Health services organization

Health services organization:

The health services organization in the country extends from the national level to the sub-centre level in the remote rural areas. Broadly, four levels of health organization may be distinguished:

            national

state

district

local.

These role played by them are described below:

1. National Level: The administration at the Centre consists of the Ministry of Health and Family Welfare, headed by a Minister, the Minister for Health and Family Welfare.

The Union Health Ministry has 2 main departments

The Department of Health,

The Department of Family Welfare.

The Secretary to the Govt. of India, in the Ministry of Health and Family Welfare is in overall charge. He is assisted by a special Secretary who1 heads the Family Welfare Department.

The Director General of Health Services (DGHS) is the chief technical adviser to the Government on all matters relating to medical care and public health.

The responsibility of the Union Health Ministry consists mainly of policy making, planning, guiding, co-ordinating and evaluating. The functions of the Union Health Ministry have been set out in the 7th Schedule of Article 246 of the Constitution of India under 2 heads

the Union List

the Concurrent List.

The functions specified in the Union List are

            administration of International Health

            administration of Central Institutes

            promotion of research; drugs control

            census operations

regulation of labour and co-ordination with the States.

The functions specified in the Concurrent List are the responsibility of both the Union and State Governments. These are

prevention of spread of communicable diseases

prevention of food adulteration

control of drugs and poisons

vital statistics

labour welfare and economics and social planning.

                    Central council of health:

The Central Council of Health was set up by a Presidential Order in 1952 to promote coordinated and concerted action between centre and the states in the implementation of health programmes and measures pertaining to health.

A similar council also exists for family welfare. In recent years, these two councils have been meeting jointly to take coordinated decisions. The Central Council of Health and Family Welfare also makes recommendations to the Central Government regarding distribution of grants-in-aid and reviews the work done through the utilization of these grants.

State Health Administration:

There are at present 28 States and 6 Union Territories and the national capital territory of Delhi in India. The States are independent in matters pertaining to the provision of health services to people living within their jurisdiction.

Consequently, each State has evolved its own pattern of health administration. But in each State there is a Minister of Health and Family Welfare elected by the people and Directorate of Health Services (known in some States as the Directorate of Health and Family Welfare).

The State Health Ministry is headed by a Minister of Health and a Deputy Minister of Health. In some States, the Health Minister is also in-charge of other portfolios. The Health Secretary is usually a senior Officer of the Indian

Administrative Service.

The Health Directorate is headed by the Director of Health Services (or Director of Medical and Health Services as it is known in some States) who is assisted by a team of Joint Directors, Deputy Directors and Assistant Directors. The Deputy and Assistant Directors may, be of two types - regional and functional. The Regional Directors Inspect all the branches of public health within their jurisdiction irrespective of their specialty.

The Functional Directors are usually specialists in a particular branch of public health such as nursing, family planning, tuberculosis, leprosy, malaria, MCH, etc. A recent development in many States is the appointment of a Director of Medical Education. The State Health Directorate is responsible for formulating and evaluating plans; directing the execution of approved plans and programmes.

The District Pattern:

The District In India is the pivot of the administrative structure. In some States (e.g.. West Bengal), the district health organization is headed by a single Chief, the Chief Medical Officer of Health who is responsible for all community services in the district.

In some States (e.g.. Andhra Pradesh, Madhya Pradesh), there are 2 Chiefs - District Medical Officer (DM0) or Civil Surgeon who is in-charge of medical services and the District Health Officer or District Health and Family Welfare Officer who is in-charge of health and family welfare.

Municipalities :

The following types of local self- government Institutions are generally found in the urban areas Town Area Committees (in areas with population ranging between 5,000 and 10,000)

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

Corporations , (with population above 2 lakhs). The health organization in a Corporation is headed by a Health Officer, assisted by Deputy and Assistant Health Officers, Sanitary Inspectors and an army of sanitation staff. The services provided comprise sanitation and public health, MCH, control of foods and food sanitation and collection of vital statistics.

The Municipal Boards are headed by elected Presidents. The services provided are usually confined to sanitation and public health because of limited financial position.

Municipalities :

The following types of local self- government Institutions are generally found in the urban areas Town Area Committees (in areas with population ranging between 5,000 and 10,000)

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

Corporations , (with population above 2 lakhs). The health organization in a Corporation is headed by a Health Officer, assisted by Deputy and Assistant Health Officers, Sanitary Inspectors and an army of sanitation staff. The services provided comprise sanitation and public health, MCH, control of foods and food sanitation and collection of vital statistics.

The Municipal Boards are headed by elected Presidents. The services provided are usually confined to sanitation and public health because of limited financial position.

Decentralised state administration

The present structure of local self- government in the State is based on a three-tier structure, known as the Panchayat Raj. The three levels are:

Village level : Gram Sabha, Gram or village Panchayatraj and Nyaya Panchayat

Block level : Panchayat Samiti

District level: ZillaParishad..

A Village Level:

Gram sabha is the basic unit of the system of Panchayati Raj, It is an assembly of all the adults of the village. The meetings of the Sabha are held twice a year.

Gram panchayat is the executive organ of the Gram Sabha. It is headed by a President known as Sarpanct or Mukhiya and the members comprise 10 to 30. Members of the Panchayat an elected by the adults of the Gram Sabha and they hold office for a period of 3 to / years.

The functions of the Panchaya cover the entire field of civil administration. e.g., sanitation, street lighting, control o disease, adult literacy, youth clubs Mahila Samitis, etc. The Panchaya Secretary helps the Panchayat in it; various activities,

Nyaya panchayat is the judicial organ of the Gram Sabha There is one Nyaya Panchayat for a group of 5 village Panchayats. The Nyay; Panchayats try civil cases and mino criminal offences. They are empowered to impose fines up to Rs. 100/-.

Village level

There are two health functionaries at the village level, namely

(a) the Health Guides, and (b) trained Dais.

Health Guides:

In India, about 72.2 per cent of the population live in rural areas. They are hardly covered by health services. It is now realised that a wide range of illnesses can be treated or prevented at the village level by a person with a relatively simple training or preparation. He has been called a village Health Guide (formerly known as community health worker or community health volunteer).

The scheme to train village health guides was initiated in the country on 2nd October 1977. These are voluntary health workers selected by the local community and trained locally for, 3 months at the primary health centre and subcentre.

After training, they are given a Manual which gives them detailed instructions of what they should do and a medical kit containing medicines worth Rs.600 a year. The Health Guides (now mostly women) provide the first contact between the community and the official health system. It is proposed to train one health guide for every 1000 rural population.

During the year 1981 the scheme was made 100 per cent centrally sponsored under family welfare programme. Now, since April 2002 the scheme is state sponsored. At present 3.23 Lakh village health guides are working in the country. Each VHG is paid an honorarium ofRs.50 per month.

Functions:

The village health guides perform vaccinations. They give advice on simple health education measures. They give advice on the construction of latrines, garbage disposal and disinfection of water supplies. They refer cases to the nearest primary health centre where and when necessary.

They provide primary health care services with greater emphasis on child survival and MCH programme. Their work is supervised by the Community Health Nurses and Health Assistants.

Evaluation reports indicate that the health guides' scheme has been accepted and welcomed by the community. and co-operation, two social education organizers, an overseer with a public health bias, 10 village level workers and some auxcillary staff.

Integrated rural development:

During 1977-78, the Government of India took up what is known as "Integrated Rural Development" to strengthen community development. A sum of Rs.5 lakhs has been provided for each block.

It is a target-oriented programme, the target groups being the weaker sections of the community viz. poor farmers below the poverty line and craftsmen. The objective is to provide full employment within the next l0 y ears.

Block Level:

The Block consists of about 100 villages and a population of about 80,000 and is provided with ; Panchayat Samiti. This Samiti consists of all Sarpanches (heads) of the village panchayats in the Block; MLAs, MPs residing in the Block area, representative; of scheduled castes and tribes. The Block Development Officer is the ex-officer (secretary of the Panchayat Samiti. The Panchayat Samiti supervises and give; technical assistance and guidance to the village Panchayats engaged in development work. The Samiti also acts as an agent of the State Government, which provides money for developmental projects.

District Level :

The instrument of local self-government at the District level is the Zilla Parishad. The members of the Zilla Parishad include all heads of the Panchayat Samitis in the district, MPs., MLAs, representatives of scheduled castes and tribes and co-operative societies. The Collector is a non-voting member. The Zilla Parishad is a supervisory and co-ordinating body. Its functions and powers vary from State to State. In Gujarat. control of primary health centres is exercised by the Zilla Parishads through the District Health Officer.

Rural health services The Govt. of India in 1977 launched a scheme known as "Rural Health Service" - on the principle of "placing people's health in people's hands". It is based on the recommendations of the Shrivastav Committee in 1975 (see page 312). One of the main recommendations of the committee is to create a band of voluntary workers (e.g., community health workers) who will function as an interface between the local community and the national health system at the peripheral level.

The rural health scheme was subsequently modified in the light of the National Health Policy, which was approved by Parliament in 1983 to achieve the goal of 'Health for All by the year 2000'. The rural health infrastructure to deliver the rural health care, as it exists today.

The Tenth Five Year Plan, covering the period 2002 to 2007, represents another step in the evolution of development planning in India. There is a visible shift in the focus of development planning from the mere expansion of services to planning of enhancement of human well being.

Primary health Centre:

The Primary health Centre plays an important role in the health care delivery system (PHC). It is an institution for providing comprehensive health care which includes preventive, promotive and curative services under one roof. Medical officer or the health officer governs the functions of the primary health centre.

Primary health centers in India:

The programme of establishing primary health centers and subcentres with 4 to 6 beds at each PHC in a community development block having a population of 60,000 to 80,000 was launched as an integral part of the community development programme in the year 1952. Since then 5499 PHC and 49300 subcentres have been established until 1980.

The population coverage of PHC has been increased up to 1 lakh and more. The population coverage of sub-centre is about 10,000. PHC are upgraded with 32 to 40 bed hospitals during the sixth five-year plan. The primary health centre and sub-centre provide an infrastructure for the delivery health services in the rural areas of the country.

Functions of the Primary Health Centre:

Medical care

MCH and family planning

RCH

Environment sanitation.

School health services.

Control of communicable diseases.

Collection of vital statistics

Health education.

Nursing services in the Primary health centre

Health services for the mother

Antenatal care

Delivery care

Postnatal care

Child health services

Under five clinics

Adequate nutrition

Immunization

Health teaching

Family planning