Introduction
India is a union of 28 states and 7 union territories under the constitution of India, the states are largely independent in the matters related to the delivery of health care of the people, Health care delivery system exists to provide services and resources for better health. This system includes hospitals, clinics, health center, nursing home and special health programmers. The health care system is enhanced through linkages that bring together various subsystems to provide care with the proper resources, technologies and skills. So strengthening of multisectrol approach should be maintained in the community to achieve the health for all by 2010.
Terminologies:
1.
Comprehensive: Including all that may concerned complete, full and whole. Referral: Who needs professional help to a person.
2.
3.
Practitioners:
Persons who works in a profession regularly does a particular activity. The practice of helping the poor and those in need, especially by giving money.
4.
Philanthropic:
5. Pharmacopeia:
An official book containing a list of medicine and drugs and instruction for their use. A person that has or may have a disease is kept away from others in order to prevent the disease from spread. That may be done by Law.
6. Quarantine:
7. Statutory:
Definition
A health care delivery system is the totality services offered by all health disciplines.
Consumer are less informed about health services than anything else they purchase
Cont
Goals / objectives
patients,families,and communities
status of population
Functions
health care
Characteristics
Cont
Private. Voluntary Government agencies. - National level. - State level. - District level and - Block level.
I) AT THE CENTRE.
i) Department of Health
Secretary Joint secretaries Administrative staff Directorate general of Health services Subordinate officer. Homeopathic pharmacopoeia laboratory
2. Administration of central Health institution training colleges, laboratories for administration and hospitals. 3. Promotion and maintenance of appropriate standards of education in,
Medical.
Function cont These standards of education are co-ordination and collaboration with various national associations in health programme. To achieve these aims the following council and association have been formed, Indian medical council.
Function cont
4. Promotion of medical and public health researches through the role in Aiding. Promoting and coordinating scientific research on human disease. Their causation Prevention and cure. 5. Regulation and development of medical, nursing, dental and pharmaceutical professions in consultations with state governments. 6. Establishment and maintenance of drug standards and control over the manufacture and sale of drugs and biological products.
Function cont 7. Collection of information regarding development in medical and health services in India and abroad through the central Bureau of Health Intelligence (CBHI). 8. Maintenance of central medical library. 9. Promotion and co-ordination of health activates through central council of health. 10. Establishment of close contact with other ministers in respect of health measures.
agencies.
13. Planning and organisation of health activities throughout the country in collaboration with the state governments and planning commission. 14. Evaluation of health schemes organized in the country.
19. Planning, guiding and coordinating all the national health programmes in the country. 20. Establishment of total medical care for the central government employees, by starting central government health scheme (CGHS) in 1954 in Delhi.
21. Carrying out the functions of health services in the centrally administration areas.
22. Power to lay down and enforce minimum standards of health administration for these services with the other departments. ExamplesRailways, Prisons and labour etc
It was created in 1966. The secretary to the government of India in the ministry of health and family welfare is in overall charge. Secretary Additional secretary
Commissioner.
One Joint secretary.
4. To disseminate the knowledge on the practice of family planning by the available publicity and educational measures and to provide service agencies nearest to the community.
5. To organise basic research on human fertility, genetics and population dynamics on the evolution of easy and more reliable methods of contraception. 6. To study the social factors that affect fertility and to take such steps as will reduce the number of children in a family. Ex- Raising the age of marriage, free education and employment of women etc
7. To coordinate the family planning programme with the child welfare and maternal health services through out the country. 8. To organise production of contraceptive devices in adequate quantities to maintain the supply at all levels preferably free or at a minimum cost.
International health relations and administration of port quarantine. Administration of central institutes like All India institutes of public health, kolkata, National institute for control of communicable disease Delhi. Promotion of research through research centers and other bodies. Regulation and development of medical, Nursing, Pharmaceutical, dental professions. Establishment and Maintaince of drug standards.
Cont
Census, collection and publication of other statistical data.
2) Concurrent list.
Prevention of extension of communicable disease from one unit to another. Prevention of adulteration of food stuffs. Control of drugs and poisons. Vital statistics. Labour welfare. Ports.
union government
Additional director of
Health services
Team of deputies Administrative Staff
The directorate comparies of three main units, Medical care and hospital.
Public Health.
General administration.
Surveys.
Planning.
Coordination. Programming and Appraisal of all health matters. International Health relations and quarantine. Control of drug standards. Medical store depots.
2. Specific Functions.
Specific cont..
Postgraduate training. Medical education. Medical research. Central Government Health Schemes. National Health programmes. Central Health Education Bureau. Health intelligence.
Health intelligence.
The union Health minister is the chairman and the state Health minister are the members.
i.
The state ministry of Health and family welfare is headed by a cabinet minister and deputy minister.
ii.
iii.
He is the principal advisor to the state government on all matters relating to medicine and public health, as he is technically qualified person in the field.
1.
He is assisted by joint director, regional joint directors and deputy and assistant directors.
It studies in depth the health problems and needs in the state and plans schemes to solve them. Providing curative and preventive services.
Establishment and maintenance of central laboratories for preparation of vaccine etc. Promotion of health education.
Collection, tabulation and publication of vital statistics.
Cont..
Family planning.
Occupational health.
services.
Cont
Planning and carrying out surveys in relation to nutrition, health education etc
Establishing training course for health personnel and formulating job descriptions.
Co-ordination of all health service with other minister of the state such as,
TEHSILS
AT DISTRICT
COMMUNITY DEVELOPMEN T BLOCK
VILLAGES
MUNICIPALI TIES
A) Subdivision.
o
B) Tehsils.
o o
The rural areas of districts have been organised in to community developmental blocks. It comprises of 100 villages and about 80,000 1, 20,000 population The in charge of this is Block Development officer.
Corporation ( above 2 lakh of population) These are headed by the chairman elected by the members. They do the development work in the town or in the city.
E) Panchayati Raj
o
The panchayati Raj is a 3 tier structure of rural local self government In India linking the village to the district they are,
PANCHAYAT RAJ
PANCHAYAT
PANCHAYAT SAMITI
ZILLA PARISHAD
GRAM SABHA
GRAM PANCAYAT
II. Gram
Panchayat.
This is the agency for planning and development at village level. The strength varies from 15 30 and covers the population from 5,000 15,000. Each panchayat has elected a president (sarpanch or sabhapati or mukhiya), a vice president and a secretary,
Functions of Panchayat.
Civic administration. Sanitation. Public health Social and economic development of village.
Co- ordinate health planning. Investigate communicable disease. Maintain free clinics for the early diagnosis of communicable disease. Provide laboratory services to assist doctor. Conduct clinics for administration of vaccine. Collect vital statistics.
4. 5. 6.
7.
8. 9.
Cont.. 10. Supervise quality and safety of meat and other foods. 11. Inspect and supervise the production, pasteurization and distribution of milk. 12. Investigate and supervise the general sanitary conditions in public eating places. 13. Conduct health education programmes. 14. Provide preventive and rehabilitative services in chronic disease control. 15. Promulgate rules and regulations . 16. Provide mental health services. 17. Provide medical care to the indigent. 18. Provide family planning services.
India is a land of villages about 80% of the population is scattered over 5,75,936 villages. Only about 20% of rural population have health care facilities. The fundamental objective of health services is to provide primary health care to all the sections of the society.
The organizational structure at the block level has the three tire structure such as
PRIMARY HEALTH CENTER
Each community health center is covering a population of 80,000 1, 20,000 with three to four PHC. Each CHC has 30 sanctioned beds and has facility for specialized services, The services are given by the team of specialist nurses and other Personnels.
2.
3.
Each PHC covers a population of 30.000 in plain area and 20,000 in hilly and tribal area. The PHC functions of all eight essential elements of primary health care The services are provided by the team of medical officer, Nurses midwife, ANM, Block extension educator, Health assistant Male and Female, Lab technician and Ancillary staff.
2.
3.
It covers the population of 5000 in general and 3000 in hilly, tribal and backward areas. Each sub-center is managed by a team of male and female health worker or ANM. The work of female and male health worker is supervised by male and female health supervisor respectively in the ratio of 1: 4 to six workers
2)
3)
4. Village.
o
The village is managed by the village health guide for thousand population who have had the three months training. The village health guide is to spare 2-3 hours daily for community health work in return they are given Rs. 200 per month as an honorarium . The other persons are a) Indigenous dais
b) Anganwadi workers.
The deputy nursing adviser provide the training to ANMs, Dais and health supervisor etc. She/he actively participates in policy formulation and decision making process. The committee strongly expressed the need for charge in nursing organisation. They look after for the improvement of nursing education and nursing research.
There is no proper and definite pattern of nursing structure in state directorates. In some state like Tamil Nadu and Maharastra two nurses are posted, one each in director of medical education and director of medical services.
community nursing services, planning, continuing education and all administrative work.
The nurses played a important role in providing the health course services in urban and rural areas. District level nurse are having the following function,
Administration and management of nursing and midwifery services in the districts. Supervision and guidance of health supervisor. In service training programme of nurses, ANMs working in her district. Attending to problems that referred to her.