Grade 10 HPE ||Consumer's Health and Community Health || Notes

PART 1: COMMUNITY HEALTH

🔵 Definition of Community Health

Community Health refers to the health status of a defined group of people and the actions and conditions to promote, protect, and preserve their health.

Definition: Community health is the organized effort of the community to maintain, protect, and improve the health of its members through collective action and available health services.

🟢 Importance of Community Health

1. Environmental Sanitation

• Clean environment prevents infectious diseases
• Collective effort required, not individual alone
• Public awareness and participation essential

2. Production of Healthy Human Resource

• Healthy individuals contribute to national development
• Healthy lifestyle practices through community health
• Individual efforts alone insufficient

3. Expansion of Health Services and Facilities

• Health services reach grassroots level
• Access for all community members
• Community participation in health programs

4. Development of Social Service Mentality

• People become responsible for community wellbeing
• Local clubs and organizations involvement
• Social service activities in health sector

🟢 Scope of Community Health

1. Quality Control of Food, Water, Milk

• Essential for health maintenance
• Contaminated food/water affects community health
• Regular quality testing required
• Community participation in monitoring

2. Control and Prevention of Communicable Diseases

• Epidemic diseases affect large population
• Some diseases controllable, some persistent
• Health education, personal hygiene, clean environment essential

3. Environmental Health and Sanitation

• Clean houses, surroundings, drains, toilets
• Prevents breeding of flies, mosquitoes, pathogens
• Regular cleaning campaigns needed
• Public awareness programs

4. Immunization Programs

• Government provides free vaccination
• Community-based immunization drives
• Protects from vaccine-preventable diseases

5. Prevention of Malnutrition

• Common problem in Nepal due to poverty, illiteracy
• Causes: poor food distribution, cultural beliefs
• Solutions: agricultural development, income generation, nutrition education

6. Prevention of Accidents and Injuries

• Accidents in homes, farms, workplaces
• Safety education required
• Community awareness programs

7. Disaster Risk Reduction and Preparedness

• Natural disasters: floods, landslides, fires, earthquakes
• Community preparedness essential
• Collective response mechanisms

8. Health Education

• Provide health knowledge to community
• Through various media and programs
• Behavior change for better health

9. Prevention of Drug Abuse

• Youth particularly vulnerable
• Need for responsible behavior
• Education and awareness programs

PART 2: HEALTH SERVICE PROVIDING AGENCIES

🔵 Types of Health Services

Health services are classified into four types:

1. Preventive Health Services

Services provided to prevent diseases before they occur.

Definition: Preventive health services are measures taken to prevent diseases rather than curing them. "Prevention is better than cure."

Examples:

• Immunization programs
• Clean environment creation
• Health education
• Isolation of infected persons

Major Preventive Programs in Nepal:

• Family Planning and Maternal Health Programs
• National Immunization Program
• Diarrhea and Respiratory Infection Control
• National TB Control Program
• Leprosy Control Program
• HIV/AIDS and STD Control Program
• Malaria and Kala-azar Control
• Awareness campaigns
• Health education
• Sanitation awareness

2. Promotive Health Services

Services that improve existing health status and reduce disease risks.

Examples:

• Nutrition programs
• Reproductive health services
• Health education and information
• Maternal and child health services
• Regular health checkups
• Immunization services

3. Curative Health Services

Services provided after disease occurrence for treatment and cure.

Facilities:

• Health posts to hospitals
• Private clinics and nursing homes
• Diagnosis of disease causes
• Treatment of patients
• Epidemic control in community

4. Rehabilitative Health Services

Services for recovery and reintegration after serious illness or disability.

Definition: Rehabilitative services help patients return to normal life after recovery from serious diseases or conditions.

Target Groups:

• HIV/AIDS patients
• Leprosy patients
• Mentally ill patients
• Physically disabled persons
• Socially isolated individuals

PART 3: HEALTH SERVICE PROVIDING INSTITUTIONS IN NEPAL

🟢 Organizational Structure of Health Services

1. Central Level

Ministry of Health and Population oversees all health services.

Major Central Hospitals:

• Bir Hospital, Kathmandu
• Paropakar Maternity Hospital, Kathmandu
• Sukraraj Tropical and Infectious Disease Hospital, Teku
• Mental Hospital, Lagankhel, Lalitpur
• Shahid Gangalal National Heart Center, Bansbari, Kathmandu
• BP Koirala Memorial Cancer Hospital, Chitwan
• BP Koirala Institute of Health Sciences, Dharan
• Kanti Children's Hospital
• Ayurveda Hospital

Services at Central Level:

• Specialized disease treatment
• Advanced diagnostic facilities (ECG, CT scan)
• Specialized services (Cancer, Mental, Cardiac)
• Research and training

2. Regional Level

• Nepal divided into 5 development regions with regional health facilities:
• Regional Hospitals
• Regional Training Centers

Functions:

• Implement Ministry policies
• Plan and monitor health programs
• Coordinate with zonal/district levels
• Provide specialized services
• Refer patients to central level

3. Zonal Level

10 zonal hospitals in Nepal with 50-200 bed capacity

Functions:

• Specialized health services
• Treatment of referred patients from districts
• Referral to regional/central level
• Preventive and promotive programs

4. District Level

Facilities:

• District Health Offices (77)
• District Hospitals (60+)
• Primary Health Centers (200+)

Functions:

• Implement central/regional policies
• Monitor health facilities in district
• Conduct training and workshops
• Control epidemics
• School health programs
• General medical care
• OPD, Indoor, Emergency services
• X-Ray and laboratory services

5. Electoral Constituency Level

One Primary Health Center per constituency (205 constituencies)

Staff: Health Assistant or equivalent

Services:

• Safe motherhood and antenatal care
• Diarrhea control and treatment
• Regular and outreach immunization
• Environmental sanitation programs
• Minor injury treatment
• Family planning services
• Referral services

6. Ilaka Level

Health posts based on population and area (about 6 per district)

Staff: Health Worker

Functions:

• Close-to-home health services
• Laboratory services (Hemoglobin, Malaria)
• School health services in area
• General checkup and treatment
• Minor injury treatment
• Preventive health services

Current Status: 1,885 Health Posts in Nepal

7. Village Level

One Sub-Health Post per Village Development Committee

Staff: Community Health Worker

Functions:

• Public awareness about communicable diseases
• Environmental sanitation campaigns
• Minor injury treatment
• Basic primary treatment
• Coordinate with mothers groups, FCHVs, NGOs

Current Status: 3,235 Sub-Health Posts

8. Community and Ward Level

• FCHVs (Female Community Health Volunteers)
• Outreach clinics
• Immunization camps

FCHV Functions:

• Family planning services
• Diarrhea control
• Respiratory infection management
• Health education

PART 4: VOLUNTARY HEALTH AGENCIES IN NEPAL

🔵 Definition

Voluntary Health Agencies are non-governmental organizations working in the health sector for community welfare.

Definition: Voluntary health agencies are non-profit, non-governmental organizations that provide health services to communities, often focusing on specific diseases or vulnerable populations.

🟢 Major Voluntary Health Agencies

1. Nepal Red Cross Society (NRCS)

Established: 1963 AD (2020 BS)

Headquarters: Red Cross Marg, Kathmandu
Branches: All districts

Objectives: Service to victims of disasters, epidemics, accidents, earthquakes, floods

Services:

• Blood transfusion services
• Eye hospital and eye camps
• First aid training
• Health education
• Community development programs
• Water and sanitation projects
• Family planning and reproductive health
• Membership expansion, meetings, training

2. Nepal Family Planning Association (NFPA)

Established: 1959 AD (2016 BS)

Headquarters: Kathmandu

Objective: Provide affordable family planning services to poor and underprivileged

Services:

• Primary health services through clinics
• Education to disabled
• Maternity hospital operation
• Blood transfusion services
• Free medicines to poor and disabled
• Child health services and free checkups

3. Family Planning Association of Nepal (FPAN)

Established: 2016 BS (1959 AD)

International Affiliation: International Planned Parenthood Federation (IPPF) member since 2026 BS

Objective: Create happy families

Services:

1. Advice on number of children
2. Maternal and child health support
3. Infertility services
4. Family planning camps
5. Community participation for successful family planning

4. Nepal Heart Foundation

Established: 2045 BS (1988 AD)

Objective: Control increasing heart diseases (high BP, diabetes, cholesterol)

Achievements: Established Shahid Gangalal National Heart Center

Services:

1. Public awareness about heart diseases
2. Healthy lifestyle promotion
3. Support for poor heart patients
4. Rheumatic Fever and Heart Disease Control Program (since 2065 BS with government support)

5. Nepal Cancer Relief Society

Also known as Nepal Cancer Prevention Society

Established: 2035 BS (1978 AD)

Branches: 40 districts

Services:

1. Public awareness about cancer
2. Financial support for poor cancer patients

6. Nepal Tuberculosis Leprosy Eradication Society

Established: 2047 BS (1990 AD)

Programs: National Tuberculosis Program since 2049 BS

Services:

1. DOTS (Directly Observed Treatment Short-course) implementation
2. Public awareness about TB
3. BCG vaccination
4. Training and education

PART 5: MAJOR HEALTH PROBLEMS OF NEPAL

🔵 Major Health Problems

1. Prevalence of Communicable Diseases

• Diarrhea causing many child deaths
• Common diseases: Diarrhea, Cholera, Dysentery, Worms, TB, Leprosy
• Past epidemics: Smallpox, Cholera, Malaria
• New challenges: HIV/AIDS, Hepatitis B, Japanese Encephalitis, Swine Flu, COVID-19
• Causes: Poverty, illiteracy, cultural beliefs

2. Malnutrition

Definition: Malnutrition is a condition resulting from insufficient or excessive intake of nutrients.

Causes:

• Lack of food
• Imbalanced nutrition
• Protein and vitamin deficiency
• Statistics: 36.4% of under-5 children underweight (2014)

Affected Groups:

• Growing children
• Pregnant women
• Other vulnerable groups

Causes in Nepal:

• Geography (Terai food availability issues)
• Poverty
• Illiteracy
• Cultural beliefs
• Inadequate health services
• Infectious diseases

Effects: Physical and mental development affected, increased child mortality

3. High Infant Mortality Rate

Definition: Number of infant deaths (under 1 year) per 1000 live births

Nepal's IMR (2016): 32 per 1000 live births

Comparison:

4. High Maternal Mortality Rate

Definition: Number of maternal deaths per 100,000 live births

Nepal's MMR (2016): 258 per 100,000

Past Situation: 5 lakh women died annually from pregnancy-related causes (1990)

5. Poverty

Nepal's Poverty Rate (2015): 23.8%

Effects on Health:

• Unable to afford nutritious food
• Limited access to health facilities
• Poor education investment
• Cannot afford preventive measures
• Increased disease and mortality

6. Lack of Health Education

Effects:

• Superstitions and illiteracy
• Reliance on faith healers, quacks
• Ignorance about hygiene
• Self-medication dangers
• Diarrhea deaths from dehydration

7. Lack of Health Services

Health Infrastructure (2015):

Issues: Services not proportional to population, rural-urban disparity

8. Population Growth

Growth Rate: 1.35%

Effects:

• Pressure on food, shelter, education, health services
• Increased disease prevalence
• Malnutrition
• Unhealthy conditions

9. Unhealthy Lifestyle

Risk Factors:

• High carbohydrate diet
• Processed/fast food consumption
• Tobacco and alcohol use
• Sedentary lifestyle (computer/mobile)
• Lack of physical exercise
• Obesity
• Results: Increased diabetes, heart diseases, cancer

PART 6: HEALTH POLICIES AND PROGRAMS

🟢 Health Policies in Nepal

Constitutional Provision (2072 BS): Every citizen has right to free basic health services

Health Policy Evolution:

• First health policy implemented in 2048 BS
• Periodic plans (First Plan 2013-18)
• 14th Plan (2072/73-2075/76) included health programs

Key Policy Provisions:

1. Free basic health services and safe motherhood nationwide
2. Increased access to essential medicines
3. Human resource development and women health volunteers
4. Expansion of health services to urban/rural areas
5. Strengthening preventive, promotive, curative, rehabilitative services
6. Integration of health programs in educational institutions
7. Effective herbal medicine production and use
8. Regular health worker services in remote areas
9. Clear policy for private and community hospitals

🟢 Major Health Programs

1. Expanded Program on Immunization (EPI)

Started: 2034 BS (1977 AD) after smallpox eradication, nationwide from 2036 BS

Objectives:

• Protect children from 6 vaccine-preventable diseases (Measles, Diphtheria, Pertussis, Tetanus, Polio, TB)
• Vaccinate all eligible children
• TT vaccine for pregnant women
• Vaccination during epidemics (Flu, Japanese Encephalitis)

Activities:

• Public motivation for vaccination
• Education and information about 6 diseases
• Outreach vaccination through health workers
• TT vaccination programs
• School-level programs

2. Community-Based Integrated Management of Childhood Illness (CB-IMCI)

Started: 2054 BS (1997 AD) with WHO/UNICEF support

Rationale: 60% of under-5 deaths due to pneumonia, diarrhea, measles, malnutrition, malaria

Objectives:

1. Reduce under-5 mortality from pneumonia, diarrhea, measles, malnutrition
2. Support child growth and development
3. Improve family/community knowledge and practices

Activities:

1. Train community health workers
2. Promote institutional delivery
3. Counsel mothers of under-5 children
4. Provide essential supplies (ORS, zinc, iron)
5. Public awareness about child disease prevention

3. Family Planning and Maternal Child Health

History: Started by FPAN, later integrated into Ministry of Health

Current: Family Health Division under Department of Health Services

Objectives:

• Child and mother health checkup
• Nutrition for children
• Maternal and child health education
• Delivery services
• Healthy families through family planning

Activities:

1. Family planning advice to couples
2. Services to eligible couples
3. Support for happy married life
4. Mother-child health checkups
5. Services during pregnancy, delivery, postnatal

4. Vitamin 'A' Deficiency and Blindness Control Project

Started: 2049 BS (1992 AD) with UNICEF/FAO support

Objective: Improve nutritional status, reduce child mortality, eliminate Vitamin A deficiency

Activities:

• Vitamin A capsules to 6-59 months children twice yearly
• Public awareness about Vitamin A
• Promotion of Vitamin A rich foods
• Treatment of affected children

5. HIV/AIDS Control Program

First Case in Nepal: 2045 BS (1988 AD)

Current: Increasing trend, no cure but can prolong life

National Center: National Center for AIDS and STD Control (NCASC)

Activities:

• Blood testing and identification
• Treatment services
• Awareness through various media
• Policy formulation
• Rehabilitation services
• Condom promotion and distribution

6. Malaria Control Program

History: Malaria Eradication Organization established 2011 BS

Current: Program in 65 districts, 13 Terai districts with high incidence

Activities:

• Timely treatment
• Insecticide spraying in affected areas
• Malaria vaccine
• Public awareness

7. National Health Education Information and Communication Center (NHEICC)

Established: 2048 BS (1991 AD)

Objective: Behavior change through health education

Activities:

• Production of reproductive health materials
• Awareness about communicable/non-communicable diseases
• Radio programs
• Print materials (pamphlets, posters)
• Newspaper articles
• Television programs

PART 7: ADDICTIONS AND THEIR EFFECTS

🔵 Definition of Addiction

Definition: Addiction is a psychological and physical inability to stop consuming a chemical, drug, activity, or substance, even though it is causing psychological and physical harm.

Types of Addiction:

• Food addiction (Fast food, Junk food)
• Smoking/Tobacco addiction
• Alcohol addiction
• Mobile/Internet addiction
• Sexual addiction

🟢 Tobacco Addiction

Tobacco Products: Cigarettes, bidis, chewing tobacco, snuff

Global Impact: 50 lakh deaths annually from tobacco-related causes

Health Effects of Tobacco:

Immediate Effects:

• Cough, chest pain
• Breathing difficulty
• Irregular heart function
• Lung damage
• Nausea and vomiting
• Weakness
• Increased blood pressure
• Reduced work capacity
• Effect on blood vessels

Long-term Effects:

1. Yellow teeth and fingers
2. High BP and heart attack risk
3. Asthma and lung cancer
4. Mouth and throat cancer
5. Stomach and intestinal problems
6. Miscarriage in pregnant women
7. Infertility
8. Sexual dysfunction
9. Premature death

Causes of Tobacco Addiction:

1. Peer pressure
2. Media influence
3. Family members using tobacco
4. Lack of knowledge about effects
5. Easy availability
6. Advertising influence
7. Showing off attitude

Prevention of Tobacco Addiction:

1. Avoid friends who use tobacco
2. Educate family members about effects
3. Public awareness through formal/informal education
4. Legal prohibition in public places
5. Parental guidance to children
6. Counseling services

🟢 Alcohol Addiction

Alcohol Products: Beer, whiskey, raksi, wine, local brews

Social Context: Used in religious ceremonies, festivals, social gatherings, easily available

Causes of Alcohol Addiction:

1. Peer pressure
2. Media influence
3. Lack of knowledge about effects
4. Social status symbol
5. Cultural/religious reasons
6. Stress relief misconception
7. Showing off

Health Effects of Alcohol:

Immediate Effects:

• Red eyes, muscle weakness
• Increased heart rate
• Impaired thinking and control
• Loss of balance, falling
• Domestic violence
• Arguments with friends

Long-term Effects:

• Liver damage (cirrhosis)
• Lung, stomach cancer
• Heart and brain damage
• High BP, heart attack, stroke
• Infertility in both sexes
• Various cancers
• Social status decline
• Family disputes and tension

Prevention of Alcohol Addiction:

• Avoid addicted friends
• Don't accept alcohol as cultural tradition
• Health education about harmful effects
• Counter media advertisements
• Prevent illegal sales near public places
• Promote healthy food habits
• Discourage alcohol in ceremonies

🟢 Drug Addiction

Definition: Any substance that alters consciousness, thinking, and physical functions when taken

WHO Definition: Any substance that when taken affects one or more functions of the living organism

Drug Types: Opium, heroin, cannabis, morphine, cocaine, hashish

Causes of Drug Addiction:

• Escape from stress
• Lack of knowledge about effects
• Peer pressure
• Failure in work/study, family neglect, unemployment
• Influence of drug dealers

Health Effects of Drugs:

Physical Effects:

1. Hepatitis B and C from injections
2. HIV/AIDS transmission
3. Skin rashes
4. Respiratory problems
5. TB and pneumonia
6. Weakened immune system
7. Loss of appetite
8. Nausea and vomiting

Social/Economic Effects:

1. Self-destructive behavior
2. Crime (theft, murder) for money
3. Family economic crisis
4. Loss of moral values
5. Loss of productive years
6. National human resource loss
7. International embarrassment

Prevention of Drug Addiction:

Avoid addicted friends

Community awareness programs

Strict legal action against trafficking

Engage children in sports, reading, entertainment

Counseling and rehabilitation

Social reintegration after treatment

Loving family environment

🔴 SUMMARY POINTS

Community Health - collective effort for community wellbeing

Importance - environmental sanitation, healthy human resource, health service expansion, social service mentality

Scope - food/water quality, disease control, environmental health, immunization, malnutrition prevention, accident prevention, disaster preparedness, health education, drug abuse prevention

Health Service Types - Preventive, Promotive, Curative, Rehabilitative

Health Institutions - Central to Village level structure

Voluntary Agencies - NRCS, NFPA, FPAN, Heart Foundation, Cancer Society, TB/Leprosy Society

Major Health Problems - Communicable diseases, Malnutrition, High IMR/MMR, Poverty, Lack of health education/services, Population growth, Unhealthy lifestyle

Health Programs - EPI, CB-IMCI, Family Planning, Vitamin A, HIV/AIDS, Malaria, NHEICC

Addictions - Tobacco, Alcohol, Drugs - causes, effects, prevention

🔑 KEY DEFINITIONS

🎯 LEARNING OBJECTIVES

After studying this chapter, students will be able to:

Define community health and explain its importance

Understand the scope of community health

Identify different types of health services

Know about health service providing agencies in Nepal

Recognize major health problems in Nepal

Understand health policies and programs

Explain causes, effects, and prevention of addictions

Apply preventive measures in daily life

💡 EXAM TIPS

1. For definitions: Memorize key terms exactly
2. For importance/scope: Remember 5-6 points each
3. For health services: Know 4 types with examples
4. For health institutions: Remember structure from central to local
5. For voluntary agencies: Know establishment year, objective, services of NRCS, FPAN, Heart Foundation, Cancer Society
6. For health problems: Remember 9 major problems with key points
7. For health programs: Know EPI, CB-IMCI, Family Planning, Vitamin A, HIV/AIDS, Malaria, NHEICC
8. For addictions: Remember causes, effects, prevention for tobacco, alcohol, drugs (3 each)

For numbers:

• NRCS: 1963 AD/2020 BS
• FPAN: 1959 AD/2016 BS
• First HIV: 1988 AD/2045 BS
• EPI start: 2034 BS
• CB-IMCI: 2054 BS
• Vitamin A project: 2049 BS
• Poverty rate: 23.8%
• IMR: 32
• MMR: 258
• Population growth: 1.35%

📊 IMPORTANT DATA

🧠 MEMORY TRICKS

4 Types of Health Services: "PPCR" - Preventive, Promotive, Curative, Rehabilitative

9 Major Health Problems: "CMIPPLPHU" - Communicable diseases, Malnutrition, IMR, MMR, Poverty, Population, Lack of health education, Lack of health services, Unhealthy lifestyle

3 Major Addictions: "TAD" - Tobacco, Alcohol, Drugs

5 Prevention of Addiction: "AECPC" - Avoid friends, Educate, Campaign, Prohibit, Counsel

6 EPI Diseases: "MDTPPM" - Measles, Diphtheria, Tetanus, Polio, Pertussis, Malaria (TB also)

4 CB-IMCI Focus Diseases: "PDMM" - Pneumonia, Diarrhea, Measles, Malnutrition