Analysis of Primary Health Care Issues and Nursing Roles in India

This report examines primary health care challenges in India, specifically focusing on infectious diseases and their contributing social determinants. It explores how factors like poverty, environment, and inequities in employment and access to healthcare impact the spread of diseases. The report analyzes epidemiological studies on diseases like diphtheria and HPV, highlighting the importance of vaccination. Furthermore, it delves into the crucial role of nurses in combating infectious diseases, emphasizing their responsibilities in infection control, documentation, and promoting cultural competence to improve patient outcomes. The report concludes by advocating for increased nursing staff and enhanced cultural awareness to address the health disparities and improve primary health care in India.

Primary health care issue in India
Student name:
Student ID:
1

The increase in drug resistance and challenges related to it has caused global awareness in the
world. India, being overly populated country has been prevailing with infectious disease in
the short as well as in the long run. Many outbreaks of infectious disease in the country has
been seen since the smallpox epidemic 1974 to the recent flu pandemic in 2009 (Nilgiriwala,
2018). Indian government and public health department of India have always been able to
tackle the infectious disease problem but the country still has many cases of people suffering
from infectious diseases on the contrary of having immunisation programmes. Many social
determinants play a crucial role in causing these infectious diseases in India. This assignment
will throw a light on the social determinants of health in India that cause the health problems.
The surveys or statistical studies done in order to find these health issues. The role of nurses
in order to diminish the infectious disease in the country and the cultural competence they
provide to support the issue.
Social determinants of health are the conditions in which the person is born, lives, works and
spends his everyday life which affects or determines its health. Social determinants of health
can vary from the salary of the person to how much access he or she has to the health care
services? What is culture? The society in which the person lives. Is the society supportive of
the person? The quality of his life that is social status. Quality of life also includes education
and the job training he or she has acquired ("Social Determinants of Health | Healthy People
2020", 2019). There are many social determinants of health in India that defines a person’s
health and are the underlying causes of infectious disease. The environment is one of the
major causes of developing infectious disease in India, the food, water, and the air is the
major medium of transmission of infectious disease. Poverty is another social determinant of
health in India that causes the infectious disease, people who have no access to health care
services are mainly prone to the infectious diseases along with the malnourished or the
underweight people, their immune systems are weak and susceptible to the infectious disease
2

(Cowling, Dandona & Dandona, 2014). The inequities in employment on the basis of gender,
caste, and religion lead to the social injustice of health. Inequities in terms of health are also
due to political participation in India. Indian health care services follow the inverse case law,
that is, the person whose priority or who needs the health care face the greatest of difficulty in
accessing it (Balarajan, Selvaraj & Subramanian, 2011). Caste is always connected to health
in India, the people at the lowest hierarchy of caste in India face many difficulties in
accessing health care services. There are ample pieces of evidence available that show the
discrimination against the people at the lowest level in terms of health, environment and even
violence in India (Acharya, 2018). Inequities lead to less of the utilization of the preventive
services regarding infectious diseases like immunization which varies according to the
gender, socio-economic status, and the geography or the place a person lives in (Balarajan,
Selvaraj & Subramanian, 2011). Studies on health inequities in India have been mostly on
communicable diseases which accounts for about 12.7% of total diseases in India. Most of
the studies were on women and children (Acharya, 2018).
There are many epidemiological studies that have been done in identifying the issues of
primary health care regarding infectious diseases. Persistence of infectious diseases in
different states of India like Delhi, Madhya Pradesh, Arunachal Pradesh, etc. have been seen
due to less utilization of vaccines. Infectious diseases such as diphtheria is a vaccine-
preventable disease with 39,231 cases in 1980 to around 2817 cases in the year 1997. (Dikid,
Jain, Sharma, Kumar & Narain, 2013). However, in the past 2 decades, there has been a
sudden increase in diphtheria cases to around 8000 in the year 2004(Dikid, Jain, Sharma,
Kumar & Narain, 2013). According to WHO only 56 -72% of immunization coverage
occurred in India for diphtheria also the NFHS that is the National Family Health Service
estimated that only 55-60% of DPT-3 vaccine were utilized in the past 2 decades that is 1992-
3

2006. There was also an epidemiological shift seen in the disease in India from affecting
children of low age to children of higher age (5-10 years) (Dikid, Jain, Sharma, Kumar &
Narain, 2013). Another epidemiological study was done on the HPV vaccines that are used
for the diseases caused by the Human Papilloma Virus and its different genotypes (around
16-18), this virus is responsible for various sexually transmitted disease in women and can
also lead to cervical cancer in the long term. Most of the HPV infections are through sexual
contact and show no symptoms of the disease. The lifetime risk of the virus is more than 50%
in males and in females. It is more than 25% in females below 25 years of age who are also
sexually active (Chatterjee, Chattopadhyay, Samanta & Panigrahi, 2016). WHO has
recognized and mentioned that the HPV vaccine breakthrough should be done in all the
countries and that it should be a part of the national immunisation programme in all the
nations around the globe. WHO also recommends giving the HPV vaccine between the ages
of 9-13 years before the first coitus of a female child. The Indian Academy of Paediatrics
Committee on Immunization (IAPCOI) also suggests giving it to females who can afford it.
The vaccine is not yet covered in the current immunisation plan but will be considered by the
National Technical Advisory Group on Immunization (NTAGI) on recommendation from the
political parties (Chatterjee, Chattopadhyay, Samanta & Panigrahi, 2016). The vaccine is
available in private clinics or practitioners and are still very active in the country. There are
some issues related to the HPV vaccine the very first one being the high-cost and the health
priorities. Secondly, being the acceptance of the vaccine in the Indian health care system.
There is no evidence of lifetime protection from the disease with the HPV vaccine, in fact,
there is no evidence of the duration of not having the disease (Chatterjee, Chattopadhyay,
Samanta & Panigrahi, 2016).
According to Economic Times 2019 article India has around 2 million shortage of nurses in
the primary health care of the country. To resolve this issue the number of nurses in India
4

should be increased. According to the National Infection Control Guidelines from the
Government of India, 2017 there are roles or functions that a nurse should play to prevent the
infectious disease from spreading. Nurses have joined the Infection Prevention and Control
Committee (IPCC) of India which is a multidisciplinary team including professionals from
various medical background to prevent the infectious disease from spreading. There is
Infection Control Nurse (ICN) which is the head or a senior nursing staff which has some
responsibilities or roles in controlling the communicable diseases like maintaining and
tracking all the positive cultures data and taking daily rounds of infection control. They
should maintain and comply with the hospital’s BMW policy. They should also maintain the
data of needles injuries which is the main transmitter of communicable disease in the
hospitals. They should also initiate and ensure the immunisation of the medical as well as the
kitchen staff in the hospital of various infectious diseases like hepatitis B, influenza and
typhoid ("NATIONAL INFECTION CONTROL GUIDELINES", 2017). They should also
consult with microbiologist or lab technician in case of any suspicious infected worker or a
patient. The main roles of the primary health care senior nurses in preventing the disease
includes documentation and maintaining the record of cases. Nurses should Participate in the
meetings of the infection control committee. They should also promote aseptic nursing
techniques or policy by the infection committee. The nurse in charge of the ward is an
important person and maintains the hygiene in the ward by promoting the aseptic technique
such as hand washing and isolation usage. They should also keep a check on patient’s
supplies and ward equipment sanitation. They should limit the infectious patient’s exposure
to the hospital staff, ward equipment and the visitors in the ward. Nurses are also appointed in
the ICT that is the infection control team to prevent the infectious disease from
communicating ("NATIONAL INFECTION CONTROL GUIDELINES", 2017).
5

Cross and colleagues have defined cultural competence as “a set of congruent behaviours,
attitudes and policies that come together in a system, agency or amongst professionals and
enable that system, agency or those professionals to work effectively in cross-cultural
situations.” They have also described the culture competent system as diverse and having the
ability to adapt to the diversity of the situations. Patient centeredness and cultural competence
should be approachable in the primary health care system by the nurses to promote health
issue and treatment of the patient. I think nurses should interact and communicate with the
patients not only about their health but also about their personal life. They should respect the
patient’s values and beliefs. I think nurses should take proper care of their needs and
necessities. They should always provide the patient with physical as well as emotional
support and coordinate with them in times of depression, fear and anxiety. Releasing of
depression or anxiety has proved to be good for the improvement in the patient’s health (L
Swihart & Martin, 2019). In my views, the nurses should be encouraged about cross-cultural
competence and should learn about the patient’s culture and influence of it on its health
(Saha, Beach & Cooper, 2013). I think cultural competence is a narrow version of diversity
competence. Nurses should maintain and make sure about the health of different or diverse
group of people. They should be well aware of 2 of the main diverse groups that is the person
with disabilities and the person identifying themselves as gay, lesbians and transgender on
ethnicity. The nurse's study modules should include the global or universal cultural scopes
and also the group-specific knowledge about the diversity and ethnicity of the people. Studies
have also shown that discrimination between the patients of colour and no- colour has also
caused decrement in the health of the patients. Therefore, the nurses should be taught about
the social and cultural barriers between the health care providers and the people of colour
receiving the treatment from the nurse. There should be logic or study models made on
6

cultural competence for nursing practice which should include the knowledge, the skills and
the attitude required for cultural competence in healthcare.
References
Acharya, S. (2018). Health Equity in India: An Examination Through the Lens of Social
Exclusion. Journal Of Social Inclusion Studies, 4(1), 104-130. doi:
10.1177/2394481118774489
Balarajan, Y., Selvaraj, S., & Subramanian, S. (2011). Health care and equity in India. The
Lancet, 377(9764), 505-515. doi: 10.1016/s0140-6736(10)61894-6
Chatterjee, S., Chattopadhyay, A., Samanta, L., & Panigrahi, P. (2016). HPV and Cervical
Cancer Epidemiology - Current Status of HPV Vaccination in India. Asian Pacific
Journal Of Cancer Prevention, 17.
Cowling, K., Dandona, R., & Dandona, L. (2014). Social determinants of health in India:
progress and inequities across states. International Journal For Equity In Health,
13(1). doi: 10.1186/s12939-014-0088-0
Dikid, T., Jain, S., Sharma, A., Kumar, A., & Narain, J. (2013). Emerging & re-emerging
infections in India: An overview. Indian Journal Of Medical Research, 138(1), 19-31.
India facing shortage of 600,000 doctors, 2 million nurses: Study. (2019). Retrieved 26
September 2019, from
https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/india-
facing-shortage-of-600000-doctors-2-million-nurses-study/articleshow/
68875822.cms?from=mdr
7

L Swihart, D., & Martin, R. (2019). Cultural Religious Competence In Clinical Practice.
NATIONAL INFECTION CONTROL GUIDELINES. (2017). Retrieved 26 September
2019, from
https://dghs.gov.in/content/1407_3_NationalCentreforDiseaseControl.aspx?
format=Print
Nilgiriwala, K. (2018). Basis of science policies for infectious disease challenges in India.
Indian Journal Of Public Health, 62(3), 193. doi: 10.4103/ijph.ijph_306_17
Saha, S., Beach, M., & Cooper, L. (2013). Patient Centeredness, Cultural Competence and
Healthcare Quality. Journal Of The National Medical Association, 100(11), 1275-
1285. doi: 10.1016/s0027-9684(15)31505-4
Social Determinants of Health | Healthy People 2020. (2019). Retrieved 26 September 2019,
from https://www.healthypeople.gov/2020/topics-objectives/topic/social-
determinants-of-health
8