Healthcare delivery system in india

3. DEFINITION:- Health care delivery system is
defined as the aggregate of institutions,
organizations and persons who enter, the health
care system, Who has responsibility that, Include
the promotion of health, prevention of illness,
detection and treatment of disease and
rehabilitation”
“It implies the organization, delivery, staffing,
regulation and quality control of health care
services.”

4. To improve the health status of population
To improve the experience of care
To reduce the economic burden of illness
TO improve social justice equity

5. Orientation toward health
Population perspective
Intensive use of information
Focus on consumer
Knowledge of treatment outcome
Constrained resources
Coordination of resources
Reconsideration of human values
Expectations of accountability
Growing interdependence

6. CENTRAL LEVEL
STATE LEVEL
DISTRICT LEVEL

7. MINISTRY OF
HEALTH & FAMILY
WELFARE
MINISTRY OF
HEALTH &
FAMILY
WELFARE
CENTER COUNCIL
OF
HEALTH
DIRECTORATE
GENERAL
OF HEALTH

8. )

9. 1.Union list
2.Concurrent list

10. International health relation and administration of
port quarantine
Administration of central institutes
Promotion of research through research centers
Regulation and development of medical,
pharmaceutical, dental and nursing profession
 Establishment and maintenance of drug standards
Census collection and publication of other statistical
data
Immigration and Emigration
Regulation of labor in the working fields
Coordination with states and other ministries

11. 
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12. CHAIRMAN- THE UNION
HEALTH MINISTER
MEMBERS
THE STATE HEALTH
MINISTER

13. 1
• Consider and recommend broad outline of the policy
2
• Make proposal of legislation in field of medical and public
health
3
• Recommendation regarding distribution of available aid
for health purposes
4
• Establish organization to maintain cooperation b/t central
and state health dept.

14. DGHS
Deputy DGHS
Medical care
Deputy DGHS
(Public health)
Deputy DGHS
(General
administration)

15. 1.GENERAL FUNCTIONS
2.SPECIFIC FUNCTIONS

16. 1.Survey
2.Planning
3.Coordination
4.Programming
4.Appraisal of all health
matters

17. 1.International health relation
2.Control of drug standard
3.Medical store depots
4.Post graduate training
5.Medical education
6.Medical research
7.Central govt. health scheme
8.National health programmes
9.Central health education
bureau
10.Health intelligence
11.National medical library

18. STATE
MINISTRY
OF
HEALTH
STATE
HEALTH
DIRECT
ORATE

19. Minister of state Health and Family
Deputy Minister
Secretary
Deputy Secretariat
Administrative
staff

20. Assisting the ministers in policy making
Formulating, review and modification of
broad policy
Execution of policies
Coordination with Govt. of India and other
state
Control for smooth and efficient functioning
Budgeting and control over expenditure

21. Director of Health
and Family Welfare
Deputy and
Assistant
Directors of
Health
Regional
Directors
Functional
Directors

22. 1.Provide adequate medical care
2.Medical education and research
3.National health programme implementation
4.Provision for health scheme
5.Food and drug administration control
6.Collection of health information
7.Control over ESI scheme
8.Enforcement of professional standards

23. 1) Sub divisions
2)Tehsils (taluks)
3) Community Development Blocks
4) Municipalities and Corporations
5) Villages
6) Panchayats

24. MUNICIPALI
TIES
CORPORATION
VILLAGE
COMMUNITY
DEVELOPMEN
T BLOCK
TEHSILS
SUB-
DIVISIONS
PANCHAYAT
ASSISTANT
COLLECTOR
TEHSILSDAR
200-600
VILLAGES
100 VILLAGES
(80000-120000
POPULATION)
CHAIRMAN
OR
PRESIDENT
(10000-200000
POPULATION)
MAYORS
POPULATION
ABOVE
2,00,000

25. The Urban areas of the district are organized into following
institutions of local Self Government:
1.Town area committee's:
In areas with population ranging between 5000 and 10,000.
2.Municipal Boards:
In areas with population ranging from 10,000 to 2 lakhs, headed
by Chairman or the President.
3.Corporations:
With population above 2 lakhs headed by Mayors.

27. ZILA PARISHAD
( district level)
PANCHAYAT SIMITI
( block level)
GRAM PANCHAYAT
(village level)

28. TIER
SYSTAM
PANCHAYATI
RAJ SYSTAM
SYSTAM
ORGANIZATIO
NAL HEAD
HEALTH
FUNCTIONA
RY
1st - DISTRICT
LEVEL
Zila parishad Chief Executive
Officer
DHO/CMHO
2nd -BLOCK
LEVEL
Panchayat
shamiti
Block
Development
officer(BDO)
BCMHO/MO
3rd –VILLAGE
LEVEL
Gram
panchayat
Village
Development
Officer(VDO)/
Gram sevak
MLHP/CHO
ANM
VHW
AWW

29. SUB
CENTER
(SC)
PRIMARY
HEALTH
CENTER
(PHC)
COMMUNITY
HEALTH
CENTER
(CHC)

31. All “Minimum Assured Services” or
Essential Services as envisaged in the Sub-
centre should be available, which include
preventive, primitives, few curative and
referral services and all the national health
programmes
one sub-centre for every 5000 population in
general and one for every 3000 population
in hilly, tribal and backward areas.

32. Type A Sub
Centre will provide all recommended services
except that the facilities for conducting
delivery will not be available here.
Type B Sub-
centre, will provide all recommended services
including facilities for conducting deliveries at
the Sub-centre itself

33.  Maternal health care:1. Antenatal care (ANC) 2.Intranatal care
3.Postnatal care (PNC)
 Child Health care
 Family Planning and Contraception
 Safe Abortion Services
 Curative services
 Adolescent Health Care
 School health services
 Control of local endemic diseases
 Water and Sanitation
 Outreach/Field services
 National Health Programmes
 Promotion of Medicinal herbs
 Recording of Vital Events

34. Type of Sub-centre Sub-centre Type A Sub-centre Type B
Staff Essential Desirable Essential Desirable
ANM/Health Worker (F) 1 1 2
Health Worker (M) 1
Staff Nurse (or ANM if
Staff
Nurse is not available)
1**
Voluntary worker* 1
(part time)
1
(Full time)

37. Type A PHC- with delivery load of less than 20
per month
Type B PHC- with delivery load of 20 or more
deliveries per month.

38. 1.Medical Care
2.Maternal and Child Health Care including
Family Planning
3.Medical termination of Pregnancies
4.Management of Reproductive Tract Infections
/Sexually Transmitted Infections
5.Nutrition services in coordination with
ICDS
6.School Health

39. 7.Adolescent Health Care
8.Promotion of Safe drinking water and Basics
sanitation.
9.Prevention and control of locally endemic diseases
10.Collection and reporting of vital events.
11.Health Education and Behavior Change
communication
12.Implementation of National Health Programmes

40. 13.Training of health care workers
14.Basic Laboratory and Diagnostic services
15.Functional Linkages with sub-centres
16.Maternal Death Reviews.
17.Mainstreaming of AYUSH.
18.Selected surgical procedures

41. Type of PHC Type A PHC Type B PHC
STAFFING Essential Desirable Essential Desirable
Medical Officer 1 1 1#
Medical Officer-AYUSH 1 1
Account.(Data Entry Operator) 1 1
Pharmacist 1 1
Pharmacist-AYUSH 1 1
Nsg.Officer (Midwife) 3 +1 4 +1
Health Worker (Female) 1* 1*
Health Assistant (Male) 1 1
Health Assistant (LHV) 1 1
Health Educator 1 1
Laboratory Technician 1 1
Logistic Vaccine Assistant 1 1
Multi-skilled Group D Worker 2 2
Sanitary Worker&Watchman 1 1 +1
Total 13 18 14 21

42. • Community Health Centers (CHCs), constituting
the First Referral Units (FRUs)
• CHCs is the secondary level of health care center
• 4 PHCs are included under each CHC thus
catering to approximately 80,000 populations in
tribal/hilly/desert areas and 1,20,000 population
for plain areas.
• CHC is a 30-bedded hospital providing specialist
care in Medicine, Obstetrics and Gynecology,
Surgery, Pediatrics', Dental and AYUSH with one
OT, X ray, Labour Room and Laboratory
facilities.

43. • To provide optimal expert care to the
community
• To achieve and maintain an acceptable
standard of quality of care
• To ensure that services at CHC are
commensurate with universal best practices
and are responsive and sensitive to the client
needs/expectations.

44. SERVICE TO BE PROVIDED at CHC
1. Outpatient and Inpatient Department with all common specialist
services
2. Care of Routine and Emergency Cases in Surgery and Medicine
3. Maternal Health - ANC, INC, PNC, 24-hour delivery services,
Caesarean Sections
4. Newborn Care and Child Health
5. Family Planning, Vasectomy, Tubectomy,MTP as per MTP act.
6. National Health Programmes services

45. SERVICE TO BE PROVIDED at CHC
7.National Health Programmes services
8.School Health Services
9.Adolescent Health care
10.Blood storage facility
11.Diagnostic services
12.Maternal Death Reviews
13.Referral (transport) Services

46. TOTAL NO. OF STAFF ON CHC IS ESSENTIAL - 46 DESIRABLE - 52
BLOCK PUBLIC HEALTH UNIT
STAFF/PERSONNAL ESSENTIAL DESIRABLE
Block Medical Officer/Medical Superintendent
(GDMO preferably with experience in Public
Health/Trained in Professional DevelopmentCourse )
1
Public Health Specialist
(MD Community Medicine/MD(PSM) with
MBA/DPH/MPH) 1
Public Health Nurse (PHN)
(M.Sc. in community health Nursing/Graduate or
Diploma in Nursing with DPHN or training in public
health)
1 +1

47. SPECIALTY MEDICAL SERVICES
STAFF/PERSONNAL ESSENTIAL DESIRABLE
Physician
MD/DNB, (General Medicine)
1
General Surgeon
(MS/DNB, (General Surgery)
1
Obstetrician & Gynecologists
DGO /MD/DNB
1
Pediatrician
DCH/MD (Pediatrics)/ DNB
1
Anesthetists
MD (Anesthesia)/DNB/ DA/
1
GENRAL DUTY MEDICAL OFFICER
General Duty Medical Officer (MBBS) 2
Dental Surgeon (BDS) 1
Medical Officer AYUSH (Graduate in AYUSH) 1

48. NURSING AND PERAMEDICAL STAFF
STAFF/PERSONNAL ESSENTIAL DESIRABLE
Staff Nurse / Nursing Officer 10
Pharmacist 1 +1
Pharmacist – AYUSH 1
Lab. Technician 2
Radiographer 1
Dietician 1
Ophthalmic Assistant 1
Dental Assistant 1
Cold Chain & Vaccine Logistic Assistant 1
OT Technician 1
Multi Rehabilitation worker 1 +1
Counselor 1

49. ADMINISTRATIVE STAFF
STAFF/PERSONNAL ESSENTIAL DESIRABLE
Registration Clerk 2
Statistical Assistant/ Data Entry Operator 2
Account Assistant 1
Administrative Assistant 1
GROUP-D STAFF
Dresser (certified by Red Cross/Johns
Ambulance)
1
Ward Boys/Nursing Orderly 5
Driver* 1 3
Total 46 52

50. HEALTH & WELLNESS CENTER

51. • The National Health Policy, 2017 recommended
strengthening the delivery of primary health
care, through establishment of "Health and
Wellness Centres" as the platform to deliver
comprehensive primary health care.
• AYUSHMAN BHARAT is an attempt to move from
a selective approach to health care to deliver
comprehensive range of services preventive,
promotive, curative, rehabilitative and palliative
care.

52. HEALTH AND WELLNESS CENTER
AYUSHMAN BHARAT has two components which are
complementary to each other. Under it -
1.Establishment of Health and Wellness Centre- In
February 2018, the Government of India's announced the
creation of 1,50,000 Health and Wellness Centres (HWCs) by
transforming existing Sub Centres and Primary Health Centres
as the base pillar of Ayushman Bharat
2.Pradhan Mantri Jan Arogya Yojana (PM-JAY)-
provides health insurance cover of Rs. 5 lakhs per year to over
10 crore poor and vulnerable families for seeking secondary
and tertiary care.

53. HEALTH AND WELLNESS CENTER
• To ensure delivery of Comprehensive Primary Health Care (CPHC)
services, existing Sub Centres covering a population of 3000 -5000
would be converted to Health and Wellness Centres, with the principle
being "time to care" to be no more than30 minutes.
• Primary Health Centres in rural and urban areas would also be
converted to HWC. Such care could also be provided Medical services
Mobile Medical Units, camps, home and community-based care.

54. • The first Health and Wellness Centre was
launched by the Hon’ble Prime Minister at
Jangla, Bijapur, Chhatisgarh on 18TH April 2018.

55. SERVICE TO BE PROVIDED at HEALTH
AND WELLNESS CENTERS
• 1. Care in pregnancy and childbirth.
• 2. Neonatal and infant health care services
• 3. Childhood and adolescent health care services.
• 4. Family planning, Contraceptive services and Other
Reproductive Health Care services
• 5. Management of Communicable diseases: National Health
Programs
• 6. Management of Common Communicable Diseases and
General Out-patient care for acute simple illnesses and minor
ailments
• 7. Screening, Prevention, Control and Management of Non-
Communicable diseases and chronic communicable disease
like TB and Leprosy
• 8. Basic Oral health care
• 9. Care for Common Ophthalmic and ENT problems
• 10. Elderly and Palliative health care services
• 11. Emergency Medical Services
• 12. Screening and Basic management of Mental health ailment

56. HWC Team at sub center
 1 Mid-Level Health Provider
(MLHP)/ CHO -B.Sc./
GNM(General Nursing and
Midwifery) or Ayurveda Practitioner
trained in 6 months Certificate
Programme in Community Health/
Community Health Officer (B.Sc.-
CH).
 2 (ANM) MPW F-as per SHC IPHS
 MPW M- 1 to be provided from
state resource
 5 ASHAs as outreach team per SHC
HWC Team at PHC
 Atleast - 1 MBBS Doctor,
 1 Staff nurses,
 1 Pharmacist,
 1 Lab Technician
 LHV + MPW + ASHAs s
 Service for NCDs and
wellness room PHC

57. Key component
of HWC

58. KEY MILESTONES OF HCW

59. ROLL OUT PLAN ON HWC