Healthcare delivery system
Healthcare delivery system in India is a 3-tier system. It operates through three levels
Primary health care
Secondary health care
Tertiary health care
Primary health care level
Primary health care delivery system in India is at 3 levels. They are
1. Village level (1000 population)
a. Community health guide
b. Trained birth attendant (trained dai)
c. Anganwadi worker (under ICDS scheme)
2. Subcentre level (3000 to 5000 population)
a. MPHA (m): Multi purpose health assistant (male)
b. MPHA (f): Multi purpose health assistant (female)
3. Primary health centre level (20000 to 30000 population)
a. 1 to 2 medical officers
Primary health care
It is the first level of contact of individuals, the family and community with the national
health system
Most of the health problems can be dealt with and resolved
Principles of primary health care are
o Equitable distribution
o Community participation
o Intersectoral coordination
o Appropriate technology
Functions of PHC center
Medical care
Maternal and child health including family planning
Safe water supply and basic sanitation
Prevention and control of locally endemic diseases
Collection and reporting of vital statistics
Education about health
National health programmes
Referral services
Training of health guides, health workers, local dais and health assistants
Basic laboratory services
Secondary health care
It is also called intermediate health care
It is provided by community health centers and hospitals
They look after specialised referral needs of PHC and health care needs of the people of
the district
Staff pattern of CHC
→ Medical officers, nurse mid wives, dresser, pharmacist, lab technician, radiographer,
ward boys, dhobi, sweepers, mali, chowkidar, aya, peon.
Staff pattern of district hospital
→ Specialists in medicine, surgery, obstetrics, gynaecology, ENT, ophthalmology,
orthopedics, anaesthesia, radiology are present. Pathologists may or may not be present
Functions
o Specialist medical care and surgical care
o Emergency care
o Specialized diagnostic services
o Inpatient services and OP services
o Supervisory services
Specialist doctor and paramedical staff provide SHC with specialised infrastructure and
intervention
It covers specialist consultation
Tertiary health care
These are called second level referral center
It is more specialized level than secondary care level
THC is provided by regional or central level institutions, e.g., medical college hospitals,
All India Institutes, regional hospitals, specialized hospitals and other apex institutions
High-tech diagnostic and therapeutic equipment
Highly specialised medical and paramedical professionals
Specialist medical care is rendered
Also provide apex level services for various national programmes and training medical
professionals
Staff
o Specialist in all specialities
o Superspecialist speciality wise
o Specialised paramedical staff
Function
o Providing a sound referral system
o It must be a two-way exchange of information and returning patients to those who
referred them for follow-up care.
o Ensure a continuity of care and inspire confidence of the consumer in the system
o Emergency care
o Speciality and superspeciality care
o Inpatient services
o Clinical training (doctors and nurses)
o High-tech diagnostic and therapeutic services
In a majority of developing countries the tertiary health care system remains very weak
Anganwadi worker
In India there is a shortage of skilled professional. To meet the goals of healthcare system
and enhance health facilities for the local community Anganwadi system was started
Anganwadi workers are honorary workers from the local community
They serve the community on part-time basis
They are given training in health, nutrition, and child development for 4 months
They are grass root functionary to implement ICDS scheme
Each Anganwadi worker covers a population of 400-800 in rural and urban areas
Anganwadi workers are not skilled and qualified as professional healthcare providers but
they have better social skills because she lives with the people and is well known
Responsibilities
Assessment of child
o Maintains growth chart of every child and weighs the child every month 3 months
o Refers malnourished child to MO, PHC
Gives therapeutic diet to grade 1 and 2 PEM child as recommended by the specialist
Non-formal education for children 3-6 years
Coordinate with PHC staff for health checkup, immunization and referral of sick child
Provide treatment for minor illness
Supplementary nutrition to children (0-6 years), pregnant women and lactating mother
Implement Kishori Shakti Yojana/Sabla programme for adolescent girls
Organize the health days with ASHA at Anganwadi center
Survey the area to find out beneficiaries
Sends monthly reports to Mukhya Sevika
