Heath System in India

1. Primary Health care in India
& Health Administration
MR. MARKAD RAVINDRA
SISTER TUTOR.
SCHOOL OF NURSING ,
K.E.M. HOSPITAL, PAREL, MUMBAI

2. THE CONCEPT OF HEALTH CARE
• Health care is a public right.
• Time since 3000 B.C it has been given the utmost
importance.
The Indus valley civilization

3. • The present health care system has taken
its shape from many hands right from
aryans in 1400B.C. to the present govt.of
india.

4. Ayurveda
Siddha
Unani
Various systems of medicine

5. Levels of health
care
1. Primary care level
• Primary health care is the 1st and foremost link
between the people and national health system,
where majority of their health problems are
dealt with and resolved.
• It is provided by the primary health centers,
their sub-centers, multipurpose health workers,
village health guides and trained dais.

6. 2. Secondary care level
• It includes district hospitals and community
health centers which also serve as the first referral
level.
3. Tertiary care level
• It is much more specialized.
• It has specific facilities and highly specialized
health workers provided by the regional or
central level institutions.
• Eg Medical college Hospital, All India instritute,
Regional or specialised Hospital or Apex
Instritute
To provide a sound referral system is the major problem and
major need of the developing countries including india.

7. character Primary
health care
Secondary
health care
Tertiary
health care
deals Prevailing
health
complaints
More complex
problems
Super specialty
care
Provided by PHC, sub
centers,
community
participation
District
hospitals,
community
health centers
Regional
&central level
institutions
provides Essential health
care,
Essentially
curative services
Planning,
managerial skills
teaching ,super
specialty care

8. CHANGING
CONCEPTS

9. With the political independence of
india various approaches towards
health care are seen.
They are:
1.Comprehensive health care
2.Basic health services
3.Primary health care

10. Comprehensive health care
• The term is 1st used by Bhore committee in 1946.
• It meant to provide integrated, preventive,
curative and promotional health services from
womb to tomb to every individual residing in a
defined geographic area.
• This concept led to the national health planning in
india and led to the establishment of a network of
primary health centers and sub-centers by the
govt during the successive 5 yr plans.

11. • But they were not able to effectively cover
the whole population and their sphere of
service did not extend beyond 2-5 km
radius, because they were understaffed and
poorly supplied with medicines and
equipment.
• As a result there was growing dissatisfaction
with the delivery of health services.

12. Basic health services
• It was in 1965 that the term was used by
UNICEF/WHO in their joint health policy.
• It is defined as a network of coordinated,
peripheral and intermediate health units
capable of performing effectively a selected
group of functions essential to the health of
an area and assuring the availability of
competent professional and auxiliary
personnel to perform these functions.

13. • It is just a change in terminology from
comprehensive to basic health services.
• Thus it shared the same drawbacks such as
lack of community participation, lack of
inter-sectoral coordination and dissociation
from socio-economic aspects of health.

14. Primary health care
• This new approach came in 1978 following
an international conference at Alma-Ata
(USSR)
• Before 1978, primary health care was
regarded synonymous with - basic health
services
- first contact care
- easily accessible care
- services provided by

15. • But Alma-Ata international conference defined it
as:
“primary health care is essential health
care made universally accessible to individuals
and acceptable to them, through their full
participation and at a cost the community and
country can afford”
• It has been accepted by all the countries as the key
to the attainment of Health for All by 2000A.D.
and also as a integral part of country’s health
system.

16. Elements of primary health care
1. Health education prevention and control
2. Promotion of food supply and proper nutrition
3. Supply of safe water and basic sanitation
4. Maternal and child health care including family
planning
5. Immunization
6. Prevention and control of locally endemic diseases
7. Appropriate treatment
8. Provision of essential drugs

17. Principles of primary health care
1. Equitable distribution
- Health services must be
shared equally by all irrespective
of their ability to pay
- Primary health care aims at
shifting the centre of gravity of
health care system from cities
(where 3/4rth of health budget is
spent) to the rural areas (where
3/4rth of people live).

18. 2. Community participation
- Primary health care cannot be achieved without
the involvement of the local community.
- The use of village health guides and trained dais
has made this type of approach successful in india.
It played a major role in delivering primary health
care services at rural level by overcoming cultural
and communication barriers.

19. 3. Inter sectoral coordination
- The health sector alone cannot fulfill the health
needs of the society.
- Hence it needs support from other sectors related
to the aspects of national and community
development, in particular agriculture, animal
husbandry, food, industry, education, housing,
public works, communication and other sectors.
- All the sectors must be coordinated by planned
reallocation of resources by the administrative
system.

20. 4. Appropriate technology
- scientifically sound
- adaptable to local needs
- acceptable to those who apply it and to those
whom it is used
- can be maintained by people themselves
- Appropriate technology doesn’t mean the use of
costly equipment, procedures and techniques
when cheaper, scientifically valid and acceptable
ones are available.

21. • Central
• State
• peripheral
Health System in India

22. Health System in India
1) At the centre
a)Ministry of health and family welfare
b)Directorate general of health services
c)Central council of health & family welfare
2) At the state level
a) State Ministry of health
b) State health directorate
3) At district level
i) Sub division
ii) Tahsils (Taluka)
iii) Community develoment blocks
iv) Muncipalities and corporation
v) Villages
vi) Panchayats

23. 1) At the centre
a)Ministry of health and family
welfare
Headed by cabinet Minister, Minister of
state & deputy health minister
It has following departments
• 1) Department of health
• 2) Department of family welfare

24. Functions
Enlisted in 7th schedule of article 246
of the constitution of India ,they are
• Union list
• Concurrent list

25. Union list functions
• International health relations and administration
of port quarantine
• Administration of central institutes
• Promotion of research
• Regulation and development of medical,dental
and nursing profession
• Immigration and emigration
• Establishment maintenance of drug standards
• Census
• Regulation of labor of mines and oil fields
• Coordination with states for promotion of health

26. Concurrent list functions
These functions are responsibility of both
the union and state government .They
are
• Labor welfare
• Prevention extension communicable disease
• Control of drugs and poison
• Economic and social planning
• Prevention of adulteration of food stuffs
• Population control
• Family planning

27. b)Directorate general of health services
• International health relations & quarantine
• Control of drug standard
• Post graduate training
• Medical education medical research
• Central govt health scheme
• National health program
• Central health education bureau
• Health intelligence
• National medical library

28. 2) At the state level
1) State Ministry of health
Headed by minister of health & family
welfare and deputy minister of
health & family welfare
2)State health directorate
Two dept medical & public health
Headed by surgeon general and
inspector general of civil hospital
& director of public health respectively

29. 3) At district level
i) Sub division – Asst collector/ Sub collector
ii) Tahsils (Taluka)-Tahsildar (200-600 village)
iii) Community develoment blocks-Block development
officer 100 village/80000-120000 population
iv) Muncipalities and corporation- population above 2
lakhs
v) Villages
vi) Panchayats-
1) Panchayat- at village level
2) Panchayat samitii- at block level
3) Zila parishad/ Zila Panchayat-district level

30. Panchayati Raj
1) Panchayat- at village level
a) Gram sabha
b) Gram Panchayat (Sarpanch/sabhapati/Mukhiya & vice
president and panchayat secretory)
c) Nyaya panchayat
2) Panchayat samitii- at block level
All serpanch in blocks, MLAs, MPs, women representive,
schedule cast and tribe & corporate society
3) Zila parishad/ Zila Panchayat-district
level
All head of Panchayat samiti, MPs, women representive,
schedule cast and tribe & corporate society, 2 person
experince in administarion

31. Health care delivary
system in India

32. 1.PUBLIC HEALTH SECTOR
(a) Primary health care
• Primary health centers
• sub‐centers
(b) Hospitals/Health centers
• Community health centers
• Rural hospitals
• District hospital/health center
• Specialist hospitals
• Teaching hospitals
(c) Health Insurances schemes
• Employees state insurance
• Central Govt. Health Scheme
(d) Other agencies
• Defence services & Railways

33. 2) Private sector
a) private hospitals, polyclinics, Nursing
homes, dispensaries
b) General practitioners & clinics
3) Indigenous system of medicine
Ayurveda & siddha, Unani & Tibbi,
Homoepathy, Unregistered practitioners
4) Voluntary health agencies
5) National health program

34. • The following schemes are in operation
a) village health guide scheme
b) training of local dais
c) Anganwadi worker under ICDS scheme
a) VILLAGE HEALTH GUIDE:
a person with an aptitude for social service and is not a
full time government functionary. The health guides
are now mostly women . They come from and are
chosen by the community in which they work .
1.They provide 1st contact btw individual and the health
system .
VILLAGE LEVEL

35. 1.The guide line for their selection are
a )they should be permanent residents of the local
community preferably women.
b) they should be to able read and write. having
minimum education up to 6th standard.
c) they should be acceptable to all sections.
d) They should be able to spare at least 2 to 3 hours
every day for health work .
e) After selection they under go training in Primary health
care. Duration is 200 hours, spread over a period of 3
months & during training they receive a stipend of 200
per month.
f) On completion of training they receive a working
manual and a kit of simple medicines.
DUTIES-1)treatment of simple ailments and activities in
the 1st aid, mother and child health including family
planning, health education and sanitation they should
refer the patients to nearest health center if necessary.

36. • 2)LOCAL DAIS –
• An extensive programme has been under taken
under the rural health scheme, to train all
categories of local dais (traditional birth
attendants ) to improve their knowledge in the
concepts of maternal and child health and
sterilization besides obstetric skills.
• The training is for 30 working days. During her
training each dai is requested to conduct at least
2 deliveries under guidance of health worker.
• Each dai is provide by a delivery kit and
certificate.

37. 3) ANGANWADI WORKER-
angan means courtyard under the ICDS scheme,
there is one Anganwadi worker for a population
of 1000.
• Anganwadi worker is selected from community,
she under goes training in various aspects of
health, nutrition, child development for 4
months.
• SERVICES – health check-ups immunization
supplementary nutrition, health education, non
–formal pre school education and referral
services.

38. • Is the peripheral out post of the existing
health delivery system in rural areas .
• Their should be one sub center for every
5000 population.
• Each sub center is manned by one male
and one female multipurpose health
workers.
• FUNCTIONS-MCH care, family planning,
immunization.
• The work is supervised by male and
female health assistants.
SUB CENTER LEVEL

39.  The BHORE committee in 1946 gave the
concept of a primary health center as a basic
health unit, to provide, as close to the people
as possible, an integrated curative and
preventive health care to rural population with
emphasis on preventive and promotive aspects
of health care.
 The national health plan (1983)proposed
reorganization of PHC on the basis of 1 PHC for
every 30,000 rural population In plains and
20,000 rural population in the e hilly tribal
backward areas for most effective coverage
PRIMARY HEALTH CENTER

40. 1. Medical care
2. MCH and 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. Health education
7. National health programmes –as relevant
8. Referral services
9. Training of health guides and workers local
dais health assistants
10.Basic lab services
FUNCTIONS OF PHC

41. AT THE PHC LEVEL
1. MEDICAL OFFICER 1
2. PHARMACIST 1
3. NURSE MID WIFE 1
4. HWF 1
5. BLOCK EXTENSION EDUCATOR 1
6. HEALTH ASSISTANT MALE 1
7. HEALTH ASSISTANT FEMAL 1
8. UDC 1
9. LDC 1
10. LAB TECNITIAN 1
11. DRIVER 1
12. CLASS IV 4
-------------------------------------------------
TOTAL 15
-------------------------------------------------
STAFFING PATTERN

42. • There should be 1CHC for 80000-
1.2lakh population with 30beds and
specialists in surgery ,medicine
,obstetrics ,gynecology, pediatrics
with x-ray lab facilities.
• Staff pattern –medical officer
-nurse mid wives
Community health centers

43. • Dresser
• Pharmacist
• Lab technician
• Radio grapher
• Ward boys
• Dhobis
• Sweepers
• Mali
• Chowkidhar
• Attender
• Peon
.

44. THANK YOU