Healthcare Delivery Levels - Pyramid Power
- Primary Care: First contact; community-based.
- Sub-Centre (SC):
- Population: 3000 (Hilly/Tribal/Difficult), 5000 (Plain).
- Staff: ANM (Auxiliary Nurse Midwife), MPHW(F/M) (Multi-Purpose Worker).
- Primary Health Centre (PHC):
- Population: 20000 (Hilly/Tribal/Difficult), 30000 (Plain).
- Staff: Medical Officer; 4-6 beds. Referral unit for ~6 SCs.
- Community Health Centre (CHC) / First Referral Unit (FRU):
- Population: 80000 (Hilly/Tribal/Difficult), 120000 (Plain).
- Staff: Specialists (Medicine, Surgery, Obs/Gyn, Paediatrics); 30 beds. Referral unit for ~4 PHCs.
- Sub-Centre (SC):
- Secondary Care: District Hospitals (DH), Sub-divisional hospitals.
- Provide more complex investigations and specialist services; link between primary & tertiary care.
- Tertiary Care: Apex institutions (e.g., AIIMS), Medical Colleges & Hospitals.
- Super-specialist care, advanced diagnostics, training, research.
⭐ ASHA (Accredited Social Health Activist) serves a population of ~1000, acting as a crucial link between the community and the public health system.
Key National Programs - Scheme Scene
Key governmental health initiatives in India aim to improve healthcare access, affordability, and quality.
| Program | Objective | Key Beneficiaries |
|---|---|---|
| Ayushman Bharat (PM-JAY & HWCs) | Universal health coverage; financial protection for ₹5 lakh/family/year | Poor, vulnerable families; all citizens (HWCs) |
| National Health Mission (NHM) | Strengthen rural (NRHM) & urban (NUHM) healthcare systems | Pregnant women, children, underserved populations |
| RMNCH+A | Reduce maternal, newborn, child, adolescent mortality & morbidity | Women, newborns, children, adolescents |
| NPCDCS | Prevent & control non-communicable diseases (NCDs) | Population at risk/with NCDs (diabetes, HTN, cancer) |
| Janani Shishu Suraksha Karyakram (JSSK) | Eliminate out-of-pocket expenses for institutional deliveries & sick newborn care | Pregnant women, sick newborns |
⭐ Ayushman Bharat has two key components: Pradhan Mantri Jan Arogya Yojana (PM-JAY) for health insurance and Health and Wellness Centers (HWCs) for comprehensive primary healthcare.
📌 Ayushman Bharat Cares (ABC) for Health & Wellness Centers and PM-JAY
Health Finance & Regulation - Fund Flow Rules
- Sources of Health Finance (India):
- Public Sector: Central & State Govt. budgets, taxes.
- Private Sector: Out-of-Pocket Expenditure (OOPE), private health insurance, NGOs.
- Social Insurance: Employees' State Insurance Scheme (ESIS), Central Govt. Health Scheme (CGHS).
- Health Expenditure:
- Public health spend: ~1.35% GDP (Target: 2.5% by 2025).
- Key Schemes: National Health Mission (NHM), Pradhan Mantri Jan Arogya Yojana (PM-JAY).
- Fund Flow Mechanisms: Budgetary allocations, grants-in-aid, Direct Benefit Transfer (DBT).
⭐ High Out-of-Pocket Expenditure (OOPE) in India: ~48.2% of Total Health Expenditure (THE), a major concern.
| Body | Key Role |
|---|---|
| MoHFW | Apex; Policy, Planning |
| NHA | PM-JAY Implementation |
| IRDAI | Health Insurance Regulation |
| SHS | NHM Fund Channel, State Implementation |
Indian Healthcare Challenges - Gaps & Gains
- Gaps:
- Low public health spend: ~1.3% GDP.
- Poor doctor-population ratio: ~1:1456 (WHO: 1:1000).
- High Out-of-Pocket Expenditure (OOPE): ~48%, pushes families to poverty.
- Rural-urban & inter-state disparities in healthcare access & quality.
- Shortage of infrastructure & skilled health workers.
- Persistent triple disease burden (Communicable, NCDs, Injuries).
- Gains:
- Significant ↑ life expectancy; ↓ IMR & MMR.
- Polio eradication achieved.
- Ayushman Bharat: PM-JAY (health insurance) & HWCs (strengthened primary care).
- National Digital Health Mission (NDHM) advancing e-health.
⭐ National Health Policy 2017 aims to ↑ public health expenditure to 2.5% of GDP by 2025.
High‑Yield Points - ⚡ Biggest Takeaways
- Ayushman Bharat (PM-JAY) offers health insurance to 10 crore+ poor and vulnerable families.
- Health & Wellness Centres (HWCs) are pivotal for delivering Comprehensive Primary Health Care.
- The National Health Mission (NHM), encompassing NRHM & NUHM, aims to strengthen public health infrastructure.
- India's healthcare delivery follows a three-tier system: Primary (Sub-centres, PHCs), Secondary (CHCs, District Hospitals), and Tertiary care.
- ASHA workers are crucial community health activists linking communities to the health system.
- The National Medical Commission (NMC) is the primary regulatory body for medical education and practice in India.
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