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HEALTH CARE DELIVERY SYSTEM
INTRODUCTION:
What comes to your mind when you had detoriation from health?
Hospital and population it covers
Type of service it gives
Is it able to give comprehensive care?
Ivory tower of disease
Alternative health delivery model came in exist
FACTORS DETERMINING HEALTH CARE DELIVERY SYSTEM
CONSUMERS OF HEALTH CARE
PROVIDERS OF HEALTH CARE
FUNDING SOURCES OTHER FACTORS: Such has political system, legislation, law, and obligation.
MODELS OF HEALTH CARE DELIVERY SYSTEM:
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Input through put out put
FIG: as per system theory
Concepts: health status:
How to measure?
Morbidity mortality
Demographic
Environment
Socio economic Cultural
Medical, health service
Other (water)
Health status
Healthproblems
Health needs
Resources
Promotive
CurativePreventive
Allopathic
AYUSH
IMPROVE
HEALTHSTATUS
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Mortality:
IMR: 58 INDIA: 54(WORLD) developed countries it is 5/ 1000
Life expectancy: 65.3 (12 to 15 more, world) Rural death (8.7 per 1000) urban (6)
UP death rate higher than rest of the states( 9.8) average 8.2
Kerala least death rate 6.4
DEMOGRAPHIC:
Sl.no content Existing statistics
1 Total population 1087 million(2004)
2 Family size 3
3 Annual growth 1.9
4 May double the population With in 30 years(2025)5 Rural population 72%
6 Adult literacy 65.4
7 Sex ratio 933
8 GNP 23,241
9 CBR 24.1
10 DEATH RATE 7.5
Morbidity:
Malaria, filarial, dengue, chikagunya still high
Cholera out break among under five still seen due to poor environment
conditions
ARI 13% admissions in wards and 13.6% of total paeds death in hospital
due to ARI
Leprosy: 60% of worlds cases are in India
2.3 per 10,000 population seen
AIDS: 5.7 million cases have been reported in India
Other: viral hepatitis, TB, helminthes diseases
Other problems:
Population
Nutrition
Environment nutrition population exposure
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PEM:
Common is morasmus
Severe mall nutrition seen in 2- 3% of preschooler
Mild moderate cases 80%
Anemia:
Half of women population, and young adults
60 to 80% of pregnant mothers are anemic
Out of total MMR 20 to 40% death are due to anemia
Iron deficiency very common than folate or B12 deficiency
Low birth weight:
30% babies born below 2.5 kg, where as developed countries it is 4%
Main cause is maternal anemia
Nutritional blindness:
Keratomalacia
Seen among 1to 3 years of age
Iodine defiency:
Common in himachal, orissa, Punjab, Darjeeling, west Bengal, arunchala
Environment:
water 100% in urban, 85% rural
Waste disposal 29% in urban and only 25 in rural
Medical care problems:
Uneven
Crowded in cities
Inadequate staff
Essential drug shortage 74% rural do not have hospital
Resources:
Doctors; 73.6% urban, 26.4% only rural
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HEALTH MAN POWER SUGESTED NORMS:
SL. NO CATAGORY NORMS
1 DOCTORS 1/ 3,500 POPULATION
2 NURSES 1/ 5OOO
3 FHW, MHW 1/5000: 1:3000(HILLY)
4 DAIS 1 PER VILLAGE
5 FHA 1: 30,000& 1: 20,000(hilly)6 PHARMACIST 1:10,000
7 LAB TECHNICIAN ;;
Finance: GNP 1to 2% only spent
Developed countries 6 to 12%
Through put:
Health services and health care system:
Health care services:
Scope:
varied
As per health problems
Finance
Purpose of health services:
Reduction in morbidity
Reduction in mortality
Increase life expectation
Decrease population rate
Improve nutritional status
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Provision of basic sanitation
Resource development
Basic sanitation
Reduce poverty
Improve food production
Literacy rate
Goal: HFA
Types of services:
Curative
Promotive, preventive
Rehabilitative
Report of WHO expert committee 1961 says:
Services should be
Comprehensive
Accessible
Community participation
Cost: economic affordable
Type of health system
Modern medicine
AYUSH
HEALTH CARE SYSTEM:
It can be decided in to sectors (5)
1. public sector:
a. primary care
primary health centre
sub centre
b. hospitals and health centers:
community health centre
rural hospital
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district hospital
specialty hospital
teaching hospital
c. health insurance scheme:
employee state insurance central government health scheme
d. other agencies:
defense services
railways
2. private sector:
private hospital, polyclinic
3. Indegeneous system:
( AYUSH):
Including unregistered practitioners
3. voluntary health agencies:
national
international
5. National health programmes:
CONCEPT OF PRIMARY HEALTH CARE
Bhore committee, 1975 shrivasthav committee
1977 Rural health scheme: placing health in peoples hand, 3 tier structure
1978 alma ata
1983 national health policy
Goals
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Now in villages rural development is done through rural health mission and
by state projects
Village health guides :(to deliver primary health care in villages)
Introduced in 1977, October 2nd
Some states did not e.g. TN instead introduced mini health centers
Criteria health guides:
Women only
Permanent residence
6th STD
Accepted by community
Voluntarily agrees to work
Honorium salary
Works only2- 3 hours daily
Works minimum 3 years after the training
Training in PHC, Sub centre
3 month training
Rs. 200 salaries
Manual issued
Drugs charges 600 RS Annually
Dais:
rural health scheme started training of dais
Training period is 30 working days
Stipend of 300
Training in MCH centers, PHC 2 days in the centers and remaining days of week in the field
During the training she has to conduct 2 deliveries under the presents of
FHA
After successful training she will be given a midwifery kit and a
certificate she get 10 Rs, on registering the case and Rs. 3 on registering
the birth
Anganwadi workers:
P .H.C. Sub-centre ,community centre.
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Insurance scheme, defense,
Private agencies
Health insurance:
Additional health insurance schemesocial insurance schemes)
1. for BPL FAMILY:
beneficiaries: 3 months to 65 years of age
premium: Rs. 1 per day per person x 365 days
family of 5 : Rs 1.50 annually Rs. 548
family of 7: Rs. 730 per year
government contribution: Rs. 100 per year
family of destitute: free health services
reimbursement: 30,000 on hospitalization
death due to accident: 25.000/
job loss: Rs 50 per day x 15 days
2. government national illness assistance fund(1997)
it is also for BPL
REEMBERSEMENT: 25000- 50000
Treatment centers: 3 government hospitals and national institute
Works under: MOH&FW
States: AP, TN, WB, BIHAR, RAJ, MAH,.
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PRIVATE AND GOVERNMENT COMBINED INSURENCES:
Kerala
Only for mother and baby
BPL families
Pilot project
216 hospitals
Service: surgical procedure, delivery
Premium: 250 + 5% tax
Reimbursement: 20,000 on hospital bills
Goa: combined insurance (government+ NGO+ UNDP)
Coverage: families generating income less than 50,000 per annum
Reimbursement: 30,000( on producing hospitalization certificate
from dean of hospital or DGHS
Service coverage: ambulance, illness loss of wage(RS 50 per day),
drugs Rs. 50 per day
PRIVATE SECTOR AND HEALTH INSURANCE
Government has given permission
Regulatory body has been appointed to monitor
Called as insurance regulatory and development body
It has covered insurance worth of 300 million and predicted to
cover 50 billion with in 5 to 7 years
Insurance companies so far has taped only 10% of the market
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It shows till awareness among the people and organization is less
about insurance benefits
Conclusion source; health action JUNE 2010.. DR. K.
GOVINDARAJAN AND ARUNACHALUM..PAGE 26.
Voluntary health agencies: National International
National voluntary agencies:
Concept:
Autonomous board
Does fund raising
Has paid and without paid workers
Conduct programme for publicon health and related matters
Functions: Supplementing the work of government
Why?
Pioneering: research, health programme and projects
Education: health education
Demonstration of projects: Rockefeller and bore hole latrines
Voicing out the work of government
Recommendation for health legislation: asking public opinion
List of voluntary agencies in India:
Indian red cross Hind kusht nivaran sangh
Indian council for child care
TB association of India
Bharath sevak samaj
Central social welfare board
Kasturba memorial fund family planning association of India
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.
Indian Red Cross:
1920 400 branches
Function:
relief work
Armed force( red cross home)
Family planning
Blood bank
First aid
HIND KUSHT NIVARAN SANGH:
1950
Head quarters in DelhiActivities:
Funds for various leprosy clinic and homes
Publication of posters
Training medical and physiotherapy
Conducting research
Conference
Publication journal leprosy in India( quarterly journal)
Council for child Indian welfare: 1952
Affiliated to international union for child welfare
Activities:
o Child security
Laws and legislation
Unable the children to develop physically, mentally, morally
healthy
Develop environment for child that gives respect and dignity
TB association of India:
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Branches all over activities: fund raising
Training doctors
Consultation
Conference1939
Health education
Bharath Sevak Samaj: 1952
Health placing in people palm
Activities:
Improvement of sanitation
Central social welfare board:
Under the general control of ministry of education
Autonomous body
1953
Activities:
Surveying the needs of voluntary health associations of India
Rendering financial aid for deserving projects
Rural areas welfare of women and children
Teaching craft
Distribution of milk to the balwadies
Literacy classes
Social education
Maternity aid for women
Kasturba memorial fund: 1944
Improving women of villages through gram sevak
Family planning association of India: 1949
Mumbai- head quarters
Function: training doctors
Health visitors and social workers
Personal interviews pertaining family planning
Has family planning clinics
All India womens conference: 1926
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:
MCH clinic
Medical education centers
Adult education centers
Milk centers
Family Has branches all over Activities planning centers
All India blind relief society: 1946
Activities:
Coordinate with different institution dealing with blind
Eye relief camps
Health education
Professional bodies:Activities:
conferences
Scientific sessions
Publication
Exhibitions
Research
Relief camps
International agencies:
ROCK FELLER, CARE, ILO, WHO, UNICEF
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CONTRIBUTION OF ROCK FELLER:
MEDICAL EDUCATION AND PUBLIC HEALTH
HOOK WORM CONTROL
ESTABLISHMENT OF NATIONAL INSTITUTE OF HYGIENE AND PUBLIC
HEALTH IN KOLKATTA
TRAINING RESERCH WORKERS
FELLOWSHIP PROGRAMME AND TRAINING DEVELOPING GRANTS TO SELECTED INSTITUTIONS
MEDICAL LIBRARY ESTABLISHMENT
RESERCH PROJECTS ASSISTANCY NATIONAL INSTITUTE OF VIROLOGY AT
PUNE
FORD FOUNDATION:
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HAND FLUSH LATRINE
TRAINING COURSES IN PPUBLIC HEALTH IN ITS TRAINING CENTER AI
SINGUR
ESTABLISHMENT OF NATIONALINSTITUTE OF HEALTH ADMINISTRATION
AT DELHI
CALCUTTA WATER SUPPLY AND DRAINAGE PROJECT
SUPPORTS RESEARCH ON FAMILY PLANNINF AND REPRODUCTORY
BIOLOGY
CARE (COOPERATIVE FOR ASSISTANCE AND RELIEF)
2ND WAR TIME IT HAS PROVIDED ASSISTANCE IN FIRST AID
NUTITION PROJECTS: WOMENS HEALTH PROJECT
ANAEMIA CONTROL PROJECTS CHILD SURVIVAL PROJECTS
ADOLESCENT GIRL PROJECT UNDER ICDS
FAO:
APPLIED NUTRITION PROGRAMME
NUTRITION SURVEYS
TRAINING COURSES
SEMINARS
RESEARCH
ZOONOTIC DISEASES TRAINING PROGRAMME
ILO
MINIMUM STANDARDS FOR WORK
SOCIAL JUSTICE
WELFARE LABOUR FORCE
WHO:
OUT BREAK OF DISEASES
VACCINES, DRUGS
HEALTH LITERATURE
MEDICAL LIBRARIES
PROGRAMME PERTAINING ENVIRONMENT AND MCH
UNICEF
APPLIED NUTRITION
SCHOOL GARDEN
SEEDS
AGRICULTURE TECHNOLOGY AND TOOLS
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National health programme:
National control programme
National eradication programmes
Special programme for mother and child
Nutrition programme
Other programme
Classification I1
Vertical or centrally sponsored
Horizontal
District sponsored programmes
Combined programme
Intergrated programmes, merged
Eg; eradication programmes
Pulse polio programme 19 2005,not achieved
National leprocy
eradication 1955 2010
filaria 1955, merged 1972 Goal-2015
Yaws 75-76 2005 onwards no new case
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Control programme
National vector
Borne disease
From 2003 it is not
centrally sponsored
combine
programme
National filarial control 1955
Kala azar control 1990
Japanese encephalitis control 1990
Dengue fever control programme 1996
Revised national TB 1992 On since 1962
National AIDS control 1987Control of blindness 1976
CANCER CONTROL 1975-
76
Control & treatment of
occupational diseases
98-99
Diabetic control programme 7th five
year
MCH PROGRAMME:
CSSM RCH
RURAL HEALTH MISSION
NUTRITIONAL PROGRAMMES
BALWADI
APPLIED
MID DAY
IDD CONTROL
IRON ANF FOLIC ACID
VIT.A DEFIECIENCY
OTHER PROGRAMMES:
UNIVERSA IMMUNISATION PROGRAMME
NATIONAL MENTAL HEALTH PROGRAMME
National surveillance programme fordiseases(1994)
Intergrated disease surviellane programme(2004)
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National family welfare programme
National water supply and sanitation programme
Minimum needs
20 points programme
Five year plans:
1951-56: I five year plan
o 2nd five year
o 3rd five year
o annual programmes
o 4th five year
o 5th five year
o out plan
o 6th
o 7th
o annual
o annual
o 8th
97-2002 9th
o 10th
11th
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CONCEPT OF PRIMARY HEALTH CARE
Bhore committee, 1975 shrivasthav committee
1977 Rural health scheme: placing health in peoples hand, 3 tier structure
1978 alma ata
1983 national health policy
Goals
Village health guides:
Introduced in 1977, October 2nd
Some states did not e.g. TN instead introduced mini health centers
Criteria health guides:
Women only
Permanent residence
6th STD
Accepted by community
Voluntarily agrees to work
Honorium salaryWorks only2- 3 hours daily
Works minimum 3 years after the training
Training in PHC, Sub centre
3 month training
200 salaries
Manual issued
Drugs charges 600 RS Annually
Dais:
P .H.C. Sub-centre ,community centre.
Insurance scheme, defense,
Private agencies
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Indigenous system of medicine
Voluntary agencies
Indian red cross
Hind kusht nivaran sangh
Indian council for child welfare T.B association
Bharat sevak samaj
Central social welfare board
Kasturba memorial fund
F.P association of India
All India womens conference
All India blind relief society
Professional bodies
International agencies
VOLUNATARY ORGANISATION
INDIAN RED CROSS
Started 1920
Over =400 braches
Aim; 1. relief work
2. milk supplies
3. armed forces
4. technical aid & financial help affiliated maternity centre
5. F. P. services affiliated6. blood bank and first aid, e.g.;
HIND KUSHT NIVARAN SANGH
1950
head quarters- Delhi
financial help , leprosy home and clinic
conduct field investigation
posters, publication material
training medical , physiotherapy
conduct research
conference national
journal LEPROCY IN INDIA
INDIAN COUNCIL FOR CHILD WELFARE
* 1952
* affiliated to international union for child welfare
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* aim: all dimension health by means of law and other means
* state and district
T. B. ASSOCIATION OF INDIA
* 1939
* all most all state
* training, campaign* it manages national T B center
BHARAT SEVAK SAMAJ
1952
sanitation
all district
CENTRAL SOCIAL WELFARE BOARD
1953
automous
survey the need of voluntary organization teach craft , social teaching, literacy
distribution of milk to balwadis
M C H activities
Play centre for children
Industrial scheme for urban
F P ASSOCIATION OF INDIA
1949
head quarters Mumbai
they conduct F P clinic
get government aid
train doctor , health visitors, social worker
clears queries
THE KASTURBA MEMORIAL FUND
* 1944
* women help through gram sevak
ALL INDIA WOMENS CONFERENCE
* 1926
* M C H clinic, adult education, milk centre ,F P clinic
ALL INDIA BLIND RELIEF SOCIETY
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* 1946
* Coordinate the work of blind institution
* eye relief campPROFESSIONAL BODIES
Eg;
INTERNATIONAL ORGANISATION
NATIONAL HEALTH PROGRAMME
Classification of health programme
Eradication programme
Control programme
Mother and child
Nutritional
Other
ERADICATION PROGRAMME
1. Guinea worm
2. Pulse polio3. Filaria
4. Leprosy
CONTROL PROGRAMME1. T.B.
2. AIDS
3. DIABETES
4. BLINDNESS5. CANCER
6. MALARIA
7. JAPANES ENCEPHALITIS
M C H PROGRAMME
1. C.S.S.M
2. R.C.H
3. F.P
NUTRITIONAL PROGRAMME
`1. VIT. A. Prophylasis
2. Iron & folic acid
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3. Balwadi
4. Applied
5. Special nutrition
6. Iodine deficiency
7. mid day meal
OTHER PROGRAMME:
UNIVERSAL IMMUNISATION
MENTAL HEALTH
20 POINTS
MINIMUM POINTS
WATER SUPPLY & SANITATION
FIVE YEARS
FIVE YEAR PLAN:
FIRST : 1951-1956
SECOND : 1956-1961
THIRD :1961-1966
FORTH : 1969-1974
FIFTH : 1974-1979
SIXTH : 1980-1985
SEVENTH : 1986-1991
EIGHT : 1992-1997
NINTH : 1997-2002
TENTH : 2002-2007
11TH 2008-2012
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PROBLEMS AT HEALTH CARE DELIVERY SYSTEM
1. Planning :1. Lack of medium ,short term plans
2. Imbalance between rural urban areas3. P H C structure
4. Referral system: hospital over loaded
Community centre- no confidence
Lacks of link between hospital and other
level
Community participation; poor people notinvolved
Resistance of part of population
Diverse interest
Staff; doctor less
Peon less No further growth
Security lacks
Unattractive terms
Selection
Training
Lacks orientation programme
Co-ordination lack of .voluntary
o govt trust
o attitude
o between directorate of healthservices
o intra and inter sector
o decentralization resistancy
o 5. concept/attitude
bare feet doctor
o advance technology-
specialization
o 6. finance management/
control fund not
utilized
o review committeeo research
lacksNot used this research knowledge in
o Practice
o university
not involved
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o space
not available
o policy making
non health personnel
o Legislationo ESI scheme
not utilized well
o Service
doctors not available at work
place
o Crowded some centre
o Long waiting hours
o Private practice
o Under utilization of other system
of medicine
o Ambulance service
HEALTH CARE DELIVERY SYSTEM OF U.N:
INSURANCE: becomes centre place in giving health care.
COUNTRY : spends first highest finance towards health.
Second highest by Canada. That means it spends 40%
more than Canada.
MONEY : 2002 census revealed that it has spent $1.4 trillion on health
Care. insurance agency have spent 15%.
PROGRESS : country has advance technology, science, medicine.
LIFE : expectation increased due to good health service.
COMPONENT OF HEALTH CARE DELIVERY SYSTEM
1. Private also called as personal care.2. Public
TYPE OF CARE GIVEN BY PERSONAL CARE COMPONENT:
Primary
Secondary
Tertiary
prevention
therapeutic
treatment
rehabilitation
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WORK FORCE TO DELIVER PERSONAL CARE:
1. Multi disciplinary team. Consist of *physician
nurse
dentist pharmacist
optometrist
nutritionist
community out reach worker
mental health care counselor
translator
allied health personnel
DELIVERY SYSTEM:
physician office
community centre
community nursing centre
managed care organization
MANAGED CARE ORGANISATION:
health maintain organization
preferred care organisation
H. M. O
First organized system of health care
fixed fee 78 million enrolled
provides services like specified period hospital stay
Emergency care, preventive care.
P. P. O.
Second common type
It acts as link between care providers and insurance company.
Fee not fixed
Can choose preferred doctor, cost
HEALTH INSURANCE
Enables people to choose own insurance health plan
Employee pay a defined contribution each year
Employer, rather than employee has to know knowledge on
different health plans.
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NURSE IN PRIMARY CARE WORK FORCE:
2 category of nurses ie. N.P and physician assistant
developed in 1960
they are also called as generalist
WHO ELSE CAN BECOME GENARALIST
Certified Nurse Mid wife
General pediatrician
Physician - community medicine or O.B.G.
N P.
M.S.C. speciality
Adopted special skills history taking, diagnosis, drug, psy-
social skill, prevention aspect and physical assessment.
They are able to perform 60- 80 % of physician work
Adv: less money equal and better quality care
C. N. M.
M.S.C.
5800 [2002]
Give antenatal, post natal, labour, F. P., prescribe medicine,
referral, newborn ,collaborative services
P. A.
B. S. C.
Under doctors license
40469 [2002]
skilled history, physical assessment, medicine, diagnosis ,
treat un complicated medical condition
PUBLIC HEALTH SYSTEM
Those cannot afford Eg; national health service corps provides care for residents of
medically underserved areas
It also forms health laws
Gives compulsory immunization
Water monitor-law
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CHALLENGES FACED BY U. S. HEALTH CARE SYSTEM
Rising cost
Access
Dissatisfied Competitive force
Evidence based care
System of recording
Shift of nurses to community
Continue edu.
Separate public health sectors
Technology
Specialized professional
Over emphasis tech-least importance -..
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