ANP

1. HEALTH CARE DELIVERY SYSTEM
AT DISTRICT LEVEL &
LOCAL LEVEL
G.SUBASRI RADHA
MSC(N) 1 YEAR
ADVANCED NURSING PRACTICE

2. INTRODUCTION
India has a vast health care systems , but there remain many
differences in quality between rural and urban areas as well
as between public and private health care .
The challenge that exists today in many countries is to
reach the whole population with adequate health care
services and to ensure their utilization .

3. DEFINITION
HEALTH:
“Health is a state of complete physical, mental and social
well-being and not merely the absence of disease or
infirmity”
- WHO

4. HEALTH CARE
Health care is defined as a “multitude of services rendered to
individuals , families or communities by the agent of the health
services or professions, for the purpose of promoting ,
maintaining , monitoring or restoring health”.
- K.PARK

5. HEALTH CARE DELIVERY SYSTEM
“Health care delivery system concern is to develop the system
which ensures based comprehensive health care services to
people at large especially those living in remote and backward
areas using available resources(manpower , money, material)
as effectively as possible.”
- K.PARK

6. HEALTH CARE DELIVERY SYSTEM IN INDIA
India is a union of 29 states and 7 union territories .
 Under the constitution of India ,the states are largely
independent of the people.
The responsibility consists mainly of policy making , planning ,
guiding , assisting , evaluating and coordinating the work of the
State Health Ministers, so that health services cover every part
of the country .
The health systems in India has 3 main links .
Central , state , local or peripheral.

7. ORGANISATION OF HEALTH SYSTEMS
DISTRICT LEVEL
Sub
Division
Taluks
Community
Development
Blocks
Municipalities/
Corporation
Villages Panchayats
Asst
collecteor
Tahsildar
Block
development
officer
Municipal
Board
Mayor
Headed
by

8. IN DISTRICT LEVEL
The principal unit of administration in India is the district
under a collector .
There are 766 districts (Aug 2022) in India.

9. 6 TYPES OF ADMINISTRTIVE AREAS IN
DISTRICT LEVEL
1. Sub – division
2. Tahsils (Talukas)
3. Community Development Block
4. Municipalities and Corporations
5. Villages
6. Panchayat

10. • Districts are divided into two or more sub
division
• In charge – ASSISTANT COLLECTOR or SUB
COLLECTOR
SUB-DIVISION
• Sub divisions is again divided intotahsils(taluks)
• In charge – TAHSILDAR
• It comprises between 200 to 600 villages
TAHSILS
• The block is the unit of rural planning and
development
• It comprises 100 villages and about 80,000 to
1,20,000 population
• In charge – BLOCK DEVELOPMENT OFFICER
COMMUNITY
DEVELOPMENT
BLOCK

11. THE URBAN AREAS OF THE DISTRICT ARE ORGANIZED INTO THE
FOLLOWING INSTITUTIONS OF LOCAL – SELF – GOVERNMENT:
1. TOWN AREA COMMITTIEES- in areas with population ranging
between 5000 and 10000
2. MUNICIPAL BOARDS - in areas with population ranging
between 10,000 and 2 lakhs
3. CORPORATIONS - with population above 2 lakhs

12. TOWN AREA COMMITTEES
Town area committees are like panchayat
FUNCTION
They provide sanitary services

13. MUNICIPAL BOARDS
Municipal boards are headed by a CHAIRMAN/
PRESIDENT , elected by the members.
The term ranges of a Municipal Board ranges from
between 3-5 years.

14. FUNCTIONS OF MUNICIPAL BOARDS:
Construction
Maintenance of roads
Sanitation & Drainage
Street lighting
Water supply
Maintenance of hospitals & dispensaries
Education
Registration of birth and death etc

15. CORPORATION
Corporations headed by MAYORS.
The Councillors are elected from different wards of the city
The executive agency includes the
◦ The commissioner
◦ The secretary
◦ The Engineer
◦ The Health officer
FUNCTIONS
The activities are similar to those of the municipalities, but on a
much wider scale

16. HEALTH ORGANIZATION- DISTRICT LEVEL
• Bhore committee (1946) recommended integrated preventive
and curative services at all levels and the setting up of a
unified health authority in each district
• Since ‘Health is a state subject, there is no uniform model of a
district health Organization in India, each state developed it’s
own pattern to suit it’s policy and convenience
• Under the Multi purpose workers scheme, it has been
suggested to the states to have an integrated set – up at the
district level

17. CONT…..
At the district level by having a chief medical
officer with three deputy CMOs
• Existing civil surgeon
• District health officer
• District family welfare officers
• With each of the Deputy CMOs being
incharge of one- third of the district for all
the health, family welfare & MCH
programmes .

18. • Health for all By 2000AD appointed by the planning
Commission, recommended that the District hospitals
should be converted into district health centres
monitoring all Preventive ,Promotive and Curative
services of one million population
• It has been recommended that the district set up
should be reorganized on the basis of the number of
primary health centres it comprises.

19. FUNCTIONS OF HEALTH ORGANIZATION AT
DISTRICT LEVEL
• Coordinate health planning
• Investigate communicable diseases
• Maintain free clinic for the early diagnosis of
communicable disease
• Provide laboratory services to assist doctors
• Conduct clinics for administration of vaccines
• Collect vital statistics
• Provide MCH services
• Maintain a public health nursing service
• Supervise water supply and sewage disposal
• Supervise quality and safety to meat and others foods

20. CONT…
• Inspect and supervise the production, pasteurization
and distribution of milk
• Investigate and supervise general sanitary conditions in
public eating places
• Provide preventive and rehabilitative services in
chronic diseases control
• Conduct health education programs
• Promulgate rules and regulations
• Provide mental health services
• Provide family planning services

21. IN LOCAL LEVEL
Panchayati Raj Comprires Of
ZILA PARISHAD
PANCHAYAT
SAMITI
PANCHAYAT
GRAM
SABHA
GRAM
PANCHAYAT NYAYA PANCHAYAT
district
Block
village

22. AT LOCAL LEVEL
PANCHAYATI RAJ
Panjayat 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 the village level
• Panchayat samiti - at the block level
• Zila Parishad - at the district level

23. AT THE VILLAGE LEVEL:
The Panchayati raj at the village level consists of
• The Gram sabha
• The Gram panchayat
• The Nyaya Panchayat
GRAM SABHA:
It is the assembly of all the adults of the village, which
meets at least twice a year.
FUNCTIONS:
The gram sabha considers
• Proposals for taxation,
• Discusses the annual program and ,
• Elects members of the gram panchayat

24. GRAM PANCHAYAT:
• It is executive organ of the gram sabha and an agency for
planning and development at the village level
• It’s strength varies from 15 to 30, The population
covered from 5000 to 15000 or more
• The members of the panchayat hold office for a period of
3 to 4 years
• Every panchayat has an elected president (Sarpanch or
Sabhapati or mukhiya)
- Vice president and
- a panchayat secretary .

25. FUNCTIONS
• The powers and functions of the panchayats secretary
are very wide - they cover the entire field of Civic
administration
• Sanitation and public health
• Social and economic development of the villages

26. NYAYA PANCHAYAT
-Nyaya panchayat is also called Panchayat Adalat
is set up for every three or four Gram Panchayats .
-These Panchayats exist only in some states
FUNCTIONS:
They ensure quick and inexpensive justice to villagers

27. AT THE BLOCK LEVEL
• Block consist of 100 villages and population about 80,000 to
1,20,000
• Panchayat Raj agency at the block level is called as the
Panchayat Samiti janpada panchayat
• The Panchayat Samiti consists of all sarpanchas( head) of the
village panchayat in Block ,
• MLAs
• MPs residing in the block area
Representatives of
- women
- Scheduled castes
- Scheduled tribes
- Co operative societies

28. The Block development officer (BDO) is the ex- officio
secretary of the panchayat samiti.
FUNCTIONS
• Execution of the community development
programme in the block
• The block development officer and his staff give
technical assistance and guidance to the panchayat
engaged in development work

29. AT THE DISTRICT LEVEL
• The zilla parishad / Zilla panchayat is the agency of rural local
self government at the district level
• The members of the zilla parishad include all heads of the
panchayat samitis in the district,
• MPs, MLAs of the district,
- representative of
- women, scheduled casted, scheduled tribes and
- 2 persons of experience in administration, public life or
rural development
• The collector of the district is non voting member.
• Thus the membership of the zila parishad from 40 to 70.

30. FUNCTIONS:
• The zilla parishad is primarily supervisory and
coordinating body
• It’s functions and powers vary from state to state
• In some states, zilla parishad are vested with
administrative functions
• In Gujarat, the District Health Officer and District
family planning & MCH officers are under the control
of the Zilla parishad

31. PRIMARY HEALTH CARE IN INDIA
SUB
CENTRE
PRIMARY
HEALTH
CENTRE
COMMUNITY
HEALTH
CENTRE
VILLAGE
LEVEL

32. VILLAGE LEVEL
• Started in 1977
• Now replaced by ASHA
VILLAGE
HEALTH
GUIDE
• Started under rural heath scheme
• Training of local dais for 30 days
• Now notprefered
TRAINING OF LOCAL
DAIS
• Advent with NRHM(per 1000
population)
• Health activist in the community
ASHA
ANGANWADI
WORKER
• Under ICDS
• FOR EVERY 400-800 POPULATION

33. SUB CENTRE LEVEL
It is the peripheral outpost of existing health care delivery
system in rural areas. They are being established on the
basis of
One Sub centre for every 5000 population in general and
3000 population in hilly , tribal and backward areas.

34. FUNCTIONS OF SUB CENTRE
Maternal and child health
Family planning
Immunization
Nutritional services
National health programmes
Control over communicable diseases
Records of vital statistics

35. PRIMARY HEALTH CENTRE
Concept of Primary Health Centre was given by Bhore
committee in 1946
1 PHC was every 30000 population in plain areas and for
20000 in hilly areas

36. FUNCTIONS OF PHC
Medical care
MCH and family planning
Safe water supply and basic sanitation
Prevention and control of diseases
Collection and reporting of vital statistics
Education about health pratices
National health programme involvement
Training of health workers

37. COMMUNITY HEALTH CENTRE
The block is unit of rural planning and development and
comprises about 80000 to 1.2 lakhs population
One community health centre is being established in each
block
The officer in-charge named as block medical officer

38. FUNCTIONS OF CHC
Care of routine and emergency cases(medicine and surgery)
24 hours delivery services
Essential and emergency obsteric care
Full range of family planning services,Safe abortion services,
Newborn care
Routine and emergency care of sick children
Foreign body removal ,tracheostomy etc
Implementation of national health programmes,
Mental health services
Blood storage facility, Laboratory services & Referral services

39. GENERAL SYSTEM THEORY
Students have lack
of knowledge
regarding Health
care delivery
system In district
level & Local level
Projected A. V.
Aids assisted
teaching on
health care
delivery system
in district level &
local level
Students gained
knowledge
regarding Health
Care Delivery
System in district
level & local level
organizations and
functions
INPUT THROUGH PUT OUTPUT
FEEDBACK

40. JOURNAL PRESENTATION
“A study on economic evaluation of an outreach Health care facility in Jhajjar district
of Haryana service delivery model for increasing access to health care”
Study Method : cross – sectional study
Objetives : This study aimed to ascertain the resources requirement for
establishing an OR health care facility and patient satisfaction
Conclussion : The study provides a preliminary evidence that OR
health care facilities can be instrumental in increasing access to health
care delivery
The services have been very well accepted by the local community
members being quality medical care with highly subsidized health care
services

41. SUMMARY
So far we discussed about definition ,
organization and functions of health care
delivery systems in district level and local level

42. CONCLUSION
Rural hospital have the opportunity to identify the unique
needs of the local community through connectivity and
collaboration.
countless studies indicate the value of
“Healing the Body by Healing the Heart”

43. THANK YOU