HEALTH CARE DELIVERY SYSTEM :

Introduction:
Community Health Nursing occurs in the context of health care delivery system and the
characteristics of that system profoundly influence community health nursing practice. For
instance, the lack of emphasis on health promotion in the health care delivery system
increases the need for health promotion efforts by community health nurses.
Health and health care concerns throughout the world, and each jurisdiction
(community, state or nation) has developed a system for addressing these concerns. A health
care system is all of the societal services and activities designed to protect and restore the
health of individuals, families, groups, or communities, and these should cover full range of
preventive, curative and rehabilitative services.

OBJECTIVES:
• To improve the health status of the population and the clinical outcomes of the care.
• To improve the experience of care of patients families and communities.
• To reduce the total economic burden of care and illness.
• To improve the social justice equity in the health status of the population.

FUNCTIONS:
• To provide health service.
• To raise and pool the resources accessible today for health.
• To generate human and physical sources that make the delivery services possible.
HEALTH CARE DELIVERY CONCERNS:
Throughout the world, approximately 4.5 million children die each year from diarrheal
diseases, while communicable diseases of all kinds remain a serious problem despite raising
immunization levels for the childhood diseases from 5% to 50% of the worlds population in
the last 10 years. An assessment of the health status is required to make a plan for the health
care delivery services. The assessment will bring out major health problems. And these health
problems are the major health care concerns.

Health concerned Areas:

1. Communicable Diseases problems
2. Nutrition anemia
3. Environmental sanitation problems
4. Medical care problems
5. Population problems
6. Human response to disasters
❖ Communicable Disease problems: Malaria , TB, diarrheal diseases, Acute
respiratory infections , leprosy, filaria, AIDS , kala Azar, meningitis, viral hepatitis,
Japanese encephalitis, Enteric fever, Helminthes infections, Immunization problems.
❖ Nutritional Problems:
• Protein energy malnutrition.
• M
• Low Birth Weight.
• Exophthalmia
• IDD ( iodine deficiency disorders)
• Endemic Fluorosis.
❖ Environmental Sanitation Problems:
• Lack of safe water.
• Primitive method of excreta disposal.
• Global concern over radiation.
• Destruction of ozone layer.
• Air pollution.
• Lead poisoning.
• Chemical contamination of food supplies.
❖ Medical care problems:
• Lack of medical care professionals.
• Over- crowding in hospitals as a result of migration of people from rural areas.
• Scarcity of resources.
• Inequitable distribution of services.
• Chronic diseases and mental health problems.
• Adolescent pregnancy.
❖ Population problems:
The population explosion has inevitable consequences in all aspects of
development, especially employment, education, housing, health care, sanitation and
environment. The country’s growth rate is 1.93% and the government goal is to reduce
it to 1%.

❖ Human Response to Disasters:

Natural and manmade disasters are affecting large numbers. E.g. Toxic
chemical leak in Bhopal in 1985. International efforts coordinated by WHO and the
International Red Cross have led to the development of disaster planning groups throughout
the world.
NATIONAL HEALTH AND FAMILY WELFARE PROGRAMMES:
Since India become free, several measures have been undertaken by the National
Government to improve the health of people. Prominent among these measures are the
National Health programs, which have been launched by the Central Government for the
control of communicable diseases, improvement of environment sanitation, control of
population etc.

National health programmes:

1) National Anti-Malaria Programme (NMCP):
It was launched in India in April 1953. In 1999, the Government of India changed the
term ‘’National Malaria Eradication Programs’’ and renamed it as ‘’National Anti-
Malaria Programs’’.

2) National Filarial Control Programme (NFCP):

It has been in operation since 1955.

3) National Leprosy Eradication Programme (NLCP):

It has been in operation since 1955. In 1983, the leprosy control programme was re-
designated as National Leprosy Eradication Programme.

4) National Tuberculosis Programme (NTP) :

It has been in operation since 1962. In 1992, the Government of India , WHO, and
world bank together reviewed the NTP and this programme is called as revised
national tuberculosis control programme.

5) National AIDS Control Programme:

It was launched in 1987. In April 2002, national AIDS prevention and control policy
were approved by Government of India.

6) National programme for control of blindness:

It was launched in 1976.

7) Iodine Deficiency disorders control programme:

It is in operation since 1962.
8) Universal immunization programme:
It was launched in 1974 by WHO.
9) National cancer control programme:
It was started by government of India in the year 1975-1976.
10) National water supply and sanitation programme:
It was initiated in 1954.
11) Minimum needs programme:
It was introduced in 1974-78.
12) National mental health programme:
It was launched in 1985.
13) Child survival and safe motherhood programme.
 14) Guinea worm eradication programme
15) STD control programme.
16) Dengue fever control programme.
17) Surveillance programme for communicable diseases.
18) Diarrheal diseases control programme.
19) Kala-Azar control programme
20) Diabetes control programme.
21) Air quality monitoring programme.
22) Expanded programme on immunization .
23) Japanese encephalitis control programme.
24) Reproductive and child health programme.

NATIONAL FAMILY WELFARE SCHEMES:

The ministry of health and family welfare has a number of schemes to cover the under
privileged sections of society and help them with maternity, post and neonatal healthcare and
family planning. These include the Janani suraksha yojana, rehabilitation of polio victims and
several financial assistance schemes for surgery and other problems. Counselling centers are
also available across the country as part of the government sponsored family welfare schemes.

❖ National family welfare programme:

India launched the national family welfare programme in 1951 with the objective of
‘’reducing the birth rate to extent necessary to stabilize the population at a level
consistent with the requirement of the national economy. The family welfare
programme in India is recognized as a priority area, and is being implemented as a
100% centrally sponsored programme.
❖ National population policy:
The national population policy, 2000 affirms the commitment of government towards
voluntary and informed choice and consent of citizens while availing of reproductive
health care services and continuation of the target free approach in administering
family planning services.
❖ National rural health mission:
The national rural health mission (2005-12) seeks to provide effective health care to
rural population throughout the country with special focus on 18 states, which have
weak public health indicators and / or weak infrastructure. The mission aims at
effective integration of health concerns with determinants of health like sanitation and
hygiene, nutrition and safe drinking water through a district plan for health.
❖ Urban family welfare schemes:
This scheme was introduced following the recommendations of the Krishnan
committee in 1983. The main focus was to provide services through setting up of health
posts mainly in slum areas. The services provided are mainly outreach of RCH services,
preventing services, first aid and referral services including distributions of
contraceptives.
❖ Reproductive and child health programme:
 The reproductive and child health programme was launched in October 1997 in
cooperating new approach to population and development issues, as exposed in the
international conference in population and development held at Cairo in 1994. The
programme integrated and strengthened in services/interventions under the child
survival and safe motherhood programme and family planning services and added to
the basket of services, new areas on reproductive tract/sexually transmitted infections
(RTI/STI).
The ‘’jansankhya sthirata kosh’’ (JSK) (National population stabilization
fund) has been registered as autonomous society established under the societies
registrations act of 1860. JSK has to promote and undertake activities aimed at
achieving population stabilization at a level consistent with the needs of sustainable
economic growth , social development and environment protection , by 2045.

INTERSECTORAL COORDINATION:
The health care system is intended to deliver health care services. It operates in context
of socio economic and political framework of the country. In ,India, it is represented by
5 major sectors which differ from each other. These are:

PUBLIC SECTOR

PRIVATE SECTOR

INDIGENOUS SYSTEM OF MEDICINE

VOLUNTARY AGENCIES.

NATIONAL HELATH PROGRAMMES.

There is an increasing realization of the fact that the health care cannot be provided by the
health sector alone. In addition to health sector, all related sectors and aspects of national and
community development, such as agriculture, animal husbandry, food, industry, education,
housing public works, municipal bodies, fisheries, voluntary agencies, information and
broadcasting and other sectors.
Intersectoral coordination is the basis of primary health care. In
the basis of primary health care, intersectoral coordination is a crucial component for
promotion of intersectoral linkages which is required for the effective implementation of
health services throughout the country. Intersectoral coordination ensures convergence of
responsive working relationships for the benefit of the society. This will enable better equity
and wider coverage.

Advantages of intersectoral coordination:

• To provide sustainable basic health services to the community and to integrate these
services with other health services provided by other health sectors.
• Early detection, treatment of patients within the community itself.
• To promote cooperation and mutual understanding among various sectors.
• To take pressure off the one sector alone.
• For attaining the goal of health for all.
• To make the services available to people with early and easy access.

ROLE OF NON-GOVERNMENTAL AGENCIES:

Introduction:
Non-governmental agencies arose because there was an unmet health need. They are the
organizations that are formed by groups of people because of their interest in a particular
health concern, such as diabetes, child abuse or, environmental pollution. Voluntary agencies
are founded by donations. They are accountable to their supporters and their activities are
determined by supporters’ interest, rather than legal proceedings.

Types of non- governmental agencies:

✓ Voluntary agencies.
✓ Professional’s agencies.
✓ Philanthropic agencies.
✓ Service, social and religious organizations.
✓ Corporate agencies.

Purposes of each non-governmental agencies:

➢ Voluntary agencies:
Voluntary agencies play an important role in research and education, although they
may provide a few direct health services. In the field of health, their role is in
promotion of health , their role is in promotion of health, creation of awareness among
 people about various measures to prevent illness and provision of welfare services for
victims of different types of diseases.
They perform eight basic functions within the scientific health care sub
systems. These are:
Pioneering.
Demonstration of pilot projects.
Education.
Supplementation.
Advocacy for public interests.
Legislation.
Health planning and organization.
Health planning and organization.
Assisting official agencies.
➢ Professionals’ agencies:
Professional agencies are made up of health professionals who have completed
specialized education and have met the standards of registration, licensure for their
respective fields’ e.g. American nurse’s associations’ , INC, PNRC etc.
Role of professional’s agencies:
promoting high standards.
Certification.
Lobbying.
➢ Philanthropic foundations:
These foundations support community health throughout the world by funding
programmes and research on the prevention, control and treatment of many diseases.
➢ Service, social and religious organizations:
These play an important role in community health e.g., rotary clubs, lions club.
Members enjoy social interactions with people of similar interests in addition
to fulfilling the needs of communities.
Though their specific mission is not health, but they make important
contributions in that direction by raising money and foundation health- related
problems.
➢ Corporate agencies:
These agencies support health related progrmmes both at and away from the worksite.

ROLES OF NON-GOVERNMENTAL AGENCIES:

They can present health care needs based on their contacts with communities.
Aid to develop and strengthen local NGO activities.
Develop innovative programs.
Conducting assessment and evaluations.
Ensure full participation by individuals and communities.
Extends efforts to develop health technologies.
Recognize role of women.
Providing relief for victims.
Assisting poor.
 Solving environmental issues.
Develop infrastructure.
Technical assistance and training.
Assist national policies formation.
Provide valuable resources.

CONCLUSION:
Indian healthcare sector can be viewed as a glass half empty or a glass half full. The
challenges the sector faces are substantial, from the need to improve physical infrastructure to
the necessity of providing health insurance and ensuring the availability of providing trained
medical personnel. For companies that view the Indian healthcare sector as a glass half full,
the potential is enormous.
The healthcare industry is a complex system with many interrelated components.
It is impossible to change one component of the system without influencing others. Some
people have attempted to fix the American health care delivery system by focusing on or more
broken components.
BIBLIOGRAPHY:
✓ EMMESS, A concise text book of Advanced Nursing Practice. No.26/3,1st cross , 1st
R block, Rajajinagar,Bangalore-560010, EMMESS medical publishers, P-72-85.
✓ Park J. E, Park. Textbook of prevention and social medicine. 19th edition. Jabalpur,
bhansari bhanot publishers,2007, p-732-745.
✓ Gupta MC, Mahajan BK. Textbook of prevention and social medicine, 3rd edition,
new Delhi, Jaypee brothers’ publication, 2005, p-450-460.
✓ Indian public health standards for PHC. Available from
URL:HTTP://WWW.mhfe.org
✓ Indian public health standards for sub centers. Available from
URL:HTTP://WWW.MHFE.ORG