Organization of Health care in India

Mr. Paul Ebenezer1st year M.Sc. Nursing

CON,CMC. Vellore

INTRODUCTION• The health care service in our country extends from the National level

to Village Level.

• The Organizational structure can be divided into health care system at:

-National Level

-State Level

-District Level

-Community Level

-PHC level

-Sub-centre level

• There are currently 29 States, 7 Union Territories and 593 Districts in India.

• Health services are designed to meet the health needs of the community

through the use of available resources.

• Its not possible to define a fixed role for health services – (because of

socio economic pattern)

• The health services are delivered by “Health System” which constitutes

the management sector and Involves Organizational Matters.

District Level

National Level

Urban Areas

State Level

Rural Areas

• Union Ministry of Health and Family welfare

• Directorate General of Health Services

• Central Council og Health and family Welfare

National Level

• State Ministry of Health

• State health directorate

State Level

•Zilla Parishad Office

•District Health Officer

District Level

• Community Health Centres

• Primary Health Centres

• Sub-Centers

Rural Areas

• Urban health centre

• Hospitals

• Dispenseries

Urban Areas

HEALTH ADMINISTRATION AT NATIONAL LEVEL

• In India, the responsibility of executing government policy in certain areas

lies with central government

• Health in India is a state subject and the union government has mainly an

advisory and coordinating role in Implementation of health policies.

• The ministry of health and family welfare of the central government plays a

vital role in the national efforts to enable the citizens to lead a happy and

healthy life.

• It has the responsibility of policy making, planning guiding, assisting,

evaluating and coordinating the work of the state health ministries.

• The central Ministry of Health initiates country-wide health

programmes and coordinate activities of state and ensures - lags

• The minister of health and family welfare hold cabinet rank as a

member of central council of minister.

Health care functions

• Areas of operation divided into Union government and State government

• The seventh schedule of constitution three list of items

-Union List.

-State List.

-Concurrent list.

Union list

• International health regulation and administration of port quarantine.

• Establishment and maintenance of drug standards.

• Census and collection of other statistical data.

• Immigration and emigration.

• Regulation of labour in the working of mines and oil fields.

• Regulation and development of medical, pharmaceutical, dental and nursing professionals

• Administration of central institutes such as national institute of communicable diseases , Delhi

• Coordination with states and other ministries for promotion of health

State list

• Public health

• sanitation

• hospitals

• dispensaries.

Concurrent list

• Population Control

• Family welfare

• Prevention of food adulteration

• Quality Control in manufacture of drugs

• Medical profession

• Vital statistics

• Registration of birth and death

Who is this ?

Shri. Jagat Prakash NaddaUnion Minister of Health and Family Welfare

National level Organization

• Headed by -> Union Minister of health and family welfare

Comprise of four departments

1. Department of Health and Family welfare

2. Department Of AYUSH

3. Department of AIDS control (created in 2008)

4. Department of health research

Who is this ?

Shri. pradeep kumar Sinhasecretary to the government of India

Department of health

• Headed by-> secretary to the government of India

• Deals with Health care.

• Awareness campaigns , immunization campaigns preventive medicine

and public health care.

• Administrative Control : National health programmes, Medical Council

of India , Dental council of India , AIISH, AIIPMR,HSCC

Department of Family welfare

• Headed by -> Additional Secretary and Commissioner

• Responsible for all National family welfare programme, including RCH, immunisation and other maternal and child related programmes, and methods of population stabilization

• organizes research on human fertility ,genetics ,new contraceptives

Also responsible for :

• 18 population Research Centres (PRC) at six Universities and six other Institutions across 17 states

• National Institute of health and family and welfare.

• International Institute of Population Science

Department of AYUSH• Established in March 1995 as the department of Indian Systems of

Medicine and Homeopathy

• Bodies under control of AYUSH are certain important research councils such as CCRAS,CCRUM,CCRH,

• It also control several educational institution • National Institute of Ayurveda, Jaipur

• National institute of Siddha, Chennai

• National Institute of Homeopathy, Kolkata

• National Institute of Naturopathy , pune

• National Institute of Unani Medicine, Bangalore.

• The Dept. of AYUSH is charged with upholding educational standards in the colleges of Indian systems of medicines and homoeopathy strengthening of research, promoting cultivation of medicinal plants and working on pharmacopeia standards

Department of AIDS Control (2008)

• Headed by-> officer of the level of Secretary

• AIDS control organisation was given the status of full – fledged

department in the ministry of health and family welfare

Department of Health Research• Headed by-> a medical professional rank of Director General

• Indian Council Medical Research was started in 1911 as Indian research fund

association.

• Re-designated as ICMR in 1949

• Recently it also designated as the department of Health research.

• It is also the ex-officio secretory of department of Health research

• ICMR is the apex body for conducting and coordinating and sponsoring large scale

research on all health matters in the Country

Directorate General of Health service

• Headed By->Director of General of Health Services

• it is an attached office of Department of Health and Family Welfare and has subordinate offices all over the country

• It gives technical advice on all medical and public health matters

• Matters relating to Nursing:

• Administrative control of the entire nursing cadre in the province in respect of those working under the provincial Health department or in the teaching hospitals

• Education (local and foreign) service and pay structure of nursing cadre

Directorate General of Health Services

Director General of Health Services

Add. Director GHS

Deputy Director GHS

Administrative staff

Central council of Health

• Chaired by -> Union Health Minister,

• Members -> health Ministers of the State

• The central council evolves health related broad policies and plans

through the central council of health

• Collection and exchange of Information

• Renders financial and technical assistance – state goverments

• Implementation of health programmes

Central Bureau of Health intelligence

• In the DGHS collects complies, analysis, and disseminates information on different aspects of health and medical care services to cater to need of various states

• Functions are

1. Collection-compilation and dissemination of health statistic at the national level

2. Coordination with various states

3. Publication of reports

4. organization and participation in national seminar in health statictisrelated field.

Who is this ?

Shri. P.longonstate Health and Family Welfare minister nagaland

Who is this ?

Dr.C. Vijaya Baskaran state Health and Family Welfare minister tamilnadu

HEALTH ADMINISTRATION AT STATE LEVEL

• Health is a state subject

• Providing health services to all people lies with state health dept, with

assistance of local self government where ever they exist

• Over all Headed by- governor

• Department of health and family welfare Headed by-> State health and

family welfare minister

• In order to keep a record of the policies framed by the minister and do

watch over the implementation and execution

• State administration office called Health Secretariat

• Headed by-> Administrative Head

• He is assisted by joint secretaries and other administrative staff

Director of health services • Chief technical advisor to State Government –medicine and

public Health

• Organization and health activity

• Over all in charge of all medical activity imparted by government sector through various hospital and health centre

• Over all in charge State laboratories

• Assisted by various regional deputy directors

• In some states designated as State Directed general of health services

Director of Family Welfare Services

• Overall responsible for implementation of family welfare programmes in the state , Including RCH , immunization, RCH, other ,maternal child health programmes in the State

• Functioning of state health and family welfare training centres in the state

• In some states no director of family welfare,

Director of Medical education and research

• All medical, dental, Nursing colleges and other training institute in the

state.

• Coordinate all supervises all medical/ health related research activity

In the state

Director of Indian System Medicine

• Oversees the training intuition for ISM and Homeopathy in the state.

Director of Food and Drug Administration

• Implementation of provision of drugs Act, and food safety act

• Implementation and monitoring of national health programmes

• Development of medical and paramedical human resource to cater to the health needs of the states

• Provision of curative service through various Hospitals and Health centers

• Providing health services ISM, growing plants

• Provision of meternal and child health care –bringing down population

• Provision of laboratory service and vaccine production unit.

HEALTH ADMINISTRATION AT DISTRICT LEVEL

• Bottom up planning and organization and top-down planning support

• Middle level management – link between state level health infrastructure on one side and district lower level health intuition on other side

• Under district health organization

• Headed by-> Chief Medical Officer or District Medical Officer

• Responsible for state health department through the regional deputy directors

• Responsible for administration of medical and health services through out the district

• Assisted by -> deputy district Medical officer

Urban Area • Providing health services in urban areas

Institution Population Norm services

Municipal Committees Between 5000 and 10000 Provided Sanitary Service

Municipal Board Between 10000 and 2,00,000 Headed by Chairman president team ranges from 3-5years , construction of roads , sanitation , water drainage, street lighting, maintenance of hospital and dispensaries, regbirth and death

Municipal Corporation >2,00,000 Headed by Mayors Similar like Board

Urban family welfare centre

• Launched during the first five year plan –expanded –outreach services

,primary health care ,MCH and distribution of Contraceptives

• Three types depend upon population - centres cover

• Type 1: 10000-25000- 2 paramedical staff

• Type 2: 25000-50000

• Type 3: more than 50000- 6 person including MO

Urban revamping scheme

• By Krishnan committee in 1983

• Provide service through setting up of health post –in slum areas

• Mainly for RCH service ,preventive , first aid and referral services including contraceptives

• 4 types of health posts

• Type A: less than 5000

• Type B : 5-10 thousand

• Type C : 10-20

• Type D : 20-25 – medical officer

District Hospital

• Curative Service of population of the district

• Headed by-> MS /CMO

• Senior specialist –assisted by junior specialist / DMO

• Ambulatory and in patient care

• Guidance and support –PHC and CHC

• Training of personnel from CHC and PHC, sub centres and hospital

National Urban Health Mission

• Improving Health status of urban poor

• Urbanization lead to increase in poor population –Slums

• Need of improving delivery of health care of urban poor recognized

by NHP – 2000 and NPP-2002 and eleventh five year plan

• NUHM is cover 21.07 core urban population with special focus 6.25

crores , spread over 430 cities.

• Disadvantage : facilitating equitable assess to quality health care

Rural Areas • 73rd constitution amendment act, 1992 –created of Panchayat raj

Institution

• Three tire system- Self Governance state in federal setup

• Decentralized development- people’s participation in the process of planning , decision making , implementation and delivery

Tire Panchayat raj system Organizational head Health functionary

District Level Zila Parishad Chief executive officer District Health officer

Block Level Panchayat Samiti Block development officer

Medical officers of PHC

Village Level Gram Panchayat Village Development officer /Gram sevak

AWW,MPW,ANM,TBA, VHG

HEALTH ADMINISTRATION AT DISTRICT LEVEL

• HEALTH CARE INFRA STRUCTURE DEVELOPED IN THREE TIRE SYSTEM

• Based on population

Center Plain Area Hilly / tribal/ difficult area

Sub-center 5000 3000

PHC 30,000 20,000

CHC 1,20,000 80,000

Health care Infrastructure in rural Areas C

HC 30 bedded

hospital/referral unit for 4 PHCs with specialized service

PH

C Referral unit for 6 sub-center , 4-6 bedded , manned by medical in charge /MO

14 staffs

Sub

-C

ente

r Periphalcontact point between PHCare system manned 1MPW (F)/ANM 1MPW (M)

Community Health Centres

• As on 31st March 2008, 4276 CHC were established by upgrading the PHC

• Specialist in Surgery, medicine and Obstetrics and Gynaecology, and Paediatrics with X-ray and Laboratory facilities.

• Preventive and promotive aspects of health care

• New non medical post –community health officer –supervising

• CHC specialist may refer patient to the state Level Hospital / nearest

• Without the patient having to go first to the sub-divisional or district Hospital

INDIAN STANDARDS FOR COMMUNITY HEALTH CENTERS

1.Care of routine and emergency cases in surgery.

2.Care of routine and emergency cases in Medicine.

3. 24Hr Delivery Services

4. Essential and Emergency Obstetric care

5. Full range of Family panning Including Laparoscopic

6. Safe Abortion Service

7. New born Care

8. Routine and Emergency Care of Chick Children

9. Other Management

10. All National Health Programme

a. RNTCP

a. RNTCP b. HIV/AIDS

a. RNTCP b. HIV/AIDS c. NVBDC

d. LEPROSY ERADICATION

e. Blindness f. IDSP

11. OTHERS

Primary Health Centre Level• Bhore Committee introduced a concept – To provide comprehensive health

services to the people in rural areas through the network of primary health

centres.

• strengthen and support primary health care through various sectors.

• maximum care to the special risk groups.

• Training.

• proper use of resources.

• continuous supply of drugs and proper managerial process, includes planning,

organizing, monitoring and evaluation of health services.

Elements

• E- Education

• L- Locally endemic disease control

• E- expanded programme immunization.

• M- Maternal and child health

• E- Environment sanitation

• N- Nutritional services

• T- Treatment of minor ailments.

• S- School health services

Functions of PHC

• ACTIVITES include:

• Medical care.

• MCH including family planning.

• Safe water supply and basic sanitation.

• Prevention and control of locally endemic diseases.

• Collection and reporting of vital statistics.

• Education about health.

• National health programmes.

• Referral services.

• Training of health guides, health workers,

local dais and health assistants.

• Basic laboratory services

• Primary health centres providing health services and selected surgical

procedure and for paediatric care.

• Reoriented medical education (ROME) towards need of country

• Primary health centres have been attached to each of 148 medical

colleges.

INDIAN STANDARDS FOR primary HEALTH CENTERS

• Building

• Manpower

• Instruments

• Equipment's

• Drugs

• Other facilities

• 20,000- 30,000 population with 6 beds

objectives

1. provide comprehensive primary health care to the community

through the PHC.

2. To achieve and maintain an acceptable standard of quality of care.

3. To make the services more responsive and sensitive to the needs of

the community.

Minimum requirements of PHC

• Medical care :

• OPD services: 4hrs in the morning 2hrs in the afternoon /evening

• OPD attendance 40 patients per doctor per day

• 24hrs Emergency service: injuries and accident , first aid, stabilization of

the condition of patient before referral

• Poisons, bites.

• referral service or in patient service

• Maternal and Child health care

• Antenatal care : Early registration of pregnancy and minimum 3 antenatal check-ups

• Minimal laboratories investigation

• Nutrition and health counselling

• Supplementary of folic acid , iron tablets and TT immunization

• Identified of high risk pregnancy- management

• Referral to first referral unit to other hospital in case of high risk

• Intranatal care: 24hrs sercice for normal delivery

• Promotion of instutional delivery

• Conducting assisting delivery including forceps and vacuum delivery

• Manual removal of placental

• Appropriate and promote referral for cases needed specialist

• Postnatal care: A minimum of 2 postpartum home visits

• First within 48 hrs of delivery second within 7 days through sub centerstaff

• Initiate breast feeding within half-hour of delivery

• Education on nutrition, hygiene and contraception

• Provision of facilities under Janani sureksha Yojana

• New born Care:

• Care of child: IMNCI, childhood illness, promotion of breast feeding till 6months

• Full immunization , vit A prophylaxis.

• Medical termination of pregnancy

• Nutritional services:

• School health services

• Adolescent health care

Training

• Health workers , traditional health workers

• Periodic training for paramedic in treatment of minor allingments

• Training of AHSA

• Medical professional

• Training of ANM

• IMNCI

• AYUSH

Sub-Centre Level

• Peripheral Outpost of existing health delivery system in rural areas

• 5000- 3000 population

• As of march 2008 146,036 established in the country

• Provide interface at gross root levels providing all primary health care services

• Package service such as immunization, antenatal and postnatal care, prevention of mal nutrition and common childhood diseases

• Family planning service and counselling

• Also provide elementary drugs

• Family health programmes through sub-system. Since April 2002 salary Govt. of India HAFW

• Staffed by : 1 FHW as ANM and 1 MHW as MPW

• 1 Health assistance (F) as Lady Health Visitor

• 1 Health assistance (M) located at PHC level are entrusted with the task of supervision of 6 sub-centres under PHC

• maternal health care

• Antenatal care

• Early registration before 12wks

• Abdominal examination

• Haemoglobin

• Examination of blood group

• Routine urine examination

• Intranatal care:

• Promotion of institutional delivery

• Skilled attendance at home delivery

• Appropriate and prompt referral in case of complication

• Postnatal care:

• Minimum 2 post – partum home visits (48hrs, 2days) (7days of delivery)

• Initiation of breast feeding ½ hrs of delivery

Conclusion

Thank You