Health care resources ,Health manpower , Money and material, Time ,HEALTH CARE SERVICES, HEALTH CARE SYSTEMS, PRIMARY HEALTH CARE IN INDIA,

1. Health care Resources
Dr. Kunadoddi Archana
MBBS, MD
Assistant Professor
Community Medicine Department (RMHC&RC)

2. No nation, however rich, has enough resources to meet
all the needs for all health care.
Therefore an assessment of the available resources, their
proper allocation and efficient utilization are important
considerations for providing efficient health care
services.
The basic resources for providing health care are:
1. Health manpower
2. Money and material
3.Time

3. Health manpower
• Health manpower requirements of a country are based on:
• (i) Health needs and demands of the population; and
(ii) Desired outputs. The health needs in turn are based on the health
situation and health problems and aspirations of the people.

4. Health manpower planning is an important aspect of
community health planning. It is based on a series of
accepted ratios such as
doctor-population ratio,
nursepopulation ratio,
bed-population ratio, etc

6. There is also maldistribution of health manpower between rural and
urban areas.
Studies in India have shown that there is a concentration of doctors
(upto 73.6 per cent) in urban areas where only 26.4 per cent of
population live.
This maldistribution is attributed to absence of amenities in
rural areas, lack of job satisfaction, professional isolation,
lack of rural experience and inability to adjust to rural life.

8. Money and material
• Money is an important resource for providing health services.
Scarcity of money affects all parts of the health delivery system.
• In most developed countries, average government expenditure for
health is about 18 per cent of GNP. In developing countries it is
less than 1 per cent of the GNP.

9. To achieve Health for All, WHO has set as a goal the expenditure of 5
per cent of each country's GNP on health care.
At present India is spending about 3 per cent of GNP on health
and family welfare development.

10. Time
"Time is money", someone said. It is an important dimension of health
care services.
Administrative delays in sanctioning health projects imply loss of time.
Resources are needed to meet the many health needs of a
community, But resources are desperately short in the health sector
in all poor countries. What is important is to employ suitable strategies
to get the best out of limited resources.

11. HEALTH CARE SERVICES
The purpose of health care services is to improve the health status of
the population.
The goals to be achieved have been fixed in terms of mortality and
morbidity reduction, increase in expectation of life, decrease in
population growth rate, improvements in nutritional status, provision
of basic sanitation, health manpower requirements and resources
development and certain other parameters such as food production,
literacy rate, reduced levels of poverty, etc.

12. Followings 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.
(a) comprehensive
(b) Accessible
( c) acceptable
(d) provide scope for community participation, and
(e) available at a cost the community and country can afford

13. HEALTH CARE SYSTEMS
• 1. PUBLIC HEALTH SECTOR
• 2. PRIVATE SECTOR
• 3. INDIGENOUS SYSTEMS OF MEDICINE
• 4. VOLUNTARY HEALTH AGENCIES
• 5. NATIONAL HEALTH PROGRAMMES

14. PRIMARY HEALTH CARE IN INDIA
As a signatory to the Alma-Ata Declaration, the Government of India
was committed to achieving the goal of Health for All through primary
health care approach which seeks to provide universal comprehensive
health care at a cost which is affordable.

15. 1. Village level
On of the basic tenets of primary health care is universal coverage and
equitable distribution of health resources.
That is, health care must penetrate into reaches of rural areas, and
that everyone should have access to it. To implement this policy at the
village level, the following schemes are in operation :
a. Village Health Guides Scheme
b. Training of Local Dais
c. ICDS Scheme
d. ASHA Scheme

16. Village Health Guides
The Health Guides are now mostly women. A circular was issued by
Government of India in May 1986 that male Health Guides would be
replaced by female Health Guide.
The Health Guides come from and are chosen by the community in
which they work. ·They serve as links between 'the community and
the governmental infrastructure. They provide the first contact
between the individual and the health system.

17. The guidelines for their selection are:
• (a) they should be permanent residents of the local · · community,
preferably women
• (b) they should he able to read and write, having minimum formal
education at least up to the VI standard
• (c) they should be acceptable to all sections of the community and (
• d) they should be able to spare at least 2 to 3 hours every day for
community health work.

18. b. Local dais
• Most deliveries in rural areas are still handled by untrained dais who
are often the only people immediately available to women during
the perinatal period. An extensive programme has been undertaken,
under the Rural Health Scheme, to train all categories of local dais
(traditional birth attendants) in the country to improve their
knowledge in the elementary concepts of maternal and child health
and sterilization, besides obstetric skills.

19. c. Anganwadi worker
Under the ICDS (Integrated Child Development Services) Scheme, there
is an anganwadi worker for a population of 400-800.
The services rendered, which include health check-up including
maintenance of growth chart, immunization, supplementary
nutrition, health education, non-formal pre-school education and
referral services.
The beneficiaries are. especially nursing mothers, pregnant women,
other women (15-45 years), children below the age of 6 years and
adolescent girls .

20. d. ASHA
The general norm of selection is one ASHA for 1000 population. In
tribal, hilly and desert areas the norm could be relaxed to one ASHA
per habitation.
Role and responsibilities of ASHA

21. 2. Sub-centre level
• They are being established on the basis of one sub-centre for every 5000
population in general and one for every 3000 population in . hilly, tribal
and backward areas.
• Indian Public Health Standards for sub-centres:
• 1. Maternal health care
• 2. Child health care
• 3. Family Planning and Contraception
• 4. Counselling and appropriate referral for safe abortion service (MTP).
• 5. Adolescent health care ; Education, counselling and referral.
• 6. Assistance to school health services.
• 7. Water quality monitoring.

22. • 8. Promotion of sanitation including use of toilet and appropriate garbage
disposal.
• 9. Field visits by appropriate health workers for disease surveillance, family
welfare services including STI, RTI awareness.
• 10. Community need assessment.
• 11. Curative services for minor ailments.
• 12. Training of Traditional Birth Attendants and ASHA/ community health
volunteers.
• 13. Co-ordinate services of anganwadi workers, ASHA, village health and
sanitation committee etc.
• 14. National health programmes.

23. 3. Primary health centre level
• The National Health Plan (1983) proposed reorganization of primary
health centres on the basis of one PHC for every 30,000 rural
population in the plains, and one PHC for every 20,000 population in
hilly, tribal and backward areas for more effective coverage.

24. Functions of the PHC
• 1. Medical care
• 2. MCH including family planning
• 3. Safe water supply and basic sanitation
• 4. Prevention and control of locally endemic diseases
• 5. Collection and reporting of vital statistics
• 6. Education about health
• 7. National Health Programmes - as relevant
• 8. Referral services
• 9. Training of health guides, health workers, local dais and health assistants
• 10. Basic laboratory services

25. STAFFING PATTERN

26. 4. Community Health Centres
As on 31st March 2014, 5,363 community health centres were
established by upgrading the primary health centres, each community
health centre covering a population of 80,000 to 1.20 lakh (one in
each community development block) with 30 beds and specialists in
surgery, medicine, obstetrics and gynaecology, and paediatrics with X-
ray and laboratory facilities.

27. Every CHC has to provide following services which are
known as the assured services:
1. Care of routine and emergency cases in surgery:
2. Care of routine and emergency cases in medicine:
3.24-hour delivery services, including normal and assisted deliveries.
4. Essential and emergency obstetric care including surgical interventions like caesarean
sections and other medical interventions.
5. Full range of family planning services including laproscopic services.
6. Safe abortion services
7. Newborn care
8. Routine and emergency care of sick children.
9. Other management, including nasal packing, tracheostomy, foreign body removal etc.
10. All the national health programmes (NHP) should be delivered through the CHCs.

29. Reference :
• K Park. Textbook of Preventive and Social Medicine. 23rd
edition. Jabalpur, Madhya Pradesh