Health Care Delivery System In India Ppt Free Download
Roseanne Dumpe
Although the first national population program was announced in 1951, the first National Health Policy of India (NHP) got formulated only in 1983 with its main focus on provision of primary health care to all by 2000.3 It prioritized setting up a network of primary health-care services using health volunteers and simple technologies establishing well-functioning referral systems and an integrated network of specialty facilities. NHP 2002 further built on NHP 1983, with an objective of provision of health services to the general public through decentralization, use of private sector and increasing public expenditure on health care overall.4 It also emphasized on increasing the use of non-allopathic form of medicines such as ayurveda, unani and siddha, and a need for strengthening decision-making processes at decentralized state level.
Schematic diagram of the Indian Public Health Standard (IPHS) norms, which decides the distribution of health-care infrastructure as well the resources needed at each level of care is shown in Figure 1.
Seeking to improve access of rural people, especially poor women and children, to equitable, affordable, accountable and effective primary health care, NRHM (2005-2012) aimed to provide effective health care to the rural population throughout the country with special focus on 18 states having weak public health indicators and/or weak infrastructure. Within the mission there are high-focused and low-focused states and districts based on the status of infant and maternal mortality rates, and these states are provided additional support, both financially and technically. Gradually it has emerged as a major financing and health sector reform strategy to strengthen the state health systems.
The strategy identifies the roles to be played at each level of care and the service provision and health systems requirement in terms of manpower and commodities for each of them. (Figure 1)21, 22, 23 SCs and PHCs are designated as delivery points; CHCs (which are the FRUs) and district hospitals have been made functional 24 7 to provide basic and comprehensive obstetric and newborn-care services. Only those health facilities are designated as FRUs that have the facilities and manpower to conduct a caesarean section. Moreover, the strategic document identifies the required capacity building efforts for which NRHM has produced manuals. So far out of 116 capacity building manuals, 10 are dedicated to newborns. The document also has the guidance for reaching remote inaccessible areas to ensure maternal and child Health care.
Why is the level of health awareness low in the Indian population? The answers may lie in low educational status, poor functional literacy, low accent on education within the healthcare system, and low priority for health in the population, among others.
Even if a healthcare facility is physically accessible, what is the quality of care that it offers? Is that care continuously available? While the National (Rural) Health Mission has done much to improve the infrastructure in the Indian Government healthcare system, a 2012 study of six states in India revealed that many of the primary health centers (PHCs) lacked basic infrastructural facilities such as beds, wards, toilets, drinking water facility, clean labor rooms for delivery, and regular electricity.[14]
As thinkers in the disciplines of community medicine and public health, we must encourage discussion on the determinants of access to healthcare. We should identify and analyze possible barriers to access in the financial, geographic, social, and system-related domains, and do our best to get our students and peers thinking about the problem of access to good quality healthcare.
While the private sector accounts for most of the health expenditures in the country, the state-run health sector still is the only option for much of the rural and peri-urban areas of the country. The lack of a qualified person at the point of delivery when a person has traveled a fair distance to reach is a big discouragement to the health-seeking behavior of the population. According to the rural health statistics of the Government of India (2015), about 10.4% of the sanctioned posts of auxiliary nurse midwives are vacant, which rises to 40.7% of the posts of male health workers. Twenty-seven percentage of doctor posts at PHCs were vacant, which is more than a quarter of the sanctioned posts.[18]
Considering that the private sector is the major player in healthcare service delivery, there have been many programs aiming to harness private expertise to provide public healthcare services. The latest is the new nationwide scheme proposed which accredits private providers to deliver services reimbursable by the Government. In an ideal world, this should result in the improvement of coverage levels, but does it represent a transfer of responsibility and an acknowledgment of the deficiencies of the public health system?
As trainers and educators in public health, how are we equipping our trainees to deliver a health service in the manner required, at the place where it is needed and at the time when it is essential? It is time for a policy on health human power to be articulated, which must outline measures to ensure that the last Indian is taken care of by a sensitive, trained, and competent healthcare worker.
It is common knowledge that the private sector is the dominant player in the healthcare arena in India. Almost 75% of healthcare expenditure comes from the pockets of households, and catastrophic healthcare cost is an important cause of impoverishment.[19] Added to the problem is the lack of regulation in the private sector and the consequent variation in quality and costs of services.
Locally, a consciousness of cost needs to be built into the healthcare sector, from the smallest to the highest level. Wasteful expenditure, options which demand high spending, unnecessary use of tests, and procedures should be avoided. The average medical student is not exposed to issues of cost of care during the course. Exposing young minds to issues of economics of healthcare will hopefully bring in a realization of the enormity of the situation, and the need to address it in whatever way possible.
In the healthcare profession, it may be argued that we are responsible for a variety of people and constituencies. We are responsible to our clients primarily in delivering the service that is their due. Our employers presume that the standard of service that is expected will be delivered. Our peers and colleagues expect a code of conduct from us that will enable the profession to grow in harmony. Our family and friends have their own expectations of us, while our government and country have an expectation of us that we will contribute to the general good. A spiritual or religious dimension may also be considered, where we are accountable to the principles of our faith.
In the turbulent times that we live in, the relationships with all the constituents listed above have come under stress, with the client-provider axis being the most prominently affected. While unreasonable expectations may be at the bottom of much of the stress, it is time for the profession to recognize that the first step on the way forward is the recognition of the problem and its possible underlying causes. Ethics in healthcare should be a hotly discussed issue, within the profession, rather than outside it.
At the federal level, the Ministry of Health and Family Welfare has regulatory power over the majority of health policy decisions but is not directly involved in health care delivery. The ministry comprises two departments:
At the state level, the Directorates of Health Services and the Departments of Health and Family Welfare are responsible for organizing and delivering health care services to their populations. These include all medical care, from primary care and pharmacies to secondary and tertiary hospital care. These state bodies are also responsible for the following:
There are various public insurance schemes, including RSBY, which provides hospital coverage for most diseases and pre-existing health conditions for individuals living below the poverty line (with a family cap of five members). Outpatient care, primary care, and high-level tertiary care are not included.
Another important health coverage scheme is the Central Government Health Scheme, organized and run by the Ministry of Health and Family Welfare for current and retired central government employees and their dependents.11 There are no income or wage requirements to be eligible. Coverage includes health care services for allopathic, homeopathic, and alternative medicine treatments.12 Approximately 3.6 million beneficiaries were registered under this scheme as of late 2019.13 Similar schemes exist for railway and defense employees.
The launch of the National Health Protection Scheme aims to insulate lower-income households from high health care costs by offering free care to beneficiaries in private facilities as well as public facilities.
Primary care: Under the Health and Wellness Centres program, 150,000 subcenters (the lowest tier of the health system) across the country are being upgraded to provide comprehensive primary health care services, free essential medicines, and free diagnostic services. Nutritional support will also be provided to all beneficiaries with tuberculosis at a rate of INR 500 (USD 7) per month during treatment. Other primary health care providers include primary health centers (PHCs) and community health centers. No patient registration is required.
Outpatient specialist care: Community health centers also provide outpatient specialist care and are required to have four medical specialists (surgeon, general practitioner, gynecologist, and pediatrician) supported by paramedical and other staff. They must also have 30 beds, a laboratory, X-ray services, and other facilities. Each center covers 80,000 to 120,000 people. All outpatient specialized services not provided at community centers are referred to district hospitals.
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