Concept of Healthcare

• Health has been declared a fundamental human right.
• National governments strive to improve health care services.
• Criticisms of current health care services include being predominantly urban-oriented, mostly curative, and accessible to only a small part of the population.
• The goal is to reach the whole population with adequate healthcare services and secure accessible and acceptable health levels for all.

Concept of Health Care

• Health care implies more than medical care, influenced by factors like food, housing, sanitation, lifestyle, and protection against hazards.
• It includes services provided to individuals or communities for promoting, maintaining, monitoring, or restoring health.
• Medical care is a subset of the health care system.
• Healthcare is a public right and the government's responsibility to provide it equally to all.
• In India, healthcare is completely or largely a governmental function.
• Health services are designed to meet the community's health needs using available knowledge and resources.
• Defining a fixed role for health services is difficult due to socioeconomic differences between countries.
• The health system delivers health services, which constitutes the management sector and involves organizational matters.
• Health services should be organized to meet the needs of entire populations, covering preventive, curative, and rehabilitation services.
• Effective primary health care services are essential for underserved rural and urban populations, supported by an appropriate referral system.
• Community participation is a major component in the healthcare system.
• The focus is shifting from medical care to health care and from urban to rural populations.

Level of Health Care

• Healthcare services are categorized into three levels: primary, secondary, and tertiary, each involving different degrees of complexity.

Primary Care Level

• This is the first point of contact between individuals/families/community and the national health system.
• Primary health care (Essential Health Care) is provided at this level.
• Most health problems can be dealt with and resolved at this level.
• Primary health care is most effective within the context of the area's needs and limitations.
• In India, primary health care is provided through primary health centers and sub-centers, involving multipurpose health workers, village health guides, and trained dais.
• Village "health teams" bridge cultural and communication gaps between rural people and the organized health sector.
• The primary health care system has been reorganized and strengthened to improve its effectiveness.

Secondary Care Level

• This is the next higher level of care where more complex problems are addressed.
• In India, this care is typically provided in district hospitals and community health centers, which also serve as first referral levels.

Tertiary Care Level

• This is a more specialized level requiring specific facilities and highly specialized health workers' attention.
• Care is provided by regional or central level institutions like Medical College Hospitals, All India Institutes, Regional Hospitals, Specialized Hospitals, and other Apex institutions.
• A fundamental function of the health system is to provide a sound referral system with information exchange and follow-up for patients.
• This aspect remains weak in many developing countries, including India.

Comprehensive Health Care

• The term was first used by the Bhore Committee in 1946
• The Bhore Committee meant provision of integrated, preventive, curative and promotional health services from "womb to tomb" to every individual residing in a defined geographic area.
• Includes adequate preventive, curative, and promotive health services
• As close to the beneficiaries as possible
• Widest cooperation between the people, the service and the profession
• Available to everyone, irrespective of ability to pay
• Looks after vulnerable and weaker communities
• Aims to maintains healthy environment in homes and workplaces

Basic Health Services

• The terms "Basic health services" was used by UNICEF/WHO in their health policy in 1965
• The drawbacks are lack of community participation, lack of intersectoral coordination and dissociation from the socio-economic aspects of health.

Primary Health Care

• Primary health care approach came into existence in 1978 following an international conference at Alma-Ata (USSR)
• Primary health care is essential health care made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and country can afford.
• The concept of primary health care has been accepted by all countries as the key to the attainment of health for all by 2000 AD.
• It has has also been accepted as an integral part of the country's health system.

Elements of Primary Health Care

• Alma-Ata has outlined the following essential components of primary health care,
• Education about prevailing health problems
• Promotion of food supply and proper nutrition
• An adequate supply of safe water and basic sanitation
• Maternal and child health care, including family planning
• Immunization against major infectious diseases
• Prevention and control of locally endemic diseases
• Appropriate treatment of common diseases and injuries
• Provision of essential drugs

Principles of Primary Health Care

• Equitable distribution of health services, irrespective of ability to pay.
• Health services must be accessible to all, rich or poor, urban or rural.
• Community involvement in planning, implementation, and maintenance of health services.
• Intersectoral coordination involving all related sectors like agriculture, education, housing, etc.
• Use of appropriate technology, that is scientifically valid, acceptable, and financially feasible.

National Strategy for HFA/2000 (Health for All by 2000)

• Defined by the World Health Assembly as enabling every individual to lead a socially and economically productive life.
• Reduction of infant mortality to below 60.
• Raise life expectancy at birth to 64 years.
• Reduce the crude death rate to 9 per 1000 population.
• Reduce the crude birth rate to 21 per 1000 population.
• Achieve a net reproduction rate of one.
• Provide potable water to the entire rural population.

National Health Policy

• Notable elements of the national health policy in India include:
• Greater awareness of health problems and means to solve these, in and by the communities
• Supply of safe drinking water and basic sanitation
• Reduction of existing imbalance to health services by concentrating on rural health infrastructure
• Establishment of dynamic health information system
• Legislative support for health protection and promotion
• Action to combat widespread malnutrition
• Research in alternative methods and low-cost health technologies
• Greater coordination of different systems of medicine

Health Care Delivery

• Necessity to reach the whole population with adequate healthcare services and ensure their utilization.
• The "large hospital" has failed in the sense that it serves only a small part of the population.
• It has been aptly said that these large hospitals are more ivory towers of diseases and centres for the delivery of comprehensive healthcare services.
• Rising costs in the maintenance of these large hospitals and their failure to meet total health needs of the community has led to the country to seek alternative models of health care delivery with the aim to provide health care services that are reasonably inexpensive, and have the

Model of Health Care System

• The Inputs are the health status or health problems of the community
• The Health care system is intended to deliver the health care services
• The changed health status or improved health status of the community is the output.

Health Problems of India

• Can be grouped under communicable diseases, nutritional issues, environmental sanitation, medical care, and population problems.

Communicable Diseases

• Communicable diseases are a major problem in India.
• Important diseases include Malaria, Tuberculosis, Leprosy, Diarrhoeal diseases, Acute respiratory diseases, Filaria and AIDS.

Nutritional Problems

• Indian society is divided into well-fed and undernourished groups.
• Specific issues include Protein Energy Malnutrition, Nutritional Anemia where it is common in women and children.
• 60-80% of pregnant women are anemic. 20-40% of maternal deaths are linked.
• Other issues are Low Birth Weight, Xerophthalmia and Iodine Deficiency Disorders.

Environmental Sanitation

• Environmental sanitation is among the most difficult problems mainly due to problems with lack of safe water and primitive excreta disposal.
• Problems result from population, urbanization and industrialization.

Medical Care Problems

• India has a national health policy, but not a national health service.
• Financial resources are inadequate to furnish the costs of running such service.
• The model has benefited mostly the urban elite, while rural areas do not enjoy the benefits of modern curative and preventive health services.
• Many villages rely on indigenous systems of medicine.

Population Problems

• India faces a significant population problem.
• Affects many aspects of development including unemployment, education, housing, healthcare, sanitation, and the environment.
• The government has a planned 1% rate of population by 2000.

Resources

• Resources must be distributed according to the needs of the community.
• Three basic resources for healthcare are health manpower, money and material, and time.
• Health manpower is referred to as all the individuals to provide and/or support health care
• Money is important for health services.
• Proper use of man-hours is crucial.

Health Care Services

• The purpose of health care services is to improve the health status of the population.
• Health services should be comprehensive, available, accessible, acceptable, community participation, and affordable.
• Primary health care serves as a central role to the delivery of health care.
• Health Care System
• The health care system is intended to deliver the health care services.
• It constitutes the management sector and involves organizational matters.

Public Health Sector

• Primary health care
• Hospitals/health centre
• Health Insurance Schemes
• Other Agencies

Primary Health Care in India

• In 1977, India launched a Rural Health Scheme
• India evolved a National Health Policy based on Primary health care in 1983.
• Steps towards achieving Health for All which are described below:
• Village Level
• Sub-Centre Level
• Primary Health Centre Level
• Community Health Centres

Village Level Schemes

• Include the following:
• Village Health Guide Scheme Health guides do community health work in their spare time and are paid a small honorarium.
• Training of Local Dais Dais get paid a stipend during their training period.
• ICDS Scheme An Aganwadi worker gets paid a monthly honorarium for their role which includes health check-up, immunization, health education, etc.

Sub-Centre Level

• Sub-centres function is mainly mother and child health care, family planning and immunization.

Primary Health Centre (PHC) level

• PHC is a basic health unit that is closest to the people as possible
• PHCs provides an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care.

Functions of Primary Health Center (PHC)

• Covers all of the ten essential elements which are:
• Medical Care
• Collection reporting of vital statistics
• National health programmes where they have roles
• Basic laboratory services.
• There are at least one PHC for each community in a Development Block.

The proposed staffing pattern is as follows

• At PHC level - Medical officer, pharmacist, nurse, mid wife, health worker
• At the subcentre level: Health worker, voluntary worker

Community Health Centres

• CHC were established throughout the country to cover the population.

Government Hospitals

• Government hospitals consist of rural hospitals, district hospitals, specialist hospitals, and teaching institutions.

Health insurance

• Health insurance is at present limited to industrial workers and their families.
• The central Government employees are also covered by the health insurance under the central government health scheme.

Employees State Insurance Scheme

• The ESI scheme provides care in cash and kind benefits and contribution by employer and employee who are protected by the act.

Central Government Health Scheme

• The central Government health scheme involves cooperation by efforts of the employer and the employees, where below are some of the facilities:
• Outpatient care through networks and dispensaries.
• Supply of drugs, laboratory and X-ray
• Hospitalization

Other Agencies for Health Care

• Defence Medical Services Defence services provide organization of medical care.
• Health Care of Railway Employees Railways provide a means for health services.
• Private Agencies Private agencies provide a a large share of health servicesto the public
• Indigenous System of Medicines Practitioners of indigenous medicine(e.g. Ayurveda, Siddha, Homoeopathy etc.) provide the bulk of medical care to the rural people

Voluntary Health Agencies

• Voluntary health agencies occupy an important place in the community.
• Categories of services include Government Agencies, Pioneering, Education, Demonstration, Health Legislation and Guarding the Work

Voluntary Health Agencies in India

• Indian Red Cross Society
• Hind Kusht Nivaran Sangh
• Indian Council for Child Welfare
• Tuberculosis Association of India
• Bharat Sewak Samaj
• Central Social Welfare Board
• The Kasturba Memorial Fund
• Family Planning Association of India
• All India-Blind Relief Society
• Professional Bodies
• International Agencies