Health Care

Delivery System
In India

By. Kailash Nagar

Asst. Professor
Dept. Community Health
 Definition
• It is a system which ensures need based
comprehensive health care services to people
at large especially those living in remote and
backward areas, using available resources,
manpower, money and material.
Health Care Delivery System
In India
• Union of 29 states
and 9 union
territories
• Population is more
than 1.3 Billion
• Rural population
65%
• Diversified culture
• Developing country
 MOHFW
National Level DGHS

CCH
State Level

Sub- District
CD Block
Panchayat District Level Taluka
Village Municipality

Village/ Local

Panchayat Panchayat Samiti Zila Parishad

 01-NATIONAL LEVEL
The official organs of the health system at the
national level consist of:
1. The ministry of health and family welfare
2. The Directorate general of health services
3. The central council of health.

Functions
• Surveys
• Planning
• Co-ordination
• Programming
• Appraisal of all health matters in the country
 02- STATE LEVEL
1. State ministry of health
2. State health directorate
Functions
• Prevention of of communicable and NCDs
• Prevention of adulteration of food stuffs
• Controls of drugs and poisons
• Vital statistics
• Labour welfare
• Ports other than major
• Economic and social planning
• Population control and family planning
 03- DISTRICT LEVEL
Administration in India is the district under the
Collector ( 720 districts in 2019). Within each district
again there are 6 types of administrative areas:
1. Sub-Divisions
2. Talukas or Tehsils
3. Community Development Blocks (Rural)
4. Municipalities and Corporations (Urban)
5. Villages
6. Panchayats
( District Collector, Dy.DC, MP, MLA, BDO, Parsad,
Sarpanch, Ward member etc)
 Function at district level
1. construction and maintenance of roads
2. sanitation and drainage
3. street lighting
4. water supply
5. maintenance of hospitals and dispensaries
6. education
7. registration of births and deaths.
 4. LOCAL LEVEL/Village
1. Panchayat ( at the village level)
2. Panchayat samiti(at block level)
3. Zila parishad(at district level)

At the village level :The Panchayati Raj at the

village level consists:
• Gram sabha
• Gram panchayat
• Nyaya panchayat
 HEALTH CARE MODEL IN INDIA

HEALTH HEALTH
INPUT CARE CARE
SYSTEM/ OUTPUTS
SERVICES
Organization

HEALTH
STATUS & PUBLIC CANGES
CURATIVE
Health Problems PRIVATE IN
PREVENTIVE
VOLUNTARY HEALTH
PROMOTIVE
INDEGENOUS STATUS
Rehabilitative
RESOURCES NGOs
HEALTH STATUS
AND
HEALTH PROBLEMS
IN INDIA
 Major HEALTH PROBLEMS IN INDIA
1.COMMUNICABLE DISEASES:

1. Malaria
2. Tuberculosis
3. Diarrheal diseases
4. Leprosy
5. Filaria
6. HIV Aids
7. ARI
8. Others
Kala-azar, meningitis, viral hepatitis, Japanese
encephalitis, enteric fever, guinea worm diseases.
 2.NUTRITIONAL PROBLEMS

a) Protein-energy malnutrition
b) Nutritional anemia
c) Low birth weight
d) Xerophthalmia
e) Iodine deficiency disorders
 3. ENVIRONMENTAL SANITATION:

a) Lack of safe water in many areas of the

country
b) Use of primitive methods for excreta
disposal/open Defecation
c) Pollution
 4. MEDICAL CARE PROBLEMS:

1. Unequal distribution of health resources

between rural and urban areas
2. Lack of penetration of health services within
the social periphery.
3. Lack of financial resources to treat persons in
large hospitals
4. No proper facilities to people
 5. POPULATION PROBLEMS:

a) employment
b) education
c) housing
d) health care
e) sanitation
f) environment
Kolkata, India
 Organizational framework of Health Care Systems
PUBLIC Sector Private Sector AYUSH NGOs & Health
Agencies
A. Primary Health a. Private a. Ayurveda a. SEVA Bharati
Care hospitals, b. Siddha Rural
a. Primary health polyclinics, nursing c. Unani b. Bhansali
centers homes d. Tibbi Trust
b. Sub centers b. General e. Homeopathy c. ARCH Mangrol
B. Hospitals practitioners’ f. Yoga ( Action Research in
a. CHC /Taluka clinics g. Unqualified and Community Health
Hospitals c. Dispensaries unregistered & Development)
b. District hospitals practitioners.
c. Teaching hospitals
d. Specialist hospitals

C. Other agencies
a. ESIC Hospitals
b. Railway hospitals
c. Defense hospitals
 Primary Health Care
• The Alma (1978) –Ata conference called for
proclaimed primary health care as way to
achieving health for all.
• Health For All (HFA)
 DEFINITION:
Primary health care is the essential
health care made universally
accessible to individuals and
acceptable to them, through their full
participation and at a cost the
community and the country can
afford.
 PURPOSES
1. Increase in life expectation.

2. Improvement in nutritional status.

3. Provision of basic sanitation.

4. Development of manpower and other

resources.
8 -Essential Components of primary
health care.
1. Education concerning prevailing health
problems and the methods of preventing and
controlling.
2. Promotion of food supply and proper
nutrition.
3. Adequate safe water supply and basic
sanitation.
4. Maternal and child health care, including
family planning.
5. Immunization against major infection
disease.
6. Privation and control of locally endemic
diseases.
7. Appropriate treatment of common disease
and injuries.
8. Provisional treatment of community.
 5 –As of Primary Health Care
Accessible

Affordable

Primary health care

Acceptable

Appropriate

Adaptable
 ATTRIBUTES OF PRIMARY HEALTH
CARE
• Essential health care

• Universally accessible

• Acceptable

• Community based

• First point of contact

• Affordability
 ATTRIBUTES Contd...
• Adaptability

• Appropriateness

• Community participation

• Continuity

• Comprehensiveness

• Coordination
 Principles
1. Equitable distribution
2. Manpower development
3. Community participation

4. Inter-sectoral coordination

5. Appropriate technology
 Tier of health care in India
The health care services in India are organized at three levels,
each level supported by the higher level, to which the patient is
referred.

Tertiary
State Hospital
Medical Colleges

Secondary
DH / CHC / Taluka Hospital
Primary
PHC / Sub Centre
 Staffing of Primary health care in
India – in rural areas
1. Village level
• At village level there are health functionaries chosen
by the local community themselves.
1. Village health guide,
2. Local Dai ,
3. ASHA and
4. Anganwadi worker.
 2. Sub-centre (SC) level
• For population of 5000 in plain areas & 3000
population in hilly, tribal and backward areas.
Staff: 1-MPHW male,
2-MPHW female (MPHW-F previously
called ANM,Auxillary nurse midwife).

At present functions of a SC are limited to

providing mother and child health care,
immunization services and family planning.
 3. Primary health centre (PHC)
The concept of a PHC was given by Bhore
committee.
• Currently there is 1 PHC per 30,000 population
in plain areas & 20,000 in tribal, hilly and
backward areas.
• It has a staff of 15 including a doctor.
• 6 Beds
 4. Community health centre (CHC)
Established at block level
Catering to a population of 80,000 to 120,000.
first referral units (FRU) from PHCs.
Total staffing strength is 25.
30 IPD beds.