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: Health Care Delivery System in India :

Health care delivery system in India

Prepared by Ms.Gipsy Sara Ninan 2nd yr Msc.Nsg SRM CON

India is a union of 28 states and 7 union territories under the constitution 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 and resources 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 proper resources, technologies and skills. So strengthening of multisectrol approach should be maintained in the community to achieve the health for all by 2010.


Comprehensive: Including all that may concerned complete, full and whole. Referral: Who needs professional help to a person.




Persons who works in a profession regularly does a particular activity. The practice of helping the poor and those in need, especially by giving money.



5. Pharmacopeia:

An official book containing a list of medicine and drugs and instruction for their use. A person that has or may have a disease is kept away from others in order to prevent the disease from spread. That may be done by Law.

6. Quarantine:

7. Statutory:


A health care delivery system is the totality services offered by all health disciplines.

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


Consumer are less informed about health services than anything else they purchase


Health system is unique beacause it is not a

competitive market.

Restricted entry into the health care system

Goals / objectives

To improve the health status of population

To improve the experience of care of

patients,families,and communities

To improve social justice,equity in the health

status of population

To reduce the total economic burden of care and illness.


Provision of health services

Raise & pool the resources accessible to pay for

health care

Generating human & physical sources that makes

the delivery of services possible


Oriented towards health

Population perspective

Intensive use of information

Focus on consumer

Knowledge of treatment outcome

Constrained resources


Set and enforce rules of the health care delivery

and provide strategic directions.


Private. Voluntary Government agencies. - National level. - State level. - District level and - Block 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 Family Welfare.

a) The union ministry of Health and family 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.

i) Department of Health
Secretary Joint secretaries Administrative staff Directorate general of Health services Subordinate officer. Homeopathic pharmacopoeia laboratory

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,


Nursing. Pharmaceutical and Ancillary health personnel.

Function cont These 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.

Function cont
4. 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.

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 activates through 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.

Function cont 12. Negotiations with international and bilateral

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.

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

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 minimum standards of health administration for these services with the other departments. ExamplesRailways, Prisons and labour etc

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

One Joint secretary.

Functions of Department of Family welfare.

1. To organise family welfare programme through family 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 leave the choice of method to the individual couple ( cafetarial approach).

4. To disseminate the knowledge on the practice of family planning by the available publicity and educational measures and to provide service agencies 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 of contraception. 6. To study the social factors that affect fertility and to take such steps as will reduce the number of children in a family. Ex- Raising the age of marriage, free education and employment of women etc

7. To coordinate the family planning programme with the child welfare and maternal health services through 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.

Functions of union ministry of Health and family welfare.

1) The union list.

International health relations and administration of port quarantine. Administration of central institutes like All India institutes of 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.

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.

2) Concurrent list.

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.

b) Directorate general of Health services (DGHS)

Principal adviser to

union government
Additional director of

Health services
Team of deputies Administrative Staff

The directorate comparies of three main units, Medical care and hospital.

Public Health.

General administration.

Functions of directorate general of Health 1. General Functions


Coordination. Programming and Appraisal of all health matters. International Health relations and quarantine. Control of drug standards. Medical store depots.

2. Specific Functions.

Specific cont..

Postgraduate training. Medical education. Medical research. Central Government Health Schemes. National Health programmes. Central Health Education Bureau. Health intelligence.

Health intelligence.

c) The central council of health and family 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.

Function of central council of Health and family welfare.

1. To consider and recommend board outlines of policy 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.

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.


The state health administration was started in the year 1919.

The state list which become the responsibility of the 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.


The state ministry of Health and family welfare is headed by a cabinet minister and deputy minister.


He is the political head of the department of health and family welfare.

Having responsibility for formulating policies and monitoring the implementation of these policies and programmes.


State Health directorate and Family welfare.


He is the principal advisor to the state government on all matters relating to medicine and public health, as he is technically qualified person in the field.


He is assisted by joint director, regional joint directors and deputy and assistant directors.

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 in the prevention of any outbreak of communicable disease especially during festivals and meals.

Establishment and maintenance of central laboratories for preparation of vaccine etc. Promotion of health education.
Collection, tabulation and publication of vital statistics.


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



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 other minister of the state such as,

Minister of Education. Minister of Agriculture.

Central health minister.

Voluntary agencies.


The principle unit of administration in India is the district.

For administration purpose the country is divided in to 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 carried out at the district level.

District is divided into 6 types,






A) Subdivision.

Most districts in India are divided in two or more sub division

Each in charge of an assistant collector or sub collector.

B) Tehsils.
o o

Tehsildar is in charge of each Talukas He comprises between 200-600 villages.

C) Community Developmental Blocks.


The rural areas of districts have been organised in to community developmental blocks. It comprises of 100 villages and about 80,000 1, 20,000 population 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

The panchayati Raj is a 3 tier structure of rural local self government In India linking the village to the district they are,






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.

II. Gram


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 vice president and a secretary,

Functions of Panchayat.

Civic administration. Sanitation. Public health Social and economic development of village.

2. Panchayat samiti (at block level)

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 castes and scheduled tribes. The block development officer (BDO) is the secretary of the Panchayat samiti.

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)

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 level.

1. 2. 3.

Co- ordinate health planning. Investigate communicable disease. Maintain free clinics for the early diagnosis of communicable disease. Provide laboratory services to assist doctor. Conduct clinics for administration of vaccine. Collect vital statistics.

4. 5. 6.

8. 9.

Provide maternal and child health care.

Maintain a public health nursing service. Supervise water supply and sewage disposal.

Cont.. 10. Supervise quality and safety of meat and other foods. 11. Inspect and supervise the production, pasteurization and distribution of milk. 12. Investigate and supervise the general sanitary conditions 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.


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 tire structure such as



1) Community health centers


Each community health center is covering a population of 80,000 1, 20,000 with three to four PHC. Each CHC has 30 sanctioned beds and has facility for specialized services, The services are given by the team of specialist nurses and other Personnels.



2. Primary health centers


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 The services are provided by the team of medical officer, Nurses midwife, ANM, Block extension educator, Health assistant Male and Female, Lab technician and Ancillary staff.



Each primary health center has 5-6 sub centers

3. Sub-centers and village health post


It covers the population of 5000 in general and 3000 in hilly, tribal and backward areas. Each sub-center is managed by a team of male and female health worker or ANM. The work of female and male health worker is supervised by male and female health supervisor respectively in the ratio of 1: 4 to six workers



The services in sub center is limited such as

M.C.H. and family welfare

Immunization. Health education

Training and supervision of the dais

4. Village.

The village is managed by the village health guide for thousand population who have had the three months training. The village health guide is to spare 2-3 hours daily for community health work in return they are given Rs. 200 per month as an honorarium . The other persons are a) Indigenous dais

b) Anganwadi workers.


I) At central level. At the central level, there is a post of nursing adviser in medical division of directorate general of health services. The nursing adviser is assisted by the nursing officer and support staff. She/he advises the DGHS, ministry of health and family 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 nursing adviser and nursing adviser

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.

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 of medical education and director of medical services.

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.

III) Role of nurse in district level.

The nurses played a important role in providing the health course services in urban and rural areas. 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.