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National health delivery system + phc +drc+national institutes

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NATIONAL HEALTH DELIVERY SYSTEM PRIMARY HEALTH CARE DISTRICT REHABILITATION CENTER NATIONAL INSTITUTES

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National health delivery system + phc +drc+national institutes

  1. 1. P a g e | 1 Dr. Nithin Ravindran Nair (PT) NATIONAL HEALTH DELIVERY SYSTEM + PHC, DRC, AND NATIONAL INSTITUTES INTRODUCTION: Healthcare may be defined as multitude of services rendered to individual or communities by the agents of the health services or professionals for the purpose of promoting, restoring and maintaining health • INPUTS: Represent health needs and demands of the community • HEALTH CARE SERVICES: Designed to meet the health needs of the community • HEALTH CARE SYSTEM: Constitutes management sector, and involves organizational matter. • OUTPUT: Represent the changed or improved health status of the community. HEALTH CARE PROVIDERS IN INDIA Departments under State Government Departments under Central Government Non-Government • Public Health Department • Medical Education Department • Municipal Administration Department • Non-Allopathic systems of medicine • Under Ministry of Health and Family Welfare (MoHFW) ✓ Central Health Services Medical Colleges ✓ Corporate Industries ✓ Central Government Health Services (CGHS) • Ministry of AYUSH • Ministries besides MoHFW ✓ Railway Hospitals (Railway Ministry) ✓ Armed Forces Hospitals (Ministry of Defence) • Private Hospitals • Private Practitioners • NGO Health Facilities • Traditional Healers
  2. 2. P a g e | 2 Dr. Nithin Ravindran Nair (PT) ORGANIZATIONAL STRUCTURE IN INDIA: Health system in India has 3 main links – Central, State, Local or Peripheral. AT CENTRAL / NATIONAL LEVEL: THE UNION MINISTRY OF HEALTH AND FAMILY WELFARE Headed by – Cabinet Minister → Minister of State → Deputy health Minister THE DIRECTORATE GENERAL OF HEALTH SERVICES Headed by – DGHS → Additional DGHS → Deputy DGHS → Administrative staff THE CENTRAL COUNCIL OF HEALTH AND FAMILY WELFARE Headed by – Union Health Minister → State Health Ministers AT STATE LEVEL: OFFICIAL ORGANS THE UNION MINISTRY OF HEALTH AND FAMILY WELFARE THE DIRECTORATE GENERAL OF HEALTH SERVICES THE CENTRAL COUNCIL OF HEALTH AND FAMILY WELFARE STATE LEVEL STATE MINISTRY OF HEALTH AND FAMILY WELFARE DIRECTORATE OF HEALTH AND FAMILY WELFARE SERVICES
  3. 3. P a g e | 3 Dr. Nithin Ravindran Nair (PT) AT DISTRICT LEVEL PANCHAYAT PANCHAYAT SMITI ZILLA PARISHAD GRAM PANCHAYAT GRAMSABHA DISTRICT SUB-DIVISION TEHSIL (TALUKA) COMMUNITY DEVELOPMENT BLOCKS VILLAGES PANCHAYATS CORPORATIONS MUNICIPAL BOARDS TOWN AREA COMMITTEES URBANRURAL
  4. 4. P a g e | 4 Dr. Nithin Ravindran Nair (PT) HEALTH CARE SYSTEMS: In India, it is represented by 5 major sectors or agencies which defer from each other by the health technology applied and by the source of fund for operation. (Ref: Preventive and Social Medicine – K Park; Textbook of Community Medicine – Dr. AP Kulkarni et al.) HEALTH CARE DELIVERY SYSTEM: Health care delivery system in India is three – tier system. It operates through 3 levels – Primary Health Care, Secondary Health Care and Tertiary Health Care (Ref: Textbook of Commuity Medicine and Community Rehabilitation for Physiotherapist – T Bhaskara Rao, Preventive and Social Medicine – K Park) HEALTH CARE SYSTEMS PUBLIC SECTOR PRIVATE SECTOR VOLUNTARY AGENCIES INDIGINEOUS SYSTEMS OF MEDICINE NATIONAL HEALTH PROGRAMS Primary Health Care ✓ Primary Health Centres ✓ Sub Centres Referral Hospital Services ✓ Community Health Centres ✓ Rural Hospitals ✓ District Hospitals ✓ Speciality Hospitals ✓ Teaching Hospitals Central Government Schemes ✓ ESIS ✓ Central Gov. Health Schemes Other Agencies ✓ Defence Services ✓ Railways ✓ Private hospitals ✓ Polyclinics ✓ Nursing homes ✓ Dispensaries ✓ General Practitioners and clinics ✓ Indian Red Cross Society ✓ Family Planning Association of India ✓ Indian Council for Child Welfare ✓ Central Social Welfare Board ✓ TB Association of India ✓ Professional Bodies – IMA, IDA, TNAI etc. ✓ Ayurveda and Siddha ✓ Unani and Tibbi ✓ Homeopathy ✓ Reproductive and Child Health Program ✓ Universal Immunization Program ✓ NPCDSCS – National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke
  5. 5. P a g e | 5 Dr. Nithin Ravindran Nair (PT) 1) Primary care level: • It is the first level of contact of individuals, the family and community with the national health system, where primary (essential) health care is provided. • Primary health care delivery system in India is at 3 levels. Village Level (1000 population) ▪ Community Health Guide (CHG) ▪ Trained birth attendant (trained dais) (TBA) ▪ Anganwadi workers (under ICDS scheme) Subcentre Level (3000 – 5000 population) ▪ Multipurpose Health Assistant (male) (MPHA – M) ▪ Multipurpose Health Assistant (female) (MPHA – F) Primary Health Center Level (20000 – 30000 population) ▪ 1 – 2 medical officers 2) Secondary Care Level (80, 000 – 1,20,000 population) • Intermediate health care level ∕ First referral level • At this level more complex problems are dealt with • In India, this kind of care is provided by – Community Health Centers and District Hospitals. 3) Tertiary Care level • Apex care ∕ Second level referral • More specialized than secondary care level and requires specific facilities (high- tech diagnostic and therapeutic equipment) and highly specialized health workers (medical and paramedical professionals) • In India, this kind of care is provided by – regional or central level institutions like Medical college hospitals, All India Institutes, Super-speciality Hospitals, Regional Hospitals etc.
  6. 6. P a g e | 6 Dr. Nithin Ravindran Nair (PT) PRIMARY HEALTH CARE Definition: Primary health care is essential health care made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and country can afford. Elements of Primary Health Care: • Health Education • Nutrition • Immunization • MCH care • Family Planning • Safe water supply • Basic Sanitation • Control of endemic diseases • Treatment of common diseases • Provision of essential drugs Principles of Primary Health Care: • Equitable distribution: Health services – shared equally by all people irrespective of their ability to pay; all people (rich or poor, urban or rural) must have access to health services. • Community Participation: Participation of community essential – during planning, implementation and maintenance of health services. • Intersectoral coordination and cooperation: All components of primary health care cannot be provided by the health sector alone. So, cooperation of other sectors (education, transportation, communication, food and agriculture) also needed to improve health status of the people. • Appropriate technology: Interventions adopted should be appropriate to local condition and it should be accepted and affordable for the people. Strategies of Primary Health Care: • Intersectoral coordination and cooperation • Development of basic health infrastructure • Prevention of disease and promotion of health
  7. 7. P a g e | 7 Dr. Nithin Ravindran Nair (PT) • Community participation and IEC (Information, Education, Communication) activities • Appropriate technologies • Training of MPHA, TBA, and CHG. THREE TIER PRIMARY HEALTH CARE DELIVERY SYSTEM A) AT VILLAGE LEVEL DESCRIPTION SELECTION CRITERIA TRAINING / DUTIES / SERVICE PROVIDED COMMUNITY HEALTH GUIDE ▪ Male / female with an aptitude to serve selected by the community ▪ Should not be full time government employee ▪ Preference – female ▪ One from each village – every 1000 population ▪ Permanent resident of village ▪ Minimum qualification: 6th class ▪ Acceptable to all sections of the community ▪ Spare at least 2 – 3 hours per day for community health work. Training – PHC (3 months – minimum 200 hrs.) ▪ Treatment of minor ailments ▪ First aid treatment ▪ MCH services ▪ Family planning ▪ Health Education ▪ Basic Sanitation TRAINED BIRTH ATTENDANT Earlier deliveries in rural area conducted by local dais (untrained) → delivery complication → government decided to train them (clean and save deliveries) → after training they are called TBA ▪ One from each village – every 1000 population ▪ Permanent resident of village ▪ Acceptable to all sections of the community ▪ Only females are selected Training – PHC or subcentre or MCH centres (30 days) emphasis on asepsis – clean – hands, surface, blade, thread, stump.) ANGANWADI WORKERS ▪ One anganwadi worker for every 1000 population ▪ Selected under ICDS Program ▪ Each ICDS block contains 100 anganwadi workers ▪ Selected from the same community ▪ Part time worker Training – 4 months in health, nutrition and mother & child development ▪ Health check-ups ▪ Health education ▪ Immunization ▪ Supplementary nutrition ▪ Referral services B) AT SUBCENTRE LEVEL ▪ In India, there is 1 subcentre for every 5000 population. In tribal, hilly, and backward areas – 1 subcentre for every 3000 population. ▪ Each subcentre manned by – MPHA (M) and MPHA (F)
  8. 8. P a g e | 8 Dr. Nithin Ravindran Nair (PT) JOB RESPONSIBILITIES MPHA (M) • Participation in national health programs • Environmental sanitation • Immunization • Family planning • Health education • Collecting vital events • Record keeping • Treatment of minor ailments • MTP (Identify & refer to PHC) MPHA (F) • Participation in national health programs • Immunization • MCH care including family planning • Health education • Nutrition • Collecting vital events • Record keeping • Treatment of minor ailments • Training of dais • School health C) AT PRIMARY HEALTH CENTRE LEVEL • In India, 1 PHC was constructed for every population of 30000 in rural areas and 20000 in tribal and hilly areas. • The medical officer – is the administrative head of primary health centre STAFF NUMBER OF POSTS Medical Officer 1 / 2 Staff Nurse 1 Pharmacist 1 Health worker (female) 1 Health educator 1 Health assistant (male) 1 Health assistant (female) 1 Upper division clerk 1 Lower division clerk 1 Lab Technician 1 Driver 1 Class IV 4 TOTAL 15
  9. 9. P a g e | 9 Dr. Nithin Ravindran Nair (PT) Functions of Primary Health Centres: A) Individual Services ▪ Medical care ▪ Maternal care ▪ Child care ▪ Family welfare ▪ School Health ▪ Heath Education B) Community Services ▪ Prevention and control of endemic diseases ▪ Environmental Sanitation ▪ Vital Statistics ▪ National Health Program C) Technical / Managerial Services ▪ Referral ▪ Laboratory ▪ Training ▪ Office and Management Duties of Medical Officer: A) Preventive and Promotive • MCH services: Antenatal, perinatal and postnatal care of mothers, infants and child. • Nutritional Program: Supervision and implementation – Vit A supplementation and iron folic acid distribution. • Immunization Program: Plan, implement and supervision of adequate supply of vaccines, proper storage and maintenance of cold chain. • Family Planning Program: Successful implementation – education, motivation, delivery of services and after care. • National Health Program: He will look after all national health programs. • Trained: Tubectomy and Vasectomy – organizes and conduct camps. • School Health: Visit school at regular interval – medical check-ups, treatment of minor illness, immunization of children. • Communicable disease: Ensure steps being taken for control of CDs and proper sanitation and will take necessary action in case of outbreak of pandemic. • Early detection/confirmation/treatment: Leprosy, TB, STD
  10. 10. P a g e | 10 Dr. Nithin Ravindran Nair (PT) • Health Education • Diarrhoeal Disorder: Early detection and provide treatment through ORT, Referral of serious cases. B) Curative • Organize: Dispensaries, outpatient department and will allot duties to ancillary staff. • Organize: Laboratory services for cases where necessary. • Arrangement: Rendering services for treatment of minor ailments at community level and PHC through subordinate staff. • Arrangement: Suitable arrangement for work distribution in case of emergency • Attend: Cases referred by health workers, health assistant, health guides etc. • Screen: Cases needing specialized attention. • Guidance: Provide guidance to health assistants, health workers. Health guides, school teachers – treatment of minor ailments. • Co-ordinate: Cooperate and coordinate with other institutes providing medical care. • Visit: Visit each subcentre in the area at least once in fortnight on a fixed day – check the work of staff and provide curative services. C) Administrative • Supervise work of staff working in PHC. • Ensure general cleanliness inside and outside premises of PHC. • Ensure proper maintenance of equipment. • Ensure to keep up to date stock registers of stores and drugs. • Will get intends prepared timely for drugs, instruments, vaccines sufficiently in advance and will submit to appropriate health authorities. • Check proper maintenance of transport given. • Display charts in the room – area, location of peripheral units, health statistics. • Conduct monthly meeting with staff – scrutinize and evaluating progress – suggestions for improvements. D) Training • Organize training programs including continuing education with the assistance of CHO (Community Health Officer)
  11. 11. P a g e | 11 Dr. Nithin Ravindran Nair (PT) • Provide training to CHGs and TBAs. • Make arrangements to provide assistance to health assistant (F) and health workers (F) in organizing training programs for Dais. • Educate community about important health problems and ways of prevention. SECONDARY HEALTH CARE (INTERMEDIATE HEALTH CARE) STAFF PATTERN OF COMMUNITY HEALTH CENTRE STAFF PATTERN OF DISTRICT HOSPITAL Specialists in medicine, surgery, obstetrics and gynaecology, ENT, ophthalmology, orthopaedics, anaesthesia, radiology are present. Pathologist may or may not be present. SERVICE PROVIDED • Medical care • Surgical care • Specialized diagnostic services • Inpatient, outpatient, supervisory services STAFF NUMBER OF POSTS Medical Officer 4 Staff Nurse 7 Pharmacist 1 Dresser 1 Lab technician 1 Radiographer 1 Ward boys 2 Dhobi 1 Sweepers 3 Mali 1 Chowkidar 1 Peon 1 Aya 1 TOTAL 25
  12. 12. P a g e | 12 Dr. Nithin Ravindran Nair (PT) TERTIARY HEALTH CARE (APEX CARE) STAFF PATTERN • Teacher – speciality wise (specialist in all speciality) • Super specialist – speciality wise • Specialised paramedical staff EQUIPMENT • High-tech diagnostic and therapeutic equipment SERVICES • Emergency care • Speciality and superspeciality care • Inpatient survices and Outpatient services • Clinical training • High-tech diagnostic and therapeutic services
  13. 13. P a g e | 13 Dr. Nithin Ravindran Nair (PT) REHABILITATION SERVICES IN INDIA 1) District Rehabilitation Center (DRC) Project started in 1985 2) Four Regional Rehabilitation Training Centers (RRTC) have been functioning under the District Rehabilitation Center (DRC) scheme at Mumbai, Cuttack, Chennai and Lucknow. 3) National Information Center on Disability and Rehabilitation 4) National Council for Handicapped Welfare 5) National Level Institutes – o National Institute for Mentally Handicap (NIMH) - Secunderabad o National Institute for Empowerment of Persons with Intellectual Disabilities (NIEPID) - Secunderabad o National Institutes for Hearing Handicap (NIHH) – Mumbai o Ali Yavar Jung National Institute of Speech and Hearing Disabilities (AYJNISHD) – Mumbai o National Institute for the Visually Handicap (NIVH) – Dehradun o National Institute for Orthopedically Handicap (NIOH) – Kolkata o National Institute for Locomotor Disabilities (NILD) - Kolkata o Institute for the Physically Handicap (IPH) – Delhi o National Institute of Rehabilitation Training and Research (NIRTAR) - Cuttack, Odhisha. o National Institute for Empowerment of Persons with Multiple Disabilities (NIEPMD) - Chennai o Indian Sign Language Research and Training Center (ISLRTC) - Delhi 6) Ministry of Social Justice and Empowerment has set up Composite Regional Centers for Skill Development, Rehabilitation and Employment of Persons with disabilities in various states to provide preventive and promotional aspects of rehabilitation. 7) The Government of India formulated National Policy for person with Disabilities, 2006 which deals with physical, educational and economical aspects of rehabilitation.
  14. 14. P a g e | 14 Dr. Nithin Ravindran Nair (PT) DISTRICT REHABILITATION CENTRE STAFF MEMBERS: • Clinical Psychologist • Sr. Physiotherapist / Occupational Therapist • Sr. Prosthetist / Orthotist • Prosthetist Orthotist Technician • Sr. Speech Therapist / Audiologist • Hearing Assistant / Jr. Speech Therapist • Mobility Instructor • Multipurpose Rehabilitation Worker • Accountant cum Clerk cum Storekeeper • Attendant cum Peon cum Messenger ROLE OF DRC: • Survey and identification of PWD through camp approaches. • Awareness generation for encouraging and enhancing prevention of disabilities. • Early detection and intervention • Counseling of PWD, their parents and family members. • Assessment of need of assistive devices, provision/fitment of assistive devices, follow up/repair of assistive devices. • Therapeutic services: Physiotherapy, Occupational therapy, Speech therapy etc. • Promotion of barrier free environment. • Facilitation of disability certificates, bus passes and other concession/facilities for PWD. • Referral and arrangement of surgical correction through government and charitable institutes. • Arrangement of loans for self-employment, through banks and other financial institutions. • To provide supportive and complimentary services to promote education, vocational training and employment of PWD. • Providing training to PWD for early motivation and early stimulation for education, vocational training and employment.
  15. 15. P a g e | 15 Dr. Nithin Ravindran Nair (PT) • Providing orientation training to teachers, community and family. • Identifying suitable vocations for PWD so as to make them economically independent, keeping in view local resources and designing. • Provide referral services for existing educational training, vocational institutes. NATIONAL INSTITUTES ROLE OF NATIONAL INSTITUTUES: • Human resource development in the field of disability. • Develop trained manpower for rehabilitation – training of personnel such as doctors, engineers, prosthetists, orthotists, physiotherapists, occupational therapists, multipurpose rehabilitation therapists, speech therapist etc. • Providing comprehensive rehabilitation services for PWD through team approach. • Undertaking research and development work. • Provide vocational skill training and placement for PWD. • Distribution of assistive aids and appliances to PWD. • Documentation and dissemination of information for PWD. COMPOSITE REGIONAL CENTRE Nineteen Composite regional center for skill development, rehabilitation and empowerment of PWD are working under supervision of National Institutes and Administrative control of the ministry. ROLE OF COMPOSITE REGIONAL CENTRE: • It works as an extended arm of National Institutes. • Provide human resource development. • Provide rehabilitation services for catering to multiple and different disabilities at one place. • Provide vocational skill training and placement for PWD. • Undertake research and development work. • Distribution of assistive aids and appliances to PWD.
  16. 16. P a g e | 16 Dr. Nithin Ravindran Nair (PT) • Undertake public education program for creation of awareness among parents and community • To establish linkages with existing medical, educational and employment services following the principles of CBR • Offer extension services in rural areas. REFERENCES: ❖ Preventive and Social Medicine – K Park ❖ Textbook of Community Medicine – Dr. AP Kulkarni et al. ❖ Textbook of Commuity Medicine and Community Rehabilitation for Physiotherapist – T Bhaskara Rao ❖ Physiotherapy in Community Health and Rehabilitation – Waqar Naqvi ❖ Disabilityaffairs.gov.in

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