Prepared By Monika Devi NR M.Sc.Nursing GMCH Jammu

1. Health Care Delivery System in
India
Prepared By
Monika Devi NR
M.Sc. Nursing
GMCH Jammu

2. Health Care Delivery System in India
• India is a union of 29 states and 7 union territories. States are
largely independent in matters relating to the delivery of health
care to the people. Each state has developed its own system of
health care delivery independent of the central government.
• The central government responsibility consists mainly of policy
making, planning, guiding, assisting, evaluating and
coordinating the work of the state health ministries.
2
Monika Devi NR, M.Sc.Nursing

3. The Health System In India Has 3 Main Links
A. Central
B. State and
C. Local or peripheral
Monika Devi NR, M.Sc.Nursing 3

4. Monika Devi NR, M.Sc.Nursing 4

5. Monika Devi NR, M.Sc.Nursing 5

6. 1. Department of Medical & Public Health
Functions
The functions of the Department of Medical & Public Health are –
– Health Policy preparation
– National Health Programs conduction
– Drug Control
– PFA enforcement
– Diseases control-
– Communicable/Non-communicable
– Supplies & Disposal Maintenance
– CME & Trainings
– Medical Education & Research
– Vital statistics & Health intelligence
– International support Monika Devi NR, M.Sc.Nursing 6

7. Monika Devi NR, M.Sc.Nursing 7

8. 2.Department of Family Welfare
• Functions
The functions of the Department of Family Welfare are –
– Policy preparation & Planning
– Information collection & Evaluation
– Contraceptive-Research /Supply
– Seeking International support for Family Welfare
– EPI/UIP/CSSM/RCH/ARI/ORT-Trainings & area development
– Maternal and Child Health Services.
– IEC - Information, Education and Communication.
– Rural Health Services
– Paraprofessional training
– NGO support
– Development of Sub-center
Monika Devi NR, M.Sc.Nursing 8

9. 3. Department of IMS&H
• Functions
The functions of the Department of IMS&H are –
– Upgrade the educational standards in the Indian Systems of
Medicines and Homoeopathy colleges in the country;
– Strengthen existing research institutions and ensure a time-bound
research programme on identified diseases for which these
systems have an effective treatment;
– Draw up schemes for promotion, cultivation and regeneration of
medicinal plants used in these systems;
– Evolve Pharmacopoeia standards for Indian Systems of Medicine
and Homoeopathy drugs
Monika Devi NR, M.Sc.Nursing 9

10. Monika Devi NR, M.Sc.Nursing 10

11. II. Directorate General of Health Services
Functions
1. International health relations and quarantine of all major ports in
country and international airport
2. Control of drug standards
3. Maintain medical store depots
4. Administration of post graduate training programmes
5. Administration of certain medical colleges in India
6. Conducting medical research through Indian Council of Medical
Research (ICMR)
7. Central Government Health Schemes.
8. Implementation of National Health Programmes
11
Monika Devi NR, M.Sc.Nursing

12. Cont…
9. Preparation of health education material for
creating health awareness through Central Health
Education Bureau.
10.Collection, compilation, analysis, evaluation and
dissemination of information through the Central
Bureau of Health Intelligence
11.National Medical Library
12
Monika Devi NR, M.Sc.Nursing

13. . III. Central Council of Health
Functions
• 1. To consider and recommend broad outlines of policy with
regard to matters concerning health like environment hygiene,
nutrition and health education.
• 2. To make proposals for legislation relating to medical and
public health matters.
• 3. To make recommendations to the Central Government
regarding distribution of grants-in-aid.
• To establish any organization or organizations invested with
appropriate functions for promoting and maintaining
cooperation between the central and state health administration
13
Monika Devi NR, M.Sc.Nursing

14. STATE Level Health Care Administration
• Organizational structure at the state level is on the
similar pattern as that as that as the central level. Health
being a state subject, the state govt. has autonomy in
dealing with health matters.
• At present there are 28 States in India, with each state
having its own health administration.
Monika Devi NR, M.Sc.Nursing 14

15. Functions
• It studies in department of the health problem and need of the state
and planning for health services in the state.
• Implementation of national health programmes and evaluating their
achievements.
• Promoting providing and supervising all types of health services in the
state such as primary health services; school health services; family
planning services; MCH; occupational health services etc.
• Collection of vital statistics.
• Encouraging reproductive and child health (Family welfare. maternal
health etc.)
Monika Devi NR, M.Sc.Nursing 15

16. Functions
• Improvement of nutrition programme and Controlling food
adulteration and also sanitation in milk and edibles.
• Medical and nursing education, training of nurses, female health
workers and other health workers.
• Controlling rural and urban health services through district
medical officer.
• Providing feedback to the state health ministry regarding health.
• Following the directives of union ministry of health/state health
ministry.
Monika Devi NR, M.Sc.Nursing 16

17. District level Health Care Administration
District - An Administrative unit Defined Geographical boundary
and Population. Within each district again, there are 6 types of
administrative areas -
1. Sub – divisions,
2. Tehsils (Talukas),
3. Community Development Blocks,
4. Municipalities and
5. Corporations (urban area),
6. Panchayats (Villages)
Monika Devi NR, M.Sc.Nursing 17

18. • District is Peripheral most Planning unit
• It is a self-contained segment of National Health System
• Middle level management organisation
• The principal unit of administration in India is the district
under a Collector.
• It is a link between the State/ regional structure on one side
and the peripheral level structures such as PHC/ Sub-Centre on
the other side.
Monika Devi NR, M.Sc.Nursing 18
District level Health Care Administration

19. Chief Medical and Health Officer (CM & HO)
• Chief Medical and Health Officer - CM & HO is a Director of health
and family welfare service at the district in rural area and are overall
in-charge of the health and family welfare programmes in the rural
area. CM&HO is assisted by Dy. CMO, rhc officer and programme
officers. Dy. CMO and rhc officer are assisted by Block CMOs.
• Principle Medical Officer (PMO)
Principle Medical Officer – PMO is a Director of health and family
welfare service at the district in urban area and is overall in-charge of
the health and family welfare programmes in urban area.
Monika Devi NR, M.Sc.Nursing 19

20. Functions of District Health System
• Liaison between Field units & Headquarter
• Field reports
• Inspections
• Meetings
• Implementation of Policy & Programs
• District level planning & Action Plans
• Rationale use of Finance & Resources
• Communication Management
• Plans/Schedules/Progress/Problems
• Control & Monitoring
Monika Devi NR, M.Sc.Nursing 20

21. Community level health care administration
• COMMUNITY HEALTH CENTRE:- Community health Centre (CHC)
has been established for every 80,000 to 120,000 population and
this centre provides the basic specialty services in general
medicine, Pediatric, surgery, obstetrics and gynecology.
Functions of Chc
• Care of Routine and emergency cases in medicine
• Care of Routine and emergency cases in surgery.
• 24 hour delivery services, including normal and assisted
deliveries.
• Essential and emergency obstetric care
• FP services including laparoscopic services
Monika Devi NR, M.Sc.Nursing 21

22. • New born care
• Routine and emergency care of sick children
• Other management including nasal packing, tracheotomy,
foreign body removal etc.
• All the national health programmes (NHP) should be
delivered through the CHC.
• Other:-
• Blood Storage Facility
• Essential laboratory Services
• Referral Services
Monika Devi NR, M.Sc.Nursing 22
Community level health care administration

23. Staffing Pattern at CHC
• Existing Clinical manpower
– General Surgeon 1
– Physician 1
– Obstetrician/ Gynecologist 1
– Pediatrician 1
• Existing Support Manpower
– Nurse- Mid wife 7+2
– Dresser 1
– Pharmacist/ Compounder 1
– Lab technician 1
– Radiographer 1
– Ophthalmic assistant 1
– Ward boy/ nursing orderly 2
– Sweepers 2
– Chownkidar 1
– OPD attendant 1
– Data Entry Operator 5
– OT attendant 1
– Registration Clerk 1
Monika Devi NR, M.Sc.Nursing 23

24. Primary health centre level
• At present there is one primary health centre covering
about 30,000 (20,000 in hilly, desert and difficult terrains) or
more population. Many rural dispensaries have been
upgraded to create these PHCs. The bed strength of Primary
health centre is 6. (but can be raised up to 10)
• Functions of Phc
• Medical Care
• MCH including Family Planning
• Safe water supply and basic sanitation
• Prevention and control of locally endemic diseases.
Monika Devi NR, M.Sc.Nursing 24

25. Primary Health Centre Level
• Collection and reporting of vital statistics.
• Education about health
• National health programmes as relevant
• Referral services
• Training of health guides, health workers local dais and
health assistants.
• Basic laboratory services.
Monika Devi NR, M.Sc.Nursing 25

26. Staffing Pattern of PHC
 Medical Officer 1
 Pharmacist 1
 Nurse Mid-wife 1
 Health Worker (female)/ANM 1
 Block Extension Educator 1
 Health Assistant (Male) 1
 Health Assistant (Female) 1
 U.D.C (Upper Division clerk) 1
 L.D.C (Lower Division Clerk) 1
 Lab. Technician 1
 Driver 1
 Class IV 4
 Total 15
Monika Devi NR, M.Sc.Nursing 26

27. Sub – Centre Level
• The sub center is the peripheral outpost of exiting health
care delivery system in rural areas. it provides interface with
community at the grass root level ,providing all the primary
health services. one sub-centre for every 5000 population in
general and one for every 3000 population in hilly, tribal
and backward areas. Each sub – centre is manned by one
male and one female multipurpose health worker.
Functions of Sub- Centre
• Mother and child health care
• Family planning and immunization
Monika Devi NR, M.Sc.Nursing 27

28. Sub – Centre Level
• It is proposed to extend the facilities at all sub- centers for IUD
insertion, and simple laboratory investigation like routine
examination of urine for albumin and sugar.
• The work at sub-centers is supervised by male and female
health assistants.
• According to the revised norm, one female HA will supervise
the work of 6 female Health Workers.
Monika Devi NR, M.Sc.Nursing 28

29. Staffing Pattern of Sub- Centre
• Health Worker (Female)/ ANM 1
• Health Worker (Male) 1
• Voluntary Worker 1
• Total 3
Monika Devi NR, M.Sc.Nursing 29

30. Role Of Health Assistant Male And Female
will supervise 4 health workers each of the corresponding
category.
• Health assistant female: Supervise and guide the health
workers in the delivery of health care services to the
community.
• Carry out supervisory home visiting. Guide the health
workers (female) in Distribution of conventional
contraceptives to the couples.
• Visit each of the 4 sub centers at least once in a week on
fixed days.
Monika Devi NR, M.Sc.Nursing 30

31. Cont…
• Respond to urgent calls from the health workers and trained
dais and render necessary help.
• Organize and utilize the mahila mandal, teachers etc., in the
family welfare programme.
• Provide information on the availability of services for MTPs and
refer suitable cases to the approved institution.
• Supervise the immunization of all pregnant women and children
(0-5 years) Collect and compile the the weekly reports of births
and deaths occurring in his area.
• Educate the community regarding the need of registration of
vital events. .
Monika Devi NR, M.Sc.Nursing 31

32. Health Assistant Male
• Supervise the work of Health worker male during concurrent
visit.
• Check minimum 10% of houses in village. Supervise the
spraying of insecticides during local spraying along with the
health worker (male).
• Conduct immunization of all school going children with the
help of health worker (male).
• Supervise the immunization of all children’s (0-5 years). Assist
M.O.PHC in organization of family planning camps and drives. .
Monika Devi NR, M.Sc.Nursing 32

33. Cont…
• Provide information on the availability of services for MTPs and
refer suitable cases to the approved institution.
• Ensures follow-up of all cases of vasectomy, tubectomy IUD
and other family planning acceptors.
• Ensure that all the cases of malnutrition infants and young
childrens (0-5years) are given the necessary treatment and
advice and refer serious cases to PHC.
Monika Devi NR, M.Sc.Nursing 33

34. Cont…
• Ensure that Iron and folic acid and Vitamin A are distributed to
the beneficiaries.
• Conduct MCH and family planning clinics and carry out
educational activities.
• Organize and conduct training for dais women leaders with the
help of health workers Collect and compile the the weekly
reports of births and deaths occurring in his area.
• Educate the community regarding the need of registration of
vital events
Monika Devi NR, M.Sc.Nursing 34

35. Thank You
35
Monika Devi NR, M.Sc.Nursing