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HEALTH CARE DELIVERY IN COMMUNITY AND MANAGEMENT PLANS

INTRODUCTION:

India is a union of 28 states and 7 union territories .under the constitution of India, the
states are largely independent in matters relating to the delivery of health care to the people.
Each state therefore has developed its own system of health care delivery, independent of the
central government. Health is fundamental human rights. This implies that the state has a
responsibility for the health of its people. But the challenge that exists today in many states is to
reach the whole population with adequate health care services and to ensure their utilization.
This can be overcome by providing health care services that are reasonably in expensive and
have the basic essentials required by rural population.

HEALTH SYSTEM

Health services are designed to meet the health needs of the community through the use
of available knowledge and resources. Health services are delivered by the ‘Health System’
which constitutes the management sector and involves organizational matters; two major themes
have emerged in recent years in the delivery of health services.

(a). First, that health services should be organized to meet the needs of the entire population and
not merely selected groups. Health services should cover the full range of preventive, curative
and rehabilitation services. Health services are now seen as part of the basic social services of
country.

(b). Secondly, the best way to provide health care to the vast majority of underserved rural
people and urban poor is to develop effective “ Primary Health Care” services supported by an
appropriate referral system. The social policy throughout the world was to build up health system
based on primary health care towards the policy objective of “Health for All”.

Levels of health care:

It is customary to describe health care service at three levels. These levels represent different
types of care involving varying degrees of complexity.

1. Primary care level:


It is the first level of contact of individuals, the family and community with the national health
system where primary health care is provided. As a level of care, it is close to the people
where most of their health problems can be dealt with and resolve it is provided by primary
health centers and their sub centers through the agency of multi purpose health worker, village
health guides, ASHA and trained dais.

2. Secondary care level:

The next higher level of care is the secondary (I intermediate) health care level. At this level
more complex problems are dealt. The care is generally provided in district hospitals and
community health centers which also serve as the first referral level.

3. Teritary care level:

It is the more specialized level than secondary care level and requires specific facilities and
attention of highly specialized health workers. This care is provided by the regional or central
level institutions, eg. Medical collqege hospitals, All India institutes, Regional hospitals,
specialized hospitals and other apex institution.

Types of Health Care Agencies

Health care is provided in various settings in India. It is represented by four major sectors or
agencies which differ from each other by the technology applied and by the source of funds for
operation. These are

I. Public health sector:

A. primary health care

- Primary health centre: It covers population about 20,000-30,000 in rural or tribal


areas. There are 23,236 PHCs are in India.

The functions are,

1. Medical care.

2. MCH including family planning.

3. Safe water supply and basic sanitation.

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4. Prevention and control of locally endemic diseases.

5. Collection and reporting of vital statistics.

6. Education about health.

7. National health programmes as relevant.

8. Referral services.

9. Training of health guides, health workers, local dais and health assistant.

10. Basic laboratory services.

- Sub center: it is a peripheral outpost of the existing health delivery system in rural
areas. One sub center for every 3,000-5,000 population in hilly or plain areas. The functions are
limited to MCH care, family planning and immunization. All these activities are carried out by
one male and female multipurpose health workers and supervised by male and female health
assistant.

- At village level: to make the health care penetrate into the farthest reach rural areas and
that everyone should have access to it. This is achieved by schemes such as village health guide
scheme, training of local dais, ICDS scheme.

B. Hospital/ health center:

1. Community health center: there are 3,076 CHCs were established by upgrading PHCs. Each
CHC is covering 80,000-1.2 lakh (1 in each community development block with 30 beds and
specialists and lab facilities. The services provided are;

1. Care of routine and emergency cases in surgeries

2. care of routine and emergency case in medicine

3. 24- hour delivery services.

4. Essential and emergency obstetric care.

5. Family planning services including laparoscopic services.

6. Safe abortion services.

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7. New born care.

8. Routine and emergency care of sick children.

9. Other management including nasal packing, tracheotomy, foreign body removal Etc.

10. All the national health programmes

11. Others; blood storage facilities, essential lab services, referral services

2. Hospitals

The present organization of health services of the government sector consist of rural hospitals,
sub divisional/tehsil/taluka hospitals, district hospitals, specialist hospitals and teaching
institution.

(a). Rural hospitals- It is now proposed to upgrade the rural dispensaries to PHC’s. At present a
good number of PHC’s are located at tehsil/ sub divisional /taluka head quarters which also have
hospitals. Such PHC’s may be shifted to the interior rural areas. It is proposed to convert the sub
divisional hospitals in to sub divisional health centers so as to cover a population of 5 lakhs these
centers will have an epidemiological wing attached to them.

(b). District hospitals: There are proposals to convert the district hospitals in to District health
centers. Today, the role of the hospital in the community is being disabled. The current opinion
is that the hospital should not remain. “An ivory tower of disease in the community, but should
take an active part in providing health services to the community. Under the multi purpose
workers scheme, it has been suggested to the states to have an Integrated set up at the district
level by having a chief medical officers of the district with three deputy CMO’s (District Health
officers and District family welfare or existing civil surgeon) with each deputy CMO being in
charge of 1/3 of the district for all the health, family welfare and MCH programmes.

(c) Health Insurance: There is no universal health insurance in India. Health Insurance is at
present limited to industrial workers and their families. The Central government employees are
also covered by the health insurances, under the banner “central government Health schemes”

 Employees state insurance schemes (1948).


 Central govt. Health Schemes (1954).

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These are the two schemes cover two large groups of wage earners in the country, they are well
organized health insurance schemes, and are providing reasonable medical care, some preventive
and promotive health services. Experience in other countries has shown that health insurance is a
logical step towards nationalization of health services.

(d) Other agencies: Defense Medical services: Defense services have their own organization for
medical care to defense personnel under the banner “Armed forces Medical Services”.

Health care of Railway Employee: The Railways provide comprehensive health care services
through the agency of Railway Hospitals, Health units and clinics.

II. Private Agencies:

Private practice of medicine provides a large share of the health services available. The
total no. of physicians is about 7.67 lakhs (2005) and the doctor population ratio is1:1428. Most
of them tend to congregate in urban areas. They provide mainly curative services. Private
services are expensive and the health care services are not organized. The Medical Council of
India and India Medical Association regulate some of the functions and activities of the large
body of private registered Medical practitioners.

III. Indigenous systems of Medicine:

The practitioners of Ayurveda, Siddha, Homeopathy,etc. provide the bulk of medical care
to the rural people. Ayurvedic Physicians are 4.38 lakhs, 90% of them serve rural areas. Many
Ayurvedic dispensaries are state- run. The govt. of India has established a National Institute of
Ayurveda in Jaipur and a National Institute of Homeopathy in Kolkata. A central council of
Indian medicine was established in1971 to prescribe minimum standards of education in Indian
Medicine.

IV. Voluntary Health Agencies:

A Voluntary health agency is an organization that is administered by an autonomous board


which holds meeting, collects funds for its support chiefly from private sectors and expends
money, with or with out paid workers in conducting a programme directed primarily to
furthering the public health by providing health services or health education, or by advancing
research or legislation for health or by a combination of these activities.

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Functions:

1. Supplementing the work of government agencies.


2. Pioneering.
3. Education.
4. Demonstration.
5. Guarding the work of Govt. agencies.
6. Advancing health legislation.
List of Voluntary agencies in India:

 Indian red cross Society.


 Hind Kusht Nivaran Sangh.
 Indian council for Child welfare.
 Tuberculosis Association of India.
 Bharat Sevak Samaj.
 Central Social welfare board.
 The Kasturba Memorial fund.
 Family planning Association of India.
 All India women’s conference.
 The All India Blind Relief Society.
 Professional bodies.
 International agencies.
Conclusion:

Nursing services covers the largest area in the health care delivery system of India.
Nurses make up the largest employment group in the Health care system. So, Nursing is a vital
process in recognizing, understanding and meeting the health needs of a person or society.
“Health for all” is the current health target of India which can be attained through the highest
practices and involvement by Nurses.

Bibliography:

1. Park.k, Preventive and Social Medicine, 19th edition, M/S Banarsidhas Bhanot,
Jabalpur.2008:730-760.

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MANAGEMENT PLANS

Management plan is:

A comprehensive plan for the program that clearly specifies intended objectives of the proposed project, including clearly defined
responsibilities, timelines, and milestones for accomplishing project tasks.

A Management plan helps:

Establish mutual understanding about what a project aims to achieve and how it will achieve it. Identify possible risks and
challenges as early as possible so that grantees can adjust strategies and the Department can offer assistance.

Components of the Management Plan

There are three levels of information that the management plan should include:

Objectives: What are you trying to achieve with your grant and what does success look like?

Strategies: What are the major initiatives/components of the intervention required to complete each phase of your grant in
support of ultimately achieving project objectives?

Activities: What are the key components that have to be completed in order for each strategy to be successful? In addition, what
are the key milestones along the way that let grantees know they are on track?

This plan will be done in the managerial level

Top level managers ---- Strategic or long term planning

Middle level managers ---- Functional planning

Low level managers ------Operational planning

The Management Plan is the main tool to guide the development and management of an Organization. it helps to

 Improve use of human and financial resources, by setting priorities.


 Provide continuity in case of staff changes.
 Increase accountability.
 Improve communication with stakeholders, the public, and potential donors.
 Ensure that management decisions are based on a clear understanding of the organizations objectives. Management
Plans have tended to be 'issue-driven', or focused on issues that were important when they were prepared. A more
useful approach is for a Plan to answer the question ‘what is needed for the objectives of the institution to be met?’
Objective-oriented management is pro=active rather than reactive, emphasizes outcomes, and makes progress easier to
measure.
Some Management Plans have the status of legal documents, in which case failure to manage an organization in
accordance with it may constitute an offence. Although this may seem stringent, legally binding Plans are advantageous
as they have greater force and help to back up management decisions and actions.

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Once the plan and any supporting documents are produced, they should be used to guide implementation of the plan in
the organization, and monitoring programmes should be designed to assess their effectiveness. Plans are often not used
or are difficult to implement, particularly if they were prepared without the participation of all those involved in
implementation, and if they were poorly structured and written.
Management Plans should be revised and adjusted at intervals to reflect new issues, lessons learnt, or changes in
management objectives, adapting the contents according to new information gained from monitoring. The review
process for this IS usually laid out in the legislation or in the Plan itself.

MANAGEMENT PLAN PREPARATION

The Plan can be prepared before or after the MPA is Set up, and will usually take at least a year to ensure adequate consultation.
MPA agencies often lack the financial resources for the work involved but donors may be willing to fund such activities.
Management Plan preparation generally involves the following steps:

1. Pre-planning: establish the planning team, define the process to be used, find funding, and train the planning team and key
stakeholders if required.

2. Review existing information (e.g. physical. biological, social, economic, policies, legislation)

3.Identify stakeholders and establish a transparent consultation process, which may involve meetings or workshops, with
individual interest groups and for all stakeholders together.

4. Analyze constraints, opportunities, threats, issues, problems, and needs, and identify solutions.

5. Formulate vision, objectives and, where appropriate, targets.

6. Design management actions and interventions,

7. Determine financing mechanisms, bearing in mind the need for benefit and revenue sharing with stakeholders.

8. Establish monitoring and evaluation protocols, including a process for periodic review and revision.

9. Prepare the draft Plan, and submit it for public consultation and review.

10. Incorporate comments and publish final Plan (preferably both as a hard copy and electronically)

11. Submit plan for approval and disseminate it.

Key points for the management plans

 Ensure that all staff are familiar with and use the management plan, and understand its status (as alegal document or
general guidance).
 Revise the plan at the appropriate intervals, involving all stakeholders, and ensuring an objective-oriented approach.
 Ensure that the budget allows for preparing and/or revising the management plan, or that special funding is sought.

Obtain copies of management plans for other MPAs, both within your country and from other countries for comparison

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