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Part of the FMGE study roadmap. Botany topic psm-003 of Botany.

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Health Administration and Health Care Delivery

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Health Administration and Health Care Delivery — Key Facts for FMGE Core concept: India’s health system has multiple levels from primary to tertiary care; understanding the structure helps in policy and management questions High-yield point: Primary Health Centre (PHC) is the basic unit; Community Health Centre (CHC) is the first referral unit; NRHM transformed rural health ⚡ Exam tip: Know the difference between Indian systems of medicine (Ayurveda, Yoga, Unani, Siddha, Homeopathy - AYUSH) and their integration into the health system

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Health Administration and Health Care Delivery — FMGE Study Guide

Indian Health System Structure

Levels of Health Care

Primary Health Care (first contact):

  • Sub-center (SC): One per 5,000 population (hilly/tribal areas: 3,000); one ANM, one male health worker
  • Primary Health Centre (PHC): One per 30,000 population (revised to one per 20,000 in hilly areas); 4-6 bed facility; medical officer + staff
  • Community Health Centre (CHC): One per 100,000 population; 30-bed facility; specialists (Medicine, Surgery, OBG, Pediatrics) + support staff; first referral unit

Secondary Health Care:

  • District Hospital (100-500 beds), Sub-divisional hospitals
  • District hospital is referral center for CHCs

Tertiary Health Care:

  • Medical colleges, super-specialty hospitals
  • Advanced diagnostic and treatment facilities

Rural Health Structure

  • Village: ASHA (Accredited Social Health Activist) - community health volunteer
  • Sub-center: Female health worker (ANM)
  • PHC: First formal health facility in villages
  • CHC: First referral unit

Urban Health Structure

  • Urban Health Posts (UHP): For 40,000-50,000 population (in slums)
  • Urban Primary Health Centres (UPHC): For 50,000 population
  • Maternal and Child Health (MCH) centres
  • District hospitals

National Health Programs

National Rural Health Mission (NRHM) / National Health Mission (NHM)

  • Launched 2005 (extended to urban areas as NUHM in 2013)
  • Goals: Accessible, affordable, quality health care
  • Key components: ASHA, Untied Funds, RCH flexipool, National Disease Control Programs
  • Accredited Social Health Activist (ASHA): Female community health volunteer; trained, incentivized; acts as link between community and health system

Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A)

  • Comprehensive approach across life cycle
  • Focus on maternal health, newborn health, child health, adolescent health

Janani Suraksha Yojana (JSY)

  • Cash assistance to pregnant women delivering in institutions
  • Reduces maternal and neonatal mortality
  • Integration with institutional delivery promotion

Janani Shishu Suraksha Karyakram (JSSK)

  • Free delivery, C-section, drugs, diagnostics, transport for pregnant women and newborns

National Immunization Program

  • Universal Immunization Programme (UIP)
  • Mission Indradhanush: Focus on unvaccinated/under-vaccinated children

National Health Mission Components

  • Free Drugs Initiative
  • Free Diagnostics Initiative
  • National Health Care Financing
  • Mobile Medical Units

Other National Programs

  • NPCDCS: National Programme for Prevention and Control of Cancer, Diabetes, CVD, Stroke
  • NVBDCP: National Vector Borne Disease Control Programme (malaria, dengue, filaria, Japanese encephalitis)
  • NLEP: National Leprosy Elimination Programme
  • NTCP: National Tobacco Control Programme
  • NMHP: National Mental Health Programme

Health Infrastructure and Resources

Human Resources in Health

  • Doctors: Allopathic, AYUSH (Ayurveda, Yoga, Unani, Siddha, Homeopathy)
  • Nursing: ANM (Auxiliary Nurse Midwife), GNM, B.Sc. Nursing, M.Sc. Nursing
  • Allied health professionals: Pharmacists, lab technicians, radiographers

Physical Infrastructure

  • District hospitals: Medical care, training center
  • CHC: First referral for PHCs
  • PHC: Primary care, health education, disease surveillance
  • Sub-centers: Outreach, ANC, immunization, health promotion

Financial Resources

  • Public health expenditure: As % of GDP (India ~1.3% of GDP on health - low)
  • Out-of-pocket expenditure: High (60%+); catastrophic health expenditure is major cause of poverty
  • Health insurance: Rashtriya Swasthya Bima Yojana (RSBY), Ayushman Bharat (PMJAY)

AYUSH Systems

  • Ayurveda: Traditional Indian medicine; doshas (vata, pitta, kapha)
  • Unani: Greek-origin medicine via Islamic tradition
  • Yoga: Mind-body practices for health
  • Siddha: Tamil tradition; similar to Ayurveda
  • Homeopathy: “Like cures like,” diluted preparations
  • Integration: These systems are officially recognized and integrated into health care delivery

Health Planning and Management

Planning Cycle

  • Situation analysis
  • Setting objectives
  • Determining strategies
  • Resource allocation
  • Implementation
  • Monitoring and evaluation

Health Management Information System (HMIS)

  • Data collection at all levels
  • Used for planning, monitoring, evaluation
  • Key indicators tracked: Morbidity, mortality, service utilization

Quality Assurance

  • Standards: Indian Public Health Standards (IPHS) for health facilities
  • NABH: National Accreditation Board for Hospitals
  • Patient safety: Infection control, medication safety, reporting systems

Decentralization

  • Panchayati Raj: Local self-government in rural areas
  • District Health Administration under District Collector
  • Village Health Sanitation and Nutrition Committee (VHSNC)

Health Policies and Acts

Important Health Legislations

  • Drugs and Cosmetics Act: Regulation of drugs and cosmetics
  • PFA Act (Prevention of Food Adulteration): Food quality
  • Maternal and Child Health Acts: RHR, MTP
  • Mental Health Act: Rights of mentally ill
  • Clinical Establishments Act: Registration and regulation

Recent Initiatives

  • Ayushman Bharat (Pradhan Mantri Jan Arogya Yojana - PMJAY): Health assurance cover of Rs. 5 lakh per family for secondary and tertiary hospitalization; targeting poor and vulnerable families
  • Health and Wellness Centres: Transforming sub-centres and PHCs into comprehensive primary care centres
  • National Digital Health Mission (NDHM): Health ID, health records, registries

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