Definition It is a system which ensures need

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.

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

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

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

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

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)

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

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

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

HEALTH STATUS AND HEALTH PROBLEMS IN INDIA

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

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

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

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

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

Kolkata, India

Organizational framework of Health Care Systems PUBLIC Sector A. Primary Health Care a. Primary health centers b. Sub centers 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 Private Sector AYUSH NGOs & Health Agencies 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)

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)

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.

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

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.

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.

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

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

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

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

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

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.

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.

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

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.