Community Health
Community Health tests how care is organised outside hospitals: the referral pyramid, national programmes, the frontline worker's role and the cold chain that keeps vaccines potent.
Core rules
- Levels of care: primary (sub-centre, PHC, community worker) → secondary (district hospital, CHC) → tertiary (medical college, super-specialty). Refer upward when the problem exceeds your level.
- Norms: sub-centre for 5,000 people (3,000 in hilly or tribal areas), PHC for 30,000 (20,000 hilly), CHC for 120,000 (80,000 hilly) with about 30 beds and four specialist services.
- Frontline workers: ASHA links the village to the health system; Anganwadi worker covers nutrition, growth monitoring and early childhood care; ANM provides maternal and child services and immunisation.
- Cold chain: vaccines are kept at +2 °C to +8 °C. OPV is the most heat sensitive; DPT, hepatitis B and TT are freeze sensitive and must never be frozen. Check the vaccine vial monitor - if the inner square is the same shade or darker than the outer circle, discard the vial.
- Health education is participatory: involve the community, use local language, demonstrate rather than lecture, and follow up.
Worked example
A PHC refrigerator fails overnight and the temperature reaches 20 °C. Reasoning: potency cannot be assumed, so you do not simply put the vials back. You check each vial's monitor, discard those with a darkened square, keep the cold box chain intact, record the incident and inform the cold chain officer before resuming vaccination.
Traps that cost marks
- Assuming freezing protects all vaccines - it destroys DPT, hepatitis B and TT.
- Putting a vaccine vial monitor reading aside and using the vial anyway.
- Referring every minor complaint upward instead of treating at primary level.
- Quoting national norms for the wrong facility type.