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Health care delivery system Health care delivery system Presentation Transcript

  • HEALTH CAREDELIVERYSYSTEMwww.drjayeshpatidar.blogspot.com
  • HEALTH CARE DELIVERY SYSTEMIntroduction:India is a union of 28 states and 7 union territories.States are largely independent in matters relating to thedelivery of health care to the people. Each state hasdeveloped its own system of health caredelivery, independent of the Central Government. TheCentral Government responsibility consists mainly ofpolicy making, planning, guiding, assisting, evaluatingand coordinating the work of the State Health Ministries.The health system in India has 3 main links1. Central2. State and3. Local or peripheralwww.drjayeshpatidar.blogspot.in
  • At the central• The official “organs” of the health system at thenational 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 Welfarewww.drjayeshpatidar.blogspot.in View slide
  • Union Ministry of Health and FamilyWelfare.Organization PatternCabinet Minister↓Department of Health Department of Family Welfare↓ ↓Joint Secretary Additional Secretary↓ ↓Deputy Secretary Commissioner↓ ↓Administrative staff Joint Secretary↓Administrative staffwww.drjayeshpatidar.blogspot.in View slide
  • Functions: Ministry of Health and Family Welfare.Union list1. International health relations and administration of portquarantine2. Administration of Central Institutes such as All IndiaInstitute of Hygiene and Public Health, Kolkata.3. Promotion of research through research centers4. Regulation and development ofmedical, pharmaceutical, dental and nursing Professions5. Establishment and maintenance of drug standards6. Census and collection and publication of other statisticaldata7. Immigration and emigration8.Regulation of labor in the working of mines and oil fields9. Coordination with states and with other ministries forpromotion of health www.drjayeshpatidar.blogspot.in
  • • Concurrent listThe functions listed under the concurrent list are the responsibilityof both the union and state governments.1. Prevention and extension of communicable diseases2. Prevention of adulteration of food stuffs3. Control of drugs and poisons4. Vital statistics5. Labor welfare6. Ports other than major7. Economic and social planning8. Population control and Family Planning9. Preparation of health education material for creating healthawareness through Central Health Education Bureau.10. Collection, compilation, analysis, evaluation an dissemination ofinformation through the Central Bureau of Health Intelligence11. National Medical Librarywww.drjayeshpatidar.blogspot.in
  • Directorate General of Health ServicesOrganization PatternDirectorate General of health services↓Director General of health services↓Additional Director General of health service↓Deputy Directorate General of health services↓Administrative staffwww.drjayeshpatidar.blogspot.in
  • FUNCTIONS OF D.G.H.S1. International health relations and quarantine of all majorports in country and International airport2. Control of drug standards3. Maintain medical store depots4. Administration of post graduate training programmes5. Administration of certain medical colleges in India6. Conducting medical research through Indian Council ofMedical Research7. Central Government Health Schemes.8. Implementation of national health programmes9. Preparation of health education material for creating healthawareness through Central Health Education Bureau.10. Collection, compilation, analysis, evaluation anddissemination of information through the Central Bureau ofHealth Intelligence11. National Medical Librarywww.drjayeshpatidar.blogspot.in
  • Central Council of HealthOrganization PatternChairman(Union health Minister)↓Members(State health Minister)www.drjayeshpatidar.blogspot.in
  • Functions Of Central Council Of Health1. To consider and recommend broad outlines ofpolicy regard to matters concerning health likeenvironment hygiene, nutrition and healtheducation.2. To make proposals for legislation relating tomedical and public health matters.3. To make recommendations to the centralgovernment regarding distribution of grants-in-aid.www.drjayeshpatidar.blogspot.in
  • AT THE STATE LEVELOrganization Pattern(1) State Ministry of Health & family welfare↓Deputy Minister of Health and Family Welfare↓Health Secretary↓Deputy Secretaries↓Administrative staffwww.drjayeshpatidar.blogspot.in
  • •(2) State Director of health↓Director of Medical Education Director of Health Services↓ ↓Dean of medical college Additional Director of Health Services↓ ↓State nursing superintendent Deputy Director of Health Services↓ ↓Hospital Education Regional Function↓ ↓ ↓ ↓Nsg Superintendent Nsg Officer MCH, TB, Leprosy, Immunization↓ ↓Ward Incharge Senior tutor↓ ↓Nsg Staff Junior tutorwww.drjayeshpatidar.blogspot.in
  • Functions of state health Director:(1) Studies in depth the health problem and needs in the state andplans scheme to Solve them.(2) Providing curative &preventive services.(3) Provision for control of milk and food sanitation.(4) Prevention of any outbreak of communicable diseases.(5) Promotion of health education(6) Promotion of health programmes such as school health, familyplanning, occupational health(7) Supervision of PHC(8) Establishing training courses for health personnel(9) Co-ordination of all health services with other minister of statesuch as minister of education, central health minister&voluntary agencywww.drjayeshpatidar.blogspot.in
  • At the district levelThere are 593 ( year 2001 ) districts in India.Within each district, there are 6 types ofadministrative areas.1. Sub –division2. Tehsils( Talukas )3. Community Development Blocks4. Municipalities and Corporations5. Villages and6. Panchayatswww.drjayeshpatidar.blogspot.in
  • Ø Most district in India are divided into two ormore subdivision, each incharge of an AssistantCollector or Sub CollectorØ Each division is again divided intotalukas, incharge of a tahsildhar. A talukausually comprises between 200 to 600 villagesØ The community development block comprisesapproximately 100 villages and about 80000 to1,20,000 population, in charge of a BlockDevelopment Officer.Ø Finally, there are the village panchayats, whichare institutions of rural local self-government.www.drjayeshpatidar.blogspot.in
  • The urban areas of the district are organized intoØ Town Area Committees (in areas withpopulation ranging between 5,000 to10,000Ø Municipal Boards (in areas with populationranging between 10,000 and 2,00,000)Ø Corporations (with population above 2,00,000)Ø The Town Area Committees are like panchayats.They provide sanitary services.Ø The Municipal Boards are headed by Chairmen/President, elected by members.www.drjayeshpatidar.blogspot.in
  • The functions of Municipal Board:Ø Construction and maintenance of roadsØ Sanitation and drainageØ Street lightingØ Water supplyØ Maintenance of hospitals and dispensariesØ Education andØ Registration of births and deaths etcwww.drjayeshpatidar.blogspot.in
  • Panchayat Raj -The panchayat raj is a 3-tier structure of rurallocal self-government in India linking the villageto the district.It includesØ Panchayat (at the village level)Ø Panchayat Samiti( at the block level)Ø Zila Parishad(at the district levelwww.drjayeshpatidar.blogspot.in
  • Panchayat (at the village level):The Panchayat Raj at the village level consists ofØ The Gram SabhaØ The Gram PanchayatThe Gram Sabha:It is the assembly of all the adults of the village, whichmeets at least twice a year.The gram sabha considersproposals for taxation,and elect members of TheGram Panchayat.www.drjayeshpatidar.blogspot.in
  • The Gram Panchayat• It is the executive organ of the gram sabha and anagency for planning and development at thevillage level. The population covered varies from5000 to 15000 or more. The members ofpanchayat hold offices for a period of 3to4 years.Every panchayat has an elected president(Sarpanch or Sabhapati or Mukhia), a vicepresident and panchayat secretary. It covers thecivic administration including sanitation andpublic health and work for the social andeconomic development of the villagewww.drjayeshpatidar.blogspot.in
  • Panchayat Samiti (at the block level):• The block consists of about 100 villages and apopulation of about 80,000 to 1,20,000. Thepanchayat samiti consists ofSarpanch, MLAs, MPs residing in blockarea, representative of women, SC, ST andcooperative societies. The primary function ofThe Panchayat Samiti is the execute thecommunity development programme in theblock. The Block development Officer and hisstaff give technical assistance and guidance indevelopment work.www.drjayeshpatidar.blogspot.in
  • Zila Parishad (at the district level):• The Zila Parishad is the agency of rural local selfgovernment at the district level . The membersof Zila parishad include all heads of panchayatsamiti in the district,MPs, MLAs, representativeof SC, ST and women and 2 persons ofexperience in administration, public life or ruraldevelopment. Its functions and powers varyfrom state to state.www.drjayeshpatidar.blogspot.in
  • Health care system:(1) At village level(2) At sub center level(3) At PHC level(4) At CHC levelwww.drjayeshpatidar.blogspot.in
  • At village level:• At the village level, elementary services arerendered by(a) Village health guides(b) Local dais(c) Anganwadi workers(d) ASHAwww.drjayeshpatidar.blogspot.in
  • Village health guides:• Village health guide is a person with anaptitude for social service and is not full timegovt. functionary. Village health guides schemewas introduced on 2nd oct. 1977.www.drjayeshpatidar.blogspot.in
  • Guidelines for their selection:(1) They should be permanent resident of the localcommunity, preferably women(2) They should be able to read and write, having minimumformal education at least up to the VI std.(3) They should be acceptable to all sections of community(4) They should be able spare at least 2 to 3 hours every dayfor community health work.After selection the health guide undergo a shorttraining in primary health care. The training is arranged inthe nearest PHC, subcenter or other suitable place for theduration of 200 hours, spread over a period of 3 months.During the training period they receive a stipend of Rs.200 per month.www.drjayeshpatidar.blogspot.in
  • Functions of Village health guides:(1) Provide treatment for common minorailments(2) First aid during accidents and emergency(3) MCH care(4) Family planning(5) Health educationwww.drjayeshpatidar.blogspot.in
  • Local dais:• Most deliveries in rural areas are handled byuntrained dais. The training for dais given for 30working days. Each dai is paid stipend of Rs. 300during the training period. The training is given atPHC,subcenters or MCH center for 2 days in a weekand on the remaining four days of the week theyaccompany the health worker(female) to the village.During her training each dai is required to conductat least 2 deliveries under the supervision andguidance of health worker (female), ANM,healthassistant (female).www.drjayeshpatidar.blogspot.in
  • Functions of dais:(1) MCH care(2) Family planning(3) Immunization(4) Education about health(5) Referral services(6) Safe water and basic sanitation(7) Nutritionwww.drjayeshpatidar.blogspot.in
  • Anganwadi worker:• Under the ICDS scheme there is an anganwadiworker for a population of 1000.There are about100 such workers in each ICDS project. Theanganwadi worker is selected from thecommunity and she undergoes training invarious aspect of health, nutrition and childdevelopment for 4 months. She is a part timeworker and paid an honorarium of Rs.200-250per month for the services.www.drjayeshpatidar.blogspot.in
  • Functions of anganwadi worker(1) MCH care(2) Family planning(3) Immunization(4) Education about health(5) Referral services(6) Safe water and basic sanitation(7) Supplementary nutrition(8) Nonformal education of childrenwww.drjayeshpatidar.blogspot.in
  • Accredited Social Health Activist(ASHA)• One of the key components of the National RuralHealth Mission is to provide every village in thecountry with a trained female community healthactivist – ‘ASHA’ or Accredited Social HealthActivist. Selected from the village itself andaccountable to it, the ASHA will be trained towork as an interface between the community andthe public health system. Following are the keycomponents of ASHAwww.drjayeshpatidar.blogspot.in
  • SELECTION OF ASHA• The general norm will be ‘One ASHA per 1000population’. In tribal, hilly, desert areas the normcould be relaxed to one ASHA perhabitation, dependant on workload etc.• The States will also need to work out the district andblock-wise coverage/phasing for selection of ASHAs.• It is envisaged that the selection and training processof ASHA will be given due attention by the concernedState to ensure that at least 40 percent of the ASHAsin the State are selected and given induction trainingin the first year as per the norms given in theguidelines. Rest of the ASHAs can subsequently beselected and trained during second and third year.www.drjayeshpatidar.blogspot.in
  • Criteria for Selection• ASHA must be primarily a woman resident of thevillage ‘Married/Widow/Divorced’ andpreferably in the age group of 25 to 45 yrs.• ASHA should have effective communicationskills, leadership qualities and be able to reachout to the community. She should be a literatewoman with formal education up to EighthClass.www.drjayeshpatidar.blogspot.in
  • Roles and responsibilities of ASHA:• provide information to the community ondeterminants of health such as nutrition, basicsanitation & hygienic practices, healthy living.• She will counsel women on birthpreparedness, importance of safe delivery, breast-feeding and complementaryfeeding, immunization, contraception andprevention of common infections includingReproductive Tract Infection/Sexually TransmittedInfection (RTIs/STIs) and care of the young child.www.drjayeshpatidar.blogspot.in
  • • ASHA will mobilize the community and facilitatethem in accessing health and health relatedservices available at the village/sub-center/primary health centers, such asImmunization, Ante Natal Check-up (ANC), PostNatal Check-up (PNC), ICDS, sanitation and otherservices being provided by the government.• ASHA will provide primary medical care forminor ailments such as diarrhea, fevers, andfirst aid for minor injurieswww.drjayeshpatidar.blogspot.in
  • • She will also act as a depot holder for essentialprovisions being made available to everyhabitation like Oral Rehydration Therapy(ORS), Iron Folic Acid Tablet(IFA), chloroquine, Disposable Delivery Kits(DDK), Oral Pills & Condoms, etc.She will inform about the births and deaths inher village and any unusual healthproblems/disease outbreaks in the community tothe Sub-Centers/Primary Health Centre.• She will promote construction of householdtoilets under Total Sanitation Campaign.www.drjayeshpatidar.blogspot.in
  • Comparison of health care delivery system inRajasthan and Maharashtra:(1) Subcenter:Topics Maharashtra Rajasthan(1) Population covered(2) Functions5000 in general3000 in tribal & hillyareas(1) MCH care(2) Family planning(3) Immunization(4) Education about health(5) Referral services3600 in general2800 in tribal & hillyareas(1) MCH care(2) Family planning(3) Immunization(4) Education about health(5) Safe water and basicsanitation(6) Prevention and controlof locally endemicdiseaseswww.drjayeshpatidar.blogspot.in
  • Topics Maharashtra Rajasthan(3) StaffingpatternHealth worker female 1Health worker male 1Voluntary worker 1(paid Rs 100 per month asHonorarium)Health worker female 1Health worker male 1ANM 1www.drjayeshpatidar.blogspot.in
  • (2) Primary health center:TOPICS Maharashtra Rajasthan(1) Population covered(2) Functions30,000 rural population in plains20,000 population in hilly, tribal(1) MCH care(2) Family planning(3) Immunization(4) Education about health(5) Referral services(6) Safe water and basic sanitation(7) Prevention and control oflocally endemic diseases(8) Collection and reporting of vitalstatistics(9) National health programmes(10) Training of health guides, healthworkers, local dais and healthassistant(11) Basic laboratory services48000 population in plains30000 population in tribal and hilly(1) MCH care(2) Family planning(3) Immunization(4) Education about health(5) Referral services(6) Safe water and basic sanitation(7) Prevention and control oflocally endemic diseases(8) Collection and reporting Of vitalstatistics(9) National health programmes(10)Training of health guides, healthworkers, local dais and healthassistant(11)Basic laboratory serviceswww.drjayeshpatidar.blogspot.in
  • TOPICS Maharashtra Rajasthan(3) Staffing pattern Medical officer 2Pharmacist 1Nurse midwife 1Health worker female 1Block extension educator 1Health assistant (female) 1Health assistant male 1U.D.C 1L.D.C 1Driver 1Class IV 4Medical officer 1Pharmacist 1Nurse midwife 1Health worker female 1Health worker male 1Block extension educator 1Health assistant (female) 1Health assistant male 1U.D.C 1L.D.C 1Driver 1Class IV 2www.drjayeshpatidar.blogspot.in
  • (3) Community health center:TOPICS Maharashtra Rajasthan(1) Populationcovered(2) Bed capacity(3) Specialty80,000 to 1.20 lakhs30 BedsSurgery, medicine,obstetrics andgynecologist andpediatrics with X-rayand lab facilities.74,000 to 1.5 lakhs24 BedsSurgery, medicine,obstetrics andgynecologist andpediatrics with X-rayand lab facilities.www.drjayeshpatidar.blogspot.in
  • TOPICS MAHARASHTRA RAJASTHAN(1) Population covered(2) Bed capacity(3) Specialty(3) Functions80,000 to 1.20 lakhs30 BedsSurgery, medicine, obstetrics andgynecologist and pediatrics withX-ray and lab facilities.Care of routine andemergency cases in surgeryCare of routine andemergency cases in medicine24 hours delivery servicesincluding normal andassisted deliveriesEssential and emergencyobstetric care includingcaesarean sections andotherMedical interventions.74,000 to 1.5 lakhs24 BedsSurgery, medicine, obstetricsand gynecologist and pediatricswith X-ray and lab facilities.(1) MCH care(2) Family planning(3) Immunization(4) Education about health(5) Referral services(6) Safe water and basicsanitation(7) Prevention and control oflocally endemic diseaseswww.drjayeshpatidar.blogspot.in
  • TOPICS MAHARASHTRA RAJASTHAN• Full range of family planning servicesincluding laparoscopic services• Safe abortion service Newborn care• Routine and emergency care ofchildren• Other management including Nasalpacking,tracheostomy,foreign bodyremoval(10) All national healthprogrammes delivered throughCHCOther services(a) Blood storagefacility(b) Essential lab.Services(c ) Referral(transport) services(8) Collection and report in ofvital statistics(9) 24 hours delivery servicesincluding normal and assisteddeliveries(10) Essential and emergencyobstetric care includingcaesarean sections and otherMedical interventions.(11) Full range of family planningservices including laparoscopicservices(12) Safe abortion service(13) Newborn care(14) Routine and emergency careof children’s.(15) ) All national healthprogrammes delivered throughCHCwww.drjayeshpatidar.blogspot.in
  • TOPICS MAHARASHTRA RAJASTHAN(4) Staffing pattern Existing clinical manpowerGeneral surgeon 1Physician 1Obstetrics/ gynecologist 1Pediatrician 1Proposed clinical man powerAnesthetics 1Eye surgeon 1Public health programme 1managerExisting clinical manpowerGeneral surgeon 1Physician 1Obstetrics/ gynecologist 1Pediatrician 1Proposed clinical man powerAnesthetic 1Public health programme 1managerwww.drjayeshpatidar.blogspot.in
  • TOPICS MAHARASHTRA RAJASTHANExisting support manpowerNurse midwife 9Dresser 1Pharmacist 1Lab. Technician 1Radiographer 1Ophthalmic 1Ward boy 2Sweeper 3Chowkidar 1OPD attendant 1Statistical assistant 1OT attendant 1Registration clerk 1Existing support manpowerNurse midwife 12Dresser 1Pharmacist 2Lab. Technician 1Radiographer 1Ophthalmic 1Ward boy 2Sweeper 3Chowkidar 2OPD attendant 1Statistical assistant 1OT attendant 1Registration clerk 2www.drjayeshpatidar.blogspot.in
  • (1) Medical officer:• He is the captain of the health team at the primaryhealth center.• He devotes the morning hours attending to patientsin the outdoor,in the afternoon and supervises thefield work.• He visits each subcenter regularly on fixed days andhours and provides guidance, supervision andleadership to the health team.• He spends one day in each month organizing staffmeetings at PHC to discuss the problems and reviewthe progress of health activities.Job description of the members of the health team:www.drjayeshpatidar.blogspot.in
  • • He ensures that national health programmes arebeing implemented in in his area properly.• The success of PHC depends largely on the teamleadership which the medical officer is able toprovide.• The medical officer must be a planner, thepromoter, the director, the supervisor, thecoordinator as well as the evaluator.www.drjayeshpatidar.blogspot.in
  • Health worker female:• She will register pregnant women from three monthsof pregnancies onwards.• Maintain maternity record, register of antenatal cases,eligible couple register, children register up to date.• She will provide care to pregnant women especiallyregistered mother throughout the period of pregnancy;• Give advice on nutrition to expectant and nursingmothers about storage, preparation and distribution offood.• Immunize pregnant mothers with tetanus toxoid.• Conduct about 50% of total deliveries at home.• Supervise deliveries conducted by Dais and whenevercall in.www.drjayeshpatidar.blogspot.in
  • • Spread the message of family planning to the couples;motivate them for family planning individually and ingroups.• Distribute conventional contraceptives to the couples.• Assess the growth and development of the infant andtake necessary action.• Records and reports births and deaths in her area.• Test urine for albumin and sugar and do Hb during herhome visit.• Arrange and help M.O and health assistant inconducting MCH and family planning clinics at subcenters.• Maintain the cleanliness of subcenter.• Attend staff meetings at PHC, CD block or both.www.drjayeshpatidar.blogspot.in
  • Health worker male:• He will survey all the families in his area and collectall the information about each village/ locality in hisarea.• Identify the cases of communicable diseases andnotify the health assistant male and M.O PHCimmediately.• Educate the community about importance ofcontrol and preventive measures againstcommunicable diseases.• Assist the village health guide in undertaking theactivities under TB programme properly.www.drjayeshpatidar.blogspot.in
  • • Educate community on the method of liquid and solidwaste, home sanitation, advantage and use of sanitarylatrines.• Assist the health assistant male in the school healthprogramme.• Utilize the information from the eligible couple andchild register for the family planning programme.• Spread the message of family planning to the couples;motivate them for family planning individually and ingroups.• Distribute conventional contraceptives to the couples.• Provide follow-up services to male family planningacceptors. www.drjayeshpatidar.blogspot.in
  • Health assistant female:• Supervise and guide the health workers in thedelivery of health care services to the community.• Carry out supervisory home visiting.• Guide the health workers (female) in Distributionof conventional contraceptives to the couples.Visit each of the 4 subcenters at least once in aweek on fixed days.• Respond to urgent calls from the health workersand trained dais and render necessary help.www.drjayeshpatidar.blogspot.in
  • • Organize and utilize the mahila mandal, teachersetc., in the family welfare programme.• Provide information on the availability of servicesfor MTPs and refer suitable cases to the approvedinstitution.• Supervise the immunization of all pregnant womenand children (0-5 years)• Collect and compile the weekly reports of birthsand deaths occurring in his area.• Educate the community regarding the need ofregistration of vital events.www.drjayeshpatidar.blogspot.in
  • Health assistant male:• Supervise the work of Health worker male duringconcurrent visit.• Check minimum 10% of houses in village.• Supervise the spraying of insecticides during localspraying along with the health worker (male).• Conduct immunization of all school going children withthe help of health worker (male).• Supervise the immunization of all children’s (0-5 years).• Assist M.O.PHC in organization of family planningcamps and drives. .• Provide information on the availability of services forMTPs and refer suitable cases to the approvedinstitution.www.drjayeshpatidar.blogspot.in
  • • Ensures follow-up of all cases of vasectomy, tubectomyIUD and other family planning acceptors.• Ensure that all the cases of malnutrition infants andyoung childrens (0-5years) are given the necessarytreatment and advice and refer serious cases to PHC.• Ensure that Iron and folic acid and Vitamin A aredistributed to the beneficiaries. Conduct MCH andfamily planning clinics and carry out educationalactivities.• Organize and conduct training for dais women leaderswith the help of health workers• Collect and compile the weekly reports of births anddeaths occurring in his area.• Educate the community regarding the need ofregistration of vital events.• www.drjayeshpatidar.blogspot.in
  • Thank youwww.drjayeshpatidar.blogspot.in