focus on better public health for a population and actively work to reduce health inequalities between different groups. There is now a clearer interface between public health and primary health care and a closer alignment in their overarching priorities. Primary care is often used as the term for the health care services which play a role in the local community. It can be provided in different settings, such as Urgent care centers which provide services to patients same day with appointment or walk‐in bases.

Primary care involves the widest scope of health care, including all ages of patients, patients of all socioeconomic and geographic origins, patients seeking to maintain optimal health, and patients with all manner of acute and chronic physical, mental and social health issues, including multiple chronic diseases. Consequently, a primary care practitioner must possess a wide breadth of knowledge in many areas. Continuity is a key characteristic of primary care, as patients usually prefer to consult the same practitioner for routine check‐ups and preventive care, health education, and every time they require an initial consultation about a new health problem. The International Classification of Primary Care (ICPC) is a standardized tool for understanding and analyzing information on interventions in primary care by the reason for the patient visit. 

Common chronic illnesses usually treated in primary care may include, for example: hypertension, diabetes, asthma, COPD, depression and anxiety, back pain, arthritis or thyroid dysfunction. Primary care also includes many basic maternal and child health care services, such as family planning services and vaccinations. In the United States, the 2013 National Health Interview Survey found that skin disorders (42.7%), osteoarthritis and joint disorders (33.6%), back problems (23.9%), disorders of lipid metabolism (22.4%), and upper respiratory tract disease (22.1%, excluding asthma) were the most common reasons for accessing a physician.

In context of global population aging, with increasing numbers of older adults at greater risk of chronic non‐communicable diseases, rapidly increasing demand for primary care services is expected around the world, in both developed and developing countries. The World Health Organization attributes the provision of essential primary care as an integral component of an inclusive primary health care strategy.

Secondary healthcare:  Secondary healthcare refers to those activities which focus on the environment such as draining puddles of water near the house, clearing bushes and spraying insecticides to control vectors like mosquitoes. It includes acute care: necessary treatment for a short period of time for a brief but serious illness, injury or other health condition, such as in a hospital emergency department. It also includes skilled attendance during childbirth, intensive care, and medical imaging services.

The "secondary care" is sometimes used synonymously with "hospital care". However many secondary care providers do not necessarily work in hospitals, such as psychiatrists, clinical psychologists, occupational therapists or physiotherapists (physiotherapists are also primary care providers and a referral is not required to see a physiotherapist), and some primary care services are delivered within hospitals. Depending on the organization and policies of the national health system, patients may be required to see a primary care provider for a referral before they can access secondary care. For example in the United States, which operates under a mixed market health care system, some physicians might voluntarily limit their practice to secondary care by requiring patients to see a primary care provider first, or this restriction may be imposed under the terms of the payment agreements in private or group health insurance plans. In other cases medical specialists may see patients without a referral, and patients may decide whether self‐referral is preferred.

Allied health professionals, such as physical therapists, respiratory therapists, occupational therapists, speech therapists, and dietitians, also generally work in secondary care, accessed through either patient self‐referral or through physician referral. 

Tertiary healthcare: Tertiary healthcare refers to those interventions that take place in a hospital setting such as intravenous rehydration or surgery. Tertiary care is specialized consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital.

Examples of tertiary care services are cancer management, neurosurgery, cardiac surgery, plastic surgery, treatment for severe burns, advanced neonatology services, palliative, and other complex medical and surgical interventions. 

As per census 2001, India is a country of 102.70 crores of people, out of whom majority (around 73%) lives in rural areas. There is a terrific imbalance between the availability of natural and capital resources Vis‐a‐ Vis the required amount of these resources for all round growth and development of  this population. Therefore, this enormity of population leads to sustenance of poverty and ill‐health, which results into the falling standard of living for quite substantial proportion of people. This sort of situation is unacceptable as it defeats our national developmental goals. Hence, the need for population controls. 

To achieve this avowed objective as well as execution of various national health programmes, a vast health infrastructure in the shape of Community Health Centers (CHCs)( 30 bedded hospital on each 80‐120 thousand population ), Primary Health Centers (PHCs) (on each 20‐30 thousand population ) and Sub‐Centers (SCs)( on each 3‐5 thousand population) has been created. In September 2004, a network of 3,222 CHCs, 23, 109 PHCs and 1, 42,655 Sub‐ Centers had been functioning in the rural and semi‐ urban areas of the country (GOI, 2006, 456).

Community Health Center is staffed with a Medical Specialist, a child specialist, a gynecologists, a surgeon and a lady doctor along with around 25 other paramedical and support staff. A Primary Health Centre (PHC) is staffed with a medical officer, a pharmacist, a staff nurse, block extension educator/ health educator, lab technician, one male and one female health worker and 4‐5 other support staff. At the Sub‐Center level, a team of health workers (one male and one female) is stationed at the village itself. The overall administrative responsibility of running these centers rests with the MO of the PHC/CHC.