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CONCEPT OF HEALTH CARE

Health care?

A multitude of services rendered by agents of health services or professions, for the purpose of promoting, maintaining, monitoring or restoring health.

“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”.

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HEALTH SYSTEM

The delivery of health services takes place through health system

Mainly by:

1. It should cover the entire populations not just the selected group.

2. Through primary health care services supported by adequate referral system

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HEALTH PROBLEMS IN INDIAHEALTH PROBLEMS IN INDIA

1. Communicable disease problems

2. Nutritional problems

3. Environmental sanitation problems

4. Medical care problems

5. Population problems

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HEALTH CARE SERVICES The purpose of health care services is to improve

the health status of the population.

Health services should be:Comprehensive

Accessible

Acceptable

Provide scope for community participation

Available at a cost the community and country can afford6

HEALTH CARE SYSTEMS

In India, it represented by five major sectors or agencies which

differ from each other by the health technology applied and by

the source of funds for operation.

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1. PUBLIC HEALTH SECTOR(a) Primary health care

Primary health centerssub-centers

(b) Hospitals/Health centersCommunity health centersRural hospitalsDistrict hospital/health centerSpecialist hospitalsTeaching hospitals

(c) Health Insurances schemesEmployees state insuranceCentral Govt. Health Scheme

(d) Other agenciesDefense servicesRailways 8

2. Private Sector (a) Private Hospitals, polyclinics, Nursing homes and Dispensaries.

(b) General practitioners and clinics

3.Indigenous system of MedicineAyurveda, Siddha, Unani and Tibbi, Homeopathy

4.Voluntary Health Agencies

5.National Health Programmes

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PRIMARY HEALTH CARE

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 country and community can afford.

-Alma-Ata International Conference 1978

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ELEMENTS OF PRIMARY HEALTH CARE

There are eight essential components of primary health care:

1) Education concerning prevailing health problems and the methods of preventing and controlling them;

2) Promotion of food supply and proper nutrition;

3) An adequate supply of safe water and sanitation;

4) Maternal and child health care including family planning 11

5) Immunization against major infectious diseases;

6) Prevention and control of major endemic diseases;

7) Appropriate treatment of common diseases and injuries; and

8) Provision of essential drugs.

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Principles of Primary Health Care

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Equitable Equitable distributiondistribution

The first key principle Health services must be shared equally by all people

irrespective of their ability to payAll rich/poor and urban/rural must have access to

health services

Primary health care aims to redress this by shifting the centre of gravity of health care system from cities to rural areas and bring these service to as near the people`s homes as possible.

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Community Community participation participation

The involvement of individuals, families and communities in promotion of their own health and welfare is an essential.

The community must involve in planning, implementation and maintenance of health services.

In India, village health guide and trained daisIn China, bare foot doctor

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Inter sectoral co-ordinationInter sectoral co-ordinationPlanning with the other sectors to avoid unnecessary

duplication of activities.

Primary health care involves in addition to the health sectore, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food industry, public work, communication and other sectors.

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The major reason for lack of success of many oral

health programms is the fact that they operate in

isolation, separate from general health care structure.

Oral health could better be integrated into general

health programms by trackling common causes, by

including oral health in general health education.

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Appropriate Appropriate technology technology

Technology that is scientifically sound, adaptable to local needs, and acceptable to those who apply it and those for whom it is used, and that can be maintained by the people themselves in keeping with the principle of self reliance with resources the community and country can afford.

Neem stick, mango leaf for tooth brushing are effective when used in proper way.

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PRIMARY HEALTH CARE IN INDIA:

Launched by Govt of India in 1977 based on the principle of “placing people’s health in people’s hands”

It’s a three-tier system of health care delivery in rural areas based on the recommendation of Srivastav Committee.

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The Bhore committee in 1946 gave the concept of a

primary health center as a basic health unit to

provide, as close to the people as possible, an

integrated curative and preventive curative and preventive health care to

the ruralrural population with emphasis on preventive

and promotive aspects of health care.

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PRIMARY HEALTH CENTRE LEVEL:

The National Health Plan (1983) proposed

one PHC = every 30,000 rural population

one PHC = every 20,000 population in hilly, tribal

and backward areas

for more effective coverage.

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Functions of PHC In India Functions of PHC In India

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

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7. National health programs

8. Referral services

9. Training of health guides, health workers, local

dais and health assistant

10. Basic laboratory services

Staff patterns

PHC - 15

Sub centers - 03

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Staff Recommended

Medical officer 3

AYUSH 1

Pharmacist 2

Nurse-midwife 5

Health worker 1

Health educator 1

Helth asstt (M/F) 2

Primary Health Care at:

1)Village level:

One of the basic contents of Primary health Care is Universal coverage and equitable distribution of health resources. To implement this at the village level the following schemes are in operation:

a) Village health Guides Schemeb) Training of local daisc) ICDS scheme

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VILLAGE HEALTH GUIDES

Introduced on 2nd October 1977

Health guides are mostly women

They should be the permanent residents of the local community.

Able to read and write, with a minimum education of at least up to 6th std.

Acceptable to all the sections of the society

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A village health guide is a person with an aptitude for social service and is not a full time government functionary.

The health guide are now mostly women. A circular was issued by government of India in may 1986 that male health guides would be replaced by female health guides.

They serve as links between the community and the governmental infrastructure. They provide the first contact between the individual and health system.

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LOCAL DAIS

Most deliveries in rural areas are still handled by untrained dais

An extensive program has been undertaken, under the Rural health scheme, to train all categories of local dais (traditional birth attendants) in the country to improve their knowledge in the elementary concepts of maternal and child health and sterilization, besides obstetric skills.

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The training is for 30 working days. She is paid a stipend of Rs. 300 during her training period. Training is given at the PHC, sub-center or MCH center for 2 days in a week, and on the remaining four days of the week they accompany the health worker.

After successful completion of training, each dai is provided with a delivery kit and a certificate. She is entitled to receive an amount of Rs. 10 per delivery provided the case is registered with the sub-center/PHC.

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ICDS SCHEME:

Under this scheme, there is an anganwadi worker for a population of 1000. There are about 100 such workers in each ICDS project.

Anganwadi worker is selected from the community she is expected to serve. The services she provides include health check-up, immunization, supplementary nutrition, health education, non-formal pre-school education and referral services.

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She undergoes training in various aspects of health, nutrition, and child development for 4 months.

She is a part-time worker and is paid an honorarium of RS.200-250 per month for the services rendered, which include health check-up, immunization, supplementary nutrition, health education, non-formal pre-school education and referral services.

The beneficiaries are especially nursing mothers, other women (15-45years) and children below the age of 6 years.

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2) SUB-CENTRE LEVEL

one sub-centre = every 5000 general populationone sub-centre = every 3000 population in hilly, tribal and backward areas

The functions of the subcentre include mother and child health care, family planning and immunization.

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COMMUNITY HEALTH CENTRES

There is one CHC for a population ranging from 80,000 to 1.20 lakh.

Each CHC is equipped with 30 beds and specialists in surgery medicine, obstetrics, gynaecology and pediatrics with X-Ray and lab facilities.

CHC staffing = 25 personnel

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Population norms for each centre

Plain area Hilly/Tribal/Difficult area

Sub centre 5,000 3,000

Primary health centre

30,000 20,000

Community health centre

1,20,000 80,000

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Community Health Centre (CHC)A 30 bedded hospital / Referral

Primary health centre (PHC)A Referral Unit for 6 Sub Centres 4-6 bedded manned with a Medical Officer in charge and 14 subordinate paramedical staff

Sub Centre (SC) Most peripheral contact point between Primary Health Care

System

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Hospitals

Apart from primary health centres, the present organization of health services of Government sector consists of

(a) Rural Hospitals(b) Sub-divisional/tehsil/talika Hospital(c) District Hospitals(d) Specialist Hospitals(e) Teaching Institutuions

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(c) Health Insurances schemes(c) Health Insurances schemes

There is no universal health insurance in India. At

present it is limited to industrial workers and their

families. The central government employees are also

covered by the health insurance, under the banner

“central govt. health scheme”

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Employees State Insurance SchemeEmployees State Insurance Scheme

Introduced by an act of Parliament in 1948, is a unique piece of

social legislation in India.

The act provides for medical care in cash and kind, benefits in the

contingency of sickness, maternity, employment injury, and pension

for dependents on the death of worker because of employment

injury.

The act covers employees drawing wages not exceeding Rs. 15000

per month.

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Central Government Health SchemeCentral Government Health Scheme

It was first introduced in New Delhi in 1954 to provide

comprehensive medical care to central government

employees.

The scheme is based on the principle of co-operative

effort by the employee and the employer, to the mutual

advantage of both.

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The facilities under the scheme include a) Out-patient care through network of dispensariesb) Supply of necessary drugsc) Laboratory and X-ray investigationd) Hospitalization facilities at government as well as private

hospitals recognized for the purpose e) Specialist consultationf) Pediatric services including immunization g) Antenatal, natal and postnatal services h) Emergency treatmenti) Supply of optical and dental aids at reasonable ratej) Family welfare services.

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(d) Other Agencies (d) Other Agencies

(a)Defence Medical Services: Defence services have their own organization for medical care to defence personnel under the banner “Armed forces medical services”.

(b)Health care of Railway Employees: Comprehensive health care services through the agency of railway hospitals, health units and clinics.

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(2) Private Agencies (2) Private Agencies

In a mixed economy such as India's private practice of

medicine provides a large share of the health services

available.

Most of them tend to congregate in in urban areas. They

provide mainly curative services. Their services are

available to those who can pay.

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(3) Indigenous Systems of Medicine(3) Indigenous Systems of Medicine

The practitioners of indigenous systems of medicine (eg,

Ayurveda, Siddha, Homeopathy, etc.) provide the bulk of

medical care to the rural people.

Most of them are local residents and remain very close to

the people socially and culturally.

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(4) Voluntary Health Agencies(4) Voluntary Health Agencies“A voluntary health agency may be defined as an organization that is administered by an autonomous board which holds meetings, collects funds for its support chiefly from private sources and expends money, whether with or without 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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Voluntary health agencies in IndiaVoluntary health agencies in India

1. Indian Red Cross Society2. Hind Kusht nivaran sangh3. Indian council for child welfare4. Tuberculosis association of India5. Bharat sevak samaj6. Central social welfare board7. The kasturba memorial fund8. Family plannin association of India 9. The All-India blind relief society10. International agencies

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(5) National health programmes(5) National health programmes

1. Anti-malaria programme2. National filaria control programme3. Kala-azar control programme4. Dengue control5. National Leprosy-eradication programme6. National tuberculosis programme7. National AIDS control programme8. National programme for control of blindness9. Iodine deficiency programme10. Universal immunization programme11. Reproductive and child health programme12. National caner control programme13. National family welfare programme14. National water supply and sanitation programme 46

Thank u47