Health System:

• A health system, also sometimes referred to as health care

system or as healthcare system, is the organization of people,

institutions, and resources that deliver health care services to meet

the health needs of target populations.

 Health care / Healthcare

It is the maintenance or improvement of health via

•prevention,
•diagnosis, and
• treatment of disease, illness, injury, and
•other physical and mental impairments in human beings.
4 Basic Health Systems:

The Beveridge Model. Named after William Beveridge, the daring social


reformer who designed Britain's National Health Service.

The Bismarck Model.



The National Health Insurance Model.



The Out-of-Pocket Model.


 The Beveridge Model.

• In this system, health care is provided and financed by the

government through tax payments, just like the police force or
the public library.

• Countries that operate their health care systems using the

Beveridge Model are
Britain, Italy, Spain, Norway, Denmark, Finland, Sweden,
and New Zealand.
The Bismarck Model.

In 1883, the reactionary German chancellor Otto von Bismarck, a

Prussian autocrat through and through, proposed the health
care model.

It is used in Germany, France, Switzerland, Belgium, Netherlands, and

others. (Japan is also a Bismarck Model country.)

In Germany, for example, employers and employees jointly fund

insurance via withholding; in Switzerland, individuals purchase their own
policies.
The National Health Insurance model:

• The National Health Insurance model has elements of both the Beveridge
and Bismarck models.

• It uses private-sector providers, but payment comes from a government-run

insurance program that all citizens fund through a premium or tax.

• These universal insurance programs tend to be less expensive and have

lower administrative costs than American-style for-profit insurance plans.
National Health Insurance plans also control costs by limiting the medical
services they pay for and/or requiring patients wait to be treated. The classic
National Health Insurance system can be found in Canada.
Contd.
Lessons we can draw from these countries include:

•The importance of a universal mandate for insurance under the auspices of single
program

•Consumer protections such as no exclusion for pre-existing conditions are feasible

only with mandates

•Immediate payment of claims without challenge lowers administrative burden and

the financial impact on patients

•Insurance regulation, nonprofit insurance, and a fixed price for procedures help
control costs

•Privatized care can exist successfully in a regulated environment

 The Out-of-Pocket Model

• The out-of-pocket model is what is used in most of the poorest

countries on earth.

• Out-of-Pocket Costs. Your expenses for medical care that aren't

reimbursed by insurance.

• Out-of-pocket costs include deductibles, coinsurance, and

copayments for covered services plus all costs for services that
aren't covered. Africa, India, China, and South America, hundreds of
millions of people go their whole lives without ever seeing a doctor.
INDIAN HEALTHCARE DELIVERY SYSTEM
 What is “ URBAN”?
• Urban Unit (or Town)

• All places with a municipality, corporation, cantonment

board or notified town area committee, etc. (known as Statutory Town)

• All other places which satisfied the following criteria

(known as Census Town):

1) A minimum population of 5,000.

2) At least 75 per cent of the male main workers engaged in non-agricultural

pursuits.

3) A density of population of at least 400 per sq. km.

http://censusindia.gov.in/2011-prov-results/paper2/data_files/india/Rural_Urban_2011.pdf
 What is “ URBAN”?
• Urban Unit (or Town)

• All places with a municipality, corporation, cantonment

board or notified town area committee, etc. (known as Statutory Town)

• All other places which satisfied the following criteria

(known as Census Town):

1) A minimum population of 5,000.

2) At least 75 per cent of the male main workers engaged in non-agricultural

pursuits.

3) A density of population of at least 400 per sq. km.

http://censusindia.gov.in/2011-prov-results/paper2/data_files/india/Rural_Urban_2011.pdf
Number of Urban Units – India
• Towns:
• Census 2001 5,161
• Census 2011 7,935 Increase: 2,774

• Statutory Towns:
• Census 2001 3,799
• Census 2011 4,041 Increase: 242

• Census Towns:
• Census 2001 1,362
• Census 2011 3,894 Increase: 2,532
Rural Areas
• All areas which are not categorized as Urban area considered as Rural Area

• Number of Rural Units (or Villages) in India:

Villages:
• Census 2001 6,38,588

• Census 2011 6,40,867 Increase: 2,279

India’s achievements:
The year 2014 marked a watershed moment in the history of Indian public
healthcare system.

The World Health Organisation (WHO) on March 27 that year declared

India a polio-free nation — the fourth WHO region globally to have
achieved this feat after Americas (1994), the Western Pacific Region
(2000) and the European Region (2002).

This achievement was made possible by technological innovations, close

monitoring and relentless efforts of some 2.3 million polio volunteers, who
worked day and night to reach every child across the country for
immunisation.
Contd.
“The government has played a vital role in the eradication of small pox,
polio, yaws and kidney worm infestation. This all has been made possible
by a robust public health system.
Even malaria, which was among the most threatening endemic diseases
in India, is now on the verge of being eliminated in the country.
We are also trying to eliminate leprosy at the district and block levels by
2018-2020,” says Dr Jagdish Prasad, the Director General-Health
Services, Directorate of Public Health Services, Ministry of Health and
Family Welfare.
What does the term “RURAL” means ?
The "rural sector" means any place as per the "latest census (External website
that opens in a new window)" which meets the following criteria,

•A population of less than 5,000.

•Density of population less than 400 per sq. km.

•More than "25 per cent of the male working population" is engaged in
agricultural pursuits.

https://archive.india.gov.in/citizen/graminbharat/graminbharat.php
India’s achievements:
The year 2014 marked a watershed moment in the history of Indian public
healthcare system.

The World Health Organisation (WHO) on March 27 that year declared

India a polio-free nation — the fourth WHO region globally to have
achieved this feat after Americas (1994), the Western Pacific Region
(2000) and the European Region (2002).

This achievement was made possible by technological innovations, close

monitoring and relentless efforts of some 2.3 million polio volunteers, who
worked day and night to reach every child across the country for
immunisation.
Policy to Make Healthcare Affordable for Masses
The National Health Mission (NHM), India’s flagship health sector programme
with an allocation of Rs 26,690 crores for 2017-18, is gradually revitalising
rural and urban health sectors by providing flexible finances to State
governments.
The mission has SIX components —
•the National Rural Health Mission,
•the National Urban Health Mission,
•tertiary care programmes
•human resources for health and medical education.
•Mission Indradhanush, which improved immunisation coverage by over 5 per
cent in the just one year.
•Kayakalp initiative, which was launched in 2016 to inculcate the practice of
hygiene, sanitation, effective waste management and infection control in
public health facilities.
Difference between a hospital and a health centre
Hospital
1. Hospital provides only
curative services.
2. Hospital has no catchment
area.
3. The hospital team consist of
only curative staff.
Health center
Health centre provides preventive,
promotive and curative- integrated
services.
Health centre is responsible for a
definite area.
The health team of a centre has an
optimal mix of medical and paramedical
workers.
With beginning of health planning in India and first five year plan
formulation (1951-1955) Community Development Programme was
launched in 1952.

It was envisaged as a multipurpose program covering health and

sanitation through establishment of primary health centers (PHCs) and
subcenters.
By the close of second five year plan (1956-1961) Health Survey and
Planning Committee (Mudaliar Committee) was appointed by
Government of India to review the progress made in health sector after
submission of Bhore Committee report.

The major recommendations of this committee report was to limit the

population served by the PHCs with the improvement in the quality of
the services provided and provision of one basic health worker per
10,000 population.
The Jungalwalla Committee in 1967 gave importance to integration of
health services. The committee recommended the integration from the
highest to lowest level in services, organization, and personnel.

The Kartar Singh Committee on multipurpose workers in 1973 laid

down the norms about health workers.
Srivastava Committee (1975) suggested creation of bands of para-

professionals and semi-professional worker from within the community

like school teachers and post masters.

It also recommended the development of referral complex by

establishing linkage between PHCs and high level referral and service

centers.
Background:

The Health Survey and Development Committee, commonly

referred to as the Bhore Committee Report, 1946, has been a
landmark report for India, from which the current health policy and
systems have evolved.

The recommendation for three-tiered health-care system to

provide preventive and curative health care in rural and urban
areas placing health workers on government payrolls and limiting
the need for private practitioners became the principles on which
the current public health-care systems were founded.
Alma-Ata Declaration, 1978
The Declaration of Alma-Ata was adopted at the International Conference on
Primary Health Care (PHC), Almaty (formerly Alma-Ata), Kazakhstan
(formerly Kazakh Soviet Socialist Republic), 6–12 September 1978.

International conference on primary health care. The Alma-Ata

Declaration of 1978 emerged as a major milestone of the twentieth century in
the field of public health, and it identified primary health care as the key to the
attainment of the goal of Health for All.
http://www.who.int/social_determinants/tools/multimedia/alma_ata/en/
Indian Public Health System. Reprinted with permission from National Rural Health Mission, Ministry of Health and Family Welfare,
Government of India. (source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5144115/)
Sub-centers:
A sub-center (SC) is established -
1)in a plain area with a population of 5000 people
2)in hilly/difficult to reach/tribal areas with a population of 3000

Purpose -
It is the most peripheral and first contact point between the primary
health-care system and the community.

Staffing -
Each SC is required to be staffed by at least one auxiliary nurse midwife
(ANM)/female health worker and one male health worker
Sub-centers contd. :

Functions -
SCs are assigned tasks relating to interpersonal communication in order
to bring about behavioral change and provide services in relation to
1.maternal and child health
2.family welfare
3.nutrition
4.immunization
5.diarrhea control
6.control of communicable diseases programs
Primary health centers :
A primary health center (PHC) is established –

1.in a plain area with a population of 30 000 people.

2.in hilly/difficult to reach/tribal areas with a population of 20 000.

Purpose:
It is the first contact point between the village community and the medical
officer.
Primary Health Center (contd.)

Staffing:
PHC is to be staffed by a medical officer supported by 14 paramedical and other
staff. Under NRHM, there is a provision for two additional staff nurses at PHCs
on a contract basis.

Function:
It acts as a referral unit for 5-6 SCs and has 4-6 beds for in-patients.
The activities of PHCs involve health-care promotion and curative services.
Attributes of Primary Health Care – ( courtesy - AH Suryakantha)
Adaptable practically

Acceptable Affordable
Culturally Economically

Acceptable
Universally
Applicable
Scientifically
Community Health Centre (CHC):

Established by upgrading PHC’s

• One CHC covers a population of 80,000 to 1.20 lakhs

– 30 beds

– X – ray facility

– Laboratory facilities
Community Health Centre (CHC): (Staffing)

• Clinical manpower:

General Surgeon 1

Physician 1

Obstetrician / Gynaecologist 1

Paediatrician 1
Community Health Centre (CHC): (Staffing) contd.
• Support manpower:
Nurse – Midwife 7 + 2 (one ANM and one PHN under NRHM)
Dresser (certified by Red Cross/ St. Johns ambulance) 1
Pharmacist 1
Lab technician 1
Radiographer 1
Ophthalmic assistant 0 – 1 (can be employed on contractual basis)
Ward boy/ nursing orderly 2
Sweepers 3
Chowkidar
OPD attendant
Statistical assistant/ Data entry operator 5
OT attendant
Registration clerk
Total essential 21 – 22 +
2
The Anganwadi Workers of India :
Reaching out to a population of 70 million
women, children and sick people, helping them
become and stay healthy.

They are the most important yet oft-ignored

essential link of Indian healthcare.
Anganwadi Worker (AWW)
• • Under I.C.D.S. Scheme (Integrated Child Development Scheme – Oct. 1975)
• One AWW for a population of 400 – 800
• Appx 100 AWW in each ICDS project
• AWW is selected from the community which she is to serve
– Trained for 4 months
– In various aspects of:
• Health
• Nutrition and
• Child development
– Honorarium of 1500 per month
AWW (contd.)
• Services include:
- Health check up
– Growth chart monitoring
– Immunization
– Supplementary nutrition
– Health education
– Non formal pre school education
– Referral
AWW (contd.)
Beneficiaries:

• Nursing mother
• Pregnant women
• Women in reproductive age
• Children below 6 yr. of age
• Adolescent girls
Accredited Social Health Activist (ASHA):

• Cadre created under NRHM

• Must be a woman
– Resident of the village
–unmarried/ Married/ widow/ divorced
– Preferred age group 25 to 45 yr.
– Formal education up to VIII std.
– Good communication skills
– Leadership qualities
 Contd.

India has also deployed nearly 100,00,00 Accredited Social Health

Care (ASHA) workers, who are playing a transformational role in the
change happening in Indian healthcare system.

They act as mobilisers for institutional deliveries, focus on integrated

management of neonatal and childhood illness and advise on home
based neo-natal care.
ASHA (contd.)

Will receive performance-based incentives for

– promoting universal immunization,

– referral and escort services for Reproductive & Child Health (RCH)

and other health programmes.

– Construction of household toilets.

ASHA (contd.)

• Norm of selection is 1 ASHA for 1000 population

– Relaxed in hilly/tribal/desert areas to: 1 ASHA per habitation
– Works in liaison with:
– Women's committees (like self-help groups or women's health
committees),
– village Health & Sanitation Committee of the Gram Panchayat,
– ANMs (Auxiliary Nurse Midwifes) and
– Anganwadi workers
Village Health Guide (VHG):
The scheme was introduced on 2nd October, 1977 (under Rural Health
Scheme)

• The scheme was not launched in states which already had alternative
systems
– Kerala
– Karnataka
– Tamil Nadu
– Arunachal Pradesh
– Jammu and Kashmir
VHG ( contd.)
• The VHG were mostly women and the GOI decided to replace all male VHG’s
with women VHG
• The VHG was chosen by the community in which they were to work
• The guidelines for their selection were:
– Permanent member of the local community
– Should be able to read and write and min. education up to VI std.
– Should be acceptable to all sections of the community
– Should be able to spare at least 2 – 3 hours every day for community health
work
VHG ( contd.)

• After selection, short training in primary health care for 200 hours and
stipend of ₹ 200 per month during training
• After completion of training they receive:
– Working manual
– Kit of simple medicines
• (both modern and traditional medicine system in vogue locally)
Duties assigned to health guides:

– Treatment of simple ailments, and REFER in time if required

– First aid
– Mother and child health
– Family planning
– Health education and
– Sanitation
 AYUSH

The Ministry of AYUSH was formed on 9th November 2014 to ensure

the optimal development and propagation of AYUSH systems of health
care.
•Earlier it was known as the Department of Indian System of Medicine
and Homeopathy (ISM&H) which was created in March 1995.
•Renamed as Department of Ayurveda, Yoga and Naturopathy, Unani,
Siddha and Homoeopathy (AYUSH) in November 2003, with focused
attention for development of Education and Research in Ayurveda,
Yoga and Naturopathy, Unani, Siddha and Homoeopathy.
 Ayurveda: Types of Treatment -

• The treatment of disease can broadly be classified as:

• Shodhana therapy (Purification Treatment)
• Shamana therapy (Palliative Treatment)
• Pathya Vyavastha (Prescription of diet and activity)
• Nidan Parivarjan (Avoidance of disease causing and aggravating factors)
• Satvavajaya (Psychotherapy)
• Rasayana therapy (use of immuno-modulators and rejuvenation medicines)
 YOGA:
The concepts and practices of Yoga originated in India about several
thousand years ago. Its founders were great Saints and Sages.

The great Yogis presented rational interpretation of their experiences of Yoga

and brought about a practical and scientifically sound method within every
one’s reach.

Yoga today, is no longer restricted to hermits, saints, and sages; it has

entered into our everyday lives and has aroused a worldwide awakening and
acceptance in the last few decades.
Naturopathy:

Naturopathy is an art and science of healthy living and a

drugless system of healing based on well founded philosophy.

It has its own concept of health and disease and also

principle of treatment. Naturopathy is a very old science.

We can find a number of references in our Vedas and other

ancient texts.
 Unani:
The Unani System of Medicine has a long and impressive record in India. It was
introduced in India by the Arabs and Persians sometime around the eleventh century.

Today, India is one of the leading countries in so for as the practice of Unani medicine is
concerned. It has the largest number of Unani educational, research and health care
institutions.

Unani system originated in Greece. The foundation of Unani system was laid by
Hippocrates, and the Arabs imbibed the knowledge.
Siddha :
Siddha medicine, traditional system of healing that originated in
South India and is considered to be one of India’s oldest systems
of medicine. The Siddha system is based on a combination of ancient
medicinal practices and spiritual disciplines as well
as alchemy and mysticism. It is thought to have developed during
the Indus civilization, which flourished between 2500 and 1700 BCE.
According to this theory, it came to South India when the Dravidian people
(speakers of Dravidian languages), who may have been the original
inhabitants of the Indus valley, migrated southwards.
Siddha:

Siddha system is one of the oldest systems of medicine in India . The

term Siddha means achievements and Siddhars were saintly persons
who achieved results in medicine.

Eighteen Siddhars were said to have contributed towards the

development of this medical system. Siddha literature is in Tamil and it
is practiced largely in Tamil speaking part of India and abroad.

The Siddha System is largely therapeutic in nature.

Homeopathy:

Homoeopathy today is a rapidly growing system and is being practiced

almost all over the world. In India it has become a household name due
the safety of its pills and gentleness of its cure.

A rough study states that about 10% of the Indian population solely
depend Homoeopathy for their Health care needs and is considered as
the Second most popular system of medicine in the Country.