Health delivery system

DEFINITION OF HEALTH

 The widely accepted definition of health is that

given by the World Health Organization ( 1948)
in the preamble to its constitution, which is as
follows :
 "Health is a state of complete physical, mental
and social well-being and not merely an absence
of disease or infirmity"
 In recent years, we have acquired a new philosophy of health,
which may be stated as below :
 health is a fundamental human right
 health is the essence of productive life, and not the result of
ever increasing expenditure on medical care
 health is intersectoral
 health is an integral part of development
 health is central to the concept of quality of life
 health involves individuals, state and international responsibility
 health and its maintenance is a major social investment
 health is a worldwide social goal.
 DEFINITION OF DISEASE

 Defines disease as "a condition in which body

health is impaired, a departure from a state of
health, an alteration of the human body
interrupting the performance of vital functions.
 The WHO has defined health but not disease.
 This is because disease has many shades
("spectrum of disease") ranging from in apparent
(subclinical) cases to severe manifest illness.
 Some diseases commence acutely (e.g., food
poisoning), and some insidiously (e.g., mental illness,
rheumatoid arthritis). In some diseases, a "carrier" state
occurs in which the individual remains outwardly
healthy, and is able to infect others (e.g., typhoid fever).
 In some instances, the same organism may cause more
than one clinical manifestation (e.g., streptococcus). In
some cases, the same disease may be caused by more
than one organism (e.g., diarrhoea). Some diseases have
a short course, and some a prolonged course.
 Health system

 The "health system" is intended to deliver health

Services.
 it constitutes the management sector and
involves organizational matters, e.g., planning,
determining priorities, mobilizing and allocating
resources, translating policies into services,
evaluation and health education
 The components of the health system include: concepts
(e.g., health and disease); ideas (e.g., equity, coverage,
effectiveness, efficiency, impact); objects (e.g.,
hospitals, health centres, health programmes) and
persons (e.g., providers and consumers). Together,
these form a whole in which all the components
interact to support or control one another.
 The aim of a health system is health development - a
process of continuous and progressive improvement of
the health status of a population.
 Levels of health care

 Health services are usually organized at three

levels, each level supported by a higher level to
which the patient is referred.
 These levels are( 3tier health delivery system )
 (a) Primary health care
 (b) Secondary health care
 (c) Tertiary health care :
 (a) Primary health care : This is the first level of
contact between the individual and the health system
where "essential" health care (primary health care) is
provided.
 A majority of prevailing health complaints and
problems can be satisfactorily dealt with at this level.
 This level of care is closest to the people.
 In the Indian context, this care is provided by the
primary health centres and their subcentres, with
community participation.
 The Declaration of Alma-Ata stated that primary health care
includes at least:
 education about prevailing health problems and methods of
preventing and controlling them;
 promotion of food supply and proper nutrition;
 an adequate supply of safe water and basic sanitation;
 maternal and child health care, including family planning;
 immunization against infectious diseases;
 prevention and control of endemic diseases;
 appropriate treatment of common diseases and injuries; and
provision of essential drugs.
 Principles of primary health care
 1. Equitable distribution
 2. Community participation
 3. Intersectoral coordination
 4. Appropriate technology
 (b) Secondary health care :
 At this level, more complex problems are dealt
with.
 This care comprises essentially curative services
and is provided by the district hospitals and
community health centres.
 This level serves as the first referral level in the
health system.
 (c) Tertiary health care : This level offers superspecialist care.
 This care is provided by the regional/central level institutions.
 These institutions provide not only highly specialized care, but
also planning and managerial skills and teaching for specialized
staff.
 In addition, the tertiary level supports and complements the
actions carried out at the primary level.
 This care is provided by the regional or central level institutions,
e.g., Medical College Hospitals, All India Institutes, Regional
Hospitals, Specialized Hospitals and other Apex Institutions.
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