In this PPT you can learn about the Health care delivery services

1. HEALTH CARE DELIVERY
(SERVICES) IN INDIA
BY KUNAL SONI
ASST. PROFESSOR
COMMUNITY HEALTH NURSING

2. HEALTH CARE DELIVERY SERVICES IN
INDIA
INTRODUCTION:
• Public health is a significant base of social services.
• Govt. of India is making efforts to provide health services to
the grass-root level right from the time of independence; yet
due to population explosion, this objectives is difficult to
attain.
• To attain ―Health for all", nation needs extensive health system
or machinery, so that health services can be made available to
each person.
• The health services and system available in the nation at
present can be made clear through the given table :

3. HEALTH CARE DELIVERY (SERVICES) IN INDIA
1) District hospital 1) ESI scheme 1) Railway hospital Sub-Centre
and dispensaries 2)FP insurance 2)Military hospital Primary Health Centre
2) Urban family welfare scheme Community Health Centre
Centre 3) central govt. Other Rural Health Services:
3) Special hospitals health scheme - village health guide
4) Medical college - TBA(Dais)
Hospitals/ - Anganwadi worker
Teaching institution
5) Super speciality -ASHA
hospitals/institutes
PUBLIC OR
GOVT. SECTOR
PRIVATE
SECTOR
URBAN HEALTH
SERVICES
National health
programmes
Ayush Rural health services
Private
consultation
services
Mission,
Trust,
Religious
Hospital
Private
hospital and
clinic
Urban
hospitals
&health
centre
Central
health
services/
health
insurance
Other govt.
health
services
VOLUNTARY
HEALTH AGENCIES
Autonomous
institutes
HEALTH CARE DELIVERY (SERVICES) IN INDIA

4. PUBLIC OR GOVT. SECTOR
Health services in the public sector are conducted by union or state govt.
which are described here as; urban health services, autonomous institutions,
AYUSH OR Indian system of medicine, rural health services and national
health programme.
(URBAN HEALTH SERVICES)
( Urban hospitals and health centre)
• Under this schemes, hospital and institution providing health care in urban
areas included.
• Important means to provide health services to urban population are
dispensaries and district hospitals.
• In order to reduce the pressure of the patient in district hospital and medical
college hospitals,satelite hospitals are established in some places.
• There is proposal to convert big dispensaries and hospitals working at the
sub-divisional level into sub-divisional health centre.

5. • the propasal to link 5 lakh population to each sub divisional centre is under
consideration.
1.District hospital and dispensaries
• To convert district hospitals to district health centre is also proposed, so that
these hospitals can take the entire responsibility of community health.
• MOHFW is focusing on the health needs of urban people and for this
proposal of NATIONAL URBAN HEALTH MISSION (NUHM) are big
examined.
• the aim of the NUHM is to improve the health status of the urban poor,
particular the slum dwellers and other vulnerable segment of urban
population
2. Urban family welfare centres
• Urban family welfare centre are functioning in urban areas from 1950 to
provide family planning services for urban population.

6. 3. Urban health post
Urban health post are categorized in 4 types: A,B,C,D. these post providing
RCH, first-aid,distribution of the contraceptives and other services in the urban
areas.
4. Speciality hospitals
In these hospitals, only certain diseases, age group or patients with specific
problems are treated and specialties and speciality trained nurses care for the
patients. Like as TB hospital, children's hopsital,women hospitals comes under
this group
5.Teaching hospitals
Hospitals associated with medical colleges under this category. Along with
teaching of doctors and nurses, these hospitals provide complete care to people
of the area

7. 6. Super speciality hospitals or institutes
• These types of hospitals comes under this group.
• In these hospitals super speciality of different system/organs or diseases are
trained and patients are also treated.
• AIIMS, is an example of this type institute and provide the these type of
services. Like as Aiims Delhi,Aiims jodhpur,Aiims patna,Aiims bhopal,
Aiims raipur, Aiims bhuvneshwar,Aiims rishikesh.
• These all aiims are under the prandhan mantri swasthya surakhsa yojana
(PMSSY).

8. (Central Health Services/Health Insurance)
The central health services was restructured in 1982 to provide medical
manpower to various units like Directorate general of health services (DGHS),
Central govt.health services (CGHS),govt. of national capital territory(GNCT)
Of the Delhi, department of post, Assam Rifles .
Since inception a number of participating units like MCD,Himachal-
pradesh,Manipur,Goa,Tripura, have formed their own cadres.
Health insurance scheme
• The MOHFW has setup a task force to explore new health financing
mechanisms.
• The ministry has advised to state /UT govt. to prepare health insurance
models as per their local needs.
• GOI will provide support to state govt. for health insurance
scheme/projects, under NRHM.

9. 1) Employees state insurance scheme (ESI)
• ESI scheme was started in 1948 by an act passed in the parliament and
amended in 1975,1984,1989 &2010.
• It is a significant social security and health insurance for employees of
India.
• It provide certain cash and medical benefits to industrial employees in case
of sickness, maternity &employment injury.
Scope of ESI act:
• The ESI 1948 covered all power using factories other than seasonal
factories where more than 10 person were employed
• The 1975 amendment of ESI act extended to cover the following too:
 Small factories employing more than 10 person, irrespective of power
usages
 shops

10.  Hotels and restaurants
 Cinemas and theatres
 Road –motor transport establishments
 News paper established
 Private medical and educational institutional employing 20 or
more in some states
• The ESI Act amended (01-05-2010) to cover all employees
like manual, clerical, supervisory and technical whose monthly
income is upto Rs.15000

11. 2)Family planning scheme
• Govt. of India has launched family planning insurance scheme Wef. From
29-11-2005 for acceptors of sterilization and indemnity insurance cover for
doctors performing sterilization procedures both in govt. and accredited
private/NGO/corporate health facilities.
• MOHFW is also implementing a central sponsored family welfare linked
health insurance scheme since 1981 to compensate for the loss of wages for
day on which he/she attended the medical facility for under going
sterilization.
3) Central Government Health Scheme
(CGHS)
The scheme was formerly known as contributory health service scheme. This
scheme was first introduced at NEW DELHI in year 1954 for providing
services to central govt. employees. This provide comprehensive health
services to the CGHS beneficiaries.

12. Beneficiaries of central govt. health scheme:
• Pensioners drawing pension from civil estimates and their family members
• Members and ex-members of parliament
• Ex-governors and Ex- vice presidents
• Former prime minister, former judges supreme court and high courts and
freedom fighters
• It provide services through following Allopathic,Homeopathic,Indian
system of medicine (AYSH)
• Employees and pensioners of autonomous bodies covered under CGHS.
Services under the scheme:
• Outpatient services
• Domiciliary care

13. • Family welfare and MCH services
• Supply of necessary drugs
• Specialist consultation facilities at dispensary, polyclinic and hospital
• Diagnostic facilities like X-ray, ECG and laboratory examination.
• Hospitalization at recognized govt.and private hospitals
• Emergency treatment
• Supply of optical dental aids at reasonable cost
• Health education

14. Other government health services:
In this, health care services for railway employees and military personnel may
be included
1) Defence Medical services:
• For defence services, there are separate hospitals and health services
system which provides medical care to military personnel and their family
members.
• Defence health services come under armed forces medical services
(AFMS).
• They are responsible for providing all preventing, curative and promotional
health services.
• Defence services their own medical college ,nursing college and nursing
schools.

15. 2.) Railway medical services:
• Indian railways is a biggest govt. organization with highest number of
railway employees in the world.
• Railways provides wide range of health services to its employees through
railways hospitals, clinics and health units.
• Similarly organizations like postal department, atomic energy department.
also provide limited health services to their employees.

16. Autonomous institutes
• Under this category, all such institutions are included which receive central
govt. aid but except few important matters, all other decisions are made by
institutes itself .
• AIIMS Delhi, NIMHANS bengaluru , are example of such essential
sponsored autonomous health institutes.
National health programmes
• Govt. of India with the co-operation of state, other institution, global
agencies, is trying to face the challenges of communicable, non-
communicable and other serious diseases.
• So this is helpful in bringing down mortality and morbidity, quality of life
and health of our citizen also can be improved

17. AYUSH(Ayurveda,Yoga, and Naturopathy,unani, Siddha and Homeopathy) OR
(Indian system of medicine)
• A large part of our population have faith in
Ayurveda,Yoga,Siddha,Unani,Naturopathy and Homeopathy system of
treatment and takes medical help from these.
• Both in villages and cities, dispensaries of ISM are found
Rural health services in India
(Primary health care system)
The rural health services are being implemented through a network of primary
health care system: Three tier system

18. Three tier system
Community health centre (CHC)
A 30 bedded hospital /referral unit for 4PHC with
specialised services
Primary health centre (PHC)
A referral unit for 6 sub-centre 4-6bedded manned with
medical officer in- charge and 14 subordinate paramedical
staff
Sub centre (SC)
Most Peripheral Contact Point Between Primary
Health Care System & Community Manned With
One MPW(F)/ANM & One MPW (M)

19. 1.Sub-centre
Organization or set up :
• This is the first unit of health system for the villagers.
• For better coverage's, a sub-centre is setup for 5000 population in the plain
area and for 3000 population in hilly/tribal areas.
Personnel /staffing pattern for sub-centre: According to IPHS
• In order to provide essential (minimum assured services )or desirable (that
all states/UTs aspire have the following manpower /staff.
Manpower Essential Desirable Existing
Health worker
(F)/ANM
1 + 1 1
Health worker male 1 1
Safai-karamchari
contractual
1 1

20. Note: i) One safai-karamchari (on contract) may be provided from the untied
Fund (provided under NRHM)
ii) where there is only one ANM,RCH services would have the first
priority
iii) At least one ANM must stay at sub-centre headquarter village.
iv) In village above 5000population, additional ANMs could be added
on the existing SCs. Separate sub- centre is not mandatory
v) The staff of SC will have the support of ASHA/VHG/TBAs/AWW.
vi) Financial aid or support for the SC are made by Union ministry of
health and family welfare
vii) Male health worker are paid by state govt.

21. Supervision of subcentre:
Supervision of 6 female health workers, that is 6 SCs is done by a female health assistant
(FHA).
Main function of sub -centre/services provided in a sub-centre
by Indian public health standards (IPHS):
1. Maternal and child health:
A) Maternal health:
i) Antenatal care:
 Early registration of all pregnancies within first trimester(before 12 weeks of pregnancy)
 Minimum 4 ANC visit including registration ( Ist visit : within 12 weeks
IInd visit : between 14 & 26 weeks
IIIrd visit: between 28 & 34 weeks
ivth visit : between 36 wk& term)

22.  Associated services like general examination such as height,weight, B.P,
anaemia, abdominal girth, Iron and folic acid supplementation (from 12
wk), TT injection ,urine test for pregnancy confirmation and for sugar&
albumin, Hb estimation
 Identification of high risk pregnancy cases & STI/RTI
 Provide information about current scheme such as JSY
 Counselling on diet, rest, tobacco cessation, institutional deliveries, clean
care, new-born care, hygiene, new born registration, exclusive
breastfeeding,weaning
 Counselling &referral for HIV/AIDS

23. ii) Intra-natal care:
 promotion of institutional deliveries, skilled attendance at home deliveries
( when called for)
 Managing labour using partogragh identification and management of danger
signs during labour, basic first aid treatment for PPH, Eclampsia, sepsis and
prompt referral of such cases, minimum 6 hours stay in case of SCs delivery
iii) Postnatal care:
 Initiation of early breast feeding (within ½ to one hour of birth)
 Postnatal home visit on 0,3,7 and 42nd day . In case of low birth weight baby,
additional visit on 14,21,28 days
 Counselling on diet, hygiene, contraception, new born care

24. B) Child health :
• New born care corner in the labor room to provide essential new born care
• Promotion of exclusive breastfeeding (for 6 months)
• Assess the growth and development of infants and under 5 children
• Immunization ,vitamin -A prophylaxis
• Prevention and control of malnutrition, infectious Diarrhoea, ARI,Anaemia
including IMNCI strategy.
2. Family planning and contraception:
• Education, motivation and counselling to adopt appropriate family planning
methods
• Provision of contraception : condom, oral pills (E pills),IUD insertion (if
ANM is trained for that)

25. • Follow-up services to the eligible couples adopting any terminal/spacing
methods
3. Safe abortion services
4. Curative services:
• Provide the treatment for minor ailments including fever, ARI, Diarrohea
worm-infestation
• Provide treatment as AYUSH If ANM/MPW(M) is trained
5. Adolescent health care
6. School health services: staff of SCs provide assistance to school health
services
7.Control of local endemic diseases: Like as JE,kala-azar,malaria,dengue

26. 8.)Disease surveillance(integrated Diseases surveillance project –IDSP):
• Surveillance about any abnormal increases in cases of diarrohea,fever with
rash/jaundice/unconsciousness/ Rigors and early reporting to concerned
PHC
• High level of alertness for any unusual health event,reporting and
appropriate action
• Weekly submission of report to PHC
9.) Water and sanitation: Disinfect of drinking water resources and
promotion of sanitation (use of toilet and proper Garbage disposal)
10.)Outreach/field services:

27. i) Village health and Nutrition Day(VHND):
• VHND should be organized at least once a month.
• Following services should be provided at VHND: ANC,immunization,VIT-
A, Contraception, symptomatic care
ii) Home visit:
• For skilled attendance at birth
• Post natal and new born visit
• Under desirable function: home visit to eligible couples, follow-up of
sterilization cases of FP, visit to community based DOTS providers, leprosy
depot holder, visit to support ASHA to take blood slides/do RDK test in
cases with suspected malaria fever.

28. iii) House to house surveys: by ANM /MPW (M) and supporting
ASHA,AWWs panchayat members and village health and sanitation
committee
iv) Community level interaction:
• Health communication related to national health programmes
• Meetings to ASHA,AWW ,panchayat members, women groups
11) Coordination and monitoring :
• Coordinated services with AWW,ASHA,VHG,PRI, Village health and
sanitation committee
12.) promotion and medicinal herbs
13.)Record of vital events: recording and reporting of vital events including births
and deaths, and maintaining all records related to subcentres
14.)National health programmes: all programmes provide the better health
services to people in villages.

29. 2.Primary health centre (PHC)
Introduction:
• PHC are the corner of the rural health services –a first port of call to
qualified doctor of the public sector in rural areas for the sick and those
directly report or referred from SCs for curative & preventive and
promotive care.
• Its act as referral unit for 6 SCs and refer out cases to CHC
Organization or setup of PHC:
• PHCs is the health facility functioning at the block level between the SC
and CHC .
• As per recommended norms, there should be One PHCs for every 30,000
population for plain area & 20,000 population for hilly, tribal and backward
areas covers.
• 4-6 beds for patients and some diagnostics facilities are also availabe.
Personnel or staffing pattern of PHC: According to IPHS

30. Staff Existing
(minimum Norms)
Recommended
(Proposed by IPHS
Medical officer 1 3(at least 1 female)
AYUSH practitioner NIL 1 (AYUSH or any ISM )
Accounts manager 1
Pharmacist 1 2
Staff nurse /nurse midwife 1 5
Health worker (F)/ANM 1 1
Health educator 1 1
Health assistants (one male
and one female/LHV)
2(1 male and 1
H.A.F/LHV)
2 (one for 3 sub-centre)
Clerks 2 2
Laboratory technician 1 2
Driver 1 Optional (can be
outsourced)
Class-IV workers 4 4
Total 15 24/25

31. Main function of PHC/Services to be provided in PHC
by (IPHS)
These services are:
1. Medical care:(Essential)
• OPD services: a total hour of OPD services out of which 4 hours of OPD
services in the morning and 2 hours in the afternoon. Time schedule will be
vary from state to state.
• 24 Hours emergency services : Appropriate management of injuries and
accident, stabilization of the patient condition before referral, Dog bite /
snake bite/scorpion bite cases and other emergency services.
• IPD services (6 Bedded)
• Other services same as SCs
2. Maternal and child care including family planning: (Essential)
A) Antenatal care: Minimum laboratory investigation like Hemoglobin,urine
albumin & sugar, RPR test for syphilis.
Timely referral of such identified cases to FRU/other hospitals.

32. B).Intra-natal care: (24 hour delivery services both normal and assisted ):
• Assisted vaginal deliveries including forceps/vacuum delivery whenever
required.
• Same as SCs function
C) Post natal care: Same as SCs function
D) New Born Care: (essential):
• Resuscitation
• Management of neonatal hypothermia ( provision of KMC)
• Infection protection ,cord care and identification of sick new born and prompt
referral.
F) Family planning: (Essential) : i)permanent methods like Tubal ligation and
vasectomy/NSV
ii) Counselling and referral for couples having infertility
iii) other function same as SCs

33. 3. Medical termination of pregnancies: Essential:
i) Counselling and appropriate referral for safe abortion referral for safe
abortion services (MTP) for those in need.
Desirable:
i) MTP using manual vacuum aspiration (MVA) technique will be provided
in PHCs, where trained personnel and facility Exist.
4. Management of RTI/STD:
• Provide the treatment
• Health education for prevention of RTI/STI
5. Nutrition services (coordinated with ICDS): same as SCs services.
6. School Health services
7. Adolescent health care

34. 8.) promotion of safe drinking water and basic sanitation
9.) prevention and control of locally endemic diseases.
10.) Collection and reporting of vital events.
11.) Health education and behaviour change communication (BCC)
12.) Other National health programme
13.) Referral services: provided by PHCs
14.)Training:
Essential services
i) Imparting training to undergraduate medical students and intern doctors
ii) Orientation training of Male/female multipurpose health worker
iii) Skilled based training of ASHA
iv) Periodic training of doctors and paramedics

35. 15.)Basic laboratory services: Essential services
• Routine urine testing, stool and blood tests(Hb%/platelets count, WBC
total RBC, bleeding &clotting time
• Diagnosis of RTI/STD with wet mounting, Grams strain
• Sputum testing for mycobacterium
• Blood smear examination malarial
• Rapid diagnostics kit for delivery, malaria, faecal contamination of water
• Estimation of chlorine level of water using orthotoludine reagent
• Blood sugar
16) Monitoring and supervision: Essential services
• Monitoring and supervision of activities of sub-centre through regular
meetings/periodic visit

36. • Monitoring of all national health programmes
• Monitoring activities of ASHA
• Medical officer should visit all sub-centre at least once a month
• Health assistants male and LHV should visit Sub-centre once a week
17.) Functional linkages with sub-centre: Essential services
i) There shall be monthly review meeting at PHC chaired By MO (or in-
charge)and attended by all the MPHW(M/F)&Health assistants (M/F)
ii) organizing health day at Anganwari centre
18.) Mainstreaming of AYUSH: Essential services
AYUSH doctor at PHC shall attend patient for system specific AYUSH
based preventive, promotive and curative

37. 19.) Selected surgical procedure:
• The vasectomy, Tubectomy (including laparoscopic tubectomy),MTP,
Hydrocelectomy and cataract surgeries as a camp/fixed day approach have
to be carried out in a PHC having facilities of OT.
20.) Record of vital events and reporting:
A) Recording and reporting of vital statistics including births and deaths.
B) Maintenance of all the relevant records concerning services provided in
PHC
C) Facility based MDR (maternal death review) shall be conducted at the
PHC

38. 3. Community health centre (CHC)
Introduction :
• The CHC provide secondary level of health care in rural health services.
• These were designed to provide referral as well as specialist health care to
the rural population
Setup or organization pattern of CHC:
• CHC is established to cover to 1,20,000 population in the pains and 80,000
population in hilly/tribal areas.
• CHC is established in each community development block.
• Each CHC has 30 bed, An X-ray room, a delivery room, operation theatre
and laboratory.
• This works as a referral centre for 4 PHC.

39. Personnel/staffing pattern of CHC
According to IPHS
Personnel Essential Desirable Qualification Remarks
Block Health
Officer(bcmo)
1 - Senior Most
Specialists/
GDMO Preferably
With Public Health
Experience
Managing The All
Block Medical And
Public Health Services
General Surgeon 1 - Ms/Dnb
Physician 1 - Md/Dnb
Obg 1 - Dgo/Md/Dnb
Paediatrician 1 - Dch/Md
Anaesthetist 1 - MD/DNB/DA/LSAS
Trained MO
Public Health Manager 1 - Md
Eye Surgeon 1 (1 For Every Five
CHC)
- Md/Ms/Doms/Dnb
Dental Surgeon 1 - Bds
1.specialist/health officers/manager:

40. Conti.
General duty medical
officer
6 (at least 2 female
doctors)
- MBBS
Specialist of AYUSH - 1 Post graduate in
AYUSH
General duty of
medical officer of
AYUSH
1 - Graduate in AYUSH
Part time cancer
surgeon/
physician
- 1 To be provided under
programme
PPP mode
TOTAL 15/16 17/18
2.Support manpower(Nursing, Paramedical,
auxiliary)
Personnel Essential Desirable
Staff nurse 15 +3
Lady health visitor 1

41. Public Health Nurse 1
Anm 1
Pharmacist -AYUSH 1
Pharmacist/Compounder 3
Lab. Technician 3
Radiographer 2
Dietition 1
Ophthalmic Assistant 1
Dental Assistant 1
Cold Chain& Vaccine Logistic
Assistant
1
Dresser 1
Ward Boys 5

42. Sweepers 5
Dhobi 1
Mali 1
Aya 1
OPD Attendant 1
Peon 2
Registration Clerk 2
Data Entry Operator 2
Trained Cooked 2
Accountant 1
O.T Technician 1
Multi Rehabilitation Worker 1
Counsellor 1
Driver 3
TOTAL 65 75

43. Function or Services to be provided in CHCs
1.)Care of routine and emergency cases in surgery :
Essential services
• This includes dressings, incision and drainage, and surgery for Hernia,
Hydrocele,
• Appendicitis, Hemorrhoids, Fistula, and stitching of injuries.
• Handling of emergencies like Intestinal Obstruction, Hemorrhage, etc.,
• Other management including nasal packing, tracheostomy, foreign body
removal etc.
• Fracture reduction and putting splints/plastic cast.
2.) Care of routine and emergency cases in medicine:
Essential services
• Specific mention is being made of handling of all emergencies like Dengue
• Hemorrhagic Fever, Cerebral Malaria and others like snake bite cases,
Poisonings,

44. Congestive Heart Failure, Left Ventricular Failure, Pneumonias,
meningoencephalitis, acute respiratory conditions, status epilepticus, Burns, Shock,
acute dehydration etc. Incase of National Health Programmes, appropriate
guidelines are already available, which should be followed.
3.)Maternal Health :
Essential services
• Minimum 4 ANC including Registration : As some antenatal cases may
directly register with CHC, the suggested schedule of antenatal visits is
reproduced below
• 1st visit: Within 12 weeks—preferably as soon as pregnancy is suspected—
for registration of pregnancy and first antenatal check-up
• 2nd visit: Between 14 and 26 weeks
• 3rd visit: Between 28 and 34 weeks
• 4th visit: Between 36 weeks and term 24-hour delivery services including
normal and assisted deliveries.

45. • Managing labour using Partograph.
• All referred cases of Complications in pregnancy, labour and post-natal period must be
• adequately treated.
• Ensure post- natal care for 0 & 3rd day at the health facility both for the mother and
new-born and sending direction to the ANM of the concerned area for ensuring 7th &
42nd day post-natal home visits Minimum 48 hours of stay after delivery, 3-7 days stay
post delivery for managing Complications.
• Proficiency in identification and Management of all complications including PPH,
Eclampsia, Sepsis etc. during PNC.
• Essential and Emergency Obstetric Care including surgical interventions like Caesarean
Sections and other medical interventions
4. New born care child health care:
• Essential New Born Care and Resuscitation by providing Newborn Corner
in the Labour Room and operation theatre (where caesarian takes place).
Details of New Born Corner given at:

46. • Early initiation of breast feeding with in one hour of birth and promotion of
exclusive breast-feeding for 6 months.
• Counseling on Infant and young child feeding as per IYCF guidelines.
• Routine and emergency care of sick children including Facility based IMNCI
strategy
• Full Immunization of infants and children against Vaccine Preventable
Diseases and Vitamin-A prophylaxis as per guidelines of Govt. of India.
• Prevention and management of routine childhood diseases, infections and
anemia etc.
5. Family planning services: essential services:
• Full range of family planning services including IEC, counseling, provision of Contraceptives, Non
Scalpel Vasectomy (NSV) & Laparoscopic Sterilization Services and their follow up Safe Abortion
Services
• Desirable services:
• · MTP Facility approved for 2nd trimester of pregnancy

47. 6. National health programmes : All NHP should be delivered through the
CHCs
7.Other services:
• Blood Storage Facility
• Diagnostic Services
• Referral (transport) Services
• Maternal Death Review

48. Other Rural Health Services:
At Village Level:
• Village Health Guide
• Local Dais
• Anganwadi Worker
• Asha
I) Village health guide scheme (VHG) :
• Introduced On 2nd October 1977 With The Idea Of Securing People’s
Participation In The Care Of Their Own Health.
• The Guidelines For Their Selection Are:
 Permanent Residents Of The Local Community, preference given to women
 Able To Read And Write, Having Minimum Formal Education at least 8th class
pass
 Acceptable To All Section Of The Community, And

49.  Able to spare at least 2 to 3 hrs every day for health work After
selection, the Health Guides undergo a short training in primary
health care.
• Function of VHG:
 The duties assigned include treatment of simple ailments and
activities in first aid, mother and child health including family
planning ,health education and sanitation.
 VHG works as a link between village community and govt. health sector
 VHG receives RS.50/- As honorarium /month

50. II. Local Dais/TBAs
• An extensive programme has been undertaken under the Rural Health
Scheme to train all categories of local dais in the country to improve their
knowledge in the elementary
• Concepts of maternal and child health and sterilization, besides obstetric
skills.
• During her training of 30 days each dais is required to conduct at least 2
deliveries under the guidance and supervision.
• After training each dai is provided with delivery kit and certificate
• They are also expected to play a vital role in propagating small family
norm since they are more acceptable to the community.

51. III. Anganwadi Worker
• Under the ICDS scheme, there is an anganwadi worker for a population of
1000.
• The anganwadi worker is selected from the community she is expected to
serve.
• She undergoes training in various aspects of health, nutrition and child
development for 4 months services rendered include health education, non
-formal pre-school education and referral services.
• The beneficiaries are generally nursing mothers, other women, adolescents
and children below the age of 6 years.

52. IV. ASHA (Accredited social health Activist): Under NRHM already done
• ASHA(accredited social health activist)will be a health activist in the community
who will create awareness on health
• Responsibilities of ASHA are:
 To create awareness and public information to the community on determinants of
health counsel women on material and child health ,prevention of communicable
infections including RTI/sexually transmitted infection, family planning ,care of
young child etc
 Provide primary medical care for minor ailments such as diarrhoea, fevers and first
aid for minor injuries act as a depot holder for essential provisions being made
available like oral rehydration therapy ,iron ,folic acid tablets, oral pills etc
 Inform about births and deaths ,any unusual health problems etc in her village
 Promote total sanitation campaign

53. VOLUNTARY HEALTH AGENCIES
• In the health agencies of India, the role of voluntary agencies is very
important.
• These agencies provide help and strength to public health system.
• They play vital role in training, exhibition, propaganda and also conducting
various community health programmes.
• These agencies are :Indain red cross society, Hind kusht nivaran
sangh,indian council of child welfare,tuberculosis association of
india,Bharat sevak samaj,central social welfare board,the kasturba
memorial fund, family planning association of india,all india womens
conference.

54. PRIVATE SECTOR
Private Hospitals And Clinics :
• Because of mixed economy and globalisation, private hospital are being opened rapidly.
• From small to large metropolitan cities, their network is spreading.
• But private hospitals, nursing homes and clinics are mainly therapeutic institutions and
provide health services to urban population only.
• To get their services, price is to be paid, hence poor and weaker section cannot get their
services.
Private consultation centre:
• With increasing number of allopathic hospitals, the tendency to start health consultation
privately, is increasing among doctors.
• In rural areas fake doctors or quacks often start private clinics and consultation which is
a mockery of health care of common people and is to be checked.
• Allopathic doctors, physicians of ISM and Homeopathy (AYUSH) also conduct &
consultation services.
• Nursing practices is also found with improvement in nursing profession.

55. Mission, Trust, or Religious hospital
• These hospitals are managed by Mission, trust or Charitable institutions.
• In many parts of the country, such hospitals and clinics provide medical
services either free of cost or at very cheap rate to common people
• Though they are functioning mainly in urban areas, they provide health
care to rural population also, through camps or community care centres.