HEALTH CARE DELIVERY SYSTEM

1. PRESENTATION ON – HEALTH CARE
DELIVERY SYSTEM IN INDIA, MAJOR
STAKEHOLDERS IN INDIA & PATTERNS
OF NURSING CARE DELIVERY
PRESENTED BY:
RITIKA RANA
MSC NSG
NEUROSCIENCES

2. HEALTH CARE
DELIVERY SYSTEM
IN INDIA

3. Some basic terms
 Health: health is a state of complete physical, mental and social
well-being and not merely an absence of disease or infirmity.
 Illness: illness is a state in which a person’s physical, emotional,
intellectual,social or spiritual functioning is diminished or
impaired.

4.  Health care: health care may be defined as multitude of
services rendered to individual or communities by the agents
of the health services or professional for the purpose of
promoting, restoring and maintaining health.
 Health care provider: a person or organization that provides
services or deliver proper health care in a systematic way to
any individual in need of health care services

5.  Health care services: Professional services that are generally
delivered by licensed health care professional such as physicians,
registered nurses and therapists or by personal care aids under the
supervision of health care professionals.

6. INTRODUCTION

7.  Health is a fundamental right of every Indian citizen and also is the
fundamental to national progress.
 It is necessitated that the subject of the health be clearly defined in
terms of responsibilities between centre and the state.

8.  The Constitution of India, which is federal in nature, the areas of
responsibilities of health care delivery service have been divided
between the Union Government and State governments.
 Health is mainly considered as State subject and matters connected
with health, fall largely under the Seventh schedule of Indian
Constitution

9. Health System in India
The Government of India has evolved health care
organization at the 3 levels:
 Central level
 State level
 District and Local level

10. At central level

11. At the Central
Level
union ministry of health
and family welfare
Director general of
health services
Central council of health
and family welfare

12. A. Union Ministry of Health and Family Welfare
It is headed by the following:
 Cabinet ministers
 Ministers of State
 Deputy health minister

13. a. Department of health:
Department of Health
Secretory to the Government of India
Joint secretory Deputy secretory Large administrative
staff
Headed by
Assisted by

14. B. Department of Family Welfare: it was created in 1966 within the
ministry of family and health welfare.
Department of Health & family welfare
Secretory to the Government of India
Joint secretory
Additional secretory
Headed by
Assisted by
Commissioner

15. FUNCTIONS:
The functions are described in the Seventh Schedule of Article 246 of
the Constitution of India under the following lists:
 Union list
 Concurrent list

16. UNION LIST
International health relations and
administration of port quarantine
Administration of central institutes
Promotion of research through research
centers
Census and collection and publication
of other statistical data
Regulation and development of medical,
pharmaceutical, dental and nursing

17. Regulation of labor
Coordination with states and with
other minister
Establishment and maintenance of
drug standards
Immigration and emigration

18. CONCURRENT LIST
Prevention of extension of communicable diseases
Prevention of adulteration of food stuffs
Control of drugs and poisons
Vital statistics
Labor welfare
Ports other than major

19. Central Council of Health
 It was set up by a Presidential order on 9August,1952
under the article 263 of the constitution of India
Chairman-The union Health
Minister
Members- the State Health
Minister

20. Functions:
 Consider and recommend broad outline of policy.
 Make proposal of legislation in field of medical and public
health.
 Recommendation regarding distribution of available aid for
health purposes.
 Establish organization to maintain cooperation between
central and state health department.

21. Director General of Health Services
DGHS
Deputy DGHS
Medical care
Deputy DGHS
(public health)
Deputy DGHS
(general
administration)
Nursing
advisor
Deputy
nursing
advisor

22. GENERAL FUNCTIONS:
 Survey
 Planning
 Coordination
 Programming
 Appraisal of all
health matters

23.  International health relation
 Control of drug standards
 Medical store depots
 Post graduate training
 Medical education
SPECIFIC FUNCTIONS

24.  Medical research
 Central govt. health scheme
 National health programme
 Central health education bureau
 Health intelligence
 National medical library
Continue….

25. AT STATE
LEVEL

26. AT STATE LEVEL:
The states are responsible for all the health-related services
within the state. Some variations are found in the health
organization at state level but the main characteristics of health
organization at the state level are almost similar in all the states

27. There are 2 organization come under state level:
 State Ministry of Health
 State Health Directorate
At the State level
State ministry of health State health Directorate

28. The minister of health and family welfare has the political vision
and is over all responsible for all matters related to health.
State Ministry of Health:
State ministry of health
Deputy Minister of health and family welfare
Minister of health and family welfare
Health secretory
Deputy secretaries
Large administrative staff

29. State Health Directorate:
State health directorate
Director of health and family welfare
Deputy director
Assistant director of health
Regional activities Functional activities
 MCH
 Nutrition
 TB
 Family planning
 Leprosy
 Health education

30. AT
DISTRICT
LEVEL

31. District
Sub division
Tehsil (taluka)
Panchayati Raj
Panchayat at
village level
Panchayat samiti
at block level
Zila parishad at
district level
Municipal
corporation
Town area
committee
Municipal
boards
District health
organization
Urban area
Rural area

32. A.) Panchayati raj at village level:
Panchayati raj institution at village level comprises of the following:
Village level
Gram Sabha Gram Panchayat
Nyaya Panchayat

33. 1. Gram Sabha:
It is the assembly of all the adults of the village who are registered
voters of the village. They meet at least twice a year.
Functions:
 discuss important issues and consider proposals pertaining to the
various developmental aspects including health matters.
 Gram Sabha elects members of the gram panchayat.

34. 2. Gram Panchayat:
• Gram panchayat comprises of 15-30 elected members, also known
as Panch. It is the executive organ of gram sabha.
• Gram panchayat covers a population of 5000-15000 or more.
• Gram Panchayat is headed by president or sarpanch.
Functions:
 Sanitation
 Public health
 Socioeconomic development of the village Planning and
organizing various health activities is the villages

35. 3. Nyaya Panchayat:
It is comprised of 5 members from the panchayat.
Functions:
 It resolves the disputes between the two parties or groups or
individuals of the village over certain matters on mutual
consent.
 It solves the troubles of going to formal judicial system and
thus creates harmony and peace among the members.

36. B.) Panchayat Samiti at the Block Level:
 Block consists of 100 villages and a population about 80,000 to
1,20,000.
 The panchayat agency at the block level is referred as panchayat
samiti. It is the local administration agency at the block level under
Panchayati raj.

37. Continue….
 The panchayat samiti consists of all sarpanches of the village, panchayats
in the block, MLAS, MPs residing in the block area, representatives of
women, schedule castes, schedule tribes and members of cooperative
societies.

38. Functions:
 Execution of the community development programs in the block
 Social and educational development in the block
 Sanitation and health matters in the area
 The heads of the panchayat samiti maintain liaison with the medical
officer
 The funds provided by the government for development are
channeled through panchayat samiti.

39. C.) Zila Parishad at District Level:
 The Panchayati Raj Institution at the district level is known as Zila
Parishad.
 Zila Parishad or Zila Panchayat is the agency of rural local self-government
at the district level.

40. Continue…
 The number of members in Zila Parishad may be 40-70.
 Zila Parishad is the supervising and coordinating agency for the
development programs carried by the gram Samities in the blocks
of districts. The function of Zila Parishad may vary state wise.

41. B. Urban areas of the District:
e:
der the administration of district collector.
are set up in areas having population in

42.  Municipal Boards are set up in areas having population between 10,000-2
lakhs.
 The Municipal Board is headed by Chairman/President, elected usually
by its members.
 The term of the members ranges from 3-5 years.
 The Municipal Board looks after sanitation, drainage, water supply,
construction and maintenance of roads, registration of births and deaths,
education, running of hospitals and dispensaries etc.
b) Municipal boards:

43. c) Municipal Corporations:
 Corporations are set up in areas having population more than 2
lakhs.
 The corporation is headed by a mayor.
 Councilors are elected from different wards of the city.
 At administrative level, the executive agency includes CEO (Chief
executive officer) also called commissioner, the secretary, an
engineer and the health officer.

44. d) District Health Organization:
i. This unified health authority is in each district, since "Health" is a state
subject there is no uniform "Model" of district health organization in India.
ii. Under the multipurpose health worker scheme, the states have been
suggested to have an integrated set-up at the district level by having a
CMO with 3 deputy CMOs i.e. existing civil surgeon, district health officer
and district family welfare officer.

45. Major STAKEHOLDERS In Health
Care Delivery System

46. Health system operates in the context of socioeconomic and political
framework of the country. Stakeholders encompass a wide sector of
society; they include consumer or patients, community health care
professionals, hospital health care professionals, pharmacists, non-
governmental organizations, suppliers etc
INTRODUCTION:

47. DEFINITION:
Stakeholder is a person, group, organization or system
who affects and can be affected by an organizational
action.

48.  Classification of Stakeholders:
Depending on their source of origin and site of operations,
stakeholders may be classified into the 3 classifications –
External
stakeholders
Interface
Stakeholders
Internal
Stakeholders

49.  A health care organization must respond to large number of external
stakeholders. They fall into three categories in their relationships with the
organization-
a) Those that provide inputs to organization.
b) Those that compete with it.
c) Those that have particular special interest in how the organization
functions.
1. External Stakeholders:

50.  The major categories of interface stakeholders include the medical
staff, the hospital board of trusties.
 The organization must provide sufficient inducements so that these
groups of stakeholders continue to make appropriate contribution.
 The organization may offer professional autonomy, institutional
prestige or political contacts, special services and benefits etc
2. Interface Stakeholders:

51. 3. Internal Stakeholders:
 These stakeholders exist almost entirely within the organization and
typically include management, professional and nonprofessional staff.
Management attempts to provide internal stakeholders and sufficient
inducements to gain continual contribution from them.
 The stakeholders determine whether the inducements are sufficient for the
contribution that they are required to make partly on the basis of alternative
contribution offer received from competitors.

52. Stakeholders in Health Care System:
Stakeholders
Government
Public
Providers
Non-Governmental
Hospital administrator
& governing boards

53. 1. Government: Many federal government health care efforts are headed by a
cabinet-level officer, the secretary for health and human services, who runs the
department of health and human services. The federal government makes
budget and other planning related to expenditure in health care.
 At central level
 At state level
 At district level

54. iii. At district level: The district level stakeholder in health care delivery system is
deputy commissioner, MLAs of the area, civil surgeons, senior medical officers &
district public health nurse.
ii. At state level: At state level, state health directorate is responsible for
administering health care services & regulating the health care delivery system.
i. At central level: Stakeholders at central level are Cabinet minister & Secretary
for Health & Human services who runs the Department of health & Human
services.

55. the public is concerned with quality, cost and access to care. They expect an
employer to offer a wide variety of option for health coverage that can be
customized to their specific needs. They also look for the employs to fund the
majority of cost of health insurance.
2. THE PUBLIC:

56. 3. THE PROVIDERS:
i. Community health care professional: i.e., nurses, health workers, dais,
doctors of community health Centres, voluntary health workers etc.
ii. Hospital health care professional: i.e., physicians, nurses, pharmacists etc.
4. HOSPITAL ADMINISTRATORS AND GOVERNING BOARDS:
The chief executive, chief financial officer, chief nursing officer, and governing
boards of hospitals strongly influence health care delivery in their institutions

57. 5. NON-GOVERNMENTAL STAKEHOLDERS:
These voluntary agencies occupy an important place in community health care
system. These organizations directly or indirectly act as stakeholder.
 There are many NGO’S in India which serves to society. Some of these
organizations are given below:
• Indian Red Cross Society
• Hindu Kusht Nivaran Sangh
• Indian council for child welfare
• Tuberculosis Association of India
• Bharat Sevak Samaj
• The Kasturba Memorial Fund
• The All-India Blind Relief Society:
• Professional Bodies

58. Identification
Diagnose
Classification
Formulation
Collaboration
Implementation
Evaluation
Steps in Management of Stakeholders:

59. Diagnosis of Key Stakeholder Relationship
The two vital steps for diagnosis of key stakeholder relationship are as
follows:
 Stakeholder potential for threat
 Stakeholder’s potential for cooperation

60. Types of Stakeholder Relationships:
• Type I: The mixed blessing stakeholder relationship
• Type II: The supportive stakeholder relationship
• Type III: The non-supportive stakeholder relationship
• Type IV: The marginal stakeholder relationship

61. Generic Strategies for Stakeholder Relationship Management:
1) Strategy 1: Collaborate cautiously in the mixed blessing relationship
2) Strategy 2: Involve trustingly in the supportive relationship
3) Strategy 3: Defend proactively in the non-supportive relationship
4) Strategy 4: Monitor efficiently in the marginal relationship
5) Strategy 5: Strategy implementation and outcome

62. Pattern of nursing care delivery in India

63. The nursing care delivery system means ‘the process of delivering care to
the client by combining various aspects of nursing service which will fit to
various patient care settings to produce a common outcome of delivering
quality care and meeting the needs of clients.
MEANING OF NURSING CARE DELIVERY SYSTEM

64. DEFINITION:
 The nursing care delivery system means “the process of
delivering care to the client by combining various aspects of
nursing service which will fit to various patient care settings to
produce a common outcome of delivering quality care and
meeting the needs of clients.

65. Needs of Nursing care delivery
a. physical needs
b. mental and social needs
c. spiritual needs
d. Nursing care is based on a helping relationship
e. It is the unique function of the nurse to provide nursing care
according to client’s needs

66. Continue….
f. The aspect of patient care has to be initiated and controlled by
nurse
g. There should be justification for selecting each delivery system
h. Before planning care organizational policies to be considered

67. Types of Patient Care Delivery System
1. Total Patient Care: Registered Nurse assumes responsibility for a
group of patients for a shift – provides all care to the patient.
 Advantages – continuity for the shift, responsibility is clear, generally
satisfying for nurses.
 Disadvantages – can be very expensive, may not utilize RN time
wisely and may not be possible with staffing shortages.

68. 2. Functional Nursing: Staff Members are assigned to a specific task or
group of tasks for patients – example Medication Nurse, IV Nurse, Vital
Signs--- Registered Nurse assumes overall direction of care.
 Advantages – incorporates the use of LPNs and UAPs and
maximizes their skills, can be cost effective.
 Disadvantages – Can lead to fragmentation and gaps in patient care
– not holistic

69. 3. Team Nursing/Modular Nursing: Registered Nurse Team Leader
coordinates care for a group of patients working with other team
members (RNs, LPNs and UAPs) utilizing their skills.
 Advantages – if done well can be very satisfying to staff and patients
as well as cost effective.
 Disadvantages – requires high level leadership skills from RN –
harder to do with high patient acuity and inconsistent team members

70. 4. Primary Nursing: Registered Nurses assume 24/7 accountability for
their Primary Patients – establish plan of care and coordinate care
even in their absence.
 Advantages – can result in high job satisfaction and excellent
holistic care for patients.
 Disadvantages – requires high RN mix, difficult to do with today’s
flexible scheduling, some staff don’t want the accountability and
responsibility

71. 5. Case Management: Registered Nurse Case Manager supervises
the care of the patient and use of resources across the continuum –
focus is on individual patients.
 Advantages – can be very cost effective and satisfying for
patients who are high risk/problem prone.
 Disadvantages – Case Management is not a true inpatient
delivery system but rather the management of patient care.

72. CONCLUSION
Today, it is clear that health system in India do not gravitate naturally towards the goal
of HEALTH FOR ALL through primary health care as articulated in the Declaration of
Alma-Ata. Health systems in India are developing in directions that contribute little to
equity and social justice and fail to get best outcomes for their resources.
Nursing is a core part in health care system, where promotion of patient's health
status, disease prevention: both curative and rehabilitative health strategies are
applied and nurse not only provide patient care but also enhance clinical competence
that is why the components like communication, social responsibility and teamwork
are important.
For the first time all the major Stakeholders in Higher Education such as University
Grants Commissions, All India Council for Technical Education, Medical Council of
India as well as State Governments participated in the data collection exercise.