https://userupload.net/ljusvo5r6nm7 The Constitution of India makes healthcare in India the responsibility of the state governments, rather than the central federal government. It makes every state responsible for "raising the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties".[1][2] The National Health Policy was endorsed by the Parliament of India in 1983 and updated in 2002 and then in 2017. The recent four main updates in 2017 mentions the need to focus on the growing burden of the non-communicable diseases, on the emergence of the robust healthcare industry,on growing incidences of catastrophic expenditure due to health care costs and on rising economic growth enabling enhanced fiscal capacity.[3] In practice, however, private healthcare sector is responsible for the majority of healthcare in India, and most healthcare expenses are paid out of pocket by patients and their families, rather than through insurance.[4] Government health policy has thus far largely encouraged private sector expansion in conjunction with well-designed but limited public health programmes.[5] There has been an ambitious healthcare project launched in the year 2018, which is perhaps one of the biggest government funded healthcare insurance, called Ayusman Bharat. According to the World Bank, the total expenditure on health care as a proportion of GDP in 2015 was 3.89%.[6] Out of 3.89%, the governmental health expenditure as a proportion of GDP is just 1%[7] and the out-of-pocket expenditure as a proportion of the current health expenditure was 65.06% in 2015.

1. HEALTH CARE DELIVERY
SYSTEMS IN INDIA
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2. Contents
Introduction
Basic considerations
Levels of health care
Changing concepts in health care
Primary Health Care and its principles
Primary Health Care in India
The Health system in India

3. Contents
Delivery of health service in the private sector
Public-Private Partnership
Alternative System of Health Care
Recent developments & projects
Bottlenecks to the effective delivery of health care services
Conclusion
References

4. introduction

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6. John Bryant : “ Large number of the worlds people perhaps more than half
have no access to health care at all , and for many of the rest the care they
receive does not answer the problems they have.”

7. Introduction
HEALTH “HAVES” IN
AFFLUENT COUNTRIES
HEALTH “HAVE NOTS”
IN DEVELOPING
COUNTRIES
EVER WIDENING GAP

8. Basic considerations
Health has been declared a fundamental human right.
Health: According to the WHO definition, “It is a complete state of
physical, mental and social well being and not merely the absence
of disease or infirmity”.
Care: Services rendered by members of the health profession for
the benefit of the patient.
HEALTH CARE MEDICAL CARE
CARE

9. Basic considerations
Concept of medical care:
Refers chiefly to those services that are provided directly by the
physicians or rendered as the result of physician’s instructions.
It ranges from domiciliary care to resident hospital care.
Subset of health care.

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11. Basic considerations :
Concept of Health care :
Health care  A multitude of “services provided to individuals or
communities by agents of health services or professions, for the
purpose of promoting, maintaining, monitoring or restoring
health”.

12. Basic considerations
WHO and UNICEF joint conf in
1978 at Alma Ata
The way to achieving
Health For All.

13. Health system:
The health services are delivered by the “health system”, which
constitutes management sector and involves organizational
matters.
Entire population Curative
Preventive
Rehabilitation

14. Health system
The best way to provide health care to the vast majority of
underserved rural people and urban poor is to develop effective
“primary health care” services supported by appropriate referral
system.
Community participation

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16. Levels of health care:
Primary care level:
 1st level of contact of individuals, family and community with
the national health system, where primary health care (essential
health care) is provided.
 Provided in PHCs and SCs and the agencies of multipurpose
workers, village health guides and trained dais.

17. Levels of health care
Secondary care level:
 Next higher level of care,
 More complex problems are dealt with.
 Provided by district hospitals and community health centres.

18. Levels of health care
Tertiary care level
More specialized level of care and requires specific facilities and
attention of highly specialized health workers.
 It is provided by regional or central level institutions e.g.
Medical college hospitals, All India Institutes, Regional
hospitals, Specialized Hospitals.

19. Comprehensive health care:
The term was 1st used by Bhore committee in 1946.
It meant provision of integrated preventive, curative and
promotional health services from “womb to tomb” to every
individual residing in a defined geographic area.
This concept formed the basis of national health planning in India
and led to the establishment of a network of Primary Health Centres
and subcentres. BUT.....
Changing concepts of health care

20. Changing concepts of health care
Basic health services:
In 1965, UNICEF / WHO used this term.
It is a network of coordinated, peripheral and intermediate health
units capable of performing effectively a selected group of
functions essential to the health of an area and assuring the
availability of competent professional and auxiliary personnel to
perform these functions.

21. Changing concepts of health care
Primary health care
in 1978, at Alma-Ata conference.
“Essential health care based on practical, scientifically sound,
socially acceptable methods and technology, made universally
accessible to individuals and families through their full
participation and at a cost that the community and country can
afford to maintain at every stage of their development in the spirit
of self reliance and self determination”.

22. Elements of primary health care

23. Principles of primary health care
EQUITABLE DISTRIBUTION: Equity or equitable distribution of
health services irrespective of their ability to pay and all must have
access to health services. There should not be “social injustice”.
COMMUNITY PARTICIPATION: Along with the central and state
government, involvement of individuals, families and communities
ex: VHGs, local dais in India, in promotion of their own health and
welfare.

24. Principles of primary health care
INTERSECTORAL APPROACH: Planning with other sectors  to avoid
unnecessary duplication of activities.
APPROPRIATE TECHNOLOGY: “Technology that is scientifically
sound, adaptable to local needs, and acceptable to those who apply
it and those for whom it is used, and that can be maintained by the
people themselves in keeping with the principle of self reliance with
the resources which community & country can afford”

25. 48
indicators
18
targets
The Millennium Development Goals
In Sep 2000, representatives from 189 countries Millennium Summit
in New York adopted the UN Millennium Declaration.
Governments have set a date of 2015 by which they would meet the
MDGs:

26. The Millennium Development goals

27. Primary health care in India
After Independence, India adopted the welfare state approach,
India's leaders envisaged a national health system  State play a
leading role in determining priorities and financing, and provide
services to the population.
The emphasis of the first health report, i.e. the Health Planning
and Development Committee's Report, 1946 on the role of the
State was explicit.

28. Primary health care in India
The Committee strongly recommended a health services system
based on the needs of the people, the majority of whom were
deprived and poor.
It felt the need for developing a strong basic health services
structure at the primary level with referral linkages.
India was therefore one of the few developing countries which
adopted a health policy that integrated the principles of
universality and equity

29. Primary health care in India
Large sections of the people were living below the poverty line.....
The Committee has decided that medical benefits would have to be
supplied free to all at the point of delivery and those who could
afford to pay should channel contributions through the mechanism
of taxation.
They recommended that State Governments should spend a
minimum of 15% of their revenues on health activities.

30. Five year plans
The objectives of the First (1951-56) and Second Five-Year
(1956-61) Plans: Provision of water supply and sanitation; control of
malaria; preventive health care of the rural population through health
units, health services for mothers and children; education,
training and health education; self-sufficiency in drugs and
equipment; family planning and population control.
The Malaria Control Programme was launched.

31. Five year plans
The concern of the Health Survey and Planning Committee
(Mudaliar Committee 1962) was limited to the development of the
health services infrastructure.
In the Third Plan (1961-66) family planning received priority for the
first time there was a shift in focus from preventive health services
to family planning.

32. Five year plans
During the Fourth Plan (1969-74), efforts were made to provide an
effective base for health services in rural areas by strengthening
the PHCs
During the Fifth Plan (1974-79) The Minimum Needs
Programme (MNP).The objective of the Programme is to establish
a network of basic services and facilities of social consumption in
all the areas up to nationally-accepted norms, within a specified
time-frame.

33. Five year plans
Meanwhile the Chaddha Committee Report (1963), the Kartar
Singh Committee Report on Multipurpose Workers (1974) and the
Srivastava Committee Report on Medical Education and Support
Manpower (1975) remained focused on giving recommendations
on how the health cadres at the primary level should be
distributed.

34. Five year plans
Then came the Primary Health Care Declaration at Alma Ata in
1978, which India was a signatory to. The Sixth Plan (1980-84) was
influenced by two policy documents: the Alma Ata Declaration and
the ICMR/ICSSR report on ‘Health for All by 2000‘.
It recommended that the Government formulate a comprehensive
national health policy dealing with all dimensions-environmental,
nutritional, educational, socioeconomic, preventive and curative.

35. Five year plans
Interventions of immunization, oral rehydration, breastfeeding and
antimalarial drugs were suggested.
UNICEF too came out with its report on The state of the world's
children and suggested immunization as the spearhead in the
selective GOBI-FF (growth monitoring, oral rehydration,
breastfeeding, immunization, food supplements for pregnant
women and children, and family planning)

36. Five year plans
The Seventh Plan (1985-90) restated that the rural health
programme and the three-tier health services system need to be
strengthened and that the government had to make up for the
deficiencies in personnel, equipment and facilities.
The Eighth Plan (1992-97) distinctly encouraged private initiatives,
private hospitals, clinics and suitable returns from tax incentives

37. Five year plans
Both the Ninth (1997-2002) and the Tenth Five-Year Plans (2002-
2007) start with a dismal picture of the health services
infrastructure and go on to say that it is important to invest more
on building good primary-level care and referral services.
The National Health Policy (2002) includes all that is wanted from
a progressive document and protect and provide primary health
care to all.

38. Rural Health Scheme
In 1977, the Government of India launched a Rural Health
Scheme, based on principle of “placing people’s health in
people’s hand”. It is a three tier system of health care delivery
in rural areas based on recommendations of Shrivastava
Committee, 1975.

39. Rural Health Scheme
Where in training of community health workers , reorientation
training of multipurpose workers and linking medical colleges to
rural health was initiated.
Also to initiate community participation the community health
volunteer – the village health guide scheme was launched.

40. Rural health system in India

41. National Health Policy
The responsibility of the state to provide comprehensive primary
health care to its people as envisioned by the alma ata declaration
led to the formation of Indias first National Health Policy ( NHP) in
1983.
The major goal was to provide universal and comprehensive
primary health services.
UNICEF also suggested its selective approach of GOBI-FFF

42. National Health Policy
National population policy was announced in the year 2000.
It is a framework for family planning and maternal and child
health goals objectives and strategies.
Its objective was to address the unmet needs of contraception,
health care infrastructure health personnel, and to provide
integrated delivery for basic reproductive and child care services
through the partnership of the government with the non
governmental and voluntary organizations.

43. National Health Policy
NHP sets out for a new approach to achieve the public health
goals.
It aims at increasing access to the decentralised public health
system by establishing new infrastructure in the deficient areas
and upgrading the infrastructure in the existing institutions.
This NHP 2002 recognized the noteworthy sucesses in health since
the NHP 1983.

45. government of india has launched the NRHM on 12 th april 2005.
To provide accessible, affordable and accountable quality health
services to the poorest households in the remotest rural regions.
With special focus on 18 states having week demographic
indicators and infrastructure.
It reaffirms the political will to increase public health fund
allocation to 2-3% of GDP from the existing allocation of 0.9%
National rural health mission

48. Accredited Social Health Activists (ASHA):
One of the key strategies under the NRHM is a community health
worker, i.e., Accredited Social Health Activist (ASHA) for every
village at a norm of 1,000 population.
Chosen by and accountable to the panchayat
Facilitate preparation and implementation of the Village Health Plan
along with Anganwadi worker, ANM, functionaries of other
Departments,
More than 5.4 lakh Accredited Social Health Activists (ASHAs) and
link workers are connecting households to health facilities.

49. NRHM Plan of Action:

50. Health
status or
health
problems
Set priorities among
health problems to
deal with lack of
resources
Curative
Preventive
Promotive
Public
Private
Voluntary
Indigenou
s
changes
in the
health
status
Inputs Health services Health systems Outputs
Model of Health Care System

51. Morbidity , mortality statistics
Demographic conditions of the populationEnvironmental conditions which have bearing on the
healthSocioeconomic factorsCultural backgrounds, attitudes and beliefs which
affect healthMedical and health services available
Other services available
Health status and health problem

52. Total population (2008)  1.121billions
Crude birth rate (2007)  22.8
Crude death rate (2006) 7.4
Annual growth rate (2007)  1.8
Rural population (2008)  71
Adult literacy rate (2007) 66
Population bellow 15 yrs (2007)  32.1
Population above 60 yrs (2007)  7.2
Demographic profile

53. Mortality profile
During the last few decades there has been an improvement in the
health status of the population.
Death rate has steadily declined from 21% (1965) to 7.5% (2006).
Life expectancy  66yrs in 2007.
Mortality rates of a number of infectious diseases like cholera, TB
and malaria have also registered a decline.

54. Mortality profile
On the other side, Indian health standards are still low compared
to the developed countries.
IMR in India is as high as 54 for every 1000 live births whereas in
developed countries it is as low as 5.(2007)
Life expectancy of 66yrs lagging behind by almost 12-15 yrs
compared to that of developed countries (76-80 yrs).
As per 2007, the rural death rate is 8 per 1000 population, and
urban 6 .

55. Communicable
disease
problems
Non
communicable
disease
problems
Nutritional
problems
Environmental
sanitation
problems
Medical care
problems
Population
problems
Health problems

56. Health
manpowe
r
Money
and
material
Time
Resources

57. Professional and auxiliary
health personnel.
Manpower requirements are
based on:
a) health needs and
demands
b) desired outputs
Country is producing annually
a) 26,449 allopathic doctors
b) 9,865 ayurvedic graduates
c) 1,525 unani graduates
d) 320 siddha graduates
e) 12,785 homeopathic
graduates
Manpower

58. Manpower
Suggested norms for health personnel:
i. Doctors : 1 for every 3,500 population
ii. Nurses : 1 for every 5000 population
iii. Health workers: 1 for 5000 population in plain area
1 for 3000 population in tribal and hilly area.
iv. Trained Dai: 1 for each village
v. Lab technician: 1 for 10,000 population
vi. ASHA: 1 for 1000 population

59. Money and material
In most developed countries average expenditure for health is 18
% of GNP.
WHO has set as a goal the expenditure of 5% of each countries
GNP on health care.
At present India is spending about 3% of GNP on health and family
welfare development.

60. Time
Administrative delays in sanctioning health projects imply loss of
time.
Proper use of man hours is also an important time factor.

61. Health care systems
Intended to deliver the health care services.
In India, it is represented by the five major sectors or agencies
which differ from each other by the health technology applied and
by the source of funds for operation.

62. 1.Public health sector:
• Primary health care
• Primary health centres
• Sub- centres
• Hospitals/ health centres
• Community health centres
• Rural hospitals
• District hospitals
• Specialist hospitals
• Teaching hospitals
• Health insurance scheme
• Employees State insurance
• Central Govt. Health Scheme
• Other agencies
• Defence services
• Railways
• Private hospitals, polyclinics,
Nursing homes, dispensaries
• General Practitioners and
clinics.
2.Private
sector
3.
Indigenous
systems of
medicine
4.Voluntary
health
agencies
5. National
health
programs
Health care systems

63. Types of Health Care Agencies:
1. Outpatient services
2. Clinic

64. Types of Health Care Agencies:
Private hospitals Government hospitals
Military hospitals

65. Health systems in India
The Central Government responsibility consists mainly of
policy making, planning, guiding, assisting, evaluating and
coordinating the work of the State Health Ministries.
The health system in India has 3 main links
– Central
– State and
– Local or peripheral

66. The official “organs”
of the health system
at the national level
consist of:
Union Ministry of
Health and Family
Welfare
The Directorate
General of Health
Services
The Central Council
of Health and
Family Welfare
I. At the center:

67. II. At the State level:
The health subjects are divided into three groups:
federal, concurrent and state.
The state list is the responsibility of the state, including provision of
medical care, preventive health services and pilgrimage within the
state.
– State Ministry of Health
– State Health Directorate

68. III. At the district level:
There are 636 (year 2010) districts in India. Within each district,
there are 6 types of administrative areas:
– Sub –division
– Tehsils (Talukas )
– Community Development Blocks
– Municipalities and Corporations
– Villages and
– Panchayats

69. III. At the district level:
Most district in India  two or more subdivision, (Assistant
Collector or Sub Collector)
Each division  taluks, (Thasildhar). A taluk usually comprises
between 200 to 600 villages
The community development block (Block Development Officer)
comprises approximately 100 villages and about 80000 to 1,20,000
population,.
Finally, there are the village panchayats, which are institutions of
rural local self-government.

70. III. At the district level:
The urban areas of the district are organized into
– Town Area Committees (in areas with population ranging between 5,000
to 10,000). They are like panchayats
– Municipal Boards (in areas with population ranging between 10,000 and
2,00,000), headed by Chairmen /President, elected by members.
– Corporations (with population above 2,00,000).

71. III. At the district level:
Panchayat Raj -The panchayat raj is a 3-tier structure of rural local
self-government in India, linking the village to the district
– Panchayat (at the village level)
– Panchayat Samiti (at the block level)
– Zila Parishad (at the district level)

72. Three-tier system :
1. Sub Centre (SC)
– Most peripheral contact point between Primary Health Care System &
Community
– Manned with one MPW(F)/ANM & one MPW(M)
2. Primary Health Centre (PHC)
– A Referral Unit for 6 Sub Centres
– 4-6 bedded
– Manned with a Medical Officer In charge and 14 subordinate para-medical
staff
3. Community Health Centre (CHC)
– A 30 bedded Hospital
– Referral Unit for 4 PHCs with Specialized services
Rural health care system in India

73. Rural health care system in India

74. COMMUNITY HEALTH
CENTRE (4,276 )
80,000-
1,20,000
PRIMARY HEALTH
CENTRE (23,730)
30,000
SUB CENTRE (1,46,036 ) 5000
VILLAGE
LEVEL
VILLAGE
HEALTH
GUIDES
LOCAL
DAIS ANGANWADI
WORKER

75. Primary Health Care should have universal coverage and equitable
distribution of health resources i.e. Health care must penetrate into
the farthest reaches of rural areas and that everyone should have
access to it.
Schemes are:
Village Health Guides Schemes
ICDS scheme (Anganwadi Workers)
Training of Local Dais
ASHA (Accredited Social Health Activists )
Village level

76. Village Health Guides Schemes:
Introduced on 2nd October, 1977 as “Community Health Workers
Scheme”.
Village health guide:
A person with an aptitude for social services & is not a full time
government functionary.
It is the 1st contact between individual & health system.
This scheme was launched in all states except Kerala, Karnataka,
Tamil Nadu, Arunachal Pradesh & Jammu & Kashmir.

77. Guidelines for VHG’s selection:
Chosen from the community by Gram Panchayat
Permanent residents of local community, preferably women
Able to read and write, having minimum education atleast upto VI
standard
Acceptable to all sections of community
Able to spare atleast 2 to 3hrs every day for community health work
Village Health Guides Schemes:

78. Village Health Guides Schemes:
Training:
undergo a short training in nearest primary health care, sub
centre or any other suitable place for the duration of 200
hours spread over a period of 3 months.
During the training period he receive Rs 200/- per month.
On completion of training, receive working manual, and
medicine kit.

79. Village Health Guides Schemes:
Duties:
– Treatment of simple ailments & activities related to first aid,
– Mother & child health, family planning,
– Health education,
– Sanitation.
– They should refer cases to nearest health centre.
– They are expected to do community health work of 2-3 hours daily for
which they are paid Rs. 50/- per month & drugs worth Rs.600/- per annum.
National Target – 1 VHG for each village or 1000 rural population

80. Local dais are trained to improve their knowledge in elementary concept
of maternal & child health and sterilization besides obstetric skills.
Training:
– 30 working days. Stipend of Rs 300 during her training period.
– Training is given at PHC or subcentres for 2 days in a week and on the remaining
4 days of the week they accompany health worker (female) to the villages.
– Conduct at least 2 deliveries under guidance or supervision of HW, ANM.
– The emphasis during training is on asepsis.
– On completion of training, each dai should be provided with a delivery kit & a
certificate.
Local dias (Traditional Birth Attendants)

81. Local dias (Traditional Birth Attendants)
Duties:
– Home deliveries conducted under safe hygienic conditions
so reducing the maternal and infant mortality.
– They are paid Rs 10/- per delivery and Rs 3/- per infant
registered
National Target:
– One local Dai in each village.
– Eighth Five Year Plan’s Objective – train the untrained

82. ICDS (Integrated Child Development
Services) Scheme:
ICDS was initiated by Govt. of India in the Ministry of Social and
Women’s Welfare in 1975.
As on 30th Sep 2007, 6284 ICDS projects have been sanctioned
out of which 5959 ICDS blocks with 9.3 lakh anganwadi centres
are functioning in the country.
The services are provided at the ‘Anganwadi’. It seeks to directly
reach out to children, below six years.

83. i. To improve the nutritional and health status of pre-school
children in the age-group of 0-6 years;
ii. To lay the foundation of proper
psychological development of the child;
iii. To reduce the incidence of mortality, morbidity, malnutrition
and school drop-out;
iv. To enhance the capability of the mother to look after the
normal health and nutritional needs of the child through
proper nutrition and health education.
ICDS (Integrated Child Development
Services) Scheme:
Objectives:

84. ICDS (Integrated Child Development
Services) Scheme:
To achieve these objectives, the ICDS aims at providing a package of
services:

85. ICDS (Integrated Child Development
Services) Scheme:

86. “Angan” means a courtyard.
An anganwadi worker per 1000 population.
100 such workers in each ICDS Project.
Selected from the community she is expected to serve.
Training: 4 months period on various aspects of health, nutrition and child
development
Pay: Rs 1500 per month
Duties:
– health check up,
– immunization,
– supplementary nutrition,
– health education,
– preschool education,
– referral services.
Anganwadi workers

87. The most peripheral and first contact point between the
primary health care system and the community in rural India.
One sub-centre for every 5000 population in general and one
for every 3000 population in hilly, tribal and backward areas.
One Health Assistant (Female) known as Lady Health Visitor
(LHV) and one Health Assistant (Male) located at PHC level
are entrusted with the task of supervision of 6 SCs
As on March 2007 1,46,036 Sub Centres
Sub centre level

88. Sub centre level

89. Sub centre level
Functions:
– Mother &child health care – antenatal, natal, postnatal
care
– Common childhood diseases
– Prevention of malnutrition
– Family planning services and counseling
– Immunization
– IUD insertions
– Lab investigations

91. Since Jan 1953 “Primary Health Centres” have increased from 725
during 1st five year plan to 22,370 PHCs on March 2007.
It is the first contact point between village community and the
medical officer.
1 PHC for every 30,000 rural population in the plains, and 1 PHC for
20,000 population in hilly, tribal and backward areas.
It is established and maintained by the State Governments under the
Minimum Needs Programme (MNP)/ Basic Minimum Services
Programme (BMS).
Primary health centre

92. Primary health centre
It has equipped with 4-6 beds and it act as referral units for 6 sub
centres.
The activities of PHC involve curative, preventive, primitive and
Family Welfare Services.
It is proposed to equip the PHC with facilities for selected surgical
procedures (vasectomy, MTP & minor surgical procedures) and for
pediatric care.
In order to reorient medical education (ROME programme)
towards the needs of the country and community care, 3 PHCs
have been attached to each of the 148 medical colleges

94. Functions :
1. Medical care
2. MCH & Family planning
3. Safe water supply & sanitation
4. Prevention & control of locally endemic diseases
5. Collection & reporting vital statistics
6. Health Education
7. National Health Programmes
8. Referral Services
9. Training – health guides, health workers, local dais, health assistants
10. Basic laboratory services
Primary health centre

96. Each CHC covers a population of 80000-1.20 lakh
Equipped with 30 beds and specialist in surgery, medicine, OBG,
pediatrics with x-ray & lab facilities, one OT, X ray, labor room.
Referral centre for 4 PHCs.
For strengthening preventive and promotive aspects of health care,
non medical post called Community health officer who is selected
from staff at PHC with minimum of 7 years experience in rural health
programmes.
4,045 CHCs were established as on March 2008
Community health centre

100. Rural health infrastructure
By 2001 Census, The shortfall in the rural health infrastructure
comes out to be of:
– 20,855 Sub Centres
– 4,883 PHCs
– 2,525 CHCs.

104. Three-quarters of the human resources and advanced medical
technology
68% of hospitals are private.
37% beds in the country are in the private sector
Estimated 13 lakh private health care provider
Over one-third of them have no registration.
25% are AYUSH practitioners.
large number of informal providers–quacks
Delivery of health services in the private
sector

105. Delivery of health services in the private
sector
The private healthcare providers consist of private practitioners, for
profit hospitals and nursing homes, and charitable hospitals.
They are numerous and fragmented.
The quality of treatment varies from one provider to another.
Size of hospitals
– 84 percent of private hospitals <30 beds
– 10 Percent 30 –100 beds
– 5 percent 100-200 beds
– 1 percent >200 beds

106. Public-Private Partnership:
I. Handing over public facilities to the private sector for
management, in the nature of a joint partnership.
Public-private sector ratio 60:40 in rural areas, 10:90 in
urban areas
35 PHCs in Karnataka & Gujarat handed over to NGOs

107. In Karnataka, the super specialty hospital constructed in Belgaum
handed over to the Apollo group for management
In Chhattisgarh, the state government provided escorts a grant
of Rs 12 crore to build and operate the cardiac specialty centre,
subject to earmarking 15% of patients identified by the
government to be treated at discounted rates.
Public – Private Partnership

108. Public – Private Partnership
Voluntary Health Association of India (VHAI)
It is a Delhi-based national network of more than 4000 non-
governmental organizations spread across the country.
VHAI is working closely with the Government of India, very often
supported by the government financially

109. Andhra Pradesh Urban Slum Health Care Project
(APUSHCP).
APUSHCP : is an initiative of public-private partnership through
contracting Urban Health Centres to NGOs.
To provide basic primary healthcare and family welfare
services to urban slums in 2002.
192 Urban Health Centres (UHCs) in 74 municipalities of the
state were contracted out to the NGOs.
These UHCs cover population of about 3 million.

110. Ayurveda
Yoga
Naturopathy
Homeopathy
Unani
Siddha
Acupressure
Acupuncture
Alternative system of health care

111. AYUSH
The Indian Systems of Medicine and Homoeopathy (ISM&H) in 1995
renamed as Department of Ayurveda, Yoga and Naturopathy, Unani,
Siddha and Homoeopathy (AYUSH) in November 2003.
The infrastructure under AYUSH sector consists of 1355 hospitals with
53296 bed capacity, 22635 dispensaries, 450 Undergraduate colleges, 99
colleges having Post Graduate Departments, 9,493 licensed manufacturing
units and 7.18 lakh registered practitioners of ISM&H in the country.
Rs.775 crore has been allocated for the Department

112. No universal health insurance in India.
Only 10% Indians have some form of health insurance.
The Indian health insurance scenario is mix of: social health
insurance (SHI), voluntary private health insurance and
community-based health insurance (CBHI).
18% of the health department’s budget is spent on less than
0.5% of the population
Health insurance

113. Employees State Insurance Scheme:1948
– For employees drawing wages < Rs.7,500/month
– Performs a dual role:
– by providing assistance in kind (medical care) it tries to
restore health and working capacity and
– by assistance in cash (cash benefit) it tries to sustain when
income is interrupted.
Health insurance

114. Central government health scheme:
The act covers employees drawing salary not exceeding Rs 10,000/- per month.
Introduced first in New Delhi for the central government employees in 1954
comprehensive medical care.
Medical services along with supply of optical and dental aids at reasonable rates.
It now has 320 dispensaries with about 42.76 lakh beneficiaries.
Health insurance

115. Voluntary health agencies in India are:
Indian red cross society
Hind Kusht Nirvan Sangh
Indian council for child welfare
Tuberculosis association of India
Bharat Sevak Samaj
Central social Welfare board
The Kasturba memorial fund

116. Agency Activities
Indian red cross society Relief work, milk and medical supplies, armed forces, family
planning and blood bank and first aid
Hind kusta nivaran sangh Financial assistance to leprosy control
Tuberculosis association of
india
Medical care for TB patients through its centres.
Bharath sewak samaj Improvement in rural sanitation
Kasturba memorial fund Welfare of women, training of gramsevikas
All India women’s conference Clinics for MCH, education and family planning
All India blind relief society Co-ordination in national blindness control programme
Central Social welfare board Assessing the needs and Financial help to various VHAS,
organizations and institutions
Family planning association of
India
Training of doctors, nurses and other Para-medical personnel
in family
planning
All India women's conference MCH clinics, medical centres, adult education centre and
family planning centre

117. National anti-malaria eradication programme
National tuberculosis programme
National AIDS control programme
National programme for the control of blindness
Iodine deficiency disorder programme
Universal immunization programme
Reproductive and child health programme
National cancer control programme
National family welfare programme
Minimum needs programme
20 point programme
National health programmes:

118. Recent developments & projects:
India Health Care Project:
ANM (Auxiliary Nurse Midwife) are in direct contact with rural
people in delivering health care
Personal Digital Assistant - PDA with suitable icons which were
handed to the ANMs for capturing data at the doorsteps of the
rural people. The user interface was developed in any local
language so that semi-literate ANMs can use PDAs with ease.
CMC Industry practices e Governance IHC.htm. India Health Care Project:
An application of IT in rural health care at grass root level,
Volume 13, No. 1, June 2003

119. Recent developments & projects:
Successfully implemented in Andhra Pradesh in Nalgonda district to
cover a population of 32,38,449 and 459 ANMs using PDAs
PDAs provide information about the health conditions in a village at
SC which is accessed by the computer at the PHC.
This system also generates reminders for immunization, ante- and
post-natal care, family planning, and other scheduled programmes.

120. Recent developments & projects:
It will help the ANM to know which house holds she needs to
visit that month and which households have persons at risk
and need attention.
She can also know the latest instructions from the district
head quarters transferred into her system.
The data from SC PHC  Districts level(District Medical
and Health Officer) State level.

121. Recent developments & projects:
Mobile based Primary Health Care:
Involves use of SMS& cell phone technology for information
management, transactional exchange, and personal communication.
– The Dokoza system in South Africa.
– Mobile telemedicine system in Indonesia.
– Systems in India.

122. Uk-based engineers have entered upon a partnership with experts
of India  To develop a unique mobile phone health monitoring
system.
First unveiled in 2005
Uses a mobile phone to transmit a person's vital signs, including the
complex electrocardiogram (ECG) heart signal, to a hospital or clinic
anywhere in the world.
Recent developments & projects:

123. Recent developments & projects:
Sehat Saathi: a rural telemedicine system is being developed at
IIT Kanpur. It can be used to extend medical care to patients in
the remote parts of the country.

124. Recent developments & projects:
Escorts Heart Institute and Research Centre (EHIRC) was
established in 1988 with the mission objective of becoming a
leading professional healthcare company in super specialty
tertiary care, with a focus on cardiac care and a range of
products, services and quality, consistent with the highest
customer expectations.

125. Recent developments & projects:
Escorts Heart Institute and Research Centre (EHIRC)
9 operation theatres, 4 labs, 2 heart stations with a capacity of more than
300 beds, of which about 164 are critical care beds.
EHIRC provides intensive care to patients, pre/post-surgery or
angioplasty.

126. Recent developments & projects:
Delivery Hut in Haryana (launched in August 2005-06):
– So far, 400 Delivery Huts have been established, 16,500
deliveries conducted, 1756 high-risk cases referred
– Chiranjeevi Yojana in Gujarat (from December 2005): Health
financing scheme for safe maternity services to BPL
beneficiaries.

127. Number of ANMs per PHC is the same throughout the country
despite the fact that some states have twice the fertility level of
others
Irrational distribution of PHCs and sub-centres.
No formal feedback mechanism and incentive to treat citizens
Lack of accountability leads to absentee doctors
Bottlenecks to the effective delivery of the
health care

128. Bottlenecks to the effective delivery of the
health care
The organizational structure requires a villager to travel an average
distance of
2.2 km to reach the first health post for getting a paracetamol;
over 6 km for a blood test
nearly 20 km for hospital care.
It is estimated that 25% of people in Madhya Pradesh and Orissa,
and 11% in Uttar Pradesh could not access medical care due to
locational reasons (NSS-India Health Report, 2003).

129. Even though India has created one of the largest health care
delivery systems in the world, people of country still suffer from a
multitude of preventable and treatable general and oral health
problems.
Lack of resources, poor utilization of the health services, lack of
political will and demand from the people only compound the
problem further.
Conclusions

130. Conclusions
Success of health systems exists in tapping the existing potential
and making appropriate structural changes.
Primary, secondary, generalist and specialist care, all have
important and inclusive roles in the healthcare system and should
be used with the objective of providing coverage for all.

131. Park K. Health Care of the Community. In: Text Book of Preventive &
Social Medicine 20h ed. Jabalpur : Banarsidas Bhanot Publishers ;
2009.
Gupta MC, Mahajan BK. Health care of the community. In : Textbook
of Preventive & Social Medicine. 3rd ed. New Delhi : Jaypee Brothers
Medical Publishers (P) Ltd ; 2003. pg. No. 486 – 502.
References

132. References
Primary health care in India: Review of policy, plan and committee
reports. Madhurima Nundy. Centre of social medicine and
community health, Jawaharlal Nehru University, New Delhi, India
Introduction to nursing and Health care delivery system in India
Rural_Health_Care_System_in_India.pdf
National Rural Health Mission (2005-2012) Mission Document
Primary Health Care in India: Coverage and Quality Issues. CGSD
Working Paper No. 15, June 2004