Health care delivery system

Health care delivery system in india

1. Health Care Delivery System In India D.SRIDHAR

2. FRAME WORK Introduction Evolution of health care system in India Committees involvement in health care Organised structure in India Health care delivery systems in India Public health sector Private sector Indigenous system of medicine Voluntary health agencies National health programmes Challenges Tamilnadu & new schemes Niti aayog

3. INTRODUCTION Older concept – Health care means patient care Objective - freedom from the disease through hospital system. 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.” Intersectoral communication & community participation

4. EVOLUTION OF HEALTH CARE SYSTEM IN INDIA Christian Era – civilization started in Indus Valley Environmental sanitation, houses with drainage 1400 B.C. – Ayurveda and Siddha system Developed a comprehensive concept of health Post vedic – teaching of buddhism and Jainism Rahula Sankirtyana – developed hospital system. Moghul empire – Arabic system of medicine ( Unani ) British Gov – British nationals, armed forces, civil servants.

5. COMITTEES INVOLVEMENT IN HEALTH CARE Bhore comitte [1943-1946][health survey & development committee] Three tier system of medicine Primary Secondary Tertiary health care service One phc =40000 Integral all round socio economic Development Of the community

6. 1962 – Mudaliar committee (Health survey and planning committee) Strengthening of PHC and district hospital Regional organization 1963 – Chaddah committee Basic health workers workers Family planning health assistant

7. 1965 – Mukerji committee Separate staff for the family planning programme 1967 – Jungalwala committee Integration of health services Elimination of private practice by Gov. doctor 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.

8. ORGANISED STRUCTURE IN INDIA Health system has 3 main links Central, state and local or peripheral. India is a Union of 28 states and 7 territories. Health is the responsibility of state. Central responsibility Policy making Guiding Assisting Evaluating Coordinating the work of state health ministries.

9. AT THE CENTER The union ministry of health and family welfare Headed by Cabinet minister Minister of state   Deputy health minister

10. The union health ministry 1.Department of health 2.Department of family welfare Department of health Secretary to the Gov. of India (Executive head)   Joint secretary Administrative staff   Directorate general of health services Subordinate officer

11. Department of family welfare Department of family welfare Was created in 1966 Headed by the secretary to the government of India. Secretary   Additional secretary   Commissioner   One joint secretary

12. Directorate general of health services - Principal advisor in both medical and public health matter. DGHS   Additional Director General of health services   Team of deputies   Administrative staff

13. The central council of health and family welfare Chairman – Union health minister Members – State health ministers Function To consider and recommend board outlines of policy in regards to matters of health To make proposals for legislation in fields of medical and public health matters and to lay down. To make recommendations to the central government regarding the health. To established any organization with appropriate functions for promoting and maintain cooperation between central and state health administrations

14. 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 Piligrim within the state State management sector State ministry of health Directorate of health and family welfare services

15. THREE TIER SYSTEM OF TAMILNADU

16. State ministry 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 . 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.

17. AT THE DISTRICT LEVEL Principal unit of administration in India District health organization identifies and provide the needs of expanding rural health and family welfare programme Within each district again, there are 6 types of administrative areas No uniform model of district health organization

18. THREE TIER SYSTEM

19. Health care delivery systems in india Public health sector Private sector Indigenous system of medicine Voluntary health agencies Health programmes

20. PUBLIC HEALTH SECTOR 1 [A] Primary health care Primary health centers Sub centers [B] Hopitals /health centers Community health centers Rural hospitals District hospitals/health centers Specialist hospitals Teaching hospitals [C] Health insurances schemes Employees state insurance Central govt.Health scheme [D] Other agencies Defence service Railways

21. 2. Private sector [A] private hospitals, nursing homes, poly clinics & dispensaries [B] general practitioners & clinics 3 Indigenous System Of Medicine Ayurvedha Yoga Naturopathy Unani Siddah Homeopathy 4.Voluntary Health Agencies 5.National health programmes

22. PRIMARY HEALTH CARE 1. Village Level A. Village Health Guides B. Training Of Local Dais C. ICDS Scheme( Anganwadi ) D. NRHM Scheme(ASHA) 2. Sub centre level 3.Primary health centre level

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

24. Local dais[trained birth assistants] Traditional Birth Attendants‐ Concepts Of Maternal And Child Health And Sterilization, Besides Obstretic Skills. 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. . Vital Role In Propagating Small Family Norms Emphasis Is Given On Asepsis So That Home Deliveries Are Conducted Hygenicaly For every 1000 population in a village . Over 6,00,000 trained birth assistants are there , at subcenter level they are called as skilled birth assistants

25. anganwadi worker Under the ICDS (integrated child development services) scheme, there is an anganwadi for a population of 1000.[400-800 in plains] [300-800 in tribal & difficult areas] training 4 months.She is a part‐time worker and is paid an honorarium of RS.200‐250 The beneficiaries are especially nursing mothers, other women (15‐ 45years ) and children below the age of 6 years . Recently Govt Had Given Maternity Benefit Scheme Availablr For Anganwadi Worker. 6months Leave With Salary & Insurance Coverage Of 280 Rs

26. SUB CENTER . Subcenters are community based first level of primary health care(grass root level) • 1 subcentre ‐ 5000 population in general but in hilly, tribal and backward areas 1 ‐ 3000 population. • Two functionaries at this level ‐ health worker male and health worker female (multipurpose worker). • 6‐8 month in service training and orientation by phcs medical officer. As on march 2012 1,48,366 subcenters against required 1,58,792(13% shortfall) Only 51,705 male health workers are avaiable as against strength of 82,563

27. Primary health centre

28. 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. NRHM - 5 additional Staff Nurses at PHCs . It acts as a referral unit for 6 Sub Centre’s and has 4 - 6 beds for patients. There were 23,887 PHCs functioning in the country as on March 2011.

29. functions 1. Education ‐ health problems and the methods of preventing an controlling them. 2. Promotion of food supply and proper nutrition. 3. An adequate supply of safe water and basic sanitation. 4. Maternal and child health care. 5. Immunization against major infectious diseases. 6. Prevention and control of locally endemic diseases. 7. Appropriate treatment of common diseases and injuries. 8. Provision of essential drugs. 9. National Health Programs‐ as relevant

30. Community health Centre’s Community health Centre’s • One out of 4 PHC’s in community developmental block upgraded and recognized as Community Health Center (CHC). Established and maintained by the State Government 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, Labour Room and Laboratory facilities. It serves as a referral centre for 4 PHCs As on March, 2012, there are 4,833 CHCs functioning in the country. AS AGAINST 6491(shortfall of 36%)

31. Citizen charter at chc’s

32. Citizen charter about functioning of phc

33. MOBILE MEDICAL UNIT

34. Rashtriya Bal Swasthya Karyakram (RBSK)

35. RBSK SCREENING CARD

36. RBSK VEHICLE

37. mission indhra dhanush Mission Indradhanush  was launched by  Union Health Minister  J.P Nadda on 25 December 2014. [1] It aims to immunize all children against seven vaccine preventable diseases namely diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis B by 2020. In addition to this, vaccines for Japanese Encephalitis (JE) and Haemophilus influenzae type B (HIB) are also being provided in selected states

38. Urban PRIMARY HEALTH CARE SERVICE The government of India has identified “Urban Health” as one of the thrust area in the tenth Five Year Plan, National population policy 2000, National Health Policy 2002 and second phase of RCH program The central government health scheme (1954) objective of providing comprehensive medical health care facilities to the central government employees and their family members. Urban Family Welfare centers launched during the first five year plan. At present 1083 centers are functioning and providing outreach services, primary health services, MCH services and distribution of contraceptives.

39. PRIVATE SECTOR Private agencies • Private hospitals • Independent clinics • 70% general practitioners • Highly unorganized, concentrated in urban areas • Provide mainly curative services • MCI, IMA regulate some functions and activities

40. PUBLIC PRIVATE PARTNERSHIP FOR HEALTH CARE “VIKALP” Its a method of identifying quality equipped nurshing home along with ngo’s and make private health providers and make them a part of public health system at low cost Beneficieries are chosen by district health & family welfare society members.

41. SECONDARY HEALTH CARE Mainly comprises of the community health center comprising the (FRU) first referal unit , private sectors nursing home & the district hospitals It mainly acts as a linkage between the centers for effective refferal and management.

42. TERTIARY HEALTH CARE Tertiary care is available through medical college hospitlas super speciality institutions, and private institution it provides complete and maximum health care in india . Strengthening of tertiary care being done under pradhan mantri swasthya suraksha yojna (PMSSY) 6 AIIMS 13 UPGRADED TO AIIMS ATANDARD

43. Indigenous system of medicine AYUSH Ayurvedha Yoga Naturopathy Unani Sidha Homeopathy Indigenous system of medicine • Provide bulk of medical care to rural people • National Institute of Ayurveda • National Institute of Homeopathy • Govt studying how these can be best utilized for more effective health coverage

44. AYUSH in most primary health centers in tamilnadu , sidha has been implementd effectively seperate pharmacy is available for them .

45. Employees state insurance scheme (ESI) Employees state insurance scheme (ESI) • Introduced in 1948 • Contribution by employer and employee • Provides for medical care in cash and kind, benefits in the contingency of sickness, maternity, employment injury and pension for dependents on death of worker due to employment injury • Covers salary < 10,000/month • Covers all employees – manual, clerical, supervisory and technical

46. Central government health scheme ( cghs ) Central government health scheme ( cghs ) • Introduced in 1954 in NewDelhi • Covers employees of autonomous organisations , retired central government servants, widows receiving family pension, MP’s, Ex‐Governors and retired judges • Covers about 42.76 lakh beneficiaries through 320 dispensaries/hospitals

47. RASHTRIYA SWATHYA BIMA YOJNA (RBSY) It’s a national insurance scheme Provides benefits for unorganised sector -93% 30,000 annum Central and state govt shares it in 75:25 ratio Draw back- it doesn’t cover primary health care & travel

48. OTHER AGENCIES Defence medical services – Armed forces medical services Health care of railway employees – Railway hospitals and clinics – Yearly health check ups

49. Voluntary health agencies in India Voluntary health agencies in India 1. Indian Red Cross Society 2. Hind Kusht nivaran sangh 3. Indian council for child welfare 4. Tuberculosis association of India 5. Bharat sevak samaj 6. Central social welfare board 7. The kasturba memorial fund 8. The All‐India blind relief society 9. Professional bodies 10. International agencies

50. National health programmes National health programmes 1. Anti‐malaria programme 2. National filaria control programme 3. Kala‐ azar control programme 4. Japanese encephalitis control 5. Dengue control 6. National Leprosy‐eradication programme 7. National tuberculosis programme 8. National AIDS control programme 9. National programme for control of blindness 10. Iodine deficiency programme 11. Universal immunization programme 12. Reproductive and child health programme 13. National caner control programme 14. National rural health mission 15 RMNCH +A( Reproductive,Newborn,Maternal , Child& Adolescent Health)

51. NGO’S NON GOVERNMENTAL ORGANISATION Providing services like relief to the blind, the disabled and disadvantaged and helping the government in mother and child health care, including family planning programmes . Greater roles for the NGOs was seen to ensure Health for All through the primary health care approach. Government of India started granting financial aids to NGOs for various schemes Contracting in – government hires individuals on a temporary basis to provide services Contracting out – government pays outside individuals to manage specific function Subsidies – government gives funds to privet groups to provide specific services. Leasing or rental – government offers the use of its facilities to a privet organization. Privatization – government gives or sells a public health facility to a privet group.

52. CHALLENGES

53. TAMILNADU HEALTH SERVICE & NEW SCHEMES

54. PHARMACY

55. EMERCENCY 108

56. NEONATAL 108

57. Niti aayog The NITI Aayog comprises the following: Prime Minister of India  as the Chairperson A Governing Council composed of  Chief Ministers  of all the States and Union territories with Legislatures and lieutenant governors of other Union Territories. Regional Councils composed of Chief Ministers of States and Lt. Governors of Union Territories in the region to address specific issues and contingencies impacting more than one state or a region. Full-time organizational framework composed of a Vice-Chairperson, three full-time members, two part-time members (from leading universities, research organizations and other relevant institutions in an ex-officio capacity), four ex-officio members of the Union Council of Ministers, a Chief Executive Officer (with the rank of Secretary to the Government of India) who looks after administration, and a secretariat. Experts and specialists in various fields  [2]

58. With Prime Minister  Narendra Modi  as the Chairperson, the committee consists of Vice Chairperson: Arvind Panagariya   [3] Ex-Officio Members:  Rajnath Singh ,  Arun Jaitley ,  Suresh Prabhu  and  Radha Mohan Singh Special Invitees:  Nitin Gadkari ,  Smriti Zubin Irani  and  Thawar Chand Gehlot Full-time Members:  Bibek Debroy  (Economist), [4]   V. K. Saraswat  (former  DRDO  Chief) and Ramesh Chand (Agriculture Expert) [5] Chief Executive Officer: Amitabh Kant [6] Governing Council: All  Chief Ministers  and  Lieutenant Governors  of States and Union Territories

59. Source Official website for NITI Aayog Official website for NGO Partnership System of NITI Aayog Ministry of health & family welfare National rural health mission cgweb.nic.in/health/ rbsk / http://www.tnhealth.org/dph/dphpm.php Parks text Book 23 rd edition Sundar lal text book of community medicine   Health & Family Welfare Minister launches ‘Mission Indradhanush ’