The document discusses India's health care delivery system at different levels from central to state to district and community. It outlines the organization and functions of the system including the roles of various ministries, directorates, and centers. It also discusses the philosophy, goals, principles and functions of the health care delivery system. Current issues and challenges facing the system are also summarized such as gaps in infrastructure and manpower as well as the increasing burden of communicable and non-communicable diseases.

2. HEALTH CARE
DELIVERY SYSTEM

3. INTRODUCTION
• Health is the birth right of every individual. Today
health is considered more than a basic human right;
it has become a matter of public concern, national
priority and political action. Our health system has
traditionally been a disease-oriented system but the
current trend is to emphasize health and its
promotion.

4. DEFINITIONS:
HEALTH:
According to WHO, health is defined as “a dynamic state of complete
physical, mental and social well-being not merely an absence of disease
or infirmity”.

5. HEALTH CARE SERVICES:
It is defined as “multiple services rendered to individuals, families or
communities by the purpose of promoting, maintaining, monitoring or
restoring health.”

6. HEALTH CARE DELIVERY SYSTEM:
According to Stanhope (2001), refers to the totality of resources that a
population or society distributes in the organization and delivery of
health population services. It also includes all personal and public
services performed by individuals or institutions for the purpose of
maintaining or restoring health.

7. PHILOSOPHY OF HEALTHCARE
DELIVERY SYSTEM:
1. Everyone from birth to death is part of the potential for health care
services.
2. The consumer of health care services is a client and not customer.
3. Consumers are less informed about health services than anything
else they purchase.
4. Health care system is unique because it is not a competitive market.
5. Restricted entry into the health care system.

8. GOALS/ OBJECTIVES OF HEALTH
CARE DELIVERY SYSTEM:
1. To improve the health status of population and the clinical outcomes
of care.
2. To improve the experience of care of patients, families and
communities.
3. To reduce the total economic burden of care and illness.
4. To improve social justice equity in the health status of the
population.

9. PRINCIPLES OF HEALTH CARE
DELIVERY SYSTEM:
1. Supports a coordinated, cohesive health-care delivery system.
2. Opposes the concept that fee-for-practice.
3. Supports the concept of prepaid group practice.
4. Emphasizes on equality assurance of the care.
5. Supports health care as basic human right for all people.
6. Supports the establishment of community based, community controlled
health-care system.
7. Urges an emphasis be placed on development of primary care.
8. Opposes the accrual of profits by health care related industries.

10. FUNCTIONS OF HEALTH CARE
DELIVERY SYSTEM:
1. To provide health services.
2. To raise and pool the resources accessible to pay for health care.
3. To generate human and physical sources that makes the delivery
service possible.
4. To set and enforce rules of the game and provide strategic direction
for all the different players involved.

11. CHARACTERISTICS OF HEALTH
CARE DELIVERY SYSTEM:

12. ORGANIZATION OF THE HEALTH CARE
DELIVERY SYSTEM AT DIFFERENTLEVELS:
India is a union of 29 states and 7 union territories.
States are largely independent in matters relating to the
delivery of health care to the people.
Each state has developed its own system of health care
delivery, independent of the Central Government.
The Central Government’s responsibility consists mainly of
policy making , planning , guiding, assisting, evaluating and
coordinating the work of the State Health Ministries.

13. • INDIA HAS 3 MAIN LINKS

14. I) AT THE CENTRALLEVEL:
• The centre makes the policy, plans, guidelines and assists and
coordinates the activities of state health ministries. It also administers
union-territories.
• The organization of health system at the centre level constitutes:

15. 1. UNION MINISTRY OF HEALTHAND
FAMILY WELFARE:
• Responsible for framing the health policy and for the programmes that
are related to family planning in India.
• It is headed by ministry of health and family welfare who is a member
of council of ministers and holds cabinet rank and assisted by ministry
of state for health and family welfare.
• It has three departments:
a. Department of health.
b. Department of family welfare.
c. Department ofAYUSH.

16. a) DEPARTMENT OF HEALTH:
• This department deals with health related issues including preventive
aspects.
• It has 8 bodies and 13 departments under its administrative control.

17. SR.
NO.
BODIES SR.
NO.
DEPARTMENTS
1. National AID’S Control Society(NACS) 1. National AIDS Control Programme
2. Medical Council Of India 2. National Cancer Programme
3. Dental Council Of India 3. National Filaria Control Programme
4. Pharmacy Council Of India 4. National Iodine Deficiency Disorders Control Programme
5. Indian Nursing Council 5. National Leprosy eradication programme
6. All Indian Institute Of Speech And Hearing (AIISH) Mysore 6. National programme for control of blindness
7. All India Institute Of Physical Medicine And Rehabilitation
(AIIPMR) Mumbai
7. National mental health programme
8. Hospital Services Consultancy Corporation Limited (HSCC) 8. National programme for prevention and control of deafness
9. National tobacco control programme
10. National vector borne disease control programme ( NVBDCP)
11. Pilot programme on prevention and control of diabetes, CVD &
stroke
12. Revised national TB control programme
13. Universal immunizational programmes

18. b) DEPARTMENT OF FAMILYWELFARE:
• Deals issues related with family welfare.
• It has following centers & institutions under its administrative control:
National Institute of Health and Family Welfare (NIHFW), South Delhi.
International Institute for Population Sciences (IIP S), Mumbai.
Central Drug Research Institute (DRI), Lucknow.
Indian Council of Medical Research (ICMR), New Delhi.
Eighteen(18) Population Research Centers (PRCs) at six universities and 6 other institutions
across 17 states.

19. c) DEPARTMENT OFAYUSH:
• Earlier established as Department of Indian systems of medicines and
homeopathy (ISM & H) in 1995, re-named in Nov.2003.

20. UNION MINISTRY OF HEALTH AND FAMILYWELFARE
HEADED BY
CABINET MINISTER
MINISTER OF STATE
DEPUTY HEALTH MINISTER
DEPARTMENTOF
HEALTH
DEPARTMENT OF
FAMILYWELFARE
DEPARTMENT OF
AYUSH
SECRETARYTO
GOVT. OF INDIA
(EXCECUTIVE HEAD)
JOINT SECRETARIES
DEPUTY
SECRETARIES
LARGE
ADMINISTRATIVESTAFF
SECRETARYTO GOVT. OF INDIA
(MINISTRY OF HEALTH & FAMILY
WELFARE)
SECRETARYTOGOVT.
OF INDIA
ADDITIONAL SECRETERYAND
COMMISSIONER (FAMILYWELFARE)
JOINT SECRETARIES - 1
DEPUTY
SECRETARIES
LARGE
ADMINISTRATIVE STAFF
JOINT SECRETARIES - 1
DEPUTY
SECRETARIES
LARGE
ADMINISTRATIVE STAFF

21. 2. THE DIRECTORATE GENERAL OF
HEALTH SERVICES:
ORGANIZATIONAL PATTERN:
DIRECTORATE GENERAL OF HEALTH SERVICES
DIRECTOR GENERAL OF HEALTH SERVICES
ADDITIONAL DIRECTOR GENERAL OF HEALTH SERVICES
DEPUTY DIRECTOR GENERAL OF HEALTH SERVICES
ADMINISTRATIVE STAFF

22. FUNCTIONS:

23. 3. THE CENTRAL COUNCILOF
HEALTH:
• Was set up by Presidential order on 9th August 1952 under article 263
of the constitution of India.
UNION HEALTH MINISTER
( CHAIRMAN )
STATE HEALTH MINISTERS
( MEMBERS )

24. FUNCTIONS:
1) Broad outlines of policy concerning health & its aspects.
2) Proposals for legislation.
3) Recommendations to the central Government.
4) To establish any organization.

25. II) AT THE STATELEVEL:
The health subjects are divided into three groups: federal, concurrent and state.
The state list is the responsibility of the state, including provision of medical
care, preventive health services and pilgrimage within the state.
STATE HEALTH ADMINISTRATION:
At present there are 29 states in India, each state having its own health
administration.

26. ORGANIZATION PATTERN:
1. STATE MINISTRY OF HEALTH:
STATE MINISTRY OF HEALTH
DEPUTY MINISTRY OF HEALTHAND
FAMILYWELFARE
HEALTH SECRETARY
DEPUTYSECRETARY
ADMINISTRATIVE STAFF

27. FUNCTIONS:
Health services provided at the same level:
• Rural health services through minimum needs programme.
• Medical development programme.
• M.C.H., family welfare and immunization programme.
• NMIP and NFCP.
• NLEP, NTCP, NPCB, Prevention and control of communicable diseases.
• School health programme, nutrition programme, & national goitre
programme.
control
• Laboratory services and vaccine production units.
• Health education & training programme, curative services, national Aids control
programme.

28. 2. STATE HEALTH DIRECTORATE:
DIRECTOR OF MEDICAL
EDUCATION
DEAN OF MEDICAL
COLLEGE
STATE NURSING
SUPERINTENDENT
HOSPITAL EDUCATION
NURSING
SUPERINTENDENT
NURSING OFFICER
DIRECTOR OF HEALTH
SERVICES
ADDITIONAL DIRECTOR OF
HEALTH SERVICES
DEPUTY DIRECTOR OF
HEALTH SERVICES
REGIONAL FUNCTIONAL
MCH, TB, LEPROSY, IMMUNIZATION
WARD INCHARGE
NURSING STAFF
SENIORTUTOR
JUNIOR TUTOR

29. FUNCTIONS:
• To study the health problems.
• To provide curative and preventive services.
• To make provision for control of milk and food sanitation.
• To take all the remedial action at the time of outbreak of communicable diseases.
• To establish and maintain central laboratories for preparation of vaccines.
• To promote health awareness among people.
• To collect, tabulate and publish vital statistics.
• To promote all the health programmes.
• To recruit health personnel for the rural health services.
• Supervision of PHC & staff.
• Planning & carrying out surveys on health related matters.
• Establishing training courses, etc.
• Coordinating of all health services with other states.

30. III) AT THE DISTRICT LEVEL:
There are 725 ( as of 2019 ) districts in India. Within each district, there are 6 types
of administrative areas.
1. Sub –division
2. Tehsils ( Talukas )
3. Community Development Blocks
4. Municipalities and Corporations
5. Villages and
6. Panchayats
 Most district in India are divided into two or more subdivision, each incharge
of an Assistant Collector or Sub Collector.
 Each division is again divided into talukas, incharge of a Tehasildar. A taluka
usually comprises between 200 to 600 village selected from different wards of
the city.

31. The community development block comprises approximately 100 villages
and about 80000 to 1,20,000 population, in charge of a Block Development
Officer.
Finally, there are the village panchayats, which are institutions of rural local
self-government.
Town Area Committees (in areas with population ranging between 5,000
to10,000
Municipal Boards (in areas with population ranging between 10,000 and
2,00,000)
Corporations (with population above 2,00,000)
The Town Area Committees are like panchayats. They provide sanitary
services.
The Municipal Boards are headed by Chairmen /President, elected by
members.

32. SUB-DIVISIONAL / TALUKALEVEL:
• At the Taluka level, healthcare services are rendered through the office
of Assistant District Health and Family Welfare Officer (ADHO).
• Medical officers of health, lady medical officers and medical officers
of general hospital assist the ADHO.
• Specialties are made available.
• Converted into community health centers (CHC’s).

33. COMMUNITY LEVEL:
• Effective referral support leads to successful primary
programme.
healthcare
• One Community Health Centre (CHC) has been established for every
80,000 to 1,20,000 population of rural areas.
• This centers provide the basic speciality in general medicine,
pediatrics, surgery, obstetrics and gynecology.

34. PRIMARY HEALTH CENTRES (PHC)
LEVEL:
• At present there is one primary health centre covering about 30,000 (20,000 in
hilly, dessert & difficult terrains) or more population.
• Rural dispensaries have upgraded to create PHCs.
• STAFFING PATTERN:
SR.NO. STAFF MEMBERS NUMBER
1. Medical Officer 1
2. 2 Health Assistant – Male
- Female
1
1
3. Health Workers F (ANM) 1
4. Pharmacist 1
5. Nurse midwife 1

35. SUB CENTRE LEVEL:
• Peripheral outpost of the existing health delivery system in rural areas.
• One sub-centre for every 5,000 population in general.
• One sub-centre for every 3,000 population in hilly tribal and backward
areas.
• STAFF PATTERN:
• 1 female health worker – Auxiliary nurse midwife
• 1 male health worker – Multipurpose worker
• Voluntary worker to help the Auxillary nurse midwife
•1 Female Health Assistant (Lady Health Visitor)
and 1 Male Health Assistant at the PHC level
Supervise the 6 sub-centers.

36. SERVICES PROVIDED:
• Antenatal, Natal, Postnatal Care
• Family Planning and Counseling
• Treatment Of Common Illnesses Like Respiratory Tract Infections,
Diarrhea, Fever, Worm Infestation
• Prevention Of Malnutrition
• Implementation Of Various National Health Programmes

37. CURRENT PROBLEMS FACED BY THE
HEALTH CARE SERVICES:
The following are the problems faced by the health care services:
• Persistent gap in manpower and infrastructure in government sector.
• Sub optimal functioning of infrastructure; poor referral services.
• Plethora of hospitals in government, voluntary and private sector not having appropriate
manpower, diagnostic and therapeutic services and drugs.
• Availability and utilization of services that are poorest in the remote rural areas in states
and districts.
• Increasing dual diseases burden of communicable and non-communicable diseases because
of ongoing demographic, lifestyle and environmental transitions.
• Technological advances that widen the spectrum of possible interventions.
• Increasing awareness and expectations of population regarding health care services.
• Escalating costs of health care.

38. CHALLENGES FOR THE HEALTH
SYSTEM IN INDIA:
• Currently there are several challenges that Indian health system is
facing.
• These are:
Old world diseases like T.B. and malaria are yet to be controlled.
The rapid transmission of HIV/AIDS.
Coronary heart disease & diabetes are diseases with major behavioral
components in its causation and prevention.
Birth rate and growth rates are a matter of great concern.
Medical education is also of great concern.

39. CURRENT RESEARCHES:

40. 2. Kirti Sundar Sahu, Bhavna Bharati conducted a community-based, cross-sectional
survey on Out-of-Pocket Health Expenditure and Sources of Financing for Delivery,
Postpartum, and Neonatal Health in Urban Slums of Bhubaneswar, Odisha, India.
Among a sample of 240 recently delivered women. Only 29.6% of the households
incurred OOPE, and the others incurred either nil OOPE or had a net income because
of benefits received from Janani Shishu Suraksha Karyakram (JSSK), Janani
Suraksha Yojana (JSY), and “Mamata” schemes of the government. The median total
OOPE was found to be 2100 INR (100–38,620). Multivariate analysis found parity,
place of delivery, type of delivery, and presence of morbidity to be significantly
associated with incurring any OOPE. Nearly 15% of the households incurred OOPE
exceeding 40% of the reported monthly household income including 9%, whose
OOPE was 100% or more of the reported household monthly income.
• Conclusion: While mechanisms such as JSSK, JSY, and Mamata had benefitted the
vast majority, around half of those who did incur OOPE experienced catastrophic
expenditure (CE). Additional insurance facility for cesarean section delivery might
reduce the excessive financial burden on households.

41. SUMMARY:

42. CONCLUSION:
• Health care delivery is a complex and difficult subject in country
with so many poor people. There have been significant advances
in the health care system in India over few decades. Despite these
recent strides the health system remains ineffective in providing
basic minimum care as promised in the Indian constitution. The
fiscal constrains on the government make it obligatory for the
private healthcare providers to take over part of the
responsibilities. New ways for establishing, strengthening and
sustaining the public-private co-operation are essential for
rejuvenating the system.

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