healthcare delivery systems SEMINAR.pptx

LONG SEMINAR
ON
HEALTH CARE DELIVERY SYSTEM
ORGANIZATION, NATIONAL, STATE,
DISTRICT, CHC, PHC, FUNCTIONS,
STAFFING PATTERN, LAYOUT,
PATTERN OF ASSISTANCE, ROLE AND
RESPONSIBILITY OF DPHNO
BY
DEEPIKA.M
MSC FIRST YEAR(CHN)

HEALTH CARE DELIVERY SYSTEM IN INDIA:
INTRODUCTION
• 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, economic, 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.
• All efforts are to design a health care system that makes comprehensive health
care available to all the people at an affordable cost.

DEFINITION
• 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.”

1.Health Care Delivery System refers to the totality of resources that a population
or society distributes in the organization and delivery of health population services.
it also includes all personal and public services performed by individuals or
institutions for the purpose of maintaining or restoring health
.-stanhope(2001)
2. It implies the organization, delivery staffing and regulation and quality control.
(j.c.pak)

Components of Health System:
Concepts e.g. health and disease
Ideas e.g. equity coverage, effectiveness, efficiency, impact.
Objects e.g. hospitals, health centres, health programs
Persons e.g. providers and consumers

Philosophy of health care delivery system:
• Everyone from birth to death is part of the market potential for health care
services.
• The consumer of health care services is a client and not customer.
• Consumers are less informed about health services than anything else they
purchase.
• Health care system is unique because it is not a competitive market.
• Restricted entry in to the health care system.

Goals/Objectives of health care delivery system:
1) To improve the health status of population and the clinical outcomes of care.
2) To improve the experience of care of patients families and communities.
3) To reduce the total economic burden of care and illness.
4) To improve social justice equity in the health status of the population.

PRINCIPLES OF HEALTH CARE DELIVERY SYSTEM
1. Supports a coordinated, cohesive health-care delivery system
2. Supports the establishment of community based, community controlled health-
care system.
3. Urges an emphasis be placed on development of primary care.
4. Emphasizes on quality assurance of the care.
5. Supports health care as basic human right for all people.

6. Supports efforts to eliminate unnecessary health care expenditures and voluntary
efforts to limit increase in health care costs.
7. Endorses to provide age old with special health maintenance.
8. Supports public and private funding.
9. Condemns health care fraud.
10. Supports the establishment of a National Health Care budget.
11. 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 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 independence.

1. Providers and Consumers:
• 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.
• 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
1. Direct or out-of-pocket payment.
2. General taxation,
3. Social health insurance,
4. Voluntary or private health insurance, and

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. Health scheme.
D.Other agencies
• Defense services.
• Railways.

II.Private sector
A. Private hospitals,
• Polyclinics,
• Nursing homes and dispensaries.
• B.General practitioners and clinics.

III. Indigenous systems of medicine
• Ayurveda
• Siddha
• Unani
• Homeopathy
• Naturopathy
• Yoga
• Unregistered practitioners.

IV. Voluntary Health Agencies
V. National Health Programmes.

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.

Organization and Administration of Health services in India at Different Levels:
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 lags
behind in health services.
Health system in India has 3 links
1. Central level.
2. State level
3. District level

1. Central level:
• Health is a state subject under the constitution of India. The health centers are mainly with
international, national and interstate health matters. The center is also responsible for execution of
health programmes in the centrally administered areas. It advises and helps the states on all health
matters. 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.

A. The ministry of health and family welfare
Functions:
• The responsibilities of the central and state governments in the area of health are
defined under article 246 of the constitution as follows.
A. Union list
1. International obligations such as international sanitary regulations regarding port
quarantine.
2.Administration of central institutes such as all India institute of hygiene and
public health, Kolkata, national institute of communicable diseases, Delhi, national
institute of health and family welfare, Delhi.

3.Promotion of research through bodies such as the Indian council of medical research.
4. Regulation and development of medical, dental, pharmaceutical and nursing education and
professionals through their respective councils.
5. Regulation of manufacture and sale of biological products and drugs, including drug
standards.
6. Undertaking census, collecting and publishing health and vital statistics data.
7. Coordination with state in their health programs, giving them technical and financial
assistance and procuring for them facilities from international agencies.
8. Coordination with other ministries in matters related to health.
9.Health regulations regarding labor in general and mines and oil fields in particular.

B. Concurrent list:
• Both center and states have simultaneous power of legislation in relation to subjects in concurrent
list
1. Interstate spread of disease
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

B. The Directorate General of Health Services:
• The main functions of the DGHS
1. Conducting various National Health Programs.
2. Organizing health services in the form of central government health scheme
3. Providing medical education through the colleges and institutions under its control e.g. Raj
kumari amrit Kaur college of nursing, Delhi, all India institute of hygiene and public health,
Kolkata, JPMER, Pondicherry etc.
4. Medical research through Indian council of medical research and the institutes under it, as also
other institutions, such as the central research institute, kasauli.

5. International health and quarantine at major ports and international airports
6. Drug control
7. Medical stores and supplies
8. Health education through central health education bureau.
9. Health intelligence, through central health intelligence bureau.

C. The central council of health and family welfare
• Functions of central council of health and family welfare
1.To consider and recommend broad outlines of policy in regard to matters concerning health in all
its aspects such as the provision of remedial and preventive care, environmental hygiene, nutrition,
health education and the promotion of facilities for training and research.
2.To make proposals for legislation in fields of activity relating to medical and public health matters
and to lay down patterns of development for the country as a whole.
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 organizations 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.
B. State Health Directorate
• The process of integration has now been completed in most states. The usual pattern now is that
the state health directorate is headed by a director, usually known as director of health services,
he is assisted by a suitable number of deputies to look after various health and medical health
services. Some states also have a separate director medical education

C. District level
Each state in Indian union is divided into districts. Total population in each district, urban as well as
rural, varies from one to three million. Just as in case of states, some autonomy has been given to
urban and rural areas in the district as well.
The autonomous bodies or local self-government are called corporation and municipal
committees in the cities, Zilla Panchayats or zilla Parishads in rural districts, Taluka panchayat or
Taluka Parishads in Taluka level and Grama Panchayat and Nagara panchayats in villages and small
towns.

Health Organizations in Urban Areas:
• There are three types of self-government in urban areas of district, depending upon the size of
population:
1. Town areas committees (5000-100000)
2. Municipal board or municipality (10- 2000000)
3. Corporation (above 200000)
Town areas committees
• : Its functions primarily limited to provision of sanitary services.
Municipal board or Municipality
• : 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 municipality, but on a larger scale. It
also maintains hospitals and dispensaries.

Health organization in Rural Areas:
• Under panchayat act 1961, the district administration was reorganized in to 3 levels, self
governing autonomous bodies were formed at different levels as follows:
1. For each Villages or group of villages with population from 1000 to 10000 there is a gram
panchayat. If the population is over 10,000 to 30,000 there is a Nagar panchayat. The gram
panchayat in constituted by 15-30 elected members, who in turn elect a Sarpanch or president, vice
president, and panchayat secretary is recruited by government.
2. For each Block: there is a panchayat Samiti or Taluka panchayat which is a elected body.
3. For each District: there is a zilla panchayat or Parishat which is an autonomous body for district
as well as a whole, responsible to the state assembly. It is constituted by elected members, MLAs,
MP’S. In all above provision has been made for reservation for schedule caste schedule tribes and
women to ensure their active participation in all round development of the village.

Primary Health Care in India:
•In 1977 government of India launched a rural health scheme, based on the principles of “placing
people’s health in people’s hands’
•As a signatory to Alma-Ata declaration, the government of India is committed to achieving the
goal of health care approach which seeks to provide universal health care at a cost which is
affordable.
Keeping in view the WHO goal of “Health for All by 2000A.D.,The government of India evolved a
national health policy in 1983.

Keep in in view the millennium development goals, the government of India revised the draft of
national health policy in 2001.
• Principles of Primary Health Care:
1.Equitable distribution
2.Community participation
3.Intersectional coordination
4.Appropriate technology
5.Preventive in nature
6.Man power development.

Primary Health Center:
• Primary health centers are the cornerstone of rural health services a first port of call to a qualified
doctor of the public sector in rural areas for the sick and those who directly report or referred
from sub centers for curative, preventive and promotive health care.
• A typical primary health centres covers a population of 20,000 in hilly, tribal,or difficult areas and
30,000 populations in plain areas with 4-6 indoor/observation beds. It acts as a referral unit for 6
sub centers and refer out cases to CHC (30 bedded hospital) and higher order public hospitals
located at sub districts and district level.
• In order to provide optimal level of quality health care, a set of standards are being recommended
for primary health centre to be called Indian public health standards(IPHS) for phcs. The
launching of national rural health mission (NRHM) has provided this opportunity.

Assured services or function of primary health centres:
• Assured services covers all the essential elements of preventive, promotive, curative and
rehabilitative primary health care:
• This implies a wide range of services that include:
1. Medical care:
• OPD services minimum 4 hours in the morning and 2 hours in the evening
• 24 hours emergency services
• Referral services
• In-patient services (6 beds)

2. Maternal and Child Health care including Family Planning:
• Antenatal care: Early Diagnosis, Minimum three antenatal checkup, identification and
management of high risk pregnancies, nutrition and health counseling, minimum laboratory
investigation urine albumin, test of syphilis, chemoprophylaxis for malaria in high endemic area
as per NVDCP.
• Intra-natal care. (24-hour delivery services both normal and assisted)
• Postnatal care.( Janani suraksha yojana (JSY)) minimum 2 postpartum visit, initiation of breast
feeding health education on hygiene, contraception etc,
• New born care.
• Care of the child.
• Family planning

3. Medical termination of pregnancies using manual vacuum aspiration(MVA) technique.
(Wherever trained personnel and facility exists)
4. Management of reproductive tract infections / sexually transmitted infections.
5. Nutrition services (coordinated with ICDS)
6. School health
7. Adolescent health care
8. Promotion of safe drinking water and basic sanitation.
9. Prevention and control of locally endemic diseases like malaria, kala azar, Japanese encephalitis,
etc
10. Disease surveillance and control of epidemics
11. Collection and reporting of vital events
12. Education about health/behaviour change communication (BCC)

13. National health programmes including reproductive and child health programme (RCH),
HIV/AIDS control programme, non communicable disease control programme etc
14. Referral services.
15. Training: ASHA, ANM, LHV
16. Basic laboratory services
17. Monitoring and supervision:

• Assured services cover all the essential elements of preventive, promotive, curative and
rehabilitative primary health care. This implies a wide range of services that include
1. Maternal and child health care including family planning:
•Antenatal care: early diagnosis, minimum three antenatal checkup, identification and management
of high risk pregnancies, nutrition and health counseling, minimum laboratory investigation urine
albumin, test for syphilis, chemoprophylaxis for malaria in high endemic area as per NVDCP.
•Intra-natal care: promotion of institutional deliveries, skilled reference at home deliveries.
Minimum 2 postpartum visit, initiation of breast feeding health education on hygiene, contraception
etc,
•Others: provision of facilities under Janani Suraksha Yojna and NRHM.
•Postnatal care:

•Child health: essential new born care, promotion of exclusive breast feeding, immunization of all
children, prevention and control of all childhood disease.
2. Family planning and contraception:
• Education motivation and counseling to adopt family planning methods, provision of contraception.
3. Counseling and appropriate referral for safe abortion services for those in need.
4. Adolescent health care
5. Assistance to school health services.
6. Control local endemic diseases such as malaria, filariasis etc.
7. Disease surveillance
8. Water quality monitoring disinfection of water sources

9. Promotion of sanitation including use of toilets and appropriate garbage disposal.
10.Field visits
11. Community needs assessment
12. Curative services: provide treatment for minor ailments, referral service, organizing health day
once in month at Anganwadi.
13. Training coordination and monitoring: training of traditional birth attendants ASHA community
health volunteers, monitoring of water quality.
14. National health programmes
15. Record of vital events

• Man power:
The staff at each sub-centre consists of:
• Health worker (male) - 1
• Health worker (female)/ANM - 1
• Voluntary worker -1

• The staff of the sub center will have the support of ASHA (accredited social health activists)
wherever the ASHA scheme is implemented / similar functionaries at village level in other areas
ASHA is primarily a trained woman volunteer, resident of the village-married/widow/divorced
with formal education up to 8th standard preferably in the age group of 25-45 years.
• The general norm is one ASHA per 1000 population.
• The job functions of ANM, male health worker, ASHA and AWW in the context of coordinated
functions under NRHM.

Hospitals and health centres
Community health centers
• 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 center 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.
• The launch of the national rural health mission (NRHM)gives us the opportunity to have a fresh look at their
functioning.
• NRHM envisages bringing up the CHC services to the level of Indian public health standards.

• Although there are already existing standards as prescribed by the bureau of Indian standards for
30-bedded hospital, these are at present not achievable as they are very resource-intensive.
• Under the NRHM, the accredited social health activist (ASHA) is being envisaged in each village
to promote the health activities. With ASHA in place, there is bound to be a grounds well of
demands for health services and the system needs to be geared to face the challenge.
• Not only does the system require up gradation to handle higher patient load, but emphasis also
needs to be given to quality aspects to increase the level of patient satisfaction.
Objectives of Indian public health standards (IPHS) for CHCs:
• To provide optimal expert care to the community
• To achieve and maintain an acceptable standard of quality of care
• To make the services more responsive and sensitive to the needs of the community.

Functions of CHCs:
• Every CHC has to provide the following services which can be known as the
Assured services:
1. Care of Routine and Emergency Cases in Surgery:
•This includes incision and drainage, and surgery for hernia, hydrocele, appendicitis, hemorrhoids,
fistula, etc.
•Handling of emergencies like intestinal obstruction, hemorrhage, etc.
2. Care of Routine and Emergency Cases in Medicine:
•Specific mention is being made of handling of all emergencies in relation to the national health
programmes as per guidelines like dengue hemorrhagic fever, cerebral malaria, etc. Appropriate
guidelines are already available under each programme, which should be compiled in a single
manual.

3.24-hour delivery services including normal and assisted deliveries
4. Essential and emergency obstetric care including surgical interventions like caesarean sections
and other medical interventions
5. Full range of family planning services including laparoscopic services
6. Safe abortion services
7. New-born care
8. Routine and emergency care of sick children
9. Other management including nasal packing, tracheostomy, foreign body removal etc.
10. All the national health programmes (NHP) should be delivered through the chcs.
11. Others: blood storage facility, essential laboratory services, referral (transport).

General surgeon 1
Physician 1
Obstetrician /gynaecologist 1
Paediatrician 1
Anesthetist 1
Public health programme manager 1
Opthamologist 1
Nurse midwive 9
Dresser 1
Pharmacist 1
Lab technician 1
STAFFING PATTERN OF CHC:

Radiographer 1
Ophthalmic assistant 1
Ward boys 2
Sweepers 3
Chowkidhar 1
OPD attendant 1
Stastical assistant 1
OT attendant 1
Registration clerk 1
Total 31

Hospitals:
• India’s 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.
Definition
• The term District Hospital is used here to mean a hospital at the secondary referral level
responsible for a district of a defined geographical area containing a defined population.

• Every district is expected to have a district hospital linked with the public hospital/health centres
down below the district such as sub-district/sub-divisional hospitals, community health centres,
primary health centers and sub-centres.
• As per the information available, 609 districts in the country at present are having about 615
District Hospitals.
• However, some of the medical college hospitals or a sub-divisional hospital is found to serve as a
district hospital where a district hospital as such (particularly the newly created district) has not
been established. Few districts have also more than one district hospital.

Objectives for District Hospitals:
• The overall objective of IPHS is to provide health care that is quality oriented and sensitive to the
needs of the people of the district. The specific objectives of IPHS for DHS are:
I. To provide comprehensive secondary health care (specialist and referral services) to the
community through the district hospital
II. To achieve and maintain an acceptable standard of quality of care.
III. To make the services more responsive and sensitive to the needs of the people of the district and
the hospitals/centres from which the cases are referred to the district hospitals

Grading of District Hospitals:
• The size of a district hospital is a function of the hospital bed requirement, which in turn is a
function of the size of the population it serves. In India the population size of a district varies
from35, 000 to 30, 00,000 (census 2001).
Grade i: district hospitals norms for 500 beds
Grade II: district hospitals norms for 300 beds
Grade III: district hospitals norms for 200 beds
Grade IV: district hospitals norms for 100 beds.
• Some may require the intervention of highly specialist services and use of sophisticated
expensive medical equipment’s.
• Patients with such diseases can be transferred to tertiary and other specialized hospitals.
• A District Hospital should however be able to serve 85-95% of the medical needs in the districts.
It is expected that the hospital bed occupancy rate should be at least 80%.

Functions
1. It provides effective, affordable healthcare services (curative including specialist services, preventive
and promotive) for a defined population, with their full participation and in co-operation with agencies in
the district that have similar concern. It covers both urban population (district headquarter town) and the
Rural population in the district.
2. Function as a secondary level referral centre for the public health institutions below the district level
such as sub-divisional hospitals, community health centres, primary health centres and sub-centres.
3. To provide wide ranging technical and administrative support and education and training for
primary health care.
• Essential services
• Services include OPD, indoor, emergency services.
• Secondary level health care services regarding following specialties will be assured at hospital:

Consultation
Services with following specialists:
General medicine
General surgery
Obg & gynec
Paediatrics including neonatology
Emergency (accident & other emergency) (casualty)
Critical care (ICU)
Anaesthesia
Ophthalmology
Ent
Orthopaedics

• Radiology
• Dental care
• Public health management
• Para clinical services
• Laboratory services
• X-ray facility
• Ecg
• Blood transfusion and storage facilities
• Physiotherapy
• Dental technology (dental hygiene)
• Drugs and pharmacy
• Support services
• Medico-legal/post-mortem
• Ambulance services
• Dietary services

• X-ray facility
• Security services.
• Waste management
• Ware housing/central store
• Maintenance and repair
• Electric supply (power generation and stabilization)
• Water supply (plumbing)
• Heating, ventilation and air-conditioning
• Transport
• Communication
• Medical social work
• Nursing services
• Sterilization and disinfection

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
• Medical benefits
• Sickness benefits
• Disabled benefits
• Maternity benefits
• Dependent benefits
• 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:
• Outpatient care through a network of dispensaries.
• Supply of necessary drugs.
• Laboratory and x-ray investigation.
• Domiciliary visits.
• Hospitalization facilities at govt as well as private hospitals recognized for the purpose.
• Special consultation.
• Pediatric services including immunization. Antenatal, natal and postnatal services.
• Emergency treatment.
• Supply of optical and dental aids at reasonable rate.

Other Agencies:
• Defense Medical Services
• Defense services have their own organization for medical care to defense personnel under the
banner “armed forces medical services”. The services are provided are integrated and
comprehensive.
• 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 India's, 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 organized.

Indigenous Systems of Medicine
• The practioners of indigenous system of medicine provide the bulk of medical care to the rural
people. Ayurvedic physicians alone are estimated to be about 4.5lakhs. Nearly 90% of Ayurvedic
physicians serve the rural areas. To promote this these indigenous systems Indian government
established Indian council for Indian medicine in 1971.
• Ayush is the new approach on this. Which encompasses ayurveda, yoga, unani, sidda,
homeopathy.

Objectives of AYUSH:
• To upgrade the educational standards in the Indian systems of medicines and homoeopathy
colleges in the country.
• To strengthen existing research institutions and ensure a time-bound research programme on
identified diseases for which these systems have an effective treatment.
• To draw up schemes for promotion, cultivation and regeneration of medicinal plants used in these
systems.
• To evolve pharmacopoeia standards for Indian systems of medicine and homoeopathy drugs.

Voluntary health agencies:
• A voluntary health agency may be defined as an organization that is administered by an
autonomous board which holds meetings, collects funds for its support, chiefly from private
sources and expands money, whether with or without paid workers, in conducting a 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:
• Indian red cross society
• Hind kusht nivaran sangh
• Indian council for child welfare
• Tuberculosis association of India
• Bharat sevak samaj
• Central social welfare board
• The Kasturba memorial fund
• Family planning association of India

• All India women’s conference
• The all- India blind relief society
• Professional bodies like TNAI, IMA, AIDA etc
• International agencies like Rockefeller foundation, CARE, ford foundation etc.

• National Health Programmes
• 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
• 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

National Rural Health Mission
• 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 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.

The objectives of the Mission:
• Reduction in child and maternal mortality.
• Universal access to public services for food and nutrition, sanitation and hygiene and universal
access to public health care services with emphasis on services addressing women and children’s
health and universal immunization.
• Prevention and control of communicable and non-communicable diseases, including locally
endemic diseases.
• Access to integrated comprehensive primary health care.

• Population stabilization, gender and demographic balance.
• Revitalize local health traditions & mainstream Ayush.
• Promotion of healthy life styles.
The core strategies of the mission
• Train and enhance capacity of panchayati raj institutions to own, control and manage public health
services.
• Promote access to improved healthcare at household level through the female health activist (ASHA).
• Health plan for each village through village health committee of the panchayat.
• Strengthening sub-centre through better human resource development, clear quality standards, better
community support and an untied fund to enable local planning and action and more multi-purpose
workers (MPHW).

• Strengthening existing (phcs) through better staffing and human resource development policy,
clear quality standards, better community support and an untied fund to enable the local
management committee to achieve these standards.
• Provision of 30-50 bedded CHC per lakh population for improved curative care to a normative
standard. (IPHS defining personnel, equipment and management standards, its decentralized
administration by a hospital management committee and the provision of adequate funds and
powers to enable these committees to reach desired levels)
• 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 blocks
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 Orissa.
• 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 ministry. Funds to the extent of 26.14% i.E. Rs. 1811.74 crore have been released under NRHM outlay.

Role of DPHNO:
• Introduction: the role of the District Public Health Nurse and the District Public Health Nurse
officers(DPHNOs) as supervisors of the public health nursing and midwifery staff in a district
was investigated.
• Public health nurses integrate community involvement and knowledge about the community
involvement and knowledge about the entire population with personal, clinical understandings of
the health and illness experiences of individuals and families with in the population.

• Definition: District Public Health Nurses or district public health nursing officers the district public
health nurses(DPHNS) are class III employees originally part of the maternal and child health division
of department of health.
• Public health nurse skills an qualification:
Verbal communication.
Health promotion
Maintenance
Listening
Quality management, energy level, integrity, infection control
Teamwork
Multitasking

Evaluating health trends and risk factors of population groups and helping to determine priorities for
targeted interventions.
Working with communities or specific population groups within the community to develop public
policy and targeted health.
 Promotion and disease prevention activities.
Participating in assessing and evaluating health care services to ensure that people are informed of
available programs and services and assisted in the utilization of those services. Providing essential input
to interdisplinary programs that monitor, anticipate and respond to public health problems in population
groups.
Providing health education, care management, and primary care to individuals and families who are
members of vulnerable population and high risk groups.
Public health nurses provides a critical linkage between epidemiological data and clinical
understanding of health and illness as it is experienced in people’s lives.

• Public Health Nurse Job Duties:
Serves patients by visiting homes: determining patient and family needs; developing health care
plans; providing nursing services and treatments; referring patients with social and emotional
problems to other community agencies.
Helps the community health care team by coordinating assessment, planning, and providing of
needed health and related services; participating in case conferences with physicians, hospital and
rehabilitative personnel and representative of other agencies.
Supervisory responsibility
Educational responsibility

Carrying out
Preventive promotive curative
Rehabilitative care.
• Supervisory responsibility:
Public health nurse supervisor, guides and supervises the functions of public health nurses, health
workers, working in her assigned field she is responsible.
• Educational responsibility:
Organize the in-service education programme for all the nursing staff.
Initiate and assist in planning and organizing the orientation programmes for the new staff.
Participate in community health field experience organized for nursing students of school or college.
Suggest in selection of area for practical experience.

Provide facilities and resources to students and staff.
Guide students during field experience.
Help to supervise and guide the traditional birth attendance.
Keep her knowledge updated by reading attending professional seminar and meeting etc.
Assisting in development of standards of the health care with the accepted philosophy, objectives and
health policies.
Assisting in the preparation of budget for the community health department.
Utilize the budget allotted to the department.
Supervision and guidance of phn, lhv, fhw, mhw working in her field.
Organizing educational programs for the community members including school children, rch group or
other interested by /targeted groups in her area.

Supervision of records and reports prepared by health workers working under her jurisdiction.
Assisting the DPHN or DPHNO for the preparation job description and assignment
responsibilities for other community health workers.
Nursing adviser:
This is the post in the medical division of directorate general of health services. The nursing
adviser is directly responsible to the deputy director general (medical), the nursing adviser is
assisted by nursing officer and support staff for all her/her work.
Advices the DGHS, the ministry health family welfare as well as other ministries, department’s
.EX:. Railways, labor.

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