health care system is community led topic usefull for nursing students and medical students who can improove their knowledge by reading this slide bhad me ja aur kitna describtion likhu

3. PRESENTOR
Mr. Rakesh Patidar
HEALTH
CARE
ORGANISA
TION
SYSTEM IN
INDIA

5. INTRODUCTION
 INDIA is union of 29 states & 7 union territories
 Older concept – Health care means patient care
 Objective - freedom from the disease through
hospital system.

6. DEFINITION
 WHO – “As an integrated care containing
promotive, preventive and curative elements
that bear the longitudinal association with an
individual, extending from womb to tomb, and
continuing in the state of health as well as
disease.”

7. EVOLUTION OF HEALTH CARE
SERVICES IN INDIA
Christian Era –
civilization
started in Indus
Valley Environmental
sanitation,
houses with
drainage
1400 B.C. –
Ayurveda and
Siddha system
Developed a
comprehensive
concept of health
Post Vedic –
teaching of
Buddhism and
Jainism
Rahula Sankirtyana
– developed
hospital system

8. STILL…66 YRS. OF HEALTH
SERVICES
Crude Death Rate ↓
Crude birth rate ↓
Life expectancy ↑
S.pox & G. worm Eradicated
Leprosy Eliminated
IMR ↓
Infrastructure – Expanded
Polio Eradicated

9. PROBLEMS
Environment
Education
Empowerment
Diseases
Communicable
Non Communicable
New emerging
Fertility
Population
Growth rate
Total Fertility
Nutrition
Malnutrition
Obesity
INDIRECTLY RELATED TO
HEALTH
DIRECTLY RELATED TO
HEALTH

10. MODEL OF HEALTH CARE
SYSTEM
INPUTS
HEALTH CARE
SERVICES
HEALTH CARE
SYSTEM
OUTPUTS
Health Status or
Health Problems
Resources
Curative
Preventive
Promotive
Public
Private
Voluntary
Indigenous
Changes in
Health Status

11. HEALTH DEMANDS &
NEEDS OF THE COMMUNITY
COMPREHENSIVE &
COMMUNITY BASED CARE
CONSTITUTES
MANAGEMENT
SECTOR &
INVOLVES ORGANIZATION
IMPROVED
HEALTH STATUS
EXPRESSED IN TERMS OF
LIVES,SAVES, DEATH A
VERTED, DISEASES PREVENTED,
LIFE EXPECTENCY
INCREASED

12. HEALTH ORGANISATION IN INDIA

13. AT THE CENTRE LEVEL
MINISTRY
OF HEALTH
AND
FAMILY
WELFARE
DIRECTORATE
GENERAL OF
HEALTH
SERVICES
CENTRAL
COUNCIL OF
HEALTH AND
FAMILY
WELFARE

14. A. THE UNION MINISTRY OF HEALTH
AND FAMILY WELFARE
DEPARTMENT OF
HEATLH
SECRETARY
JT. SECRETARY
DY. SECRETARY
ADMN. STAFF
DEPARTMENT OF FAMILY
WELFARE
SECRETARY
JT. SECRETARY
DY. SECRETARY
OFFICE STAFF

15. CENTRAL LIST
 International Health,
 Port Health Research
 Technical & Scientific Education

16. FUNCTIONS

17. CONT…
Establishment of drug standards
Census and collection & publication of other statistical
data
Coordination with other states for promotion of health
Regulating labor in mines and oil mines
Immigration & emigration

18. 2. CONCURRENT LIST

19. B. DIRECTORATE GENERAL OF
HEALTH SERVICES (DGHS)
Administrative Staff
Team Of Deputies
Additional Director Of Health Services
Principal Adviser To Union Government

20. ORGANIZATION
DGHS
Additional
DGHS
Deputy
DGHS
(Medical
care)
Office
Staff
Deputy
DGHS
(Public
health)
Office
Staff
Deputy
DGHS
(Gen.
Administ
rator)
Office
Staff

21. FUNCTIONS OF DIRECTORATE
GENERAL OF HEALTH
Surveys
Planning
Coordination
Programming
Appraisal of all
health matters
International Health
relations
Control of drug
standards
Medical store depots
Postgraduate training
Medical education
Medical research
CGHS, NHP, CHEB etc.
GENERAL FUNCTIONS SPECIFIC FUNCTIONS

22. C. THE CENTRAL COUNCIL OF
HEALTH AND FAMILY WELFARE
The central council of health was set up by the presidential
order on 9th August 1952 under article 263 of the constitution
of India for promoting coordinated and concerted action
between the center and the state for the implementation
of all the programmes and measures pirating to the health of
the nation.
Chairman The Union Health
Minister
Members The State
Health Minister

23. FUNCTION OF CENTRAL COUNCIL
OF HEALTH AND FAMILY WELFARE
1. To consider and recommend broad outlines of policy
in regard to matters of health such as,
Provision of remedial and preventive care.
Environment Hygiene.
Nutrition.
Health education and
Promotion of facilities for training and research.

24. Cont..
2. To make proposals for legislation in fields of medical
and public health matters and to lay down.
3. To make recommendations to the central government
regarding the health.
4. To established any organization with appropriate
functions for promoting and maintain cooperation
between central and state health administrations

25. MILE STONES
NRHM-2005
NHP-2002
NPP-2000
RCH-1996
UIP-1985
NHP-1983
Alma Ata-1978 (HFA)
Juggling
Priorities
Small pox eradicated-July 5, 1975
NFPP-1952
India Joins WHO-1948
HSDC-1946

26. STATE LEVEL OF HEALTH
CARE

27. At present there are 29 States in
India, with each state having its
own health administration. In all
the States, devide in two
department
1. State ministry of health and family
welfare
2. State health directorate

28. State ministry of health and
family welfare
State Ministry of health & family welfare
Minister of health & Family
Deputy Minister of health
Secretary of Health Minister
Deputy Secretary of Health Minister
Secretary of Urban Health Secretary of Rural Health

29. State Director Of Health
Directorate of medical
Education & Research
Directorate of health
Services
Dean of Medical College Additional Director
of health services of
medial care
Additional Director of
health services of
medial care
Medical Nursing
Medical Staff
Education
Matron Principal
Hospital Staff Tutor
Services Education
Joint D.H.S. Joint D. H. S.
Deputy D.H.S. Deputy D.H.S.
Regional
Deputy
D.H.S.
Functional
Deputy D.
H. S.
R. D.
D.H.
S.
R. D
D.H
S.

30. FUNCTIONS OF STATE
HEALTH DEPARTMENT
1. To provide adequate medical and preventive
health care services in rural and urban areas,
2. To carry out National Health Programme in the
State.
3. Control of communicable diseases.
4. To carry out health promotion activities like
maternal and child health, immunization,
nutrition programmes, school health services,
food control, etc.
5. To control adulteration of food and drugs and
enforce minimum standards Said down.

31. 6.To maintain health services in jails.
7. To collect and transmit information on health and
vital static
8. Collection and compilation of
information regarding incidence of
notifiable diseases.
9. To provide education in medical, dental,
nursing, pharmacy, sanitation, etc.
10. To determine and maintain the standards
of professional education, research and
practice through statutory bodies like
University, State Medical Council, etc.
11. To co-operate and co-ordinate with Central
Health Ministry in their aided programmes.
12. To develop and encourage indigenous
medical systems like Ayurveda, Unani and
Homeopathy.
13. To maintain laboratories for production and
distribution of vaccines, Toxoid, etc.

32. 14. To maintain stores for hospital drugs
and hospital appliances.
15. To assist development of health services
by local bodies and carry out
supervision and co-ordination
of work,
16. To study the health problems in the
State and take active steps to
alleviate, morbidity.
17. To enact necessary legislation dealing
with public health and medical care.
18. Health education Maintain Regional
Laboratories for chemical and
bacteriological examination.

33. AT THE DISTRICT LEVEL
The principal unit of administration in
India is the district under a collector.
There are 675 districts in India.
Districts are known as “ZILA”

34. DISTRICT HEALTH ORGANIZATION
Identifies and provide the needs of
expanding rural health and family
welfare programme
Within each district again, there are 6
types of administrative areas
No uniform model of district health
organization

35. ORGANIZATION
Panchayats
Villages
Community
Development
Blocks
Town Area
Committees
Tahsil
(Taluka)
District
Sub-division
Corporations
Municipal
Boards
Rural Urban

36. PANCHAYATI RAJ
3 tier structure of rural local self government
Linking the village to the district

37. 3- TIER SYSTEM
PANCHAYAT RAJ
PANCHAYAT ( AT
VILLAGE LEVEL)
GRAM SABHA
GRAM PANCHAYAT
NYAYA PANCHAYAT
PANCHAYAT SAMITI
(AT BLOCK LEVEL)
ZILLA PARISHAD (AT
DISTRICT LEVEL)

38. THE GRAM SABHA
 It is comprised of all the adult men and
women of the village. This body meets at
least twice in a year and discuss important
issues. They elect members of panchayat.

39. THE GRAM PANCHAYAT
 consists of 15-30 elected members
 covers the population of 5000 to 20000.
 chaired by the president i.e. sarpanch/ mukhya/ sabhapati.
 There is a vice- president and a secretary.
 Responsible for overall planning and development of the
villages.
 The panchayat secretary has been given powers to
functions for wide areas such as maintenance of sanitation
and public health, socio-economic development of the
villages etc.

40. THE NYAYA PANCHAYAT
 It is comprised of 5 members from the panchayat.
 It tries to solve the dispute between two parties/
groups/ individuals over certain matters on mutual
consent.

41. AT THE BLOCK LEVEL
 Is known as Panchayat samiti.
 Members of panchayat samiti are:
o Sarpanches from all the gram panchayats in the
block
o MLAs and MPs residing in the area
representative of women, schedule castes, schedule
tribes and cooperative societies.

42. AT THE DISTRICT LEVEL
 The panchayati raj institution at the district
level is known as ZILA PARISHAD.
 Is headed by the chairman also known as
adhikashak.

43. CONT….
It includes the following members:
 The heads of all the gram samities in the
district, MLA and MPs from the district,
 Representatives of women, SC/ST, 2 persons
who have experience in administration, rural
development officer etc.

44. HEALTH CARE DELIVERY SYSTEM
IN INDIA
At the block level
 Objective - to provide primary health care to all the
sections of the society.
 80% of the population is scattered in villages
 20% of rural population have health care facilities
Centre Plain area Hilly / Tribal /
Difficult area
Community health
centre
1,20,000 80,000
Primary health
centre
30,000 20,000
Sub-centre 5,000 3,000

46. COMMUNITY HEALTH CENTRE’S
 Established and maintained by the State Government under
MNP/BMS programme.
 As per minimum norms, a CHC is required to be manned by
four Medical Specialists i.e. Surgeon, Physician, Gynecologist
and Pediatrician supported by 21 paramedical and other staff.
 It has 30 in-door beds with one OT, X-ray, Labor Room and
Laboratory facilities.

47. CONT..
 It serves as a referral centre for 4 PHCs and also
provides facilities for obstetric care and specialist
consultations.
 As on Sep 2013, there are 4,833 CHCs functioning in
the country.
 In Haryana 2013, there are 108 CHCs functioning.

48. PRIMARY HEALTH CENTRE’S
 First contact point between village community and the Medical
Officer.
 To provide an integrated curative and preventive health care
with emphasis on preventive and promotive aspects of health
care.
 Established and maintained by the State Governments under the
MNP/ BMS Programme.
 Manned by a Medical Officer supported by 14 paramedical and
other staff.

49. CONT….
 NRHM - two additional Staff Nurses at PHCs
(contractual).
 It acts as a referral unit for 6 Sub Centre’s and has 4 -
6 beds for patients.
 There were 24,049 PHCs functioning in the country as
on Sep 2013.
 In Haryana Sep 2013, there were 425 PHCs
functioning.

50. SUB-CENTRE
 Most peripheral and first contact point between the
primary health care system and the community.
 Manned by at least one ANM / Female Health Worker
and one Male Health Worker.
 Under NRHM, one additional second ANM on
contract basis.

51. CONT…
 Provide services in relation to maternal and child
health, family welfare, nutrition, immunization and
control of communicable diseases.
 Ministry of Health & Family Welfare is providing
100% Central assistance to all the Sub-Centre’s
 1,48,366 Sub Centre’s functioning in the country as on
Sep 2013
 In Haryana Sep 2013, there were 2465 SCs
functioning

52. ASHA
 Accredited Social Health Activist (ASHA) for 1000 population
 Chosen by and accountable to the panchayat. Act as the interface
between the community and the public health system.
 Honorary volunteer, receiving performance-based compensation
 Facilitate preparation and implementation of the Village Health Plan
 The other persons are
 Indigenous dais
 Anganwadi workers

53. CONT…
ASHA
(Accredited
Social Health
Activist)
Total Number of
ASHA in position as
on 30-06-2013
High Focus
states 5,72,573
Other than High
Focus states 3,17,163
Total Number of
ASHA selected and
trained up to IV
module
High Focus
states 4,94,155
Other Than
High Focus
states
2,89,923
NUMBER OF ASHA WORKERS ACC SEP 2013

54. A SURVEY REPORT PUBLISHED IN
NEW INDIAN EXPRESS
 There is only one doctor per 1,700 citizens in India; the World
Health Organization stipulates a minimum ratio of 1:1,000.
 There are 387 medical colleges in the country—181 in
government and 206 in private sector. India produces 30,000
doctors, 18,000 specialists, 30,000 AYUSH graduates, 54,000
nurses, 15,000 ANMs and 36,000 pharmacists annually.
 Health ministry claims that there are about 6-6.5 lakh doctors
available. But India would need about four lakh more by 2020
to maintain the required ratio of one doctor per 1,000 people

55. INTEGRATED APPROACH OF
HEALTH CARE DELIVERY
ICDS – integrated child development scheme
Agriculture, irrigation and engineering
Animal Husbandry
Education
Social and Women's Welfare
Urban Family Welfare Centers

56. CONTRIBUTION BY NGOS
Providing services like relief to the blind, the disabled and disadvantaged
and helping the government in mother and child health care, including
family planning programmes.
Greater roles for the NGOs was seen to ensure Health for All through the
primary health care approach.
Government of India started granting financial aids to NGOs for various
schemes
Contracting in & out – government hires individuals on a temporary basis
to provide services
Privatization

57. CHALLENGES
Prices of services in private sector
Earning commission from diagnostic laboratories
Financial protection against medical expenditure
Non availability of medical, nursing and
paramedical staff
Inadequate and weak drug control infrastructure
Inadequate drug testing facility
Extremely high drug cost
No clear urban health care delivery model

58. CONCLUSION
 “The number of students graduating from
secondary schools, which can be expressed as
“the percent of health schools that are
accredited” which can be expressed as “ the
reflection of health care of the country”

59. BIBLIOGRAPHY
 Park K. Textbook of preventive & social medicine. 22nd ed.
Banarsidas Bhanot: Jabalpur; 2005. 671- 702,728,732,745
 Stanhope M , L ancaster J. Community & public health
nursing.Mosby publishers: U S. 2004;103-4 ,1097-1098
 Basavanthappa B T. Community health nursing.2nd edition.
Jaypee publishers : New Delhi. 2008; 38,43, 894- 903
 Behind_the_numbers_Medical_cost_trends_for_2011
 http://pwchealth.com/cgilocal/hregister.cgi?link=reg/
 www.pubmed.com
 www.google.com

60.  Indian Public Health Standards (IPHS) guideline for community
health centers, Revised 2012. DGHS, MOHFW, GOI. 1-94
 http://www.newindianexpress.com/magazine/India-has-just-
one-doctor-for-every-1700-people/2013
 www.tradingeconomics.com/india/health-expenditure.html
 www.haryanahealth.nic.in
 www.nrhm.gov.in/nrhm-in-state/state-wise-information.html

61. THANK YOU 