Introduction to Healthcare and the Healthcare System
This domain tests whether you know where care is delivered in India, how patients move between facilities, and where the General Duty Assistant (GDA) fits.
Levels of care
- Primary – first point of contact: sub-centre, Primary Health Centre (PHC), urban dispensary. Preventive, promotive and basic curative care.
- Secondary – Community Health Centre (CHC), sub-district and district hospitals: specialist outpatient, inpatient and basic surgical care.
- Tertiary – medical college hospitals and super-speciality centres: advanced investigation, complex surgery, intensive care.
IPHS planning norms worth memorising: one sub-centre per 5,000 population (3,000 in hilly/tribal areas), one PHC per 30,000 (20,000 hilly), one CHC per 1,20,000 (80,000 hilly). The CHC is the first referral unit.
Hospital organisation
Clinical areas include OPD, IPD, casualty/emergency, operation theatre, ICU, labour room and dialysis; support areas are laboratory, radiology, pharmacy, CSSD, laundry, dietary, medical records, ambulance and housekeeping. Ayushman Bharat PM-JAY is a health assurance scheme that pays for treatment - it is not a level of hospital.
Worked example
A man at a sub-centre has central chest pain and sweating. The sub-centre has no ECG or defibrillator, so the ANM gives first aid as per protocol and arranges urgent referral to the CHC or district hospital. Question: which level of care does he now need? Reasoning: the diagnosis needs ECG and a doctor, which are secondary-level services, so the answer is secondary (or tertiary if a cardiac centre is required) - never primary.
Traps that cost marks
- Swapping the PHC (30,000) and CHC (1,20,000) population norms.
- Claiming a GDA can diagnose or prescribe; your role is observation, safe assistance and reporting.
- Forgetting that the referral system runs upward, and that a discharged patient is followed up at the lower level.