Health care Delivery System in India

Health care Delivery System in India

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  TOPIC HEALTH CARE DELIVERYSYSTEM NATIONAL,STATE,DISTRICT AND LOCAL LEVEL SUBMITED BY SUBMITED TO Mr. NARESH KATIJA DR. SUMOL C. ABRAHAM MSC PREVIOUS YEAR HOD (DEPT. OF C H N) GOVT. COLLEGE OF NSG. UDAIPUR
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  Introduction • Constitutionally everyindividual in India has the right of availing health services to protect his/her basic right of being healthy. • To this effect govt. of India have developed health administration machinery and Mechanism to plan, Organize and Deliver health care service to the people in rural and urban area • India comprise the 28 state and 9 union territories. Union territories are administered by the president of India through chief commissioner or Lieutenant governor. • Each state and union territories is divided in to district. There are 732 district in the country. District under administrative control of collector. • Health care services are rendered by the government through a network of health centres from the grass root areas to the block level in the rural areas and through hospital , dispensaries, maternal , child health and family welfare centres in the urban areas. The hospital in the sub division / taluks level , district level etc. provide referral services to the infrastructure in the rural area. There are also voluntary and private agencies which are functioning to deal with the health problems of the people.
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  • To knowabout health care delivery system of India, we must know about some term like Health- Acc. To WHO health is a state of complete physical, mental, social, and spiritual well being and not merely absence of disease or infirmity. Illness- Illness is a state in which a person physical, emotional, social or spiritual functioning is diminished or impaired. Health care- health care is multitude of services rendered to individual or communities the agents of health services or professional for the purpose of – promoting restoring and maintaining health. Health care delivery system- Health care delivery system is defined as the aggregate of institution, organization and person who enter, the health care system, who has responsibility that, include the promotion of health, prevention of illness, detection and treatment of disease and rehabilitation.
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  Determinants • Factor whichwould determine health care delivery system are. 1. Consumer of health care - The people to whom health care services are to be rendered. 2. provider of health care – Health manpower who are authorized and responsible to provide health care Services to people. 3. Funding factor-
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  Components of healthcare delivery system- 1. structure of health system 2. Process of health care delivery consist of two part a. behavior of professional b. participation of people 3. outcomes of health care 4. flow of the patients in health care system
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  HEALTH CARE DELIVERYSYSTEM IN INDIA The health care delivery system in India has four levels. That are- 1. National level 2. State level 3. District level 4. Local level
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  NATIONAL LEVEL • Theofficial ‘organ’ of health system at national level are 1.Union ministry of health and family welfare. 2.The directorate general of health services 3.The central council of health
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  Union ministry ofhealth and family welfare • formed- 1976 Formed • Headquarter – cabinet secretariat Raisina hill new Delhi. • Annual budget – Rs 69,000 crore allocated for health sector in budget 2020. • Union ministry of health and family welfare is headed by cabinet health minister. • Members of union ministry of health and family welfare are state health minister and deputy health minister. • DR. HARSH VARDHAN is our present union health minister. • For all administrative purpose, ministry seek the help to health secretariat • Union ministry of health and family welfare comprised two department
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  • The departmentof health- • The department of health deals with health care, including awareness campaigns, immunization 1campaigns, preventive medicine, and public health. • The department of family welfare- • The department of family welfare (FW) is responsible for aspects relating to family welfare, especially in reproductive health, maternal health, pediatrics, information, education and communications; cooperation with NGOs and international aid groups; and rural health services.
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  Organizational structure- Cabinet healthminister Health minister of state Deputy health minister Department of health department of family welfare Ism & Homeopathy Secretary Joint Secretary Deputy Secretary Administrative Staff Secretary Joint Secretary Deputy Director Administrative Staff Secretary Joint Secretary One Director 4 Adviser
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  Functions- •Union list- 1. Maintenanceof international health relations, administration of port Health and quarantine laws. 2. Administration of central health institutions, training colleges and hospitals. 3. Promotion and maintenance of appropriate standards of education health medicine, nursing, dental, pharmaceutical. 4.Promotion of medical and public health researches through the Indian council of medical research and other research institutions and bodies.
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  5. Regulation anddevelopment of medical, dental, nursing and pharmaceutical professions. 6. Establishment and maintenance of drug standards. 7.Census and collection and publication of other statically data. 8. Immigration and emigration 9.Regulation of labour working in mines and oil fields 10 . Co-ordination with states and other ministry for promotion of health. •
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  Concurrent list- 1. Preventionof extension of communicable disease from one unit to another 2. Prevention of adulteration on of food stuff 3. Control of drug and poisons. 4. Vital statics 5. Labour welfare 6. Regulation of ports and other majors 7. Economic and social planning. 8. Population control and family welfare and family planning.
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  The directorate generalof health services- The directorate general of health services is repository of technical knowledge concerning public health, medical education and health care. • It is attached organization of health and family welfare. • The directorate general of health services is headed by general director of health services. • Ms. Bindu Tiwari our present general director of health services. • The directorate general of health services is renders technical advice in all medical and public health matters to ministry of health and family welfare
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  Organizational structure Director generalof health services Additional director general of health services Deputy DGHS Deputy DGHS Deputy DGHS Medical care Public health general administration
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  Functions- 1. General function •Survey • Planning • Coordination • Programming and appraisal of all health matters
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  Specific Function A. Internationalhealth relation B. Medical store depot C. Control of drug standards. D. Post graduate training E. Medical research F. Medical education G. Central govt. Health scheme H. Implementation of national health programmes I. Administration of certain medical collage es in India
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  Central council ofhealth family welfare • This ‘organ’ was set up to help promote a working relationship between the center and the states in implementation of all health programs and provide a forum for co-operation. • The constitution provides for consultation between the various state government and central government. As a result the central council of health has been formed in august 1952 under article 263 of the constitution. • CCHFW is composed of union health minister as chairman, health ministers of all states and union territories as members. • It meets once a year and decides what needs to be done in the areas of family planning, health, medical education and research. • There are also zonal health councils in the - central, northern, western, eastern, and southern zone. • Each zonal council perform the same function as that of central health council at the zonal level
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  Organization chart Union healthminister ( Chairperson ) State health minister ( members )
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  The functions ofthe council are • Promoting co-operation and co-ordination between the health organizations at the central and state levels • Formulating broad policy and program outlines for the provision of medical relief and health care and also for training of health personnel • Proposing suitable legislations in public health matters • Recommending a framework for appropriate distribution of grants-in-aid to states for health purposes • Reviews the health work done in the past one year.
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  STATE LEVEL • Theofficial ‘organ’ of health system at state level are- • (a) State ministry of health and family welfare. • (b) State directorate general of health • (c) State health secretaria
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  ( a )State ministry of health and family welfare • State ministry of health and family welfare headed by state health minister and deputy health minister. • Present health minister of Rajasthan is Dr. Raghu sharma.(MLA kekdi Ajmer ) • Present state health minister of Rajasthan is subhash garg • State ministry of health and family welfare perform both activities that are political and administrative activities. • Ministers have political responsibilities toward their constituencies as per their political agenda and responsibilities for administration and management of health and family welfare services in their state.
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  The functions ofstate ministry of health and family welfare are: • Support and safeguard the policies. • Bring the all the bill to his department for approval. • Policy implementation.
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  (b) State directorategeneral of health • State directorate general of health headed by director of health and family welfare • Present director of health and family welfare of Rajasthan is Dr. R.S Chhipi. • State directorate general of health is principle advisor of state govt. On all medicine and public health matters. • It is a technical wing of mohfw • fore independence medical & public health services at state level like at the Centre administered by two separate department
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  The functions ofstate ministry of health and family welfare are: • A. providing adequate medical care in rural and urban area. • B. Arrangement of medical education and research. • C. Implementation of national health programs. • D. Make provision for personal and impersonal health services. • E. Control food and drug adulteration • F. Control over ESI scheme. • G. Supervision and control of local bodies.
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  (c) State healthsecretariat - • State health secretariat is official organ of state health ministry. • State health secretariat keep records of policies. • State health secretariat headed by state health secretary. • Present state health secretary of Rajasthan is Shri Rohit Kumar Singh.
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  The functions ofstate health secretariat are: • A. Assist in forming and modification of policies. • B. Control, supervision and co-ordinate policies.. • C. Budgeting. • D. Maintain contact with central and other state govts.. • E. Observe administrative machinery
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  DISTRICT LEVEL • Theprinciple unit of administration in India is the district under a collector. • There are total 732 district in India. • There are total 33 district in Rajasthan • There are six type of administrative area in a district- 1. Sub-division 2. Tahsils 3. Community developmental blocks 4. Municipalities and corporations. 5. Villages. 6. Panchayats.
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  ORGANIZATION- District Sub - division Tahsil Community Development Block Village Panchayats Corporation Munciple Board TownArea Committees
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  LOCAL LEVEL  Rurallocal self government work with its three constitutions- I)Gram Panchayat II)Gram Sabha III)Nyaya panchayat
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  Health care system. •InIndia, health care delivery system is represented by five major sectors. 1 Public health sector • Primary health care • Primary health care • Sub centers • Hospitals/health centers • Community health centers • Rural hospitals • District hospital • Specialist hospitals • Teaching hospitals
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  •Health insurance schemes •Employees state insurance • Central govt. health system •Other agencies • Defense services • Health care of railway employees
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  2.Private sector a.Private hospitals,polyclinic, nursing homes and dispensaries b.General practitioners
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  3.Indigenous system ofmedicine a. Ayurveda and siddha b. Unani c. Homeopathy d. Unregistered practitioners 4. Voluntary health agencies 5. National health programme
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  A.Primary health services 1.Village level To implement this policies at the village level the following schemes are in operation. a. Village health guide b.ASHA scheme ( accredited social health activist ) 1. Must be resident of the village a women (married / widow / divorced ) 2. 25 - 45 year of age 3. 8th class pass 4. One ASHA for 1000 population.
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  • Function ofASHA – 1. Take steps to create awareness and provide information to community of health such as. - Nutrition - basic sanitation and hygienic practice. - healthy living and working condition - information on existing health services - timely utilization of health and family welfare services
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  2. Counsel womenfor – - Safe delivery - breast feeding - complementary feeding - immunization - contraception - prevention of common infection – UTI - STD etc.
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  3. ASHA willmobilize the community and facilitate them in health and health related servicesa vailable at – aganwadi - SC, PHC such as – immunization - ANC, PNC etc. 4. she will work with village health and sanitation committee of gram panchayat to develop village health plan. 5. provide primary medical care for minor ailment. 6. Act as depot holder for – ORS , pills, condoms etc. 7. Inform about the birth and death in her village or any unusual health problem disease. 8. Provide construction of house hold toilet under total sanitation campaign.
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  C. Anganwadi worker– - under ICDS programme start in 1975 with 33 block & 4891 centers - one Anganwadi worker for 400 – 800 people. - 100 workers in each ICDS block - 7067 ICDS block functioning in country. - four month training - 7500 Rs salary per month - more than 1.3 million ( 13.73 lakh ) anganwadi centres in India. - 12.8 lakh anganwadi workers in country. - 11.6 lakh helpers - at present total 54677 centers functioning in Rajasthan -2977 anganwadi centers functioning in Udaipur. - budget for 2020. 35600 crore - govt. gave 6 lakh anganwadi workers smartphones in this budget.
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  - ICDS provide– Beneficiaries Calories Protein ( g ) Children (6 month to 72 month ) 500 12 – 15 Severely malnourished children ( SAM ) 800 20 – 25 Pregnant women and lactating mothers 600 18 - 20 - ICDS provide –
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  Financial norms forsupplementary nutrition under ICDS Category Cost norms per beneficiary per day Children (6 month to 72 month ) Rs. 6 Severely malnourished children ( SAM ) Rs. 9 Pregnant women and lactating mothers Rs. 7
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  d. Local dias -training of dias initiated during 2001-02 - the scheme was implemented in 156 district in 18 states / UTs of the country. - the district selected were on the basis of the safe delivery rate being less than 30 % - the scheme was extended to all the district of EAG ( Empowered Action Group )state. - the aim was to train at least one dias in every village with objectives of making delivery safe
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  Rural health caresystem in India • The health care infrastructure in rural areas has been developed as a three tire system and is based on the population norms. Health facility Population norms Plain area Hilly / Tribal / Difficult area Sub – center 5000 3000 Primary Health center 30,000 20,000 Community health center 1,20,000 80,000
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  Sub center level •Categories of sub centers Type A Type B 1. Provide all recommended services except that the facilities for conducting delivery will not be available here. 1. The sub-centers in the following situation may be included in this categories A. Sub centers not having adequate space and physical infrastructure for conducting deliveries due to which providing labor room facilities and equipment at these subcenters not possible. A. Subcenters situated in the vicinity of other higher health facilities like PHC / CHC / FRU / Hospital where deliveries facilities are available. A. Subcenters in headquarter area . B. Subcenters where present no deliveries or occasional delivery may be taking place. This would include following type of subcenters A. Centrally or betters located subcenters with good connectivity to catchment area B. They have good physical infrastructure preferable with own building , adequate space residential accommodation and labour room facilities. C. They already have good case load of deliveries from catchment area D. There are no nearby higher level deliveries facilities.
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  Services provided atsubcenters 1. maternal and child health services – ANC , Intranatal , PNC etc. 2. family planning and contraceptive 3. counseling – MTP, abortion etc. 4. adolescent health care 5. assistance to school health services 6. water quality monitoring 7. promotion of sanitation including use of toilet and appropriate garbage disposal 8. field visit for - disease surveillance , family welfare service including STI, RTI, awareness 9. community need assessment
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  10. curative servicesfor minor ailment 11. training of TBA (Trained Birth Attendant ) and ASHA 12. cooperative services of anganwadi workers ,ASHA, village health and sanitation committee etc. 13. disease surveillance 14. national health programme 15. promotion of medical herbs 16. records of vital events 17. coordination and monitoring 18. outreach services.
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  Manpower Type of ScsA B ANM / Health worker (female) 1(E) + 1(D) 2 Health worker (Male) 1 1 Staff nurse 1 (no. of deliveries more than 2 or more in month) Safai karmchari 1 (part time) 1 (full time)
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  Primary health centerslevel • - The bhore committee in 1946 gave the concept of the of PHCs • - PHC is the first contact point between village community and medical officer. • - it act as a referral unit of 6 subcenters and refer out cases to CHCs • - it cover population of 30,000 in plain and 20,000 in hilly and tribal area • - as on 31 march 2019 – 24,855 in country • - 2066 in Rajasthan • - it has 4- 6 beds for patients • - From services delivery angle PHCs may be of two type depending upon the delivery case load. • • Type A – PHCs with less than 20 deliveries per month • Type B – PHCs with 20 or more deliveries per month
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  Function of PHCs 1.medical care 2. MCH including family planning 3. Safe water supply and basic sanitation 4. Prevention & control of local endemic disease 5. Collection and reporting of vital statistics 6. Education about health 7. National health programme 8. Referral services
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  • Training ofhealth guides , health workers , local dais , and health assistance • Basic laboratory services • Selected surgical procedure • Mainstreaming of AYUSH • PMR • Maternal death review • Functional linkage with sub centers • Monitoring & supervision
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  Staffing of PHCs StaffType A Type B Essential Desirable Essential Desirable Medical Officer- MBBS 1 1 1* Medical Officer- AYUSH 1* 1* Accountant cum data entry operator 1 1 Pharmacist 1 1 Pharmacist- AYUSH 1 1 Nurse- midwife(staff-nurse) 3 +1 4 +1 Health worker female 1* 1* Health assistant(male) 1 1 Health assistant(Female)/Lady health visitor 1 1 Health educator 1 1 Laboratory technician 1 1 Cold chain & Vaccine logistic assistant 1 1 Multi skilled group-D worker 2 2 Sanitary cum watchman 1 1 +1 Total 13 18 14 21
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  Community health centers •- these were established by upgrading the primary health centers • - CHCs are being established and maintained by the state govt. • - each community health centers cover 80,000 population in rural area & 1,20,000 population in plain area • - it is manned by four medical specialist i.e. Surgeon , Physician , Gynecologist , Pediatrician . and 21 paramedical & other staff. - It has 30 indoor beds with one OT, X-ray , labour room , and laboratory facilities. - It serve as a referral center for 4 PHCs . First referral unit - Criteria – emergency obstetric care including surgical intervention like CS - New born care - Blood storage facility on 24 hours
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  Function of CHCs •Care of routine and emergency cases in surgery • Care of routine and emergency cases in medicine • Maternal health • New born care and child health • Family planning • All national health programme delivered through CHCs • School health services • Blood storage facility • Essential laboratory • Referral (transport services ) • Maternal death review ( MDR )
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  Health and wellnesscenters • The national health policy 2017 recommended strengthening the delivery system of primary health care through establishment of health and wellness centers as the platform to deliver comprehensive primary health care. - Govt. of India is committed toward creation of 150000 health & wellness centers by transforming existing subcenters and PHCs as basic pillar of Ayushman bharat to deliver comprehensive primary health care. - As on 31 march 2019 there are -157411 SCs • - 24855 PHCs • - 5335 CHCs which are functioning in the country. - Further there are 7821 SCs which are upgraded as health and wellness centers – sub centers ( HWC- SCs ) as of total 157411 and - 8242 health & wellness centers – primary health centers ( HWC -PHCs ) has been upgraded out of 24855.
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  Hospitals a.Rural hospital –cover 5 lakh population b.District hospital – Hospital differ from a health centers 1. In a hospital services provided are mostly curative in nature. in a health centers the services are preventive, promotive and curative. 2. Hospital has no catchment area i.e. it has no definite area of responsibility. Patient may be drawn from many part of the country. A health centers and on the other hand is responsible for a definite area and population
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  Health insurance 1. Employeesstate insurance scheme – introduced by an act of parliament in 1948. 2. Central government health scheme – introduce in 1954 for central govt. employee.
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  Other agencies 1. Defensemedical services – medical care to defense personal under care the banner AFMS (Armed Forces Medical Services ) 2. Health care of railway employee
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  . Private agencies .Indigenous system of medicine - AYUSH . Voluntary health agencies – 1. Indian red cross society – 1920 - 400 branches in India 2. Hindu kusht nivaran singh – 1950 3. Indian council for child welfare – 1950 4. Tuberculosis association of India 1939 5. Bharat sevak samaj – 1952 6. Central social welfare board – 1953 •
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  7 The Kasturbamemorial fund – 1944 8. Family planning association of India – 1949 9. All India women conference – 1926 10. All India blind relief society – 1946 11. Professional bodies – TNAI , IMA ete. 12. International agencies – 1. The Rockefeller foundation 2. Ford foundation 3. CARE ( Cooperative for Assistance & Relief Every