Determinants of health include genetic, behavioral, socio-cultural, environmental, and socio-economic factors. A health care system aims to meet the needs of the entire community through preventive, curative, and rehabilitative services with community participation. India's health care system has three levels - primary, secondary, and tertiary care. The government aims to transform 150,000 primary health centers into Health and Wellness Centers by 2022 as part of the Ayushman Bharat program to provide comprehensive primary health care.

1. Determinants of health and
health care system
RDM 202
Rural Health and well being
Dr. Rajeev Kumar
M.S.W.,(TISS, Mumbai), M.Phil., (CIP, Ranchi), UGC-JRF.,
Ph.D., (IIT Kharagpur)

2. Determinants of health

3. Previous models

4. BPSS model

5. activity
• Comparison of all model
• And listing of all factors
• 5-10 minutes

6. What are those determinants?
• Genetic disposition
• Behavioural and socio-cultural conditions

7. Environment
• Internal environment
Each and every component part, every tissue,
organ, organ system, and their harmonious
functioning within system
External environment
Macro-environment are kind of things, human
being are exposed,
Micro-environment: it is also called personal
environment, way of living, smoking, drinking

8. Socio-economic condition
• Economic status
• Education
• Occupation
• Political system

9. What is health care system?
• Since health is influenced by number of
factors: nutrition, housing, basic sanitation,
healthy life style, protection against
environment hazards and communicable
disease.
• Therefore medical care is not synonymous
with health care.
• Medical care is subset of health care system

10. Health system
• Health services should be organized to meet
the need of entire community and not mere
selected groups.
• It should covers full range of preventive,
curative, and rehabilitation service.
• Community participation is now recognized a
major component in health care system

11. Health for all
• After three decade of trial and error and
dissatisfaction in meeting people’s health need,
the WHO ( world health organization) in may
1977 decided the main social goal of
government.
• “ attainment by all the people of the world by the
year 2000 of a level of health that will permit
them to lead a socially and economically
productive life.
• This goal has come to be popular known as
“health for all by the year 2000” (HFA)

12. Level of health care

13. Sub centre level
• It is for 5000 population in plain and 3000 for
hilly regions.
• It is managed by one male and female
multipurpose health worker
• Its function is limited to mother and child
health care
• And primary laboratory investigations

14. Primary health care
• Primary care level
• It is the first level of contact of individual , the
family, community with national health system.
• It is very close to community.
• In Indian context, primary health care is provided
by PHC and sub-centre, through multipurpose
worker, village health guide, ASHA, Sevika,
• It is for 30,000 population in plain and 20,000
population in hilly region

15. Primary health care and Alma-Ata
declaration
• The concept of primary health care came in to
lime-light in 1978 following an international
conference in Alma-Ata USSR. It defined
• “ essential health care based on practical
scientifically sound and socially acceptable
methods and technology made universal
accessible to individual and families in the
community through participation at a cost that
community and country could afford to maintain
every stage of their development in spirit of self-
determination”

16. Declaration of Alma-Ata
1. Education about prevailing health problems and
method of preventing and controlling them
2. Promotion of food supply and proper nutrition
3. Promotion of safe water and basic sanitation
4. Maternal and child health care, including family
planning;
5. Immunization against infectious disease
6. Prevention and control of endemic diseases
7. Appropriate treatment of common disease and
injuries and
8. Provisions of essential drugs

17. Alma-Ata declaration and India
• As a signatory of Alma-Ata declaration,
Government of India ha pledged itself to
provide primary health care.
• It was first proposed by Bhore Committee in
1946 in India
• Before Alma-Ata declaration, primary health
care was regarded as “basic health care”, “first
contact health care”, “easily accessible health
care”, and “service provided by generalists”

18. Principle of primary health care
• Equitable distribution
• Community participation
• Intersectoral coordination
• Appropriate technology

19. Function of PHC
• Education about health
• National health programme
• Referral services
• Training of health guides and health workers
local dai
• Basic laboratory service

20. Secondary care level
• Higher level of care
• More complex problems are dealt with
• In India, it is district hospital and CHC
(community health centre).
• It is also first referral level
• It covers a population of 80,000 to 1,20,000
• 30 bed and specialist in surgery

21. Tertiary care level
• Tertiary level is more specialized than
secondary level and requires specific facilities.
• Medical college, All India Institutes, Regional
hospitals, specialized hospitals and other apex
hospital

22. Health and wellness centre
• 1,50,000 Sub Health Centres(SHC), Primary
Health Centres (PHC) and Urban Primary
Health Centres (UPHC) to be transformed as
Health Wellness Centres by 2022

23. Current progress
• Ayushman Bharat – Health and Wellness Centres
• Ayushman Bharat (AB) is an attempt to move from a
selective approach to health care to deliver comprehensive
range of services spanning preventive, promotive, curative,
rehabilitative and palliative care.
• It has two components which are complementary to each
other.
• Under its first component, 1,50,000 Health & Wellness
Centres (HWCs) will be created to deliver Comprehensive
Primary Health Care, that is universal and free to users,
with a focus on wellness and the delivery of an expanded
range of services closer to the community.

24. Ayushman Bharat – Health and
Wellness Centres
• The second component is the Pradhan Mantri Jan Arogya
Yojana (PM-JAY) which provides health insurance cover of
Rs. 5 lakhs per year to over 10 crore poor and vulnerable
families for seeking secondary and tertiary care.
• HWC are envisaged to deliver expanded range services that
go beyond Maternal and child health care services to
include care for non -communicable diseases, palliative and
rehabilitative care, Oral, Eye and ENT care, mental health
and first level care for emergencies and trauma , including
free essential drugs and diagnostic services

25. Thanks for listening