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1. CHAPTER - 2
HEALTH CARE DELIVERY SYSTEMS

<scplnay team in ti, Is provided by bok pub

volumary agencies und nonprofit agencies. Hesse

services ae provided tothe public. Services provided
include curativo services, preventive services
(nmuizations, maternal and childcare, prevention anal
contol of chronic and non-communicable diseases
Sanitation), promotive services and rehabilitative
services. Itisadminsteredin the central level and

Private sectors It includes all non-govetnmental

ences. I comprises of largest segment ofthe health
sare system, All services rendered by publi sector are
provided by private sector also,

LEVELS OF ILUNESS| PREVENTION,

The prevention i an anticipatory medicine. The word
Prevention" is derived from a Latin word pr
sang of which iso come before
a tk

healthy people to ensu
which permit them told

Tie, Preventive action
development of di

their safe health
productive and socially useful
and measures ar taken before the

HEALTH PROMOTION AND PREVENTION

Health promotion: is he proc,
inerease contol over and to
beyond a focus on indivi
range of social

of gnabling pegple to
improve thei health moves
improve their hea

idl behavior Wards wide
ná environmental nterventions (W110)
Hal promotion seeks o improve the lve of health in a
prie by pesxenine diseases, controling pagando
improving Bess and wellbeing and eme oe

ay of workers o work and to faction ie aie
Health promotion actvitics are generale dived
Saale. healın protection and prevention

lth promotion empowers individuals and communities

haviors and make changes that
reduce the risk of developing chronic diseases and other
more

Better health will contibute to an increase in both

individual nd social product, Society as a whole bears
“ome responiiliy for the hal of ts members. Health
Promotion and disease prevention programe focus ON

Health promotion activities

Meal promotion activites include educations, pol

ica,
sullory and environmental supports fo
étions and conditions of ving

Conduive othe health of
inva, families and communities.

The ac

ies for health promotion and disease
prevention programs include te following,

oninunication: I helps o raie av

es about healthy

Exemples of
clude public service
announcsments, health fir, mass media campaigns, and

Preventive services: These sevies include inmuniz
sneer sceening-ete Special attention isto be
schools to make it heal

Promoting ares, Schoo! heath

fn utmost importance in al community activities,
Health Education: tis the empowering of behavior
change and actions through increased knowledge, I helps
10 modify individual and collective life sy
health education helps o encourage people to u
leisure time productively
health related life skills
ste

Positive
vse their
and 10 help people to develop

Examples of heal

Jude courses, taining prog

Policy: Regulating or mandating activities by

rganizations or Governmental agencies that encourage

healthy decision-making. Public policy can be used to
‘enhance health

2. UNIT 2 (chopter=2)

Environment: Changing environments 10 make healthy
decisions more readily available 1 large populations
Improving health Ieracy: I can be achieved through
the improvement of level of knowledge, persona sill
and confidence 10 take actions to improve personal and
community health by changing persona life styles and
living conditions.

Reordering health servicos: It may be necessary so that

health care can be easily available to all people whether
they ae in rural or in urban area,

ja

À me | 7
Communication Het
N 7 cto

Health Protection refers toa set of activities within the
public health function which involves activities such as

transmission of

Heth Core Dave,

The concep of prevention is dese a Ing
primary, secondary and tertiary prevention age
Sale primordial prevention, was tater ase

leg
rhone

Determinants of prevention:
Successful prevention depends upon:
+ Knowledge of cause ofthe disease

- Modesivays of transmission

Identification of risk factors an rk pr
avait of prophylactic men
+ Anni

pues

those measures appropiate es

+ Continuous evaluation

Disease preven

reduce the risk of developing clonic diseases an! cin”
‘morbidities. Health promotion and disease preven

ns address social determinents of heath

influence modifiable risk behaviors, Social deters
of health are the economie, social, cultural nd pales
conditions, in which people are bom, grow and live ar
affect heath status. Modifiable risk behavior nde
tobacco use, poor eating habits and lack of physi ay
hich contribute to the development of ehrani dies

LEVELS OF ILLNESS PREVENTION AND
(CARE ACTIVITIES

PRIMORDIAL PREVENTION)

general environment and preventing th
communicable diseases

Prevention

Prevention isthe action aimed at cudicating: climintingr
ar minimizing the impact of dsesse and disability or»
retarding the progress ofthe disease and disability. The
goals of health care are

+ 10 promote heath
+ to preserve health
2 to restore health when it is impaired
+ 10 minimize suffering and distress,

‘als are embodied inthe word “prevention,

Inhibit the emergence of ris faa |

is the prevention ofthe emergence or developmen of

Fisk factors in countries or population groups whe’
hangaot yet appeared

Gr example, many adult heath problems (2%
diabetes and hypertension) have thc culy ig E
childhood as it is Te time when lifestyles ae
(smoking, eating patterns, physical exercise

Core acti

TT
nisi

In primordial prevention, efforts ae take
children rom adopting harmful fetes.
include: providing adequate nition, encoun
Physical activities, prevention of drug and alee! 2,
improving recreational facilites, and enhaei
heath

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3. PRIMARY PREVENTION

¿mary prevention is defined a the ation en pr
He onsct of dao, which temor e possibly tht
ee ng occ se

_2-The intervention is squid out during the pre
pathogenesis aes of a ditease or health problem.

mary prevention can be accomplished by
+ Te includes the concep of “postive bea, à

concept IN CITO acbieusment and
maintenance of "an necepab oul of healt hat,
‘Peale every individual oleada socially and
economicaliy productive life

+ Primary prevention can be achieved by takin
measures promote ARTETA well-being,

‘of life of people or by specific protective
Approaches of primary prevention

The WHO has recommended the following approaches for
the primary prevention of erani diseases where the risk
factors are established:

a, Population (mass) strategy

D. High steps

Populaion strategy" is aimed atthe whole population

of individe ik loves

Studies have shown that oven a small reduction in the
Average blood pressure orsrum cholesterol ofa population
Would produce a lage reduction inthe incidence of
cardiovascular diseases.

‘This strategy is directed towards socio-economic,
‘ehavira and lifestyle changes

strategy aims to bring preventive car 10
individu PR ae
Individuals at high risk are detected by using clinical

nethods and preventive care isvendered to ther
Primary prevention services and activities include:

+ Provision fr information on behavioral and medical
lth risks

sks athe individ

2 Measures to reduce

1 and
population level ~

+ nclsion of disease prevention programs at primary
And specialized healt cars levels

+ Nutritional and fod supplementation

+ Oral and den

À hygiene education and ore health

+ Clinical preventive services such a immunization —
and vaccination of children, adults and the elderly

2. assination or post-exposureprophy/aisfor people
expose to cornmunicable diseases
Protection from Diseases

Protection fom disease canbe achieved by controling the
disease occurence and spread. The control activite lead
w elimination and actions for elimination lead to
eraicain.

[com

Disease Control

The disease contol includes operations tat ae aimed to
reduce the incidence of disease and he duration of disease
and thereby the risk of ransmission

(NURSING FOUNDATIONS ES

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4. Health Care Deliv
ry Syst
fem

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Disease Eradica

|, physiological or anatomical

5. Heath Core Delivery Systems

Rehobilitaion:

cos, and
Frida to the Mghos posi level of funcion
aay.

vocational measures for tain

Te fo

ns reed to
Retubilttin refers he actions taken to restora person
10 the fllest physical, mental.

canons potential pos

socia, vocational and

Itheps the lent and family to adjust to necessary changes
in lifestyle and learn five with he limits

and level of

Continuing Care

Continuing care refers to variety of services heal,

personal and social: provided over a prolonged period of

time to clients who are diablo or Functional dependen

rho are with terminal lines. The ned for coming

Ica service is increasing day by day. A considerable

decense in the number of family members (espetaly
1) today acts he services provided. Contin

homes, hospices, day caro centers lc, Nurses need to

x

(Secondary Healthcare) A

¿crap un 2

here most ofthe heath

2 Ars close te people
ble on deat nd reses.
Ti cre does. ppr eae a cat and ca be
‘re ren, bya sere ye

I is provided at ile leve by primary health
ene ani en,

Measures of li promotion and prevention are

ponte a ale

> Atte level more co

ai

at

(care is moy provided a is hospitals

Homes iy centeit which Serve as Ts refer

ae proved a ileso, 4

+ gls and the adyanced mesial cre

Tertiary Health Care

ideality the needs of liens and help tem to approach
institutions rendering continuing cae

LEVELS OF CARE

dieses has increased the Bandwidth of healicre has
‘volved at various levels, Health are provide in hee
levee suchas pinay, secondary and ery level

Primary Healthcare

bse belle serves that address the heath

red by an individual. H is also called

wl > e
SÉ SCT fs tga come or ind, Fami

any levels amore ses pestis
and atetion of highly specialized heath worker,
This sto care comes into the pls. referia

to puns by the primary aná secondary heslbeare

¡A The individuals may require advanced medic
cedures such ag major sur trgsplans,

ents_and long-term medical care

RSA Tor diseases such as cancer,

nized consulted medal

Arancel Gags seen, saint nie
core un nd modem dial tas be fy

ire the Tertiary Medical Cae

+ The practices that provide teary medic! care
could PARTNER coi

6. 222) UNIT=2 (Chepler=2)

ach publi and privat sectors, The halhe

system in din example ofthe lat

fito breves
care vides whoa prt se ths
feats rte, togeter provide medical services suc
as heath sue ining, evaluating, providing treatment or
refing tothe next level fear based onthe hen nee
Heath cor setngs extend fom the national t village
‘ove. includes senings o health cae system tational
sae, irc regional, talk and village lve

focos of these agencies ate 1 pone
proven lines nd o provide ewer oe
Shima sim io reduce the mortality and

shih an Be achieved by the following an

+ Provision for promotve and preventive eae
- Rendering cu
+ Reduction in population growth rate

+ Improvement in nutritional status
+ Improvement in the sanitation faciles
+ Development of manpower resources
+ Provision for safe water ad food supply
+ Increasing the literacy rate
+ Reducing levels of poverty

Types of Health Care Agencies:
"Hospital Agencies:

Hospital ar he main health cat agencies ad ie
Services rendered depend upon tee special
may be private or government. The services marke
delivered on inpatient or outpatient ears +
fevernment sector there are primary heath een
community health centers, rural hospitals ice
spl, district hospitals, specials hospi,
leaching institutions

Health Insurance Schemes

# EST (Employes State Insurance): las
inoduedinl948. Employees wostng onda
this scheme are given maternity bah,
sacan cash and Kind, Benefit ice,
Stetploymentinury, pension fo depen
SEM of worker due to employment jay

(CUA! Government Health scheme
(CGHS): »

This scheme was introduced in
n nduced

USO employees of autonomous organz
ed Central G
Fam

Governors and retired judges

inst Are about 4276 lakh beneficiaries
= 2.76 lakh b

"8h 320 dispensaries hospital in Indi,

954 in New

8. the sick and injured.

+ Its a place where people who ar il ij

treated an taken care of by doctors and nur

providing inpatient cae

Hospital is an isitaion that i built, safe, and
isis of disease for the
cal and surgical, ofthe sick and

equipped forthe dia
treatment, oth

the injured: and forthe housing during tis process
The modern hospital also often serves as à come

CLASSIFICATION/TYPES OF HOSPITA

Hospitals can be classified in maty ways.
(© According to ownersbip/sontrol: On the bass of
‘ovnershiplontol, hospital can he divided no four
categories, ie: publi hospitals, voluntary hospitals,

orate Hospital,

the egntealistate-goveritént or municpalor local
bodies on now comercial basis, These Hospitals
may be general hospils or specialized hospitals or
both: General hospitals are those which provide

mentor common diseases, wheres specialized
hospitals provide treatment for specifi diseases.
Examples ar cance centers, hospital or Eye, ENT
and eariac diseases, children’s hospitals et

yf Voluntary or charitable hosptal ae thse whi
IE enable nd incorpore dre Gazeta

FRogisraionag: Aboardsofanustess usualy

pe

Health ar

Detive
JO

and aid from the central governing,

government and om philanthropi

both national and International,

‚rate hospitals are run by public
Corpo pi re tang

company, formed nde the Company Age
eral, specialized oF both,

y 10 Clinical Speciatiies: ly o,

which that hospital has been setup, such y,

patina treated fo hose dies

tratenity,tubereulosis,canecr, cardiac diseases
These may be cbr government or privat has
es Mamen and Child Hospital, Reg

Contre, Eye hospital

onal, Cage

‘According to length of stay:

Long Term Hospital (Chronic Care
Hospital: In these hospitals patients may
stay for longtime The disease may be chronic
in nature og Leprosy Hospital

Ae Short term (Acute care hospital. The
liens may sayin tbe Boop dr a mat

period only, e. Fever, Gastroengriis

Ds sa uspias are those where pate
Ta fom morning cr one eat

the family may not be at ne Lo take care
Pets Toons

1 or non-teaching facil ya
A teaching hospital has a Medical/Nucsing! 7"
Paramedical Colege/School attached toi Research 4”
activities ae cam #

A hospital without a Medical College Nusing/#
Paramedical institution is termed as x

ww"

non-teaching

hospital Research activities may be conducted in 7
these hospitals aso, sens
The changing role of Hospitals ig

AERO idea ofa hospital was that itis a place for retmen!

tthe sick. Now with emphasis on physical, mental, sil
REP: teaching out to community and van

Ha Nort, the health cae services have undergone 4
steady metamorphosis,

The cole ofthe hos
om shifting from

has changed with the emphasis

9. Hospital should possess ad
‘qualified personnel to ps
promotive and curative
of eo

tiary and secondary care.

10 primary heath care
late iii

owiehe en

and eeonomi
mie status, I shout

Le search activities an

ne pa cr
FUNCTIONS OF A HOSPITar

b

day hospital is divided into me

primary function of
medie

2 ho

Provision of

The role ofthe present

stig! functions.

ns: These

nthe hospital el en

Therapewt

Diagnostic

It consists of providing in-patient service and finding
‘out the cause of the ailments
Provides treatment for al ailments

Rehabilitation,

Faciliates physical, mentl, social and vocational
rehabilitation

Care of emergencies:

I in accidents
trauma and acute fe threatening condition,

Preventive: Preventive care is provided through
[Antenatal and postnatal services.

Well baby clins and immunizations

Family welfare serien

Control of communicable diseases.

Health education

Hospitals attached to training
Educat a
institutions provide education to stents such as:

(Chopter- 2) un. 2 >
* Medical education: Graduate, post graduate,
eco und postdoctoral level medial eure a

ondusted depending on the flies etn
the bsp

|
|

aduat and doctoral level musing era an
urs bated on he bd eng and the eins
available in the hospital te acia oma)

Pera medi ring: ab Tec
Occupational Therapy

Physiotherapy, X Ray et
Community beat ining

(0) Researeh: Research in various areas of medicine
“ná uring ae conducted in hospital seg

Eta mural funcions are thse which ae extended
outside the spa nach,

Output service.

ore care Out reac service Domisiry services
School Health Se

Industrial Heath Activites

Departments in « Hospital

© Ouai Damen (PD) Ouse,
‘hen eave without Saving overnight fe ct

Point conan be hospi. General Dual
De

secre the nas Ih has
et eu acesso quintal sold be separate
from inpatient cc. 1 us 1 Be located in uch à
place that patient get easy access to Medi
Records Department, Laboratory. Pharmacy and
billing section. OPD shoud have an enqui where
patients get guidance, Other required folic m
the OPD are wating rc, consliion rooms.
boards; oles (separate for mal

ond female)
des rendered in that
Particular hospital aná names of media! provider
wil be much appecited bythe patients

Majority of hospitals have OPD. Patents ar mo
dm in the hospital but they can recive te
following services:

+ Cobalto with doctors
+ Undergo investigation
Under minor procedures

Rive speciality servicos

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10. UNIT 2 (Chapter-2)

+ Receive réhabilitation service such 98
pysiotherapy and occupational thers

+ Receive prevent and promotive hea
provided in varios lines such as antenatal,
posnaal, inmunizaion clic.

Different outpatient departments in hospitals ate
Medical, Surgical, OD and Gynac, Ophthaltogy
ENT Orthopedic, Cardiology
Nephrology, Urology. Newrlogy,Payeiary ce

D Emergency/Casualty Department: Is located in

an area which is easly accessible 0 tb paient
Emergency department should have suficen,
medical and nursing personnel, supplies and
‘equipment and faites or meting the emergency
‘Station, Usually victims of accidents, patents with
‘aise ares patients wih breathing dificult ete

(Gi) Im Patients Service (IP): Patients who require

in hospital and ey stay overnight or Fr ever
days or wecks or months fr diagnosis, eaten or
therapy Patient ar given the faites fo loding
medica and nursing ere. They et the services of
Aicary dénarment pharmacy and other arameo
ta a needed, Provision for ding investigation

‘Operating Room comple: ls located in anar
which i least contaminated and a the same te

accessible. Number of oper

‘depends on te Facilites and departments available
in the hospital
Department: Nursing department consists
6) Nursing Departa dep

service: This is one ofthe most important

deportnents in the hospital Is the ganizations
vetar rough which nurses provide nursing
nts in various departments ofthe ho

end of the musing staf ls nursing officer
nena superintendent. As per organizational

pe personnel in dis department include

e Superiniendent, nursing

NURSING FOUNDATION:

Health Core Daler Sy

supervisors Head muss and fT uses, Na,

cas ot ao int
Meparment. 1 mandatry that ay
ths dr =

jstation/license from State Nee?

possess regi

Nursing Education: Some hospitals may py,
educational institu

astachod nursing cd $ Ths

ion prepares nursing students to became

Seele profesional nuses. Thought hares

ing carried out in the teching ins

to the hospital the eine

teach

attached experince à

‘ered inthe hospital, The different categories ot
caso involved in the clinical tachi

Various pes of nursing courses ate offered under
iis service. ce: ANM, GNM. BSe Nursing, Pos.
Basie BSe Nursing. Post Basic Diploma, Me
Nursing, PRD in Nursin

Annie educsion to the staf also is provided ine
to time which is very essential 10 update the

(9 Paramedical Departments

+ Laboratory: Various investigations ae cari out
inthe laboratories such as of blood, urine, fx,
CSF. Body ids, Laboratory has different sessions

Bacterilog
Blood bon

as Hematology
>
Histopathology st, Laboratories have tbe located

so. Laboratory services must be available ra

the lock,

+ Radiology Department
radio

inations (Aras. CT Sean, MAI
Scan, Sonogram ete) and treatment (Radioactive

Cobalt and other radioactive isotope 4

sarried out. This department should have sy

o prevent radiological exposure and

radiation hazard tothe patients and stall of the
hospital ®

Dietary Department: This department meets the
Aietary requirements of the patients, Special dis
are served depending on the disease condition of
the pation. eg. Sal restricted det
and diet, diabetic diet, s

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11. Heclih Care Delivery Systems

or dat, hypertensive

Administeatoroy

sted upon
15 Hospital Superitende

Secretary, Department heads

“Maintenance Departments Maintenance works ss

needed ts carried ou by hi depariment

Central Supply Department: The sponsibility of
~ is department ist prepare and furnish equipment
and supplies needed for patient care in other

departments
pGaundry Department: Taking care ofthe entre
hospital is vested on this

ity linen, repairing tom

~ "ines used in t
epariment. Washi
linen, replacing condenined linen are the main

(chapter = 2) UNIT = 2

Factors to be considered while constructing ©
hospital

an ssl accessible arcs

7 Hospital sto be
that patients ean be brow

Hospital should preferably be in a quiet, less
shouldbe away rom nda ares, smoke, dus,

ting monsoons

o around 0 that there is
on. Open area

+ There should be provision for safe dinking water

00d drainage system,

White planning the hospital lay out, consider the
Following points:

+ Total arca should be sufiient
departments

+ The general wards shouldbe spacious with space
‘6 100-200em in between the beds.

* The walls and ors should be nonabsorbent, non
Porous and shack absorbing

* The Moots and walls should he such thai can be
asile cas

* The doors and windows are placed in such a way

NURSING FOUNDATIONS:

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13. u enter ura |)

À tano Hest Sera
—PHs/oue

Pit Mabel fico

Hal Supaienden

Medical Superinten
Resident Medical Oita,

Hood Nurses

Organization of Private Hospitals _
In private hos

CL oa

Ir

14. [UNIT 2 (Chopter=2)

Factors Allecting Health Care Delivery

special Housing, treatment services, financial
support and social networks

isvery me fete by a ou à
total economie stars.

more tres in woman sand chales health ep.

Seung such a biting co

‘of overnight facilities for parents in children

hospitals. Curent provision of hal care shows

yeaa poes

5 Uneven Distribution of Series: Serious problems
inthe dis

uni, Al patents are not geting qua ces.
health are facilities. Ex. peopl living in ral areas
get less medical facily comparing to people in

6. The Homeless and the poor: Many poor and
homeless people do not itive medical rios
to poverty which least exacerbation of he disse
‘conditions. This can lead to chronic illness.

HEALTH CARE TEAM

Health care 1e
ing together to assist a client or his famly

beat health are needs, Te hal caro

depending upon
= ists of the following members.

INURSING FOUNDATIONS =

Heli are Devry Sst,

Mei merapy. He she should be tet
aueh ain
a nas lo paces main
auto inh

ares provide nursing cart the
Leader Nursing superintendent ot

gos esponsibiltisto other une.

ft: Assists patients who have

15. Heal

Care Delivery Systems Lari
(Chapter - 2) UNIT - 2

The health team members ore mainly responsible for the

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members. Nurse hos fo be adequately prepared to be a
"health care provider in whichever area she is expected to
incon,

Suggested Activities

lo learn the structure and various
spi

1. Visit your hes
departments o

Doctors
Nurses

2. Prepare on organization chart of your hospital.

Hoc
Care Teom

on. Discuss
level. (446-10)

€

phormacist seach)

Fig. 2.9 Members of Health Teom

wy

1
3 A
N 2. Primary pre
x he 3. Disease cor