 Hello everyone, welcome back to a new session on dentist treatment. Today's topic is healthcare delivery system in India. So in India, how the health is provided to the people. So let's see what is health and what is care health is a fundamental right. And according to W.H.A. definition, we have already seen this definition. It is a complete state of physical mental and social well-being and not just absence of disease or infirmity. Care is what services rented by members of health profession. It can be classified as healthcare or medical care. So healthcare is a multitude of services provided to individual by agents of health services or profession. It includes everything. It includes hospitals, it includes PhDs, community health centers and NGO workers and voluntary associations. Medical care is strictly based on the services that are provided directly by the physicians or entered as a result of physicians instructions, which is a subset of healthcare. So medical care is when we seek for a service, when we go to a hospital and we diagnose with a disease and doctor prescribes certain treatments or certain care. So that becomes medical care. So this is a small subset because not all people go to medical care because many of the people will not be knowing the disease what they have because mostly they will be on asymptomatic or early stage. So healthcare is a multitude of services and medical care is just a subset of healthcare which is directly given by the physicians. So the best way to provide healthcare to the vast majority of undeserved rural people and urban poor is by primary healthcare services. So primary healthcare is what India is following currently because India is such a huge country with around 130 crores of people. So building so many hospitals and so many medical colleges will not be sufficient for such a huge country with such a huge population and the best way to provide a good health, optimum health for all the citizens of India is to provide health at the grass root level or at the primary level through the primary health centers and sub centers. That is a concept India adopted after 1978. So that is known as primary healthcare will see much more details of primary healthcare in the coming slides. So primary healthcare has a biggest advantage of community participation because we are involving the community people into this health system so that the health will be accessible for many of the people. So levels of healthcare. So I told you that primary level of healthcare that is the first contact of this individual's family and community with the health system. So that is a grass root level. It is usually done by primary health centers and sub centers. We know that every Indian can reach to a sub center or a primary health center by walking or by using a bicycle or rickshaw because it is that much spread out in our country. Any Indian can have an access to a sub center or primary health centers but a lack of people are not having access to a medical college or a bigger hospital or a tertiary care hospital. So the accessibility is the prime most important thing in healthcare facility. So if you have a good access people will seek for healthcare. So primary health centers and sub centers are the primary care unit. So these are the agencies for multi-purpose workers, village health care and trained eyes. So we know we have seen many people in our villages with name multi-purpose worker, village health care, ASHA workers, trained eyes. So they are connecting link between the people and our primary care level that is PhDs and sub centers. So these people are working for us under PhD and sub centers. So these are the connecting link between people and primary level. So what is secondary level? So as the level goes, the number of healthcare system reduces but the facility increases. So the secondary level is next higher level. More complex problems are dealt with. They are like district hospitals and community health centers. They have more beds, more doctors, more facilities, x-ray facilities, more surgical options. So they have better facilities but there will be less in number compared to the primary level. So tertiary care level is the most specialized level of care and which requires specific facilities and highly specialized health workers. So they are the ultimate level of healthcare. So beyond that there is no level of healthcare and the tertiary levels are very few in number just like government hospitals that is government medical colleges all in the institute of medical science or such tertiary level where all the treatment facility for an individual will be done. Okay. So these are the medical colleges all in the institute regional hospitals and specialized hospitals. So let's see what are the changing concepts of healthcare. So we have seen many changing concept, the changing concept of health, changing concept of public health. So that is different. We are seeing changing concepts of healthcare in our country or in world. So the first one was comprehensive healthcare which was first used by Boer committee in 1946. It meant provision of integrated so integrated preventive, curative and promotional health services. It is a comprehensive way. So we give everything from home to home. So from a childbirth till he goes to a dome. So all preventive, curative, promotional services will be provided. That is a very holistic approach and very idealistic approach. Two will be provided to individuals residing in a defined geographic area. So that was comprehensive healthcare and the basic health services put forward by UNICEF and WHO in 1965. It is like network of coordinated peripheral and intermediate health units which are capable of performing effective selected group of functions essential to the health of an area and assuring the availability of competent professional and auxiliary persons. It is nothing but just like our primary health centers and community health centers. They act as a peripheral and intermediate units with proper workforce and to provide healthcare. So that is basic health services that is different, different concept how to provide health to people. And this is most accepted concept in the developing country or country with huge population where the accessibility is an issue that is primary healthcare concept. So it is started in a World Health Assembly that is Alma Mater Conference 1978. The matter is a place in USSR that is Russia. So this has defined as healthcare based on practical, scientifically sound, socially acceptable methods and technology made universally accessible. So accessibility is a big thing to individuals and families through their full participation. Community participation is a key at a cost that the community and country can afford. So in China they were doctors like barefoot doctors they used to go to houses and treat patients. So from that concept this primary healthcare is evolved because it has to be at accessible level and socially acceptable level and also with a full participation of the community. So what are the principles of primary healthcare? So again we have seen different principle, principles of health education, principles of epidemiology. So many principles are there. So never get confused. So principles of primary healthcare. So how a primary healthcare should be? So the first one is equitable distribution. So equity and equality is different. Equality is if we have if we have 50 people and if we have 50 apples and 5 people if it is equally distributing means we give 10 apples to each person that is one will be getting 10 so totally 50. But if it is an equitable distribution we need to first know the need of the person. If one feels very hungry we need to provide more apples to that person. If one feels not very hungry we can give a little bit of apples like 4 or 5 apples. If somebody is not at all feeling hungry we can just provide him a one or two apples. It is based on the felt need, need of a person, how much he wants. So that is equitable distribution. So there should be a social justice. So always there should be injustice when we give equal distribution. We cannot provide equal healthcare to all the people because rural people are more affected with diseases. So there should be more they should be given more health facilities compared to the urban people. So that is equity. So equitable distribution is the irrespective of their ability to pay and almost have access to health service. So that is the first and foremost principle equitable distribution then community participation that is the key of primary healthcare. We should involve the people from the community. So we have seen the primary health centers have workers like village health guide, Asha workers, local dies. They are all selected from that community itself. So they are the non people for the villages. So when there is a problem they'll ease they have a very ease of access to these people. They communicate very well compared to some other unknown stranger who has come from different state or different part. So they don't get a good rapport with strangers. So when they have a very known people, when they have a neighbor at primary health centers, they communicate very easily and they have a good understanding and the rapport will provide a good healthcare for those in need. So that is community participation just like village health guide, local dies and Asha workers. They are taken from the community itself. And the third principle is intersectoral approach. So always there should be intersectoral coordination of the all the activities. So any activity we are planning to put into this community there should be a communication between all the sectors administrative section, political section and the health department and the educational department and all other departments should be in unison to provide a proper program which would benefit for the community. And the last one is appropriate technology. The technology should be appropriate based on the needs of the community. So community, the people should accept it, people should comprehend it. So it is scientifically should be scientifically sound, adaptable to local needs that is important. It should be adaptable to local needs. We provide a screen with health education classes with English language or any other language in a rural area is not at all acceptable. It is not at all adaptable to local needs. So I have a acronym for this also ECIS that is equitable distribution, community participation, intersectoral coordination. And this is a sorry, this is a ECIA. So eclair cake is awesome. So that is a name. So we have that epidemiology acronym every coffee requires sugars. So that is EC or S. So this is ECIA. So let it be anything ECIA or ECRS. So just keep in mind that primary health care is a village level provision of health care through the community participation and with equitable distribution. So though these are the principles of primary health care, so now we look into healthcare system of our country. So we have basically five levels that is public health sector, private and indigenous system, voluntary health agencies and national health programs. So public health sector, we have primary health care. That is primary health centers and sub centers secondary level, that is community health centers, rural hospital, district hospital and this is tertiary level like specialist hospital. Then we have few health insurance schemes like ESIS and central government health schemes and some other agencies they provide to their employees like defense and railway hospitals. So we know that the main sector is belong to this private sector. So private hospitals, polyclinics, nursing homes and we have our own medical system that is Ayurveda, which is Indian origin, Siddha, Ayunani, Permianpathy and we have voluntary health agencies and various national health programs which was under the five year plans. So what are the primary health care system in India? So we have three tier systems. So this is a common question, what is the three-tier system of primary health care or rural health care? So we have sub-center, primary health centers and community health centers. So this is a three-tier system and we provide primary health care. So these are the people, these are the programs or these are the people which connect people to our sub-center or the primary level that is village health guide, local dhais, asha workers. So these are the people who are involved in the village among the people. Those people like asha and local dhais and village health guide connect the people to primary level that is sub-centers or primary health centers. So village level we have seen it is for equitable distribution. So we have many schemes at village level that is village health guide, ICDS, local dhais and asha workers. Asha is accredited social health activists. So let's see what is village health guide scheme which was started in 1977 under community health worker scheme. It is a person with good social service and not a full-time government employee. So it will be the first contact between individual and health system. So it was launched in all states except Kerala Karnataka, Tamil Nadu, AP and Jammu Kashmir because already there were existing programs in Kerala Karnataka. All these states already have having program. So in union ministry, in 2002 discontinued this program and later asha program was replaced. So local dhais, so this village health guide preferably will be women of six standard education and they should be able to spend two to three hours every day for community health worker and will be chosen by the grand panchayat. So local dhais is like birth attendants. So they are very not very common nowadays because nowadays government is promoting hospital delivery not house delivery. So these people were trained for delivery at house. So they have training like PhDs and sub centers for two days in a week and four days a week they accompany health worker in villages. So this is mainly for the rural India where the hospital delivery is not very common. So they need to conduct at least two deliveries under the guidance and they should know about asepsis they will be having a kit. So ICDS is a wonderful program to improve the child's nutritional status. So it is mainly focusing on zero to six years for their psychological development. It is to reduce the incidence of mortality, mobility, while nutrition and school report. So up to six years the government provides nutrients like milk, egg and cereals so that the child will be sent to these places for at least for food. So they will be getting good nutrients if they are at home a poor parent might not be able to feed him. So just for the sake of getting good food they will be sent to these places that is mostly Anganwadi Anganwadis. So they get good nutrients and mild nutrition problems will be solved to an extent. So that was ICDS and next is ASHA workers. So this is accredited social health activities before it was village health guide scheme. So what they do is we keep Indian government after the NRHM scheme they work under NRHM. So every one ASHA worker is 4,000 population that is the norm and they will be chosen by the panchayat and ASHA workers will be it should be between 25 to 45 years married, widowed or divorced woman and she should be having an education of class 8. So we will go back to Anganwadi workers. So it is for 1,000 population and 100 such workers in each ICDS project. So training a 4 months period and they will be paid 1,500. Now it is very high this is very old data. So they have to do health checkup immunization, nutrition programs, health education and preschool education. So that's about Anganwadi workers and ASHA workers and village health guide. They were the village level people which connects people to health system or the primary level of health system. So this is a rural health care so three tier system that is sub-center primary health centers and community health center. Sub-center is the most peripheral unit between primary health care system and community. There will be only one male multi-purpose worker, female and one multi-purpose worker male. So there will be only two people at the sub-centers. They have very basic facilities like cleaning of a wound, providing some basic medicines. Whereas primary health centers is a referral unit of six sub-centers which should be four to six printed and there will be a doctor, there is a medical officer and there will be 14 subordinate paramedical staff. Community health centers is with 30 bed and which is of referral unit of four primary health centers with many specialized services. So we have seen this sub-centers referral for six and this is for referral for four primary health centers. So just see the scenario of India. We have to select a sub-center. We have to keep a sub-center for 5000 people and a primary health center for 30,000 people and community health center for 120,000 people and it is different in hilly areas. So in India presently we have around 150,000 sub-centers, 25,000 primary health centers and 5000 community health centers. So these are the population they should serve. So village level, we have dyes and then body workers, village health guide schemes and Asha workers which connects people to sub-centers. So community health centers we have seen it should be serving 80,000 to 1.2 lakh, there should be 30 bed, there should be medicine surgery, lab facilities, x-rays and there should be non-medical post and community health officer. So these are the community health center details. So we have Aayush scheme that is Indian system of medicine and Home Empathy later renamed as department of Aayush that is Ayurveda, Yoga, Urani, Sita and Home Empathy in 2003. So Aayush department or Aayush system came in 2003. So Aayush sector consists of around 1350 hospitals, all these dispensaries. So 99 colleges having postgraduate department. So Aayush is our indigenous system. So let's see what is NRHM. So NRHM is national rural health mission started in 2005. It was to provide accessible affordable and accountable quality of health services to the remotest rural region with special focus on 18 states which is having weak demographic indicators. So that is NRHM. NRHM has this structure that is village level, grand panjath level and cluster of grand panjath PHC level and block level. So these are the details, thousand population, village level 5 to 6 villages at sub centers and 30 to 40 villages at primary health center level. So always remember that PHC is primary health center and again PHC is primary health care. So wherever it is coming, meaning is different. This is primary health center. So primary health care is the first level of care we provide again primary health care has sub centers and primary health centers. So these are the NRHM go on community involvement, world capacity, building flexible financing, human resource management, monitor against great milestones. So we have few health insurance that is very health insurance. There is no health insurance like Europe, in countries or USA. Only 10% Indians have some forms of health insurance that is one is employee state insurance scheme that is one scheme which started in 1948. People who draw wages less than 15,000 and they have cash benefits and also medical care. And central government health scheme is another health insurance scheme which is for exclusively for central government employees. They have dispensaries and around 42 lack beneficiaries. Defense medical services and health care for railway employees are another two. We have many voluntary health agencies like Indian Red Cross Society, Hind Kush, Nivar and Sub-Indian Council of Child Welfare, Tuberculosis Association, BSS, Central Social Welfare Board, Kasurba Memorial Board. So these are the works they do. So rural sanitation is done by Bharat Sevak Samaj, welfare of women by Kasurba Memorial Fund, and Hind Kush, Nivar and Subba financial assistance to leprosy control. So these are activities by these voluntary health agencies. So we have many programs under national health programs which were part of our five-year plans like anti malaria, tuberculosis aids, blindness, identity efficiency, immunization program, reproductive and child health program, cancer controlled, minimum needs and 20-point programs. So health course we know that health for all was our concept in public health, the last concept was health for all concept 2000. So later the goals of Millennium Development Goals came in 2015. So this was health for all goal. These are idealistic goals WSU provides for the countries so that they can make a nationalistic plan. Then the Millennium Development Goals like eradicate poverty, achieve universal primary health education. All these are the Millennium Development Goals not very important for us. So that's all about the healthcare delivery systems. The important things are the principles of primary health care and what is primary health care and the rural system, the three-tier system existing in rural that is village level primary health centers, sub centers and community centers. That is a three-tier system and the rural health system existing in India and voluntary health agencies, national health programs and the manpowering primary health centers, sub centers, community health centers and the levels of healthcare are the main topics, main points in this chapter. So I'll come up with a new session on dentistry and more. That's all for today. Thank you.