HEALTH CARE DELIVERY SYSTEM IN INDIA

INTRODUCTION

India is a union of 29 states and 7 union territories. Under the constitution of India, the states
are largely independent in matters relating to the delivery of health care to the people. Each state,
therefore, has developed its own system of health care delivery, independent of the central
Government. The central responsibility consists mainly of policy making, planning, guiding,
assisting, evaluating and coordinating the work of the State Health Ministries, so that health
services cover every part of the country, and no State lags behind for want of these services.

The health system in India has 3 main links- Central, State and Local or peripheral.

AT THE CENTRE LEVEL

The official “organs” of the health system at the national level consist of

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1. Union Ministry of Health and Family Welfare
a) Organization

b) Functions

Union list
 International health relations and administration of port quarantine
 Administration of Central Institutes such as the All India Institute of Hygiene and Public
Health, Kolkata; National Centre for Disease Control, Delhi
 Promotion of research through research centres and other bodies
 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

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  Coordination with states and with other ministries for promotion of health
Concurrent list
 Prevention of Communicable diseases
 Prevention of food adulteration
 Control of drug and poison
 Vital statistics
 Labour welfare
 Economic and social planning
 Population control and family planning

2. Union Ministry of Health and Family Welfare

a) Organization

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 b) Functions
General functions
 Surveys
 Planning
 Coordination
 Programming and appraisal of all health matters
Specific functions
 International health relations and quarantine
- All major ports in the country (Kolkata, Visakhapattanam, Chennai, Cochin,
Mumbai, and Kandla) and international airport (Mumbai, Kolkata, Chennai,
Tiruchirapalli, Delhi) are directly controlled by the Directorate General of Health
Services.
 Control of drug standards
- The Drugs Control Organization is part of the Directorate General of Health
Services, and is headed by the Drugs Controller.
- Its primary function is to lay down and enforce standards and control the
manufacture and distribution of drugs through both central and State Government
Officers.
- The Drugs Act (1940) vests the Central Government with the power to test the
quality of imported drugs.
 Medical store depots
- The union government runs medical store depots at Mumbai, Chennai, Kolkata,
Karnal, Gauwahati and Hyderabad.
- These depots supply the civil medical requirements of the central government
and of the various State Governments.
- These depots also handle supplies from
 Post graduate training
- The Directorate General of Health Services is responsible for the administration
of national institutes, which also provide post-graduate training to different
categories of health personnel.

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 Medical education
- The central Directorate is directly in charge of the following medical colleges in
India: The lady Hardinge, the Moulana Azad and the medical colleges at
Pondicherry and Goa.
- There are many colleges in the country which are guided and supported by the
Centre.
 Medical Research
- Medical Research in the country is organized largely through the Indian Council
of Medical Research , founded in 1911 in New Delhi
- The council plays a significant role in aiding, promoting and coordinating
scientific research on human diseases, their causation, prevention and cure.
- The funds of the council are wholly derived from the budget of the Union of
Ministry of Health.
 Central Govt. Health Scheme
 National Health Programmes
- The various national health programmes for the eradication of malaria and for the
control of tuberculosis, filarial, leprosy, AIDS and other communicable diseases
involve expenditure of crores of rupees.
- The Central Directorate plays a very important part in planning, guiding and
coordinating all the national health programmes in the country.
 Central Health Education Bureau
- An outstanding activity of this Bureau is the preparation of education material for
creating health awareness among the people.
 Health intelligence
- The central Bureau of Health intelligence was established in 1961to centralize
collection, compilation, analysis, evaluation and dissemination of all information
on health statistics for the nation as a whole.
- The Bureau has an epidemiological unit, a Health Economics Unit, a National
Morbidity Survey unit and a manpower cell.

 National Medical Library

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 - The Central Medical Library of the Directorate General Health Services was
declared the National Medical Library in 1966.
- The aim is to help in the advancement of medical, health and related sciences by
collection, dissemination and exchange of information.
3. Central Council of Health
a) Organization

 The Central Council of Health was set up by a Presidential Order on 9 August, 1952
under Article 263 of the constitution of India for promoting coordinated and concerted
action between the Centre and the States in the implementation of all the programmes and
measures pertaining to the health of the nation.
Functions
- To consider and recommend broad outlines of policy in regard to matters
concerning health in all its aspects such as the provision of remedial and
preventive care, environment hygiene, nutrition, health education and the
promotion of facilities for training and research.
- To make proposals for legislation in fields of activity relating to medical and
public health matters and to lay down the pattern of development for the country
as whole.
- To make recommendations to the Central Government regarding distribution of
available grants-in-aid for health purposes to the states and to review periodically
the work accomplished in different areas through the utilization of these grants-in-
aid.

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 - To establish any organization or organizations invested with appropriate functions
for promoting and maintaining cooperation between the Central and State Health
administrations.

II AT THE STATE LEVEL

 The milestone in state health administration was the year 1919, when the States (then
known as provinces) obtained autonomy, under the Montague-Chelmsford reforms, from
the Central government, in matters of public health.
 By 1921-22, all the states had created some form of public health organization
 The Government of India Act, 1935 gave further autonomy to the states
 The health subjects were divided into three groups-federal, concurrent and state
 The “state” list which became the responsibility of the state included provision of
medical care, preventive health services and pilgrimages within the state.
 The state is the ultimate authority responsible for all the health services operating within
its jurisdiction.
State health administration
 At present there are 29 states in India, with each state having its own health
administration.
 In all the States, the management sector comprises the State Ministry of Health and a
Directorate of Health
1. State Ministry of Health

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2. State Health Directorate

 For a long time, two separate departments, medical and public health, were functioning in
the states; the heads of these departments were known as Surgeon General and Inspector
General of Civil Hospitals and Director of Public Health respectively.
 The Bhore Committee (1946) recommended that the medical and public health
organizations should be integrated at all levels and therefore, should have a single
administrative officer for the curative and preventive departments of health.
 The Director of Health Services is the chief technical adviser to the State Government on
all matters relating to medicine and public health.
 He is also responsible for the organization and direction of all health activities.
 The designation of Director of Health Services has been changed in some states as
Director of Health and Family Welfare.
 The Director of Health and Family Welfare is assisted by a suitable number of deputies
and assistants.
 The functional directors are usually specialists in a particular branch of public health such
as mother and child health, family planning, nutrition, TB, leprosy, health education
 The Public Health Engineering Organization in most States is part of the Public Works
Department of the State Government.
 The chief Engineer of Public Health should have the status of an Additional Director of
Health Services.
 In Kerala

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 Health Minister
Mrs.K K Shailaja Teacher

Director of Health services Dr.Sarita

RL

Secretary
Mr.Rajeev Sadanandan

III-AT THE DISTRICT LEVEL

At District
 The principal unit of administration in India is the district under a collector.
 There are 707 (2016) districts in India.
 There is no average district that is districts vary widely in area and population.
 Within each district again, there are 6 types of administrative areas:
1) Sub-divisions
2) Tahsils (Talukas)
3) Community Development Blocks
4) Municipalities and corporations
5) Villages
6) Panchayats
 Most districts in India are divided into two or more subdivisions, each in charge of an
Assistant Collector.
 Each division is again divided into Tahsils (taluks), in charge of a Tahsildar

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  A Tahsil usually comprises between 200-600 villages.
 Since the launching of the Community Development Programme in India in 1952, the
rural areas of the district have been organized into Blocks, known as Community
Development blocks, the area of which may or may not coincide with a tahsil.
 Block is a unit of rural planning and development, and comprises approximately 100
villages and about 80,000-120000 population, in charge of a Block Development Officer.
 Finally there are the villages Panchayats, which are institutions of rural local self
government.
 The urban areas of the district are organized into the following institutions of local self-
government
1. Town area committees- in areas with population ranging between 5,000 &
10,000
2. Municipal Boards- in areas with population ranging between 10,000- 2 lakhs
3. Corporations- with population above 2 lakhs
 The Town area committees are like Panchayats.
 They provide sanitary services.
 The Municipal Boards are headed by a Chairman/President, elected usually by the
members.
 The term of a Municipal Board ranges between 3-5 years.
 The functions of a municipal board are: Construction and maintenance of roads,
sanitation and drainage, street lighting, water supply, maintenance of hospitals and
dispensaries, education, registration of births and deaths etc.
 Corporations are headed by Mayors.
 The councilors are elected from different wards of the city.
 The executive agency includes the Commissioner, the Secretary, the Engineer and the
Health Officer.
 The activities are similar to those of the municipalities, but on a much wider scale.
Health Organization
 The Bhore committee (1946) recommended integrated preventive and curative services at
all levels and the setting up of a unified health authority in each district.

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  Subsequent expert committees, appointed by the Government of India have also
recommended the same.
 Since “health” is a state subject, there is no uniform “model” of a district health
organization in India; each State developed its own pattern to suit its policy and
convenience.
 Under Multi-Purpose Workers Scheme, it has been suggested to the states to have an
integrated set-up at the district level by having a Chief Medical Officer with three Deputy
CMOs (existing civil surgeons, District Health Officers and District Family Welfare and
MCH programmes.
 The recent working group on Health on Health for All by 2000 AD, appointed by the
Planning Commission, recommended that the District hospitals should be converted into
District Health Centres each centre monitoring all preventive, promotive and curative
services of one million populations.

It has been recommended that the district set-up should be reorganized on the basis of the
number of primary health centres it comprises.

 Thrissur is a district in the Kerala State of India. Total area of Thrissur is 3,027 km²
including 1,865.83 km² rural area and 1,161.17 km² urban area.
 Thrissur has a population of 31,21,200 peoples. There are 7,59,210 houses in the district.
 The Thrissur district is further divided in to Tehsils / Blocks / Community Development
Blocks (C.D.Blocks) for administrative purposes.
 In India, the Block or C.D.Block is often the next level of administrative division after
the tehsil. It is important to note that, In some states of India C.D.Blocks are equal to
tehsils.
 For those who don't know, the C.D.Block is a rural area earmarked for administration and
development in India.
 The area is administered by a BDO (Block Development Officer).
 A C.D.Block covers several gram panchayats, local administrative unit at the village
levelList of Blocks (CD) / Tehsils in Thrissur

1. Chavakkad 2. Kodungallur 3. Mukundapuram 4. Talappilly 5. Thrissur

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 PANCHAYATI RAJ

 The Panchayati Raj is a 3-tier structure of rural local self government in India, linking the
village to the district.
 The three institutions are:
1) Panchayat - at the village level
2) Panchayat Samiti- at the block level
3) Zilla Parishad- at the district level
 The Panchayat Raj institutions are accepted as agencies of public welfare
 All development programmes are channelled through these bodies.
 The Panchayat Raj institutions strengthen democracy at its root, and ensure more
effective and better participation of the people in the government.
1. At the Village level
 The Panchayati Raj at the village level consists of:
I. The gram Sabha
II. The Gram Panchayat
III. The Nyaya Panchayat
Gram Sabha
 It is the assembly of all the adults of the village, which meets at least twice a year.
 The gram sabha considers proposals for taxation, discusses the annual programme and
elects members of the gram Panchayat.
Gram Panchayat
 It is the executive organ of the gram sabha, and an agency for planning and development
at the village level.
 Its strength varies from 15-30, and the population covered also varies widely from 5000-
15000 or more.
 The member of the Panchayat holds office for a period of 3-4 years.
 Every Panchayat has an elected President (Sarpanch or Sabhapati or Mukhiya), a vice-
President and a Panchayat Secretary.

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 The powers and functions of the Panchayat secretary are very wide- they cover the entire
field of civic administration, including sanitation and public health; and of social and
economic development of the village.
2. At the Block level
 The block consists of about 100 villages and a population of about 80,000-1,20,000
 The Panchayati Raj agency at the block level is the Panchayat Samiti/Janpada Panchayat.
 The Panchayat Samiti consists of all Sarpanchas( heads) of the village Panchayats in the
Block; MLAs, MPs residing in the block area; representatives of women, scheduled
castes, scheduled tribes, and cooperative societies.
 The Block Development ( BDO) is the ex-officio

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