Health care Delivery system

community health nursing
M.Sc. NURSING 1ST YEAR

1. WELCO MES YO U ALL .. 

2. MODERATOR PRESENTOR Mr. PRAMOD K S NITU LECTURER M.SC. (N) 1 st YEAR CON 403/13 HEALTH CARE DELIVERY SYSTEM IN IN D IA

3. INTR ODUC TION IN D IA is union of 28 states & 7 union terrorties Older concept – Health care means patient care Objective - freedom from the disease through hospital system.

4. DEF INIT ION 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.”

5. EVOLUTION OF HEALTH CARE SERVICES IN INDIA

6. STILL…66 YRS . OF HEALTH SERVICES Crude Death Rate ↓ Crude birth rate ↓ Life expectancy ↑ S.pox & G. worm Eradicated Leprosy Eliminated IMR ↓ Infrastructure – Expanded Polio Eradicated

7. ROLE OF DIFFERENT COMMITTEES 1946 – BHORE COMMITTEE (HEALTH SURVEY AND DEVELOPMENT COMMITTEE) Integration of preventive and curative services Development of PHC 3 months training in PSM 1962 – MUDALIAR COMMITTEE (HEALTH SURVEY AND PLANNING COMMITTEE ) Strengthening of PHC and district hospital Regional organization

8. CONT… 1973 – KARTAR SINGH Committee on multipurpose worker ANM replaced by female health worker Basic health worker replaced by male health worker Lady health worker designated as female health supervisor.

9. PRO BLE MS Environment Education Empowerment Diseases Communicable Non Communicable New emerging Fertility Population Growth rate Total Fertility Nutrition Malnutrition Obesity INDIRECTLY RELATED TO HEALTH DIRECTLY RELATED TO HEALTH

10. MODEL OF HEALTH CARE SYSTEM INPUTS HEALTH CARE SERVICES HEALTH CARE SYSTEM OUTPUTS Health Status or Health Problems Resources Curative Preventive Promotive Public Private Voluntary Indigenous Changes in Health Status

11. HEALTH DEMANDS & NEEDS OF THE COMMUNITY COMPREHENSIVE & COMMUNITY BASED CARE CONSTITUTES MANAGEMENT SECTOR & INVOLVES ORGANIZATION IMPROVED HEALTH STATUS EXPRESSED IN TERMS OF LIVES,SAVES, DEATH A VERTED, DISEASES PREVENTED, LIFE EXPECTENCY INCREASED

12. HEALTH ORGANISATION IN INDIA

13. AT THE CENTRE LEVEL

14. THE UNION MINISTRY OF HEALTH AND FAMILY WELFARE

15. CEN TRAL LIST International Health, Port Health Research Technical & Scientific Education

16. FUN CTI ONS

17. CONT…

18. 2. CONCURRENT LIST

19. B. DIRECTORATE GENERAL OF HEA LTH SERVICES (DGHS)

20. ORGA NIZA TION

21. FUNCTIONS OF DIRECTORATE GENERAL OF HEALTH Surveys Planning Coordination Programming Appraisal of all health matters International Health relations Control of drug standards Medical store depots Postgraduate training Medical education Medical research CGHS, NHP, CHEB etc. GENERAL FUNCTIONS SPECIFIC FUNCTIONS

22. C. THE CENTRAL COUNCIL OF HEALTH AND FAMILY WELFARE The central council of health was set up by the presidential order on 9th August 1952 under article 263 of the constitution of India for promoting coordinated and concerted action between the center and the state for the implementation of all the programmes and measures pirating to the health of the nation. Chairman  The Union Health Minister Members  The State Health Minister

23. FUNCTION OF CENTRAL COUNCIL OF HEALTH AND FAMILY WELFARE To consider and recommend broad outlines of policy in regard to matters of health such as, Provision of remedial and preventive care. Environment Hygiene. Nutrition. Health education and Promotion of facilities for training and research.

24. Cont.. 2. To make proposals for legislation in fields of medical and public health matters and to lay down. 3 . To make recommendations to the central government regarding the health. 4 . To established any organization with appropriate functions for promoting and maintain cooperation between central and state health administrations

25. MIL E STO NES NRHM-2005 NHP-2002 NPP-2000 RCH-1996 UIP-1985 NHP-1983 Alma Ata-1978 (HFA) Juggling Priorities Small pox eradicated-July 5, 1975 NFPP-1952 India Joins WHO-1948 HSDC-1946

26. STATE LEV EL OF HE ALTH CARE

27. THE STATE LIST The government of India act, 1935 gave further autonomy to the states. The health subjects were divided into three lists under the 7 th schedule of the India constitution. They are:   1 The Union List 2 The State List 3 The Concurrent List

28. FUNCTIONS UNDER ST ATE LIST Public health sanitations , hospitals and dispensaries. Local government, i.e. the constitutions and powers of municipal corporations, district boards. Intoxicating liquors that is production, manufacture, possession, transport, purchase and sale of intoxicating liquors.

29. Cont…. Relief of the disabled and unemployable. Burials and burial grounds, cremation grounds. Markets and fairs.

30. AT THE STATE LEVEL

31. ORGA NIZA TION

32. STATE MINISTRY OF HEALTH AND FAMILY WELFARE

33. 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.

34. AT THE DISTRICT LEVEL

35. DISTRICT HEALTH ORGANIZATION

36. ORGA NIZAT ION Panchayats Villages Community Development Blocks Town Area Committees Tahsil (Taluka) District Sub-division Corporations Municipal Boards Rural Urban

37. PANC HAYATI RAJ

38. 3- TIE R SYS TEM

39. THE GRAM SABHA It is comprised of all the adult men and women of the village. This body meets at least twice in a year and discuss important issues. They elect members of panchayat .

40. THE GRAM PAN CHAYAT consists of 15-30 elected members covers the population of 5000 to 20000. chaired by the president i.e. sarpanch/ mukhya/ sabhapati. There is a vice- president and a secretary. Responsible for overall planning and development of the villages. The panchayat secretary has been given powers to functions for wide areas such as maintenance of sanitation and public health, socio-economic development of the villages etc .

41. THE NYAYA PANCHAYAT It is comprised of 5 members from the panchayat. It tries to solve the dispute between two parties/ groups/ individuals over certain matters on mutual consent.

42. AT THE BLOCK LEVEL Is known as P anchayat samiti. Members of panchayat samiti are: Sarpanches from all the gram panchayats in the block MLAs and MPs residing in the area representative of women, schedule castes, schedule tribes and cooperative societies.

43. AT THE DISTRICT LEVEL The panchayati raj institution at the district level is known as ZILA PARISHAD . Is headed by the chairman also known as adhikashak .

44. CONT…. It includes the following members: The heads of all the gram samities in the district, MLA and MPs from the district, Representatives of women, SC/ST, 2 persons who have experience in administration, rural development officer etc.

45. HEALTH CARE DELIVERY SYSTEM IN INDIA At the block level Objective - to provide primary health care to all the sections of the society. 80% of the population is scattered in villages 20% of rural population have health care facilities Centre Plain area Hilly / Tribal / Difficult area Community health centre 1,20,000 80,000 Primary health centre 30,000 20,000 Sub-centre 5,000 3,000

46. COMMUNITY HEALTH CENTRE’S Established and maintained by the State Government under MNP/BMS programme. 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, Labor Room and Laboratory facilities.

47. CONT.. It serves as a referral centre for 4 PHCs and also provides facilities for obstetric care and specialist consultations. As on Sep 2013 , there are 4,833 CHCs functioning in the country. In Haryana 2013 , there are 108 CHCs functioning.

48. PRIMARY HEALTH CENTRE’S 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.

49. CONT…. NRHM - two additional Staff Nurses at PHCs (contractual). It acts as a referral unit for 6 Sub Centre’s and has 4 - 6 beds for patients. There were 24,049 PHCs functioning in the country as on Sep 2013 . In Haryana Sep 2013 , there were 425 PHCs functioning.

50. SUB -CEN TRE Most peripheral and first contact point between the primary health care system and the community. Manned by at least one ANM / Female Health Worker and one Male Health Worker. Under NRHM, one additional second ANM on contract basis.

51. CONT… Provide services in relation to maternal and child health, family welfare, nutrition, immunization and control of communicable diseases. Ministry of Health & Family Welfare is providing 100% Central assistance to all the Sub-Centre’s 1,48,366 Sub Centre’s functioning in the country as on Sep 2013 In Haryana Sep 2013, there were 2465 SCs functioning

52. A SH A Accredited Social Health Activist (ASHA) for 1000 population Chosen by and accountable to the panchayat. Act as the interface between the community and the public health system. Honorary volunteer, receiving performance-based compensation Facilitate preparation and implementation of the Village Health Plan The other persons are Indigenous dais Anganwadi workers

53. CONT… ASHA (Accredited Social Health Activist) Total Number of ASHA in position as on 30-06-2013 High Focus states 5,72,573 Other than High Focus states 3,17,163 Total Number of ASHA selected and trained up to IV module High Focus states 4,94,155 Other Than High Focus states 2,89,923 NUMBER OF ASHA WORKERS ACC SEP 2013

54. A SURVEY REPORT PUBLISHED IN NEW INDIAN EXPRESS There is only one doctor per 1,700 citizens in India; the World Health Organization stipulates a minimum ratio of 1:1,000. There are 387 medical colleges in the country—181 in government and 206 in private sector. India produces 30,000 doctors, 18,000 specialists, 30,000 AYUSH graduates, 54,000 nurses, 15,000 ANMs and 36,000 pharmacists annually. Health ministry claims that there are about 6-6.5 lakh doctors available. But India would need about four lakh more by 2020 to maintain the required ratio of one doctor per 1,000 people

55. PHC PROGRESS IN INDIA (2012-13)

56. Progress made in CHCs during 2005-12

57. INTEGRATED APPROACH OF HEALTH CARE DELIVERY

58. BUDGET IN FIVE YEAR PLANS

59. BUD GET SUPP ORT Budget Support for Central Departments in Eleventh Plan (2007–12) and Twelfth Plan (2012–17) Projections (` Crore) Department of MoHFW Eleventh Plan Expenditure (in Crore) Twelfth Plan Outlay( in Crore) % Increase Department of Health and Family Welfare 83407 268551 322% Department of Ayurveda , Yoga &Naturopathy, Unani , Siddha & Homoeopathy (AYUSH) 2994 10044 335% Department of Health Research 1870 10029 536% Aids Control 1305 11394 873% Total MoHFW 89576 300018 335%

60. HEALTH EXPENDITURE, PUBLIC (% OF GDP) IN INDIA

61. HEALTH EXPENDITURE, PRIVATE (% OF GDP) IN INDIA

62. OUT-OF-POCKET HEALTH EXPENDITURE (% OF PRIVATE EXPENDITUTEON HEALTH) IN INDIA

63. EXTERNAL RESOURCES FOR HEALTH EXPENDITURE (% OF TOTALEXPENDITUTEON HEALTH) IN INDIA

64. NURSES AND MIDWIVES (/ 1000 PEOPLE) IN INDIA

65. CONTRIB UTION BY NGOS

66. CHA LLEN GES

67. CON CLUS ION “The number of students graduating from secondary schools, which can be expressed as “the percent of health schools that are accredited” which can be expressed as “ the reflection of health care of the country”  

68. BIBL IOGR APHY Park K. Textbook of preventive & social medicine. 22 nd ed. Banarsidas Bhanot: Jabalpur; 2005. 671- 702,728,732,745 Stanhope M , L ancaster J. Community & public health nursing.Mosby publishers: U S. 2004;103-4 ,1097-1098 Basavanthappa B T. Community health nursing.2 nd edition. Jaypee publishers : New Delhi. 2008; 38,43, 894- 903 Behind_the_numbers_Medical_cost_trends_for_2011 http://pwchealth.com/cgilocal/hregister.cgi?link=reg/ www.pubmed.com www.google.com

69. Indian Public Health Standards (IPHS) guideline for community health centers, Revised 2012. DGHS, MOHFW, GOI. 1-94 http://www.newindianexpress.com/magazine/India-has-just-one-doctor-for-every-1700-people/2013 www.tradingeconomics.com/india/health-expenditure.html www.haryanahealth.nic.in www.nrhm.gov.in/nrhm-in-state/state-wise-information.html

70. THANK YOU 