Health Care Delivery System Final Doc.

INDEX 1

INTRODUCTION

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2

AT THE CENTRE

2-7

The Ministry of Health and Family Welfare The Directorate General of Health Services

The Central Council of Health and family welfare

3

STATE LEVEL

8-9

State Health Directorate State Ministry of health

4

DISTRICT LEVEL

10-11

5

Panchayati Raj

11-13

6

Conclusion

14

7

Bibliography

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HEALTH SYSTEM IN INDIA India is a union of 28 states and 7 union territories. Under the constitution of India, the states are largely independent in matters relating to the delivery of health care to the people. Each state has therefore developed its own system of health care delivery independent of the central government. The central responsibility consists mainly of policy making, planning, guiding, assisting, evaluating and co-coordinating the work of the state health ministries, so that health services cover every part of the country and no state lags behind for want of these services. AT THE CENTRE The official organs of the health system at the national level consists of : 1. The Ministry of Health and Family Welfare 2. The Directorate General of Health Services 3. The Central Council of Health and family welfare

 Union Ministry of Health and Family Welfare ORGANIZATION The Union Ministry of Health and Family Welfare are: 1. Headed by a Cabinet Minister 2. Minister of state and, 3. Deputy Health Minister , DEPARTMENTS  Department Of Health  Department Of Family Welfare(Created in 1966) Department Of Health 1. 2. 3. 4.

Secretary to the Government of India(Executive Head) Joint Secretaries Deputy Secretaries Large administrative Staffs

Department Of Family Welfare 1. The Secretary to the Government of India(Overall charge) 2. Additional Secretary & Commissioner 3. One Joint Secretary 2

FUNCTIONS The functions are set out in the 7th Schedule of Article 246 of the Constitution of India under:  Union List  Concurrent List Union List 1. International Health relations and Quarantine. 2. Administration of Central Institutes Such as National Institute for the Control of Communicable diseases, Delhi. 3. Promotion of Research through the research centres &other bodies. 4. Regulation and development of medical, pharmaceutical, dental, and nursing professions. 5. Establishment and Maintenance of Drug standards. 6. Census, and collection and publication of other statistical data. 7. Immigration and emigration 8. Regulation of labour in the working of mines and oil fields. 9. Co-ordination with States and with other ministries for the promotion of Health Concurrent List The functions listed under this list are the responsibility of both the Union and State Governments. The centre and the State have simultaneous powers of legislation. The power of the latter are restricted to the framework of such legislation as may be undertaken by the centre. Concurrent List includes: 1. 2. 3. 4. 5. 6. 7. 8.

Prevention of extension of Communicable disease from one unit to the other. Prevention of adulteration of food stuffs. Control of drugs and poisons. Vital Statistics. Labour welfare. Ports other than major. Economic and Social Planning. Population control and Family planning.

 Directorate General of health Services ORGANIZATION 1. The Director General of Health Services (Principal adviser to Union Government in both medical and public health matters) 2. Additional Director general of health services 3

3. A team of deputies 4. Large administrative staff The Directorate comprises of 3 main units,  Medical care & Hospitals,  Public health  General administration FUNCTIONS  GENERAL Surveys, planning, co-ordination, programming and appraisal of all health matters in the country.  SPECIFIC 1. International Health relations and Quarantine: All the major ports in the country9kolkatta,vishakhapattanam, Chennai,Cochin, Mumbai,,kandla) and International airports(Mumbai-Santa Cruz, Chennaimeenambakkam, Tiruchirapalli ,Delhi-Palam) are directly controlled by the Directorate General of Health Services 2. Control of Drug standards The Drugs Control Organization is part of the Directorate general of Health Services, and is headed by the Drugs controller .Its Primary function is to lay down and enforce standards and controls the manufacture and distribution of drugs through both Central and State Government Officers. The Drugs Act (1940) vests the central government with the powers to test the quality of the imported drugs. 3. Medical store depots The Union Government runs medical depots at Mumbai, Chennai, Kolkatta, Carnal, Gauhati, and Hyderabad. These depots supply the civil medical requirements of the Central Government and of the various State Governments. These depots also carries supplies from foreign agencies 4. Post Graduate Training The Directorate General of Health Services is responsible for the administration of national Institutes, which also provide Post graduate training to different categories of health personnel. Some of these Institutes are National Institute of Mental Health at Bangalore, College of Nursing at Delhi, and National institute of communicable Diseases at Delhi etc 5. Medical Education 4

The Central Directorate is directly in charge of the following medical Colleges in India: the Lady Hardinge, the Maulana Azad and the Medical Colleges at Goa and Pondicherry. Besides there are many medical Colleges in India which are guided and supported by the Centre. 6. Medical Research The Medical Research in India is largely organized through the Indian Council of Medical Research, founded in 1911 in New Delhi. The Council plays a significant role in aiding, promoting, and promoting scientific research on human diseases, their causation, prevention and cure. The research work is done through the Councils permanent research institutes, Research Units, Field surveys, and a large number of ad-hoc research enquiries financed by the Council. It maintains cancer Research Centre, Tuberculosis chemotherapy centre at Chennai etc. The funds of the council are wholly derived from the budget of the Union ministry of Health. 7. Central Government Health Scheme The Central Government health scheme for the Central Government employees was first introduced in 1954 in New Delhi.The Scheme is based on the principle of co-operative effort by the employeeand the employer, to the mutual advantage of both.The Facilities under the scheme are :1, Out patient care 2.supply of necessary drugs 3,lab & X-ray investigations 4.domicilliary visits 5.hospitalisation facilities at government as well as private facilities 6. Specialist consultation 7.paediatric services including immunization 8.antenatal, natal, and postnatal services 9.post natal services 10. Emergency treatment 11. Supply of optical and dental aids at reasonable rate 12. Family welfare 8. National Health programmes The various national health programmes for the eradication of malaria, control of tuberculosis, filarial, leprosy, AIDS and other communicable disease involves expenditure. The Central Directorate plays an important role in planning, guiding and co-coordinating all the national health programmes in the country. 9. Central health Education Bureau: Preparation of educational material for creation of health awareness among the people .The Bureau offers training courses in health education to different categories of health workers. 10. Health Intelligence The Central Bureau of Health Intelligence was established in 1961 to centralize collection, compilation, analysis, evaluation and dissemination of all information on health statistics for the nation as a whole. It disseminates epidemic Intelligence to states and International agencies. The Bureau has an epidemiological unit, a Health Economics unit, a National Morbidity Survey Unit, a Manpower Cell. 11. National Medical Library 5

The Central Medical Library of the Directorate General of Health services was declared the National Library in 1966.The aim is to help the advancement of medical, health and related sciences by collection, dissemination and exchange of information.

 Central Council of Health The Central Council of Health was set up by a Presidential order on 9th August 1952, under article 263 of the Indian Constitution for promoting co-ordinated and concerted action between the centre and the states in the implementation of all the programmes and measures pertaining to the health of the nation. ORGANIZATION 1. The Union Health Minister 2. State Health Ministers FUNCTIONS 1. To consider and recommend broad outlines of the policy in regard to matters concerning health an all its aspects such as provision of remedial and preventive care, environmental hygiene, nutrition, health education, and the promotion of facilities for training and research. 2. To make proposals for legislation in fields of activity relating to medical and public health matters and to lay down the pattern of development for the country as a whole 3. To make recommendations to the Central Government regarding distribution of available grants-in-aid for health purposes to the states and to review periodically the work accomplished in different areas through the utilization of these grantsin-aid . 4. To establish any organization or organizations invested with appropriate functions for promoting and maintaining co-operation between the Central and State Health administration

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Centre level Union ministry of health &family welfare

Directorate General of Health

Headed by Cabinet Minister Minister of State & deputy health minister

The Director Council of health services

Additional Director General of Health Services Department of health Deputies &

Department of family welfare Administrative staffs

Secretary to the Govt of India

Secretary to the Govt of India

Joint Secretaries

Additional Secretary & Commissioner

Deputy Secretary

Joint Secretary

Administrative staffs

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Central Council of health

Union Health Minister (chairman)

Union Health Minister State Health Minister

AT THE STATE LEVEL At present there are 28 states in India with each state having its own health administration .In all the States, the management sector comprises of :  The State Ministry of Health  State Health Directorate

 State Ministry of Health ORGANIZATION  Headed by Minister of Health and family Welfare  Deputy Minister of Health and Family Welfare Health Secretariat (Official Organ of State Ministry of Health) 1. 2. 3. 4.

Headed by Secretary Assisted by Deputy Secretariat Under Secretaries Large Administrative staff

 State Health Directorate The Director of Health services (Known in some states as Director of Medical and Health Services) is the chief technical adviser to the state government on all matters relating to medicine and public health. He is also responsible for the organization and direction of all health activities. With the advent of family planning, the designation of the Director of health Services has been changed in some states as Director of Health and Family Welfare. A recent development in some states is the appointment of a Director of Medical Education in view of the Increasing number of medical Colleges.

ORGANIZATION 1. The Director of Health and family Welfare 2. Assisted by the Deputy and Assistant Directors of Health.  Regional Directors(Inspect all branches of public health within their jurisdiction, irrespective of their specialty.  The Functional Directors are specialists in a particular branch of public health such as mother and child health, family planning, nutrition, tuberculosis, leprosy, health education etc 8

State Level Administration

State Ministry of Health

Minister of Health and Family Welfare

State health Directorate

Director of health and family welfare

Deputy Minister of Health and Family Welfare

Deputies and Assistants

Health Secretariat

Secretary

Deputy Secretaries Under secretaries and Administrative staffs

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AT THE DISTRICT LEVEL The Principal unit of administration in India is the District under a Collector. Districts vary widely in area and population. Within each District,there are again 6 administrative areas: 1. 2. 3. 4. 5. 6.

Sub divisions Tehsils (taluks) Community Development Blocks Municipalities and Corporations. Villages Panchayats

Sub divisions; Most Districts in India are divided into two or more subdivisions each in charge of an Assistant collector or Sub Collector Tehsils(Taluks) Each division is again divided into tehsils (taluks) headed by Tehsildar. It comprises 200 to 600 villages. Community Development Blocks The Block is a unit of rural planning and development, and comprises about 100 villages and about 80,000 to 20,000 population. The Urban areas of the district are organized into following institutions of local Self Government: Town area committee’s: In areas with population ranging between 5000 and 10,000. Municipal Boards

:

In areas with population ranging from 10,000 to 2 lakhs, headed by Chairman or the President Corporations: With population above 2 lakhs headed by Mayors. 10

FUNCTIONS OF MUNICIPAL BOARDS:        

Construction Maintenance of roads Sanitation and drainage Street Lighting Water supply Maintenance of hospitals and dispensaries Education Registration of Births and Deaths.

PANCHAYATI RAJ This is a three tier system of Rural Local self Government, linking the Village to The District. These are: 1. Panchayat (at the Village Level) 2. Panchayat Samiti( at the Block Level) 3. Zila Parishad ( at the District Level)  At the Village Level  The Gram sabha  The Grama Panchayat  The Nyaya Panchayat Gram sabha:  

It is the assembly of all the adults of the village which meets at least twice a year. It considers proposals for taxation, discusses the annual programme and elects members of Grama Panchayat.

Gram Panchayat:    

It is an Executive organ of the gramsabha, an agency for the planning and development at the village level. Its strength varies from 15 to 30, and population varies from 5000 to 15000 or more. The members of the Gram Panchayat hold office for a period of 3 to 4 years. Every Panchayat has an elected President, Vice-President and Panchayat Secretary.

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 At the Block Level 

The Block consists of about 100 villages. Its population varies from 80,000 to 1,20,000.  Panchayati Raj agency at the Block level is the Panchayat Samiti ( Janpada Panchayat)  

The Panchayat Samiti consists of all Sarpancha’s(head)of the village, MLA’s, MP’s residing in the block area, representatives of women, Scheduled castes , Scheduled Tribes, and Co-operative Societies. The Block Development Officer is the Ex –Officio Secretary of the Panchayat Samiti.

Functions of Panchayat Samiti  

Execution of Community Development Programme in the Block. Funds provided for stage 1 and stage11 are channeled through the Panchayat Samiti.

 At the District Level It is the agency of rural local self Government at the District level. Members include all heads of Panchayat Samiti’s of the District, MP’s, MLA’s of the District, representatives of Scheduled tribes and women, and 2 persons of experience in administration, public life or rural development Functions: It is primarily supervisory and coordinating body. Its function varies from state to state.

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AT THE DISTRICT LEVEL Headed by Collector. Sub divisions

Tehsils

Community Development Blocks

Assistant Tehsildar collector (Sub Collector)

200 - 600 villages

Municipalities Corporations Villages

Panchayats

Chairman Mayors or the President

100 villages 80,000 - 20,000 population.

10,000 to 2 lakhs Population population above 2 lakhs

.

PANCHAYATI RAJ (At the Village Level) Panchayat

( At the Block Level) Panchayat Samiti ( Janpada Panchayat)

The Gram Sabha The Grama Panchayat The Nyaya Panchayat

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( At the District Level) Zila Parishad

CONCLUSION Various levels of health care has been discussed. Each state has its own system of health care delivery independent of the central Government. BIBLIOGRAPHY 

K Park 2005, “The Text book of Preventive Medicine” 18th edition, pp. 674-677



http://www.healthsystem.com/delivery/agencies.html

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