HEALTH CARE DELIVERY SYSTEM

RUSHIKESH .B PAWAR

CONCEPTS OF HEALTH CARE: It can be defined as multitude of services

rendered to individuals, families or communities by the agents of health services or professions,for the purpose of promoting,maintaining,monitoring or restoring health.

Such services might be staffed,organized, administered and financed in every imaginable way,but they all have one thing in common:, people are being “served”,i.e diagnosed,helped,cured, educated and rehabilitated by health personnel. In many countries health care is completely or largely a government function.

Health care includes “medical care”. Many people mistakenly believe that both are synonymous. Medical care is a subset of a health care system. The term “medical care” refers chiefly to those personal services that are provided favour by physicians or rendered as a result of the physician’s instructions.

CHARACTERISTICS OF HEALTH CARE:Appropriateness(relevance)ComprehensivenessAdequacyAvailabilityAffordabilityAccessibilityFeasibility

LEVELS OF HEALTH CARE: Primary health care

Secondary health care

Tertiary health care

PRIMARY HEALTH CARE:o This is the first level of contact between the

individual and the health system where “essential” health care (primary health care) is provided.

o A majority of prevailing health complaints and problems can be satisfactorily dealt with at this level.

o This level of care is closest to the people.o In Indian context, this care is provided by

the PRIMARY HEALTH CENTERS and the SUBCENTERS, with community participation.

SECONDARY HEALTH CARE:o At this level, more complex problems

are dealt with. This care comprises essentially curative services and is provided by the DISTRICT HOSPITALS and COMMUNITY HEALTH CENTERS.

o This level serves as the first referral level in the health system.

TERTIARY HEALTH CARE:o This level offers super specialist care.o This care is provided by the REGIONAL /

CENTRAL LEVEL institutions.o These institutions provide not only

highly specialized care, but also planning and managerial skills and teaching for specialized staff.

o In addition, the tertiary level supports and complements the action carried out at the primary level.

HEALTH CARE DELIVERY SYSTEM IN INDIA: Comprises of all the delivery models in

the practice.

Organized efforts of both the central and the state governments.

Three tier system of primary health care infrastructure in rural areas.

HEALTH ORGANIZATION IN INDIA : Private Agencies Voluntary Agencies Government Agencies : 1. National level2. State level3. District level4. Block level

ADMINISTRATION AND ORGANIZATION AT NATIONAL LEVEL: It consists of :• Union ministry of health and family

welfare.

• Directorate general of health services (DGHS)

• Central council of health

The Union ministry of health and welfare has 3 departments:

Department of health

Department of family welfare

Department of Indian systems of Medicine and Homeopathy

The department of health is supported by the technical wing, the DGHS, rendering technical advice on all medical and public health matters and is involved in monitoring of various health schemes.

• The directorate functions in 3 units: Medical care and hospitals, Public health and

General administration.• The Central council of health was set up for

promoting coordinated and concreted action between the centre and the states in the implementation of all the programmes and measures pertaining to the health of the nation.

SPECIFIC FUNCTION ACCORDING TO CENTRAL GOVT: Union list: International health relations and

quarantine Control of drug standards Administration of centrally run institutes Promotion of research through various

centers and bodies Regulation and development of medical,

dental, nursing and pharmacy as professions

CONTD… Census, health intelligence

publications for statistical data Immigration and Emigration Regulation of laborers working in

mines and oil fields. Coordination with states, other

ministries.

Concurrent list: Prevention of communicable diseases. Health programmes, e.g., Malaria, T.B,

leprosy, filaria etc Prevention of adulteration of foodstuffs Control of drugs and poisons Vital statistics Labor welfare Economic and social planning

CONTD…. Ports other than major Population control and family planning

ADMINISTRATION AND ORGANIZATION AT STATE LEVEL:

The states are also responsible for the health of the people like the centre.

The management sector comprises the:

I. State Ministry of health II. State Health Directorate

FUNCTIONS OF THE STATE HEALTH DEPARTMENT ARE:Provide adequate medical care through

the hospitals, dispensaries, health centers in urban and rural areas.

Make proper arrangements for medical, nursing education and research.

Properly implementing the National health programmes.

Making provisions for personal and impersonal health care like nutrition, industrial health, family planning.

CONTD…..Control of drug, food administration.Control and supervision of local bodies.Setting up of laboratoriesProvision for indigenous system of

medicine

ADMINISTRATION AND ORGANIZATION AT REGIONAL LEVEL: In states like Bihar, M.P., U.P.,

Karnataka and other zonal/regional/ divisional set ups have been created between the State directorate of health services and District health administration.

Each regional/zonal organization differs but they are known as Additional/joint/deputy directors of health services in different states.

ADMINISTRATION AND ORGANIZATION AT DISTRICT LEVEL: The principal unit of administration in

India is the district under a collector. There are 593 (yr 2001) districts in India. Within each district again, there are 6

types of administrative areas:I. SubdivisionsII. Tehsils (Talukas)III. Community development blocksIV. Municipalities V. VillagesVI. Panchayats

Subdivisions: Most districts in India are divided in 2 or more subdivisions. Each in charge of an assistant collector or sub collector.

Tehsils: Tehsildar is in charge of each taluka. A tehsil comprises between 200 to 600 villages.

Community development blocks: The rural areas of districts have been organized into community development blocks. It comprises of 100 villages and about 80,000 to 1,20,000 population. The in charge is Block development officer.

Municipalities & Corporations: Town municipal council (5,000 to 10,000

of population) City municipal council (10,000 to 2 lakh

of population.

CONTD………. Corporation (above 2 lakh of

population).These are headed by the chairman

elected by the members. They do the development work in the town or city.

Panchayati Raj : The Panchayati Raj is a 3 tier structure of rural local self government in India, linking the village to the district.

ORGANIZATION:PANCHAYATI RAJ

PANCHAYAT

GRAM SABHA

PANCHAYAT SAMITI

ZILLA PARISHAD

PANCHAYAT (AT VILLAGE LEVEL) :THIS CONSISTS OF: GRAM SABHA It is the assembly of all the adults of

village, which meets at least twice a year. The gram sabha proposes for taxation, discusses the annual programme and elects members of gram panchyat.

CONTD….. Gram panchayat It is the agency for planning and development

at village level. The strength varies from 15 to 30 and covers the population from 5,000 to 15,000. Each panchayat has elected a president (sarpanch or sabhapati or mukhiya), a vice president or a secretary.

FUNCTIONS OF PANCHAYAT: Civic administration Public health Sanitation Social and economic development of

village

PANCHAYAT SAMITI (AT BLOCK LEVEL):The block consists of 100 villages and a

population of 80,000 to 1,20,000.The panchayat samiti consists of all

sarpanchas of panchayat, MLA, MP’s residing in the block area and representative of women, scheduled tribes and scheduled castes.

The block development officer is the ex-officio secretary of the panchayat samiti.

FUNCTION OF PANCHAYAT SAMITI: Community development programme The funds provided by government is

channeled by the panchayat samiti. The BDO and his staff give technical

assistance and guidance to the village development work.

ZILLA PARISHAD (AT DISTRICT LEVEL): It is the local self government at all the

district level. The member of zilla parishad includes all

heads of panchayat samiti, MLA of the district, MP of the district, representative of the SC and ST.

Representative of women Two person of experience in administration,

public life or rural development. Membership of zilla parishad is fairly large

varying from 40 to 70.

FUNCTIONS OF ZILLA PARISHAD: The zilla parishad is primarily

supervisory and coordinating body. Its function and powers vary from

state to state. In some states, the zilla parishad are

vested with administrative functions.

ADMINISTRATION AND ORGANIZATION AT COMMUNITY OR BLOCK LEVEL: India is a land of villages, about 80% of

the population is scattered over 5,75,936 villages.

Only about 20% of rural population have health care facilities.

The fundamental objective of health services is to provide primary health care to all the sections of the society.

Organization structure at community or block level has:

(a) Primary health center(b) Sub center(c) Village(d) Community health center

HEALTH CARE SYSTEM: The ‘health system’ is intended to

deliver health services; in other words, it constitutes the management sector and involves organizational matters, e.g. planning, determining priorities, mobilizing and allocating resources, translating policies into services, evaluation and health education.

It operates in the context of the socioeconomic and the political framework of the country.

COMPONENTS OF HEALTH SYSTEM:Concepts

Ideas

Objects

Persons

5 MAJOR SECTORS OF HEALTH CARE SYSTEM: In India, the Health Care System is

represented by five major sectors or agencies which differ from each other by the health technology applied and by the source of funds for operation.

These are: PUBLIC HEALTH SECTOR(a) Primary health care Primary health centers Sub-centers

CONTD…… (b) Hospitals / Health centers Community health centers Rural hospitals District hospital / health center Specialist hospitals Teaching hospitals (c) Health Insurance schemes Employees State Insurance Central Govt. Health Scheme

CONTD………. (d) Other agencies Defence Services Railways private sector (a) Private hospitals, polyclinics,

Nursing homes and dispensaries. (b) General practioners and clinics

CONTD..... indigenous systems of medicine Ayurveda and Siddha Unani and Tibbi Homeopathy Unregistered practionersVoluntary health agenciesNational health programmes

ROLE OF NURSE IN HEALTH CARE DELIVERY SYSTEM: AT THE CENTRAL LEVEL:At the central level, there is a post of

nursing advisor in medical division of directorate general of health services.

The nursing advisor is assisted by the nursing officer and support staff.

She/ he advises the DGHS, ministry of health and family welfare and other departments like railway, labour etc..

There is also a post of deputy nursing advisor.

CONTD… The deputy nursing advisor provide

the training to ANMs, dais, health supervisor etc.

She/ he actively participates in policy formulation and decision making process.

The committee strongly expressed the need for charge in nursing organization.

They look after the improvement of nursing education and nursing reasearch.

AT THE STATE LEVEL: There is no proper and definite pattern of

nursing structure in state directorate. In some states like Tamilnadu and

Maharashtra, 2 nurses are posted, one each in director of medical education and director of medical services.

The nurse working in the office are responsible for all matters of:

Nursing services Nursing education of ANM, health supervisor

of schools attached to district hospitals.

CONTD… Community health nursing services

She/ he is responsible for hospital as well as community nursing services, planning, continuing education and all administrative work.

AT DISTRICT LEVEL: The nurse plays a important role in providing

the health care services in rural and urban areas.

District level nurses have the following function:• Administration and management of nursing and

midwifery services in the districts.• Supervision and guidance of health supervisor.• In service training programme of nurses, ANMs

working in her district.• Attending to the problems that is referred to

her.

EXPANDED ROLE OF A NURSE:oCare provideroSensitive observeroEducatoroPlanneroOrganizeroAdministratoroEvaluator