CM17.1-6 | Health Care of the Community — Practice Quiz

Correct. Community health focuses on the health status of a population as a whole, not individual patients. Determinants operate across biological, behavioural, environmental, and socioeconomic domains — the approach that distinguishes public health from clinical medicine.

Park (2021): Community health is the health status of a defined community determined by the combination of biological, behavioural, environmental, and socioeconomic factors. The goal is to promote health, prevent disease, and ensure adequate care for the community as a whole.

Incorrect. Community health is not limited to government hospitals (A), individual records (C), or infectious disease burden alone (D). It encompasses the overall health status of a defined population shaped by multiple interacting determinants.

Correct. Community diagnosis is the systematic process of describing community health status, identifying health problems, and establishing priority order using epidemiological methods. It is the cornerstone of evidence-based planning at the PHC level.

Park (2021): Community diagnosis aims to identify and measure the health problems of a community, determine their causes and contributing factors, identify available resources, and set priorities for intervention — analogous to clinical diagnosis but for the population.

Incorrect. Health impact assessment (A) evaluates a specific policy/project. Clinical audit (C) evaluates clinical practice against standards. Vital statistics review (D) is one data source within community diagnosis, not the whole process.

Correct. Hospital-based specialist care is NOT one of Alma-Ata's 8 PHC elements. The 8 elements are: (1) Health education, (2) Nutrition and food supply, (3) Safe water and sanitation, (4) MCH including family planning, (5) Immunisation, (6) Prevention and control of endemic diseases, (7) Appropriate treatment of common diseases and injuries, and (8) Essential medicines. Specialist hospital care is secondary/tertiary care.

Park's 8 PHC elements (Alma-Ata 1978): Health education; Nutrition; Water & sanitation; MCH + FP; Immunisation; Control of endemic diseases; Appropriate treatment of common ailments; Essential drugs. Remember the mnemonic: HEWN-MICE-D.

Incorrect. Options A, B, and C are all authentic Alma-Ata elements. The element NOT listed is hospital-based specialist care, which belongs to secondary/tertiary care, not PHC.

Correct. Equitable distribution is a PRINCIPLE of PHC. The five Alma-Ata principles are: (1) Equitable distribution, (2) Community participation, (3) Focus on prevention, (4) Appropriate technology, (5) Intersectoral coordination. The 8 elements (including options A, B, D) are the SERVICE components.

Distinguish PHC elements (what services are provided) from PHC principles (how they are organised). Principles: Equitable distribution, Community participation, Prevention-focus, Appropriate technology, Intersectoral coordination.

Incorrect. Options A, B, and D are all elements (service components) of PHC, not principles. Principles describe HOW PHC should be organised and delivered.

Correct. NHP 2017 targets raising public health expenditure to 2.5% of GDP (from ~1.15% at time of policy), with a long-term goal that 75% of all health expenditure is publicly funded.

Key NHP 2017 targets: Public health expenditure to 2.5% GDP; life expectancy to 70 years; IMR to 28 per 1,000 LB; MMR to 100 per 1,00,000 LB; TFR to 2.1 by 2025; 80% child immunisation coverage.

Incorrect. 1% (A) approximates the actual spend at time of NHP 2017, not the target. 5% (C) and 7% (D) are not the NHP 2017 figures — these are too high for a stated 2017 target.

Correct. A Sub-Centre covers 3,000–5,000 population in plains (reduced to 3,000 for hilly/tribal areas). It is the peripheral-most contact point of the health system, staffed by 1 ANM (female health worker) and 1 MPW (male health worker).

Population norms: Sub-Centre = 3,000–5,000 (plains) / 3,000 (tribal/hilly); PHC = 20,000–30,000 (plains) / 20,000 (tribal/hilly); CHC = 80,000–1,20,000; District Hospital = entire district. Halved for hilly/tribal.

Incorrect. 1,000–2,000 (A) is too small — no standard health facility tier is set at this level. 20,000–30,000 (C) is the PHC norm. 80,000–1,20,000 (D) is the CHC norm.

Correct. ASHA (Accredited Social Health Activist) is a community health activist — not a nurse or a government employee in the formal service. She is a village-level volunteer (honorary worker with incentives) whose primary function is to mobilise the community and link households to the formal health system.

ASHA vs ANM vs AWW: ASHA = community link worker (NHM, village level, honorary); ANM = trained auxiliary nurse-midwife at Sub-Centre (government employee); AWW = Anganwadi Worker under ICDS/WCD ministry (nutrition, child development).

Incorrect. ASHA is not a trained nurse (A) — she has approximately 23 days of modular training. She is not a government employee (C) — she is an honorary activist with performance incentives. She is employed under NRHM/NHM (Ministry of Health), not Women and Child Development Ministry (D) — AWW (Anganwadi Worker) is under that ministry.

Correct. Absence of doctors at PHCs represents a Health Workforce gap — inadequate supply, training, or deployment of health workers is a workforce building block failure.

Incorrect. Service delivery (A) failure is the downstream consequence; the root building block failure here is workforce. Drug stock-outs (C) represent medical products failure. Health information (D) concerns data collection and use.

Correct. Bypass behaviour is a rational response — when CHCs lack specialists, essential drugs, or functioning equipment, patients rationally conclude that lower-level care is inadequate and go directly to higher facilities, incurring catastrophic out-of-pocket expenditure.

Incorrect. This is a public facility bypassing a public facility — it is not about private vs public preference (A). There is no such government policy directing elective procedures exclusively to district hospitals (C). Low health literacy may reduce uptake of preventive services, but patients experiencing illness are generally aware of facilities nearby (D).

Correct. India did NOT achieve MDG-4 by 2015 — the under-5 mortality rate fell from ~126 per 1,000 LB in 1990 but did not reach the two-thirds reduction target (to ~42) by 2015. However, the reason is TRUE — NRHM did strengthen the health system through infrastructure, ASHAs, and immunisation.

India missed MDG-4 (U5MR reduction) and MDG-5 (MMR reduction) by 2015, though significant progress was made. MDGs transitioned to SDGs in 2016 (Agenda 2030). SDG-3 targets include ending preventable deaths of newborns and children under 5.

Incorrect. Review whether India actually achieved MDG-4 before 2015. While NRHM (the reason) is genuinely true, the assertion about achieving MDG-4 is factually incorrect.

Correct. IMR is a composite indicator because infant survival depends on maternal health (nutrition, antenatal care), immunisation, sanitation, clean water, and access to skilled birth attendance and child health services — making it sensitive to improvements or deteriorations across multiple health determinants simultaneously.

Park (2021): IMR is the 'best single barometer of community health' because it integrates maternal health, nutritional status, immunisation coverage, water/sanitation quality, and health service utilisation — all in one easily computed number. India's IMR (NFHS-5): 35.2 per 1,000 live births.

Incorrect. IMR requires birth and death registration (A is false). WHO uses multiple indicators for health systems comparisons (C is false). IMR measures deaths in the first year of life, not adult mortality (D is false).