Health Care

System
in India
Department of Community medicine
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 Model

• Inputs- health status/health problems

• Health care services – to meet the health needs
• Health care system – to deliver
• Output – changed/ improved health status

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 Health System

• By WHO- “Sum total of all organisations,

institutions and resources whose primary purpose is
to improve health”

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 Health System
• Health services are designed to meet health needs of the
community

• Through the use of available knowledge & resources

• Health services are delivered by the “ Health System”,
which constitutes the management sector & involves
organizational matters

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 Health System

• In the delivery of health services:

a) It should be organized to meet the needs of entire

population, cover a full range of preventive, curative &
rehabilitative services

b) It should be through Effective “primary health care”

services supported by an appropriate referral system
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 Health Care system

Public Private

Primary Secondary Tertiary Profit Non-

Profit(NGO)

District
1. Subcentre 1.Community Hospitals and
Health centres medical
2. Subdistrict colleges
2. PHC hospitals 6
 Health Care Systems

Public Systems
PHC and HWC
Rural Hospitals
District Hospitals
Teaching Hospitals
ESI and CGHS
Defense and Railways

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 Health Care Systems
 Private Sector
Polyclinics , Nursing
Homes, GP’s and clinics

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 Health Care Systems
Indigenous Systems
Ayurveda and Siddha
Unani and Tibbi
Homeopathy
Naturopathy
Voluntary Health Agencies
National Health Programme

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10
 Levels of health care

• Primary Health Care

• Secondary Health Care

• Tertiary Health Care

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 Primary Health Care

It is essential health care is made universally

accessible to individuals and acceptable to them,
through their full participation and at a cost the
community and country can afford.

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 Primary Health Care
• First level of contact of individuals, family & community

• Provided by Complex of Primary Health Centres & their

Sub centres through Agency of Multipurpose Health
Workers, Village Health Guides & Trained dais.

• “Health teams” bridge cultural &

communication gap
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 Functions of PHCs
Cover all the 8 essential elements of the primary health care
outlined in Alma Ata Declaration:
 Medical care
 MCH including family planning
 Safe water supply and basic sanitation
 Prevention and control of locally
endemic diseases.
 Collection and reporting of vital statistics

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 Functions of PHCs

 Education about health.

 National health programmes-as relevant.
 Referral services.
 Training of health guides, health workers, local
dais and health assistants.
 Basic laboratory services.

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Principles of Primary Health Care
Equitable Distribution

Community Participation

Intersectoral coordination

Appropriate Technology
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 Secondary Health Care

• Intermediate health care level

• More complex problems dealt with
• Provided in District hospital & community health centres
• First referral unit

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 Community health centre

• Established by upgrading the primary health centers

• Covers a population of 80000 to 1.20 lakh
• Equipped with 30 beds and specialists in Medicine,
Surgery, Obs and Gyn, pediatrics with X-ray and

laboratory facilities.
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 Tertiary Health Care

• More specialized level

• Requires specific facilities & attention of highly specialized
health workers

• Provided by Regional & Central level institutions, e.g.,

Medical College Hospital, All India Institutes, Regional
Hospitals, Specialized Hospitals & Apex Institutes. 19
 Comprehensive Health Care

• Term coined by Bhore Committee(1946) in India.

• Provision of preventive, curative and promotional
health services from “womb to tomb” to every
individual residing in a defined geographic area.

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 Health System Development

Health System Development is a combination of management sector

& involves organizational matters to translate policies into services

• Components of Health System Development
• Quality Care component
• Human Resources Development
• NGO participation
• Public-Private Participation
• IEC
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 Health Care Delivery System in India

• India is a union of 28 states and 8 union territories.

• States are largely independent on people in the delivery
of health care.
• Each state has developed its own system of health care
delivery, independent of Central Government.
• Central Government responsibility consists mainly of policy
making , planning , guiding, assisting, evaluating and
coordinating work of the State Health Ministries.
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Health Care Delivery System in India

• The health system in India has 3 main links

1.Central

2.State and

3.Local or peripheral

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 At the center

• The official “organs” of the health system at national level

consist of

• 1.Ministry of Health and Family Welfare

• 2.The Directorate General of Health Services
• 3.The Central Council of Health and Family Welfare

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 At the State level

• The health subjects are divided into three groups:

federal, concurrent and state.
• The state list is the responsibility of state, including
provision of medical care, preventive health services
& pilgrimage within state.

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 At the district level
• There are 766 ( August 2022) districts in India
• Within each district, there are 6 types of administrative areas
1. Sub –division

2. Tehsils( Taluks )

3. Community Development Blocks

4. Municipalities and Corporations

5. Villages
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6. Panchayats
 At the district level
• The urban areas of the district are organized into
• Town Area Committees (in areas with population ranging
between 5,000 -10,000)
• Municipal Boards (in areas with population ranging
between 10,000 & 2,00,000)
• Corporations (with population above 2,00,000)
• The Town Area Committees are like panchayats.
• The Municipal Boards are headed by Chairmen / President,
elected by members. 28
 Functions of Municipal Board
• Construction and maintenance of roads
• Sanitation and drainage
• Street lighting
• Water supply
• Maintenance of hospitals and dispensaries
• Education and Registration of births and deaths etc
• The Corporations are headed by Mayors, elected by
councilors, who are elected from different wards of city. The
executive agency includes the commissioner, the secretary,
the engineer & the health officer.
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 Panchayat Raj
The panchayat raj is a 3-tier structure of rural local self-
government in India, linking the village to the district

• Panchayat (at the village level)

• Panchayat Samiti( at the block level)
• Zila Parishad(at the district level)

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 Health care services
1. Health promotion
› Prenatal classes
› Nutrition counselling
› Family Planning
› Stress management
2. Illness prevention
› Screening programs (Eg. Hypertension, breast cancer)
› Immunization
› Occupational health & safety measures
› Mental health counseling
› AIDS control program.
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 Health care services
3. Primary care
• School health units
• Routine physical examination
• Follow up for chronic illnesses (Eg: Diabetes,
Epilepsy)
4. Diagnosis
• Radiological procedure (Eg: CT scans, X ray Studies)
• Physical examination
• Laboratory investigations 32
 Health care services
5. Treatment
• Surgical intervention
• Laser therapies
• Pharmacological therapy
6. Rehabilitation
• Cardiovascular programs
• Sports medicine
• Mental illness program
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THANK YOU

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