HEALTH CARE SERVICES IN INDIA

HEALTH CARE

SERVICES IN INDIADR. MAHESWARI JAIKUMAR.

maheswarijaikumar2103@gmail.com

PURPOSE OF HEALTH CARE

• The purpose of the health care services is to improve the health status of a population.

CHARACTERISTICS OF A GOOD HEALTH SERVICE

• 1. Comprehensive.• 2. Accessible. • 3. Acceptable. • 4.Provide scope for community

participation.• 5. Available at a cost the country &

community can afford.

HEALTH CARE SYSTEMS• The health care system is

intended to deliver the health care services.

• It operates within the context of the socioeconomic & political framework of the country.

• In India it is represented by five major sectors or agencies which differ from each other by the health technology applied & by the source of funds for operation.

AGENCIES OF HEALTH CARE• 1.PUBLIC HEALTH SECTOR.• 2.PRIVATE SECTOR.• 3. INDIGENOUS SYSTEM OF

MEDICINE.• 4. VOLUNTARY HEALTH AGENCIES.• 5. NATIONAL HEALTH

PROGRAMMES.

I. PUBLIC HEALTH SECTOR• 1. PRIMARY HEALTH CARE : A. Primary Health Centres. B. Sub Centres.

2. HOSPITALS & HEALTH CENTRES : A. Community Health Centres. B. Rural Hospitals. C. District Hospitals / Health

Centre. D. Specialist Hospitals. E. Teaching Hospitals.

3.HEALTH INSURANCE SCHEMES.

A. Employees State Insurance. B. Central Govt Health Scheme

4. OTHER AGENCIES.

A. Defense Services. B. Railways.

II.PRIVATE SECTOR A. Private Hospitals, Polyclinics,

Nursing Homes & Dispensaries.

B. General Practitioners & Clinics

III.INDIGENOUS SYSTEM OF MEDICINE

A. Ayurveda & Siddha. B. Unani & Tibbi. C. Homeopathy. D. Unregistered Practitioners.

IV. VOLUNTARY HEALTH AGENCIES.

V. NATIONAL HEALTH PROGRAMMES

PRIMARY HEALTH CARE IN INDIA

• In 1977 the Govt of India launched a Rural Health Scheme, based on the principles of “placing people’s health in people's hand.

• It is a three tier system of health care delivery in rural areas based on the recommendation of the Srivatsav Committee(1975).

• Close on the heels of these recommendations an International Conference at Alma Ata (1978), set the goal of an acceptable level of Health For All the people of the world by the year 2000 through Primary health care approach

• As a signatory to the Alma Ata Declaration, the govt of India was committed to achieving the goal of Health for All through primary health care approach which seeks to provide universal comprehensive health care at a cost which is affordable.

• Keeping view the WHO goal of “Health For All” by 2000 AD, the govt of India evolved a National Health Policy based on primary health care approach.

• The National Health Policy 1983 laid down a plan of action for reorienting & shaping the existing rural health infrastructure with specific goals to be achieved by 1985, 1990 & 1995.

• National Health Policy 2000, 2002 & National Rural Health Mission have been recently introduced to achieve HFA goals.

VILLAGE LEVEL• One of the basic tenets of

primary health care is universal coverage & equitable distribution of health resources.

• To implement this policy at the village level, the following schemes are in operation.

1. Village Health Guide Scheme. 2. Training of Local Dias. 3. ICDS Scheme. 4. Asha Scheme

VILLAGE HEALTH GUIDES• A Village Health Guide is a

person with an aptitude for social service & is not a full time government functionary.

• The Village Health Guide Scheme was introduces on 2 Oct 1977.

• The VHG provide the first contact between the individual & the health system.

The guidelines for their selection are :

1. They should be a permanent residents of the local community, preferable women.

• 2. They should be able to read & write, having minimum

formal education at least up to the VI standard.

• 3. They should be acceptable to all sections of the society.

4. They should be able to spare at least 2 to 3 hrs every day for community health work.

5. After selection, the Health Guides undergo a short training in primary health care.

6. The training is arranges in the nearest PHC,HSc for 200 hrs, spread over for a period of 3 months.

7. During the training period they receive a stipend of Rs. 200 per month.

TRAINING

8. On completion of their training, they receive a working manual & a kit of simple medicines belonging to the modern & traditional medicine.

9. The VHG are free to attend to their normal vocation.

10. For their work they are paid a honorarium of Rs.50 per month & drugs worth Rs. 600 per annum.

11. At present there are 3.23 lakh VHG & the national target is to achieve 1 VHG for each village or 1000 rural population

LOCAL DAIS

• Most deliveries in rural are handled by untrained dais.

A LOCAL DAI

• An extensive programme has been to undertaken under the Rural Health Scheme, to train all

categories of local dais in the country to develop their knowledge in the elementary concepts of maternal & child health & sterilization, besides

obstetric skills.

• The training is for 30 working days.

• Each Dai is paid a stipend of Rs.300 during her training period.

• Training is given at the PHC, Sub center or MCH centre for 2

days in a week & on the remaining 4 days of the week they accompany the Health Worker to the villages preferably in the dai’s own area.

• During her training each dai is required to conduct at least 2 deliveries under the guidance & supervision of the HW (F), ANM or HA(F).

• The emphasis during training is on asepsis so that home deliveries are conducted under safe

hygienic conditions thereby reducing the maternal & infant mortality.

• After successful completion of training, each dai is provided with a delivery kit & a certificate.

• These dais are also expected to play a vital role in propagating small family norm since they are more acceptable to the community.

• The national target is to train one local Dai in each village.

• She undergoes a training in various aspects of health, nutrition & child development for 4 months.

• She is a part time worker & is paid an honorarium of Rs 1500 per

month for the service rendered, which include health checkup chart, immunization, supplementary nutrition, health education, non formal pre school education & referral services.

ANGANWADI WORKER• Under ICDS scheme, there is

anganwadi worker for a population of 1000.

• There are about 100 such workers in each ICDS project.

ANGANWADI WORKER

• As of date over 5959 ICDS blocks are functioning in the

country.

• An anganwadi worker is selected from the community she is

expected to serve

• The beneficiaries are especially nursing mothers, pregnant women, other women (15 -45 yrs), children below the age of 6 yrs & adolescent girls.

• Anganwadi workers are the primary link with the health services & all other services for young children.

ASHA• Recognizing the importance of

health in the process of economic & social development & to improve the quality of life of the citizens, the

govt of India launched “NATIONAL RURAL HEALTH MISSION” (NRHM) on 5 April 2005.

• The main aim of NRHM is to provide accessible, affordable, accountable, effective & reliable primary health care through creation of a cadre of Accredited Social Health Activist (ASHA).

• ASHA must be a resident of the village.

• A women (married/widow/divorced) preferably in the age group of 25-45 years with a formal education upto 8 class.

• The general norm for selection of ASHA is 1 ASHA/1000 population.

• ASHA will take steps to create awareness & provide information to the community on determinants of health, information on existing health services, & the need for timely utilization of health

& family welfare services.

• She will counsel women on birth preparedness, importance of safe delivery, breast feeding & complementary feeding, immunization, contraception & prevention of common infections including RTI/STD & care of a young child.

• ASHAS will mobilize the community & facilitate them in accessing

health & health related services available in anganwadi/PHC etc.

• She will work with the village health & sanitation committee of the gram panchayat to develop a

comprehensive village health plan.

• ASHA will provide primary medical care for minor ailments such as diarrhoea, fevers & first aid for minor injuries etc.

• She will also act as a depot holder for essential provisions being made available to every habitation like ORS kit, IFA tab, disposable delivery kit, etc.

• She will inform about the births & deaths in her village, any unusual health problems in the community to the PHC.

• She will promote the construction of household toilets under total sanitation campaign

SUB CENTRE LEVEL• The sub centre is the peripheral

outpost of the existing health delivery system in rural areas.

• They are being established on the basis of 1 HSc for every 5000 population in general & I for every 3000 population in hilly, tribal & backward areas.

• As on March 2008, 146036 sub centres were established in the country.

• A sub centre provides interface with the community at the grass root level, providing all the primary health care services.

• The package of services provided by the HSc include,

immunization, antenatal, natal & post natal care, prevention of malnutrition & common childhood diseases, family planning services & counseling.

• They also provide elementary drugs for minor ailments such as ARI, diarrhoea, fever, worm

infestation etc.

• The government implements several National Health & Family

Welfare programmes through these frontline workers.

• A HSc is staffed by one Female Health Worker known as Auxiliary Nurse Midwife (ANM) & one Male Health Worker known as Multipurpose Worker (Male).

• 1 Lady Health Visitor (LHV) & 1 Health Assistant (Male) located at PHC level are entrusted with the task of supervision of six sub centres under a PHC.

PRIMARY HEALTH CENTRE• The Bhore

Committee in 1946 gave the concept of a primary Health Centre as a basic health unit, to provide primary health care services.

PHC IN NORTH INDIA

• The health planners in India have visualized the PHC as a

proper infrastructure to provide health services to the rural

population.

• The National Health Plan 1983 proposed 1 PHC for every 30,000 population in plain areas & 1 PHC for every 20,000 population in hilly, tribal & backward areas for more effective coverage.

• As on March 2008, 23,458 PHCs have been established.

FUNCTIONS OF A PHC 1.Medical Care. 2.MCH including family planning. 3.Safe water supply & basic

sanitation. 4.Prevention & control of

communicable diseases. 5.Collection & reporting of vital

statistics.

6.Education about health. 7.National Health Programmes – as

relevant. 8.Refferal services. 9.Training of health guides, health

workers, local dais & health assistance.

10.Basic laboratory services.

THANK YOU