This document provides an overview of health status, health problems, and healthcare delivery in India in 3 paragraphs: The first paragraph summarizes India's overall health status, including high private healthcare expenditures mostly out-of-pocket, lower public expenditures per capita, and leading health issues like communicable diseases, nutritional problems, and environmental sanitation issues. The second paragraph outlines India's major public healthcare system, which operates primary care centers and hospitals at state and central levels but has unequal access between rural and urban areas. It also describes limited public health insurance programs. The third paragraph discusses the large private healthcare sector concentrated in urban areas, as well as indigenous medicine systems and voluntary organizations that provide additional healthcare access across

1. Health status,
Health problems,
Health care delivery in India
Dr. Rizwan S A
Assistant Professor
Dept. of Community Medicine
VMCHRI, Madurai

2. Learning objectives
• At the end of this lecture you sh be able to
• Describe the overall health status of India
• List the MC health issues in India
• Describe various portals of health care
delivery in India
• Think about your position in the overall health
system

3. HEALTH STATUS OF INDIA

4. Total health expenditure
Government,
30%
Private, 70%

5. Private sector health expenditure
Out-of-pocket,
81%
Insurance,
19%

6. Public sector health expenditure
• Money spent by government on health
– Rs. 1 lakh crore
– Rs. 890 per capita
State
govt., 67%
Central
govt., 33%

8. To understand the health status…
• We need to know about
– Demographic profile
– Morbidity and mortality profile
– Environmental conditions
– Socio-economic factors
– Cultural background
– Health services available
– Other services

9. Demographic profile of India

10. Mortality profile

11. HEALTH PROBLEMS IN INDIA

12. Communicable diseases
• Malaria
• Tuberculosis
• Diarrheal diseases
• Leprosy
• Filariasis
• Others: Kala-azar, meningitis, viral hepatitis,
Japanese encephalitis, enteric fever, guinea worm
disease and other helminthic infestations

13. Nutritional problems
• Protein-energy malnutrition
• Nutritional anaemia
• Low birth weight
• Xerophthalmia
• Iodine deficiency disorders

14. Environmental sanitation
• Lack of safe
• Use of primitive methods for excreta disposal

15. Medical care problems
• Unequal distribution of health resources
between rural and urban areas
• Lack of penetration of health services within
the social periphery

16. Population problems
• Employment
• Education
• Housing
• Health care
• Sanitation
• Environment

17. HEALTH CARE DELIVERY IN INDIA

18. Example of a health care delivery
model
Inputs
• Health status
or health
problems
• Resources
Health care
services
• Curative
• Preventive
• Promotive
• Restorative
Health care
systems
• Public
• Private
• Indigenous
• Voluntary
Outputs
• Changes in
health status

19. Health care services
• Purpose
– To improve the health status of the population
• Goals
– Mortality and morbidity rate reduction, increase
in expectation of life, decrease in population
growth rate, improvement in nutritional status,
basic sanitation, health manpower requirement
and resource development

20. Health care system
• It implies the organization of the people,
institution and resources to deliver health care
services to meet the health needs of target
population

21. Evolution of health care services in India
• Civilization started in Indus Valley
– Environmental sanitation, houses with drainage
• 1400 BC Ayurveda and Siddha system
– Developed a comprehensive concept of health
• Post vedic – teaching of Buddhism and Jainism
• Rahula Sankirtyana – developed hospital system.
• Moghul empire – Arabic system of medicine (Unani)
• British Era – armed forces, civil servants

22. Consumers Providers
SYSTEM
Public
sector
Medical officer
Nurses
Pharmacist
Lab technician
BEE, ANM, HA
1 billion
Private
sector
Indigenous
system of
medicine
Voluntary
health
agencies
National
health
programmes

23. Health care systems
• In India, it is represented by five major sectors
or agencies which differ from each other by
the health technology applied and by the
source of funds for operation

24. PUBLIC SECTOR

25. Public sector health system
The health system in India has 3 main links

26. State and centre responsibility
• Health is the responsibility of state
• Central responsibility
– Policy making
– Guiding
– Assisting
– Evaluating
– Coordinating the work of state health ministries

27. Public health sector
• Primary health care
– Primary health centre, subcentre
• Hospitals/Health centers
– Community health centers Rural hospitals
– District hospital/health center Specialist hospitals
– Teaching hospitals
• Health Insurances schemes
– Employees state insurance Central Govt. Health Scheme
• Other agencies
– Defence services
– Railways
• National health programmes

28. Health insurance
• No universal health insurance in India
• At present limited to industrial workers and
their families
• Central government employees covered by
health insurance

29. Employees state insurance scheme
• Introduced in 1948
• Contribution by employer and employee
• Provides for medical care in cash and kind,
benefits in the contingency of sickness,
maternity, employment injury and pension for
dependents on death of worker due to
employment injury

30. Central government health scheme
• Introduced in 1954 in New Delhi
• Covers employees of autonomous
organizations, retired central government
servants, widows receiving family pension,
MP’s, Ex‐Governors and retired judges

31. Other agencies
• Defence medical services
– Armed forces medical services
• Health care of railway employees
– Railway hospitals and clinics
– Yearly health check ups

32. National health programmes
• Anti‐malaria programme
• National filaria control programme
• Kala‐azar control programme
• Japanese encephalitis control
• Dengue control
• National Leprosy‐eradication programme
• National tuberculosis programme
• National AIDS control programme
• National programme for control of blindness
• Iodine deficiency programme
• Universal immunization programme
• Reproductive and child health programme
• National caner control programme

33. PRIVATE SECTOR

34. Private health sector
• Private hospitals
• Polyclinics
• Nursing homes
• Dispensaries
• General practitioners and clinics

35. Private agencies
• Private hospitals
• Independent clinics
• 70% general practitioners
• Highly unorganized,
• Concentrated in urban areas
• Provide mainly curative services
• MCI, IMA regulate some functions

36. INDIGENOUS SYSTEMS

37. Indigenous system of medicine
• Ayurveda
• Sidda
• Unani and Tibb
• Homeopathy

38. Indigenous system of medicine
• Provide bulk of medical care to rural people
• National Institute of Ayurveda
• National Institute of Homeopathy
• Govt. studying how these can be best utilized
for more effective health coverage

39. VOLUNTARY AGENCIES

40. Voluntary health agencies in India
• Indian Red Cross Society
• Hind Kusht Nivaran Sangh
• Indian council for child welfare
• Tuberculosis Association of India
• Bharat Sevak Samaj
• Central social welfare board
• The kasturba memorial fund
• The All‐India blind relief society
• Professional bodies
• International agencies

41. Indian Red Cross Society
• 400 branches in India
• Activities:
– Relief work
– Milk and Medical supplies
– Armed forces
– Maternal and child welfare services
– Family Planning
– Blood Bank and First Aid

42. Hind Kusht Nivaran Sangh
• Financial assistance to leprosy clinics, health
education, training of medical workers and
physiotherapists, conducting research and
field investigations, organizing all India leprosy
workers conferences and publishing journal

43. Tuberculosis Association of India
• Activities comprise organizing TB seal
campaign every year to raise funds, training of
doctors, health visitors and social workers,
promotion of health education and promotion
of consultations and conferences

44. Central Social Welfare Board
• The functions of the board are
• Surveying the needs and requirements of
voluntary welfare organizations in the country
• Promoting and setting up of social welfare
organizations
• Rendering of financial and to deserving
existing organizations and institutions

45. The Kasturba Memorial Fund
• The fund was raised with the main object of
improving the life of women, especially in the
villages, through gram sevikas

46. Family Planning Association of India
• It had done pioneering work in propagating
family planning in India

47. All India Blind Relief Society
• It organizes eye relief camps and other
measures for the relief of blind.

48. Professional bodies
• The Indian Medical Association
• All India Dental Association
• The Trained Nurses Association of India

49. International agencies
• The Rockefeller Foundation
• Ford Foundation
• CARE (Co-operative for American Relief
Everywhere)
• BMGF

50. THANK YOU