Introduction to Health Care and the Health Care Team
This domain asks how health care is organised in India, who staffs each level, and which cadre a villager should contact first. Question stems usually give a community situation and ask for the correct facility level or the correct team member.
The three levels of care
- Primary: sub-centre (ANM and MPW-M) and the Ayushman Bharat Health and Wellness Centre/PHC with a medical officer; first contact, promotive, preventive and basic curative care.
- Secondary: CHC (IPHS norm of 30 beds with specialist services) and the district hospital; the first referral level.
- Tertiary: medical college and super-specialty hospitals for advanced investigation and training.
- Referral normally moves up one level at a time, except in an emergency.
Team roles not to mix up
- ASHA: a trained female community volunteer, about one per 1,000 population, incentive-based; the bridge between households and the facility.
- ANM: salaried multipurpose worker at the sub-centre - antenatal care, immunisation, family planning.
- AWW: ICDS anganwadi worker - nutrition, pre-school education, growth monitoring; not clinical care.
- CHO, staff nurse, pharmacist, laboratory technician, medical officer and specialist complete the team.
Worked example
A woman at 38 weeks reports leaking fluid at 11 pm. Reasoning: rupture of membranes is a danger sign needing facility delivery within hours. The ASHA alerts the ANM, who arranges transport (JSSK gives free delivery and referral transport; 108 ambulance if no vehicle) and refers her to the CHC. The medical officer decides on further referral. Follow the chain: volunteer, then frontline worker, then facility.
Traps that cost marks
- Treating ASHA as a salaried government nurse.
- Calling a PHC tertiary care.
- Forgetting that JSSK makes delivery and referral transport free for pregnant women.