DETERMINANTS OF HEALTH

1. HEALTH
CARE
SERVICES
IN INDIA
DR. MAHESWARI JAIKUMAR.
maheswarijaikumar2103@gmail.com

2. PURPOSE OF HEALTH CARE
• The purpose of the health
care services is to improve the
health status of a population.

3. CHARACTERISTICS OF A
GOOD HEALTH SERVICE
• 1. Comprehensive.
• 2. Accessible.
• 3. Acceptable.
• 4.Provide scope for community
participation.
• 5. Available at a cost the country &
community can afford.

4. HEALTH CARE SYSTEMS
• The health care system is
intended to deliver the health
care services.
• It operates within the context of
the socioeconomic & political
framework of the country.

5. • In India it is represented by five
major sectors or agencies which
differ from each other by the
health technology applied & by
the source of funds for
operation.

6. AGENCIES OF HEALTH CARE
• 1.PUBLIC HEALTH SECTOR.
• 2.PRIVATE SECTOR.
• 3. INDIGENOUS SYSTEM OF
MEDICINE.
• 4. VOLUNTARY HEALTH AGENCIES.
• 5. NATIONAL HEALTH
PROGRAMMES.

7. I. PUBLIC HEALTH SECTOR
• 1. PRIMARY HEALTH CARE :
A. Primary Health Centres.
B. Sub Centres.

8. 2. HOSPITALS & HEALTH CENTRES :
A. Community Health Centres.
B. Rural Hospitals.
C. District Hospitals / Health
Centre.
D. Specialist Hospitals.
E. Teaching Hospitals.

9. 3.HEALTH INSURANCE SCHEMES.
A. Employees State Insurance.
B. Central Govt Health Scheme

10. 4. OTHER AGENCIES.
A. Defence Services.
B. Railways.

11. II.PRIVATE SECTOR
A. Private Hospitals, Polyclinics,
Nursing Homes &
Dispensaries.
B. General Practitioners & Clinics

12. III.INDIGENOUS SYSTEM OF
MEDICINE
A. Ayurveda & Siddha.
B. Unani & Tibbi.
C. Homeopathy.
D. Unregistered Practitioners.

13. IV. VOLUNTARY HEALTH
AGENCIES.

14. V. NATIONAL HEALTH
PROGRAMMES

15. PRIMARY HEALTH CARE
IN INDIA
• In 1977 the Govt of India
launched a Rural Health Scheme,
based on the principles of
“placing people’s health in
people's hand.

16. • It is a three tier system of health care
delivery in rural areas based on the
recommendation of the Srivatsav
Committee(1975).
• Close on the heels of these
recommendations an International
Conference at Alma Ata (1978), set the
goal of an acceptable level of Health For
All the people of the world by the year
2000 through Primary health care
approach

17. • As a signatory to the Alma Ata
Declaration, the govt of India was
committed to achieving the goal of
Health for All through primary
health care approach which seeks to
provide universal comprehensive
health care at a cost which is
affordable.

18. • Keeping view the WHO goal of
“Health For All” by 2000 AD, the
govt of India evolved a National
Health Policy based on primary
health care approach.

19. • The National Health Policy 1983
laid down a plan of action for
reorienting & shaping the
existing rural health
infrastructure with specific goals
to be achieved by 1985, 1990 &
1995.

20. • National Health Policy 2000,
2002 & National Rural Health
Mission have been recently
introduced to achieve HFA goals.

21. VILLAGE LEVEL
• One of the basic tenets of
primary health care is universal
coverage & equitable
distribution of health resources.

22. • To implement this policy at the
village level, the following
schemes are in operation.
1. Village Health Guide Scheme.
2. Training of Local Dias.
3. ICDS Scheme.
4. Asha Scheme

23. VILLAGE HEALTH GUIDES
• A Village Health Guide is a
person with an aptitude for
social service & is not a full time
government functionary.
• The Village Health Guide Scheme
was introduces on 2 Oct 1977.

24. • The VHG provide the first
contact between the individual
& the health system.

25. The guidelines for their
selection are :
1. They should be a permanent
residents of the local
community, preferable
women.

26. • 2. They should be able to read &
write, having minimum
formal education at least up
to the VI standard.
• 3. They should be acceptable to
all sections of the society.

27. 4. They should be able to spare at
least 2 to 3 hrs every day for
community health work.
5. After selection, the Health
Guides undergo a short
training in primary health
care.

28. 6. The training is arranges in the
nearest PHC,HSc for 200 hrs,
spread over for a period of 3
months.
7. During the training period they
receive a stipend of Rs. 200
per month.

29. TRAINING

30. 8. On completion of their
training, they receive a
working manual & a kit of
simple medicines belonging to
the modern & traditional
medicine.
9. The VHG are free to attend to
their normal vocation.

31. 10. For their work they are paid a
honorarium of Rs.50 per month &
drugs worth Rs. 600 per annum.
11. At present there are 3.23 lakh
VHG & the national target is to
achieve 1 VHG for each village or
1000 rural population

32. LOCAL DAIS
• Most
deliveries in
rural are
handled by
untrained dais.

33. A LOCAL DAI

34. • An extensive programme has been
to undertaken under the Rural
Health Scheme, to train all
categories of local dais in the
country to develop their
knowledge in the elementary
concepts of maternal & child
health & sterilization, besides
obstetric skills.

35. • The training is for 30 working
days.
• Each Dai is paid a stipend of
Rs.300 during her training
period.

36. • Training is given at the PHC, Sub
center or MCH centre for 2
days in a week & on the
remaining 4 days of the week
they accompany the Health
Worker to the villages
preferably in the dai’s own
area.

37. • During her training each dai is
required to conduct at least 2
deliveries under the guidance &
supervision of the HW (F), ANM
or HA(F).

38. • The emphasis during training is on
asepsis so that home deliveries
are conducted under safe
hygienic conditions thereby
reducing the maternal & infant
mortality.

39. • After successful completion of
training, each dai is provided
with a delivery kit & a
certificate.
• These dais are also expected to
play a vital role in propagating
small family norm since they are
more acceptable to the
community.

40. • The national target is to train
one local Dai in each village.
• She undergoes a training in
various aspects of health,
nutrition & child development
for 4 months.

41. • She is a part time worker & is paid
an honorarium of Rs 1500 per
month for the service rendered,
which include health checkup
chart, immunization,
supplementary nutrition, health
education, non formal pre school
education & referral services.

42. ANGANWADI WORKER
• Under ICDS scheme, there is
anganwadi worker for a
population of 1000.
• There are about 100 such
workers in each ICDS project.

43. ANGANWADI WORKER

44. • As of date over 5959 ICDS blocks
are functioning in the country.
• An anganwadi worker is selected
from the community she is
expected to serve

45. • The beneficiaries are especially
nursing mothers, pregnant
women, other women (15 -45
yrs), children below the age of 6
yrs & adolescent girls.
• Anganwadi workers are the primary
link with the health services & all
other services for young children.

46. ASHA
• Recognizing the importance of health
in the process of economic & social
development & to improve the
quality of life of the citizens, the
govt of India launched “NATIONAL
RURAL HEALTH MISSION” (NRHM)
on 5 April 2005.

48. • The main aim of NRHM is to
provide accessible, affordable,
accountable, effective &
reliable primary health care
through creation of a cadre of
Accredited Social Health
Activist (ASHA).

49. • ASHA must be a resident of the
village.
• A women
(married/widow/divorced)
preferably in the age group of
25-45 years with a formal
education upto 8 class.

50. • The general norm for selection of
ASHA is 1 ASHA/1000 population.
• ASHA will take steps to create
awareness & provide information
to the community on
determinants of health, information
on existing health services, & the
need for timely utilization of health
& family welfare services.

51. • She will counsel women on birth
preparedness, importance of safe
delivery, breast feeding &
complementary feeding,
immunization, contraception &
prevention of common infections
including RTI/STD & care of a
young child.

52. • ASHAS will mobilize the community
& facilitate them in accessing
health & health related services
available in anganwadi/PHC etc.
• She will work with the village health
& sanitation committee of the
gram panchayat to develop a
comprehensive village health plan.

53. • ASHA will provide primary
medical care for minor
ailments such as diarrhoea,
fevers & first aid for minor
injuries etc.

54. • She will also act as a depot
holder for essential provisions
being made available to every
habitation like ORS kit, IFA
tab, disposable delivery kit,
etc.

55. • She will inform about the births
& deaths in her village, any
unusual health problems in the
community to the PHC.
• She will promote the
construction of household
toilets under total sanitation
campaign

56. SUB CENTRE LEVEL
• The sub centre is the peripheral
outpost of the existing health
delivery system in rural areas.
• They are being established on the
basis of 1 HSc for every 5000
population in general & I for
every 3000 population in hilly,
tribal & backward areas.

57. • As on March 2008, 146036 sub
centres were established in the
country.
• A sub centre provides interface with
the community at the grass root
level, providing all the primary
health care services.

58. • The package of services provided
by the HSc include,
immunization, antenatal, natal
& post natal care, prevention
of malnutrition & common
childhood diseases, family
planning services &
counseling.

59. • They also provide elementary drugs
for minor ailments such as ARI,
diarrhoea, fever, worm
infestation etc.
• The government implements several
National Health & Family Welfare
programmes through these
frontline workers.

60. • A HSc is staffed by one Female
Health Worker known as
Auxiliary Nurse Midwife
(ANM) & one Male Health
Worker known as
Multipurpose Worker (Male).

61. • 1 Lady Health Visitor (LHV) & 1
Health Assistant (Male)
located at PHC level are
entrusted with the task of
supervision of six sub centres
under a PHC.

62. PRIMARY HEALTH CENTRE
• The Bhore
Committee in 1946
gave the concept of
a primary Health
Centre as a basic
health unit, to
provide primary
health care services.

63. PHC IN NORTH INDIA

65. • The health planners in India have
visualized the PHC as a proper
infrastructure to provide
health services to the rural
population.

66. • The National Health Plan 1983
proposed 1 PHC for every
30,000 population in plain
areas & 1 PHC for every
20,000 population in hilly,
tribal & backward areas for
more effective coverage.

67. • As on March 2008, 23,458 PHCs
have been established.

68. FUNCTIONS OF A PHC
1.Medical Care.
2.MCH including family planning.
3.Safe water supply & basic
sanitation.
4.Prevention & control of
communicable diseases.
5.Collection & reporting of vital
statistics.

69. 6.Education about health.
7.National Health Programmes – as
relevant.
8.Refferal services.
9.Training of health guides, health
workers, local dais & health
assistance.
10.Basic laboratory services.

70. THANK YOU