community health nursing M.Sc. NURSING 1ST YEAR

3. HEALTH CARE
DELIVERY
SYSTEM IN INDIA
Mr. PRAMOD
MODERATOR
NITU
LECTURER
YEAR CON
403/13
KS
PRESENTOR
M.SC. (N) 1st

5. INTRODUCTION
 INDIA is union of 28 states & 7 union terrorties


Older concept – Health care means patient care
Objective - freedom from the disease through
hospital system.

6. DEFINITION

WHO – ―As an integrated care containing
promotive, preventive and curative elements
that bear the longitudinal association with an
individual, extending from womb to tomb, and
continuing in the state of health as well as
disease.‖

7. EVOLUTION OF HEALTH CARE
SERVICES IN INDIA
Christian Era –
civilization
started in Indus
Valley
Rahula Sankirtyana
– developed
hospital system
Environmental
sanitation, hou
ses with
drainage
Post Vedic –
teaching of
Buddhism and
Jainism
1400 B.C. –
Ayurveda and
Siddha system
Developed a
comprehensive
concept of health

8. STILL…66 YRS. OF HEALTH
SERVICES
Crude Death Rate ↓
Crude birth rate ↓
Life expectancy ↑
S.pox & G. worm Eradicated
Leprosy Eliminated
IMR ↓
Infrastructure – Expanded
Polio Eradicated

9. ROLE OF DIFFERENT COMMITTEES

1946 – BHORE COMMITTEE (HEALTH SURVEY AND
DEVELOPMENT COMMITTEE)
Integration of preventive and curative services
 Development of PHC
 3 months training in PSM


1962 – MUDALIAR COMMITTEE (HEALTH SURVEY AND
PLANNING COMMITTEE)
Strengthening of PHC and district hospital
 Regional organization


10. CONT…

1973 – KARTAR SINGH
 Committee on multipurpose worker
 ANM replaced by female health worker
 Basic health worker replaced by male health worker
 Lady health worker designated as female health supervisor.

11. PROBLEMS
INDIRECTLY RELATED TO
HEALTH
Environment
Education
Empowerment
DIRECTLY RELATED TO
HEALTH
Diseases
Communicable
Non Communicable
New emerging
Fertility
Population
Growth rate
Total Fertility
Nutrition
Malnutrition
Obesity

12. MODEL OF HEALTH CARE
SYSTEM
INPUTS
HEALTH CARE HEALTH CARE
SERVICES
SYSTEM
OUTPUTS
Health Status or
Health Problems
Curative
Preventive
Promotive
Resources
Public
Private
Voluntary
Indigenous
Changes in
Health Status

13. HEALTH DEMANDS &
NEEDS OF THE COMMUNITY
COMPREHENSIVE &
COMMUNITY BASED CARE
CONSTITUTES
MANAGEMENT
SECTOR &
INVOLVES ORGANIZATION
IMPROVED
HEALTH STATUS
EXPRESSED IN TERMS OF
LIVES,SAVES, DEATH A
VERTED, DISEASES PREVENTED,
LIFE EXPECTENCY
INCREASED

14. HEALTH ORGANISATION IN INDIA

15. AT THE CENTRE LEVEL
MINISTRY
OF HEALTH
AND
FAMILY
WELFARE
DIRECTORATE
GENERAL OF
HEALTH
SERVICES
CENTRAL
COUNCIL OF
HEALTH AND
FAMILY
WELFARE

16. A.
THE UNION MINISTRY OF HEALTH
AND FAMILY WELFARE
DEPARTMENT OF
HEATLH
SECRETARY
DEPARTMENT OF FAMILY
WELFARE
SECRETARY
JT. SECRETARY
JT. SECRETARY
DY. SECRETARY
DY. SECRETARY
ADMN. STAFF
OFFICE STAFF

17. CENTRAL LIST
International Health,
 Port Health Research
 Technical & Scientific Education


18. FUNCTIONS

19. CONT…
Establishment of drug standards
Census and collection & publication of other statistical
data
Coordination with other states for promotion of health
Regulating labor in mines and oil mines
Immigration & emigration

20. 2. CONCURRENT LIST

21. B. DIRECTORATE GENERAL OF
HEALTH SERVICES (DGHS)
Principal Adviser To Union Government
Additional Director Of Health Services
Team Of Deputies
Administrative Staff

22. ORGANIZATION
Deputy
DGHS
DGHS
Additional
DGHS
(Medical
care)
Office
Staff
Deputy
DGHS
(Public
health)
Office
Staff
Deputy
DGHS
(Gen.
Administ
rator)
Office
Staff

23. FUNCTIONS OF DIRECTORATE
GENERAL OF HEALTH
GENERAL FUNCTIONS SPECIFIC FUNCTIONS
Surveys
Planning
Coordination
Programming
Appraisal of all
health matters
International Health
relations
Control of drug
standards
Medical store depots
Postgraduate training
Medical education
Medical research
CGHS, NHP, CHEB etc.

24. C.
THE CENTRAL COUNCIL OF
HEALTH AND FAMILY WELFARE
The central council of health was set up by the presidential
order on 9th August 1952 under article 263 of the constitution
of India for promoting coordinated and concerted action
between the center and the state for the implementation
of all the programmes and measures pirating to the health of
the nation.
Chairman The Union Health
Minister
Members The State
Health Minister

25. FUNCTION OF CENTRAL COUNCIL
OF HEALTH AND FAMILY WELFARE
1. To consider and recommend broad outlines of policy
in regard to matters of health such as,
Provision of remedial and preventive care.
Environment Hygiene.
Nutrition.
Health education and
Promotion of facilities for training and research.

26. Cont..
2. To make proposals for legislation in fields of medical
and public health matters and to lay down.
3. To make recommendations to the central government
regarding the health.
4. To established any organization with appropriate
functions for promoting and maintain cooperation
between central and state health administrations

27. MILE STONES
NRHM-2005
NHP-2002
NPP-2000
RCH-1996
UIP-1985
NHP-1983
Alma Ata-1978 (HFA)
Juggling
Priorities
Small pox eradicated-July 5, 1975
NFPP-1952
India Joins WHO-1948
HSDC-1946

28. STATE LEVEL OF HEALTH
CARE

29. THE STATE LIST
 The government of India act, 1935 gave further
autonomy to the states. The health subjects were
divided into three lists under the 7th schedule of the
India constitution. They are:
1 The Union List
2 The State List
3 The Concurrent List

30. FUNCTIONS UNDER STATE LIST
Public health sanitations , hospitals and
dispensaries.
Local government, i.e. the constitutions and
powers of municipal corporations, district boards.
Intoxicating liquors that is
production, manufacture, possession, transport, pu
rchase and sale of intoxicating liquors.

31. Cont….
Relief of the disabled and unemployable.
Burials and burial grounds, cremation
grounds.
Markets and fairs.

32. AT THE STATE LEVEL
• STATE MINISTRY OF HEALTH
• STATE HEALTH DIRECTORATE

33. ORGANIZATION

34. STATE MINISTRY OF HEALTH AND
FAMILY WELFARE
HEADED - Cabinet minister and deputy
minister. (Political head)
RESPONSIBILITY - formulating policies
Monitoring the implementation of these
policies and programmes
Coordination with government of India and
other state government.

35. STATE HEALTH DIRECTORATE AND
FAMILY WELFARE
 Principle
advisor in matters relating to
medicine and public health
 Assisted
by joint director, regional joint
director and assistant directors.

36. AT THE DISTRICT LEVEL
The principal unit of administration in
India is the district under a collector.
There are 597 districts in India.
Districts are known as “ZILA”

37. DISTRICT HEALTH ORGANIZATION
Identifies and provide the needs of
expanding rural health and family
welfare programme
Within each district again, there are 6
types of administrative areas
No uniform model of district health
organization

38. ORGANIZATION
District
Sub-division
Rural
Urban
Community
Development
Blocks
Tahsil
(Taluka)
Corporations
Municipal
Boards
Villages
Panchayats
Town Area
Committees

39. PANCHAYATI RAJ
3 tier structure of rural local self government
Linking the village to the district

40. 3- TIER SYSTEM
PANCHAYAT RAJ
PANCHAYAT ( AT
VILLAGE LEVEL)
PANCHAYAT SAMITI
ZILLA PARISHAD (AT
(AT BLOCK LEVEL)
DISTRICT LEVEL)
GRAM SABHA
GRAM PANCHAYAT
NYAYA PANCHAYAT

41. THE GRAM SABHA

It is comprised of all the adult men and
women of the village. This body meets at
least twice in a year and discuss important
issues. They elect members of panchayat.

42. THE GRAM PANCHAYAT
 consists of 15-30 elected members
 covers the population of 5000 to 20000.
 chaired by the president i.e. sarpanch/ mukhya/ sabhapati.
 There is a vice- president and a secretary.
 Responsible for overall planning and development of the
villages.
 The panchayat secretary has been given powers to
functions for wide areas such as maintenance of sanitation
and public health, socio-economic development of the
villages etc.

43. THE NYAYA PANCHAYAT
 It is comprised of 5 members from the panchayat.
 It tries to solve the dispute between two parties/
groups/ individuals over certain matters on mutual
consent.

44. AT THE BLOCK LEVEL
 Is known as Panchayat samiti.
 Members of panchayat samiti are:
o Sarpanches from all the gram panchayats in the
block
o MLAs and MPs residing in the area
representative of women, schedule castes, schedule
tribes and cooperative societies.

45. AT THE DISTRICT LEVEL
 The panchayati raj institution at the district
level is known as ZILA PARISHAD.
 Is headed by the chairman also known as
adhikashak.

46. CONT….
It includes the following members:
 The heads of all the gram samities in the
district, MLA and MPs from the district,
 Representatives of women, SC/ST, 2 persons
who have experience in administration, rural
development officer etc.

47. HEALTH CARE DELIVERY SYSTEM
IN INDIA
At the block level
 Objective - to provide primary health care to all the
sections of the society.
 80% of the population is scattered in villages
 20% of rural population have health care facilities
Centre
Plain area
Hilly / Tribal /
Difficult area
Community health
centre
1,20,000
80,000
Primary health
centre
30,000
20,000
Sub-centre
5,000
3,000

49. COMMUNITY HEALTH CENTRE’S



Established and maintained by the State Government under
MNP/BMS programme.
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.

50. CONT..



It serves as a referral centre for 4 PHCs and also
provides facilities for obstetric care and specialist
consultations.
As on Sep 2013, there are 4,833 CHCs functioning in
the country.
In Haryana 2013, there are 108 CHCs functioning.

51. PRIMARY HEALTH CENTRE’S




First contact point between village community and the Medical
Officer.
To provide an integrated curative and preventive health care
with emphasis on preventive and promotive aspects of health
care.
Established and maintained by the State Governments under the
MNP/ BMS Programme.
Manned by a Medical Officer supported by 14 paramedical and
other staff.

52. CONT….




NRHM - two additional Staff Nurses at PHCs
(contractual).
It acts as a referral unit for 6 Sub Centre’s and has 4 6 beds for patients.
There were 24,049 PHCs functioning in the country as
on Sep 2013.
In Haryana Sep 2013, there were 425 PHCs
functioning.

53. SUB-CENTRE

Most peripheral and first contact point between the
primary health care system and the community.

Manned by at least one ANM / Female Health Worker
and one Male Health Worker.

Under NRHM, one additional second ANM on
contract basis.

54. CONT…




Provide services in relation to maternal and child
health, family welfare, nutrition, immunization and
control of communicable diseases.
Ministry of Health & Family Welfare is providing
100% Central assistance to all the Sub-Centre’s
1,48,366 Sub Centre’s functioning in the country as on
Sep 2013
In Haryana Sep 2013, there were 2465 SCs
functioning

55. ASHA

Accredited Social Health Activist (ASHA) for 1000 population

Chosen by and accountable to the panchayat. Act as the interface
between the community and the public health system.

Honorary volunteer, receiving performance-based compensation

Facilitate preparation and implementation of the Village Health Plan

The other persons are
 Indigenous dais
 Anganwadi workers

56. CONT…
NUMBER OF ASHA WORKERS ACC SEP 2013
Total Number of
ASHA in position as
on 30-06-2013
ASHA
(Accredited
Social Health
Activist)
High Focus
states
5,72,573
Other than High
3,17,163
Focus states
Total Number of
ASHA selected and
trained up to IV
module
High Focus
states
Other Than
High Focus
states
4,94,155
2,89,923

57. A SURVEY REPORT PUBLISHED IN
NEW INDIAN EXPRESS

There is only one doctor per 1,700 citizens in India; the World
Health Organization stipulates a minimum ratio of 1:1,000.

There are 387 medical colleges in the country—181 in
government and 206 in private sector. India produces 30,000
doctors, 18,000 specialists, 30,000 AYUSH graduates, 54,000
nurses, 15,000 ANMs and 36,000 pharmacists annually.

Health ministry claims that there are about 6-6.5 lakh doctors
available. But India would need about four lakh more by 2020
to maintain the required ratio of one doctor per 1,000 people

58. PHC PROGRESS IN INDIA (2012-13)

59. 
Progress made in CHCs during 2005-12

60. INTEGRATED APPROACH OF
HEALTH CARE DELIVERY
ICDS – integrated child development scheme
Agriculture, irrigation and engineering
Animal Husbandry
Education
Social and Women's Welfare
Urban Family Welfare Centers

61. BUDGET IN FIVE YEAR PLANS
FIRST PLAN (1951-56)
SECOND PLAN (1956-61)
• BUDGET: 1,960 Crore HEALTH: 5.9%
• BUDGET: 4,672 Crore HEALTH: 5%
THIRD PLAN (1961-66)
• BUDGET: 8,576 Crore HEALTH: 4.3%
FOURTH PLAN (1969-74)
• BUDGET: 15,778 Crore HEALTH: 7.2%
FIFTH PLAN (1974-79)
• BUDGET: 39,322 Crore HEALTH: 8.8%
SIXTH PLAN (1980-85)
• BUDGET: 97,500 Crore HEALTH: 1.8%
SEVENTH PLAN (1985-90) • BUDGET: 1,80,000 Crore HEALTH: 1.9%
EIGHTH PLAN (1992-97)
• BUDGET: 79,8000 Crore HEALTH: 9.5%
NINTH PLAN (1997-2002)
• BUDGET:8,59,200 Crore HEALTH: 1.25%
TENTH PLAN (2002-07)
• BUDGET: 14,84,131.30Crore HEALTH: 1%
ELEVENTH PLAN (2007-12) • BUDGET: 136,147Crore HEALTH: 1.5%
TWELFTH PLAN (2012-17) • BUDGET ALLOCATED: 90,000 Crore

62. BUDGET SUPPORT
Budget Support for Central Departments in Eleventh Plan (2007–12) and Twelfth
Plan (2012–17) Projections (` Crore)
Department of
MoHFW
Eleventh Plan
Twelfth
Expenditure (in Plan Outlay(
Crore)
in Crore)
%
Increase
Department of Health and Family
Welfare
83407
268551
322%
Department of Ayurveda, Yoga
&Naturopathy, Unani, Siddha &
Homoeopathy (AYUSH)
2994
10044
335%
Department of Health Research
1870
10029
536%
Aids Control
1305
11394
873%
Total MoHFW
89576
300018
335%

63. HEALTH EXPENDITURE, PUBLIC (%
OF GDP) IN INDIA

64. HEALTH EXPENDITURE, PRIVATE
(% OF GDP) IN INDIA

65. OUT-OF-POCKET HEALTH
EXPENDITURE (% OF PRIVATE
EXPENDITUTEON HEALTH) IN
INDIA

66. EXTERNAL RESOURCES FOR HEALTH
EXPENDITURE (% OF
TOTALEXPENDITUTEON HEALTH) IN
INDIA

67. NURSES AND MIDWIVES (/ 1000
PEOPLE) IN INDIA

68. CONTRIBUTION BY NGOS
Providing services like relief to the blind, the disabled and disadvantaged
and helping the government in mother and child health care, including
family planning programmes.
Greater roles for the NGOs was seen to ensure Health for All through the
primary health care approach.
Government of India started granting financial aids to NGOs for various
schemes
Contracting in & out – government hires individuals on a temporary basis
to provide services
Privatization

69. CHALLENGES
Prices of services in private sector
Earning commission from diagnostic laboratories
Financial protection against medical expenditure
Non availability of medical, nursing and
paramedical staff
Inadequate and weak drug control infrastructure
Inadequate drug testing facility
Extremely high drug cost
No clear urban health care delivery model

70. CONCLUSION

“The number of students graduating from
secondary schools, which can be expressed as
“the percent of health schools that are
accredited” which can be expressed as “ the
reflection of health care of the country”

71. BIBLIOGRAPHY







Park K. Textbook of preventive & social medicine. 22nd ed.
Banarsidas Bhanot: Jabalpur; 2005. 671- 702,728,732,745
Stanhope M , L ancaster J. Community & public health
nursing.Mosby publishers: U S. 2004;103-4 ,1097-1098
Basavanthappa B T. Community health nursing.2nd edition.
Jaypee publishers : New Delhi. 2008; 38,43, 894- 903
Behind_the_numbers_Medical_cost_trends_for_2011
http://pwchealth.com/cgilocal/hregister.cgi?link=reg/
www.pubmed.com
www.google.com

72. 




Indian Public Health Standards (IPHS) guideline for community
health centers, Revised 2012. DGHS, MOHFW, GOI. 1-94
http://www.newindianexpress.com/magazine/India-has-justone-doctor-for-every-1700-people/2013
www.tradingeconomics.com/india/health-expenditure.html
www.haryanahealth.nic.in
www.nrhm.gov.in/nrhm-in-state/state-wise-information.html

73. THANK YOU 