HEALTH CARE DELIVERY SYSTEM

HEALTH CARE DELIVERY SYSTEM IN INDIA

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.

Selected health care 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.
 Health care services: It is defined as ―multitude of services rendered to
individuals, families or communities by the agents of the health services
or professions for the purpose of promoting, maintaining, monitoring or
restoring health.

Definitions of health care delivery:

1. Health care delivery system 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.
-Stanhope(2001)

2. It implies the organization, delivery staffing regulation and quality control.

J.C.Park(2001)

Philosophy of Health Care Delivery System:

 Everyone from birth to death is part of the market potential for health care
services.
 The consumer of health care services is a client and not customer.
 Consumers are less informed about health services than anything else they
purchase.
 Health care system is unique because it is not a competitive market.
 Restricted entry in to the health care system.

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.

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. Supports the establishment of community based, community controlled
health-care system.
5. Emphasizes on quality assurance of the care
6. Supports health care as basic human right for all people.
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.

The health system in India has 3 main links

1. Central

2. State and

3. Local or peripheral
1. At the central:- The official “organs” of the health system at the national
level consist of-

1. Ministry of Health and Family Welfare

2. The Directorate General of Health Services

3. The Central Council of Health and Family Welfare

1. Ministry of Health and Family Welfare

Functions:- Ministry of Health and Family Welfare.

Union list

1. International health relations and administration of port quarantine

2. Administration of Central Institutes such as All India Institute of Hygiene and

Public Health, Kolkata.
3. Promotion of research through research centers

4. Regulation and development of medical, pharmaceutical, dental and nursing

Professions

5. Establishment and maintenance of drug standards

6. Census and collection and publication of other statistical data

7. Immigration and emigration

8.Regulation of labor in the working of mines and oil fields

9. Coordination with states and with other ministries for promotion of health

Concurrent list:-The functions listed under the concurrent list are the
responsibility of both the union and state governments.

1. Prevention and extension of communicable diseases

2. Prevention of adulteration of food stuffs

3. Control of drugs and poisons

4. Vital statistics

5. Labor welfare

6. Economic and social planning

7. Population control and Family Planning

8. Preparation of health education material for creating health awareness

through Central Health Education Bureau.

9. Collection, compilation, analysis, evaluation an dissemination of information

through the Central Bureau of Health Intelligence

10. National Medical Library

 2. The Directorate General of Health Services

FUNCTIONS OF D.G.H.S

1) International health relations and quarantine of all major ports in country

and International airport
2) Control of drug standards
3) Maintain medical store depots
4) Administration of post graduate training programmes
5) Administration of certain medical colleges in India
6) Conducting medical research through Indian Council of Medical
Research
7) Central Government Health Schemes
8) Implementation of national health programmes
9) Preparation of health education material for creating health awareness
through Central Health Education Bureau
10) Collection, compilation, analysis, evaluation and dissemination of
information through the Central Bureau of Health Intelligence
11) National Medical Library
 3. The Central Council of Health and Family Welfare

Functions of Central Council Of Health

1. To consider and recommend broad outlines of policy regard to matters
concerning health like environment hygiene, nutrition and health
education.
2. To make proposals for legislation relating to medical and public health
matters.
3. To make recommendations to the central government regarding
distribution of grants-in-aid.

2. State level
 Functions of state health Director:
(1) Studies in depth the health problem and needs in the state and plans
scheme to Solve them.
(2) Providing curative &preventive services.
(3) Provision for control of milk and food sanitation.
(4) Prevention of any outbreak of communicable diseases.
(5) Promotion of health education
(6) Promotion of health programmes such as school health, family
planning, occupational health
(7) Supervision of PHC
(8) Establishing training courses for health personnel
(9) Co-ordination of all health services with other minister of state such
as minister of education, central health minister & voluntary agency

At the district level

There are 739 ( year 2020 ) 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

1) Most district in India are divided into two or more subdivision, each
incharge of an Assistant Collector or Sub Collector
2) Each division is again divided into talukas, incharge of a tahsildhar. A
taluka usually comprises between 200 to 600 villages
3) The community development block comprises approximately 100
villages and about 80000 to1,20,000 population, in charge of a Block
Development Officer.
4) Finally, there are the village panchayats, which are institutions of rural
local self-government.

The urban areas of the district are organized into-

a) Town Area Committees (in areas with population ranging between

5,000 to10,000
 b) Municipal Boards (in areas with population ranging between 10,000 and
2,00,000)
c) Corporations (with population above 2,00,000)
d) The Town Area Committees are like panchayats. They provide sanitary
services.
e) The Municipal Boards are headed by Chairmen/President, elected by
members.

The functions of Municipal Board:

 Construction and maintenance of roads

 Sanitation and drainage
 Street lighting
 Water supply
 Maintenance of hospitals and dispensaries
 Education and
 Registration of births and deaths etc

Panchayat Raj

The panchayat raj is a 3-tier structure of rural local self-government in India

linking the village to the district. It includes

1) Panchayat (at the village level)

2) Panchayat Samiti( at the block level)
3) Zila Parishad(at the district level

Panchayat (at the village level): The Panchayat Raj at the village level consists
of-

a) The Gram Sabha

b) The Gram Panchayat
The Gram Sabha:It is the assembly of all the adults of the village, which meets
at least twice a year. The gram sabha considers proposals for taxation,and elect
members of The Gram Panchayat.

The Gram Panchayat:- It is the executive organ of the gram sabha and an
agency for planning and development at the village level. The population
covered varies from5000 to 15000 or more. The members of panchayat hold
offices for a period of 3to4 years.Every panchayat has an elected president
(Sarpanch or Sabhapati or Mukhia), a vice president and panchayat secretary. It
covers the civic administration including sanitation and public health and work
for the social and economic development of the village

Panchayat Samiti (at the block level):

The block consists of about 100 villages and apopulation of about 80,000 to
1,20,000. The panchayat samiti consists of Sarpanch, MLAs, MPs residing in
block area, representative of women, SC, ST and cooperative societies. The
primary function ofThe Panchayat Samiti is the execute the community
development programme in the block. The Block development Officer and his
staff give technical assistance and guidance in development work.

Zila Parishad (at the district level):- The Zila Parishad is the agency of rural
local self -government at the district level. The members of Zila parishad
include all heads of panchayat samiti in the district, MPs, MLAs, representative
of SC, ST and women and 2 persons of experience in administration, public life
or rural development. Its functions and powers vary from state to state.

Primary healthcare in India

It is a three-tier system of healthcare delivery in rural areas based on the

recommendations of the Shrivastav Committee in 1975.
1. Village level: The following schemes are operational at the village level:
a. Village health guides scheme: Started in 1977, now replaced by ASHA.
b. Training of local dais; started under rural health scheme,training of local dias
for 30 days,now not preferred.
c. ASHA: Under NRHM , important link between community and health
services.
d. AWW-Under ICDS, for every 400-800 population.
2. Sub-centre level: This is the peripheral outpost of the existing health
delivery system in rural areas. 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. Each sub-centre is manned by one
male and one female multipurpose health worker.

Functions
a. Mother and child healthcare
b. Family planning
c. Immunization
d. IUD insertion
e. Simple laboratory investigations
3. Primary health centre level: The Bhore committee in 1946 gave the concept
of a primary health centre as a basic health unit to provide as close to the people
as possible. The Bhore committee aimed at having a health centre to serve a
population of 10,000 to 20,000. 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.

Functions of the PHC

a. Medical care.
b. MCH including family planning.
c. Safe water supply and basic sanitation.
d. Prevention and control of locally endemic diseases.

e. Collection and reporting of vital statistics.

f. Education about health.
g. National health programmes as relevant.
h. Referral services.
i. Training of health guides, health workers, local dais, and health assistants.
j. Basic laboratory services
.

Community health centres As on 31st March 2003, 3076 community health

centres were established by upgrading the primary health centres, each CHC
covering a population of 80,000 to 1.20 lakh with 30 beds and specialist in
surgery, medicine, obstetrics and gynecology, and pediatrics‘ with x-ray and
laboratory facilities. Functions
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 cases including surgical interventions.
5. Full range of family planning services including laparoscopic 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 national health programmes should be delivered.
11. Blood shortage facility.
12. Essential laboratory services.
13. Referral services.