🔹 Discover the Health System in India, including its organizational structure, central & state administration, and district-level health governance.

Health System in India

Organizational Setup

The Indian health system operates at four levels:

1. Central Level
2. State Level
3. District Level
4. Block and Local Level

Health System Overview

Health services are designed to meet the healthcare needs of the community by using available resources efficiently. The health system consists of management sectors that ensure the organization and delivery of healthcare services.

Two Key Principles:

1. Health services should cater to the entire population, not just select groups.
2. Primary health care is the most effective way to serve rural and urban poor communities.

Health System in India

India consists of 28 states and 8 union territories. Under the Indian Constitution, healthcare delivery is primarily the responsibility of the state governments. The central government provides support through policymaking, planning, and coordination.

Roles of the Central Government

• Policy Making
• Planning
• Evaluating
• Guiding
• Assisting
• Coordinating state health ministries to ensure nationwide healthcare coverage

Three Main Links of the Health System

1. Central Level
2. State Level
3. Local/Peripheral Level

Health System Structure

Central Level

1. Union Ministry of Health and Family Welfare
2. Directorate General of Health Services (DGHS)
3. Central Council of Health & Family Welfare

State Level

1. State Ministry of Health
2. State Health Directorate

District Level

• Rural Areas:
  • Tehsils (Taluks)
  • Community Development Blocks
  • Villages (under Panchayat Raj)
• Urban Areas:
  • Town Area Committees
  • Municipal Boards & Corporations

Central Level Health Administration

1. Union Ministry of Health & Family Welfare

Headed by:

• Cabinet Minister
• Minister of State
• Deputy Health Minister

Departments:

1. Health
2. Family Welfare

Functions: Union List (Central Government’s Responsibility)

• International health relations and port quarantine
• Administration of central institutes (e.g., AIIMS, Public Health Institutes)
• Promotion of medical research

Concurrent List (Shared Responsibility of Central and State Governments)

• Control of communicable diseases
• Prevention of food adulteration
• Drug and poison regulation
• Vital statistics collection
• Labour welfare
• Economic and social planning
• Regulation of medical, pharmaceutical, and nursing professions
• Population control and family planning
• Maintenance of drug standards
• Immigration and emigration
• Regulation of labour in mines and oil fields
• Coordination with states for health promotion

2. Directorate General of Health Services (DGHS)

General Functions:

• Health surveys
• Planning
• Coordination
• Programming and appraisal of health matters

Specific Functions:

• International health relations and quarantine (ports and airports)
• Drug standards control
• Medical store depots management
• Medical education and research
• Postgraduate medical training
• National health programs implementation
• Central Health Education Bureau operations
• Collection and dissemination of health intelligence
• Establishment of epidemiological and health economics units
• National Medical Library maintenance

3. Central Council of Health & Family Welfare

The Central Council of Health ensures cooperation between the central and state health administrations.

Functions:

• Formulation of broad health policies
• Planning and implementation of remedial and preventive healthcare
• Proposals for health legislation
• Distribution of grants for healthcare projects
• Coordination between central and state health services

Ministry of Health & Family Welfare Hierarchy

Department of Health

• Secretary to the Government of India
• Joint Secretary
• Deputy Secretary
• Administrative Staff
• Central Council of Health (Policy Making & Legislation)

Department of Family Welfare

• Commissioner & Regional Directors
• Joint Secretary
• Deputy Secretary
• Administrative Staff

Directorate General of Health Services (DGHS)

• Advisor to Government of India
• Additional DGHS
• Medical Care & Hospitals Division
• Public Health Division
• General Administration
• Nursing Advisor
• Deputy Nursing Advisor

State Level Health System in India

Historical Background

• The first milestone in state health administration was the establishment of state health administration in 1919.
• The Government of India Act, 1935 granted further autonomy to the states.
• Health subjects were divided into three groups:
  1. Federal
  2. Concurrent
  3. State

Administrative Division of States

For administrative purposes, states are divided into:

• Districts
  • Taluks
  • Municipalities (Towns)
  • Panchayats (Rural)

State Health Administration

• India has 28 states, each with its own health administration.
• The state health administration consists of:
  • State Ministry of Health
  • State Health Directorate

State Ministry of Health

• Headed by the Minister for Health and Family Welfare
• Supported by:
  • Deputy Minister of Health and Family Welfare
  • Health Secretaries
  • Deputy Secretaries
  • Administrative Staff

State Health Directorate

• Previously, two separate departments existed for medical and public health:
  • Medical Department – Headed by the Surgeon General, responsible for general and civil hospitals.
  • Public Health Department – Headed by the Inspector, managing public health programs.
• The Bhore Committee (1946) recommended the integration of these departments to ensure a unified administration for both curative and preventive health services.

Structure of the State Health Directorate

• Director of Health Services (Director of Medical & Health Services in some states)
  • Deals with medical and public health matters.
  • Acts as the chief technical adviser.
  • Oversees family welfare programs.
  • Manages increasing medical colleges through the Director of Medical Education.
• Director of Health and Family Welfare
  • Assisted by a suitable number of Deputy and Assistant Directors.

Functional Divisions of the State Health Directorate

The Deputy and Assistant Directors of Health oversee various health programs:

• Regional Responsibilities
  • Public health inspection
• Specific Functional Areas
  • Maternal and Child Health (MCH)
  • Family Planning
  • Nutrition
  • Tuberculosis (TB) Control
  • Leprosy Eradication
  • Health Education
  • Primary Health Care (PHC)
  • Immunization Programs

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District-Level Health Administration

1. Role of the District Health Officer (DHO)

• The District Health Officer (DHO) is responsible for planning, implementing, and monitoring health programs at the district level.
• They oversee both preventive and curative health services in collaboration with other district officials.
• They work under the Chief Medical Officer (CMO) and coordinate with state-level health authorities.

2. Components of District Health Administration

The district health system is broadly divided into:

• Preventive Health Services (Public Health)
• Curative Health Services (Hospitals and Clinics)
• Family Welfare and Maternal & Child Health (MCH) Services
• National Health Programs Implementation

3. Key Officials and Their Roles

• Chief Medical Officer (CMO): Head of district health services, supervises all health programs.
• Deputy CMOs (3 positions): Each oversees one-third of the district’s health activities.
• Civil Surgeons: Manage hospitals and curative care facilities.
• District Family Welfare Officer: Oversees maternal and child health (MCH) and family planning programs.
• District Health Officers: Implement national health programs (except family welfare).

4. District Hospitals and Primary Health Care Services

• The District Hospital is the highest referral unit in the district.
• It serves as a hub for specialized medical care, with departments like:
  • General Medicine
  • Surgery
  • Obstetrics & Gynecology
  • Pediatrics
  • Orthopedics
  • Intensive Care Units (ICUs)
  • Blood Banks
• Primary Health Centers (PHCs) serve rural populations and act as the first point of contact.

5. Urban Health Services at District Level

• Municipal Health Authorities provide health services in towns and cities.
• Urban Primary Health Centers (UPHCs) cater to slums and underserved urban areas.
• Municipal Corporations handle sanitation, water supply, and public health campaigns.

6. Panchayati Raj and Community Participation

• The Panchayati Raj system strengthens local governance in rural health.
• At the district level, Zila Parishad monitors health and family welfare programs.
• At the village level, Gram Panchayats play a role in sanitation, nutrition, and disease control.

7. Integration of Health Programs

• The Bhore Committee (1946) and later policies recommended integration of health services.
• The District Health Action Plan (DHAP) aligns national programs with local needs.
• Programs like Ayushman Bharat, National Health Mission (NHM), and Universal Health Coverage (UHC) are implemented at the district level.

8. Recent Reforms and Digital Health Initiatives

• E-Health Services: Telemedicine, electronic health records (EHR), and digital monitoring systems.
• National Digital Health Mission (NDHM): Integration of digital platforms for seamless healthcare delivery.
• Strengthening of District Hospitals: Converting them into District Health Centers (DHCs) with preventive, promotive, and curative services.

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Block and Village-Level Health Administration in India

Block-Level Administration

At the block level, the Panchayati Raj agency is the Panchayat Samiti (Janpada Panchayat), which serves as the intermediary between the district and village administration.

Structure of the Block

• A block typically consists of around 100 villages with a population ranging from 80,000 to 1,20,000.
• The Panchayat Samiti comprises:
  • All Sarpanches (Heads) of the Village Panchayats within the block
  • MLAs and MPs residing in the area
  • Representatives of women, Scheduled Castes (SCs), Scheduled Tribes (STs), and co-operative societies

Key Roles and Responsibilities

• The Block Development Officer (BDO) serves as the ex-officio secretary of the Panchayat Samiti.
• The Panchayat Samiti is responsible for block-level developmental activities under the Community Development Programme.
• The BDO and technical staff provide guidance and support to Gram Panchayats in implementing various development initiatives.
• The Panchayat Samiti leaders coordinate with the Medical Officer of Primary Health Centers (PHCs) and Community Health Centers (CHCs) to support healthcare initiatives and provide assistance when needed.

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Village-Level Administration

At the village level, the Panchayati Raj system consists of:

1. Gram Sabha
2. Gram Panchayat
3. Nyaya Panchayat

1. Gram Sabha (Village Assembly)

• The Gram Sabha includes all adult residents of the village.
• It convenes at least twice a year to discuss important community issues, including health and sanitation, education, and rural development.
• It also elects members of the Gram Panchayat.

2. Gram Panchayat (Village Executive Body)

• The Gram Panchayat consists of 15-30 elected members and serves a population of 5,000 to 20,000.
• It is led by:
  • A President (Sarpanch)
  • A Vice President
  • A Secretary (Panchayat Secretary)

Key Functions of the Gram Panchayat:

• Acts as the executive organ of the Gram Sabha and is responsible for the overall planning and development of the village.
• The Panchayat Secretary oversees:
  • Sanitation and public health services
  • Implementation of rural health programs
  • Socio-economic development initiatives
• Plays a vital role in organizing and supporting health-related activities, such as immunization drives, maternal and child health programs, and awareness campaigns.

3. Nyaya Panchayat (Village Judicial System)

• The Nyaya Panchayat consists of 5 members selected from the Gram Panchayat.
• It resolves disputes at the village level to avoid lengthy judicial processes.
• It promotes mutual conflict resolution, reducing the need for villagers to approach formal courts.

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Read more: Health System in India: Structure, Administration & Overview