HEALTH CARE DELIVERY SYSTEM IN INDIA

HEALTH CARE DELIVERY SYSTEM IN INDIA
INTRODUCTION
The challenge that exists today in many countries in to reach the whole population with adequate health care services and to ensure their utilization. The large hospital which was chosen hetherto for the delivery of health services has failed in the sense that is serves only a small part of the population that too, living with in a small radius of the building and the services rendered are mostly curative in nature. Therefore it has been aptly said that these large hospitals are more ivory towers of disease that centres for the delivery of comprehensive health care services. Rising costs in the maintenance of these large hospitals and their failure to meet the total health needs of the community have led many countries to seek alternative models of health care delivery with a view to provide health car services that are reasonably inexpensive and have the basic essentials required by rural population.

Definitions of health according to WHO
“A state of complete physical, mental and social well being and not merely the absence of disease or infirmity”.

Brody & Sobel (1981) using a system theory view, defines health as “a ability of a system (for example, cell organism, family, society, to respond adaptively to a wide variety of environmental challenges (for ex. Physical, chemical, infections, psychological, Social)”.

Definitions of health care delivery system
“It is the organized local, state, or national effort designed to deliver services deemed essential to obtain a pre-established set of goals”

Concept of health
Health is a common theme in most cultures. Infact all communities have their concepts of health, as part of their culture. Among definitions still used, probably the oldest is that health is the “absence of disease”. In some cultures, health and harmony are considered equivalent, harmony being defined as a being at peace with the self, the community god and cosmos”. The ancient Indians and Greeks shared this concept and attributed disease to disturbances in bodily equilibrium of what they called “humors”.

The model
The number of models have been developed for the delivery of health care services. One of the simplest models is shown in this figure.

Inputs : Health status or health problems of the community represents health needs and health demands of the community.

Resources : Limited to meet the health needs, priorities have to be set.

Health care services : Designed to meet the health needs through the use of available knowledge and resources.
Services provided should be comprehensive and community based and must be distributed according to the needs of the community.
Health care system is intended to deliver the health care services.

Out put : it is the changed health status or improved health status of the community i.e., lives saved, death averted, diseases prevented, cases treated, expectation of life prolonged.

INPUTS : HEALTH STATUS
1.Morbidity and mortality statistics
2.Demographic conditions of the populations.
3.Environmental conditions which have a bearing on health.
4.Socio-economic factors which have a direct effect on health.
5.Cultural background, attitudes, beliefs and practices which affect health.
6.Medical and health services available.

Input health problems
1.Communicable disease problems
2.Nutritional problems
3.Environmental sanitations problems
4.Medical care problems
5.Population problems

Resources
1.Health manpower
2.Money and material
3.Time

Health care system
The health care system is intended to deliver the health care services. It constitutes the management sector and involves organizational matters. In India, it is represented by five major sectors or agencies which differ from each other by the health technology applied and by the source of funds for operation.

Sectors of health care systems
1.Public sector

a.Primary health care
Primary health centres
Sub centres
b.Hospitals / health centres
Community health centres
Rural hospital
District hospital/ health centre
Specialist hospital
Teaching hospital
c.Health insurance schemes
Employees state insurance
Central Govt. health scheme.
d.Other agencies
Defence services
Railways

1.Private sector
a.Private hospitals, polyclinics, Nsg homes, and dispensaries.
b.General practitioners and clinics.

2.Indigenous systems of medicine
Ayurveda and siddha
Unani and tibbi
Homeopathy
Unregistered practitioners

3.Voluntary health agencies

4.National health programmes

1. PUBLIC SECTOR
a. Primary health care in India
In 1977, Govt. of India launched a rural health scheme, based on the principles of “Placing peoples health in peoples hands”. It is a three tier system of health care delivery in rural areas based on the recommendation of the shrivastav committee in 1975. Close on the heels of these recommendations an international conference at Alma – Ata in 1978, set the goal of an acceptable level of health for all the people of the world by the year 2000 atrough primary health care approach.
1.Village health guides
2.Local dais.
3.Anganwadi worker
4.Sub centre level
5.Primary health center level

Function of the PHC
a.Medical care
b.MCH including family planning
c.Safe water supply and basic sanitation
d.Prevention and control of locally endemic disease.
e.Collection and reporting of vital statistics
f.Education about health
g.National health programme as relevant
h.Referral services
i.Training of health guides, health workers, local dais and health assistants.

Hospitals / health center
1.Community health centres
2.Rural hospital
3.District hospital

a.Health insurance scheme
1.Employees state insurance schemes
2.Central govt. health scheme

b.Other agencies
1.Defence medical services
2.Health care of railway employees
2. Private agencies
3.Indigenopus systems of medicine
4.Voluntary health agencies

Voluntary health agencies of the India
1.Indian red cross society
2.The hind Kusht Nivaran Sangh
3.Indian council for child welfare
4.Tuberculosis association of Indian
1.Bharat sevak samaj
2.Central social welfare board
3.Kasturba memorial fund
4.Family planing association of India
5.All India womens conference
6.The all India blind relief society
7.Professional bodies
8.International agencies

National health programs
National – Malaria eradication programme
National filaria control programme
National tuberculosis programme
National leprosy eradication programme
Diarrhea disease control programme
STD control programme
National programes for control of blindness
Iodine deficiency disorders programme
Universal immunization programme
National family welfare programme
National water supply and sanitation programme
Guinea worms eradication programmes
Minimum needs program

National diabetic control programme
National cancer control programme
National AIDS control programme
20-point programme
Child survival and safe motherhood programme