Healthcare Delivery System in India

Healthcare Delivery System in India

Introduction

·       Health care delivery refers to the mechanism and organization through which health care services are planned, financed, and provided to individuals and populations.

·       It involves:

·        Health care providers

·        Infrastructure

·        Technology

·        Governance

·        Community participation

Models

Rural Health Care Delivery Model (Three-Tier System)

 a. Sub-Centre (SC)

• First point of contact between community and health system
• Covers: 5,000 population (3,000 in hilly/tribal areas)
• Staff: 1 ANM + 1 Male Health Worker
• Services:
• Immunization, Antenatal/PNC care
• Health education, contraception
• Record maintenance and basic disease surveillance

 b. Primary Health Centre (PHC)

• Covers: 30,000 population (20,000 in hilly/tribal areas)
• Staff: Medical Officer + Para-medical staff
• Services:
• OPD services, minor procedures
• Referral to CHC
• Implementation of National Health Programs
• Health promotion, basic laboratory testing

 c. Community Health Centre (CHC)

• Covers: 1,20,000 population (80,000 in hilly/tribal areas)
• Acts as a Referral Unit for 4 PHCs
• Staff: 4 Specialists (Surgeon, Physician, Gynae, Pediatrician)
• Services:
• Inpatient care (30 beds)
• Emergency services (24x7)
• Minor surgeries, deliveries, lab and diagnostic services

Urban Health Care Delivery Model

 a. Urban Primary Health Centre (UPHC)

• Covers: 50,000 population
• Services:
• OPD care, MCH services, immunization
• Screening for NCDs, health education
• Referral to higher centres

b. Urban Community Health Centre (UCHC)

• Acts as referral centre for 4-5 UPHCs
• Provides:
• Specialist care (OPD/IPD)
• Emergency services
• Diagnostic, surgical, and inpatient facilities

Tertiary Care Centres (District & Referral Hospitals)

• District Hospitals: 100–500 bedded, provide secondary and some tertiary services.
• Medical Colleges/AIIMS/Referral Institutes: Provide super-specialty care, teaching, and research.
• Linked with National Health Programs, training, and policy-making.

Present Health Status of India

A. Demographic Indicators

• Population (2024): ~1.44 billion
• Life Expectancy: ~70.1 years
• Crude Birth Rate: ~19.5 per 1000
• Crude Death Rate: ~6.2 per 1000
• Infant Mortality Rate (IMR): ~28 per 1000 live births
• Maternal Mortality Ratio (MMR): ~97 per 100,000 live births
• Total Fertility Rate (TFR): ~2.0

B. Health Infrastructure

• Sub-Centres: ~160,000+
• PHCs: ~30,000+
• CHCs: ~6,000+
• District Hospitals: ~1,000+
• AIIMS, State Medical Colleges, ESI, CGHS etc.
• Expansion of Telemedicine and Ayushman Bharat - Health and Wellness Centres

C. Human Resources

• Shortage of doctors, nurses, paramedics, specialists in rural areas
• Urban-rural and state-wise disparities

Major Health Problems in India

A. Communicable Diseases

• Tuberculosis, Malaria, Dengue, HIV/AIDS, Hepatitis
• Diarrheal diseases, Respiratory infections
• Vector-borne diseases

B. Non-Communicable Diseases (NCDs)

• Cardiovascular diseases
• Diabetes
• Cancer
• Hypertension
• Stroke
• Mental health issues

C. Nutritional Disorders

• Undernutrition (especially in children and pregnant women)
• Anemia, Vitamin A and Iodine deficiency
• Increasing trend of obesity in urban populations

D. Maternal and Child Health

• High MMR and IMR in some states
• Unsafe deliveries
• Lack of skilled birth attendants in rural areas

E. Environmental and Occupational Hazards

• Air and water pollution
• Occupational injuries in mining, construction, agriculture
• Climate change-related health issues

Overview of the Indian Health System

A. Structure

1. Central Level
• Ministry of Health & Family Welfare
• Policy formulation, budgeting, national health programs
• Organizations: NITI Aayog, DGHS, ICMR, AIIMS, CGHS
2. State Level
• State Health Departments
• Implementation of health schemes
• State hospitals, medical education, training
3. District Level
• Chief Medical Officer (CMO) heads health services
• District Hospitals, CHCs, PHCs, Sub-Centres
4. Panchayati Raj Institutions (PRIs)
• Local governance of health services in rural areas
• Community participation in health programs

B. Health Schemes and Programs

• Ayushman Bharat (PMJAY + HWCs)
• National Health Mission (NHM)
• RMNCH+A
• NUHM
• Integrated Disease Surveillance Programme (IDSP)
• Revised National Tuberculosis Control Programme (RNTCP)
• National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)
• Poshan Abhiyan for nutrition

C. Key Features of Indian Health System

• Mixed delivery system
• Focus on preventive, promotive, curative, and rehabilitative care
• Significant urban-rural disparities
• High out-of-pocket expenses (approx. 55% of total health expenditure)
• Gradual shift to universal health coverage (UHC)

D. Challenges

• Inadequate financing (~2.1% of GDP spent on health)
• Poor infrastructure in rural and tribal areas
• Shortage of skilled human resources
• Fragmented service delivery
• Low insurance coverage

E. Reforms and Future Directions

• Digital health ecosystem (e.g., ABHA ID, Telemedicine)
• Health and Wellness Centres under Ayushman Bharat
• National Digital Health Mission (NDHM)
• Increased focus on preventive and promotive health
• Strengthening primary health care

Video Description

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