Health Care Delivery System.. (FON).pptx

Health Care Delivery (FON).

1. UNIT-II Health Care Delivery Systems

2. Definitions: Health: health is defined as “ a dynamic state of complete physical, mental and social well-being and not merely an absence of any disease or infirmity”- WHO Health care: health care is defined as “multitude of services rendered to individuals, families or communities by the agents of health services or professions for the purpose of promoting, preventing, maintaining, monitoring or restoring health”- Oxford dictionary System: a set of interrelated and independent parts designed to achieve a set of goal. Health care system: health care delivery system is a system in which the services related health care is delivered to the target population.

3. Model of health care delivery system:

4. Input: health status or health problems of community. They represents the health needs of the community. Health care services: they are designed to meet the health care needs of the community through the use of available knowledge and resources. The services should be community based. Health care system: it is intended to deliver health care services. It includes the management sector and involves the organizational matters. Output: it is the outcome of the system. Whether health status has improved or changed. It includes the terms ‘lives saved’, ‘deaths averted’, ‘diseases prevented’ etc.

5. Aspects of health:

6. Health promotion: Health promotion is the process of enabling people to increase control over and to improve their health. It moves beyond a focus on individual behaviour towards a wide range of behaviour.

7. Key elements for health promotion: Good governance for health: policy makers need to make health, a central line of government policy. These policies must be supported by the regulations that match private sectors with public sectors. Health literacy: people need to gain knowledge, skill and information to make healthy choices. For that proper information regarding health need to spread all over the world. Healthy cities: cities have key role in health promotion. Strong leadership and commitment in municipality will help improving condition of urban aeras. Healthy cities involves healthy countries and ultimately heathy world.

8. Aspects of health promotion:

9. Levels of illness prevention:

10. Levels of care:

11. Levels of care Settings for care Services provided Primary Clinics, PHC, CHC Routine health check up, immunization, treatment of common acute illness. Secondary hospitals, specialist clinic Uncomplicated diagnostic or therapeutic procedures. Tertiary Rehabilitation centres, extended care facility Complicated therapeutic and diagnostic procedures.

12. Types of health care agencies:

13. Public sector: This is the government’s agency established at the local, state and central level to provide heath care services. Following are the types of services provided by the public sector: Primary health care Hospitals Health insurance scheme Other agencies

14. Primary health centers : PHC is a traditional health care system which focuses on health equity producing social policy. It is an essential healthcare made universally accessible to individuals and acceptable to them through full participation and at a cost that the community can afford. PHC aims to attain better health services for all.

15. Elements of primary health centres:

16. Extended elements in 21 st century: Expanded options of immunization Reproductive health needs Provision of essential technologies for health Health promotion Prevention and control of communicable and non-communicable diseases Food safety and provision of selected food supplements

17. Principles of PHC: Equitable distribution of health care Improvement of community Community participation Inter-selected co-ordination Use of appropriate technologies Focus on prevention Improvement of sanitation and hygiene Reduction of morbidly and mortality rates Extension of essential health care services

18. Role of nurse in PHC: Provision of direct care service Health education on antenatal, postnatal and newborn care Education and training Research and development Referral services Conduction of deliveries Follow ups

19. Hospitals and CHC: CHC: it is established and maintained by the state Government. One CHC provides specialized care to 4 PHC Rural hospitals: it is an integral part of rural health care system. It gives services from primary care to long term care, to the clients in rural area who requires specialized care, before transferring to large hospital. District hospitals: it is a hospital at secondary referral level responsible for a district containing defined population. It gives extensive care as per needs of referring centres. Specialist hospital: these hospitals concentrate on giving medical and nursing care in a specific area. These hospitals gives treatment for special diseases like ophthalmic, ENT,TB, leprosy etc. Teaching hospitals: it gives medical education and training to health professionals like, doctors, nurses, medical and nursing students, dietitian etc.

20. Health insurance scheme: Employees state insurance(ESI): it was introduced in 1948. employees working under this scheme will get maternity benefits, pension, benefit in case of injury or death etc. Central Government health scheme(CGHS): it was introduced in 1954. it covers employees of autonomous organizations, retired central Government employees, widows receiving a family pension.

21. Other agencies: Defence health services: the motto of this is to provide comprehensive health care including combat and operational medical support to serving Armed forces personnel, their families and dependents. Railway health services: comprehensive health services provided to railway employees, retired railway employees and their dependents.

22. Private sector: Private hospitals: it is a department managed by a group of doctors and nurses and health team. They provide all preventive, promotive and curative care. Nursing homes: these are extended care facilities where care is provided to the clients of all age group who require rehabilitation or custodial care. Treatment of minor ailments also carried out here. Clinics: it involves a department where patient do not require hospitalization, receive medical care. General practitioners: it is a traditional primary care setting. The client usually goes to physician’s office for routine check up, diagnosis and minor treatment.

23. Day care centre: it provides care to the infants and children where parents are working. Some day care centres provides care for elderly also who can not take care of themselves and have nobody to take care . Rehabilitation centres: health workers co-ordinates with the client activities and ensure that clients are accompanying with the treatment and helps them to get back to normal life. Old age homes: nurses look after both the physical and physiological needs of aged clients. Industrial clinics: this agency is designed by the management for employees of their organization. Hospice services: traditionally it is a space of travellers to rest. But recently the term has come to mean health care facilities for dying patient. It provides care to the terminally ill patients.

24. Indigenous system of medicines: It is a natural form of medicine outside the stream of western or allopathic medicines practiced by majority of the doctors. These system includes: ‘AYUSH’ Naturopathy

25. Voluntary health agencies: These organizations are administered by autonomous board that conduct health programmes to provide health services or health education for the improvement of health. Some of the nationally recognized voluntary agencies are: Indian red cross society Hind kusht nivaran sangh Bharath sevak samaj Indian council of child welfare Some of the international voluntary agencies are: Rockefeller foundation Ford foundation CARE (co-operative for assistance and relief everywhere)

26. National health programmes: The health programmes of India includes: National health mission Reproductive and child health RNTCP National AIDS control programme Nutritional programmes National immunization strategies National anti-tobacco programme 20point programme National programme for control of- cancer, diabetes, CVD, stroke The integrated disease surveillance project

27. Organization and administration of health system in India: National level( central level) State level District level Community level

28. Central level health care administration: The central level health care administration system is consists of: Union ministry of health and family welfare Directorate general of health services The central council of health and family welfare

29. A. Union ministry of health and family welfare: Organization: The union ministry of health and family welfare is headed by a cabinet minister and a minister of state and deputy minister. The union ministry has three departments: Departments of health Departments of family welfare Departments of Indian systems of medicine and homeopathy (ISH & H)

30. Functions: the functions of the union health ministry are set out in the seventh schedule of article 246 of the Constitution of India under: The Union list The Concurrent list The union list: the functions given in the union list are: International health relations and administration of port quarantine Administration of central institutes Promotion of research through research centres and other bodies Regulation and development of health care professionals Establishment and maintenance of drug standards Census and collection of publication of other statistical data Immigration and emigration Regulation of labour in the working of mines and oil fields Coordination with state and with other ministries for promotion of health

31. The concurrent list: the functions under the concurrent list are responsibility of both the Union and state governments. The functions are: Prevention of communicable diseases Control of drug and poisons Labour welfare Economic and social planning Prevention of adulteration of foodstuffs Vital signs Ports other than major Population control and family planning

32. Functions of Department of Medical & Public Health: Health policy preparation Drug control Communicable and non-communicable diseases CME( continuing medical education) and training Vital statistics and health intelligence National health programmes conduction PFA(prevention of food adulteration act) enforcement Supplies and disposal maintenance Medical education and research International support

33. Functions of departments of family welfare: Policy preparation and planning Contraceptive research and supply Information collection and evaluation Maternal and child health services Rural health services NGO support IEC( information, education and communication) Paraprofessional training Development of sub-centres

34. Functions of department of IMS & H : Upgrade the educational standards of Indian System of Medicines and Homeopathy colleges in the country Strengthen the existing research institutions and ensure time bound research programme on identified diseases Draw up schemes for promotion, cultivation and regeneration of medical plants used in these systems Evolve pharmacological standards for Indian System of Medicine and Homeopathic drugs

35. B. The directorate general of health services: Organization: Directorate general of health services( DGHS) is the principal advisor for the union Govt. in both medical and public health matters. He is assisted by additional director, a team of deputies and a large administrative staff. It comprises of three units: Medical care and hospital Public health General health

36. Functions: International health relations and quarantine Control of drug standards Medical store depots Post graduate training Medical education Medical research Central Govt. health scheme: National health programme Central health education bureau Central bureau of health intelligence National medical library

37. C. Central council of health and family welfare: Organization: The union health minister is the chairman and the state health ministers are the members of this council. Functions: To consider and recommend broad outlines of policies in regard to matters concerning health in all its aspects. To make proposals for legislation in the fields of activity relating to medical and public health matters and lay down the pattern of development for the country. To make recommendations to the central government regarding distribution of available grants in aid for health purposes to states. To establish any organization with appropriate functions for promoting and maintaining co-operation between the central and health administrations.

38. State level health care administration State ministry of health and family welfare: The state ministry of health is headed by a minister of health and family welfare and deputy minister of health and family welfare. These are political appointments and they are elected by members of legislative assembly. They have political responsibilities, responsibilities towards their constituencies as per political agenda and responsibilities for administration and management of health and family welfare services in their state.

39. Health secretariat: the health secretary is headed by the secretary who is assisted by deputy and assistant secretaries. Functions: The major functions which are performed by the secretariat include helping minister in- Formulation, review and modification of broad policy outlines. Execution of policies programmes etc. Co-ordination with Government of India and other state Governments. Control of smooth and efficient functioning of administrative machinery.

40. State health directorate: state health directorate is the technical wing of state ministry of health and family welfare. Functions: Implementation of national health programmes Collection of vital statistics Encouraging reproductive and child health Education of all health care professionals Controlling rural and urban health services Promoting, providing and supervising all type of health services in the state Providing feedback to the state health ministry regarding health Following the directives of union ministry of health

41. District level health care administration: District: It is an administrative unit defined geographical boundary and population. Within each district, there are 6 administrative areas: Sub-division Tehsils( Taluk ) Community development blocks Municipalities Corporations Panchayats

42. Chief medical and health officer: CM & HO is a director of health and family welfare services at the district in rural area are overall in-charge of the rural area for health and family welfare in rural area. Principle medical officer: PMO is a director of health and family welfare service at district in urban area. Functions: Field reports Inspection Meetings Implementation of policies District level planning and actions Communication management Control and monitoring

43. Community level health care administration

44. Functions of community level health care administration organization: Functions of CHC: Care of routine and emergency cases in medicine and surgery 24 hour delivery services including normal and assisted deliveries Essential and emergency obstetric care New born care Routine and emergency care of sick children Referral services

45. Functions of PHC: Medical care Safe water supply and sanitation Prevention and control of locally endemic disease Collection and reporting vital statistics Education about health Training of health guides Referral services Functions of SC: Mother and child health care Family planning and immunization IUD insertion and simple lab tests

46. Hospitals: A hospital is a residential establishment which provides short term and long term medical care consisting of observational, diagnostic, therapeutic and rehabilitative services for persons suffering or suspected to be suffering from disease or injury and for the parturient. It may or may not also provide services for ambulatory patients on an out patient basis. __WHO expert committee,1963

47. Types of hospital:

48. Functions of hospitals: Care of sick and injured with restoration of health Investigation, diagnosis and treatment of sick or injured Health supervision, immunization and prevention of disease Promotion of health Rehabilitation Vocational training Outpatient services Inpatient services research

49. Health care team and its members Health care team consists of a group of people who co-ordinate their particular skills in order to assist a patient or family. Team members: Physician Nurse Dietitian Physiotherapist Social workers Occupational therapist Paramedical technologies Radiologist Pharmacist Inhalation therapist Psychologist Non-professional workers

50. Role of nurse: Care giver Communicator Teacher Client advocate Counsellor Leader Manager Research consumer Expanded roles( nurse educator, researcher, clinical nurse, specialist nurse, nurse anaesthetist etc)

51. Organization of the hospital: Organization can be defined as the process of identifying and grouping the work to be performed, defining and delegating responsibility and authority and establishing relationship to enable people to work together most effectively in accomplishing the objectives.

52. Functions: Division of activities Determination of responsibility Delegation of authorities Co-ordination Communication

53. Relationships between the positions in organization: Line relationship: it exists between two superior or subordinates. Here the superior is directly involved. Example, relationship between NS and head nurse. Lateral relationship: this exists between various positions in the organization where the superior is not directly involved. Example, relationship between NS and the nursing educator. Functional relationship: it exists when an individual has right to control certain activities in other department outside his chain of command. Example, in charge of laundry departments also controls the supply of linen in medical ward. Staff relationship: this consists of expert experts and specialists in various field who give support to executive authority.

54. Organizational chart: It is the hierarchy of authority presented in a flow chart. There are 2 types: Vertical organizational chart: used in government hospitals Horizontal organizational chart: used on basically private hospitals

55. Vertical organizational chart: RMO Technical staff NS AO HOD OT technician Lab technician ARMO Associate professor Head nurse accountant Sr. assistant Sr. consultant Jr. consultant Staff nurse

56. Horizontal organizational chart: supervisor supervisor supervisor supervisor Staff nurse Staff nurse