HEALTH CARE DELIVERY

AMRITA SCHOOL OF DENTISTRY

1. HEALTH CARE DELIVERY SYSTEM IN INDIA

2. Contents

3. Evolution of Health Systems 3

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5. Health System Administration in India 5

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9. Health Care Sectors in India Public Health Sector Primary Health Care Primary Health Centres Sub- Centres Hospitals / Health Centres Community Health Centres Rural Hospitals District Hospitals/ Health Centre Specialist Hospitals Teaching Hospitals Health Insurance Schemes Employees State Insurance(ESI) Central Government Health Scheme(CGHS) Ayushmann Bharath- NPHS Other Agencies Defence Services Railways Indigenous Systems Of India Ayurveda And Siddha Unani And Tibbi Homoeopathy Unregistered Practitioners Voluntary Health Agencies National Health Programmes Private Sector Private hospitals, polyclinics, nursing homes, and dispensaries General practitioners and clinics 9

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11. 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 3months 1 for each village per 1000 rural population Village Health Guides Scheme 11

12. A scheme for training of Dais was initiated during 2001-02. The scheme was implemented in 156 districts in 18 states The districts selected were on the basis of the safe delivery rate being less than 30 percent. The scheme was extended to all the districts of Empowered Action Group ( EAG) states. The aim was to train at least one Dai in every village with the objective of making deliveries safe . Training is for 30 working days. Paid a stipend of Rs. 300 During her training period. Training at PHC, sub‐center or MCH center for 2 days in a week, four days of the week they accompany the health worker. Training of local Dais 12

13. Angan literally means a courtyard. Under the ICDS(Integrated Child Development Services) scheme, there is an anganwadi worker for a population of 400-800. There are about 100 such workers in each ICDS project. As of date over 707 ICDS blocks are functioning in the country . The anganwadi worker is selected from the community she is expected to serve. She undergoes training in various of health, nutrition and child development for 4 months .She is a part time worker and is paid an honorarium of Rs. 1500 per month for the services rendered, which include health checkup including maintenance of growth chart etc., Anganwadi Worker ICDS Scheme (Integrated Child Development Services) 13

14. ASHA must be resident of the village – a women ( married/widow/ divorced) preferably in the age group of 25 to 45 years. The general norm of selection is one ASHA for 1000 population .In tribal, hilly and desert areas the norm could be relaxed to one ASHA per habitation Role and Responsibilities ASHA will take steps to create awareness and provide information to the community on determinants of health. She will counsel women on birth preparedness, importance of safe delivery, breast feeding Accredited Social Health Activist ( ASHA) 14

15. ASHA will mobilize the community and facilitate them in accessing health and health related services available at anganwadi / subcentre /primary health centres . She will work with the village health and sanitation committee of the gram panchayat She will arrange escort/accompany pregnant women and children requiring treatment/admission to the nearest pre- identified health facility. ASHA will provide primary medical care for minor ailments such as diarrhoea, fevers and first aid for minor injuries. 15

16. 2. Sub- Center Level The sub- centre is the peripheral outpost of the existing health delivery system in rural areas. They are being established on the basis of one-sub centre for every 5000 population in general ,3000 population in hilly , tribal and backward areas. As of March 2017, 2,550 PHCs were working with 6 sub centres under each. A sub centre provides interface with the community at the grass root level, providing all the primary health care services. One lady health visitor (LHV) and one health assistant (male) located at PHC are entrusted with the task of supervision of six sub centres Indian public Health Standards For Sub centers are of 2 types: TYPE-A and TYPE-B (MCH- sub centre ) 16

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18. 3. Primary Health Center Level The concept of primary health centre is not new to India. The Bhore committee in 1946 gave the concept of a primary health centre . The health planners in India have visualized the primary health centre and its subcentres as the proper infrastructure to provide health services to the rural population. Staffing pattern in PHC: At present in each community development block, there are 1 or more PHCs each of which covers 30,000 rural population. 3 workers at the subcenter level and 9 or more workers at PHC level. Indian public Health Standards For PHCs: TYPE A PHC –PHC with less than 20 deliveries/ month TYPE B PHC – PHC with 20 or more deliveries/ month 18

19. Staffing pattern in PHC Medical officer 1 Pharmacist 1 Nurse mid-wife 1 Health worker (female)/ANM 1 Block extension educator 1 Health assistant (male) 1 Health assistant (female) 1 U.D.C 1 L.D.C 1 Lab.technician 1 Driver 1 Class IV 4 19

20. Functions of the PHC Medical care MCH including family planning Safe water supply and basic sanitation Prevention and control of locally endemic diseases Collection and reporting of vital statistics Education about health National Health Programmers - as relevant Referral services Training of health guides, health workers, local dais and health assistants Basic laboratory services 20

21. 4. Community Health Center Level Established by upgrading PHC’s One centre for population of 80,000 to 1,20,000 Requirements 30 beds X-ray and lab facilities Specialists surgery and medicine Obstetric and gynecology Pediatrics Community health officer Referrals- State level hospitals and medical collage hospitals 21

22. Staffing pattern in CHC Medical officer 4 Pharmacist 1 Nurse mid-wife 7 Dresser 1 Block extension educator 1 Radiographer 1 Ward boys 2 Dhobi 1 Sweepers 3 Mali 1 Chowkidhar 1 Aya 4 Peon 1 22

23. Functions of the PHC Care of routine and emergency cases in surgery Care of routine and emergency cases in medicine Maternal health Newborn care and child health Family planning All the national health programmes (NHP) Physical Medicine and Rehabilitation (PMR) Oral health School health services Adolescent health care Blood storage Diagnostic services Referral (transport) services Maternal Death Review(MDR) 23

24. 5. Hospitals Rural hospitals Proposed to upgrade rural dispensaries to PHC Hospitals present at tehsils/sub-divisional/taluka head quarters are shifted to rural areas These sub-divisional health centre cover a population of 5 lakhs Each centre will have epidemiological wing attached to them District hospital Proposed to convert into district health centre 24

25. 6. Health Insurance There is no universal health Insurance in India. Health insurance is limited to industrial workers under the Employees State Insurance Scheme (ESI scheme) Central Government Health Scheme- Introduced in New Delhi in 1954 to provide comprehensive medical care to Central Government employees. The scheme is based on the principle of cooperative effort by the employee and the employer, to the mutual advantage of both. Universal Health Insurance Scheme (UHIS) - families under below poverty line (BPL) 25

26. 7. Other Agencies Defense medical services Health care of railway employees Private agencies 8. Indigenous Systems of Medicine The practitioners of indigenous systems of medicine (e.g., Ayurveda, Siddha , Homoeopathy, etc.)provide the bulk of medical care to the rural people. Ayurvedic physicians alone are estimated to be about 7.73 lakhs. Studies indicate that nearly 90 percent of Ayurvedic physicians serve the rural areas. 26

27. 9 . Voluntary Health Agencies Occupy important place in community health programmes Compared with “motor trucks” which can penetrate the by-ways. Functions Supplementing the work of Govt. agencies Pioneering Education Demonstration Guarding the work of Govt. agencies Advancing health legislation 27

28. Activities of VHAS in India Indian red cross society Hind kusta nivaran sangh Tuberculosis a association of india Bharath se v ak samaj Kasturba memorial fund 28

29. 10. National Health programmes in India National Vector Borne Disease Control Programme (NVBDCP) National Filaria Control Programme National Leprosy Eradication Programme Revised National TB Control Programme National Programme for control of Blindness National Iodine Deficiency Disorders Control Programme National Mental Health Programme National Aids Control Programme 29

30. Health Agencies Around the World NGO’S IN HEALTH CARE Rockfellar foundation Assistance to virus research project, Establishment of all India institute of hygiene and public health Ford foundation Water supply and sanitation schemes CARE Mid-day school meals programme USAID Support to health programmes, Water supply, sanitation. World bank, UNFPA etc Provide assistance in health programmes in India 30

31. Conclusion Health care systems are essential for improving and maintaining the health of the population of any country. Health systems are the result of the combined efforts of government agencies, institutions and resources with the main aim of improving the health of their people . Properly designed health systems have a strong preventive component which can detect possible illnesses through a combination of action and advice. 31

32. Suggested Reading Soben Peter (2018). Essentials of Preventive and Community Dentistry. 6th Edition, Arya Publishing House, New Delhi. Park K. Textbook of preventive and social medicine; 25th Edition 32

33. 33 Expected Questions Health care system in India Health care sectors in India

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