163576682 Health Care Delivery System

HEALTH CARE DELIVERY SYSTEM
IN INDIA AND ABROAD
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. The nursing profession exists to meet the health need of the people.
Unprecedented changes have occurred in the structure of our society, in lifestyles, in specific and
technological advances.
Health is a multi dimensional ith physical, biological, economical, social, cultural and
vocational. Health is not static. ! person ho is healthy no may not be healthy the next moment.
"ublic has become more aare and emphasizing on health, health promotion, ellness and self care.
#mphasis has shifted from a focus on cure to a focus on prevention and health maintenance. This has
led to a evolution of a ide range of health promotion techni$ues, and programmes including
multiphasic screening, life time health monitoring programs.
%pecial efforts being made by the health care professionals to reach and motive members of
various cultural and social economic groups concerning life style and health practices. !ll efforts are
to design a health care system that ma&es comprehensive health care available to all the people at an
affordable cost.
Selected health care definitions'
• Health' !ccording to (HO, health is defined as )a dynamic state of complete physical,
mental and social ell-being not merely an absence of disease or infirmity.*
• Health care services' +t is defined as )multitude of services rendered to individuals, families or
communities by the agents of the health services or professions for the purpose of promoting,
maintaining, monitoring or restoring health.*
Definitions of health care delier!"
,. Health care delivery system refers to the totality of resources that a population or society
distributes in the organisation and delivery of health population services. +t also includes
all personal and public services performed by individuals or institutions for the purpose of
maintaining or restoring health.
-%tanhope-.//,0
.. +t implies the organisation, delivery staffing regulation and $uality control.
#$C$%a&'())*+
1. Health care delivery system is the organisation by hich health care is provided.
,i&i-edia'()).+
2. ! collection of fragmented services provided on free for service basis by numerous
organisations and providers.
3addy %usan
Co/-onents of Health S!ste/"
• 4oncepts e.g. health and disease
• +deas e.g. e$uity coverage, effectiveness, efficiency, impact.
• Ob5ects e.g. hospitals, health centres, health programms
• "ersons e.g. providers and consumers
%hiloso-h! of Health Care Delier! S!ste/"
• #very one from birth to death is part of the mar&et potential for health care services.
• The consumer of health care services is a client and not customer.
• 4onsumers are less informed about health services than anything else they purchase.
• Health care system is uni$ue because it is not a competitive mar&et.
• 6estricted entry in to the health care system.
0oals1O23ecties of Health Care Delier! S!ste/"
,0 To improve the health status of population and the clinical outcomes of care.
.0 To improve the experience of care of patients families and communities.
10 To reduce the total economic burden of care and illness.
20 To improve social 5ustice e$uity in the health status of the population.
%rinci-les of Health Care Delier! S!ste/'
,. %upports a coordinated, cohesive health-care delivery system.
.. Opposes the concept that fee-for-practice.
1. %upports the concept of prepaid group practice.
2. %upports the establishment of community based, community controlled health-care system.
7. Urges an emphasis be placed on development of primary care
8. #mphasizes on $uality assurance of the care
9. %upports health care as basic human right for all people.
:. Opposes the accrual of profits by health-care-related industries.
;. %upports individuals unrestricted access to the provider, clinic or hospital.
,/. Urges that in the establishment of priorities for health-care funding, resource be allocated to
maintain services for the economically deprived.
,,. %upports efforts to eliminate unnecessary health care expenditures and voluntary efforts to
limit increase in health care costs.
,.. #ndorses to provide age old ith special health maintenance.
,1. %upports public and private funding.
,2. 4ondemns health care fraud.
,7. %upports the establishment of a national health care budget.
,8. %upports universal health insurance.
4unctions of Health Care Delier! S!ste/"
,0 To provide health services.
.0 To raise and pool the resources accessible to pay for health care.
10 To generate human and physical sources that ma&es the delivery service possible.
20 To set and enforce rules of the game and provide strategic direction for all the different
players involved.
Characters of Health Care Delier! S!ste/'
,0 Orientation toard health.
.0 "opulation perspective.
10 +ntensive use of information.
20 <ocus on consumer.
70 =noledge of treatment outcome.
80 4onstrained resources.
90 4oordination of resources.
:0 6econsideration of human values.
;0 #xpectations of accountability.
,/0 >roing interdependence$
*$ %roiders and Consu/ers$
! health care provider or health professional is an organization or person ho delivers
proper health care in a systematic ay professionally to any individual in need of health care services.
! health care provider could be a government, institution such as a hospital or laboratory physicians,
support staff, nurses, therapists, psychologists, veterinarians, dentists, pharmacists, or even a health
insurance company.4onsumers are the people of the hole orld.
4inancin5
There are generally five primary methods of funding health care systems
,. ?irect or Out-of-"oc&et payment.
.. >eneral Taxation,
1. %ocial Health +nsurance,
2. @oluntary or private health insurance, and
Health care s!ste/s /odels
• "urely private enterprise health care systems are comparatively rare. (here they exist, it is
usually for a comparatively ell-off subpopulation in a poorer country ith a poorer standard
of health careAfor instance, private clinics for a small, ealthy expatriate population in an
otherise poor country. But there are countries ith a ma5ority-private health care system
ith residual public service eg medicare, medicaid.
• The other ma5or models are public insurance systems'
o Social securit! health care /odel, here or&ers and their families are insured by
the %tate.
o %u2licl! funded health care /odel, here the residents of the country are insured by
the %tate.
o Social health insurance, here the hole population or most of the population is a
member of a sic&ness insurance company.
HEALTH CARE DELIVERY SYSTEM IN INDIA
+n +ndia it is represented by five ma5or sectors or agencies hich differ from each other by
health technology applied and by the source of fund available. These are"
I$ %6BLIC HEALTH SECTOR
!. "rimary Health 4are
"rimary health centres.
%ub- centres.
B. HospitalCHealth 4entres
4ommunity health centres.
6ural health centres.
?istrict hospitalsChealth centre.
%pecialist hospitals.
Teaching hospitals.
4. Health +nsurance %chemes
#mployees %tate +nsurance.
4entral >ovt. Healh %cheme.
?. Other !gencies
?efence services.
6ailays.
II$ %RIVATE SECTOR
!. "rivate hospitals, polyclinics, nursing homes and dispensaries.
B. >eneral practitioners and clinics.
III$ INDI0ENO6S SYSTEMS O4 MEDICINE
• !yurveda
• %idda
• Unani
• Homeopathy
• Daturopathy
• Eoga
• Unregistered practioners.
•
IV$ VOL6NTARY HEALTH A0ENCIES
V$ NATIONAL HEALTH %RO0RAMMES
Model of Health Care S!ste/ In India
The )inputs* are the health status or health problems of the community, they represent the
health needs and health demands of the community. %ince resources are alays limited to meet the
many health needs, priorities have to be set.
The )health care services* are designed to meet the health needs of the community through
the use of available &noledge and resources. The services provided should be comprehensive and
community based.
The )health care system* is intended to deliver the health care services, it constitutes the
management sector and involves organizational matters.
The )output* is the changed health status or improved health status of the community hich is
expressed in terms of lives saved, deaths averted, diseases prevented etc.

OR0ANISATION AND ADMINISTRAION O4 HEALTH SERVICES IN INDIA AT
DI44ERENT LEVELS.
+ndia is a union of .: states and 9 Union territories. Under the constitution states are largely
independent in matters relating to the delivery of health care to the people. #ach %tate, therefore , as
developed its on system of health care delivery, independent of the 4entral >overnment. 4entral
responsibility consists mainly of policy ma&ing, planning, guiding, assisting, evaluating and
coordinating the or& of the %tate Health Finistries, so that no state %tate lags behind in health
services.
Health system in +ndia has 1 lin&s
,. 4entral level.
.. %tate level
1. ?istrict level
*$ CENTRAL LEVEL"
Health is a %tate sub5ect under the constitution of +ndia. The health 4entres are mainly ith
international, national and interstate health matters. The centre is also responsible for execution of
health programmes in the centrally administered areas. +t advises and helps the %tates on all health
matters.
Official organs of the health system at the Dational level consists of'
!. The ministry of Health and <amily (elfare.
B. The ?irectorate >eneral of Health %ervices.
4. The 4entral 4ouncil of Health and <amily (elfare.
A$ THE MINISTRY O4 HEALTH AND 4AMILY ,EL4ARE
4unctions"
The responsibilities of the central and state governments in the area of health are defined under
!rticle .28 of the constitution as follos.
a$ 6nion list
,. +nternational obligations such as +nternational %anitary 6egulations regarding port
$uarantine.
.. !dministration of central institutes such as !ll +ndia +nstitute of Hygiene and "ublic
Health, =ol&ota, Dational +nstitute of 4ommunicable ?iseases, ?elhi, Dational
+nstitute of Health and <amily (elfare, ?elhi.
1. "romotion of research through bodies such as the +ndian 4ouncil of Fedical 6esearch.
2. 6egulation and development of medical, dental, pharmaceutical and nursing education
and professionals through their respective councils.
7. 6egulation of manufacture and sale of biological products and drugs, including drug
standards.
8. Underta&ing census, collecting and publishing health and vital statistics data.
9. 4oordination ith %tate in their Health "rograms, giving them technical and financial
assistance and procuring for them facilities from international agencies.
:. 4oordination ith other ministries in matters related to health.
;. Health regulations regarding labour in general and mines and oil fields in particular.
2$ Concurrent List"
Both centre and %tates have simultaneous poer of legislationin relation to sub5ects in
concurrent list.
,. +nterstate spread of disease
.. "revention of adulteration of foods
1. 4ontrol of drugs and poisons
2. @ital statistics
7. 3abour elfare
8. Finor ports
9. "opulation control and family planning
:. %ocial and economic planning
B$ THE DIRECTORATE 0ENERAL O4 HEALTH SERVICES
The main functions of the ?>H%
,. 4onducting various national health programs.
.. Organising health services in the form of central government health scheme
1. "roviding Fedical #ducation through the colleges and institutions under its control e.g
6a5 =umari !mrit =aur 4ollege of Dursing, ?elhi, !ll +ndia +nstitute of Hygiene and
"ublic Health, =ol&ota, G"F#6, "ondicheri etc.
2. Fedical research through +ndian 4ouncil of Fedical 6esearch and the institutes under it,
as also other institutions, such as the 4entral 6esearch +nstitute, =asauli.
7. +nternational health and $uarantile at ma5or ports and international airports.
8. ?rug control
9. Fedical stores and supplies
:. Health education through 4entral Health #ducation Bureau.
;. Health intelligence, through 4entral Health +ntelligence Bureau.
C$ THE CENTRAL CO6NCIL O4 HEALTH AND 4AMILY ,EL4ARE
4unctions of Central Council of Health and 4a/il! ,elfare
,. 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.
.. To ma&e proposals for legislation in fields of activity relating to medical and public health
matters and to lay don patterns of development for the country as a hole.
1. To ma&e recommendations to the 4entral >overnment regarding distribution of available
grants-in-aid for health purposes to the states and to revie periodically the or&
accomplished in different areas through the utilization of these grants-in-aid.
2. To establish any organisation or organisations invested ith appropriate functions for
promoting and maintaining cooperation beteen the 4entral and %tate Health
administrations.
($ STATE LEVEL
There are .: states in the country. Health, as states earlier is a %tate sub5ect. Therefore,
the pattern of organisation, state of integration, level of health services, public health las and
scales of pay differ from state to state. The aim, hoever of all states and their "ublic Health
!dministration is the same- health, happiness and longevity for all the people.
A$ State Ministr! of Health
The ministry has a minister and deputy minister of health. The secretary and Goint secretary,
etc. held by the +!% cadre.
B$ State Health Directorate
The process of integration has no been completed in most %tates. The usual pattern no is
that the %tate Health ?irectorate is headed by a ?irector, usually &non as ?irector of health
services, He is assisted by a suitable number of deputies to loo& after various health and
medical health services. %ome states also have a separate ?irector Fedical #ducation.
C$ District Leel'
#ach state in +ndian union is divided into districts. Total population in each district, urban as
ell as rural, varies from one to three million. Gust as in case of states, some autonomy has been
given to urban and rural areas in the district as ell. The autonomous bodies or local self government
are called 4orporation and Funcipal 4ommittees in the cities, Hilla panchayats or Hilla "arishads in
rural districts, Talu&a "anchayat or Talu&a "arishats in talu&a level and >rama panchayat and Dagara
"anchayats in villages and small tons.
Health or5anisations in 6r2an Areas"
There are three types of self-gevernment in urban areas of district, depending upon the size of
population'
,. Ton areas committees -7///-,/////0
.. Funcipal board or Funcipality -,/- .//////0
1. 4orporation -!bove ./////0
To7n areas co//ittees' +ts functions primarily limited to provision of sanitary services.
Munci-al 2oard or Munci-alit!' +ts functions are more diverse. These include regulation regarding
construction of houses, latrines and urinals, hotels, and mar&ets; provision of ater supply, drainage
and disposal of refuse and excreta, disposal of the dead, registration of births and deaths, &eeping of
dogs and control of communicable diseases.
Cor-oration' 4orporation provides essentially the same services as the muncilapity, but on a larger
scale. +t also maintains hospitals and dispensaries.
Health or5anisation in Rural areas'
Under panchayat act ,;8,, the district administration as reorganised in to 1 levels, self
governing autonomous bodies ere formed at different levels as follos'
,. <or each villages or group of villages ith population from ,/// to ,//// there is a >ram
panchayat. +f the population os over ,/,/// to 1/,/// there is a Dagar "anchayat. The gram
panchayat in constituted by ,7-1/ elected members, ho in turn elect a %arpanch or president,
@ice president, and panchayat secretary is recruited by government.
.. <or each bloc&' There is a "anchayat samiti or talu&a panchayat hich is a elected body.
1. <or each district' there is a zilla panchayat or parishat hich is an autonomous body for
district as ell as a hole, responsible to the state assembly. +t is constituted by elected
members, F3!s, F"s.
+n all above provision has been made for reservation for schedule caste schedule tribes and
omen to ensure their active participation in all round development of the village.

%ri/ar! Health Care In India
• +n ,;99 government of +ndia launched a rural health scheme, based on the principles of
)"lacing peopleIs health in peopleIs handsI
• !s a signatory to !lma-!ta ?eclaration, the government of +ndia is committed to
achieving the goal of Health care approach hich see&s to provide universal health care at
a cost hich is affordable.
• =eeping in vie the (HO goal of )Health for !ll* by ./// !?, the government of +ndia
evolved a Dational Health "olicy in ,;:1.
• =eeping in vie the Fillennium ?evelopmental >oals, the government of +ndia revised
the draft of Dational Health "olicy in .//,.
%rinci-les of -ri/ar! Health Care
,. #$uitable distribution
.. 4ommunity participation
1. +ntersectoral coordination
2. !ppropriate technology
7. "reventive in Dature
8. Fan poer development.
Co/-arison of infracture in India and 8arna&a&a
=arnata&a +ndia
?istrict Hospitals .2 8,7
4H4 .72 1128
"H4 ,8:, .1.18
%UB 4#DT6#% :,21 ,28/.8
%ri/ar! Health Centre
"rimary Health 4enters are the cornerstone of rural health services- a first port of call to a
$ualified doctor of the public sector in rural areas for the sic& and those ho directly report or
referred from %ub-centers for curative, preventive and promotive health care.
! typical "rimary Health 4entre covers a population of ./,/// in hilly, tribal, or difficult
areas and 1/,/// populations in plain areas ith2-8 indoorCobservation beds. +t acts as a referral unit
for 8 sub-centers and refer out cases to 4H4 -1/ bedded hospital0 and higher order public hospitals
located at sub-district and district level.
+n order to provide optimal level of $uality health care, a set of standards are
being recommended for "rimary Health 4entre to 2e called Indian %u2lic Health
Standards 'I%HS+ for %HCs. The launching of Dational 6ural Health Fission
-D6HF0 has provided this opportunity.
Assured serices or 4unctions of %ri/ar! health centres"
!ssured services cover all the essential elements of preventive, promotive, curative and
rehabilitative primary health care.
This implies a ide range of services that include'
,. Medical care"
• O"? services' minimum 2 hours in the morning and . hours in the evening.
• .2 hours emergency services
• 6eferral services
• +n-patient services -8 beds0
.. Maternal and Child Health Care includin5 fa/il! -lannin5"
• !ntenatal care' #arly diagnosis, minimum three antenatal chec& up, identification and
management of high ris& pregnancies, nutrition and health counseling, minimum
laboratory investigation urin albumin, test ofr syphilis, chemoprophylaxis for malaria in
high endemic area as per D@?4".
• +ntra-natal care. -.2-hour delivery services both normal and assisted+
• "ostnatal 4are.- Ganani %ura&sha Eo5ana -G%E00 Finimum . postpartum visit, initiation of
breast feeding health education on hygiene, contraception etc,
• De Born care.
• 4are of The 4hild.
• <amily "lanning
1. Fedical Termination of "regnancies using Fanual @acuum !spiration
-F@!0 techni$ue. -(herever trained personnel and facility exists0
2. Fanagement of 6eproductive Tract +nfections C %exually Transmitted
+nfections'
7. Dutrition %ervices -coordinated ith +4?%0
8. %chool Health
9. !dolescent Health 4are
:. "romotion of %afe ?rin&ing (ater and Basic %anitation
;. "revention and control of locally endemic diseases li&e malaria, =alaazar,
Gapanese #ncephalitis, etc
,/. ?isease %urveillance and 4ontrol of #pidemics
,,. 4ollection and reporting of vital events
,.. #ducation about healthCBehaviour 4hange 4ommunication -B44+
,1. Dational Health "rogrammes including 6eproductive and 4hild Health"rogramme -64H0,
H+@C!+?% control programme, Don communicable
disease control programme etc
,2. 6eferral %ervices.
,7. Training' !%H!, !DF, 3H@
,8. Basic 3aboratory %ervices
,9. Fonitoring and %upervision'
,:. !EU%H services as per local peopleIs preference -Fainstreaming of !EU%H0
,;. 6ehabilitation
./. %elected %urgical "rocedures
Man %o7er in %HC
#J+%T+D> 6#4OFF#D?#?
Fedical Officer , .-one may be from !EU%H or
lady medical officer0
"harmascist , ,
Durse-midife -staff nurse0 , 1
Health or&er-<0 , ,
Health #ducator , ,
Health assistant-F K <0
-3H@ and Health !ssistant
Fale0
. .
4lerc&s . .
3aboratory Technician , ,
?river , ,
4lass +@ 2 2
S6BCENTRE
+n the public sector, a %ub-health 4entre is the most peripheral and first contact point beteen
the primary health care system and the community. !s per the population norms, one %ub-centre is
established for every 7/// population in plain areas and for every 1/// population in
hillyCtribalCdesert areas. ! %ub-centre provides interface ith the community at the grass-root level,
providing all the primary health care services. !s sub- centres are the first contact point ith the
community, the success of any nation ide programme ould depend largely on ell functioning
sub-centres providing services of acceptable standard to the people. The current level of functioning
of the %ubcentres are much belo the expectations.
There is a felt need for $uality management and $uality assurance in health care delivery
system so as to ma&e the same more effective, economical and accountable. Do concerted effort has
been made so far to prepare comprehensive standards for the %ub-centres. The launching of D6HF
has provided the opportunity for framing +ndian "ublic Health %tandards.
O23ecties of Su29centres"
i. To provide basic "rimary health care to the community.
ii. To achieve and maintain an acceptable standard of $uality of care.
iii. To ma&e the services more responsive and sensitive to the needs of the community.
Assured serices or 4unctions of %ri/ar! health centers"
!ssured services cover all the essential elements of preventive, promotive, curative and
rehabilitative primary health care. This implies a ide range of services that include'
,. Maternal and Child Health Care includin5 fa/il! -lannin5"
• !ntenatal care' #arly diagnosis, minimum three antenatal chec& up, identification and
management of high ris& pregnancies, nutrition and health counseling, minimum
laboratory investigation urin albumin, test ofr syphilis, chemoprophylaxis for malaria in
high endemic area as per D@?4".
• +ntra-natal care' "romotion of institutional deliveries, s&illed reference at home
deliveries. Finimum . postpartum visit, initiation of breast feeding health education on
hygiene, contraception etc,
• Others' "rovison of facilities under Ganani %ura&sha Eo5na and D6HF.
• "ostnatal 4are'
• 4hild health' #ssential De born care, promotion of exclusive breast feeding,
immunization of all children, prevention and control of all childhood disease.
.. 4a/il! -lannin5 and contrace-tion" #ducation motivation and counseling to adopt family
planning motheds,provision of contraception$
1. 4ounseling and appropriate referral for safe abortion services for those in need.
2. !dolescent health care'
7. !ssistance to school health services.
8. 4ontrol local endemic diseases such as Falaria, filariasis etc.
9. ?isease surveillance
:. (ater $uality monitering" ?isinfection of ater sources
;. "romotion of sanitation including use of toilets and appropriate garbage disposal.
,/. <ield visits
,,. 4ommunity needs assessment
,.. 4urative services' "rovide treatment for minor ailments, referral service, organizing health
day once in month at anganvadi.
,1. Training coordination and monitering' Training of traditional birth attendants !%H!
community health volunteers, omonitering of ater $uality.
,2. Dational Health "rogrammes
,7. 6ecord of @ital #vents
Man %o7er
Man-o7er E:istin5 %ro-osed
Health 7or&er'fe/ale+ * (
Au:illar! Nurse Mid7ife
Health 7or&er'/ale+
Multi %ur-ose ,or&er
* *
Viluntar! 7or&er'-aid rs *))
-er /onth as honorariu/+
* *
The staff of the %ub center ill have the su--ort of ASHA 'Accredited Social Health
Actiists+ herever the !%H! scheme is implemented 1 si/ilar functionaries at illa5e leel in
other areas. !%H! is primarily a trained oman volunteer, resident of the village-
marriedCidoCdivorced ith formal education up to :th standard preferably in the age group of .7-
27 years. The general norm is one !%H! per ,/// population. The 5ob functions of !DF, Fale
Health or&er, !%H! and !(( in the context of coordinated functions under D6HF.
HOS%ITALS AND HEALTH CENTRES
Co//unit! Health Centers
Health care delivery in +ndia has been envisaged at three levels namely primary, secondary
and tertiary. The secondary level of health care essentially includes
4ommunity Health 4enters -4H4s0, constituting the <irst 6eferral Units-<6Us0 and the district
hospitals. The 4H4s ere designed to provide referral health care for cases from the primary level
and for cases in need of specialist care approaching the centre directly. 2 "H4s are included under
each 4H4 thus catering to approximately :/,/// populations in tribal C hilly areas and ,, ./,///
population in plain areas. 4H4 is a 1/ bedded hospital providing specialist care in medicine,
Obstetrics and >ynecology, %urgery and "ediatrics. These centers are hoever fulfilling the tas&s
entrusted to them only to a limited extent. The launch of the Dational 6ural Health Fission -D6HF0
gives us the opportunity to have a fresh loo& at their functioning.
D6HF envisages bringing up the 4H4 services to the level of +ndian "ublic Health
%tandards. !lthough there are already existing standards as prescribed by the Bureau of +ndian
%tandards for 1/-bedded hospital, these are at present not achievable as they are very resource-
intensive. Under the D6HF, the !ccredited %ocial Health !ctivist -!%H!0 is being envisaged in
each village to promote the health activities. (ith !%H! in place, there is bound to be a groundsell
of demands for health services and the system needs to be geared to face the challenge. Dot only does
the system re$uire upgradation to handle higher patient load, but emphasis also needs to be given to
$uality aspects to increase the level of patient satisfaction.
O23ecties of Indian %u2lic Health Standards 'I%HS+ for CHCs"
• To provide optimal expert care to the community
• To achieve and maintain an acceptable standard of $uality of care
• To ma&e the services more responsive and sensitive to the needs of the community.
4unctions of CHCs"
#very 4H4 has to provide the folloing services hich can be &non as the Assured
Services:
,. 4are of routine and emergency cases in surgery'
• This includes +ncision and drainage, and surgery for Hernia, hydrocele,
!ppendicitis, hemorrhoids, fistula, etc.
• Handling of emergencies li&e intestinal obstruction, hemorrhage, etc.
.. 4are of routine and emergency cases in medicine'
• %pecific mention is being made of handling of all emergencies in relation to the
Dational Health "rogrammes as per guidelines li&e ?engue Haemorrhagic fever,
cerebral malaria, etc. !ppropriate guidelines are already available under each
programme, hich should be compiled in a single manual.
1. .2-hour delivery services including normal and assisted deliveries
2. #ssential and #mergency Obstetric 4are including surgical interventions li&e 4aesarean
%ections and other medical interventions
7. <ull range of family planning services including 3aproscopic %ervices
8. %afe !bortion %ervices
9. De-born 4are
:. 6outine and #mergency 4are of sic& children
;. Other management including nasal pac&ing, tracheostomy, foreign body removal etc.
,/. !ll the Dational Health "rogrammes -DH"0 should be delivered through the 4H4s.
,,. Others" Blood storage facility, #ssential laboratory services, 6eferral -transport0.
Man -o7er"
%ersonnel
0eneral Sur5eon *
%h!sician *
O2stetrician10!nacolo5ist *
%aediatrics *
Anaesthestist *'%ro-osed+
%u2lic Health %ro5ra//e Mana5er *'%ro-osed+
O-thal/olo5ist *'-ro-osed+
Nurse9/id 7ife ;
Dresser 'certified 2! red cross1 St #ohns
A/2ulance+
*
%har/ascist *
La2$ Technician *
Radio5ra-her *
O-thal/ic Assistant *'o-tional+
,ard 2o!s (
S7ee-ers <
Cho7&idar *
O%D attendant *
Statical Assistant1Data entr! o-erator *
OT attendant *
Re5istration Cler& *
HOS%ITALS
+ndiaIs "ublic Health %ystem has been developed over the years as a 1-tier system, namely
primary, secondary and tertiary level of health care. ?istrict Health %ystem is the fundamental basis
for implementing various health policies and delivery of healthcare, management of health services
for defined geographic area. ?istrict hospital is an essential component of the ?istrict health system
and functions as a secondary level of health care, hich provides curative, preventive and promotive
healthcare services to the people in the district.
#very district is expected to have a district hospital lin&ed ith the public hospitalChealth
centres don belo the district such as %ub-districtC%ub-divisional hospitals, 4ommunity Health
4entres, "rimary Health 4enters and %ub-centres. !s per the information available, 8/; districts in
the country at present are having about 8,7 ?istrict hospitals. Hoever, some of the medical college
hospitals or a sub-divisional hospital is found to serve as a district hospital here a district hospital as
such -particularly the nely created district0 has not been established. <e districts have also more
than one district hospital.
O23ecties for district hos-itals"
The overall ob5ective of +"H% is to provide health care that is $uality oriented and sensitive to the
needs of the people of the ?istrict. The specific ob5ectives of +"H% for ?Hs are'
i. To provide comprehensive secondary health care -specialist and referral services0 to
the community through the ?istrict Hospital.
ii. To achieve and maintain an acceptable standard of $uality of care.
iii. To ma&e the services more responsive and sensitive to the needs of the people of the
district and the hospitalsCcentres from hich the cases are referred to the district
hospitals
Definition
The term ?istrict Hospital is used here to mean a hospital at the secondary referral level
responsible for a ?istrict of a defined geographical area containing a defined population.
0radin5 of district hos-itals"
The size of a district hospital is a function of the hospital bed re$uirement, hich in turn is a
function of the size of the population it serves. +n +ndia the population size of a district varies from
17,/// to 1/,//,/// -4ensus .//,0. Based on the assumptions of the annual rate of admission as ,
per 7/ populations and average length of stay in a hospital as 7 days, the number of beds re$uired for
a district having a population of ,/ la&hs ill be around 1// beds. Hoever, as the population of the
district varies a lot, it ould be prudent to prescribe norms by grading the size of the hospital as per
the number of beds.
>rade +' ?istrict hospitals norms for 7// beds
>rade ++' ?istrict hospitals norms for 1// beds
>rade +++' ?istrict hospitals norms for .// beds
>rade +@' ?istrict hospitals norms for ,// beds
The disease prevalence in a district varies idely in type and complexities. +t is not possible
to treat all of them at district hospitals. %ome may re$uire the intervention of highly specialist
services and use of sophisticated expensive medical e$uipments. "atients ith such diseases can be
transferred to tertiary and other specialized hospitals. ! district hospital should hoever be able to
serve :7-;7L of the medical needs in the districts. +t is expected that the hospital bed occupancy rate
should be at least :/L. 4unctions
,. +t provides effective, affordable healthcare services -curative including specialist services,
preventive and promotive0 for a defined population, ith their full participation and in co-
operation ith agencies in the district that have similar concern. +t covers both urban
population -district head$uarter ton0 and the rural population in the district.
.. <unction as a secondary level referral centre for the public health institutions belo the
district level such as %ub-divisional Hospitals, 4ommunity Health 4entres, "rimary Health
4entres and %ub-centres.
1. To provide ide ranging technical and administrative support and education and training for
primary health care.
Essential Serices
%ervices include O"?, indoor, emergency services.
%econdary level health care services regarding folloing specialties ill be assured at hospital'
Consultation services ith folloing specialists'
 >eneral Fedicine
 >eneral %urgery
 Obg K >yne
 "aediatrics including Deonatology
 #mergency -!ccident K other emergency0 -4asualty0
 4ritical care -+4U0
 !naesthesia
 Ophthalmology
 #DT
 Orthopaedics
 6adiology
 ?ental care
 "ublic Health Fanagement
%ara clinical serices
• 3aboratory %ervices
• J-6ay <acility
• #4>
• Blood transfusion and storage facilities
• "hysiotherapy
• ?ental Technology -?ental Hygiene0
• ?rugs and "harmacy
Su--ort Serices
 Fedico-legalCpost-mortem
 !mbulance services
 ?ietary services
 %ecurity services.
 (aste management
 (are housingCcentral store
 Faintenance and repair
 #lectric %upply -poer generation and stabilization0
 (ater supply -plumbing0
 Heating, ventilation and air-conditioning
 Transport
 4ommunication
 Fedical %ocial (or&
 Dursing %ervices
 %terilization and ?isinfection
HEALTH INS6RANCE'
There is no universal health insurance in +ndia. Health +nsurance is at present is limited to
industrial or&ers and their families.
,. #mployees %tate +nsurance %cheme
+t as introduced by an act of parliament in ,;2:. +t covers employees
draing ages not exceeding 6s. ,/,/// per month.
The act provides
o Fedical benefits
o %ic&ness benefits
o ?isabled benefits
o Faternity benefits
o ?ependent benefits
o <uneral benefits
.. 4entral >overnment Health %cheme'
This scheme as introduced in De ?elhi in ,;72 to provide comprehensive medical care to
4entral >overnment employees. The schemes based on the principles of cooperative effort by
the employee and the mutual advantage of both.
<acilities under the scheme include'
o Outpatient care through a netor& of dispensaries.
o %upply of necessary drugs.
o 3aboratory and x-ray investigation.
o ?omiciliary visits.
o Hospitalisation facilities at >ovt as ell as private hospitals recognized for the
purpose.
o %pecial consultation.
o "aediatric services including immunization.
o !ntenatal, natal and postnatal services.
o #mergency treatment.
o %upply of optical and dental aids at reasonable rate.
OTHER A0ENCIES'
Defence Medical Serices'
?efence services have their on organization for medical care to defence personnel under the
banner )!rmed <orces Fedical %ervices*. The services are provided are integrated and
comprehensive.
Health Care of Rail7a! E/-lo!ees' The 6ailays provide comprehensive health care services
through the agencies of 6ailay Hospitals, Health Units and 4linics. #nvironmental sanitation is
ta&en care of by Health +nspectors in big stations. Health chec&-up of employees is provided at the
time of recruitment and thereafter at yearly intervals.
%RIVATE A0ENCIES'
+n a mixed economy such as +ndiaIs, private practice of medicine provides a large share of the
health services available. There has been a rapid expansion in the number of $ualified allopathic
physicians to 9.7 la&hs in .//7 and doctor population ration is ,',2.:. Fost of them they concentrate
in urban areas. They provide mainly curative services. Their services are available to those ho can
pay. The private sector of health care services is not organised.
INDE0INO6S SYATEMS O4 MEDICINE'
The practioners of indigenous system of medicine provide the bul& of medical care to the rural
people. !yurvedic physicians alone are estimated to be about 2.7la&hs. Dearly ;/L of ayurvedic
physicians serve the rural areas. To promote this these indigenous systems +ndian government
established +ndian 4ouncil <or +ndian Fedicine in ,;9,. !EU%H is the ne approach on this. (hich
encompasses !yurveda, Eoga, Unani, %idda, Homeopathy.
Ob5ectives of AY6SH'
o To upgrade the educational standards in the +ndian %ystems of Fedicines and Homoeopathy
colleges in the country.
o To strengthen existing research institutions and ensure a time-bound research programme on
identified diseases for hich these systems have an effective treatment.
o To dra up schemes for promotion, cultivation and regeneration of medicinal plants used in
these systems.
o To evolve "harmacopoeial standards for +ndian %ystems of Fedicine and Homoeopathy
drugs.
Voluntar! Health A5encies"
! voluntary health agency may be defined as an organization that is administered by an
autonomous board hich holds meetings, collects funds for its support, chiefly from private sources
and expands money, hether ith or ithout paid or&ers, in conducting a programme directed
primarily to furthering the public health by providing health services or health education by
advancing research or legislation for health or by a combination of these activities.
The oluntar! health a5encies in India are"
o +ndian 6ed 4ross %ociety
o Hind =usht Divaran %angh
o +ndian 4ouncil for 4hild (elfare
o Tuberculosis !ssociation of +ndia
o Bharat %eva& %ama5
o 4entral %ocial (elfare Board
o The =sturba Femorial <und
o <amily "lanning !ssociation of +ndia
o !ll +ndia (omenIs 4onference
o The !ll- +ndia Blind 6elief %ociety
o "rofessional Bodies li&e TD!+, +F!, !+?! etc
o +nternational !gencies li&e 6oc&feller <oundation, 4!6#, <ord <oundation etc.
NATIONAL HEALTH %RO0RAMMES
%ince +ndia became free, several measures have been underta&en by Dational >overnment to
improve the health of the people. "rominent among these measures are the Dational Health
"rogrammes. (hich have been launched by the 4entral >overnment for controlCeradication of the
communicable diseases, improvement of environmental sanitation, raising the standard of nutrition,
control of population and improving rural health. @arious international agencies li&e (HO, UD+4#<,
UD<"! etc have been providing technical and material assistance in the implementation of these
programmes.
Dational Health "rogrammes are'
• Dational @ector Borne ?isease 4ontrol "rogramme
• Dational 3eprosy #radication "rogramme
• 6evised Dational Tuberculosis 4ontrol "rogramme
• Dational !+?% 4ontrol "rogramme
• Dational "rogramme for 4ontrol of Blindness
• +odine ?eficiency ?isorders "rogramme
• Universal +mmunization "rogramme
• Dational 6ural Health Fission
• 6eproductive and 4hild Health "rogramme
• Eas #radication "rogramme
• Dational 4ancer 4ontrol "rogramme
• Dational >uinea- (orm #radication "rogramme
• Dational 4ancer 4ontrol "rogramme
• Dational Fental Health "rogramme
• Dational ?iabetes 4ontrol "rogramme
• Dational "rogramme for 4ontrol and Treatment of Occupational ?isease
• Dutritional "rogramme
• Dational %urveillance "rogramme for 4ommunicable ?isease
• +ntegrated ?isease %urveillance "rogramme
• Dational <amily (elfare "rogramme
• Dational (ater %upply and %anitation "rogramme
• Finimum Deeds "rogramme
• ./-"oint "rogramme
Need 4or an Alternatenatie Health S!ste/s of Health Care"
*$ The present system is limited to the urban areas$
.. +t has greater emphasis on curative aspects rather than preventive and promotive
aspects care.
1. +t is expensive.
2. +nade$uacy and misdistribution of resources for health services
7. There is lac& of clear-cut referral system.
8. There is lac& of intersectoral collaboration and community involvement.
9. Over centralization of authority.
:. There is insufficient orientation and training of the primary health care staff and there
is also lac& of proper 5ob descriptions resulting in poor implementation of the
pro5ects.
;. The unsuitable or&ing hours of the personnel in the rural areas.
NATIONAL R6RAL HEALTH MISSION
The Dational 6ural Health Fission -D6HF0 has been launched ith a vie to bringing about
dramatic improvement in the health system and the health status of the people, especially those ho
live in the rural areas of the country. The Fission see&s to provide universal access to e$uitable,
affordable and $uality health care hich is accountable at the same time responsive to the needs of
the people, reduction of child and maternal deaths as ell as population stabilization, gender and
demographic balance. +n this process, the Fission ould help achieve goals set under the Dational
Health "olicy and the Fillennium ?evelopment >oals.
To achieve these goals D6HF ill'
• <acilitate increased access and utilization of $uality health services by all.
• <orge a partnership beteen the 4entral, state and the local governments.
• %et up a platform for involving the "anchayati 6a5 institutions and community in the
management of primary health programmes and infrastructure.
• "rovide an opportunity for promoting e$uity and social 5ustice.
• #stablish a mechanism to provide flexibility to the states and the community to
promote local initiatives.
• ?evelop a frameor& for promoting inter-sectoral convergence for promotive and preventive
health care.
The Vision of the Mission
• To provide effective healthcare to rural population throughout the country ith
special focus on ,: states, hich have ea& public health indicators andCor
ea& infrastructure.
• ,: special focus states are !runachal "radesh, !ssam, Bihar, 4hattisgarh,
Himachal "radesh, Ghar&hand, Gammu and =ashmir, Fanipur , Fizoram,
Feghalaya, Fadhya "radesh, Dagaland, Orissa , 6a5asthan, %i&&im, Tripura,
Uttaranchal and Uttar "radesh.
• To raise public spending on health from /.;L >?" to .-1L of >?", ith
improved arrangement for community financing and ris& pooling.
• To underta&e architectural correction of the health system to enable it to
effectively handle increased allocations and promote policies that strengthen
public health management and service delivery in the country.
• To revitalize local health traditions and mainstream !EU%H into the public health system.
• #ffective integration of health concerns through decentralized management at district, ith
determinants of health li&e sanitation and hygiene, nutrition, safe drin&ing ater, gender and
social concerns.
• !ddress inter %tate and inter district disparities.
• Time bound goals and report publicly on progress.
• To improve access to rural people, especially poor omen and children to e$uitable,
affordable, accountable and effective primary health care.
The O23ecties of the Mission
• 6eduction in child and maternal mortality.
• Universal access to public services for food and nutrition, sanitation and hygiene and
universal access to public health care services ith emphasis on services addressing omenIs
and childrenIs health and universal immunization.
• "revention and control of communicable and non-communicable diseases, including locally
endemic diseases.
• !ccess to integrated comprehensive primary health care.
• "opulation stabilization, gender and demographic balance.
• 6evitalize local health traditions K mainstream !EU%H.
• "romotion of healthy life styles.
The core strate5ies of the Mission
• Train and enhance capacity of "anchayati 6a5 +nstitutions -"6+s0 to on, control and manage
public health services.
• "romote access to improved healthcare at household level through the female health activist
-!%H!0.
• Health "lan for each village through @illage Health 4ommittee of the "anchayat.
• %trengthening sub-centre through better human resource development, clear $uality standards,
better community support and an untied fund to enable local planning and action and more
Fulti "urpose (or&ers -F"(s0.
• %trengthening existing -"H4s0 through better staffing and human resource
development policy, clear $uality standards, better community support and an
untied fund to enable the local management committee to achieve these
standards.
• "rovision of 1/-7/ bedded 4H4 per la&h population for improved curative care to a
normative standard. -+"H% defining personnel, e$uipment and management standards, its
decentralized administration by a hospital management committee and the provision of
ade$uate funds and poers to enable these committees to reach desired levels0
• "reparation and implementation of an inter sector ?istrict Health "lan prepared by the ?istrict
Health Fission, including drin&ing ater, sanitation, hygiene and nutrition.
• +ntegrating vertical Health and <amily (elfare programmes at Dational, %tate,
District and Bloc& leels.
• Technical support to Dational, %tate and ?istrict Health Fission, for public health
management %trengthening capacities for data collection, assessment and revie for evidence
based planning, monitoring and supervision.
• <ormulation of transparent policies for deployment and career development of
human resource for health.
• ?eveloping capacities for preventive health care at all levels for promoting healthy life style,
reduction in consumption of tobacco and alcohol, etc.
• "romoting non-profit sector particularly in underserved areas.
%ro5ra//es
• 6eproductive and 4hild Health "rogramme A ++ -64H-++0 and the Ganani
%ura&sha Eo5ana -G%E0 launched.
• "olio eradication programme intensified A cases reduced from ,12 in .//2-/7 to 81 -up to
no0.
• %terilization compensation scheme launched.
• !ccelerated implementation of the 6outine +mmunization programme ta&en up. 4atch up
rounds ta&en up this year in the %tates of Bihar, Ghar&hand and Orisaa.
• >round or& for introduction of G# vaccine completed.
• >round or& for Hepatitis vaccines to all %tates completed.
• !uto ?isabled %yringes introduced throughout the country.
• %tate "rogramme +mplementation "lans for 64H ++ appraised by the Dational
"rogramme 4oordination 4ommittee set up by the Finstry. <unds to the
extent of .8.,2L i.e. 6s. ,:,,.92 crore have been released under D6HF
Outlay.
Mission on nursin5 education"
The Fission ould support strengthening of Dursing 4olleges herever re$uired, as the
demand for !DFs and %taff Durses and their development is li&ely to increase significantly.
This ould be done on the basis of need assessment, identification of possible partners for
building capacities in the governmental and non governmental sectors in each of the
%tatesCUTs, and ays of financing such support in a sustainable ay. %pecial attention ould
be given to setting up !DF training centres in tribal bloc&s hich are currently para-medically
underserved by lin&ing up ith higher secondary schools and existing nursing institutions
HEALTH CARE DELIVERY SYSTEM IN ABROAD
6NITED STATES O4 AMERICA
+n the United %tates the health care delivery system in constantly changing. +mplementation
and changes are brought according to needs of the citizens. There is a great division and
responsibility.
Health care system is divided in to private and public sector. The public section includes
federal state and local divisions and is cincerned ith provision of healthy environment. "rivate
sector usually care for individuals and families.
Health Care Delier! S!ste/ Models

#lementary Fodel of the health care delivery system
4onsumers engaged in exchange of relationship ith providers. +t refelts a strange blend of
public and private enterprises. Fostly private patients are charged. Fore number of specialists
complicate the entry, there is lot of competetion among providers fee for service.
"ublic and private sector models'
"ublic system in composed of public health agencies, both voluntary and official at federal,
state and local levels. The private health care delivery system includes clinic, ""O, HFO, Hospital
based etc, here funding agencies are third party.
Health 4are ?elivery model' public and private sectors
OR0ANISATION O4 THE HEALTH CARE SYSTEM
%6BLIC SECTOR
"ublic agencies are financed ith tax monies, thus these are accountable to the public. The public
sector includes official-governmental0 agencies and voluntary agencies.M
4ore %u2lic Health 4unctions a--lied to %o-ulations and %e-le at Ris&
%o-ulation9 ,ide Serices
Assess/ent
Health status monitering and disease surveillance
%u2lic %olic!
3eadership, policy, planning and administration
Assurance
+nvestigation and control of diseases and in5uries
"rotection of environment, or&places, housing, food, and ater
3aboratory services to support diseasecontrol and envirnmental proction.
Health education and information
4ommunity mobilization for health-related issues
Targeted outreach and lin&age to personal services
Health services $uality assurance and assurance and accountability
Training and education of public health professionals
%ersonal Serices and Ho/e Visits for %eo-le at Ris&
"rimary care for unserved and underserved people
Treating services for targeted conditions
4linical preventive services
"ayments for personal services delivered by others
OR0ANISATION O4 THE %6BLIC HEALTH SYSTEM
The public health system is organised in to many levels in the
• <ederal,
• %tate,
• 3ocal systems.
THE 4EDERAL SYSTEM'
<ederal >overnmnet has the responsibility for the folloing aspects of health care.
!t the federal level, the primary agencies are concerned ith health are organized under the
?epartment of Health and Human %ervices-?HH%0.
• "roviding direct care for certain groups such as Dative !mericans, military personnel, and
veterans.
• %afeguarding the public health by regulating $uarrentines and immigration las and the
mar&eting food, drugs and products used in medical care.
• "revents environmental hazzards, gives grantsin aids to states, local areas and individuals and
supports research.
• !dministration of social security, social elfare and related programmes
• "ublic health service administer health functions such as mental health, health resources, the
Dational +nstitutes of health -D+H0 4entres for ?isease 4ontrol and preparation -4?40 and
the food and drug administration -<?!0
• The federal government loo&s in to the ?ivision of Dursing to provide the competence and
expertise for administering nurse education legislation, interpreting trends and needs of the
nursing component of the nations health care delivery system.
STATE SYSTEM'
• Health financing -such as Fedicaid0 providing mental health and professional education,
establishing health codes, licensingfacilities and personneland regulating insurance industry.
• ?irect assistance to local health departments
• Typical "rograms in a %tate Health ?epartment
o !+?% %ervices
o ?isaster management
o 4ase management
o ?epartmental licensing boards
o ?ivision of vital records
o #nvironmental programmes
o #pidemiology
o Health planning and development
o Health services cost revie
o Guveline services
o 3egal services
o Fedia and public relations and educational information
o Fedical assistance' policy, compliance operations
o Fental health and addictions
o Fental retardation and developmental disabilities
o "reventive medicine and medical affairs
o Nuality assurance
o 6eferral to resources
o %ervice to chronically ill and ageing
o %T?-screening and treatment
• Durses serve in many capacities in state health departments as consultants, direct servicce
providers, researchers, teachers and supervisors, as ell as participating in programme
development planning, and evaluation of health programs. Fany departments have a division
or department of nursing.
LOCAL SYSTEM
• 3ocal health department has direct responsibility to the citizens in its community 5uridiction.
• "rogrammes provided by local health departments
o !ddiction and alcohol clinics
o !dult health
o ?isaster management
o Birth and death records
o 4hild day care and development
o 4hild health clinic
o ?ental health clinic
o #nvironmental health
o #pidemiology and disease control
o <amily planning
o Health education
o Home health agency
o Hospital discharge planning
o Hypertension clinic
o +mmunization clinic
o +nformation services
o Faternal health
o Fedical social or&
o Fental health
o Dursing
o Dursing home licences
o Dutrition
o Occupational therapy
o %chool health
• The local level often provides an opportunity for nurses to ta&e on signifacant leadership
roles, ith many nurses serving as directors or managers.
%RIVATE SECTOR
The non governmental and voluntary arm of the health care delivery system includes many
types services.
• "rivately oned, non profit agencies hich includes most hospitals and lfare agencies ma&e
up one large group.
• "rivately oned for profit agencies
• "rivate professional health care practice, composed largely of physician in solo practice or
group practice.
"rivate health services are complementary and supplementary to government healh agencies
4INANCIN0 O4 HEALTH CARE
<inancing and health care significantly affects community health and community health
nursing practice. +t influences the type and $uality of services offered as ell as the ays in hich
those services are used. %ources of payment may be clustered in to three categories
• Third party payments
• ?irect consumer payment
• "rivate or philanthropic support
Third -art! -a!/ents"
These are monetary reimbursements made to providers of health care by some one other that
the consumer ho received the care. Organizations that administer these funds are called third party
payers.
<our types of payment sources
• "rivate insurance companies
• +ndependent health plans
• >overnment health programmes
• 4laims payment agents
%riate insurance co/-anies
"rivate insurance companies mar&et and underrite policies aimed at decreasing consumer
ris& of economic loss because of a need to use health services.
Three types of private insurers
,0 4ommercial stoc& companies' These sell health insurances, usually as a side line. They are
private stoc& hoders corporations that sell insurance nationally e.g !etna, Travelers
.0 Futual companies' These insurer that operates in national mar&etplace are oned by their
policy holders e.g "rudentials,
10 Don profit' These operate under special state enabling las that give them an exclusive
franchise to hole state and to a specific type of insurance.
#.g Blue cross sells only hospital coverage, Blue %heild covers only medical insurance, ?elta
?ental only dental insurance.
Inde-endent Health %lans
+ndependent or self health plans underrite the remaining health insurances in U%. Usually
they may only sell health insurances; in some casee they may also provide health services. They focus
on a localized population
0oern/ent Health %ro5ra/s
>overnment health programs ma&e up the largest source of third party reimbursement in
United %tates. The governments four ma5or health programme are
• Fedicacare,
• Fedicaid,
• <ederal Health Benefits "lan
• 4ivilian Health and Fedical "rogram of the Uniformed %ervices
Fedicare'
• "rovides mandatory federal health insurance for adults 87 years and older ho have paid in to
social securtiy system and for certain disabled persons.
• +t is the largest health insurance in U% covering about ,8L of the population. !mong that .L
are younger than 87 years of age and permanently disabled and chronically ill.
Fedicaid
• "rovides medical assistance to children, those ho are aged, blind or disabled.
4laims payment !gents'
The government contracts ith private agents to handle the claims payment process. Fore
than :/L of the governments third party payments have been handled by these private contractors.
Direct Consu/er Rei/2urse/ent'
! second ma5or source of health care financing comes from direct fees paid by consumers.
This refers to individual out-of Apoc&et payments made for several different reasons.
Health Maintainance Or5anisation'
! HFO is a system in hich participants prepay a fixed monthly premium to receive
comprehensive health services delievered by a defined netor& providers to plan particiapants. HFO
are the oldest model of co ordinated or managed care..
4omponents of HFO'
• They serve a voluntary population
• There is a fixed annual or monthly payment
• The HFO some finaicial ris& or gain.
• +n contrast ith physician in private practice, physician employed by HFO ecieve a fixed
salary$
There is a little co ordination beteen health care resources. There is variation in access,
$uality of care, availability of health services ithin the state. +t is said the U% society in
individualistic, materialistic, aggressively competitive and mar&et oriented.
Helath Care Delier! S!ste/ in 6nited 8in5do/
U= has a tax-supported heath system that is oned by the governmnet, services are available
to all its citizens ith out cost or for a small fee.
• +n ,;2:, the United =ingdom passed the !cts hich created the three separate but co-
operating Dational Health %ervices of %cotland, Dorthern +reland and #ngland and (ales that
provided free physician and hospital services to all people resident in the United =ingdom.
• Hospital staff are salaried employees according to nationally agreed contracts,
• hilst primary care is largely provided by independent practices, ho are paid, again via a
nationally agreed contract, according to the number of patients registered ith them and the
range of additional services offered.
• The Dational Health %ervice has been amended from time to time, but is largely intact.
!round :8L of prescriptions are provided free. "rescriptions are provided free to people ho
satisfy certain criteria such as lo income or permanent disabilities. "eople that pay for
prescriptions do not pay the full cost.
• <unding comes from a hypothecated health insurance tax and from general taxation.
• "rivate health services are also available. "rivate health care continued parallel to the DH%,
paid for largely by private insurance, but it is used only by a small percentage of the
population, and generally as a supplement to DH% services
Health Care Delier! S!ste/ in Canada
• The 4anadian health care delivery system is based on a national health insurance program that
is operated by each provincial governmnet.
• %pecialists are concentrated in centres, here as primary health care providers are evenly
distributed through out canadian provinces.
• 4anada has a federally sponsored, publicly funded Fedicare system. 4anadaOs system is
&non as a single payer system, here basic services are provided by private doctors, ith the
entire fee paid for by the government at the same rate. These rates are negotiated beteen the
provincial governments and the provinceOs medical associations, usually on an annual basis. !
physician cannot charge a fee for a service that is higher than the negotiated rate - even to
patients ho are not covered by the publicly funded system - unless he opts out of billing the
publicly funded system altogether.
Health Care Delier! S!ste/ in Australia
• !ustralia and De Healand both have publicly funded health care systems, though under the
4onservative government in !ustralia, there has been ne funding and incentives for people
ho pay for private health insurance.
• +n !ustralia the current system, &non as Fedicare, as instituted in ,;:2. +t coexists ith a
private health system.
• Fedicare is funded partly by a ,.7L income tax levy -ith exceptions for lo-income
earners0, but mostly out of general revenue.
• !n additional levy of ,L is imposed on high-income earners ithout private health insurance.
!s ell as Fedicare, there is a separate "harmaceutical Benefits %cheme that heavily
subsidises prescription medications
Health Care Delier! S!ste/ in Cu2a
4uba is an island ith an estimated population of ;,9////.The climate is subtropical.
!griculture is the most important economic activity. The orldIs biggest producer of sugar.
"rinciples of health care delivery system in 4uba'
,. Health of a population is government responsibility.
.. Health services should be available to all the population
1. The community should participate actively in health or&
2. "reventive and curative health services should be intergraded.
• 4uba has a health service system accessible and available to practically ,//L of the
population, ith a referral system ensuring the approriate level of care for each patient.
• "reventive curative and rehabilitative services are ell planned and integrated and sho
excellent result in terms of service indicators and mortality and morbidity data.
• 7/L or more of the budget is allotted to to health and education.
• 4ertain factors have helped to ma&e the 4uban health services efficient, such as extremely
high motivation of health services, complete literacy, high proportion of doctors and other
proffessionals staff, good transport facilities, mass mobilization and full participation of the
people.
Health Care Delier! S!ste/ in %eru
"eru is a poor country that is considered to be transition. There has never been centrally
controlled or e$uity in availability of health care. "eople in countryside are treated by
)curanderos* ho are traditional healers. The ministry of health of "eru obtained technical help
from "an !merican health organisation and the start of a system of organized care for the poor,
and for the rich began to become a reality. The government has began surveillance of infectious
diseases and has omplememented progras to imoprove sanitation$
,HO or&s closely ith other organizations ithin the United Dation %ystem. +t is a
constitutional re$uirement that (HO should establish and maintain effective collaboration ith
the United Dations and provide health services and facilities. UD+4#< has been one of the closest
partners. +n ,;:; (HO and UD+4#< 5ointly launched an initiatives for mothers and children
called )facts of life*
Health s!ste/ in Africa
• Health care in !frica is usually non existent or highly limited and under resourced. The
outbrea& and spread of H+@C!+?% in !frica has crippled many populations and sent life
expectancies plummeting.
• Hoever some countries have been able to tac&le the challenges, for instance health care in
Uganda as ell as education has reduced H+@C!+?% infections from ,1L to 2.,L from ,;;/
to .//1.
Health s!ste/ in Ni5eriria Health care provision in Digeria is a concurrent responsibility of the
three tiers of government in the country. Hoever, because Digeria operates a mixed economy,
private providers of health care have a visible role to play in health care delivery.
• The federal governments role is mostly limited to coordinating the affairs of the university
teaching hospitals, hile the state government manages the various general hospitals and the
local government focus on dispensaries.
• The total expenditure on health care as L of >?" is 2.8, hile the percentage of federal
government expenditure on health care is about ,.7L.
• Dational Health +nsurance %cheme, the scheme encompasses government employees, the
organized private sector and the informal sector. %cheme also covers children under five,
permanently disabled persons and prison inmates
Health Care Delier! S!ste/ in Asia
+srael, %outh =orea, %eychelles and Taian have universal health care. Thailand plans to.+n
%ri 3an&a, drugs are provided by a government oned drug manufcaturer called the %tate
"harmaceuticals 4orporation of %ri 3an&a. +n the "hilippines, the ?epartment of Health -"hilippines0
organises public health for the country, and as established at the initiative of the !merican
governers, before independence. %audi !rabia has a publicly funded health system, although its levels
are loer than the regional average.
Health care delier! s!ste/ in Sin5a-ore
%ingapore has a dual system of healthcare delivery, comprising of the public and private
systems. "rimary healthcare is provided at outpatient polyclinics and private medical practitionersO
clinics. %econdary and tertiary specialist care are provided in the public and private hospitals.
The private practitioners provide :/L of the primary healthcare services hile the public
polyclinics provide the remaining ./L. <or hospital care, it is the reverse ith :/L of hospital care
being provided by the public sector and the remaining ./L by the private sector.
+n ,;;;, the public healthcare delivery system as re-organized into to vertically
integrated delivery netor&s, the Dational Healthcare >roup and the %ingapore Health %ervices. This
as to enable the delivery of more integrated and better $uality and healthcare services through
greater cooperation and collaboration among the public sector healthcare providers. This system also
minimises the duplication of services and ensures the optimal development of clinical capabilities.
This public healthcare system is supported by the %ingapore 4ivil ?efence <orceOs !mbulance
%ervice hich provides paramedical support and transport for accident and trauma victims as ell as
medical emergencies.
Health S!ste/ in China
>reat advances in public health have been hallmar& of the "eopleIs 6epublic of 4hina since it
as founded in ,;2;. #xamples of public health advances that ere made in china including
controlling contagious disease such as cholera, typhoid etc. These accomplishments in public health
ere credited to a political system that as and is largely socialistic terms as collective.
• The collective health care system as oned and controlled by the state and as
characterised by the use of barefoot doctors ho ere medical practioners trained at the
community level and ho could provide a minimal level of health throughout the country.
• Barefoot doctors combined estern medicine ith traditional techni$ues such as acupuncture,
herbal remedies.
• 4hinas health care system is modified by the introduction of primary health care system in
community health clinics-4H40 based on the health care system in 4anada. (ith this system,
a family practice physician is assigned 7// or more individuals for hom to provide health
care.
A Co/-aratie Stud! Of Health Care Delier! S!ste/
4omparison of #ffectiveness of ?ifferent Health 4are ?elivery %ystem through !vailable ?ata
Countr!
Life
e:-ectanc!
Infant
/ortalit!
rate
%h!sicians
-er *)))
-eo-le
Nurses
-er
*)))
-eo-le
%er ca-ita
e:-enditure
on health
'6SD+
Healthcare
costs as a
-ercent of
0D%
= of
5oern/ent
reenue
s-ent on
health
= of health
costs -aid
2!
5oern/ent
!ustralia :/.7 7./ ..29 ;.9, .,7,; ;.7 ,9.9 89.7
4anada :/.7 7./ ..,2 ;.;7 .,88; ;.; ,8.9 8;.;
4hina 1,./ ../ ..9 .2.;
%rilan&a ,8.// /.. ,./. 1./ 27.2
Gapan :..7 1./ ,.;: 9.9; .,88. 9.; ,8.: :,./
%eden :/.7 1./ 1..: ,/..2 1,,2; ;.2 ,1.8 :7..
U= 9;.7 7./ ..1/ ,..,. .,2.: :./ ,7.: :7.9
U%! 99.7 8./ ..78 ;.19 7,9,, ,7.. ,:.7 22.8
In India
• 3ife expectancy' 82.2 years-.///0
• +nfant mortality rate'9/-,;;;0
• "hysicians per ,/// people' /.2-,;;:0
• Durses per ,/// people' /.27-,;;:0
• Health care costs as percentage of >?"'8L
• "ercentage of public expenditure on health to total health',9.1L
+n +ndia technological improvements and increased access to health care have resulted in a steep
fall in mortality, but the disease burden due to communicable and non communicable disease,
environmental pollution and malnutrition problems continued to be high. +n spite of the fact
that norms for creation of infrastructure and manpoer are similar through out the country, that
remains substantial variation beteen states and districts ith in the states, in availability and
utilization of health care services and health indices of the population.
Conclusion
The health care delivery system is a large complex organisation comprising a variety of
agencies and many health care professionals. Health care can be considered a right of all people. The
idea that health is the responsibility of each individual in society is gaining greater acceptance.
@arious providers of health care co-ordinate their s&ills to assist a client. Their mutual goal is to
restore a clients health and promote ellness.
B+B3+O>6!"HE
,. Farcia %tanhope, Geanette 3ancaster. 4ommunity and public Health Dursing. 8
th
ed. United
%tates of !merica. Fosby. .// .". 9.-:7
.. Gudith !nn !llender, Barbara (alton %pradley. 4ommunity Health Dursing. 8
th
ed. De
Eor&. 3ippincott (illiams and (il&ins. .// .". ,/:-,2.
1. "ar&.G.#, "ar&.&. Text Boo& of "reventive and %ocial Fedicine. ,;
th
ed. Gebalpur. Bhansari
Bhanot publishers. .//9.p. 91.-927
2. >upta F4, Faha5an B=. Text Boo& of "reventive and %ocial Fedicine. 1
rd
ed. De ?elhi.
Gaypee Brothers "ublications. .//7. ".27/-28/.
7. =asturi %undar 6ao. !n +ntrodction to 4ommunity Health nursing. 2
th
ed. 4hennai. B+
"ublications. .//7. ". 181-19;
8. "atricia !, "otter, !nnie >refin "erry. <undamnetals of Dursing. 8
th
e.d. Fissouri, Fosby
"ublications. .//8. "..8-21
9. +ndian "ublic Health %tandards for "H4. !vailable from U63'http'CC.mhf.org
:. +ndian "ublic Health %tandards for %ub 4entres. !vailable from U63'http'CC.mhf.org
;. +ndian "ublic Health %tandards for 4H4. !vailable from U63'http'CC.mhf.org
,/. http'CC.hpp.moh.gov.sgCH""C,,.:789:.:8,7.html