What are the different Health care services in India? Discuss.

 India’s health care system can be classified into many categories based on various parameters.

Depending upon the function it addressesthe Health Care system in India consists of four components. They are:

·         Primary, secondary, tertiary institutions manned by medical and para-medical personnel;

·         Medical colleges and para-professional training institutions to train the needed manpower and give the required academic input;

·         Programme managers, managing on-going programmes at central, state and district levels; and

·         Health management information system consisting of a two-way system of data collection, collation, analysis and response.

Depending upon the source of funds for operation and health resources (technology/work force) used, health care system is divided into five sectors as follows:

 

Public Health Sector — Include Primary health care (Sub-Centers and Primary Health Centres), Hospitals (Community Health Centres, Rural Hospitals, district Hospitals, medical colleges, specialist hospitals), health insurance schemes (ESI, Central Government Health Scheme) and other agencies health services (like defence hospitals, railway hospitals). Private Health Sector — This includes private hospitals, nursing homes, dispensaries, clinics etc.

Voluntary Health Agencies – which are not-for-profit organisations working in the field of health Depending Upon Type of Medical Systems we have

·         Allopathy and AYUSH services are two broad categories. Indigenous System of Medicine consists of Ayurveda, Yoga, Unani, Siddha, Homeopathy, SowaRigpa shortly termed as AYUSH. This has a separate ministry to provide fund, support Research and Development. Public hospitals, clinics and private hospitals/ clinics form part of this network.

·         Various National Health Programmes National Health Programmes-they are vertical programmes, planned, developed, implemented and funded by the federal (central) government to combat particular diseases like malaria/leprosy etc. We will be studying more about these national programmes in detail in the following sections.

a) Public Sector Health Care in India

Primary Health Care in India forms the backbone of the health system, especially in rural areas. At village level, it consists of Village Health Guides, trained Dais and Anganwadi workers (From Integrated Child Development Scheme). This is supported and supervised/coordinated by the Sub-centres and the Primary Health Care Centres.

 

Accredited Social Health Activist (ASHA) is a woman who is selected from the village itself and she is trained to work as interface between the community and the public health system. ASHA will be a health activist in the community who will create awareness on health and its social determinants and mobilise the community towards local health planning and increased utilisation and accountability of the existing health services. She would be a promoter of good health practices and will also provide a minimum package of curative care as appropriate and feasible for that level and make timely referrals.

 

Village Health Guide: is a person who has an aptitude for social service and he or she is not a full-time government employee. He or she serves as a link between the community and the government health infrastructure. He or she is selected at the village level (1 for each 1000 rural population) and undergoes training in the nearest Primary Health Care Centre for three months. Primary responsibility of village health guide includes, helping the community with minor medical problems, ensure first aid, maternal-child health care, health education and sanitation.

 

Trained Birth attendants: Woman from village is selected and she undergoes a training of thirty working days at the Primary health care centre or maternal and child health centre. After the training she is provided with delivery kits, her main responsibility is to ensure safe delivery and promote small family norm.

 

Anganwadi Worker: Under the Integrated Child Development Scheme (ICDS) there is one Anganwadi worker employed for 1000 population. She is trained in various aspects of health, nutrition, primary education etc. and she plays a pivotal role in ensuring health access and health/ nutritional/ health supplements benefit to pregnant women, 0-6 year children, lactating mothers and adolescents.

Subcentre (SC): Government of India approves one SC for 5000 population in general and in hilly / tribal areas it is one per 3000 population. Two multipurpose workers (shortly called as MPW — one male and one female) are employed here. They are responsible for all health service and health programme implementation in that area. Generally, the male MPW looks after programmes like malaria, Tuberculosis etc., whereas the female MPW will look after maternal and child health/ family planning services.

Primary Health Centre (PHC): One PHC is approved for 30000 population in rural/ plains whereas it is one PHC for every 20000 population in tribal/ hilly areas. The major functions of PHC includes health education, promotion of nutrition, sanitation, immunisation, MCH care, appropriate treatment of common diseases/ injuries, essential drug supply, implementing and supervising various national health programmes and referral services. PHC will have medical officers, staff nurse, nursing assistants, pharmacists and other supporting staff.

Angwanwadi Centers (Department of Women and Child Development): Nutritional needs of pregnant woman, nutritional needs of 0-6 year old children and adolescent girls’ health requirements are met through anganwadi centers where food grains and medicines are distributed.

 

Secondary Level of Health Care consists of community health centres, rural hospitals, district hospitals and speciality hospitals.

Community Health Centres (CHC): One out of four PHC in a block is usually upgraded and recognised as a Community Health Centre (CHC). It should have 30 beds with specialists in surgery, medicine, gynaecology/ obstetrics and paediatrics. It also should have diagnostic facilities like X ray and laboratory facilities. One CHC usually covers a population of 80000- 120000.

Health Insurance: No universal health insurance is mandatory in our country. However, two insurance-based programmes are well-implemented and managed in India. They are ESI and Central Government Health scheme. ESI was introduced in 1948 to provide medical care for people working in industries. Central Government Health Scheme was introduced in 1954 and it covers the employees of autonomous organisations, retired central government servants, retired judges, MPs of Parliament and their families. Ayushman India is a new scheme that was recently launched, and it aims to provide universal insurance coverage to the citizens of this country.

Other Agencies: This includes medical services provided by defence forces, through their hospitals/ medical colleges. Similarly, Indian railways also provide health care facilities for their employees and family members.

 

b) Private Health Care in India - This mainly consists of private hospitals, independent clinics, nursing homes etc. This sector is highly unorganised and is concentrated in urban areas. It provides mainly curative and immunisation services. Medical Council of India and Indian Medical Association regulate and control some aspects of the private health care sector.

c) Ministry of AYUSH and its Health Care Institutions -  Ministry of AYUSH (which was initially the department of AYUSH), regulates, maintains and develop manpower, infrastructure, Research and Development, drugs etc., for AYUSH systems (Ayurveda, Yoga, Unani, Sidha, Homeopathy and Sowa-Rigpa). Both public sector institutions (primary level clinics, Ayurveda hospitals, Ayurveda/ homeopathy medical colleges) and private hospitals/clinics/colleges are under the control and supervision of Ministry of AYUSH.

d) Voluntary Health Agencies - Voluntary health institutions are not-for-profit organisations usually registered under the Societies Registration Act or the Trust Act. International level organisations like Red Cross Society, World Health Organisation etc., are also part of this network, which provides specialised training, skill development, R&D support to the federal (central) government. Indian Council for Child Welfare, Voluntary Health Association of India, The All India Blind Relief Society etc., are some other important organisations that render their services in the area of health.

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