HEALTH CARE DELIVERY SYSTEM IN INDIAIntroduction

Health is the birth right of every individual. Today health is considered more than a

basic human right; it has become a matter of public concern, national priority and political

action. Our health system has traditionally been a disease-oriented system but the current

trend is to emphasize health and its promotion.

Definition

Health:

WHO: defined health as “a state of complete physical, mental, social and spiritual well being

not merely the absence of disease or infirmity.”

WEBSTER: defined health as “ a quality of life resulting from total functioning of the

individual that empower him to achieve personally satisfying and socially useful life.”

H.S HAYMAN: defined health as “ a state of feeling sound in body, mind, and spirit with

sense of reserve power.”

Health care services:

It is defined as multitude of services rendered to individuals, families or communities

by the agents of the health services or professions for the purpose of promoting, maintaining,

monitoring or restoring health.

Definitions of health care delivery:

Health care delivery system refers to the totality of resources that a population or

society distributes in the organization and delivery of health population services. It

also includes all personal and public services performed by individuals or institutions

for the purpose of maintaining or restoring health. -Stanhope(2001)

It implies the organization, delivery of staffing regulation and quality control.

Philosophy of Health Care Delivery System:

Everyone from birth to death is part of the market potential for health care services.

The consumer of health care services is a client and not a customer.

Consumers are less informed about health services than anything else they purchase.

Health care system is unique because it is not a competitive market

Restricted entry in to the health care system.

Goals/Objectives of Health Care Delivery System:

1) To improve the health status of population and the clinical outcomes of care.

2) To improve the experience of care of patients families and communities.

3) To reduce the total economic burden of care and illness.

4) To improve social justice equity in the health status of the population.

Principles of Health Care Delivery System:

1. Supports a coordinated, cohesive health-care delivery system.

2. Opposes the concept that fee-for-practice.

3. Supports the concept of prepaid group practice

4. Supports the establishment of community based, community controlled health-care system.

5. Urges an emphasis be placed on development of primary care

6. Emphasizes on quality assurance of the care

7. Supports health care as basic human right for all people.

8. Opposes the accrual of profits by health-care-related industries.

Functions of Health Care Delivery System:

1) To provide health services.

2) To raise and pool the resources accessible to pay for health care.

3) To generate human and physical sources that makes the delivery service possible.

4) To set and enforce rules of the game and provide strategic direction for all the different

players involved.

Characters of Health Care Delivery System

1) Orientation towards health.

2) Population perspectives.

3) Intensive use of information.

4) Focus on consumer.

5) Knowledge of treatment outcome.

6) Constrained resources

HEALTH CARE DELIVERY SYSTEM IN INDIA

In India it is represented by five major sectors or agencies which differ from each other

by health technology applied and by the source of fund available. These are:

I. PUBLIC HEALTH SECTOR

A. Primary Health Care

Primary Health Centres, Sub- Centres.

B. Hospital/Health Centres

Community Health Centres, Rural Health Centres, District Hospitals/ District Health

Centre, Specialist Hospitals, Teaching Hospitals.

C. Health Insurance Schemes

Employees State Insurance

Central Government Health Scheme

D. Other Agencies

Defence services, Railways.

II. PRIVATE SECTOR

A. Private Hospitals, Polyclinics, Nursing Homes and Dispensaries.

B. General Practitioners and Clinics.

III. INDIGENOUS SYSTEMS OF MEDICINE

Ayurveda

Sidda

Unani

Homeopathy

Naturopathy

Yoga

Unregistered practioners

IV. VOLUNTARY HEALTH AGENCIES

V. NATIONAL HEALTH PROGRAMMES

India is a union of 31 states and 7 Union territories. Under the constitution states are

largely independent in matters relating to the delivery of health care to the people. Each State,

therefore, as developed its own system of health care delivery, independent of the Central

Government.

Health system in India has 3 links

1. Central level. 2. State level 3. District level

Synoptic view of the health system in India

Community Health Centres

PHCs

Village Health Guide, ASHAs, Trained Dais, Anganwadi

Workers

People/ Community/ Society/ Villages

National level

State and Union Territories

District Health Organization and Basic Specialities Hospitals

Sub- District / Taluk Hospital

Sub – Centres

Health administration at the central level

The official organs of the health system at the national level consist of

3 units:

1. Union Ministry of Health and Family Welfare.

2. The Directorate General of Health Services.

3. The Central Council of Health and Family Welfare.

I. Union Ministry of Health and Family Welfare Organisation

The Union Ministry of Health and Family Welfare is headed by a

Cabinet Minister, a Minister of State, and a Deputy Health Minister. These

are political appointment and have dual role to serve political as well as

administrative responsibilities for health. Currently the union health

ministry has the following departments:

1. Department of Health

2. Department of Family Welfare

3. Department of Indian System of Medicine and Homoeopathy

a. Department of Health

It is headed by a secretary to the Government of India as its

executive head, assisted by joint secretaries, deputy secretaries, and a

large administrative staff.

Functions

This includes the Union list and the Concurrent list. (Article 246 of the Constitution of India)

Union list

1. International health relations and administration of port-quarantine

2. Administration of central health institutes such as All India Institute of

Hygiene and Public Health, Kolkata; National Institute for Control of

Communicable Diseases, Delhi, etc.

3. Promotion of research through research centres and other bodies.

4. Regulation and development of medical, nursing and other allied health

professions.

5. Establishment and maintenance of drug standards.

6. Census, and collection and publication of other statistical data.

7. Immigration and emigration.

8. Regulation of labour in the working of mines and oil fields.

Concurrent list

The functions listed under the concurrent list are the responsibility

of both the union and state governments. The centre and states have

simultaneous powers of legislation. They are as follows:

1. Prevention of extension of communicable diseases from one unit to another.

2. Prevention of adulteration of food stuffs.

3. Control of drugs and poisons.

4. Vital statistics.

5. Labour welfare.

6. Ports other than major.

7. Economic and social health planning

8. Population control and family planning.

Department of Family Welfare

It was created in 1966 within the Ministry of Health and Family

Welfare. The secretary to the Government of India in the Ministry of

Health and Family Welfare is in overall charge of the Department of

Family Welfare. He is assisted by an additional secretary and

commissioner, and one joint secretary.

The following divisions are functioning in the department of family

welfare.

1. Programme appraisal and special scheme

2. Technical operations: looks after all components of the technical

programme viz. Sterilization/IUD/Nirodh, post partum, maternal and

child health, UPI, etc.

3. Maternal and child health

4. Evaluation and intelligence: helps in planning, monitoring and

evaluating the programme performance and coordinates demographic

research.

5. Nirodh marketing supply/ distribution.

Functions

a. To organize family welfare programme through family welfare centres.

b. To create an atmosphere of social acceptance of the programme and

to support all voluntary organizations interested in the programme.

c. To educate every individual to develop a conviction that a small family

size is valuable and to popularize appropriate and acceptable method

of family planning

d. To disseminate the knowledge on the practice of family planning as

widely as possible and to provide service agencies nearest to the

community

ORGANISATIONAL STRUCTURE OF THE HEALTH AND SERVICES

AT CENTRAL LEVEL

ADNL. DIR. A.V ADNL. DIR. (P) ADNL. DIR. (PH) ADNL. DIR. (M)

DDA(C&B) DD (CBHI) DDG(P) DDG(M)

DDA(G) DDG(RH) ADG(M)

ADMIN SECTION DDG(PH) DG(NCD)

ADMN.STAFF DDA(CGHS)

ADG(ME)

DDA(C&B)

NSG ADV

DY.DIR(LIB)

ADG(OPTH)

DIR(CGHS)

ADG(CGHS)

DDA(CGHS)

CHIEFARCHT

DDG(STORES)

MINISTRY OF HEALTH AND

FAMILY WELFARE

CENTRAL COUNCIL OF HEALTH

CABINET MINISTERSPOLICY MAKING AND

LEGISLATION

DEPARTMENT OF HEALTH DEPARTMENT OF FAMILY WELFARE

SECRETARY TO GOVERNMENT

DIRECTOR GENERAL OF HEALTH SERVICE

DIRECTOR A.V - Director Audio-Visual Aids.

DDG (P) - Deputy director general planning.

ADNL.DIR. (PH) - Additional Director Public Health.

ADNL.DIR. (M) - Additional Director Medicine.

DDA (C&B) - Deputy director in administration communication and

Broad casting.

DDA (G) - Deputy Director in Administration General.

ADMIN - Administration.

DIR (CBHI) - Director of Central Bureau of Health Institute.

DDG (RH) - Deputy Director General Rural Health.

DDG (PH) - Deputy Director General Public Health.

DDG (M) - Deputy Director General Medicine.

ADG (M) - Additional Deputy General Medicine.

DG (NCD) - Director General National Communicable Diseases.

DDA (CGHS) - Deputy Director of Administrative Central

Government Health Service.

ADG (ME) - Additional Director General Medical Education.

NSG ADV - Nursing Advisor.

DY.DIR (LIB) - Deputy Director in Library Science.

ADG (OPTH) - Additional Director General Opthalmology.

CHIEF ARCHT - Chief Architect.

UNION MINISTRY OF HEALTH AND FAMILY WELFARE

CABINET MINISTER

HEADED BY MINISTER OF STATE

DEPUTY HEALTH MINISTER

UNION MINISTRY OF HEALTH AND FAMILY WELFARE

DEPARTEMENT OF HEALTH DEPARTEMENT OF FAMILY WELFARE

SECRETARY TO GOVT. OF INDIA

( EXECUTIVE HEAD)

SECRETARY TO GOVT. OF INDIA (MINISTRY OF HEALTH AND FAMILY

WELFARE)

JOINT SECRETARIES

ADDITIONAL SECRETARY AND COMMISSIONER (FAMILY WELFARE)

DEPUTY SECRETARIES

JOINT SECRETARY - 1

LARGE ADMINISTRATIVE STAFF

DEPUTY SECRETARIES

LARGE ADMINISTRATIVE STAFF

DEPARTMENT OF ISM & H

SECRETARY TO GOVT. OF INDIA

JOINT SECRETARIES

DEPUTY SECRETARIES

LARGE ADMINISTRATIVE

3. The department of Indian system of medicine and homeopathy

It was established in March 1995 and had continued to make

steady progress. Emphasis was on implementation of the various schemes

introduced such as education, standardization of drugs, enhancement of

availability of raw materials, research and development, information,

education and communication and involvement of ISM and Homeopathy in

national health care.

Most of the functions of this ministry are implemented through an

autonomous organization called DGHS.

II. Directorate General of Health Services Organisation

The DGHS is the principal adviser to the Union Government in both

medical and public health matters. He is assisted by a team of deputies

and a large administrative staff. The Directorate comprises of three main

units:

i. Medical care and hospitals

ii. Public health

iii. General administration Functions

General functions:

1. The general functions are surveys, planning, coordination,

programming and appraisal of all health matters in the country.

Specific functions

1. International health relations and quarantine

All the major ports in the country and international airports are directly controlled by

Directorate General of Health Services. All matters relating to obtaining assistance

from International agencies and the coordination of their activities in the country are

undertaken by Directorate General of Health Services.

2. Control of drug standards

The Drugs Control Organization is a part of DGHS. Its primary function is to lay

down and enforce standards and control of the manufacture and distribution of drugs

through both Central and State Government Officers. It also has the powers to test the

quality of the imported drugs.

3. Medical store depot

The union government runs medical store depots at Mumbai, Chennai, and Kolkata

etc. These depots supply the civil medical requirements of the Central and State

Governments. The Medical Stores Organization endeavour to ensure the highest

quality, cheaper bargain and prompt supplies.

4. Post graduate training

The DGHS is responsible for the administration of the national institutes. Such as All

India Institute of Hygiene and Public Health at Kolkata, National Institute of Mental

Health Science at Bangalore etc.

5. Medical education

The DGHS is directly in charge of the following medical colleges in India; the Lady

Hardinge, the Maulana Azad and the medical colleges at Pondicherry and Goa and

many medical colleges in country are guided and supported by the centre.

6. Medical research

The council plays a significant role in aiding, promoting and coordinating scientific

research on human diseases, their causation, prevention and cure. The research work

is done through the councils several permanent research institutes, research units,

field surveys etc. It maintains Cancer Research Centre, Tuberculosis Chemotherapy

Centre at Chennai.

7. Central government health scheme

8. National health programmes

The various health programmes for the eradication of the malaria and for the control

of tuberculosis, filaria, leprosy, AIDS and other communicable diseases are going on.

The DGHS plays a very important role in planning, guiding and coordinating all the

national health programmes in the country.

9. Central health education bureau

An outstanding activity of bureau is the preparation of education material for creating

health awareness among the people.

10. Health statistics

The DGHS is responsible for maintenance of statistics regarding health.

11. National medical library

The central medical library of DGHS was started in 1966, to help in advancement of

medical health and related sciences by collection, dissemination, and exchange of

information.

DIRECTORATE GENERAL OF HEALTH SERVICES (DGHS)

Organization:

PRINCIPAL ADVISER TO UNION GOVERNMENT

DIRECTORATE GENERAL OF HEALTH SERVICES

DIRECTOR GENERAL OF HEALTH SERVICES

ADDITIONAL DIRECTOR GENERAL OF HEALTH SERVICE

TEAM OF DEPUTIES

LARGE ADMINISTRATIVE STAFFS

MEDICAL AND PUBLIC

HEALTH MATTERS

III. Central Council of Health

The Central Council of Health was set up by a Presidential Order on

August 9, 1952, under Article 263 of the Constitution of India for

promoting coordinated and concerted action between the centre and the

states in the implementation of all the programmes and measures

pertaining to the health of the nation. The Union Health Minister is the

chairman and the state health ministers are the members.

Functions

1. To consider and recommend broad outlines of policy in regard to

matters concerning health in all its aspects such as the provision of

remedial and preventive care, environmental hygiene, nutrition, health

education and the promotion of facilities for training and research.

2. To make proposals for legislation in fields of activity related to medical

and public health matters and to lay down the pattern of development

for the country as a whole.

3. To make recommendations to the Central Government regarding

distribution of available grants-in-aid for health purposes to the states

and to review periodically the work accomplished in different areas

through the utilisation of these grants-in-aid.

4. To establish any organisation or organisations invested with

appropriate functions for promoting and maintaining cooperation

between the Central and State Health administrations.

AT THE STATE LEVEL

Historically, the first milestone in the state health administration

was the year 1919, when the states (provinces) obtained autonomy,

under the Montague-Chelmsford reforms, from the central Government in

matters of public health. By 1921-22, all the states had created some

form of public health organisation. The Government of India Act, 1935

gave further autonomy to the states. The state is the ultimate authority

responsible for health services operating within its jurisdiction.

State health administration

At present there are 31 states in India, with each state having its

own health administration. In all the states, the management sector

comprises the state ministry of Health and a Directorate of Health.

1. State Ministry of Health

The State Ministry of Health is headed by a Minister of Health and

FW and a Deputy Minister of Health and FW. In some states, the Health

Minister is also in charge of other portfolios. The Health secretariat is the

official organ of the State Ministry of Health and is headed by a Secretary

who is assisted by Deputy Secretaries, and a large administrative staff.

The major functions which are performed by the secretariat which includes the following

Formulation, review, and modification of policy outlines.

Execution of policies programmes etc.

Coordination with government of India and other state governments.

Control of smooth and efficient functioning of administrative machinery.

ORGANIZATION PATTERN AT STATE LEVEL

M.of H&FW M. of M.E

H. SECRETARY M.E SECRETARYSTATE HEALTH COUNCIL

H.COMMISSIONERSTATE POLICY MAKING

LEGISLATION&RECORDING

DSIH&FW DH&FWS D of H.S (CMD)

AUTO INS. DME RGUHS

AD RCH AD CMD AD AIDS AD PHC LOGISTIC

OFFICER

JD FW RCH

R

JD CMD

JD

HET

JD

TB

JD

H&P

JD

LEP

JDM

DD

TB

DD

H&P

DD

LEP

HFW TC(5)

DTC(24) DD FW

LHV TC(4)

ANM

TC(24)

ADNS(2)

MC(5)

TH(14)

DC(1)

Nsg.C(4)

Nsg.S(11)

PMB(1)

JD

LAB

DD

M

DD

PHA

M .of H&FW - Ministry of Health and Family Welfare.

M.E - Medical Education.

DSIH - Director of State Institute of Health.

DH&FWS - Director of Health and Family Welfare Service.

DHS (CMD) - Director Health System Communicable Diseases.

HFW TC - Health and Family Welfare Training Centres.

DTC - District Training Centres.

AD - Additional Director.

JD - Joint Director.

RCH - Reproductive and Child Health.

CMD - Communicable Diseases.

AIDS - Acquired Immuno Deficiency Syndrome.

PHC - Primary Health Centre.

HET - Health Education Training.

AUTO INS - Autonomous Institutions.

RGUHS - Rajiv Gandhi University of Health Sciences.

MC - Medical Colleges.

TH - Teaching Hospitals.

DC - Dental Colleges.

PMB - Para Medical Board.

ADNS - Additional Director of Nursing Services.

LHV - Lady Health Visitor.

LHV TC(4)

ANM

TC(24)

2. State Health Directorate

The Director of Health Services is the chief technical adviser to the

state Government on all matters relating to medicine and public health. He is

also responsible for the organization and direction of all health activities. The

Director of Health and Family Welfare is assisted by a suitable number of

deputies and assistants. The Deputy and Assistant Directors of Health may be of

two types –

Regional

Functional.

The regional directors inspect all the branches of public health

within their jurisdiction, irrespective of their specialty. The functional

directors are usually specialists in a particular branch of public health such as

mother and child health, family planning, nutrition, tuberculosis, leprosy, health

education, etc.

Responsibilities

1. It studies in depth the health problems and needs in the state and plans schemes to solve

them.

2. Provide curative and preventive services.

3. Provision for control of milk and food sanitation.

4. Assumes total responsibility for taking steps in prevention of outbreak of communicable

diseases.

5. Establishment and maintenance of central laboratories for preparation of vaccines.

6. Promotion of health education.

7. Promotion of health programmes such as family planning and school health.

8. Recruitment of personnel for rural health services.

9. Planning and carrying out surveys in relation to nutrition, health education etc.

10. Collection, tabulation and publication of vital statistics.

11. Establishing training courses for health personnel and formulating job descriptions.

Eg; for health worker, sanitary inspector.

12. Coordination of all health services with other ministeries of state such as minister of

education, agriculture with the central health ministry and voluntary agencies.

AT THE DISTRICT LEVEL

The district is the most crucial level in the administration and implementation of

medical /health services. At the district level there is a district medical and health officer or

CMO who is overall Subdivisions

i. Tehsils (talukas)

ii. Community development blocks

iii. Municipalities and corporations

iv. Villages

v. Panchayaths

Most of the districts in India are divided into two or more subdivisions, each in

charge of an assistant collector or sub-collector. Each division is again divided into tehsils in

charge of a Tehsildar. A tehsil usually comprises between 200 and 600 villages. Finally, there

are the village panchayaths, which are institutions of rural local self-government. The urban

areas of the district are organised into the following local self-government:

o Town area committee – 5,000 – 10,000

o Municipal boards – 10,000 – 2,00,000

o Corporations – population above 2,00,000.

The town area committees are like panchayaths. They provide sanitary services.

The municipal boards are headed by a chairman/president, elected

usually by the members. Corporations are headed by mayors. The councilors

are elected from different wards of the city. The executive agency includes the

commissioner, the secretary, the engineer, and the health officer. The activities

are similar to those of the municipalities but on a much wider scale.

HEALTH ORGANIZATION AT DISRICT LEVEL

HEALTH MINSTER

HEALTH SECRETARY

DIRECTOR OF H&FW

DISTRICT COMMISSIONER

DFWO

DISTRICT M.SDISTRICT H.O

DNO

PHN

SENIOR HA M&F

JUNIOR HA M&F

TD/CHV/AWW

DLO DMO

NSG SUPNT

WARD SISTER

STAFF NURSES

ANM

DTO

DHO - District Health Officer.

DMS - District Medical Superintendent.

DFWO - District Family Welfare Officer.

DLO - District Leprosy Officer.

DMO - District Medical Officer.

DTO - District Tuberculosis Officer.

DNO - District Nursing Officer.

PHN - District Public Health Nurse.

HA M&F - Health Assistant Male and Female.

TD - Trained Dias.

CHV - Community Health Visitor.

AWW - Anganwadi Workers.

ASHA - Accredited Social Health Activitist.

ANM - Auxillary Nurse Midwives.

NSG SUPNT - Nursing Superintendent.

PANCHAYATHI RAJ

The panchayath Raj is a 3-tier structure of rural local self-

government in India linking the villages to the district. The three

institutions are:

a. Panchayath – at the village level.

b. Panchayath samithi – at the block level.

c. Zilla parishad – at the district level.

The panchayathi Raj institutions are accepted as agencies of public

welfare. All development programmes are channelled through these bodies.

The panchayathi Raj institutions strengthen democracy at its root and ensure

more effective and better participation of the people in the government.

At the village level

The panchayathi Raj at the village level consists of:

1. The gram sabha

2. The gram panchayath

3. The nyaya panchayath

Gram sabha: It is the assembly of all the adults of the village,which meets atleast twice a

year. It considers proposals for taxation, discusses the annual programme and elects members

of the gram panchayat.

Gram panchayat: it is an executive organ of the gram sabha, and an agency for planning and

development at the village level. Its strength varies from 15 to 30 and covers 5000 and 15,000

population and more. Members of panchayat hold office for a period of 3 to 4 years.every

panchayat has an elected president(sarpanch), a vice president, and a panchayat secretary.

The power of panchayat secretary cover the entire field of civic administration, including

sanitation and public health and social and economic development of village.

Nyaya panchayat: it consists of 5 members from the panchayat. Its functions includesolving

of disputes between two groups, two parties etc.

At the block level

The panchayathi raj agency at the block level is the panchayath

samithi. The panchayathi samithi consists of all sarpanchs of the village

panchayaths in the block. The block development officer is the ex-officio

secretary of the panchayath samithi.

The prime function of the panchayat samiti is the execution of the

community development programme in the block.

The block development officer and his staff give technical assistance and

guidance to the village panchayaths engaged in the development work.

At the district level

The zilla parishad is the agency of rural local self-government at the

district level. The members of the zilla parishad include all leaders of the

panchayath samithis in the district, MPs, MLAs of the district, representatives of

SC, SD and women, and 2 persons of experience in administration. The

collector of the district is a non-voting member. Thus, the membership of the

zilla parishad is fairly large varying from 40 to 70.

The zilla parishad is primarily supervisory and coordinating body. Its

functions and powers vary from state to state. In some states, the zilla

parishads are vested with the administrative functions.

Healthcare systems

The healthcare system is intended to deliver the healthcare services.

It constitutes the management sector and involves the organisational

matters. It operates in the context of the socioeconomic and political

framework of the country. In India, it is represented by five major sectors

and agencies which differ from each other by the health technology

applied and by the source of funds for the operation.

i. Public health sector

ii. Private sectors

iii. Indigenous system of medicine

iv. Voluntary health agencies

v. National health programmes

Primary healthcare in India

It is a three-tier system of healthcare delivery in rural areas based on

the recommendations of the Shrivastav Committee in 1975.

1. Village level: The following schemes are operational at the village

level:

a. Village health guides scheme

b. Training of local dais

c. ICDS scheme

2. Sub-centre level:

This is the peripheral outpost of the existing health delivery

system in rural areas. They are being established on the basis of one

sub-centre for every 5000 population in general and one for every

3000 population in hilly tribal and backward areas. Each sub-centre is

manned by one male and one female multipurpose health worker.

Functions

a. Mother and child healthcare

b. Family planning

c. Immunization

d. IUD insertion

e. Simple laboratory investigations

3. Primary health centre level:

The Bhore committee in 1946 gave the concept of a primary

health centre as a basic health unit to provide as close to the people as

possible. The Bhore committee aimed at having a health centre to serve a

population of 10,000 to 20,000. The national health plan, 1983 proposed

reorganization of primary health centres on the basis of one PHC for every

30,000 rural population in the plains, and one PHC for every 20,000

population in hilly, tribal and backward areas for more effective coverage.

Functions 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 diseases.

e. Collection and reporting of vital statistics.

f. Education about health.

g. National health programmes as relevant.

h. Referral services.

i. Training of health guides, health workers, local dais, and health

assistants.

j. Basic laboratory services.

STAFFING PATTERN:

Population in hilly tribal areas : 20,000

Population in rural areas(plain): 30,000

MAIN PHC

Medical officers - 2 Pharmacist – 1

Block extension educator – 1 Lab technichian – 1

Community health nurse – 1 Opthalmic assistant – 1

Staff nurse -3 Siddha pharmacist -1

Jr. Health assistant - 6 Group D workers – 4

ADDITIONAL PHC

Medical officer - 1

Staff nurse -3

Community health nurse/LHV - 1

Male health assistant -1

Auxillary nurse mid-wife – 6

Jr. Health assistant -3

Pharmacist - 1

SDA/ Computer operator - 1

Driver - 1

Group D worker - 4

ORGANIZATION CHART OF PRIMARY HEALTH CENTER

MINISTER OF HEALTH AND FAMILY WELFARE

DIRECTOR OF HEALTH AND FAMILY WELFARE SERVICES

ZILLA PARISHAD

DISTRICT HEALTH OFFICER

TALUK HEALTH OFFICER

MEDICAL OFFICER FOR HEALTH LADY MEDICAL OFFICER

Sr. HAM Sr. HAF BHEO

Jr. HAM Jr. HAf

LAB TECHNICIAN

(1)

REFRACTIONIST(1)

PHARMACIST(1)

FDA (1)

SDA (1)

DRIVER(1)

GROUP D OFFICIALS(4)

Sr. HAM : Senior Health Assistant Male

Sr. HAF : Senior Health Assistant Female

BHEO : Block Extension Officer

FDA : First Division Assistant

SDA : Second Division Assistant

RESPONSIBILITIES OF MALE HEALTH ASSISTANT

1. Conduct survey of the sub centre area and maintain records of all families.

2. Maintain information of all vital events.

3. Participate in malaria control programme.

4. Participate in leprosy control programme.

5. Participate in family planning services by keeping list of eligible couples, provide

information on the family planning method and follow up of family planning

acceptors.

6. Identifying and reporting of all communicable diseases.

7. Co ordinate the activities with health workers and the block staff.

8. Maintaining records.

RESPONSIBILITIES OF FEMALE HEALTH ASSISTANT

1. Registration and care of prenatal, intranatal, and postnatal mothers and children at

home.

2. Registration and follow up of all eligible couples.

3. Conduct and supervise deliveries conducted by dais.

4. Immunize pregnant mother and children.

5. Refer mother and children at the time of need to hospitals and follow up them after

discharge.

6. Carry out family planning services including the distribution of contraceptives.

7. Treatment for minor ailments.

8. Prevent communicable diseases.

9. Maintenance of records and registrs of all the services provided and also of vital

events such as births and deaths.

SUB CENTRE

The Sub Centre is the peripheral outpost of the existing health care delivery system in rural

areas. They are being established on the basis of one Sub Centre for every 5000 population in

plains and one for every 3000 population in hilly, tribal and backward areas.

STAFFING PATTERN:

Population in hilly tribal areas - 3000.

Population in rural area (plains) - 5000.

M.P.H.W/ V.H.N - 1

M.P.H.W/ H.W(M) – 1

Village health guide – 1

Traditional health attendant – 1

VILLAGE LEVEL

1. Village health guides scheme.

2. Local dias.

3. Anganwadi worker.

4. ASHA workers.

The above schemes are in operation for universal coverage and equitable distribution of

health resources so that health care must penetrate into the farthest reaches of rural areas

1. VILLAGE HEALTH GUIDES .

They are from the same community and serve as a link between community and

governmental infrastructure. They undergo training in primary health centre, subcentre for

knowledge regarding primary health care. The national target is to achieve one health guide

for each village or 1000 rural population. Guidelines for selection include three months

training with stipend rupees 200 per month.

The guidelines include:

They should be permanent residents of the local community.

They should be able to read and write, minimum sixth standard education.

They should be acceptable to all sections of the community.

They should be able to spare at least two to three hours per day for community health

work.

2. LOCAL DAIS (TRADITIONAL BIRTH ATTENDANTS)

Under rural health scheme training is given for all local dais in the country to improve

their knowledge in the elementary concepts of maternal and child health and sterilization,

besides obstetric skills. Training is given for 30 days with stipend of rupees 300. Training

is given at PHC, sub centre, or MCH centre. During training each dai is required to

conduct at least two deliveries under guidance and supervision of health worker female,

ANM or health assistant female. They should practice asepsis. On successful completion

of training each dais is provided a delivery kit and a certificate. They should propagate

small family norm needs. The national target is to train one local dais in each village.

3. ANGANWADI WORKERS

Angan literally means a courtyard. Under integrated child developmental service, there is

an anganwadi worker for a population of 1000. The anganwadi worker is selected from

the community she is expected to serve. She under goes training in various aspects of

health, nutrition, and child development for four months. She must have passed SSLC.

OBJECTIVES:

To improve health status of under five children.

To reduce incidence of mortality, malnutrition, school drop outs.

To promote maternal education and training for child care and child rearing.

FUNCTIONS:

1. Non formal preschool education for 3 to 6 years age children.

2. Immunization.

3. Maintenance of growth chart.

4. Health and nutrition education of women and children.

5. Supplementary and therapeutic nutrition to under five, pregnant mothers, and lactating

mothers.

6. Growth monitoring and referral services.

BENEFICIARIES:

Nursing mothers

Pregnant women

Other women(15 to 45 years)

Children below the age of 6 years

Adolescent girls

4. ASHA WORKERS UNDER NRHM

National rural health mission aims to provide accessible, affordable, accountable,

effective, and reliable primary health care and bridging gap in rural health care

through Accredited social health activist (ASHA). ASHA must be the resident of the

village – a woman preferably in the age group of 25 to 45 years with formal education

up to eighth class, having communication skills and leadership qualities. The general

norm of selection will be one ASHA for 1000 population. In tribal, hilly and desert

areas the norm could be relaxed to one ASHA per habitation. Target is to select and

train at least 40 percentage of ASHA in one year.

Community health centres

As on 31st March 2003, 3076 community health centres were

established by upgrading the primary health centres, each CHC covering a

population of 80,000 to 1.20 lakh with 30 beds and specialist in surgery,

medicine, obstetrics and gynecology, and pediatrics‘ with x-ray and laboratory

facilities.

Functions

1. Care of routine and emergency cases in surgery.

2. Care of routine and emergency cases in medicine.

3. 24-hour delivery services including normal and assisted deliveries.

4. Essential and emergency obstetric cases including surgical

interventions.

5. Full range of family planning services including laparoscopic services.

6. Safe abortion services.

7. Newborn care.

8. Routine and emergency care of sick children.

9. Other management including nasal packing, tracheostomy, foreign

body removal, etc.

10. All national health programmes should be delivered.

11. Blood shortage facility.

12. Essential laboratory services

13. Referral services.

JOB DESCRIPTION OF NURSING PERSONNEL

PUBLIC HEALTH NURSE

Essential qualification

B.Sc degree in nursing from any university or institute or certificate in Public Health

Nursing from any recognised institution.

Professional qualification

Experience of working with rural communities.

Pay scales

The pay scale should be the same as prescribed by State Government for similar

categories of personnel under them.

Membership

The Public Health Nurse should be a member of the District Health and Family

Welfare Team in the District Health Organization and will enjoy the status equivalent to that

of the District Mass E ducation and the Information Officer.

Duties and functions

To help in the organization of Maternal and Child Health Programme as a whole.

To promote health and nutrition education activities through the Lady Health Visitors

and Auxillary Nurse Midwives by providing them with printed material produced by

various agencies.

To ensure that the LHVs/ANMs/Female Multipurpose Workers, etc. Integrated

MCH/FP and Health and Nutrition/Education in their day to day activities.

To help in developing school health programme in the district.

To ensure regular supply of equipments, records, registers, drugs, vaccines and other

sundries necessary for MCH work.

To ensure the maintenance of prescribed records and submission of periodical

progress of MCH/FP/Nutrition work activities.

To help the Statistical Officer in the District Family Welfare Bereau in compiling the

periodic progress report of MCH activities.

to provide continuing education for the female MCH/FO/functionaries in the district

through short in-service training sources.

To work together with the functionaries of other government departments like Social

Welfare, Rural Department and Education engaged in programmes for women and

children.

To co-operate MCH/FP activities undertaken through the voluntary organization in

the district and provide health inputs to the possible extent for mothers and children

organized in balwadis, anganwadis etc.

To tour for a minimum of 15 days in a month and visit PHCs, Sub-centres, village

dais, balwadi etc. According to an advance programme duly approved by the District

Medical Officer/ District Family Welfare Officer.

NURRSING SUPERINTENDENT GRADE I

Educational qualification

General: Pre- university course/ 10+2 or equivalent exam

Professional : 3 years General Nursing/9months/6months Midwifery/Psychiatric Nursing

Diploma/certificate, recognised by INC.

OR

Revised GNM/Psychiatric Nursing Diploma/certificate, recognised by INC.

OR

Basic B.Sc Nursing from recognosed university according to INC norms.

Registration : Registered with the Karnataka State Nursing Council/INC

Experience: Should have experience as NS grade II.

Standard norms

There should be one NS grade I for 200 bedded hospital, one NS grade I for 2-4 NS grade II.

Job summary

NS is responsible to the Medical Superintendent, in a hospital having 200 or above bed

strength. She is accountable for the safe and efficient running of the various nursing

department in the hospital. She is assisted in carrying out her duties by DNS/ANS, ward

supervisor and clerical, linen room and domestic staff.

General and office duties

Maintain necessary records concerning the nursing staff, student, confidential report

and health records etc.

Submit annual report of nursing service department of Medical Superintendent, INC

and Nurses Registration Council.

Participate in professional and community activities.

Maintain cordial relation with public and voluntary workers.

Nursing Services

Participate in the formulation of philosophy of the hospital in general and those

specific to nursing service.

Determines goals, aims, objectives and policies of the nursing services.

Implement hospital policies and rules through various nursing unit.

Decide and recommend personnel and material requirement in nursing service

department.

Interview and recruit nursing staff.

Assist in student selection and recruitment

Ensure safe and efficient nursing care.

Make regular visit in hospital and wards.

Take hospital rounds with Medical Superintendent.

Select and secure proper equipment needed for hospital.

Look after the welfare of patients, their relatives and nursing staff.

Prepare budget for nursing service department.

Function as a member of the condemnation for linen and other nursing home

equipment.

Prepares duty roster and plan staff leave.

Give guidance and counselling to the subordinate staff.

Maintain discipline among nurses and other auxiliary staff.

Enforces implementation of hospital rules, regulations and policies.

Participate in hospital and inter-hospital meeting.

Investigate complaints and take necessary action.

Evaluate confidential staff report and recommends for promotion

Plan staff development programme and arrange for in-service education.

Inspect hospital kitchen and dietary services of the hospital.

Arranges students clinical experiences.

Initiate and participate in nursing research.

NURRSING SUPERINTENDENT GRADE II

Educational qualification

General: Pre- university course/ 10+2 or equivalent exam

Professional : 3 years General Nursing/9months/6months Midwifery/Psychiatric Nursing

Diploma/certificate, recognised by INC.

OR

Revised GNM/Psychiatric Nursing Diploma/certificate, recognised by INC.

OR

Basic B.Sc Nursing from recognised university according to INC norms.

Registration : Registered with the Karnataka State Nursing Council/INC

Experience: Should have experience as senior staff nurse.

Standard Norms

Since it is the second level nursing supervisory role, it needs at least the Nursing

Superintendent group II for three senior staff nurse (1:3).

Job Summary

She/he is responsible for developing and supervising nursing service of a department or a

floor consisting of two or more wards or units managed by the senior staff nurses. These units

may be in-patient wards, out-patient department clinics, operatio theatres, obstetric unit,

CSSD etc. She/he is responsible to the NS Gr I.

Patient care and ward/ unit management

Organises and plan the nursing care activities of the department.

Plan staffing pattern and necessary requirement for his/her department.

Complies and submit nursing statistics to the concerned authorities.

Conduct and attend to the departmental and inter-departmental meeting.

Make regular rounds of her/his department.

Look in to general comfort of patients and their relatives.

Receive report from the Night Supervisors of his/her department.

Evaluate nature and quantum of care required in each unit.

Make rotation plan for nursing staff and domestic staff under his/her jurisdiction.

Plan ward management with each ward.

Reinforces the principles of good management in the ward.

Supervises the proper use and care of equipment.

Act as the public relation officer of the unit and deal with the problem faced by the

ward supervisor.

Officiate in the absence of NS Gr I.

Educational function

Arrange classes and clinical teaching of nursing students in the department related to

the speciality experiences

Implement the ward teaching programme and clinical experience of the students with

the help of doctors and nurses.

Does counselling and guidance of staff and the students.

Arrange and conduct staff development programmes.

Assist in planning for and participation in the training of auxiliary personnel.

General

Escorts NS Gr I, Medical Superintendent and special visitors for hospital rounds.

Acts as a Liaison officer between the nursing department and higher hospital

authoriyies.

Carried out any other duties delegated by the NS Gr I.

BIBLIOGRAPHY

1. Park K. Preventive and social medicine. Banasridas bhanot publications; 20TH ed.

2009, p 776-815

2. Basvanthappa. B.T, Nursing Administration (2007), Jaypee Brothers Medical

Publication. New Delhi. P 535-547.

3. Gulani. Community health nursing. Kumar medical publishers; 1ST ed. 2005. P591-

610.

4. Kasturi Sundar Rao. An introduction to community health nursing. Bi publications;

4TH ed.2004. P363-376.

5. Louis White. Foundation of skills and concepts. 1ST ed. P 72-76.

6. Jaiwanti P. TNAI. Nursing administration and management. Dhalta publications;