Challenges of health care delivery system

1. CHALLENGES OF
HEALTHCARE DELIVERY
SYSTEM
BY: ARUSHI NEGI, M.SC NURSING I YEAR

2. INTRODUCTION:
• The robust transformation of India’s public healthcare system
witnessed in the past few decades has not only been progressive
but also an example for the developing economies of the world.
• The healthcare system in India can be divided into two parts viz
urban and rural areas and both have a significant differential gap in
terms of treatment.

3. DEFINITIONS:
• HEALTH is a state of complete physical, mental and social well being and not
merely an absence of disease or infirmity which allows a person to live a
socio-economically productive life.
• HEALTHCARE is multitude of services rendered to individuals or
communities by the agents of health services or professional for the purpose
of promoting, restoring and maintaining health embraces all the goods and
services designed for “prevention, promotion and rehabilitation interventions”
Includes medical care

4. • HEALTH CARE PROVIDER is a person or organization that
provides services and/or health care personnel to deliver proper
health care in a systematic way to any individual in need of health
care services could be a government or the health care industry, a
health care equipment company, an institution such as a hospital or
laboratory.
• HEALTH CARE PROFESSIONALS may include physicians, nurses,
dentists, and other support staff.
• HEALTH SERVICES permanent countrywide system of established
institutions with the objective of coping with the various health needs
and demands of population. Thereby provide health care to
individuals and community with preventive and curative activities
utilizing health care workers.

5. LEVELS OF HEALTH CARE
Primary health care- provided at the community level
Secondary health care- provided at PHC, CHC, DH etc.
Tertiary health care- provided at hospitals tertiary health care

6. HEALTH CARE DELIVERY SYSTEM IN INDIA
• India is a union of 28 states and 8 union territories. States are largely independent in
matters relating to the delivery of health care to the people.
• The central government’s responsibility consists mainly of policy making , planning ,
guiding, assisting, evaluating and coordinating the work of the state health ministries.
• Health system in India has 3 main links
At the central level
the official “organs” Of health
system at national level are
1.Ministry of health and
family welfare
2.Directorate general of
health services
3.Central council of health
State level
1.State health minister
2.Deputy health minister
3.Health secretary
4.Deputy secretary
5.Administrative staff
At district level
Within each district, there are 6 types of administrative areas.
1.Sub –division
2.Tehsils ( talukas )
3.Community development blocks
4.Municipalities and corporations
5.Villages and
6.Panchayats

7. HEALTH CARE SYSTEMS
Intended to deliver healthcare services and represented by five major sectors different from each other by health
technology
1.Public health sector
• a.Primary health care
• b.Hospitals/health centres
• c.Health insurance schemes
2.Private sector
• a.Private hospitals, polyclinic, nursing homes and dispensaries
• b.General practitioners and clinics
3.Indigenous system of medicine
• a.Ayurveda and siddha
• b.Unani and tibbi
• c.Homeopathy
• d.Unregistered practitioners
4.Voluntary health agencies
5. National health programmes

8. FIVE “A'S” FOR OUR CONSIDERATION:
• Awareness or the lack of it: How aware is the Indian population about important issues
regarding their own health?
• Access or the lack of it: Access (to healthcare) is defined by the Oxford dictionary as “The
right or opportunity to use or benefit from (healthcare)”. “What is the level of access of
our population to healthcare of good quality?”
• Absence or the humanpower crisis in healthcare: Do we have adequate numbers of
personnel, are they appropriately trained, are they equitably deployed and is their morale in
delivering the service reasonably high?
• Affordability or the cost of healthcare: Quite simply, how costly is healthcare in India, and
more importantly, how many can afford the cost of healthcare?
• Accountability or the lack of it: Being accountable has been defined as the procedures and
processes by which one party justifies and takes responsibility for its activities

9. CHALLENGES:
Mitigating
burden of
disease -
infectious and
chronic
degenerative,
prevalence of
Non
communicable
diseases
Maternal
mortality, under-
5 mortality,
malnutrition
Healthcare
finance
Lack of
universal access
to health care +
health inequality
Lack of
healthcare
related resources

10. BURDEN OF DISEASE INFECTIOUS DISEASES
• 1.Poor implementation of public health programs
• 2.Lack of environmental sanitation, safe drinking
water, information and awareness regarding
importance of hygiene and nutrition
• Poor living conditions

11. BURDEN OF CHRONIC DEGENERATIVE DISEASES
• 1)Lack of access to diagnostics (e.g. Pap smear tests)
• 2)Poor diagnosis
• 3)Lack of specialists such as gynecologists

12. PREVALENCE OF NON-COMMUNICABLE DISEASES
• 1.Lack of awareness of diseases such as diabetes and hypertension.
• 2.Focus is more on communicable diseases such as tuberculosis and
polio.
• 3.Less emphasis on preventive care
• 4.Delay in diagnosis of illnesses

13. MATERNAL MORTALITY, UNDER-5 MORTALITY,
MALNUTRITION
1.Explosive
population
growth (high
birth rates)
2.Gender
inequality
3.Childbirth at
home instead
of hospital
4.Poor
education
5.Poor
nutrition
6.Lack of
breastfeeding
7.Vulnerable
to weakness
and infection
8.Poor
immunity

14. HEALTHCARE FINANCE
1.High cost of curative medical services
2.Expensive health insurance
3.Poor vaccination coverage
4.Inappropriate and irrational use of high tech diagnostics
5.The poor are more price sensitive to health care and are
more likely to report financial cost as a barrier for foregoing
care when suffering from illness

15. LACK OF HEALTHCARE RELATED RESOURCES
• 1.Migration of qualified professionals
• 2.Workforce concentrated in urban areas
• 3.Under-investment in health care related infrastructure in certain areas; Not enough funds are
allocated for public healthcare in india and the inequality in urban and rural facilities is well known.
• 4.Limited opening hours
• 5.Limited availability of drugs
• 6.Poor physical environments
• 7.Poor provider training and knowledge
• 8.Poor governance of health care sector
• 9.Adequate regulation of public and private sector has been difficult to achieve
• 10.Implementation of laws and codes is problematic
• 11.No support for medical research

16. LACK OF UNIVERSAL ACCESS + HEALTH EQUITY
1.Health services not easily accessible to rural populations
2.Economics of scale achievable only in urban areas but the majority of vulnerable groups
exist where services are scarce thereby affecting equity physical distance to facilities is an
issue
3.Health insurance only covers about a fifth of the entire population Insurance as a
concept and its usefulness is still not understood in India
4.Unorganized private sector accounts for almost 80% of outpatient healthcare
5.Dearth of qualified medical professionals in rural areas
6.Inappropriate drug use
7.Emergence of anti-microbial drug resistance, drug toxicity, adverse drug reactions

17. SOLUTIONS

18. SOLUTIONS FOR BURDEN OF DISEASE
(INFECTIOUS)
1.Decentralized planning in districts
2.Effective service delivery in communities
3.Install adequate health facilities such as diagnostics in every community
and make check-ups compulsory and free of costs/subsidized cost
sustained programs to change household behaviors and spread awareness
4.Creation of centers of excellence for health + nutrition policy research

19. SOLUTIONS FOR BURDEN OF DISEASE (CHRONIC)
• 1)Prevention and management of the associated risk
factors
• 2)Avoid onset of disease
• 3)Limit severity
• 4)Improve vaccination coverage
• 5)Develop newer vaccines and newer modes of delivery

20. SOLUTIONS FOR PREVALENCE OF NON
COMMUNICABLE DISEASES:
• 1.Preventive care can actually solve a lot of problems for the patient in terms
of misery or financial losses.
• 2.Proper preventive care can help save huge costs for the patient and reduce
the burden on the limited healthcare infra system in the country
• 3.Post preventive care, the next step is the diagnosis, if done in time can not
only help save cost but also lives in some cases. We often hear of cases being
diagnosed only at an advanced stage when very little can be done to save the
life. The importance of diagnosis is mostly doubted in india.

21. SOLUTIONS TO MATERNAL MORTALITY,
UNDER-5 MORTALITY, MALNUTRITION
• 1.Needs a system that can meet the demands over a billion people
professional leadership
• 2.Trained cadre of personnel
• 3.Coordinated approach
• 4.Patient and physician education
• 5.Antibiotic policy
• 6.Hospital infection control team
• 7.Regional and international antibiotic resistance surveillance

22. SOLUTIONS FOR HEALTHCARE FINANCE
• 1)Data driven approach + analytic system driven by
systems analysis and software development
• 2)Public-private partnerships directed at data capture,
analysis, and implementation
• 3)Accountability, transparency, and better leadership
• 4)Development of the decision making process relating to
achieving health equity

23. SOLUTIONS TO LACK OF UNIVERSAL ACCESS
AND INEQUALITY
• 1.Formation of an integrated national/state public health system
• 2.Functional public health infrastructure that is shared between central and state governments
• 3.Efficient allocation of resources between different levels of services and between different geographical regions -national, state, and
local
• 4.Increase public financing
• 5.Improve physical access to preventive and curative health services especially in india’s rural population (e.g. Hospital beds)
• 6.Improve infrastructure (better transport, roads, and communication networks)
• 7.Awareness campaigns and the government’s schemes such as ayushman bharat, employment state insurance, etc. Have immensely
helped in bringing insurance inclusiveness and enabling a large population in india to avail financial security cover on healthcare costs.
• 8.Building capacity of frontline workers: Their role is indispensable. However, they need to be constantly reskilled and upskilled to meet
the demands of the constantly changing healthcare scenario.
• 9.Technology-led new initiatives - The medical professionals and pharmaceutical companies should keep themselves updated with
knowledge of the latest development in the field of the medical sector that will help them to cater the right services to patients with
minimum risk.

24. SOLUTIONS FOR LACK OF HEALTHCARE
RELATED RESOURCES
• 1)Education of physicians and nurses in public sector
• 2)Incentives and policies to attract and retain personnel
• 3)Make it mandatory for professionals to do 3 years of rural service
• 4)telemedicine and mobile medical units: These have emerged as an effective way to take primary healthcare services
and specialist advice to the doorsteps of people in remote corners of the country.
• 5)The telemedicine units have a well-equipped infrastructure and work on a hub-and-spoke model. Doctors based in
a central hub, a parent hospital, consult patients virtually, facilitated by a trained nurse in remote locations where
patients reside.
• 6)Increasing technology adoption in improving primary healthcare access: From medical devices to patient records,
and from screening data to assessing the impact of interventions and treatment, technology plays a pivotal role in
improving primary healthcare access.
• 7)Making the right kind of medical devices and hardware available, introducing smart digital platforms, and
providing the right kind of technical training and expertise are essential in helping frontline workers and communities
adopt technology for better health outcomes.

25. SUMMARY
• Through this topic we came to know about ,
challenges in healthcare delivery system, levels of
healthcare , health system, and solutions to the
challenges

26. CONCLUSION
• The robust transformation of India’s public healthcare system witnessed in the past few decades has not
only been progressive but also an example for the developing economies of the world. The problems of
healthcare delivery system were:
• Mitigating burden of disease - infectious and chronic degenerative, prevalence of Non communicable
diseases
• Maternal mortality, under-5 mortality, malnutrition
• Healthcare finance
• Lack of universal access to health care + health inequality
• Lack of healthcare related resources

27. BIBLIOGRAPHY
• Johari Satyendra , BW business world, Challenges faced by the indian healthcare
system. available at :
https://www.businessworld.in/article/Challenges-faced-by-the-Indian-healthcare-
system/21-08-2020-311268/
• Kasthuri A. Challenges to Healthcare in India - The Five A's. Indian J Community Med.
2018 Jul-Sep;43(3):141-143. doi: 10.4103/ijcm.IJCM_194_18. PMID: 30294075; PMCID:
PMC6166510.