HEALTH CARE DELIVERY SYSTEM IN INDIA

Introduction
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. Selected health care definitions:
-being not
merely an absence of disease or infirmity.
agents of the health services or professions for the purpose of promoting, maintaining, monitoring or restoring health.
Definitions of health care delivery:
1. 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)
2. It implies the organization, delivery staffing regulation and quality control.
J.C.Pak(2001)
Philosophy of Health Care Delivery System:
eryone from birth to death is part of the market potential for health care services.

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 toward health.
2) Population perspective.
3) Intensive use of information.
4) Focus on consumer.
5) Knowledge of treatment outcome.
6) Constrained resources.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch) PREPARED BY: ANOOP,
CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN

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/health centre. Specialist hospitals. Teaching hospitals.
C. Health Insurance Schemes
Employees State Insurance. Central Govt. 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

IV. VOLUNTARY HEALTH AGENCIES

V. NATIONAL HEALTH PROGRAMM

ORGANIZATION AND ADMINISTRATION OF HEALTH SERVICES IN INDIA AT DIFFERENT LEVELS.

India is a union of 28 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
1/80,000 1,20,000
1/30,000
1/3,000 5,000
1/1,000
Community Health Centres
Sub-district/Taluka hospital
PHC
Sub-centres Health worker (M & F)
Village health guide, trained dai
District health organisation and basic specialities hospital/districts
States (28) an Union Territories (7) Ministry of Health and Directorate of Health
National Level Ministry of Health and Family Welfare
People in the population PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN

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 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 and

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. PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011
batch) PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN

Ministry of Health and Family Welfare

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.
Minister of State
Deputy Ministers
Dept. of Family Welfare
Dept. of Health
Dept. of Indian System of Medicine and Homoeopathy
Secretary
JS (ISM)
Director Ayurveda & Sidha
Secretary
Secretary health
Additional Secretary
Joint Secretaries (9)
Director General of Health Services
Addl. Director Generals (4)
Chief Director (1)
Cabinet Minister
Joint Secretary (3) PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch) PREPARED
BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN

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
1. General functions: The general functions are surveys, planning, coordination, programming and appraisal of all health
matters in the country.
2. Specific functions
a. International health relations and quarantine:
b. Control of drug standards
c. Medical store depots
d. Postgraduate training
e. Medical education
f. Medical research
g. Central Government Health Scheme.
Family welfare services
h. National Health Programmes.
i. Central Health Education Bureau
j. Health intelligence.
k. National Medical Library
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. PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II
years (2009-2011 batch) PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN

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.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch) PREPARED BY: ANOOP,
CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN

Organisational structure of the health and family welfare services at state level
Functions: Health services provided at the state level
Minister in charge of health and family welfare portfolio in the state
Secretary or commissioner, Department of Health and Family Welfare

Director Health Services

Director FW Services

Director Medical education & research

Director ISM and Homoeopathy
Additional/deputy joint directors of health services dealing with one or more programmes
Assistant Directors health services dealing with one or more programmes
Principal/Deans of medical colleges
Divisional set up in some states
District health organisation
Taluk Health organisation
Block level health organisation
Rural health services through minimum needs programme
Medical development programme
M.C.H., family welfare & immunization programme
NMIP (malaria) & NFCP(filarial)
NLEP, NTCP, NPCB, prevention and control of communicable diseases like diarrheal disease,
KFD, JE,
School health programme, nutrition programme, and national goitre control programme
Laboratory services and vaccine production units