HEALTH CARE DELIVERY

HEALTH: Is a state of complete physical mental, and social well being not merely the absence of the disease and infirmity HEALTH CARE: Embraces a multitude of services provided to the individuals/communities by agents of the health services or professions for the purpose of promoting,maintaining,monitoring or restoring health MEDICAL CARE: Is that service provided by the physician or rendered by the physicians instructions, which ranges from domiciliary care to resident hospital care. Medical care is a component of health care.

HEALTH SYSTEM: Is a system which constitutes the management sector , involves the Organizational matters and delivers the health care services to the individuals / communities
Community participation is a major component in the approach to the whole system of health care (treatment, promotion, prevention and rehabilitation). LEVELS OF HEALTH CARE: 1. PRIMARY LEVEL 2. SECONDARY LEVEL 3. TERTIARY LEVEL

LEVELS OF HEALTH CARE:

1.

PRIMARY CARE LEVEL It is the first level of contact of individual, family & community with the health care system where essential primary health care is provided. In India, through PHCS and their sub-centers by MPHWs,VHGs and trained dais. The village health teams not only deliver the health care but also bridge the cultural & communication gap between the people and health sector.

2. SECONDARY CARE LEVEL At this level more complex health problems are dealt with through district hospitals and community health centers. 3. TERTIARY CARE LEVEL Here more specialized services than the secondary level health care is provided and it requires more sophisticated facilities and specialized faculty. Regional and central level institutions e.g. Medical college hospital, All India Institutes, regional hospitals Specialized hospitals etc. are providing this care.

CHANGING CONCEPTS OF HEALTH CARE

COMPREHENSIVE HEALTH CARE-1946
This term was first used by Bhore committee in 1946 with the meaning of provision of integrated preventive,promotive and curative services from womb to tomb to every individual residing in a defined geographic area.

CRITERIA FOR COMPREHENSIVE HEALTH CARE:

1. Provide adequate preventive, curative & primitive health services. 2. Be as close as possible to the beneficiaries . 3. To have widest co-operation between people ,service &profession. 4. Be available to all irrespective of their ability to pay. 5. Specific to the vulnerable & weaker sections of the community. 6. Create and maintain a healthy environment both in homes as well as working places. But it is not able to cover effectively to the whole population under their jurisdiction and their sphere of service area is not more than 2-5km.This is not gain the confidence of the people because of under staffed and poor supply of medicines.

CHANGING CONCEPTS OF HEALTH CARE ---------continuation

BASIC HEALTH SERVISES-1965 This term was used by UNICEF/WHO in their joint health policy. They defined the basic health service is a understood to be a network of co-coordinated, peripheral intermediate health units capable of performing effectively a selected group of functions Essential to the health of an area and assuring the availability of competent professional and auxiliary personal to perform these functions. Drawbacks: 1. Lack of community participation 2. Lack of coordination and 3. Dissociation from the socio-economic aspects

CHANGING CONCEPTS OF HEALTH CARE --------continuation

PRIMARY HEALTH CARE:1978 Alma-Ate defined the primary health care is essential health care made universally accessible to individuals and acceptable to them through their full participation and at a cost the community and country can afford. The concept of primary health has been accepted by all countries as the key to the attainment of health foe all by 2000AD.

ELEMENTS OF PRIMARY HEALTH CARE

Even though , specific services may vary from country to country. Alma-Ata Declaration outlined 8 essential components of primary health care. They are 1. Education concerning prevailing health problems and the methods of preventing and controlling them. 2. Promotion of food supply and proper nutrition. 3. Adequate supply of safe drinking water & basic sanitation. 4. Maternal & child health care, including family planning. 5. Immunization against major infectious diseases. 6. Prevention & control of locally endemic diseases. 7. Appropriate treatment of common diseases & injuries and 8. Provision of essential drugs.

PRINCIPLES OF PRIMARY HEALTH CARE

1.Equitable distribution:
Irrespective of their ability to pay every individual should have access to health care services (rural/urban/slums & poor/rich) means Example: th population of India lives in rural but 3/4th budget used to spent on urban population, so primary health care concept is to eliminate this in equality)

.2.Community

participation:

Preparation of village health plan and its implementation , based on their health needs . Example: The MPHW with help of village health guides, trained dais and other health volunteers. It helps to overcome the cultural and communication barriers so that the services offered may acceptable to the whole village.

PRINCIPLES OF PRIMARY HEALTH CARE----CONTINUATION

3:Inter-sectoral co-ordination:
In addition to the health sectors Other sectors related to health must also involve in providing health care to the community. Example: Family planning camp

4:Appropriate technology:
A technology that is scientifically sound, adaptable to local needs & acceptable to those who apply it and those for whom it is used, and that can be maintained by the people themselves in keeping with the principle of self reliance with the resources of the community and country can afford The term appropriate means to use cheaper and easily manageable method than cost method in all means.
Example: Use of ORS for diarrhea ,Stand pipes (bore wells ).

PRIMARY HEALTH CARE in INDIA

In 1977, the government of India had launched a Rural Health Mission, based on the principle of placing the peoples health in peoples hands. It is a three tier system of health care delivery in rural areas, as per the recommendation of Shrivastave committee.

Bhore committee 1946:

1.PHC a basic health unit to provide an integrated preventive and curative services to rural population. 2.one PHC/10 to 20,000 population with 6 medical officers and 6 public health nurses and other supporting staff.

PRIMARY HEALTH CARE in INDIA--CONTINUATION

CENTRAL COUNCIL OF HEALTH: 1. In 1953 ,recommended for establishment of PHCs in community
development blocks to provide comprehensive health care to rural population. 2.One PHC is for 1,00,000 population. 3.with little or no community involvement. 4.poorly staffed and equipped, inadequately for covering the population.

Mudaliar committee,1962:
1.strenthenig of existing PHCs and 2.One PHC for 40,00 population.

NATIONAL HEALTH PLAN:

As a signatory to the Alma-Ata declaration , India has proposed reorganization of primary health centers on the basis of one PHC for 30,000 population in plain areas and 20,000 population in tribal and hilly areas for more effective coverage.

Shrivastav committee-1975:
Community health care should be provided by health workers who are from the same community after proper training. So that peoples health is placed in peoples hands.

FUNTIONS OF PHC
It covers the all the 8 essential elements of Alma-Ata declaration. The functions of a primary health care centre are:

1.Medical care 2.MCH including family planning 3.Safe potable water supply and basic sanitation 4.Prevention and control of locally endemic diseases 5.Education about health 6.National health programmes(relevent) implementation. 7.Refferal services 8.Training of health guides, health workers, local dais and health assistants.

COMMUNITY HEALTH CENTERE On 30th June 1996 CHCs were established by upgrading the PHCs. One CHC/80,000 to 1,20,000 population. It is having 30 beds. It also has specialists in surgery,peadiatrics and Obstetrics and gynecology with X-ray and lab facilities . Community health officer/second medical officer (for preventive & promotive services).

STAFF PATTERN
AT PHC LEVEL Medical officer -1 Pharmacist - 1 Nurse mid wife-1 Female health worker-1 Female health assistant-1 Male health assistant-1 Block extension educator-1 U.D.C-1 L.D.C-1 Labtechnician-1 Driver (if vehicle present)-1 Others-4 AT SUBCENTRE LEVEL Female health worker-1 Male health worker-1 Voluntary worker-1

AT CHC LEVEL Medical officer -4 pharmacist/compounder Nurse mid wife-7 Labtechnician-1 Radiographer-1 Ward boys-2 Dhobi-1 Sweepers-3 Mali-1 Chowkidar-1 Aya-1 Peon-1

JOB OF MEDICAL OFFICER OF PHC

He is captain of PHC health team and also planner,promoter,director,supervisor,co-ordinator and evaluator. Morning hours O.P & afternoon hours field services. Visits all sub centers on fixed days & hours to provide guidence,supervision and leadership to the health team, Programs staff meeting once in a month. He ensures that the National health programmes being implemented properly in his area. JOB OF SECOND MEDICAL OFFICER OF PHC similar functions except drawing powers.

JOB OF FEMALE HEALTH WORKER OF PHC

REGISTRATION: Registration: pregnant mothers ,married women of reproductive period and children. Maintenance of maternity ,antenatal eligible couple and children registers. Categorize the ECs as per age of women and number of children. CARE AT HOME: Curative services Spread the family planning message & motivate for family planning. Distribute medicines and family planning contraceptives. Immunization services Refer cases Conduct 50% of total deliveries of her area. Supervise deliveries conducted by dais. Provide follow up care Provide at least 3 antennal & post natal home visits Educate about feeding of the newborn,childern and pregnant mothers.

JOB OF FEMALE HEALTH WORKER OF PHCcontinuation

Educate about personal hygiene, environmental sanitation. Assess the growth & developments of the infant and take necessary action. Treatment of minor elements Record keeping of vital events Notify notifiable diseases Test urine for albumin sugar ,blood for HB% and blood smear taking for malaria parasite. Identify the cases that require help for MTP,provide information on availability of services and refer them to the nearest approved institution.

CARE AT THE CLINIC:

1.Arrange & help medical officer and health assistant (F) in conducting the MCH & FP clinics at the sub centre. 2.Conduct urine examination for albumin & sugar and blood for HB%. 3.Educate the mother individually and in groups in better family health including MCH,FP,nutrition,Immunisation,hyiene and minor elements.

JOB OF FEMALE HEALTH WORKER OF PHC -------continuation

CARE AT THE COMMUNITY:

She will identify women leaders & help the HA(F) and participate in

the training of women leaders. Set up women depot holders for condom distribution and help the HA(F) in training programme. Participate in Mahila Mandalay Meetings and utilize such gatherings foe educating women in family welfare programmes. Utilize satisfied customer, village leaders, dais and others for promoting FWP. OTHER FUNCTIONS: Maintain the cleanliness of the centre. Attend staff meetings at PHC/CD block/ district level. List dais in her area and involve them in promoting of FP work. Help the HA(F) in the training programmes. Coordinate her activities with male health workers. Prepare and maintain all registers and records and maps, charts for her area in the sub-centre and submit the prescribed periodical reports in time to the HA as per standing orders.

JOB OF MALE HEALTH WORKER OF PHC

Record keeping:
1.Survey all the families of his area & collect general information about each village of his area. 2.Prepare,maintain and utilize family records and village registers. i.e. Record particulars concerning of FP,immunisation,vital events,environmetal sanitasion,other local health programmes,educational activities, services rendered & achievements etc.

Malaria:
1.Identify fever cases. 2.Make thick & thin blood smear slides. 3. Send those slides to lab for investigation.

4. Administer presumptive treatment to all the fever patients.

5.Record the results of blood examination slides. 6.educate about the importance of blood smear examination for fever cases and insecticidal spraying of houses etc.

JOB OF MALE HEALTH WORKER OF PHC-continuation Communicable diseases:

1.Identify cases of diarrhoea /dycentery,fever with rash,jaundice,encephalitis,dipthria,whooging cough and tetanus and notify the HA(male), medical officer immediately. 2.Carry out control measures until the arrival of the HA and MO to help his for the same. 3.Give ORS to all cases of diarrhoea/dysentery/vomiting. 4.Educate about the importance of control and preventive measures against communicable diseases. & about the complete and regular treatment. 5.Identify & refer cases of genital sore or urethral discharge on non-itchy rash over the body to MO ,PHC. 6.Identify & refer cases of blindness.

Leprosy:
1.Identify cases of patches with loss of sensation & take skin smears and refer the patient to PHC. 2.Check whether the all the cases are taking treatment regularly or not. Motivate defaulter to take treatment.

JOB OF MALE HEALTH WORKER OF PHC-continuation Tuberculosis:

1.Identify persons 15 yrs and above with prolonged fever/cough/spitting of blood and take sputum smear. Refer the cases to MO,PHC. 2.Check whether the all the cases are taking treatment regularly or not. Motivate defaulter to take treatment. 3.Educate community on various aspects of TB programme. 4.Assit village health guide in undertaking the activities of TB control programme. 5.Provide the village wise list of TB patients to VHG ,so that he is able to motivate them in taking regular treatment.

Environmental sanitation:
1.Chlorinate public water sources including wells at regular intervals 2.Education on a). method of safe solid & liquid waste disposal. b). Home sanitation c). Advantage and use of sanitary latrine d). Construction of smoke less chulhas.

JOB OF MALE HEALTH WORKER OF PHC-continuation

Expanded programme of immunization:

1.Administer DPT,Polio,Measels,BCG,Tetanus,HBV and Vitamin A to all the eligible children. 2.Assist HW(F) in giving TT inj. To all ANCs. 3.Assist HA(M) in school immunization programme.

Family planning:
1.Utilise the information of EcS & Child registers for the FPprogramme. 2.Spread the message of FP and motivate the ECs to adapt FP. 3.Distribute contraceptives to the couples. 4.Provide follow-up services to FP methods acceptors. 5.Establish male depot holders in the area. Help the HA (male & female) in training them and provide a continuous supply of conventional contraceptives to the depot holders.

COMMON JOB FUNTIONA OF HEALTH ASSISTANT MALE & FEMALE

Supervise & guide HW in delivery of health care services. Strengthen the knowledge & skills of HW . Help the HW in improving their human relations skill. Help & guide the HWs in planning and organizing their programmes. Promote team work among the HWs. Coordinate the activities with other workers and agencies. Visit each worker periodically: Observe & guide the health worker in the day to day activities. Arrange group meetings with leaders & involve them in spreading the message for various health programmes. Scrutinize the maintenance of registers & records by HWS and help them in proper maintenance.

COMMON JOB FUNTIONA OF HEALTH ASSISTANT MALE & FEMALEcontinuation

Conduct regular staff meetings for HWs. Attend staff meetings at PHC/District Asses the progress of work of HWs periodically & submit their assessment reports to MO. Assist the MO,PHC in organizing the different health services. Participate in mass camps & campaigns. Indent, procure & supply material to health workers. Prepare, maintain & utilize prescribed records & reports. Review, consolidate & submit periodical reports to MO and Attend to cases referred by Hws and refer cases beyond his/her competency to PHC/CHC.

SPECIFIC JOB FUNCTIONS OF FEMALE HEALTH ASSISTANT OF PHC. Visit each of the 4 sub centers at least once a week on fixed days and supervise and guide the health workers. Guide the HW in establishing women depot holders foe conventional contraceptives. Conduct MCH & FP clinics and educational activities. Organize & conduct training for dais and women leaders with the help of health workers. Respond to urgent calls from the health workers and trained dais and render necessary help. Organize & utilize the Mahila Mandals ,teachers etc.in the FWP. Personally motivate resistant cases for FP. Provide information on the availability of services for MTP and refer suitable cases to approved institutions and Supervises the all Immunization secessions.

SPECIFIC JOB FUNCTIONS OF MALE HEALTH ASSISTANT OF PHC: CONTONUATION MALARIA: 1.Supervise the work of HW male during concurrent visits. 2.Check min of 10% of the houses in a village 3. Collect blood smears of fever case he come across & will administer presumptive treatment of antimalarial drug 4.Administer radical treatment for malaria positive cases in his area. 5.Supervise the spraying of insecticides during local spraying along with the HW male. COMMUNICABLE DISEASES: 1.Be alert to the sudden rise of epidemics of diseases like diarrhoea/dycentery ,whooping cough,tetanus,polio etc. And take all possible remedial measures. 2.Take the necessary control measures when any notifiable disease is reported to him. And carry out the destruction of stray dogs with help of HW male. LEPRACY: 1.In cases suspected of having leprosy take skin smears and send them for examination. 2.Ensure that all cases of leprosy take regular & complete treatment and inform MO, PHC about defaulters of treatment.

SPECIFIC JOB FUNCTIONS OF MALE HEALTH ASSISTANT OF PHC: continuation

TUBERCULOSIS:
1.Ensure that all TB cases take regular & complete treatment and inform MO, PHC about defaulters of treatment.

ENVIRONMENTAL SANITATION: 1.Help the community in construction of a) safe water source b) soakage pits c) kitchen garden d) Manure pits e) Compost pits f) Sanitary latrines g)Smokeless chullhas and supervise their construction & supervise the chlorination of water sources.

SPECIFIC JOB FUNCTIONS OF MALE HEALTH ASSISTANT OF PHC: CONTONUATION EPI: 1.Conduct immunization of all school children with the help of HW male. 2.Supervise the immunization of all children from one to five years. FAMILY PLANNING:

Personally motivate resistant cases of FP. Guide the HW male in establishing male depot holders with the assistance of the HW male & supervise the functioning. Assist MO,PHC in organization of FP camps. Provide information on the availability of services for the MTP & refer suitable cases to the approved institutions. Ensure follow-up services of vasectomy,tubectomy and IUD and other family planning acceptors.

NUTRITION: 1.Ensure that all cases of malnutrition among the infants & children <6 years are given the necessary treatment and advice and refer serious cases to PHC. 2.Ensure that Iron & folic acid tablets and vitamin A are distributed to the beneficiaries.

SPECIFIC JOB FUNCTIONS OF MALE HEALTH ASSISTANT OF PHC: CONTONUATION

CONTROL OF BLINDNESS: 1.All cases of blindness including suspected cases of cataract be referred to MO,PHC.

VITAL EVENTS:
1.Collect and complete the weekly reports of births and deaths in his area and submit them to the MO,PHC. 2.Educate the community regarding the need of registration of Vital events.

HEALTH FOR ALL

This movement was decided to launch in 1977 by the world health assembly. The fundamental principle of HFA strategy is equity. Health for all is defined As attainment of a level of health that

will enable every individual to lead a socially and economically productive life.
In 1978,the Alma-Ata conference on primary health care reaffirmed HFA as the major social goal of governments. And stated that Provision of primary health care is the best approach to attain HFA. In 1981,who developed a global strategy for HFA. Which provides a global frame work that is broad enough to apply to all member states and flexible enough. By using global strategy individual countries developed their own strategies foe achieving HFA. Who has established 12 global indicators for assessing the progress towards HFA.

HEALTH FOR ALL-continution

National strategy for HFA/2000: As a signatory to Alma-Ata declaration in 1978 ,the government of India has appointed two groups i.e. (1).Study group on HFA ,sponsored by ICSSR & ICMR, which was given a report on HFA an alternative strategy. (2).Working group of HFA by 2000AD , sponsored by Ministry of health & family welfare GOVT.of India. And reports of both these groups formed the basis of the National Health Policy of MOHFW of govt.of India which was formed in 1983 . National Health policy echoes the WHO call for HFA & the AlmaAta declaration for Primary healthcare. NHP had laid down specific goal in respect to the various health indicators by different date i.e.1990 and 2000.

HEALTH FOR ALL-continuation

GOALS OF NHP(1983),INDIA TO BE ACHIEVED BY 2000AD.
1.Reduction of IMR from 125 t0 <60. 2.To raise the life expectancy at birth from 52years to 64 years. 3.To reduce the crude death rate from 14 to 9/1000 population. 4.To reduce the crude birth rate from 33 to 21/1000 population. 5.To achieve the Net reproductive rate to one. 6.To provide the potable water to the entire rural population.

MODEL OF HEALTH CARE DELIVERY SYSTEM

HEALTH CARE SERVECES HEALTH CARE SYSTEM

INPUTS

OUTPUTS

HEALTH STATUS OR HEALTH PROBLEMS

CURATIVE PREVENTIVE PROMOTIVE

PUBLIC PRIVATE VOLUNTARY INDIGENOUS

CHANGES IN HEALTH STATUS

RESOURCES

HEALTH CARE STATUS & HEALTH PROBLEMS

An assessment of the health care status & health problems of a community is known as a community diagnosis. It is required for the planning of health care services. Indias health care status & health problems are discussed under following headings: Demographic profile, Mortality profile and Health problems - communicable diseases. - Nutritional problems - Environmental sanitation problems - Medical care problems - Population problems - Resource problems (money, manpower and time)

1. 2. 3.

HEALTH CARE SYSTEMS

1.Public sector . Primary health care(PHC & SC). .Hospitals and health centers(CHC,RH,DH, SH,TC) . Health Insurance schemes ( ESI & CGHS). .Other agencies (railways & defense)

2.Private sector Private hospitals, Gps etc.

4.voluntary organizations 5.National health programmes

3.Indigenous systems of medicine Ayurveda,Sidda, Unani and Homeopathy

HEALTH CARE SERVICES

PROMOTIVE PREVENTIVE CURATIVE

HEALTH CENTER HOSPITALS

HOSPITAL
1.Services Provided are mostly Curative. 2.Has no catchment area i.e. it has no definite area of responsibility. 3.The health team is of curative staff. i.e.doctors,nurces and compounders.

HEALTH CENTRE
1.Services provided are integrated i.e. preventive,promotive and curative. 2.It has catchment area i.e. has definite area and population. 3.The health team of health centre is a optimum mix of medical and paramedical workers.

HOSPITALS(GOVT)
RURAL HOSPITALS: All the rural hospitals and dispensaries are converted to upgraded PHCs. SUB-DIVISIONAL HOSPITALS : Now converted in to sub-divisional centers to cover 5 lack population and or community health centers to cover 80-1.20 lack population. DISTRICT HOSPITALS: SPECIALISED HOSPITALS: TEACHING HOSPITALS:

PRIVATE HOSPITALS

CLINICS HOSPITAL NURSING HOMES CORPORATE HOSPITALS

VOLUNTARY HEALTH AGENCIES(NGOs)

INDIA:
1. 2. 3. 4. 5. 6.

7.
8. 9. 10.

11.
12.

INDIAN RED-CROSS SOCIETY HIND KUSHT NIVARAN SANGH INDIAN COUNCIL FOR CHILD WELFARE TUBERCULOSIS ASSOCIARION OF INDIA BHARAT SEVAK SAMAJ CENTRAL SOCIAL WELFARE BOARD THE KASTURBA MEMORIAL FUND FAMILY PLANNING ASSOCIATION OF INDIA ALL INDIA WOMENS CONFERENCE THE ALL INDIA BLIND RELIEF SOCIETY PROFESSIONAL BODIES INTERNATIONAL AGENCIES REDCROSS, CARE,FORD FOUNDATION,ROCK-FELLER FOUNDATION ETC.

WORLD (NGOs)
WHO UNICEF FAO UNDP WORLD BANK ILO

BILATERAL HEALTH AGENCIES

USAID THE COLOMBO PLAN SIDA: DANIDA

HEALTH INSURANCE
EMPLOYEES INSURANCE SCHEEME(ESI) CENTRA GOVERNMENT HEALTH INSURANCE(CGHS) LIFE INSURANCE OF INDIA (LIC) OTHERS