1. HEALTH CARE DELIVERY SYSTEM IN INDIA
By Dr. Vaishali Bhagat
Moderator Dr. Chetna Maliye

2. FRAMEWORK Introduction Historical Background Structural Organization
Health care delivery system in India
Challenges

3. 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 males
Birth Rate-21.4
Death Rate-7
IMR-40
Under5 mortality rate-52

4. Introduction
A Health System is the sum total of all the organisations , institutions and resources –whose primary purpose is to improve health ( WHO )

5. Historical background..
year
Event
1864
sanitary commissioners appointed in 3 major povinces-Bombay,Madras,Bengal
1888
sanitation look after by local bodies
1896
severe epidemic of plague occur
1904
plague commission recommendated reorganization and expansion of public health department
1912
GOI decided to help local bodies with grants and sanctioned the appointment of Deputy Sanitary commissioner and health officers
1946
Bhore committee appointed

6. 1947 1951 1952 1958 1959 Ministers of centre and state established
YEAR
EVENT
1947
Ministers of centre and state established
1951
First 5 yr plan
1952
Community development programme launched
Central council of health constituted to coordinate health policies between central and state gov.
1958
Panchayati raj, three tier structure recommended
Rajasthan was first state to introduce Panchayati raj
1959
Mudaliar committee appointed
Health survey and planning committee
Strengthening of existing PHC

7. YEAR
EVENT
1963
Chadah committee gave the concept of basic health worker
1965
Mukherjee committee appointed
-Strengthening of administrative set up at different level from PHC to state health services.
-Separate staff for family planning
1967
Jungalwala committee appointed
-Integration of health services
-Elimination of private practice by gov. doctors
1973
Kartar Singh committee appointed
-Female health worker and male health worker

8. YEAR
EVENT
1974
Shrivastav committee appointed
Concept of people’s health in people’s hand
Creation of MPW and HA
Village health guide or community health volunteer.
1981
Adopted global strategy of health for all
1985
UIP launched
1992
Child Survival and Safe Motherhood(CSSM) launched
1997
Reproductive and Child Health programme launched

9. YEAR
EVENT
2oo5
RCH two,JSY,NRHM,IPHS for CHC launched
2007
11th 5yr plan, IPHS for subcentres and PHC formulated
2008
NCD programme launched as pilot project
2013
NHM,RMNCH+A launched

10. Organizational Structure In India
India is union of 29 state and7 union territories.
Each state has developed it’s 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

11. Union Ministry of Health and Family Welfare Headed by Cabinet Minister
At central level
Union ministry of health and family welfare
The Directorate general of Health services
The central council of Health and Family Welfare
Union Ministry of Health and Family Welfare
Headed by Cabinet Minister
Minister of State
Deputy Health Minister

12. 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

13. 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 administration

14. 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.

15. At State level
The 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

16. State Health Directorate and Family Welfare
State Ministry of Health and Family Welfare
Headed by Health Minister and Deputy Minister
State Health Directorate and Family Welfare
Administrative Officer-Director of Health Services
Assisted by Deputy Director and Assistant Director
Chief technical adviser relating to Medicine and Public Health

17. 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

18. Panchayati raj 3 tier structure of rural local self gov.
Link village to district
Gram panchayat at village level
Panchayat samiti at block level
Zilla parishad at district level

19. 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

20. Health Care Systems
It 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 sector
a)Primary health care
PHC
Sub centres
b)Hospitals/Health centres
CHC
District hospitals
Specialist hospitals
Teaching hospitals

21. c) Health insurance scheme Central gov
c) Health insurance scheme Central gov. health scheme Employees state insurance scheme d)Other Agencies Defense services Railways 2.Private sector a)Private hospitals,polyclinics,Nursing home and dispensaries b)General practitioners and clinics 3.Indian System of Medicine Ayurveda and sidha Unani Homeopathy Unregistered practitioner 4.Voluntary Health Agencies 5.National Health Programmes

22. Primary Health Care Delivery system
In 1977-Rural health scheme on principle of placing people’s health in people’s hands
Three tier system of health care delivery system
Basic tenet of primary health care is universal coverage
village level
1)Anganwadi worker
2)ASHA worker

23. Under ICDS prog. 1 AWW for 1000 population
Anganwadi Worker
Under ICDS prog. 1 AWW for 1000 population
Training for 4 month
Functions-
1.MCH care
2.Family planning
3.Immunization
4.Referral services
5.Nutrition and education

24. 1 ASHA for 1000 population ASHA worker key component of NRHM
Functions-
1.VHND
2.Health information
3.Councelling
4.Depot holder
5.Information to subcentre,PHC
6.Accompany preg.women
7.DOTS provider
8.National prog.

25. Sub-Centre Peripheral outpost of existing health care system
One 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 April2002
Sub Centre’s functioning in the country as on March 2014.

26. 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 Centre’s and has beds for patients.
There were PHCs functioning in the country as on March 2014.

27. Community health Centres
One 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.

28. Urban health care delivery system in India
NUHM is part of NHM launched in2013
Special focus on urban slum-By making them available essential health care services and reducing out of pocket expenditure on health

29. Total % GDP on health expenditure

30. IPHS NHM IPHS launched in 2005
Set of uniform standards to improve quality of health care delivery in the country
IPHS for CHC launched in2005 and for PHC and Sub centre launched in 2007
It serves as benchmark for assessing functional status of health facilities
NHM
Launched in 2013
Two submission 1)NRHM in )NUHM in2013
Main components are Health system strengthening in rural and urban area-reproductive-maternal-neonatal-child and adolescent health and communicable, NCD
It envisages achievement of universal access to equitable,affordable and quality health care services that are accountable and responsive to people’s need

31. NHM has 6 financing components
NRHM –RCH flxipool
NUHM-flexipool
Flexi pool for communicable diseases
Flexi pool for NCD including injury and trauma
Infrastructure maintenance
Family welfare control sector component

32. Challenges Population of India Increased burden of disease
Low % of GDP on health expenditure

33. References:
Park Textbook of Preventive and Social Medicine,23rd edition,Prem Nagar,Jabalpur(M.P.),India:Banarsidas Bhanot;2015
SRS Bulletin2014
WHO,Global health expenditure database
NHM,Ministry of Health and Family Welfare,GOI

34. Thank U