Organization of Health services

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Organization of Health services : 

Organization of Health services Dr Naresh T Chauhan Curtsey: SIHFW, Jaipur

Constitutional commitment: Health: State subjectCentral List International Health, Port Health Research Technical & Scientific EducationState List All other Health issuesConcurrent list Epidemics : 

Constitutional commitment: Health: State subjectCentral List International Health, Port Health Research Technical & Scientific EducationState List All other Health issuesConcurrent list Epidemics 2 10/20/2010

Slide 3: 

Mile stones: NRHM-2005 NHP-2002 NPP-2000 RCH-1996 UIP-1985 NHP-1983 Alma Ata-1978 (HFA) Small pox eradicated-July 5, 1975 NFPP-1952 India Joins WHO-1948 HSDC-1946 Juggling Priorities 3 10/20/2010

Slide 4: 

NO Health Policy for 36 years Committees and Commissions Single issue addressed by Committee Comprehension was missing recommendations- reiterations of Bhore Committee. Individual “Health” Programs - situational exigency. Uni-purpose workers later baptized as Multi-purpose. Programs worked in complete isolation till 1980 (e.g. NTCP). Fragmented approach to Health 4 10/20/2010

Still…62 yrs. of Health Services : 

Still…62 yrs. of Health Services Crude Death Rate ↓ Crude birth rate ↓ Life expectancy ↑ S.pox & G. worm eradicated Leprosy eliminated IMR ↓ Infrastructure – expanded 5 10/20/2010

Slide 6: 

6 10/20/2010

Core functions of Public Health : 

Core functions of Public Health Monitoring health situation Disease surveillance Health promotion Regulations Partnerships Planning & Policies HRD Reducing impact of emergencies on health 7 10/20/2010

Bhore Committee, 1946 : 

Bhore Committee, 1946 PHCS : nodal points for Health care Phased expansion Prevention stressed Population based 8 10/20/2010

Committees & Commissions : 

Committees & Commissions 1959-62 Mudaliar committee (Health Survey And Planning Committeee) Health services restructuring 1963: Chaddah committee Malaria 1964:Mukherjee committee Family planning 1964-67:Junglewala committee Integration Of Health Services 1972-73:Kartar Singh committee MPW scheme 1974-75:Srivastav committee Medical Education & Support Man-Power 9 10/20/2010

Challenges : 

Challenges Manpower- Number & Norms Rural / Urban differential Geographical divide across States S-E groups –accessibility/ reach Gaps between Policy & Action Health sector expenditure Newer Infections 10 10/20/2010

Service delivery:3-tier structure : 

Service delivery:3-tier structure DH CHC Underutilized for- Services Supplies Funding 11 PHC SC 10/20/2010

Health System’s Organization-India : 

Health System’s Organization-India Central Govt. Planning Commission National Development Council CCHFW MOHFW FW Medical & Public Health ISM&H Secretary Secretary Secretary Jt.Secy. Addl.Secy. Director Director Jt.Secy. Jt.Secy. DGHS Addl.DGHS 12 10/20/2010

Role of Central Govt. in Health Care : 

Role of Central Govt. in Health Care Policy formulation Maintaining International health relations Administration of central health institutions Regulating Medical education through statutory bodies-MCI/DCI/Councils Medical & Public health research-funding Standards- laying & maintenance(Drugs/Education) Coordination-Other ministries/States/Statutory bodies Central Health Acts Negotiation with International agencies 13 10/20/2010

Functions of Dept of Family Welfare : 

Functions of Dept of Family Welfare Policy preparation & Planning Information collection & Evaluation Contraceptive-Research /Supply Seeking International support EPI/UIP/CSSM/RCH/ARI/ORT-Trainings & area development IEC Rural Health Paraprofessional training NGO support Development of Sub-center 14 10/20/2010

Functions of Medical & Public Health : 

Functions of Medical & Public Health Health Policy preparation National Health Programs conduction Drug Control PFA enforcement Diseases control-Communicable/Non-communicable Supplies & Disposal Maintenance CME & Trainings Medical Education & Research Vital statistics & Health intelligence International support 15 10/20/2010

Organization at State level : 

Organization at State level Gujarat Government Medical Education MoH & FW Secretary-ME Principal Secretary-Health Secretary-FW Principals Directors (Service divisions) (Medical Education) FW Public Health AIDS IEC Addl. Directors Jt. Directors Dy. Directors State Program Officers Zonal Directors 16 10/20/2010

District Health Care Administration : 

District Health Care Administration 17 10/20/2010

District : 

District An Administrative unit Defined Geographical boundary and Population Peripheral most Planning unit A self contained segment of National Health System 18 10/20/2010

District Health Organization : 

District Health Organization CMHO H O (Rural),Preventive (Urban),Curative Dy.CMHO Program Officers (registered society-DHS) Block CM&HO C H C Pop.-80000-120000 Beds(30) Specialists(7-IPHS) Referral P H C Pop.20-30000 Primary health Medical Officer(2-IPHS) SC (3-5000)HW-M/F SBA/AWW/VHG/ ASHA 19 10/20/2010

Functions of District Health System : 

Functions of District Health System Liaison between Field units & Headquarter Field reports Inspections Meetings Implementation of Policy & Programs District level planning & Action Plans Rationale use of Finance & Resources Communication Management Plans/Schedules/Progress/Problems Control & Monitoring 20 10/20/2010

Problem Areas at District : 

Problem Areas at District Quantity v/s Quality Cluttered Policy guidelines Decentralization on papers Roles/Responsibilities poorly defined Program integration ? HMIS-generation & use ? Managerial skills Donor initiative – “Societies” Resource restriction 21 10/20/2010

Rural Health services : 

Rural Health services Institution– Primary Health Centers(20-30000) Functions- Medical Care RCH services Immunization Child Health Obstetric services MTP NHP School Health Environment Health/ Nutrition education Management 22 10/20/2010

Manpower and Education : 

3 Manpower and Education Manpower Statistics Medical Colleges Medical Infrastructure in Gujarat (Map) MBBS – 13 (6 Govt. & 7 Private) Homeopathic – 13 Ayurvedic – 9 Dental – 12 ( 5 Govt. & 7 Private) Physiotherapy – 17 Pharmacy - 50 Source : Department of Health, Government of Gujarat Key Education Centres Institute of Kidney Disease and Research Centre (IKDRC) Gujarat Cancer Research Institute ( GCRI) U.N. Mehta Cardiology Research Institute B.J. Medical College Ahmedabad Gujarat Ayurvedic University , Jamnagar Pramukh Swami Medical College , Karamsad Anand Nathiba Hargovindas Lalbhai Medical College, Ahmedabad Surat Municipal Institute of Medical Education & Research

Thank you : 

Thank you 10/20/2010 24