UNDER THE GUIDANCE OF GROUP -18

Dr. 1) SANDESH YADAV

DEEPA RAGHUNATH 2) SANYAM GUPTA
& 3) SAPNA GAJBHIYE
Dr. GEETA SHIVRAM 4) SARIKA ARGADE
5) SOURABH N. JAIN
HEALTH CARE DELIVERY SYSTEM IN INDIA

Two major themes in the delivery of health services are –

1.It should be organized to meet needs of entire population & not merely
selected groups .
2.It should cover the full range of preventive , curative & rehabilitation
services.

In the beginning ,

LARGE HOSPITALS

Were chosen for health care delivery

 LARGE HOSPITALS FAILED

It served only small part of population.

Services rendered were mostly
CURATIVE only.
Cost of maintenance were high.
Failure to meet the total health needs
of community.
This led to development of NEW MODEL
OF HEALTH CARE SYSTEM.
 MODEL OF HEALTH CARE SYSTEM

INPUT HEALTH CARE HEALTH CARE OUTPUT

SERVICES SYSTEM
Health Curative Public Changes in
status/Health Preventive Private health status
problems + promotive Voluntary
Resources Indigenous
 INPUT
A. Inputs are the health status & major problems of the
community.

 These represents health needs & health demands of

community.
 Data required for analyzing the health situations & for
defining the health problems comprises the following
 Mortality & morbidity status
 Demographic conditions
 Environmental conditions
 Socioeconomic factors
 Cultural background, attitudes, etc.
 Medical & health services available.
 B.RESOURCES

• No country, however rich has enough

resources to meet the needs for all health
care.
• Basic resources for providing health care are
-Health manpower
-Money & material
-Time
 HEALTH MANPOWER
• Suggested norms for health personnel

Category of personnel Norms suggested

1.Doctors 1 / 3500 population
2. Nurses 1 /5000 population
3. Health workers M/F 1 /5000 population- plain
areas,3000 population-tribal
& hilly areas

4. Trained dais 1/village

5.Health assistant M/F 1/30000 population-plains,&
1/20000-tribal& hilly areas
6. Pharmacists 1/ 10000
7. Lab. technicians 1/ 10000
 HEALTH CARE SERVICES
• Health care services are designed to meet the
health needs of the community through the use of
available knowledge & resources
• In the light of health for all by 2000AD the goals to
be achieved are fixed in terms of :-
 Mortality& Morbidity reduction
 Increase in expectation of life
 Decrease in population growth rate
 Increase in nutritional status
 Provision of basic sanitation
 Health manpower requirement
 Resource development
HEALTH CARE SYSTEM IN INDIA
DEFINITION-Health care delivery system is
one which is intended to deliver the health
services ,it constitutes the management
sector & involves organizational matters.
•
India is a union of 28
states & 7 union territories.
• Each state has developed its own system
of health care delivery with central
responsibility of-
 Policy making
 Planning
 Guiding
 Assisting
 Evaluating &
 Coordinating the work,
of State
Health Ministry.
THE HEALTH CARE IN INDIA HAS THREE MAIN
LINKS

CENTRAL LEVEL
STATE LEVEL
DISTRICT LEVEL
 CENTRAL LEVEL
• Consist of
I. Union Ministry of Health & Family
Welfare
II.The Directorate General of Health
Services
III.Central Council of Health & Family
Welfare
UNION MINISTRY OF HEALTH AND FAMILY
WELFARE

ORGANIZATION

HEADS

A Cabinet A State A Deputy

minister minister health minister
Departments – U M H F W
1.DEPARTMENT OF HEALTH:-
Executive Head:- Secretary to the Govt. of
India
Assisted by

Joint secretaries Deputy secretaries Administrative staff

2.DEPARTMENT OF FAMILY WELFARE:-
Over all In charge:- Secretary to Govt. of
India in Ministry of Health & Family
Welfare.
 FUNCTIONS
1.Union list:-
 International health relations &
administration of port quarantine.
 Administration of central institutes .
 Promotion of research through research
centers .
 Regulation and development of
medical , pharmaceutical , dental ,
nursing profession.
Establishment and maintenance of drug standard
data.
Census & collection of other statistical data.
2.CONCURRENT LIST:-
Prevention of extension of communicable diseases
from one unit to other.
Prevention of adulteration of food stuffs.
Control of drugs and poisons.
Vital statistics.
 Labour welfare.
Population control & family planning.
 DIRECTORATE GENERAL OF HEALTH SERVISES

ORGANIZATION
Principal advisor-Directorate General of Health
Services.
Assisted by

Additional Director General Team of deputies Administrative staff

DGHS COMPRISES OF 3 MAIN UNITS

UNITS

Medical care General

Public health
& hospitals administration
FUNCTIONS
• International health relations & quarantine
at all the major ports.
• Control of drug standards.
• Medical store depots to insure quality
,cheaper bargain,& prompt supply.
• Post graduate training .
• Medical education- In charge of medical
colleges.
• Planning ,guiding ,coordinating national
health programmes.
CENTRAL COUNCIL OF HEALTH

Set up by presidential order on 9th August

1952, under article 263 of constitution of
India.
AIM:-
Promoting coordinated and concerted action
between centre and state
To
Implement all programmes and measures
pertaining to the health of nation.
Organization

Chair person –Union Health Minister

Other members – State Health Ministers
AT STATE LEVEL
In all the 28 states the management
sector comprises of –

a.State Ministry of health

b.State health Directorate
STATE MINISTRY OF HEALTH
Organization :-

HEAD

A deputy Minister
Minister of Health
of Health &
& Family Welfare
Family Welfare
STATE HEALTH DIRECTORATE
Organization:-
Chief advisor:- Director of health & family
welfare.
Assisted by:- Deputies
-Assistants
Regional Functional

Inspect all branches of public health Specialists

within their jurisdiction
 AT DISTRICT LEVEL
District
TAC

RURAL URBAN

MB

SUBDI TEHSIL CDB PANCHA

VISON VILLAGE YATS COORPORATI
N
TEHSIL:-
Between 200-600 villages
In charge- Tehsildar.
COMMUNITY BLOCK DEVELOMENT
Comprises of approx 100 villages.
Between 80000-120000 population.
In charge-Block development officer.
District oUrban areas rganized into
following institutions
TOWN AREA COMMITEES
In areas with population of 5000-15000.
It is like panchayat.
Provide sanitary services.
THE DISTRICT

The principal unit Administration in

India .
HEAD:- COLLECTOR
There are 539 districts in India.
Administrative types under
district
Sub division:-
May be 2 or more.
In charge- Assistant collector.
MUNICIPAL BOARDS
In population of 10000-20000.
In charge-President.
Functions-Construction & maintenance of roads.
-Sanitation, Drainage, Water supply.
-Maintenance of hospitals &
dispensaries.
-Registrations of vitals.
COORPORATIO
Head-Mayors, Counsilors.
Executive agency- Commissioner
-Secretary
-Engineer
Organization at district level
There should be an integrated set up by having
:-
 Chief medical officer
 3 Deputy CMOs
Each deputy CMO in charge of 1/3rd of the
district for all the health, family welfare &
MCH services.
This set up should be recognized on the basis
of the number of Primary health centers it
comprises.
PANCHAYATI RAJ
LINK BETWEEN VILLAGE & DISTRICT

AT VILLAGE AT BLOCK AT DISTRICT

LEVEL LEVEL LEVEL
PANCHAYAT PANCHAYAT ZILLA
SAMITI PARISHAD
AT VILLAGE LEVEL
Panchayati raj at this level consist of

NYAYA PANCHAYAT

GRAM PANCHAYAT

NYAYA PALIKA
Gram Sabha
Assembly of all the adults.
• Meet twice a year.
• Functions:-Considers proposals for
taxations,.
-Discusses the annual
progarmme.
- Elect members of gram
panchayat.
Gram Sabha
Assembly of all the adults.
• Meet twice a year.
• Functions:-Considers proposals for
taxations,.
-Discusses the annual
progarmme.
- Elect members of gram
panchayat.
Gram panchayat
• Varies from 15-20 in number.
• Population covered-5000-15000.
• Members hold office for 3-4 years.
• President-SARPANCH
• Other members-Vice secretary
-Panchayat secretary
• Functions – Covers entire field of civic
administration.
At the Block level
PANCHAYAT SAMITI/ JANPAD PANCHAYAT
Consist of:- Sarpanchas
-MLAs , MPs , residing in the
block area.
- Representatives of women
,SC,ST, cooperative societies.
-Ex-officio secretary-Block
development officer.
FUNCTION:- Execution of the community
development program me in the block.
AT DISTRICT LEVEL
ZILLA PANCHAYAT
Organization:-Head of the panchayat samitis
-MLAs , MPs , residing in the block
area.
-Representatives of women ,SC,ST,
cooperative societies.
-Two persons of experience in
administration or rural development.
FUNCTION:- Its a Supervisory & coordinating body.
THE INDIGENOUS SYSTEM OF MEDICINE

Includes
AYURVEDA & SIDDHA
UNANI & TIBBI
HOMEOPATHY
UNREGISTERED PRACTITIONERS
• These provide a bulk of medical care to rural
population.

• Ayurvedic physicians alone are estimated to

be about 4.38 lakhs.

• 90% serve rural areas.

• Local residents ,close to people socially &

culturally.

• ISM drugs are manufactured by Tamil Nadu

Medicine Plant Co orporation.
Total values of IMS drugs are Rs 30 crs/-

Training of the health functionaries on the use of

IMS drugs is under progress.

Training cost-Rs 3.30 crs/-.

Beneficiaries are- 8.6 lakhs and steadily

increasing.
HEALTH CARE SYSTEM
 FIVE MAJOR SECTORS ▬

1. Public Health Sector

a) Primary Health Care –
- Primary health centers
- Sub-centers
b) Hospitals / health centre
- Community health centre
- Rural hospitals
- District hospitals/health centers
- Specialist hospitals
- Teaching hospitals
c) Health Insurance Schemes
- Employees State Insurance
- Central Govt. Health Scheme
d) Other Agencies –
- Defence services
- Railways
2. PRIVATE SECTOR
a) Private hospitals, Polyclinics, Nursing homes
& dispensaries
b) General practitioners & clinics

3. INDIGENOUS SYSTEM OF MEDICINE

a) Ayurveda & Siddha
b) Unani & Tibbi
c) Homeopathy
d) Unregistered practitioners

4. VOLUNTARY HEALTH AGENCIES

5. NATIONAL HEALTH PROGRAMMES

PRIMARY HEALTH CARE IN INDIA

 In 1977, the Govt. of India launched a Rural Health

Scheme based on the principle :
“Placing people’s health in people’ hands”

 Based on recommendation of Shrivastav Committee

in 1975.

 As a signatory to Alma-Ata Declaration Govt. of India

is committed to achieve the goal of health for all
through primary health care approach .
It is a three tier system operating at

VILLAGE LEVEL

SUBCENTRE LEVEL

PRIMARY HEALTH CENTRE LEVEL

VILLAGE LEVEL
To penetrate the health care into the
farthest reach of rural area schemes in
operation

• Village health Guide scheme

• Training of local Dais
• ICDS scheme
VILLAGE HEALTH GUIDE/ ASHA
• The scheme was introduced on 2nd Oct. 1977
• VHG – A person with an aptitude for social
service & is not a full time govt. functionary.
• Guideline for selection-
- Permanent resident of local community
- Able to read & write mini. education-VI std
• Duties :
- treat simple ailments
- MCH care with family planning
- Education- health, sanitation
LOCAL DAIS
• All dais are trained to improve their
knowledge about MCH & sterilization.
• Training -PHC centre, sub centre, MCH
centre.
- 2 days /week for 30 working days.
- Conduct at Least 2 deliveries under
guidance of HW/ANM.
• Provided with a delivery kit & a certificate.
• Also, vital role in propagating small family
norm.
ANGANWADI WORKER
• Under ICDS scheme 1AWW/1000
population.
SERVICES RENDERED-
• Health check up
• Immunization
• Supplementary nutrition
• Health education
• Non-formal preschool education.
• BENEFICIARIES- Nursing mother
- Women (15-45 years)
- Children <6 years
SUB CENTRE LEVEL
 A peripheral out post of existing health delivery
system in rural area
 Norms – 1 sub centre covers –
In general – 5000 population
In hilly tribal area – 3000 population

Manpower –
1 male
MPW
1 female MPW
Supervisors - M+F Health assistant for 6 female HW
FUNCTIONS OF SUBCENTRE –
• MCH Care
• Family planning services
• Immunization
 The proposed extension of facilities -
• IUD insertion
• Simple lab investigations.
PRIMARY HEALTH CENTRE LEVEL
 Bhore committee in 1946 gave the concept.
 According to it, PHC is a basic health unit to provide heath care
to the rural population which is –
 As close as possible to people
 Integrated curative, preventive, promotive.
 The central council of health in 1953 recommended the
establishment of PHC in community development block.
 The Declaration of Alma-Ata conference in 1978 setting the
goal of health for all by 2000 AD has ushered in the primary
health care approach.
 The National Health Plan reorganized PHC on the basis of 1 PHC
for

30,000 rural population –plains

20,000 population in tribal, hilly, backward areas.
FUNCTIONS OF PHC
• It covers all the 8 essential elements of primary health care
as outlined in the Alma-Ata Declaration –
1. Medical care
2. MCH including family planning
3. Safe water supply & basic sanitation
4. Prevention & control of locally endemic diseases
5. Collection & reporting of vital statistics
6. Education about health
7. National health programmes
8. REFERRAL SERVICES
9. Training of health guides health workers local dais & health
assistants
10. Basic lab services
Proposed facilities –
Vasectomy, tubectomy, MTP
STAFF
At the PHC level :

Medical officer 1
Pharmacist 1
Nurse mid wife 1
Health worker (female)/ANM 1
Block extension educator 1
Health assistant male 1
Health assistant female 1
U.D.C 1
L.D.C. 1
Lab technician 1
Driver 1
Class IV 4
 HOSPITALS

HOSPITALS

RURAL DICTRICT SPECIALIS TEACHING

CHC
HOSPITALS HOSPITALS T HOSPITALS
HOSPITALS
COMMUNITY HEALTH CENTRE
 Established on 31st March 2003 by upgrading
the primary health centre.
 1 CHC in each community development block
covers population 80,000 – 1.2 lac .
 It should have :
-30 beds
-Specialists in surgery, medicine, obstetrics &
gynecology pediatrics with X- ray facilities.
 A new non- medical post : community health
officer has been created at CHC to strengthen
preventive & promotive aspect of health.
 Indian Public Health Standards
for CHC

Prescribed to –
o Provide quality care & optimal expert care
o Achieve & maintain an standard of quality of
care.
o Monitor & improve functions of CHC
 Assured Services –

 Care of routine & emergency cases in

surgery & medicine
 24-hour delivery services, including normal
& assisted delivery
 Essential & emergency obstetric care
including caesarean section
 Full range of family planning services
 Safe abortion services
 Newborn care
 Routine & emergency care of sick children
ASSURED SERVICES cont…

 Delivery of all national health programmes

like :
RNTCP
NVBDCP
HIV/AIDS Control programme
Blindness Control programme
NLEP
IDSP
 Others : - Blood storage facility
Lab services
Referral services
ROGI KALYAN SAMITI
 CONCEPT
• “PATIENT WELFARE COMMITTEES”
AIM
To create a model of management of public
institutions for the people
with active participation of the
community and with minimal recourse to
the state exchequer.

• Constituted by including people’s

representatives with a few govt. officials.

• Given control over all assets of hospital .

 OBJECTIVE
• Ensure compliance to minimum standard for
facility & hospital care.

• To ensure discipline & monitor accountability .

• Upgrade & modernize health services.

• Introduce transparency in management of funds.

• Supervise implementation of National Health

Programmes

• Organize out reach services.

 OBJECTIVE (cont…)
• Generate resources locally through donation,
user’s fees.

• To establish public private partnership for

betterment of the institution.

• Maintenance & expansion of hospital building.

• Ensure safe & adequate disposal of hospital waste.

• Organize training & workshop for staff members.

 FUNCTIONS
• Identify problem faced by people & solve.
• Ensure equity via provision of free treatment
– BPL
• Ensure proper maintenance of hospital wards
beds, equipments.
• Arrange for good quality diet & stay
arrangement for patient’s attendants.
• Offer private organs to set up CT Scan, MRI,
pathology lab services within hospital
premises
 USER CHARGES
• To ensure excellent health care on cont.
basis.
• Free health care – not perceived as best kind
of health care.
• Guidelines are drawn up for user fees
e.g. OPD ticket, pathology test, indoor beds,
specialized treatment, operations etc.
• BPL, FF etc.- exempted from user charges.
• Funds received – Deposited in RKS & not in
govt. exchequer .
 Committees
DISTRICT HOSPITAL (EXECUTIVE
BODY):

 CHAIRMAN: COLLECTOR

 MEMBER SECRETARY: Civil Surgeon cum

Hospital Superintendent.

 MEMBERS :Municipal Commissioner, CEO

Zila Panchayat, Chief Medical officer,
Senior  MO of Hospital, Ex. Eng. PWD, One 
Donors ( donated Rs.50,000)Nominated by
Chairman
 Committees
TEHSIL & BLOCK LEVEL HOSPITAL (GENERAL BODY)

 CHAIRMAN: MLA of the area.

 MEMBER SECRETARY: Block MO/ MO of hospital

 MEMBERS-
People’s representatives with few Govt. officials
S.D.M, President Janpad Panchayat, President of Municipality,
President of Health Committee of Municipality, CEO Janpad
Panchayat, one Parshad  of area, SDO. PWD & PHED, Two Donors (
donated Rs. 20,000) nominated by Chairman, Sr. M.O.  nominated
by CMHO.
 Committees
TEHSIL & BLOCK LEVEL HOSPITAL (EXECUTIVE
BODY)

 CHAIRMAN: SDM

 MEMBER SECRETARY: Block MO/ MO of

hospital

 MEMBERS : President Janpad, CEO Janpad Panchayat, PWD,

Sr. M.O.  nominated by C M H O
Committees
OTHER HEALTH INSTITUTIONS/
DISPENSARY/ PHC (GENERAL
BODY):

 CHAIRMAN: Janpad Panchayat

Member of area.

 MEMBER SECRETARY: I/C MO

Hospital
 Committees
OTHER HEALTH INSTITUTIONS/ DISPENSARY/ PHC
(EXECUTIVE BODY):

 CHAIRMAN: TEHSILDAR/ NAYAB TEHSILDAR.

 MEMBER SECRETARY: I/C MO Hospital.

 MEMBERS: President of Health Committee of

Nagar/Gram Panchayat, Eng.. PWD & MPEB.
 MONITORING COMITTEE

• Constituted by Governing body.

• Visit hospital wards.
• Collect patient’s feedback.
• Send monthly monitoring report to
Collector.