Advance & Delivery System

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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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Advance & Delivery System