HEALTH CARE DELIVERY

SYSTEM
Introduction:

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 center level
Conti…

India is a union of 28 states and 8 union

territories under the constitution of India,
the states are largely independent in matters
relating to the delivery of health care to the
people.
DEFINITION :
Health care delivery system refers to the
totality of resources that a population or
society distributes in the organization and
delivery of health services.

It also includes all personal and public

services performed by individuals or
institutions for the purpose of maintaining or
restoring health.
(STANHOPE, 2001)
OBJECTIVES :
To improve health status of population and
clinical outcomes of care.

To improve social justice equity in the health

status of the population.

To reduce the total economic burden of

health care.

To raise and pool the resources accessible to

deliver health care services.
FUNCTIONS :

To promote health education and health

services.
To promote quality of life and life
expectancy.
To promote maternal and child health, family
planning, adolescent health.
To prevent and control locally endemic
diseases. E.g.dengue fever, filariasis etc.
PRINCIPLES :
It supports co-ordinate, cohesive health care
services.

It supports the concept of pre-paid group

practice.

It supports the establishment of community

based, community controlled health care system.

It urges an emphasis to be placed on

development of primary care.
CONTI..

It emphasizes on equality assurance of the

care.It supports health care as a basic human
right for all people.

It supports individuals unrestricted to access

to the provider, clinic or hospital.

It supports public and private funding.

CONTI..

It supports the establishment of national

health care budget.

It supports universal health insurance.

STRUCTURE OF HEALTH CARE
SYSTEM
National level

State level

District levels

Local level
NATIONAL LEVEL

The organization of health services at the

national level consist of Union Ministry of
Health & Family Welfare. Central Council of
health and Directorate general of health
services
CONTI..
The Union ministry of Health & Family welfare
The Union ministry of Health & Family welfare
is headed by, Cabinet Minister ( a Minister of
State) Deputy Health Minister These are
political appointments. The Union health
ministry has two department:
CONTI..
Department of health

Secretary
Joint Secretary
Deputy Secretary
Administrative Staff
Department of family welfare

The department of family welfare was created in

1966 within the ministry of health and family
welfare. The secretary to the Govt. of india in the
ministry of health and family welfare is in overall
in charge of the department of family welfare.
Function
The functions of union health ministry are set
out in the seventh schedule of article 246 of
constitution of India under:
Union List
Concurrent List
Union List
International health relations and
administration of part quarantine.

Administration of central institutes such as

the All India Institute of Hygiene and Public
Health Kolkata, National Institute for the
control of Communicable Disease, Delhi etc.

Promotion of research through research

centers and other bodies.
CONTI..
Regulation and development of medical,
pharmaceutical, dental & Nursing
professions.

Establishment and maintenance of drug

standards.

Censuses and collection and publication of

other statistical data.

Immigration and emigration.

CONTI..
Regulation of labor in working of mines and
oil fields.

Co-ordination with states and with other

ministries for promotion of health.
Concurrent list
Prevention of extension of communicable disease from
one unit to another.

Prevention of adulteration of foods tuffs.

Control of drugs and poisons.

Vital statistics.

Labour welfare

Economic and social planning.

Population control and family welfare

Directorate Genral of Health
services
Organization

The director general of health services in 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 comprise of three main units eg.

Medical care and hospitals, public health and
general administrationtion:
Function
International health relations and
quarantine:

All major parts in the country and

international airports are directly controlled by
DGHS. All matters relating to the obtaining of
assistance from international agencies and the
coordination of their activities in the country
are undertaken by the DGHS
Control of drug standards:
The drugs control organization is part of DGHS,
and is headed by the drug controller. Its primary
function is to lay down enforce standards and
control of manufacture and distribution of drugs
through both central and state government
officers.
Medical Store Depot:
The Union govt. runs medical store depots at
Mumbai, Chennai, Kolkata, Karnal, Guhati, and
Hyderabad. These depots supply the civil medical
requirement of the central government an of
various state governments.
CONTI..
These depots also handle supplies from
foreign agencies. The medial store
organization endeavors to ensure the
highest quality. Cheaper bargain and prompt
supplies
Post Graduate Training:
The DGHS is responsible for the
administration of national institutor, which
also provide post graduate training to
different categories of health personnel.
Some of these institutes are:

The all India Institute of Hygiene and Public

Health at Kolkata. All India Institute of
Mental Health at Bangalore
CONTI..
The all India Institute of Hygiene and Public
Health at Kolkata. All India Institute of Mental
Health at Bangalore.

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 of Pondicherry and Goa

Medical Research:

Medical research in the country is organized

largely through the Indian Council of Medical
Research, Founded in 1911 in New Delhi.

The council plays a significant role in aiding,

promoting and coordinating scientific
research on human disease their causation,
prevention and cure
CONTI..
The research work is done through the
councils several permanent research
institutes, research units, Field surveys and
financed by the council:
It Maintains:-
Cancer Research Centre
Tuberculosis Chemotherapy centre at
Chennai
Virus Research centre at Poona.
CONTI..
National Institute of Nutrition at Hyderabad.
Blood Group Reference Centre at Mumbai.
The funds of the council are derived from the
budget of Union Ministry of Health
National Health Program
The various National Health Programmes for
the eradication of disease involve
expenditure of crores of rupees. This all
comes under DGHS.

Central Govt. Health Schemes

Function
To consider and recommend 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 promotion of
facilities for training and research.

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.
CONTI..
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.

To establish any organization or organizations

invested with appropriate functions for
promoting and maintaining cooperation between
the central and state health administration.
AT STATE LEVEL
At present there are 28 states in India, with
each state heaving its own health
administration. In all states, the management
sector comprise, the state ministry of health,
Health, secretariat, and Directorate of Health.
State Ministery of Helth And Family
Welfare

The State ministry of health and family welfare

is headed by cabinet minister. Deputy minister.
CONTI..
The minister of cabinet rank is the political
head of the department of health and family
welfare. The health minister has to perform
both the activities i.e. political as well as
administrative as follow:
Function
As a member of the state Legislature, it is his
duty to support and safeguard the total
policies of Govt. because of the collective
responsibility of the Cabinet.

The state ministry of health and family

welfare has to see the policies approved by
the legislature are faithfully implemented or
not
Health secretariat
organization:
In order to keep a record of the health
policies framed by the political heads and to
watch over their implementation the ministry
has to seek the help of an office, which is
known as ‘ Health Secretariat’. So, The
Health Secretariat is the official organ of the
State Ministry of Health and Family welfare.
Functions:
Assisting the minister in policy making, in
modifying policies from time to time and in
the discharge of his legislative
responsibilities.

Formulation, review and modification of

broad policy outline.

Execution of policies, programme etc.with

Govt. of India and other state Governments.
CONTI..

Control for smooth and efficient functioning

of administrative machinery.
AT DISTRICT LEVEL
Chief Medical Officer is overall responsible
for the administration of medical/ health
services in the entire districts.

The district level structure of health services

is a linkage system between the state and
peripheral level structure.Within each
districts, there are six types of administrative
areas:
CONTI..
Subdivision
Tehsils (Taluks)
Community development blocks
Municipalities and corporation
Village
Panchayats
Most district in India are divided into two or
more subdivision
CONTI..
The urban areas of the districts are
organized intoTown Areas committees ( in
areas with population ranging between
5,000 to 10,000).

Municipal Boards ( in areas with population

ranging between 10,000 and 2,00,000)

Corporations ( with population above

2,00,000)
CONTI..
Most district in India are divided into two or
more subdivision, each incharge of an
Assistant collector or Sub collector. Each
division is again divided into Taluks,
incharge of a Thasildhar. A taluk usually
comprises between 200 to 600 villages
CONTI

The community development block comprises

approximately 100 villages and about 80000 to
1,20,000 population, incharge of a Block
Development Officer. Finally there are the village
panchayats, which are instructions of rural local
self-government.
CONTI..
Construction and maintenance of roads
Sanitation and drainage
Street lighting
Water supply
Maintenace of hospitals and dispensaries
Education and Registration of births and
deaths etc
 Panchayat Raj-
The panchayat raj is a 3-tier structure of rural
local self- government in India linking the
village to the districts. It includes-

1. Panchayat ( at the village level)

2. Panchayat Samiti (at the block level)
3. .Zila parishad ( at the district level)
CONTI..

Panchayat:-

The Panchayat Raj at the village level consists of-

A) The Gram Sabha
B) The Gram Panchayat
The Gram Sabha-
It is t The Gram Sabha-
It is the assembly of all the adults of the
village, which meets at least twice a year.
 CONTI..
The gram sabha considers proposals for
taxation, and elect members of The Gram
Panchayat. The assembly of all the adults of
the village, which meets at least twice a year.
The gram sabha considers proposals for
taxation, and elect members of The Gram
Panchayat
CONT..
Gram Panchayat-

It is the executive organ of the gram Sabah and

an agency for planning and development at the
village level. The population covered varies from
5000 to 15000 or more. The member of
panchayat hold offices for a period of 3 to 4
years.

Each panchayat has an elected president (

sarpanch or Sabhapati or Mukhia ), a vice
president and panchayat secretary.
CONT..

It covers the civic administration including

sanitation and public health and work for the
social and economic development of the
village.
Panchayat Samiti :
The block consists of about 100 villages and a
population of about 80,000 to 1,20,000. The
panchayat samiti consists of Sarpanch, MLAS,
MPs residing in block area, representative of
women, SC, ST and cooperative socitiies.

The primary function of the Panchayat Samiti is

the execute the community development
programme in the block. The Block development
officer and his staff give technical assistance and
guidance in development work.
Zila Parishad
The Zila Parishad is the agency of rural local
self government at the district level.

The members of Zila parishad include all

heads of panchayat samiti in the district, MPs,
MLAs, representative of SC, ST and women
and 2 persons of experience in
administration, public life or rural
development. Its functions and powers vary
from state to state.
LOCAL LEVEL
It is classified into four level
Village health guide
Local dias
Anganwadi workers
ASHA
Village health guides :
Village health guide is a person with an
aptitude for social service and is not full time
government functionary. Village health
guides scheme was introduced on 2nd
oct.1997.
Guidelines for their
selection
They should be permanent resident of the
local community, preferably women.
They should be able to read and write,
having minimum formal education at least
up to the VI std.
They should be acceptable to all sections of
community.
They should be able spare at least 2 to 3
hours every day for community health work.
Functions of Village health
guides
Provide treatment for common minor
ailments.
First aid during accidents and emergency.
MCH care
Family planning
Health education
. Local dais
Most deliveries in rural areas are handled by
untrained dais. The training for dias given for 30
working days.

Each dais is paid stipend of Rs.300 during the

training period.

The training is given at PHC, subcenters or MCH

center for 2 days in a week and on the remaining
four days of the week they accompany the health
worker (female) to the village.
CONTI..
During her training each dai is required to
conduct at least 2 deliveries under the
supervision and guidance of health worker
(female), ANM, health assistant (female).
 Functions of dias
MCH care
Family planning
Immunization
Education about health
Referral services
Safe water and basic sanitation
Nutrition
Anganwadi worker:

Under the ICDS scheme there is an

anganwadi worker for a population of 1000.
There are about 100 such workers in each
ICDS project

The anganwadi worker is selected from the

community and undergoes training in
various aspect of health, nutrition and child
development for 4 months.
CONTI..
She is a part time worker and paid an
honorarium of Rs. 1500 to 2000 per month
for the services.
Functions of anganwadi
worker:
MCH care
Family planning
Immunization
Education about health
Referral services
Safe water and basic sanitation
Supplementary nutrition
Nonformal education of children
ASHA :
One of the key components of the National
Rural Health Mission is to provide every
village in the country with a trained female
community health activist- ASHA.

Selected from the village itself and

accountable to it, the ASHA will be trained to
works as interface between the community
and the public health system.
Criteria for selection –
ASHA must be primarily a women resident of
the village ‘Married/ widow/ Divorced’ and
preferably in the group of 25 to 45 yrs.

ASHA should have effective communication

skills, leadership qualities and be able to
reach out to the community.
CONTI..
She should be a literate woman with formal
education up to Eight class. This may be
relaxed only if no suitable person with this
qualification is available.
Adequate representation from
disadvantaged population groups should be
ensured to serve such groups better
Role and Responsibilities of
ASHA –
ASHA will take steps to create awareness and
provide information to the community on
determinants of health such as nutrition,
basic sanitation & hygiene practices, healthy
living and working conditions, information
on existing health services and the need for
timely utilization of health and family welfare
services.
Conti..
ASHA will mobilize the community and facilitate
them in accessing health and health related
services available at the village/ sub-center/
primary health center, such ass Immunization.

She will work the Village Health & Sanitation

Committee of the Gram Panchayat to develop a
comprehensive village health plan.
She will arrange escort/ accompany pregnant
women & children requiring treatment/
admission to the nearest pre-identified health
facility.
Conti..
ASHA will provide primary medical care for
minor ailments such as diarrhea, fever, and
first aid for minor injuries. She will be a
provider of DOTS under Revised National
Tuberculosis Control Programmed.
SUMMARY:-

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 subcenter level