Organization of Health services

Dr Naresh T Chauhan

Curtsey: SIHFW, Jaipur

Constitutional commitment: Health: State subject Central List International Health, Port Health Research Technical & Scientific Education State List All other Health issues Concurrent list Epidemics

10/20/2010

Mile stones:

NRHM-2005 NHP-2002 NPP-2000 RCH-1996

UIP-1985 NHP-1983
Juggling Priorities

Alma Ata-1978 (HFA) Small pox eradicated-July 5, 1975

NFPP-1952 India Joins WHO-1948

HSDC-1946
10/20/2010

NO Health Policy for 36 years Committees and Commissions Single issue addressed by Committee Comprehension was missing recommendations- reiterations of Bhore Committee. Individual Health Programs - situational exigency. Uni-purpose workers later baptized as Multipurpose. Programs worked in complete isolation till 1980 (e.g. NTCP). Fragmented approach to Health
4

10/20/2010

Still62 yrs. of Health Services

Crude Death Rate Crude birth rate Life expectancy S.pox & G. worm eradicated Leprosy eliminated IMR Infrastructure expanded

10/20/2010

Five year Plan I II III IV V VI VII VIII IX X XI

10/20/2010

Period 1951-55 1956-61 1961-66 1969-74 1974-79 1980-85 1985-89 1992-97 1997-02 2002-07 2007-12

Major areas addressed Infrastructure Industry Panchayat & Green Revolution Expenditure , Agriculture Agriculture Health , Technology Poverty, Agriculture & Justice Pop., Agriculture , Poverty Employment, Basic facilities HRD, Industry, Technology Education, Health, Empowerment
6

Core functions of Public Health

Monitoring health situation Disease surveillance Health promotion Regulations Partnerships Planning & Policies HRD Reducing impact of emergencies on health
7

10/20/2010

Bhore Committee, 1946

PHCS : nodal points for Health care Phased expansion Prevention stressed Population based

10/20/2010

Committees & Commissions

1959-62 Mudaliar committee (Health Survey And Planning Committeee)

Health services restructuring Malaria Family planning Integration Of Health Services MPW scheme Medical Education & Support Man-Power
9

1963: Chaddah committee

1964:Mukherjee committee

1964-67:Junglewala committee

1972-73:Kartar Singh committee

1974-75:Srivastav committee

10/20/2010

Challenges

10/20/2010

Manpower- Number & Norms Rural / Urban differential Geographical divide across States S-E groups accessibility/ reach Gaps between Policy & Action Health sector expenditure Newer Infections
10

Service delivery:3-tier structure

DH CHC PHC SC Underutilized forServices Supplies Funding
10/20/2010

11

Health Systems OrganizationIndia

Central Govt. Planning Commission MOHFW National Development Council CCHFW

FW Secretary Jt.Secy. Director

Medical & Public Health Secretary Addl.Secy. Jt.Secy. DGHS Addl.DGHS

ISM&H Secretary Director Jt.Secy.

10/20/2010

12

Role of Central Govt. in Health Care

Policy formulation Maintaining International health relations Administration of central health institutions Regulating Medical education through statutory bodies-MCI/DCI/Councils Medical & Public health research-funding Standards- laying & maintenance(Drugs/Education) Coordination-Other ministries/States/Statutory bodies Central Health Acts Negotiation with International agencies

10/20/2010

13

Functions of Dept of Family Welfare

10/20/2010

Policy preparation & Planning Information collection & Evaluation Contraceptive-Research /Supply Seeking International support EPI/UIP/CSSM/RCH/ARI/ORT-Trainings & area development IEC Rural Health Paraprofessional training NGO support Development of Sub-center

14

Functions of Medical & Public Health

10/20/2010

Health Policy preparation National Health Programs conduction Drug Control PFA enforcement Diseases control-Communicable/Noncommunicable Supplies & Disposal Maintenance CME & Trainings Medical Education & Research Vital statistics & Health intelligence International support
15

Organization at State level

Gujarat Government Medical Education Secretary-ME MoH & FW Principal Secretary-Health Principals (Medical Education) Directors (Service divisions) Secretary-FW

FW

Public Health

AIDS

IEC

Addl. Directors Jt. Directors Dy. Directors State Program Officers Zonal Directors
10/20/2010

16

District Health Care Administration

10/20/2010

17

District
An Administrative unit Defined Geographical boundary and Population Peripheral most Planning unit A self contained segment of National Health System

10/20/2010

18

District Health Organization

CMHO (Rural),Preventive Dy.CMHO Program Officers (registered society-DHS)
Beds(30) Specialists(7-IPHS) Referral Pop.20-30000

HO (Urban),Curative

Block CM&HO CHC Pop.-80000-120000

PHC

Primary health Medical Officer(2-IPHS) SC (3-5000)HW-M/F SBA/AWW/VHG/ ASHA

10/20/2010

19

Functions of District Health System

Liaison between Field units & Headquarter

Field reports Inspections Meetings

Implementation of Policy & Programs District level planning & Action Plans Rationale use of Finance & Resources Communication Management

10/20/2010

Plans/Schedules/Progress/Problems
20

Control & Monitoring

Problem Areas at District

Quantity v/s Quality Cluttered Policy guidelines Decentralization on papers Roles/Responsibilities poorly defined Program integration ? HMIS-generation & use ? Managerial skills Donor initiative Societies Resource restriction

10/20/2010

21

Rural Health services

Institution Primary Health Centers(20-30000) Functions Medical Care RCH services Immunization Child Health Obstetric services MTP NHP School Health Environment Health/ Nutrition education Management
22

10/20/2010

Manpower and Education

Manpower Statistics Number of Doctors - 39,734 Number of Nurses - 16,816 Medical Colleges MBBS 13 (6 Govt. & 7 Private) Homeopathic 13 Ayurvedic 9 Dental 12 ( 5 Govt. & 7 Private) Physiotherapy 17 Pharmacy - 50 Key Education Centres Institute of Kidney Disease and Research Centre (IKDRC) Gujarat Cancer Research Institute ( GCRI) U.N. Mehta Cardiology Research Institute B.J. Medical College Ahmedabad Gujarat Ayurvedic University , Jamnagar Pramukh Swami Medical College , Karamsad Anand Nathiba Hargovindas Lalbhai Medical College, Ahmedabad Surat Municipal Institute of Medical Education & Research Medical Infrastructure in Gujarat (Map)

R & D Organisation Medical Colleges MBBS & Dental Hospitals

Source : Department of Health, Government of Gujarat

Thank you

10/20/2010

24