AMRITA SCHOOL OF DENTISTRY

1. HEALTH CARE
DELIVERY
SYSTEM IN INDIA

2. Contents
Introduction
Evolution of Health Systems
Levels of Healthcare in India
Health System Administration in India
Health Care Sectors in India
Conclusion
Suggested Reading

3. Evolution of Health Systems
Various Phases
• Phase I (1947- 83)
• Phase II (1983- 2000)
• Phase III (post-2000)
Five-year plan
• Almost 13 five-year plan
• Fourth five-year
plan(1969-74)

4. Levels of Healthcare in India
Primary Health Care
Provided at PHC and sub centre
Secondary Health Care
Provided at District hospital and CHC
Tertiary Health Care
Provided at regional and central level Institution
(medical college hospitals , all india institutes, regional
hospitals, specialized hospitals, other apex institutions)

5. Health System Administration in India
Centre
State
District

6. Centre
Ministry of Health and Family Welfare
• Department of Health and Family Welfare
• Department of AYUSH
• Department of Health Research
• Department of AIDS Control
Directorate General of Health Services[DGHS]
Central Council of Health and Family Welfare

7. State
State ministry of health
State health Directorate

8. District
Sub division
Tahsils
Community development block
Municipalities and corporations
Villages
Panchayati Raj
• Gram panchayat at village level
• Panchayat samiti at block level
• Zilla parishad at district level

9. Health Care Sectors in India
1. Public Health Sector
a. Primary Health Care
• Primary Health Centres
• Sub- Centres
b. Hospitals / Health Centres
• Community Health Centres
• Rural Hospitals
• District Hospitals/ Health
Centre
• Specialist Hospitals
• Teaching Hospitals
c. Health Insurance Schemes
• Employees State
Insurance(ESI)
• Central Government Health
Scheme(CGHS)
• Ayushmann Bharath- NPHS
d. Other Agencies
• Defence Services
• Railways
3. Indigenous Systems Of India
a. Ayurveda And Siddha
b. Unani And Tibbi
c. Homoeopathy
d. Unregistered Practitioners
4. Voluntary Health Agencies
5. National Health Programmes
2. Private Sector
a. Private hospitals, polyclinics,
nursing homes, and
dispensaries
b. General practitioners and
clinics

10. 1. Village Level Workers
1.Village Health Guides Scheme
1.Training of local Dais
1.Anganwadi Worker (ICDS Scheme)
1.ASHA scheme

11. • They serve as links between the community and the governmental
infrastructure. They provide the first contact between the individual and health
system.
• ASHA’S are now used as health guides at village level under NRHM
Guidelines:
• Be permanent resident
• Minimum formal education (VI class)
• Spare at least 2‐3 hours/day for community health work
• After selection ,they undergo training in nearest PHC for 3months 1 for each
village per 1000 rural population
Village Health Guides Scheme

12. • A scheme for training of Dais was initiated during 2001-02.
• The scheme was implemented in 156 districts in 18 states
• The districts selected were on the basis of the safe delivery rate being less than
30 percent. The scheme was extended to all the districts of Empowered Action
Group (EAG) states.
• The aim was to train at least one Dai in every village with the objective of
making deliveries safe .
• Training is for 30 working days. Paid a stipend of Rs. 300
• During her training period. Training at PHC, sub‐center or MCH center for 2
days in a week, four days of the week they accompany the health worker.
Training of local Dais

13. • Angan literally means a courtyard. Under the ICDS(Integrated Child Development
Services) scheme, there is an anganwadi worker for a population of 400-800.
• There are about 100 such workers in each ICDS project. As of date over 707 ICDS
blocks are functioning in the country . The anganwadi worker is selected from the
community she is expected to serve.
• She undergoes training in various of health, nutrition and child development for 4
months .She is a part time worker and is paid an honorarium of Rs. 1500 per month
for the services rendered, which include health checkup including maintenance of
growth chart etc.,
Anganwadi Worker
ICDS Scheme (Integrated Child Development Services)

14. • ASHA must be resident of the village – a women ( married/widow/ divorced)
preferably in the age group of 25 to 45 years.
• The general norm of selection is one ASHA for 1000 population .In tribal, hilly
and desert areas the norm could be relaxed to one ASHA per habitation
Role and Responsibilities
• ASHA will take steps to create awareness and provide information to the
community on determinants of health.
• She will counsel women on birth preparedness, importance of safe delivery,
breast feeding
Accredited Social Health Activist (ASHA)

15. • ASHA will mobilize the community and facilitate them in accessing health and
health related services available at anganwadi/ subcentre/primary health centres.
• She will work with the village health and sanitation committee of the gram
panchayat
• She will arrange escort/accompany pregnant women and children requiring
treatment/admission to the nearest pre- identified health facility.
• ASHA will provide primary medical care for minor ailments such as diarrhoea,
fevers and first aid for minor injuries.

16. 2. Sub- Center Level
• The sub-centre is the peripheral outpost of the existing health delivery
system in rural areas. They are being established on the basis of one-sub
centre for every 5000 population in general ,3000 population in hilly , tribal
and backward areas. As of March 2017, 2,550 PHCs were working with 6
sub centres under each.
• A sub centre provides interface with the community at the grass root
level, providing all the primary health care services. One lady health visitor
(LHV) and one health assistant (male) located at PHC are entrusted with
the task of supervision of six sub centres
• Indian public Health Standards For Sub centers are of 2 types: TYPE-A and TYPE-B
(MCH- sub centre)

18. 3. Primary Health Center Level
• The concept of primary health centre is not new to India. The Bhore committee
in 1946 gave the concept of a primary health centre.
• The health planners in India have visualized the primary health centre and its
subcentres as the proper infrastructure to provide health services to the rural
population.
• Staffing pattern in PHC: At present in each community development block, there
are 1 or more PHCs each of which covers 30,000 rural population. 3 workers at
the subcenter level and 9 or more workers at PHC level.
• Indian public Health Standards For PHCs:
• TYPE A PHC –PHC with less than 20 deliveries/ month
• TYPE B PHC – PHC with 20 or more deliveries/ month

19. Staffing pattern in PHC
Medical officer 1
Pharmacist 1
Nurse mid-wife 1
Health worker (female)/ANM 1
Block extension educator 1
Health assistant (male) 1
Health assistant (female) 1
U.D.C 1
L.D.C 1
Lab.technician 1
Driver 1
Class IV 4

20. • Functions of the PHC
1. Medical care
2. MCH including family planning
3. Safe water supply and basic sanitation
4. Prevention and control of locally endemic diseases
5. Collection and reporting of vital statistics
6. Education about health
7. National Health Programmers - as relevant
8. Referral services
9. Training of health guides, health workers, local dais and health assistants
10. Basic laboratory services

21. 4. Community Health Center Level
• Established by upgrading PHC’s
• One centre for population of 80,000 to 1,20,000
Requirements
• 30 beds
• X-ray and lab facilities
• Specialists
• surgery and medicine
• Obstetric and gynecology
• Pediatrics
• Community health officer
• Referrals- State level hospitals and medical collage hospitals

22. Staffing pattern in CHC
Medical officer 4
Pharmacist 1
Nurse mid-wife 7
Dresser 1
Block extension educator 1
Radiographer 1
Ward boys 2
Dhobi 1
Sweepers 3
Mali 1
Chowkidhar 1
Aya 4
Peon 1

23. Functions of the PHC
• Care of routine and emergency cases in surgery
• Care of routine and emergency cases in medicine
• Maternal health
• Newborn care and child health
• Family planning
• All the national health programmes (NHP)
• Physical Medicine and Rehabilitation (PMR)
• Oral health
• School health services
• Adolescent health care
• Blood storage
• Diagnostic services
• Referral (transport) services
• Maternal Death Review(MDR)

24. 5. Hospitals
Rural hospitals
• Proposed to upgrade rural dispensaries to PHC
• Hospitals present at tehsils/sub-divisional/taluka head quarters
are shifted to rural areas
• These sub-divisional health centre cover a population of 5 lakhs
• Each centre will have epidemiological wing attached to them
District hospital
• Proposed to convert into district health centre

25. 6. Health Insurance
• There is no universal health Insurance in India.
• Health insurance is limited to industrial workers under the Employees State
Insurance Scheme (ESI scheme)
• Central Government Health Scheme- Introduced in New Delhi in 1954 to provide
comprehensive medical care to Central Government employees. The scheme is
based on the principle of cooperative effort by the employee and the employer, to
the mutual advantage of both.
• Universal Health Insurance Scheme (UHIS) - families under below poverty line (BPL)

26. 7. Other Agencies
• Defense medical services
• Health care of railway employees
• Private agencies
8. Indigenous Systems of Medicine
• The practitioners of indigenous systems of medicine (e.g., Ayurveda, Siddha ,
Homoeopathy, etc.)provide the bulk of medical care to the rural people.
• Ayurvedic physicians alone are estimated to be about 7.73 lakhs. Studies
indicate that nearly 90 percent of Ayurvedic physicians serve the rural areas.

27. 9. Voluntary Health Agencies
• Occupy important place in community health programmes
• Compared with “motor trucks” which can penetrate the by-ways.
Functions
• Supplementing the work of Govt. agencies
• Pioneering
• Education
• Demonstration
• Guarding the work of Govt. agencies
• Advancing health legislation

28. Activities of VHAS in India
Indian red cross society
Hind kusta nivaran sangh
Tuberculosis aassociation of india
Bharath sevaksamaj
Kasturba memorial fund

29. 10. National Health programmes in India
National Vector Borne Disease Control Programme (NVBDCP)
National Filaria Control Programme
National Leprosy Eradication Programme
Revised National TB Control Programme
National Programme for control of Blindness
National Iodine Deficiency Disorders Control Programme
National Mental Health Programme
National Aids Control Programme

30. Health Agencies Around the World
NGO’S IN HEALTH CARE
Rockfellar foundation Assistance to virus research
project,
Establishment of all India institute
of hygiene and public health
Ford foundation Water supply and sanitation
schemes
CARE Mid-day school meals programme
USAID Support to health programmes,
Water supply, sanitation.
World bank, UNFPA
etc
Provide assistance in health
programmes in India

31. Conclusion
• Health care systems are essential for improving and maintaining
the health of the population of any country.
• Health systems are the result of the combined efforts of
government agencies, institutions and resources with the main
aim of improving the health of their people .
• Properly designed health systems have a strong preventive
component which can detect possible illnesses through a
combination of action and advice.

32. Suggested Reading
• Soben Peter (2018). Essentials of Preventive and Community
Dentistry. 6th Edition, Arya Publishing House, New Delhi.
• Park K. Textbook of preventive and social medicine; 25th Edition

33. Expected Questions
• Health care system in India
• Health care sectors in India