The document discusses India's health care system and delivery models at primary level. It begins by defining health care and outlining India's constitutional mandate to improve public health. It then describes the primary health care model comprising multiple tiers from village to district levels. Key functions at village level include village health guides, dais/traditional birth attendants, anganwadi workers, and ASHAs. The roles and training of these frontline workers are explained. The document also outlines the national health policy and goals to achieve 'Health for All' through primary healthcare approach.

2. • Health care is an expression of concern for fellow human
beings.
• It is defined as a “multitude of services rendered to
individuals, families of communities by the agents of the
health services or professions for the purpose of promoting,
maintaining, monitoring or restoring health”.
maintaining, monitoring or restoring health”.
• Staffing, organizing, administering and financing such services
might be done in every imaginable way, but they all have
focus on the ultimate, ie the people are being served,
diagnosed, helped, cured, educated and rehabilitated by health
personnel.

3. • For most of the countries around the world, health care
completely or largely is taken by government.
• Health care includes “medical care.”
• Both are different in their operational aspects and hence, not
synonymous.
• Medical care is one component under the umbrella of the
health care system.
• The term medical care refers chiefly to those personal services
that are provided directly by physicians or rendered as a result
of physician’s instruction.

4. A health care delivery system is the totality
of services offered by all health disciplines.
Traditionally the primary purpose of a
health care system had been to offer care to
health care system had been to offer care to
ill and injured.
For this reason the health care system of
the past might be more accurately described
as illness care system

5. • The challenges that exist today in many countries is to reach
the whole population with adequate health care services and to
ensure their utilization.
• Rising costs in the maintenance of 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
led many countries to seek alternative models of health care
delivery with a view to provide health care services that are
reasonably inexpensive and have the basic essentials required
by rural population.

6. HEALTH STATUS AND PROBLEMS IN INDIA
• Health care in India features a universal health care system run
by the constituent states and territories of India.
• The constitution changes every state with raising of the level
of nutrition and the standard of living of its people and the
improvement of public health as among its primary duties.

7. HEALTH STATUS AND HEALTH PROBLEMS
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8. HEALTH PROBLEMS OF INDIAARE
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10. • Environmental sanitation problems:
• Due to population explosion, urbanization and industrialization
leading to the hazards to human health in the air, water and
food chain.
• Medical care problems:
• Uneven distribution of doctors, lack of curative and health care
• Uneven distribution of doctors, lack of curative and health care
services in rural areas, inequitable distribution of available
health care resources etc.
• Population problems:
• Due to over population unemployment, education, housing,
health care and sanitation are the major population problems.

11. The data required for analysing the health situation and
for defining the
health problems comprise the following:
1.Morbidity and
mortality
statistics.
• 2.Demographic
conditions of
the population.
3.Environmental
conditions which
have a bearing on
health.
• 4.Socio-economic
factors which
have a direct
effect on health.
5.Cultural background,
attitudes, beliefs, and
practices which affect
health.
• 6.Medical and health
services available.
• 7.Other services
available.

12. HEALTH CARE SERVICES
The purpose of health
care services is to
improve the health
improve the health
status of the
population.

13. The goals to be achieved
• Mortality
and
morbidity
reduction
• Increase in
• Decrease
in
populatio
n growth
rate
• Resources
development
• Food
production
• literacy rate
• Increase in
expectation
of life
• Health
manpower
requirements
• Improvem
ents in
nutritional
status
• Provision
of basic
sanitation
• literacy rate
• Reduced
levels of
poverty, etc.

14. The scope of health services varies widely from country to
country and influenced by general and ever changing national,
state and local health problems, needs and attitudes as well as
the available resources to provide these services.
A comprehensive list of health services may be found in the
Report of the WHO Expert Committee (1961) on "Planning of
Public Health Services" .

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16. These are the essential ingredients of primary health care which
forms an integral part of the country'
s health system, of
which it is the central function and main agent for delivering
health care .

17. HEALTH CARE
DELIVERY
CONSUMERS PROVIDERS SYSTEM
PUBLIC
SECTOR
Medical officer
Nurses
Pharmacist
Lab technician
BEE, ANM, HA
1015 million
PRIVATE
SECTOR
INDIGENOUS
SYSTEM OF
MEDICINE
VOLUNTARY
HEALTH
AGENCIES
NATIONAL
HEALTH
PROGRAMMES

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19. THE MODEL
• The INPUTS are the health status or health problems of the
community, they represent the health needs and health
demands of the community.
• Since resources are always limited to meet the many health
needs, priorities have to be set.
• This envisages proper planning so that resources are not
wasted.

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21. • The HEALTH CARE SYSTEM is intended to deliver the
health care services, in other words, it constitutes the
management sector, and involves organizational matters.
• The final outcome or the OUTPUT is the changed health status
or improved health status of the community which is
expressed in terms of lives saved, death averted, diseases
expressed in terms of lives saved, death averted, diseases
prevented, cases treated, expectation of life prolonged, etc.
• Models such as these are being employed for improving health
care services.

22. The health care system is intended to deliver the health care
services.
It constitutes the management sector and involves
organisational matters.
It operates in the context of the socioeconomic and political
It operates in the context of the socioeconomic and political
framework of the country.
In it is represented by five major sector or agencies which
from each other by the health technology applied and by the
source of funds for operation .

23. Health care delivery system
1. PUBLIC HEALTH SECTOR
a) Primary Health Care
Primary health centers
Sub centers
b) Hospitals/Health centers
b) Hospitals/Health centers
community health centers
Rural hospitals
District hospital/health center
Specialist hospitals
Teaching hospitals

24. c) Health insurances schemes
Employees state insurance
Central Govt. Health scheme
d) Other agencies
Defence service
Railways
Railways
2. PRIVATE SECTOR
a) Private hospitals, polyclinics, nursing homes, and
dispensaries
b) General practitioners and clinics

25. 3.INDIGENOUS SYSTEMS OF MEDICINE
Ayurveda and siddha
Unani and tibbi
Homeopathy
Unregistered practitioners
4. VOLUNTARY HEALTH AGENCIES
4. VOLUNTARY HEALTH AGENCIES
5. NATIONAL HEALTH PROGRAMMES

26. PRIMARY HEALTH CARE IN INDIA
In 1977, the Government of India launched a Rural Health
the Scheme, based on the principle of "placing people'
s health in
people'
s hands". It is a three tier system of health care delivery
in rural areas based on the recommendation of the Shrivastav
Committee in 1975.
Committee in 1975.
Close on the heels of these recommendations an International
conference at Alma-Ata in 1978, set the goal of an acceptable
level of Health for All the people of the world by the year
2000 through primary health care approach.

27. As a Signatory to the Alma-Ata Declaration, The Government
of India is committed to achieving the goal of Health for Al!
through primary health care approach Which Of seeks to
provide universal comprehensive -health care at cost which is
provide universal comprehensive -health care at cost which is
affordable.
Keeping in view the WHO goal of "Health for All" by 2000
AD, the Government of India evolved a National Health
Policy based on primary health care approach.

28. It was approved by Parliament in 1983.
The National Health Policy has laid down a plan of action for
reorienting and shaping the existing rural Health infrastructure
with specific goals to be achieved by 1985, 1990 and 1995
within the framework of the Sixth (1980- 85) and Seventh (1985-
90) Five Year Plans and the new 20 point Programme.
90) Five Year Plans and the new 20 point Programme.
Steps are already under way to implement the National Health
Policy objectives towards achieving Health for All by the year
2000.

29. / 0
One of the basic tenants of primary health care is
universal coverage and equitable distribution of health
services, that is health care must penetrate into the
farthest reaches of rural area, and that everyone should
have access to it.

30. village level the following
schemes are in operations:
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31. / /6 0
Village health guide is a person with an aptitude for
social service and is not a full time government
functionary.
The village health guides scheme was introduced on 2nd
The village health guides scheme was introduced on 2nd
October 1977with idea of securing peoples participation in
the care of their own health.
The scheme was launched in all states except some states
like kerala,Karnataka,Tamilnadu,etc..which have
alternative systems of providing health services at the
village level.

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33. After selection , the health guides undergo a short
training in primary health centre, sub centre or any
other suitable place for the duration of 200 hours,
spread over a period of 3 months.
During the training period they receive a stipend of Rs.
200 per month.
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34. FUNCTIONS OF VILLAGE HEALTH
GUIDE
Treatment Of
Simple
Ailments
Mother
Activities In
First Aid
Mother
And Child
Health
Family
Planning
Sanitation.
Health
Education

35. *.
Most deliveries in rural areas are still handled by
untrained dais who are often the only people
immediately available to women during perinatal
period.
period.
An extensive programme has been undertaken under
the rural health scheme to train all categories of local
dais in the country to improve their knowledge in the
elementary concepts of maternal and child health and
sterilization besides obstetric skills

36. The training is for 30 working days.
Each Dai is paid a stipend of Rs 300 during her training period.
The training is given at the PHC, Sub-centre or MCH centre
for 2 days in a week, and on the remaining 4 days they will be
accompany the health worker ( female) to the village
preferably in the dais own area.
During her training each dai is required to conduct at least 2
deliveries under the guidance and supervision of the
deliveries under the guidance and supervision of the
HW( F),ANM OR HA(F).
After successful completion of training, each dai is provided
with a delivery kit and a certificate.
She is entitled to receive an amount of rs.10 per delivery
provided the case is registered with sub-centre/PHC.

37. * / 7 7 . 9
anganliterallymeansacourtyard.
Under the ICDS scheme there is an anganwadi worker for a
population of 1000.
There are about 100 such workers in each ICDS project
There are about 100 such workers in each ICDS project
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 200-
250 per month for the services rendered.

38. SERVICES RENDERED BY
ANGANWADI WORKER
health
education
nonformal
pre school
education
health
check
up
immunization
supplement
ary
nutrition,
education education
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39. * 0: .
;
:-
ASHA must be the resident of village a women
preferably in the age group of 25- 45 years with
formal education upto eighth class having
communication skills and leadership qualities.
communication skills and leadership qualities.
Adequate representation from the disadvantaged
population group should be ensured to serve such
groups better.
the general norm of selection will be one ASHA for 1000
population.

40. . . . < 0
ASHA will take steps to
create
awareness and
provide
nutrition, basic
sanitation and
hygiene practices,
healthy living and
She will counsel
women on birth
preparedness
provide
information to
the community
on
determinants of
health
healthy living and
working conditions,
information on
existing health
services and the need
for timely utilization
of health and family
welfare services
preparedness
importance of
safe delivery,
breastfeeding and
complementary
feeding.etc..

41. ASHA will mobilize community and facilitate them
in accessing health and health related services
available., at the anganwai/subcenter/primary
health centres
•immunization
•antenatal check-up
2
3
3
•Postnatal check up
•supplementary nutrition
4
5
•sanitation
•other services provided by the
government
=
8

42. She will arrange escort/accompany
pregnant women and children
requiring treatment/admission to
the nearest pre identified health
facility ie primary health
center/community health
center/first referral unit.
ASHA will provide primary
medical care for minor ailments
such as Diarrhoea, fevers, and
first aid for minor injuries.
She will be a provider of
directly observed treatment
short course (DOTS)under
revised National
Tuberculosis Control
programme.
She will also act as depot
holder for essential
provisions being made
available to every
habitation like oral
rehydration therapy.iron
folic acid tablet,oral
pills,condoms etc.

43. . / . 7 / 7 :-
On health day the women ,adolescent girls and children
from 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
Anganwadi and ANM’s will act as resource persons for
training of ASHA
Anganwadi workers will inform ANM to participate and
guide organizing the health days at anganwadi center
Anganwadi worker will update the list of eligible couple
and also the children less than one year of age in the
village with the help of ASHA.

44. . / . 7
ANM will guide ASHA in performing
following activities.
Anganwadi and ANM’s will act as resource person for
training ASHA
She will hold weekly/fortnightly meeting with ASHA and
discuss activities undertaken during week/fortnight
She will guide her in case ASHA had encountered any
She will guide her in case ASHA had encountered any
problem during the performance of her activity.
ANM will guide ASHA in motivating pregnant women for
taking full course of IFA tablets and TT injections etc..
•ANM will participate and guide in organizing health days
at anganwadi center.
ANM’s will orient ASHA on the dose schedule and side
effects of oral pill
•ANM will participate and guide in organizing health days
at anganwadi center.
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45. 6
It is the peripheral outpost of the existing health care
delivery system in rural areas .
They are being established on the basis of one sub
center for every 5000 population in general and one for
every 3000 population in hilly, tribal and backward
areas .
As of march 2015 , 153,655 sub-centres were
established in the country.

46. • A sub – centre provides interface with the community at the
grass –root level, providing all the primary health care
services.
• One LHV and one health assistant ( male ) located at PHC are
entrusted with the task of supervision of six sub –centre'
s.

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55. . 6
These were established by upgrading the primary health
centers,each community health center should cover a
population of 8000 to 1 lakh with 30 beds and
specialists in surgery
,medicine,obstetrics,paediatrics etc.the community
health officer is selected from amongst the supervisory
category of staff at phc and district level with minimum
of 7 yrs experience in rural health programmes.

56. • 6 <.
• 6 <.
. 6 0

57. 24 hrs delivery
services
including normal
This includes
incision and
drainage and
also surgery
for
Hernia,Hydro
Every CHC has
to provide
following
services which
including normal
and assisted
devices.
Hernia,Hydro
coele,Appendi
citis,Haemorr
hoids,fi stulas
etc.
services which
are known as
assured
services.

58. Essential and
emergency
Safe abortion
services,new
born
care,routine
emergency
Care of
routine
and
emergenc
y cases in
medicine
emergency
obstetric care
including
surgical
interventions like
caesarian,and
other medical
interventions.
care,routine
emergency
care of sick
children

59. Rural Hospitals:-it Is Now Proposed To
Upgrade The Rural Dispensaries To
Phc’s.
District hospitals:-There are
proposals to convert the district
proposals to convert the district
hospitals to District health center
Health insurance:-There is no universal
health insurance in india.Health
insurance I snow available to industrial
workers and their families only.

60. #

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63. 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 was introduced for the first time in India the principle of
contribution by employer and employee.
• The act provides for medical care in cash and kind, benefits in
• 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 because of
employment injury.
• The act covers employees drawing wages not exceeding rs.
7500 per month.

64. FACILITIES UNDER THE ESI SCHEME
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2
3
4
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65. FUNCTION ESI SCHEME
medical care
benefits in the contingency of
sickness
Maternity
employment injury
pension for dependents on the death of
worker because of employment injury

66. Central Govt Health Scheme
• The central government health scheme for the central
government employees was first introduced in new Delhi in
1954 to provide comprehensive medical care to central
Govt.Empolyees.
• The scheme is based on the principle of cooperation effort by
the employee and the employer, to the mutual advantage of
both*

67. The facilities under the scheme
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68. • The scope of the scheme has been gradually extended over the
years to cover cities outside Delhi as well as other sectors of
population such as the employees of the autonomous
organizations, retired central govt. servants, widows receiving
family pension, members of parliament, ex-governors and
retired judges.
• Now the scheme covers all the states.

69. • The employees state insurance scheme and the central
government health scheme cover two large groups of wage –
earners in the country,
• They are well organized health insurance schemes, and are
• They are well organized health insurance schemes, and are
providing reasonable medical care plus some essential
preventive and promotive health services.
• Health insurance is a logical step towards nationalization of
health services.

70. Other agencies
• DEFENCE MEDICAL SERVICES;
• Defence services have their own organization for medical care
to defence personnel under the banner “ armed forces medical
services.”
• The services provided are integrated and comprehensive
embracing preventive, promotive, and curative services.

71. Health care of rail way emplo'
• The railways provide comprehensive health care services
through the agency of railway hospitals, health units and
clinics.
• Environmental sanitation is taken care by health inspectors in
big stations.
big stations.
• A chief health inspector supervises the divisions work.
• Health check-up of employees is provided at the time of entry
into service, and there after at yearly intervals.
• There are lady medical officers, health visitors and midwives
who look after MCH and school health services.
• Specialists services are also available at the divisional
hospitals.

72. Private agencies
• In a mixed economy such as India’s private practice of
medicine provides a large share of the health services available
• There has been a rapid expansion in the number of qualified
allopathic physician from about 50,000 at the time of
allopathic physician from about 50,000 at the time of
independence to about 3.94 lakhs in 1992 and the doctor-
population ratio for the country as a whole is 1: 2100.
• The general practitioners constitute 70 per cent of the medical
profession.

73. • Most of them tend to congregate in urban areas.
• They provide mainly curative services.
• Their services are available to those who can pay.
• The private sector of health care services is not organized.
• The private sector of health care services is not organized.
• Some statutory bodies like the medical council of India
and Indian medical association regulate some of the
functions and activities of the large body of private
registered medical practitioners*

74. PRADHAN MANTRI SURAKSHIT
MATRITVAABHIYAN
MATRITVAABHIYAN

75. • The Pradhan Mantri Surakshit Matritva Abhiyan has been
launched by the Ministry of Health & Family Welfare
(MoHFW), Government of India.
• The program aims to provide assured, comprehensive and
quality antenatal care, free of cost, universally to all pregnant
women on the 9th of every month.
• Hon’ble Prime Minister highlighted the aim and purpose of
introduction of the Pradhan Mantri Surakshit Matritva
Abhiyan in the 31st July 2016 episode of Mann Ki Baat.

76. • PMSMA guarantees a minimum package of antenatal care
services to women in their 2nd / 3rd trimesters of pregnancy at
designated government health facilities
• The programme follows a systematic approach for engagement
with private sector which includes motivating private
practitioners to volunteer for the campaign developing
strategies for generating awareness and appealing to the
private sector to participate in the Abhiyan at government
health facilities.

78. RATIONALE FOR THE PROGRAM
• Data indicates that Maternal Mortality Ratio (MMR) in India
was very high in the year 1990 with 556 women dying during
child birth per hundred thousand live births as compared to the
global MMR of 385/lakh live births.
• As per RGI- SRS (2011-13), MMR of India has now declined
• As per RGI- SRS (2011-13), MMR of India has now declined
to 167/lakh live births against a global MMR of 216/lakh live
births (2015). India has registered an overall decline in MMR
of 70% between 1990 and 2015 in comparison to a global
decline of 44%.

79. • While India has made considerable progress in the reduction of
maternal and infant mortality, every year approximately 44000
women still die due to pregnancy-related causes and
approximately 6.6 lakh infants die within the first 28 days of
life.
• Many of these deaths are preventable and many lives can be
• Many of these deaths are preventable and many lives can be
saved if quality care is provided to pregnant women during
their antenatal period and high risk factors such as severe
anemia, pregnancy-induced hypertension etc are detected on
time and managed well.

80. GOAL & OBJECTIVES OF PMSMA
• Goal of the PMSMA
• Pradhan Mantri Surakshit Matritva Abhiyan envisages to
improve the quality and coverage of Antenatal Care (ANC)
including diagnostics and counselling services as part of the
Reproductive Maternal Neonatal Child and Adolescent Health
Reproductive Maternal Neonatal Child and Adolescent Health
(RMNCH+A) Strategy

81. OBJECTIVES OF THE PROGRAM
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83. KEY FEATURES OF PMSMA
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88. Significance
• As India strives to achieve the Sustainable Development Goals (SDGs),
reducing MMR and IMR becomes important. As a pregnant woman can
develop life-threatening complications with little or no advance warning,
this initiative is a significant step towards reducing maternal mortality in
India.
India.
• Quality and coverage of health facilities would get improved.
• The initiative could avoid many preventable deaths if every pregnant
woman is routinely examined and appropriately followed up.
•

89. Indigenous systems of medicine
• The practitioners of indigenous systems of medicine(
ayurveda, siddha, homoeopathy,etc) provide the bulk of
medical care to the rural people.
• Ayurvedic physicians alone are estimated to be about 3.37
• Ayurvedic physicians alone are estimated to be about 3.37
lakhs.
• In recent years there has been considerable state
patronage to foster these systems of medicine.
• Many ayurvedic dispensaries are state –run.
• the govt. of India is utilizing indigenous systems of
medicine for more effective or total coverage.

90. Voluntary health agencies
• The voluntary health agencies occupy an important place in
community health programmes.
• A voluntary health agency may be defined as an organization
that is administered by an autonomous board which holds
meetings, collects funds for its support chiefly from private
meetings, collects funds for its support chiefly from private
sources and extends money, whether with or without paid
workers, in conducting a programme directed primarily to
furthering the public health by providing health services or
health education, or by advancing research or legislation for
health, or by combination of these activities

91. • The voluntary health agencies have been compared to motor
trucks which can penetrate the by-ways, and the official
agencies to railway trunk lines which must run on tracks
established by law.

92. FUNCTIONS
• By lending personnel, or
contributing funds for special
equipment, supplies or services.
Supplementing the
work of government
agencies
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94. • By setting a good
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health agencies can
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95. Voluntary Health Agencies In India
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100. HEALTH PROGRAMS IN INDIA
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