Health care delivery system

HEALTH CARE
DELIVERY
SYSTEM
www.drjayeshpatidar.blogspot.com

HEALTH CARE DELIVERY SYSTEM
Introduction:
India is a union of 28 states and 7 union territories.
States are largely independent in matters relating to the
delivery of health care to the people. Each state has
developed its own system of health care
delivery, independent of the Central Government. The
Central Government responsibility consists mainly of
policy making, planning, guiding, assisting, evaluating
and coordinating the work of the State Health Ministries.
The health system in India has 3 main links
1. Central
2. State and
3. Local or peripheralwww.drjayeshpatidar.blogspot.in

At the central
• The official “organs” of the health system at the
national level consist of
• 1. Ministry of Health and Family Welfare
• 2. The Directorate General of Health Services
• 3. The Central Council of Health and Family Welfare
www.drjayeshpatidar.blogspot.in

Union Ministry of Health and Family
Welfare.
Organization Pattern
Cabinet Minister
↓
Department of Health Department of Family Welfare
↓ ↓
Joint Secretary Additional Secretary
↓ ↓
Deputy Secretary Commissioner
↓ ↓
Administrative staff Joint Secretary
↓
Administrative staff

Functions: Ministry of Health and Family Welfare.
Union list
1. International health relations and administration of port
quarantine
2. Administration of Central Institutes such as All India
Institute of Hygiene and Public Health, Kolkata.
3. Promotion of research through research centers
4. Regulation and development of
medical, pharmaceutical, dental and nursing Professions
5. Establishment and maintenance of drug standards
6. Census and collection and publication of other statistical
data
7. Immigration and emigration
8.Regulation of labor in the working of mines and oil fields
9. Coordination with states and with other ministries for
promotion of health www.drjayeshpatidar.blogspot.in

• Concurrent list
The functions listed under the concurrent list are the responsibility
of both the union and state governments.
1. Prevention and extension of communicable diseases
2. Prevention of adulteration of food stuffs
3. Control of drugs and poisons
4. Vital statistics
5. Labor welfare
6. Ports other than major
7. Economic and social planning
8. Population control and Family Planning
9. Preparation of health education material for creating health
awareness through Central Health Education Bureau.
10. Collection, compilation, analysis, evaluation an dissemination of
information through the Central Bureau of Health Intelligence
11. National Medical Library

Directorate General of Health Services
Directorate General of health services
↓
Director General of health services
↓
Additional Director General of health service
↓
Deputy Directorate General of health services
↓

FUNCTIONS OF D.G.H.S
1. International health relations and quarantine of all major
ports in country and International airport
2. Control of drug standards
3. Maintain medical store depots
4. Administration of post graduate training programmes
5. Administration of certain medical colleges in India
6. Conducting medical research through Indian Council of
Medical Research
7. Central Government Health Schemes.
8. Implementation of national health programmes
9. Preparation of health education material for creating health
awareness through Central Health Education Bureau.
10. Collection, compilation, analysis, evaluation and
dissemination of information through the Central Bureau of
Health Intelligence
11. National Medical Librarywww.drjayeshpatidar.blogspot.in

Central Council of Health
Chairman
(Union health Minister)
↓
Members
(State health Minister)

Functions Of Central Council Of Health
1. To consider and recommend broad outlines of
policy regard to matters concerning health like
environment hygiene, nutrition and health
education.
2. To make proposals for legislation relating to
medical and public health matters.
3. To make recommendations to the central
government regarding distribution of grants-
in-aid.

AT THE STATE LEVEL
(1) State Ministry of Health & family welfare
↓
Deputy Minister of Health and Family Welfare
↓
Health Secretary
↓
Deputy Secretaries
↓

•
(2) State Director of health
↓
Director of Medical Education Director of Health Services
↓ ↓
Dean of medical college Additional Director of Health Services
↓ ↓
State nursing superintendent Deputy Director of Health Services
↓ ↓
Hospital Education Regional Function
↓ ↓ ↓ ↓
Nsg Superintendent Nsg Officer MCH, TB, Leprosy, Immunization
↓ ↓
Ward Incharge Senior tutor
↓ ↓
Nsg Staff Junior tutor

Functions of state health Director:
(1) Studies in depth the health problem and needs in the state and
plans scheme to Solve them.
(2) Providing curative &preventive services.
(3) Provision for control of milk and food sanitation.
(4) Prevention of any outbreak of communicable diseases.
(5) Promotion of health education
(6) Promotion of health programmes such as school health, family
planning, occupational health
(7) Supervision of PHC
(8) Establishing training courses for health personnel
(9) Co-ordination of all health services with other minister of state
such as minister of education, central health minister
&voluntary agency

At the district level
There are 593 ( year 2001 ) districts in India.
Within each district, there are 6 types of
administrative areas.
1. Sub –division
2. Tehsils( Talukas )
3. Community Development Blocks
4. Municipalities and Corporations
5. Villages and
6. Panchayats

Ø Most district in India are divided into two or
more subdivision, each incharge of an Assistant
Collector or Sub Collector
Ø Each division is again divided into
talukas, incharge of a tahsildhar. A taluka
usually comprises between 200 to 600 villages
Ø The community development block comprises
approximately 100 villages and about 80000 to
1,20,000 population, in charge of a Block
Development Officer.
Ø Finally, there are the village panchayats, which
are institutions of rural local self-government.

The urban areas of the district are organized into
Ø Town Area Committees (in areas with
population ranging between 5,000 to10,000
Ø Municipal Boards (in areas with population
ranging between 10,000 and 2,00,000)
Ø Corporations (with population above 2,00,000)
Ø The Town Area Committees are like panchayats.
They provide sanitary services.
Ø The Municipal Boards are headed by Chairmen
/President, elected by members.

The functions of Municipal Board:
Ø Construction and maintenance of roads
Ø Sanitation and drainage
Ø Street lighting
Ø Water supply
Ø Maintenance of hospitals and dispensaries
Ø Education and
Ø Registration of births and deaths etc

Panchayat Raj -
The panchayat raj is a 3-tier structure of rural
local self-government in India linking the village
to the district.It includes
Ø Panchayat (at the village level)
Ø Panchayat Samiti( at the block level)
Ø Zila Parishad(at the district level

Panchayat (at the village level):
The Panchayat Raj at the village level consists of
Ø The Gram Sabha
Ø The Gram Panchayat
The Gram Sabha:
It is the assembly of all the adults of the village, which
meets at least twice a year.The gram sabha considers
proposals for taxation,and elect members of The
Gram Panchayat.

The Gram Panchayat
• It is the executive organ of the gram sabha and an
agency for planning and development at the
village level. The population covered varies from
5000 to 15000 or more. The members of
panchayat hold offices for a period of 3to4 years.
Every panchayat has an elected president
(Sarpanch or Sabhapati or Mukhia), a vice
president and panchayat secretary. It covers the
civic administration including sanitation and
public health and work for the social and
economic development of the village

Panchayat Samiti (at the block level):
• The block consists of about 100 villages and a
population of about 80,000 to 1,20,000. The
panchayat samiti consists of
Sarpanch, MLAs, MPs residing in block
area, representative of women, SC, ST and
cooperative societies. The primary function of
The Panchayat Samiti is the execute the
community development programme in the
block. The Block development Officer and his
staff give technical assistance and guidance in
development work.www.drjayeshpatidar.blogspot.in

Zila Parishad (at the district level):
• The Zila Parishad is the agency of rural local self
government at the district level . The members
of Zila parishad include all heads of panchayat
samiti in the district,MPs, MLAs, representative
of SC, ST and women and 2 persons of
experience in administration, public life or rural
development. Its functions and powers vary
from state to state.

Health care system:
(1) At village level
(2) At sub center level
(3) At PHC level
(4) At CHC level

At village level:
• At the village level, elementary services are
rendered by
(a) Village health guides
(b) Local dais
(c) Anganwadi workers
(d) ASHA

Village health guides:
• Village health guide is a person with an
aptitude for social service and is not full time
govt. functionary. Village health guides scheme
was introduced on 2nd oct. 1977.

Guidelines for their selection:
(1) They should be permanent resident of the local
community, preferably women
(2) They should be able to read and write, having minimum
formal education at least up to the VI std.
(3) They should be acceptable to all sections of community
(4) They should be able spare at least 2 to 3 hours every day
for community health work.
After selection the health guide undergo a short
training in primary health care. The training is arranged in
the nearest PHC, subcenter or other suitable place for the
duration of 200 hours, spread over a period of 3 months.
During the training period they receive a stipend of Rs.
200 per month.

Functions of Village health guides:
(1) Provide treatment for common minor
ailments
(2) First aid during accidents and emergency
(3) MCH care
(4) Family planning
(5) Health education

Local dais:
• Most deliveries in rural areas are handled by
untrained dais. The training for dais given for 30
working days. Each dai is paid stipend of Rs. 300
during the training period. The training is given at
PHC,subcenters or MCH center for 2 days in a week
and on the remaining four days of the week they
accompany the health worker(female) to the village.
During her training each dai is required to conduct
at least 2 deliveries under the supervision and
guidance of health worker (female), ANM,health
assistant (female).

Functions of dais:
(1) MCH care
(2) Family planning
(3) Immunization
(4) Education about health
(5) Referral services
(6) Safe water and basic sanitation
(7) Nutrition

Anganwadi worker:
• Under the ICDS scheme there is an anganwadi
worker for a population of 1000.There are about
100 such workers in each ICDS project. The
anganwadi worker is selected from the
community and she undergoes training in
various aspect of health, nutrition and child
development for 4 months. She is a part time
worker and paid an honorarium of Rs.200-250
per month for the services.

Functions of anganwadi worker
(1) MCH care
(2) Family planning
(3) Immunization
(7) Supplementary nutrition
(8) Nonformal education of children

Accredited Social Health Activist
(ASHA)
• One of the key components of the National Rural
Health Mission is to provide every village in the
country with a trained female community health
activist – ‘ASHA’ or Accredited Social Health
Activist. Selected from the village itself and
accountable to it, the ASHA will be trained to
work as an interface between the community and
the public health system. Following are the key
components of ASHA

SELECTION OF ASHA
• The general norm will be ‘One ASHA per 1000
population’. In tribal, hilly, desert areas the norm
could be relaxed to one ASHA per
habitation, dependant on workload etc.
• The States will also need to work out the district and
block-wise coverage/phasing for selection of ASHAs.
• It is envisaged that the selection and training process
of ASHA will be given due attention by the concerned
State to ensure that at least 40 percent of the ASHAs
in the State are selected and given induction training
in the first year as per the norms given in the
guidelines. Rest of the ASHAs can subsequently be
selected and trained during second and third year.

Criteria for Selection
• ASHA must be primarily a woman resident of the
village ‘Married/Widow/Divorced’ and
preferably in the age group of 25 to 45 yrs.
• ASHA should have effective communication
skills, leadership qualities and be able to reach
out to the community. She should be a literate
woman with formal education up to Eighth
Class.

Roles and responsibilities of ASHA:
• provide information to the community on
determinants of health such as nutrition, basic
sanitation & hygienic practices, healthy living.
• She will counsel women on birth
preparedness, importance of safe delivery, breast-
feeding and complementary
feeding, immunization, contraception and
prevention of common infections including
Reproductive Tract Infection/Sexually Transmitted
Infection (RTIs/STIs) and care of the young child.

• ASHA will mobilize the community and facilitate
them in accessing health and health related
services available at the village/sub-
center/primary health centers, such as
Immunization, Ante Natal Check-up (ANC), Post
Natal Check-up (PNC), ICDS, sanitation and other
services being provided by the government.
• ASHA will provide primary medical care for
minor ailments such as diarrhea, fevers, and
first aid for minor injuries

• She will also act as a depot holder for essential
provisions being made available to every
habitation like Oral Rehydration Therapy
(ORS), Iron Folic Acid Tablet
(IFA), chloroquine, Disposable Delivery Kits
(DDK), Oral Pills & Condoms, etc.
She will inform about the births and deaths in
her village and any unusual health
problems/disease outbreaks in the community to
the Sub-Centers/Primary Health Centre.
• She will promote construction of household
toilets under Total Sanitation Campaign.

Comparison of health care delivery system in
Rajasthan and Maharashtra:
(1) Subcenter:
Topics Maharashtra Rajasthan
(1) Population covered
(2) Functions
5000 in general
3000 in tribal & hilly
areas
(1) MCH care
(2) Family planning
(3) Immunization
3600 in general
2800 in tribal & hilly
areas
(1) MCH care
(2) Family planning
(3) Immunization
(5) Safe water and basic
sanitation
(6) Prevention and control
of locally endemic
diseaseswww.drjayeshpatidar.blogspot.in

Topics Maharashtra Rajasthan
(3) Staffing
pattern
Health worker female 1
Health worker male 1
Voluntary worker 1
(paid Rs 100 per month as
Honorarium)
ANM 1

(2) Primary health center:
TOPICS Maharashtra Rajasthan
(2) Functions
30,000 rural population in plains
20,000 population in hilly, tribal
(1) MCH care
(2) Family planning
(3) Immunization
(7) Prevention and control of
locally endemic diseases
(8) Collection and reporting of vital
statistics
(9) National health programmes
(10) Training of health guides, health
workers, local dais and health
assistant
(11) Basic laboratory services
48000 population in plains
30000 population in tribal and hilly
(1) MCH care
(2) Family planning
(3) Immunization
(8) Collection and reporting Of vital
statistics
(9) National health programmes
(10)Training of health guides, health
workers, local dais and health
assistant
(11)Basic laboratory serviceswww.drjayeshpatidar.blogspot.in

(3) Staffing pattern Medical officer 2
Pharmacist 1
Nurse midwife 1
Block extension educator 1
Health assistant (female) 1
Health assistant male 1
U.D.C 1
L.D.C 1
Driver 1
Class IV 4
Medical officer 1
Pharmacist 1
Nurse midwife 1
Block extension educator 1
Health assistant (female) 1
Health assistant male 1
U.D.C 1
L.D.C 1
Driver 1
Class IV 2

(3) Community health center:
(1) Population
covered
(2) Bed capacity
(3) Specialty
80,000 to 1.20 lakhs
30 Beds
Surgery, medicine,
obstetrics and
gynecologist and
pediatrics with X-ray
and lab facilities.
74,000 to 1.5 lakhs
24 Beds
Surgery, medicine,
obstetrics and
gynecologist and
pediatrics with X-ray
and lab facilities.

TOPICS MAHARASHTRA RAJASTHAN
(2) Bed capacity
(3) Specialty
(3) Functions
80,000 to 1.20 lakhs
30 Beds
Surgery, medicine, obstetrics and
gynecologist and pediatrics with
X-ray and lab facilities.
Care of routine and
emergency cases in surgery
Care of routine and
emergency cases in medicine
24 hours delivery services
including normal and
assisted deliveries
Essential and emergency
obstetric care including
caesarean sections andother
Medical interventions.
74,000 to 1.5 lakhs
24 Beds
Surgery, medicine, obstetrics
and gynecologist and pediatrics
with X-ray and lab facilities.
(1) MCH care
(2) Family planning
(3) Immunization
(6) Safe water and basic
sanitation

• Full range of family planning services
including laparoscopic services
• Safe abortion service Newborn care
• Routine and emergency care of
children
• Other management including Nasal
packing,tracheostomy,foreign body
removal
(10) All national health
programmes delivered through
CHC
Other services
(a) Blood storage
facility
(b) Essential lab.
Services
(c ) Referral
(transport) services
(8) Collection and report in of
vital statistics
(9) 24 hours delivery services
including normal and assisted
deliveries
(10) Essential and emergency
obstetric care including
caesarean sections and other
Medical interventions.
(11) Full range of family planning
services including laparoscopic
services
(12) Safe abortion service
(13) Newborn care
(14) Routine and emergency care
of children’s.
(15) ) All national health
programmes delivered through
CHCwww.drjayeshpatidar.blogspot.in

(4) Staffing pattern Existing clinical manpower
General surgeon 1
Physician 1
Obstetrics/ gynecologist 1
Pediatrician 1
Proposed clinical man power
Anesthetics 1
Eye surgeon 1
Public health programme 1
manager
Existing clinical manpower
General surgeon 1
Physician 1
Obstetrics/ gynecologist 1
Pediatrician 1
Proposed clinical man power
Anesthetic 1
Public health programme 1
manager

Existing support manpower
Nurse midwife 9
Dresser 1
Pharmacist 1
Lab. Technician 1
Radiographer 1
Ophthalmic 1
Ward boy 2
Sweeper 3
Chowkidar 1
OPD attendant 1
Statistical assistant 1
OT attendant 1
Registration clerk 1
Existing support manpower
Nurse midwife 12
Dresser 1
Pharmacist 2
Lab. Technician 1
Radiographer 1
Ophthalmic 1
Ward boy 2
Sweeper 3
Chowkidar 2
OPD attendant 1
Statistical assistant 1
OT attendant 1
Registration clerk 2

(1) Medical officer:
• He is the captain of the health team at the primary
health center.
• He devotes the morning hours attending to patients
in the outdoor,in the afternoon and supervises the
field work.
• He visits each subcenter regularly on fixed days and
hours and provides guidance, supervision and
leadership to the health team.
• He spends one day in each month organizing staff
meetings at PHC to discuss the problems and review
the progress of health activities.
Job description of the members of the health team:

• He ensures that national health programmes are
being implemented in in his area properly.
• The success of PHC depends largely on the team
leadership which the medical officer is able to
provide.
• The medical officer must be a planner, the
promoter, the director, the supervisor, the
coordinator as well as the evaluator.

Health worker female:
• She will register pregnant women from three months
of pregnancies onwards.
• Maintain maternity record, register of antenatal cases,
eligible couple register, children register up to date.
• She will provide care to pregnant women especially
registered mother throughout the period of pregnancy;
• Give advice on nutrition to expectant and nursing
mothers about storage, preparation and distribution of
food.
• Immunize pregnant mothers with tetanus toxoid.
• Conduct about 50% of total deliveries at home.
• Supervise deliveries conducted by Dais and whenever
call in.

• Spread the message of family planning to the couples;
motivate them for family planning individually and in
groups.
• Distribute conventional contraceptives to the couples.
• Assess the growth and development of the infant and
take necessary action.
• Records and reports births and deaths in her area.
• Test urine for albumin and sugar and do Hb during her
home visit.
• Arrange and help M.O and health assistant in
conducting MCH and family planning clinics at sub
centers.
• Maintain the cleanliness of subcenter.
• Attend staff meetings at PHC, CD block or both.www.drjayeshpatidar.blogspot.in

Health worker male:
• He will survey all the families in his area and collect
all the information about each village/ locality in his
area.
• Identify the cases of communicable diseases and
notify the health assistant male and M.O PHC
immediately.
• Educate the community about importance of
control and preventive measures against
communicable diseases.
• Assist the village health guide in undertaking the
activities under TB programme properly.www.drjayeshpatidar.blogspot.in

• Educate community on the method of liquid and solid
waste, home sanitation, advantage and use of sanitary
latrines.
• Assist the health assistant male in the school health
programme.
• Utilize the information from the eligible couple and
child register for the family planning programme.
• Spread the message of family planning to the couples;
motivate them for family planning individually and in
groups.
• Distribute conventional contraceptives to the couples.
• Provide follow-up services to male family planning
acceptors. www.drjayeshpatidar.blogspot.in

Health assistant female:
• Supervise and guide the health workers in the
delivery of health care services to the community.
• Carry out supervisory home visiting.
• Guide the health workers (female) in Distribution
of conventional contraceptives to the couples.
Visit each of the 4 subcenters at least once in a
week on fixed days.
• Respond to urgent calls from the health workers
and trained dais and render necessary help.

• Organize and utilize the mahila mandal, teachers
etc., in the family welfare programme.
• Provide information on the availability of services
for MTPs and refer suitable cases to the approved
institution.
• Supervise the immunization of all pregnant women
and children (0-5 years)
• Collect and compile the weekly reports of births
and deaths occurring in his area.
• Educate the community regarding the need of
registration of vital events.

Health assistant male:
• Supervise the work of Health worker male during
concurrent visit.
• Check minimum 10% of houses in village.
• Supervise the spraying of insecticides during local
spraying along with the health worker (male).
• Conduct immunization of all school going children with
the help of health worker (male).
• Supervise the immunization of all children’s (0-5 years).
• Assist M.O.PHC in organization of family planning
camps and drives. .
• Provide information on the availability of services for
MTPs and refer suitable cases to the approved
institution.

• Ensures follow-up of all cases of vasectomy, tubectomy
IUD and other family planning acceptors.
• Ensure that all the cases of malnutrition infants and
young children's (0-5years) are given the necessary
treatment and advice and refer serious cases to PHC.
• Ensure that Iron and folic acid and Vitamin A are
distributed to the beneficiaries. Conduct MCH and
family planning clinics and carry out educational
activities.
• Organize and conduct training for dais women leaders
with the help of health workers
• Collect and compile the weekly reports of births and
deaths occurring in his area.
• Educate the community regarding the need of
registration of vital events.
• www.drjayeshpatidar.blogspot.in

Thank you

Health care delivery system

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