HEALTH CARE DELIVERY SYSTEM – NATIONAL

STATE, DISTRICT AND LOCAL LEVEL :

ORGANIZATION OF HEALTH :-

System in India :- India is a union of 28 states and

7 union territories under the constitution of India, the states
are largely independent in matters relating to the delivery of
health care to the people.

Each state therefore, has developed its own system

of health care delivery, independent of the central
government. The central responsibility consist of mainly
policy, planning, guiding, assisting, evaluating and
coordinating the work of state health ministries so that health
services cover every part of the country , and no states lags
behind for want of these services.

The health care services organization in the country

extends from the national level to village level from the total
organization structure, we can slice the structure of health
care system at national, state, district, community, PHC and
sub-centre level.

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 ORGANIZATION OF HEALTH SERVICES AT THE NATIONAL
LEVEL:-

Ministery of health and family welfare

Ministery
Central
DGHS (Advisor
Council
of Health
to
of
Government
andHealth
Family(Policy
Welfare
of India)
Making,
(Cabinet
Legislation
Minister)or
Recommendation)

Addl. DGHS

Dy. DGHS Dy. DGHS Dy. DGHS

Dept.
Dept.
of of
Family
Health
Welfare
Medical Care Public Health General
Commissioner
SecretaryRegional
to the
Directors
Govt. of India

Administration
Joint Secretary Joint Secretary

Nursing Advisor
Deputy Secretary Deputy Secretary

Administration Administration Staff

Staff
DEPUTY NURSING ADVISOR

Union Ministery of Health And Family Welfare :-

The Union Ministery of Health and family welfare is

headed by :

Cabinet Minister

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 (A minister of State)

Deputy Health Minister

There are political appointments

The Union Health Ministery has two departments :

1) Department of Health :

Secretary (i.e. Executive Head)

Joint Secretary

Deputy Secretary

Administrative Staff

2) Department of Family Welfare :-

The Department of family welfare was created in

1966 within the ministery of health and family welfare.

The secretary to the Govt. of India in the ministery

of Health and family welfare is in overall incharge of the
department of family welfare. He is assisted by the additional
secretary and commissioner and one joint secretary.

3) FUNCTIONS :-

The functions of Union Health Ministery are set-out in the seventh

schedule of Article 246 of the constitution of India under (a) Union
list.

(B) CONCURRENT LIST

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(A) UNION LIST :-

1) International health relations and administration of post

quarantine.

2) Administration of central institutes such as the All India

Institute of Hygiene and Public Health Kolkata, National
Insititute for the control of Communicable Diseases, Delhi,
etc.

3) Promotion of research through research centres and other

bodies.

4) Regulation and development of medical, pharmaceutical

dental and nursing professions.

5) Establishment and maintenance of drug standards.

6) Censuses and collection and publication of other stastical

data.

7) Immigration and emigration.

8) Regulation of labour in working of mines and oil fields.

9) Coordination with states and with other ministeries for

promotion of health.

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b) Concurrent List :-

The Concurrent list includes

1) Prevention of extension of communicable disease from one

unit to another.

2) Prevention of adulteration of foodstuffs.

3) Control of drugs and poisons.

4) Vital statistics

5) Labour welfare

6) Ports other than major

7) Economic and social planning

8) Population control and family planning.

2) DIRECTORATE GENERAL OF HEALTH SERVICES :-

a) Organization :-

The director general of health services is the principal advisor to

the union Government in both medical and public health matters.

He is assisted by an additional director general of Health services,

a team of deputies and a large administrative staff.

The directorate comprises of three main units, e.g. medical care

and hospitals, public health and general health administration.

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b) Functions :- The Specific functions are :

1) International health relations and quarantine :

All major posts in the country and international airports

are directly controlled by the directorate general of Health
Services. All matters relating to the obtaining of assistance from
international agencies and the coordination of their activities in
the country are undertaken by the directorate general of health
services.

2) Control of drug standards :-

The drugs control organization is port of Directorate

general of Health Services, and is headed by the drug controller.
Its primary function is to lay down and enforce standards and
control the manufacture and distribution of drugs through both
central and state government officers.

3) Medical Store Depots :-

The Union Government runs medical Store depots at

Mumbai, Chennai, Kolkata, Karnal, Gauhati and Hyderabad. These
depots supply the civil medical requirement of the central
Government and of various state Governments. These depots also
handle supplies from foreign agencies. The Medical store
organization endeavours to ensure the highest quality, cheaper
bargain and prompt supplies.

4) Post Graduate Training :-

The Directorate General of Health Services is

responsible for the administeration of national institutes, which

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also provide post-graduate training to different categories of
health personnel. Some these institutes are :

The all India Institute of Hygiene and Public Health at

Kolkata, All India Institute of Mental Health at Banglore, College of
Nursing at Delhi, National Tuberculosis, Institute at Banglore,
National communicable disease at Delhi, etc.

5) Medical Education :-

The central directorate is directly in charge of the

following medical college in India.

The lady Hardinge

The Maulana Azad

The Medical College at Pondicherry and Goa

6) Medical Research :-

Medical research in the country is organized largely

through the Indian council of Medical Research, founded in Lall in
New Delhi. The council plays a significant role in aiding, promoting
and coordinating scientific research on numan diseases, their
causation, prevention and cure. The research work is done through
the council's several permanent research institutes, research units,
field surveys and a large no of ad-hoc research enquiris financed
by the council. It maintains cancer research centre, Tuberculosis
chemotherapy centre at chennai, Virus research centre at Poona,
National institute of Nutrition at Hyderabad and blood Group
reference centre at Mumbai. The funds of the council are wholly
derived from the budget of Union ministery of Health.

7) Central Govt. Health Schemes

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8) National Health Programmes :-

The various national health programmes for the

eradication of malaria and for the control of tuberculosis, filarial,
leprosy, AIDS and other communicable disease involve expenditure
of crores of rupees.

9) Central Health Education Bureau :-

An outstanding activity of this bureau is the preparation

of education material for creating health awareness among the
people. The bureau offers training courses in health education to
different categories of health workers.

10) Health Intelligence :-

The central bureau of health intelligence was

established in 1961 to centralize collection, compilation, analysis,
evaluation and dissemination of all information on health statistics
for the nation as a whole.

11) National Medical Library :-

The central Medical Library of the Directorate General

of Health services was declared the national medical library in
1966. The aim is to help in the advancement of medical, health
and related sciences by collection, dissemination and exchange of
information.

CENTRAL COUNCIL OF HEALTH

The central council of health was set up by a

Presidential order on a August, 1952 under article 263 of the
constitution of India for promoting coordinated concerted action
between the centre and the states in implementation of all the

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programmes and measures pertaining to the health of the national.
The union health minister is the chairman and the state health
ministers are the members.

FUNCTIONS

1) To consider and recommended broad outline of policy in

regard to matters concerning health in all its aspects such as
the provision of remedial and preventive care, environmental
hygiene, nutrition, health education and the promotion of
facilities for training and research.

2) To make proposals for legislation in fields of activity relating

to medical and public health matters and to lay down the
pattern of development for the country as a whole.

3) To make recommendations to the central Government

regarding distribution of available grants-in-aid for the health
purpose to the states and to review periodically the work
accomplished the different areas through the utilization of
these grants-in-aid.

4) To establish any organization or organizations invested with

appropriate functions for promoting and maintaining
cooperation between the central and state Health
Administration.

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PLACEMENT OF NURSES AT THE CENTRAL LEVEL

DGHS

Addl. DG (PH) Addl. DDG (N) Addl. DG (M)

DDG(N)

ADG ADG ADG

(Community Nsg. Services) (Nss. Edu. & Research) (Hospital Nsg. Services.)

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STATE LEVEL :-

At present there are 28 states in India, with each state

having its own health administration. In all states, the
management sector comprises the state ministery of health and a
Directorate of Health.

STATE MINISTERY OF HEALTH AND FAMILY WELFARE :-

(a) Organization :-

The state ministery of Health and family welfare is

headed by cabinet Minister Deputy minister. The minister of
Cabinet rank is the political head of the department of Health and
FW. The Health Minister has to perform both the activities, i.e.
Political as well as administrative as follow :-

FUNCTIONS :-

1) As a member of the state legislature, it is his duty to support

and safeguard the total policies of the Govt. because of the
collective responsibility of the cabinet.

2) As a member of ministery, he brings all the bills pertaining to

his department for approval of the legislature.

3) As political head of the health department, he acts as an

executive & administrator. He has to see the policies
approved by the legislature are faithfully implemented.

4) He is the custodian of the interests of the people in general

and his constituency in particular.

5) As a member of Govt. he performs Ceremonial duties.

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HEALTH SECRETARIAT ORGANIZATION :-

In order to keep a record of the policies framed by the

political heads and to watch over their implementation he has to
seek the help of an office which is known as "Secretariat" Health
Secretariat is the official organ of the state Health Ministery. The
secretary of the state Govt. is a senior officer of the Indian
Administrative services, is the administrative head and is assisted
by Addition Secretary, Deputy Secretary etc. The main duties of
Health department are as follow :-

FUNCTIONS

1) Assisting the Minister in policy making in modifying policies

from time to time and in the discharge of his legislative
responsibility.

2) Framing draft regislation and rules and regulations.

3) Coordination of policies and programmes, supervision and

control over their execution and review of results.

4) Budgeting and control of expenditure.

5) Maintaining contact with Govt. of India and other state

Govts.

6) Overseeing the smooth and efficient running of

administrative machinery.

STATE HEALTH DIRECTORATE ORGANIZATION :-

The Director of health and family welfare is the

principal advisor to the state Govt. on all matters relating to
medicine and public health as he is technically qualified person in

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the field, may be called as technical head of the Department of
health and family welfare. He is assisted by joint Director,
Regional joint Director and Deputy and Assistant Directors of
major wing.

FUNCTIONS

1) To provide adequate medical care through hospitals,

dispensaries, health centres and mobile domiciliary units
both in rural and urban areas.

2) To make proper arrangement for medical education and

research.

In order to improve the functioning of the medical

education the state health department is to take following
steps :

 Increase the out-turn of para-medical staff in view of large

expansion of rural services.

 Reorientation of medical education with a view to

progressively making training of medical students more
community based.

 To make good the efficiency in nursing / paramedical /

ministerial and other services staff in accordance with the
norm prescribed by the Inc.

 To improve and expand common facilities like hospital,

pharmacy, blood bank, encourgency services, intensive
care unit and rehabilitation services in the hospitals.

 Continuing encouragement to research activities in Medical

colleges.

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3) Proper implementation of National Health Programmes.

The national health programmes are planned, guided,

directed and financed by the union Ministery of health and
family welfare only operational cost of these schemes are
born by the state.

4) To make previsions for personal and impersonal health

services. The following are the personal and impersonal
health services :

a) Immunization services

b) Nutrition

c) School Health

d) Industrial Health

e) Family planning

f) Rural & Urban Sanitation

g) Control of Fairs & Festivals

h) Drugs and food control

i) Production of vaccines and carrying out mass

immunization programme.

j) Emergency health services during flood, famine,

earthquake, refugee influx etc.

5) Control of food and drug administration state health

department has responsibility to control adulteration of food

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 and drugs and enforce minimum standards of food and drugs
laid down by the state.

6) Collection and Dissemination of Health information state

health Department of collects and transmits information of
health and vital statistics for the states.

7) Control over ESI scheme.

State health department supervises the ESI Scheme. The

expenditure on this scheme is shared in the ration of 1:7 by
the Govt. and ESI corporation.

8) Enforcement of Professional Ltd.

The dept. determines and maintains the standards of

professional education, research and practice through
statutory bodies like the university, state medical council,
state Nursing Council, state pharmacy council etc.

9) Promotion of Indigenous systems of medicine. The dept.

encourages the Indigenous system of medicine.

10) Setting up of laberateries.

11) Supervision and control over the local bodies.

12) Preparation for the enactment of Health legislation.

13) Provision of Integrated family welfare services.

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Placement of Nurses at State level :-

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REGIONAL LEVEL :-

In the state of Bihar, Madhya Pradesh, Uttar Pradesh,

Adnhra Pradesh, Karnatka, and others, Zonal or regional or
divisional set-ups have been created between the state Directorate
of Health Services and District Health Administration. Each
regional, zonal set-up covers three to five districts and acts under
authority delegated by the state Directorate of Health services.
The status of officers/incharge of such regional/zonal
organizations differs, but they are known as
additional/joint/Deputy Directors of Health Services in different
States.

DISTRICT LEVEL :-

The Major unit of administration in India is the District

for administration purpose the country is divided into 28 states
and 67 union territories which in turn are divided into 432
administration districts. Each district is divided into sub-districts or
taluks, under which are situated the Community Development
Blocks at present there are 600 community development Blocks in
India.

Functions of health organization at District level or local

level :

1) Coordinate health Planning.

2) Investigate communicable disease.

3) Maintain free clinics for the early diagnosis of

Communicable disease.

4) Provide laboratory services to assist doctors.

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5) Conduct clinics for administration of vaccines.

6) Collect vital statistics

7) Provide MCH services

8) Maintain a Public health Nursing service.

9) Supervise water supply and sewage disposal

10) Supervise quality and safety to meat and other foods.

11) Inspect and supervise the production, parteurisation and

distribution of milk.

12) Investigate and supervise general sanitary conditions in

public eating places.

13) Provide preventive and rehabilitative services in chronic

disease control.

14) Conduct health education programmes.

15) Promulgate rules and regulations.

16) Provide mental health services.

17) Provide family planning services.

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