Health care delivery system

- DR K HIMABINDU REDDY
JR1, MD COMMUNITY MEDICINE
JNMC & DMIMS (DU), WARDHA

 HEALTH HAS BEEN DECLARED A FUNDAMENTAL HUMAN RIGHT.
 National governments all over the world are striving to expand and improve their health care services.
 The current criticism against health care services is that they are:
(a) predominantly urban-oriented
(b) mostly curative in nature
(c) accessible mainly to a small part of the population.
 The present concern in both developed and developing countries is not only to reach the whole
population with adequate health care services, but also to secure an acceptable level of Health for All,
through primary health care programs.

 "HEALTH CARE" IMPLIES MORE THAN "MEDICAL CARE"
 Medical care refers chiefly to those personal services that are provided directly by physicians or
rendered as the result of physician's instructions. Ranges from domiciliary care to resident hospital care.
Medical care is a subset of health care system.
 Health care embraces a multitude of "services provided to individuals or communities by agents of the
health services or professions, for the purpose of promoting, maintaining, monitoring, or restoring
health.
 Health care is a public right, and it is the responsibility of governments to provide this care to all people
in equal measure .
 These principles have been recognized by nearly all governments of the world and enshrined in their
respective constitutions

 LEVELS OF HEALTH CARE
Primary Care Level
• PHCs & their subcentres.
• Multipurpose health workers,
ANM , ASHA , Anganwadi
worker, Village health guides ,
Trained Dais.
• The “village health teams “
bridge cultural &
communication gap between
rural people & organized
health sector
Secondary Care Level
• First referral level
• District hospitals &
Community health centres
Tertiary Care Level
• Needs specific facilities &
attention of highly specialized
health workers .
• Regional or Central level
institutions. Eg : All India
Institutes , Apex institutions.

 PRINCIPLES OF PRIMARY HEALTH CARE
1. Equitable Distribution :
 At present, health services are mainly concentrated in the major towns and cities resulting in
inequality of care to the people in rural areas. This has been termed as Social injustice.
 Primary health care aims to redress this imbalance by shifting the centre of gravity of the health care
system from cities (where ¾ th of the health budget is spent) to the rural areas (where ¾ th of the
people live).

2. Community Participation :
 Effort is made to secure involvement of the community in the planning, implementation
and maintenance of health services, besides maximum reliance on local resources such as
manpower, money and materials.
 Village health guides and trained dais are selected by the local community and trained
locally in the delivery of primary health care free of charge.
 By overcoming cultural and communication barriers, they provide primary health care in
ways that are acceptable to the community.

3. Intersectoral Coordination :
 To achieve such cooperation, countries have to review their administrative system, reallocate their
resources and introduce suitable legislation . This requires strong political will to translate values into
action.
 An important element of intersectoral approach is planning - planning with other sectors to avoid
unnecessary duplication of activities.
"

4. Appropriate technology :
Appropriate technology can be defined as "technology that is
scientifically sound, adaptable to local needs, and acceptable to
those who apply it and those for whom it is used, and that can
be maintained by the people themselves in keeping with the
principle of self reliance with the resources the community and
country can afford“
 This also applies to using costly equipment, procedures and
techniques when cheaper, scientifically valid and acceptable
ones are available, viz, oral rehydration fluid, standpipes
which are socially acceptable, and financially more feasible
than house-to-house connections,

HEALTH FOR ALL :
• In 1977, it was decided in the World Health Assembly to launch a movement known as "Health for All by
the year 2000".
• In 1978, the Alma-Ata International conference on Primary Health Care reaffirmed ‘Health for All’ as the
major social goal of governments, and stated that the best approach to achieve HFA is by providing
primary health care, especially to the vast majority of underserved rural people and urban poor.
• The fundamental principle of HFA strategy is equity, that is, an equal health status for people and
countries, ensured by an equitable distribution of health resources.
• In 1981, a global strategy for HFA was evolved by WHO (13). The global strategy provides a global
framework that is broad enough to apply to all Member States and flexible enough to be adapted to
national and regional variations of conditions and requirements.
• WHO has established 12 Global indicators as basic points of reference for assessing

NATIONAL STRATEGY FOR HFA/2000:
 The National Health Policy echoes the WHO call for HFA and the Alma-Ata Declaration.
 Foremost among the goals to be achieved by 2000 AD were : Reduction of infant mortality, raise the
expectation of life at birth, reduce the Crude Birth & Death rate, provide potable water to the entire rural
population, & achieve a net reproduction rate of one.

MILLENEUM DEVELOPMENT GOALS:
 The MDGs place health at the heart of development and represent commitments by governments
throughout the world to do more to reduce poverty and hunger and to tackle ill-health; gender
inequality; lack of education; access to clean water; and environmental degradation
SUSTAINABLE DEVELOPMENT GOALS:
 On 25th September 2015, the UN General Assembly adopted a new development agenda
"Transforming our world : the 2030 agenda for sustainable development".
 The 17 goals of the new development agenda integrates all three dimentions of sustainable
development (economic, social and environmental) around the theme of people, planet, prosperity,
peace and partnership.
 The SDGs aim to be universal, integrated and interrelated in nature.

HEALTH CARE DELIVERY
 The challenge that exists today in many countries is to reach the whole population with adequate
health care services and to ensure their utilization.
 Large hospitals are more ivory towers of diseases than centres for the delivery of comprehensive health
care services.
 Rising costs in the maintenance of these large hospitals and their failure to meet the total health needs
of the community have led many countries to seek 'alternative' models of health care delivery.
 Aim is to provide health care services that are reasonably inexpensive , and have the basic essentials
required by rural population.

HEALTH CARE DELIVERY : THE MODEL
• A number of models have been developed for the delivery of health care services. Below is a basic
model.
• In actual practice the model is more detailed and complex.

HEALTH STATUS & HEALTH PROBLEMS
 An assessment of the health status and health problems is the first requisite for any planned effort to
develop health care services. This is also known as Community Diagnosis.
 The data required for analyzing the health situation and for defining the health problems comprise
the following :
1. Demographic conditions of the population.
2. Morbidity and mortality statistics.
3 . Environmental conditions which have a bearing on health.
4. Socio-economic factors which have a direct effect on health.
5. Cultura l background, attitudes, beliefs, and practices which affect health.
6. Medical and health services available.

DEMOGRAPHIC PROFILE
Source : Park ,25th edition.
The demographic profile is characterised by:
a. Large population base;
b. High fertility both in terms of birth rate and
family size;
c. Low or declining mortality;
d. “Young" population (below the age of 15
years);
e. The proportion of illiterate population is
close to 34.62 %;
f. Dependency ratio of 50.5 %,i.e every
economically productive member has to
support almost one dependant.

MORTALITY PROFILE
 During the last few decades, there has been a notable improvement in the health status of the
population.
 However, a deeper study reveals distressing situation. India's health standards are still low compared to
those in developed countries.
 While in the world as a whole, the !MR for the year 2015 is about 32 per 1000 live births, and in the
developed countries as low as 5 , in India it is as high as 38.
 Among the states, Kerala had the lowest IMR of 12 per 1000 live births and Madhya Pradesh had the
highest IMR of 52 per 1000 live births
 Table shows that the death rate is the highest
in the age group 0-4 years.
 This is as a result of malnutrition and infection.
 15 - 25 % of total deaths are attributed to
infectious and parasitic diseases.

HEALTH PROBLEMS
1. Communicable disease problems :
• Malaria;
• Tuberculosis [India accounts for one-fifth of the
world incidence]
• Diarrhoeal diseases;
• ARI;
• Leprosy[India has achieved the goal of leprosy elimination
at national level.]
• Filaria[endemic in about 255 districts in 16 States and 5
Uts]
• AIDS,
• Others
2. Non-communicable disease problems:
• Diabetes mellitus,
• CVDs,
• Cancer,
• Stroke,
• Chronic lung diseases

HEALTH PROBLEMS: NUTRITIONAL PROBLEMS
*PEM: “Food gap"- appears to be the chief cause of PEM.
~ 80 % PEM are mild and moderate cases.
The problem exists in all the States and the nutritional
Marasmus is more frequent than Kwashiorkor.
*Nutritional Anemia : About 50% of non-pregnant women and
young children are estimated to suffer from anaemia.
50.3 % of pregnant women are anaemic. 19 % of maternal
deaths are attributed to anaemia.
*Low birth weight: About 28 % of babies born are of low birth
weight (less than 2.5 kg).
Maternal malnutrition and anaemia are mainly responsible for
this condition
*Iodine deficiency disorders :
Reassessment of the magnitude of the problem
by the ICMR showed that IDD is not restricted
to the "goitre belt; as was thought earlier, but is
extremely prevalent in other parts of India as
well.
It has been found that out of 324 districts
surveyed in 29 states and all UTs, 263 districts
are endemic [ the prevalence of IDD is more
than 10 %.]
•Xerophthalmima(nutritional blindness)
* Lathyrism
* Food adulteration

HEALTH PROBLEMS
4. Environmental sanitation :
• The most difficult problem to tackle in this country is perhaps the environmental sanitation problem,
which is multifaceted and multifactorial.
• The twin problems of environmental sanitation are, lack of safe water in many areas of the country &
primitive methods of excreta disposal.
• Besides these, there has been a growing concern about the impact of "new" problems resulting from
population explosion, urbanization and industrialization leading to hazards to human health in the air,
in water and in the food chain.

HEALTH PROBLEMS
5. Medical care problems:
• India has a national health policy. It does not have a national health service.
• The existing hospital-based, disease-oriented health care model has provided health benefits mainly to
the urban elite.
• Many villages rely on indigenous systems of medicine.
• Thus the major medical care problem in India is unequal distribution of available health resources
between urban and rural areas, and lack of penetration of health services to the social periphery.

HEALTH PROBLEMS
6. Population problems:
• The population problem is one of the biggest problems facing the country, with its inevitable
consequences on all aspects of development, especially employment, education, housing, health care,
sanitation and environment
• The Government had set a goal of 1 % population growth rate by the year 2000 (which was not attained);
• Currently, the country's growth rate is 1.6 %. This calls for the "two child family norm".
• The population size and structure represent the most important single factor in health and manpower
planning in India, today ,where the law of diminishing returns, among other factors, plays an important
role in the economic development of the country.

RESOURCES
• Resources are needed to meet the vast health needs of a community.
• No nation, however rich, has enough resources to meet all the needs for all health care.
• Therefore an assessment of the available resources, their proper allocation and efficient
utilization are important considerations for providing efficient health care services.
• The basic resources for providing health care are :
(i) Health manpower;
(ii) Money and material
(iii) Time.

RESOURCES
1.Health Manpower:
• Health manpower requirements of a country are based on (i) health needs and demands of the
population; & (ii) desired outputs.
• Health manpower planning is an important aspect of community health planning.
• It is based on a series of accepted ratios such as
doctor-population ratio,
nurse-population ratio,
bed-population ratio, etc.

MONEY & MATERIAL
• Money is an important resource for providing health services.
• Scarcity of money affects all parts of the health delivery system.
• In most developed countries, average government expenditure for health is ~ 18 % of GNP but In
developing countries it is < 1 % of the GNP.
• To achieve Health for All, WHO has set as a goal the expenditure of 5 % of GNP on health care.
• At present India is spending about 3 %of GNP on health and family welfare development.
• Since deaths from preventable diseases such as whooping cough, measles, tuberculosis. tetanus,
diphtheria, malnutrition frequently occur, the case is strong for investing resources on preventing
these diseases rather than spending money on multiplying prestigious medical institutions which
absorb a large portion of the national health budget.
• Management techniques such as cost-effectiveness and cost-benefit analysis are now being used for
allocation of resources in the field of community health

TIME
 “ Time is money“
• Administrative delays in sanctioning health projects imply loss of time.
• Proper use of man-hours is also an important time factor.
Eg: a survey by WHO has shown that an Auxiliary Nurse Midwife spends 45 %of her time in
giving medical care; 40 % in travelling; 5 % on paper work; and only 10 % in performing
duties for which she has been trained
• To summarize, resources are needed to meet the many health needs of a community.
• But resources are desperately short in the health sector in all poor countries. What is
important is to employ suitable strategies to get the best out of limited resources.

HEALTH CARE SERVICES
• The purpose of health care services is to improve the health status of the population.
• The goals to be achieved have been fixed in terms of mortality and morbidity reduction, increase in
expectation of life, decrease in population growth rate, improvements in nutritional status, provision of
basic sanitation, health manpower requirements and resources development and certain other
parameters such as food production, literacy rate, reduced levels of poverty, etc.
• Health services should be
(a) comprehensive
(b) accessible
(c) Acceptable
(d) provide scope for community participation,
(e) available at a cost the community and country can afford.

HEALTH CARE SYSTEMS
• The health care system is intended to deliver the health care services.
• It constitutes the management sector and involves organizational matters.
• It operates in the context of the socioeconomic and political framework of the country.
• In India, it is represented by 5 major sectors or agencies which differ from each other by the *health
technology applied and by *the source of funds for operation.
1. PUBLIC HEALTH SECTOR
2. PRIVATE SECTOR
3. INDIGENOUS SYSTEMS OF MEDICINE
4. VOLUNTARY HEALTH AGENCIES
5. NATIONAL HEALTH PROGRAMMES
•

HEALTH CARE SYSTEMS
1. PUBLIC HEALTH SECTOR :
(a) Primary Health Care-
Primary health centres
Sub- centres
(b) Hospitals/Health Centres –
Community health centres
Rural hospitals
District hospital
Specialist hospitals
Teaching hospitals
(c) Health Insurance Schemes
ESI & CGH scheme
(d) Other agencies
Defence services
Railways
2. PRIVATE SECTOR
(a) Private hospitals, polyclinics, Nursing
homes, and dispensaries
(b) General practitioners and clinics
3. INDIGENOUS SYSTEMS OF MEDICINE
Ayurveda , Siddha ,Unani &Tibbi, Homoeopathy

PRIMARY HEALTH CARE IN INDIA
1. At Village Level:
• For equitable distribution of health resources, everyone should have access to it , even rural
areas.
• To implement this policy at the village level, the following schemes are in operation:
a . ASHA Scheme;
b. ICDS Scheme;
c. Training of Local Dais.
• ASHA:
• ASHA must be resident of the village - a woman in the age group of 25 to 45 years with education
upto 8th class, having communication skill and leadership qualities.
• The general norm of selection is one ASHA for 1000 population. In tribal, hilly and desert areas the
norm could be relaxed to one ASHA per habitation.

ROLES & RESPONSIBILITIES OF ASHA
1. ASHA will take steps to create awareness and provide information to the community on
determinants of health.
2. She will counsel women on birth preparedness, importance of safe delivery, breast-feeding and
complementary feeding, immunization, contraception and prevention of common infections.
3. ASHA will mobilize the community and facilitate them in accessing health and health related
services available at the anganwadi/subcentre/primary health centres.
4. She will work with the village health and sanitation committee of the gram panchayat to develop a
comprehensive village health plan.
5. She will arrange escort/accompany pregnant women and children requiring treatment/admission to
the nearest pre-identified health facility .

6. ASHA will provide primary medical care for minor ailments
such as diarrhoea, fevers, and first-aid for minor injuries.
7. She will be a provider of directly observed treatment
short-course (DOTS) under revised national tuberculosis
control programme
8. She will also act as a depot holder for essential
provisions being made available to every habitation like
oral rehydration therapy, iron folic acid tablet,
chloroquine, disposable delivery kits, oral pills and
condoms etc.
9. Her role as a provider can be enhanced subsequently.
States can explore the possibility of graded training to
her .
.

10. She will inform about the births and
deaths in her village and any unusual health
problems/disease outbreaks in the
community to the sub-centre/primary health
centre.
11. She will promote construction of
household toilets under total sanitation
campaign.

ROLE AND INTEGRATION OF ASHA WITH
ANGANWADI
• Anganwadi worker will guide ASHA in performing following activities:
1. Organizing Health Day once/twice a month.
 On health day, the women, adolescent girls and children from the village will be mobilized for orientation
on health related issues such as importance of nutritious food, personal hygiene, care during pregnancy,
importance of antenatal check-up and institutional delivery, home remedies for minor ailment and
importance of immunization etc.
2. AWWs and ANMs will act as resource persons for the training of ASHA.
3. IEC activity through display of posters, folk dances etc undertaken to sensitize the beneficiaries on health
related issues.
4. ASHA will support the AWW in mobilizing pregnant and lactating women and infants for nutrition
supplement.

ROLE AND INTEGRATION OF ASHA WITH ANM
• Auxiliary Nurse Midwife (ANM) will guide ASHA in performing following activities :
1. She will hold weekly/ fortnightly meeting with ASHA and discuss the activities undertaken
during the week/fortnight
2. She will hold weekly/ fortnightly meeting with ASHA and discuss the activities undertaken
during the week/fortnight
3. ANM will guide ASHA in motivating pregnant women for taking full course of iron and folic
acid tablets and tetanus toxoid injections etc.;

ROLE AND INTEGRATION OF ASHA WITH
ANM
4. ANMs will orient ASHA on the dose schedule and side effects of oral
pills
5. ANMs will educate ASHA on danger signs of pregnancy and labour.
6. ANMs will inform ASHA on date, time and place for initial and periodic
training schedule. She will also ensure that during the training ASHA gets
the compensation for performance .

ANGANWADI WORKER
• Under the ICDS (Integrated Child Development Services) Scheme, there is 1 Anganwadi worker
for a population of 400-800.
• The anganwadi worker is selected from the community she is expected to serve.
• She undergoes training in various aspects of health, nutrition, and child development for 4
months.
• She is a part-time worker and is paid an honorarium of Rs. 1500 per month for the services
rendered, which include health check-up including maintenance of growth chart, immunization,
supplementary nutrition, health education, non-formal pre-school education and referral
services.
• Along with Village Health Guides, the anganwadi workers are the community's primary link
with the health services and all other services for young children.

LOCAL DAIS
• A scheme for training of Dais was initiated during 2001-02.
• The scheme was implemented in 156 districts in 18 states/UTs of the country.
• The districts selected were on the basis of the safe delivery rate being less than 30 per
cent.
• The scheme was extended to all the districts of EAG states.
• The aim was to train at least one Dai in every village with the objective of making
deliveries safe.

SUB-CENTRE LEVEL
• The sub-centre 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.
• A sub-centre provides interface with the community at the grass-root level, providing all the primary
health care services.
• As of March 2017, 25,650 PHCs were working with 6 sub-centres under each.
• Categorization of sub-centres : Type A & Type B
• Categorization has taken into consideration various factors namely catchment area, health seeking
behaviour, case load, location of other facilities like PHC/CHC/FRU/Hospitals in the vicinity of the sub-
centre.
• This shall result in optimum use of available resources

SERVICES TO BE PROVIDED AT SUB-CENTRE
1. Maternal & Child health :
Antenatal care ; Intranatal care ; Postnatal care
2. Family planning and contraception
3. Counselling and appropriate referral for safe abortion service (MTP).
4. Adolescent health care : Education, counselling and referral.
5. Assistance to school health services.

6. Water quality monitoring .
7. Promotion of sanitation including use of toilet and
appropriate garbage disposal.
8. Field visits by appropriate health workers for disease
surveillance, family welfare services including STI, RTI
awareness
9. Community need assessment
10. Curative services for minor ailments including fever, diarrhoea,
worm infestation and first-aid including firstaid for animal bite and
snake bite; appropriate and prompt referral if needed.

11. Training of Traditional Birth Attendants and ASHA.
12. Disease surveillance; Integrated Disease Surveillance Project (IDSP)
13. Implementing National Health Programmes
14. Recording and reporting of vital events .
15. Coordinated services with AWWs, ASHAs, Village Health sanitation
and Nutrition Committee PRI etc.
16. Out reach/ Field services
ASHA & ANM & AWW

PRIMARY HEALTH CENTRE LEVEL
• The functions of the primary health centre in India cover all the 8 "essential" elements of primary
health care :
1. Medical care;
2 . MCH including family planning;
3. Safe water supply and basic sanitation;
4. Prevention and control of locally endemic diseases;
5. Collection and reporting of vital statistics;
6. Education about health;
7. National Health Programmes - as relevant;
8. Referral services;
9. Training of health guides, health workers, local dais and health assistants;
10. Basic laboratory services.

INDIAN PUBLIC HEALTH STANDARDS FOR PHCS
• From service delivery angle, PHCs may be of two types, depending upon the delivery case load :
 Type A PHC: PHC with less than 20 deliveries per month.
 Type B PHC: PHC with 20 or more deliveries per month.
• The objectives of IPHS for PHCs are :
i. To provide comprehensive primary health care to the community through the Primary Health Centres.
ii. To achieve and maintain an acceptable standard of quality of care.
iii. To make the services more responsive and sensitive to the needs of the community.

COMMUNITY HEALTH CENTRE LEVEL
• As on 31st March 2017, 5,624 community health centres were established by upgrading the primary
health centres.
• Each community health centre covering a population of 80,000 to 1.20 L with 30 beds and specialists.
• Every CHC has to provide following services which have been indicated as essential and desirable:
1. Care of routine and emergency cases in surgery
 Essential : - This includes dressings, incision and drainage, and surgery for hernia, hydrocele,
appendicitis, haemorrhoids, fistula , and stitching of injuries, Fracture reduction and putting
splints/plaster cast.
 Handling of emergencies like intestinal obstruction, haemorrhage, etc.
 Conducting daily OPD.

2. Care of routine and emergency cases in medicine
 Specific mention is being made of handling of all emergencies like dengue haemorrhagic fever,
cerebral malaria and others like dog & snake bite cases, poisonings, congestive heart failure etc
 Conducting daily OPD.
3. Maternal health
 Minimum 4 ANC check ups
 24-hour delivery services
 Ensure post-natal care for 0 and 3rd day at the health facility
 Proficiency in identification and management of all complications including PPH, eclampsia, sepsis
etc, during PNC;
 Minimum 48 hours of stay after delivery, 3-7 days stay post delivery for managing complications
 Provisions of JSY & JSSK as per guidelines.

4. . Newborn care and child health
Essential newborn care and resuscitation
Early initiation of breast feeding
Newborn stabilization unit
Counselling on infant and young child feeding
Routine and emergency care of sick children including facility based IMNCI
strategy
Full immunization of infants and children
Management of malnutrition cases & prevention and management of
routine childhood diseases
5. Family Planning
Full range of family planning services
Safe abortion services

6. All the national health programmes (NHP)
All the national health programmes should be delivered through the CHCs
7. Physical Medicine and Rehabilitation (PMR)
8. Oral health
Dental care and dental health education services as well as root canal treatment and filling/extraction of
routine and emergency cases.

9. School health services
Doctor from CHC/PHC will also visit one school per week. Overall
the services to be provided under school health shall include:
 Screening of general health, assessment of
anaemia/nutritional status, visual acuity, hearing problems,
dental check up, common skin conditions, heart defects,
physical disabilities, learning disorders, behavior problems, etc]
 Immunization, Micronutrient (Vitamin A & IFA) management,
De-worming .
 Mid day meal.

10.Adoloscent health care
11 Blood storage facility.
12.Diagnostic Services:
X-Ray , ECG with appropriately trained technicians.
All necessary reagents & glassware for collection and transport of samples.
13. Referral Transport Services
14. Maternal Death Reveiw

JOB DESCRIPTION OF
MEMBERS OF HEALTH
CARE TEAM

HEALTH CARE TEAM
1. Medical officer , PHC
2. Secondary Medical officer
3. Health worker , male (HWM)
4. Health worker , female (ANM)
5. Health Assistant (female)
6. Health Assistant (male)
7. Accredited Social Health Activist (ASHA)

MEDICAL OFFICER ,PHC
• He is the captain of the Health team at PHC. Morning, he attends to patients in opd & afternoons
he supervises the field work.
• He covers all basic health services including Family planning services.
• He will plan and implement UIP according to guidelines and ensure maximum possible coverage
under his PHC. He will ensure proper storage of vaccine and maintainance of cold chain.
• He will ensure proper implementation of IMNCI.
• He will visit schools in his area at regular intervals & conduct health camps there.
• He will organize and conduct Tubectomy & Vasectomy camps.
• Organize and oversee training of ASHA , ANM, Dais, etc.

MEDICAL OFFICER ,PHC
• He ensures Nationall health programmes are being implemented.
• Visits subcentres and provides guidance , supervision and leadership.
• He holds meetings at PHC to evaluate progress, discuss problems and review activities.
• The MO must be planner , supervisor , promoter, director, coordinator as well as evaluator.
• Success of a PHC depends on its MO.

Apart from the PHCs, the present organization of health services of the Government sector
consists of Rural hospitals, Sub-divisional hospitals, District hospitals, specialist hospitals &
Teaching institutions.
1. Rural hospitals : It is now proposed to upgrade the rural dispensaries to PHCs.
2. Sub-divisional hospitals : It is proposed to convert these into Sub-divisional health centers
so as to cover a population of 5 lakhs . These centres will have an epidemiological wing
attached to them.
3. District hospitals: There are proposals to convert the district hospital into District Health
Centre
,

A hospital differs from a health centre in the following respects :
(a)in a hospital, services provided are mostly curative; in a health centre, the services are
preventive, promotive and curative - all integrated;
(b)A hospital has no catchment area, i.e. , it has no definite area of responsibility. Patients may
be drawn from any part of the country. A health centre , on the other hand, is responsible
for a definite area and population;
(c)The health team in a health centre is a optimum "mix" of medical and paramedical workers; in
a hospital, the team consists of only the curative staff,

HEALTH INSURANCE
• There is no Universal health insurance in India.
• Health insurance is at present limited to industrial workers and their families. [ESI] + The Central
Government employees are also covered by the health insurance, under the banner "Central Govt.
Health Scheme“
• The ESI Scheme and the CGH Scheme cover two large groups of wage -earners in the country.
• Experience in other countries has shown that health insurance is a logical step towards nationalization
of health services.

HEALTH INSURANCE
 Employees State Insurance Scheme
• The ESI scheme, introduced by an Act of Parliament in 1948, is a unique piece of social legislation in
India.
• It has introduced for the first time in India the principle of contribution by the employer and
employee.
• The Act provides for medical care in cash and kind , benefits in the contingency of sickness, maternity,
employment injury, and pension for dependents on the death of worker .

HEALTH INSURANCE
 Central Government Health Scheme
The scheme is based on the principle of cooperative effort by the employee and the employer, to the mutual
advantage of both.
The facilities under the scheme include :
(a) Out-patient care through a network of dispensaries;
(b) Supply of necessary drugs;
(c) Laboratory and X-ray investigations
(d) Domiciliary visits;
(e) Hospitalization facilities
(f) Specialist consultation;
(g) Pediatric services including immunization
(h) Antenatal, natal and postnatal services
(i) Emergency treatment
(j) Supply of optical and dental aids at
reasonable rate
(kl) Family welfare services

Health care delivery system

Health care delivery system

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