MAMATA COLLEGE OF NURSING

KHAMMAM
Date:
Time:
SUBJECT: NURSING MANAGEMENT
TOPIC
: HEALTH CARE DELIVERY SYSTEM: NATIONAL, STATE AND LOCAL
GUIDE : MRS. RATNA PHILIP, PRINCIPAL
PRESENTED BY: UDAYA SREE.G, M.Sc. (N) II YEAR

SEMINAR ON HEALTH CARE DELIVERY SYSTEM IN INDIA

INTRODUCTION
Health administration is a branch of public administration which deals with
matters relating to the promotion of health, preventive services, medical
care, rehabilitation, and the delivery of health services, the development of
health manpower, medical education and training. Public health
administration is the science and art of organizing and coordinating
government agencies whose purpose is to improve the physical, mental
and social wellbeing of people. It aims at prevention of disease, prevention
and promotion of health.
PRINCIPLES OF HEALTH ADMINISTRATION
1. Centralized direction and decentralized activity.
2. When a special function is to be undertaken, it should be undertaken
by co-operation with the official body.
3. Treatment and prevention of disease should be administratively
combined.
4. Administration must be based on a sound economic consideration and
practicable financial budgeting.
5. A clear picture of the complete plan must be made before starting a
programme.
6. A programme of continuing staff education is essential.
7. Programme should be planned on a scientific priority basis.
8. Periodic appraisal of service rendered, effectiveness of programmes
and evaluation of results is major responsibility of the health
administration.

9. Provision must be made for desirable working conditions for all

members of the staff.

OBJECTIVES OF HEALTH ADMINISTRATION

To increase the average length of human life.
To decrease mortality and morbidity rates
To increase the physical, mental and social well-being of the
individual.
To provide total health care to enrich quality life.
To increase the pace of adjustment of individual to his environment
To make provision of primary health care services to everyone
To develop healthy manpower to provide proper services to the
community
To formulate health policies and their periodic revision from time to
time.

HISTORY OF HEALTH ADMINISTRATION IN INDIA

Health administration is part of public administration of the country and is
one of the aspects of the social welfare activities of the government.
Modern public health organization and administration is designed to
prevent disease prolong life and to promote physical and mental efficiency
through organized community efforts.
During the independence period
The medical and public health services at the center were administered by
two separate departments headed by Director General of India medical
services and commission, of public health service respectively but after
independence these two offices were amalgamated into Directorate
general of health services which was headed by director of health services.
Post-independence era
For public health in post-independence year in 1947, after independence, a
democratic regime was set up in India with a new concept aimed towards
the establishment of a welfare state

In 1947
Ministries of health were established at the center and states. The post of
Director General Indian medical service and of public health commissioner
with government of India was integrated into the post of Director General
of health science (DHS).
In 1948
India becomes a member of world Health organization. The WHO is a
specialized non-political health agency constituted on 7 th April 1948 with
the objective of attainment of the highest level of health for all people. The
employee state insurance act (ESI) passed in the parliament.
Planning commission
The Government of India setup a planning commission in 1950 to make an
assessment of maternal, capital and human resources of the country and
to draft develop-mental plans for the most effective utilization of these
resources.

HEALTH CARE DELIVERY SYSTEM IN INDIA

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.
India is a union of 28 states and 7 union territories. States are largely
independent in matters relating to the delivery of health care to the
people. Each state has developed its own system of health care delivery,
independent of the Central Government.
The Central Government responsibility consists mainly of policy
making, planning, guiding, assisting, evaluating and coordinating the work
of the State Health Ministries.

SELECTED HEALTH CARE DEFINITIONS

a. Health: According to WHO, health is defined as a dynamic state of

complete physical, mental and social well-being not merely an
absence of disease or infirmity.
b. Health care services: It 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 DELIVERY
a. Health care delivery system refers to the totality of resources that a
population or society distributes in the organization and delivery of
health population services. It also includes all personal and public
services performed by individuals or institutions for the purpose of
maintaining or restoring health.
-Stanhope(2001)
b. It implies the organization, delivery staffing regulation and quality
control.
-J.C.Pak(2001)

Philosophy of Health Care Delivery System

Everyone from birth to death is part of the market potential for health
care services.
The consumer of health care services is a client and not customer.
Consumers are less informed about health services than anything else
they purchase.
Health care system is unique because it is not a competitive market.
Restricted entry in to the health care system.
Goals/Objectives of Health Care Delivery System
1) To improve the health status of population and the clinical
outcomes of care.
2) To improve the experience of care of patients families and
communities.
3) To reduce the total economic burden of care and illness.
4) To improve social justice equity in the health status of the
population.

Principles of Health Care Delivery System

1. Supports a coordinated, cohesive health-care delivery system.
2. Opposes the concept that fee-for-practice.
3. Supports the concept of prepaid group practice.
4. Supports the establishment of community based, community
controlled health-care system.
5. Urges an emphasis be placed on development of primary care
6. Emphasizes on quality assurance of the care
7. Supports health care as basic human right for all people.
8. Opposes the accrual of profits by health-care-related industries.
Functions of Health Care Delivery System
1) To provide health services.
2) To raise and pool the resources accessible to pay for health care.
3) To generate human and physical sources that makes the delivery
service possible.
4) To set and enforce rules of the game and provide strategic direction
for all the different players involved.
Characters of Health Care Delivery System:
1) Orientation toward health.
2) Population perspective.
3) Intensive use of information.
4) Focus on consumer.
5) Knowledge of treatment outcome.
6) Constrained resources.

The health system in India has 3 main links

1. Central
2. State and
3. Local or peripheral
The states are largely independent in matters relating to the delivery of
health care to the people. The central responsibility consists mainly of
policy making, planning, guiding assisting, evaluating, and co-coordinating
the work of the state health ministries.

I. AT THE CENTRAL LEVEL

T he official organs of the health system at the national level consist of
1. Union ministry of Health and Family Welfare
2. The Directorate General of Health Services
3. The Central Council of Health.
1. Union Ministry of Health and Family Welfare.
The union ministry of health and family welfare is headed by a cabinet
minister, a minister of state and a deputy health minister. Currently the
union ministry has the following departments-(a) Department of health,(b)
Department of family welfare.
The department of family welfare was created in 1966 within the
ministry of health and family welfare for the administrative purpose of
the union health and family welfare minister which seek the help of
health secretariat headed by secretary. The secretary is assisted by a
number f additional, joint deputy and assistant secretaries and
various administrative staff.
Department
of
health
deals
with
planning,
coordination,
programming, evaluation of medical and public health matters
including drug control and prevention of food adulteration. The
department of health functions through the directorate general of
health service
ORGANIZATION PATTERN
CABINET
MINISTER

DEPUTY HEALTH
MINISTER

DEPARTMENT
OF HEALTH

DEPARTMENT OF
FAMILY WELFARE

HEALTH
SECRETARY TO
THE GOVERNMENT

JOINT
SECRETARIES

DEPUTY
SECRETARIES

SECRETARY TO THE
GOVERNMENT OF
INDIA

ADDITIONAL
SECRETARY AND
COMMISSIONER
(FAMILY WELFARE)
JOINT
SECRETARIES

ADMINISTRATIV
E STAFF

Functions
Union list
1. International health relations and administration of port quarantine
2. Administration of Central Institutes such as All India Institute of Hygiene
and Public Health, Kolkata.
3. Promotion of research through research centers
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. Coordination with states and with other ministries for promotion of
health
Concurrent list
The functions listed under the concurrent list are the responsibility of both
the union and state governments
1. Prevention and extension of communicable diseases
2. Prevention of adulteration of food stuffs
3. Control of drugs and poisons

4.
5.
6.
7.
8.

Vital statistics
Labour welfare
Ports other than major
Economic and social planning
Population control and Family Planning

2. Directorate General of Health Services

The directorate general of health services is the principal advisor to the
union government in both medical and public matters. The DGHS is headed
by Director General (DG) who renders technical advice on all medical and
public health matters and is involved in the implementation and monitoring
of various health schemes. The DG is assisted by a team of additional
Director General of Health Services (ADGHS), Deputy Director General
(DDG), assistant Deputy Director General (ADDG) and large number of
other administrative staff in hierarchy.

Directorate general of health services

Organization of pattern
DIRECTORATE GENERAL OF
HEALTH SERVICES
DIRECTOR GENERAL OF
HEALTH SERVICES

ADDITIONAL DIRECTOR
GENERAL OF HEALTH
SERVICES
DEPUTY DIRECTOR GENERAL
OF HEALTH SERVICES

ADMINISTRATIVE STAFF

Functions of DGHS
1. International health relations and quarantine of all major ports in country
and international airport
2. Control of drug standards
3. Maintain medical store depots
4. Administration of post graduate training programmes
5. Administration of certain medical colleges in India
6. Conducting medical research through Indian Council of Medical Research
(ICMR)
7. Central Government Health Schemes.
8. Implementation of national health programmes
9. Preparation of health education material for creating health awareness
through Central Health Education Bureau.
10. Collection, compilation, analysis, evaluation and dissemination of
information through the Central Bureau of Health Intelligence
11. National Medical Library
3. Central Council of Health
The central council of health was set up by a presidential order on 9 th
August 195, under article 263 of constitution of India for promoting
coordinated and concerned action between the center and the states in the
implementation of all the programmes and measures pertaining to health
of the nation. The central health council has other consultative and
advisory bodies such as consultative committee of child welfare. Statutory
and technical advisory bodies

Organization Pattern of central council of health

UNION HEALTH MINISTER
CHAIRPERSON

STATE HEALTH MINISTERS

MEMBERS

Functions
1. To consider and recommend broad outlines of policy regard to matters
concerning health like environment hygiene, nutrition and health
education.
2. To make proposals for legislation relating to medical and Public health
matters.
3. To make recommendations to the Central Government regarding
distribution of grants-in-aid.
4. To establish any organization/organizations for promoting and
maintaining cooperation between the central and state health
administrations.

II. AT THE STATE LEVEL

The health subjects are divided into three groups: federal, concurrent and
state. The state list is the responsibility of the state, including provision of
medical care, preventive health services and pilgrimage within the state.
At present there are 28 states in India, each state having its own health
administration.
The health organization at the state level consists of the state health
minister and state health secretariat, the state director of health services
and health directorate.
1. State Ministry of Health
The state ministry of health is headed by a minister of health and family
welfare and a deputy minister of health and family welfare. These are
political appointments and they are elected members of legislative
assembly.
Organization Pattern of state ministry of health
MINISTRY OF HEALTH AND
FAMILY WELFARE

DEPUTY MINISTER OF HEALTH

AND FAMILY WELFARE

HEALTH SECRETARIAT
HEALTH SECRETARY

DEPUTY SECRETARIES

ADMINISTRATIVE STAFF
MEMBERS

RESPONSIBILITIES
1. As a member of state legislature it is his duty to support, and
safeguard the total policies of the government.
2. As a member of ministry- he brings all the bills pertaining to his
department for approval of the legislature.
3. As political head of the health department he acts as executive and
administrator

2. State Health Directorate

The state health directorate is the technical wing of state ministry of health
and family welfare. He is also responsible for the organization and direction
of all health activities.
Responsibilities of state health Directorate
1. Providing curative and preventive services.
2. Promotion of health education
3. Collection, tabulation and publication of vital statics.
4. Promotion of all health programmes such as school health, family
planning, occupational health, maternal and child health.
5. Assumes total responsibility for taking all steps in the prevention of
any outbreak of communicable diseases.
6. Recruitment of personnel for rural health services.
7. Planning and carrying out surveys in relation to nutrition, health
education etc.
8. Co-ordination of all health services with other ministries of state.

III. AT THE DISTRICT LEVEL

There are 593 (year 2001) districts in India. Within each district, there are 6
types of administrative areas.
1. Sub division
2. Tehsils (Taluks)
3. Community Development Blocks
4. Municipalities and Corporations
5. Villages and
6. Panchayats
The district health organization is headed by chief medical officer of health
(CMOH) who is the director of health service at the district. He is assisted
by a number of officers in charge of different programmes. They are district
family welfare officer (DFWO), district malaria officer (DMO), district leprosy
officer (DLO), District health officer (DHO), civil surgeon in charge district
hospital.
Most district in India are divided into two or more subdivision,
each in charge of an Assistant Collector or Sub Collector.
Each division is again divided into taluks, incharge of a Thasildhar.
A taluk usually comprises between 200 to 600 villages.
The community development block comprises approximately 100
villages and about 80000 to 1, 20,000 population, in charge of a Block
Development Officer.
Finally, there are the village panchayats, which are institutions of
rural local self-government.
The urban areas of the district are organized into: Town Area Committees (in areas with population ranging
between 5,000 to 10,000)
Municipal Boards (in areas with population ranging between
10,000 and 2, 00,000)
Corporations (with population above 2, 00,000)
The Town Area Committees are like panchayats. They provide
sanitary services.
The Municipal Boards are headed by Chairmen / President,
elected by members.

The

functions of Municipal Board

Construction and maintenance of roads
Sanitation and drainage
Street lighting
Water supply
Maintenance of hospitals and dispensaries
Education and
Registration of births and deaths etc
The Corporations are headed by Mayors, elected by councilors, who
are elected from different wards of the city. The executive agency
includes the commissioner, the secretary, the engineer and the
health officer.

The activities are similar to those of municipalities, on a much wider scale.

Panchayat Raj -The panchayat raj is a 3-tier structure of rural
local self-Government in India, linking the village to the district
Panchayat (at the village level)
Panchayat Samiti ( at the block level
Zilla Parishad(at the district level)
Panchayat (at the village level):
The Panchayat Raj at the village level consists of
The Gram Sabha
The Gram Panchayat
The Gram Sabha considers proposals for taxation, and elects members of
the Gram Panchayat.
The Gram Panchayat covers the civic administration including sanitation
and public health and work for the social and economic development of
the village.
Panchayat Samiti (at the block level):
The Panchayat Samiti executes the community development
programme in the block. The Block Development Officer and his
staff give technical assistance and guidance in development
work.

Functions of the Panchayat raj at village level:a) Developmental functions - All developmental functions, e.g. agriculture,
animal husbandry, cottage industries medical relief and public health are
to be implemented.
b) Law and order functions-the panchayat also help in maintaining law and
orders in the village.
c) Administrative and civic functions- the panchayat is expected to perform
all the elementary civic functions such as arrangements of sanitation,
conservancy, construction and repair of roads, water supply streetlights,
etc.
Zilla Parishad (at the district level):
The Zilla Parishad is the agency of rural local self government at the
district level. Its functions and powers vary from state to state.
Zilla parshad functions:
a) It is the primarily a coordinating and supervisory agency.
b) It plans such schemes or the district as a whole.
c) Any special programme may be assigned to Zilla parishad by the
state government from time time to time.
d) It scrutinizes and approves the budget of the Block samitis.
SUMMARY AND CONCLUSION
Nurses make up the largest employment group in the health care
delivery system of in India. Nursing is the process of recognizing,
understanding and meeting the health needs of a person or society.
Health is a state of physical, mental and social wellbeing, not merely
the absence of disease or infirmity.
Illness is a state in which a persons physical, emotional, intellectual,
social or spiritual functioning is diminished or impaired.
Internal variables such as developmental stage, intellectual
background and emotional and spiritual factors influence the health
beliefs and practices of
Individuals
External variables such as family practices socioeconomic factors and
cultural background also influence the health beliefs and practices of
individuals.

Smoking, nutrition, exercise, substance abuse and family

relationships also affect patients health status.
The health care delivery system in India has three main links Central,
state and local or peripheral.
International health relations, administration of central institutes,
drugs standards, vital statistics immigration and emigration are the
main functions of Central Govt under union list.
Control of communicable diseases, prevention of food adulteration,
labour welfare and economic and social planning are the functions of
central Govt. under the concurrent list.
National Medical library, ICMR, central Health Education Bureau and
Central Govt Health Services are under the control of Directorate
General of Health Services.
The Central Council of Health makes proposals for legislation relating
to medical and public health matters. Provision of medical care,
preventive health services and pilgrimage within the state are the
responsibilities of the State Government.
Sub-division, Tehsils, Community Development Blocks, Municipalities
and Corporations, Villages and Panchayats are 6 administrative areas
within each district.
Sanitation, water supply, street lighting, education and registration of
births and deaths are the functions of Municipal Board.
The Panchayat Raj is a 3-tier structure of rural local self
government in India.

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Text book of The Indian constitution
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AG. Chandorkar, Text book of hospital administration and planning;
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banarsidas bhanot publishers; Jabalpur.
Extract of article in "India - Perspectives" (August '97) by K.G.
Joglekar, a noted Indian journalist.
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