HEALTH CARE DELIVERY SYSTEM IN INDIA

HEALTH CARE DELIVERY SYSTEM IN INDIABy Dr. Vaishali BhagatModerator Dr. Chetna Maliye1FRAMEWORK

IntroductionHistorical BackgroundStructural OrganizationHealth care delivery system in India Challenges

Population 125 crores (17.31% of the world's population,)

0- 25 yrs 50% of total population UT 7 States- 29

Sex ratio 943 females per 1000 malesBirth Rate-21.4Death Rate-7IMR-40Under5 mortality rate-52

3IntroductionA Health System is the sum total of all the organisations , institutions and resources whose primary purpose is to improve health ( WHO )Historical background..year Event1864sanitary commissioners appointed in 3 major povinces-Bombay,Madras,Bengal 1888sanitation look after by local bodies1896severe epidemic of plague occur 1904plague commission recommendated reorganization and expansion of public health department

1912GOI decided to help local bodies with grants and sanctioned the appointment of Deputy Sanitary commissioner and health officers

1946Bhore committee appointedYEAR EVENT1947Ministers of centre and state established

1951First 5 yr plan

1952Community development programme launchedCentral council of health constituted to coordinate health policies between central and state gov.

1958Panchayati raj, three tier structure recommendedRajasthan was first state to introduce Panchayati raj

1959Mudaliar committee appointed Health survey and planning committee Strengthening of existing PHC

6YEAR EVENT1963Chadah committee gave the concept of basic health worker

1965Mukherjee committee appointed -Strengthening of administrative set up at different level from PHC to state health services. -Separate staff for family planning1967Jungalwala committee appointed -Integration of health services -Elimination of private practice by gov. doctors

1973Kartar Singh committee appointed -Female health worker and male health worker

YEAR EVENT1974Shrivastav committee appointed Concept of peoples health in peoples hand Creation of MPW and HA Village health guide or community health volunteer.

1981Adopted global strategy of health for all

1985UIP launched1992Child Survival and Safe Motherhood(CSSM) launched1997Reproductive and Child Health programme launched

YEAREVENT2oo5RCH two,JSY,NRHM,IPHS for CHC launched2007

11th 5yr plan, IPHS for subcentres and PHC formulated

2008

NCD programme launched as pilot project2013

NHM,RMNCH+A launched Organizational Structure In India India is union of 29 state and7 union territories.Each state has developed its own system of health care delivery, independent of the central gov.The central gov. responsibility-policy making, planning, guiding, assisting, evaluating and coordinating work of all state ministers. The health system in India has 3 main links 1.central 2.state level 3.peripheral/local

At central levelUnion ministry of health and family welfareThe Directorate general of Health servicesThe central council of Health and Family Welfare

Union Ministry of Health and Family Welfare Headed by Cabinet Minister

Minister of State

Deputy Health Minister

Union Ministry Of Health And Family Welfare

Dep. Of Health Dep. Of Family Welfare Was created in 1966 Secretary to gov. of India Headed by Secretary to gov. India

Joint Secretary Additional Secretary

Deputy Secretary Commissioner Administrative staff Joint Secretary Administrative staff 12

Directorate General of Health Services Principal adviser in both medical and public health matter Directorate General of Health Services[DGHS]

Additional Director General of Health Services Team of Deputies

Administrative Staff Directorate-three main links 1.Medical care and Hospitals 2.Public Health 3.General administration13 Central Council of Health and Family Welfare Chairman- Union Health Minister Member- State Health Minister Functions- 1.To consider and recommend broad outline of policy regarding environment hygiene, nutrition and health education. 2.To make proposal for legislations regarding medical and public health matter.3.To make recommendation to central gov. regarding distribution of grant. At State levelThe State Health administration was started in1919 State list is responsibility of state including provision of 1.Medical care 2.Preventive health services. 3.Pilgrimages within the state

State Ministry of Health and Family WelfareHeaded by Health Minister and Deputy Minister

State Health Directorate and Family WelfareAdministrative Officer-Director of Health ServicesAssisted by Deputy Director and Assistant DirectorChief technical adviser relating to Medicine and Public Health At district level 6 types of administrative area 1)Sub division 2)Tahsils 3)Community development block 4)Muncipalities and corporations 5)Villages 6)Panchayat Panchayati raj3 tier structure of rural local self gov.Link village to districtGram panchayat at village levelPanchayat samiti at block levelZilla parishad at district level Health Care System -Levels Primary Health Care Provided at PHC and sub centre Secondary Health Care Provided at District hospital and CHC

Tertiary Health Care Provided at regional and central level Institution Health Care SystemsIt is represented by 5 major sectors or agencies which differ from each other by health technology applied and by source of fund for operation. 1.Public health sectora)Primary health care PHC Sub centresb)Hospitals/Health centres CHC District hospitals Specialist hospitals Teaching hospitals c) Health insurance scheme Central gov. health scheme Employees state insurance scheme d)Other Agencies Defense services Railways2.Private sector a)Private hospitals,polyclinics,Nursing home and dispensaries b)General practitioners and clinics3.Indian System of Medicine Ayurveda and sidha Unani Homeopathy Unregistered practitioner4.Voluntary Health Agencies5.National Health Programmes

Primary Health Care Delivery systemIn 1977-Rural health scheme on principle of placing peoples health in peoples handsThree tier system of health care delivery system Basic tenet of primary health care is universal coverage village level 1)Anganwadi worker 2)ASHA worker22

Anganwadi Worker Under ICDS prog. 1 AWW for 1000 population Training for 4 month Functions- 1.MCH care2.Family planning3.Immunization 4.Referral services5.Nutrition and education ASHA worker key component of NRHM 1 ASHA for 1000 population Functions-1.VHND2.Health information3.Councelling4.Depot holder5.Information to subcentre,PHC6.Accompany preg.women7.DOTS provider8.National prog. Sub-Centre

Peripheral outpost of existing health care systemOne subcentre for 5,000 population in plain and 3,000 population in hilly tribal,difficult area Manned by at least one ANM / Female Health Worker and one Male Health Worker. Provide services in relation to maternal and child health, family welfare, nutrition, immunization and control of communicable diseases. Provided with basic drugs for minor ailments. Ministry of Health & Family Welfare is providing Central assistance to all the Sub-Centres since April2002152326 Sub Centres functioning in the country as on March 2014. Primary health Centre

One PHC for 30,000 population in plain and20,000 population in hilly,tribal,difficult area

Provide an integrated curative and preventive health care with emphasis on preventive and promotive aspects of health care.

Manned by a Medical Officer supported by 14 paramedical and other staff.

It acts as a referral unit for 6 Sub Centres and has 4 - 6 beds for patients.

There were 25020 PHCs functioning in the country as on March 2014.

Community health CentresOne CHC for 1.20 lakh population in plain area and 80,000 population in hilly, tribal difficult area

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.

It serves as a referral centre for 4 PHCs and also provides facilities for obstetric care and specialist consultations.

As on March, 2014, there are 5,363 CHCs functioning in the country.

Urban health care delivery system in IndiaNUHM is part of NHM launched in2013Special focus on urban slum-By making them available essential health care services and reducing out of pocket expenditure on health

Total % GDP on health expenditure IPHSIPHS launched in 2005Set of uniform standards to improve quality of health care delivery in the countryIPHS for CHC launched in2005 and for PHC and Sub centre launched in 2007It serves as benchmark for assessing functional status of health facilities NHMLaunched in 2013Two submission 1)NRHM in 2005 2)NUHM in2013Main components are Health system strengthening in rural and urban area-reproductive-maternal-neonatal-child and adolescent health and communicable, NCDIt envisages achievement of universal access to equitable,affordable and quality health care services that are accountable and responsive to peoples needNHM has 6 financing componentsNRHM RCH flxipoolNUHM-flexipoolFlexi pool for communicable diseasesFlexi pool for NCD including injury and traumaInfrastructure maintenanceFamily welfare control sector component ChallengesPopulation of IndiaIncreased burden of diseaseLow % of GDP on health expenditureReferences:Park Textbook of Preventive and Social Medicine,23rd edition,Prem Nagar,Jabalpur(M.P.),India:Banarsidas Bhanot;2015SRS Bulletin2014WHO,Global health expenditure databaseNHM,Ministry of Health and Family Welfare,GOI

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