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Health Care Delivery

System in India

Introduction
Health is..
..a state of complete Physical, Mental and Social
well being and not merely an absence of disease or
infirmity.
..which allows a person to live a socio-economically
productive life.

Illness is..
a state in which a person s physical, emotional,
intellectual, social or spiritual functioning is diminished or
impaired.

Cont.

Health care is...


.multitude of services rendered to
individuals or communities by the agents of
health services or professional for the purpose of
Promoting
Restoring and
Maintaining health

Embraces all the goods and services designed


for prevention, promotion and rehabilitation
interventions includes Medical Care

Health Care provider


A person or organization that provides services
and/or health care personnel.
.to deliver proper health care in a systematic way
to any individual in need of health care services.
Could be a governmentor
.the health care industry,
.a health care equipment company,
.an institution such as a hospital or laboratory.
Health care professionals may include physicians,
dentists, and other support staff.

Cont.

Health services
Permanent countrywide system of estabilished
institutions with the objective of
.coping with the various health needs and
demands of population
thereby provide health care to individuals and
community with preventive and curative activities
.utilizing health care workers

Cont

System
Includes concepts ( e.g health and diseases)
Ideas(e.g equity)
Objects(e.g hospitals, health centres)
Persons (health care workers viz. physician, nurses)

Together these forms a system interacting with


each other, supporting and controlling each
other

Components of healthcare
delivery system

1. Structure of health system


.Aspects of the design of health services that influences the way in
which they are delivered Includes.
Number and type of personnel and staff
Way of these personnel organized to work
Nature and extend of facility and equipment
Range of services offered
System of management and amenities
Financing
Enumeration and determination of the eligible population for these
services
Governance and decision making

Cont

2. Process of health care delivery


.Consists of two parts
.Behavior of professionals
Recognition of the problem i.e diagnosis
Diagnostic procedure
Recommendation of treatment or management
Appropiate follow up

.Participation of people
Utilization of services
Understanding the recommendations
Satisfaction with the services
Participation in decision making

Cont
3. Outcomes of health care
.Aspects of health that results from interventions provided by the
health system

4. Flow of patients in health care system


.Varies from country to country
.India harbors a multistage (three tier) system, where majority of
health care is delivered by community health care worker
.Indian system is more cost effective if health workers are skilled and
effectively supervised
.Such system could one of the reason to reduced cost of health care
in developing countries

Levels of health care


Primary Health care
Provided at the community level
Secondary health care
Provided at PHC, CHC, DH etc.
Tertiary health care
Provided at hospitals

Tertiary health
care

Secondary
health care

Primary health care

Alma-Ata international conference


In 1977, World Health Assembly decided to launch a movement
called Health for all by 2000
Fundamental principle of this concept was equity, an equal health
status for all the people in all countries
This is to be ensured by equitable distribution of health resources
In 1978, the note of Health for all was reaffirmed and marked as
the major social goal for every country.
It was stated in the declaration that the best way to achieve HFA
is by providing primary health care
especially to vast size of underserved rural and urban poor

Alma-Ata conference, 1978

Alma-Ata Declarations
A main social target of governments, international organizations
and the whole world community in the coming decades should be
the attainment by all peoples of the world by the year 2000 of a
level of health that will permit them to lead a socially and
economically productive life. - HEALTH FOR ALL BY 2000
Primary health care is the key to attaining this target as part of
development in the spirit of social justice.
Primary health care is essential health care based on practical,
scientifically sound and socially acceptable methods and
technology, made universally accessible to individuals and families
in the community through their full participation and at a cost that
the community and country can afford.

Alma-Ata Declaration
It forms an integral part of the country's health system,
and of the overall social and economic development of
the community.
It is the first level of contact of individuals, the family
and community with the national health system.
All governments should formulate national policies,
strategies and plans of action to launch and sustain
primary health care as part of a comprehensive national
health system and in coordination with other sectors.

Primary health care


Primary Health Care as defined by the World Health
Organization (WHO) in 1978 is
Essential health care; based on
practical,
scientifically sound, and
socially acceptable method and technology.

.made universally accessible to individuals and


families of the community through their full participation.

at a cost that community and country can afford to


maintain every stage of their development in the spirit of self
determination.

Cont

Definition
Primary health care is essential health
care made universally accessible to
individuals and acceptable to them
through their full participation and at a cost
the community and country can afford

What is there in Primary


Health Care..?????
Primary Health Care includes:
Primary Care (physicians, midwives & nurses);
Health promotion, illness prevention;
Health maintenance & home support;
Community rehabilitation;
Pre-hospital emergency medical services and
Coordination and referral to other areas of health care.

Cont.

It is the first level of contact with the health system to promote


health, prevent illness, care for common illnesses, and manage
ongoing health problems.
Primary Health Care involves concerted effort to provide rural
population of developing countries with least bare minimum of
health services.
Some services are also provided community and hospitals
Primary Health Care is different in each community depending
upon:
Needs of the residents;
Availability of health care providers;
The communities geographic location; &
Proximity to other health care services in the area.

Elements of primary health care


1. Education about prevailing health conditions and methods to
prevent and control them
2. Promotion of food supply and proper nutrition
3. Adequate water supply and basic sanitation
4. Maternal and child health care with family planning
5. Immunization against major infectious diseases
6. Prevention and control of locally endemic diseases
7. Appropriate treatment of common diseases and injuries
8. Provision of essential drugs

Principles of primary health care


Equitable distribution

Community participation

Intersectoral coordination

Appropriate technology

Health Care Delivery System in India


India is a union of 28 states and 7 union territories.
States are largely independent in matters relating to
the delivery of health care to the people.
Each state has developed its own system of health
care delivery, independent of the Central Government.
The Central Governments responsibility consists
mainly of policy making , planning , guiding, assisting,
evaluating and coordinating the work of the State
Health Ministries.

Health System in India


The health system in India has 3 main links

Central
State
Local or peripheral

At the central level


The official organs of health system at
national level are
The Ministry of Health and Family welfare

The directorate general of Health Services

The central council of health and family


welfare

Ministry of Health
and Family Welfare

Organization
Structure

Functions of MoHFW

Union list
International health relations and administration of port quarintine
Administration of Central Institutes
Promotion of research
Regulation and development of medical, pharmaceutical, dental
and nursing professions
Establishment and maintenance of drug standards
Census and collection and publication of other statistical data
Coordination with states

Union list
TheUnion ListorList-I is alistof
100 items (the last item is numbered
97) given in Seventh Schedule in the
Constitution of India on which
Parliament has exclusive power to
legislate. The legislative section is
divided into threelists:Union List,
StateListand ConcurrentList.

cont.

Concurrent List:

Prevention of Communicable disease

Prevention of food adulteration

Control of drug and poison

Vital statistics

Labour welfare

Economic and social planning

Poulation control and family planning

TheConcurrent
ListorList-III
(Seventh Schedule) is alistof 52
items (though the last item is
numbered 47) given in the Seventh
Schedule to the Constitution of India.

Directorate General
of Health Services

Organization chart

Functions of Directorate General of


Health services
General functions
Surveys
Planning
Coordination
Programming and appraisal of all health matters
Specific function
International health relations and quarantine of all major
ports in country and international airport.
Control of drug standards
Maintain medical store depots
Administration of post graduate training programmes

Cont
Administration of certain medical colleges in India
Conducting medical research through Indian Council of Medical
Research ( ICMR )
Central Government Health Schemes.
Implementation of national health programmes
Preparation of health education material for creating health
awareness through Health Education Bureau
Collection, compilation, analysis, evaluation and dissemination of
information
National Medical Library

Central Council of health

Organization chart

Functions
To consider and recommend broad outlines of
policy related to matters concerning health like
environment hygiene, nutrition and health
education.
To make proposals for legislation relating to
medical and public health matters.
To make recommendations to the Central
Government regarding distribution of grants-inaid.

State Level

At District level
There are 687 ( year 2016 census) districts in
India. Within each district, there are 6 types of
administrative areas.
1. Sub division
2. Tehsils ( Talukas )
3. Community Development Blocks
4. Municipalities and Corporations
5. Villages and
6. Panchayats

Disrtict Level
Districts
Tehsils /Talukas (200-600
villages)
Community Development Blocks
(approx 100 Villages & 80,000
-1.2 Lac Pop)
Municipalities & Corporations

Town Area
Committee (5,00010,000 Pop)

Municipal Board
(10,000- 2 Lac
Pop)

Villages
Corporations (> 2
lac pop)
Panchayats

Health Services
Out patient services -Patients who dont require hospitalization can receive
health care in a clinic. An out patient setting is designed to be convenient and
easily accessible to the patient.
Clinics Clinics involve a department in a hospital where patients not
requiring hospitalization, receive medical care.
Institutions Hospitals Hospital have been the major agency of health
care system.
In broad sense the health services should be

a.

Comprehensive

b.

Accessible

c.

Acceptable

d.

Provide scope of community participation and.

e.

Available at an affordable cost by country and commuity

Health care systems


Intended to delivery healthcare services and represented by five major
sectors different from each other by health technology
1. Public health sector
a. Primary health care
Primary health centres
Sub centres

b. Hospitals/Health centres
Community health centres
Rural hospitals
District hospitals/health centres
Specialist hospitals
Teaching hospitals

c. Health insurance schemes


Employees State Insurance
Central Govt. Health Schemes

d.

Other agencies
Defense services
Railways

Cont

2. Private sector
a. Private hospitals, polyclinic, nursing homes and
dispensaries
b. General practitioners and clinics
3.
a.
b.
c.
d.

Indigenous system of medicine


Ayurveda and Siddha
Unani and Tibbi
Homeopathy
Unregistered practitioners

4. Voluntary health agencies


5. National health programmes

Primary health care in


India

Introduction
In 1977, GoI launched Rural Health Scheme based on the
principle of placing peoples health in peoples hand
Subsequently in the international conference of AlmaAta(1978)the goal of Health for all by 2000 through
primary health care approach was set.
Keeping in view WHO Health for all by 2000 GoI
formulated National health policy 2002

Cont.
More recently GoI formulated NRHM and Indian Public
Health Standards (IPHS) in this regards
In order to provide quality care in the public health agencies
of health care delivery IPHS are being prescribed.
These standards provides basic promotive, preventive and
curative primary health care to the community and
.achieve and maintain an acceptable quality of care
These standards would help monitor and improve
functioning of the health care delivery system

Rural Health care system in India


Community Health Centre (CHC)

A 30 bedded Hospital/ Referral unit for 4 no. of PHCs with


specialized Health Services

Primary Health Centre (PHC)

A Referral unit for 4-6 Subcentres; 4-6 bedded manned with a


Medical Officer in-charge and 14 subordinate paramedical staff
no. of PHCs with specialized Health Services

Sub Centre (SC)

Most peripheral contact point of community with Primary Health


Care system; manned with one MPW(M) and MPW(F)

Rural Health care system in India


The health care infrastructure in rural areas has
been developed as a three tier system and is
based on the above population norms.
Population Norms
Health Facility

Plain Area

Hilly/Tribal/Difficult
Area

Sub-Centre

5000

3000

Primary Health
Centre

30,000

20,000

Community Health
Centre

1,20,000

80,000

Sub Center

The most peripheral and first contact point between the primary
health care system and the community.
The Ministry of Health & Family Welfare is providing 100% Central
assistance
They are established on the basis of
One SC for every 5,000 pop in general and
One SC for every 3,000 pop in hilly, tribal and backward areas

Each Sub-Centre is manned by one Male and one female Health


Worker.
One Lady Health Worker (LHV) is entrusted with the task of
supervision of six Sub-Centers.

Cont.

Sub Centre are assigned tasks relating to


interpersonal communication
..in order to bring about behavioral change
and provide services in relation to.
Maternal and child health,
Family welfare,
Nutrition,
Immunization,
Diarrhea control and
Control of communicable diseases programmes.

The sub centre are provided with basic drugs


for minor ailments.

Primary Health Center


PHC is the first contact point between village
community and the Medical Officer.
The PHCs were envisaged to provide an integrated
curative and preventive health care to the rural
population with emphasis on preventive and promotive
aspects of health care.
The PHCs are established and maintained by the State
Governments.
At present, a PHC is manned by a Medical Officer
supported by 14 paramedical and other staff.

Cont.

It acts as a referral unit for 6 SubCentres.


It has 4 - 6 beds for patients.
The activities of PHC involve curative, preventive,
primitive and Family Welfare Services.
National Health Plan (1983) proposed reorganization of
PHCs on the basis of.
One PHC for every..30,000 pop in Rural areas
One PHC for every..50,000 pop in Urban areas

PHC Pakyong

Functions of PHCs
Medical care
Health programmes
MCH care and family planning
Health education and training
Referral services
Safe water supply and basic sanitation
Prevention and control of locally endemic diseases
Collection and reporting of vital events
Basic laboratory services

Staffing of PHCs

Source: IPHS 2012

Community Health Center (CHC)


These were established by upgrading the primary health centers
CHCs are being established and maintained by the State Government.
centers,each community health center should cover a population of 8000
to 1.2 lakh
It is manned by four medical specialists
Physician, Gynecologist and Pediatrician and.

i.e.

Surgeon,

supported by paramedical and other staff.


It has 30 in-door beds with one OT, X-ray, Labour Room and Laboratory
facilities.
It serves as a referral centre for 4 PHCs and also provides facilities for
obstetric care and specialist consultations.

Functions of CHCs
Care of Routine and Emergency Cases in Surgery
Dressings, I&D, and surgery for Hernia, Hydrocele, Appendicitis etc.
Emergencies like Intestinal Obstruction, Haemorrhage, etc.
Other management including nasal packing, tracheostomy, foreign
body removal etc.
Fracture reduction and putting splints/plaster cast.
Conducting daily OPD.

Care of Routine and Emergency Cases in Medicine


Daily OPD
Handling all the emergency and routine cases

Cont

Maternal Health
Minimum 4 ANC check ups including Registration & associated
services
1st visit: Within 12 weekspreferably as soon as pregnancy
2nd visit: Between 14 and 26 weeks
3rd visit: Between 28 and 34 weeks
4th visit: Between 36 weeks and term
24 hr delivery services including normal and assisted delivery
and cesarean section
Managing labour using Partograph.
Minimum 48 hours of stay after delivery, 3-7 days stay post
delivery for managing Complications

Cont.

Newborn Care and Child Health


Essential Newborn Care and Resuscitation
Counseling on Infant and young child feeding
Routine and emergency care of sick children
Full Immunization of infants and children against VPDs
Management of Malnutrition cases.

Family Planning
Counseling, provision of Contraceptives, NSV, Laparoscopic
Sterilization Services and their follow up.
Safe Abortion Services

Cont.

All National Health Programmes delivered through


CHCs
School health services
Others
Blood storage facility
Essential laboratory services
Referral (transport) services

Maternal Death review (MDR)

Staffing of CHCs

Cont

Cont.

Thank you