HEALTH CARE DELIVERY

CONCERNS IN INDIA

HEALTH CARE SYSTEM

The WHO has recently defined a health care system as all the activities whose primary purpose is to promote, restore or maintain health.

OBJECTIVES

To improve the health status of the population and the clinical outcomes of the care

To improve the experience of care of patients families and communities

To reduce the total economic burden of care and illness.

To improve the social justice equity in the health status of the population

PRINCIPLES

1. Supports a co-ordinated, cohesive health care delivery system.

2. Opposes the concept that fee for practice.

3. Emphasis be placed on development of primary health care.

4. Support the health care basic human right for all the people

FUNCTIONS

To provide health service. To raise and pool the resources

accessible to pay for health. To generate human and physical

sources that make the delivery services possible.

AN OUTLINE OF HEALTH CARE DELIVERY SYSTEM IN INDIA

NATIONAL LEVEL

Union ministry of health and family welfare

Health developme

nt dpt

Director general of

health services[DGHS]

Family welfare

dpt

Commissioner, Family

welfare

Dpt of Ayush

Secretary, Ayush

Dpt of AIDS

control

Director General,

NACO

STATE LEVEL

Health Minister

State dpt of health and family welfare

Secretary / commissioner (IAS)( Health and family welfare)

State director of health services (SDHS) (Director of public health and preventive

medicine (DPH &PM))

Director Of Medical

Education

State director of Health Services and District health Administration

REGIONAL LEVEL

Additionally/joint/Deputy Director Of Health Service

District District District

DISTRICT LEVEL

The major unit of administration in India is the District for administration purpose the country is divided into 28 states and 67 union territories which in turn are divided into 432 administration districts.

Each district is divided into sub-districts or taluks, under which are situated the Community Development Blocks

at present there are 600 Community Development Blocks in India.

1. PUBLIC HEALTH SECTOR:-

a) Primary health care:- i) Primary health centres. ii) Sub-centres.

  b) Hospitals/ Health Centres:- 

i) Community health centres. ii) Rural hospitals. iii) District hospitals/health centres. iv) Specialist hospitals v) Teaching hospitals 

CENTRAL GOVT. HEALTH SCHEME (CGHS) OTHER AGENCIES:-

Defense services Railways 

2. PRIVATE SECTORS:-

a) Private hospitals, Polyclinics, Nursing homes,& dispensaries

b) General practitioners & clinics.

3. INDIGENOUS SYSTEMS OF MEDICINE (AYUSH)

a) Ayurveda , Yoga & Siddha.b) Unani & Tibbi.c) Homoepathyd) Unregistered practitioners.

4. VOLUNTARY HEALTH AGENCIES. 5. NATIONAL HEALTH PROGRAMMES

HEALTH CARE DELIVERY CONCERNS

INTRODUCTION

India - health ministry national level and state level has -its own health ministry.

The constitution of India clearly recognizes the Government responsibility for the health and state that “The state shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties”..

HEALTH CONCERENED AREAS:

1.Communicable Disease Problems: 2. Nutritional Problems: 3. Environmental Sanitation Problems:4. Medical Care Problems: 5. Population Problems:

INDIAN HEALTH PROFILE

PROBLEMS IN HEALTHCARE DELIVERY IN INDIA

PROBLEMS OF INEQUALITY

Unequal distribution of health care

urban rich, not accessible to the vast rural population.

Ratio of hospital bed to population in rural areas 15 times lower than that for urban areas.

Ratio of doctors : 6times lower than urban population.

Per capita expenditure on public health is 7times lower in rural areas , when compare to Govt health spending for urban areas.

Infant mortality rate: in poorest 20% of population is 2.5times higher than in richest 20%.

SOCIO-ECONOMIC PROBLEMS

The state of economy has a direct effect on the state of health in a country. The recent changes in the economic policies had a definite effect on the healthcare in IndiaPersistence of poverty in the social structure also complicates the health scene.The poor suffer disproportionately because of double burden of traditional disease as well as modern diseases

The poor lack adequate access to healthcare facilities

POLITICAL WILL

In a large developing country like India, there are numerous gaps left by the government in the development process - sometimes by intention, sometimes due to lack of funds, sometimes due to lack of awareness. Most Indian politicians are hesitant to take harsh but healthy decisions as the politics of vote dominates the agenda.

EMERGENCE OF PRIVATE HEALTHCARE

The dominance of the private sector denies access to poorer sections of society, skews the balance towards urban-biased,

tertiary level health services profitability overrides equality,

The increasing cost of healthcare that is paid by ‘out of pocket’ payments is making healthcare unaffordable for a growing number of people

CENTRALIZATION:

Splitting’ the healthcare infrastructure Primary Health Care Services in India are predominately delivered through centralized programmes. Large parts of the population who do not have access to or cannot afford private care depend on these programmes. However these centralized services are often unresponsive to local needs.

HIGH RISK PREGNANCY BEHAVIOR

The pregnancy pattern in India - too early, too many, too close together - enhances the risk of maternal mortality. About one- fifth of fertility is contributed by women in the age group of 15-19 years. The birth interval is about one- fourth of this group is 18 months. Of the total births, about a quarter is higher order births, of order 4 or more.

POOR PERCENTAGE OF INSTITUTIONAL DELIVERIES

Institutional deliveries are a critical factor in determining maternal deaths. The NFHS II indicates that the institutional deliveries are low in the country (33.6%) and very low in rural areas (24.6%). Though various measures have been under implementation under RCH programme for promoting institutional deliveries, they still need to be seen for the better results.

POOR PROGRAMME IMPLEMENTATION

The RCH programme though has various provisions such as emergency transportation, supply of emergency obstetric care equipment and IFA tablets, and provision of hiring private gynaecologist by public health facilities.The RCH Facility Survey conducted in 2000 reveals poor availability and utilisation of these provisions. The programme implementation has to be improved for attaining set objectives. 

POPULATION PROBLEM

Population explosion absorbs the national income and lowers the standard of living. It leads to food shortage and thus several nutritional problems arise. Uncontrolled fertility directly threatens the health of mothers and infants. Rapid population growth has serious pollution consequences as well.

SHORTAGE OF REQUIRED MEDICAL PRACTITIONERS

About 75% medical facilities are concentrated in urban areas where only 25% population resides, resulting in gross unavailability of health care support in the rural areas.The number of physicians per 10,000 populations for the world is 1.5, for India it is 7 which is at par with low income countries. For public sector, the figure is paltry 2.  Similarly, number of nurses per 10,000 population in India is 8, while it is 33 for the world and 16 for low income countries.

STRATEGIES SET BY THE GOVT. OF INDIA TO OVERCOME THE HEALTH

CARE DELIVERY CONCERNS

1. Operationalisation of 24 x 7 facility at PHC level

2. First Referral Units (FRUs) 3. Mobile Medical Units (MMU) 4. Patient Transport Services: 5. Special New Born Child Care units

(SNCU)

6. Stabilisation units (SU) 7. New born baby corners 8. Life Saving Anaesthetic Skills (LSAS) 9. Rogi Kalyan Samitis (RKS)10. Village Health and Sanitation Committee (VHSC)

11. Integrated District Action Plan 12. Accredited Social Health Activist (ASHA)13. Contractual Appointments 14. Integrated Management of Neonatal and Childhood Illness (IMNCI) 15. Navjaat Shishu Suraksha Karyakram (NSSK)

16. Facility based Integrated Management of Neonatal and Childhood Illness (F-IMNCI)  a) Emergency Obstetric Care (EMOC)b) Institutional Deliveries c) Janani Suraksha Yojana (JSY) d) District Mental Health Programme

(DMHP)

CONCLUSION

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 improve physical infrastructure to the necessity of providing health insurance and ensuring the availability of providing trained medical personnel. For companies that view the Indian healthcare sector as a glass half full, the potential is enormous.