HEALTH CARE SYSTEM

IN INDIA 
Dr Smaraki Mohanty
INTRODUCTION
• 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 came into existence in 1978 following an international
conference at Alma-Ata(USSR).
History
• Bhore Committee in 1946- gave the concept of comprehensive health
care(integrated preventive, curative and promotional health care)
• UNICEF/WHO in 1965-gave the concept of basic health services.
• Alma-Ata declaration in 1978-gave the concept of primary health
care. Signed by all member countries including India. Goal was to
achieve health for all by 2000 A.D.
Elements of Primary Health Care
• Health Education.
• Promotion of food supply and proper nutrition.
• Adequate supply of safe water and basic sanitation.
• Maternal and child health care include family planning.
• Immunization against major infectious diseases.
• Prevention and control of locally endemic diseases.
• Appropriate treatment of common diseases and injuries.
• Provision of essential drugs.
Principles of Primary Health Care
• Equitable Distribution
• Community Participation
• Inter-sectoral Coordination
• Appropriate Technology
Primary health care in India
• In 1977- GoI launched Rural Health Scheme based on
recommendations of Shrivastava committee.(placing people’s health
in people’s hands)
• Gave the concept of male & female health worker.
• In 1983-GoI launched a National Health Policy based on primary
health care approach.
• NHM places more importance to primary health care with
formulation of IPHS.
LEVELS OF HEALTH CARE 

• Primary care level 

• Secondary care level 

• Tertiary care level 

HEALTH PROBLEMS 
The health problems in India can be grouped into 
1. Communicable disease problems 
2. Non-communicable disease problems 
3. Nutritional problems
4. Environmental sanitation problem 
5. Medical care problems 
6. Population problems 
RESOURCES
• Resources are needed to meet the vast health needs of a community 
1. Health manpower 
2. Money and material 
3. Time 
HEALTH CARE SYSTEMS 
1. PUBLIC HEALTH SECTOR 
     a) Primary health care 
              Primary health centres 
               Sub centres 
      B) Hospitals/health centres 
2. PRIVATE SECTOR 
3.INDIGENOUS SYSTEMS OF MEDICINE
4. VOLUNTARY HEALTH AGENCIES 
5.NATIONAL HEALTH PROGRAMMES
PRIMARY HEALTH CARE IN INDIA 
1. VILLAGE LEVEL – one of the main goals of primary health care is
universal coverage and equitable distribution of health resources 
To implement this policy at village level the following schemes are in
operation 
1.ASHA scheme 
2. ICDS scheme 
3.Training of local dais 
ICDS Scheme
- Started in 1975.
-In rural & urban areas-
1 AWC for 400-800 population.
1 mini AWC for 150-400 population.
-In tribal and hilly areas-
1 AWC for 300-800 population.
1 mini AWC for 150-300 population.
-BENEFICIARIES-
Children 0-6 yrs, pregnant and nursing mothers,
women 15-45 yrs and adolescent girls.
• ROLE OF ANGANWADI-
-supplementary nutrition.
-immunization.
-health check up.
-nutrition & health education for women.
-medical referral services.
-non formal education of children up to 6 yrs.
• 1 anganwadi worker and 1 anganwadi helper are posted in each
anganwadi centre.
ASHA
• Accredited Social Health Activist created under the NRHM
programme.
• In plains
1 ASHA per 1000 population
In tribal & hilly areas
1 ASHA per habitation
ASHA is the lowest level of health care in the present health care
scenario providing health care services at the village level.
Role of ASHA
• Take steps to create awareness and provide information to
community on determinants of health such as nutrition, basic
sanitation and regarding existing health services.
• Counsel women on birth preparedness , importance of safe delivery,
breast feeding, immunization, contraception, RTIs/STIs.
• Will mobilize the community and facilitate them in accessing health
services at anganwadi centre, subcentre,PHC.
• Prepare a village health plan
• Accompany pregnant women and children to PHC/CHC/FRU’s.
• Provide primary medical care for minor ailments.(DOTS provider).
• Depot holder for ORS,IFA tablet , chloroquine , disposable delivery
kits, contraceptives etc.
• Will coordinate with AWW and ANM for various health activities going
on in the village and subcentre .
Local Dai
• Training TBA
• Infection / Hypothermia / Asphyxia
2.SUB CENTRE LEVEL 
The sub centre is the peripheral outpost of the existing health delivery
system in rural areas.
• One sub centre for every 5000 population. 
• One sub centre for every 3000 population in hilly/tribal areas. 
• Type A- all recommended services except delivery
• Type B- all recommended services with delivery
 SERVICES TO BE PROVIDED IN  A SUB
CENTRE 
1) Maternal and child health care 
2) Family planning and contraception 
3) Counselling for MTP 
4) Adolescent health care 
5) Assistance to school health services 
6) Water quality monitoring 
7) Promotion of sanitation 
8) Field visits 
9) Community need assessment 
10) Curative services 
11) Co-ordinate services 
12) Disease surveillance 
13) National health programmes 
TYPE OF SUB CENTRE              SUB CENTRE A             SUB CENTRE B 
Staff                                        essential   desirable         essential desirable
ANM /health worker           1                     +1                     2 
Health worker (male)         1                                                1
Staff nurse                                                                               1     
Safai karamchari             1 (part time)                              1(full time )   

         
 3.PRIMARY HEALTH CENTRE LEVEL 
According to national health plan there is one PHC for every 30,000 rural
population and one PHC for every 20,000 population in hilly areas.
INDIAN PUBLIC HEALTH STANDARDS for PHC:
1. To provide comprehensive primary health care to the community
through PHC 
2. To achieve and maintain an acceptable standard of quality of care 
3. To make services more responsive and sensitive to the needs of the
community.
TYPE A PHC- less than 20 deliveries per month 
TYPE B PHC – 20 or more deliveries per month 
SERVICES PROVIDED BY A PHC 
1. Medical care-OPD running for 4 hours in the morning and 2 hours in the evening 
2. Maternal and child health care 
3. Full range of family planning services
4. Medical termination of pregnancy 
5. Health education 
6. Nutrition services 
7. Record of vital events 
8. Training 
9. Basic laboratory services 
10. Selected surgical services- vasectomy, tubectomy MTP, cataract surgeries
11. Mainstreaming of AYUSH 
12. Functional linkage with sub centres 
STAFF                                        TYPE A                       
TYPE B 
1. Medical officer                               1                                             1 
2. Accountant /data entry operator 1                                          1
3. Pharmacist                                        1                                          1 
4. Staff nurse                                         3                                       4 
5. Health worker (FEMALE)                  1                                      1
6. Health assistant (MALE)               1                                            1
7. Health assistant (FEMALE)           1                                            1
8. Lab technician                                1                                            1
9. Multi skilled group D worker        2                                           2 
10. Sanitary worker/watchman          1                                             1
TOTAL                                                   13                                            14 
4.COMMUNITY HEALTH CENTRE 
 A community health centre covers a population of 80,000 to 1.20
lakh with 30beds and specialists in Surgery, Medicine, O & G and
Pediatrics with X-ray and Laboratory facilities.

 IPHS for CHC - have to provide optimal expert care  to the

community and achieve and maintain an acceptable standard of
quality of care.
SERVICES TO BE PROVIDED IN A CHC 
1) Care of routine and emergency cases in medicine and surgery
2) Maternal, new born and child health care 
3) All the national health programmes
4) Physical medicine and rehabilitation 
5) Family planning 
6) Oral health 
7) School health services
8) Blood storage facilities 
9) Diagnostic services 
10) Referral (transport services)
Personnel       Strength       Qualification 
1. Block health officer   1                      senior most specialist 
2. General surgeon        1                     MS/DNB (general surgery)
3. Physician                     1                      MD/DNB (general medicine)
4. Obstetrician              1                           MD/DNB/DGO( OBG)
5. Paediatrics                  1                        MD/DNB/DCH 
6. Anaesthetist             1                           MD(anaesthesia)
7. Public health manager     1                 MD (PSM)/MD(CHA)/MD                                             
                                 (Community medicine )
8. Eye surgeon                    1                    MD/MS/DOMS/DNB (OPTHAL)
9. Dental surgeon           1                           BDS 
10. General duty Medical officer (atleast 2 female doctors)               6                           
 MBBS 
11. Specialist of AYUSH      1                             post graduate in AYUSH 
12. General duty medical officer of ayush 1 graduate in AYUSH 
Total-15/16 
Personnel                                          Strength 
1. Staff nurse                                                                19
2. Public health nurse                                                   1
3. ANM                                                                            1
4. Pharmacist                                                                  3
5. Pharmacist AYUSH                                                      1
6. Lab technician                                                              3
7. Radiographer                                                                2
8. Opthalmic assistant                                                    1
9. Dresser                                                                          2
10. Ward boy                                                                       5
11. Sweeper                                                                        5
12. Chowkidar                                                                     5
13.Dhobi                                                                  1
14. Mali                                                                    1
15. Aya                                                                      5
16. Peon                                                                    2
17. OPD attendant                                                   1
18. Registration clerk                                              2
19. Statistical asst/ data entry operator               2
20. Accountant                                                          1
21. OT technician                                                       1
Total –64 
THANK YOU