HEALTH CARE DELIVERY-

1. HEALTH CARE DELIVERY

3. Health status or
health problems
Curative
Preventive
Promotive
Public
Private
Voluntary
Indigenous
Changes
in health
status
Resources
Inputs Health care
services
Health care
system
Outputs
Model of a health care system

4. Health status and health problems
• Demographic profile
• Mortality profile

5. • Health problems-
1.Communicable disease problems-
• malaria
• Tuberculosis
• Diarrhoeal ds’s
• ARI
• Leprosy
• Filaria
• AIDS
• Others
2.Non-communicable ds’s

6. 3.Nutritional problems-
• PEM
• Nutritional anaemia
• LBW
• Xerophthalmia
• IDD
• Others
4.Environmental sanitation
5.Medical care problems
6.Population problem

7. Resources
• Health manpower
• Money and material
• Time

8. Health care services
• Curative
• Preventive
• Promotive

9. Health care systems
• 1.PUBLIC HEALTH SECTOR
a) Primary Health Care
Primary health centres
Sub-centres
b) Hospitals/Health Centres
Community health centres
Rural hospitals
District hospital/health centre
Specialist hospitals
Teaching hospitals

10. c) Health Insurance Schemes
ESI
CGHS
d) Other agencies
defence services
railways

11. 2. PRIVATE SECTOR
a) Private hospitals, polyclinics, nursing homes,
and dispensaries
b) General practitioners and clinics

12. 3. INDIGENOUS SYSTEMS OF MEDICINE
Ayurveda and siddha
Unani and tibbi
Homeopathy
Unregistered practitioners

13. 4. VOLUNTARY HEALTH AGENCIES
5. NATIONAL HEALTH PROGRAMMES

14. HEALTH SYSTEM IN INDIA
1. AT THE CENTRE
The ministry of health and family welfare
The directorate general of health services
The central council of health and family welfare

15. • Union ministry of health and family welfare
Dept. of health
Dept. of family welfare
Functions-
Union list
Concurrent list

16. • Directorate general of health services-
Organization
Functions-general , specific
• Central Council of health-
functions

17. 2. AT THE STATE LEVEL
State ministry of health
State health directorate-
director of health services
director of medical education

18. 3. AT THE DISTRICT LEVEL
Sub-divisions
Tehsils
Community development blocks
Municipalities and corporations
Villages
Panchayats

19. • PANCHAYATI RAJ
Panchayat-at the village level
Panchayat samiti-at the block level
Zilla parishad-at the district level

20. LEVELS OF HEALTH CARE
• PRIMARY CARE LEVEL
• SECONDARY CARE LEVEL
• TERTIARY CARE LEVEL
REFERRAL SYSTEM

23. PRIMARY HEALTH CARE
• “Is the essential health care made universally
accessible to individuals and acceptable to
them, through their fulll participation and at a
cost the community and country can afford.”

24. ELEMENTS
• Education of prevailing health problems and
methods of preventing and contolling them
• Promotion of food supply and proper nutrition
• Safe water and basic sanitation
• MCH +FP

25. • Immunization
• Locally endemic ds’s
• Common ds’s and injuries
• Essential drugs

26. PRINCIPLES
• Equitable distribution
• Community participation
• Intersectoral coordination
• Appropriate technology

27. Primary health care in India
• VILLAGE LEVEL-
village health guides scheme
Local dais
Anganwadi workers
ASHA

28. SUB-CENTRE LEVEL
• Immunization
• Antenatal care
• Natal care
• Post natal care
• Prevention of malnutrition
• Common childhood illnesses
• Family planning and counseling
• Drugs for ARI, diarrhoea,fever,worm
infestation
• NHPs

29. staff
• MHW(F)=ANM=1/2
• MHW(M)=BHW=1
• HA(F)=LHV
• HA(M)=SI
• VHW=1
•
• Total=2-3/3-4

30. services
• Maternal health care- ANC,INC,PNC
• Child health care
• FP and counseling
• MTP
• Adolescent health
• School health services
• Water quality monitoring
• Sanitation

31. • Field visits
• Community needs assessment
• Curative
• + AYUSH
• Training-TBA/ASHA
• NHP-
NACP,NVBDCP,NLEP,IDSP,RNTCP,NBCP,NCDCP
• Vital events

32. PRIMARY HEALTH CENTRE LEVEL
• Medical care
• MCH+FP
• Safe water and sanitation
• Local endemic ds’s
• Vital stats
• HE
• NHP
• Referral services
• Training
• Basic lab

33. IPHS standards
• Medical care- OPD, 24 hr emergency, referral,
IPD(6 beds)
• MCH- ANC-lab,nut & counseling,
supplementary, high risk, referral
• Intranatal
• PNC
• New born care
• IMNCI

34. • FP
• MTP
• HE
• Nutrition
• School health services
• Adolescent health services
• Ds surveillance and epidemic ds control
• Vital events

35. • Sanitation
• Water quality
• NHP
• Referral
• Training
• Basic lab
• Monitoring and supervision
• Selected surgical
• AYUSH

36. staff
• MO=1/3(1 F)
• AYUSH=0/1
• Pharmacist=1/2
• Nurse=1/5
• HW(F)=1/1
• HA(M&F)=1/2
• HE=1/1
• Account manager=0/1

37. • Clerk=2/2
• LT=1/2
• Driver=1/optional
• Class IV=4/4
Total=15/24-25

38. COMMUNITY HEALTH CENTRES
IPHS std:
• Care of routine & emergency surgery cases
• Care of routine & emergency medicine cases
• 24 hr delivery-normal &CS
• Essential & emergency obstetric care
• FP+ laparoscopic sterilization
• Safe abortion

39. • New born care
• Sick children
• Others- tracheostomy, nasal packing, FB
removal
• NHPs
• Others- blood storage,
essential lab
referral(transport)

40. staff
• Surgeon=1/1
• Physician=1/1
• Obs/gynaecologist=1/1
• Paediatrician=1/1
• Anaesthetist=0/1
• PHM=0/1
• Opthalmologist= 0/1 for 5 CHCs
• Dental surgeon=0/1
• MO=6 MBBS(2F)
• AYUSH=0/2(1 ug+1pg)
Total=4/15-16

41. • Nurse=7+2
• Dresser=1
• LT=1
• Radiographer=1
• OA=0-1
• Ward boy=2
• Sweeper=3
• OPD att./stat asst./data entry operater/OT
att./reg clerk=5
Total=21-22+2

42. • SN=19
• PHN=1
• ANM=1
• Pharmacist=3
• Pharmacist AYUSH=1
• LT=3
• Radiographer=2
• OA=1
• Dresser=2
• Ward boy=5
• Sweeper=5

43. • Chowkidar=5
• Dhobi=1
• Mali=1
• Aya=5
• Peon=2
• OPD asst.=1
• Reg clerk=2
• Stat asst.=2
• Accountant=1
• OT tech=1
Total=64

44. Job descriptions
MO, PHC
HW(F)-
• MCH
• FP
• MTP
• Nutrition

45. • UIP
• Dai training
• Communicable ds’s
• Vital events
• Record keeping
• Treatment
• Team activity

46. HW(M)
• Record keeping
• Vector borne ds’s-malaria,filaria,JE,KA
• Communicable ds
• Leprosy
• TB
• NBCP
• Environmental sanitation
• EPI
• FP

47. • ASHA
• HA(M&F)

48. • HOSPITAL Vs HEALTH CENTRE