HEALTH CARE DELIVERY SYSTEM

1. Presented By:
Archana Tripathy
Msc tutor
SNC

2. LEVELS OF HEALTH CARE
Introduction :-
 Health care is a multitude of services rendered to
individual, families or communities by the agent of
health services or professions for the purposes of
promoting, maintaining monitoring or restoring health.
 The health care goal of system is health
development i.e. a process of continuous and
progress improvement of health status of a
population.
 To achieve this goal health care service are usually
organized at three levels, each level supported by a
higher level to which the client is referred.

3. Levels of health care
Primary prevention
Secondary prevention
 Tertiary prevention

4. PRIMARY HEALTH CARE :
Also called as essential health care or health care
at door step
It is the first level of contact of individual, the
family and community with national health
system, where primary health care is provided.
A level of health care, it is close to the people,
where most of the health problem can be dealt
with and resolved.
It provided at village level and through primary
health centers and their sub-centers through the
agency of multi-purpose health worker, village
health guide & ASHA worker.

5. Cont..
The measures of health promotion and
prevention are taken a maximum effort at this
level of health care.
Besides providing primary health care the villages
“health team” bridge the cultural and community
gap between rural people and organized health
sector.

6. SECONDARY CARE LEVEL:
The next higher level of care is the secondary
(intermediate) health care level.
At this level more complex problem are dealt with.
Care is generally provided in district hospital and
community centers which also serves as the first
referral level.
Curative services are provided at this level.

7. Tertiary level:
The tertiary level is a more, specialized specific
facilities and attention of highly specialized health
workers.
This care is provided by the regional or central
level institutions. E.g. medical college hospitals.
All Indian institutes, regional hospitals,
specialized hospitals and other apex institutions.

8. HEALTH CARE SETTINGS

9. HEALTH CARE SETTINGS
The health care setting organization to country
extends from the national to village level. From
the total organization structure, include the setting
of health care system at national, state , regional,
district and village level.

12. NATIONAL LEVEL:
The organization at the national level consists of
the union ministry welfare.
The ministry has two technical departments the
health development headed by the director
general of health services and the family welfare
department headed by the commissioner, family
welfare.

14. STATE LEVEL:
Functions of state health director
1. To provide adequate medical care through hospitals,
dispensaries, and health centers.
2. To make proper arrangement for medical education
and research.
3. Proper implementation of research & health
programs.
4. To make provision for personal and impersonal
health services.
5. Control of food and drug administration
6. Collection and dissemination of health information
7. Promotion of indigenous system medicine.

15. DISTRICT LEVEL:
The district level settings of health services is a
middle level management organization and it is a
linkage system between the state as well as
regional structure on one side and the peripheral
level settings PHC as well as sub center on the
other side.
It receives information from the state level and
transmits the same to the periphery by suitable
modification to meet local needs.

16. Division of Administration at District Level
AdministrationatDistrict
Level
Urban Administration
Municipal Corporation
Municipality
(Municipal Board)
Town Area Committees
Rural Administration
Panchayat
Panchayat Samiti
Zilla Parishad

17. ۞ It is the top level urban local government.
۞ Constituted in areas having population >200000.
۞ Headed by a mayor.
۞Its members are the councillors who are elected
from various wards of the city.

18. ۞Have a executive committee headed by the
commissioner.
۞The health officer of the corporation is responsible
for the health and sanitation of the city, disposal of
waste etc.

19. Municipality
(Municipal Board):
It is constituted in areas
having population between
10,000-200000.
It is headed by
chairman/president, elected
by its members.

20. Municipality (Municipal Board):
It also has an executive officer/commissioner.
The municipality looks after sanitation, drainage,
water supply, registration of births and deaths,
education, running of hospitals and clinics etc.

21. Town Area Committees:
These are setup in areas having population in the range of
5,000-10,000.
These are neither village nor city. It lies between the village
and city.
A Town area committee is under the administration of
district collector.
These committees are responsible for sanitation in the area.

22. RURAL ADMINISTRATION
(PANCHAYAT RAJ)

23. Rural Administration (Panchayat Raj):
The Panchayat Raj is a 3-tier structure
of rural local self-government in India where
villages are linked to district administration
through Panchayati Raj institutions. It
includes:
 Panchayat ( At The Village Level)
 Panchayat Samiti ( At The Block Level)
 Zilla Parishad (At The District Level)

24. The Gram Sabha:
Comprised by the registered voters of the
village.
This body meets at least twice in a year and
discuss important issues and proposals
pertaining to various developmental aspects
including health.
Elects the members of gram panchayat.
Panchayat ( At the Village Level)

25. Gram Panchayat
It consist of 15-30
elected members.it
covers a population of
5000-20000.
It is chaired by the
president
i.e. Sarapancha.

26. Gram Panchayat
There is also vice-president (Upa-
Sarapancha/Nayab Sarapancha) and a
secretary.
It looks after the wide variety of
development programmes for the
villagers.

27. Nyaya Panchayat:
Nyaya Panchayat is comprised of five
members from panchayat.
It is the village level platform to resolve
the disputes between two
groups/paties/individuals.

28. Panchayat Samiti (At the Block Level):
Panchayat raj institution at the block level is
known as panchayat samiti.
The primary function of the Panchayat
Samiti is to execute the community
development programme in the block.
The Block Development Officer and his
staff give technical assistance and guidance
in development work.

29. Zilla Parishad (At the District Level):
Panchayat raj institution at the district level is
known as Zila Parishad.
The members of Zilla parishad include all
heads of panchayat samiti in the district ,MPs,
MLAs, representative of SC, ST and women
and 2 persons of experience in administration,
public life or rural development.

30. Zilla Parishad (At the District Level):
The district collector is also a member of
Zilla parishad without having voting power.
Its function is primarily supervisory and co-
ordinating.

31. HEALTH CARE AT BLOCK LEVEL:
The organization at the block level is developed to
provide health care services in the rural areas. It is
a three tier structure.
Community
Health
Centres
Sub Centre
Primary
Health
Centre

32.  The community health centre provides
secondary level of health care in rural health
services.
 It covers around 120000 populations in
plains and 80000 in hilly and tribal areas.
 It is established in each community
development block.
 It has 30 beds and four specialist doctors in
Different speciality with some basic
laboratory facilities.

33. FUNCTION OF CHC:
Providing speciality services
Caring and supervision of PHCs
Giving all preventive and curative health services
Providing referral services
Provide RCH services including family planning
Implementation of all national health programmes.

34. PRIMARY HEALTH CENTRE
 Primary health centers are the corner stone of
rural health services.
 It acts as a referral unit for 6 sub centers and refer
out cases to CHCs.
 It covers a population of 30,000 in plain area and
20,000 in hilly and tribal area.
 There are 4-6 beds for patients and some
diagnostic facilities are also available.

35. FUNCTIONS OF PRIMARY HEALTH
CENTRE:
 Medical care.
 MCH including family planning.
 Safe water supply and basic sanitation.
 Prevention and control of locally endemic diseases.
 Collection and reporting of vital statistics.
 Education about health.
 National Health Programmes.
 Referral services.
 Training of health guide, health workers and local dais
and health assistants.
 Basic laboratory services.

36. SUB CENTRE
The sub centre is the first unit of health system for the
villagers.
covers about 5000 population in general and 3000
population in hilly, tribal and backward areas.
The sub centre is staffed by a health worker male
and health worker female.
Function of SCs:
Immunization services
Family planning services
MCH services

37. Function of SCs cont…
Primary treatment and referral services
Prevention of malnutrition and common
childhood diseases.
Counselling.
Provides elementary drug for minor
ailments such as ARI/diarrhoea, fever, worm
infestation etc. and carry out community needs
assessment.

38. HEALTH CARE AT VILLAGE LEVEL:
It is a grass root services in a health care delivery
system. One of the basic principle of primary care is
universal coverage and equitable distribution of
health resources. That is health care must penetrate
into the remote rural areas and that everyone should
have access to it. To implement this policy at the
village level the following schemes are in operation.
Village Health Guide Scheme
Training of Local Dais
ICDS Scheme
ASHA Scheme

39. VILLAGE HEALTH GUIDE:
 Village health guide is a person with an
aptitude for social service and is not a full
time government functionary.
 Introduced on 2nd October 1977 with idea
of securing peoples participation in the care
of their own health.
 They serve as a link between the
community and government infrastructure.

40. Guidelines of Their Selection:
They should be permanent residents of their
community.
They should be acceptable to all sections of the
community.
They should be able to read and write having formal
education at least up to VI standard.
They should be able to share at least 2 to 3 hours every
day for community health work.

41. Broadly the Duties of a health guides
include:
1) Treatment of simple ailments and
activities in first aid.
2) Mother and child health including family
planning
3) Health education.
4) Sanitation.

42. LOCAL DAIS:
Most deliveries in rural areas are previously handled by
untrained dais.
As extensive programme has been undertaken, under
the rural health scheme to train all categories of local
dais in the community to improve their knowledge in
the elementary concepts of maternal and child health
and sterilization besides obstetric skill.
Training is given at PHC, sub centre or MCH centres
for 2 days in a week and on the remaining 4 days of the
week they accompany the health worker(F) to the
villages preferably in the dais own area.

43. Cont…
After successful completion of training each
Dai is provided with a delivery kit and a
certificate.
These DAIS are also expected to play a vital
role in propagating small family norm since
they are more acceptable to the community.
The normal target is to train one local dais in
each village.

44. ANGANWADI WORKER:
 Under the ICDS scheme there is an
Anganwadi worker for a population
of 1000.
 The Anganwadi worker is selected
from the same community.
 She undergoes training in various
aspects of health, nutrition and child
development for 4 months.

45.  She is a part time worker and is paid an
honorarium of Rs 4500 per month for the
services rendered, which include health
check-up including maitainence of growth
chart, immunization, supplementary
nutrition, health education, on formal
preschool education and referral services.
 The beneficiaries are especially lactating
mothers, pregnant women, other women (15-
45years), children below the age of 6 years
and adolescent girls.
Cont…

46. ASHA (ACCREDITED SOCIAL HEALTH ACTIVIST)
Must be the resident of the village with formal
education up to eight class, having communication
skills and leadership qualities.
One ASHA for 1000 population. The target is to
select and train at least 40% of ASHA’s in the first
year. Rest of the ASHA’s can be selected and
trained during second and third year. At present
about 1 lakh ASHA’s have already selected and are
being trained.

47. ROLE AND RESPONSIBILITY OF ASHA:
ASHA will be a health activist in the
community who will create awareness on
health. Her responsibilities will be as follows:
 ASHA will take steps to create awareness
and provide health information to the
community.
 She provide counselling to the people of
community.

48. ROLE AND RESPONSIBILITY OF ASHA
cont….
 ASHA will mobilise the community and
facilitate them in accessing health related
services available at the Anganwadi/sub-
centre/primary health centres such as
immunization, antenatal check-up post
natal check-up, supplementary nutrition
,sanitation and other services provided by
the government.

49. ROLE AND RESPONSIBILITY OF ASHA
cont….
 She will work with the village health and
sanitation committee of the gram panchayat
to develop a comprehensive village health
plan.
 She will arrange and accompany pregnant
women and children requiring treatment to
the nearest pre identified health facility i.e.
primary health centre/community health
centre/first referral unit.

50. ROLE AND RESPONSIBILITY OF ASHA
cont….
 ASHA will provide primary medical care for
minor ailments such as diarrhoea, fever, first
aid for injuries.
 She will act as a depot holder for essential
provision being made available to every
habitation like oral rehydration therapy, iron,
folic acid tablet, disposable delivery kits, oral
pills and condom.