f507health care delivery system

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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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