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Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
Health care Delivery system
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Health care Delivery system
Health care Delivery system
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Health care Delivery system
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Health care Delivery system
Health care Delivery system
Health care Delivery system
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Health care Delivery system

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community health nursing …

community health nursing
M.Sc. NURSING 1ST YEAR

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  1. HEALTH CARE DELIVERY SYSTEM IN INDIA Mr. PRAMOD MODERATOR NITU LECTURER YEAR CON 403/13 KS PRESENTOR M.SC. (N) 1st
  2. INTRODUCTION  INDIA is union of 28 states & 7 union terrorties   Older concept – Health care means patient care Objective - freedom from the disease through hospital system.
  3. DEFINITION  WHO – ―As an integrated care containing promotive, preventive and curative elements that bear the longitudinal association with an individual, extending from womb to tomb, and continuing in the state of health as well as disease.‖
  4. EVOLUTION OF HEALTH CARE SERVICES IN INDIA Christian Era – civilization started in Indus Valley Rahula Sankirtyana – developed hospital system Environmental sanitation, hou ses with drainage Post Vedic – teaching of Buddhism and Jainism 1400 B.C. – Ayurveda and Siddha system Developed a comprehensive concept of health
  5. STILL…66 YRS. OF HEALTH SERVICES Crude Death Rate ↓ Crude birth rate ↓ Life expectancy ↑ S.pox & G. worm Eradicated Leprosy Eliminated IMR ↓ Infrastructure – Expanded Polio Eradicated
  6. ROLE OF DIFFERENT COMMITTEES  1946 – BHORE COMMITTEE (HEALTH SURVEY AND DEVELOPMENT COMMITTEE) Integration of preventive and curative services  Development of PHC  3 months training in PSM   1962 – MUDALIAR COMMITTEE (HEALTH SURVEY AND PLANNING COMMITTEE) Strengthening of PHC and district hospital  Regional organization 
  7. CONT…  1973 – KARTAR SINGH  Committee on multipurpose worker  ANM replaced by female health worker  Basic health worker replaced by male health worker  Lady health worker designated as female health supervisor.
  8. PROBLEMS INDIRECTLY RELATED TO HEALTH Environment Education Empowerment DIRECTLY RELATED TO HEALTH Diseases Communicable Non Communicable New emerging Fertility Population Growth rate Total Fertility Nutrition Malnutrition Obesity
  9. MODEL OF HEALTH CARE SYSTEM INPUTS HEALTH CARE HEALTH CARE SERVICES SYSTEM OUTPUTS Health Status or Health Problems Curative Preventive Promotive Resources Public Private Voluntary Indigenous Changes in Health Status
  10. HEALTH DEMANDS & NEEDS OF THE COMMUNITY COMPREHENSIVE & COMMUNITY BASED CARE CONSTITUTES MANAGEMENT SECTOR & INVOLVES ORGANIZATION IMPROVED HEALTH STATUS EXPRESSED IN TERMS OF LIVES,SAVES, DEATH A VERTED, DISEASES PREVENTED, LIFE EXPECTENCY INCREASED
  11. HEALTH ORGANISATION IN INDIA
  12. AT THE CENTRE LEVEL MINISTRY OF HEALTH AND FAMILY WELFARE DIRECTORATE GENERAL OF HEALTH SERVICES CENTRAL COUNCIL OF HEALTH AND FAMILY WELFARE
  13. A. THE UNION MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEATLH SECRETARY DEPARTMENT OF FAMILY WELFARE SECRETARY JT. SECRETARY JT. SECRETARY DY. SECRETARY DY. SECRETARY ADMN. STAFF OFFICE STAFF
  14. CENTRAL LIST International Health,  Port Health Research  Technical & Scientific Education 
  15. FUNCTIONS
  16. CONT… Establishment of drug standards Census and collection & publication of other statistical data Coordination with other states for promotion of health Regulating labor in mines and oil mines Immigration & emigration
  17. 2. CONCURRENT LIST
  18. B. DIRECTORATE GENERAL OF HEALTH SERVICES (DGHS) Principal Adviser To Union Government Additional Director Of Health Services Team Of Deputies Administrative Staff
  19. ORGANIZATION Deputy DGHS DGHS Additional DGHS (Medical care) Office Staff Deputy DGHS (Public health) Office Staff Deputy DGHS (Gen. Administ rator) Office Staff
  20. FUNCTIONS OF DIRECTORATE GENERAL OF HEALTH GENERAL FUNCTIONS SPECIFIC FUNCTIONS Surveys Planning Coordination Programming Appraisal of all health matters International Health relations Control of drug standards Medical store depots Postgraduate training Medical education Medical research CGHS, NHP, CHEB etc.
  21. C. THE CENTRAL COUNCIL OF HEALTH AND FAMILY WELFARE The central council of health was set up by the presidential order on 9th August 1952 under article 263 of the constitution of India for promoting coordinated and concerted action between the center and the state for the implementation of all the programmes and measures pirating to the health of the nation. Chairman The Union Health Minister Members The State Health Minister
  22. FUNCTION OF CENTRAL COUNCIL OF HEALTH AND FAMILY WELFARE 1. To consider and recommend broad outlines of policy in regard to matters of health such as, Provision of remedial and preventive care. Environment Hygiene. Nutrition. Health education and Promotion of facilities for training and research.
  23. Cont.. 2. To make proposals for legislation in fields of medical and public health matters and to lay down. 3. To make recommendations to the central government regarding the health. 4. To established any organization with appropriate functions for promoting and maintain cooperation between central and state health administrations
  24. MILE STONES NRHM-2005 NHP-2002 NPP-2000 RCH-1996 UIP-1985 NHP-1983 Alma Ata-1978 (HFA) Juggling Priorities Small pox eradicated-July 5, 1975 NFPP-1952 India Joins WHO-1948 HSDC-1946
  25. STATE LEVEL OF HEALTH CARE
  26. THE STATE LIST  The government of India act, 1935 gave further autonomy to the states. The health subjects were divided into three lists under the 7th schedule of the India constitution. They are: 1 The Union List 2 The State List 3 The Concurrent List
  27. FUNCTIONS UNDER STATE LIST Public health sanitations , hospitals and dispensaries. Local government, i.e. the constitutions and powers of municipal corporations, district boards. Intoxicating liquors that is production, manufacture, possession, transport, pu rchase and sale of intoxicating liquors.
  28. Cont…. Relief of the disabled and unemployable. Burials and burial grounds, cremation grounds. Markets and fairs.
  29. AT THE STATE LEVEL • STATE MINISTRY OF HEALTH • STATE HEALTH DIRECTORATE
  30. ORGANIZATION
  31. STATE MINISTRY OF HEALTH AND FAMILY WELFARE HEADED - Cabinet minister and deputy minister. (Political head) RESPONSIBILITY - formulating policies Monitoring the implementation of these policies and programmes Coordination with government of India and other state government.
  32. STATE HEALTH DIRECTORATE AND FAMILY WELFARE  Principle advisor in matters relating to medicine and public health  Assisted by joint director, regional joint director and assistant directors.
  33. AT THE DISTRICT LEVEL The principal unit of administration in India is the district under a collector. There are 597 districts in India. Districts are known as “ZILA”
  34. DISTRICT HEALTH ORGANIZATION Identifies and provide the needs of expanding rural health and family welfare programme Within each district again, there are 6 types of administrative areas No uniform model of district health organization
  35. ORGANIZATION District Sub-division Rural Urban Community Development Blocks Tahsil (Taluka) Corporations Municipal Boards Villages Panchayats Town Area Committees
  36. PANCHAYATI RAJ 3 tier structure of rural local self government Linking the village to the district
  37. 3- TIER SYSTEM PANCHAYAT RAJ PANCHAYAT ( AT VILLAGE LEVEL) PANCHAYAT SAMITI ZILLA PARISHAD (AT (AT BLOCK LEVEL) DISTRICT LEVEL) GRAM SABHA GRAM PANCHAYAT NYAYA PANCHAYAT
  38. THE GRAM SABHA  It is comprised of all the adult men and women of the village. This body meets at least twice in a year and discuss important issues. They elect members of panchayat.
  39. THE GRAM PANCHAYAT  consists of 15-30 elected members  covers the population of 5000 to 20000.  chaired by the president i.e. sarpanch/ mukhya/ sabhapati.  There is a vice- president and a secretary.  Responsible for overall planning and development of the villages.  The panchayat secretary has been given powers to functions for wide areas such as maintenance of sanitation and public health, socio-economic development of the villages etc.
  40. THE NYAYA PANCHAYAT  It is comprised of 5 members from the panchayat.  It tries to solve the dispute between two parties/ groups/ individuals over certain matters on mutual consent.
  41. AT THE BLOCK LEVEL  Is known as Panchayat samiti.  Members of panchayat samiti are: o Sarpanches from all the gram panchayats in the block o MLAs and MPs residing in the area representative of women, schedule castes, schedule tribes and cooperative societies.
  42. AT THE DISTRICT LEVEL  The panchayati raj institution at the district level is known as ZILA PARISHAD.  Is headed by the chairman also known as adhikashak.
  43. CONT…. It includes the following members:  The heads of all the gram samities in the district, MLA and MPs from the district,  Representatives of women, SC/ST, 2 persons who have experience in administration, rural development officer etc.
  44. HEALTH CARE DELIVERY SYSTEM IN INDIA At the block level  Objective - to provide primary health care to all the sections of the society.  80% of the population is scattered in villages  20% of rural population have health care facilities Centre Plain area Hilly / Tribal / Difficult area Community health centre 1,20,000 80,000 Primary health centre 30,000 20,000 Sub-centre 5,000 3,000
  45. COMMUNITY HEALTH CENTRE’S    Established and maintained by the State Government under MNP/BMS programme. As per minimum norms, a CHC is required to be manned by four Medical Specialists i.e. Surgeon, Physician, Gynecologist and Pediatrician supported by 21 paramedical and other staff. It has 30 in-door beds with one OT, X-ray, Labor Room and Laboratory facilities.
  46. CONT..    It serves as a referral centre for 4 PHCs and also provides facilities for obstetric care and specialist consultations. As on Sep 2013, there are 4,833 CHCs functioning in the country. In Haryana 2013, there are 108 CHCs functioning.
  47. PRIMARY HEALTH CENTRE’S     First contact point between village community and the Medical Officer. To provide an integrated curative and preventive health care with emphasis on preventive and promotive aspects of health care. Established and maintained by the State Governments under the MNP/ BMS Programme. Manned by a Medical Officer supported by 14 paramedical and other staff.
  48. CONT….     NRHM - two additional Staff Nurses at PHCs (contractual). It acts as a referral unit for 6 Sub Centre’s and has 4 6 beds for patients. There were 24,049 PHCs functioning in the country as on Sep 2013. In Haryana Sep 2013, there were 425 PHCs functioning.
  49. SUB-CENTRE  Most peripheral and first contact point between the primary health care system and the community.  Manned by at least one ANM / Female Health Worker and one Male Health Worker.  Under NRHM, one additional second ANM on contract basis.
  50. CONT…     Provide services in relation to maternal and child health, family welfare, nutrition, immunization and control of communicable diseases. Ministry of Health & Family Welfare is providing 100% Central assistance to all the Sub-Centre’s 1,48,366 Sub Centre’s functioning in the country as on Sep 2013 In Haryana Sep 2013, there were 2465 SCs functioning
  51. ASHA  Accredited Social Health Activist (ASHA) for 1000 population  Chosen by and accountable to the panchayat. Act as the interface between the community and the public health system.  Honorary volunteer, receiving performance-based compensation  Facilitate preparation and implementation of the Village Health Plan  The other persons are  Indigenous dais  Anganwadi workers
  52. CONT… NUMBER OF ASHA WORKERS ACC SEP 2013 Total Number of ASHA in position as on 30-06-2013 ASHA (Accredited Social Health Activist) High Focus states 5,72,573 Other than High 3,17,163 Focus states Total Number of ASHA selected and trained up to IV module High Focus states Other Than High Focus states 4,94,155 2,89,923
  53. A SURVEY REPORT PUBLISHED IN NEW INDIAN EXPRESS  There is only one doctor per 1,700 citizens in India; the World Health Organization stipulates a minimum ratio of 1:1,000.  There are 387 medical colleges in the country—181 in government and 206 in private sector. India produces 30,000 doctors, 18,000 specialists, 30,000 AYUSH graduates, 54,000 nurses, 15,000 ANMs and 36,000 pharmacists annually.  Health ministry claims that there are about 6-6.5 lakh doctors available. But India would need about four lakh more by 2020 to maintain the required ratio of one doctor per 1,000 people
  54. PHC PROGRESS IN INDIA (2012-13)
  55.  Progress made in CHCs during 2005-12
  56. INTEGRATED APPROACH OF HEALTH CARE DELIVERY ICDS – integrated child development scheme Agriculture, irrigation and engineering Animal Husbandry Education Social and Women's Welfare Urban Family Welfare Centers
  57. BUDGET IN FIVE YEAR PLANS FIRST PLAN (1951-56) SECOND PLAN (1956-61) • BUDGET: 1,960 Crore HEALTH: 5.9% • BUDGET: 4,672 Crore HEALTH: 5% THIRD PLAN (1961-66) • BUDGET: 8,576 Crore HEALTH: 4.3% FOURTH PLAN (1969-74) • BUDGET: 15,778 Crore HEALTH: 7.2% FIFTH PLAN (1974-79) • BUDGET: 39,322 Crore HEALTH: 8.8% SIXTH PLAN (1980-85) • BUDGET: 97,500 Crore HEALTH: 1.8% SEVENTH PLAN (1985-90) • BUDGET: 1,80,000 Crore HEALTH: 1.9% EIGHTH PLAN (1992-97) • BUDGET: 79,8000 Crore HEALTH: 9.5% NINTH PLAN (1997-2002) • BUDGET:8,59,200 Crore HEALTH: 1.25% TENTH PLAN (2002-07) • BUDGET: 14,84,131.30Crore HEALTH: 1% ELEVENTH PLAN (2007-12) • BUDGET: 136,147Crore HEALTH: 1.5% TWELFTH PLAN (2012-17) • BUDGET ALLOCATED: 90,000 Crore
  58. BUDGET SUPPORT Budget Support for Central Departments in Eleventh Plan (2007–12) and Twelfth Plan (2012–17) Projections (` Crore) Department of MoHFW Eleventh Plan Twelfth Expenditure (in Plan Outlay( Crore) in Crore) % Increase Department of Health and Family Welfare 83407 268551 322% Department of Ayurveda, Yoga &Naturopathy, Unani, Siddha & Homoeopathy (AYUSH) 2994 10044 335% Department of Health Research 1870 10029 536% Aids Control 1305 11394 873% Total MoHFW 89576 300018 335%
  59. HEALTH EXPENDITURE, PUBLIC (% OF GDP) IN INDIA
  60. HEALTH EXPENDITURE, PRIVATE (% OF GDP) IN INDIA
  61. OUT-OF-POCKET HEALTH EXPENDITURE (% OF PRIVATE EXPENDITUTEON HEALTH) IN INDIA
  62. EXTERNAL RESOURCES FOR HEALTH EXPENDITURE (% OF TOTALEXPENDITUTEON HEALTH) IN INDIA
  63. NURSES AND MIDWIVES (/ 1000 PEOPLE) IN INDIA
  64. CONTRIBUTION BY NGOS Providing services like relief to the blind, the disabled and disadvantaged and helping the government in mother and child health care, including family planning programmes. Greater roles for the NGOs was seen to ensure Health for All through the primary health care approach. Government of India started granting financial aids to NGOs for various schemes Contracting in & out – government hires individuals on a temporary basis to provide services Privatization
  65. CHALLENGES Prices of services in private sector Earning commission from diagnostic laboratories Financial protection against medical expenditure Non availability of medical, nursing and paramedical staff Inadequate and weak drug control infrastructure Inadequate drug testing facility Extremely high drug cost No clear urban health care delivery model
  66. CONCLUSION  “The number of students graduating from secondary schools, which can be expressed as “the percent of health schools that are accredited” which can be expressed as “ the reflection of health care of the country”
  67. BIBLIOGRAPHY        Park K. Textbook of preventive & social medicine. 22nd ed. Banarsidas Bhanot: Jabalpur; 2005. 671- 702,728,732,745 Stanhope M , L ancaster J. Community & public health nursing.Mosby publishers: U S. 2004;103-4 ,1097-1098 Basavanthappa B T. Community health nursing.2nd edition. Jaypee publishers : New Delhi. 2008; 38,43, 894- 903 Behind_the_numbers_Medical_cost_trends_for_2011 http://pwchealth.com/cgilocal/hregister.cgi?link=reg/ www.pubmed.com www.google.com
  68.      Indian Public Health Standards (IPHS) guideline for community health centers, Revised 2012. DGHS, MOHFW, GOI. 1-94 http://www.newindianexpress.com/magazine/India-has-justone-doctor-for-every-1700-people/2013 www.tradingeconomics.com/india/health-expenditure.html www.haryanahealth.nic.in www.nrhm.gov.in/nrhm-in-state/state-wise-information.html
  69. THANK YOU 

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