Maniba bhula nursing college

Subject : Nursing Management

Topic: Indian constitution, Indian administration
and health care delivery system in India

Submitted To Submitted By
Mr. Chhanagiri Aursang Mrs. Meghana Goswami
Asst. Professor 2nd year M.Sc Nursing
M.B.N.C M.B.N.C

Submitted on
7-11-2017
Indian constitution
▶ Introduction
Almost everything we do is governed by some set of rules. There are rules for games (like-soccer),
for social clubs and for adults in the workplace. There are also rules imposed by morality and custom
that play an important role in telling us what we should and should not do.
Some rules that are made by the legislatures (also known as Lok sabha/Rajya Sabha in India), for
there own country, are called “Law”. We need Laws in Society so our society can regulate and work
properly. They are designed to protect us and our property and to ensure that everyone in society
behaves the way that the community expects them too.
Laws tell us what to expect as a consequence of our actions. Laws have been the glue that has kept
society together. Without laws there would be complete anarchy.

▶ What Is Constitution Anyway?

I) In General-
The Constitution is the supreme law of the land. All other laws have to conform to the Constitution.
The constitution contains laws concerning the government and its relations with the people.
A constitution is concerned with 2 main aspects:
a) The relation between the different levels of government and
b) Between the government and the citizens.
Role of Constitution in relationship between Government and its people:-
Constitution

Government People

LEGISLATIVE Makes Laws

JUDICIARY Interprets Laws

EXECUTIVE Enforces Laws

▶ Definition
A constitution is a set of fundamental principles or established precedents according to which a state
or other organization is governed. These rules together make up, i.e. constitute, what the entity is.
When these principles are written down into a single collection or set of legal documents, those
documents may be said to comprise a written constitution.
OR
The document containing laws and rules which determine and describe the form of the government,
the relationship between the citizens and the government, is called a Constitution.
OR
The Constitution is not an instrument for the government to restrain the people, it is an instrument for
the people to restrain the government.” --Patrick Henry (1736-1799)
▶ Why Do We Need Constitution?
o In General-
I. We need a constitution to govern a country properly.
II. The constitution defines the nature of political system of a country.
III. Sometimes we feel strongly about an issue that might go against our larger interests and the
constitution helps us guard against this.
IV. All the 3 organs of government (executive, legislature and judiciary) functions within the
constitution. All the 3 organs of government, including ordinary citizens, derive their power and
authority (i.e. Fundamental Right) from the constitution. If they act against it, it is unconstitutional
and unlawful.
So constitution is required to have authoritative allocation of power and function, and also to restrict
them within its limit.
o To perform following Functions we need Constitution-
I. The first function of a constitution is to provide a set of basic rules that allow for minimal
coordination amongst members of a society.
II. The second function of a constitution is to specify who has the power to make decisions
in a society. It decides how the government will be constituted.
III. The third function of a constitution is to set some limits on what a government can
impose on its citizens. These limits are fundamental in the sense that government may
ever trespass them.
IV. The fourth function of a constitution is to enable the government to fulfil the separations
of a society and create conditions for a just society.

▶ The History of Constitution of India.

Constitution of India(1950AD)
The date 26 January was chosen to commemorate the Purna Swaraj declaration of independence of
1930. With its adoption, the Union of India officially became the modern and contemporary
Republic of India and it replaced the Government of India Act 1935 as the country's fundamental
governing document.
Conscious efforts were made to have consensus on different issues and principles and thereby avoid
disagreement. The consensus came in the form of the ‘Objectives Resolution’ moved by Jawahar Lal
Nehru in the Constituent Assembly on December 17, 1946 which was almost unanimously adopted
on January 22, 1947.
Finally Constitution of India, created in independent India by its own free people, was adopted on 26
November 1949 and came into effect on 26 January 1950. As we know it and use it today.
In the light of these ‘Objectives’ the Assembly completed its task by November
26, 1949. The constitution was enforced with effect from January 26, 1950.
From that day India became Republic of India.

▶ The Framing of Constitution of India.

The Constituent Assembly of India was elected to write the Constitution of India. This body was
formed in 1946 for the purpose of making independent India's constitution. The assembly passed a
resolution in 1947 January defining the objectives of the constitution:

1) To set up a Union of India comprising British India and the princely states.
 2) To set up a federal form of government with separate state and central governments.
3) To set up a democracy in which all power is derived from the people:
I) where all people are guaranteed justice, equality and freedom;
II) where minorities, depressed classes and the tribal's rights are protected;
4) To protect the integrity of India and her sovereign rights over land, sea and air.
5) To help India attain its rightful place in the world -and work for peace and welfare of all mankind.
Dr. Sachchidananda Sinha was the first president (temporary) of the Constituent Assembly
when it met on December 9, 1946. Later, Dr. Rajendra Prasad became the President of the
Constituent Assembly and Dr. Bhimrao Ambedkar became the Chairman of its drafting committee
on December 11,1946 .

▶ The Preamble to Constitution of India.

The first words of the Preamble -"We, the people" - signifies that power is ultimately vested in the
hands of the People of India. So far the Preamble has been amended only once in 1976 by 42nd
amendment (change) which inserted the words Socialism, Secularism and Integrity. A brief
description of these concepts are as follows: (in the order they come in Preamble)
1. Sovereign-It means free to follow internal and external Policies.
2. Secular-It means no particular Religion is preferred.
3. Socialist-It means no concentration of Power and Money.
4. Democratic-It means rule by elected representative of the People of India.
5. Republic-It means no room for hereditary ruler or monarch.

▶ What Is The constitution of India?

(i) Constitution of India In General:-
Constitution of India is considered to be the supreme law of the country, as it puts forth the
framework of fundamental political principles. It establishes the structure, procedures, powers and
duties of the government and mentions the fundamental rights, directive principles and duties of
citizens.
The Constitution declares India as a Sovereign, Socialist Democratic, and Republic with a
parliamentary form of government.
o The Indian Constitution shows Federal as well as Unitary
System.
1. Federal System-powers are divided and/or shared between state and central governments
2. Union System-power concentration in central government with weak state Government

§ Federal Features
1. Supremacy of the Constitution,
2. Division of power between the Union (central Governments) and State, and
3. The existence of an independent judiciary in the Indian Constitution.

§ Unitary Features
1. Single Citizenship
2. Single Constitution
3. Power of union to override on the state matters
4. During emergency the system became virtually unitary
5. Changes in the names and boundaries of the states by the Parliament
6. Integrated Judiciary System
7. Centre appoints the Governors
 8. Dependence of states on the centre for economic assistance and grants.

ii) Structure of Constitution of India:-The Constitution, in its current form (March 2011),consists
of 1 preamble, 25 parts containing 450 articles, 12 schedules, 2 appendices and 97 amendments to
date. Although it is federal in nature it also has a strong unitary bias.

Different elements of constitution are described as follows:

1. Preamble (1) -The Preamble to the Constitution of India is a brief introductory statement that sets
out the guiding purpose and principles of the document.

2. Parts (25) – The individual Articles of the Constitution are grouped together into the following
Parts:

1. Part I – Union and its Territory

2. Part II – Citizenship.

3. Part III – Fundamental Rights.

4. Part IV – Directive Principles of State Policy.

3. Article (1-450) -It is subcategory of different Parts in the constitution which contains detail
information of the subject or the Title which an Article 42represents.

4. Amendments (97) -Amendment of the Constitution of India is the process of making changes to
the nation's fundamental law. Changes to the Indian constitution are made by the federal
parliament. The procedure is laid out in Part XX, Article 368, of the Constitution.

5. Schedules (12) -Schedules are lists in the Constitution that categorize and tabulate bureaucratic
activity and policy of the Government.

6. Appendices (2) -They are extension to the constitution.

7. Fundamentals Rights (Part III-Article12-35) -The word fundamental suggests that these rights
are so important that the Constitution has separately listed them and made special provisions for
their protection. The Fundamental Rights are so important that the Constitution itself ensures that
they are not violated by the government.

The Constitution of India recognizes certain basic fundamental rights for every citizen of India,
such as:

(a) Right to Equality

(b) Right to Freedom

(c) Right to Freedom of Religion

(d) Right against Exploitation

(e) Cultural & Educational Rights

(f) Right to Constitutional Remedies

8. Fundamental Duties (Part IV Article 51A )-These Fundamental rights have been provided at the
cost of some fundamental duties. These are considered as the duties that must be and should be
performed by every citizen of India. These fundamental duties are defined as:

It shall be the duty of every citizens of India:

a. To abide by the Constitution.

b. To uphold & protect the sovereignty, unity and integrity of India.

c. To Cherish & follow the noble ideas which inspired our national struggle for freedom

d. To defend the country & render national service when called upon to do so.

e. To promote harmony & the spirit of common brotherhood.

f. To value & preserve the rich heritage of our composite culture.

g. To protect & improve the national environment.

h. To develop the scientific temper, humanism and the spirit of inquiry and reform.

i. To safeguard public property & to abjure violence.

j. To strive towards excellence in all spheres of individual & collective activity, so that the nations
constantly rises to higher levels of endeavour & achievement.

9. Directive Principles (Part IV-Article36-51)-It provides the social and economic base of a genuine
democracy. The classification of these are as follows.

1.Socio-economic Principles

2. Liberal Principles

3. Gandhian Principles

4. International principles
 Health care delivery system in India

 INTRODUCTION
A health care delivery system is the totality of services offered by all health disciplines. Traditionally the
primary purpose of a health care system had been to offer care to ill and injured. For this reason the health
care system of the past might be more accurately described as illness care system.
 Definition
 Health is a state of complete Physical, Mental and Social well being and not merely an absence of
disease or infirmity. Which allows a person to live a socio-economically productive life.
 Illness is a state in which a person’s physical, emotional, intellectual, social or spiritual functioning
is diminished or impaired.
 Health care is multitude of services rendered to individuals or communities by the agents of health
services or professional for the purpose of Promoting, restoring and maintaining health.
 All the goods and services designed for “prevention, promotion and rehabilitation interventions”
includes Medical Care.

 Definitions of health care delivery:

1. Health care delivery system refers to the totality of resources that a population or
society distributes in the organization and delivery of health population services. It
also includes all personal and public services performed by individuals or institutions
for the purpose of maintaining or restoring health. -Stanhope(2001)

2. It implies the organization, delivery staffing regulation and quality control. - J.C.Pak(2001)

 HEALTH CARE PROVIDER

 A person or organization that provides services and/or health care personnel to deliver proper health
care in a systematic way to any individual in need of health care services.
 Could be a government or the health care industry, a health care equipment company, an institution
such as a hospital or laboratory. Health care professionals may include physicians, dentists, and other
support staff.

 Philosophy of Health Care Delivery System:

o Everyone from birth to death is part of the market potential for health care services.
o The consumer of health care services is a client and not customer.
o Consumers are less informed about health services than anything else they purchase.
o Health care system is unique because it is not a competitive market.
o Restricted entry in to the health care system.

 Goals/Objectives of Health Care Delivery System:

1) To improve the health status of population and the clinical outcomes of care.
2) To improve the experience of care of patients families and communities.
3) To reduce the total economic burden of care and illness.
4) To improve social justice equity in the health status of the population.

 Principles of Health Care Delivery System:

1. Supports a coordinated, cohesive health-care delivery system.

2. Opposes the concept that fee-for-practice.
3. Supports the concept of prepaid group practice.
4. Supports the establishment of community based, community controlled health-care
system.
5. Urges an emphasis be placed on development of primary care
6. Emphasizes on quality assurance of the care
7. Supports health care as basic human right for all people.
8. Opposes the accrual of profits by health-care-related industries.

 Functions of Health Care Delivery System:

1) To provide health services.
2) To raise and pool the resources accessible to pay for health care.
3) To generate human and physical sources that makes the delivery service possible.
4) To set and enforce rules of the game and provide strategic direction for all the different
players involved.

 Characters of Health Care Delivery System:

1) Orientation toward health.
2) Population perspective.
3) Intensive use of information.
4) Focus on consumer.
5) Knowledge of treatment outcome.
6) Constrained resources.

 COMPONENTS OF HEALTHCARE DELIVERY SYSTEM

Structure of health system

Aspects of the design of health services that influences the way in which they are delivered Includes
o Number and type of personnel and staff
o Way of these personnel organized to work
o Nature and extend of facility and equipment
o Range of services offered
o System of management and amenities
o Financing
o Enumeration and determination of the eligible population for these services
o Governance and decision making

 PROCESS OF HEALTH CARE DELIVERY

 Consists of two parts
 Behavior of professionals
 Recognition of the problem i.e diagnosis
 Diagnostic procedure
 Recommendation of treatment or management
 Appropriate follow up
 Participation of people
 Utilization of services
 Understanding the recommendations
 Satisfaction with the services
 Participation in decision making

 LEVELS OF HEALTH CARE

 Primary Health care: Provided at the community level
 Secondary health care: Provided at PHC, CHC, DH etc.
 Tertiary health care: Provided at hospitals

 HEALTH CARE DELIVERY SYSTEM IN INDIA

India is a union of 28 states and 7 union territories. States are largely independent in matters relating to the
delivery of health care to the people. Each state has developed its own system of health care delivery,
independent of the Central Government.
The Central Government’s responsibility consists mainly of policy making, planning, guiding, assisting,
evaluating and coordinating the work of the State Health Ministries.

 HEALTH SYSTEM IN INDIA

1. Central
2. State
3. Local or peripheral

1) AT THE CENTRAL LEVEL

 The official “organs” of health system at national level are
I. The Ministry of Health and Family welfare
II. The directorate general of Health Services
III. The central council of health and family welfare

I. Union Ministry of Health and Family Welfare

Organization
The Union Ministry of Health and Family Welfare is headed by a Cabinet Minister, a Minister of
State, and a Deputy Health Minister. These are political appointment and have dual role to serve
political as well as administrative responsibilities for health.
Currently the union health ministry has the following departments:
a. Department of Health
b. Department of Family Welfare
c. Department of Indian System of Medicine and Homoeopathy

a. Department of Health: It is headed by a secretary to the Government of India as its executive head,
assisted by joint secretaries, deputy secretaries, and a large administrative staff.
 Functions
Union list
1. International health relations and administration of port quarantine
2. Administration of Central Institutes
3. Promotion of research through research body and centers.
4. Regulation and development of medical, pharmaceutical, dental and nursing professions
5. Establishment and maintenance of drug standards
6. Census and collection and publication of other statistical data
7. Coordination with states
Concurrent List:
1. Prevention of Communicable disease
2. Prevention of food adulteration
3. Control of drug and poison
4. Vital statistics
5. Labour welfare
6. Economic and social planning
7. Population control and family planning
b. Department of Family Welfare

It was created in 1966 within the Ministry of Health and Family Welfare. The secretary to the Government
of India in the Ministry of Health and Family Welfare is in overall charge of the Department of Family
Welfare. He is assisted by an additional secretary and commissioner, and one joint secretary.
The following divisions are functioning in the department of family welfare.
1. Programme appraisal and special scheme
2. Technical operations: looks after all components of the technical programme viz.
Sterilization/IUD/Nirodh, post partum, maternal and child health, UPI, etc.
3. Maternal and child health
4. Evaluation and intelligence: helps in planning, monitoring and evaluating the programme
performance and coordinates demographic research.
5. Nirodh marketing supply/ distribution

 Functions
a. To organize family welfare programme through family welfare centres.
b. To create an atmosphere of social acceptance of the programme and to support all voluntary
organizations interested in the programme.
c. To educate every individual to develop a conviction that a small family size is valuable and to
popularize appropriate and acceptable method of family planning
d. To disseminate the knowledge on the practice of family planning as widely as possible and to
provide service agencies nearest to the community. Ministry of Health and Family Welfare

c. The department of Indian system of medicine and homeopathy

It was established in March 1995 and had continued to make steady progress. Emphasis was on
implementation of the various schemes introduced such as education, standardization of drugs, enhancement
of availability of raw materials, research and development, information, education and communication and
involvement of ISM and Homeopathy in national health care.

Most of the functions of this ministry are implemented through an autonomous organization called
DGHS.

Organization Structure

Ministry of health and family welfare

Cabinet minister

Ministers of states

Deputy ministers
 Dept. of health Dept. of family welfare Dept. of Indian
System of Medicine
and Homeopathy

Secretary health secretary

secretary

Additional secretary
Chief Director Joint secretary
Joint secretaries Director Ayurveda JS
and siddha
Director General Health services

Addl. Director generals.

II. Directorate General of Health Services

Organization chart

Functions of Directorate General of Health services

General functions
 Surveys
 Planning
 Coordination
 Programming and appraisal of all health matters
Specific function
 International health relations and quarantine of all major ports in country and international airport.
 Control of drug standards
 Maintain medical store depots
 Administration of post graduate training programmes
 Administration of certain medical colleges in India
 Conducting medical research through Indian Council of Medical Research ( ICMR )
 Central Government Health Schemes.
 Implementation of national health programmes
 Preparation of health education material for creating health awareness through Health Education
Bureau
 Collection, compilation, analysis, evaluation and dissemination of information
 National Medical Library

III. Central Council of health

Organization chart

Functions
 To consider and recommend broad outlines of policy related to matters concerning health like
environment hygiene, nutrition and health education.
 To make proposals for legislation relating to medical and public health matters.
 To make recommendations to the Central Government regarding distribution of grants-in-aid.

2) At State Level
At present there are 29 states in India ,with each state having its own health administration.
In all the states, the management sector comprises the State ministry of Health & a directorate of health.
It is headed by a minister of health and family welfare and a deputy minister of health and family welfare.
The health secretariat is the official organ of the state minister of health and is headed by a secretary who is
assisted by deputy secretary, under secretary and a large administrative staff. The secretary is a senior officer
of the Indian administrative services.

1. State ministry of health

2. State health director

 Two separate major departments, medical and public health were functioning in the state
 The heads of this departments were known as surgeon general & Inspector general of civil hospitals
& director of public health.
 The directorate of health services or the directorate of medical and health services. chief technical
adviser of state government.
 The directorate of health and family welfare. assisted by deputies & assistants.
Two types: Regional & functional.
 Regional director inspect all the branches of public health.
 functional directors are usually specialist of particular branch of public health such as mother &
child health, family planning etc.
3)At District level
 There are 707 ( year 2016census) districts in India. Within each district, there are 6 types of
administrative areas.
1. Sub –division
2. Tehsils ( Talukas )
3. Community Development Blocks
4. Municipalities and Corporations
5. Villages and
6. Panchayats
Disrtict Level
Districts

Tehsils /Talukas (200-600 villages) Town Area Committee (5,000-10,000 Pop)

Community Development Blocks Municipal Board (10,000- 2 Lac Pop)

(approx 100 Villages & 80,000 -1.2 Lac Pop) Corporations (> 2 lac pop)

Municipalities & Corporations

Villages

Panchayats
• Most districts in India are divided into two or more Sub divisions, each in charge of an assistants
collector.
• Each division is again divided into talukas, incharge of tehsildar. A taluka usually comprises between
200 to 600 villages.
• The community development block comprises approximately 100 villages, and about 80,000 to
1,20,000 population, in charge of a block development officer.
• Finally, there are the village panchayats, which are institutions of rural local self - government.

The urban area of the district are organized into..

• Town area committees.(5,000 to 10,000) like panchayats. provide sanitary services.
• Municipal boards.(10,000 to 2,00,000)-chairman/president,3-5 year.
• Function – construction, maintenance of roads, sanitation, drainage, street lighting, water supply,
maintenance of hospitals & dispensaries, education, registration of death& birth.
• Corporations.(above 2,00,000) -Mayors

Panchayati raj:
The Panchayati raj is a 3-tier structure of rural local self government in India, linking the villages to the
district. The three institutions are:
• Panchayat (at the village level)
• Panchayat Samiti (at block level)
• Zila parisad ( at the district level)

1) At Village Level:
a) Panchayati Raj at village level consist of:
The Gram Sabha : Assembly of all adults of village –twice a year- discuss important issues &
proposals related health matters & elects members of gram panchayat.
The Gram Panchayat: It consist of 15-30 elected members. covers 5000 to 20,000 population.
Elected president (Sarpanch, Mukhya Sabhapati),Vice president & a panchayat secretory. It is
executive organ of gram sabha & resposible for overall planning & dev. Of villages.
The functions of the panchayat secretory is: Maintenance of sanitation & public health, socio-
economic development of villages
 Nyaya Panchayat: Consist of 5 members from panchayat. It tries to solve dispute between two
parties.
b) Panchayat Samiti at block level:
• It consist of 100 villages & 80,000 to 1,20,000 population.
• It includes following members: all sarpanches of village panchayat in the block, MLAs, MPs from
the district, Representative of women, SC,ST & cooperative societies.
• BDO is the ex-officio secretory of the panchayat samiti.is resposible for community development
programme, the funds provided from government.
• The BDO & his staff give technical assistance & guidance to the village panchayats engaged in
development work.
c) Zilla Parishad at district Level:
• It is the agency of rural local self-government at the district level.
• Members: All the heads of panchayat samities in the district, MPs, MLAs of district, Representative
of women, SC ST, two person who have experience in administration, rural development.
• The collector of district is a non voting member. Zilla Parishad is headed by the chirman also known
as Adhikasha.
• Supervise & co-ordinate development programmes carried by the Gram samities in the blocks.
• Functions & Powers vary from state to state. In Gujarat District heath & family planning officers are
under zilla parishad.

 Health Services
o Out patient services -Patients who don’t require hospitalization can receive health care in a clinic.
An out patient setting is designed to be convenient and easily accessible to the patient.
o Clinics – Clinics involve a department in a hospital where patients not requiring hospitalization,
receive medical care.
o Institutions – Hospitals – Hospital have been the major agency of health care system.

In broad sense the health services should be

a. Comprehensive
b. Accessible
c. Acceptable
d. Provide scope of community participation and….
e. Available at an affordable cost by country and community

Health care systems

Intended to delivery healthcare services and represented by five major sectors different from each other by
health technology
1. Public health sector
a. Primary health care
 Primary health centers
 Sub centers
b. Hospitals/Health centers
 Community health centers
 Rural hospitals
 District hospitals/health centers
 Specialist hospitals
 Teaching hospitals
c. Health insurance schemes
 Employees State Insurance
 Central Govt. Health Schemes

2. Private sector
a. Private hospitals, polyclinic, nursing homes and dispensaries
b. General practitioners and clinics
3. Indigenous system of medicine
b) Ayurveda and Siddha
c) Unani and Tibbi
d) Homeopathy
e) Unregistered practitioners

4. Voluntary health agencies

5. National health programmes

 PRIMARY HEALTH CARE IN INDIA

Introduction
In 1977, GoI launched Rural Health Scheme based on the principle of “placing people’s health in people’s
hand”. Subsequently in the international conference of Alma-Ata(1978)the goal of “Health for all” by 2000
through primary health care approach was set. Keeping in view WHO “Health for all” by 2000 GoI
formulated National health policy 2002
More recently GoI formulated NRHM and Indian Public Health Standards (IPHS) in this regards
In order to provide quality care in the public health agencies of health care delivery IPHS are being
prescribed. These standards provides basic promotive, preventive and curative primary health care to the
community and achieve and maintain an acceptable quality of care
These standards would help monitor and improve functioning of the health care delivery system

 RURAL HEALTH CARE SYSTEM IN INDIA

 Sub Centre (SC)
Most peripheral contact point of community with Primary Health Care system; manned with one MPW(M)
and MPW(F)
 Primary Health Centre (PHC)
A Referral unit for 4-6 Subcentres; 4-6 bedded manned with a Medical Officer in-charge and 14
subordinate paramedical staff no. of PHCs with specialized Health Services
 Community Health Centre (CHC)
o A 30 bedded Hospital/ Referral unit for 4 no. of PHCs with specialized Health Services

 RURAL HEALTH CARE SYSTEM IN INDIA

 The health care infrastructure in rural areas has been developed as a three tier system and is based
on the above population norms.
Health Facility Population Norms

Plain Area Hilly/Tribal/Difficult Area

Sub-Centre 5000 3000

Primary Health Centre 30,000 20,000
Community Health Centre 1,20,000 80,000

2) Sub Center
 The most peripheral and first contact point between the primary health care system and the
community.
 The Ministry of Health & Family Welfare is providing 100% Central assistance
 They are established on the basis of
o One SC for every 5,000 pop in general and…
o One SC for every 3,000 pop in hilly, tribal and backward areas
 Each Sub-Centre is manned by one Male and one female Health Worker.
 One Lady Health Worker (LHV) is entrusted with the task of supervision of six Sub-Centers.
 Sub Centre are assigned tasks relating to interpersonal communication in order to bring about
behavioral change and provide services in relation to..
 Maternal and child health,
  Family welfare,
 Nutrition,
 Immunization,
 Diarrhea control and
 Control of communicable diseases programmes.
 The sub centre are provided with basic drugs for minor ailments.

 Primary Health Center

 PHC is the first contact point between village community and the Medical Officer.
 The PHCs were envisaged to provide an integrated curative and preventive health care to
the rural population with emphasis on preventive and promotive aspects of health care.
 The PHCs are established and maintained by the State Governments.
 At present, a PHC is manned by a Medical Officer supported by 14 paramedical and other
staff.
 It acts as a referral unit for 6 SubCentres.
 It has 4 - 6 beds for patients.
 The activities of PHC involve curative, preventive, primitive and Family Welfare Services.
 National Health Plan (1983) proposed reorganization of PHCs on the basis of….
 One PHC for every…..30,000 pop in Rural areas
 One PHC for every…..50,000 pop in Urban areas
Functions of PHCs
 Medical care
 Health programmes
 MCH care and family planning
 Health education and training
 Referral services
 Safe water supply and basic sanitation
 Prevention and control of locally endemic diseases
 Collection and reporting of vital events
 Basic laboratory services

Staffing of PHCs
Staff Type-A Type-B
Essential Desirable Essential Desirable
Medical officer-MBBS 1 1 1*
Medical officer-AYUSH 1* 1*
Accountant cum data entry 1 1
operator
Pharmacist 1 1
Pharmacist AYUSH 1 1
Nurse midwife (Staff-nurse) 3 +1 4 +1
Health worker (female) 1* 1*
Health Assistant (male) 1 1

Health assistant (female)/lady 1 1

health visitor
Health educator 1 1
Laboratory technician 1 1
Cold chain & vaccine logistic 1 1
assistant
Multi skill group-d worker 2 1
Sanitary worker cum watchman 1 1 +1
Total 13 18 14 21

 Community Health Center (CHC)

  These were established by upgrading the primary health centers
 CHCs are being established and maintained by the State Government.
 centers, each community health center should cover a population of 8000 to 1.2 lakh
 It is manned by four medical specialists i.e. Surgeon, Physician, Gynecologist and
Pediatrician and supported by paramedical and other staff.
 It has 30 in-door beds with one OT, X-ray, Labour Room and Laboratory facilities.
 It serves as a referral centre for 4 PHCs and also provides facilities for obstetric care and
specialist consultations.

Functions of CHCs
1. Care of Routine and Emergency Cases in Surgery
 Dressings, I&D, and surgery for Hernia, Hydrocele, Appendicitis etc.
 Emergencies like Intestinal Obstruction, Haemorrhage, etc.
 Other management including nasal packing, tracheostomy, foreign body removal etc.
 Fracture reduction and putting splints/plaster cast.
 Conducting daily OPD.
 Care of Routine and Emergency Cases in Medicine
 Daily OPD
 Handling all the emergency and routine cases
2. Maternal Health
 Minimum 4 ANC check ups including Registration & associated services
 1st visit: Within 12 weeks—preferably as soon as pregnancy
 2nd visit: Between 14 and 26 weeks
 3rd visit: Between 28 and 34 weeks
 4th visit: Between 36 weeks and term
 24 hr delivery services including normal and assisted delivery and cesarean section
 Managing labour using Partograph.
 Minimum 48 hours of stay after delivery, 3-7 days stay post delivery for managing Complications
3. Newborn Care and Child Health
 Essential Newborn Care and Resuscitation
 Counseling on Infant and young child feeding
 Routine and emergency care of sick children
 Full Immunization of infants and children against VPDs
 Management of Malnutrition cases.
 Family Planning
 Counseling, provision of Contraceptives, NSV, Laparoscopic Sterilization Services and their follow
up.
 Safe Abortion Services
4. All National Health Programmes delivered through CHCs
 School health services
 Others
 Blood storage facility
 Essential laboratory services
 Referral (transport) services
 Maternal Death review (MDR)

Staffing of CHCs
Health services of Urban Area:
• Hospitals: District hospitals, state level hospitals, medical college hospitals.
 • Health services for Defense & Railway Employers are rendered by specially organized “Armed
Forces Medical Services” & Railway Health Services.
• National Health Programmes
• The indigenous system of medicine
Health insurance
It is at present limited to industrial workers and their families. The central government employees are
also covered by the health insurance.
These are two types
• ESIS
• CGHS
Employees state insurance scheme(ESI)
• It was started under Parliament Act in 1948 to provide for medical Benefits in cash and kind of
sickness, maternity, employment injury,
• pension for dependent on the death of worker because of employment injury.
 Central Government Health Scheme: (CGHS)
• For central government Employees. Gradually it was extended for Autonomous organisations
employees, Member of Parliament, retired central government servants, Widows, governors &
retired judges.
VOLUNTARY SYSTEM:
NGOs – voluntary in nature & contribute in public health by providing health services or health education,
by advertising research etc.
• Voluntary Health Agencies :
 Tuberculosis Association of India
 Family Planning association of India
 Indian Red Cross Society
 The All India Blind Relief Society

COMMUNITY NURSING SERVICES:

• 1 ANM for 3000 population (2 per sub centre)
• 1 ANM for 1500 population for hilly areas.
• 1 Health supervisor for 7500 population (for supervision of 3 ANMs)
• 1 PHN for 1 PHC (3000 population to supervise 4 Health Supervisors)
• 1 PHN officer for 1, 00, 000 population (Community Health Centre.)
• 2 District Public Health Nursing Officers for each district.

SUMMARY
Today I covered Indian constitution and health care delivery system in India. Indian constitution’s
definition, purpose, need and preambles of constitution. Health care delivery system’s objectives, purposes,
philosophy, levels of health care, levels of health care delivery system India.

CONCLUSION
Indian constitution is a very important part and every individual should know the rights and duties to make
the country more powerful and development. Health care delivery system is a process to provide care to
each individual for the promotion of health and prevention of disease.

BIBLIOGRAPHY
1. BT Basvanthappa,” NURSING ADMINISTRATION”, 3 rd Edi; Jaypee Brothers,Medical Publishers
(P) Ltd, Daryaganj, New Delhi (India), P.P. 211-218.
2. I.Clement,” MANAGEMENT OF NURSING SERVICES AND EDUCATION”,2 nd Edi;
ELSEVIER publication India pvt ltd, Haryana (India), P.P. 438-463.
3. Basheer .P.Shebeer ,A CONCISE TEXT BOOK OF ADVANCED NURSING PRACTICE 1st
edition, EMMESS Medical Publishers, 2012,Pp:316-325
4. BrarNavdeepKaur and RawatHc,“TEXTBOOK OF ADVANCED NURSING PRACTICE” ,1st
edition, Jaypee Brothers Medical Publishers(p) Ltd,New Delhi. 2015, Pp- 211-229
Net reference
1. Levels of health care in India, Available from URL:
http://www.arthapedia.in/index.php?title=Primary,_Secondary_and_Tertiary_HealthCare
2. https://www.slideshare.net/jamesmacroony/healthcare-delivery-system-in-india
3. https://www.slideshare.net/drjayeshpatidar/health-care-delivery-system-20064220