2. HEALTH CARE SYSTEM
ORGANISATION:
INTRODUCTION :India is a union of 29 states and
9 Union territories. Under the Constitution of India.
Under the states are largely Independent in matters
relating to the delivery of health care to the people.
Each state therefore, has developed its own system of
health care delivery, independent of the central
government. The central responsibility consist of
mainly policy, planning, guiding, assisting, evaluating
and coordinating the work of state health ministries
so that state health services cover every part of the
country, and no states lags behind for want of these
services.
3. Conti.
According to the 7th schedule constitution ,three list are
made for the division of function:
1.Union list: function of the centre are included in this
defense ,foreign relation etc. comes under list
2.State list: the areas of responsibility of the states are
included. Finance, health ,home, local administration etc.
3.Concurrent list: in this matter of national significance
which require the joint effort of centre and state are
included public health, medical aid, sanitation ,education,
social welfare etc. comes under this category.
4. Thus the health is an area which comes mainly under the state
govt. but the role of the central govt. is also significant.
Providing assistance to state for health is a constitutional
responsibility of the central govt.
The health organisation of our nation under three headings:
1.HEALTH ORGANISATION AT CENTRAL
LEVEL
2.HEALTH ORGANISATION AT STATE LEVEL
3.HEALTH ORGANISATION AT DISTRICT
LEVEL
5. 1.HEALTH ORGANISATION AT CENTRAL
LEVEL :
The health system at CENTRAL level consist
of three main components:
1. Ministry of Health and Family Welfare
2. The Directorate General of Health
Services
3. The Central Council of Health and
Family Welfare
6. Cabinet Minister of state
Deputy health Minister
Department of health Department of family welfare
Joint secretaries
Joint secretaries
Additional secretory&commissioner.(F.W)
Health secretary to govt of
India
Secretary to the govt of India
Deputy
Administrative
7. ORGANISATION PATTERN MOHFW:
The ministry of health and family welfare (MOHFW) is headed
by the union minister of heath and family welfare. State minister
and deputy minister help him. These are all political appointment
Which are nominated by the prime minister of India
At administrative level each departments is headed by the
secretary to the govt. of India .for their assistance, there are
additional secretary, joint secretary, under secretary ,deputy
secretary
Brief division of work of the departments in as follows:
8. Department of health and family welfare:
Department of health mainly takes care of matters of
medical and public health, which include drug control
and prevention of adulteration in food materials.
Family welfare department was established in 1966.
The objectives of the dept. is to conduct family welfare
programmes in order to stablise the population at the
earliest and to ensure best RCH for the exsting
population
9. FUNCTION OF THE MOHFW:
(1) Union list :
1. International health relations and administration
of port quarantine
2. Administration of Central Institutes such as All
India Institute of Hygiene and Public Health, Kolkata.
3. Promotion of research through research centers
4. Regulation and development of medical,
pharmaceutical, dental and nursing Professions
10. 5. Establishment and maintenance of drug standards
6. Census and collection and publication of other
statistical data
7. Immigration and emigration
8. Regulation of labor in the working of mines and oil
fields
9. Coordination with states and with other ministries for
promotion of health
11. 2.Concurrent list:
The functions listed under the concurrent list are the
responsibility of both the union and state governments.
1. Prevention and extension of communicable diseases
2. Prevention of adulteration of food stuffs
3. Control of drugs and poisons
4. Vital statistics
5. Labor welfare
6. Ports other than major
12. 7. Economic and social planning
8. Population control and Family Planning
9.Preparation of health education material for creating
health awareness through Central Health Education
Bureau.
10. Collection, analysis, evaluation and dissemination of
information the Central Bureau of Health Intelligence
11. National Medical Library
13. 2.Directorate General of Health Services
Organization pattern:
Director general of health services
Additional Director General of health service
↓
Deputy Directorate General of health services
↓
Administrative staff
14. The director general of health services in the
principal advisor to the union government in
both medical and public health matters. He is
assisted by an additional director general of
health services, a team of deputies and a large
administrative staff. The directorate comprise
of three main units eg. Medical care and
hospitals, public health and general
administration.
15. Function :
1.International health relations and quarantine of all major
ports in country and International airport
2. Control of drug standards
3. Maintain medical store depots
4. Administration of post graduate training programmes
5. Administration of certain medical colleges in India
6. Conducting medical research through Indian Council of
Medical Research
7. Central Government Health Schemes.
8. Implementation of national health programmes
16. 9. Preparation of health education material for
creating health awareness through Central Health
Education Bureau.
10. Collection, compilation, analysis, evaluation and
dissemination of information through the Central
Bureau of Health Intelligence
11. National Medical Library
17. 3.Central council for health :
The central Council of health was set up by a
President order on a 9th August, 1952 under
Article 263 of the constitution of India. For
promoting coordinated concerted action the
centre and the states is implementation of all
the programs and measures pertaining to the
health of the Nation. The Union health
minister is the Chairman and the state health
ministers are the members.
19. Function:
1. To consider and recommend broad outlines of policy
regard to matters Concerning health like environment
hygiene, nutrition and health education.
2. To make proposals for legislation relating to medical
and public health matters.
3. To make recommendations to the central government
regarding distribution of available grants-in-aid for the
health purpose to the states and to review periodically the
work accomplished the different areas through the
utilization of these grants-in-aid.
21. 2.HEALTH ORGANISATION AT STATE LEVEL
• At present there are 29 states in India, with each
state heaving its own health administration. In all
states, the management sector comprise, the state
ministry of health, Health secretariat, and Directorate
of Health.
• State ministry of health and family welfare is headed
by cabinet minister. Deputy minister. The minister of
cabinet rank is the political head of the department of
health and family welfare. The health minister has to
perform both the activities i.e. political as well as
administrative as follow:
22. ORGANISATION FLOW CHART:
1. State Ministry of Health & family welfare
State health minister
↓
Deputy Minister of Health and Family Welfare
↓
Health Secretary
↓
Deputy Secretaries
↓
Administrative staff
23. Organization pattern:
State ministry of health and family welfare is
headed by cabinet minister. Deputy minister.
The minister of cabinet rank is the political
head of the department of health and family
welfare. The health minister has to perform
both the activities administrative &political
and linked to health secretariat
24. Function: SMOH
• As a member of the state Legislature, it is his duty to
support and safeguard the total policies of Govt.
because of the collective responsibility of the
Cabinet. The state ministry of health and family
welfare has to see the policies approved by the
legislature are faithfully implemented or not.
• HEALTH SECRETARIAT:(link to smofw)
25. • In order to keep a record of the health policies framed
by the political heads and to watch over their
implementation the ministry has to seek the help of an
office, which is known as ‘Health Secretariat’. So,
The Health Secretariat is the official organ of the
State Ministry of Health and Family welfare. The
Secretary of the State Govt. is a senior officer of
Indian Administrative Services, is the administrative
head and is assisted by Addl. Secretary, Deputy
Secretary and a large administrative staff.
26. Function of health secretariat:
1. Assisting the minister in policy making, in modifying
policies from time to time and in the discharge of his
legislative responsibilities.
2. Formulation, review and modification of broad policy
outline.
3. Execution of policies, programme etc.
4. Coordination with Govt. of India and other state
Governments.
5. Control for smooth and efficient functioning of
administrative machinery.
28. Organization pattern:
• In the state; state health directorate takes the
responsibility of the health services, execution of the
health policy and programmes and evaluation.
• The chief of health directorate is director.
• In some states it is popularly known as director of
• medical and health services (DMHS).
• Director gives technical advices to the states health
ministry and govt. on matters related to health, family
welfare services, public health, family planning
29. FUNCTION OF THE STATE HEALTH DIRECTORATE :
1.To provide adequate medical care through
hospitals, dispensaries, health centers and mobile
domiciliary units both in rural and urban areas.
2. To make proper arrangement for medical education
and research. In order to improve the functioning
of the medical education the state health dept. is to
take the following steps:
30. • Increase the out-turn of pure-medical staff in view of
large expansion of rural services.
• Reorientation of medical education with a view to
progressively making training of medical students more
community based.
• To make the good efficiency in nursing/paramedical and
other service staff in accordance with the norms prescribed
by the INC.
• To improve and expand common facilities like hospital,
pharmacy, blood bank, emergency services, intensive care
unit and rehabilitation services in the hospitals.
• Continuing encouragement to research activities in
Medical Colleges.
31. 3. Proper Implementation of National Health
Programme
4. To make provision for personal and impersonal
health schemes.
5.Control of Food & Drug administration
6.Collection & Dissemination of Health Information:
State Health Department collects and transmits
information on health & vital statistics for the states
32. 7.Control over E.S.I. Scheme: State health
department supervises the ESI scheme.
8. Enforcement of Professional standards: The
department determines and maintains the
standards of professional education, research and
practice through statuary bodies like the
university, state medical council state Nursing
council, State Pharmacy Council etc
33. 3. HEALTH ORGANISATION AT
DISTRICT LEVEL:
Administrative setup:
The major unit of administration in India is the
District for administration purpose the country is
divided into 29 states & 9 Union territories which in
turn are divided into 725 administrative districts.
District is the basic unit of administration in Indian
republic and collector is responsible for
administration of the districts.
34. Within each district, there are 6 types of
administrative areas :.
1. Sub –division : district is divided in two or
more parts in SD. SD administered by sub-
divisional officer or deputy collector or SDM
2.Tehsils(Taluka):each part of the subdivision
is divided into tehsil and tahsildar is in-charge
of the on tehsil or talukas 200 to 600 villages)
35. • 3. Community Development Blocks: after
independence the rural areas of the districts were
reorganized into blocks to plan and implement
community development programme which was
launched by the govt. of India in 1952.the areas of
blocks may or may not be coincide with tahsil.
A block consist of around 100 villages and
population ranging between 80,000 to 1,20,000
and in- charge of the block development
officer(BDO) who is assisted by 8 extension
officers in different areas. At present there are
6,311community development blocks in India.
36. 4.villages and panchayat: after blocks, there are village
panchayats.which are institutions of rural local self-
government.
5.Municipalities and Corporations : there are Municipalities
and Corporations in cities which are local self govt. for
population from 10,000 to 2lakh,there are municipalities and
for over 2lkah population there are municipal corporations.
Here the administration at district level is being
administration being described under two headings:urban
administration and rural administration (panchayati raj)
37. URBAN ADMINISTRATION:
The main units of the urban administration are:
• Municipal corporation
• Municipality (municipal board)
• Town area committees
• In some states ; single objective authority,cantonment board
and notified area committees are also important components
of urban administration
38. Municipal corporation:
• It can be said as top level urban govt.
• It is constituted where the population of the city is above 2
lakhs.
• It is headed by mayor
• It has a council. Councillors are elected from different wards
of the city.
• Its term is of 5 years
• At administrative level, CEO (chief executive officer )looks
after the administration, it is also called as commissioner.
• Health officer of the corporation is responsible for the health
and sanitation of the city, disposal of waste
39. Municipality (municipal boards):
• it is constituted where the population of the city/town is
ranging between 10,000 to 2 lakhs.
• It has three components : chairman,board,municipal
commissioner or executive office.
• Municipality is headed by chairman which is elected by board
members. Board members are elected from the different
wards, also termed as ward members.
• Sanitation, waste disposable ,construction of the roads, birth
and death registration are important function of the board
• It’s a term period for 5 years
40. Town area committees:
• Commonly towns are such areas which are in between the
village and city.
• These are neither village nor city.
• Town area committees are constituted for the administration of
the such towns.
• Town area committee is under the administration of the district
collector.
• Town area committee are found in
J&K,MP,UP,WB,KERALA,ASSAM,
GUJ.,KARNATAKA,TN,HP,
41. Single objectives authorities:
Are constituted for fulfilling the single or specific objectives.
These are also called as specific objectives authorities.
The urban improvement trust(UIT), urban development authority
(UDA),housing board, port trust are example of the single
objectives authorities
Cantonment boards :are constituted in such places, where
military remain in cantonment. Half of the members of the cannt.
Boards are taken from the military whereas remaing half are
elected from the civilians
42. RURAL ADMINSTRATION OR LOCAL SELF
GOVT. RURAL AREA IN THE
DISTRICT:(PANCHAYAT RAJ SYSTEM)
The panchayat raj system is introduced since 1952 to
link villages to the district , to have people
participation and strengthen the administration at
grass root level-the villages.
The panchayati raj system is comprised of three tier
structure of rural local self govt. to involve people at
various levels of administration and making it
meaningful and effective . The three institutions are:
Panchayat – at village level.
Panchayat Samiti – at Block Level.
Zila Parishad – at the district level
44. Panchayat samiti(block level):
The panchayati raj institution at the block level is know
as the panchayat samiti. Block consist of about
80,000 to 1,20,000. panchayat samiti is constituted by
all sarpanch of the gram panchayat in the
block,MLAs and MP related to block and members of
cooperative societies, women,SCs/STs. BDO is the
officers takes care of administration of panchayat
samiti and he is representative of the state
govt.panchayat samiti should meet at least once in a
month
45. At Village Level:- The Panchayati Raj at the Village
level consist of :
The Gram Sabha
The Gram Panchayat
The Nyaya Panchayat
The Gram Sabha:
It is the assembly of all the adults of village which
meets at least twice a year. The gram Sabha consider
proposals for taxation, discussion the annual
programmes & elect members of the gram panchayat.
46. Gram panchayat:
Gram panchayat consist of 15-30 elected members.it
covers a population of 5000-20000.it is chaired by the
president –sarpanch mukhiya sabhapati. There is a vice-
president and secretary . The gram sabha and is
responsible for overall planning and development of the
villages. The panchayat secretary has been given
powers to function for wide areas such as maintenance
of sanitation and public health , socio economic
development of villages. Gram panchayat involve in
various health activity
47. Nyaya panchayat:
Is the village platform to resolve the dispute between
the villagers/local groups . this tries to create harmony
and peace among villagers .
48. 3. Zila parishad at the district level:
Zila parishad is constituted at the district level and represents as
an agency of PRI.
The members include all heads of the panchayat samiti in the
district,reprentatives of women,SCs/STs and two members
related to rural development
District collector is also member of the zila parishad but does not
have the voting power
Mainly zila parishad is the supervising and coordinating agency
and functions may vary state wise.
