SMCH/HCDS/07: Health Care System In India at Central Level

Quadrant-I

Personal Details

Role Name Affiliation

Principal Investigator Prof. CP Mishra Department of Community Medicine, Institute
of Medical Sciences, Banaras Hindu
University, Varanasi

Paper Coordinator Prof. Najam Khalique Department of Community Medicine, JN

Medical College, AMU, Aligarh

Content Writer Dr. M. Salman Shah Assistant Professor

Department of Community Medicine, JN
Medical College, AMU, Aligarh

Content Reviewer Dr. A. J Abedi Department of Community Medicine, JN

Medical College, AMU, Aligarh

Description of Module

Items Description of Module

Subject name Social Medicine & Community Health
Paper name Health Care Delivery System
Module name/Title Health Care System In India at Central Level
Module Id SMCH/HCDS/07
Pre-requisites Understanding of organisations in general terms
To understand organisation and functioning of health care system at
Objectives central level.
Director General Health Services, Family welfare, Indian System of
Keywords Medicine and Homeopathy,

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Introduction

The Health care system constitutes the management sector and involves organizational matters. It
operates in the context of the socio economic and political framework of the country.

Learning Outcomes

Upon completion of this module, the reader should be able to:

 Mention the sectors providing healthcare in India.

 Give synoptic view of Health System in India.
 Describe health care organization at national level.
 State funding of health care.
 Provide an overview of at central level health care set up and organization.

Main Text

1. Overview of sectors providing healthcare in India.

In India it is represented by five major sectors or agencies.

1.1.Public health sectors

(a) Primary Health Care

 Primary health centres
 Sub-centres
(b) Hospitals/health centres
 Community health centres
 Rural hospitals
 District hospitals/health centres
 Specialist hospitals
 Teaching hospitals
(c) Health Insurance Scheme
 Employees State insurance
 Central Government Health Scheme
(d) Other Agencies
 Defence services
 Railways

1.2.Private sector

(a) Private Hospitals, polyclinics, Nursing homes, and dispensaries

(b) General practitioners and clinics

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1.3.Indigenous system of medicine

 Ayurveda and Siddha

 Unani and Tibbi
 Homeopathy
 Unregistered practitioners

1.4.Voluntary health agencies

1.5.National health programmes (1)

Healthcare is one of India's largest service sectors. The Indian healthcare sector can be viewed as a glass
half empty or a glass half full. The challenges the sector faces are substantial, from the need to reduce
mortality rates, improve physical infrastructure, necessity to provide health insurance, ensuring
availability of trained medical personnel etc. (2)

In India Public and Private sector provides health care of primary to tertiary level to the
patients/community through various kind of set up. Approximately 70% patients are getting services from
private sector while remaining 30% patients are getting services from Govt. sector.(3)

Structure and Organization

Under the Indian Constitution, health is a state subject. Each state therefore has its own healthcare
delivery system in which both public and private (for profit as well as non-profit) actors operate. While
states are responsible for the functioning of their respective healthcare systems, certain responsibilities
also fall on the federal (Central) government, namely aspects of policy-making, planning, guiding,
assisting, evaluating and coordinating the work of various provincial health authorities and providing
funding to implement national programmes (2)

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Figure 1: Organization of Health Care System in India (2)

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2. Synoptic view of health system in India (3)

•Ministry of health and family welfare

National
Level

States and •Department of health and family welfare

union
territories

•District health organisation

District •private sector, voluntary sector
Level

Sub •Community health centres

district
level

•Primaryhealth centres
Village
Level

•SC, Village health guide, trained dai.

Periphery
level

3.Health care organization at the national level

Health system at the national level consists of:

3.1.The Ministry of Health and Family Welfare;
3.2.The Directorate General of Health Services; and
3.3The Central Council of Health and Family Welfare. (3)
The organization at the national level consists of the Union Ministry of Health and Family Welfare. The
Ministry has three departments, viz. –
 Department of Health & Family Welfare,
 Department of Indian system of Medicine and Homeopathy
 Department of Health Research.

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Each of these departments is headed by respective secretaries to Govt. of India. The department of Health
& Family Welfare is supported by a technical wing, the Directorate General of Health Services, headed
by Director General of Health Services(DGHS).(4)

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 3.1.Union ministry of health and family welfare

 Headed by a cabinet Minister, a Minister of State and Deputy Health Minister.

 The Ministry has three departments, viz. – Health, Family Welfare, and Indian System of
Medicine and Homeopathy, headed by two Secretaries, one for Health and Family Welfare and
the other for ISM and H.
 The department of Health is supported by a technical wing, the Directorate General of Health
Services, headed by Director General of Health Services (DGHS).
According to India’s Constitution, services are divided into “lists” which specify who is responsible for
them and empowered to pass legislation on them:
1) The Union list for the Central (federal) government,
2) The State list,
3) And the Concurrent List for tasks deemed the shared responsibility of the Central and State
governments.
Union laws override those made by the states for items in the concurrent list.
The health-related provisions in the union list relate to port quarantine, research, and scientific and
technical education. The concurrent list includes ‘prevention of the extension from one State to another of
infectious or contagious diseases or pests’, and other issues with wider national ramifications such as food
and drugs, family planning, medical education, and vital statistics. All other public health and
environmental sanitation services are supposed to be the exclusive responsibility of states. However, the
center exercises a great deal of power through fiscal control. (3)

Functions
The functions of the union Health Ministry are under
(a) Union list:
a. International health relations and administration of port quarantine
b. Administration of Central institutes such as the All India Institute of Hygiene and Public
Health, Kolkata;
c. Promotion of research through research centers and other bodies
d. Regulation and development of medical,
e. Establishment and maintenance of drug standards
f. Census, and collection and publication of other statistical data
g. Immigration and emigration
h. Regulation of labour
i. Coordination with States and with other ministries for promotion of health.
(b) Concurrent list: Functions listed under the concurrent list are responsibility of both the Union and
State governments. The Centre and the States have simultaneous powers of legislation: The concurrent
list includes:
a. Prevention of extension of communicable diseases from one unit to another
b. Prevention of adulteration of foodstuffs
c. Control of drugs and poisons
d. Vital statistics
e. Labour Welfare
f. Ports other than major
g. Economic and social planning, and
h. Population control and Family Planning.(3)

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  Department of Health:
 Headed by a secretary to the Government of India as its executive head, assisted by joint
secretaries, deputy secretaries and a large administrative staff.
 Deals with medical & public health maters including drugs control & prevention of food
adulteration.

The MoHFW’s Department of Health is supported in its work by a vast network of autonomous research
and training institutions, which are spread all over the country but administratively under the central
government. These include the National Institute of Communicable Diseases (Delhi), which was set up as
a center for disease control; the Central Bureau of Health Intelligence (New Delhi), several apex and
regional training institutes, and specialized institutions such as the Central Food Laboratory and Central
Drugs Laboratory. It also includes the Indian Council of Medical Research, which is headquartered in
New Delhi and has 6 Regional Medical Research Centers, and over 20 specialized research institutions
and laboratories across the country. The Department of Family Welfare is supported by another network
of institutions, and 18 research centers across the country. Besides these, the work of the MoHFW is
supported by institutions run by other bodies, such as the central government’s Council of Scientific &
Industrial Research which has institutions specialized in drug research and environmental engineering (3)

 Department of Family Welfare:

The Department of Family Welfare was created in 1966. Assisted by an Additional
Secretary & Commissioner (Family Welfare), and one Joint Secretary.
Oversees the implementation of programs concerning family welfare & MCH.
It has the following technical divisions:
i. Programme appraisal & special schemes
ii. Technical operations
iii. MCH
iv. Evaluation & intelligence
v. Nirodh marketing
vi. Transport
vii. UIP
viii. Area project
ix. Mass education & media (3)

 Department of ISM & H:

Established in March 95.
The main areas of its functioning are:
i. Education
ii. Standardization of drugs
iii. Enhancement of availability of raw materials
iv. Research & development
v. IEC
vi. Mainstreaming ISM & H in health care (3)
3.2.Directorate general of health services

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  Organization: The Director General of Health Services is the principal adviser to the Union
Government in both medical and public health matters. He is assisted by an additional
Director General of Health Services, a team of deputies and a large administrative staff. The
Directorate comprises of three main units, e.g., medical care and hospitals, public health and
general administration.

 Functions:

A. The GENERAL functions are surveys, planning, coordination, programming

and appraisal of all health matters in the country.
B. The SPECIFIC functions are
i. International health relations and quarantine
ii. Control of drug standards: The Drugs Control Organization is headed by the Drugs
Controller.
iii. Medical store depots: These depots supply the civil medical requirements of the Central
Government and of the various State Governments.
iv. Post graduate training: The Directorate General of Health Services is responsible for the
administration of national institutes. Some of these institutes are:- the all India Institute of
Hygiene and Public Health at Kolkata, All India Institute of Mental Health at Bangalore,
College of Nursing at Delhi.
v. Medical education: The Central Directorate is directly in charge of the following medical
colleges at Pondicherry, and Goa.
vi. Medical Research: Medical Research in the country is organized largely through the
Indian Council of Medical Research,
vii. Central Govt. Health Scheme:
viii. National Health Programmes:
ix. Central Health Education Bureau: An outstanding activity of this bureau is the
preparation of education material for creating health awareness among the people.
x. Health Intelligence: The Central Bureau of Health Intelligence was established in 1961 to
centralize collection, compilation, analysis, evaluation and dissemination of all
information on health statistics for the nation as a whole. The Bureau has an
Epidemiological Unit, a Health Economics Unit, a National Morbidity Survey Unit and a
Manpower Cell.
xi. National Medical Library: The aim is to help in the advancement of medical, health and
related sciences by collection, dissemination and exchange of information.(3)

3.3.Central council of health

Union Health Minister is the Chairman and the State Health Ministers are the members.
 Functions:
i. To consider and recommend broad outlines of policy in regard to provision of
remedial and preventive care, environmental hygiene, nutrition, health education
and the promotion of facilities for training and research.
ii. To make proposals for legislation in medical and public health matters.
iii. To make recommendations to the Central Government regarding distribution of
available grants-in-aid for health purpose to the States and to review periodically
the work accomplished in different areas through the utilisation of these grants-
in-aid.

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 iv. To establish any organization or organizations invested with appropriate
functions for promoting and maintaining cooperation between the Central and
State Health administrations.

4.Funding of health care

Spending on health care in India was an estimated five percent of gross domestic product (GDP) in 2013
and is expected to remain at that level through 2016.Total health care spending in local-currency terms is
projected to rise at an annual rate of over 12 percent, from an estimated $96.3 billion in 2013 to $195.7
billion in 2018.While this rapid growth rate will reflect high inflation, it will also be driven by increasing
public and private expenditures on health.(5)
5.Health care setup at central level

MINISTRY OF HEALTH AND FAMILY WELFARE

Nirman Bhavan, New Delhi
CABINET MINISTER
And STATE MINISTERS (one or two)
ADMINISTRATORS
(IAS OFFICERS CADER)
Principal secretary Health & Family Welfare
HEALTH FAMILY
WELFARE
Secretary Secretary
Joint Secretary Joint Secretary
Deputy Secretary Deputy Secretary
Under Secretary Under Secretary
TECHNICAL EXPERTS
1.DIRECTOR GENERAL
Health Services
HEALTH FAMILY
WELFARE
Director Director
Deputy Director Deputy Director
Joint Director Joint Director

Summary:
The Health care system constitutes the management sector and involves organizational matters. It
operates in the context of the socio economic and political framework of the country. In India it is
represented by five major sectors or agencies.

Health system at the national level consists of- The Ministry of Health and Family Welfare; The
Directorate General of Health Services; and The Central Council of Health and Family Welfare. The
organization at the national level consists of the Union Ministry of Health and Family Welfare. The
Ministry has three departments, viz. Department of Health & Family Welfare; Department of Indian
system of Medicine and Homeopathy; Department of Health Research. Each of these departments is
headed by respective secretaries to Govt. of India. The department of Health & Family Welfare is

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supported by a technical wing, the Directorate General of Health Services, headed by Director General of
Health Services (DGHS).

At the central level mainly planning & policy making is done whereas the state & districts helps in the
implementation of policies as well as provides feedback to the higher level for further revisions.

References:

1. Park’s Textbook of Preventive and Social Medicine, K. Park, 23rd edition, Page number 902.
2. India’s Healthcare System Overview and Quality Improvement, Swedish Agency for Growth
Policy Analysis, Direct response 2013:04.
3. Post Graduate Certificate Course in Health System and Management, 2013, Module 2: Chapter
6.A INTRODUCTION TO HEALTH SYSTEM IN INDIA - GOVERNMENT SET – UP,
IAPSM Gujarat Chapter.
4. Organization of Health Care in India, Leo S. Vaz.
5. Industry Report, Healthcare: India, The Economist Intelligence Unit, July 2014.

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