Professional Documents
Culture Documents
Health is the birth right of every individual. Today health is considered more than a
basic human right; it has become a matter of public concern, national priority and political
action. Our health system has traditionally been a disease-oriented system but the current
trend is to emphasize health and its promotion. The nursing profession exists to meet the
health need of the people. Unprecedented changes have occurred in the structure of our
society, in lifestyles, in specific and technological advances.
Health is a multi dimensional with physical, biological, economical, social, cultural
and vocational. Health is not static. A person who is healthy now may not be healthy the next
moment. Public has become more aware and emphasizing on health, health promotion,
wellness and self care. Emphasis has shifted from a focus on cure to a focus on prevention
and health maintenance. This has led to a evolution of a wide range of health promotion
techniques, and programmes including multiphasic screening, life time health monitoring
programs.
Special efforts being made by the health care professionals to reach and motive
members of various cultural and social economic groups concerning life style and health
practices. All efforts are to design a health care system that makes comprehensive health care
available to all the people at an affordable cost.
DEFINITIONS
Health
According to WHO, health is defined as a dynamic state of complete physical, mental and
social well-being not merely an absence of disease or infirmity.
Health care services: It is defined as multitude of services rendered to individuals,
families or communities by the agents of the health services or professions for the
purpose of promoting, maintaining, monitoring or restoring health.
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2. It implies the organisation, delivery staffing regulation and quality control.
J.C.Pak(2001)
3. Health care delivery system is the organisation by which health care is provided.
Wikipedia(2005)
4. A collection of fragmented services provided on free for service basis by numerous
organisations and providers.
Laddy Susan
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10. Urges that in the establishment of priorities for health-care funding, resource be
allocated to maintain services for the economically deprived.
11. Supports efforts to eliminate unnecessary health care expenditures and voluntary
efforts to limit increase in health care costs.
12. Endorses to provide age old with special health maintenance.
13. Supports public and private funding.
14. Condemns health care fraud.
15. Supports the establishment of a national health care budget.
16. Supports universal health insurance.
Functions of Health Care Delivery System:
1) To provide health services.
2) To raise and pool the resources accessible to pay for health care.
3) To generate human and physical sources that makes the delivery service possible.
4) To set and enforce rules of the game and provide strategic direction for all the
different players involved.
Characters of Health Care Delivery System:
1) Orientation toward health.
2) Population perspective.
3) Intensive use of information.
4) Focus on consumer.
5) Knowledge of treatment outcome.
6) Constrained resources.
7) Coordination of resources.
8) Reconsideration of human values.
9) Expectations of accountability.
10) Growing interdependence.
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1. Providers and Consumers.
A health care provider or health professional is an organization or person who
delivers proper health care in a systematic way professionally to any individual in need of
health care services. A health care provider could be a government, institution such as a
hospital or laboratory physicians, support staff, nurses, therapists, psychologists,
veterinarians, dentists, pharmacists, or even a health insurance company.Consumers are the
people of the whole world.
Financing
There are generally five primary methods of funding health care systems
Purely private enterprise health care systems are comparatively rare. Where they exist, it is
usually for a comparatively well-off subpopulation in a poorer country with a poorer standard
of health carefor instance, private clinics for a small, wealthy expatriate population in an
otherwise poor country. But there are countries with a majority-private health care system
with residual public service eg medicare, medicaid.
o Social security health care model, where workers and their families are
insured by the State.
o Publicly funded health care model, where the residents of the country are
insured by the State.
o Social health insurance, where the whole population or most of the
population is a member of a sickness insurance company.
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HEALTH CARE DELIVERY SYSTEM IN INDIA
In India it is represented by five major sectors or agencies which differ from each other by
health technology applied and by the source of fund available. These are:
I. PUBLIC HEALTH SECTOR
A. Primary Health Care
Primary health centres.
Sub- centres.
B. Hospital/Health Centres
Community health centres.
Rural health centres.
District hospitals/health centre.
Specialist hospitals.
Teaching hospitals.
C. Health Insurance Schemes
Employees State Insurance.
Central Govt. Healh Scheme.
D. Other Agencies
Defence services.
Railways.
II. PRIVATE SECTOR
A. Private hospitals, polyclinics, nursing homes and dispensaries.
B. General practitioners and clinics.
III. INDIGENOUS SYSTEMS OF MEDICINE
Ayurveda
Sidda
Unani
Homeopathy
Naturopathy
Yoga
Unregistered practioners.
IV. VOLUNTARY HEALTH AGENCIES
V. NATIONAL HEALTH PROGRAMMES
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MODEL OF HEALTH CARE SYSTEM IN INDIA
The inputs are the health status or health problems of the community, they represent
the health needs and health demands of the community. Since resources are always limited to
meet the many health needs, priorities have to be set.
The health care services are designed to meet the health needs of the community
through the use of available knowledge and resources. The services provided should be
comprehensive and community based.
The health care system is intended to deliver the health care services, it constitutes
the management sector and involves organizational matters.
The output is the changed health status or improved health status of the community
which is expressed in terms of lives saved, deaths averted, diseases prevented etc.
India is a union of 28 states and 7 Union territories. Under the constitution states are
largely independent in matters relating to the delivery of health care to the people. Each State,
therefore , as developed its own system of health care delivery, independent of the Central
Government. Central responsibility consists mainly of policy making, planning, guiding,
assisting, evaluating and coordinating the work of the State Health Ministries, so that no state
State lags behind in health services.
1. CENTRAL LEVEL:
Health is a State subject under the constitution of India. The health Centres are mainly
with international, national and interstate health matters. The centre is also responsible for
execution of health programmes in the centrally administered areas. It advises and helps the
States on all health matters.
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Official organs of the health system at the National level consists of:
A. The ministry of Health and Family Welfare.
B. The Directorate General of Health Services.
C. The Central Council of Health and Family Welfare.
b. Concurrent List:
Both centre and States have simultaneous power of legislationin relation to subjects in
concurrent list.
1. Interstate spread of disease
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2. Prevention of adulteration of foods
3. Control of drugs and poisons
4. Vital statistics
5. Labour welfare
6. Minor ports
7. Population control and family planning
8. Social and economic planning
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3. To make recommendations to the Central Government regarding distribution of
available grants-in-aid for health purposes to the states and to review periodically
the work accomplished in different areas through the utilization of these grants-in-
aid.
4. To establish any organisation or organisations invested with appropriate functions
for promoting and maintaining cooperation between the Central and State Health
administrations.
2. STATE LEVEL
There are 28 states in the country. Health, as states earlier is a State subject.
Therefore, the pattern of organisation, state of integration, level of health services, public
health laws and scales of pay differ from state to state. The aim, however of all states and
their Public Health Administration is the same- health, happiness and longevity for all
the people.
A. State Ministry of Health
The ministry has a minister and deputy minister of health. The secretary and Joint
secretary, etc. held by the IAS cadre.
Town areas committees: Its functions primarily limited to provision of sanitary services.
Muncipal board or Muncipality: Its functions are more diverse. These include regulation
regarding construction of houses, latrines and urinals, hotels, and markets; provision of water
supply, drainage and disposal of refuse and excreta, disposal of the dead, registration of births
and deaths, keeping of dogs and control of communicable diseases.
Corporation: Corporation provides essentially the same services as the muncilapity, but on a
larger scale. It also maintains hospitals and dispensaries.
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PRIMARY HEALTH CARE IN INDIA
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SUBCENTRE
In the public sector, a Sub-health Centre is the most peripheral and first contact point
between the primary health care system and the community. As per the population norms,
one Sub-centre is established for every 5000 population in plain areas and for every 3000
population in hilly/tribal/desert areas. A Sub-centre provides interface with the community at
the grass-root level, providing all the primary health care services. As sub- centres are the
first contact point with the community, the success of any nation wide programme would
depend largely on well functioning sub-centres providing services of acceptable standard to
the people. The current level of functioning of the Subcentres are much below the
expectations
Health care delivery in India has been envisaged at three levels namely primary,
secondary and tertiary. The secondary level of health care essentially includes
Community Health Centers (CHCs), constituting the First Referral Units(FRUs) and the
district hospitals. The CHCs were designed to provide referral health care for cases from the
primary level and for cases in need of specialist care approaching the centre directly. 4 PHCs
are included under each CHC thus catering to approximately 80,000 populations in tribal /
hilly areas and 1, 20,000 population in plain areas. CHC is a 30 bedded hospital providing
specialist care in medicine, Obstetrics and Gynecology, Surgery and Pediatrics. These centers
are however fulfilling the tasks entrusted to them only to a limited extent. The launch of the
National Rural Health Mission (NRHM) gives us the opportunity to have a fresh look at their
functioning.
HOSPITALS
Indias Public Health System has been developed over the years as a 3-tier system,
namely primary, secondary and tertiary level of health care. District Health System is the
fundamental basis for implementing various health policies and delivery of healthcare,
management of health services for defined geographic area. District hospital is an essential
component of the District health system and functions as a secondary level of health care,
which provides curative, preventive and promotive healthcare services to the people in the
district.
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HEALTH INSURANCE:
There is no universal health insurance in India. Health Insurance is at present is
limited to industrial workers and their families.
1. Employees State Insurance Scheme
It was introduced by an act of parliament in 1948. It covers employees
drawing wages not exceeding Rs. 10,000 per month.
The act provides
o Medical benefits
o Sickness benefits
o Disabled benefits
o Maternity benefits
o Dependent benefits
o Funeral benefits
2. Central Government Health Scheme:
This scheme was introduced in New Delhi in 1954 to provide comprehensive medical
care to Central Government employees. The schemes based on the principles of
cooperative effort by the employee and the mutual advantage of both.
Facilities under the scheme include:
o Outpatient care through a network of dispensaries.
o Supply of necessary drugs.
o Laboratory and x-ray investigation.
o Domiciliary visits.
o Hospitalisation facilities at Govt as well as private hospitals recognized for the
purpose.
o Special consultation.
o Paediatric services including immunization.
o Antenatal, natal and postnatal services.
o Emergency treatment.
o Supply of optical and dental aids at reasonable rate.
OTHER AGENCIES:
Defence Medical Services:
Defence services have their own organization for medical care to defence personnel
under the banner Armed Forces Medical Services. The services are provided are integrated
and comprehensive.
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Health Care of Railway Employees: The Railways provide comprehensive health care
services through the agencies of Railway Hospitals, Health Units and Clinics. Environmental
sanitation is taken care of by Health Inspectors in big stations. Health check-up of employees
is provided at the time of recruitment and thereafter at yearly intervals.
PRIVATE AGENCIES:
In a mixed economy such as Indias, private practice of medicine provides a large
share of the health services available. There has been a rapid expansion in the number of
qualified allopathic physicians to 7.5 lakhs in 2005 and doctor population ration is 1:1428.
Most of them they concentrate in urban areas. They provide mainly curative services. Their
services are available to those who can pay. The private sector of health care services is not
organised.
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programme directed primarily to furthering the public health by providing health services or
health education by advancing research or legislation for health or by a combination of these
activities.
The voluntary health agencies in India are:
Since India became free, several measures have been undertaken by National
Government to improve the health of the people. Prominent among these measures are the
National Health Programmes. Which have been launched by the Central Government for
control/eradication of the communicable diseases, improvement of environmental sanitation,
raising the standard of nutrition, control of population and improving rural health. Various
international agencies like WHO, UNICEF, UNFPA etc have been providing technical and
material assistance in the implementation of these programmes.
National Health Programmes are:
National Vector Borne Disease Control Programme
National Leprosy Eradication Programme
Revised National Tuberculosis Control Programme
National AIDS Control Programme
National Programme for Control of Blindness
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Iodine Deficiency Disorders Programme
Universal Immunization Programme
National Rural Health Mission
Reproductive and Child Health Programme
Yaws Eradication Programme
National Cancer Control Programme
National Guinea- Worm Eradication Programme
National Cancer Control Programme
National Mental Health Programme
National Diabetes Control Programme
National Programme for Control and Treatment of Occupational Disease
Nutritional Programme
National Surveillance Programme for Communicable Disease
Integrated Disease Surveillance Programme
National Family Welfare Programme
National Water Supply and Sanitation Programme
Minimum Needs Programme
20-Point Programme
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CONCERNS
Problems of Inequality
Unequal distribution of health care. urban rich, not accessible to the vast rural
population.Ratio of hospital bed to population in rural areas 15 times lower than that for
urban areas. Ratio of doctors : 6times lower than urban population.Per capita expenditure on
public health is 7times lower in rural areas , when compare to Govt health spending for urban
areas.Infant mortality rate: in poorest 20% of population is 2.5times higher than in richest
20%.
Socio-economic problems
The state of economy has a direct effect on the state of health in a country. The recent
changes in the economic policies had a definite effect on the healthcare in India. Persistence
of poverty in the social structure also complicates the health scene. The poor suffer
disproportionately because of double burden of traditional disease as well as modern diseases
The poor lack adequate access to healthcare facilities Political will In a large developing
country like India, there are numerous gaps left by the government in the development
process - sometimes by intention, sometimes due to lack of funds, sometimes due to lack of
awareness. Most Indian politicians are hesitant to take harsh but healthy decisions as the
politics of vote dominates the agenda.
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The dominance of the private sector denies access to poorer sections of society, skews the
balance towards urban-biased, tertiary level health services profitability overrides
equality,The increasing cost of healthcare that is paid by out of pocket payments is making
healthcare unaffordable for a growing number of people
centralization:
Splitting the healthcare infrastructure Primary Health Care Services in India are
predominately delivered through centralized programmes. Large parts of the population who
do not have access to or cannot afford private care depend on these programmes. However
these centralized services are often unresponsive to local needs.
The pregnancy pattern in India - too early, too many, too close together - enhances the risk of
maternal mortality. About one- fifth of fertility is contributed by women in the age group of
15-19 years. The birth interval is about one- fourth of this group is 18 months. Of the total
births, about a quarter is higher order births, of order 4 or more.Poor percentage of
institutional deliveries Institutional deliveries are a critical factor in determining maternal
deaths. The NFHS II indicates that the institutional deliveries are low in the country (33.6%)
and very low in rural areas (24.6%). Though various measures have been under
implementation under RCH programme for promoting institutional deliveries, they still need
to be seen for the better results.
The RCH programme though has various provisions such as emergency transportation,
supply of emergency obstetric care equipment and IFA tablets, and provision of hiring private
gynaecologist by public health facilities.The RCH Facility Survey conducted in 2000 reveals
poor availability and utilisation of these provisions. The programme implementation has to be
improved for attaining set objectives.
Population Problem
Population explosion absorbs the national income and lowers the standard of living. It leads
to food shortage and thus several nutritional problems arise. Uncontrolled fertility directly
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threatens the health of mothers and infants. Rapid population growth has serious pollution
consequences as well.
About 75% medical facilities are concentrated in urban areas where only 25% population
resides, resulting in gross unavailability of health care support in the rural areas.The number
of physicians per 10,000 populations for the world is 1.5, for India it is 7 which is at par with
low income countries. For public sector, the figure is paltry 2. Similarly, number of nurses
per 10,000 population in India is 8, while it is 33 for the world and 16 for low income
countries.
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14. Integrated Management of Neonatal and Childhood Illness (IMNCI)
16. Facility based Integrated Management of Neonatal and Childhood Illness (F-IMNCI)
Since India became free, several measures have been undertaken by National
Government to improve the health of the people. Prominent among these measures are the
National Health Programmes. Which have been launched by the Central Government for
control/eradication of the communicable diseases, improvement of environmental sanitation,
raising the standard of nutrition, control of population and improving rural health. Various
international agencies like WHO, UNICEF, UNFPA etc have been providing technical and
material assistance in the implementation of these programmes.
National Health Programmes are:
National Vector Borne Disease Control Programme
National Leprosy Eradication Programme
Revised National Tuberculosis Control Programme
National AIDS Control Programme
National Programme for Control of Blindness
Iodine Deficiency Disorders Programme
Universal Immunization Programme
National Rural Health Mission
Reproductive and Child Health Programme
Yaws Eradication Programme
National Cancer Control Programme
National Guinea- Worm Eradication Programme
National Cancer Control Programme
National Mental Health Programme
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National Diabetes Control Programme
National Programme for Control and Treatment of Occupational Disease
Nutritional Programme
National Surveillance Programme for Communicable Disease
Integrated Disease Surveillance Programme
National Family Welfare Programme
National Water Supply and Sanitation Programme
Minimum Needs Programme
20-Point Programme
The National Rural Health Mission (NRHM) has been launched with a view to
bringing about dramatic improvement in the health system and the health status of the people,
especially those who live in the rural areas of the country. The Mission seeks to provide
universal access to equitable, affordable and quality health care which is accountable at the
same time responsive to the needs of the people, reduction of child and maternal deaths as
well as population stabilization, gender and demographic balance. In this process, the
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Mission would help achieve goals set under the National Health Policy and the Millennium
Development Goals.
To achieve these goals NRHM will:
Facilitate increased access and utilization of quality health services by all.
Forge a partnership between the Central, state and the local governments.
Set up a platform for involving the Panchayati Raj institutions and community in the
management of primary health programmes and infrastructure.
Provide an opportunity for promoting equity and social justice.
Establish a mechanism to provide flexibility to the states and the community to
promote local initiatives.
Develop a framework for promoting inter-sectoral convergence for promotive and
preventive health care.
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To improve access to rural people, especially poor women and children to equitable,
affordable, accountable and effective primary health care.
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Preparation and implementation of an inter sector District Health Plan prepared by the
District Health Mission, including drinking water, sanitation, hygiene and nutrition.
Integrating vertical Health and Family Welfare programmes at National, State,
District and Block levels.
Technical support to National, State and District Health Mission, for public health
management Strengthening capacities for data collection, assessment and review for
evidence based planning, monitoring and supervision.
Formulation of transparent policies for deployment and career development of
human resource for health.
Developing capacities for preventive health care at all levels for promoting healthy
life style, reduction in consumption of tobacco and alcohol, etc.
Promoting non-profit sector particularly in underserved areas.
Programmes
Reproductive and Child Health Programme II (RCH-II) and the Janani
Suraksha Yojana (JSY) launched.
Polio eradication programme intensified cases reduced from 134 in 2004-05 to 63
(up to now).
Sterilization compensation scheme launched.
Accelerated implementation of the Routine Immunization programme taken up. Catch
up rounds taken up this year in the States of Bihar, Jharkhand and Orisaa.
Ground work for introduction of JE vaccine completed.
Ground work for Hepatitis vaccines to all States completed.
Auto Disabled Syringes introduced throughout the country.
State Programme Implementation Plans for RCH II appraised by the National
Programme Coordination Committee set up by the Minstry. Funds to the
extent of 26.14% i.e. Rs. 1811.74 crore have been released under NRHM
Outlay.
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THE NATIONAL FAMILY WELFARE PROGRAMME
INTRODUCTION : -
The National Family Welfare Programme was lanced in 1952 as National Family
Planning Program . India was the first one to do so. It is 100% centrally sponsored
program. The ministry of health and family welfare is responsible for this program.
In 1977 the government of India redesignated the National
Family Planning Program as the National Family Welfare Program.
CONCEPT
The term family welfare is in much broader in scope then family Planning . The
concept of welfare is basically related to quality of life. It includes
OBJECTIVE :-
To destabilize the population at the level of some 130 million by the year 2050 AD
through small family norms.
AIM :-
To achieve a higher end that is to improve the quality of the life of the people.
EARLY DEVELOPMENT : -
The second 5 year plan (1956 to 1961) the clinic approach was adopted . Large
no of family planning clinic were opened .
The 3rd year plan (1961 to 1966) emphatic recognition was given to family
planning .
In 1960 the NFWP entered a New technological era with introduction of the
Lippi's loop later replaced by copper T
Later Development:-
Target bound program .
IUD insertion at the rate of 20/1000 urban and 10/1000 rural.
Integration with maternal and child welfare , immunization , nutrition and non
formal education.
Medical termination of Pregnancy Act
COMPONENTS
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GOALS
Family welfare programme has laid down the following long term goals to be
achieved by the year 2000 AD:
1.Reduction of birth rate from 29 per 1000 (in 1992) to 21 by 2000 AD
2.Reduction of death rate from 10 (in 1992) to 9 per 1000.
3.Raising couple protection rate from 43.3 (in 1990) to 60 per cent.
4.Reduction in average family size from 4.2 (in 1990) to 2.3.
5.Decrease in Infant mortality rate from 79 (in 1992) to less than 60 per 1000 live
births.
6.Reduction of Net Reproduction Rate from 1.48 (in 1981) to 1
SERVICES
It is a Centrally sponsored programme. For this, the states receive 100 per cent
assistance from Central Government
1. The concept of welfare is basically related to quality of life.
2. As such it includes education, nutrition, health, employment, womens welfare and
rights ,shelter, safe drinking water-all vital factors associated with the concept of
welfare
The services are taken to every doorstep in order to motivate families to accept the
small family norm
The current policy is to promote family planning on the basis of voluntary and
informed acceptance with full community participation.
Also, the emphasis is on spacing methods along with terminal methods,
The emphasis is on a child family.
IMPACTS
. Nearly 98% of women and 99% of men in the age group of 15 and 49 have a good
knowledge about one or more methods of contraception. Adolescents seem to be well
aware of the modern methods of contraception
2. Over 97% of women and 95% of men are knowledgeable about female
sterilization, which is the most popular modern permanent method of family planning.
While only 79% of women and 80% of men have heard about male sterilization.
3. 93% of men have awareness about the usage of condoms while only 74% of
women are aware of the same.
4. Around 80% of men and women have a fair knowledge about contraceptive pills.
CONCLUSION
In India technological improvements and increased access to health care have resulted in a
steep fall in mortality, but the disease burden due to communicable and non communicable
disease, environmental pollution and malnutrition problems continued to be high. In spite of
the fact that norms for creation of infrastructure and manpower are similar through out the
country, that remains substantial variation between states and districts with in the states, in
availability and utilization of health care services and health indices of the population.
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The health care delivery system is a large complex organisation comprising a variety of
agencies and many health care professionals. Health care can be considered a right of all
people. The idea that health is the responsibility of each individual in society is gaining
greater acceptance. Various providers of health care co-ordinate their skills to assist a client.
Their mutual goal is to restore a clients health and promote wellness
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