Health care system in India

1. Health Care Delivery
Primary Health Care
in India
Dr.Pallavi S.Shelke
Professor (Addl)
Dept. Community Medicine
L.T.M.M.C.& L.T.M.G.H.

2. SLOs
Students should know –
 The Health Care Infrastructure of India
 Urban Health Problems & Primary Health Care
 Rural Health Problems & Primary Health Care

3. SLOs
4. Infrastructure for Primary Health
Care
Primary Health Care

7. 748 ( Year 2021)

9. Panchayat Raj
THREE TIER STRUCTURE
1) Panchayat – At Village Level
a) Gram Sabha
b) Gram Panchayat
c) Nyaya Panchayat
2) Panchayat Samiti – At the Block Level
3) Zilla Parishad – At the District Level

15. Concept Of Health Care
1)Primary care level –
-1st level of contact of individuals, The family & the
community where “Primary Health Care” is provided
-Provided by PHCs & their Sub-centres through the
agency of Multi-purpose Health Workers, Village
Health Guides & Trained Dais
-Bridges the cultural & communication gap between
the rural people & organised Health Sector

16. Concept Of Health Care
2)Secondary care level –
-The next higher level
-More complex problems are dealt with
-Generally provided in District Hospitals & CHCs
which also serve as the 1st Referral Level

17. Concept Of Health Care
3)Tertiary care level –
-Require specific facilities & attention of highly
specialized health workers
-Provided by The Regional or Central Level Instit-
utions like Medical College Hospitals, All India
Institutes, Regional Hospitals, Specialized Hosp-
itals & Other apex Institutions
-Provides a sound Referral System

19. Health Care System
1) Public Sector –
a) Primary Health Care -
PHCs
Sub-centers
b) Hospitals/Health centres -
CHCs
Rural hospitals
District Hospitals
Specialist hospitals
Teaching Hospitals

20. Suggested norms for heath
personnel
Category of personnel Norms suggested
Doctors 1 per 3,500 population
Nurses 1 per 5,000 population
Health worker female and male 1 per 5,000 population in plain area and
3,000 population in tribal and hilly areas
Trained dai One for very village
Health assistant (male and female) 1 per 30,000 population in plain area
and 20,000 population in tribal and hilly
areas provides supportive supervision to
6 health workers ( male / female)
Pharmacists 1 per 10,000 population
Lab. Technicians 1 per 10,000 population
ASHA 1 per 1000 population

21. A. Communicable Diseases
Problem
Malaria
TB
Diarrhoea
ARI
AIDS

22. B. Non communicable
Diseases
Diabetes mellitus
Cardiovascular diseases
Stroke
Chronic lung disease
Cancer
Oral health

23. C. Health related problems
 Population explosion
 35% population in Urban area
and 80% of doctors serve
them

24. Urban Health Problems
 Urban Environment
 Air, Water Pollution
 Depletion of Natural Resources
 Improper waste disposal
 Noise pollution
 Traffic pressure
 Industrialization,
 Comm and Non comm diseases

25. Rural Health Problems
1. Communicable diseases
2. Nutritional
3. Environmental &
Sanitation
4. Medical care
5. Population

26. Primary Health Care in India
 In 1977, Govt. of India launched a Rural Health
Scheme based on the principle of “Placing
people’s health in people’s hands”
 The Primary Health Care is implemented at the
following 3 levels
1)Village Level
a)Village Health Guide Scheme
b) Local Dais
c) Anganwadi Worker
2) Sub-centre Level
3) Primary Health Centre Level

27. Primary Health Care in India
1)Village Level
a)Village Health Guides
-A person for social service & not a full time Govt.
functionary
-Mostly women
-Come from & are chosen by the community in which they
work
-Links between the community & governmental
infrastructure
-Provide the 1st contact between the individual & health
system

28. VHG-Selection
criteria:
They should be-
i)permanent residents of the
local community
ii)able to read & write,educated
at least upto VI std.
iii)acceptable to all sections of
community

29. Primary Health Care in India
a)Village Health Guides
-Undergo 200 hrs. of training, spread over a period of 3 months
-Stipend of Rs. 200 per month during the training
-Receive a working manual & a kit of simple medicines on
completion of training
-Duties: i) Treatment of simple ailments & injuris
ii) Mother & Child health,including family planning
iii) Health education & sanitation
-Paid an honorarium of Rs. 50 per month & drugs worth Rs.600
per
annum

30. Primary Health Care in India
b) Local Dais
-All categories of local dais in the country are trained to
improve
their knowledge in the elementary concepts of maternal &
child
health & sterilization,besides obstetric skills
-30 days training with a stipend of Rs. 300
-After training, each dai receives a delivery kit & a certificate
-Receives an amount of Rs.10 per delivery if the case is
registered
-To each infant registered by her, she will receive Rs.3

31. Primary Health Care in India
c) Anganwadi Worker
-Trained under the ICDS (Integrated Child Development Services)
scheme, 1 for a population of 1000
-Undergoes training in various aspects of health, nutrition & child
development for 4 months
-Paid an honorarium of 200-250 per month
-Services rendered : Health check ups, Immunization, supplemen-
tary nutrition, health education, non-formal pre-school education
and referral services
-The beneficiaries are nursing mothers, other women(15-45 yrs)
and children below the age of 6 yrs.

32. Accredited Social Health
Activist (ASHA)

33. ASHA

34. ASHA

35. ASHA

36. ASHA

37. ASHA

42. Role and integration with
ANM
 ANM will guide ASHA
 Meeting periodically to discuss and solve problems
during activities
 Motivating and getting beneficiaries to out reach session
 Organizing Health Days
 Motivating PW to take IFA tablets
 Awareness about dose schedule and side effects of OC
pills

48. National AYUSH Mission
Training Prog for ASHA, AWW, PRI
members

63. Primary Health Care in India
2) Sub-centre Level
-Peripheral outpost of the rural health delivery system
-One sub-centre for a population of 5000 in general & 1 for every
3000 population in hilly, tribal & backward areas
-25650 PHCs x 6 sub-centres in the country as on March 2017
-Manned by one male & one female multipurpose health worker
-Functions : i)Mother & Child health care
ii)Family planning
iii)Immunization

64. Primary Health Care in India
3) Primary Health Centre Level (PHC)
-The Central Council of Health recommended the establishment of
PHCs in January 1953
- each PHC covering a population of 1,00,000 or more spreading
over some 100 villages in each community development block
-The National Health Plan (1983) proposed one PHC for every
30,000 rural population in the plains,& one PHC for every 20,000
population in hilly, tribal & backward areas
-

69. Sites of delivering services
 Village- Village Health/ Nutrition Day/ Immu. Session
 Home visits
 House to house survey
 Meetings and events with the community
 Facility premises- OPD services

70. IPHS standards for sub-
centres
 Type A
-all recommended services except facilities to conduct
delivery
- In the vicinity of other higher facilities
 Type B (MCH centre)
-centrally or better located
-Good physical infrastructure
-good case load of deliveries

83. Health and Wellness Centre
 National Health Policy , 2017
 By transforming existing Sub-centres and PHCs as basic
pillars of Ayushman Bharat to deliver Comprehensive
Primary Health Care (CPHC)
 Principle- Time To Care not more than 30 min.
 Equity , universality and no financial hardship

84. NMC- RHTC –Staffing Pattern
Designation No. of posts
Medical Officer of Health –Cum-
Lecturer/ Asstant Proefessor
1
Lady Medical Officer 1
Medical Social Workers 2
Public Health Nurse 1
Health Inspectors/ Health Assistant
(Male)
1
Health Educator 1
Technical Assistant/ Technician 1
Peon 1
Van driver 1
Store keeper- cum-Record Clerk 1
Sweepers 2

85. Urban Primary Health Center
 Hub of preventive, promotive and basic curative
healthcare for its catchment population.
 Within its catchment area, the UPHC is responsible
for providing the primary health care and public
health needs of the population. The U-PHC is located
preferably closer to slum or similar habitations.


86. Urban Primary Health Center
 The package of services envisaged at UPHC
inclusive of preventive, promotive, curative,
rehabilitative and palliative care.
 Further, in order to strengthen Comprehensive
Primary Health Care across the country through
“Ayushman Bharat-HWCs”, states are upgrading
their Primary Health Care centers as Health and
Wellness Centres (HWCs).

93. NMC- UHTC –Staffing Pattern
Designation No. of posts
Medical Officer of Health –Cum-
Lecturer/ Asstant Proefessor
1
Lady Medical Officer 1
Medical Social Workers 2
Public Health Nurse 1
Health Inspectors 2
Health Educator 1
Technical Assistants/ Technicians 2
Peon 1
Van driver 1
Store keeper 1
Record clerk 1
Sweepers 2

96. THANK YOU