SYSTEM IN INDIA
M.SC. (N) 1st
INDIA is union of 28 states & 7 union terrorties
Older concept – Health care means patient care
Objective - freedom from the disease through
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
EVOLUTION OF HEALTH CARE
SERVICES IN INDIA
Christian Era –
started in Indus
Post Vedic –
1400 B.C. –
concept of health
STILL…66 YRS. OF HEALTH
Crude Death Rate ↓
Crude birth rate ↓
Life expectancy ↑
S.pox & G. worm Eradicated
Infrastructure – Expanded
ROLE OF DIFFERENT COMMITTEES
1946 – BHORE COMMITTEE (HEALTH SURVEY AND
Integration of preventive and curative services
Development of PHC
3 months training in PSM
1962 – MUDALIAR COMMITTEE (HEALTH SURVEY AND
Strengthening of PHC and district hospital
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.
INDIRECTLY RELATED TO
DIRECTLY RELATED TO
MODEL OF HEALTH CARE
HEALTH CARE HEALTH CARE
Health Status or
HEALTH DEMANDS &
NEEDS OF THE COMMUNITY
COMMUNITY BASED CARE
EXPRESSED IN TERMS OF
LIVES,SAVES, DEATH A
VERTED, DISEASES PREVENTED,
AT THE CENTRE LEVEL
THE UNION MINISTRY OF HEALTH
AND FAMILY WELFARE
DEPARTMENT OF FAMILY
Port Health Research
Technical & Scientific Education
Establishment of drug standards
Census and collection & publication of other statistical
Coordination with other states for promotion of health
Regulating labor in mines and oil mines
Immigration & emigration
FUNCTIONS OF DIRECTORATE
GENERAL OF HEALTH
GENERAL FUNCTIONS SPECIFIC FUNCTIONS
Appraisal of all
Control of drug
Medical store depots
CGHS, NHP, CHEB etc.
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
Chairman The Union Health
Members The State
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.
Health education and
Promotion of facilities for training and research.
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
Alma Ata-1978 (HFA)
Small pox eradicated-July 5, 1975
India Joins WHO-1948
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
FUNCTIONS UNDER STATE LIST
Public health sanitations , hospitals and
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.
Relief of the disabled and unemployable.
Burials and burial grounds, cremation
Markets and fairs.
AT THE STATE LEVEL
• STATE MINISTRY OF HEALTH
• STATE HEALTH DIRECTORATE
STATE MINISTRY OF HEALTH AND
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.
STATE HEALTH DIRECTORATE AND
advisor in matters relating to
medicine and public health
by joint director, regional joint
director and assistant directors.
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”
DISTRICT HEALTH ORGANIZATION
Identifies and provide the needs of
expanding rural health and family
Within each district again, there are 6
types of administrative areas
No uniform model of district health
3 tier structure of rural local self government
Linking the village to the district
3- TIER SYSTEM
PANCHAYAT ( AT
ZILLA PARISHAD (AT
(AT BLOCK LEVEL)
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.
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
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
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
AT THE BLOCK LEVEL
Is known as Panchayat samiti.
Members of panchayat samiti are:
o Sarpanches from all the gram panchayats in the
o MLAs and MPs residing in the area
representative of women, schedule castes, schedule
tribes and cooperative societies.
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
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.
HEALTH CARE DELIVERY SYSTEM
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
Hilly / Tribal /
COMMUNITY HEALTH CENTRE’S
Established and maintained by the State Government under
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
It serves as a referral centre for 4 PHCs and also
provides facilities for obstetric care and specialist
As on Sep 2013, there are 4,833 CHCs functioning in
In Haryana 2013, there are 108 CHCs functioning.
PRIMARY HEALTH CENTRE’S
First contact point between village community and the Medical
To provide an integrated curative and preventive health care
with emphasis on preventive and promotive aspects of health
Established and maintained by the State Governments under the
MNP/ BMS Programme.
Manned by a Medical Officer supported by 14 paramedical and
NRHM - two additional Staff Nurses at PHCs
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
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
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
In Haryana Sep 2013, there were 2465 SCs
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
NUMBER OF ASHA WORKERS ACC SEP 2013
Total Number of
ASHA in position as
Other than High
Total Number of
ASHA selected and
trained up to IV
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
INTEGRATED APPROACH OF
HEALTH CARE DELIVERY
ICDS – integrated child development scheme
Agriculture, irrigation and engineering
Social and Women's Welfare
Urban Family Welfare Centers
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
Budget Support for Central Departments in Eleventh Plan (2007–12) and Twelfth
Plan (2012–17) Projections (` Crore)
Expenditure (in Plan Outlay(
Department of Health and Family
Department of Ayurveda, Yoga
&Naturopathy, Unani, Siddha &
Department of Health Research
HEALTH EXPENDITURE, PUBLIC (%
OF GDP) IN INDIA
HEALTH EXPENDITURE, PRIVATE
(% OF GDP) IN INDIA
EXPENDITURE (% OF PRIVATE
EXPENDITUTEON HEALTH) IN
EXTERNAL RESOURCES FOR HEALTH
EXPENDITURE (% OF
TOTALEXPENDITUTEON HEALTH) IN
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
Contracting in & out – government hires individuals on a temporary basis
to provide services
Prices of services in private sector
Earning commission from diagnostic laboratories
Financial protection against medical expenditure
Non availability of medical, nursing and
Inadequate and weak drug control infrastructure
Inadequate drug testing facility
Extremely high drug cost
No clear urban health care delivery model
“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”
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
Indian Public Health Standards (IPHS) guideline for community
health centers, Revised 2012. DGHS, MOHFW, GOI. 1-94