3. 2nd PBBSc - Comty - Unit - 3 - Organization and administration of health services in India.pptx

2nd Year PBBSc Nursing
community Health Nursing
Organization and administration of
health services in India
By : M. Thiru murugan

UNIT III:
Organization and administration of health services in India.
National health policy
Health Care Delivery system in India.
Health team concept
Centre, State, district, urban health services, rural health
services
System of medicines
Centrally sponsored health schemes
Role of voluntary health organizations and international health
agencies
Role of health personnel in the community
Public health legislation.

Important questions:
1. Different level of health services in india (Centre,
State, district, urban health services, rural health
services)
2. Health team
3. System of medicines / AYUSH
4. Role of health personnel in the community
5. National health policy
6. voluntary health organizations – WHO, UNICEF,
Red cross
7. Public health legislation.

National health policy:
Definition:
Health policy can be defined as the "decisions, plans, and
actions that are undertaken to achieve specific healthcare
goals within a society”
National health policy 1983:
National health policy in India was not framed and announced in
1983.
The ministry of health and family welfare evolved a National
Health Policy in 1983.
The policy focus on the preventive, promotive, public health
and rehabilitation aspects of health care.
To attain the objectives “Health for all by 2000 AD”.

KEY ELEMENTS OF NATIONAL HEALTH
POLICY 1983:-
Awareness of health problems
Safe drinking water and sanitation
Rural health infrastructure
Health management of information system
Legislative support to health
Combat wide spread of malnutrition
Research in health care
 Different system of medicines

Factors interfering with the progress towards health for all:
Insufficient political commitment
Failure to achieve equality
The low status of women.
Slow socio-economic development.
Lack of human resources.
Inadequacy of health promotion activities.
Weak health information system and no baseline data.
Pollution, lack of water supply and sanitation.
Uncontrolled population
Advanced technology
Natural and man-made disasters

National Health Policy 2002:
The national health policy 1983 revised in 2002 with new
objectives and strategies in order meet the health
problems and demand of peoples
Objectives:
To achieve an acceptable standard of good health
To upgrading health infrastructure
To improve equitable health service
To give priority for prevention and first line curative
To promote rational use of drugs.
To increase use of Traditional Medicine (AYUSH)

National Health Policy 2002 - Policy
prescriptions:
Equity
Delivery of national health programmes
Extending public health services
Education of health care professionals
Need for specialists in 'public health' & 'family
medicine
Nursing personnel
Urban health
Mental health

Information Education and Communication
Health research
Role of private sector
Health statistics
Women's health
Medical ethics
Enforcement of quality standard for food &drugs
Regulation of standards in paramedical disciplines
Environmental and occupational health

National Health Policy 2017:
New health policy is need to change again according
to the changes in the country
The primary aim of the national health policy, 2017, is
to inform, clarify, strengthen and prioritize the role of
the government in shaping health systems
Goal: to achieve highest possible level of health and
wellbeing for all at all ages, through a preventive and
promotive health care.
Priority areas of National Health Policy -2017: NHP-
2017 also identifies 7 priority areas

7 Priority areas of National Health Policy -2017:
1. The Swachh Bharat Abhiyan
2. Balanced, healthy diets and regular exercises.
3. Addressing tobacco, alcohol and substance
abuse
4. Yatri Suraksha - preventing deaths due to rail
and road traffic accidents
5. Nirbhaya Nari -action against gender violence
6. Reduced stress and improved safety in the
work place
7. Reducing indoor and outdoor air pollution

Key Policy Principles:
Professionalism, Integrity & Ethics
Equity – equal to all
Affordability – able to access
Universality – common
Patient Centered & Quality of Care
Accountability – responsibility
Inclusive Partnerships – involve many sectors
Pluralism – focus on many
Decentralization – dividing to many areas
Dynamism ( capacity) and Adaptiveness (adjustment)

Services – National health policy 2017:
Implementation of National health programme
for communicable, non communicable &
nutritional problems
Health system strengthening programs
Health care for all
Free drugs, diagnostics & emergency care at
CHC, PHC & district hospital
Involvement of private sectors to achieve goals
Screening of NCDs (cancer at earliest stage)

Conversion of sub centres/health centres into
Wellness centre
National health standard organization (NHSO)
Standard guidelines & protocol of care
Separate empowered tribunal
Intersectoral convergence (Coordination with
ministry)
Mainstreaming of Indian system (1st time)
Digital medicine

HEALTH CARE DELIVERY SYSTEM:
Health care delivery system is defined as the combination of
institutions, organizations & health workers who is
providing or delivering the health care to the people (Include
the promotion of health, prevention of illness, detection and
treatment of disease & rehabilitation)
The characteristic of the modern health care delivery system is
the proper use of medical technology.
Medical technology includes not only medical devices, drugs,
and biologics, but also the medical, surgical & nursing
procedures
Diagnosis, monitoring, treatment, and rehabilitation all services
depends on medical technologies.

Model of health care delivery system:

input:
Assessment of health status, problems & resources
Assessment of health status through collecting
details & observation
Identifying the health problems include
communicable diseases, non communicable
diseases, nutritional problems & mental illness
among the people
Assessment of resources include man power
(health workers), money & materials (equipments &
articles)

Health care services:
The kind of services provided to the peoples
It may be
Curative - treatment
Preventive – avoidance of diseases
Promotive – improving health
Rehabilitative – long term support for chronic ill
Health care system/ Organization:
1.Public health sector:
this include all the health care facilities & health
institutions maintained by state & central governments.

Public health sector includes:
 Primary health care:
 Primary health centers (PHC)
 Sub centers (SC)
 Community health centers (CHC)
 Rural hospitals
 District hospitals.
 Specialty hospitals
 Teaching hospitals
 Health Insurance Schemes:
 Employee state insurance (ESI)
 Central government health schemes (CGHS)
 Other Agencies: Defense services & Railways

2. PRIVATE SECTOR:
 Private Hospitals,
 polyclinics,
 Nursing homes & dispensaries.
 General practitioners & clinics.
3. VOLUNTARY HEALTH AGENCIES & NGO:
National Voluntary Health Agencies
Red cross, TB association of india
International voluntary health agencies
WHO, UNICEF, CARE, FAO, ILO

4. INDIGENOUS SYSTEM OF MEDICINE: (AYUSH)
 Ayurveda
 Yoga & Naturopathy
 Unani
 NATIONAL HEALTH PROGRAMMES:
Communicable – NMCP, NACP
Non Communicable – NDCP,NCPB
Nutritional – Mid day MP, ICDS
Out put: changes or improvement in health status of
peoples after provided health care services
Siddha
 Homeopathy

Health center:
 a small form health institute mainly located at
rural & remote areas for providing all the basic
health services
Types:
Generally there are 3 types
1.Sub-center(SC)
2.Primary health center (PHC)
3.Community health center (CHC)

Sub centres:
Introduction:
 Sub-health Centre is the most peripheral (outside) and first
contact point between the health care system & the community.
 It provides all the basic health care to the community
Population: 1 Sub-centre for every 5000 population in plain areas
& 1 for every 3000 population in hilly/tribal/desert areas. 1 PHC
covers 6 sub centres
Objectives:
 To provide basic Primary health care to the community.
 To achieve and maintain standard of quality of care.
 To deliver the services to the needs of the community.

Staffing Pattern:
Each Sub Centre is required to be manned by at
least 1 ANM / FHW & 1 MHW.
Under National Rural Health Mission (NRHM),
there is a provision for 1additional second ANM
on contract basis.
1LHV for supervision of 6 Sub Centres.
Government of India bears the salary of ANM &
LHV while the salary of the MHW is borne by the
State governments

 Functions of Sub centre:
 Basic health care services
 Antenatal care
 Intra-natal care
 post-natal care
 Essential Newborn Care
 Promotion of breast-feeding
 Immunization
 Vitamin A prophylaxis
 Prevention and control of diseases
 Family Planning
 Counselling and referral for safe abortion services
 Adolescent health care:
 Assistance to school health services

 Control of local endemic diseases
 Disease surveillance
 Water Quality Monitoring
 Promotion of sanitation
 Field visits
 Community needs assessment
 Curative Services: Provide treatment and First Aid
 Referral services
 Organizing Health Day at Anganwadi centres
 Training, Coordination and Monitoring
 Planning and implementation of National Health Programmes
 Maintaining health records and report

Primary health centres:
 Primary Health Centre is an institution for providing
comprehensives health care viz., preventive, promotive and
curative services, to the people living in a defined geographical
area.
 The primary health centre occupies a key position in the nation’s
health care system.
 The PHCs are established and maintained by the State
governments under the Minimum Needs Programme (MNP)/
Basic Minimum Services (BMS) Programme.
Population covered by one PHC:
 Rural populations in the plains - 30,000
 In hilly, tribal & backward areas - 20,000

Medical officer 1
Pharmacist 1
Nurse midwife 1
Health worker F (ANM) 1
Block extension Educator 1
Health Assistant (F)/LHV 1
Health Assistant (M) 1
UDC and LDC 2 (1 each)
Lab technician 1
Driver (if vehicle is there) 1
Class IV 4
Total 15
Staffing pattern of PHC:

Function of Primary health centre:
Basic health care services
Medical care
MCH services
Immunization
Family planning
Safe water supply and sanitation
Prevention and control of communicable and
non communicable diseases

Minor surgeries
Conducting important day
Collection and reporting of vital statistics
Health education
Training and supervision
Planning and implementation of national health
programmes
Referral services
Maintenance of health records and reports

Community health centre:
 These were established by upgrading the primary health
centers, CHCs are being established and maintained by the
State Government.
 Each community health center should cover a population of
80,000 to 1.2 lakh.
 It is manned by 4 medical specialists i.e. Surgeon,
Physician, Gynecologist & Pediatrician and supported by
paramedical and other staff.
 It has 30 in-door beds with one OT, X-ray, Labour Room and
Laboratory facilities.
 It serves as a referral centre for 4 PHCs and also provides
facilities for obstetric care and specialist consultations.

Staff for community Health Centre:
Medical officer 4
Nurse midwife 7
Dresser 1
Pharmacist/Compounder 1
Lab technician 1
Radiographer 1
Ward boys 2
Sweepers 3
Dhobi 1
Mali 1
Chowkidar 1
Aya 1
Peon 1
Total 25

Functions of CHC:
 Basic health and medical services
 Care of Routine & Emergency Cases in Surgery
 Dressings, I&D, and surgery for Hernia, Hydrocele,
Appendicitis etc.
 Other management including nasal packing,
tracheostomy, foreign body removal etc.
 Fracture reduction and putting splints/plaster cast.
 Conducting daily OPD.
 Care of Routine and Emergency Cases in Medicine
 Handling all the emergency and routine cases

 Maternal Health
 ANC checkups including Registration & associated services
 Deliver - normal, assisted delivery & LSCS
 Management of labour
 Managing post natal complications
 Newborn Care and Child Health
 Essential Newborn Care and Resuscitation
 Counseling on Infant and young child feeding
 Routine and emergency care of sick children
 Full Immunization of infants and children against VPDs
 Management of Malnutrition cases.
 Family Planning

 Counseling, provision of Contraceptives, NSV,
Laparoscopic Sterilization Services and their follow up.
 Safe Abortion Services
 All National Health Programmes delivered through
CHCs
 School health services
 Blood storage facility
 Essential laboratory services
 Referral (transport) services
 Maternal Death review (MDR)
 Training and supervision
 Maintenance of health records and reports

HEALTH TEAM:
Definition:
A group of health personnel provide better health services
to the community.
Group of persons with different levels of knowledge,
qualification, abilities & personalities who share a common
goal.
A health team is a group of persons who work together to
promote better health in the community.
The health team members function according to the rules
of Ministry of Health and Family Welfare, Govt of India.

CONCEPT OF HEALTH TEAM:
1. Shared goals
2. Clearly defined roles
3. Shared knowledge and skills
4. Effective, timely communication
5. Mutual respect
6. Leaders - who set the mood

Health team members:
Doctors
Physician Assistants
Nurses
Pharmacists
Dentists
Therapists & rehabilitation specialists
Emotional, social and spiritual support providers
Administrative & support staff

Health Assistants and Dias.
Village Health Guides.
Panchayat leaders
Teachers.
Woman Health Leader
Characteristics of a team:
Team has an objective.
Team follows rules.
Team organizes themselves to achieve their goals.
Team members co-operate

Community health team: It refers to a group of people working
together for common goal in order to provide preventive, promotive,
curative, rehabilitative, restorative services to the individual, family and
community.
1. Anganwadi worker
2. Physician
3. Village health guide
4. ASHA
5. Female health worker
6. Male health worker
7. Birth attendant/dai
8. Panchayat leader
9. Collector
10. Teacher

Functions of health care team:
• Maternal and child health services.
• Family planning.
• Medical termination of pregnancy.
• Control & prevention of communicable disease.
• Dai training.
• Registration of vital events.
• Maintenance of records.
• Provision of primary medical care.
• Team activities.
• To conduct survey.

• Organization & implementation of immunization
• Identification of reports about communicable diseases.
• To provide follow up &referrals.
• Guiding the health workers for planning programmes.
• Conducting group meetings.
• Organization of health programmes.
• Supervision and guidance.
• Supplies, equipment maintenance.
• Training.
• Primary medical care.
• Continuing education.

• Cooperative activities within the team and village peoples.
• Home visit.
• Administration in primary and sub centres and district
levels.
• Supervision of health care team members.
• Education, orientation, in-service education, dai training,
training of students.
• Provision of school health services.
• Carry out laboratory investigations (malaria, tb) and
medication administration on prescription.

CENTRE, STATE, DISTRICT, URBAN HEALTH SERVICES,
RURAL HEALTH SERVICES:
• Health sector in India is the responsibility of the local, state,
and also the central government.
• The central government is responsible for health services in
union territories.
• And also responsible for controlling & implementing all the
health services in state governments.
3 main links of health system:
Central level State level Local or
peripheral level

Centre level:
 The central level is the supreme authority of all the health
care services.
 This is responsible for the planning, executing,
implementing and evaluating all the events, activities,
programmes for the whole country.
 The health of nation is completely depends on the central
level of health care services.
 The organization of health services at the national level
consist of union ministry of health & family welfare,
directorate general of health services and central council
of health

Departments:
1. Union ministry of health & family welfare,
2. Directorate general of health services (DGHS)
3. Central council of health
1. Union ministry of health & family welfare:
 Head is central health minister through political
appointment by ruling government through election
 It has 2 department:
 1)Dept of health – providing all health services
 2)Dept of family welfare – family welfare and family
planning

Functions of Union ministry of health & FW:
Union List function:
o International health relations
o Administration of central health institutes, ex – AIIMS
o Promotion of research
o Regulation of medical, pharmaceutical, dental & Nursing
professions.
o drug standards.
o Immigration and emigration.
o Regulation of labour
o Co-ordination with states and with other ministries for promotion
of health.

Concurrent List:
oPrevention of communicable disease
oHealth survey
oPrevention of adulteration of foods tuffs.
oControl of drugs and poisons.
oVital statistics.
oLabour welfare.
oPosts other than major.
oEconomic and social planning.
oPopulation control and family welfare.

2. Directorate general of health services (DGHS):
 The director general of health services in the principal advisor to the
union government in both medical and public health
 He is assisted by an additional directors, a team of deputies and a
large administrative staff.
 The directorate comprise of 3 main units ex. Medical care &
hospitals, public health and general administration.
 Functions:
International health relations
Control of drug standards
Medical Store Depot
Post Graduate Training
Medical Education
Medical Research
National health programme
Central Govt. Health Schemes
Central Health Education
National Medical Library

3. CENTRAL COUNCIL OF HEALTH:
 It was set up by a President in1952
 promoting coordination between the centre & the states
 The Union health minister is the Chairman & the state health
ministers are the members.
Functions:
 To consider and recommend all its aspects of health services
 To make proposals for legislation in medical and public health
 To make recommendations to the central government for the
health benefits to the states
 promoting and maintaining cooperation between the central and
state health administration.

 STATE LEVEL:
 Each state having its own health administration with the guidance of
central government
 Departments:
1. State ministry of health & family welfare
2. State Health secretariat
3. State Health Directorate
1. State ministry of health and family welfare:
 State ministry of health and family welfare is headed by cabinet minister,
assisted by Deputy Minister.
 This is political appointment by state ruling party through election
 Functions:
 Support and safeguard the all health policies of state Govt.
 Approval of all health services at state level

2. State health secretariat:
Supporting, guiding and observing the implementation of the state
health ministry
It is a official organ of the State Ministry of Health and Family
welfare.
The Secretary of the State Govt. is a senior officer of IAS
Functions:
Assisting the minister in policy making & planning
Formulation, review and modification
Execution of policies, programme
Coordination with Govt. of India and other state Governments.
Control for smooth and efficient administration

3. State health Directorate:
o The director of health and family welfare is the principal advisor to
the state Govt. on all matters relating to medicine and public
wealth
o He is assisted by joint directors, deputy directors & assistant
directors
Functions:
o Provide adequate medical care
o Medical education and research.
o Proper Implementation of National Health Programme
o To make provision health schemes.
o Immunization services & Nutritional services
o School health & Industrial health

o Family planning
o Rural & urban sanitation
o Control of fair & festivals
o Drugs & food control
o Emergency health services during disaster
o Collection & maintenance of health information
o Maintains the standards of professional education,
o Promotion of indigenous system of medicine.
o Setting up of laboratories.
o Health legislation.

DISTRICT LEVEL
 The major unit of administration in India is the District for
administration purpose
 the country is divided into many states & Union territories
which in turn are divided into many more districts.
 Each district is divided into sub-division or taluka
Local Self Government in the Urban Areas of District:
Town Area Committee: The town area committee is set
up in areas having population in the range of 5000-10000.
These are like Panchayat and provide sanitary services in
area.

Municipal Boards:
Municipal boards are set up in the areas having population between
10000 - 200000.
The municipal board is headed by chairman/president, elected usually
by its members. (The term : 3-5 years)
The municipal board looks after sanitation, drainage, water supply,
construction and maintenance of roads, registration of births and death,
education, running of hospital and dispensaries.
Corporations:
Corporations are set up in the areas having population more than
200000. The corporation is headed by a mayor.
It members are councilors who are elected from various wards
It carries the similar function or that of municipal board but on a large &
wide scale.

Local self government in rural area of district:
Panchayati Raj: The Panchayati Raj is a 3-tier structure of
rural local self-Government in India, Linking the village to the
district.
The three institutions are:
 Panchayat – at village level.
 Panchayat Samiti – at Block Level.
 Zila Parishad – at the district level
At Village Level:- The Panchayati Raj at the Village level:
1. The Gram Sabha
2. The Gram Panchayat
3. Nyaya Panchayat

1. The Gram Sabha: It is the assembly of all the adults of
village, which meets at least twice a year. The gram Sabha
elect members of the gram panchayat.
2. The Gram Panchayat: It is executive organ of the gram
sabha and an agency for planning and development at the
village level. a period of 3-4 years. Every panchayat has an
elected president (Sarpanch, Sabhapati or Mukhiya) a vice
president & a panchayat secretary. They cover the entire field
of civic administration including sanitation & public health and
of social and economic development of village.
3. Nyaya Panchayat: 5 members from the panchayat. It tries to
solve the dispute between two parties/ groups/individuals
over certain matters or mutual consent.

At the Block Level:
The block consists of about 100 villages and a population of
about 80,000 to 120000.
The Panchayat Raj agency at the block level is the Panchayat
Samiti.
The Block development officer (BDO) is the secretary of the
panchayat samiti.
Functions:
The Prime Function of the Panchayat samiti, is the execution
of the community development Program in the block.
The funds provided by the Government are channeled through
the panchayat samiti.

District Level / The Zila Parishad / Zila
Panchayat:
The Zila Parishad/ Zila Panchayat is the
agency of rural local self-Government at the
district level.
Functions:
 It functions and powers vary from state to state.
 In some states Zila Parished are vested with
administrative functions.

SYSTEM OF MEDICINES:
 Definition: It means the way of using the treatment methods to
the patient or to the particular disease
Systems of medicines In India: there are two systems of
medicines In India
1. Allopathic medicine
2. Alternative (or) Indigenous system of medicines (ISM)
(AYUSH)
1. Allopathic medicine: The term 'allopathy' was invented by
German physician Samuel Hahnemann, He conjoined allos
'opposite' and pathos 'suffering' as a referent to medical
practices of his era which included bleeding, purging, vomiting
and the administration of drugs."

Allopathic Methods of Treatment:
There are so many methods are used in allopathic
treatments that depends upon the disease conditions and its
sign and symptoms.
Common Allopathic methods used bleeding, leeching,
cupping, blistering, purging, puking, poulticing and rubbing
with toxic ointments to treat their patients.
All of these allopathic treatment methods were thought to be
cleansing, purifying, and balancing treatments which sought
to re-establish the health status.
Allopathy provide quick relief from symptoms but it can
produce side effects

 Bleeding: "Bleeding was usually the initial treatment."There were a few
different methods of bleeding. It was believed that the use of bleeding
released impure blood that contained disease from a person's body. "
 Blood-Letting: A patient's vein was directly cut with a lancet (venesection)
 Leeching: Leeching is a method of bleeding with leeches. "A leech was
placed in a thin tube while the patient's skin. To encourage the leech to bite,
and the leech sucked blood from the vein. When it was felt that the leech had
taken enough blood, salt was sprinkled on the leech, causing the leech to
stop sucking
 Cupping: A treatment in which evacuated glass cups are applied to cut skin in
order to draw blood. Cupping was usually used in combination with blood
letting. After one or two aggressive bleedings, a patient's blood pressure
would drop, so heated cups were placed over cuts to help draw more blood.
Special cups were heated and placed over the cuts, allowing the blood to
freely flow from the vein.

Blistering: It was believed that the pain of blistering caused the
patient to focus on a new pain, taking their minds away from the
more serious pain from which they suffered. The practice of
blistering was performed by deliberately giving the patient a
second-degree burn.
Plastering: Plasters were paste-like mixtures, made from a variety
of ingredients, including even substances such as cow manure.
They were applied to the chest or back of a person suffering from
a chest cold, or an internal pain--even pneumonia.
Poulticing: Poultices were made from bread and milk, and
sometimes other ingredients were added such as potatoes,
onions, herbs, and linseed oil. Poultices were applied to cuts,
wounds, bites, and boils.

Puking: Puking consisted of dosing a patient with emetics in
order to produce vomiting. The practice of puking was
believed to relieve tension on arteries and to expel poisons
from the body.
Sweating: Sweating is a treatment where patients were made
to sweat out the poisons that caused their disease.
Fumigations: The practice of fumigating was one of drugging
the breathing apparatus with everything that could be smoked,
solvented, pulverized and gasified
In modern world we know there are so many different form
for medicines like drugs, injections, ointments, drops and
different types of surgical methods are used under allopathic
medicines

2. Indigenous system of medicine (ISM):
Introduction:
The Indian System of Medicine is of great antiquity (ancient
times) .
Our scriptures which gave us the science of Ayurveda, yoga &
naturopathy, unani, Siddha and Homeopathy (AYUSH).
Like the multifaceted culture in our country, traditional
medicines have evolved over centuries blessed with these
medicines and practices.
An indigenous system is a natural form of medicine outside
the stream of Western or allopathic medicine practiced by
majority of doctors all over the world today.

Ayurveda:
The term “Ayurveda” is derived from 2 Sanskrit words , “Ayur” &
“Veda”
“Ayur” means “life” &“Veda” means “knowledge/science”
Therefore Ayurveda means science or knowledge of life.
Principles:
The principle of Ayurveda is based on the concept of 5 basic
elements
According to Ayurveda, the whole universe made up of 5 basic
elements
The five elements are Akasha (ether), Vayu (air), Agni (fire), Jala
(water), Prithvi (earth) The growth and development of body matrix
depends on its nutrition i.e. on food. The food, in turn, is composed
of above elements

Diagnosis:
Ayurveda diagnosis is done by questioning and by
undertaking some investigation including pulse, urine,
faeces, tongue, eyes, visual/sensual exam
Treatment:
Treatment includes preventive and curative measures.
Preventive measures include personal hygiene, regular
daily routine, appropriate social behavior.
The curative measures include three major measures
including aushadhi i.e. drugs, Anna i.e. diets and vihar
i.e. exercise

YOGA:
Yoga is a science which helps to co-ordinate body and mind
more effectively.
It promote maintain physical, social and spiritual health.
It also helps in prevention and cure of various psychosomatic
disorders, psychic and physical disorder.
Yoga is a way of life and consist of 8 components namely
1. Restraints
2. Observances of austerity (disciplined spiritual practice)
3. Physical postures
4. Breathing exercise

5. Restraining the sense organ
6.Contemplation ( 'The action of looking thoughtfully at
something for a long time),
7. Meditation
8.Samadhi (enlightenment - highest state of
consciousness one can achieve through meditation).
These yoga practices have potential for improvement of
personal and social behavior, improvement of individual
resistance and ability to endure stressful situations.
These needed to be learnt under supervision and
guidance.

NATUROPATHY:
Naturopathy is not only a system of treatment but also a way of
life.
It is often referred to as a drugless therapy.
Special attention a is being given to eating habits using only
natural sources, use of hydrotherapy, cold-packs, mud-packs, bath
massage and variety of methods to tone up the system, increasing
energy level aimed at producing a state of good health and
happiness.
Naturopathy is holistic system and it helps promote physical,
mental /emotional, social and spiritual health by self regulation of
life activities on normal and natural basis.
It requires real effort, will power and proper discipline to follow
naturopathy way of life.

SIDDHA:
Siddha is one of the oldest systems of medicine in India.
The siddha system is practiced in the state of Tamil Nadu in
India.
Siddha system of medicine is an ancient science, which
belongs to Dravidian culture.
Siddha system insists the scientific mode of life. Its preliminary
aim is prevention and preservation of health.
The foremost Sridhar Lord Siva preached Siddha medicine to
his followers. They are called as Sridhar’s.
Then Siddha developed the system further and called as
Siddha system of medicine.

Diagnosis:
The diagnosis of disease involves identify its causes,
causative factors are identified by examination of pulse, eyes,
color of body ,tongue status of digestive system, urine and
study of voice
Treatment:
The treatment is individualized according to diagnosis
Siddha medicines makes use of mercury, silver, arsenic, lead,
sulphur etc. mineral plants and animal parts.
The siddha system is effective in treating chronic cases of
rheumatic problems, anemia, peptic ulcer, bleeding piles, liver
and skin diseases

 UNANI SYSTEM OF MEDICINE:
 Unani name is derived from the word 'Ionian' which originated in Greece.
 Unani medicine, like any other form of medical science strives to find the
best possible ways by which a person can lead a healthy life with the least
or zero sickness.
 Origin:
 It was introduced in India around 10th century with the spread of Islamic
civilization.
 Now Unani-pathy has become a part of Indian system of Medicine and
India is one of the leading countries so far as its practice is concerned.
 Diagnosis:
 The diagnosis of a disease is done by feeling pulse, observation of urine,
stool, color of skin and gait etc.

 Treatment:
 3 components namely preventive, curative & restoration of the body as whole
 Treatment is carried out in the 4 form i.e. regimental therapy, pharmaco therapy, dieto
therapy and surgery.
 Regimental Therapy: It includes venesection, diaphoresis, diuresis, Turkish bath,
massage, cauterization, exercise and leeching.
 These are the drugless therapies and are found to be effective in treating diabetes,
high blood pressure, obesity, arthritis and migraine etc
 Diet Therapy: It deals with certain ailments by administration of specific diets or by
regulating the quantity and quality of food.
 Pharmacotherapy: It deals with the use of naturally occurring drugs mostly herbal
drugs of animal and mineral origin.
 The drugs are used singly or in the form of infusion, powder and syrup
 Unani system of medicine specializes on rheumatic arthritis, jaundice, filariasis,
eczema, sinusitis and bronchial asthma.
 Surgeries also performed depend on the severity of diseases

HOMEOPATHY:
Homeopathy = homois (similar) + pathos (suffering)
Homeopathy is a specialized method of drug therapy curing a
natural disease by administration of drugs.
Treatment:
Remedies used in homeopathy are derived from naturally
occurring substances such as plant extract and minerals.
Extremely low concentrations are prepared in specific way.
Homeopathy has definite and effective treatment for chronic
diseases such as diabetes, arthritis, bronchial asthma,
immunological disorder, behavior disorder and mental disorder.

CENTRALLY SPONSORED HEALTH SCHEMES:
Definition:
People who have the risk of a certain event contribute a
small amount (premium) towards a health insurance fund.
This fund is then used to treat patients who experience
that particular event (e.g. hospitalization)
Objective: it have 2 main objectives:
To increase the access to health care
To protect the employees from high medical expenses at
the time of illness.

Health scheme in India:
It is mainly classified into following types:
I. Mandatory Health schemes:
Central Government Health Schemes(CGHS)
Employee’s state insurance scheme(ESIS )
II. Employer based scheme:
The railways ,
Defence and security forces provides medical benefits to
the employees
III. Voluntary Health Insurance Schemes Or Private For
Profit Scheme

I. Mandatory scheme:
Employees state insurance scheme (ESI):
ESI was started in the year 1948.
Provides health care to industrial workers & their
families.
Money is contributed by the management as well as the
employees.
The ESI scheme is extends to the whole India for
providing benefits to the employees in different sectors.
It provides both cash and medical benefits.

Beneficiaries:
Factories employing ten or more persons.
Road transport establishments
Cinemas and theatres
Hotels and restaurants
Shops & educational institutions
Benefits:
1. Medical
2. Sickness
3. Maternal
4. Disablements
5. Dependent
6. Funeral
7. Rehabilitation

 Medical Benefit:
 All member of the worker gets the medical cover including the outdoor
treatment, specialist services, ambulance services, and indoor services.
 Sickness Benefit:
 At the rate of 70% of the daily average wage is given to the employee for a
maximum period of 91 days in one year. In diseases like tuberculosis, leprosy,
fracture, malignancy etc, the sickness benefits are extended to two
years.(80% of wages)
 Maternity Benefit:
 At the rate of full wages for a period of 84 days in case of pregnancy and 6
weeks in case of miscarriage or MTP.
 Disablement Benefit:
 In cash, 90% of the wages is given to the temporary disabled person during
the period of disablement. In case of permanent disablement, the payment is
made at the same rate for the whole of his life in the form of pension.

 Dependent Benefit:
 Paid at the rate of 90% of wage in the form of monthly payment to the
dependants of a deceased Insured person.
 Funeral Benefit:
 An amount of Rs.10, 000 is paid to the eldest surviving member for the
funeral purpose.
 Rehabilitation:
 It is also provide supportive and restorative services for long and chronically ill
patients.
 To avail of the sickness benefit, the employee has to have worked for 78 days
prior to the sickness.
 Similarly, to avail of the maternity benefit, the woman has to have worked for
70 days prior to availing the benefit.
 Act does not include employees whose wages exceed Rs. 25000 per month.

 CENTRAL GOVERNMENT HEALTH SCHEME:
 Introduction:
 For the central government employees
 It was introduced in Delhi in 1954
 Aim:
 To provide comprehensive health care to the employees
 Objectives:
 To give extensive medical facilities too central government employees and
their family members
 To save the government from heavy expenses on medical refund.
 Beneficiaries:
 Central government employees and their family members
 Members of parliament
 Judge of supreme court and high court

 Freedom fighters
 Pensioners of central government semi government organizations
 Journalists
 Governors and ex- Vice presidents
 Facilities:
 Outdoor treatment facilities in all medical systems
 Emergency services in allopathic system
 Free medication
 Facilities for laboratory tests and radiological tests
 Treatment facilities for serious patients at their home
 Specialist consultation facilities
 Treatment facilities in the government or government recognized private
institutes.
 Facilities for 90 percent advanced payment, in case of need.

EMPLOYEE BASED SCHEME:
Defense Scheme
Railway Scheme
PRIVATE AGENCIES:
Mediclaim
Third Party Administrator
Insurance Regulatory Development Authority
Role of nurse:
Educator
Collaborator
Advocate
Case Finder
Counselor

 Role of voluntary health organizations and international health
agencies:
 “Voluntary health agencies may be defined as an organization that is
administered by an autonomous board which holds meetings, collect’s
funds for its support chiefly from private sources and expends money in
conducting a programme and providing health services or HE or
legislation for health.”
I. International Voluntary Health Agencies
1. WHO
2. UNFPA
3. UNDP
4. World Bank
5. FAO
6. UNICEF
7. DANIDA
8. European Commission (EC)
9. Red Cross
10.USAID
11.UNESCO
12.Colombo Plan
13.ILO
14.CARE etc.

WHO:
The World Health Organization is a specialized agency of the United
Nations responsible for international public health.
The WHO Constitution states its main objective as "the attainment by all
peoples of the highest possible level of health".
Founded in 7 April 1948 & Headquarters: Geneva, Switzerland
OBJECTIVES:
1. To attainment highest level of health by all peoples
2. To provide Complete well being
3. To insist No discrimination in health.
4. To attainment of peace and security.
5. To all Equal development in promotion and control & psychological
7. To Inform opinion and active co-operation

Membership in WHO:
Open to all countries.
Most of the members of both the UN and the WHO.
Each member contributes yearly to the budget and
each is entitled to the services and aid the organization
can provide.
Structure of WHO:
World health assembly
Executive board
Secretariat

1. World health assembly:
Supreme governing body and the health parliament of nations.
Annual meeting-May, Venue-Geneva
It is composed of Delegates from different respective countries
and each is given the power of one vote
Functions of World health assembly:
International health policy and programmes
Review the work of the past year.
Approve the budget of the following year.
Approve the budget needed for the following year.
Elect Member for executive board and to replace the retiring
members

2. The Executive Board:
Members to be technically qualified in the field of health
Designated by their respective governments
One third of the membership is renewed every year
Executive board meets every year in the month of January
and May after the meeting of the World Health Assembly.
The main work of the board is to give effect to the
decisions and policies of the assembly
Emergent and immediate action in epidemics,
earthquakes

3.The Secretariat:
Headed by the Director General
Function:
To provide member states with technical and
managerial support for their national
development programmes.
There are 5 Assistant Director Generals who
are assigned different tasks by the Director
General

Function OF WHO:
7th April - “ WORLD HEALTH DAY”
Prevention and control of specific diseases
Development of Comprehensive services
Family health
Bio-Medical Research
Health Statistics
Environmental Health,
Health literature and information
Co-operation with other organization

UNICEF:
Established in 1946 to rehabilitate children in war affected countries,
Headquarters-New York
Works in collaboration with FAO, UNDP, WHO and UNESCO
Provides assistance in varied fields of MCH and environmental
sanitation.
Goals:
Provide long term humanitarian and development assistances to
children & mothers in developing countries
Emphasize developing community level services to promote health &
well being of children
Funding:
Funding is derived voluntarily from governmental and non-governmental
organizations.

UNICEF SERVICES
1. Child nutrition: low cost protein rich food, aided Applied
Nutrition Programme & Enriched food in endemic areas of
nutritional deficiency.
2. Immunization: Production of vaccines & distribution
3. Prevent spread of HIV
4. Water & Sanitation
5. Hygiene
6. UNICEF Tap Project (For clean accessible Water)
7. Basic education & gender equality
8. Child protection from violence, exploitation & abuse

17. GOBI campaign
18.UNICEF in health:
In collaboration with WHO, FAO, UNDP, &
UNESCO, More attention on health aspects of
mother & child, Eradicate TB, malaria , venereal
disease – with WHO
11. Programmes on RCH
12. Child environment
13. Child education

International Committee of Red Cross (ICRC):
The red cross is a non-political and nonofficial international
humanitarian organization
Formation: 17 February 1863; the International committee of
red cross(ICRC).
Headquarters : Geneva, Switzerland
In 1919 the League of the Red Cross Society was created with
headquarters at Geneva coordinating with 90 national Red
Cross Society.
Role of Red Cross:
It was largely confined to the victims of the war.
Disaster relief activities

Supply of relief materials
Temporary shelters
Organizing disaster relief services, in the form of milk,
medicines, food, vitamins, clothes, blankets.
Maintaining blood banks and
Promoting blood donation for the benefit of those
wounded in wars and in disasters.
MCH services
Research in disaster management and has designed
emergency protocols.

 Co-operative for Assistance and Relief Everywhere (CARE):
 Introduction: Launched in 1945, Operation in India from 1950
 It is on of the world’s largest independent, nonprofit, non-sectarian international
relief and development organization.
 CARE provides emergency aid and long term development assistance.
 Activities:
 Emergency response, food security, water and sanitation, economic development,
climate change, agriculture, education, and health.
 CARE also advocates at the local, national, and international levels for policy
change and the rights of poor people.
 Empowering and meeting the needs of women and girls and promoting gender
equality.
 Educational & vocational training.
 Improvement of medical care by supplying medical equipment and supplies
 Help in the projects such as Nutrition & Health Project,

ROLE OF HEALTH PERSONNEL:
All members of the health team work together
collectively and cooperatively to achieved the
desired health outcome of the people.
With the changes in health care delivery system the
public health team also has to change.
There are many health care personnel involving in
care of community health services.
Each and every health workers has a specified role
and responsibilities.

Medical officer:
He is the captain of the health team at the primary health center.
morning hours attending the OPD, in the afternoon supervises the field
work.
He visits each sub center regularly on fixed days and hours and
provides guidance, supervision and leadership to the health team.
He spends one day in each month organizing staff meetings at PHC to
discuss the problems and review the progress of health activities.
He ensures that national health programmes are being implemented in
in his area properly
The medical officer must be a planner, the promoter, the director, the
supervisor, the coordinator as well as the evaluator.

Community health nurse:
Implement or support virtually all of the services offered to
community.
Participate in programme planning, development and
evaluation
The special competencies and technical knowledge
Organizing clinics and recruiting and training volunteers.
Provide family healthcare.
She plans her work and evaluates its effectiveness in terms of
community as a whole.
Provides direct nursing care to non hospitalized sick
Teaches the family member to give care to the sick.

Health Counseling and Teaching
Assist individual to make and carry out his own plans to meet
health problems.
Control of environmental health hazard
Observation and teaching in this respect help to control the
accidents, hazards at home, school, and industries and also to
prevent unnecessary exposure to injury or infection.
Participating in development of the total public programme, the
public health nurse plans with medical and administrative
personnel within the agency regarding nursing participation and
carries out the nursing activities.
She participates in planning, conducting and evaluating
educational programme

Health worker male and female: Under the multipurpose worker
scheme, 1 HWF & 1 HWM are posted to each sub-centres and are
expected to cover 5000 of population (3000 in tribal and hilly
areas) health worker female limits her activities among 350-500
families.
Health worker female:
Register pregnant women from 3 months of pregnancies.
Maintain maternity record, register of antenatal cases, eligible
couple register, children register up to date.
Provide care to pregnant women
Give advice on nutrition to expectant and nursing mothers
Immunize pregnant mothers with tetanus toxoid.
Conduct about 50% of total deliveries at home. Supervise
deliveries

Motivate for family planning individually and in groups.
Distribute conventional contraceptives to the couples.
Assess the growth and development of the infant
Records and reports births and deaths in her area.
Test urine for albumin and sugar and do Hb during her
home visit.
Arrange and help M.O and health assistant in conducting
MCH and family planning clinics at sub centers.
Maintain the cleanliness of sub center.
Attend staff meetings at PHC, CD block or both.

 Health worker male:
 Conduct survey and collect all the information
 Identify the cases of communicable diseases and notify
 Educate the community about importance of control and preventive
measures against communicable diseases.
 Assist the village health guide in undertaking the activities under TB
programme properly.
 Educate community on waste disposal & sanitary latrines.
 Assist the health assistant male in the school health programme.
 Utilize the information from the eligible couple and child register for the
family planning programme.
 Motivate for family planning
 Supply of contraceptives to the couples.
 Provide follow-up services

 Health assistant male and female: Health assistant male and female will
supervise 4 health workers
 Health assistant female:
 Supervise and guide the health workers in the delivery of health services
 Guide the health workers
 Visit each of the 4 sub enters at least once in a week on fixed days.
 Organize and utilize the mahila mandal, teachers etc., in the family welfare
programme.
 Provide information on MTPs
 Supervise the immunization of all pregnant women and children (0-5 years)
 Collect and compile the weekly reports of births and deaths
 Educate the community regarding the need of registration of vital events.

 Health assistant male:
 Supervise the Health worker male
 Supervise the spraying of insecticides
 Conduct immunization of all school going children
 Supervise the immunization of all children’s (0-5 years).
 Assist M.O.PHC in organization of family planning camps
 Ensures follow-up of all cases of vasectomy, tubectomy & IUD
 Treatment of malnutrition
 Supply of Iron and folic acid and Vitamin A are distributed to the beneficiaries.
 Conduct MCH and family planning clinics and carry out educational activities.
 Organize and conduct training for dais women leaders
 Educate the community regarding the need of registration of vital events.

Community Health Volunteers:
They are non-government personnel, providing
comprehensive health care to the defined community.
They voluntarily work for 3 months and get a stipend of
Rs.l20/month during the three months training.
At the end of the training they are given a kit with
emergency equipment for minor ailments and wounds and
Rs.60/- every month.
CHV is responsible to provide immediate first aid in
emergency, treatment of minor ailments, health education
on immunization, nutrition, family planning etc.

Traditional Birth Attendants (TBAs):
These are the indigenous trained dais, who conducts 70% of rural
deliveries.
They don't receive any special training, but they learn by practice in
the field or by elders or seniors who practice in their homes.
Due to their unscientific knowledge, the maternal and infant mortality
is very high.
Hence the need was felt to train the TBAs of all community; at least
one TBA for 1000 of population should prove safe and scientific
deliveries to community.
They are provided one month training & a kit at the end of training to
use safe equipment for delivery.
The TBAs already in the field of practice are selected for the training

School Health Nurse:
Assuming a wide variety of roles, often more than one at a time.
Nurse Practitioner: identification of children and young at risk for
specific health problem
for management of certain chronic disease
Nurse Teacher: The transmitting knowledge
Consultant: the nurse can be a consultant to students, parents and
teachers.
Advocate: to maintain rights of children
Functional Role: Nurses in the functional role - screening, follow up,
control of communicable diseases, immunization, records
Team Member: active member of school health team

 Occupational Health Nurse
 health care of the working employees
 health maintenance, health promotion and health education.
 Pre-placement Examination
 CHN must assist in physical examination
 Periodical Examination
 Control of Communicable Diseases
 Environmental Sanitation
 Water Supply
 Cleanliness of workplace
 Mental Health
 Detect signs of emotional stress and strain
 Treatment of employees suffering from mental health.
 Rehabilitation of those who become ill.

Public health legislation:
Public health laws is the study of the legal powers and duties of
the state to assure the conditions for people to be healthy
The Constitution of India has sufficient provision for the protection,
promotion and growth of every individual, worker, groups and
vulnerable population in relation to health and nutrition.
implementation of public health law is an essential element in
ensuring population health.
It provides public health professionals with the legal basis for their
practice and defines the scope of their practice.
In recent decades, public health law has developed as a
specialization both for general and public health practitioners.

Definition: Public health legislation examines the authority of the
government at various jurisdictional levels to improve the health of the
general population. Public health law also focuses on legal issues in
public health practice and on the public health effects of legal practice.
Objectives:
1. Protect and promote the health of their population,
2. Sustain the health policies and programs,
3. Prevent ill health resulting from unsafe products and unsafe living
conditions,
4. Fight new and re-emerging communicable disease,
5. Support the development of health systems,
6. Combat continuing poverty, inequities in health and discrimination

For Medical Education and services:
 Indian medical council act, 1956 and regulations 2002
 Indian Nursing council act, 1947
 Dentist Act, 1948
 Pharmacy Act,1948
 Homeopathy central council act, 1973
For Public Registration:
 Registration of Births and Deaths Act, 1969
 Census Act, 1948
For Public Health Problems:
 Epidemic Diseases Act, 1897
 Food safety and standards act, 2006

For maternal health:
 MTP Act,1971
 Maternity Benefit Act, 1961
 Dowry Prohibition Act, 1961
 Immoral Traffic Act, 1956
 Pre-Conception and Pre-Natal Diagnostic Techniques Act,(PCPNDT
Act, 1994)
For children safety:
 Juvenile Justice Act, 2000
 Child Labour Act, 1986
For disabled:
 Persons with disabilities Act,1995
 Mental Health Act, 1987

For drug abuse & misuse:
 Narcotic Drugs and Psychotropic Substances Act,1985
 Drugs and cosmetics Act, 1940
 Drugs Act,1948
For employee:
Factories Act,1948
Mines act, 1952
ESI Act , 1948
Workmen’s Compensation Act, 1923

Indian medical council act, 1956 and regulations 2002: for
maintain ethics & standard of medical education
Indian Nursing council act, 1947 - for maintain ethics & standard
of nursing education
Registration of Births and Deaths Act, 1969: Uniform law across
the country on the registration of births and deaths. Reporting and
registration of all births and deaths compulsory
Epidemic Diseases Act, 1897 : The Act provides power to
exercise for the control and to prevent any epidemic or spread of
epidemic in the States or Country.
Food safety and standards act, 2006: laws relating to food and
to establish the food safety and standards in India & also to
prevent food adulteration (prevention of food adulteration act)

MTP Act,1971: for maintaining legalized and safe abortion
Maternity Benefit Act, 1961: prevent unfair unemployment
practices and exploitation of women in work place and to
safeguard the health and wellbeing of the mother and child
Dowry Prohibition Act, 1961: to control dowry system
Immoral Traffic Act, 1956: to control kidnapping &
prostitution
Pre-Conception and Pre-Natal Diagnostic Techniques
Act,(PCPNDT Act, 1994): to prevent identification of fetus
sex during pregnancy

Juvenile Justice Act, 2000: to control child crimes
Child Labour Act, 1986: to prevent the child in working
conditions
Narcotic Drugs and Psychotropic Substances
Act,1985: to prevent misuse of medicine as drug abuse
Drugs and cosmetics Act, 1940: to prevent misuse &
adulteration in drugs and cosmetics
Factories Act,1948: to maintain facilities at factory & to
control pollution
ESI Act , 1948: for benefits of employees

3. 2nd PBBSc - Comty - Unit - 3 - Organization and administration of health services in India.pptx

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3. 2nd PBBSc - Comty - Unit - 3 - Organization and administration of health services in India.pptx