Health status, Health problems,

Health care delivery in IndiaDr. Rizwan S A

Assistant ProfessorDept. of Community Medicine

VMCHRI, Madurai

Learning objectives

• At the end of this lecture you sh be able to

• Describe the overall health status of India• List the MC health issues in India• Describe various portals of health care

delivery in India• Think about your position in the overall health

system

HEALTH STATUS OF INDIA

Total health expenditure

Government; 30%

Private; 70%

Private sector health expenditure

Out-of-pocket; 81%

Insurance; 19%

Public sector health expenditure

• Money spent by government on health– Rs. 1 lakh crore– Rs. 890 per capita

State govt.; 67%

Central govt.; 33%

To understand the health status…

• We need to know about – Demographic profile– Morbidity and mortality profile– Environmental conditions– Socio-economic factors– Cultural background– Health services available– Other services

Demographic profile of India

Mortality profile

HEALTH PROBLEMS IN INDIA

Communicable diseases

• Malaria• Tuberculosis• Diarrheal diseases • Leprosy• Filariasis• Others: Kala-azar, meningitis, viral hepatitis,

Japanese encephalitis, enteric fever, guinea worm disease and other helminthic infestations

Nutritional problems

• Protein-energy malnutrition• Nutritional anaemia• Low birth weight• Xerophthalmia• Iodine deficiency disorders

Environmental sanitation

• Lack of safe • Use of primitive methods for excreta disposal

Medical care problems

• Unequal distribution of health resources between rural and urban areas

• Lack of penetration of health services within the social periphery

Population problems

• Employment• Education• Housing• Health care• Sanitation • Environment

HEALTH CARE DELIVERY IN INDIA

Example of a health care delivery model

Inputs

• Health status or health problems

• Resources

Health care services

• Curative• Preventive• Promotive• Restorative

Health care systems

• Public• Private• Indigenous• Voluntary

Outputs

• Changes in health status

Health care services

• Purpose– To improve the health status of the population

• Goals– Mortality and morbidity rate reduction, increase in

expectation of life, decrease in population growth rate, improvement in nutritional status, basic sanitation, health manpower requirement and resource development

Health care system

• It implies the organization of the people, institution and resources to deliver health care services to meet the health needs of target population

Evolution of health care services in India

• Civilization started in Indus Valley – Environmental sanitation, houses with drainage

• 1400 BC Ayurveda and Siddha system– Developed a comprehensive concept of health

• Post vedic – teaching of Buddhism and Jainism• Rahula Sankirtyana – developed hospital system.• Moghul empire – Arabic system of medicine (Unani)• British Era – armed forces, civil servants

Consumers Providers

SYSTEM

Public sector

Medical officerNurses

Pharmacist Lab technicianBEE, ANM, HA

1 billion

Private sector

Indigenous system of medicine

Voluntary health agencies

National health

programmes

Health care systems

• In India, it is represented by five major sectors or agencies which differ from each other by the health technology applied and by the source of funds for operation

PUBLIC SECTOR

Public sector health system

The health system in India has 3 main links

Local or peripheral

State

Central

State and centre responsibility

• Health is the responsibility of state

• Central responsibility– Policy making– Guiding– Assisting– Evaluating– Coordinating the work of state health ministries

Public health sector• Primary health care

– Primary health centre, subcentre

• Hospitals/Health centers– Community health centers Rural hospitals– District hospital/health center Specialist hospitals– Teaching hospitals

• Health Insurances schemes– Employees state insurance Central Govt. Health Scheme

• Other agencies– Defence services – Railways

• National health programmes

Health insurance

• No universal health insurance in India• At present limited to industrial workers and

their families• Central government employees covered by

health insurance

Employees state insurance scheme

• Introduced in 1948• Contribution by employer and employee• Provides for medical care in cash and kind,

benefits in the contingency of sickness, maternity, employment injury and pension for dependents on death of worker due to employment injury

Central government health scheme

• Introduced in 1954 in New Delhi• Covers employees of autonomous

organizations, retired central government servants, widows receiving family pension, MP’s, Ex Governors and retired judges‐

Other agencies

• Defence medical services– Armed forces medical services

• Health care of railway employees– Railway hospitals and clinics– Yearly health check ups

National health programmes• Anti malaria programme‐• National filaria control programme• Kala azar control programme‐• Japanese encephalitis control• Dengue control• National Leprosy eradication programme‐• National tuberculosis programme• National AIDS control programme• National programme for control of blindness• Iodine deficiency programme• Universal immunization programme• Reproductive and child health programme• National caner control programme

PRIVATE SECTOR

Private health sector

• Private hospitals• Polyclinics• Nursing homes • Dispensaries• General practitioners and clinics

Private agencies

• Private hospitals• Independent clinics• 70% general practitioners• Highly unorganized, • Concentrated in urban areas• Provide mainly curative services• MCI, IMA regulate some functions

INDIGENOUS SYSTEMS

Indigenous system of medicine

• Ayurveda• Sidda• Unani and Tibb• Homeopathy

Indigenous system of medicine

• Provide bulk of medical care to rural people

• National Institute of Ayurveda

• National Institute of Homeopathy

• Govt. studying how these can be best utilized for more effective health coverage

VOLUNTARY AGENCIES

Voluntary health agencies in India• Indian Red Cross Society• Hind Kusht Nivaran Sangh• Indian council for child welfare• Tuberculosis Association of India• Bharat Sevak Samaj• Central social welfare board• The kasturba memorial fund• The All India blind relief society‐• Professional bodies• International agencies

Indian Red Cross Society

• 400 branches in India

• Activities:– Relief work– Milk and Medical supplies– Armed forces– Maternal and child welfare services– Family Planning– Blood Bank and First Aid

Hind Kusht Nivaran Sangh

• Financial assistance to leprosy clinics, health education, training of medical workers and physiotherapists, conducting research and field investigations, organizing all India leprosy workers conferences and publishing journal

Tuberculosis Association of India

• Activities comprise organizing TB seal campaign every year to raise funds, training of doctors, health visitors and social workers, promotion of health education and promotion of consultations and conferences

Central Social Welfare Board

• The functions of the board are

• Surveying the needs and requirements of voluntary welfare organizations in the country

• Promoting and setting up of social welfare organizations

• Rendering of financial and to deserving existing organizations and institutions

The Kasturba Memorial Fund

• The fund was raised with the main object of improving the life of women, especially in the villages, through gram sevikas

Family Planning Association of India

• It had done pioneering work in propagating family planning in India

All India Blind Relief Society

• It organizes eye relief camps and other measures for the relief of blind.

Professional bodies

• The Indian Medical Association

• All India Dental Association

• The Trained Nurses Association of India

International agencies

• The Rockefeller Foundation• Ford Foundation• CARE (Co-operative for American Relief

Everywhere)• BMGF

THANK YOU