CONTENTS

Alma ata declaration

Astana declaration

SDG’s
Aardram Mission

David Kolb's Experiential Learning Theory (ELT)

SHRC

RSBY
Anganwadis

Population norms in Sun center, HWC, PHC, CHC

Triage

HEALTH CARE SYSTEM IN INDIA

 1. ALMA ATA DECLARATION

 It was adopted at the International Conference on Primary Health Care in Alma-Ata (now
Almaty, Kazakhstan) in 1978.
 It is a landmark document that laid the foundation for global health policy, particularly
emphasizing primary health care (PHC).
 It remains influential in shaping global health policies, especially concerning universal health
coverage and health equity.

The key points are:

1. Health as a Fundamental Human Right:

- The Declaration affirms that health is a basic human right and that attaining the highest possible
level of health is a global priority.

2. Health Inequality:
- It highlights the gross inequalities in health status between developed and developing countries,
and even within nations, calling for urgent actions to reduce these disparities.

3. Primary Health Care (PHC) as the Key to Health for All:

- PHC is described as essential health care based on practical, scientifically sound, and socially
acceptable methods. It should be universally accessible and affordable to individuals and families.

4. Comprehensive and Intersectoral Approach:

- Health is seen as being influenced by multiple sectors, including agriculture, education, nutrition,
housing, and the environment. The declaration stresses the need for coordinated efforts across
these sectors.

5. Community Participation:
- The declaration emphasizes the importance of involving individuals, families, and communities in
the planning and delivery of their health care.

6. Health for All by the Year 2000:

- The goal of the declaration was to achieve “Health for All by the Year 2000” through a
comprehensive approach to health care and the active participation of all stakeholders.

7. National and International Cooperation:

- The Declaration calls for national governments and international organizations to work together
to ensure that primary health care is available to all and to mobilize resources for the same.

8. Equity in Access to Health Services:

- It promotes equitable distribution of health resources and services, ensuring that marginalized
populations have access to the care they need.

ASTANA DECLARATION 2018

Adopted at the Global Conference on Primary Health Care in Astana, Kazakhstan, in 2018, reaffirms
and updates the principles of the 1978 Alma-Ata Declaration on Primary Health Care (PHC).
It emphasizes the importance of strengthening PHC to achieve Universal Health Coverage (UHC) and
the Sustainable Development Goals (SDGs).
Key points of the Astana Declaration:

1. Commitment to Universal Health Coverage (UHC)

- The Astana Declaration reaffirms the commitment of countries to achieving UHC, ensuring that
everyone can access essential health services without financial hardship.

2. Primary Health Care as the Foundation of Health Systems

- PHC is recognized as the most effective way to achieve universal health care. The Declaration
advocates for strong, people-centered primary health care systems that address the needs of
communities and provide comprehensive health services.

3. Health and Well-Being Across the Life Course

- It emphasizes promoting health and well-being at all stages of life. This includes preventive,
promotive, curative, rehabilitative, and palliative services.

4. Health as a Human Right

- The Declaration reaffirms that health is a fundamental human right and that addressing health
inequities is essential for achieving health for all.

5. Equity and Access to Quality Health Services

- It calls for equitable access to quality health services for all, especially vulnerable and
marginalized populations. Addressing social, economic, and environmental determinants of health is
also prioritized.

6. Role of Governments
- Governments are urged to take a leading role in shaping health policies, regulations, and resource
allocation to ensure the delivery of PHC. Countries should prioritize investments in health and create
a strong political commitment to health systems strengthening.

7. Multisectoral Action and Integration

- The Declaration promotes the integration of health care with other sectors (such as education,
agriculture, and the environment) to create a holistic approach to health and well-being.

8. Community Engagement and Empowerment

- It emphasizes the importance of involving individuals, families, and communities in the design,
implementation, and monitoring of health care systems. Empowering communities to take
ownership of their health and participate in decision-making is a key principle.

9. Sustainable Health Financing

- The Declaration calls for sustainable financing of health systems and innovative financing
mechanisms to support PHC. This includes mobilizing resources at the national and global levels to
ensure continuous investments in health systems.

10. Accountability and Monitoring

- Countries and global partners are urged to strengthen accountability mechanisms, monitor
progress toward UHC, and report on actions taken to achieve health-related goals.

The Astana Declaration builds upon the foundation of the Alma-Ata Declaration and renews global
efforts to achieve health for all by making primary health care the cornerstone of health systems
globally.
17 SUSTAINABLE DEVELOPMENT GOALS (SDG)

The Sustainable Development Goals (SDGs) are a set of 17 global goals adopted by the United
Nations (UN) in 2015 as part of the 2030 Agenda for Sustainable Development. They aim to address
global challenges like poverty, inequality, climate change, environmental degradation, and peace.
The SDGs build on the Millennium Development Goals (MDGs) and provide a more comprehensive
and inclusive framework for global development.

- The SDGs apply to all countries, (universal) regardless of their level of development.
They emphasize that development must balance economic growth, environmental protection, and
social inclusion.

17 Goals and 169 Targets

- Each SDG is associated with specific targets to be achieved by 2030. The goals cover a broad
range of areas, including:
- Goal 1: No Poverty
- Goal 2: Zero Hunger
- Goal 3: Good Health and Well-being
- Goal 4: Quality Education
- Goal 5: Gender Equality
- Goal 6: Clean Water and Sanitation
- Goal 13: Climate Action…
- Goal 17: Partnerships for the Goals

Interconnected Goals
- The SDGs are interlinked, meaning progress in one area impacts other goals. For example, good
health (SDG 3) is influenced by clean water (SDG 6), poverty reduction (SDG 1), and education (SDG
4).

1. No Poverty
- End poverty in all its forms everywhere. This goal aims to
 eradicate extreme poverty,
 reduce the number of people living in poverty
 ensure access to social protection systems and economic resources.

2. Zero Hunger
 End hunger
 achieve food security and improved nutrition,
 promote sustainable agriculture. This involves addressing malnutrition, ensuring all people
have access to sufficient food, and promoting sustainable farming practices.

3. Good Health and Well-being

- Ensure healthy lives and promote well-being for all at all ages. This includes reducing maternal
and child mortality, combating communicable diseases, addressing non-communicable diseases,
promoting mental health, and achieving universal health coverage.
SDG 3 focuses on ensuring healthy lives and promoting well-being for all at all ages. It aims to:
- Reduce maternal and child mortality
- Combat epidemics (HIV, malaria, tuberculosis)
- Achieve universal health coverage (UHC)
- Address mental health, substance abuse, and non-communicable diseases (NCDs)
 4. Quality Education
- Ensure inclusive and equitable quality education and promote lifelong learning opportunities for
all. The goal focuses on equal access to education, improving learning outcomes, and ensuring
literacy for all.

5. Gender Equality
- Achieve gender equality and empower all women and girls. It addresses discrimination, violence,
and exploitation against women and girls, and promotes equal opportunities and participation in
leadership.

6. Clean Water and Sanitation

- Ensure availability and sustainable management of water and sanitation for all. This goal seeks to
ensure access to safe drinking water, sanitation, and hygiene while protecting water-related
ecosystems.

7. Affordable and Clean Energy

- Ensure access to affordable, reliable, sustainable, and modern energy for all. It focuses on
increasing access to energy, improving energy efficiency, and promoting renewable energy sources.

8. Decent Work and Economic Growth

- Promote sustained, inclusive, and sustainable economic growth, full and productive employment,
and decent work for all. This goal emphasizes creating jobs, improving labor conditions, and
fostering economic growth.

9. Industry, Innovation, and Infrastructure

- Build resilient infrastructure, promote inclusive and sustainable industrialization, and foster
innovation. It focuses on modernizing infrastructure, fostering innovation, and promoting industrial
growth that is environmentally sound.

10. Reduced Inequality

- Reduce inequality within and among countries. This goal aims to reduce income inequality,
promote social, economic, and political inclusion, and ensure equal opportunities for all.

11. Sustainable Cities and Communities

- Make cities and human settlements inclusive, safe, resilient, and sustainable. It focuses on
improving urban infrastructure, ensuring safe housing, enhancing disaster resilience, and promoting
sustainable urbanization.

12. Responsible Consumption and Production

- Ensure sustainable consumption and production patterns. The goal promotes resource efficiency,
sustainable management of natural resources, reducing waste, and encouraging responsible
production and consumption behaviors.

13. Climate Action

- Take urgent action to combat climate change and its impacts. This involves reducing greenhouse
gas emissions, strengthening climate resilience, and integrating climate change measures into
national policies.

14. Life Below Water

 - Conserve and sustainably use the oceans, seas, and marine resources. This goal focuses on
reducing marine pollution, protecting marine ecosystems, and ensuring the sustainable use of ocean
resources.

15. Life on Land

- Protect, restore, and promote sustainable use of terrestrial ecosystems, manage forests
sustainably, combat desertification, halt and reverse land degradation, and halt biodiversity loss. It
emphasizes preserving ecosystems, reforestation, and halting biodiversity decline.

16. Peace, Justice, and Strong Institutions

- Promote peaceful and inclusive societies, provide access to justice for all, and build effective,
accountable, and inclusive institutions. This goal targets reducing violence, corruption, and ensuring
legal rights and effective governance.

17. Partnerships for the Goals

- Strengthen the means of implementation and revitalize the global partnership for sustainable
development. It encourages global cooperation, financial resources, capacity building, and
technology sharing to achieve the SDGs.

These goals form the core of the 2030 Agenda for Sustainable Development, aiming to create a more
just, inclusive, and sustainable world.

The Aardram Mission is a flagship healthcare initiative launched by the Government of Kerala under
the broader Nava Kerala Mission to reform and strengthen the state's public health system. The
mission’s core objective is to improve the quality of healthcare services, making them more
accessible, patient-friendly, and efficient, especially at the grassroots level. It targets primary health
centers (PHCs), family health centers (FHCs), and district hospitals.

Key Objectives of Aardram Mission:

1. People-Friendly Health Services:

- The mission aims to transform public health centers into patient-friendly healthcare institutions.
This includes improved infrastructure, shorter waiting times, and better interaction between
healthcare providers and patients.

2. Comprehensive Primary Healthcare:

- Aardram seeks to enhance the scope of services provided at primary healthcare centers by
upgrading them into Family Health Centers (FHCs). The focus is on a preventive and promotive
healthcare approach, rather than just curative care.
- These centers offer services such as screening for non-communicable diseases (NCDs), maternal
and child health care, geriatric care, and mental health services.

3. Universal Health Coverage (UHC):

- One of the mission's major goals is to work towards Universal Health Coverage, ensuring
equitable healthcare for all, especially for marginalized sections of society. The focus is on creating a
more inclusive healthcare system that is easily accessible and affordable to everyone.

4. Focus on Preventive Healthcare:

- The Aardram Mission emphasizes preventive healthcare services. Regular screenings for lifestyle
diseases like hypertension, diabetes, and cancer are promoted to catch diseases at an early stage.
 - There is also a focus on raising awareness about healthy lifestyles, sanitation, and community-
based health interventions.

5. Upgrading of Healthcare Infrastructure:

- Aardram includes upgrading the infrastructure of health centers to provide modern facilities. This
involves better outpatient services, more advanced equipment, and improved diagnostic capabilities
at the local level.
- PHCs are transformed into FHCs, which function as the first point of contact for community
healthcare.

6. Decentralized Health Services:

- The mission promotes decentralization of healthcare services, empowering local health
institutions to take more responsibility in planning and executing health programs. This leads to
faster responses to local health needs.

7. Integration with IT and eHealth:

- The Aardram Mission incorporates eHealth systems for better patient management and efficient
tracking of health services. The digitization of patient records and the use of technology to improve
the management of healthcare facilities is a core component.
- Telemedicine and online consultations are also promoted to improve healthcare access,
especially in remote areas.

8. Skill Development and Training:

- The mission includes the training and upskilling of healthcare personnel, including doctors,
nurses, and paramedics. This ensures they can provide better care and manage the upgraded
systems and equipment.
- Continuous education programs and workshops are conducted to enhance the skills of healthcare
workers to deliver high-quality services.

9. Strengthening Secondary and Tertiary Care:

- The mission extends to secondary and tertiary healthcare levels, ensuring that district hospitals
and specialty hospitals are better equipped to handle complicated cases referred from primary
health centers.
- It seeks to integrate care at various levels of the healthcare system so that there is a smooth
referral system from primary to tertiary care.

Major Achievements of the Aardram Mission:

- Upgradation of Family Health Centers (FHCs): Many Primary Health Centers (PHCs) in Kerala have
been converted into Family Health Centers (FHCs) with expanded services under the Aardram
Mission.
- Improved Health Indicators: The mission has contributed to improving health indicators in Kerala,
such as higher immunization rates, better maternal and child health outcomes, and effective disease
surveillance.
- Patient Satisfaction: The mission's patient-friendly approach has led to higher satisfaction rates
among those seeking care at government health institutions, with better communication, shorter
waiting times, and a more comfortable healthcare experience.

Alignment with National Health Mission (NHM):

The Aardram Mission is closely aligned with the objectives of the National Health Mission (NHM),
but it focuses on tailoring these objectives to Kerala’s unique healthcare needs, particularly the
growing burden of non-communicable diseases, an aging population, and the need for a more robust
primary care system.

In summary, the Aardram Mission is an ambitious reform that aims to make healthcare more
accessible, patient-centered, and efficient in Kerala. By focusing on upgrading health centers,
decentralizing services, and integrating technology, the mission is playing a vital role in transforming
the state's public health system to meet both current and future healthcare needs.

DAVID KOLB'S EXPERIENTIAL LEARNING THEORY (ELT) is a well-known educational framework

that emphasizes learning as a process that emerges through experience. According to Kolb, learning
is not a static outcome but an ongoing process where knowledge is created through the
transformation of experience. His model is based on a four-stage learning cycle and four distinct
learning styles, each related to this cycle.

The Four-Stage Learning Cycle

Kolb’s learning cycle involves four stages, which form a continuous loop that learners can enter at
any point:

1. Concrete Experience (CE):

- This stage involves engaging in an experience firsthand, where learners participate actively in a
situation.

2. Reflective Observation (RO):

- After the experience, learners reflect on what happened. They observe and analyze the
experience from different perspectives.

3. Abstract Conceptualization (AC):

- Based on the reflection, learners develop theories, ideas, or concepts. They begin to understand
the general principles that can be applied to new experiences.

4. Active Experimentation (AE):

- Learners test these new concepts or ideas in different situations. This phase involves applying
knowledge and making decisions to solve problems or navigate new experiences.

Learning Styles
Kolb also identified four learning styles, which are linked to preferences for different stages of the
cycle. These styles are determined by the way individuals prefer to approach and process new
information:

1. Diverging (CE/RO):
- These learners prefer observing rather than acting, and they are good at looking at things from
different perspectives. They are imaginative and often interested in brainstorming or generating
ideas.

2. Assimilating (RO/AC):
- Learners with this style are more focused on abstract concepts than on people. They prefer
logical theories and models and enjoy exploring complex ideas.

3. Converging (AC/AE):
 - Convergers are problem solvers who enjoy applying ideas and theories in a practical context. They
tend to focus on technical tasks and often prefer working alone.

4. Accommodating (AE/CE):
- These learners rely on hands-on experiences and tend to act more intuitively. They enjoy new
challenges, adapting to circumstances, and working in teams.

Key Principles of Kolb’s Experiential Learning Theory

- Learning as a Process: Learning is viewed as a continuous, cyclical process rather than an outcome.
- Experiential Nature: The theory stresses the importance of experience in shaping knowledge.
- Adaptation to the Environment: Learners adapt their approaches based on their experience and the
situation they face.
- Individual Differences: People have different learning styles based on their preferences for
particular stages of the cycle.

Kolb's theory has been widely applied in education, management training, and personal
development, offering insights into how to design effective learning experiences that cater to
different learning preferences.

A **STATE HEALTH RESOURCE CENTER (SHRC )** is typically established at the state level in
India to support the government in strengthening health systems and improving public health
services. SHRCs serve as technical and capacity-building agencies that provide expertise, guidance,
and resources to state health departments. Their primary goal is to enhance the quality, equity, and
accessibility of healthcare services across the state.

Though specific functions and roles may vary from state to state, the key responsibilities of an SHRC
usually include the following:

### **Key Functions of State Health Resource Centers (SHRCs)**

1. **Technical Assistance**:
- SHRCs provide technical support to the state government in designing, implementing, and
monitoring health programs. This can include areas like maternal and child health, disease control
programs, immunization, and public health policies.

2. **Capacity Building and Training**:

- SHRCs conduct training and workshops to build the capacity of health officials, medical
professionals, and frontline health workers (e.g., ASHAs, ANMs) to improve the delivery of health
services. These centers help equip healthcare staff with the necessary skills and knowledge.

3. **Health Systems Strengthening**:

- They work on strengthening the overall health system by providing expertise in areas such as
health management information systems (HMIS), logistics management, supply chains, and hospital
management.

4. **Program Implementation Support**:

- SHRCs often assist in the rollout and implementation of national health programs and initiatives
at the state level, such as the National Health Mission (NHM) or specific campaigns on
communicable and non-communicable diseases.

5. **Policy Support and Advocacy**:

 - These centers assist the government in formulating evidence-based health policies by providing
research, data analysis, and evaluations of ongoing health programs. They advocate for policy
changes to improve the healthcare system.

6. **Monitoring and Evaluation**:

- SHRCs play a crucial role in monitoring and evaluating health programs and initiatives to assess
their effectiveness and identify areas for improvement. This includes collecting data, analyzing
health outcomes, and making recommendations for adjustments.

7. **Health Research**:
- SHRCs conduct and promote health-related research to understand the needs of the population
better and develop interventions tailored to the state’s unique healthcare challenges.

8. **Support for Health Governance and Accountability**:

- These centers contribute to improving governance in the health sector by promoting
transparency, accountability, and community participation. They often work to strengthen grievance
redressal systems and ensure better health outcomes for marginalized populations.

9. **Collaboration with NGOs and Civil Society**:

- SHRCs may collaborate with non-governmental organizations (NGOs) and civil society
organizations (CSOs) to strengthen community-level interventions and promote public health
initiatives, particularly in underserved areas.

10. **Innovative Health Solutions**:

- SHRCs also help identify and promote innovative practices in healthcare delivery, particularly in
resource-limited settings, such as using mobile technology for health monitoring or community-
based health interventions.

### **SHRC in Trivandrum (Kerala)**

If we refer specifically to the **State Health Resource Center in Kerala**, it would likely focus on the
unique healthcare challenges and goals of the state, such as:
- Supporting Kerala’s decentralized health system,
- Improving access to primary healthcare in rural and urban areas,
- Addressing non-communicable diseases (NCDs), communicable diseases, and public health
emergencies,
- Enhancing maternal, neonatal, and child health (MNCH) outcomes,
- Strengthening public health infrastructure.

While each state's SHRC will have its distinctive priorities, they share the common goal of improving
the health system’s effectiveness and making healthcare more equitable and accessible for all
residents.

**Rashtriya Swasthya Bima Yojana (RSBY)** is a government-run health insurance scheme launched
by the Ministry of Labour and Employment, Government of India, in **2008**. Its primary objective
is to provide financial protection to low-income families against health expenses by offering cashless
hospitalization services through health insurance.

RSBY was specifically designed for the **Below Poverty Line (BPL)** families and some categories of
unorganized sector workers, providing them with access to affordable healthcare services.

### **Key Features of Rashtriya Swasthya Bima Yojana (RSBY)**

1. **Target Population**:
- The scheme is targeted at **BPL families** and certain categories of workers in the unorganized
sector, such as street vendors, domestic workers, construction workers, and others.
- The scheme aims to cover these families and help them access healthcare services without
financial strain.

2. **Coverage and Benefits**:

- **Insurance Coverage**: RSBY provides a **family floater health insurance coverage of up to
₹30,000 per year** for a family of five (including the head of the household, spouse, and up to three
dependents).
- **Cashless Treatment**: Beneficiaries can avail **cashless** inpatient treatment at
**empaneled hospitals** (both public and private) for a wide range of medical conditions, including
surgeries and hospitalization.
- **Pre-existing Conditions Covered**: All pre-existing diseases are covered from the first day of
enrollment, providing immediate healthcare benefits.

3. **Smart Card System**:

- Beneficiaries receive a **smart card**, which contains their personal and insurance information.
- The smart card is used to authenticate beneficiaries at empaneled hospitals, enabling **cashless
treatment**.
- The portability feature of the smart card allows beneficiaries to access healthcare services at
empaneled hospitals across the country, irrespective of their location.

4. **Empaneled Hospitals**:
- Hospitals (public and private) that are part of the RSBY network are **empaneled** to offer
healthcare services under the scheme.
- These hospitals are reimbursed by the insurance provider for the services provided to
beneficiaries, allowing the system to be cashless for the patients.

5. **Low Premium**:
- The premium for the insurance policy is mostly funded by the government, with the **central
government covering 75%** and the **state government covering 25%** of the total premium.
- Beneficiaries only need to pay a **nominal registration fee** of **₹30** at the time of
enrollment.

6. **Portability**:
- One unique feature of RSBY is its **portability**. Beneficiaries can avail services across any
empaneled hospital in the country, which is particularly beneficial for migrant workers and families.

7. **Inclusion of Other Sectors**:

- Over time, RSBY expanded its scope to cover various workers from the **unorganized sector**,
including beedi workers, domestic workers, and others.

### **Advantages of RSBY**

- **Financial Protection**: It reduces the financial burden on low-income families by providing
access to healthcare without out-of-pocket expenses.
- **Increased Access to Health Services**: By empaneling both public and private hospitals, RSBY
allows beneficiaries more options for healthcare providers.
- **Focus on the Vulnerable**: It focuses on marginalized and vulnerable sections of society who are
often excluded from formal healthcare schemes.
- **Cashless Treatment**: The cashless feature allows families to receive medical care without
needing to arrange funds upfront.

### **Challenges of RSBY**

1. **Low Coverage Amount**: The **₹30,000 coverage** may not be sufficient for more severe or
chronic health conditions that require long-term treatment or expensive surgeries.
2. **Awareness and Utilization**: Many eligible families are unaware of the scheme, leading to
underutilization. Outreach and awareness campaigns have been a challenge in many areas.
3. **Quality of Care**: In some cases, there have been concerns about the quality of care provided
by empaneled hospitals, especially in rural areas.
4. **Administrative and Implementation Issues**: There have been challenges in the smooth
implementation of the scheme, such as delays in claim processing, misuse of smart cards, and
fraudulent claims.

### **Transition to Ayushman Bharat**

RSBY served as a precursor to **Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PM-JAY)**,
which was launched in **2018**. Ayushman Bharat expanded the scope of RSBY, providing a higher
insurance cover of **₹5 lakh per family per year** for hospitalization, covering a wider range of
beneficiaries and a broader set of health services.

With the introduction of Ayushman Bharat, RSBY has largely been subsumed into this broader
scheme, though in some states, the transition from RSBY to Ayushman Bharat is still underway.

### **Conclusion**
Rashtriya Swasthya Bima Yojana was an important initiative that provided essential health insurance
coverage to millions of low-income families in India. Though it had its limitations, it paved the way
for more comprehensive health insurance schemes like Ayushman Bharat, which now covers a larger
portion of the population with higher insurance limits and wider benefits.

ANDANWADIS

Part of ICDS programme

Anganwadis provide holistic development services to children, pregnant women, and nursing
mothers.
Key components:
supplementary nutrition, immunisation, health check ups, and preschool education.

Staff
AWW: Anganwadi worker
AWH: Anganwadi Helper
Supervisor
Child Development Project Officer (CDPO) – Heads ICDS project, coordinates Anganwadi activities

FUNCTIONS:
1. Nutrition

In India, population norms for different levels of healthcare facilities aim to ensure adequate
healthcare coverage based on population density, geographic terrain, and healthcare needs. Here
are the standard population norms for each facility:
### 1. **Sub-Center (SC)**
- **Population Coverage**:
- **Plain Areas**: One sub-center per 5,000 people.
- **Hilly/Tribal/Difficult Areas**: One sub-center per 3,000 people.
- **Services Provided**: Preventive, promotive, and basic curative services, including
immunizations, antenatal care, family planning, and health education.
- **Staffing**: Generally staffed by an Auxiliary Nurse Midwife (ANM) and a Male Health Worker.

### 2. **Primary Health Center (PHC)**

- **Population Coverage**:
- **Plain Areas**: One PHC per 30,000 people.
- **Hilly/Tribal/Difficult Areas**: One PHC per 20,000 people.
- **Services Provided**: Includes outpatient services, maternal and child health, immunization,
minor surgeries, family planning, and preventive healthcare.
- **Staffing**: Typically staffed by at least one medical officer, nurses, health assistants, and
support staff.

### 3. **Community Health Center (CHC)**

- **Population Coverage**:
- **Plain Areas**: One CHC per 120,000 people.
- **Hilly/Tribal/Difficult Areas**: One CHC per 80,000 people.
- **Services Provided**: Acts as a referral center for PHCs and provides specialized services,
including general surgery, gynecology, pediatrics, and medicine.
- **Staffing**: Expected to have four specialists (surgeon, physician, gynecologist, and
pediatrician), nurses, paramedics, and support staff.

### 4. **Health and Wellness Center (HWC)**

- **Population Coverage**:
- Similar to Sub-Centers and PHCs, depending on location and population density.
- **Services Provided**: Expanded scope of services, including screening and management of non-
communicable diseases, mental health, geriatric, and palliative care, in addition to traditional PHC
services.
- **Staffing**: Usually staffed by a mid-level healthcare provider, ANMs, and ASHA (Accredited
Social Health Activist) workers, focusing on primary care and community health.

### 5. **Urban Primary Health Center (Urban PHC)**

- **Population Coverage**:
- One Urban PHC per 50,000 people in urban areas.
- **Services Provided**: Similar to rural PHCs, with a focus on reproductive, maternal, newborn,
child, and adolescent health (RMNCH+A), as well as communicable and non-communicable disease
management.
- **Staffing**: Medical officer, nurses, lab technician, pharmacist, and other support staff as
needed.

These population norms help ensure that healthcare facilities are distributed according to
community needs, facilitating better access to essential healthcare services across both rural and
urban settings in India.
TRIAGE IN FHC KUMILY
**Triage color coding** is a system used to prioritize patients based on the severity of their
conditions, especially in emergency situations or busy healthcare settings like Family Health Centers
(FHCs) in Kerala. Each color represents a different level of urgency, guiding healthcare providers to
manage patient care efficiently.

Here’s the typical color code used in triage:

### **1. Red (Immediate)**:

- **Description**: Life-threatening condition requiring immediate treatment.

- **Priority**: Highest priority; these patients need urgent medical intervention to survive.

- **Examples**: Severe trauma, heart attacks, respiratory failure, major bleeding, unconscious
patients, severe allergic reactions.

### **2. Yellow (Urgent)**:

- **Description**: Serious but not immediately life-threatening condition.

- **Priority**: Second-highest priority; these patients need treatment soon but can wait a short
period without major risk.

- **Examples**: Moderate trauma, fractures, high fever in children, moderate breathing difficulties,
stable chest pain, dehydration.

### **3. Green (Non-urgent)**:

- **Description**: Minor injuries or conditions that are not urgent.

- **Priority**: Lowest priority; these patients can wait for longer periods without their condition
worsening.

- **Examples**: Minor cuts, sprains, rashes, mild respiratory infections, stable patients needing
routine care.

### **4. Black (Deceased or Expectant)**:

- **Description**: Used for deceased patients or those with injuries so severe that survival is
unlikely even with treatment.

- **Priority**: No treatment or minimal intervention; focus is on others who can benefit from care.

- **Examples**: Patients with fatal injuries, catastrophic brain injuries, or those who have already
passed away.
### **5. White (Sometimes used)**:

- **Description**: For patients who require no medical care (used in some systems).

- **Priority**: No medical care is required or only minor first aid.

- **Examples**: Patients with very minor issues like superficial bruises or scratches.

### **Application of Triage in FHCs (Kerala)**

- In Family Health Centers (FHCs), this color-coding system helps healthcare providers quickly assess
and prioritize patients based on their medical needs.

- During large-scale public health events (e.g., outbreaks, health camps), this system helps allocate
limited resources effectively.

### **Benefits of Triage Color Code**

- **Efficiency**: Healthcare teams can quickly identify patients requiring urgent attention.

- **Resource Allocation**: Ensures that limited medical staff and resources are focused on the most
critical patients first.

- **Patient Safety**: Reduces the risk of critical patients waiting too long for care.

Triage color coding ensures that healthcare facilities, including FHCs in Kerala, can manage patient
flow efficiently, especially during emergencies or times of high patient volume.