Health care delivery system.ppt..........

A health care delivery system is the organization of people, institutions, and resources that provides medical services to meet a population's health needs.

1. Introduction Health is the birth right of every individual. Today health is considered more than a basic human right. Traditionally focus was disease oriented but now it emphasize on health and its promotion.

2. Health According to WHO, it is defined as “a dynamic state of complete physical, mental and social well being not merely an absence of disease or infirmity.

3. Health care delivery system “ It refers to the totality of resources that a population or society distributes in the organization and delivery of health services. or “It include all personal and public services performed by individuals or institutions for the purpose of maintaining or restoring health.” by stanhope (2011)

4. Health care services According to WHO “multitude of services rendered to individuals,families or communities by the agent of health services or professions for the purpose of promoting,maintaining , monitoring or restoring health.”

5. Objectives To improve the health status of population and the clinical outcome of care. To improve the experience of care of patients, families and communities. To reduce the total economic burden of care and illness. To improve social justice equity in the health status of the population.

6. Functions To provide health services. To raise and pool the resources accesible to pay for health care. To generate human and physical sources that makes the delivery services possible. To set and enforce rules and provide strategic direction for all.

7. MODEL OF HEALTH CARE SYSTEM   Health Status or Health Problems Resources Curative Preventive Promotive Public Private Voluntary Indigenous Changes in Health Status Input Health care services Health care system Output

8. Health problems Communicable dieaseas problems Non communicable dieases problem Nutritional problems Environmental sanitation problems Medical care problems Population problems

9. Resources Manpower Money Material Time Health care services Promotive Preventive Curative

10. Health care delivery system in india 1. Public health sector (a) Primary health care Primary health centers sub‐centers (b) Hospitals/Health centers Community health centers ( Taluka Hospitals) Rural hospitals District hospital/health center Specialist hospitals Teaching hospitals

11. Conti.. (c) Health Insurances schemes Employees state insurance hospitals Central Govt. Health Scheme (d) Other agencies Defense services Railways hospitals

12. Conti.. 2. Private sector   (a) Private Hospitals, polyclinics, Nursing homes and Dispensaries. (b) General practitioners and clinics

13. Conti.. 3. Indigenous system of medicine Ayurveda, Sidha , Unani and Tibbi , Homeopathy, yoga   4.Voluntary health agencies   5.National health programmes  

14. Primary health care In 1977,government of india launched a rural health scheme based on the principle of “placing people’s health in people hand.” Based on the recommendation of shrivastava committee 1975.

15. At local level 1.Village health guide The scheme was introduced on 2 nd oct 1977 emphasize on peoples participation in the care of their own health . Launched in all states except Kerela,Tamilnadu , Arunchal Pradesh and Jammu Kashmir.

16. Conti.. 2.Local dais Traditional Birth Attendants Under elementary concepts of maternal and child health Sterlization Obstetric skills

17. Conti.. 3. Anganwadi worker Angan means “ courtyard” Anganwadi worker is a local lady, studied up to 10 th standard, selected as a worker/teacher for 1000 population to provide basic health services( primary health care ) to children below 6 years, mothers and other women of reproductive age.

18. Conti.. ASHA (Accredited social health activist)  ASHA must be the resident of the village a woman ( married,widow,divorced ) preferably in the group of 25 to 45 years with formal education up to 8th class having communication skills and leadership qualities. The general norm of selection will be one ASHA for 1000 population. In tribal,hilly and desert the norm could be relaxed to one ASHA per habitation.  

19. At subcenter level It is the contact point between PHC and community manned with one health worker male and female. One subcenter for every 5000 population(planes) One subcenter for every 3000 population( hilly,tribal,backward areas)

20. Functions: Mother and child health care Family planning Immunization Work is supervised by male and female health assisstant.One female health assistant supervises six female health workers.

21. Primary health center level Bhore committee in 1946 gave this concept. To provide an integrated curative and preventive health care to rural population which emphasizes on preventive and promotive aspects of health care.

22. Conti.. The PHCs are established and maintained by the State Governments under the Minimum Needs Programme (MNP)/ Basic Minimum Services Programme (BMS). At present, a PHC is manned by a Medical Officer supported by 14 paramedical and other staff. It acts as a referral unit for 6 Sub Centres . It has 4 - 6 beds for patients.

23. Conti.. 1PHC=30,000(Plain) 1 PHC=20,000(hilly, tribal and backward areas) Facilities provided: Surgical procedures(vasectomy, MTP, tubectomy ) along with pediatric care

24. Staff for primary health centre 1. Medical Officer 1 2. Pharmacist 1 3. Nurse Mid-wife (Staff Nurse) 1 4. Health Worker (Female)/ANM 1 5. Health Educator 1 6. Health Assistant (Male) 1 7. Health Assistant (Female)/LHV 1

25. Conti.. 8. Upper Division Clerk 1 9. Lower Division Clerk 1 10. Laboratory Technician 1 11.Driver (Subject to availability of Vehicle) 1 12.Class IV 4 Total:15

26. Functions of PHC Medical care MCH including family planning Safe water supply and basic sanitation Prevention and control of locally endemic disease Collection and reporting of vital statistics Education about health

27. Conti.. National health programmes Referral services Training of health guides,health worker,local dais. Basic lab services

28. Community health centre The secondary level of health care essentially includes Community Health Centres (CHCs), constituting the First Referral Units(FRUs) and the district hospitals. The CHCs were designed to provide referral health care for cases from the primary level and for cases in need of specialist care approaching the centre directly.

29. Conti.. 4 PHCs are included under each CHC thus catering to approximately 80,000 population in tribal / hilly areas and 1, 20,000 population in plain areas. CHC is a 30- bedded hospital providing specialist care in medicine, Obstetrics and Gynaecology , Surgery and Paediatrics .

30. Staff for community health centre:  1.Medical Officer 4 2.Nurse Mid– Wife(staff Nurse) 7 3.Dresser 1 4.Pharmacist/Compounder 1 5.Laboratory Technician 1 6.Radiographer 1 7.Ward Boys 2

31. Conti.. 8. Dhobi 1 9.Sweepers 3 10.Mali 1 11.Chowkidar 1 12.Aya 1 13.Peon 1 Total: 25

32. Health Insurance Schemes 1) Employees state insurance- Introduce by parliament in 1948. It introduce the principle of contribution by the employer and the employee. Provides for medical care Act covers employees drawing wages not exceeding Rs 6500/month and less then 15000/month.

33. Conti.. 2.Centeral government health scheme a) Introduce in Delhi in 1954. b) To provide care to central government employees. c) Based on the principle of cooperative efforts. Facilities. a) Supply of necessary drugs b) Lab and x-ray investigations c) Hospitalization facilities at government as well as private hospitals.

34. Conti.. 3. Other Agencies Defence services Railways II Private Sector Private hospital, Polyclinics, nursing homes and dispensaries

35. Cont.. III. Indigenous System of medicine Ayurveda, Sidha , Unani and Tibbi , Homeopathy, Yoga

36. Voluntary health agencies These are the non profit organizations concerned with various aspects of health eg . Education,promotion,treatment,services etc. They complement the work of governmental efforts to promote family welfare programmes .

37. Functions : Supplementing the work of government agencies Pioneering(research) eg family planning Education Demonstration Guarding the work of government agencies

38. Indian red cross society Established in 1920. Network of over 400 branches all over india. Executing programmes for the promotion of health, prevention of disease and mitigation of suffering among the people.

39. Activities : 1.Relief work 2.Milk and medical supplies 3.Armed forces 4.Maternal and child welfare services 5.Family planning 6.Blood bank

40. Indian council for child welfare It was established in 1952. Affiliated with the international union for child welfare. Services are devoted to secure for indian children those opportunities and facilities by law and other means which are necessary to develop physical ,mental, social and spiritually healthy.

41. Tuberculosis association of india Formed in 1939. branches in all states of india. Activities involve: Organizing a TB seal campaign every year to raise funds. Training of doctors Health workers and social worker in antituberculosis work Promotion of health education Promotion of consultation and organizing conferences New Delhi tuberculosis center

42. Bharat sevak samaj Non political and non official organization was formed in 1952. Main objective is to help people to achieve health by their own actions and effort. Branches are there in all states Improvements of sanitation in villages

43. Central Social Welfare Board Autonomous organization under the general administrative control of the ministry of education. Set up in august 1953. Functions: surveying the needs and requirements of voluntary welfare organization in the country Promoting and setting up of social welfare organization on voluntary basis Rendering of financial aid to deserving existing organization.

44. Kasturba Memorial Funds Created in commemoration of Kasturba Gandhi,after her death in 1944. Main objective of improving the status of women in villages. Through gram sevikas

45. National health programmes Main purpose is to improve the health status of the population. Goals to be achieved have been fixed in terms of mortality and morbidity reduction, decrease in population growth rate, improvements in nutritional status, provision of basic sanitation,manpower requirements.

46. Programmes for Communicable Diseases National Vector Borne Diseases Control Programme (NVBDCP) Revised National Tuberculosis Control Programme National Leprosy Eradication Programme National AIDS Control Programme Universal Immunization Programme National Guinea worm Eradication Programme Integrated Disease Surveillance Programme

47. Programmes for Non Communicable Diseases National Cancer Control Program National Mental Health Program National Diabetes Control Program National Program for Control and treatment of Occupational Diseases National Program for Control of Blindness National program for control of diabetes, cardiovascular disease and stroke National program for prevention and control of deafness

48. National Nutritional Programs Integrated Child Development Services Scheme Midday Meal Programme Special Nutrition Programme (SNP) National Nutritional Anemia Prophylaxis Programme National Iodine Deficiency Disorders Control Programme  

49. Public private partnership (PPP) For more than two decades public-private partnerships have been used to finance health infrastructure. Governments may look to the PPP-model to solve larger problems in healthcare delivery . A health services PPP can be described as a long-term contract (typically 15–30 years) between a public-sector authority and one or more private sector companies operating as a legal entity.

50. Cont.… The government provides purchasing power, outlines goals for an optimal health system, and contracts private enterprise to innovate, build, maintain or manage the delivery of agreed-upon services over the term of the contract . The larger scope of health PPPs to manage and finance care delivery and infrastructure means a larger potential market for private organizations.

51. PPP FUNCTION Contracting management of primary health centres :- Free services- diagnosis, consultation, treatment and drugs . Contracting management of community health centre :- Except select surgeries all services are free for poor patients

52. Contracting management of super specialty hospital:- 40% beds for Poor patients; Free OPD services to poor . Contracting management of ct scan/ mri diagnostics:- Free for all poor Patients; Subsidized rate for others Demand side financing for institutional delivery:- Institutional Deliveries for Primarily for poor women. Ameen welfair trust ( swasthya koopan )

53. Community based health insurance:- Hospitalization for more than 1600 surgeries. Members of farmers’ cooperatives and their dependents. ( yashswini co-operative farmer health scheme ). Mobile health clinic:- Clinical & Radio diagnostics through health camps, lab tests. Free to all Below Poverty line (BPL) cardholders. Telemedicine:- Tele-diagnosis and consultation in cardiac care and specialist care. Free diagnosis, medicines and treatment for BPL patients

54. Summary