1. B Y - D R . D H A R M E N D R A G A H W A I
( P G S T U D E N T )
M O D E R A T O R -
P R O F . Y . D . B A D G A I Y A N
H E A D O F D E P A R T M E N T
D E P A R T M E N T O F C O M M U N I T Y M E D I C I N E
C I M S , B I L A S P U R ( C G )
An Overview of Health Care
Delivery System in India

2. INTRODUCTION
 As is well known , the majority of India’s population
lives in the rural areas
and
• this segment of population have been given
inadequate attention so far as health and medical
care facilities are concerned.

3.  The dense rural population with varied ethnic
background , high level of illiteracy, low per capita
income have been a challenge to Central and state
government to improve the quality of people’ lives.
 To cope up with various plans, programmes were
developed aiming to improve the level of living and
health of the people.

4.  This planned development of about five decades has
resulted in increase in the health infrastructure to
meet the increasing demand on health services at
various level.
 At the same time , there has been marked shift in
National Health Policy from hospital based services
to community based services duly backed by strong
referral services.

5.  Today , it is clear that health system in India do not
gravitate naturally towards the goal of HEALTH
FOR ALL through primary health care as
articulated in the Declaration of Alma-Ata.
 Health systems in India are developing in directions
that contribute little to equity and social justice
and
 Fail to get best outcomes for their resources.

6.  Three worrisome trends of health care system in
India -
 1.Health system that disproportionately focus on narrow
offer of specialized health care.
 2.Health system where a command and control approach
focused on short-term results and is fragmenting the
service delivery.
 3.Health systems where governance has allowed
unregulated commercialization of health to flourish.

7. SHORTCOMINGS OF HEALTH CARE
DELIVERY SYSTEM IN INDIA

8. Common shortcomings
 1.Inverse care.
 2.Impowerising care.
 3.Fragmented and fragmenting care.
 4.Unsafe care.
 5.Misdirected care.

9. INVERSE CARE
 People with most means - whose needs for health
care are often less - consume the most health care
services.
 Whereas those with the least means and greatest
health problems consume the least.
 Public spending on health services most
often benefits the rich more than the poor.

10. IMPOVERISHING CARE
 Wherever people are lack of social protection and
payment for health care , they are largely out of
pocket at the point of health services.
 They can be confronted with catastrophic expenses.
 Millions of people fall in to poverty because they
have to pay for health care services.

11. FRAGMENTED AND FRAGMENTING CARE
 The excessive specialization of health care providers
and the narrow focus on many disease control
programmes discourage the holistic approach to the
individuals and families.
 Health services for the poor and marginalized groups
are highly fragmented and severely under resourced .

12. UNSAFE CARE
• Poor system design that is unable to ensure safety
and hygiene standards leads to high rates of hospital
acquired-infection.
• Medication error and other avoidable adverse
effects are underestimated cause of death and ill
health.

13. MISDIRECTED CARE
 Resource allocation clusters around curative services
at great cost and it is neglecting the potential of
primary prevention and health promotion to
prevent up to 70% of disease burden in developing
countries.
 Health sector lacks to mitigate the adverse effects on
health from other sectors and
 At the same time, unable to make most of what these
sector can contribute to health.

14. ORGANIZATIONAL SET-UP
OF HEALTH CARE DELIVERY
IN INDIA

15.  Health development is integral to overall
socioeconomic development.
 Ministry of Health and Family welfare plays a vital
role in planning and making policies.

16.  Under the Constitutions of India, the item like
public health, sanitation, hospitals and dispensaries
fall in the state list.
 Health care is the subject of state government and
each state in India has developed its own system of
health care delivery independent of central
government.
 The central organization is mainly for policy making
and planning and is mostly consultative and
advisory.

17. At Central Level
 The organization at centre comprise of :
 1.Union Ministry of Health and Family Welfare.
 2.Directorate General of Health Services.
 3.Central Council of Health and Family Welfare.
 Ministry of Health and Family Welfare is headed by
 1. A Cabinet Minister.
 2.A Minister of State.

18.  Currently it consist of four departments –
 1.Department of Health and Family Welfare.
 2.Department of AYUSH.
 3.Department of Health Research.
 4.Department of AIDS control.

19.  The Union Ministry –
- formulates national policies on health and gives
advise on health allied matters.
- coordinates health programmes and policies.
-supplies technical information and equipments.
-provides financial and other assistance towards
health measures.
In general it promotes the health and well
being of people.

20. At State Level
 The state is ultimate authority responsible
for all the health services operating within its
jurisdiction.
 At present there are 28 states and 9 union territories
in India and as many type of health administration.
 In all the state it comprises of –
 1. State Ministry of Health and Family Welfare.
 2.Directorate General of Health Services.

21.  The State Ministry of Health and FW is headed by-
 1.A Minister of Health and Family Welfare.
 2.A Deputy Minister of Health and Family Welfare.
• Health Secretariat is a official organ-
• 1. Health Secretary.(Head)
• 2. Joint Secretaries.(2 or 3)
• 3. Deputy Secretaries and
• 4. Under Secretaries.

22.  Director General of Health Services is chief
technical advisor to the state government in all
matter of medical and public health.
 DGHS is assisted by 2-3 Joint Directors.
 Joint Directors may be-
 1. Regional.
 2. Functional.

23.  The Regional Directors are at Divisional level and
area classified according to geographical
distribution.
 The Functional Directors are in particular branch
of public health such as –
 Maternal and Child health
 Family Planning
 Nutrition
 Health Education.

24.  To coordinate the health and family welfare activities
between State government and Central government
there are 17 Regional Health Offices.
 For the large state there is one regional office while
2-3 smaller state have been linked with one regional
office.

25. At District Level
 The District level structure of health services is a
linkage between state structure on one side and
peripheral structure such as CHC , PHC and sub-
center on other side.
 The district officer of overall control designated as
CMHO.

26.  CMHO are assisted by deputies , programme officers
and State Civil Medical Officers of different
specialities.
 They are responsible for implementing health and
family welfare programmes according to policies lay
down at higher level.

27. At Block Level
 The block is unit of rural planning and development and
comprises about 80,000 to 1.2 lakh population.
 One Community Health Center is being established
in each block.
 The officer in-charge of CHC is k/as Superintendent
CHC or Block Medical Officer.
 Normally one CHC should have –
 - 30 bed hospital .
 - Specialist doctors in Pediatrics, Obstetrics, Medicine
and Surgery .
 - Four Medical Officer.

28. At Primary Health Center
 The delivery of Primary Health Care is principal
objective of rural health care system.
 One PHC covers about 20000 – 30000 population.
 PHC is manned by Medical Officer and paramedical
staff.
 The Primary Health Center is expected to provide
“essential health care” including MCH and
family planning.
 MCH services are provided through PHC clinic, sub-
center and out reach sessions.

29. At Sub-center level
 Sub-centers are peripheral outpost of health care
delivery system.
 Each sub center covers 3000-5000 population and
manned by one MPW male and one MPW female.
 MPW female is crucial to provide MCH services.

30. At Village level
 1.ASHA.
 2.AWW.
 3.Village Health Guide.
 4. Trained dais.

31. HEALTH CARE REFORMS

32.  The annual report of World Health Organization’s
(WHO) 2008 focused on “the place of primary
healthcare (PHC) in health systems”.
 The report arguing that, in three decades since the
Declaration of Alma-Ata (WHO 1978) on primary
healthcare, only little has changed.
 Member countries had largely implemented
'selective' primary care focused on provision of
medical care and services and treatment of specific
conditions.

33. FOUR SETS OF PHC REFORMS
 The WHO report (2008) laid out a four-point
framework for Primary Health Care policy.
 1.Universal Coverage Reforms.
 2.Service Delivery Reforms.
 3.Public Policy Reforms.
 4.Leadership Reforms.

34. 1.Universal Coverage Reforms
 Universal coverage reforms is to improve health
equity, end exclusion and promote social justice.
 Primary care should be accessible to all and ideally,
be free at the point of services.

35. 2.Service Delivery Reforms
 Service delivery reforms designed to re-organize
services around primary care.
 In this sense, the WHO argued that PHC should be
the ‘hub’ from which patients are guided through the
health care system.
 PHC should be delivered by multi-professional
teams that provide comprehensive care, co-ordinate
hospital and other specialized patient services, build
partnerships with patients, and promote disease
prevention.

36. 3.Public Policy Reforms.
 The WHO advocated for public policy reforms that
integrate public health initiatives into primary care
delivery and
 work to promote health in the policies of other
sectors that influence community behaviour and
outcomes.
 'intersectoral collaboration'.

37. 4.Leadership Reforms.
 The Leadership Reforms replace disproportionate
reliance on command and control on one hand.
 The inclusive , participatory , negotiation based
leadership is required by the complexity of health
system.

38. INDIAN PUBLIC HEALTH STANDARDS

39.  The health system in India has expanded
considerably over the last few decades.
 But , due to non availability of man power, problems
of access and lack of community involvement, the
quality of health services is not up to the mark.
 Hence, standards are being introduced in order to
improve the quality of health care at public health
level.

40.  The Bureau of Indian Standards has already
prescribed standards for health care facilities,
 but , at present these are not achievable as they are
very resource – intensive.

41.  IPHS are the set of standards envisaged to improve
the quality of health care delivery in the country.
 IPHS defining personnel , equipment and
management standards.
 It decentralized administration by a hospital
management committee and provision of adequate
funds and powers to enable these committees to
reach desired levels.

42. Objectives of IPHS
 1.To provide optimal support and comprehensive
primary health care to the community.
 2.To achieve and maintain an acceptable standards
of quality care.
 3.To make the services more responsible and
sensitive to the need of community.

43.  NRHM aims at strengthening hospital care for rural
areas.
 So, as the first step, requirement for Minimum
Functional Grade for CHCs, PHCs and Sub-center
are being prescribed.

44. CONCLUSIONS

45.  There have been significant advances in the
healthcare system in India over last few decades.
 Despite these recent strides the health system
remains ineffective in providing basic minimum
care as promised in the Indian Constitution.

46.  The fiscal constrains on the government make it
obligatory for the private healthcare providers to
take over part of the responsibilities.
 New ways for establishing, strengthening and
sustaining the public-private co-operation are
essential for rejuvenating the system.

47.  At the same time decentralization exercises can
make the health system more efficient and improve
the quality of healthcare delivery.
 All these changes will need to be based on a strong
political will and should be accompanied by
economic and social reforms.

48. THANK YOU