ASSIGNMENT

ON
CHALLENGES OF HEALTH CARE DELIVERY
SYSTEM

SUBJECT: CLINICAL SPECIALITY-I (COMMUNITY HEALTH NURSING)

SUBMITTED BY,

C.DHASARATHAN

I YEAR

M.Sc., NURSING

CCN, CARE

SUBMITTED TO,

Prof. YAGA JAYANTHI

M.Sc., NURSING

HOD COMMUNITY HEALTH NURSING

CCN, CARE

SUBMITTED ON: 06.09.2022

 CHALLENGES OF HEALTH CARE DELIVERY SYSTEM

INTRODUCTION

According to the World Health Organization a health care delivery system

consists of all organizations, people and actions whose primary intent is to
promote, restore or maintain health. This includes efforts to
influence determinants of health as well as more direct activities that improve
health. A health system is, therefore, more than the pyramid of publicly owned
facilities that deliver personal health services but include the institutions,
people and resources involved in delivering health care to individuals for
example, a mother caring for a sick child at home; a child receiving
rehabilitation services within the school setting; an individual access vocational
rehabilitation services within the work place, Private providers, behavior
change programmes, such as vector-control campaigns. Health insurance
organisations, occupational health and safety legislation which include inter-
sectoral action by health staff, for example, encouraging the ministry of
education to promote female education, a well-known determinant of better
health.

DEFINITION OF HEALTH CARE DELIVERY SYSTEM

A health care delivery system is an organization of people, institutions, and

resources to deliver health care services to meet the health needs of a target
population. The selected domains were chosen in an effort to cluster those
elements that describe similar aspects of the delivery system.

HEALTH CARE DELIVERY SYSTEM IN INDIA

India is a union of 29 states and 7 union territories. States are largely independent
in matters relating to the delivery of health care to the people. Each state has
developed its own system of health care delivery independent of the Central
Government.
The Central Government responsibility consists mainly of policy making,
planning, guiding, assisting, evaluating and coordinating the work of the State
Health Ministries.
The health system in India has 3 main links
A.      Central
B.      State and
C.      Local or peripheral
FACTORS AFFECTING HEALTH CARE DELIVERY SYSTEM
1. Patient socio-demographic variables.
2. Patient cooperation.
3. Type of patient illness (severity of illness)
4. Provider socio-demographic variables.
5. Provider competence (Knowledge and skills)
6. Provider motivation and satisfaction.
7. Healthcare system.

CHALLENGES OF HEALTH CARE DELIVERY SYSTEM

1. Mitigating burden of disease

2. Infectious
3. Chronic degenerative
4. Maternal mortality
5. under-5 mortality
6. malnutrition
7. Healthcare finance
8. Lack of universal access to health care + Health inequality
9. Lack of healthcare related resources

BURDEN OF DISEASE 
Infectious diseases
1. Poor implantation of public health programs
2. Lack of environmental sanitation, safe drinking water, information and
awareness regarding importance of hygiene and nutrition
3. Poor living conditions
Chronic degenerative diseases
a. Lack of access to diagnostics (e.g. pap smear tests)
b. Poor diagnosis
c. Lack of specialists such as gynecologists
Prevalence of non-communicable diseases
i. Lack of awareness of diseases such as diabetes and
hypertension. 63 million diabetic patients in India
 ii. Focus is more on communicable diseases such as tuberculosis
and Polio.
Rise of psychological disorders
i. Lack of awareness and understanding

SOLUTIONS 

1. Prevention and management of the associated risk factors

2. Avoid onset of disease
3. Limit severity
4. Improve vaccination coverage
5. Develop Newer vaccines and Newer modes of delivery

MATERNAL MORTALITY, UNDER 5 MORTALITY

1. Malnutrition
2. Explosive population growth (High birth rates)
3. Gender inequality
4. Childbirth at home instead of hospital
5. Poor education
6. Poor nutrition
o Lack of breastfeeding
o Vulnerable to weakness and infection
o Poor immunity

According to UNICEF, 1.7 million under the age of 5 die , 98000 affected with
uncontrolled diarrhea

SOLUTIONS 

1. Needs a system that can meet the demands over a billion people
2. Professional leadership
3. Trained cadre of personnel
4. Coordinated approach
5. Patient and physician education
6. Antibiotic policy
7. Hospital infection control team
 8. Regional and international antibiotic resistance surveillance

HEALTH CARE FINANCE

o High cost of curative medical services

o Expensive health insurance
o Poor vaccination coverage
o Inappropriate and irrational use of high tech diagnostics
o The poor are more price sensitive to health care and are more likely to report
financial cost as a barrier for foregoing care when suffering from illness

SOLUTIONS
1. Data driven approach + analytic system driven by systems analysis and
software development
2. Public-private partnerships directed at data capture, analysis, and
implementation
3. Accountability, transparency, and better leadership
4. Development of the decision making process relating to achieving health
equity

LACK OF HEALTH CARE RELATED RESOURCES

1. Migration of qualified professionals

2. Workforce concentrated in urban areas
3. Underinvestment in health care related infrastructure in certain areas
a. Limited opening hours
b. Limited availability of drugs
c. Poor physical environments
d. Poor provider training and knowledge
e. Poor governance of health care sector
4. Adequate regulation of public and private sector has been difficult to achieve
Implementation of laws and codes is problematic

SOLUTIONS
1. Education of physicians and nurses in public sector
2. Incentives and policies to
(a) Attract and
(b) Retain personnel
3. Make it mandatory for professionals to do 3 years of rural service
LACK OF UNIVERSAL ACCESS +HEALTH EQUITY

Health services not easily accessible to rural populations Economics of scale

achievable only in urban areas but the majority of vulnerable groups exist where
services are scarce thereby affecting equity. physical distance to facilities is an
issue Health insurance only covers about a fifth of the entire
population .unorganized private sector accounts for almost 80% of outpatient
healthcare dearth of qualified medical professionals in rural areas inappropriate
drug use. Emergence of anti-microbial drug resistance, drug toxicity, adverse drug
reactions

SOLUTIONS

o Formation of an integrated national/state public health system

o Functional public health infrastructure that is shared between central and
state governments
o Efficient allocation of resources between different levels of services and
between different geographical regions
o National, state, and local
o Increase public financing
o Improve physical access to preventive and curative health services especially
in India’s rural population (e.g. hospital beds)
o Improve infrastructure (better transport, roads, and communication
networks).

BIBLIOGRAPHY

BOOK REFERENCE

A textbook of “Community Health Nursing” Bijulaksmi dass, 2nd edition, 2019,

page.no:200-218

NET REFERENCE

https://www.slideshare.net/kripak93/healthcare-challenges-solutions-in-india
JOURNAL REFERENCE

 Healthcare policy and administration in India: by sapru r k, sterling publication, ii

edition, chapter 15, pages 228-249. my books: indian health sector and healthcare
system: a critical insight, lap lambert academic publishing, Germany, 2012, isbn-
10: 3659268895, isbn-13: 978-3659268892, prashant Mehta.