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Health care has become increasingly focused on heath promotion , wellness,and illness
Prevention.The rapid rise of health care costs has motivated people to seek ways of decreasing
the incidence and minimizing the results of illness or disability.The concepts of health promotion
are closeil related and in practice,overiap to some extent.



According to WHO,health is defined as “Health is a dynamic state of complete physical,mental

and social well being and not merely an absence of diseases or infirmity


Acccording to American Journal of health promotion ,is the science and art of helping people
change their lifestyle to move toward state of optimal health.


According to Potter and Perry,activities such as routine exercise and good nutriti0n, help clients
maintain or enhance their present levels of health.Health promotion activities motivate people to
act positively to reach more stable levels of health.

HEALTH PROMOTION is “the process of enabling people to increase control over,and to

improve health.”

 Pre-placement or pre-employment examination:The purpose of complete physical and

medical examination of workers before employment is to assess their health in totality,
identify and deviation and accordingly do the needful to fit the job to the worker and
worker to the job.At times the worker may be rejected from the job. This way it would
ensure employment of healthy employees and also heip in treatment of latent conditions.
 Job training and continuing education: Workers would be given adequate job training and
continuing education about their work environment to improve their abilities and work
environment so that they can adapt to their work environment and can work efficiently.
 Periodical health check ups: The periodical health check up for fit and healthy worker is
done for early recognition of any health problems including emotional problems due to
occupational exposure or otherwise and accordingly take actions to promote health
efficiency of health worker. The periodic examinations of some employees are required
by law.Eg:- workers exposed to radiation, noise, food handler, drivers etc.
 Health education and couselling: The workers need to be imparted health education about
various aspects of healthful living and occupational hazards. Counseling of workers and
their family.
 Health education and communiton: It is important that good health education and
communition programme should be planned and organized for adolescents as part of
school health programme and school curriculum in which school administration and
teacher should take active responsibility. Health personnel can give assistance and
guidance. It should include information on growth and development,nutrition, sexuality,
personal hygiene and lifestyle substance abuse,utilization of health services
etc.Adolescents should be involved in organizing health education sessions and preparing
audio visual material.Mass media such as
newspaper,magazines,radio,television,videos,audios,etc can be made use of for
communicating information messages etc.
 Counselling services Often adolescents require counselling services to deal with their
individual problems which they face during their period of development.The problems
may be related to physical,psychological development,sexuality,lifestyle and behaviour
problems such as drug abuse,smoking etc.academic performance etc.Therefore need
based counselling services need to be provided at school,RCH clinics, drug addiction
clinics etc.


 Safe and supportive environment:-

The safe and supportive environment not only includes hygienical physical environment
but also biological psychological and spiritual environment. The environment should be safe and
 Personal hygiene and adoption of healthy life style

It is very important to maintain good personal hygiene, should take bath everyday wear
clean undergarments and clothes.

 Good nutrition and food hygiene:-

Both boys and girls require well balanced nutritious diet to have normal growth and to
keep fit.
Beside being nutritious the food which is consumed by people should be clean and safe.
The food should be well cooked under and safe environment following all the principles
of cooking. Cooked food should be consumed as soon as possible. Unconsumed food
should be stored properly in the refrigerator below 10c .Hands must be thoroughly
washed with clean water before consuming or preparing food.
 Sex Education:-

Adolescent generally are less informed less experienced and less confident about get in
to lot of sexual related problems such as premarital unprotected sexual indulgence
resulting in STDs,illegimate teenage pregnancies, sexual abuse, violence, exploitation

 Gender sensitization:-
Though the Indian constitution prohibits any kind of discrimination on the ground of sex
but discrimination against the girl child continues to be practiced in various parts of our
Studies done in this area have revealed that there is discrimination in such areas as
distribution of food in amount and quality, opportunities for education skill training ,
employment, wages, health care etc. The neglect of the girl child affects her health in
many ways. They are malnourished, underweight, anaemic etc.These problems get
complicated because of early marriage and pregnancy and result in low birth weight
babies,high mortality and morbidity etc.Girl children are considered a financial burden
and are killed before they are born by many parents after sex determination inspite of its
ban.It is therefore very important that adolescents must be sensitized to gender
issues.They should be helped to develop logical thinking for providing oppurtunities on
the basis of interest and choice and not on the basis of sex.Members is also done to help
them to deal with their problems related to their occupations and families.


It includes consideration of physical,biological and psycho-social aspects of

environment,physically,the environment should be adequately lighted,well ventilated,should
have desirable temperature and humidity,washing and toilet facilities.The environment should be
clean.The environment should also be free from harmful organisms as far as
possible.Socially,there should be congenial environment.Efforts should be put into encourage
and promote healthy working relationships among workers,between workers and authority,have
satisfying working conditions etc.


Welfare facilities which should be provided include insurance against loss of job,illness and
disablement,MCH and family welfare services,first aid,place for meals,rest,change of clothes etc.


It is very important to follow rules for works hours,weekly holidays and earned leave etc.

Provision for houring facilities,recreation grounds and clubs etc should be there.


*Health education.

*Environmental modifications.

*Nutritional interventions.

*Lifestyle and behavioural changes.


This is one of the most cost effective interventions.A large number of diseases could be
prevented with little or no medical intervention if people were adequately informed about them
and if they were encouraged to take necessary precautions in time.Recognizing this truth,the
WHO constitution states that “the extension to all people of the benefits of
medical,psychological and related knowledge is essential to the fullest attainment of health”.The
targets for educational efforts may include the general public,patients,priority groups,health
providers,community leaders and decision-makers.

A comprehensive approach to health promotion require environmental modifications,such as

provision of safe water,instillation of sanitary latrines,control of insects and rodents,
improvements of houring etc.The history of medicine has shown that many infectious diseases
have been successfully controlled inwestern countries through environmental modifications,even
prior to the development of specific vaccines or chemotherapeutic drugs.Environmental
interventions are non-clinical and donot involve the physician.


These comprise food distribution and nutrition improvement of vulnerable groups.Child feeding
programmes, food fortification ,nutrition education,etc


The conventional public health measures or interventions have not been successful in making in
roads into lifestyle reforms.the action of prevention in this care,is one individual and community
responsibility for health,the physician and in fact each health worker acting as an educator than
a therapirit. Health education is a basic element of all health activity . It is of paramount
importance in changing the view behaviour and habits of people.


To avoid disease aitogether is the ideal but this is possible only in a limited number of cases. The
following are some of the currently available interventions aimed at specific protection.

 Immunization.
 Use of specific nutrients.
 Chemoprophylaxis.
 Protection against occupational hazards.
 Protection against accidents.
 Protection from carcinogens.
 Avoidance of allergens
 The control of specific hazards in the general environment eg:air pollution,noise control.
 Control of consumer product quality and safety of foods,drugs,cosmetics,etc


A WHO expert committee defined early detection of health impairement as “the detection
of disturbances of homeostatic and compensatory mechanism while biochemical
morphological and functional changes that precede the occurance of manifest signs and
symptoms.This is of particular importance in chronic diseases.Early detection and
treatment are the main interventions disease control.The earlier a disease is diagnosed
and treated the better it is from the point of view of prognosis and preventing the
occurance of further cases[2 degreebcases] or any long term disability.It is like stamping
out the “spark”rather than calling the fire brigade to put out the fire.

When a patient reports late in the pathogenesis phase, the mode of intervention is
disability limitation. The objective of this intervension is to prevent or halt the transition
of the disease process from impairment to handicap.
Concept of disability,
The sequence of events leading to disability and handicap have been stated as follows.
Disease impairment disability handicap
The WHO has defined there terms as follows,
1.Impairment:- “Any loss or abnormality of psychological, psysiological or anatomical
structure or function”
Eg:- loss of foot, defective vision or mental getardation An impairement visible or
invisible, permanent or temporary, progressive or regression.
2.Disability:-Because of an impairement, the affected person may be unable to carryout
certain activities considered normal for his age, sex etc. This inability to carry out certain
activities is termed “disability” A disability has been defined as “any restriction or within
the range considered normal for a human being.
3.Handicap:-As a result of disability, the person experiences certain disadwantages in life
and is not able to discharge the obligations required of him and play the role expected of
him in the society.The term ‘Handicaped’ and is defined as a disadvantage for a given
individual,resulting from an impairment or a disability,that limits or prevents the
fulfillments of a role that is normal(depending on the age,sex, and social and cultural
factors)for that individual.
Taking accident as an example ,the above terms can be explained further as follows.
Accident-Diseease or disorder.
Loss of foot-impairment(extrinsic or intrinsic).
Cannot walk-Disability or objectified.
Unemploted-Handicaped or socialized.

Rehabilitation has been defined as “the combined or co-ordinated use of
medical,social,educational and vocational measures for training the individual to the
highest possible level of functional ability”.
It includes all measures aimed at reducing the impact of disabling and handicapping
conditions and at enabling the disabled and handicapped to achieve social integration have been defined as the active participation of disabled and
handicapped people in the community life.
The following areas of concern in rehabilitation have been identified,
a)Medical rehabilitation;restoration of function.
b)social rehabilitation;restoration of family and social relationships.
c)Vocational;restoration of capacity to earn a livelihood.
D)Psychological:restoration of personal dignity and confidence.


Primary health care has evolved over a years partly in light of experience-positive and
negative,gained in basic health services in a number of countries.It is much mr than basic
health forms an integral part both of the country’s health care system and of
the over all social and economicdevelopement of the community.It is the nucleus of the
of health care delivery system.
According to WHO and UNICEF:
“Primary health care is essential health care and technology based on
practical,scientifically sound and socially acceptable methods and technology made
universally accessible to individuals and families in the community by means acceptable
to them,through their full participation and at a cost that the community and country can
ALMA –ATA conference declaration:
“primary health care is an essential health care made universally accessible to individuals
and acceptable to them,through their full participation and at a cost the community and
country can afford”.
According to institute of Medicine:
Primary health care as the provision of integrated ,accessible health care
needs,developing a sustained partnership with clients and practicing in the cotext of
family and community.

Conceptually primary health care conveys varying ideas from varying dimensions .
From natural history of disease and level of prevention of disease point of view primary
health care for primary level prevention which is preventive and promotive in nature and
lays emphasis on positive health values, where as secondary level of prevention cannot
cure and rehabilitation orientation towards health.
1) Equitable distribution:-
It means the primary health care services must be shared equally by all the people
irrespective of their ability to pay, belonging to urban or rural areas and to any
segment of the community but giving priority to the underprivileged and underserved
sections of the society.
2) Coverage and accessibility:-
Primary health care aims at providing essential health care to the whole population. It
implies providing health care services to all which are required by
children, to mothers, adults, elderlies etc and also which are reachable geographically,
financially, culturally and functionally. The care has to be appropriate and adequate in
content &in amount to
Satisfy the essential health needs of the people and has to be provided by methods
acceptable to them.
3) Community participation:-
Community participation is the process by which individuals and families assume
responsibilities for their own health and welfare and for those of the community
&develop the capacity to contribute to their and country’s development.
This process creates awareness among people about their health situations and
resources etc. and motives them to solve their common problems. This is possible
trough ongoing dialogue by health worker with the community people on primary
health care aspects and their willingness to learn about and participate for the same.
These are many ways in which community can participate in every stage of primary
health care. They can be involved in the assessment of health situations. Defining of
health problems health needs, setting of the priorities, planning of alternative actions,
implementations of actions by the people, monitoring and evaluation and the
feedback. In addition, people can also contribute their labour, financial and other
4) Multi sectorial approach:-
No sector involved in socio-economic development can function properly in isolation.
Activities of any sector have impact on the goals of any other sector. Hence, there is a
need for consultation and co-ordination of the inter sectorial activities. So also is true
with the health sector. It cannot achieve its goals in isolation of others sector. As IS
DECLARED BY Alma Ata Conference “that the attainment of the highest possible
levels (of health) is a most important worldwide social goal whose realization
requires the action of many other social and economic sectors in addition to health
5) Appropriate Health Technology:-
Appropriate health technology is very important factor for successful primary health
care. It implies the use of methods, technique and equipments which are scientifically
sound but simple, in accordance to local culture so that there are understood by and
acceptable to those who use and to those for whom there are used. It is advantageous
if drugs and equipments selected can be manufactured locally at low cost and
maintained within the capacity of local people & facilities uniform standards to be
maintained all over the country.
6) Human Resources:-
Human resources are very important factor for the success of primary health care.
Often this resource is not used efficiently and sufficiently. For effective
implementation of primary health care. It is very essential to make full use of all the
available resources including the human potential of the entire community. This is
possible through active involvement of people, helping them to develop their
competencies to the health team to deal with primary health care aspects of the
community as a whole.
7) Services by community health workers and traditional health practitioners:-
Primary health care is the first level care which is provided by community health
workers who form a link between the community people and health system. The type
of community health workers may vary by country and community depending upon
community needs and resources. It is advantageous if there workers belong to the
community they serve. They are given short and simple training to be able to take
care of some of the simple and basic health needs of people.
8) Referral System:-
To ensure the primary health care personnel/organization at the periphery enjoys the
confidence of the community. It is essential that it is given the support of higher level
health personnel/ organization, which has the specialized technical knowledge and
technology which is too complex to be available routinely through primary health
care. It would be described to develop a system of referral from one level to the other
with laid down procedures and policies so that there institutions give required referral
The transportation of patients to and from referral services has to be properly
organized, making the most of the available facilities.
9) Logistics of Supply:-
The logistics of supply include planning and budgeting for the supplies required
procurement or manufacture, storage distribution and control. Supplies of right
quality &quantity have to be delivered to primary health care facilities at the right
time to make it possible to provide services on a continuing basis. It is advisable to
have a standard list of drugs and equipments which can be adjusted according to local
variations, such as seasonal fluctuations in the incidence of certain diseases. A system
should be established to ensure continuity of supply.
10) The Physical Facilities:-
The physical facilities for primary health care need to be simple and clean. Already
existing health facilities can be used for the purpose. If there are to be specially built
the community people can be involved to contribute their own labour and materials. It
should have a spacious waiting area with toilet facility.
It is essential to have well developed first referral unit i.e. at the level next in line
from primary health care. Here more substantial buildings and equipments are
11) Control and Evaluation:-
Primary health care, with its supporting services has to be evaluated to ensure that it
is functioning in accordance with national policy and strategy and measures are taken
to improve as found necessary. Community can be involved in managerial control of
primary health care. Any deviation found by them can be reported and actions can be
taken. Technical monitoring is done by professionals at various levels by supervision,
guidance and education. A Process of evaluation has to be built in to assess the
relevance, progress, efficiency, effectiveness and impact of the services. Indicators
need to be specified to assess the quality of services rendered.

Elements of primary health care:-

1) Education of the people concerning prevailing health problems and methods of

preventing and controlling them.
2) Promotion of food supply and proper nutrition.
3) Adequate supply of safe water and basic sanitation.
4) Maternal and child health care & family planning.
5) Immunization against the major infectious diseases.
6) Prevention and control of lo9cally endemic diseases.
7) Appropriate treatment of common diseases and injuries.
8) Provision of essential drugs.


 There should be shift from cure model of nursing which is applicable only in
technologically sophisticated institutions to a model which is built around and responsive
to the needs of change in nursing services but also in nursing education so that nurses
being prepared will be able to give nursing care services within the primary health care
concept and approach.
 The nursing care services should be universally accessible in all the countries. AS such
nursing care services, by and large are available in the hospitals to few people who come
with major problems in the hospitals. This implies preparation and development of
nursing manpower to provide nursing services in the community in the context of
respective national primary health care system in all the countries.
 Nursing care should be acceptable to those receiving it.
 The people should participate in their care rendered by nurses and by any other health
personnel and develop their self determination &self reliance.
 The care should be given at a cost which the community and country can afford and
within the resources which are available in community.
 Nursing should be integral part of country’s primary health care based system. There
should be rational distribution and integration of nursing manpower to provide essential
health services in all areas and to meet the primary, secondary and tertiary health care
requirements of the community.
 For effective nursing practice in primary health care, nurses should collaborate with
variety of health workers. Other community based personnel from other sectors, with
political leaders and groups in formal &informal association etc.
 There should be increased involvement of nurses in policy making and programmes
planning in setting priorities, in the development and allocation of resources for primary
health care.


 To develop nurses who are well informed in primary health care and who can bring about
change in nursing system.
 To include nurses at all levels of policy making and administration
So that described actions are taken for nursing profession.
 To involve nurses and their skills in initiating and their skills in initiating and extending
primary health care.
 To change or modify basic, post basic and continuing education so as to prepare nurses to fit
in to health care needs of people and the national health care system.

 To conduct research in the field of nursing administration, practice and education that will
demonstrate the need for nurses contribution to primary health care, clarify the implication
and evaluate results.


 Arrange series of workshops at various levels for orientation guidance in planning for
primary health care.
 Develop texts, guides and communication aids including educational programme on
administration and management techniques, political and legislative process.
 Creation of administrative positions in nursing at all levels of government.
 Establishing a system of demand, training and supply of nurses as per needs of
 Preparation of nurses either by continuing or in- service education at work for 1 level
care in the community.
 Encourage nurses and provide facilities and incentive for the practice for primary health
care at the periphery
 Making efforts to close existing gap in nursing education &nursing practice.
 Re orientation of post basic nursing education preparing nurses for taking and conducting
research in primary health care issues.
 Continuing and in- service education on ongoing basis for professional growth &
development etc.
 Inclusion of research component in all nursing education programme.


The TNA, HELD THE III All India Nursing Education conference on primary health care in
1979 from November 15-17 at college of nursing.PGT, Chandigarh to discuss and recommend
various actions for nursing in primary health care. The participants resolved and recommended to
re-orient and restructure nursing education to prepare nurses for primary health care and also to
upgrade nursing education to university level to attain full professional status.


 Period of clinical practice for students in primary health be increased from 3 months
to 6 months.
 Teachers in the nursing schools/college to be oriented to primary health care concept.
The reorientation course to be at least of 3 months duration.
 There should be 3 nurses at the State directorate of health services, one each for
nursing services, nursing education and community health nursing.
 The same pattern of three nurses at DGHS level also should be followed.
 More posts for nurses should be created at the district and block primary health centre
and sub-centre level.
 The school and colleges for nursing should be manned by qualified personnel
available to achieve the goals of primary health care.
 All schools of nursing attached to medical colleges and institutions should be
upgraded to degree programme.
 Improvement in the course content is necessary so that nurses can manage minor
ailments independently.
It is essential to plan and provide health care services to help people in meeting their
health needs and thus promote and maintain their health. Health care is more than
medical care. It is said to be multiple services rendered to individuals, families or
communities by the purpose of promoting, maintaining, monitoring or restoring
1. Krishnakumari Gulani,Community health nursing,Principles and practices,
I Edition,Kumar publishing house,Delhi-2005,Page no;322-329,461-505,574-585.
2. Dr,BSridhar rao,principles of Community Medicine,4th Edition,AITBS Publishers
Page no:544-559.




5.Patricia.a Potter,Anne Griffin Perry,Fundamentals of nursing,Mosby Missouri,6th

Edition,Page no 92-94.

6. promotion.

7.K.Park,Park’s text book of preventive and social medicine,17th Edition.M/S Banarsidas

Bhanot-2002,Page No:650-651,35,10,7.









SUMITTED ON: 30/10/09.