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CM17.1-6 | Health Care of the Community — Graded Quiz
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In public health, the concept of 'healthcare to the community' differs from individual clinical care primarily because it:
Correct. Community healthcare shifts the unit of care from the individual patient to the entire community — encompassing health promotion, prevention, and protection for all, not just those who present sick.
Community healthcare adopts a population perspective: the community is both the subject and the setting of care. This includes health promotion, disease prevention, protection from environmental hazards, and ensuring adequate care for all — not only for those who seek care.
Incorrect. Community healthcare is not limited to communicable diseases (A), government rural hospitals (C), or curative care (D). Its defining feature is population-level promotion and protection.
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Which of the following is the FIRST step in conducting a community diagnosis?
Correct. The first step of community diagnosis is defining the community — specifying the geographic area, population size, and demographic composition. Without knowing WHO is in the community, data collection and problem identification are impossible.
Six steps of community diagnosis: (1) Define the community; (2) Collect data (vital statistics, survey, facility records); (3) Analyse data; (4) Identify health problems; (5) Establish priorities; (6) Plan interventions. Step 1 is always community definition.
Incorrect. Priority ranking (A) comes after data collection. Disease-specific data collection (C) is step 2-3 after community definition. Intervention design (D) is the output of community diagnosis, not a step within it.
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The landmark international conference that defined Primary Health Care and produced the Alma-Ata Declaration was held in:
Correct. The International Conference on Primary Health Care was held in Alma-Ata (now Almaty, Kazakhstan) in September 1978, jointly convened by WHO and UNICEF. It produced the Alma-Ata Declaration and the 'Health for All by 2000' goal.
Key dates: WHO founded 1948; Alma-Ata Declaration on PHC = 1978; Ottawa Charter (Health Promotion) = 1986; MDGs = 2000; SDGs = 2015. The 'Health for All by 2000' slogan emerged from Alma-Ata 1978.
Incorrect. 1947 (A) is the year of Indian independence and WHO constitution coming into force. 1965 (B) has no particular PHC landmark. 1986 (D) is the year of the Ottawa Charter for Health Promotion.
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Village Health, Sanitation and Nutrition Committees (VHSNCs) at the Sub-Centre level embody which principle of Primary Health Care?
Correct. VHSNCs are community-level governance bodies that include villagers, ASHA workers, Anganwadi Workers, and elected representatives. They embody the Alma-Ata principle of community participation — communities are not passive recipients but active co-planners of health services.
Community participation operationalised in India: VHSNCs, Rogi Kalyan Samitis (hospital committees), Jan Arogya Samitis — all bring communities into health governance. This is the fourth Alma-Ata principle in action.
Incorrect. Appropriate technology (A) refers to using medically sound, culturally acceptable, low-cost technologies suited to local conditions. Intersectoral coordination (B) involves collaboration between health and other sectors (agriculture, education, water). Equitable distribution (D) concerns fair geographic and demographic access.
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The Millennium Development Goals (MDGs) were replaced by the Sustainable Development Goals (SDGs) in:
Correct. The 17 SDGs (Agenda 2030) were adopted in September 2015 at the UN General Assembly, replacing the 8 MDGs (2000–2015). SDG-3 specifically addresses 'Good Health and Well-being'.
MDGs (2000–2015): 8 goals, 21 targets; health-specific: MDG-4 (child mortality), MDG-5 (maternal mortality), MDG-6 (HIV/AIDS, malaria, TB). SDGs (2015–2030): 17 goals, 169 targets; SDG-3 = Good Health and Well-being with 13 targets.
Incorrect. The MDG period was 2000–2015; SDGs were adopted in 2015 (not 2010, 2018, or 2020).
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According to IPHS norms, a Primary Health Centre (PHC) in the plains is mandated to have as its minimum essential staff complement:
Correct. IPHS norms for a PHC require 1 MBBS doctor (medical officer) plus 14 paramedical and support staff, covering health assistants (male and female), ANMs, pharmacist, laboratory technician, health educator, and administrative staff.
Key health facility staffing: Sub-Centre = 1 ANM (female) + 1 MPW (male); PHC = 1 MBBS doctor + 14 staff; CHC = 4 specialists (surgeon, physician, OBG, paediatrician) + 21 staff, 30 beds; District Hospital = 75–100+ beds.
Incorrect. Option A understates the PHC's staff requirement. Option C describes a CHC (4 specialists, 30 beds). Option D describes a Sub-Centre (MPW + ANM, no resident doctor).
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A Community Health Centre (CHC) is the first referral unit (FRU) in India's rural health delivery system. It serves a population of:
Correct. A CHC covers 80,000–1,20,000 population (plains), has 30 beds, 4 specialist doctors (surgery, medicine, obstetrics-gynaecology, paediatrics), and serves as the first referral unit from PHCs.
Referral hierarchy: household → Sub-Centre (3,000–5,000) → PHC (20,000–30,000) → CHC/FRU (80,000–1,20,000, 30 beds) → Sub-District/District Hospital → Medical College Hospital. All norms halved for tribal/hilly.
Incorrect. 3,000–5,000 (A) = Sub-Centre. 20,000–30,000 (B) = PHC. 5,00,000–10,00,000 (D) is too large — this is roughly a district population, served by a District Hospital.
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The WHO Health System Building Blocks framework (2007) identifies how many essential building blocks of a well-functioning health system?
Correct. The WHO (2007) framework identifies 6 building blocks: (1) Service delivery, (2) Health workforce, (3) Health information systems, (4) Medical products/vaccines/technologies, (5) Health financing, (6) Leadership and governance (stewardship).
6 WHO Building Blocks (2007): Delivery, Workforce, Information, Products/Vaccines/Technologies, Financing, Leadership/Governance. Goal: improved health (equity, efficiency), responsiveness, social and financial risk protection. Commonly tested: 'What are the 6 building blocks?'
Incorrect. 4 (A) is not the WHO figure. 8 (C) is the number of Alma-Ata PHC elements. 10 (D) is not a standard WHO framework number.
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The National Population Policy 2000 (NPP 2000) set a medium-term demographic goal of achieving which Total Fertility Rate (TFR) by 2010?
Correct. NPP 2000 set the medium-term goal of achieving TFR of 2.1 (replacement level) by 2010. India's actual TFR reached replacement level (2.0) only by NFHS-5 (2019–21), about a decade later than targeted.
NPP 2000 goals: Immediate — meet unmet need for contraception, reduce MMR to <100, IMR to <30; Medium-term (by 2010) — TFR 2.1; Long-term (by 2045) — stable population. India's NFHS-5 TFR: 2.0 (at replacement). Replacement TFR = 2.1.
Incorrect. 1.8 (A) is below replacement — NPP 2000 targeted 2.1, not below replacement. 2.5 (C) and 3.0 (D) are above replacement — NPP 2000 aimed to reduce TFR TO replacement, not maintain it above.
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A major indicator of health system financing weakness in India is that a large proportion of health expenditure is out-of-pocket (OOP). Catastrophic health expenditure is defined as OOP spending that exceeds what threshold of household income or consumption?
Correct. WHO defines catastrophic health expenditure as OOP spending exceeding 10% of total household expenditure (or >40% of non-food/capacity-to-pay expenditure). India has one of the highest OOP expenditure shares globally (~60% of total health expenditure), pushing millions into poverty annually.
Catastrophic health expenditure (WHO): OOP > 10% of total household expenditure OR > 40% of non-food expenditure. India: OOP ~60% of total health expenditure (one of highest globally); NHP 2017 aims to reduce this by strengthening public financing. Impoverishment: households pushed below poverty line by medical costs.
Incorrect. 5% (A) is too low for the standard WHO catastrophic threshold. 25% of annual savings (C) and 50% of per capita GDP (D) are not the standard WHO definitions.
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