Presentation on Health system in India

1. Health System In India
PG Students: Dr. Santosh Kadle
Dr. Sunil Panigrahi
PG Teachers: Dr. Usha Ranganathan
Dr. Pallavi Uplap
Dr. Shubhada Hamjade

2.  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

3.  Historical evolutionof healthsystems:
Family Religion
Ancient
medical
systems
Era of
Buddhism and
Christianity
Early sanatoria
built by
Emperor
Ashoka in 2nd
century BC.
The Rise of
Modern
System of
Medicine

4. 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

5. 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.

6.  Evolutionof healthsystemin India after 1947
Phase I
[1947-1983]
Phase II
[1983-2000]
Phase III
[Post 2000]

7.  Definitionandconcepts of healthsystem:
 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. ”

8.  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 healthsystem
Health
System
Concept
Ideas
Persons
Objects

9.  HealthSystem:
 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

10.  Goals of a HealthSystem:
 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.

11.  HealthCareSystemModels:
 Private Systems: Capitalistic model
 Public Systems : Public insurance systems
3 model:
- Social security model
- Publicly funded health care model
- Social health insurance models.

12.  Planning of HealthSystem:
Dispersed
health planning
Focused health
planning
Central health
planning
Health
Planning

13. Financingthe ModernHealthCare 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 ?

14. Financingthe ModernHealthCare 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

15. Financingthe ModernHealthCare Systemin
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/community
financing (0.4%).
It is thus evident
that public health
investment has
been comparatively
low

16.  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

17. 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

18. 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

19. 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

20. Model of health care system :
Inputs
Health status
or health
problems and
Resources
Health care
services
Curative,
Preventive,
Promotive
services
Health care
systems
Public.
Private,
Voluntary
,Indigenous
system
Outputs
Changes in health
status

21. 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.

22. Health System in India
The health system in India has 3 main links

23. At the central level
The official “organs” of health system at national level are

24. Ministry of Health and Family
Welfare

25.  Organization Structure Of MoHFW

26.  Functions of MoHFW
oUnion 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

27. oConcurrent List:
1) Prevention of Communicable disease
2) Prevention of food adulteration
3) Control of drug and poison
4) Vital statistics
5) Labour welfare
6) Economic and social planning
7) Population control and family planning
 Functions of MoHFW

28. Directorate General of Health
Services

29.  Organization chart of DGHS

30.  Functions of DGHS
General functions:
1) Surveys
2) Planning
3) Coordination
4) Programming and appraisal of all health matters
Specific functions:
1) International health relations and quarantine of all major ports in
country and international airport.
1) Control of drug standards
2) Maintain medical store depots
3) Administration of post graduate training programmes

31. 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

32. Central Council of health

33.  Organization Chart Of CCH

34.  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.
1) To make proposals for legislation relating to medical and public
health matters.
2) To make recommendations to the Central Government regarding
distribution of grants-in-aid.

35. State Level

36. State Level

37.  In Maharashtra State :
State Minister of
public health
Additional chief
secretory public
health and family
welfare
Mission director
NRHM
Project Director
MSACS
Secretory and
commissioner
Family welfare
Director ESIS
Director Health
services
Minister of Public
health

38. State Level

39.  Division to District Level
Deputy
Director
ADHS
NVBDCP
ADHS
leprosy
DHO
ADHS
Medicine
Civil
Surgeon

40.  District Level
Districts
Tehsils /Talukas (200-600 villages)
Community Development Blocks (approx
100 Villages & 80,000 -1.2 Lac Pop)
Municipalities & Corporations
Municipal Board
(10,000- 2 Lac Pop)
Corporations (> 2 lac pop)
Town Area Committee
(5,000-10,000 Pop)
Panchayats
Villages

41.  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

42. Thank you
!!!