Health Care Delivery System India for CCCH

1. Health Care
Delivery System
In India
By. Kailash Nagar
Asst. Professor
Dept. Community Health

2. Definition
• It is a system which ensures need based
comprehensive health care services to people
at large especially those living in remote and
backward areas, using available resources,
manpower, money and material.

3. Health Care Delivery System
In India
• Union of 29 states
and 9 union
territories
• Population is more
than 1.3 Billion
• Rural population
65%
• Diversified culture
• Developing country

4. National Level
State Level
District Level
CCH
DGHS
MOHFW
Village/ Local
Sub- District
Taluka
Municipality
CD Block
Panchayat
Village
Panchayat Samiti Zila ParishadPanchayat

5. 01-NATIONAL LEVEL
The official organs of the health system at the
national level consist of:
1. The ministry of health and family welfare
2. The Directorate general of health services
3. The central council of health.
Functions
• Surveys
• Planning
• Co-ordination
• Programming
• Appraisal of all health matters in the country

6. 02- STATE LEVEL
1. State ministry of health
2. State health directorate
Functions
• Prevention of of communicable and NCDs
• Prevention of adulteration of food stuffs
• Controls of drugs and poisons
• Vital statistics
• Labour welfare
• Ports other than major
• Economic and social planning
• Population control and family planning

7. 03- DISTRICT LEVEL
Administration in India is the district under the
Collector ( 720 districts in 2019). Within each district
again there are 6 types of administrative areas:
1. Sub-Divisions
2. Talukas or Tehsils
3. Community Development Blocks (Rural)
4. Municipalities and Corporations (Urban)
5. Villages
6. Panchayats
( District Collector, Dy.DC, MP, MLA, BDO, Parsad,
Sarpanch, Ward member etc)

8. Function at district level
1. construction and maintenance of roads
2. sanitation and drainage
3. street lighting
4. water supply
5. maintenance of hospitals and dispensaries
6. education
7. registration of births and deaths.

9. 4. LOCAL LEVEL/Village
1. Panchayat ( at the village level)
2. Panchayat samiti(at block level)
3. Zila parishad(at district level)
At the village level :The Panchayati Raj at the
village level consists:
• Gram sabha
• Gram panchayat
• Nyaya panchayat

10. HEALTH CARE MODEL IN INDIA
HEALTH
CARE
SERVICES
INPUT
HEALTH
CARE
SYSTEM/
Organization
OUTPUTS
HEALTH
STATUS &
Health Problems
RESOURCES
CURATIVE
PREVENTIVE
PROMOTIVE
Rehabilitative
PUBLIC
PRIVATE
VOLUNTARY
INDEGENOUS
NGOs
CANGES
IN
HEALTH
STATUS

11. HEALTH STATUS
AND
HEALTH PROBLEMS
IN INDIA

12. Major HEALTH PROBLEMS IN INDIA
1.COMMUNICABLE DISEASES:
1. Malaria
2. Tuberculosis
3. Diarrheal diseases
4. Leprosy
5. Filaria
6. HIV Aids
7. ARI
8. Others
Kala-azar, meningitis, viral hepatitis, Japanese
encephalitis, enteric fever, guinea worm diseases.

13. 2.NUTRITIONAL PROBLEMS
a) Protein-energy malnutrition
b) Nutritional anemia
c) Low birth weight
d) Xerophthalmia
e) Iodine deficiency disorders

14. 3. ENVIRONMENTAL SANITATION:
a) Lack of safe water in many areas of the
country
b) Use of primitive methods for excreta
disposal/open Defecation
c) Pollution

15. 4. MEDICAL CARE PROBLEMS:
1. Unequal distribution of health resources
between rural and urban areas
2. Lack of penetration of health services within
the social periphery.
3. Lack of financial resources to treat persons in
large hospitals
4. No proper facilities to people

17. 5. POPULATION PROBLEMS:
a) employment
b) education
c) housing
d) health care
e) sanitation
f) environment

18. Kolkata, India

20. Organizational framework of Health Care Systems
PUBLIC Sector Private Sector AYUSH NGOs & Health
Agencies
A. Primary Health
Care
a. Primary health
centers
b. Sub centers
a. Private
hospitals,
polyclinics, nursing
homes
b. General
practitioners’
clinics
c. Dispensaries
a. Ayurveda
b. Siddha
c. Unani
d. Tibbi
e. Homeopathy
f. Yoga
g. Unqualified and
unregistered
practitioners.
a. SEVA Bharati
Rural
b. Bhansali
Trust
c. ARCH Mangrol
( Action Research in
Community Health
& Development)
B. Hospitals
a. CHC /Taluka
Hospitals
b. District hospitals
c. Teaching hospitals
d. Specialist hospitals
C. Other agencies
a. ESIC Hospitals
b. Railway hospitals
c. Defense hospitals

21. Primary Health Care
• The Alma (1978) –Ata conference called for
proclaimed primary health care as way to
achieving health for all.
• Health For All (HFA)

22. DEFINITION:
Primary health care is the essential
health care made universally
accessible to individuals and
acceptable to them, through their full
participation and at a cost the
community and the country can
afford.

23. PURPOSES
1. Increase in life expectation.
2. Improvement in nutritional status.
3. Provision of basic sanitation.
4. Development of manpower and other
resources.

24. 8 -Essential Components of primary
health care.
1. Education concerning prevailing health
problems and the methods of preventing and
controlling.
2. Promotion of food supply and proper
nutrition.
3. Adequate safe water supply and basic
sanitation.
4. Maternal and child health care, including
family planning.

25. 5. Immunization against major infection
disease.
6. Privation and control of locally endemic
diseases.
7. Appropriate treatment of common disease
and injuries.
8. Provisional treatment of community.

26. 5 –As of Primary Health Care
Accessible
Affordable
Primary health care
Acceptable
Appropriate
Adaptable

27. ATTRIBUTES OF PRIMARY HEALTH
CARE
• Essential health care
• Universally accessible
• Acceptable
• Community based
• First point of contact
• Affordability

28. ATTRIBUTES Contd...
• Adaptability
• Appropriateness
• Community participation
• Continuity
• Comprehensiveness
• Coordination

29. Principles
1. Equitable distribution
2. Manpower development
3. Community participation
4. Inter-sectoral coordination
5. Appropriate technology

30. Tier of health care in India
The health care services in India are organized at three levels,
each level supported by the higher level, to which the patient is
referred.
Tertiary
State Hospital
Medical Colleges
Secondary
DH / CHC / Taluka Hospital
Primary
PHC / Sub Centre

31. Staffing of Primary health care in
India – in rural areas
1. Village level
• At village level there are health functionaries chosen
by the local community themselves.
1. Village health guide,
2. Local Dai ,
3. ASHA and
4. Anganwadi worker.

32. 2. Sub-centre (SC) level
• For population of 5000 in plain areas & 3000
population in hilly, tribal and backward areas.
Staff: 1-MPHW male,
2-MPHW female (MPHW-F previously
called ANM,Auxillary nurse midwife).
At present functions of a SC are limited to
providing mother and child health care,
immunization services and family planning.

33. 3. Primary health centre (PHC)
The concept of a PHC was given by Bhore
committee.
• Currently there is 1 PHC per 30,000 population
in plain areas & 20,000 in tribal, hilly and
backward areas.
• It has a staff of 15 including a doctor.
• 6 Beds

34. 4. Community health centre (CHC)
Established at block level
Catering to a population of 80,000 to 120,000.
first referral units (FRU) from PHCs.
Total staffing strength is 25.
30 IPD beds.