Download - Health System in India
Health System In India
PG Students: Dr. Santosh Kadle Dr. Sunil Panigrahi PG Teachers: Dr. Usha Ranganathan Dr. Pallavi Uplap Dr. Shubhada Hamjade
Contents of presentation: Historical evolution of health system Definition and concepts of health system Components & Goals of health system, Financing the Modern Health Care System Health Care System Models Planning & Development of Health System Health Care System in India Health Care Systems in the World Challenges
Historical evolution of health systems:
Family ReligionAncient medical systems
Era of Buddhism and
Christianity
Early sanatoria built by Emperor Ashoka in 2nd
century BC.
The Rise of
Modern System
of Medicine
Sarve Jana Sukhino Bhavatu (May all men be free from disease and may all be healthy)
The Manu Samhita
Aryans around 1,400 B.C. the Ayurveda and the Siddha systems of medicine came into existence.
suggesting the practices of environmental sanitation
The Indus Valley Civilization.
One of the most ancient civilizations in history
Then from 1947 after independence, GOI works on development of current Health system
Then British had established their rule in India till 1947
The Moghul rulers introduced the Arabian system of medicine, the Unani system in around 1.000 A.D.
System Expanded by King Ashoka.
A hospital system developed during the reign of Rahula Sankirtyana
Medical education was introduced in universities of Taxila and Nalanda
The Post-Vedic period (600 B.C.-600 A.D ) - religious teachings of Buddhism and Jainism.
Evolution of health system in India after 1947
Phase I [1947-1983]
Phase II [1983-2000]
Phase III[Post 2000]
Definition and concepts of health system :
Health system covers a whole gamut of health activities, health programmes,
institutions providing medical care such as hospitals, clinics and primary health
care centres and the policies enunciated by governments to provide optimal
health care for its citizens.
A health system as described by WHO is the “sum total of all the organisations,
institutions and resources whose primary purpose is to improve health. ”
Health System Includes.. Concepts ( e.g. health and diseases) Ideas (e.g. equity) Objects (e.g. hospitals, health centres) Persons (health care workers viz. physician, nurses)
Components of health system Healt
h Syste
m
Concept
Ideas
Persons
Objects
Health System : Development of health policies, plan for their implementation and
development of a system of regulation of health services
Define and develop the institutional framework to deliver the health
services within the purview of this system
Allocate and mobilise financial and human resources for its functioning.
Plan, manage and deliver the health services
Goals of a Health System : Effective in contributing to better health throughout the entire population
Responsive to people’s expectations, including safeguarding patient’s dignity,
confidentiality and autonomy and being sensitive to the specific needs and
vulnerabilities of all population groups
Fair in how individuals contribute to funding the system so that everyone
has access to the services available and is protected against potentially
impoverishing levels of spending.
Health Care System Models : Private Systems: Capitalistic model Public Systems : Public insurance systems 3 model: - Social security model - Publicly funded health care model - Social health insurance models.
Planning of Health System :
Dispersed health
planning
Focused health
planningCentral health
planning
Health Planning
Financing the Modern Health Care System :
Who is financing ?
What are the services covered ?
Which financier pays for how much of the service provided?
Who are the organisations or individuals receiving this funding?
What is the basis for this payment ?
Financing the Modern Health Care System :
Five primary methods of financing health care systems:
Direct or out-of-pocket payments
General taxation
Social health insurance
Voluntary or private health insurance
Donations or community health insurance
Financing the Modern Health Care System in INDIA :
India spends about 4.9% of
GDP on health (WHR,
2002).
The per capita total
expenditure on health in India
is US$ 23
Of which the per capita
Government expenditure on health is US$
4.
Total health expenditure is
around 5% of GDP, with breakdown of
public expenditure (0.9%); private
expenditure (4.0%).
The private expenditure -
(OOP) expenditure
(3.6%) & employees/com
munity financing (0.4%).
It is thus evident that public health investment has been
comparatively low
Components of healthcare delivery system
Structure of Health systems
Process of health care delivery
Flow of patient in health care system
Outcome of health system
1. Structure of health system :
Number and type of personnel and staff
Way of these personnel organized to work
Nature and extend of facility and equipment
Range of services offered
System of management and amenities
Financing
Enumeration and determination of the eligible population for these services
Governance and decision making
2. Process of health care delivery :
I] Behavior of professionals Recognition of the problem i.e. diagnosis Diagnostic procedure Recommendation of treatment or management Appropriate follow up
II] Participation of people Utilization of services Understanding the recommendations Satisfaction with the services Participation in decision making
3.Flow of patients in health care system :Varies from country to country
India harbors a multistage (three tier) system, where majority of health care is delivered by community health care worker
Indian system is more cost effective if health workers are skilled and effectively supervised
Such system could one of the reason to reduced cost of health care in developing countries
4. Outcomes of health care :
Aspects of health that results from interventions provided by the
health system
Model of health care system :
Inputs Health status
or health problems and
Resources
Health care
servicesCurative,
Preventive, Promotive services
Health care
systems Public. Private,
Voluntary ,Indigenous
system
Outputs Changes in
health status
Health Care Delivery System in India
India is a union of 29 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’s responsibility consists mainly of policy making , planning , guiding, assisting, evaluating and coordinating the work of the State Health Ministries.
Health System in IndiaThe health system in India has 3 main links
Local or peripheral
State
Central
At the central levelThe official “organs” of health system at national level are
The Ministry of Health and Family welfare
The directorate general of Health Services
The central council of health and family welfare
Ministry of Health and Family Welfare
Organization Structure Of MoHFW
Functions of MoHFWoUnion list :
1) International health relations and administration of port quarantine
2) Administration of Central Institutes
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) Coordination with states
8) Immigration and emigration
9) Regulations of labour in the working of mines & oil fields
oConcurrent List:
1) Prevention of Communicable disease2) Prevention of food adulteration3) Control of drug and poison4) Vital statistics5) Labour welfare6) Economic and social planning7) Population control and family planning
Functions of MoHFW
Directorate General of Health Services
Organization chart of DGHS
Functions of DGHSGeneral functions: 1) Surveys2) Planning3) Coordination 4) Programming and appraisal of all health matters
Specific functions: 5) International health relations and quarantine of all major ports in country and international airport.6) Control of drug standards7) Maintain medical store depots8) Administration of post graduate training programmes
Specific functions Of DGHS :
4) Administration of certain medical colleges in India
5) Conducting medical research through Indian Council of Medical Research ( ICMR )
6) Central Government Health Schemes.
7) Implementation of national health programmes
8) Preparation of health education material for creating health awareness through
Central Health Education Bureau[ CHBI ]
9) Central bureau of health intelligence[CBHI] to Collection, compilation, analysis, evaluation and dissemination of information
10) National Medical Library
Central Council of health
Organization Chart Of CCH
Functions Of Central Council of Health
1) To consider and recommend broad outlines of policy related 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.
State Level
State Level
In Maharashtra State :
State Minister of public health
Additional chief secretory public health and family
welfare
Mission directorNRHM
Project Director MSACS
Secretory and commissioner Family welfare
Director ESISDirector Health services
Minister of Public health
State Level
Division to District LevelDeputy Directo
r
ADHS NVBDC
P
ADHS leprosy DHO
ADHS Medicin
e
Civil Surgeo
n
District LevelDistricts
Tehsils /Talukas (200-600 villages)
Community Development Blocks (approx 100 Villages & 80,000 -1.2 Lac Pop)
Municipalities & CorporationsMunicipal Board
(10,000- 2 Lac Pop)
Corporations (> 2 lac pop)
Town Area Committee (5,000-10,000 Pop)
Panchayats
Villages
References:
1] Bhalwar R. et al ,Text book of Public Health and Community Medicine, 1 st edition, Dept. of
community medicine, AFMC, Pune,2009
2] Kishore J ,Textbook of Community medicine National programmes Of India, 11 th edition, Century
publications, New Delhi , 2014
3] Suryakanta AH, Textbook of Community medicine with recent advances, 3 rd edition, Jaypee
brothers publishers ,New Delhi 2014
4] Sunderlal K , Textbook of Community medicine with recent advances, 3 rd edition, Jaypee
brothers publishers ,New Delhi 2014
5] ] Park k. Park’s Textbook of Preventive and social medicine, 23 rd edition, Bhanot publishers ,
Jabalpur, 2015; page no.29,878,890,897,901
6] Information regarding health system in Mumbai downloaded from the website
http://www.mcgm.gov.in/irj/portal/ on 01 /7/2016
Thank you !!!