Community Health Nursing is shaped by global powerhouses—WHO, UNFPA, UNDP, and World Bank. Learn their impactful roles in improving public health globally.

WHO (World Health Organization)

Overview

• Full Name: World Health Organization (WHO)
• Headquarters: Geneva, Switzerland
• Established: April 7, 1948 (celebrated as World Health Day)
• Membership: 193 countries (as of 2006)
• Goal: To help all people achieve the highest level of health.

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Structure of WHO

WHO has three main parts:

1 World Health Assembly (WHA):

• The main decision-making body.
• Meets once a year in May.
• Includes representatives from all member countries.
• Functions:
  • Sets global health policies.
  • Reviews progress and approves budgets.
  • Chooses the Director-General.

2 Executive Board:

• Made up of 34 health experts.
• Meets twice a year.
• Functions:
  • Carries out decisions made by the WHA.
  • Takes action during health emergencies.

3 Secretariat:

• Led by the Director-General.
• Functions:
  • Provides support to countries for health programs.
  • Manages daily operations.

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Core Functions of WHO

• Set global health standards and policies.
• Track health trends and encourage research.
• Offer technical help to countries.
• Build partnerships for health projects.
• Develop and test new health tools and guidelines.

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Key Achievements

• Smallpox Eradication:
• In 1967, smallpox was a major problem in 31 countries.
• WHO led a worldwide vaccination effort.
• The last case was reported in 1977, and smallpox was declared eradicated in 1980.

Funding

• Funded by member countries based on their ability to pay.
• Richer countries contribute more.

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Functions of WHO

1. Fight diseases and epidemics.
2. Improve health for mothers and children.
3. Encourage cooperation among scientists and health professionals.
4. Conduct health research.
5. Provide health advice and support.

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UNFPA (United Nations Population Fund)

Overview

• Full Name: United Nations Population Fund (UNFPA)
• Established: Began operations in 1969 (introduced in 1967)
• Headquarters: New York, USA
• Mission: To promote the right of every woman, man, and child to enjoy a life of health, equality, and opportunity.
• Key Focus Areas:

• Reproductive Health
• Gender Equality
• Population and Development Strategies

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History and Evolution

• 1967: Introduced as a trust fund.
• 1969: Officially began operations under UNDP administration.
• 1971: Recognized by the UN General Assembly as a leader in population programs.
• 1979: Declared a subsidiary organ of the UN General Assembly.
• 1987: Name changed to United Nations Population Fund (UNFPA), but the abbreviation remained the same.
• 1993: Governance shifted to an executive board under the Economic and Social Council.
• 1996: Became a founding co-sponsor of UNAIDS (Joint UN Program on HIV/AIDS).
• 2003: Granted formal authority over personnel matters by the UN Secretary-General.

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Core Areas of Work

1. Reproductive Health:

• Supports governments in providing sexual and reproductive health care.
• Key areas include:
  • Family planning
  • Safe pregnancy and childbirth
  • Prevention and treatment of infertility
  • Prevention and management of unsafe abortion
  • Treatment of reproductive tract infections
  • Prevention and care for sexually transmitted infections (STIs), including HIV
  • Education and counseling on reproductive health and sexuality
  • Prevention of violence against women and support for survivors
  • Referrals for specialized care

1. Gender Equality and Women’s Empowerment:

• Promotes gender equality through:
  • Girls’ education
  • Women’s economic and political empowerment
  • Balancing reproductive and productive roles
• Works to end harmful practices like child marriage and female genital mutilation (FGM)
• Addresses gender-based violence and promotes women’s rights in emergencies, climate change, and migration.
• Engages men and boys in promoting gender equality and reproductive health.

• Population and Development Strategies:

1. Assists countries in addressing population challenges, including:
   • Migration
   • Aging populations
   • Climate change
   • Urbanization
2. Helps governments collect and analyze population data to create effective policies.
3. Supports global, regional, and national efforts to manage population dynamics.

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Key Achievements

• Works in over 140 countries to improve reproductive health and rights.
• Plays a leading role in global efforts to:
• Reduce maternal mortality
• Ensure access to family planning
• Combat gender-based violence
• Address population challenges like urbanization and aging.

Funding and Governance

• Funded by voluntary contributions from governments and private donors.
• Governed by an executive board under the UN Economic and Social Council.

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Importance of UNFPA

• UNFPA is a vital organization that works to ensure:

• Every pregnancy is wanted.
• Every childbirth is safe.
• Every young person is free from HIV/AIDS.
• Every girl and woman is treated with dignity and respect.

UNDP (United Nations Development Programme)

Overview

• Full Name: United Nations Development Programme (UNDP)
• Role: The UN’s global development network, connecting countries to knowledge, resources, and expertise to improve lives.
• Mission: To advocate for change and support countries in achieving sustainable development, reducing poverty, and empowering women.
• Focus Areas:

1. Democratic Governance
   • Poverty Reduction
     • Crisis Intervention and Recovery
       • Environment and Energy
         • HIV/AIDS and Development

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Key Goals

• Support the achievement of the Millennium Development Goals (MDGs) and national development objectives.
• Improve the lives of the poorest, marginalized, and disadvantaged communities.
• Promote human development through inclusive, equitable, and sustainable growth.

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Areas of Work in India

• Democratic Governance:

• Supports Panchayati Raj institutions (local self-governance) to strengthen democratic processes.
• Helps integrate human development into state and district planning.
• Promotes social, economic, and political inclusion, especially for women and girls.
• Works with 2.8 million local representatives to enhance governance.

• Poverty Reduction:

• Partners with governments to improve skills and livelihoods for deprived households.
• Supports initiatives in agriculture, forestry, fisheries, and handicrafts.
• Promotes gender equality through:
  • Mainstreaming gender perspectives in policies.
  • Investing in specific interventions for women’s empowerment.

1. Crisis Intervention and Recovery:

• Strengthens disaster management capacities to reduce vulnerabilities.
• Implements community-based disaster risk management programs.
• Focuses on:
  • Preparedness and early recovery.
  • Institutionalizing disaster risk reduction.
  • Reducing risks in urban areas.

• Environment and Energy:

• Integrates environmental concerns and climate change adaptation into development policies.
• Promotes access to clean energy in rural and remote areas.
• Enhances energy efficiency in sectors like transport, SMEs, and residential areas.
• Supports renewable energy technologies and applications.

• HIV/AIDS and Development:

• Assists India’s National AIDS Control Programme.
• Works to integrate HIV into development responses in vulnerable districts.
• Conducts research on the social dimensions of HIV.
• Supports policies for gender equality and the involvement of people living with HIV.

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Key Achievements

• Played a key role in strengthening Panchayati Raj institutions in India.
• Implemented Asia’s largest community-based disaster risk management program.
• Supported the integration of human development into state and district planning.
• Promoted clean energy and climate change adaptation measures.
• Contributed to India’s efforts in combating HIV/AIDS through research and policy support.

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Importance of UNDP

UNDP works to:

• Empower communities and promote inclusive growth.
• Reduce poverty and inequality.
• Strengthen governance and disaster resilience.
• Address environmental challenges and promote sustainable energy.
• Combat HIV/AIDS and support vulnerable populations.

World Bank

Overview

• Established: 1944
• Headquarters: Washington, D.C., USA
• Mission: To fight poverty and support sustainable development by providing financial and technical assistance to developing countries.
• Structure: Comprises two main institutions:

1. International Bank for Reconstruction and Development (IBRD): Supports middle-income and creditworthy poorer countries.
2. International Development Association (IDA): Focuses on the world’s poorest countries.

• Complementary Institutions:
• International Finance Corporation (IFC)
• Multilateral Investment Guarantee Agency (MIGA)
• International Centre for Settlement of Investment Disputes (ICSID)

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Key Functions

• Provides low-interest loans, interest-free credits, and grants to developing countries.
• Funds projects in areas like:
• Education
• Health
• Infrastructure
• Agriculture
• Environmental and natural resource management
• Private sector development
• Shares global expertise and knowledge to address development challenges.

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Governance

• Membership: 187 member countries.
• Board of Governors:
• Composed of finance or development ministers from member countries.
• Meets annually to set policies.
• Executive Directors:
• 25 directors oversee daily operations.
• Five largest shareholders (France, Germany, Japan, UK, and USA) appoint one director each; others are represented by 20 directors.
• President:
• Chairs the Board of Directors.
• Responsible for overall management.
• Traditionally a U.S. national, nominated by the U.S. and selected by the Board for a 5-year term.

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Operations

• Works closely with governments, NGOs, private sectors, and other development partners.
• Focuses on:
• Reducing poverty.
• Promoting sustainable development.
• Building capacity and sharing knowledge.
• Supports countries in achieving their development goals through financing, expertise, and partnerships.

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World Bank in India

• Membership: India is a founding member (joined in 1944).
• Partnerships:
• Works with Central and State Governments.
• Collaborates with NGOs, private sectors, academics, and local communities.
• Focus Areas:
• Infrastructure development.
• Poverty reduction.
• Education and health.
• Environmental sustainability.
• Private sector growth.

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Importance of the World Bank

• A major source of funding and knowledge for developing countries.
• Helps countries achieve long-term development goals.
• Promotes inclusive and sustainable globalization.
• Supports projects that improve living standards and reduce poverty worldwide.

World Bank’s Plan of Action in India

• Country Strategy (CAS):
• Aligns with India’s development priorities, particularly the Eleventh Five-Year Plan (2007-2012).
• Focuses on:
  1. Fast-tracking infrastructure development.
  2. Supporting the seven poorest states (Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, and Uttar Pradesh).
  3. Addressing the impact of the global financial crisis.
• Total Proposed Lending: $14 billion for 2009-2012.
• Implementation:
• Provides financial assistance through loans and grants.
• Engages in policy dialogue and analytical work.
• Builds capacity and supports private sector engagement.
• Stakeholder Involvement:
• Developed through consultations with the government, civil society, and other stakeholders.

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FAO (Food and Agriculture Organization)

Overview

• Established: 1945
• Headquarters: Rome, Italy
• Mission: To lead international efforts to defeat hunger and improve agriculture, forestry, and fisheries.
• Key Objectives:

1. Raise levels of nutrition.
2. Improve agricultural productivity.
3. Enhance the lives of rural populations.
4. Contribute to the growth of the world economy.

Focus Areas

• Rural Development:
• Focuses on rural areas, home to 70% of the world’s poor and hungry.
• Sustainable Agriculture:
• Promotes modern and sustainable practices in agriculture, forestry, and fisheries.
• Biotechnology:
• Supports the use of biotechnology for sustainable development.
• Advocates for science-based evaluation of benefits and risks.
• Encourages access to diverse genetic resources.

Key Initiatives

• Biotechnology and Biosafety:
• FAO’s 2000 Statement on Biotechnology highlights:
  • Biotechnology as a tool for sustainable agriculture and food security.
  • Genetic engineering’s potential to increase yields on marginal lands.
• 2003-2004 Report: Focused on agricultural biotechnology to meet the needs of the poor.
• Capacity Building:
• Provides advice and support to member countries on biotechnology and agricultural development.

Role in Global Food Security

• Acts as a neutral forum for nations to negotiate agreements and debate policies.
• Assists developing countries in improving food production and ensuring good nutrition.

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Importance of FAO

• Plays a critical role in addressing global hunger and malnutrition.
• Promotes sustainable agricultural practices to ensure food security.
• Supports rural development and empowers farming communities.
• Advocates for the responsible use of biotechnology to enhance food production.

UNICEF (United Nations Children’s Fund)

Overview

• Full Name: United Nations Children’s Fund (UNICEF)
• Established: 1946 (initially as a relief organization for children after World War II)
• Headquarters: New York, USA
• Mission: To defend, promote, and protect children’s rights, especially for the most disadvantaged.
• Core Belief: Every child has the right to:
• Adequate nutrition
• Education
• Health
• Participation
• Protection
• Clean water

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Structure

• Governing Body: Executive Board (36 members representing UN regional groups).
• Provides oversight and approves policies, programs, and budgets.
• Supported by the Office of the Secretary.
• Sessions: Held annually at the UN headquarters in New York.

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Strategic Areas of Work

UNICEF’s work is aligned with the Millennium Development Goals (MDGs) and focuses on five interrelated areas:

1. Young Child Survival and Development:

• Focus: Reduce child mortality (MDG 4) and combat diseases like malaria (MDG 6).
• Key Activities:
  • Immunization programs (e.g., measles, polio).
  • Nutrition support (e.g., vitamin A supplements).
  • Maternal and neonatal care (antenatal and postnatal care).
  • Prevention of diseases like diarrhoea and malaria.

1. Basic Education and Gender Equality:

• Focus: Achieve universal primary education (MDG 2) and promote gender equality (MDG 3).
• Key Activities:
  • Improve school readiness for disadvantaged children.
  • Reduce gender gaps in education.
  • Provide school supplies and create child-friendly learning environments.
  • Support water, sanitation, and hygiene in schools.

1. HIV/AIDS and Children:

• Focus: Combat HIV/AIDS (MDG 6).
• Key Activities:
  • Prevention education for adolescents.
  • Support for children orphaned by HIV/AIDS.
  • Programs to prevent mother-to-child transmission.
  • Increase access to antiretroviral drugs.

1. Child Protection:

• Focus: Protect children from violence, exploitation, and abuse.
• Key Activities:
  • Advocate for laws to protect children.
  • Strengthen community and family resources.
  • Support marginalized children, including those affected by HIV/AIDS.

1. Policy Analysis, Advocacy, and Partnerships for Children’s Rights:

• Focus: Promote global partnerships (MDG 8) and strengthen policies for children’s rights.
• Key Activities:
  • Advocate for investments in children’s well-being.
  • Conduct research and monitor progress.
  • Promote children’s participation in decision-making.

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Progress and Challenges

• Progress:
• UNICEF has made significant strides in improving child survival, education, and protection.
• Vaccination programs have saved millions of lives.
• Advocacy has led to stronger child protection laws.
• Challenges:
• Millions of children still lack access to basic needs like education, healthcare, and clean water.
• Achieving the MDGs by 2015 requires stronger global commitment.

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Importance of UNICEF

• UNICEF plays a critical role in ensuring children’s rights are met.
• By focusing on survival, development, and protection, UNICEF helps break the cycle of poverty.
• Its work contributes to global peace and development by investing in the future of children.

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UNICEF and the Millennium Development Goals (MDGs)

MDG	UNICEF Focus Area
Goal 1: Poverty and hunger	Young Child Survival and Development
Goal 2: Universal education	Basic Education and Gender Equality
Goal 3: Gender equality	Basic Education and Gender Equality
Goal 4: Child mortality	Young Child Survival and Development
Goal 5: Maternal health	Young Child Survival and Development
Goal 6: HIV/AIDS, malaria	HIV/AIDS and Children
Goal 7: Environmental sustainability	Water and Sanitation
Goal 8: Global partnerships	Policy Analysis, Advocacy, and Partnerships

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DANIDA (Danish International Development Agency)

Overview

• Full Name: Danish International Development Agency (DANIDA)
• Parent Organization: Ministry of Foreign Affairs of Denmark
• Established: To provide humanitarian aid and development assistance to developing countries.
• Focus Areas:

1. Human Rights and Democracy
2. Green Growth
3. Social Progress
4. Stability and Protection

Key Activities

• Works with nonprofit organizations in developing countries like India.
• Provides support for programs such as the National Blindness Control Programme since 1978.
• Operates in 73 countries and regions (as of 2015), with 21 high-priority countries (mostly in Africa and Asia).

Importance

• DANIDA plays a crucial role in addressing poverty and promoting sustainable development in some of the world’s poorest regions.
• Focuses on long-term development goals while addressing immediate humanitarian needs.

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European Commission (EC)

Overview

• Role: The executive arm of the European Union (EU), responsible for proposing legislation, implementing decisions, and managing EU policies.
• Structure:
• 28 Commissioners (one from each EU country).
• Led by the Commission President (as of 2017, Jean-Claude Juncker).
• Includes 7 Vice-Presidents and 20 Commissioners overseeing specific policy areas.
• Term: The Commission’s term runs for 5 years (current term until October 31, 2019).

Key Functions

• Proposing Legislation:

• Drafts laws for adoption by the European Parliament and Council of the EU.
• Focuses on issues that cannot be effectively addressed at the national level.

• Managing EU Policies and Funding:

• Sets EU spending priorities and drafts annual budgets.
• Supervises the allocation and use of EU funds.

• Enforcing EU Law:

• Ensures EU laws are properly applied in all member countries.
• Works with the Court of Justice to address violations.

• Representing the EU Internationally:

• Speaks on behalf of EU countries in international organizations.
• Negotiates international agreements, particularly in trade and humanitarian aid.

Importance

• The EC ensures the smooth functioning of the EU. It does this by proposing and enforcing laws, managing budgets, and representing the EU globally.
  • Plays a key role in addressing transnational issues and promoting cooperation among member states.

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USAID (United States Agency for International Development)

Overview

• Full Name: United States Agency for International Development (USAID)
• Established: 1961 by President John F. Kennedy
• Purpose: To provide economic development and humanitarian assistance to advance U.S. economic and political interests globally.
• Key Focus Areas:

1. Promoting economic growth
2. Advancing democracy
3. Delivering humanitarian assistance
4. Protecting public health and supporting family planning
5. Protecting the environment

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Key Activities

USAID is a global leader in providing assistance during crises such as floods, famines, and conflicts. It also supports long-term development programs in health, education, and economic growth.

Health Programs

USAID has been a pioneer in improving global health, particularly in child and maternal health. Key initiatives include:

1. Child Health Programs:

• Prevents over 4 million infant and child deaths annually.
• Focus areas:
  • Oral Rehydration Therapy (ORT): Developed with USAID support to treat diarrhoea.
  • Acute Respiratory Infections (ARI): Supports diagnosis, treatment, and vaccine research.
  • Immunization: Protects children from diseases like measles, polio, and tuberculosis.
  • Breastfeeding: Promotes breastfeeding through “baby-friendly” hospitals.
  • Vitamin A Supplementation: Reduces child mortality in deficient populations.
  • Malaria Control: Conducts research and implements programs in countries like India, Pakistan, and Nepal.
  • Maternal Health: Reduces maternal mortality through training, safe birthing techniques, and tetanus immunisation.

• Family Planning:

• Supports access to family planning information and services.
• Over 50 million couples use family planning due to USAID programs.
• Helps reduce maternal mortality and prevent HIV/AIDS through condom promotion.

• HIV/AIDS Prevention:

• Operates in 50 countries.
• Provides education, training, and condom distribution.
• Focuses on behavior change and integrating HIV/AIDS into national planning.

• Displaced Children and Orphans:

• Assists children separated by war, AIDS, or social crises.
• Reunites families and provides support in countries like Ethiopia, Liberia, and Rwanda.

Innovations in Health Technologies

• Develops cost-effective health technologies, such as:
• Single-use, self-destruct syringes to prevent disease transmission.
• Low-cost delivery kits for safe home births.
• Tools for detecting low birth weight and other health risks.

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Importance of USAID

• Plays a critical role in addressing global health challenges, reducing poverty, and promoting democracy.
• Saves millions of lives through health programs and humanitarian aid.
• Supports long-term development by strengthening healthcare systems, promoting education, and fostering economic growth.
• Advances U.S. foreign policy objectives by building partnerships and improving global stability.

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Key Achievements

• Child Survival: Over 4 million child deaths prevented annually.
• Family Planning: Over 50 million couples using family planning services.
• HIV/AIDS Prevention: Programs in 50 countries to combat the epidemic.
• Humanitarian Aid: Assistance to victims of war, famine, and natural disasters.

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UNESCO (United Nations Educational, Scientific and Cultural Organization)

Overview

• Full Name: United Nations Educational, Scientific and Cultural Organization (UNESCO)
• Headquarters: Paris, France
• Established: 1945
• Mission: To promote peace, sustainable development, and intercultural dialogue through education, science, culture, and communication.
• Core Goals:

• Build peace through education, culture, and science.
• Eradicate poverty.
• Promote sustainable development.
• Foster intercultural dialogue.

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Key Focus Areas

• Education:

• Ensure quality education for all and promote lifelong learning.
• Support initiatives to achieve Millennium Development Goals (MDGs) related to education.

1. Science:

• Mobilize scientific knowledge for sustainable development.
• Address emerging social and ethical challenges through science.

• Culture:

• Promote cultural diversity and intercultural dialogue.
• Protect cultural heritage and foster a culture of peace.

• Communication and Information:

• Build inclusive knowledge societies.
• Promote freedom of expression and access to information.

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Structure

• General Conference:

• The supreme decision-making body.
• Meets every two years.
• Composed of representatives from all member states.
• Functions:
  • Sets policies and programs.
  • Approves the budget.
  • Elects the Executive Board and appoints the Director-General.

• Executive Board:

• Ensures the implementation of decisions made by the General Conference.
• Composed of 58 members elected by the General Conference.
• Represents diverse cultures and geographical regions.

• National Commissions:

• Established by member states to link UNESCO with governmental and non-governmental organizations.
• Over 369 National Commissions worldwide.

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Key Activities

• Education:
• Promotes universal access to quality education.
• Supports teacher training and curriculum development.
• Science:
• Funds research on climate change, water management, and renewable energy.
• Promotes ethical standards in science and technology.
• Culture:
• Protects world heritage sites and intangible cultural heritage.
• Encourages cultural exchange and creativity.
• Communication:
• Promotes media literacy and freedom of the press.
• Supports access to information and communication technologies (ICTs).

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Importance of UNESCO

• Plays a vital role in promoting global peace and sustainable development.
• Bridges cultural divides and fosters mutual understanding.
• Protects cultural and natural heritage for future generations.
• Advances education and scientific research to address global challenges.

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Achievements

• Education:
• Contributed to the global increase in literacy rates.
• Supported the Education for All (EFA) initiative.
• Science:
• Led efforts in oceanographic research and environmental protection.
• Promoted ethical guidelines for scientific research.
• Culture:
• Designated over 1,000 World Heritage Sites.
• Safeguarded intangible cultural heritage like traditional music and crafts.
• Communication:
• Promoted freedom of expression and access to information worldwide.

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COURSES

GNM

BSC NURSING

Master the 3rd Year GNM Community Health Nursing-II syllabus at RGUHS, Bengaluru, Karnataka. Covers Epidemiology, Health Planning, National Health Programs, and Disaster Nursing.

SYLLABUS
UNIT I. HEALTH SYSTEM IN INDIA
UNIT II. HEALTH CARE DELIVERY SYSTEM
UNIT III. HEALTH PLANNING IN INDIA
UNIT IV. SPECIALIZED COMMUNITY HEALTH SERVICES AND NURSES ROLE
UNIT V. NATIONAL HEALTH PROBLEMS
UNIT VI. NATIONAL HEALTH PROGRAMS
UNIT VII. DEMOGRAPHY AND FAMILY WELFARE
UNIT VIII. HEALTH TEAM
UNIT IX. HEALTH INFORMATION SYSTEM
UNIT X. HEALTH AGENCIES
TAB: SYLLABUS

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COURSES

GNM

B.SC NURSING

(more…)

Learn essential growth monitoring methods for B.Sc Nursing students in community areas. This includes anthropometric measurements and Gomez classification. It also involves measuring vital signs, menstrual cycle tracking, and testicular self-examination (TSE).

Methods of Growth Monitoring

Growth monitoring is essential for assessing a child’s development and identifying malnutrition early. Various methods are used, including growth charting and anthropometric measurements.

1. Growth Charting

Growth charts were initially designed by David Morley and later modified by the World Health Organization (WHO). Also known as the “road-to-health” chart, they visually represent a child’s growth and development.

• Under the Integrated Child Development Services (ICDS), a Mother and Child Protection Card is used separately for boys and girls.
• This card includes information on family identification and birth record. It also covers pregnancy details, immunization schedules, nutrition, and milestones. There are special care requirements under schemes like Janani Suraksha Yojana.

Basic Features of Growth Charts:

• Weight-for-age chart does not consider height.
• Weight is a more sensitive indicator of growth than height.
• Deviation from normal growth curves signals potential health issues.
• A child can lose weight but not height due to malnutrition.
• When plotted correctly, growth charts provide early detection of growth failure, especially Protein-Energy Malnutrition (PEM).

Uses of Growth Charts:

• Growth Monitoring: Helps track child health in a simple, cost-effective way.
• Diagnostic Tool: Identifies high-risk children, especially those with malnutrition.
• Planning and Policy-Making Tool: Supports health programs and decision-making.
• Educational Tool: Helps uneducated parents understand child growth patterns.
• Intervention Tool: Guides health workers in planning appropriate actions.
• Teaching Tool: Used in health education about feeding, nutrition, and illnesses.
• Evaluation Tool: Measures the impact of health interventions.

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2. Anthropometric Measurements

These measurements help assess a child’s growth and nutritional status by comparing them to standard reference values.

Key Measurements:

1. Weight: A primary indicator of physical growth. Periodic weight checks (especially in ages 1-5 years) help detect growth faltering.
2. Height: Indicates long-term growth trends. Low height-for-age is called nutritional stunting, a sign of past malnutrition.
3. Head and Chest Circumference: At birth, head circumference (HC) is larger than chest circumference (CC). In severe malnutrition, CC may take longer (3-4 years) to surpass HC due to poor thoracic growth.
4. Mid-Arm Circumference (MAC): Reflects muscle mass and nutritional status. A decrease signals malnutrition.

Interpretation of Anthropometric Data:

• Mean or Median: A variation of ±2 standard deviations is considered normal.
• Percentile or Centiles:
  • Below the 3rd percentile or above the 97th percentile is unusual but not necessarily abnormal.
• Weight-for-Height/Length:
  • <70% of expected weight-for-height indicates severe malnutrition.
  • WHO standards guide weight assessments.

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3. Grading Malnutrition

Several classifications assess malnutrition severity:

1. Waterlow’s Classification (Stunting & Wasting)

Category	Stunting (Height-for-Age %)	Wasting (Weight-for-Height %)
Normal	>95%	>90%
Mild	87.5-95%	80-87.5%
Moderate	80-90%	70-80%
Severe	<80%	<70%

2. Gomez Classification (Weight-for-Age %)

Category	Reference Weight %
Normal	90-110%
Mild Malnutrition (Grade I)	75-89%
Moderate Malnutrition (Grade II)	60-74%
Severe Malnutrition (Grade III)	<60%

3. Indian Academy of Pediatrics (IAP) Classification

• Grade I: 70-80% of standard weight-for-age
• Grade II: 60-70%
• Grade III: 50-60%
• Grade IV: <50%

4. WHO/UNICEF Malnutrition Criteria

• Moderate Acute Malnutrition (MAM): Weight-for-Height Z-score <-2 but >-3.
• Severe Acute Malnutrition (SAM):
  • Weight-for-Height Z-score <-3.
  • Mid-Upper Arm Circumference (MUAC) <11.5 cm.
  • Bilateral pitting edema (Marasmic-Kwashiorkor).

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4. Measuring Weight Using Salter Scale

The Salter scale is a spring hanging scale used for weighing preschool children. It measures up to 25 kg with 100 g accuracy.

Steps for Measuring Weight:

1. Hook the scale securely at eye level.
2. Hang the weighing pants on the lower hook.
3. Set the scale to zero before weighing.
4. Undress the infant and place them in the weighing pan.
5. Ensure the child hangs freely without support.
6. Record weight only when stable, to the nearest 100 g.
7. Inform the parent of the child’s weight and compare with previous records.

Purpose of Weighing:

• Assess growth and health status.
• Calculate drug dosages.
• Determine BMI for underweight/obesity screening.

Articles Required:

• Weighing scale.
• Health card and pen to record weight.

Steps Involved:

1. Establish rapport with parent and child.
2. Explain the procedure.
3. Check previous weight records.
4. Place the scale on a firm, level surface.
5. Remove shoes and heavy clothing.
6. Ensure the child stands properly on the scale.
7. Record weight to the nearest decimal fraction.
8. Inform the parent about the child’s weight progress.

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Measuring Vital Signs

Oral Temperature Using Community Health Nursing Bag

Steps Involved

1. Preparation:
   • Spread a newspaper or a plastic square on a flat surface and place the community health nursing bag on it.
   • Obtain a newspaper. Use it to make a paper bag for discarding soiled cotton. Place the bag at one corner of the spread-out newspaper.
   • Explain the importance of the paper bag to the family and keep it standing in one corner.
2. Hand Hygiene:
   • Remove your watch and pin it securely (e.g., on a sari or salwar kameez).
   • Identify a suitable washing area with the help of a family member.
   • Wash hands thoroughly with soap and water for 3-5 minutes, following proper handwashing techniques.
   • Be mindful of water usage, especially in areas with water scarcity.
   • Dry hands using air or a towel.
3. Setting Up Equipment:
   • Return to the working area where the bag is placed.
   • Lift the unzipped outer covering of the upper compartment using the elbow.
   • Open the inner cardboard lining by pulling the attached small cloth piece.
   • Take out the necessary items for checking oral temperature. These include an oral thermometer, two cotton balls, a long layer of cotton for disinfection, and spirit. Place these on the newspaper.
   • Close the inner cardboard lining to prevent contamination.
4. Cleaning and Measuring Temperature:
   • Take the oral thermometer to the wash area.
   • Wash it under running cold water or pour water over it.
   • Use a cotton ball from the newspaper to wipe the thermometer from bulb to stem.
   • Explain the procedure to the patient, obtain consent, and place the thermometer under the tongue.
   • Ask the patient to close their mouth carefully and hold the thermometer in place with their lips.
   • Wait for three minutes.
   • Remove the thermometer. Read the temperature at eye level. Wipe it from stem to bulb with the used cotton ball.
   • Discard the used cotton into the paper bag.
5. Post-Procedure Care:
   • Wrap the thermometer in a long cotton strip soaked with soap and leave it for 10-15 minutes.
   • Use this time to collect patient history, provide health education, or conduct physical/nutritional assessments.
   • After 10-15 minutes, remove the thermometer. Clean it using a spiral motion with a fresh cotton ball. Rinse it with water and dry it. Disinfect with spirit. Lastly, place it back in its case.
   • Wash hands thoroughly.
   • Securely dispose of the soapy cotton swab in the paper bag and give it to a family member for safe disposal (e.g., burning).
   • Repack all items in the bag and zip it properly.
   • Fold the newspaper, ensuring the side that touched the floor remains inside.
   • Dry the towel upon returning to the health center.

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Measuring Blood Pressure

Purpose:

To assess systolic and diastolic arterial blood pressure.

Equipment Needed:

• Sphygmomanometer with cuff
• Stethoscope
• Antiseptic solution
• Paper bag for disposal

Procedure:

1. Preparation:
   • Explain the procedure to the patient or their relative.
   • Arrange the equipment in a convenient workspace.
   • Expose the patient’s arm above the elbow and ensure they are relaxed.
2. Cuff Placement:
   • Position the compression bag over the inner aspect of the arm, approximately 1 inch above the elbow.
   • Before application, squeeze and expel excess air from the cuff.
   • Secure the strap firmly using the Velcro sleeve band.
   • Adjust the manometer to eye level.
3. Palpation and Inflation:
   • Locate the brachial artery by palpation at the antecubital area.
   • Tighten the screw on the inflation bulb.
   • Inflate the cuff until the brachial pulse is no longer palpable.
   • Increase pressure by an additional 20-30 mmHg beyond the point where the pulse disappeared.
4. Auscultation and Reading Blood Pressure:
   • Place the diaphragm or bell of the stethoscope over the brachial artery.
   • Insert the stethoscope earpieces correctly, pointing forward.
   • Slowly release the pressure valve, allowing the mercury to fall at 2-3 mmHg per second.
   • Listen for the first pulse sound (systolic pressure).
   • Continue releasing pressure until the last pulse sound is heard (diastolic pressure).
   • Rapidly release the remaining pressure and remove the cuff.
5. Post-Procedure Care:
   • Clean the stethoscope’s bell or diaphragm with antiseptic solution.
   • Discard the used swab in the paper bag for safe disposal.

Menstrual Cycle

Definition & Basics

• Menstruation: Shedding of the uterus lining if no pregnancy occurs.
• Menarche: First menstrual period, marking puberty onset.
• Cycle Duration: Typically 28 days (can range from 21-42 days).
• Menstrual Flow: Lasts about 4-5 days, with 50-60mL blood loss.

Hormones Involved

• Estrogen: Develops & maintains female reproductive system.
• Progesterone: Produced by corpus luteum, supports pregnancy.
• FSH (Follicle-Stimulating Hormone): Stimulates estrogen & ovulation.
• LH (Luteinizing Hormone): Triggers ovulation & progesterone production.
• GnRH (Gonadotropin-Releasing Hormone): Regulates FSH & LH release.

Phases of the Menstrual Cycle

1. Proliferative Phase (Before Ovulation)
   • FSH rises → Estrogen secretion → Uterine lining thickens.
2. Ovulatory Phase (Day 14 in a 28-day cycle)
   • LH surge → Ovulation (release of egg).
3. Secretory (Luteal) Phase
   • Progesterone rises → Endometrium thickens for pregnancy.
   • If fertilization occurs → Hormones remain high.
   • If no fertilization → FSH & LH drop → Menstrual bleeding starts.

Psychological & Physical Changes

• Breast tenderness, fatigue, mood swings.
• Mild pain/discomfort in lower back, legs, pelvis.
• Important to normalize menstruation as a natural process.

Role of Community Health Nurse

• Educates girls & women about menstrual health.
• Ensures cultural sensitivity in discussions.
• Encourages hygiene, proper nutrition, and exercise.

Menstrual Hygiene Tips

• Use clean cotton pads or sanitary napkins.
• Change pads frequently based on flow.
• Wash perineal area & hands with soap and water.
• Dispose of used pads properly, avoiding toilet blockage.
• Maintain clean clothing & undergarments.

Pain Management

• Regular exercise & low-fat diet.
• Heating pads for cramps.
• NSAIDs for excessive pain (consult doctor if severe).

Breast Self-Examination (BSE)

• Check for lumps, skin changes, or nipple discharge monthly.
• Best done 7-10 days after period starts.
• Women aged 20-39: BSE monthly & clinical check every 1-3 years.
• Women 40+: BSE monthly & yearly clinical breast exam.

Testicular Self-Examination (TSE)

Why Perform TSE?

• Helps detect testicular cancer early.

How to Perform TSE?

1. Choose Privacy: Stand undressed in front of a full-length mirror.
2. Check for Swelling: Look for any changes in size or shape.
3. Palpate the Testis:
   • Use both hands.
   • Roll the testis gently between the thumb and fingers.
   • Feel for lumps or abnormalities.
4. Check the Epididymis & Spermatic Cord:
   • Epididymis is a soft cord-like structure at the top and back.
   • The spermatic cord runs from the testis upward.
   • Do not mistake them for lumps.
5. Repeat on the Other Side: One testis may be slightly larger – this is normal.
6. Consult a Doctor If:
   • You feel a small lump.
   • The testis is swollen or painful.

How Often?

• Perform TSE once a month.

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COURSES

GNM

BSC NURSING

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