HEALTH CARE DELIVERY SYSTEM.pptx.....................

HEALTH CARE
DELIVERY SYSTEM IN
INDIA

INTRODUCTION
 India is a union of 28 states and 8 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 Responsibility Consists Mainly
Of Policy Making, Planning, Guiding, Assisting,
Evaluating And Coordinating The Work Of The State
Health Ministries.

The Health System In India Has 3 Main Links
1. Central
2. State
3. Local Or Peripheral

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

UNION MINISTRY OF HEALTH AND FAMILY
WELFARE
• The Union Ministry Of Health And Family Welfare is headed by a
cabinet minister, a minister of state, and a deputy health minister.
• These are political appointment and have dual role to serve
political as well as administrative responsibilities for health.
Currently the union health ministry has the following departments:
1. Department Of Health
2. Department Of Family Welfare
3. Department Of Indian System Of Medicine And Homoeopathy

UNION MINISTRY OF HEALTH AND
FAMILY WELFARE
Organization Pattern
Cabinet Minister
↓
Department of Health Department of Family Welfare
↓
↓
Joint Secretary Additional Secretary
↓ ↓
Deputy Secretary Commissioner
↓ ↓
Administrative staff Joint Secretary
↓
Administrative staff

FUNCTIONS OF DEPARTMENT OF HEALTH

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.
 Prevention Of Communicable Diseases
 Prevention Of Adulteration Of Food Stuffs
 Control Of Drugs And Poisons
 Vital Statistics
 Labor Welfare
 Ports Other Than Major
 Economic And Social Planning
 Population Control And Family Planning
 Preparation Of Health Education Material For Creating Health Awareness
Through Central Health Education Bureau.
 Collection, Compilation, Analysis, Evaluation And Dissemination Of
Information Through The Central Bureau Of Health Intelligence
 National Medical Library

D E PA RT M E N T O F FA M I LY W E L FA R E
• It was created in 1966 within the Ministry of Health and Family Welfare.
• The secretary to the Government of India in the Ministry of Health and Family
Welfare is in overall charge of the Department of Family Welfare. He is
assisted by an additional secretary and commissioner, and one joint secretary.
The following divisions are functioning in the department of family welfare.
1. Programme appraisal and special scheme.
2. Technical operations: looks after all components of the technical
programme viz. Sterilization/IUD/Nirodh, post- partum, maternal and child
health, UPI, etc.
3. Maternal and child health.
4. Evaluation and intelligence: helps in planning, monitoring and evaluating
the programme performance and coordinates demographic research.
5. Nirodh marketing supply/ distribution .

F U N C T I O N S
• To organize family welfare programme through family
welfare centers.
• To create an atmosphere of social acceptance of the
programme and to support all voluntary organizations
interested in the programme.
• To educate every individual to develop a conviction
that a small family size is valuable and to popularize
appropriate and acceptable method of family planning.
• To disseminate the knowledge on the practice of
family planning as widely as possible and to provide
service agencies nearest to the community

DEPARTMENT OF INDIAN SYSTEM OF
MEDICINE AND HOMOEOPATHY
• It Was Established In March 1995 And Had Continued To
Make Steady Progress.
• Emphasis Was On Implementation Of The Various Schemes
Introduced Such As Education, Standardization Of Drugs,
Enhancement Of Availability Of Raw Materials, Research And
Development, Information, Education And Communication
And Involvement Of Ism And Homeopathy In National Health
Care.
• Most Of The Functions Of This Ministry Are Implemented
Through An Autonomous Organization Called DGHS

DIRECTORATE GENERAL OF
HEALTH SERVICES
• The DGHS is the principal adviser to the union government
in both medical and public health matters.
• He is assisted by a team of deputies and a large
administrative staff.
The Directorate Comprises Of Three Main Units:
i. Medical Care And Hospitals.
ii. Public Health .
iii. General Administration.

DIRECTORATE GENERAL OF HEALTH
SERVICES
Directorate General Of Health Services
↓
Director General Of Health Services
↓
Additional Director General Of Health Service
↓
Deputy Directorate General Of Health Services
↓
Administrative Staff

F U N C T I O N S
• International health relations and quarantine of all major ports in
country and international airport
• Control of drug standards
• Maintain medical store depots
• Administration of post graduate training programs
• Administration of certain medical colleges in India

• Conducting medical research through Indian council of medical
research
• Central government health schemes.
• Implementation of national health programmes
• Preparation of health education material for creating health awareness
through central health education bureau.
• Collection, compilation, analysis, evaluation and dissemination of
information through the central bureau of health intelligence
• National medical library

CENTRAL COUNCIL OF HEALTH:
The central council of health was set up by a presidential on 9 august, 1952 under
article 263 of the constitution of India for promoting coordinated and concerted action
between the centers and states the implementation of all the programmes and
measures pertaining o the heath of the nation
Chairman
(Union Health Minister)
↓
Members (State Health Minister)

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

At present there are 28 states in INDIA, with each
state having its own health administration.
The management sector comprises of
1. State Ministry Of Health
2. State Health Directorate

State Ministry of Health & family welfare
↓
Deputy Minister of Health and Family Welfare
↓
Health Secretary
↓
Deputy Secretaries
↓
Administrative staff

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 806 Districts In India.
• The principle unit of administration in India.
• Districts are known as ‘zila’
• With each district again, there are 6 types of administrative
areas.
1. Sub –Division
2. Tehsils(talukas )
3. Community Development Blocks
4. Municipalities And Corporations
5. Villages
6. Panchayats

The administration at district level is being
described under 2 headings:
• Urban Administration
• Rural Administration(Panchayati Raj)

URBAN ADMINISTRATION
The Main Units Of Urban Administration Are:
• Municipal Corporation: It can be said as a top level urban local
government. it is constituted where the population of city is above 2
lakhs. It is headed by mayor and municipal commissioner.
• Municipality (Municipal Boards): It is constituted where the
population of city or town ranging between 10,000 to 2 lakhs. it has three
components: chairman, board and municipal commissioner or executive
officer. municipality is headed by the chairman who is elected by board
members.
• Town Area Committees: Commonly towns are such areas, which are in
between village and city. town area committee is under the
administration of district collector. town area committees cover the
population ranging between 5,000 to 10,000 and responsible for
sanitation in the area

The Functions Of Municipal Board:
 Construction and maintenance of roads sanitation
and drainage
 Street Lighting
 Water Supply
 Maintenance of hospitals and dispensaries
 Education
 Registration of births and deaths etc

RURAL ADMINISTRATION
 Most District in India are divided into two or more subdivision,
each in charge of an assistant collector or sub collector
 Each Division Is Again Divided Into Talukas, Incharge Of A
Tahsildar. A Taluka Usually Comprises Between 200 To 600
Villages
 The Community Development Block comprises approximately
100 villages and about 80,000 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. ,

Mr. Kranthi Kumar Pati I.A.S,. District
Collector, Coimbatore.

PANCHAYAT RAJ SYSTEM
• It is described as the pillar of village administration
• Under this system every village was self sufficient
and whole administration was in the hands of
panchayat, whose head was called “Sarpanch”
• Panchayati Raj institutes village local government
that plays a significant role in the development of
villages especially in areas like primary education,
health, agricultural developments, women and child
development and women participation in local
government

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
 Panchayat (At The Village Level)
 Panchayat Samiti ( At The Block Level)
 Zila Parishad (At The District Level)

The Gram Sabha:
 A Gram Sabha is a vital component of the Panchayati Raj
system in India, serving as the grassroots-level democratic
institution.
 The Gram Sabha consists of all the registered voters within a
village or group of villages that form a Gram Panchayat.
 It is the primary body through which villagers participate
directly in the administration and development of their local
area

 Assembly of all adults
 Must meet at twice in 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 From 5000 To 15000 Or More.
 The Members Of Panchayat Hold Offices For A Period Of 3 to 4
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

Nyaya panchayat
• Nyaya panchayat is also called Panchayat Adalat is set up for
every three- or four-Gram Panchayats
• These Panchayats exist only in some states
FUNCTIONS: They ensure quick and inexpensive justice to
villager

Panchayat Samiti (At The Block Level):
 The Block Consists of about 100 villages and a population 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 of the 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.

Zilaparishad (At The District Level):
 The Zilaparishad is the agency of rural local self
government at the district level .
 The members of zilaparishad 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.
 Functions : Maintenance of primary and secondary schools,
hospitals, dispensaries, minor irrigation works, promotes
local industries and art.Planning and Development,
Education, Social Welfare, Public Distribution System

S U B C E N T R E
The sub Centre is the peripheral outpost of the
existing health delivery system in rural areas.
Population coverage : 1 subcentre for every 5000
population in general & 1 subcentre for every 3000
population in hilly, tribal & backward areas.
As on March 2010, 1,47,069 sub centres were
established in the country.
A subcentre provides interface with the
community at the grass root level, providing all the
primary health care services.

TYPES OF SUBCENTRE
Type A
• Type A Sub Centre will provide all recommended services except that
the facilities for conducting delivery will not be available here.
However, the ANMs have been trained in midwifery, they may
conduct normal delivery in case of need.
Type B (MCH Sub-Centre)
This would include following types of Sub-centres:
Centrally or better located Sub-centres with good connectivity to
catchment areas.
They have good physical infrastructure preferably with own buildings,
adequate space, residential accommodation and labour room facilities.
They already have good case load of deliveries from the catchment
areas.
There are no nearby higher level delivery facilities.

F U N C T I O N S O F S U B C E N T R E
1. Maternal health care
• Antenatal care
• Intranatal care
• Postnatal care
2. Child health care
3. Family planning and contraception
4. Counselling and appropriate referral for safe abortion service (MTP).
5. Adolescent health care ; Education, counselling and referral.
6. Assistance to school health services.
7. Water quality monitoring.
8. Promotion of sanitation including use of toilet and appropriate garbage
disposal.
9. Field visits by appropriate health workers for disease surveillance, family
welfare services including STI, RTI awareness.

10. Community need assessment.
11. Curative services for minor ailments including fever,
diarrhoea, worm infestation and first-aid, appropriate and
prompt referral if needed.
12. To organize Health Day at anganwadi centres at least once
in a month.
13. To provide AYUSH treatment.
14. Training of Traditional Birth Attendants and ASHA/
community health volunteers.
15. Co-ordinate services of anganwadi workers, ASHA, village
health and sanitation committee etc.
16. National health programmes

STAFF FOR SUB CENTRE
S.No Staff For Sub
Centre
Existing Proposed
1 Health Worker (Female)
/ANM
1 2
2 Health worker (Male) /
MPW
1 1
3 Voluntary Worker 1 1
TOTAL 2/3 3/4

PRIMARY HEALTH CENTRE
Basic health unit to provide an integrated curative and
preventive health care to the rural population with
emphasis on preventive and promotive aspects of
health care.
PHC is the first contact point between village
community and the Medical Officer.
The PHCs were envisaged to provide an
integrated curative and preventive health care to
the rural population

PRIMARY HEALTH CENTRE
 The PHCs are established and maintained by the State
Governments.
 At present, a PHC is manned by a Medical Officer supported
by 14 paramedical and other staff.
 It acts as a referral unit for 6 SubCentres.
 It has 4 - 6 beds for patients.
 The activities of PHC involve curative, preventive, promotive
and Family Welfare Services.

 Population coverage
National Health Plan (1983) proposed
One PHC for every…..30,000 pop in Rural areas
One PHC for every…..50,000 pop in Urban areas
One PHC for every…..20,000 pop in hilly and
tribal areas..

CLASSIFICATION OF PHC
From the service delivery angle, PHCs may be classified
into two types, depending upon the delivery case load :
•TYPE A PHC : PHC with delivery load of less than 20
deliveries in a month
•TYPE B PHC : PHC with delivery load of 20 or more
deliveries in a month
•All services provided by PHCs have been classified
as; - Essential (Minimum Assured Services) or -
Desirable (which all States/UTs should aspire to
achieve at this level of facility)

S E R V I C E S AT T H E P R I M A R Y H E A LT H C E N T R E F O R M E E T I N G T H E I P H S
1. MEDICAL CARE :
A. OPD services : 4 hours in the morning and 2 hours in the
afternoon/evening. Time schedule will vary from state to state.
Minimum OPD attendance should be 40 patients per doctor
per day
B. 24 hours emergency services: appropriate management of
injuries and accident, First-aid, stabilization of the condition of
patient before referral, dog bite/snake bite/ scorpion bite cases,
and other emergency conditions;
C. Referral services
D. In-patient services (6 beds)

2. Maternal And Child Health Care
 Antenatal care
 Intranatal care
 Postnatal care
 Child care
3. Full range of family planning services including counselling and
appropriate referral for couples having infertility.
4. Medical termination of pregnancy using manual vacuum
aspiration technique, wherever trained personnel and facility exists.
5. Health education for prevention and management of RTl/STI.
6. Nutrition Services: Diagnosis and management of malnutrition,
anaemia and vitamin A deficiency and coordination with ICDS.
7. School health services.

8. Adolescent health care.
9. Disease surveillance and control of epidemics.
10. Collection and reporting of vital events.
11. Promotion of sanitation including use of toilet and appropriate
garbage disposal.
12. Testing of water quality and disinfection of water sources.
13. National health programmes.
14. Appropriate and prompt referral of cases needing special care and
providing transport facilities either by PHC vehicle or other available
referral transport. The funds should be made available for referral
transport as per the provision under NRHM/RCH-11 programme.
15. Record of vital events, reporting of births and deaths, and
maintenance of all relevant records concerning services provided in
PHC.

16. Training :
a. Health workers and traditional birth attendants.
b. Initial and periodic training of paramedics in treatment of minor
ailments.
c. Training of ASHAs.
d. Periodic training of doctors through continuing medical
education, conferences, skill development training, etc. on
emergency obstetric care.
e. Training of ANM and LHV in antenatal care and skilled birth
attendance.
f. Training under Integrated Management of Neonatal and
Childhood Illness (IMNCI).
g. Training of pharmacist on AYUSH component with standard
modules.
h. Training of AYUSH doctor in imparting health services related
to National Health and Family Welfare programme.

17. Basic laboratory services
18. Monitoring and supervision
19. Selected surgical procedures The vasectomy, tubectomy
(including laparoscopic tubectomy), MTP, hydrocelectomy and
cataract surgeries as a camp/fixed day approach have to be
carried out in a PHC having facilities of O.T.
20. Mainstreaming of AYUSH

STAFFING PATTERN
•The manpower that should be available in the PHC is as follows:
STAFF EXISTING RECOMMEDED
Medical officer 1 3 (At least 1 female)
AYUSH practitioner Nil 1 (AYUSH or any ISM system
prevalent locally)
Account Manager Nil 1
Pharmacist 1 2
Nurse-midwife (Staff)
(Nurse)
1 5
Health workers (F) 1 1
Health Educator 1 1
Health Asstt.
(Male & Female).
2 2
Clerks 2 2
Laboratory Technician 1 2
Driver
1 Optional/vehicles may be
out-sourced.
Class IV 4 4
Total 15 24/25

C O M M U N I T Y H E A L T H C E N T R E
 The community health centres are established and maintained by
state government under MNP/BMS programme.
 It has 30 indoor beds with x- ray labour room, operation theatre, and
laboratory facilities.
 It is managed by four medical specialists i.e. surgeon, physician,
gynecologist and pediatrician.
 As on 31st March 2014, 5,363 community health centres were
established by upgrading the primary health centres
 Each community health Centre covering a population of 80,000 to
1.20 lakh (one in each community development block).

 For strengthening preventive and promotive aspects of health care, a
new non-medical post called community health officer has been
created at each community health centre.
 The community health officer is selected from amongst the
supervisory category of staff at the PHC and district level with
minimum of 7 years experience in rural health programmes.
 Some states have not accepted this scheme and have opted for a
second medical officer.
 The specialists at the community health centre may refer a patient
directly to the State level hospital or the nearest/ appropriate Medical
College Hospital, as may be necessary, without the patient having to
go first to the sub-divisional or District Hospital.

FUNCTIONS
Every CHC has to provide following services which are known as the
assured services
1. Care of routine and emergency cases in medicine & surgery:
• This includes incision and drainage, and surgery for hernia, hydrocele,
appendicitis, haemorrhoids, fistula, etc.
• Handling of emergencies like intestinal obstruction, haemorrhage, etc.
2. 24-hour delivery services, including normal and assisted deliveries.
3. Essential and emergency obstetric care including surgical interventions like
caesarean sections and other medical interventions.
4. Full range of family planning services including laproscopic services
5. Safe abortion services.
6. Newborn care.

7.Routine and emergency care of sick children.
8. Other management, including nasal packing, tracheostomy,
foreign body removal etc.
9. All the national health programmes (NHP) should be delivered
through the CHCs. Integration with the existing programmes like
blindness control, Integrated Disease Surveillance Project, is vital
to provide comprehensive services
10. Others:
a. Blood storage facility
b. Essential laboratory services
c. Referral (transport) services

Manpower for community health centres
The existing staff for CHC is as follows :
• Block Health Officer
• General Surgeon 1
• Physician 1
• Obstetrician & Gynaecologist 1
• Paediatrics 1
• Anaesthetist 1
• Public Health Manager 1
• Eye surgeon 1 (1 for every five CH Cs)
• Dental Surgeon 1
• General Duty Medical Officer 1 (at least 2 female doctors)
• Specialist of AYUSH 1
• General Duty Medical Officer of AYUSH 1
Total 15/16

Support manpower:
Staff Nurse 19
Public Health Nurse (PHN) 1
ANM 1
Pharmacist/compounder 3
Pharmacist-AYUSH 1
Lab. Technician 3
Radiographer 2
Ophthalmic Assistant 1
Dresser (certified by Red
Cross/St. Johns Ambulance) 2
Ward Boys/Nursing Orderly 5
Sweepers · 5
Chowkidar 5
Dhobi 1
MALI 1
Aya 5
Peon 2
OPD Attendant 1
Registration Clerk 2
Statistical Assistant/Data Entry
Operator 2
Accountant/Admin. Assistant · 1
OT Technician 1

Health care delivery system
Central
Ministry of health and
family welfare
The directorate general
of health services
The council of health and
family welfare
State
State ministry of health and
family welfare
State director of health
District
Subdivision
Talukas
Community development blocks
Municipalities and coporation
Villages
Panchayats

Panchayat raj
system
Panchayat (At
TheVillage
Level)
The Gram
Sabha
The Gram
Panchayat
Panchayat
Samiti( AtThe
Block Level)
Zila Parishad
(AtThe
District
Level)

HEALTH CARE DELIVERY SYSTEM.pptx.....................

HEALTH CARE DELIVERY SYSTEM.pptx.....................

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