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Healthcaresystem 140122110305-phpapp02

HEALTH ARE DELIVERY

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Healthcaresystem 140122110305-phpapp02

  1. 1. PRESENTED BY -RISHABH KUMAR MBBS 2009 BATCH HEALTH CARE DELIVERY SYSTEM IN INDIA
  2. 2. CONTENTS
  3. 3. 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.
  4. 4. 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.”
  5. 5. EVOLUTION OF HEALTH CARE SERVICES IN INDIAChristian Era – civilization started in Indus Valley Environmental sanitation, houses with drainage 1400 B.C. – Ayurveda and Siddha system Developed a comprehensive concept of health Post Vedic – teaching of Buddhism and Jainism Rahula Sankirtyana – developed hospital system
  6. 6. 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
  7. 7. ROLE OF DIFFERENT commiteescoCOMMITTEESc  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
  8. 8. 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.
  9. 9. PROBLEMS Environment Education Empowerment Diseases Communicable Non Communicable New emerging Fertility Population Growth rate Total Fertility Nutrition Malnutrition Obesity INDIRECTLY RELATED TO HEALTH DIRECTLY RELATED TO HEALTH
  10. 10. MODELOF HEALTH CARE SYSTEM INPUTS HEALTH CARE SERVICES HEALTH CARE SYSTEM OUTPUTS Health Status or Health Problems Resources Curative Preventive Promotive Public Private Voluntary Indigenous Changes in Health Status
  11. 11. 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
  12. 12. HEALTH ORGANISATION IN INDIA
  13. 13. AT THE CENTRE LEVEL MINISTRY OF HEALTH AND FAMILY WELFARE DIRECTORATE GENERAL OF HEALTH SERVICES CENTRAL COUNCIL OF HEALTH AND FAMILY WELFARE
  14. 14. A. THE UNION MINISTRYOFHEALTH AND FAMILYWELFARE DEPARTMENT OF HEATLH SECRETARY JT. SECRETARY DY. SECRETARY ADMN. STAFF DEPARTMENT OF FAMILY WELFARE SECRETARY JT. SECRETARY DY. SECRETARY OFFICE STAFF
  15. 15. CENTRALLIST  International Health,  Port Health Research  Technical & Scientific Education
  16. 16. FUNCTIONS
  17. 17. 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
  18. 18. 2. CONCURRENT LIST
  19. 19. B. DIRECTORATE GENERALOF HEALTH SERVICES (DGHS) Administrative Staff Team Of Deputies Additional Director Of Health Services Principal Adviser To Union Government
  20. 20. ORGANIZATION DGHS Additional DGHS Deputy DGHS (Medical care) Office Staff Deputy DGHS (Public health) Office Staff Deputy DGHS (Gen. Administ rator) Office Staff
  21. 21. FUNCTIONS OFDIRECTORATE GENERALOFHEALTH 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. GENERAL FUNCTIONS SPECIFIC FUNCTIONS
  22. 22. THE CENTRALCOUNCIL OF HEALTHAND FAMILYWELFARE 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
  23. 23. FUNCTION OF CENTRALCOUNCIL OF HEALTHAND 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.
  24. 24. 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
  25. 25. 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
  26. 26. STATE LEVEL OF HEALTH CARE
  27. 27. 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
  28. 28. 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, purchase and sale of intoxicating liquors.
  29. 29. Cont…. Relief of the disabled and unemployable. Burials and burial grounds, cremation grounds. Markets and fairs.
  30. 30. AT THE STATE LEVEL • STATE MINISTRY OF HEALTH • STATE HEALTH DIRECTORATE
  31. 31. ORGANIZATION
  32. 32. STATE MINISTRYOF HEALTHAND FAMILYWELFARE 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.
  33. 33. STATE HEALTH DIRECTORATE AND FAMILYWELFARE  Principle advisor in matters relating to medicine and public health  Assisted by joint director, regional joint director and assistant directors.
  34. 34. AT THE DISTRICT LEVEL The principal unit of administration in India is the district under a collector. There are 672 districts in India. Districts are known as “ZILA”
  35. 35. 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
  36. 36. ORGANIZATION Corporations Panchayats Villages Community Development Blocks Town Area Committees Tahsil (Taluka) District Sub division Municipal Boards Rural Urban
  37. 37. PANCHAYATI RAJ  It is a three tier structure of rural local self government of India linking village to the district  The three institutions are - Panchayat - Panchayat Samiti - Zilla Parishad
  38. 38. Contd  At village level Panchayati Raj consist of: - Gram Sabha - Gram Panchayat - Nyaya Panchayat Every Panchayat consist of Sarpanch , Up Sarpach and a Pachayat secretary whose functions are to cover entire field of civic admindstration including sanitation and public health.
  39. 39. Contd  At Block level Panchayati Raj agency is the Panchayat Samiti consisiting of village sarpachas,MLA’s and MP’s residing in that area , representatitives of women , SC and ST’s and cooperative societies .  At the District level the Zilla Parishad consist of all heads of Panchayat Samitis ,MLA’s and MP’s of the area and two persons of experience in adminstration, public life or rural development.
  40. 40. HEALTH CARE DELIVERYSYSTEM 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
  41. 41. 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.
  42. 42. 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.
  43. 43. 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.
  44. 44. 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.
  45. 45. PRIMARY HEATH CARE DEFINITION: Essential health care based upon practical and scientifically sound socially acceptable methods and technology made universally accessible to individuals and families in the community at an affordable price.
  46. 46. Contd…  Hallmarks of Primary Health Care: -Acceptability -Affordability -Availability -Accessibility Pillars of Primary Health Care: -Equitable distribution -Community participation -Intersectoral Coordination -Appropriate technology
  47. 47. Components of PRIMARY HEALTH CARE - Education of health problems and their control - Locally endemic diseases prevention and control - Essential drugs - Maternity and Child health care - Immunisation - Nutrition and proper food supply -Treatment of common diseases -
  48. 48. Levels of Primary Health care  Primary level: Includes -Village level -Sub centre -PHC Secondary level:First referral unit Includes CHC TERTIARY LEVEL: 2ND referral unit Includes gov hospitals and medical colleges
  49. 49. Village level  At village level following schemes are in operation: - village health guide scheme - training of local dais - ICDS scheme - ASHA scheme
  50. 50. Village Health guide scheme  Introduced on 2nd October 1977.  Village health guides serve as first contact between individual and heath system.Criteria of their selection: -permanent residents -formal education till 6th standard -acceptable to all sections of society
  51. 51. Local dais They are trained traditional birth attendants -Trained for 30 working days -paid a stipend of Rs 300. -Training given at PHC or sub centre for 2 days a week. - Each dai is required to conduct atleast 2 deliveries supervised by ANM of FHW.
  52. 52. Aanganwadi Worker -1 per 1000 population -100 such workers in each ICDS project - She is trained in various aspects of health nutrion and child development for a period of 4 months - Salary 1500 per month Beneficiaries are nursing mothers,pregnant women,adolescent girls and children.
  53. 53. Functions of Aanganwadi Worker - Health checkup - Maintanence of growth charts - Immunisation - Supplementary nutrition - Heath education - Non formal pre school education - Referral services
  54. 54. ASHA (Accredited Social Health activist)  Selection : - Must be the resident of the village -Age between 25 to 45 years -Preferrably a women -Formal education till 8th class -Having communication and leadership skills -Suggested norm 1per 1000.
  55. 55. Functions of ASHA - Create awareness on nutrition,sanitation, Hygiene and healthy environment. - Counsel women on birth preparedness, safe delivery,breast and complementary feeding,immunisation and contraception - Mobilise community to sub centres and PHC - She will work with the village health and sanitation committee.
  56. 56. Contd.. - Escort pregnant women and children req treatment to the PHC’s. - Provide primary medical care for minor ailments like diarrhoea and injuries - Provider of DOTS. - Depot holder for ORS,IFA tablets, DDK’s,chlororoquine, OCP’s and condoms. - Inform about the births and deaths in her community.
  57. 57. Role and integration with ANM - ANM will hold fortnightly meetings with ASHA - She will act as resource person in the training of ASHA - Inform ASHA about date and time of outreach session. -Will participate in organising health days - She would educate ASHA on all her resposibilties and use her in motivating all sections of community on health issues.
  58. 58. Evaluation of ASHA’s work  % of newborns weighed and families counselled  % of children with diarrhoea receiving ORS  % of deliveries with skilled assistance  % of institutional deliveries  % of completely immunised children below 2yrs of age.
  59. 59. Sub centre  Peripheral outpost of the health care delivery in rural areas.  1 per 5000 in plains and per 3000 in hilly areas.  Staff – 3 1 MPW male 1 MPW female 1 volunteer worker No. of subcentres in India ,152326(2014)
  60. 60. Functions of Sub Centre  Antenatal care  Intranatal care  Child health care  Family planning and contraception  Counselling for safe abortion  Adolescent care  School health services
  61. 61. Primary Health Centres  First contact point between village community and Medical Officer.  Staff of PHC - 15 - Medical officer – 1 Pharmacist - 1 - Nurse -1 Health worker(f)- 1 - Heath Educator – 1 - Health assistant ( m and f ) -2 - Clerk – 2 lab assistant -1 - driver -1 class 4 - 1
  62. 62. Functions of PHC and medical officer  PHC: - OPD,emergency and referral services -Maternal and child health care -Family planning services -MTP services -prevention/management of RTI/STI. -nutrional services. -school/adolescent health services -National heath programmes.
  63. 63. Contd… - Disease survillience and epidemic control - Collection and reporting vital events - Sanitation promotion - Prompt referral to CHC’s - Training of health workers, birth attendants , ASHA ,ANM ,Aanganwadi,pharmacist. - Vasectomy and tubectomy - Basic laboratory services
  64. 64. Community heath centres  Each CHC acts as referral centre for 4 PHC’s  Staff 30-31 -Physician,General Surgeon- 1 each -Pediatrician,Gynaecologist- 1 each -Nurse- midwife – 9 -pharmacist and lab tech – 1each -radiographer and ophthalmic ass -1 other staff – 15
  65. 65. Suggested population norms  Doctor:1 per 1000  Nurse:3 per 1 doctor  Health worker:1 per 5000 & 3000  Health assistant:1 per 30000 & 20000  Pharmacist:1 per10000  Lab technician:1 per 10000  ASHA:1 per 1000  Trained dai:1 per 1000  AWW:1 per 400 & 800
  66. 66. RURAL HEALTH STATISTICS  No. of subcentres : 152326  No. of PHC’s : 25020  No. of CHC’s : 5363  No. of districts : 672  No. of villages : 640867  Rural population : 68.9%  CBR : 21.4 (SRS)  CDR : 7.0 (SRS)  IMR : 40
  67. 67. PHC PROGRESS IN INDIA (2012-13)
  68. 68.  Progress made in CHCs during 2005-12
  69. 69. INTEGRATEDAPPROACH 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
  70. 70. Health planning  Steps of health planning 1- analysis of heath situation 2- establishment of goals 3- assessment of resources 4- fixing priorities 5- formulating plan 6- programming & implementation 7- monitoring 8- evaluation
  71. 71. BUDGET IN FIVE YEAR PLANS • BUDGET: 1,960 Crore HEALTH: 5.9%FIRST PLAN (1951-56) • BUDGET: 4,672 Crore HEALTH: 5%SECOND PLAN (1956-61) • BUDGET: 8,576 Crore HEALTH: 4.3%THIRD PLAN (1961-66) • BUDGET: 15,778 Crore HEALTH: 7.2%FOURTH PLAN (1969-74) • BUDGET: 39,322 Crore HEALTH: 8.8%FIFTH PLAN (1974-79) • BUDGET: 97,500 Crore HEALTH: 1.8%SIXTH PLAN (1980-85) • BUDGET: 1,80,000 Crore HEALTH: 1.9%SEVENTH PLAN (1985-90) • BUDGET: 79,8000 Crore HEALTH: 9.5%EIGHTH PLAN (1992-97) • BUDGET:8,59,200 Crore HEALTH: 1.25%NINTH PLAN (1997-2002) • BUDGET: 14,84,131.30Crore HEALTH: 1%TENTH PLAN (2002-07) • BUDGET: 136,147Crore HEALTH: 1.5%ELEVENTH PLAN (2007-12) • BUDGET ALLOCATED: 90,000 CroreTWELFTH PLAN (2012-17)
  72. 72. Twelth five year plan goals  IMR - 25  MMR - 100  TFR - 2.1  Under 3 yr malnutrition - 50% reduction  Anaemia in 15 to 49 – 28%  0 to 6 child sex ratio - 950  TB- mortality reduction by 50 %  Leprosy- zero incidence  Malaria - incidence < 1/1000  Filaria – Mf prevalence <1%  Dengue – CFR<1%  HIV/AIDS – ZERO NEW INFECTIONS  Kala Azar - Elimination by 2015
  73. 73. BUDGET SUPPORT Budget Support for Central Departments in Eleventh Plan (2007–12) and Twelfth Plan (2012–17) Projections (` Crore) Department of MoHFW Eleventh Plan Expenditure (in Crore) Twelfth Plan Outlay( 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%
  74. 74. HEALTH EXPENDITURE, PUBLIC (% OF GDP) IN INDIA
  75. 75. HEALTH EXPENDITURE, PRIVATE (% OF GDP) IN INDIA
  76. 76. OUT-OF-POCKET HEALTH EXPENDITURE (% OF PRIVATE EXPENDITUTEON HEALTH) IN INDIA
  77. 77. EXTERNALRESOURCES FOR HEALTH EXPENDITURE (% OF TOTALEXPENDITUTEON HEALTH) IN INDIA
  78. 78. NURSESAND MIDWIVES (/ 1000 PEOPLE) IN INDIA
  79. 79. 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
  80. 80. 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
  81. 81. 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”
  82. 82. 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
  83. 83.  Indian Public Health Standards (IPHS) guideline for community health centers, Revised 2012. DGHS, MOHFW, GOI. 1-94  http://www.newindianexpress.com/magazine/India-has- just-one-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
  84. 84. THANK YOU 

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