HISTORICAL

DEVELOPMENT OF
COMMUNITY HEALTH
AND COMMUNITY
HEALTH NURSING IN
WORLD & INDIA.
INTRODUCTION
DEFINITIONS
 COMMUNITY :
A community is a social
group determined by geographical
boundaries or common values and interest.
Its members know and interacts with each
other. Its functions within a particular
structure and exhibits and creates certain
norms, values and social institutions.

. ( WHO )
COMMUNITY HEALTH
Community health refers to the
health status of the members of the
community, to the problems affecting
their health and to the totality of
health care provided for the
community. .
. (WHO)
COMMUNITY HEALTH NURSING

Community health nursing is a

synthesis of nursing practice and
public health practice applied in
promoting and preserving the
health of populations.
HISTORICAL DEVELOPMENT OF COMMUNITY HEALTH NURSING IN
WORLD

 
 Early home care nursing(Before mid 1800)

 District Nursing(Mid 1800-1900)

 Public Health Nursing(1900-1970)

 Community Health Nursing(1970-present)

1. Early home care nursing(Before mid 1800)

 Prototype of community-based
nursing
 Focus to reduce suffering and
promote healing
 Began with religious and charitable
groups
 Sisters of charity in 1617.
(St Vincent De Paul, Paris )
 Friendly Visitor Volunteers,France.
(Madame De Chantel)
Early home care nursing( cont…)
 Babies were delivered at home by
midwives with little or no training
 Midwifery programs started in
France and England in 1720 &
1741 respectively by Dr William
Smellie .
 Catholic and Anglican nursing
orders continued caring for the
sick poor in their homes.
Madame De Chantel
St.Vinsent De Poul
Dr.Willam Smellie
2.District Nursing(Mid 1800-1900)
 The foundation of modern CHN laid
by Florence Nightingale.

 During the Crimean war she

established competent nursing care .

 She demonstrated how population-

focused nursing works (CHN)

 Home Nursing – William Rathbone.

District Nursing Cont…..

 In 1861 visiting nurse training

program established at Royal
Liverpool Infirmary by Rathbone
with the help of Florence
Nightingale .

 School for nurses in St.Thomas

Hospital, London.

 Black Nightingale- Mary Seacole.

Florence Nightingale
St.Thomas Hospital, London.(1860)
District Nursing(Mid 1800-1900)
William Rathbone
Mary Seacole
The District Nursing Stage
Milestones in USA
 1872 American Public Health Association
established
 1886 First visiting nurse society in
Philadelphia provides home health care
 1889 Chicago visiting nursing association
established
 1895 Industrial nursing program initiated at
Vermont
 1899 International Council of Nurses
organised; university education for nurses
introduced at Teachers College, New York
3.Public Health Nursing(1900-1970)
 Specialized programs such as infant
welfare, tuberculosis clinics, and
veneral disease control were
developed.

 Role of the district nurse expanded

during this stage

 Lillian Wald was the first to use the

term “ public health nursing” and
promoted rural nursing and family-
focused nursing
3.Public Health Nursing(1900-1970) Cont…

 1902 School nursing started in

New York

 1900- 200 public health nurses

providing public health nursing .

 1912- Nurses number grown to

3000.
Public Health Nursing(1900-1970)
cont…
By the 1920 s public health nursing
was acquiring a professional status
in comparison to its earlier
association with charity

The institutional base moved from

charitable organisations to the
government

Industrial nursing expanded during

this stage as well
Public Health Nursing(1900-1970)
cont…
1912 National Organisation for Public
Health Nursing formed with Lillian
Wald as first president.
1917 Publication of the Standard
Curriculum for Nursing schools
1934 Survey of Public Health Nursing
published by National Organisation of
Public Health Nursing
1942 American Association of
Industrial Nurses established
Public Health Nursing(1900-1970)

Lillian D Wald
4.Community Health Nursing(1970-
present)
 Distinction between public health
nursing and community health nursing
done by the US Department of Health in
1984
 Community health nursing refers to all
nursing practicing in the community
regardless of their educational
preparation
 1978 Established Association of
Graduate Faculty in Community Health
Nursing / Public Health Nursing (later
became Association of Community
Health Nursing Educators
 In 1980 the ANA developed a
Conceptual Model of Community Health
Nursing
Community Health Nursing(1970-
present) cont..
 1980 Both American Nurses Association and
American Public Health Association
developed statements on the role and
conceptual foundations of community
health nursing
 1985 Establishment of Center for Nursing

Research
 1990 Association of Community Health

Nursing Educators publishes Essentials of

Baccalaureate Nursing Education
ANCIENT PERIOD VEDIC PERIOD:
 Ayurveda and Siddha Systems of medicine
came into existence which suggested
development of comprehensive concept of
health.
 Ayurveda practiced throughout the India but

the Siddha system is practiced in tamilnadu.

 Atreya (about 800 b.c) is acknowledged as
the first great Indian physician and teacher.
 He lived in the ancient university of

takshashila.
 Charaka compiled his famous treatise on

medicine, the “charaka samhita”.

 He explained about 500 drugs.
 He was a first physician to explain the

concept of digestion, metabolism, immunity,

genetics and drugs.
 shusruta
 Father of Indiansurgery •
 Written “shusruta samhita”
 Performed so many surgeries in ancient India
eg. Amputation, tumor extraction, hernia
repair and plastic surgery etc.
 British physicians learned rhinoplasty from
Indian surgeons.
King Ashoka
 King Ashoka and other Buddhist kings

established Ayurveda hospitals and schools

of medicine inIndia.
 King Ashoka patronized Ayurveda as state

medicine.
Medical education
 Nalanda university
 Takshashila university
MUGHAL PERIOD
Introduced unani system of medicine.
 Ayurveda started to decline.
 Exchange of thoughts and experience

between the Hindu, Arab, Persians, Greek and

Jewish scholars.
2. PRE INDEPENDENCE ERA
 Homeopathy was introduced by Samuel
Hahnemann during 1810- 1839.
 India claims to have the largest number of

practitioners of homeopathy medicine in the

world.
 MILITARY NURSING •

 1664 : east india company started hospital

for soldiers in a house at fort.St. George,

madras
BRITISH PERIOD
 The first real development of modern public health in
India took place in 1859 when the administration of India
was taken over from east India companyby the crown.
 British soldiers were died because of poor sanitation
conditions.
 1859: • A Royal Commission was appointed in India to
investigate the causes of unhealthy conditions
prevailingin British ArmystationedinIndia .
 This commission recommended that there was a need in
each presidency to protect the water supply, construction
of drains and prevention of epidemics incivilpopulation.
FLORENCE NIGHTINGALE
 Florence nightingale studied the public health
conditions in India and suggested the
preventive measures for it.
 She suggested the measures for the welfare

of the army.
 She suggested the system of nursing for

hospitals inIndia.
 She motivated to start the nursing training

schools inIndia
MADRAS 1871:
FIRST NURSING TRAINING SCHOOL STARTED
IN GOVT. GENERAL HOSPITAL, MADRAS.
 SEPARATE CLINICAL FACILITIES FOR

WOUNDED SOLDIERS IN ST.GEORGE FORT.

CHRISTIAN MISSION HOSPITALS
 During 1874 – 90the Christian Mission
Hospitals in India startedtrainingcourses for
nurses.
 The Roman Catholic Nuns served as nurses in

many Govt.Hospitals inIndia as well as in

Hospitals run byreligiousorders.
SCHOOL OF NURSING
FIRST SCHOOL OF NURSING ESTABLISHED IN
ST.STEPHENS HOSPITAL, NEW DELHI.
 1890 – 1900 SO MANY NURSING SCHOOLS

ESTABLISHED BY THE GOVERNMENT AND

MISSION HOSPITALS.
 1881 – First Indian Factories Act was passed and First All
India Census was taken.
 1885 – Local self Government Act was passed.
 1888 – Government directed that local bodies should be
responsible for sanitation.
 1930 • At Calcutta ,an All India Institute of Hygiene and
Public Health was established with aid from the Rockefeller.
 1931 • A Maternal Child Welfare Bureau was established by
IRC Society.
 1935 • All the health activities in the country were grouped
as under the control of • (a)Central (b)Central cum
provincial (c) Provincial government
 1937 – A Central Advisory Board of health was set up
 1939 – Madras Public Health Act was passed. – Rural Health
Training Centre at Singur near Calcutta(Rockefeller
Foundation)
 1940 – The Drugs Act was passed.
 Nursing colleges established in c.m.c Vellore
and RAK college in Delhi to provide degree in
nursing.
 1943 – A health survey and development

committee (Bhore Committee) was appointed

under the chairman of sir. Joseph Bhore
 1946 – Bhore Committees report was

submitted.
INDIAN NURSING COUNCIL
 INDIAN NURSING COUNCIL IS STARTED TO
SET THE NURSING STANDARD IN INDIA.
POST INDEPENDENDENCE ERA
CENTRAL GOVERNMENT
 The national government took up the

responsibility of improving health of people

with the Bhore committee’s report.
 Ministry of health was established at Central

andState level
 1948:
 India joined as a member of WHO.
 ESI Act was passed
 Environment Hygiene Committee was

published.
 1950:

 Planning Commission was set up in India.

 Central Food Technological Institute was

established.
 1951
• FirstFive YearPlan began.
• BCG Vaccination programme was launched.
• Central Drug ResearchInstitute wasopened at
Lucknow.
 1952

• Central council of health was statutorily

constituted with Union minister of health as
chairmanand health Minister of states as
members.
 1953:
 Model Public Health Act Committee was
appointed.
 National Malaria Control Programme was
initiated.
 National Smallpox Eradication Programme
was started.
 Family Planning Programme began, Family
Planning Research and
 Programme was set up.
 1954:
 Contributory Health Services Scheme was
initiated in Delhi.
 Central Social Welfare board was setup
 National water supply and sanitation scheme
was inaugurated.
 National Leprosy Control Programme was
started.
 VDRL antigen production was setup.
 Food Adulteration Act was passed.
 1955:
 • NationalFiliria ControlProgramme was started.
 • Central Research Centre and Central Leprosy Training

was established in TN.

 • National TB Survey Commenced.
 1956
 • SecondFive Year plan began.
 • Central Health education bureau was established.
 • Director ofFamilyPlanning was established.
 • Chemotherapy centre started at Madras
 1958
 • NMCP was changed to NMEP.
 1959
• Mudaliar Committee was appointed.
• Rajasthan was first state to introducePanchayat Raj
• National TB Institute at Bangalore was established.
• 1960
• School Health Committee was formed.
 1961

• 3rdFive Year Plan was launched.

 1962

• Central Family Planning Institute was established in New

Delhi.
• National Smallpox eradication Programme, National
Goitre Control Programme, National School Health
Programme and district TB control programme was
established.
 1963
• Applied Nutrition Programme started.
• NICD established.
• National Trachoma control programme was
started.
 1965

• IUCD was introduced

• Direct BCG vaccination programme without
tuberculin tests was introduced.
In modern period changes in development
of medicine and public health under
different stages.
 • Empirical health era (1800-1850 )
 • Basic science era (1850-1900)
 • Clinical science era (1900-1950)
 • Public health science era (1950-1975)
 • Political science era (1975-2000)
Empirical health era (1800-1850 )
 During this period diagnosis was made on
empirical basis and also the given treatment
was according to symptoms. So this era was
called symptom oriented era. The health
education was provided by lectures on
authoritarian instruction
Basic Science Era (1850-1900)
 This period witnessed the invention of
microscope, thermometer, BP apparatus and
other tools for detection and measurement of
diseases. Laboratory investigations were
carried out to make This period was called as
bacteria- oriented or disease oriented era
 Clinical Science Era(1950-1975): 
This is an era which witnessed her individual
centered or patient centered approach for
taking care of the health and illness of the
people. Clinical instructions abd bed side
teaching started in the field of medical
education education. The development of
clinical techniques was initiated in medical
science and technology.
Public Health Science Era (1950-
1975)
 In this period prevention oriented approach started. It
was initiated by our ancient Indians at the time of Indus
Valley Civilisation. 19 | P a g e U N I T - I I N T R O D U C
T I O N T O C O M M U N I T Y H E A L T H COMMUNITY
HEALTH NURSING-I  it is being called era of
Community centered approach, in which diagnosis and
treatment at community level emerged, clinical public
health instructions, community- side teachings were
included in the field of medical education.  Studies
releted to community development, community
measurement and criteria planning techniques also
started  Integration of social sciences, and public
health sciences in this era took place.
Political Health Science Era (1975-
2000 AD)
 In this period the involvement of the community
leaders and members of the community in
planning and implementation of the health
programmes was practiced at this stage.
 The national level health planning was

established by political authorities ofparticular

country by involving national and international
health agencies to provide health for all.
 The people-centered approach has been

emphasized in this era.