HEALTH CARE DELIVERY

SYSTEM IN INDIA
RAMAKANT D.GAIKWAD
R
E
S
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R
C
E
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CURATIVE
PREVENTIVE
PROMOTIVE
PUBLIC
PRIVATE
VOLUNTARY
INDIGENOUS
CHANGE
IN
HEALTH
STATUS
HEALTH STATUS
OR
HEALTH
PROBLEM

An assessment of the health status & health
problems is the first requisite for any planned
effort to develop health care services This is also
known as Community Diagnosis. Following is the data
require for health situation & defining the health problems:
Morbidity & mortality statistics.
Demographic conditions of the population.
Environmental condition which have a bearing on health.
Socio-economic factors which have a direct effect on health.
Cultural background, attitudes, beliefs,& practices which
affect health
Medical & health services available.
Other services available.


The health problems of India may be
conveniently grouped under the following
heads:-
Communicable disease problems.
Nutritional problems.
Environmental sanitation problems.
Medical care problems.
Population problems.

4M
MANPOWER
MATERIAL
MONEY
MINUTE
In the light of Health for all by 2000AD, the goals
to be achieved have been fixed in terms of
mortality & morbidity reduction, increase in
expectation of life, decrease in population
growth rate, improvements in nutritional
status, provision of basic sanitation, resources
development & certain other parameters such
as food production, literacy rate, reduction
level of poverty. A comprehensive list of health
services may found in the report of WHO expert
committee.

Comprehensive.
Accessible.
Acceptable.
Provide scope for community
participation
Affordable at low cost.


1.PUBLIC HEALTH SECTOR:-
a) Primary health care:-
i) Primary health centres.
ii) Sub-centres.
b) Hospitals/ health centres:-
i) Community health centres.
ii) Rural hospitals.
iii) District hospitals/health centres.
iv) Specialist hospitals
v) Teaching hospitals

Central Govt. Health Scheme (CGHS)
Other agencies:-
Defence services.
Railways.
2. PRIVATE SECTORS:-
a) Private hospitals, Polyclinics, Nursing homes,& dispensaries
b) General practitioners & clinics.
3. INDIGENOUS SYSTEMS OF MEDICINE (AYUSH)
a) Ayurveda , Yoga & Siddha.
b) Unani & Tibbi.
c) Homoepathy
*d) Unregistered practitioners.
4. VOLUNTARY HEALTH AGENCIES.
5.NATINAL HEALTH PROGRAMMES.


a) Health services for rural area:-
Village Health Guide
Training of local Dais/Anganwadi workers.
ICDS Scheme
b) Health services in urban area:-
Medical care
MCH including family planning.
Safe water supply & basic sanitation.
Prevention & control of locally endemic diseases.
Collection & reporting of vital statistics.
Education about health.
National health programmes.
Referral services.
Basic lab. Services etc.



Health Care System

In India 617 districts,
6345 blocks and
623706 villages incorporating 581
District Hospitals (DHs),
4045 Community Health Centres (CHCs)
and
22370 Primary Health Centres (PHCs) in
India in 2007.



Rural Health Care System the structure
and current scenario
The health care infrastructure in rural areas has been developed as a
three tier system and is based on the following population
norms: Population norms
centre Plain Area Hilly/Tribal/Difficult
Sub-centre 5000 3000
Primary Health Centre 30,000 20,000
Community Health Centre 1,20,000 80,000



The Sub-Centre is the most peripheral and
first contact point between the primary
health care system and the community.. The
Ministry of Health & Family Welfare is
providing 100% Central assistance

There are 1,45,272 Sub Centres functioning
in the country as on March 2007.

The entire family welfare programme is being
implemented through Primary Health Care system.
The Primary Health Care Infrastructure has been
developed as a three tier system with Sub Centre,
Primary Health Centre (PHC) and Community
Health Centre (CHC) being the three pillars of
Primary Health Care System. Progress of Sub
Centres, which is the most peripheral contact
point between the Primary Health Care System
and the community, is a prerequisite for the
overall progress of the entire system
Staff:-
1. Auxiliary Nurse Midwife (ANM) and
one 2. Male Health Worker/ MPW(M)
3. Lady Health Worker (LHV) is entrusted
with the task of supervision of six Sub-
Centres.
4. Village Health guide
5.AWW
6.TBA(Dai)
Functions:-
maternal and child health, family welfare,
nutrition, immunization, diarrhea control
and control of communicable diseases
programmes.
The Sub-Centres are provided with basic
drugs for minor ailments needed for taking
care of essential health needs of men,
women and children.
PHC is the first contact point between
village community and the Medical Officer.
It acts as a referral unit for 6 Sub Centres. It
has 4 - 6 beds for patients.
The activities of PHC involve curative,
preventive, primitive and Family Welfare
Services.
There are 22,370 PHCs functioning as on
March 2007 in the country.

Function:-
to provide an integrated curative and
preventive health care to the rural
population with emphasis on preventive
and promotive aspects of health care.
The PHCs are established and maintained by
the State Governments under the Minimum
Needs Programme (MNP.)
Provides Tertiary care.
All speciality care including AYUSH.

CHCs are being established and maintained by the
State Government.caters 80000-120000
population
programme . It is manned by four medical
specialists i.e. Surgeon, Physician, Gynecologist and
Pediatrician supported by 21 -Nursing &
paramedical and other staff. It has 30 in-door beds
with one OT, Xray, Labour Room and Laboratory
facilities. It serves as a referral centre for 4 PHCs
and also provides facilities for obstetric care and
specialist consultations. As on March, 2007, there
are 4,045 CHCs functioning in the country.

c) Health insurance schemes:-

i) Employees State Insurance.
ii) Central Government Health Scheme:- The Central
Government Health Scheme (CGHS) provides
comprehensive health care facilities for the Central Govt.
employees and pensioners and their dependents residing
in CGHS covered cities.
Started in New Delhi in 1954, Central Govt. Health
Scheme is now in operation in Allahabad ,Ahemdabad
,Bangalore , Bhubhaneshwar ,Bhopal ,Chandigarh ,
Chennai ,Delhi , Dehradun ,Guwahati , Hyderabad , Jaipur ,
Jabalpur , Kanpur , Kolkatta , Lucknow , Meerut , Mumbai ,
Nagpur , Patna , Pune , Ranchi , Shillong , Trivandrum and
Jammu.
CGHS provides comprehensive health care to
the CGHS Beneficiaries in India. The medical facilities are
provided through Wellness Centers(previously referred to as
CGHS Dispensaries) /polyclinics under Allopathic, Ayurveda,
Yoga, Unani, Sidha and Homeopathic systems of medicines.
248 allopathic dispensaries,
19 polyclinics.
78 Ayush dispensary/ units
3 Yoga Centres
65 Laboratories
17 Dental Units

* The insurable population in India has been assessed at 250
million and at an average of Rs 1000/- per person the premium
amount per year would be Rs 25,000/- crores and is expected to
treble in ten years-

AYUSH facilities had been co-located with
208 District Hospitals, 910 Community
Health Centres and 3883 Primary Health
Centres in the country . About 36%
District hospitals had been co-located
with AYUSH. All the District hospitals
existing in the states and union
territories. Nearly 23% Community
Health Centres had been colocated with
AYUSH.


DISTRICTS-35
BLOCKS-358
Rural Health Infrastructure
VILLAGES-43711
DISTRICT HOSPITAL-35
CHC-407
PHC-1800
Rural Health Infrastructure CO-LOCATED WITH AYUSH
DH-33 (94.3%)
CHC-105 (25.8%)
PHC-491 (27.3%)
2007 report
on 2001 Population Census, the
shortfall in the rural health
infrastructure comes out to be of
20855 Sub-Centres,
4883 PHCs and
2525 CHCs.

Building Status :-
About 50% of Sub Centres, 76% of PHCs
and 91% of CHCs are located in the country.
Government buildings. The rest are located
either in rented building or rent free
Panchayat / Voluntary Society buildings. As
on March, 2007, in case of Sub Centres,
overall 66382 buildings are required to be
constructed. Similarly, for PHCs 3618 and for
CHCs 199 buildings are required to be
constructed.


The existing manpower is an important
prerequisite for the efficient functioning.
Rural Health Infrastructure. As on March, 2007
the overall shortfall (which excludes the existing
surplus in some of the states) in the posts of
HW(F) / ANM was 12.6% of the total
requirement. Similarly, in case of HW(M), there
was a shortfall of 55.4% of the requirement. In
case of Health Assistant (Female)/LHV, the
shortfall was 32.8% and that of Health Assistant
(Male) was 28.8%. For Doctors at PHCs, there
was a shortfall of 7.8% of the total requirement.
Even out of the sanctioned posts, a significant
percentage of posts are vacant at all the levels.
For instance, about 8.8% of the sanctioned
posts of HW(Female)/ ANM were vacant as
compared to about 32% of the sanctioned
posts of MPW(Male)/Male Health Worker. At
PHC, about 13.8% of the sanctioned posts of
Female Health Assistant/ LHV,. 22.1% of Male
Health Assistant and 18% of the sanctioned
posts of doctors were vacant

At the Sub Centre level the extent of existing manpower
can be assessed from the fact
that about 5% of the Sub Centres were without a
Female Health Worker / ANM, about 37.2% Sub
Centres were without a Male Health Worker
and about 4.7% Sub Centres were without both
Female Health Worker / ANM as well as Male
Health Worker.

This indicates a large shortfall in Male Health
Workers, resulting in poor male participation in
Family Welfare and other health programmes and
overburdening of the ANMs.



As on March, 2007, about 5.3% of the PHCs were without a
doctor, about 41% were without a Lab technician and about
17% were without a Pharmacist.
The current position of specialists manpower at CHCs reveal
that out of the sanctioned posts, about 59.2% of Surgeons,
46.4% of Obstetricians & Gynaecologists, 56.6% of
Physicians and about 51.9% of Paediatricians were vacant.
Overall about 50% of the sanctioned posts of specialists at
CHCs were vacant. Moreover, there was a shortfall of 64.8%
specialists at the CHCs as compared to the requirement for
existing infrastructure on the basis of existing norms.

Life expectancy increased from 50 yrs. to 64
yrs. in 2000 AD.
IMR come down from 1476 to 7.
5 lakh doctors working under pleural
system
7 lakh ANMs, MPWS & AWW AND
community volunteers.
*THE CREATION OF SUCH PUBLIC WORK
FORCE SEEN AS A MAJOR ACHIEVEMENT.
Total 1.6 lakh subcentres with 1.27 lakh
ANMs in position.
22975 PHCs and CHCs with 24000 doctors
& over 3500 specialists .
To promote Indian system Of Medicine
22000 dispensaries 2800 hospitals are
functioning. i.e AYUSH
6 lakh AWW serve nutrition needs of nearly
20 million children & 4 million mothers.

Strengthening of Rural Health Infrastructure
Under National Rural Health Mission
The National Rural Health Mission (NRHM) has
been conceptualized and the same is being
operationalised from April, 2005 throughout the
country,
with special focus on 18 states which includes 8
Empowered Action Group States (Bihar, Jharkhand,
Madhya Pradesh, Chhattisgarh, Uttar Pradesh,
Uttaranchal, Orissa and Rajasthan), 8 North East States
(Assam, Arunachal Pradesh, Manipur, Meghalaya,
Mizoram, Nagaland, Sikkim and Tripura) Himachal
Pradesh and Jammu & Kashmir.
ASHA(Accredited Social Health Activist)
www.mohfw.gov
www.who.org
www.mahaarogya.gov


Thank you