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Health care delivery
system in India
Prepared by
Ms.Gipsy Sara Ninan
2nd yr Msc.Nsg
SRM CON
: Health Care Delivery System in India :
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Introduction
India is a union of 28 states and 7 union territories under theconstitution of India, the states are largely independent in the
matters related to the delivery of health care of the people,
Health care delivery system exists to provide services andresources for better health. This system includes hospitals, clinics,
health center, nursing home and special health programmers. The
health care system is enhanced through linkages that bring
together various subsystems to provide care with the properresources, technologies and skills.
So strengthening of multisectrol approach should be maintained in
the community to achieve the health for all by 2010.
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Terminologies:1. Comprehensive: Including all that may
concerned complete, full andwhole.
2. Referral: Who needs professional help
to a person.3. Practi t ioners: Persons who works in a
profession regularly does a
particular activity.
4. Phi lanthropic: The practice of helping the
poor and those in need,
especially by giving money.
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5. Pharmacopeia: An official book containing a
list of medicine and drugs andinstruction for their use.
6. Quarantine: A person that has or may
have a disease is kept awayfrom others in order to prevent
the disease from spread.
7. Statutory: That may be done by Law.
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Definition
A health care delivery system is
the totality services offered by all
health disciplines.
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Philosophy of health care delivery
system Everyone from birth to death is part of market
potential for health healthcare services Consumer of healthcare services is a client and not
customer
Consumer are less informed about health services
than anything else they purchase
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Cont
Health system is unique beacause it is not a
competitive market. Restricted entry into the health care system
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Goals / objectives
To improve the health status of population
To improve the experience of care ofpatients,families,and communities
To improve social justice,equity in the health
status of population
To reduce the total economic burden of care and
illness.
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Functions
Provision of health services
Raise & pool the resources accessible to pay forhealth care
Generating human & physical sources that makes
the delivery of services possible
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Characteristics
Oriented towards health
Population perspective
Intensive use of information
Focus on consumer
Knowledge of treatment outcome
Constrained resources
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Cont
Set and enforce rules of the health care delivery
and provide strategic directions.
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HEALTH ORGANISATION ININDIA Private.
Voluntary
Government agencies.
- National level.
- State level.- District level and
- Block level.
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I) AT THE CENTRE.
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I) ATTHECENTRAL LEVEL.
The official organs of the health system at the
national level consists of
1. The Union Ministry of Health and Family
Welfare.
2. The Directorate General of Health
services.
3. The Central Council of Health and FamilyWelfare.
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a) The union ministryof Health andfamily welfare.- The union ministry of health and family welfare is headed
by a
Cabinet minister
Minister of state
Deputy Health minister.
- The union health ministry has the fallowing departments,
i) Department of Health
ii) Department of Family Welfare.
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i) Department of Health
Secretary
Joint secretaries
Administrative staff
Directorate general of Homeopathic pharmacopoeia
Health services laboratory
Subordinate officer.
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Functions of Department of Health
1. Maintenance of International health relations,
administration of port health and quarantine laws.
2. Administration of central Health institution training
colleges, laboratories for administration and
hospitals.3. Promotion and maintenance of appropriate
standards of education in,
Medical.
Nursing.
Pharmaceutical and
Ancillary health personnel.
Function cont
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Function contThese standards of education are co-ordination and
collaboration with various national associations in
health programme. To achieve these aims the
following council and association have been
formed,
Indian medical council. Indian Nursing council.
Dental council of India.
Pharmaceutical council of India. Indian medical association and
Trained Nurses association of India.
F ti t
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Function cont4. Promotion of medical and public health researches through
the role in
Aiding. Promoting and coordinating scientific research
on human disease.
Their causation
Prevention and cure.
5. Regulation and development of medical, nursing, dental and
pharmaceutical professions in consultations with state
governments.
6. Establishment and maintenance of drug standards and
control over the manufacture and sale of drugs and
biological products.
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Function cont
7. Collection of information regarding development in
medical and health services in India and abroad
through the central Bureau of Health Intelligence(CBHI).
8. Maintenance of central medical library.
9. Promotion and co-ordination of health activatesthrough central council of health.
10. Establishment of close contact with other
ministers in respect of health measures.
Examples- ESI scheme, Factories Act.
11. Coordination of various activities through
consultative committees and associations.
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Function cont
12. Negotiations with international and bilateralagencies.
13. Planning and organisation of health activities
throughout the country in collaboration with the
state governments and planning commission.
14. Evaluation of health schemes organized in the
country.
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15. Assessment of health conditions in the country
through health and morbidity survey and by regular
collection of vital and health statistics.
16. Promulgations of central enactments on health
matters as may be provided by the constitution of
India.
17. Organisation of health measures of country.
18. Organisation and maintenance of a central health
services
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19. Planning, guiding and coordinating all the
national health programmes in the country.
20. Establishment of total medical care for the central
government employees, by starting central
government health scheme (CGHS) in 1954 in
Delhi.21. Carrying out the functions of health services in
the centrally administration areas.
22. Power to lay down and enforce minimumstandards of health administration for these
services with the other departments. Examples-
Railways, Prisons and labour etc
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ii) Department of family welfare.
It was created in 1966.
The secretary to the government of India in the
ministry of health and family welfare is in overall
charge.
Secretary
Additional secretary
Commissioner.
One Joint secretary.
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Functions of Department of Family welfare.
1. To organise family welfare programme throughfamily welfare centers, throughout the country.
2. To create atmosphere of social acceptance of the
programmes and to support all voluntary
organisations interested in the programme.
3. To educate every individual to develop a conviction
that a small family size by the appropriate and
acceptable method of family planning and to leavethe choice of method to the individual couple
( cafetarial approach).
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4. To disseminate the knowledge on the practice of
family planning by the available publicity and
educational measures and to provide serviceagencies nearest to the community.
5. To organise basic research on human fertility,
genetics and population dynamics on the evolution
of easy and more reliable methods ofcontraception.
6. To study the social factors that affect fertility and to
take such steps as will reduce the number ofchildren in a family.
Ex- Raising the age of marriage, free education and
employment of women etc
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7. To coordinate the family planning programme with
the child welfare and maternal health servicesthrough out the country.
8. To organise production of contraceptive devices in
adequate quantities to maintain the supply at all
levels preferably free or at a minimum cost.
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Functions of union ministry of Health and familywelfare.
1)The unionlist.
International health relations and administration of port
quarantine.
Administration of central institutes like All India institutesof public health, kolkata, National institute for control of
communicable disease Delhi.
Promotion of research through research centers and
other bodies. Regulation and development of medical, Nursing,
Pharmaceutical, dental professions.
Establishment and Maintaince of drug standards.
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Cont
Census, collection and publication of other
statistical data.
Immigration and emigration.
Regulation of labour in working of mines and oil
fields.
Co-ordination with states and other ministries for
promotion of health.
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2) Concurrentlist.
Prevention of extension of communicable disease
from one unit to another.
Prevention of adulteration of food stuffs.
Control of drugs and poisons.
Vital statistics.
Labour welfare.
Ports.
Economic and social planning.
Population control and family planning.
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b) Directorate general of Health services(DGHS)Principal adviser tounion government
Additional director ofHealth services
Team of deputies
Administrative Staff
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The directorate comparies of threemain units,
Medical care and hospital.
Public Health. General administration.
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Specific cont..
Postgraduate training.
Medical education.
Medical research.
Central Government Health Schemes.
National Health programmes.
Central Health Education Bureau.
Health intelligence.
Health intelligence.
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c) The central councilof health andfamily welfare. The central council of health was set up on 9th
August 1952.
The union Health minister is the chairman and the
state Health minister are the members.
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Function of central council of Health and familywelfare.
1. To consider and recommend board outlines ofpolicy in regard to matters of health such as,
Provision of remedial and preventive care.
Environment Hygiene.
Nutrition.
Health education and
Promotion of facilities for training and
research.
2. To make proposals for legislation in fields of
medical and public health matters and to lay
down.
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4. To make recommendations to the central
government regarding the health.
5. To established any organization with appropriate
functions for promoting and maintaing cooperation
between central and state health administrations.
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I) AT THE STATELEVEL.
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The state health administration was started in the
year 1919.
The state list which become the responsibility ofthe state included,
Provision of medical care.
Preventive health services and Piligrim with in the state.
In all state, the management sector comprises
the, State ministry of Health.
A directorate of Health and Family welfare
services.
State Ministry of Health and Family welfare
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State Ministry of Health and Family welfare.
i. The state ministry of Health and family welfare is
headed by a cabinet minister and deputy minister.ii. He is the political head of the department of
health and family welfare.
iii. Having responsibility for formulating policies and
monitoring the implementation of these policies
and programmes.
St t H lth di t t d F il lf
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State Health directorate and Family welfare.
1. He is the principal advisor to the state
government on all matters relating to medicineand public health, as he is technically qualified
person in the field.
1. He is assisted by joint director, regional joint
directors and deputy and assistant directors.
Functions of State Health directorate
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Functions of State Health directorate.
It studies in depth the health problems and needs
in the state and plans schemes to solve them.
Providing curative and preventive services.
Provision for control of milk and food sanitation.
Assumes total responsibility for taking all steps inthe prevention of any outbreak of communicable
disease especially during festivals and meals.
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Establishment and maintenance of central
laboratories for preparation of vaccine etc.
Promotion of health education.
Collection, tabulation and publication of vitalstatistics.
Cont
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Cont..
Promotion of health programmes such as,
School health programme.
Family planning.
Occupational health.
Maternal and child health.
Recruitment of personnel for rural health services.
Supervision of primary health centers and the staff
at PHC through the organisation of district health
services.
C t
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Cont
Planning and carrying out surveys in relation to
nutrition, health education etc Establishing training course for health personnel
and formulating job descriptions.
Co-ordination of all health service with otherminister of the state such as,
Minister of Education.
Minister of Agriculture.
Central health minister.
Voluntary agencies.
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I) AT THE DISTRICTLEVEL.
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The principle unit of administration in India is the
district.
For administration purpose the country is divided into 31 states and 7 union territories, in which there
are 593(2001) districts in India.
District Health organisation identifies and provide
the needs of expanding rural health and family
welfare programme.
It will plan, implemented and monitoring of health
and family welfare programmes are to be carriedout at the district level.
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District is divided into 6 types,
PANCHAY
ATS
VILLAGES
MUNICIPALI
TIES
COMMUNITY
DEVELOPMEN
T BLOCK
TEHSILS
SUB
DIVISION
AT
DISTRICT
A) Subdivision
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A) Subdivision.
o Most districts in India are divided in two or more
sub divisiono Each in charge of an assistant collector or sub
collector.
B) Tehsils.
o Tehsildar is in charge of each Talukas
o He comprises between 200-600 villages.
C) Community Developmental Blocks.
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C) Community Developmental Blocks.
o The rural areas of districts have been organised in to
community developmental blocks.
o It comprises of 100 villages and about 80,000
1, 20,000 population
o The in charge of this is Block Development officer.
D) Municipalities and corporation.
Town municipal council (5,000 10,000 of population)
City municipal council ( 10,000 2 lakh of population)
Corporation ( above 2 lakh of population)
These are headed by the chairman elected by the members.
They do the development work in the town or in the city.
E) Panchayati Raj
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E) Panchayati Raj
o The panchayati Raj is a 3 tier structure of rural local
self governmento In India linking the village to the district they are,
PANCHAYAT
RAJ
PANCHAYATPANCHAYAT
SAMITIZILLA
PARISHAD
GRAM
SABHA
GRAM
PANCAYAT
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1. Panchayat(at village level)This consists of
I. Gram sabha.
It is the assembly of all the adults of village,
which meets at least twice a year.
The gram sabha proposals for taxation,discusses the annual programme and elects
member of gram Panchayat.
G P h t
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II.Gram Panchayat.
This is the agency for planning and development
at village level. The strength varies from 15 30 and covers the
population from 5,000 15,000.
Each panchayat has elected a president
(sarpanch or sabhapati or mukhiya), a vicepresident and a secretary,
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Functions of Panchayat.
Civic administration.
Sanitation.
Public health
Social and economic development of village.
2. Panchayat samiti (at block level)
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y ( )
The block consists of 100 villages and a
population of 80,000 1,20,000.
The panchayat samiti consists of all sarpanchas of
panchayat, MLA, MPs residing in the block area
and representatives of women, scheduled castesand scheduled tribes.
The block development officer (BDO) is the
secretary of the Panchayat samiti.
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Function of panchayat samiti. Community development programme.
The funds provided by government is channeled by
the panchayat samiti.
The BDO and his staff give technical assistance
and guidance to the village development work.
3 Zilla Parishad (at district level)
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3. Zilla Parishad (at district level)
It is the local self government at all the district
level. The members of Zilla parishad includes,
All the heads of panchayat samiti,
MLA of the district. MP of the district.
Representative of the SC and ST.
Representative of women. Two person of experience in administration.
It varying about 40 70 members.
Functions of Health organisation at district
l l
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u ct o s o ea t o ga sat o at d st ctlevel.
1. Co- ordinate health planning.
2. Investigate communicable disease.
3. Maintain free clinics for the early diagnosis of
communicable disease.
4. Provide laboratory services to assist doctor.
5. Conduct clinics for administration of vaccine.
6. Collect vital statistics.
7. Provide maternal and child health care.
8. Maintain a public health nursing service.
9. Supervise water supply and sewage disposal.
Cont..
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10. Supervise quality and safety of meat and otherfoods.
11. Inspect and supervise the production,pasteurization and distribution of milk.
12. Investigate and supervise the general sanitaryconditions in public eating places.
13. Conduct health education programmes.14. Provide preventive and rehabilitative services in
chronic disease control.
15. Promulgate rules and regulations .
16. Provide mental health services.
17. Provide medical care to the indigent.
18. Provide family planning services.
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I) AT THE BLOCKLEVEL.
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India is a land of villages
about 80% of the
population is scattered
over 5,75,936 villages.
Only about 20% of rural
population have health
care facilities.
The fundamental objective
of health services is to
provide primary health
care to all the sections of
the society.
The organizational structure at the block level has the three
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The organizational structure at the block level has the three
tire structure such as
COMMUNITY HEALTH CENTE
VILLAGE HEALTH POST
SUBCENTERS
PRIMARY HEALTH CENTER
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1)Community health centers1. Each community health center is covering a
population of 80,000 1, 20,000 with three to
four PHC.
2. Each CHC has 30 sanctioned beds and hasfacility for specialized services,
3. The services are given by the team of specialist
nurses and other Personnels.
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2.Primary health centers1. Each PHC covers a population of 30.000 in plain
area and 20,000 in hilly and tribal area. The PHC
functions of all eight essential elements of primary
health care
2. The services are provided by the team of medicalofficer, Nurses midwife, ANM, Block extension
educator, Health assistant Male and Female, Lab
technician and Ancillary staff.
3. Each primary health center has 5-6 sub centers
3. Sub-centers and village
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health post1) It covers the population of 5000 in general and
3000 in hilly, tribal and backward areas.
2) Each sub-center is managed by a team of male
and female health worker or ANM.
3) The work of female and male health worker issupervised by male and female health supervisor
respectively in the ratio of 1: 4 to six workers
Th i i b t i li it d h
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The services in sub center is limited such as
M.C.H. and family welfare
Immunization.
Health education Training and supervision of the dais
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4.Village.o The village is managed by the village health guide
for thousand population who have had the threemonths training.
o The village health guide is to spare 2-3 hours
daily for community health work in return they aregiven Rs. 200 per month as an honorarium .
o The other persons are
a) Indigenous dais
b) Anganwadi workers.
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ROLE OF NURSE IN HEALTH CAREdELIVERY SYSTEM.I) At central level. At the central level, there is a post of nursing
adviser in medical division of directorate generalof health services.
The nursing adviser is assisted by the nursingofficer and support staff.
She/he advises the DGHS, ministry of health andfamily welfare and other departments like railway,
labour etc. There is also a post of deputy nursing adviser and
there is no link between the deputy nursingadviser and nursing adviser
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The deputy nursing adviser provide the training
to ANMs, Dais and health supervisor etc.
She/he actively participates in policy formulation
and decision making process.
The committee strongly expressed the need for
charge in nursing organisation. They look after for the improvement of nursing
education and nursing research.
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II) At state level. There is no proper and definite pattern of nursing
structure in state directorates.
In some state like Tamil Nadu and Maharastra
two nurses are posted, one each in director ofmedical education and director of medical
services.
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The nurse working in this office are responsible
for all matters of,
Nursing services.
Nursing education of ANM, health supervisor
and schools attached to district hospital.
Community health nursing services.
He/she is responsible for hospital and as well as
community nursing services, planning, continuing
education and all administrative work.
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III) Role of nurse in district level. The nurses played a important role in providing
the health course services in urban and ruralareas.
District level nurse are having the following
function, Administration and management of nursing
and midwifery services in the districts.
Supervision and guidance of health
supervisor. In service training programme of nurses,
ANMs working in her district.
Attending to problems that referred to her.
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