HEALTHCARE SYSTEM IN INDIA😊

HEALTHCARE SYSTEM IN INDIA

• Home affairs come to disaster spot and take census

• National Health Mission (2013):
• NRHM + NUHM.

NITI Aayog

Establishment

• Formed on January 1, 2015

• Replaced the National Planning Commission (NPC)

Role

• Acts as the "Think Tank of India"

• Responsible for framing all administrative policies

Leadership

• Chairperson: Prime Minister of India

Major Initiatives

• Aspirational Districts Programme

• Atal Innovation Mission

• Atal Tinkering Labs

• SDG India Index

• National Health Stack

• National Medical Registry (proposed)

Key Differences from Planning Commission

• Acts as an advisory body

• No power to allocate funds

• Bottom-up approach instead of centralized planning

United Nations

• The United Nations framed the Sustainable Development Goals.

• Headquarters is in: New York

Sustainable Development Goals (2015-2030)

• Formulated by United Nations.

• Chart for India → Prepared by NITI Ayog

• Total goals:
• 17 goals + 169 targets
• Goal 3: Health related.

• Targets of goal 3: MNOP
• 3.1:
• M → Reduce MMR <70/ 1 lakh live birth.
• 3.2:
• N → NMR <12/1000 live births (20)
• U5MR <25/1000 live births (32)
• 3.3:
• O → End epidemic of AIDS, TB, malaria & neglected tropical diseases by 2030.
• OATM
• 3.4:
• P → Reduce 1/3rd of premature deaths from NCD by 2030.

Functions of Health Workers

ASHA (Accredited Social Health Activist):

Functions:

• Primary medical care to all.

• Home visit.

• Create awareness on health & social issues.

• Facilitate access to health care services.

• Mother + child care:
• Counsel on reproduction & child care.

• Ensure healthcare access to pregnant, malnourished & special needs individuals.
• Accompany or Escort Pregnant women and children to hospital

• Inform births, deaths, epidemics etc.

• Depot holder for ORS, antibiotics, IFA tablets.

• Household toilets:
• Total sanitation campaign.

• All other NHP + important member of VHSN committee.

• DOTS provider

• Facilitate development of a comprehensive village health plan

• Facilitate construction of community and household toilets

Criteria:

• Female.

• Age: 20/25 to 45 years.

• 10th graduate.

• Married/ Divorced/Separated/Widow

• ≥ 1, ≤2 children.

• Permanent resident of village.

• Selected by Village Panchayat

• Under supervision of Medical Officer

• Accountable to Village Panchayat

• Training
• Provided by Dakshata training (Under MoHFW).
• Trained by ANM / AWW
• 23 days in 5 sessions within 1 year.
• 1st session: 7 days.
• Next 4 sessions: 4 days each.

• Existing norm: 1 per 1000 population

• Proposed norm: 2 per 1000 population

Note:

• VHSND (Village Health, Nutrition & Sanitation Day):
• Observed monthly
• Implement all National Health Programs at community level.

Lady Health Visitor / Health Assistant Female

• At level of PHC

• Monitoring & supervision of healthcare staff.

• Data management.

Multi-Purpose Workers (MPW)

• At level of subcentre

MPW male

1. National Vector Borne Disease Control Programme (NVBDCP) functions in village.
• Active Malaria Surveillance

2. Collect sputum

3. Maintenance of water quality (Chlorination).

4. Maintenance of past medical records/register.
• Include past records of family planning (not current)

5. Stock management.

6. Cold chain maintenance.

7. OPD & survey

8. Family planning

MPW female / Health Worker Female / ANM:

1. Mother & child care:
• ANC/PNC
• Conduct deliveries
• Register Pregnant females

2. Immunisations
• They take immunisations → Not Asha, Not Male MPW

3. Current Family planning (Except IUCD) including registers

4. Eligible Couple registers

5. OPD & survey

6. Collect Blood and Urine Samples

Community Participation:

Rogi Kalyan Samiti (RKS):

• For community participation & management of health centres.

• Under NHM:
• At PHC & CHC levels.

Mahila Arogya Samiti (MAS):

• Urban areas.
• Works with USHA worker.
• Handles 50 to 100 houses.

Which of the options below is established to facilitate health planning at the village level?

4 Principles / Pillars of Primary Health Care

1. Community Participation

• Involvement of grassroots-level workers

• Empowers the community in health care delivery

• Examples:
• ASHA workers
• Rogi Kalyana Samithi

Grass Root Level Workers

• ASHA

• Village Health Guide (VHG)

• Anganwadi Worker (AWW)

• Trained Birth Attendant (TBA)

2. Appropriate Technology

• Should be cost-effective and of good quality

• Examples:
• ORS
• VVM(Vaccine Vial Monitor): Heat-sensitive label for vaccines
• Shakir Tape: Assesses malnutrition
• Kangaroo Mother Care: For preterm infant care
• DOTS-99: TB treatment adherence
• NIKUSHTH: Leprosy case tracking

3. Equitable Distribution

• Health services should be equitably distributed

• Available to all, regardless of:
• Wealth (rich/poor)
• Location (urban/rural)

4. Intersectoral Coordination

• Involves multiple sectors for maintaining health

• Supporting sectors include:
• Agriculture
• Education
• Environment

• Example:
• ICDS: Jointly implemented by MoHFW and MoWCD

Types of Centres

NRHM

Structure:

• HTF: Hilly, Tribal and Forest areas.

• MPW: Multi-purpose Worker.

Subcentre & PHC:

NUHM Structure:

CHC:

• Referral centre for 4 - 5 PHCs

• Non-FRU.
• CHC: 30 beds.
• Urban-CHC: 50 – 100 beds.

• FRU 
• AKA upgraded CHC: Blood bank Present
• CHC: 50 - 100 beds.
• U-CHC: ~100 beds.

• Mnemonic:
• FRU → 50-100 bed
• (U+) CHC → 50-100 bed

District Hospitals

• Administrative unit of MoHFW.

• Bed capacity:
• 1/1000 population: Essential.
• 2/1000 population: Desirable.

Bed Capacity:

• Best primary healthcare: 
• PHC.

• Only subcentre:
• Under central government.

• NHM
• under Ministry of Health & Family Welfare (MoHFW).

Training of Health Workers

Integrated Child Development Services (ICDS) Scheme

• Under Ministry of Women & Child Development (MoWCD).

• Beneficiaries:
• Children: 0 to 6 years.
• Adolescent girls: 10 to 19 years.
• Women of reproductive age: 15 to 49 years.
• Pregnant & lactating women.
• All females except 6-10 years and over 50 years
• Male only upto 6 years

• Note:
• National Health Mission → Ministry of health and family welfare
• ICDS →MoWCD

Structure:

• Anganwadi:
• Population 500 to 800.
• Single best ans: 800

• Anganwadi supervisor:
• Supervise 25 - 30 anganwadi
• Population 25,000.

• CDPO (Child Development Project Officer):
• Population 1,00,000.

CDPO:

• Administrative unit, works at block level 
• (1 block = 1 lakh population).

• 4 anganwadi supervisors report to 1 CDPO.

Note:

• Mini-Anganwadi:
• Only Anganwadi worker (No helpers),
• for 150 to 300 population.

• Administrative unit in MoHFW:
• District level

• Administrative unit in Anganwadi:
• Block level

Functions:

1. Supplementary nutrition

ㅤ	Energy (kcal)	Protein (g)
Child	500	12-15
Pregnant & lactating	600	15-18
Malnourished children	800	20-25

2. Health education.

3. Non-formal education.

4. Adolescent education.

5. Mother & child care.

6. Health care
• Vitamin A Prophylaxis to children
• Basic → like Paracetamol
• Advice regarding Sanitisation
• It is not under the Health and Family department → so have limitations

7. Facilitating immunization
• (In a/w VHNSD → Village Health Sanitisation Days).

Ayushman Bharat

COMPONENTS:

 

1. PMJAY (Pradhan Mantri Jan Arogya Yojna):

• Aka National Health Protection Mison

• World’s largest health insurance scheme.

• ₹5 lakh to 10 crore families.

• Beneficiaries: ~50 cr population.

• Blanket coverage (Irrespective of age, type of disease etc).

2. Comprehensive Primary Health Care (CPHC):

• Health & Wellness Centre-Sub-centre set up

• Aka Arogya Mandir

• Under New Indian Public Health standards.

• Officer: Community Health Officer (CHO).
• Nodal officer for HWC (Health & Wellness Centre).
• Qualification: Nurses
• Functions: Diagnosis, treatment, maintenance of medical records.

• Functions:
• Comprehensive primary health care
• At subcentre >>>
• At PHC
• Continuum of care:
• Diagnostic, therapeutic, preventive, promotive.
• <30 min: Time to care.
• ABHA ID:
• Centralised ID for all medical records.

• In addition to CHO → New IPHS guidelines:
• Pharmacist & Lab technician
• 1 per 10,000 population (At sub-centre level).
• To help CHO diagnose and Rx
• Ophthalmologist:
• 1 per 3 to 5 CHCs.
• They are less in number → so relaxed norms

Suggested Norms for Health Personnel

• WHO: 1 doctor and 3 nurses for 1000 population

eHealth & Training Programmes

• eHealth applications made by: 
• National Informatics Centre (NIC).

Vaccine Applications	Role
ANMOL	• Track Pregnant females and children • Use Tablet to monitor
SAFE VAC	• Adverse effect following Vaccine
EVin ↳ Electronic Vaccine Intelligence Network	• To manage Immunization logistics • Electronic win → logistics
UWin	• Online immunisation card • 0 - 5 year old • U win a card
Kilkari	• Information sent out via Mobile App • For Pregnant females • Immunization compliance

Other Portals	Service provided
eHospital	Hospital records maintenance; OPD services
e-Sanjeevani	Telemedicine services
eRakt Kosh	Blood banks
NHP	National health portal for national guidelines
mera aspatal	For OPD registration (↑Hospital services)
mDiabetes	Diabetes awareness
m-cessation	To quit smoking
NIKSHAY	TB drug compliance, register TB cases
NIKUSHT	Leprosy drug compliance

Training Programs:

1. Dakshatha:
• Healthcare workers → ASHA

2. Udisha:
• Anganwadi workers.

3. SAKSHAM:
• Stimulating Advanced Knowledge for Sustainable Health Management.
• Portal for training modules.

Drug Kits

Important Question:

Assumptions

ㅤ	ㅤ
Crude birth rate	20 (per 1000 population in India)
Expected birth rate	3 (per 1000 population in India)
Village Population	1000
Subcentre	5000
ANC registration	>50% of expected annual pregnancies

In 10,000 population

• Live births (LB) =
• Crude birth rate x Population + Pregnancy wastage
  1000
• Pregnancy wastage = 10% of LB = 20
• Live birth = 200 + pregnancy wastage (20) = 220

• ANC registration:
• >50% of expected annual pregnancies.
• ANC registration ≥ 110

Vaccine doses required =

• Beneficiaries (LB) x Total no. of doses x Vaccine multiplication factor (VMF).
• VMF
• BCG: 2
• MR: 1.3
• Others : 1.1

• BCG vaccine ≥ 400 (2x 200)

• Degree of Freedom (for Chi-square test)
• Formula: (Rows - 1) x (Columns - 1)