Healthcare System Structure in India

Healthcare System Structure in India

Introduction

·       The healthcare system in India is a multi-tiered structure designed to provide accessible, affordable, and quality health services to its vast population.

·       It operates at three main levels—central, state, and district—along with a strong foundation in rural areas through the Panchayati Raj system.

·       This structure integrates public and private sectors, ensuring a coordinated approach to preventive, promotive, and curative healthcare across urban and rural regions.

Central Level (Union Government)

Authority: Ministry of Health and Family Welfare (MoHFW), Government of India

Major Divisions:

• Department of Health and Family Welfare
• Department of Health Research
• Department of AYUSH
• Department of Pharmaceuticals

Key Functions:

• Policy formulation and national-level planning.
• International health relations (WHO, UNICEF, etc.).
• Regulation of medical education (e.g., NMC, INC).
• Disease surveillance and control programs (e.g., NVBDCP, NTEP).
• Funding and support to states through Centrally Sponsored Schemes (CSS) and Central Sector Schemes.

Major Institutions:

• DGHS (Directorate General of Health Services) – technical wing.
• NCDC (National Centre for Disease Control)
• ICMR (Indian Council of Medical Research)
• AIIMS, NIHSAD, PGIMER – Tertiary care and teaching institutions.

State Level (State Health Department)

Authority: State Ministry/Department of Health & Family Welfare

Key Officials:

• State Health Minister
• Principal Secretary/Secretary (Health)
• Director of Health Services (DHS)
• Director of Medical Education
• State Nodal Officers for Health Programs

Key Functions:

• Implementation of national health programs at state level.
• Recruitment and training of health personnel.
• Infrastructure development: hospitals, PHCs, CHCs.
• Monitoring and evaluation of health services.
• Control of communicable/non-communicable diseases in state.

District Level (District Health System)

Authority: District Health Society under District Collector

Key Officers:

• Chief Medical Officer (CMO) or District Medical & Health Officer (DMHO)
• District Program Officers (DPOs)
• Medical Superintendents of District Hospitals
• Block Medical Officers (BMOs)

Institutions under District:

• District Hospital (DH)
• Community Health Centres (CHCs)
• Primary Health Centres (PHCs)
• Sub Centres (SCs)

Functions:

• Delivery of health services to rural and urban areas.
• Supervision of block-level and village-level health institutions.
• Implementation of NHM activities.
• Disease surveillance and outbreak response.

Panchayati Raj Institutions (PRIs)

·       Established under 73rd Constitutional Amendment Act, 1992

·       Empowered by Article 243G to plan and implement schemes for economic development and social justice, including health and sanitation.

Three-tier System:

Level	Body	Head	Health Role
Village	Gram Panchayat	Sarpanch	Oversees SCs, Anganwadi Centres, sanitation
Block	Panchayat Samiti	Block Pramukh	Coordinates PHCs/CHCs
District	Zila Parishad	President	Oversees District Health Programs

Health Responsibilities:

• Ensure proper sanitation and hygiene.
• Monitor services at SCs, PHCs.
• Mobilize community for immunization and nutrition.
• Support Accredited Social Health Activists (ASHAs).
• Strengthen Village Health Sanitation and Nutrition Committees (VHSNCs).

Rural Development System

Objective: Improve socio-economic conditions and infrastructure in rural areas, including health determinants.

Key Ministries/Departments:

• Ministry of Rural Development (MoRD)
• Ministry of Panchayati Raj
• Department of Drinking Water and Sanitation

Key Programs:

• MGNREGA (employment guarantee, indirect health determinant)
• NRLM (Self-help groups for women empowerment)
• Pradhan Mantri Awas Yojana – Gramin
• Swachh Bharat Mission – Gramin
• National Rural Drinking Water Programme
• Pradhan Mantri Gram Sadak Yojana

Health-Related Contributions:

• Improved roads for healthcare access.
• Sanitation and clean drinking water.
• Women’s empowerment via SHGs (important for nutrition, MCH care).
• Skill development in health sector (Rural Health Volunteers, ASHAs).

Integration through NHM (National Health Mission)

• NHM acts as a bridge across Centre, State, District, PRI, and Rural Development.
• Health & Wellness Centres (HWCs) are developed under Ayushman Bharat.
• Emphasizes Decentralized Planning, Community Participation, and Intersectoral Convergence.

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