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 !!!