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• Department of AYUSH
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• Department of AIDS Control
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Uploaded byAneesa K Ayoob
HEALTH CARE DELIVERY
The document describes India's health care delivery system. It discusses the evolution of health systems in India through various phases and five-year plans. It outlines the different levels of health care - primary, secondary, and tertiary. It then examines the administration of health systems from the central, state, and district levels. The document also explores the various sectors that make up India's health care system including public, private, insurance, and traditional medicine. It analyzes the roles of community health workers and different facilities like PHCs, CHCs, and hospitals. In conclusion, it mentions other agencies and national health programs involved in health care delivery in India.
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HEALTH CARE DELIVERY
- 1.
- 2. Contents Introduction Evolution of HealthSystems Levels of Healthcare in India Health System Administration in India Health Care Sectors in India Conclusion Suggested Reading
- 3. Evolution of HealthSystems Various Phases • Phase I (1947- 83) • Phase II (1983- 2000) • Phase III (post-2000) Five-year plan • Almost 13 five-year plan • Fourth five-year plan(1969-74)
- 4. Levels of Healthcarein India Primary Health Care Provided at PHC and sub centre Secondary Health Care Provided at District hospital and CHC Tertiary Health Care Provided at regional and central level Institution (medical college hospitals , all india institutes, regional hospitals, specialized hospitals, other apex institutions)
- 5. Health System Administrationin India Centre State District
- 6. Centre Ministry of Healthand Family Welfare • Department of Health and Family Welfare • Department of AYUSH • Department of Health Research • Department of AIDS Control Directorate General of Health Services[DGHS] Central Council of Health and Family Welfare
- 7. State State ministry ofhealth State health Directorate
- 8. District Sub division Tahsils Community developmentblock Municipalities and corporations Villages Panchayati Raj • Gram panchayat at village level • Panchayat samiti at block level • Zilla parishad at district level
- 9. Health Care Sectorsin India 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 Centre • Specialist Hospitals • Teaching Hospitals c. Health Insurance Schemes • Employees State Insurance(ESI) • Central Government Health Scheme(CGHS) • Ayushmann Bharath- NPHS d. Other Agencies • Defence Services • Railways 3. Indigenous Systems Of India a. Ayurveda And Siddha b. Unani And Tibbi c. Homoeopathy d. Unregistered Practitioners 4. Voluntary Health Agencies 5. National Health Programmes 2. Private Sector a. Private hospitals, polyclinics, nursing homes, and dispensaries b. General practitioners and clinics
- 10. 1. Village LevelWorkers 1.Village Health Guides Scheme 1.Training of local Dais 1.Anganwadi Worker (ICDS Scheme) 1.ASHA scheme
- 11. • They serveas links between the community and the governmental infrastructure. They provide the first contact between the individual and health system. • ASHA’S are now used as health guides at village level under NRHM Guidelines: • Be permanent resident • Minimum formal education (VI class) • Spare at least 2‐3 hours/day for community health work • After selection ,they undergo training in nearest PHC for 3months 1 for each village per 1000 rural population Village Health Guides Scheme
- 12. • A schemefor training of Dais was initiated during 2001-02. • The scheme was implemented in 156 districts in 18 states • The districts selected were on the basis of the safe delivery rate being less than 30 percent. The scheme was extended to all the districts of Empowered Action Group (EAG) states. • The aim was to train at least one Dai in every village with the objective of making deliveries safe . • Training is for 30 working days. Paid a stipend of Rs. 300 • During her training period. Training at PHC, sub‐center or MCH center for 2 days in a week, four days of the week they accompany the health worker. Training of local Dais
- 13. • Angan literallymeans a courtyard. Under the ICDS(Integrated Child Development Services) scheme, there is an anganwadi worker for a population of 400-800. • There are about 100 such workers in each ICDS project. As of date over 707 ICDS blocks are functioning in the country . The anganwadi worker is selected from the community she is expected to serve. • She undergoes training in various of health, nutrition and child development for 4 months .She is a part time worker and is paid an honorarium of Rs. 1500 per month for the services rendered, which include health checkup including maintenance of growth chart etc., Anganwadi Worker ICDS Scheme (Integrated Child Development Services)
- 14. • ASHA mustbe resident of the village – a women ( married/widow/ divorced) preferably in the age group of 25 to 45 years. • The general norm of selection is one ASHA for 1000 population .In tribal, hilly and desert areas the norm could be relaxed to one ASHA per habitation Role and Responsibilities • ASHA will take steps to create awareness and provide information to the community on determinants of health. • She will counsel women on birth preparedness, importance of safe delivery, breast feeding Accredited Social Health Activist (ASHA)
- 15. • ASHA willmobilize the community and facilitate them in accessing health and health related services available at anganwadi/ subcentre/primary health centres. • She will work with the village health and sanitation committee of the gram panchayat • She will arrange escort/accompany pregnant women and children requiring treatment/admission to the nearest pre- identified health facility. • ASHA will provide primary medical care for minor ailments such as diarrhoea, fevers and first aid for minor injuries.
- 16. 2. Sub- CenterLevel • The sub-centre is the peripheral outpost of the existing health delivery system in rural areas. They are being established on the basis of one-sub centre for every 5000 population in general ,3000 population in hilly , tribal and backward areas. As of March 2017, 2,550 PHCs were working with 6 sub centres under each. • A sub centre provides interface with the community at the grass root level, providing all the primary health care services. One lady health visitor (LHV) and one health assistant (male) located at PHC are entrusted with the task of supervision of six sub centres • Indian public Health Standards For Sub centers are of 2 types: TYPE-A and TYPE-B (MCH- sub centre)
- 18. 3. Primary HealthCenter Level • The concept of primary health centre is not new to India. The Bhore committee in 1946 gave the concept of a primary health centre. • The health planners in India have visualized the primary health centre and its subcentres as the proper infrastructure to provide health services to the rural population. • Staffing pattern in PHC: At present in each community development block, there are 1 or more PHCs each of which covers 30,000 rural population. 3 workers at the subcenter level and 9 or more workers at PHC level. • Indian public Health Standards For PHCs: • TYPE A PHC –PHC with less than 20 deliveries/ month • TYPE B PHC – PHC with 20 or more deliveries/ month
- 19. Staffing pattern inPHC Medical officer 1 Pharmacist 1 Nurse mid-wife 1 Health worker (female)/ANM 1 Block extension educator 1 Health assistant (male) 1 Health assistant (female) 1 U.D.C 1 L.D.C 1 Lab.technician 1 Driver 1 Class IV 4
- 20. • Functions ofthe PHC 1. Medical care 2. MCH including family planning 3. Safe water supply and basic sanitation 4. Prevention and control of locally endemic diseases 5. Collection and reporting of vital statistics 6. Education about health 7. National Health Programmers - as relevant 8. Referral services 9. Training of health guides, health workers, local dais and health assistants 10. Basic laboratory services
- 21. 4. Community HealthCenter Level • Established by upgrading PHC’s • One centre for population of 80,000 to 1,20,000 Requirements • 30 beds • X-ray and lab facilities • Specialists • surgery and medicine • Obstetric and gynecology • Pediatrics • Community health officer • Referrals- State level hospitals and medical collage hospitals
- 22. Staffing pattern inCHC Medical officer 4 Pharmacist 1 Nurse mid-wife 7 Dresser 1 Block extension educator 1 Radiographer 1 Ward boys 2 Dhobi 1 Sweepers 3 Mali 1 Chowkidhar 1 Aya 4 Peon 1
- 23. Functions of thePHC • Care of routine and emergency cases in surgery • Care of routine and emergency cases in medicine • Maternal health • Newborn care and child health • Family planning • All the national health programmes (NHP) • Physical Medicine and Rehabilitation (PMR) • Oral health • School health services • Adolescent health care • Blood storage • Diagnostic services • Referral (transport) services • Maternal Death Review(MDR)
- 24. 5. Hospitals Rural hospitals •Proposed to upgrade rural dispensaries to PHC • Hospitals present at tehsils/sub-divisional/taluka head quarters are shifted to rural areas • These sub-divisional health centre cover a population of 5 lakhs • Each centre will have epidemiological wing attached to them District hospital • Proposed to convert into district health centre
- 25. 6. Health Insurance •There is no universal health Insurance in India. • Health insurance is limited to industrial workers under the Employees State Insurance Scheme (ESI scheme) • Central Government Health Scheme- Introduced in New Delhi in 1954 to provide comprehensive medical care to Central Government employees. The scheme is based on the principle of cooperative effort by the employee and the employer, to the mutual advantage of both. • Universal Health Insurance Scheme (UHIS) - families under below poverty line (BPL)
- 26. 7. Other Agencies •Defense medical services • Health care of railway employees • Private agencies 8. Indigenous Systems of Medicine • The practitioners of indigenous systems of medicine (e.g., Ayurveda, Siddha , Homoeopathy, etc.)provide the bulk of medical care to the rural people. • Ayurvedic physicians alone are estimated to be about 7.73 lakhs. Studies indicate that nearly 90 percent of Ayurvedic physicians serve the rural areas.
- 27. 9. Voluntary HealthAgencies • Occupy important place in community health programmes • Compared with “motor trucks” which can penetrate the by-ways. Functions • Supplementing the work of Govt. agencies • Pioneering • Education • Demonstration • Guarding the work of Govt. agencies • Advancing health legislation
- 28. Activities of VHASin India Indian red cross society Hind kusta nivaran sangh Tuberculosis aassociation of india Bharath sevaksamaj Kasturba memorial fund
- 29. 10. National Healthprogrammes in India National Vector Borne Disease Control Programme (NVBDCP) National Filaria Control Programme National Leprosy Eradication Programme Revised National TB Control Programme National Programme for control of Blindness National Iodine Deficiency Disorders Control Programme National Mental Health Programme National Aids Control Programme
- 30. Health Agencies Aroundthe World NGO’S IN HEALTH CARE Rockfellar foundation Assistance to virus research project, Establishment of all India institute of hygiene and public health Ford foundation Water supply and sanitation schemes CARE Mid-day school meals programme USAID Support to health programmes, Water supply, sanitation. World bank, UNFPA etc Provide assistance in health programmes in India
- 31. Conclusion • Health caresystems are essential for improving and maintaining the health of the population of any country. • Health systems are the result of the combined efforts of government agencies, institutions and resources with the main aim of improving the health of their people . • Properly designed health systems have a strong preventive component which can detect possible illnesses through a combination of action and advice.
- 32. Suggested Reading • SobenPeter (2018). Essentials of Preventive and Community Dentistry. 6th Edition, Arya Publishing House, New Delhi. • Park K. Textbook of preventive and social medicine; 25th Edition
- 33. Expected Questions • Healthcare system in India • Health care sectors in India
Editor's Notes
- #4 Strengthening of phc sfor effective base for health services
- #6 3 main tiers of health system in India are:
- #12 NRHM- Health System Strengthening in rural and urban areas- Reproductive-Maternal- Neonatal-Child and Adolescent Health (RMNCH+A), and Communicable and Non-Communicable Diseases.
- #17 The services have been classified on Essential or Desirable.
- #20 15 staffs
- #23 28 staffs
- #30 Some of the programmes are