Health is the cornerstone of human well-being, encompassing not just the absence of illness, but the overall physical, mental, and social state of an individual. It holds paramount importance as it directly influences one’s quality of life, productivity, and longevity. Recognizing its multifaceted nature, health care is classified into three essential categories: primary, secondary, and tertiary. Each tier plays a distinctive role in promoting, maintaining, and restoring health at various stages of an individual’s life. While primary care focuses on preventive measures and early intervention, secondary care delves into specialized treatments and diagnostic services. Tertiary care, on the other hand, deals with complex medical interventions and rehabilitation for severe health conditions. Together, these classifications form a comprehensive framework aimed at addressing diverse health needs and ensuring holistic well-being for all.
Primary Healthcare:
Primary healthcare denotes the first level of contact between individuals and families with the health system. According to Alma Atta Declaration of 1978, Primary Health care was to serve the community it served; it included care for mother and child which included family planning, immunization, prevention of locally endemic diseases, treatment of common diseases or injuries, provision of essential facilities, health education, provision of food and nutrition and adequate supply of safe drinking water.
In India, Primary Healthcare is provided through a network of Sub centres and Primary Health Centres in rural areas, whereas in urban areas, it is provided through Health posts and Family Welfare Centres.
Secondary Health Care
Secondary Healthcare refers to a second tier of health system, in which patients from primary health care are referred to specialists in higher hospitals for treatment. In India, the health centres for secondary health care include District hospitals and Community Health Centre at block level.
Tertiary Health Care
Tertiary Health care refers to a third level of health system, in which specialized consultative care is provided usually on referral from primary and secondary medical care. Specialised Intensive Care Units, advanced diagnostic support services and specialized medical personnel on the key features of tertiary health care. In India, under public health system, tertiary care service is provided by medical colleges and advanced medical research institutes.
Rural Health Care System in India
The health care infrastructure in rural areas has been developed as a three tier system as follows:
| Sub Centre | Most peripheral contact point between Primary Health Care System & Community manned with one HW(F)/ANM & one HW(M) |
| Primary Health Centre (PHC) | A Referral Unit for 6 Sub Centres 4-6 bedded manned with a Medical Officer Incharge and 14 subordinate paramedical staff |
| Community Health Centre (CHC) | A 30 bedded Hospital/Referral Unit for 4 PHCs with Specialized services |
Sub Centres (SCs)
The Sub Centre is the most peripheral and first contact point between the primary health care system and the community. Sub Centres are assigned tasks relating to interpersonal communication in order to bring about behavioral change and provide services in relation to maternal and child health, family welfare, nutrition, immunization, diarrhoea control and control of communicable diseases programmes.
Each Sub Centre is required to be manned by at least one auxiliary nurse midwife (ANM) / female health worker and one male health worker. Under National Rural Health Mission (NRHM), there is a provision for one additional second ANM on contract basis. Government of India bears the salary of ANM and LHV while the salary of the Male Health Worker is borne by the State governments.
Primary Health Centre (PHC)
PHC is the first contact point between village community and the medical officer.
The PHCs were envisaged to provide an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care. The PHCs are established and maintained by the State governments under the Minimum Needs Programme (MNP)/ Basic Minimum Services (BMS) Programme. The activities of PHC involve curative, preventive, promotive and family welfare services.
Community Health Centres (CHCs)
CHCs are being established and maintained by the State government under MNP/BMS programme. It serves as a referral centre for 4 PHCs and also provides facilities for obstetric care and specialist consultations.
First Referral Units (FRUs)
An existing facility (District Hospital, Sub-divisional Hospital, Community Health Centre etc.) can be declared a fully operational First Referral Unit (FRU). It should be noted that there are three critical determinants of a facility being declared as a FRU:
- Emergency Obstetric Care including surgical interventions like caesarean sections;
- new-born care
- blood storage facility on a 24-hour basis.
Urban Health Care System in India
The health care infrastructure in urban areas consists of the Community Health Centres and Primary Health Centres.
Population norms for urban health infrastructure
- Community Health Centres – 2,50,000 population (5 Lakh for metros)
- Primary Health Centres – 50,000 population.
Urban Primary Health Center
In order to provide comprehensive primary healthcare services, the National Urban Health Mission aims to establish Urban Primary Healthcare Centers, not as a stand-alone health facility, but as a hub of preventive, promotive and basic curative healthcare for its catchment population. Within its catchment area, the UPHC is responsible for providing the primary health care and public health needs of the population. The U-PHC is located preferably closer to slum or similar habitations.
Urban Community Health Centres (U-CHCs)
Urban Community Health Centre (U-CHC) is set up as a referral facility for every 4-5 U-PHCs. The U-CHC caters to a population of 250000 to 5 Lakhs. For the metro cities, UCHCs may be established for every 5 lakh population with 100 beds.
FAQs
1. Why is health important?
- Health is crucial because it affects every aspect of our lives. It enables us to pursue our goals, enjoy relationships, and engage fully in activities we value. Good health also reduces the burden on healthcare systems and contributes to economic productivity.
2. What are the primary components of healthcare?
- Primary healthcare focuses on prevention, promotion, and initial treatment of common illnesses and injuries. It includes services like routine check-ups, vaccinations, and basic diagnostic tests, aiming to keep individuals healthy and address health concerns at an early stage.
3. What is the role of secondary healthcare?
- Secondary healthcare involves specialized services provided by medical professionals who typically require more advanced training. These services include diagnostic procedures, treatment for acute illnesses or injuries, and specialized care for specific health conditions, often requiring referrals from primary care providers.
4. How does tertiary healthcare differ from primary and secondary care?
- Tertiary healthcare offers highly specialized medical services aimed at managing complex and rare conditions. It involves advanced medical procedures, specialized equipment, and expertise not available at primary or secondary levels. Tertiary care often occurs in specialized hospitals or medical centers.
5. How do primary, secondary, and tertiary healthcare work together?
- These three levels of healthcare form a comprehensive system that addresses the full spectrum of health needs. Primary care acts as the first point of contact for individuals, providing preventive and basic healthcare services. Secondary care steps in when specialized expertise or equipment is required, offering more targeted treatments. Tertiary care provides the highest level of medical intervention for complex conditions, often involving collaboration with primary and secondary care providers to ensure continuity of care.
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