Delivery of community health services

Improve knowledge on health care delivery system

1. UNIT-3 DELIVERY OF COMMUNITY HEALTH SERVICES

2. INTRODUCTION India is a union of 29 states and 7 union territories States are largely independent in matters relating to the delivery of health care to the people. Each state has developed its own system of health care delivery , independent of the central government.

3. The central governments responsibility consists mainly of policy making , planning , guiding , assisting , evaluating and coordinating the work of the state health ministries.

4. HEALTH SYSTEM IN INDIA THE HEALTH SYSTEM IN INDIA 3 MAIN LINKS

5. CENTRAL LEVEL : Union ministry of health and family welfare Directorate general of health services Central council of health

6. STATE LEVEL : State ministry of health State health directorate

7. DISTRICT LEVEL : RURAL : Tehsils ( taluks ) Community development blocks Villages Panchayat raj

8. URBAN : Townarea (committees)5000-10000 population Muncipal board (10000- 2 lakhs ) Corporation ( above 2 lakhs )

9. FUNCTIONS : Construction and maintenance of roads Sanitation and drainage Street lighting Water supply Maintenance of hospitals and dispensaries Education Registration of births and deaths

10. VILLAGE LEVEL : The Panchayat raj at the village level comprises of the GRAM SABHA GRAM PANCHAYAT NYAYA PANCHAYAT

11. GRAM SABHA : It is the assembly of all the adults of the village which meets at least twice a year All the adult men and women will discuss important issues and consider proposals pertaining to various developmental aspects including health matters etc

12. The gram sabha elects members of panchayat GRAM PANCHAYAT : It consists of 15-30 elected members. It covers a population of 5000 to 20,000 It is chaired by the president, there is a vice president and a secretary.

13. The gram panchayat is an executive organ of gram sabha and is responsible for overall planning and development of the villages. The panchayat secretary has been given powers to function for wide areas such as maintenance of sanitation and public health, socio economic development of the villages.

14. It is involved in planning and organising various health activities in the villages. NYAYA PANCHAYAT : It is comprised of 5 members from the panchayat it tries to solve the dispute between two parties or groups or individuals over certain matters on mutual consent. This saves the trouble of going to formal judicial system

15. SUB CENTRE LEVEL The sub centre is the peripheral outpost in rural areas There is one sub centre for every 5000 population in general and one for every 3000 population in hilly, tribal and backward areas. Each sub centre is served by one male and female MPHW.

16. FUNCTIONS : Mother and child care Family planning and immunization Extended services IUD insertion Simple laboratory investigations e,g : urine for albumin and sugar

17. STAFFING PATTERN : Female health assistant -1 Health worker female ANM -1 Health worker male -1 Voluntary worker -1 Local dais -3

18. PRIMARY HEALTH CENTRE It provide an integrated health care to the rural population as close to the people as possible. One PHC for every 30,000 rural population in the plains and one PHC for every 20,000 population in hilly , tribal and backward areas for more effective coverage.

19. FUNCTIONS OF PHC Medical care MCH including family planning Safe water supply and basic sanitation Prevention of and control of locally endemic diseases Collection and reporting of vital statistics Health education National health Programmes Basic laboratory services

20. staffing pattern of phc Medical officer -1 Pharmacist -1 Nurse midwife -1 Health worker female -1 Block extension educator -1 Health assistant male -1 Health assistant female -1 Lab technician -1 Driver -1 Class 4 employees -4

21. COMMUNITY HEALTH CENTRE These centres were established in 1996 These are upgraded PHC. IT COVERS A POPULATION OF 80,000 -1,20,000. In each centre there will be 30 beds with specialist for medicine, surgery, obstetrics , gynecology and pediatric , x-ray and laboratory services.

22. For each 100 villages , one community health centre will be there this is also called as community development block. From community health centres patients are refferred to MEDICAL COLLEGE HOSPITAL OR DISTRICT HOSPITAL.

23. STAFFING PATTERN OF CHC Medical officers -4 Chowkidar -1 Nurse midwives -7 Aya -1 Dresser -1 Peon -1 Pharmacist /compounder -1 Lab technician -1 Radiographer -1 Ward boys -2 DHOBI -1 Sweepers -3 Mali -1

24. COMMUNITY DEVELOPMENT BLOCK The community development Programme in India was born as part of the nations five year plans This is a method to facilitate social, economic, and cultural progress of the rural people through multi disciplinary approach.

25. OBJECTIVES : To bridge the gap between poverty, disease and ignorance through the community efforts thus awakening the interest and enthusiasm of millions of people in improving their own conditions.

26. ACTIVITIES : Identification of the health needs of the community Agricultural development Improvement of communication Education Improvement of health Rural sanitation Special programmes for women and children such as balwadis

27. HOSPITALS DISTRICT HOSPITALS STATE CENTRAL

28. DISTRICT HOSPITALS Services provided are mostly curative It has no catchment area , patients may be drawn from any part of the country The team consists of only curative staff e,g : doctors , compounders , nurses etc

29. STATE HEALTH INSURANCE There is no universal health insurance in india At present , it is limited to industrial workers and their families The central govt employees are also covered by the health insurance under the banner CENTRAL GOVT HEALTH SCHEME.

30. EMPLOYEES STATE INSURANCE SCHEME: ESI has been introduced for the first time in india based on the principle of contribution by the employer and the employee The ACT provides for medical care in cash and kind benefits in the contingency of sickness, maternity, employment injury, and pension for dependents on the death of worker because of employment injury

31. The act covers employees drawing wages not exceeding Rs 7,500/ month. CENTRAL GOVT HEALTH SCHEME : It has been first introduced in new delhi in 1954 to provide comprehensive medical care to central govt employees.

32. FACILITIES : Outpatient care Supply for necessary drugs Lab and x-ray investigations Domicilary visits Hospitalization at government as well as private hospital

33. Referral services Paediatric services Obstetrical services Emergency treatment Supply of optical and dental aids Family welfare services

34. PLANNING According to the population of subcentres , PHCs community health centres should plan for the developmental programmes and services needed by the community people e,.g Immunization Personal hygiene Environmental sanitation Institutional deliveries Family planning services MCH services

35. Health education Growth monitoring ORS distribution Balanced diet

36. MATERIAL MANAGEMENT DEFINITION ; Material mgt is a service function affecting the flow of materials in a manner in which its helps in conserving the materials, cost , best utilization of materials and maintaining the quality of both incoming and outgoing materials.

37. FUNCTIONS PLANNING AND SOURCING BUDGETING RESEARCHING AND ANALYSIS INDENTING RECEIVING , STORING , AND PRESERVING ACCOUNTING AND CONTROLLING ISSUING AND DISPATCHING DISPOSING

38. BUDGETING One of the primary objectives of management accounting is to provide information to management for planning and control A widely used device for managerial control is the budget

39. DEFINITION : Budgeting is the formulation of plans for a given period in numerical terms - H arold koortz A budget is a plan that uses numerical data to predict that activities of an organization over a period of time - B essie

40. PURPOSES : It supplies the mechanism for translating fiscal objectives in to project monthly spending pattern It clearly recognizes controllable and uncontrollable cost areas It allows feedback of utilization of budget It helps to identify problem areas and facilitates effective solution

41. BUDGET PROCESS INDIAN METHOD QUALITY : ANNUAL METHOD MONTHLY METHOD STARTS FROM SEP/OCT OF CURRENT YEARS

42. urban slums A slum is a highly populated urban residential area consisting mostly of closely packed, decrepit housing units in a situation of incomplete infrastructure, impoverished persons