1. DELIVERY OF HEALTH CARE SERVICES IN RURAL.ppt

health care delivery system in rural area as per latest IPHS standard s

1. DELIVERY OF HEALTH CARE SERVICES
IN RURAL AREAS

2. #
MEANING
•THISSYSTEMISDEVELOPTOPROVIDE
COMPREHENSIVE HEALTH CARE
SERVICESTOTHEPEOPLE.
•ESPECIALLYTHOSELIVINGINREMOTE
AND BACKWARD AREAS.USING
AVAILABLERESOURCES
(ie.MANPOWER,MONEY,MATERIAL.)

3. #
DETERMINANTS OF H.C.D.S.
•CONSUMERS OF HEALTH CARE.
•PROVIDERS OF HEALTH CARE.
•THE FUNDING SOURCES.
•OTHER FACTORS.

4. #
INPUT
HEALTH
CARE
SYSTEM
HEALTH
CARE
SERVICES
OUTPUTS

5. #
I.P.H.S.
•Indian Public Health Standards(IPHS) are a
set of standards envisaged to improve the
quality of health care delivery in the country
under the National Rural Health Mission.
•Started in 2007 for CHC,PHC & SC .
•IPHS Standard reviewed in 2012.

6. #
The Need for IPHS?
ThehealthcaresysteminIndiahasexpanded
considerablyoverthelastfewdecades,however,
thequalityofservicesisnotuniform,
•Duetovariousreasonslikenon-availabilityof
manpower,
•Problemsofaccess,
•Acceptability,
•Lackofcommunityinvolvement,etc.
Hence,standardsarebeingintroducedinorderto
improvethequalityofpublichealthlevel.

7. #
Planning, Budgeting & Material
management of SC, PHC, CHC.
Planning of Health manpower:-It include both
professional and auxiliary health personnel who
are needed to provide the health care.
Health care requirement based on :-
1.Health needs and demands of the population.
2.Desired output.
It is based on doctor population ratio, nurse
population ratio, bed population ratio.

8. #
Money and Material
•To achieve of “health for all” WHO
recommended 5% of (Gross National
Product )GNP of each country.
•India has 3% of GNP on health and
family welfare.
•Use of money and material should cost
effective and cost-benefit.

9. #
Health Care Delivery in India:-

10. #
HEALTH SERVICES IN RURAL AREAS.
THIS SCHEME “RURAL HEALTH SERVICES”
WAS LAUNCHED BY GOVT. OF INDIA IN
1977
THE RURAL HEALTH SCHEME WAS
MODIFIED IN LIGHT OF NATIONAL HEALTH
POLICY.
WHICH WAS APPROVED BY PARLIAMENT
IN 1983.
TO ACHIEVE THE GOAL OF “HEALTH FOR
ALL” BY THE YEAR 2000.

11. #
h.c.d.s in; Rural
Organization staffing and functions of rural
health services (As per syllabus)…..
•Village
•Sub-centre
•Primary health centre
•Community health centre/sub-divisional
•Hospitals
•District
•State
•Centre

12. #
Urban
Organization staffing and function of urban
health servicesProvided by GOVT at Slums
•Dispensaries
•Maternal and child health centers
•Special clinics
•Hospitals
•Corporation /municipality/board

13. #
RURAL ORGANIZATION
Health care system:
•At village level
•At sub center level
•At PHC level
•At CHC level
•District level
•State level.
•National level

14. #
AT VILLAGE LEVEL
•Village health guides
•Local dais
•Aganwadi workers
•ASHA

15. #
Village health guides
Village health guide is a person with an aptitude for social
service and is not full time govt. functionary. Village
health guides scheme was introduced on 2
nd
October
1977.
Guidelines for their selection:
•They should be permanent resident of the local community,
preferably women
•They should be able to read and write, having minimum formal
education at least up to the VI standard
•They should be acceptable to all sections of community
•They should be able spare at least 2 to 3 hours every day for
community health work.

16. #
Village health guides
The training is arranged in the nearest PHC,
sub center or other suitable place.
The duration of 200 hours, spread over a
period of 3 months.
During the training period they receive a
stipend of Rs. 200 per month.

17. #
Village health members
Local dais: Aganwadi worker:
Most deliveries in rural areas are handled
by untrained dais.
The training for dais given for 30 working
days.
Each dais is paid stipend of Rs. 300
during the training period. The training is
given at PHC, sub centers or MCHcenter
for 2 days in a week and on the
remaining four days of the week they
accompany the health worker (female) to
the village.
During her training each dais is required
to conduct at least 2 deliveries under the
supervision and guidance of health
worker (female), ANM, health assistant
(female).
Under the ICDS scheme there is
an Aganwadi worker for a
population of 1000. (400-800)
Training in various aspect of
health, nutrition and child
development for 4 months.
She is a part time worker and
paid an honorarium of Rs.1500
per month for the services.

18. #
Function of health personnel
Functions of Village health
guides:
Functions of dais:Functions of Aganwadi
worker
(1) Provide treatment for
common minor ailments.
(2) First aid and
emergency
(3) MCHcare
(4) Family planning
(5) Health education
(1) MCHcare
(2) Family planning
(3) Immunization
(4) Education about
health
(5) Referral services
(6) Safe water and basic
sanitation
(7) Nutrition
(1) MCHcare
(2) Family planning
(3) Immunization
(4) Education about
health
(5) Referral services
(6) Safe water and basic
sanitation
(7) Supplementary
nutrition
(8) Non-formal education
of children

19. #
Accredited Social Health Activist (ASHA)
•One of the key components of the
National Rural Health Mission is to
provide every village in the country.
•Selected from the village itself and
accountable to it, the ASHA will be
trained to work as an interface between
the community and the public health
system.

20. #
Criteria for Selection
•The general norm will be ‘One ASHA per 1000
population’. In tribal, hilly, desert areas the norm could
be relaxed to one ASHA per habitation, dependent on
workload etc.
•ASHA must be primarily a woman resident of the village
‘Married / Widow / Divorced’ and preferably in the
•Age group of 25 to 45 yrs.
•ASHA should have effective communication skills,
•Leadership qualities and be able to reach out to the
community.
•She should be a literate woman with formal education up
to 8 to 10 Class.

21. #
Roles and responsibilities of ASHA:
•She Provides information to the community.
•She will counsel women on birth preparedness,
•ASHA will mobilize the community and facilitate them in
accessing health and health related services.
•ASHA will provide primary medical care for minor ailments
such as diarrhea, fevers, and first aid for minor injuries
•She will also act as a depot holder for essential provisions
such as Oral Rehydration Therapy (ORS), Iron Folic Acid
Tablet (IFA), chloroquine, etc.
•She will inform about the births and deaths in her village
•She will promote construction of household toilets under
Total Sanitation Campaign.

22. #
SUB-CENTRE
•Most peripheral and first contact point between the
primary health care system and the community.
•Population covers 5000 in general and 3000 in hilly and
tribal.
•Total SC was153655in March 2015
•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 100%
Central assistance to all the Sub-Centre’s.
•Functions are mother and child health care, family
planning and immunization.

23. #
Categorization of SC
•Type—A :-provide all the
recommended services except that
facilities of conducting delivery not be
available. (ANM trained for midwifery
they may conduct normal delivery in
case of need)

24. #
TYPE-B ;MCH sub centre
•Centrally or better located with good
connectivity.
•Good infrastructure with delivery room.
•Expected delivery 20 in month.
•2 bed facilities at sub centre, if delivery
more than 20 than 2 additional bed.

25. #

26. #
FUNCTION
1.Maternal care (ANC, PNC, INTRA NATAL)
2.Child care.
3.Family planning and contraceptive.
4.Counseling and appropriate referral.
5.Adolescent health care.
6.Water quality and sanitation.
7.Field visits.
8.Community need assessment.
9.Disease surveillance.
10.National health program.
11.Records of vital events

27. #
PRIMARY HEALTH CENTERS:
PRIMARY HEALTH CENTRE’S Functions of primary health centers:
First contact point between village
community and the Medical Officer.
Population covers 30000 in
general and 20000 in hilly and
tribal.
March 2015 total PHCwas 25308.
BEDS =06
Established and maintained by the
State Governments under the MNP/
BMS Programme.
Manned by a Medical Officer
supported by paramedical and other
staff.
It acts as a referral unit for 6 Sub
Centre’s and has 6 beds for patients.
Medical care
MCHand family welfare
Safe water supply and basic sanitation
Prevention and control of communicable
diseases
Collection and reporting of vital statistics
Health education
National health programmes
Training of health guides, health workers.
Basic laboratory services
School health services
Prevention of food adulteration practices

28. #
Categorization of PHC
•TYPE-A :-PHC with less than 20
delivery.
•TYPE-B :-PHC with more than 20
delivery.

29. #

30. #
COMMUNITY HEALTH CENTRE’S
COMMUNITY HEALTH CENTRE’S
Indian public health standards for
community health centers:-
Established and maintained by the State
Government under MNP/BMS
programme.
Population covers 80000 to 120000 .
It has 30 in-door beds with one OT, X-ray,
Labor Room and Laboratory facilities.
It serves as a referral center for 4 PHCs
and also provides facilities for obstetric
care and specialist consultations.
Every CHChas to provide following
services which are known as assured
services.
Care of routine and emergency cases in
medicine
24 hours delivery services including
normal and assisted devices.
Essential and emergency obstetric care
including surgical interventions like
caesarian and other medical
interventions.
Safe abortion services, new born care,
routine emergency care of sick children

31. #
STAFFING PATTERN FOR CHC
S.N.PERSONNEL STRENGHT
1 PHYSICIAN 1
2 GENERAL SURGEON 1
3 OBSTETRICIAN& GYNECOLOGIST 1
4 PEDIATRIC 1
5 ANESTHETIST 1
6 EYE SURGEON 1 (1 For every 5 CHC)
7 DENTAL SURGEON 1
8 GENERAL DUTY MEDICAL OFFICER 06 (At least2 female doctor)
9 SPECIALIST OF AYUSH 1
10 GENERAL DUTY MEDICAL OFFICER OF AYUSH 1
11 Public health manager 1
Total 15 / 16

32. #
S.N.PERSONNEL STRENGTH
1 Staff Nurse 19
2 Public Health Nurse 1
3 ANM 1
4 Pharmacist 3
5 Pharmacist AYUSH 1
6 Lab. Tachnician 3
7 Radiographer 2
8 Ophthalmic Assistant. 1
9 Dresser 2
10 Ward Boys / Nursing Orderly 5
11 Sweepers 5

33. #
S.N.PERSONNEL STRENGTH
12 Chowkidar 5
13 Dhobi 1
14 Mali 1
15 Aya 5
16 Peon 2
17 OPDAttendant 1
18 Registration Clerk 2
19 Statistical Assistance / Data Entry Operator2
20 Accountant 1
21 O T Technician 1
TOTAL 64

34. #
•Category I: Sub-district hospitals norms
for 31-50 beds.
•Category II: Sub-district hospitals norms
for 51-100 beds.
•In India the population size of a Sub-
district varies from 1,00,000 to 5,00,000.
Sub-district hospitals

35. #

36. #

37. #

38. #

39. #
•605 district hospitals in 640 districts of the
country as per NRHM data as on 30-6-2010.
•As per Census 2001, the population of a
district varies from as low as 32,000 (Yanam
in Pondicherry, Lahaul & Spiti in Himachal
Pradesh) to as high as 30 lakhs (Ludhiana,
Amritsar districts). The bed strength also
varies from 75 to 500 beds depending on the
size, terrain and population of the district.
Districthospitals

40. #
•Grade I: District hospitals norms for 500 beds
•Grade II: District Hospital Norms for 400 beds
•Grade III: District hospitals norms for 300
beds
•Grade IV: District hospitals norms for 200
beds
•Grade V: District hospitals norms for 100
beds
Grade of district Hospital

41. #

42. #

43. #
AT THE DISTRICT LEVEL
•Principal unit of administration in India
•Rural hospitals:-It is now proposed to
upgrade the rural dispensaries to PHC’s.
•District hospitals:-There are proposals to
convert the district hospitals to District health
center.
•Chief Medical Officer is overall responsible for
the administration of medical/ health services
in the entire district.
•The principal unit of administration in India is
the district under a collector.

44. #
Within each district again there are 6 types of administrative areas
1. Sub –divisions
2. Tehsils (Talukas)
3. Community Development Blocks
4. Municipalities and Corporations
5. Villages
6. Panchayats

45. #
•Most districts in India are divided into two or more
sub divisions, each in charge of an assistant
Collector or sub collector. Each division is again
divided in to tehsils(talukas), in charge of a
Tehsildar.
•A tehsilusually comprises between 200 to 600
villages. Since the launching of the community
Development programme in India in 1952.
•The block is a unit of rural planning and
development, and comprises approximately 100
villages and about 80,000 to 1,20,000 population,
in charge of a block development officer.
•Finally there are the village panchayats, which are
institutions of rural local self government.

46. #

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48. #
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

49. #
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.

50. #
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.

51. #

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THANKS