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Chapter: 11th Nursing : Chapter 2 : Nursing - Health Care Delivery System in India

Health Care Delivery System in India

The health system in India has 3 main links A. Central B. State and C. Local or peripheral

Health Care Delivery System in India

India is a union of 29 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.

The health system in India has 3 main links

A.      Central

B.      State and

C.      Local or peripheral


At the Central Level

·           The official “organs” of health system at national level are

DGHS - Director General of Health Services

CDCO - Central Drugs Control Organisation

HR - Health Research

WHO – World Health Organization

SEARO – South East Asia Regional Office

I. Ministry of Health and Family Welfare


The functions of the Union Ministry of Health and Family Welfare are set out in the seventh schedule of Article 246 of the constitution of India under

1.        Union list and

2.        Concurrent list

1. 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 centres

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

2. 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.        Vital statistics

5.        Labour welfare

6.        Ports other than major

7.        Economic and social planning

8.        Population control and Family Planning

II. Directorate General of Health Services


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

III. Central Council of Health


1.        To consider and recommend broad outlines of policy with 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 or organizations invested with appropriate functions for promoting and maintaining cooperation between the central and state health administration


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.

DM & RHS - Directorate of Medical and Health Services

DME - Directorate of Medical Education DPH & PM - Directorate of Public Health and Preventive Medicine

DDC – Directorate of Drugs control

State Health Administration

At present there are 29 states in India, each state having its own health administration. In all the states, the management sector comprises the state ministry of health and a directorate of health

1. Department of Health & Family Welfare

State Department of Health and Family Welfare headed by the state minister of Health and Family Welfare.

1.        State health Directorate

There are three separate major departments in Health and Family Welfare.

·           The Directorate of medical and Rural Health Services, Directorate of Medical Education and Directorate of Public Health and preventive Medicine are the chief Technical directorates to the statte government on all matters related to public health.

·           There are other directorates such as Directorate of Health and Family Welfare, Directorate of Drugs control, Directorate of health Transport, Tamilnadu AIDS control society, State health mission etc.


At the District Level

There are 614 (year 2007) districts in India. Within each district, there are 6 types of administrative areas.

1.        Sub-division

2.        Thasils (Taluks)

3.        Community Development Blocks

4.        Municipalities and Corporations

5.        Villages and

6.        Panchayats

Most district in India are divided into two or more subdivision, each incharge 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 the following institutions of local self-government:

1.        Town Area Committees (in areas with population ranging between 5,000 to 10,000)

2.        Municipal Boards (in areas with population ranging between 10,000 and 2,00,000)

3.        Corporations (with population above 2,00,000)

The Town Area Committees are like panchayats. They provide sanitary services. The Municipal Boards are headed by Chairman / President, elected by members.

The functions of Municipal Board & Corporations

1.        Construction and maintenance of roads

2.        Sanitation and drainage

3.        Street lighting

4.        Water supply

5.        Maintenance of hospitals and dispensaries

6.        Education and

7.        Registration of births and deaths etc.

The Corporations are headed by Mayors, elected by councillors, 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

The three institutions are:

1)       Panchayat (at the village level)

2)       Panchayat Samiti (at the block level)

3)       Zila Parishad (at the district level)

1) Panchayat (at the village level)

The Panchayat Raj at the village level consists of

·           The Gram Sabha

·           The Gram Panchayat

·           The Nyaya 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.

2) Panchayat Samiti (at the block level):

The Panchayat Samiti execute the community development programme in the block. The Block Development Officer and his staff give technical assistance and guidance in development work.

3) Zila Parishad (at the district level):

The Zila Parishad is primarily supervisory and coordinating body. This is the agency of rural local self-government at the district level. Its functions and powers vary from state to state.


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