An overview of health care delivery system in


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An overview of health care delivery system in

  1. 1. B Y - D R . D H A R M E N D R A G A H W A I ( P G S T U D E N T ) M O D E R A T O R - P R O F . Y . D . B A D G A I Y A N H E A D O F D E P A R T M E N T D E P A R T M E N T O F C O M M U N I T Y M E D I C I N E C I M S , B I L A S P U R ( C G ) An Overview of Health Care Delivery System in India
  2. 2. INTRODUCTION  As is well known , the majority of India’s population lives in the rural areas and • this segment of population have been given inadequate attention so far as health and medical care facilities are concerned.
  3. 3.  The dense rural population with varied ethnic background , high level of illiteracy, low per capita income have been a challenge to Central and state government to improve the quality of people’ lives.  To cope up with various plans, programmes were developed aiming to improve the level of living and health of the people.
  4. 4.  This planned development of about five decades has resulted in increase in the health infrastructure to meet the increasing demand on health services at various level.  At the same time , there has been marked shift in National Health Policy from hospital based services to community based services duly backed by strong referral services.
  5. 5.  Today , it is clear that health system in India do not gravitate naturally towards the goal of HEALTH FOR ALL through primary health care as articulated in the Declaration of Alma-Ata.  Health systems in India are developing in directions that contribute little to equity and social justice and  Fail to get best outcomes for their resources.
  6. 6.  Three worrisome trends of health care system in India -  1.Health system that disproportionately focus on narrow offer of specialized health care.  2.Health system where a command and control approach focused on short-term results and is fragmenting the service delivery.  3.Health systems where governance has allowed unregulated commercialization of health to flourish.
  8. 8. Common shortcomings  1.Inverse care.  2.Impowerising care.  3.Fragmented and fragmenting care.  4.Unsafe care.  5.Misdirected care.
  9. 9. INVERSE CARE  People with most means - whose needs for health care are often less - consume the most health care services.  Whereas those with the least means and greatest health problems consume the least.  Public spending on health services most often benefits the rich more than the poor.
  10. 10. IMPOVERISHING CARE  Wherever people are lack of social protection and payment for health care , they are largely out of pocket at the point of health services.  They can be confronted with catastrophic expenses.  Millions of people fall in to poverty because they have to pay for health care services.
  11. 11. FRAGMENTED AND FRAGMENTING CARE  The excessive specialization of health care providers and the narrow focus on many disease control programmes discourage the holistic approach to the individuals and families.  Health services for the poor and marginalized groups are highly fragmented and severely under resourced .
  12. 12. UNSAFE CARE • Poor system design that is unable to ensure safety and hygiene standards leads to high rates of hospital acquired-infection. • Medication error and other avoidable adverse effects are underestimated cause of death and ill health.
  13. 13. MISDIRECTED CARE  Resource allocation clusters around curative services at great cost and it is neglecting the potential of primary prevention and health promotion to prevent up to 70% of disease burden in developing countries.  Health sector lacks to mitigate the adverse effects on health from other sectors and  At the same time, unable to make most of what these sector can contribute to health.
  15. 15.  Health development is integral to overall socioeconomic development.  Ministry of Health and Family welfare plays a vital role in planning and making policies.
  16. 16.  Under the Constitutions of India, the item like public health, sanitation, hospitals and dispensaries fall in the state list.  Health care is the subject of state government and each state in India has developed its own system of health care delivery independent of central government.  The central organization is mainly for policy making and planning and is mostly consultative and advisory.
  17. 17. At Central Level  The organization at centre comprise of :  1.Union Ministry of Health and Family Welfare.  2.Directorate General of Health Services.  3.Central Council of Health and Family Welfare.  Ministry of Health and Family Welfare is headed by  1. A Cabinet Minister.  2.A Minister of State.
  18. 18.  Currently it consist of four departments –  1.Department of Health and Family Welfare.  2.Department of AYUSH.  3.Department of Health Research.  4.Department of AIDS control.
  19. 19.  The Union Ministry – - formulates national policies on health and gives advise on health allied matters. - coordinates health programmes and policies. -supplies technical information and equipments. -provides financial and other assistance towards health measures. In general it promotes the health and well being of people.
  20. 20. At State Level  The state is ultimate authority responsible for all the health services operating within its jurisdiction.  At present there are 28 states and 9 union territories in India and as many type of health administration.  In all the state it comprises of –  1. State Ministry of Health and Family Welfare.  2.Directorate General of Health Services.
  21. 21.  The State Ministry of Health and FW is headed by-  1.A Minister of Health and Family Welfare.  2.A Deputy Minister of Health and Family Welfare. • Health Secretariat is a official organ- • 1. Health Secretary.(Head) • 2. Joint Secretaries.(2 or 3) • 3. Deputy Secretaries and • 4. Under Secretaries.
  22. 22.  Director General of Health Services is chief technical advisor to the state government in all matter of medical and public health.  DGHS is assisted by 2-3 Joint Directors.  Joint Directors may be-  1. Regional.  2. Functional.
  23. 23.  The Regional Directors are at Divisional level and area classified according to geographical distribution.  The Functional Directors are in particular branch of public health such as –  Maternal and Child health  Family Planning  Nutrition  Health Education.
  24. 24.  To coordinate the health and family welfare activities between State government and Central government there are 17 Regional Health Offices.  For the large state there is one regional office while 2-3 smaller state have been linked with one regional office.
  25. 25. At District Level  The District level structure of health services is a linkage between state structure on one side and peripheral structure such as CHC , PHC and sub- center on other side.  The district officer of overall control designated as CMHO.
  26. 26.  CMHO are assisted by deputies , programme officers and State Civil Medical Officers of different specialities.  They are responsible for implementing health and family welfare programmes according to policies lay down at higher level.
  27. 27. At Block Level  The block is unit of rural planning and development and comprises about 80,000 to 1.2 lakh population.  One Community Health Center is being established in each block.  The officer in-charge of CHC is k/as Superintendent CHC or Block Medical Officer.  Normally one CHC should have –  - 30 bed hospital .  - Specialist doctors in Pediatrics, Obstetrics, Medicine and Surgery .  - Four Medical Officer.
  28. 28. At Primary Health Center  The delivery of Primary Health Care is principal objective of rural health care system.  One PHC covers about 20000 – 30000 population.  PHC is manned by Medical Officer and paramedical staff.  The Primary Health Center is expected to provide “essential health care” including MCH and family planning.  MCH services are provided through PHC clinic, sub- center and out reach sessions.
  29. 29. At Sub-center level  Sub-centers are peripheral outpost of health care delivery system.  Each sub center covers 3000-5000 population and manned by one MPW male and one MPW female.  MPW female is crucial to provide MCH services.
  30. 30. At Village level  1.ASHA.  2.AWW.  3.Village Health Guide.  4. Trained dais.
  32. 32.  The annual report of World Health Organization’s (WHO) 2008 focused on “the place of primary healthcare (PHC) in health systems”.  The report arguing that, in three decades since the Declaration of Alma-Ata (WHO 1978) on primary healthcare, only little has changed.  Member countries had largely implemented 'selective' primary care focused on provision of medical care and services and treatment of specific conditions.
  33. 33. FOUR SETS OF PHC REFORMS  The WHO report (2008) laid out a four-point framework for Primary Health Care policy.  1.Universal Coverage Reforms.  2.Service Delivery Reforms.  3.Public Policy Reforms.  4.Leadership Reforms.
  34. 34. 1.Universal Coverage Reforms  Universal coverage reforms is to improve health equity, end exclusion and promote social justice.  Primary care should be accessible to all and ideally, be free at the point of services.
  35. 35. 2.Service Delivery Reforms  Service delivery reforms designed to re-organize services around primary care.  In this sense, the WHO argued that PHC should be the ‘hub’ from which patients are guided through the health care system.  PHC should be delivered by multi-professional teams that provide comprehensive care, co-ordinate hospital and other specialized patient services, build partnerships with patients, and promote disease prevention.
  36. 36. 3.Public Policy Reforms.  The WHO advocated for public policy reforms that integrate public health initiatives into primary care delivery and  work to promote health in the policies of other sectors that influence community behaviour and outcomes.  'intersectoral collaboration'.
  37. 37. 4.Leadership Reforms.  The Leadership Reforms replace disproportionate reliance on command and control on one hand.  The inclusive , participatory , negotiation based leadership is required by the complexity of health system.
  39. 39.  The health system in India has expanded considerably over the last few decades.  But , due to non availability of man power, problems of access and lack of community involvement, the quality of health services is not up to the mark.  Hence, standards are being introduced in order to improve the quality of health care at public health level.
  40. 40.  The Bureau of Indian Standards has already prescribed standards for health care facilities,  but , at present these are not achievable as they are very resource – intensive.
  41. 41.  IPHS are the set of standards envisaged to improve the quality of health care delivery in the country.  IPHS defining personnel , equipment and management standards.  It decentralized administration by a hospital management committee and provision of adequate funds and powers to enable these committees to reach desired levels.
  42. 42. Objectives of IPHS  1.To provide optimal support and comprehensive primary health care to the community.  2.To achieve and maintain an acceptable standards of quality care.  3.To make the services more responsible and sensitive to the need of community.
  43. 43.  NRHM aims at strengthening hospital care for rural areas.  So, as the first step, requirement for Minimum Functional Grade for CHCs, PHCs and Sub-center are being prescribed.
  45. 45.  There have been significant advances in the healthcare system in India over last few decades.  Despite these recent strides the health system remains ineffective in providing basic minimum care as promised in the Indian Constitution.
  46. 46.  The fiscal constrains on the government make it obligatory for the private healthcare providers to take over part of the responsibilities.  New ways for establishing, strengthening and sustaining the public-private co-operation are essential for rejuvenating the system.
  47. 47.  At the same time decentralization exercises can make the health system more efficient and improve the quality of healthcare delivery.  All these changes will need to be based on a strong political will and should be accompanied by economic and social reforms.
  48. 48. THANK YOU