M.Sc. Nursing

1. SUBJECT: COMMUNITY HEALTH NURSING
NURSING
ASSIGNMENT
ON
HEALTH CARE DELIVERY SYSTEM
SUBMITTED TO - SUBMITTED BY-
MRS. MALLIKA ROY MR. DEEPAK P. GAUTAM
ASSISTANT PROFESSOR MSC NSG 1ST
YEAR
R.D. MEMORIAL COLLEGE OF R.D. MEMORIAL COLLEGE OF
NURSING, BHOPAL NURSING,BHOPAL

2. HEALTH CARE DELIVERY SYSTEM
INTRODUCTION:-
Health care services in general are rendered by the government
through a network of health centres from the grass root areas to the block
level in the rural areas and through hospitals, dispensaries, maternal, child
health and family welfare centres in the urban areas. The hospitals in the
sub divisional/ taluka level, district level etc. Provide referral services to
the infrastructure in the rural area.
HEALTH CARE DELIVERY SYSTEM –
NATIONAL STATE, DISTRICT AND LOCAL LEVEL:
ORGANIZATION OF HEALTH:-
System in India :- India is a union of 28 states and 7 union territories
under the constitution of India, the states are largely independent in matters
relating to the delivery of health care to the people. Each state therefore,
has developed its own system of health care delivery, independent of the
central government. The central responsibility consist of mainly policy,
planning, guiding, assisting, evaluating and coordinating the work of state
health ministries so that health services cover every part of the country, and
no states lags behind for want of these services.
The health care services organization in the country extends
from the national level to village level from the total organization structure,
we can slice the structure of health care system at national, state, district,
community, PHC and sub-centre level.
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3. ORGANIZATION OF HEALTH SERVICES AT THE NATIONAL
LEVEL:-
Ministery of health and family welfare
Addl. DGHS
Dy. DGHS Dy. DGHS Dy. DGHS
Medical Care Public Health General Administration
Nursing Advisor
DEPUTY NURSING ADVISOR
Union Ministery of Health And Family Welfare :-
The Union Ministery of Health and family welfare is headed by :
Cabinet Minister
(A minister of State)
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Ministery of Health
and Family Welfare
(Cabinet Minister)
DGHS (Advisor to
Government of India)
Central Council of
Health (Policy
Making, Legislation
Dept. of Health
Joint Secretary Joint Secretary
Secretary to the
Govt. of India
Commissioner
Regional Directors
Dept. of Family
Deputy SecretaryDeputy Secretary
Administration
Staff
Administration Staff

4. Deputy Health Minister
There are political appointments
The Union Health Ministery has two departments :
1) Department of Health :
Secretary (i.e. Executive Head)
Joint Secretary
Deputy Secretary
Administrative Staff
2) Department of Family Welfare :-
The Department of family welfare was created in 1966 within
the ministery of health and family welfare.
The secretary to the Govt. of India in the ministery of Health
and family welfare is in overall incharge of the department of family
welfare. He is assisted by the additional secretary and commissioner and
one joint secretary.
3) FUNCTIONS :-
The functions of Union Health Ministery are set-out in the seventh schedule
of Article 246 of the constitution of India under (a) Union list.
(B) CONCURRENT LIST
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5. (A) UNION LIST :-
1) International health relations and administration of post quarantine.
2) Administration of central institutes such as the All India Institute of
Hygiene and Public Health Kolkata, National Insititute for the
control of Communicable Diseases, Delhi, etc.
3) Promotion of research through research centres and other bodies.
4) Regulation and development of medical, pharmaceutical dental and
nursing professions.
5) Establishment and maintenance of drug standards.
6) Censuses and collection and publication of other stastical data.
7) Immigration and emigration.
8) Regulation of labour in working of mines and oil fields.
9) Coordination with states and with other ministeries for promotion of
health.
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6. b) Concurrent List :-
The Concurrent list includes
1) Prevention of extension of communicable disease from one unit to
another.
2) Prevention of adulteration of foodstuffs.
3) Control of drugs and poisons.
4) Vital statistics
5) Labour welfare
6) Ports other than major
7) Economic and social planning
8) Population control and family planning.
2) DIRECTORATE GENERAL OF HEALTH SERVICES :-
a) Organization :-
The director general of health services is the principal advisor to the union
Government in both medical and public health matters.
He is assisted by an additional director general of Health services, a team
of deputies and a large administrative staff.
The directorate comprises of three main units, e.g. medical care and
hospitals, public health and general health administration.
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7. b) Functions :- The Specific functions are :
1) International health relations and quarantine :
All major posts in the country and international airports are
directly controlled by the directorate general of Health Services. All
matters relating to the obtaining of assistance from international agencies
and the coordination of their activities in the country are undertaken by the
directorate general of health services.
2) Control of drug standards :-
The drugs control organization is port of Directorate general of
Health Services, and is headed by the drug controller. Its primary function
is to lay down and enforce standards and control the manufacture and
distribution of drugs through both central and state government officers.
3) Medical Store Depots :-
The Union Government runs medical Store depots at Mumbai,
Chennai, Kolkata, Karnal, Gauhati and Hyderabad. These depots supply the
civil medical requirement of the central Government and of various state
Governments. These depots also handle supplies from foreign agencies. The
Medical store organization endeavours to ensure the highest quality,
cheaper bargain and prompt supplies.
4) Post Graduate Training :-
The Directorate General of Health Services is responsible for
the administeration of national institutes, which also provide post-graduate
training to different categories of health personnel. Some these institutes
are :
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8. The all India Institute of Hygiene and Public Health at Kolkata,
All India Institute of Mental Health at Banglore, College of Nursing at
Delhi, National Tuberculosis, Institute at Banglore, National communicable
disease at Delhi, etc.
5) Medical Education :-
The central directorate is directly in charge of the following
medical college in India.
The lady Hardinge
The Maulana Azad
The Medical College at Pondicherry and Goa
6) Medical Research :-
Medical research in the country is organized largely through the
Indian council of Medical Research, founded in Lall in New Delhi. The
council plays a significant role in aiding, promoting and coordinating
scientific research on numan diseases, their causation, prevention and cure.
The research work is done through the council's several permanent research
institutes, research units, field surveys and a large no of ad-hoc research
enquiris financed by the council. It maintains cancer research centre,
Tuberculosis chemotherapy centre at chennai, Virus research centre at
Poona, National institute of Nutrition at Hyderabad and blood Group
reference centre at Mumbai. The funds of the council are wholly derived
from the budget of Union ministery of Health.
7) Central Govt. Health Schemes
8) National Health Programmes :-
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9. The various national health programmes for the eradication of
malaria and for the control of tuberculosis, filarial, leprosy, AIDS and other
communicable disease involve expenditure of crores of rupees.
9) Central Health Education Bureau :-
An outstanding activity of this bureau is the preparation of
education material for creating health awareness among the people. The
bureau offers training courses in health education to different categories of
health workers.
10) Health Intelligence :-
The central bureau of health intelligence was established in
1961 to centralize collection, compilation, analysis, evaluation and
dissemination of all information on health statistics for the nation as a
whole.
11) National Medical Library :-
The central Medical Library of the Directorate General of
Health services was declared the national medical library in 1966. The aim
is to help in the advancement of medical, health and related sciences by
collection, dissemination and exchange of information.
CENTRAL COUNCIL OF HEALTH
The central council of health was set up by a Presidential order
on a August, 1952 under article 263 of the constitution of India for
promoting coordinated concerted action between the centre and the states in
implementation of all the programmes and measures pertaining to the health
of the national. The union health minister is the chairman and the state
health ministers are the members.
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10. FUNCTIONS
1) To consider and recommended broad outline of policy in regard to
matters concerning health in all its aspects such as the provision of
remedial and preventive care, environmental hygiene, nutrition, health
education and the promotion of facilities for training and research.
2) To make proposals for legislation in fields of activity relating to
medical and public health matters and to lay down the pattern of
development for the country as a whole.
3) To make recommendations to the central Government regarding
distribution of available grants-in-aid for the health purpose to the
states and to review periodically the work accomplished the different
areas through the utilization of these grants-in-aid.
4) To establish any organization or organizations invested with
appropriate functions for promoting and maintaining cooperation
between the central and state Health Administration.
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11. PLACEMENT OF NURSES AT THE CENTRAL LEVEL
DGHS
Addl. DG (PH) Addl. DDG (N) Addl. DG (M)
DDG(N)
ADG ADG ADG
(Community Nsg. Services) (Nss. Edu. & Research) (Hospital
Nsg. Services.)
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12. STATE LEVEL :-
At present there are 28 states in India, with each state having its
own health administration. In all states, the management sector comprises
the state ministery of health and a Directorate of Health.
STATE MINISTERY OF HEALTH AND FAMILY WELFARE :-
(a) Organization :-
The state ministery of Health and family welfare is headed by
cabinet Minister Deputy minister. The minister of Cabinet rank is the
political head of the department of Health and FW. The Health Minister has
to perform both the activities, i.e. Political as well as administrative as
follow :-
FUNCTIONS :-
1) As a member of the state legislature, it is his duty to support and
safeguard the total policies of the Govt. because of the collective
responsibility of the cabinet.
2) As a member of ministery, he brings all the bills pertaining to his
department for approval of the legislature.
3) As political head of the health department, he acts as an executive &
administrator. He has to see the policies approved by the legislature
are faithfully implemented.
4) He is the custodian of the interests of the people in general and his
constituency in particular.
5) As a member of Govt. he performs Ceremonial duties.
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13. HEALTH SECRETARIAT ORGANIZATION :-
In order to keep a record of the policies framed by the political
heads and to watch over their implementation he has to seek the help of an
office which is known as "Secretariat" Health Secretariat is the official
organ of the state Health Ministery. The secretary of the state Govt. is a
senior officer of the Indian Administrative services, is the administrative
head and is assisted by Addition Secretary, Deputy Secretary etc. The main
duties of Health department are as follow :-
FUNCTIONS
1) Assisting the Minister in policy making in modifying policies from
time to time and in the discharge of his legislative responsibility.
2) Framing draft regislation and rules and regulations.
3) Coordination of policies and programmes, supervision and control
over their execution and review of results.
4) Budgeting and control of expenditure.
5) Maintaining contact with Govt. of India and other state Govts.
6) Overseeing the smooth and efficient running of administrative
machinery.
STATE HEALTH DIRECTORATE ORGANIZATION :-
The Director of health and family welfare is the principal
advisor to the state Govt. on all matters relating to medicine and public
health as he is technically qualified person in the field, may be called as
technical head of the Department of health and family welfare. He is
assisted by joint Director, Regional joint Director and Deputy and Assistant
Directors of major wing.
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14. FUNCTIONS
1) To provide adequate medical care through hospitals, dispensaries,
health centres and mobile domiciliary units both in rural and urban
areas.
2) To make proper arrangement for medical education and research.
In order to improve the functioning of the medical education the
state health department is to take following steps :
 Increase the out-turn of para-medical staff in view of large
expansion of rural services.
 Reorientation of medical education with a view to progressively
making training of medical students more community based.
 To make good the efficiency in nursing / paramedical / ministerial
and other services staff in accordance with the norm prescribed by
the Inc.
 To improve and expand common facilities like hospital, pharmacy,
blood bank, encourgency services, intensive care unit and
rehabilitation services in the hospitals.
 Continuing encouragement to research activities in Medical
colleges.
3) Proper implementation of National Health Programmes.
The national health programmes are planned, guided, directed
and financed by the union Ministery of health and family welfare only
operational cost of these schemes are born by the state.
4) To make previsions for personal and impersonal health services. The
following are the personal and impersonal health services :
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15. a) Immunization services
b) Nutrition
c) School Health
d) Industrial Health
e) Family planning
f) Rural & Urban Sanitation
g) Control of Fairs & Festivals
h) Drugs and food control
i) Production of vaccines and carrying out mass immunization
programme.
j) Emergency health services during flood, famine, earthquake,
refugee influx etc.
5) Control of food and drug administration state health department has
responsibility to control adulteration of food and drugs and enforce
minimum standards of food and drugs laid down by the state.
6) Collection and Dissemination of Health information state health
Department of collects and transmits information of health and vital
statistics for the states.
7) Control over ESI scheme.
State health department supervises the ESI Scheme. The expenditure
on this scheme is shared in the ration of 1:7 by the Govt. and ESI
corporation.
8) Enforcement of Professional Ltd.
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16. The dept. determines and maintains the standards of professional
education, research and practice through statutory bodies like the
university, state medical council, state Nursing Council, state
pharmacy council etc.
9) Promotion of Indigenous systems of medicine. The dept. encourages
the Indigenous system of medicine.
10) Setting up of laberateries.
11) Supervision and control over the local bodies.
12) Preparation for the enactment of Health legislation.
13) Provision of Integrated family welfare services.
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17. REGIONAL LEVEL :-
In the state of Bihar, Madhya Pradesh, Uttar Pradesh, Adnhra
Pradesh, Karnatka, and others, Zonal or regional or divisional set-ups have
been created between the state Directorate of Health Services and District
Health Administration. Each regional, zonal set-up covers three to five
districts and acts under authority delegated by the state Directorate of
Health services. The status of officers/incharge of such regional/zonal
organizations differs, but they are known as additional/joint/Deputy
Directors of Health Services in different States.
DISTRICT LEVEL :-
The Major unit of administration in India is the District for
administration purpose the country is divided into 28 states and 67 union
territories which in turn are divided into 432 administration districts. Each
district is divided into sub-districts or taluks, under which are situated the
Community Development Blocks at present there are 600 community
development Blocks in India.
Functions of health organization at District level or local level :
1) Coordinate health Planning.
2) Investigate communicable disease.
3) Maintain free clinics for the early diagnosis of Communicable
disease.
4) Provide laboratory services to assist doctors.
5) Conduct clinics for administration of vaccines.
6) Collect vital statistics
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18. 7) Provide MCH services
8) Maintain a Public health Nursing service.
9) Supervise water supply and sewage disposal
10) Supervise quality and safety to meat and other foods.
11) Inspect and supervise the production, parteurisation and
distribution of milk.
12) Investigate and supervise general sanitary conditions in public
eating places.
13) Provide preventive and rehabilitative services in chronic disease
control.
14) Conduct health education programmes.
15) Promulgate rules and regulations.
16) Provide mental health services.
17) Provide family planning services.
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19. CONCLUSION
Health care services in general are rendered by the government
through a network of health centres from the grass root areas to the
block level in the rural areas and through hospitals, dispensaries,
maternal, child health and family welfare centres in the urban areas.
The following are the personal and impersonal health services :
Immunization services, Nutrition, School Health, Industrial Health,
Family planning, Rural & Urban Sanitation, Control of Fairs &
Festivals, Drugs and food control etc.
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20. BIBLIOGRAPHY
• Swarnkar Keshav “ The Text Book Of Community Health Nursing”
3rd
edition. Page no.- 585-591
• K Park “Text Book Of Community Health Nursing”
2nd
edition ,page no.- 279-285
• Kk Gulani “Text Book Of Community Health Nursing”
4th
edition. Page no.- 348-355
• http://www.wikipedia.org/health-care-delivery-system-india/
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