Health Care Delivery

System in Rural Area

Health Care : Changing Concept

From Negative Health (curative cure )-

Freedom from disease – through Hospital

To

Positive Health (Health &disease )-

Integrated Comprehensive Health Care -
Long association from womb to Tomb .
 Health Services should be

• Comprehensive
• Accessible
• Acceptable
• Provide scope for community participation
• Cost the community & Country afford
 Health care
Prevention

Treatment & management of illness

Preservation of mental & physical well-being

through services provided by health professionals
&Para health professionals.
 ELEMENTS OF PRIMARY HEALTH
CARE
Education about
prevailing health
Promotion of food Safe water and Basic
problems & the
supply & Nutrition Sanitation
methods of prevention
& control

Prevention and
MCH care including Immunization against
control of Endemic
Family Planning major infections
disease

Appropriate treatment Provision of essential

of common illnesses drugs
 System

INPUT PROCESS
OUTCOME
POLICIES
PATIENTS PATIENT CARE
MANPOWER
PROGRAMMES COMMUNITY
TECHNOLOGY GOVERNANCE HEALTH
CAPITAL STATUS
EQUIPMENT EDUCATION
MEDICAL
INFORMATIO RESEARCH
N STAFF

6
FEEDBACK
 A health care system

is organization of people, institutions, and

resources to deliver health care services to
meet the health needs of target populations
 Health care delivery System
• Comprises of all the delivery models in the
practice.

• Organized efforts of both the central and the

state governments.

• Three tier system of primary health care

infrastructure in rural areas .
 RURAL LOCAL GOVERNMENT
ZILA
DISTRICT
Parishad

Panchyat Samiti
BLOCK

VILLAGE
VILLAGE PANCHAYAT

GRAM SABHA

12/21/2021 9
 District level :
• Structure is middle management organization
• Link between the state structure on one side and
peripheral level structures on the other .
• Receives message from the state and transmits to
the periphery .
• The urban areas have City municipal Corporations
/ Council / Town area committees.
• Zilla Parishad also functions in rural areas headed
by chairman
 District Level
• Urban & Semi urban Area
Sub –Division Hospital
District Hospital

• Rural Area : Health Centers

( According to size and Function)
 Block Level
• Rural block level administration is by panchayat
samiti .

• The chairman of the samiti maintains liaison with

the medical officer of community .

• Block Development Officer is also head of a

particular block.
 
 Community / Block Level:
Rural Infra structure
(Size and Functions)
There is existence of

• Community health centers

• Primary Health centers
• Subsidiary Health Centres
• sub centers
• Village workers at the village level.  
 Primary Health Care Infra structure
Level Population Size Functionaries

Village 1,000 HG, AWW, ASHA, TD

Sub centre 5,000 Health workers

Sub sidiary Health centre 10,000 Health professional

Primary health centre 30,000 Health Professionals

Community health centre 1,20,000 Specialists

 AT VILLAGE LEVEL : 

• The village level is the grass root of the services in

the health care delivery.
• The system in village includes:
• 1. Village health guides.
• 2. Local Dias/Birth attendants.
• 3. Anganwadi worker.
• Under NRHM , a cadre of Accredited Social Health
Activist (ASHA ) has come up with the USHA as a
counter- part in Urban areas as community level.
 VILLAGE HEALTH GUIDE
 One VHG for each village or 1000 rural population.
 Training: At PHC over a period of three months
stipend Rs .200 per month
 Duties :treatment of simple ailments
first aid
mother and child health
health education and sanitation
community health work 2 to 3 hours daily for which

they are paid Rs. 50 per month & provided drugs

worth Rs. 600 per year.
 TRAINED DAI
TRAINING
• For 30 working days. Two days in a week at
PHC,SC or MCH centre & four days she
accompany HWF to village.
• Required: At least 2 deliveries conducted
under the guidance of HWF to the village.
STIPEND: Rs.300
 ANGANWADI WORKER
• TRAINING: For 4 months in various aspects of health,
nutrition & child development.
• STIPEND:Rs.200-250 per month.
• BENEFICIARIES: 0-6 yrs. Children.
• FUNCTIONS:1.Health checkup.
2.Supplementary nutrition.
3.Immunitation .
4.Non formal Pre-School
education.
5.Referral services.
6.Health education.
 ACCREDITED SOCIAL HEALTH
IntroducedACTIVIST-ASHA
under NRHM
For every village/large habitat
Chosen by and accountable to the
panchayat
Interface b/w community & public health
system
Bridge b/w ANM & the village &
accountable to the panchayat
Honorary volunteer, performance based
compensation
 ACCREDITED SOCIAL HEALTH
ACTIVIST-ASHA
Training monitored at national level
Preparation & implementation of village
health plan with other functionaries at
village level
Drug kit provided which will be
replenished from time to time & will
contain generic AYUSH & allopathic
formulations
Induction training 23 days spread
over 12 months also on job training
throughout the year
Prototype material to be developed
at National level
Cascade model of training
Partnership with NGOs /ICDS
training centers & State health
institutes for training
 Village health & Sanitation
Committee
• Constituted under NRHM for village health
action plan & implementation
• V H N &S day is organized every month at
AWW in each Village for RCH services.
 Health Centre
Refers to frontline facilities
capable of providing health promotion and
health protection ,as well as treatment ,
rehabilitation and health care services
according to community needs
 Sub-centre
 Most peripheral outpost of the existing health
care delivery system.
 Health care delivery system interface with the
community at the rural level
 1 per 5000 population in general areas &
1 per 3000 population in hilly, tribal &
backward areas
 Staff
1. One Female health worker known as Auxiliary
nurse midwife(ANM).
2. It is under Govt. quota & another ANM is provided
in difficult area on contract bases (centrally
sponsored).
3. One Male health worker(Multipurpose worker)
4. A Voluntary worker (helper) is provided if required.
One health assistant(Female)&One health
assistant(Male) located at the PHC level are
supervisors of 6 sub-centre under a PHC.
 Functions

• It provides basic promotive, preventive and

few curative primary health care services to
the community and achieve & maintain an
acceptable standard of quality of care.

• These services are called assured services.

1) Maternal health care

Antenatal

Natal
Postnatal care

2) Immunization

3) Prevention of malnutrition & common childhood diseases

4) Family planning & contraception

5) Counselling & appropriate referral for safe abortion services(MTP)

6) Provides drugs for minor ailments such as ARI,
diarrhea, fever, worm infestation etc.

7) Adolescent health care: education, counselling&

referral.

8) Training of traditional birth attendants & ASHA

workers.

9) Co-coordinating services of ASHA, Anganwadi

worker & Village health guides.

10) National health programmes.

 Subsidiary Health Centre
• It is a special category of health set up in
Punjab
• Covers a population of 10,000.
• Staffing pattern includes Medical Officer-1 &
Pharmacist-1 & a class IV.
• Also includes Sub-Centre staff.
 Primary health centre

• It is a peripheral, rural hospital, where

comprehensive health care services, such as
preventive, promotive, curative, rehabilitative
& referral services are provided to the rural
people.
 Primary Health Centre
• Population - 30,000(20,000 in hilly and tribal )
• Houses 6,000 or so
• Area 150 KM square
• Radius 7 KM
• Bed Capacity 4-6
• Staff members 15
Provide Integrated curative ,preventive and
Promotive services
 Staffing pattern
Staff Existing Recommended
Medical Officer 1 2(at least female )
AYUSH practitioner Nil 1(AYUSH or any ISM
system prevalent locally)
Account Manager Nil 1
Pharmacist Nil 2
Nurse-midwife(staff) 1 5
(nurse)
Health workers(F) 1 1
Health educator 1 1
Health asstt. 2 2
(male & female) 2 2
Clerks
Laboratory Technician 1 2
Class IV 4 4
Total 15 24/25
Functions of Primary health Centre
• Medical Care including referral & Lab. Services
• Control of Communicable Diseases
• Environmental sanitation & safe water Supply
• RCH programme
• School health services
• Information Education & Communication
• Collection of Vital Statistics
• Implementation of Health Programmes
• Training of personnel
 Duties of Medical Officer at PHC
• Running OPD & Indoor services
• Attending Medico legal cases
• Attending to emergencies
• Organizing Lab. Services at PHC
• Supervise all subordinate staff
• Assisting in referral services
• Preparing Reports
• Liaison with other functionaries at the District level
• Managing Suppliers & stores
 Community Health Centre
CHC set up on the recommendation of working Group on
Health For All (1981)
Population - 1 lakhs(50,000 in hilly and tribal )
Villages - 300-400
Area - 1,500 KM square
Radius - 20 KM
Bed Capacity - 30
Staff Members - 25
First referral Unit For Rural Population
Community health centers

One per 80,000 to 1.20 lakh.

Minimum 30 beds.

Specialists in surgery,
medicine, obstetrics,
gynecology & peadiatrics.

X-ray and laboratory facilities

are must.
 Staff Pattern
Existing clinical manpower
1. General Surgeon 1
2. Physician 1
3. Obstetrician/Gynecology 1
4. Pediatrician 1
Existing support manpower
Nurse –midwife * 7+2
Dresser 1
Pharmacist/compounder 1
Lab. Technician 1
Radiographer 1
Ophthalmic assistant** 0-1
Ward boy/nurse orderly 2
Sweepers 3
Chowkidar
OPD attendant
Statistical assistant /data Entry operator 5***
OT attendant
Registration
----------------------------------------------------------------------------
Total essential 21-22+2
_____________________________________________
 Community health Centre:
(Functions)
• It is the first referral unit and has to provide services as
under:
• Care of routine and emergency cases in surgery and
medicine.
• 24 hour delivery services.
• Full range of family planning services.
• Safe abortion services.
• Newborn care.
• Routine and emergency care of sick children.
• All the national programmes to be delivered.
 District Health Organization

Civil Surgeon District Medical

Commissioner
(Rural),Preventive (Urban),Curative
ACS
Program Officers –DHO, DFPO

DIO,
Epidemiologist
(registered society-DHS)
 PARADIGM SHIFT (contd…)
• Super Specialization to Family Physician
• Science to Science/Art
• Medicines to Behavioral Modification
• Medical Care System to Public Health System
• Government to Public Private Partnership