The document provides an overview of India's health care delivery system, including its evolution, structure, and key components. It describes the three-tier system consisting of primary, secondary, and tertiary care. Primary care is delivered through subcenters, primary health centers, and community health centers. The public sector delivers most primary care, while the private sector and indigenous systems also play roles. National health programs address specific diseases. Reforms aim to strengthen primary care and increase access through public-private partnerships.

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 workersworkers
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

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’