Health Care Delivery Concepts and Issues Shiv Chandra Mathur Professor of Public Health and Director State Institute of Health and Family Welfare, Rajasthan Jaipur, India Dr.Shiv Chandra Mathur is a public health specialist. He has taught epidemiology in Medical Colleges of Rajasthan for more than two decades. Currently he is Director of apex level training and research institute in the Health sector in the largest state of India. Dr.Shiv Mathur is deeply involved in implementing the HRD component of RCH project (funded by World Bank/UNFPA/European Commission) in India. He has earlier contributed seven lectures to the Supercourse including different components of Reproductive Health which are available on the same website. . Dr.Shiv Chandra Mathur is a public health specialist. He has taught epidemiology in Medical Colleges of Rajasthan for more than two decades. Currently he is Director of apex level training and research institute in the Health sector in the largest state of India. Dr.Shiv Mathur is deeply involved in implementing the HRD component of RCH project (funded by World Bank/UNFPA/European Commission) in India. He has earlier contributed two lectures to the Supercourse on different components of Reproductive Health which are available on the same website. This lecture is focused on issues related to organization of health care delivery services through publi system. This lecture is primarily addressed to the s Young students of Public Health who should develop the capacity to conceptualize the issues involved in organizing the health care services by the State.

Issues Health is a fundamental human right National Governments all over the World are striving to expand and improve their health care services. 11/23/2018 Shiv Chandra Mathur

Predominantly urban oriented Mostly curative in nature Limited Access Current Criticism of Health Care Services (Provided by the Governments) Predominantly urban oriented Mostly curative in nature Limited Access Developing countries in particular are struggling to carry the quality health services to the far flung villages, trying to broaden the base by strengtening the health care services delivered through peripheral facilities and seeking participation of the communities to enhance the access to the health care services. 11/23/2018 Shiv Chandra Mathur

What is Health Care It is more than Medical Care It embraces a multitude of services provided to individuals and families by health professionals to promote, monitor and uphold the status of their health. Medical care is a subset of health care. 11/23/2018 Shiv Chandra Mathur

Levels of Health Care Primary Health Care Secondary Health Care Tertiary Health Care 11/23/2018 Shiv Chandra Mathur

Health Care Delivery - Changing Concepts Comprehensive Health Care Basic Health Services Primary Health Care Health Care System Development Over last fifty years, most of the political democracies have passed through changing modes in their health care delivery which can broadly be clubbed into four groups. 11/23/2018 Shiv Chandra Mathur

Comprehensive Health Care Term coined by Bhore Committee(1946) in India Provision of preventive, curative and promotional health services from “womb to tomb” to every individual residing in a defined geographic area. It implies carrying services as close to the people as possible; eliciting community participation to the fullest possible; available to all irrespective of their capacity to pay for it; and should particularly look after the vulnerable section (women, children and old age) of the society. In india, health care delivery system throughout all states were developed on this premise for over ten five year plans. 11/23/2018 Shiv Chandra Mathur

Basic Health Services Coined jointly by WHO/Unicef in 1975 It is a network of coordinated, peripheral and intermediate health units capable of performing effectively a selected group of functions essential to the health of an area and assuring the availability of competent professionals and auxiliary personnel to perform these functions. Change in terminology from ‘comprehensive’ to ‘basic’ did not affect materially the quality or content of health services. But it was an indication of keeping the Government on toes in making efforts to sharpen the delivery of health care services consistently. 11/23/2018 Shiv Chandra Mathur

Primary Health Care It is essential health care made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and country can afford. Essentially it is the outcome of Alma-Ata convention organized jointly by WHO, Unicef and UNFPA in September 1978. Although details of Primary Health Care (PHC) are out of scope of this lecture but it would not be out of place to mention here that PHC embraces in education on health issues; food and nutrition; mother and child health; immunization; prevention snd control of locally endemic diseases and provision of essential drugs. 11/23/2018 Shiv Chandra Mathur

Principles of Primary Health Care Equitable Distribution Community Participation Intersectoral Coordination Appropriate technology 11/23/2018 Shiv Chandra Mathur

Health For All Attainment of a level of health that wil enable every individual to lead a socially and economically productive life. Movement on HFA-2000 was initiated through World Health Assemble 1977 on the fundamental UN principle of striking equity everywhere. It got a boost through Alma-Ata convention in 1978. WHO evolved a global strategy and 12 global indicators as the basic point of reference for assessing the progress towards HFA. 11/23/2018 Shiv Chandra Mathur

Health Care Systems Public Systems: Private Sector: Indigenous Systems PHC and Subentries Rural Hospitals; District Hospitals; Teaching Hospitals ESI and CGHS Defense and Railways Private Sector: Polyclinics and Nursing Homes GP’s and clinics Indigenous Systems Ayurveda and Siddha Unani and Tibbi Homeopathy Naturopathy Voluntary Health Agencies National Health Programme 11/23/2018 Shiv Chandra Mathur

Components of Health System Development Quality Care component Human Resources Development NGO participation Public-Private Participation IEC 11/23/2018 Shiv Chandra Mathur

Health System Development It is a combination of management sector and involves organizational matters to translate policies into services In India, Health System has three main links i.e. Central, State, and local or peripheral Lately there is lot of emhasisi on developing the health systems which implies concurrent development of primary and secondary systems at large , linking them and strengtening the referral between the three levels including the tertialry level. Most of the Indian states in last 15 years have implemented World Bank supported projects to develop their health systems. 11/23/2018 Shiv Chandra Mathur