Fundamentals of Health Care and the Health Care Delivery System
This domain tests whether you can define health, place a service at the correct level of care, and name the machinery that runs health services in India and Karnataka.
Defining health and care
WHO (1948) defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Care is delivered in three levels: primary (first contact, preventive and basic curative - sub-centre, PHC, Health and Wellness Centre), secondary (district hospital, CHC - specialist inpatient care) and tertiary (medical college and super-specialty hospitals - advanced and referral care).
Levels of prevention
Primordial (reduce population risk factors), primary (prevent onset - immunisation, safe water), secondary (early detection - screening, treatment) and tertiary (disability limitation - rehabilitation).
Rural three-tier norms (IPHS)
- Sub-centre: one ANM plus one male health worker; 5,000 population in plains, 3,000 in hilly or tribal areas.
- PHC: MBBS medical officer with staff nurses; 30,000 plains, 20,000 hilly.
- CHC: 30 beds with four specialists (medicine, surgery, paediatrics, obstetrics and gynaecology); 120,000 plains, 80,000 hilly.
Programmes and state structure
National Health Mission (from NRHM, 2005), Ayushman Bharat (Health and Wellness Centres plus PM-JAY), IPHS 2022. In Karnataka, the Department of Health and Family Welfare runs the system with Arogya Karnataka and the Suvarna Arogya Suraksha Trust for cashless treatment.
Worked example
A 45-year-old with a blood pressure of 160/100 is checked by the ANM at a sub-centre, referred to the PHC where the medical officer prescribes treatment, and is later evaluated for target-organ damage at the district hospital. Reasoning: first contact at the sub-centre is primary care; treating an established case to prevent complications is secondary prevention; specialist inpatient work at the district hospital is secondary care, not tertiary.
Traps that cost marks
Primary care is not primary prevention. The sub-centre is nurse-led, not doctor-led. Tertiary care means super-specialty, not district-level.