HEALTH CARE DELIVERY SYSTEMIN INDIAD.SRIDHAR

FRAME WORK Introduction Evolution of health care system in India Committees involvement in health care Organised structure in India Health care delivery systems in India Public health sector Private sector Indigenous system of medicine Voluntary health agencies National health programmes Challenges Tamilnadu & new schemes Niti aayog

INTRODUCTION

Older concept – Health care means patient care

Objective - freedom from the disease through hospital system.

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.”

Intersectoral communication & community participation

EVOLUTION OF HEALTH CARE SYSTEM IN INDIA Christian Era – civilization started in Indus Valley

Environmental sanitation, houses with drainage 1400 B.C. – Ayurveda and Siddha system

Developed a comprehensive concept of health Post vedic – teaching of buddhism and Jainism Rahula Sankirtyana – developed hospital system. Moghul empire – Arabic system of medicine (Unani) British Gov – British nationals, armed forces, civil

servants.

COMITTEES INVOLVEMENT IN HEALTH CARE

Bhore comitte[1943-1946][health survey & development committee]

Three tier system of medicine

Primary Secondary Tertiary health care service

One phc =40000

Integral all round socio economic Development Of the community

1962 – Mudaliar committee (Health survey and planning committee)

Strengthening of PHC and district hospital Regional organization

1963 – Chaddah committee

Basic health workersworkersFamily planning health assistant

1965 – Mukerji committeeSeparate staff for the family planning programme

1967 – Jungalwala committeeIntegration of health servicesElimination of private practice by Gov. doctor

1973 – Kartar singhCommittee on multipurpose worker ANM replaced by female health workerBasic health worker replaced by male health worker Lady health worker designated as female health supervisor.

ORGANISED STRUCTURE IN INDIA Health system has 3 main links

Central, state and local or peripheral.

India is a Union of 28 states and 7 territories.

Health is the responsibility of state.

Central responsibility Policy making Guiding Assisting Evaluating Coordinating the work of state health ministries.

AT THE CENTER

The union ministry of health and family welfare

Headed by Cabinet minister

Minister of state 

Deputy health minister

The union health ministry

1.Department of health2.Department of family welfare

Department of health Secretary to the Gov. of India

(Executive head) 

Joint secretary

Administrative staff 

Directorate general of health services

Subordinate officer

DEPARTMENT OF FAMILY WELFAREDepartment of family welfare Was created in 1966 Headed by the secretary to the government

of India.

Secretary 

Additional secretary 

Commissioner 

One joint secretary

DIRECTORATE GENERAL OF HEALTH SERVICES

- Principal advisor in both medical and public health matter.

DGHS 

Additional Director General of health services

 Team of deputies

 Administrative staff

The central council of health and family welfare

Chairman – Union health ministerMembers – State health ministers

Function To consider and recommend board outlines of policy in regards to matters of healthTo make proposals for legislation in fields of medical and public health matters and to lay down.To make recommendations to the central government regarding the health.To established any organization with appropriate functions for promoting and maintain cooperation between central and state health administrations

AT THE STATE LEVEL

The state health administration was started in the year 1919.

The state list which become the responsibility of the state included Provision of medical care Preventive health services Piligrim within the state State management sector

State ministry of health

Directorate of health and

family welfare services

THREE TIER SYSTEM OF TAMILNADU

STATE MINISTRY

State ministry of health and family welfareHeaded - Cabinet minister and deputy

minister. (Political head)Responsibility - formulating

policies,Monitoring the implementation of these policies and programmes.

State health directorate and family welfarePrinciple advisor in matters relating to

medicine and public healthAssisted by joint director, regional joint

director and assistant directors.

AT THE DISTRICT LEVEL

Principal unit of administration in India

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

THREE TIER SYSTEM

HEALTH CARE DELIVERY SYSTEMS IN INDIA Public health sector

Private sector

Indigenous system of medicine

Voluntary health agencies

Health programmes

PUBLIC HEALTH SECTOR 1 [A] Primary health care Primary health centers Sub centers [B] Hopitals/health centers Community health centers Rural hospitals District hospitals/health centers Specialist hospitals Teaching hospitals [C] Health insurances schemes Employees state insurance Central govt.Health scheme [D] Other agencies Defence service Railways

2. Private sector [A] private hospitals, nursing homes, poly clinics & dispensaries

[B] general practitioners & clinics

3 Indigenous System Of Medicine Ayurvedha Yoga Naturopathy Unani Siddah Homeopathy 4.Voluntary Health Agencies

5.National health programmes

PRIMARY HEALTH CARE 1. Village Level

A. Village Health Guides B. Training Of Local Dais C. ICDS Scheme(Anganwadi)

D. NRHM Scheme(ASHA)

2. Sub centre level

3.Primary health centre level

VILLAGE HEALTH GUIDES

Village Health Guides

They serve as links between the community and the governmental infrastructure. They provide the first

contact between the individual and health system. ASHA’S are now used as health guides at village

level under NRHM

Guidelines: Be permanent resident minimum formal education (VI class) Spare at least 2‐3 hours/day for community health

work

After selection ,they undergo training in nearest PHC for 3 months .1 for each village per 1000 rural population

LOCAL DAIS[TRAINED BIRTH ASSISTANTS] Traditional Birth Attendants‐ Concepts Of Maternal And Child

Health AndSterilization, Besides Obstretic Skills.

Training is for 30 working days. Paid a stipend of rs. 300 duringher training period. Training at phc, sub‐center or mch centerfor 2 days in a week, four days of the week theyaccompany the health worker.

. Vital Role In Propagating Small Family NormsEmphasis Is Given On Asepsis So That Home Deliveries Are Conducted Hygenicaly For every 1000 population in a village

. Over 6,00,000 trained birth assistants are there , at subcenter level they are

called as skilled birth assistants

ANGANWADI WORKER Under the ICDS (integrated child development services)

scheme, there is an anganwadi for a population of 1000.[400-800 in plains] [300-800 in tribal & difficult areas]

training 4 months.She is a part‐time worker and is paid an honorarium of RS.200‐250The beneficiaries are especially nursing mothers, other women (15‐45years) and children below the age of 6 years.

Recently Govt Had Given Maternity Benefit Scheme Availablr For Anganwadi Worker.

6months Leave With Salary & Insurance Coverage Of 280 Rs

SUB CENTER . Subcenters are community based first level of primary health

care(grass root level)

• 1 subcentre ‐ 5000 population in general but in hilly, tribal and backward areas 1 ‐ 3000 population.

• Two functionaries at this level ‐ health worker male and health worker female (multipurpose worker).

• 6‐8 month in service training and orientation by phcs medical officer.

As on march 2012 1,48,366 subcenters against required

1,58,792(13% shortfall)

Only 51,705 male health workers are avaiable as against strength of 82,563

PRIMARY HEALTH CENTRE

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.

NRHM - 5 additional Staff Nurses at PHCs .

It acts as a referral unit for 6 Sub Centre’s and has 4 - 6 beds for patients.

There were 23,887 PHCs functioning in the country as on March 2011.

FUNCTIONS

1. Education ‐ health problems and the methods of preventing ancontrolling them.2. Promotion of food supply and proper nutrition.3. An adequate supply of safe water and basic sanitation.4. Maternal and child health care.5. Immunization against major infectious diseases.6. Prevention and control of locally endemic diseases.7. Appropriate treatment of common diseases and injuries.8. Provision of essential drugs.9. National Health Programs‐ as relevant

COMMUNITY HEALTH CENTRE’S

Community health Centre’s• One out of 4 PHC’s in community developmental

block upgraded andrecognized as Community Health Center(CHC).

Established and maintained by the State Government 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, Labour Room and Laboratory facilities.

It serves as a referral centre for 4 PHCs As on March, 2012, there are 4,833 CHCs functioning

in the country. AS AGAINST 6491(shortfall of 36%)

CITIZEN CHARTER AT CHC’S

CITIZEN CHARTER ABOUT FUNCTIONING OF PHC

MOBILE MEDICAL UNIT

RASHTRIYA BAL SWASTHYA KARYAKRAM (RBSK)

RBSK SCREENING CARD

RBSK VEHICLE

MISSION INDHRA DHANUSH

Mission Indradhanush was launched by Union Health Minister J.P Nadda on 25 December 2014.[1]

It aims to immunize all children against seven vaccine preventable diseases namely diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis B by 2020. In addition to this, vaccines for Japanese Encephalitis (JE) and Haemophilus influenzae type B (HIB) are also being provided in selected states

URBAN PRIMARY HEALTH CARE SERVICE The government of India has identified “Urban Health” as

one of the thrust area in the tenth Five Year Plan, National population policy 2000, National Health Policy 2002 and second phase of RCH program

The central government health scheme (1954) objective of providing comprehensive medical health care

facilities to the central government employees and their family members.

Urban Family Welfare centers launched during the first five year plan. At present 1083 centers are functioning and providing

outreach services, primary health services, MCH services and distribution of contraceptives.

PRIVATE SECTOR Private agencies

• Private hospitals• Independent clinics• 70% general practitioners• Highly unorganized, concentrated in urbanareas• Provide mainly curative services• MCI, IMA regulate some functions andactivities

PUBLIC PRIVATE PARTNERSHIP FOR HEALTH CARE “VIKALP” Its a method of identifying quality equipped

nurshing home along with ngo’s and make private health providers and make them a part of public health system at low cost

Beneficieries are chosen by district health & family welfare society members.

SECONDARY HEALTH CARE Mainly comprises of the community health

center comprising the (FRU) first referal unit , private sectors nursing home & the district hospitals

It mainly acts as a linkage between the centers for effective refferal and management.

TERTIARY HEALTH CARE

Tertiary care is available through medical college hospitlas super speciality institutions, and private institution it provides complete and maximum health care in india.

Strengthening of tertiary care being done under pradhan mantri swasthya suraksha yojna(PMSSY)

6 AIIMS 13 UPGRADED TO AIIMS ATANDARD

INDIGENOUS SYSTEM OF MEDICINE AYUSH Ayurvedha Yoga Naturopathy Unani Sidha Homeopathy

Indigenous system of medicine• Provide bulk of medical care to rural people• National Institute of Ayurveda• National Institute of Homeopathy• Govt studying how these can be best utilizedfor more effective health coverage

AYUSH in most primary health centers in tamilnadu, sidha has been implementd effectivelyseperatepharmacy is available for them.

EMPLOYEES STATE INSURANCE SCHEME (ESI) Employees state insurance scheme (ESI)

• Introduced in 1948• Contribution by employer and employee• Provides for medical care in cash and kind, benefits in the contingency ofsickness, maternity, employment injury and pension for dependents on deathof worker due to employment injury• Covers salary < 10,000/month• Covers all employees – manual, clerical, supervisory and technical

CENTRAL GOVERNMENT HEALTH SCHEME (CGHS) Central government health scheme (cghs)

• Introduced in 1954 in NewDelhi• Covers employees of autonomousorganisations, retired central governmentservants, widows receiving family pension,MP’s, Ex‐Governors and retired judges

• Covers about 42.76 lakh beneficiaries through320 dispensaries/hospitals

RASHTRIYA SWATHYA BIMA YOJNA (RBSY) It’s a national insurance scheme

Provides benefits for unorganised sector -93%

30,000 annum

Central and state govt shares it in 75:25 ratio

Draw back- it doesn’t cover primary health care & travel

OTHER AGENCIES

Defence medical services– Armed forces medical servicesHealth care of railway employees– Railway hospitals and clinics– Yearly health check ups

VOLUNTARY HEALTH AGENCIES IN INDIA Voluntary health agencies in India

1. Indian Red Cross Society2. Hind Kusht nivaran sangh3. Indian council for child welfare4. Tuberculosis association of India5. Bharat sevak samaj6. Central social welfare board7. The kasturba memorial fund8. The All‐India blind relief society9. Professional bodies10. International agencies

NATIONAL HEALTH PROGRAMMES National health programmes

1. Anti‐malaria programme2. National filaria control programme3. Kala‐azar control programme4. Japanese encephalitis control5. Dengue control6. National Leprosy‐eradication programme7. National tuberculosis programme8. National AIDS control programme9. National programme for control of blindness10. Iodine deficiency programme11. Universal immunization programme12. Reproductive and child health programme13. National caner control programme14. National rural health mission

15 RMNCH +A(Reproductive,Newborn,Maternal, Child& Adolescent Health)

NGO’S NON GOVERNMENTAL ORGANISATION 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 – government hires individuals on a temporary

basis to provide services Contracting out – government pays outside individuals to

manage specific function Subsidies – government gives funds to privet groups to provide

specific services. Leasing or rental – government offers the use of its facilities to a

privet organization. Privatization – government gives or sells a public health facility

to a privet group.

CHALLENGES

TAMILNADU HEALTH SERVICE & NEW SCHEMES

PHARMACY

EMERCENCY 108

NEONATAL 108

NITI AAYOG The NITI Aayog comprises the following: Prime Minister of India as the Chairperson A Governing Council composed of Chief Ministers of all the

States and Union territories with Legislatures and lieutenant governors of other Union Territories.

Regional Councils composed of Chief Ministers of States and Lt. Governors of Union Territories in the region to address specific issues and contingencies impacting more than one state or a region.

Full-time organizational framework composed of a Vice-Chairperson, three full-time members, two part-time members (from leading universities, research organizations and other relevant institutions in an ex-officio capacity), four ex-officio members of the Union Council of Ministers, a Chief Executive Officer (with the rank of Secretary to the Government of India) who looks after administration, and a secretariat.

Experts and specialists in various fields [2]

With Prime Minister Narendra Modi as the Chairperson, the committee consists of

Vice Chairperson: Arvind Panagariya [3]

Ex-Officio Members: Rajnath Singh, Arun Jaitley, Suresh Prabhu and Radha Mohan Singh

Special Invitees: Nitin Gadkari, Smriti Zubin Irani and Thawar Chand Gehlot

Full-time Members: Bibek Debroy (Economist),[4] V. K. Saraswat (former DRDO Chief) and Ramesh Chand (Agriculture Expert)[5]

Chief Executive Officer:Amitabh Kant[6]

Governing Council: All Chief Ministers and Lieutenant Governors of States and Union Territories

SOURCE

Official website for NITI Aayog Official website for NGO Partnership System o

f NITI Aayog

Ministry of health & family welfare National rural health mission cgweb.nic.in/health/rbsk/ http://www.tnhealth.org/dph/dphpm.php Parks text Book 23 rd edition Sundar lal text book of community medicine

 Health & Family Welfare Minister launches ‘Mission Indradhanush’