A_Text_book_on_Nursing_Management_Accord.pdf

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
A Text book on
Nursing
Management
(According to Indian Nursing Council Syllabus)
AUTHORS :
Mr. Anoop.N
Mr. Chetan Kumar.M.R
Mr. Deepak.K
Mr. Lingaraju.C.M
Mr. Mithun Kumar.B.P
Mr. Sarath Chandran.C

Dedicated to all
M.Sc. Nursing
students
From:
M.Sc. (Nursing) II year
Batch: 2009-2011
PADMASHREE INSTITUTE
OF NURSING

Forward
It gives me an immense happiness to forward this Text Book of Nursing Management
written by budding authors Mr.Annop, Mr. Chetan.M.R, Mr. Deepak.K, Mr. Sarath
Chandran, Mr.Mithun Kumar, Mr.Lingaraj.C.M, studying in Padmashree Institute of
Nursing, Bangalore, Karnataka.
This book is designed according to INC syllabus of M.Sc. Nursing. Each unit is described in
detailed according to the updated with recent and advanced information on nursing
management and administration. All the authors struggled a lot tirelessly round the clock
for the birth of this successful text book.
It is not an easy task to deliver such excellent knowledge information on nursing
management topics. It is the effort, dedication and commitment of Mr.Deepak.K who was
the backbone, pillars and implanted the seed to initiate, organized arrange systematically
the flow contents of Mr.Anoop, Mr. Chetan Kumar. C.M, Mr.Sarath Chandran,
Mr.Mithun Kumar, Mr.Lingaraj.C.M has joined their efforts with Mr.Deepak.K in
delievering the sweet essence on the units they selected and written in simple language.
I hope this book will be benefitted to Postgraduate nursing students to develop
understanding and apply the nursing management services in clinical setting and
educational institution too.
I am sure that this book will be widely used and will make a worthy contribution to the
nursing profession. I wish all the best for the authors for such a contribution in the field of
nursing management.
Mr. Ellakuvana Bhaskara Raj.D
Associate Professor
HOD of Psychiatric Nursing Department
Padmashree Institute of Nursing
Kommagatta village, Bangalore-60

Acknowledgement
Service to mankind is service to GOD. We believe in invisible power which guided us
throughout our success.
Thandhe, Tayee, Guru, Devaru. We are very much indebted to our lovable parents for
their continuous guidance, support and encouragement for accomplishment of our dream,
the release of this text book.
Guide us when we are in need, we extremely thankful to Asso. Prof. Ellakuvana Bhaskara
Raj.D, for his encouragement, timely guidance, constant advice and support for successful
completion of this book.
We also thank all PG faculties of Padmashree Institute of Nursing who guided, supported
in all our endeavors.
An evergreen unforgettable memory is friendship. We express our deep sense of gratitude
and heartfelt thanks to all my classmates who are the main inspiration behind this book.

UNIT I:
Introduction
 Philosophy, purpose, elements, principles and scope of
Administration
 Indian Constitution, Indian Administrative system vis a
vis health care delivery system: National, State and Local
 Organization and functions of nursing services and
education at National, State , District and institutions:
Hospital and Community
 Planning process: Five year plans, Various Committee
Reports on health, State and National Health policies,
national population policy, national policy on AYUSH and
plans,

UNIT I: INTRODUCTION:
―Administer‖ derived from the Latin word ―ad + ministraire‖, - to care for or to look after
people to manage affairs. Administration is the activities of groups co-operating to accomplish
common goals. -Herbert A Simon
Administration may be defined as the management of affairs with the use of well thought out
principles and practices and rationalized techniques to achieve certain objectives. - Goel
DEFINITION:
ADMINISTRATION:
―Administration is the organization and direction of human and material resources to achieve
desired ends‖ - Pfiffner and presthus
Administration has to do with getting things done; with the accomplishment of defined
objectives. - Luther Gullick
MANAGEMENT:
• Management may be defined as the art of securing maximum results with a minimum of
effort so as to secure maximum prosperity and happiness for both employer and
employee and give the public the best possible service. - John Mee
• Management is distinct process consisting of planning, organising, actuating, activating
and controlling, performed to determine and accomplish the objectives by the use of
people and resources. - George
Management and Administration:
These two words are slightly similar and can employ interchangeable.
 Management‘ refers to private sector. Whereas administration refers to public sector‖.
 Management or Administration is the process for exceeding the goal expected."
- Derek French and Heather Saward.

Difference between administration and management
Basis of difference Administration Management
Nature of work It is concerned about the
determination of objectives
and major policies of an
organization
It puts into action the policies
and plans laid down by the
administration.
Type of function It is a determinative function It is an executive function
Scope It takes major decisions of an
enterprise as a whole
It takes decisions within the
framework set by the
administration.
Level of authority It is a top-level activity. It is a middle level activity
Nature of status It consists of owners who
invest capital in and receive
profits from an enterprise.
It is a group of managerial
personnel who use their
specialized knowledge to
fulfill the objectives of an
enterprise
Nature of usage It is popular with government,
military, educational, and
religious organizations.
It is used in business
enterprises.
Decision making Its decisions are influenced by
public opinion, government
policies, social, and religious
factors.
Its decisions are influenced by
the values, opinions, and
beliefs of the managers.
Main functions Planning and organizing
functions are involved in it.
Motivating and controlling
functions are involved in it.
Abilities It needs administrative rather
than technical abilities.
It requires technical activities
Managerial Concerns:
Efficiency - ―Doing things right‖ Getting the most output for the least inputs
Effectiveness - ―Doing the right things‖ Attaining organizational goals
Efficiency and Effectiveness in management

Managerial levels
Who are Managers?
Someone who coordinates and overseas the work of other people so that organizational goals are
accomplished.
First-line Managers
Individuals who manage the work of non-managerial employees.
Middle Managers
Individuals who manage the work of first-line managers.
Top Managers
Individuals who are responsible for making organization-wide decisions and establishing plans
and goals that affect the entire organization.
Functions:
• Planning - Defining goals, establishing strategies to achieve goals, developing plans to
integrate and coordinate activities.
• Organizing - Arranging and structuring work to accomplish organizational goals.
• Leading - Working with and through people to accomplish goals.
• Controlling - Monitoring, comparing, and correcting work.

Role:
• Interpersonal roles - Figurehead, leader, liaison
• Informational roles - Monitor, disseminator, Spokesperson
• Decisional roles - Entrepreneur, Disturbance handler, resource allocator, negotiator
Skills:
• Technical skills - Knowledge and proficiency in a specific field
• Human skills - The ability to work well with other people
• Conceptual skills - The ability to think and conceptualize about abstract and complex
situations concerning the organization
Skills Needed at Different Management Levels
Importance of management:
The Value of Studying Management:
 The universality of management
 Good management is needed in all organizations.
 The reality of work
 Employees either manage or are managed.
 Rewards and challenges of being a manager
 Management offers challenging, exciting and creative opportunities for meaningful and
fulfilling work.
 Successful managers receive significant monetary rewards for their efforts.

Universal Need for Management

PHILOSOPHIES OF ADMINISTRATION
Philosophy is based on the following key points: Administration believes in:
• Cost effectiveness
• Execution and control of work plans
• Delegation of responsibility
• Human relations and good morale
• Effective communication
• Flexibility in certain situation
PRINCIPLES OF ADMINISTRATION
Meaning of management principles: Management principles are statements of fundamental truth
which act as guidelines for taking managerial action.
Management principles are derived and developed in the following two steps.
(a) Deep Observations
(b) Repeated experiments
Henri Fayol (1841 - 1925): Graduated from the National School of Mines in Saint Etrenne in
1860
Fayol‟s 14 principles of management
1. Division of Work. Specialization allows the individual to build up experience, and to
continuously improve his skills. Thereby he can be more productive. Small task, Competent,
Specialization, Efficiency, Effectiveness
2. Principle of Authority and Responsibility Authority means power to take decisions.
Responsibility means obligation to complete the job assigned
3. Principle of discipline: General rules and regulations for systematic working in an
organization.
4. Principle of unity of command: Employee should receive orders from one boss only.

5. Unity of direction: All the efforts of the members and employees of the organization must be
directed to one direction that is the achievement of common goal.
6. Subordination of individual interest to general interest: Subordination of individual
interest to general interest the interest of the organization must supersede the interest of the
individuals.
7. Principle of remuneration of persons: Employees must be paid fairly or adequately to give
them maximum satisfaction
8. Principle of centralization and decentralization: Centralization refers to concentration of
power in few hands. Decentralization means evenly distribution of power at every level.
9. Principle of scalar chain: Means line of authority or chain of superiors from highest to
lowest rank
10. Principle of Order: Principle of Order It refers to orderly arrangement of men and material
a fixed place for everything and everyone in the organization
11. Principle of Equity: Principle of Equity Fair and just treatment to employees.
12. Stability of tenure of personnel: Stability of tenure of personnel No frequent termination or
transfer.
13. Principle of Initiative: Principle of Initiative Employees must be given opportunity to take
some initiative in making and executing a plan
14. Principle of Esprit De Corps: Principle of Esprit De Corps Means union is strength.
PRINCIPLES OF ADMINISTRATION

Fayol's definition of management roles and actions distinguishes between Five Elements:
Five Elements: management roles and actions
• Prevoyance. (Forecast & Plan)- Examining the future and drawing up a plan of action.
The elements of strategy.
• To organize - Build up the structure, both material and human, of the undertaking.
• To command - Maintain the activity among the personnel.
• To coordinate - Binding together, unifying and harmonizing all activity and effort.
• To control -Seeing that everything occurs in conformity with established rule and
expressed command.
ELEMENTS OF ADMINISTRATION:
POSDCORB”
• Planning
• Organizing
• Staffing
• Directing
• Co-ordinating
• Reporting
• Budgeting
SCOPE OF ADMINISTRATION
 Political: Functions of the administration includes the executive –legislative relationship.
 Defensive: It covers the hospital protective functions.

 Economic: Concerns with the vast area of the health care activities.
 Educational: Its involves educational administration in its broadest senses.
 Legislative: It includes most not mealy delegated legislation, but the preparatory work
done by the administrative officials.
 Financial: It includes the whole of financial, budget, inventory control managements.
 Social: It includes the activities of the department s concerned with food, social factors.
 Local: It concerned with the activities of the local bodies.
INDIAN CONSTITUTION
Introduction
The majority of the Indian subcontinent was under British colonial rule from 1858 to
1947. This period saw the gradual rise of the Indian nationalist movement to gain independence
from the foreign rule. The movement culminated in the formation of the on 15 August 1947,
along with the Dominion of Pakistan. The constitution of India was adopted on 26 January 1950,
which proclaimed India to be a sovereign democratic republic.
Evolution of the Constitution
Acts of British Parliament before 1935
After the Indian Rebellion of 1857, the British Parliament took over the reign of India
from the British East India Company, and British India came under the direct rule of the Crown.
The British Parliament passed the Government of India Act of 1858 to this effect, which set up
the structure of British government in India.
Government of India Act 1935
The provisions of the Government of India Act of 1935, though never implemented fully,
had a great impact on the constitution of India. The federal structure of government, provincial
autonomy, bicameral legislature consisting of a federal assembly and a Council of States,
separation of legislative powers between center and provinces are some of the provisions of the
Act which are present in the Indian constitution.
The Cabinet Mission Plan
In 1946, at the initiative of British Prime Minister Clement Attlee, a cabinet mission to
India was formulated to discuss and finalize plans for the transfer of power from the British Raj
to Indian leadership and providing India with independence under Dominion status in the
Commonwealth of Nations. The Mission discussed the framework of the constitution and laid

down in some detail the procedure to be followed by the constitution drafting body. Elections for
the 296 seats assigned to the British Indian provinces were completed by August 1946. The
Constituent Assembly first met and began work on 9 December 1946.
Indian Independence Act 1947
The Indian Independence Act, which came into force on 18 July 1947, divided the British
Indian territory into two new states of India and Pakistan, which were to be dominions under the
Commonwealth of Nations until their constitutions were in effect.
Constituent Assembly
The Constitution was drafted by the Constituent Assembly, which was elected by the
elected members of the provincial assemblies. Jawaharlal Nehru, C. Rajagopalachari, Rajendra
Prasad, SardarVallabhbhai Patel, MaulanaAbulKalam Azad, Shyama Prasad Mukherjee and
NaliniRanjanGhosh were some important figures in the Assembly.
In the 14 August 1947 meeting of the Assembly, a proposal for forming various
committees was presented. Such committees included a Committee on Fundamental Rights, the
Union Powers Committee and Union Constitution Committee. On 29 August 1947, the Drafting
Committee was appointed, with DrAmbedkar as the Chairman along with six other members. A
Draft Constitution was prepared by the committee and submitted to the Assembly on 4
November 1947.
Parts
Parts are the individual chapters in the Constitution, focused in single broad field of laws,
containing articles that address the issues in question.
Preamble
 Part I - Union and its Territory
 Part II - Citizenship.
 Part III- Fundamental Rights
 Part IV - Directive Principles and
Fundamental Duties.
 Part V- The Union.
 Part VI- The States.
 Part XII - Finance, Property, Contracts and
Suits
 Part XIII - Trade and Commerce within the
territory of India
 Part XIV - Services Under the Union, the
States and Tribunals
 Part XV - Elections
 Part XVI - Special Provisions Relating to
certain Classes.

 Part VII - States in the B part of
the First schedule (Repealed).
 Part VIII - The Union Territories
 Part IX - Panchayat system and
Municipalities.
 Part X - The scheduled and Tribal
Areas
 Part XI - Relations between the
Union and the States.
 Part XVII - Languages
 Part XVIII - Emergency Provisions
 Part XIX - Miscellaneous
 Part XX - Amendment of the Constitution
 Part XXI - Temporary, Transitional and
Special Provisions
 Part XXII - Short title, date of
commencement, Authoritative text in Hindi
and Repeals
Federal Structure
The constitution provides for distribution of powers between the Union and the States.
It enumerates the powers of the Parliament and State Legislatures in three lists, namely Union
list, State list and Concurrent list. Subjects like national defense, foreign policy, issuance of
currency are reserved to the Union list. Public order, local governments, certain taxes are
examples of subjects of the State List, on which the Parliament has no power to enact laws in
those regards, barring exceptional conditions. Education, transportation, criminal laws are a few
subjects of the Concurrent list, where both the State Legislature as well as the Parliament has
powers to enact laws.
Changing the constitution
In 2000 the National Commission to Review the Working of the Constitution (NCRWC) was
setup to look into updating the constitution of India.
Judicial review of laws
This section requires expansion.
Judicial review is actually adopted in the Indian constitution from the constitution of the United
States of America. In the Indian constitution, Judicial Review is dealt under Article 13. Judicial
Review actually refers that the Constitution is the supreme power of the nation and all laws are
under its supremacy. Article 13 deals that
1. All pre-constitutional laws, after the coming into force of constitution, if in conflict with it in
all or some of its provisions then the provisions of constitution will prevail. If it is compatible
with the constitution as amended. This is called the Theory of Eclipse.

2. In a similar manner, laws made after adoption of the Constitution by the Constituent Assembly
must be compatible with the constitution, otherwise the laws and amendments will be deemed to
be void-ab-initio.
In such situations, the Supreme Court or High Court interprets the laws as if they are in
conformity with the constitution.
HEALTH CARE DELIVERY SYSTEM IN INDIA
Introduction
Health is the birth right of every individual. Today health is considered more than a basic
human right; it has become a matter of public concern, national priority and political action. Our
health system has traditionally been a disease-oriented system but the current trend is to
emphasize health and its promotion.
Selected health care definitions:
 Health: According to WHO, health is defined as ―a dynamic state of complete physical,
mental and social well-being not merely an absence of disease or infirmity.‖
 Health care services: It is defined as ―multitude of services rendered to individuals,
families or communities by the agents of the health services or professions for the
purpose of promoting, maintaining, monitoring or restoring health.‖
Definitions of health care delivery:
1. Health care delivery system refers to the totality of resources that a population or
society distributes in the organization and delivery of health population services. It
also includes all personal and public services performed by individuals or institutions
for the purpose of maintaining or restoring health. -Stanhope(2001)
2. It implies the organization, delivery staffing regulation and quality control.
J.C.Pak(2001)
Philosophy of Health Care Delivery System:
 Everyone from birth to death is part of the market potential for health care services.
 The consumer of health care services is a client and not customer.
 Consumers are less informed about health services than anything else they purchase.
 Health care system is unique because it is not a competitive market.

 Restricted entry in to the health care system.
Goals/Objectives of Health Care Delivery System:
1) To improve the health status of population and the clinical outcomes of care.
2) To improve the experience of care of patients families and communities.
3) To reduce the total economic burden of care and illness.
4) To improve social justice equity in the health status of the population.
Principles of Health Care Delivery System:
1. Supports a coordinated, cohesive health-care delivery system.
2. Opposes the concept that fee-for-practice.
3. Supports the concept of prepaid group practice.
4. Supports the establishment of community based, community controlled health-care
system.
5. Urges an emphasis be placed on development of primary care
6. Emphasizes on quality assurance of the care
7. Supports health care as basic human right for all people.
8. Opposes the accrual of profits by health-care-related industries.
Functions of Health Care Delivery System:
1) To provide health services.
2) To raise and pool the resources accessible to pay for health care.
3) To generate human and physical sources that makes the delivery service possible.
4) To set and enforce rules of the game and provide strategic direction for all the different
players involved.
Characters of Health Care Delivery System:
1) Orientation toward health.
2) Population perspective.
3) Intensive use of information.
4) Focus on consumer.
5) Knowledge of treatment outcome.
6) Constrained resources.

HEALTH CARE DELIVERY SYSTEM IN INDIA
In India it is represented by five major sectors or agencies which differ from each other
by health technology applied and by the source of fund available. These are:
I. PUBLIC HEALTH SECTOR
A. Primary Health Care
Primary health centres.
Sub- centres.
B. Hospital/Health Centres
Community health centres.
Rural health centres.
District hospitals/health centre.
Specialist hospitals.
Teaching hospitals.
C. Health Insurance Schemes
Employees State Insurance.
Central Govt. Health Scheme.
D. Other Agencies
Defence services.
Railways.
II. PRIVATE SECTOR
A. Private hospitals, polyclinics, nursing homes and dispensaries.
B. General practitioners and clinics.
III. INDIGENOUS SYSTEMS OF MEDICINE
 Ayurveda
 Sidda
 Unani
 Homeopathy
 Naturopathy
 Yoga
 Unregistered practioners.

IV. VOLUNTARY HEALTH AGENCIES
V. NATIONAL HEALTH PROGRAMMES

ORGANIZATION AND ADMINISTRATION OF HEALTH SERVICES IN INDIA AT
DIFFERENT LEVELS.
India is a union of 28 states and 7 Union territories. Under the constitution states are
largely independent in matters relating to the delivery of health care to the people. Each State,
therefore, as developed its own system of health care delivery, independent of the Central
Government.
Health system in India has 3 links
1. Central level. 2. State level 3. District level
Synoptic view of the health system in India
1/80,000 – 1,20,000
1/30,000
1/3,000 – 5,000
1/1,000
Community Health
Centres
Sub-district/Taluka
hospital
PHC
Sub-centres
Health worker (M & F)
Village health
guide, trained dai
District health organisation and basic
specialities hospital/districts
States (28) an Union Territories (7)
Ministry of Health and Directorate of Health
National Level
Ministry of Health and Family Welfare
People in the
population

Health administration at the central level
The official organs of the health system at the national level consist of 3 units:
1. Union Ministry of Health and Family Welfare.
2. The Directorate General of Health Services.
3. The Central Council of Health and Family Welfare.
I. Union Ministry of Health and Family Welfare
Organisation
The Union Ministry of Health and Family Welfare is headed by a Cabinet Minister, a
Minister of State, and a Deputy Health Minister. These are political appointment and have dual
role to serve political as well as administrative responsibilities for health.
Currently the union health ministry has the following departments:
1. Department of Health
2. Department of Family Welfare
3. Department of Indian System of Medicine and Homoeopathy
a. Department of Health
It is headed by a secretary to the Government of India as its executive head, assisted by
joint secretaries, deputy secretaries, and a large administrative staff.
Functions
Union list
1. International health relations and administration of port-quarantine
2. Administration of central health institutes such as All India Institute of Hygiene and
Public Health, Kolkata; National Institute for Control of Communicable Diseases, Delhi,
etc.
3. Promotion of research through research centres and other bodies.
4. Regulation and development of medical, nursing and other allied health professions.
5. Establishment and maintenance of drug standards.
6. Census, and collection and publication of other statistical data.
7. Immigration and emigration.
8. Regulation of labour in the working of mines and oil fields and

Concurrent list
The functions listed under the concurrent list are the responsibility of both the union and
state governments. The centre and states have simultaneous powers of legislation. They are as
follows:
1. Prevention of extension of communicable diseases from one unit to another.
2. Prevention of adulteration of food stuffs.
3. Control of drugs and poisons.
4. Vital statistics.
5. Labour welfare.
6. Ports other than major.
7. Economic and social health planning
8. Population control and family planning.
Department of Family Welfare
It was created in 1966 within the Ministry of Health and Family Welfare. The secretary
to the Government of India in the Ministry of Health and Family Welfare is in overall charge of
the Department of Family Welfare. He is assisted by an additional secretary and commissioner,
and one joint secretary.
The following divisions are functioning in the department of family welfare.
1. Programme appraisal and special scheme
2. Technical operations: looks after all components of the technical programme viz.
Sterilization/IUD/Nirodh, post partum, maternal and child health, UPI, etc.
3. Maternal and child health
4. Evaluation and intelligence: helps in planning, monitoring and evaluating the
programme performance and coordinates demographic research.
5. Nirodh marketing supply/ distribution
Functions
a. To organize family welfare programme through family welfare centres.
b. To create an atmosphere of social acceptance of the programme and to support all voluntary
organizations interested in the programme.
c. To educate every individual to develop a conviction that a small family size is valuable and to
popularize appropriate and acceptable method of family planning
d. To disseminate the knowledge on the practice of family planning as widely as possible and to
provide service agencies nearest to the community.

Ministry of Health and Family Welfare
3. The department of Indian system of medicine and homeopathy
It was established in March 1995 and had continued to make steady progress. Emphasis
was on implementation of the various schemes introduced such as education, standardization of
drugs, enhancement of availability of raw materials, research and development, information,
education and communication and involvement of ISM and Homeopathy in national health care.
Most of the functions of this ministry are implemented through an autonomous
organization called DGHS.
Minister of State
Deputy Ministers
Dept. of Family Welfare
Dept. of Health Dept. of Indian
System of Medicine
and Homoeopathy
Secretary
JS
(ISM)
Director
Ayurveda & Sidha
Secretary
Secretary health
Additional Secretary
Joint Secretaries (9)
Director General of
Health Services
Addl. Director Generals (4)
Chief Director
(1)
Cabinet Minister
Joint Secretary
(3)

II. Directorate General of Health Services
Organisation
The DGHS is the principal adviser to the Union Government in both medical and public
health matters. He is assisted by a team of deputies and a large administrative staff. The
Directorate comprises of three main units:
i. Medical care and hospitals
ii. Public health
iii. General administration
Functions
1. General functions: The general functions are surveys, planning, coordination,
programming and appraisal of all health matters in the country.
2. Specific functions
a. International health relations and quarantine:
b. Control of drug standards
c. Medical store depots
d. Postgraduate training
e. Medical education
f. Medical research
g. Central Government Health Scheme.
Family welfare services
h. National Health Programmes.
i. Central Health Education Bureau
j. Health intelligence.
k. National Medical Library
III. Central Council of Health
The Central Council of Health was set up by a Presidential Order on August 9, 1952,
under Article 263 of the Constitution of India for promoting coordinated and concerted action
between the centre and the states in the implementation of all the programmes and measures
pertaining to the health of the nation. The Union Health Minister is the chairman and the state
health ministers are the members.

Functions
1. To consider and recommend broad outlines of policy in regard to matters concerning
health in all its aspects such as the provision of remedial and preventive care,
environmental hygiene, nutrition, health education and the promotion of facilities for
training and research.
2. To make proposals for legislation in fields of activity related to medical and public health
matters and to lay down the pattern of development for the country as a whole.
3. To make recommendations to the Central Government regarding distribution of available
grants-in-aid for health purposes to the states and to review periodically the work
accomplished in different areas through the utilisation of these grants-in-aid.
4. To establish any organisation or organisations invested with appropriate functions for
promoting and maintaining cooperation between the Central and State Health
administrations.
AT THE STATE LEVEL
Historically, the first milestone in the state health administration was the year 1919,
when the states (provinces) obtained autonomy, under the Montague-Chelmsford reforms, from
the central Government in matters of public health. By 1921-22, all the states had created some
form of public health organisation. The Government of India Act, 1935 gave further autonomy to
the states. The state is the ultimate authority responsible for health services operating within its
jurisdiction.
State health administration
At present there are 31 states in India, with each state having its own health
administration. In all the states, the management sector comprises the state ministry of Health
and a Directorate of Health.
1. State Ministry of Health
The State Ministry of Health is headed by a Minister of Health and FW and a Deputy
Minister of Health and FW. In some states, the Health Minister is also in charge of other
portfolios. The Health secretariat is the official organ of the State Ministry of Health and is
headed by a Secretary who is assisted by Deputy Secretaries, and a large administrative staff.

Organisational structure of the health and family welfare services at state level
Functions: Health services provided at the state level
 Rural health services through minimum needs programme
 Medical development programme
 M.C.H., family welfare & immunization programme
 NMIP (malaria) & NFCP(filarial)
 NLEP, NTCP, NPCB, prevention and control of communicable diseases like
diarrheal disease, KFD, JE,
 School health programme, nutrition programme, and national goitre control
programme
 Laboratory services and vaccine production units
Minister in charge of health and family welfare portfolio in the state
Secretary or commissioner, Department of Health and Family Welfare
Director
Health Services
Director
FW Services
Director
Medical education
& research
Director
ISM and
Homoeopathy
Additional/deputy
joint directors of
health services
dealing with one or
more programmes
Assistant Directors
health services
dealing with one or
more programmes
Principal/Deans of
medical colleges
Divisional set up in
some states
District health
organisation
Taluk Health
organisation
Block level health
organisation

 Health education and training programme, curative services, national Aids control
programme
2. State Health Directorate
The Director of Health Services is the chief technical adviser to the state Government on
all matters relating to medicine and public health. He is also responsible for the organization and
direction of all health activities. The Director of Health and Family Welfare is assisted by a
suitable number of deputies and assistants. The Deputy and Assistant Directors of Health may be
of two types –
Regional
Functional.
The regional directors inspect all the branches of public health within their jurisdiction,
irrespective of their specialty. The functional directors are usually specialists in a particular
branch of public health such as mother and child health, family planning, nutrition, tuberculosis,
leprosy, health education, etc.
AT THE DISTRICT LEVEL
The district is the most crucial level in the administration and implementation of medical /health
services. At the district level there is a district medical and health officer or CMO who is overall
Subdivisions
i. Tehsils (talukas)
ii. Community development blocks
iii. Municipalities and corporations
iv. Villages
v. Panchayaths
Most of the districts in India are divided into two or more subdivisions, each in charge of
an assistant collector or sub-collector. Each division is again divided into tehsils in charge of a
Tehsildar. A tehsil usually comprises between 200 and 600 villages.
Finally, there are the village panchayaths, which are institutions of rural local self-
government.
The urban areas of the district are organised into the following local self-government:
 Town area committee – 5,000 – 10,000
 Municipal boards – 10,000 – 2,00,000
 Corporations – population above 2,00,000.
The towns‟ area committees are like panchayaths. They provide sanitary services.

The municipal boards are headed by a chairman/president, elected usually by the
members.
Corporations are headed by mayors. The councilors are elected from different wards of
the city. The executive agency includes the commissioner, the secretary, the engineer, and the
health officer. The activities are similar to those of the municipalities but on a much wider scale.
Primary Healthcare Infrastructure of District Level
Sub-
Centre
T.B.A.
VHG
T.B.A.
VHG
T.B.A.
VHG
T.B.A.
VHG
T.B.A.
VHG
Primary
Health
Centre
Sub-
Centre
Sub-
Centre
Sub-
Centre
Sub-
Centre
Sub-
Centre
PHC
PHC
District Health and
Family Welfare
PHC
CEO
Zilla
parishad
Community
Health Centre
Covers 1,00,000 population
Covers
30,000
population
Covers
5,000
population
Covers
1,000
population

PANCHAYATHI RAJ
The panchayath Raj is a 3-tier structure of rural local self-government in India linking the
villages to the district. The three institutions are:
a. Panchayath – at the village level.
b. Panchayath samithi – at the block level.
c. Zilla parishad – at the district level.
The panchayathi Raj institutions are accepted as agencies of public welfare. All
development programmes are channelled through these bodies. The panchayathi Raj institutions
strengthen democracy at its root and ensure more effective and better participation of the people
in the government.
At the village level
The panchayathi Raj at the village level consists of:
1. The gram sabha
2. The gram panchayath
3. The nyaya panchayath
At the block level
The panchayathi raj agency at the block level is the panchayath samithi. The panchayathi
samithi consists of all sarpanchs of the village panchayaths in the block. The block development
officer is the ex-officio secretary of the panchayath samithi.
The prime function of the panchayat samiti is the execution of the community
development programme in the block.
The block development officer and his staff give technical assistance and guidance to the
village panchayaths engaged in the development work.
At the district level
The zilla parishad is the agency of rural local self-government at the district level. The
members of the zilla parishad include all leaders of the panchayath samithis in the district, MPs,
MLAs of the district, representatives of SC, SD and women, and 2 persons of experience in
administration. The collector of the district is a non-voting member. Thus, the membership of the
zilla parishad is fairly large varying from 40 to 70.
The zilla parishad is primarily supervisory and coordinating body. Its functions and
powers vary from state to state. In some states, the zilla parishads are vested with the
administrative functions.

Healthcare systems
The healthcare system is intended to deliver the healthcare services. It constitutes the
management sector and involves the organisational matters. It operates in the context of the
socioeconomic and political framework of the country. In India, it is represented by five major
sectors and agencies which differ from each other by the health technology applied and by the
source of funds for the operation.
i. Public health sector
ii. Private sectors
District
Level
Zilla Panchayat
(ZP)
Taluka
Level
Taluka Panchayat
(TP)
Village
Level
Gram Panchayat
(GP)
Gram
Sabha
Direct election @ 1:40,000
(except Uttara Kannada, Coorg
and Chickmagalore where it is
1:30,000). 20 months‘ term for
Adhyakshas and Upadhyakshas
and 5 standing committees.
Direct election @ 1:10,000.
Voting rights to MPs, MLAs,
MLCs. One year membership to
1/5 of Gram Panchayat
Adhyakshas and 5 standing
committees.
Direct election @ 1:4,000. Ban on
political parties. 5 years term.3
standing committees.
Minimum of two meetings per
annum, under the chairmanship of
GP Adhyaksha, for approval of
Budget/accounts, review of
development programme

iii. Indigenous system of medicine
iv. Voluntary health agencies
v. National health programmes
Primary healthcare in India
It is a three-tier system of healthcare delivery in rural areas based on the
recommendations of the Shrivastav Committee in 1975.
1. Village level: The following schemes are operational at the village level:
a. Village health guides scheme
b. Training of local dais
c. ICDS scheme
2. Sub-centre level: This is the peripheral outpost of the existing health delivery system in
rural areas. They are being established on the basis of one sub-centre for every 5000
population in general and one for every 3000 population in hilly tribal and backward
areas. Each sub-centre is manned by one male and one female multipurpose health
worker.
Functions
a. Mother and child healthcare
b. Family planning
c. Immunization
d. IUD insertion
e. Simple laboratory investigations
3. Primary health centre level: The Bhore committee in 1946 gave the concept of a
primary health centre as a basic health unit to provide as close to the people as possible.
The Bhore committee aimed at having a health centre to serve a population of 10,000 to
20,000. The national health plan, 1983 proposed reorganization of primary health centres
on the basis of one PHC for every 30,000 rural population in the plains, and one PHC for
every 20,000 population in hilly, tribal and backward areas for more effective coverage.
Functions of the PHC
a. Medical care.
b. MCH including family planning.
c. Safe water supply and basic sanitation.
d. Prevention and control of locally endemic diseases.

e. Collection and reporting of vital statistics.
f. Education about health.
g. National health programmes as relevant.
h. Referral services.
i. Training of health guides, health workers, local dais, and health assistants.
j. Basic laboratory services.
Community health centres
As on 31st
March 2003, 3076 community health centres were established by upgrading
the primary health centres, each CHC covering a population of 80,000 to 1.20 lakh with 30 beds
and specialist in surgery, medicine, obstetrics and gynecology, and pediatrics‘ with x-ray and
laboratory facilities.
Functions
1. Care of routine and emergency cases in surgery.
2. Care of routine and emergency cases in medicine.
3. 24-hour delivery services including normal and assisted deliveries.
4. Essential and emergency obstetric cases including surgical interventions.
5. Full range of family planning services including laparoscopic services.
6. Safe abortion services.
7. Newborn care.
8. Routine and emergency care of sick children.
9. Other management including nasal packing, tracheostomy, foreign body removal, etc.
10. All national health programmes should be delivered.
11. Blood shortage facility.
12. Essential laboratory services.
13. Referral services.

Organisational Structure of Panchayat Raj Institutions
District
Level
Zilla Panchayat
(ZP)
Taluka
Level
Taluka Panchayat
(TP)
Village
Level
Gram Panchayat
(GP)
Gram
Sabha
Direct election @ 1:40,000
(except Uttara Kannada, Coorg
and Chickmagalore where it is
1:30,000). 20 months‘ term for
Adhyakshas and Upadhyakshas
and 5 standing committees.
Direct election @ 1:10,000.
Voting rights to MPs, MLAs,
MLCs. One year membership to
1/5 of Gram Panchayat
Adhyakshas and 5 standing
committees.
Direct election @ 1:4,000. Ban on
political parties. 5 years term.3
standing committees.
Minimum of two meetings per
annum, under the chairmanship of
GP Adhyaksha, for approval of
Budget/accounts, review of
development programme

Organisational structure of health department at district level
DISTRICT HEALTH AND FAMILY WELFARE OFFICER
Dy. CMO/
Medical
Officer (FW
& MCH)
Asst. District
Health &
Family
Welfare
Officer (HQ)
Asst. District
Health and
Family
Welfare
Officer (Sub-
division
level/Dy.
CMOs)
District
Malaria
Officer
Senior
Malaria
Officer
Senior
Medical
Superin
tendent
Medical officers of
Dt. General
Hospital and other
Govt. Hospitals
District
Leprosy
Officer
District
Health
Education
Officer/
Dmeio
Medical
Officer
(District
Lab.)
District
Tubercul
osis
Officer
(TB
Centre)
Gazetted
Assistant
District
Nursing
Supervisor
Medical Officers
of Primary
Health centres
(Coordinators at
PHC level)
Assistant
Statistical
Officer
Lady
Medical
Officers/
11 MO of
Primary
Health
Centres
Service
Engineer
(Mobile
Workshop)

Planning and organizing nursing service at various levels – local, regional, national, and
international
Placement of nurses in the healthcare organization
A high power committee on nursing and nursing profession was set up by the
Government of India in July 1987 under the chairmanship of Smt. Sarojini Vasadapan, an
eminent social worker and former chairperson of Central Social Welfare Board with Smt.
Rajkumari Sood, Nursing Advisor to Government of India, as the member secretary. The terms
of reference of the committee were as follows:
a. Looking into the existing working conditions of nurses with particular reference to the
status of the nursing care services both in rural and urban areas.
b. To study and recommend the staffing norms necessary for providing adequate nursing
personnel to give the best possible care, both in the hospitals and community.
c. To look into the training of all categories and levels of nursing, midwifery personnel to
meet the nursing manpower needs at all levels of health service and education.
d. To study and clarify the role of nursing personnel in the healthcare delivery system
including their interaction with other members of the health team at every level of health
services management.
e. To examine the need for organisation of the nursing services at the national, state,
district, and lower levels with particular reference to the need for planning and
implementing the comprehensive nursing care services with the overall healthcare system
of the country at their respective levels.
f. To look into all other aspects which the committee may consider relevant with reference
to their terms of reference.
g. While considering the various issues under the above norms of reference, the committee
will hold consultations with the state governments.
The findings of this committee give a grim picture of the existing working condition of
nurses, staffing norms for providing adequate nursing personnel, education of nursing personnel
to meet the nursing manpower needs at all levels and the role of nursing personnel in the
healthcare delivery system.
Their recommendations on the organisation of nursing services at central, state and
district levels, and the norms of nursing service and education are given below.
Placement of nurses at the central level
At the central level there is a post of nursing advisor in the medical division of
Directorate General of Health Services. The nursing advisor is directly responsible to the Deputy
Director General (Medical). The nursing advisor is assisted by nursing officer and support staff
for all his/her work. She/he advises the DGHS, Ministry of Health and Family Welfare as well as

other ministries and departments, for example, railways, labour, Delhi Administration, etc. on all
matters of nursing services, nursing education, and research. The nursing advisor also takes care
of administration aspects of Raj Kumari Amrit Kaur College of Nursing and Lady Hardinge
Health School, Delhi.
There is a post of deputy nursing advisor at the rank of Assistant Director General (ADG-
Nsg) in the training division of Department of F. W. Presently the deputy nursing advisor deals
with training of ANMs, dais, health supervisor, etc. There is no direct linkage between the
nursing advisor and deputy nursing advisor as there are independent posts.
Nursing organisational set up at the central level
DGHS
Additional DG (N) Additional DG (M)
Additional DG (PH)
DDG (N)
ADG (Nursing education
& research)
ADG (Hospital nursing
service)
ADG (Community
nursing service)
DADG DADG
DADG
Community &
nursing officer
PHN Supervisor
PHN
LHV
ANM
Principal tutor SON
Senior tutor
Tutor
Clinical instructors
Nursing superintendent
Deputy Nursing
superintendent
Assistant Nursing
superintendent
Ward sister
Staff nurse

Placement of nurses at state level
There is no proper and definite pattern of nursing structure in the state directorates except
the state of West Bengal. Usually one or two nurses are posted with varying designations, e.g., in
Tamilnadu there is one assistant director nursing who is responsible to Director, Medical
Services, and Director, Medical Education.
In Maharashtra, two nurses work, one each in the office of the Director, Medical
Education, and Director, Health Services.
Recommended organization at state level (union territory level)
Secretary (Health)
ADNS (Nursing
education & research)
ADNS (Hospital/
nursing service)
ADNS (Community
nursing)
DADNS Nursing Superintendent
District Nursing
Officer
Public health
nursing officer
PHN at PHC
LHV (HSV)
LHV
ANM
Principal SON
Senior tutor
Tutor
Clinical instructors
Deputy Nursing
superintendent
Assistant nursing
superintendent
Ward sister
Staff nurse
Director, Nursing Services
Joint/Deputy Director, Nursing Services
DADNS (Nursing
education & research)
DADNS (Nursing
service)
DADNS (Community
health nursing)

Note
The Principal, College of Nursing will be equal to the rank of ADNS and will be eligible
for promotion to the post of DDNS/DNS. The salary scales and structure of the staff of colleges
of nursing will be as per norms of the Indian Nursing Council and the UGC.
Placement of nurses at district level
Nurses, public health nurses, lady health visitors, auxiliary nurse midwives, etc. have
played vital role in providing healthcare services at various levels in both urban and rural areas
of the district. They have been the mainstream in providing primary healthcare services in the
rural and urban areas from the very beginning.
Director nursing
officer
DHO
DMO
Dist. P. N. O.
Nsg. Superintendent/Dy.
Nsg. Suptd.
Asst. Nsg. Suptd.
Ward sister
Staff nurse
P. N. Supervisor
(CHC)
PN (PHC)
LHV/HS
ANM
Director, Nursing Services
Dy. Asst. Director, Nursing Services
Assistant Dist. Nsg. Officer
(Hosp. & Nsg. Edu)
Dy. Director, Nursing Services
Asst. Director, Nursing Services
Assistant Dist. Nsg. Officer
(Community)
LHV

The above recommended organisational set up will need full administrative and financial
support of the government. It will look after the overall nursing components, development of
nursing standards, norms, policies, ethics, recruitment, selection and placement roles__ for both
hospitals and community health nursing, development in speciality nursing, higher education in
nursing, and research. These will promote professional autonomy and accountability.
NATIONAL RURAL HEALTH MISSION
The National Rural Health Mission (NRHM) has been launched with a view to bringing
about dramatic improvement in the health system and the health status of the people, especially
those who live in the rural areas of the country..
To achieve these goals NRHM will:
 Facilitate increased access and utilization of quality health services by all.
 Forge a partnership between the Central, state and the local governments.
 Set up a platform for involving the Panchayati Raj institutions and community in the
management of primary health programmes and infrastructure.
 Provide an opportunity for promoting equity and social justice.
The Vision of the Mission
 To provide effective healthcare to rural population throughout the country with
special focus on 18 states, which have weak public health indicators and/or weak
infrastructure.
 18 special focus states are Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal
Pradesh, Jharkhand, Jammu and Kashmir, Manipur, Mizoram, Meghalaya, Madhya
Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura, Uttaranchal and Uttar Pradesh.
 To rise public spending on health from 0.9% GDP to 2-3% of GDP, with improved
arrangement for community financing and risk pooling.
 To undertake architectural correction of the health system to enable it to effectively
handle increased allocations and promote policies that strengthen public health
management and service delivery in the country.
 To revitalize local health traditions and mainstream AYUSH into the public health
system.

The Objectives of the Mission
 Reduction in child and maternal mortality.
 Universal access to public services for food and nutrition, sanitation and hygiene and
universal access to public health care services with emphasis on services addressing
women‘s and children‘s health and universal immunization.
 Prevention and control of communicable and non-communicable diseases, including
locally endemic diseases.
 Access to integrated comprehensive primary health care.
 Population stabilization, gender and demographic balance.
 Revitalize local health traditions & mainstream AYUSH.
 Promotion of healthy life styles.
The core strategies of the Mission
 Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own, control and
manage public health services.
 Promote access to improved healthcare at household level through the female health
activist (ASHA).
 Health Plan for each village through Village Health Committee of the Panchayat.
 Strengthening sub-centre through better human resource development, clear quality
standards, better community support and an untied fund to enable local planning and
action and more Multi Purpose Workers (MPWs).
 Provision of 30-50 bedded CHC per lakh population for improved curative care to a
normative standard. (IPHS defining personnel, equipment and management standards, its
decentralized administration by a hospital management committee and the provision of
adequate funds and powers to enable these committees to reach desired levels)
District and Block levels.
Programmes
 Reproductive and Child Health Programme – II (RCH-II) and the Janani Suraksha
Yojana (JSY) launched.
 Polio eradication programme intensified – cases reduced from 134 in 2004-05 to 63 (up
to now).

 Accelerated implementation of the Routine Immunization programme taken up. Catch up
rounds taken up this year in the States of Bihar, Jharkhand and Orisaa.
 Ground work for introduction of JE vaccine completed.
 Ground work for Hepatitis vaccines to all States completed.
 Auto Disabled Syringes introduced throughout the country.
 State Programme Implementation Plans for RCH II appraised by the National Programme
Coordination Committee set up by the Ministry. Funds to the extent of 26.14% i.e. Rs.
1811.74 core have been released under NRHM Outlay.
Mission on nursing education:
The Mission would support strengthening of Nursing Colleges wherever required, as the
demand for ANMs and Staff Nurses and their development is likely to increase significantly.
Special attention would be given to setting up ANM training centers in tribal blocks which are
currently para-medically underserved by linking up with higher secondary schools and existing
nursing institutions.
ORGANISATION OF THE HEALTH CARE SYSTEM
Public sector
Public agencies are financed with tax monies, thus these are accountable to the public. The
public sector includes official (governmental) agencies and voluntary agencies.
Organization of the public health system
The public health system is organised in too many levels in the
 Federal,
 State,
 Local systems.
THE FEDERAL SYSTEM:
Federal Government has the responsibility for the following aspects of health care.
At the federal level, the primary agencies are concerned with health are organized under the
Department of Health and Human Services (DHHS).

 Providing direct care for certain groups such as Native Americans, military personnel,
and veterans.
 Safeguarding the public health by regulating quarantines and immigration laws and the
marketing food, drugs and products used in medical care.
 Prevents environmental hazards, gives grantsin aids to states, local areas and individuals
and supports research.
 Administration of social security, social welfare and related programmes
Organization and Functions of Nursing Services and Education at National, State,
District, and Institutions: Hospital and Community
Organization and functions of nursing services and education At centre/ national level
Organization of health care at centre level is done by three structures these are
1) Union ministry of health and family welfare
2) Centre council of health
3) Centre family welfare council
Functions:
The functions which are performed by the department of health and through DGHS are given in
the union list and concurrent list and these are as under:
1. Conducting health and morbidity surveys, planning and organizing health programmes
with active participate of state governments, co-ordination of health care activities
through central health council, consultative committee of parliament, statutory bodies
etc.; appraisal of health schemes and feed back in order to maintain uniformity, norms
etc.
2. Maintenance of international health relations, administration of port health and
quarantine laws..
3. Administration of central health institutions, training colleges, laboratories and hospitals,
4. Promotion and maintenance of appropriate standards of education in medical, nursing,
dental, pharmaceutical and ancillary health personnel through statutory bodies.
5. Promotion of medical and public health research.
6. Establishing and maintenance of drug standards,
7. Health intelligence.
8. Central bureau of health intelligence was set up in 1961 for collection, complication,
analysis and evaluation of information.
9. Maintenance of a central medical library.

Central family welfare council
This department mainly deals with FW matters. Secretary with support of team members, plan
co-ordinates, evaluates and supervises the implementations of FW programme in the state and
co-ordinates the activities and the functions of the technical divisions of the FW department like
 Programme appraisal co-ordination and training and sterilization division
 Technical operation division
 Maternal child health division
 Evaluation and intelligence division
Centre council of health
Health is a state subject. The union government has mainly an advisory, guiding and
coordinating function. The main functions of the council are as under:
 To consider and recommend broad lines of policy on all matters of health like, primary
health care, medical care, nutrition, environmental health, health education etc.
 To make proposal for legislation in the field of medical and public health matters
 To lay down the pattern of development in the country as a whole
 To make recommendations regarding distribution of available grants-in-aid
Apart from Governmental actions, Nursing education and services are organized by Indian
nursing council and other statutory bodies in national level.
AT STATE LEVEL
State ministry of health and family welfare
They have political responsibilities, responsibilities towards their constituencies as per
their political agenda, and responsibilities for administration and management of health and
family welfare services in their state.
Health secretariat
It is the official organ of the ministry. Major function of the secretariat include helping
minister in
 Formulation, review and modification of board policy outlines
 Execution of policies programmes etc.
 Coordination with government of India and other state governments
 Control for smooth and efficient functioning of administrative machinery.

State health directorate
 Providing curative and preventive services
 Provision for control of milk and food sanitation
 Assumes for total responsibility for taking all steps in the prevention of any outbreak of
communicable diseases specially during festivals and special seasons
 Establishment and maintenance of central laboratories for preparation of vaccines, etc
 Promotion of health education
 Collection, tabulation and publication of vital statistics
Apart from governmental actions it will be organized by state nursing councils and universities
Functions of university are
 Organize the courses
 Plan for the examinations
 Setting question papers
 Planning the examination date
 Plan the curriculum
AT DISTRICT LEVEL
At district level health organisation is maintained by taluks or block, their main function
is, to plan and implement community development programmes.
Panchayati raj system is a local self governing system in rural area which work parallel
to official structure of administration. It consists of three –tier structure of rural local self
government.
Gram sabha- it is comprised of all the adult men and women of the village. This body
meets at least twice in a year and discusses important issues and considers proposals pertaining
to various developmental aspects including health matters
Gram Panchayat- it is the executive organ of the gram sabha. Its main function is
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.
Panchayat samiti- it is responsible for the block development programme. The funds for
the development activities are processed through Panchayat samiti. The block development
officer and his/her technical staff extend assistance and guidance to gram Panchayats in carrying
out developmental activities in their villages.

INSTITUTIONAL LEVEL –
AT HOSPITAL
Organization of nursing services and education
 Director of nursing
Nursing services must function under a senior competent nursing administrator –
variously called as director of nursing, nursing superintendent, principal matron, or matron-in-
chief. She is responsible to the hospital administrator for overall programme and activities of
nursing care of all patients in the hospital. Nursing programme is administered by her through
appropriate planning of services, determining nursing policies in collaboration with hospital
management and nursing procedures in collaboration with nursing staff, giving general
supervision, delegation of responsibility, coordination of interdepartmental nursing activities‘,
and counseling the hospital administration on nursing problems.
She has a dual role: the first one is the administrative responsibility towards hospital
administration, and the second one is the coordinating of all professional activities of nursing
staff with those of medical staff.
The role of the nursing superintendent starts in a new hospital from helping to establish
the overall goals, policies and organization, and facilities to accomplish these goals in the most
effective and efficient manner. The functional elements of the role of nursing superintendent
includes the following
 Formation of the aims, objectives and policies of nursing services as an integral part of
hospital service
 Staffing based on nursing requirements in relation to accepted standard of medical care
 Planning and directing nursing services
 Maintaining supplies and equipments
 Budgeting
 Records and reports
 Nursing supervisor
Each department or clinical division, e.g. Medical, surgical, obstetrical, operation
theatres, outpatient department, nurseries, etc. should have a supervisor. As they may be more
than one nursing unit in each division or department, supervisors have a general administrative
and coordinating function within their respective division. However, supervisors will also have
limited clinical functions
 Head nurse / nursing tutor
A head nurse is assigned to a nursing unit, or ward, or a section of department. She works
under the general direction of the supervisor of the division.

 Staff nurse / clinical instructor
Staff nurses are employed at the ‗floor‘ level for carrying out skilled bedside nursing.
This is the real work force of the hospital upon whose competency, state of training and
dedication depend the success of the nursing department.
 Student nurse
Students nurse cannot be employed on nursing duties except under supervision of fully
qualified staff nurses.
Policies and procedures
In order that a good standard of nursing care be maintained, the nursing superintendent
should develop written policies and procedures to serve as a guides for nurses of the various
units of the hospital. Important topics that should be incorporated are as follows
 Organization
 Status and relationship
 Responsibilities
 Staffing pattern, shift pattern
 Departmental functions
 Requisitioning of supplies
 Utilization, care and maintenance of equipment
 Nursing procedures, coordination with domestic services
 Handling of the patients clothing and valuables
 Isolation technique
Functions
Of hospital in nursing services and education
 As a basic function, to assist the individual patient in performance of those activities
contributing to his health or recovery that he would otherwise perform unaided has had
the strength will, or knowledge.
 As an extension of the above basic function, to help and encourage the patients to carry
out the therapeutic plan initiated by the physician
 As a member of health team, to assist other members of the team to plan and carryout the
total programme of care

AT COMMUNITY
PHCs (Primary Health Care)
Introduction
The PHC is the first contact point between the village community and the medical
officer. These are established and maintained by the state government under minimum needs/
basic minimum services programme. It acts as a referral unit for six sub centre and has 4-6 beds.
A PHC covers population of 30000 in plain area and 20000 in hilly remote and tribal area. The
activities of PHC‘s involve curative, preventive, promotive and family welfare services. The
number of PHC‘s functioning in the country is 22975.
Definition
Primary health centre is the basic structural and functional unit of public health services
for rendering primary health care in peripheral areas.
Elements of PHC
e- Ensure safe water supply
l- Locally endemic disease control
E- Education/ expanded programme on immunization
m- Maternal and child health
e- Environmental sanitation
n- Nutritional services
t- Treatment of minor aliments
s- School health services
Standards of PHC
The IPHHS for PHCs has been prepared keeping in view the resources available with respect to
functional requirement for PHCs with minimum standards such as-
 Building
 Man power
 Instrument
 Equipments
 Drugs
 Other facilities

The standards prescribed are , a PHC covering 20000-30000 population with six beds on well the
block level PHC are ultimately going to be upgraded as CHC with 30 beds of providing
specialized services.
The objectives of IPHS for PHCs are:-
 To provide comprehensive primary health care to the community through the PHC
 To achieve and maintain an acceptable standards of quality of care
 To make the services more responsible and sensitive to the needs of the community
Minimum requirements are:-
The assured services cover all the essentials of preventive, promotive, curative and rehabilitative
primary health care. This implies a wider range of services that includes
 Medical care
 Maternal and child health care
 Full rage family planning services including counseling and appropriate referral for
couples having infertility
 MTP services
 Health education for prevention and management of malnutrition, anemia and vitamin A
deficiency and co-ordinates with ICDS
 School health services
 Adolescent health care
 Disease surveillance and control of epidemics
 Collection and reporting of vital events
 Promotion of sanitation
 Testing water quality
 Nutritional health programme
 Training health workers
 Training of ASHA

Staffing pattern
The man power that should be available in the PHC is as follows
STAFF EXISTING RECOMMENDED
Medical officer 1 3(at least 1 female)
AYUSH practitioner - 1
Accountant manager - 1
Pharmacist 1 2
Nurse midwife(staff) nurse 1 5
Health worker 1 1
Health educator 1 1
Health assistant (m/f) 2 2
Clerks 2 2
Laboratory technician 1 2
Driver 1 OPTIONAL / vehicle
may be from out side
Class IV 4
Major role of nurse in PHC
 Facilitative role
 Developmental role
 Clinical role
 Supportive role
Functions of PHC
 Medical care
 Maternal and child health
 Control of communicable diseases

 Collection and reporting of vital statistics
 Immunization services
 Improvement in environmental sanitation
 School health programmes
CHCs (community health centres)
Introduction
The community health centres are established and maintained by state government under
MNP/BMS programme. It has 30 indoor beds with x-ray labour room, operation theatre, and
laboratory facilities. It is managed by four medical specialists i.e. surgeon, physician,
gynecologist and pediatrician. On 31st
march 2003, 3076 CHC were established each covering a
population of 80000 to 1.20 lakh.
Definition
Community health centres are the nonprofit community governed health organizations
that provide primary health care, health promotion and community development services, using
them inter disciplinary terms of health providers.
Principles
 Excellence
 Innovations
 Accountability
 Collaboration
 Accessibility
 Integrity
 Environment
Elements
 Primary care
 Illness prevention
 Health promotion
 Community capacity building
 Service integration
Standards of CHC
In order to provide quality care in CHCs IPHS are being prescribed to provide optimal expert
care to the community and achieve and maintain an acceptable standards of quality of care.
These standards would help to monitor and improve the functioning of CHCs.
CHCs has to provide the following services like

 Care of routine and emergency cases in surgery
 Care of routine and emergency cases in medicine
 24 hour delivery services
 Essentials of emergency obstetric care.
 Full range of family planning services including laparoscopic services
 Safe abortion services
 New born care
 Routine and emergency care of sick children
 Other management of medical and accidental conditions
 All the national health programmes should be delivered through CHCs
PLANNING PROCESS
HEALTH IN FIVE YEARS PLANS
INTRODUCTION
Five years plan is mechanism to bring about uniformity in policy formulation in programmes of
national importance
The specific objectives of the health programme, during Five years plan, are as follows:
1. Control & eradication of major communicable diseases.
2. Strengthening of basic health services through the establishment of the PHC & sub
enters.
3. Population control.
4. Development of health manpower resources.
For the purpose of planning the health sectors has been divided in two following sub sectors.
1. Water supply & sanitation.
2. Control of communicable diseases.
3. Medical education, training & research.
4. Medical care including hospitals, dispensaries & PHCs.
5. Public health services.
6. Family planning.
7. Indigenous system of medicine.
FIRST FIVE YEAR PLAN (1951 – 1956)
The first Indian Prime Minister, Jawaharlal Nehru presented the first five-year plan to the
Parliament of India on 8 December 1951. The first plan sought to get the country's economy out
of the cycle of poverty. The plan addressed, mainly, the agrarian sector, including investments in

dams and irrigation. The agricultural sector was hit hardest by the partition of India and needed
urgent attention.[2]
The total planned budget of 206.8 billion was allocated to seven broad areas:
1) Irrigation and energy
2) Agriculture and community development
3) Transport and communications
4) Industry
5) Social services
6) Land rehabilitation
7) Other sectors and services
The specific objectives were;
1. Provision of water supply & sanitation.
2. Control of malaria.
3. Preventive health care of the rural population.
4. Health services for mother & children.
5. Education & training in health.
6. Self sufficiency in drug & equipments.
7. Family planning & population control.
During this plan period the public sector outlay was Rs. 2356 crore of which Rs. 140 crore were
allotted for health programs.
SECOND FIVE YEAR PLAN (1956-1961)
The second five-year plan focused on industry, especially heavy industry. Unlike the First
plan, which focused mainly on agriculture, domestic production of industrial products was
encouraged in the Second plan, particularly in the development of the public sector.
The plan followed the Mahalanobis model, an economic development model developed by
the Indian statistician Prasanta Chandra Mahalanobis in 1953. The plan attempted to determine
the optimal allocation of investment between productive sectors in order to maximize long-run
economic growth.
The specific objectives were;
1. Establishment of institutional facilities to serve as a basis from which service could be
render to the people both locally & surrounding territory.
2. Development of technical man power through appropriate training programmes.
3. Intensifying measures to control widely spread communicable disease.

4. Encouraging active campaign for environmental hygiene.
5. Provision of family planning and other supporting services.
During this plan period the public sector outlay was Rs. 4,800 crore of which Rs. 225 crore were
allotted for health programs.
THIRD FIVE YEAR PLAN (1961-1966)
The third plan stressed on agriculture and improving production of rice
Many primary schools were started in rural areas. In an effort to bring democracy to the
grassroots level, Panchayat elections were started and the states were given more development
responsibilities.
State electricity boards and state secondary education boards were formed. States were made
responsible for secondary and higher education.
The specific objectives were in tuned with the 1st
& 2nd
five years plan except that integration of
public health with maternal & child welfare, nutrition & health education was planned.
During this plan period the public sector outlay was Rs. 7,500 crore of which Rs. 341.8 crores
were allotted for health programs.
FOURTH FIVE YEAR PLAN (1969-1974)
At this time Indira Gandhi was the Prime Minister. The Indira Gandhi government nationalized
Green Revolution in India advanced agriculture
Certain objectives of the Mudaliar committee were the base for this plan in relation to health.
1. To provide an effective base for health services in rural areas by strengthening the PHCs.
2. Strengthening of sub-division & district hospitals to provide effective referral services
for PHCs,
3. Expansion of medical & nursing education & training of Para –medical personnel to meet
the minimum technical man power requirements.
During this plan period the public sector outlay was Rs. 16,774 crore of which Rs. 1,156 crore
FIFTH FIVE YEARS PLAN (1974-1979)
Stress was laid on employment, poverty alleviation, and justice. The plan also focused on self-
reliance in agricultural production and defense. In 1978 the newly elected Morarji Desai
government rejected the plan. Electricity Supply Act was enacted in 1975,

The emphasis of the plan was on removing imbalance in respect of medical facilities &
strengthening the health infrastructure in rural areas.
Specific objectives to be pursued during the plan were:
1. Increase accessibility of health services to rural areas.
2. Correcting regional imbalance.
3. Further development of referral services.
4. Integration of health, family planning & nutrition.
5. Intensification of the control & eradication of communicable diseases especially malaria
& smallpox.
6. Quantitative improvement in the education & training of health personnel.
During this plan period the public sector outlay was Rs. 37,250 crore of which Rs. 3,277 crores
The sixth plan also marked the beginning of economic liberalization. Price controls were
eliminated and ration shops were closed. This led to an increase in food prices and an increase in
the cost of living.
Family planning was also expanded in order to prevent overpopulation. In contrast to China's
strict and binding one-child policy, Indian policy did not rely on the threat of force. More
prosperous areas of India adopted family planning more rapidly than less prosperous areas,
which continued to have a high birth rate.
SEVENTH FIVE YEAR PLAN (1985-89)
The main objectives of the 7th five year plans were to establish growth in the areas of increasing
economic productivity, production of food grains, and generating employment opportunities.
The thrust areas of the 7th Five year plan have been enlisted below:
 Social Justice
 Removal of oppression of the weak
 Using modern technology
 Agricultural development
 Anti-poverty programs
The objectives were
1. Eliminate poverty & illiteracy by 2000

2. Achieve near full employment secure satisfaction of the basic needs of food, cloth,
shelter
and provide health for all.
3. To provide an effective base for health services in rural areas by strengthening the PHCs.
4. universal immunization programme
5. Promotion of voluntary acceptance of contraceptives
During this plan period the public sector outlay was Rs. 1.80.000 crores of which Rs. 3,392
crores were allotted for health programs.
Period between 1989-91
P.V. Narasimha Rao was the twelfth Prime Minister of the Republic of India and head of
Congress Party
1989-91 was a period of political instability in India and hence no five year plan was
implemented. Between 1990 and 1992, there were only Annual Plans.
EIGHTH FIVE YEAR PLAN (1992-97)
India became a member of the World Trade Organization on 1 January 1995.This plan can be
termed as Rao and Manmohan model of Economic development. The major objectives included,
containing
1. population growth,
2. poverty reduction,
3. employment generation,
4. strengthening the infrastructure,
5. Institutional building,tourism management,
6. Human Resource development,
7. Involvement of Panchayat raj,
8. Nagarapalikas,
9. N.G.O‘s and
10. Decentralization and people's participation.
It is based on the national health policies.
1. Human development is the ultimate goal of this plan.
2. Employment generation, population control literacy, education, health, drinking water &
provision of adequate food &basic infrastructure.
3. Towards health for the underprivileged‖ was the of the aim of this plan.
The PHCs were strengthened staff vacancies, by supplying essential equipment &drugs.

AIDS control program was initiated during this plan.
NINTH FIVE YEAR PLAN (1997-2002)
Ninth Five Year Plan India runs through the period from 1997 to 2002 with the main aim of
attaining objectives like speedy industrialization, human development, full-scale employment,
poverty reduction, and self-reliance on domestic resources.
Background of Ninth Five Year Plan India: Ninth Five Year Plan was formulated amidst the
backdrop of India's Golden jubilee of Independence.
The main objectives of the Ninth Five Year Plan India are:
 to prioritize agricultural sector and emphasize on the rural development
 to generate adequate employment opportunities and promote poverty reduction
 to stabilize the prices in order to accelerate the growth rate of the economy
 to ensure food and nutritional security
 to provide for the basic infrastructural facilities like education for all, safe drinking water,
primary health care, transport, energy
During this plan, vertical health program were integrated horizontally with general health
services.
The Reproductive & child health program was improved under following guidelines;
1. Decentralize RCH to the level of PHCs.
2. Base planning for RCH services on assessment of the local needs.
3. Meet the needs of contraceptives
4. Involve the general practitioners & industries in family welfare work.
TENTH FIVE YEAR PLAN (2002-2007)
 Reduction of poverty ratio by 5 percentage points by 2007;
 Providing gainful and high-quality employment at least to the addition to the labour
force;*All children in India in school by 2003; all children to complete 5 years of
schooling by 2007;
 Reduction in gender gaps in literacy and wage rates by at least 50% by 2007
This plan has laid down the following targets
 Bring down the decadal growth rate by 16.2% in the decade from 2001 to 2011.

 Reduce infant mortality rate to 35/1000 live births by 2007 & to 28/1000 live births by
2012
 Reduce maternal mortality rate to 2/1000 live births by 2007 & 2/1000 live births by
2012.
To achieve the above, the government is planning to do the following
1. Restructure existing health infrastructure.
2. Upgrade the skills of health personnel
3. Improve the quality of reproductive & child health‘
4. Improve logistic supplies.
5. carry out the research on nutritional deficiency
6. Promote rational drug use.
ELEVENTH PLAN (2007-2012)
1. Income & Poverty
o Create 70 million new work opportunities.
o Reduce educated unemployment to below 5%.
o Raise real wage rate of unskilled workers by 20 percent.
2. Education
o Reduce dropout rates of children from elementary school from 52.2% in 2003-04
to 20% by 2011-12
o Develop minimum standards of educational attainment in elementary school, and
by regular testing monitor effectiveness of education to ensure quality
o Increase literacy rate for persons of age 7 years or above to 85%
3. Health
o Reduce infant mortality rate to 28 and maternal mortality ratio to 1 per 1000 live
births
o Reduce Total Fertility Rate to 2.1
o Provide clean drinking water for all by 2009 and ensure that there are no slip-
backs
o Reduce malnutrition among children of age group 0-3 to half its present level

4. Women and Children
o Raise the sex ratio for age group 0-6 to 935 by 2011-12 and to 950 by 2016-17
o Ensure that at least 33 percent of the direct and indirect beneficiaries of all
government schemes are women and girl children
o Ensure that all children enjoy a safe childhood, without any compulsion to work
5. Infrastructure
o Ensure electricity connection to all villages and BPL households by 2009 and
round-the-clock power.
o Ensure all-weather road connection to all habitation with population 1000 and
above (500 in hilly and tribal areas) by 2009, and ensure coverage of all
significant habitation by 2015
o Connect every village by telephone by November 2007 and provide broadband
connectivity to all villages by 2012
o Provide homestead sites to all by 2012 and step up the pace of house construction
for rural poor to cover all the poor by 2016-17
6. Environment
o Increase forest and tree
o Attain WHO standards of air quality in all major cities by 2011-12.
o Treat all urban waste water by 2011-12 to clean river waters.
o Increase energy efficiency by 20 percentage points by 2016-17.
I. Various health and family welfare committees
1. Bhore committee
In 1946, the recommendations and guidance provided by the Bhore Committee formed
the basis for organization of basic health services in India. The report was submitted to
the government.-side was the focal point of these recommendation
The Bhore Committee made two types of recommendations;
a) A Comprehensive blue print for the distant future (20 to 40 years from then) and the
smallest service unit was to be Primary Health Unit, serving a population of 10,000 to
20,000
b) A short-term scheme covering 2 to 5 years period from then with emphasis on setting up
30 bedded hospitals, one for every two Primary Health Care

The country – side was the focal point of these recommendations. Other
recommendations were:
 Formation of village health committee to secure active cooperation and support in the
development of health program.
 Provision of Doctors of future who should be ―Social Doctor‖, combines both
curative and preventive of the public.
 Formation of District Health Board for each district with district health officials and
representatives of the public.
 To ensure suitable housing, sanitary surroundings, safe drinking water supply
elimination of unemployment and lay special emphasis on preventive work.
2. Mudaliar committee 1962
In 1959, the Government of India appointed another committee known as ―Health Survey
and Planning Committee popularly known as Mudaliar Committee under the
Chairmanship of Dr. A.L mudaliar.
Recommendations:
a) Consolidation of advances made in the first two-year plans
b) Strengthening of the district hospital with specialist services
c) Regional organizations in each state
d) Each primary health centre not to serve more than 40,000 populations.
e) To improve the quality of health care provided by primary health centres
f) Integration of medical and health services on the pattern of Indian Administrative
service.
3. Chadah Committee, 1963
Under the chairmanship of Dr. M.S. Chadah, Government of India appointed a committee
to study the arrangement necessary for the maintenance phase of the National Malaria
Eradication Programe.
Recommendations
1. Vigilance operations in respect of the NMEP should be the responsibility of the
general health services (e.g.) PHC.
2. The vigilance operations should be should be done through monthly home visits by
basic workers (Junior Health Assistant male)
3. Now each Junior Health Assistant Male to cover 3 – 5000 population

4. Mukherjee Committee, 1965
Under the chairmanship of Shri Mukerji, the then secretary of health to the Government
of India was appointed to review the strategy for the family planning program.
Recommendations
 To have separate staff for the family planning program.
The family planning assistants were to undertake family planning duties only
The basic health workers were to be utilized for purposes other than family planning.
To delink the malaria activities from family planning of it‘s that the later would receive
undivided attention of its staff.
Mukherjee Committee, 1966
Multiple activities of the mass programmes like family planning, small pox, leprosy,
trachoma, etc. were making it difficult for the states to undertake these effectively because of
shortage of funds. A committee of state health secretaries, headed by the Union Health
Secretary, Shri Mukherjee, was set up to look into this problem.
5. Jungalwalla Committee, 1967
Under the Chaimanship of Dr. Jungalwalla Director, National Institute of Health
Administration and Education, New Delhi was appointed to examine the various
problems of service conditions of doctors. This committee is known as the committee on
integration of Health Services.
Recommendation
1. The main steps recommended towards integration were
a) Unified cadre
b) Common Seniority
c) Recognition of extra qualifications
d) Equal pay for equal work
e) No private practice and good service conditions
6. Kartar Singh committee, 1973
The Government of India constituted a committee in 1922, known as the committee on
multipurpose workers under Health and Family Planning, under the Chairmanship of
kartar Singh, Additional Secretary, Ministry of Health and Family Planning, Government
of India.

Recommendations
 The Present Auxiliary Nurse Midwives to be replaced by the newly designated ―Female
Health Workers‖ and the present day Basic Health Workers, malaria surveillance
workers, vaccinators, health education assistants (Trachoma)and the family planning
health assistants to redesignated by ―Male Health Workers‖.
 The program has to be introduced in areas where malaria is in maintenance phase and
smallpox has been controlled and later to other areas.
 One primary health centre for 50,000 populations.
 Each PHC should be divided into 16 sub centers and each covers 3,000 to 35, 00
population.
 Each sub centre to be staffed by a male and female health worker.
 One male health supervisor to supervise 3 to 4 male health workers and one female health
supervisor to supervise the work of 4 female health workers.
 The lady health visitors to be designated as female health supervisors.
 The doctor in charge of a primary health centre should have the overall in charge of all
the supervisors and health workers in the area.
7. Shrivastav Committee, 1975
The Government of India in the Ministry of Health and Family Planning had in
November 1974 set up a ‗Group on Medical Education and Support Manpower‘
popularly known as Shrivastav Committee.
Recommendations
 Creation of bands of paraprofessional and semiprofessional health workers from within
the community itself (e.g. school teachers, postmasters, gram sevaks) to provide simple
promotive, preventive and curative health services needed by the community.
 Establishment of 2 cadres of health workers, namely multipurpose health workers and
health assistants between the community level workers and doctors at PHC.
 Development of a ‗Referral Services Complex‘ by establishing proper linkages between
PHC and higher level referral services.
 Establishment of a Medical and Health Education Commission for planning and
implementing the referrals needed in health and medical education on the lines of the
University Grants Commission.

8. Balaji Committee 1986-19877
The Ministry of Health and Family welfare, Government of India, following the adoption
of the National Policy on education, 1986, set-up a committee on Health Manpower,
Planning, Production and Management in 1986 under the chairmanship of Prof. JS Balaji,
Professor of Medicine, AIIMS, and New Delhi
Recommendations
 To formulate a National Policy on education in Health Services
 To prepare curriculum for schoolteachers this should constitute a holistic approach
including social, moral, health and physical education.
 Health service statistics needs to be improved in quality
 To utilize the services of Indian system of medicine viz. Homeopathy, in the area of
National Health Program.
 Health related components to be included in IX, X Grades
 Continuing education program for the health personnel.
 Health manpower requirements for nursing personnel.
NATIONAL HEALTH POLICY - 2002
Introduction
National Health Policy was last formulated in 1983, and since then there have been
marked changes in the determinant factors relating to the health sector. Some of the policy
initiatives outlined in the NHP-1983 have yielded results, while, in several other areas, the
outcome has not been as expected.
Current scenario
Financial resources: The public health investment in the country over the years has been
comparatively low, and as a percentage of GDP has declined from 1.3 percent in 1990 to 0.9
percent in 1999. The aggregate expenditure in the Health sector is 5.2 percent of the GDP. Out of
this, about 17 percent of the aggregate expenditure is public health spending, the balance being
out-of-pocket expenditure.
Equity: In the period when centralized planning was accepted as a key instrument of
development in the country, the attainment of an equitable regional distribution was considered
one of its major objectives.
Delivery of national public health programmes
 Extending public health services

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