📘 Definition of Planning

Planning is the process of setting objectives, determining priorities, and deciding in advance the strategies, resources, and steps required to achieve specific goals within a given time frame.

✅ Key Features:

It is a systematic and future-oriented process
Involves decision-making, resource allocation, and goal setting
Helps in effective use of time, money, manpower, and materials

📌 Example: A school planning its academic calendar and budget for the next year.

🏥 Definition of Health Planning

Health planning is the process of identifying community health needs, setting goals and priorities, and developing strategies to achieve optimal health outcomes using available resources.

✅ Key Features:

Focused on public health improvement
Based on data collection, health indicators, and population needs
Includes planning of services, infrastructure, health manpower, budget, and programs

📌 Example: Planning a maternal health program in a rural area to reduce maternal mortality by improving antenatal care and delivery services.

🔄 Comparison

Feature	Planning	Health Planning
Scope	General – for any activity or field	Specific to health and healthcare
Focus	Goals, resources, actions	Health needs, service delivery, public health goals
Example	Business project plan	National Immunization Program plan

🏥 Steps of Health Planning

Health planning is a systematic process aimed at identifying health problems and setting goals to design and implement effective health programs.

🧭 1. Analysis of the Health Situation

🔍 What it means:

Collecting and analyzing data on health status, resources, services, and population needs
Understand demographic patterns, morbidity and mortality trends, and existing gaps

📌 Example: Gathering data on maternal mortality rates and immunization coverage in a district

🎯 2. Setting Goals and Objectives

🎯 What it means:

Define what the health plan aims to achieve
Goals are broad, and objectives are specific, measurable, achievable, relevant, and time-bound (SMART)

📌 Example:

Goal: Reduce infant mortality
Objective: Increase full immunization coverage from 70% to 90% in 2 years

🛠️ 3. Assessing Resources

📊 What it means:

Identify available and required resources:
- Manpower (doctors, nurses)
- Materials (medicines, vaccines)
- Money (budget)
- Infrastructure (PHCs, ambulances)

📌 Example: Number of nurses available for school health programs

🧠 4. Formulating the Plan

📝 What it means:

Develop a detailed action plan:
- What services to provide
- Where and how to deliver them
- Who will be responsible
- Timeline and cost estimation

📌 Example: Creating a district-wide antenatal check-up schedule with mobile health teams

🔧 5. Implementing the Plan

🚀 What it means:

Putting the plan into action
Requires coordination, leadership, teamwork, and public involvement

📌 Example: Launching a mobile immunization drive in underserved villages

📈 6. Monitoring and Evaluation

📋 What it means:

Monitoring: Ongoing review of implementation (Are activities happening as planned?)
Evaluation: Checking effectiveness and outcomes (Did the program meet objectives?)

📌 Example:

Monitoring: Monthly progress reports from PHCs
Evaluation: Survey showing 90% immunization achieved

✅ Summary Table: Steps of Health Planning

Step No.	Step Name	Purpose
1️⃣	Situation Analysis	Understand the health problem
2️⃣	Set Goals & Objectives	Decide what to achieve
3️⃣	Assess Resources	Check available manpower, funds, etc.
4️⃣	Formulate the Plan	Design how to do it
5️⃣	Implement the Plan	Put the plan into action
6️⃣	Monitor & Evaluate	Track progress and impact

Health Planning in India – Introduction

Health planning in India refers to the systematic process of identifying national health problems, setting priorities, allocating resources, and designing strategies to improve the health status of the population.

After gaining independence in 1947, India recognized the importance of health as a key component of national development. Since then, health planning has been integrated into Five-Year Plans, guided by expert committees and government policies to address both preventive and curative health needs.

The goal of health planning in India is to ensure:

Equitable access to healthcare services
Reduction in disease burden and mortality
Strengthening of public health infrastructure
Promotion of preventive, promotive, and rehabilitative health

📋 Major Health Committees in India (Chronological Order)

🔹 1. Bhore Committee (1946)

Official Name: Health Survey and Development Committee
Chairperson: Sir Joseph Bhore

✅ Key Report: Published in 1946 (pre-independence)

✳️ Key Recommendations:

Integration of preventive and curative services at all levels
Establishment of a three-tier system of health care:
1. Primary Health Centres (PHCs)
2. Secondary Health Centres
3. District Hospitals
PHC for every 40,000 population
Strong emphasis on medical education reform
Advocated for universal health coverage

📌 Importance: It is considered the foundation of modern health planning in India

🔹 2. Mudaliar Committee (1962)

Official Name: Health Survey and Planning Committee
Chairperson: Dr. A. Lakshmanaswami Mudaliar

✅ Key Report: 1962

✳️ Key Recommendations:

Strengthening existing PHCs before opening new ones
Each PHC should cater to only 40,000 people with improved quality
More focus on training and skilled manpower
Improve specialist services at district hospitals
Better coordination between health and medical education

🔹 3. Chadha Committee (1963)

Purpose: Review of national malaria eradication strategy

✳️ Key Recommendations:

One Basic Health Worker (BHW) per 10,000 population
BHW should carry out duties of malaria surveillance and also support family planning and MCH programs

🔹 4. Mukherjee Committee (1965 & 1966)

Chairperson: Dr. Mukherjee
Two reports: 1965 (Family Planning) and 1966 (Integration)

✳️ Key Recommendations:

Create separate staff for family planning work
Strengthen administrative setup for health and family welfare at block and district levels
Proposed integration of health services

🔹 5. Jungalwalla Committee (1967)

Purpose: Integration of medical and health services

✳️ Key Recommendations:

Unified cadre for health services (no separation of preventive and curative)
Elimination of private practice by government doctors
Standardization of pay structure, promotion policies

🔹 6. Kartar Singh Committee (1973)

Purpose: Review staffing patterns under Minimum Needs Programme

✳️ Key Recommendations:

Introduction of Multipurpose Health Workers (MPHWs)
One male and one female health worker per sub-centre
One health assistant (supervisor) for every 4 MPHWs
One PHC for every 50,000 population

📌 Impact: Led to creation of the multipurpose worker scheme used today

🔹 7. Shrivastava Committee (1975)

Full Name: Group on Medical Education and Support Manpower

✳️ Key Recommendations:

Creation of bands of paramedical and semi-professional health workers
Establishment of a Referral Services Complex
Medical education to be community-based
Emphasis on rural health manpower training

📌 Importance: Paved the way for the Village Health Guides Scheme

🧠 Why These Committees Matter:

Laid the foundation for today’s PHCs, CHCs, and sub-centres
Contributed to the development of national programs (e.g., family planning, malaria eradication)
Introduced multipurpose worker schemes, health education, and community-based training
Helped frame National Health Policies (1983, 2002, 2017) and the National Health Mission (2005 onward)

📝 Summary Table of Health Committees

Committee	Year	Key Focus	Key Contribution
Bhore	1946	Overall health planning	3-tier system, PHCs, integration
Mudaliar	1962	Planning & evaluation	Strengthening PHCs
Chadha	1963	Malaria program	Basic Health Worker
Mukherjee	1965–66	Family planning	Separate FP staff, better coordination
Jungalwalla	1967	Service integration	Unified cadre, no private practice
Kartar Singh	1973	Staffing pattern	MPHW scheme
Shrivastava	1975	Manpower & education	Referral system, Village Health Guides

Commissions on Health and Family Welfare in India

Various commissions have been established by the Government of India to evaluate, reform, and strengthen the health and family welfare systems. These commissions offer long-term policy guidance, assess program implementation, and recommend improvements in healthcare delivery.

🧭 Key Commissions on Health and Family Welfare (Post-Independence)

🔹 1. National Commission on Population (2000)

Established by: Ministry of Health and Family Welfare
Chairperson: Prime Minister of India
Vice Chairperson: Union Minister of Health & Family Welfare

✳️ Objectives:

Monitor and implement the National Population Policy 2000
Promote family welfare, reproductive health, and gender equity
Support state governments in population stabilization efforts
Guide demographic research and public health initiatives

📌 Key Focus Areas:

Achieve Total Fertility Rate (TFR) of 2.1 (replacement level)
Promote delayed marriage, spacing of births, and girls’ education
Strengthen access to contraceptives and reproductive health services

🔹 2. National Commission on Macroeconomics and Health (NCMH, 2005)

Established by: Ministry of Health and Family Welfare
Chairperson: Union Health Secretary
Supported by: WHO & Ministry of Finance

✳️ Purpose:

To assess economic consequences of health problems
To recommend health investment strategies for India

📌 Key Recommendations:

Health expenditure should be increased to at least 2–3% of GDP
Priority funding for communicable diseases, maternal-child health, and NCDs
Emphasized the need for universal healthcare access, especially for the poor
Advocated public-private partnerships (PPP) in healthcare

🔹 3. National Commission on Human Resources for Health (NCHRH) – Proposed 2011

Proposed under: Ministry of Health & Family Welfare
Purpose: To regulate health education and manpower development

✳️ Key Objectives:

Replace multiple councils (MCI, INC, DCI, PCI) with a single regulatory body
Standardize education and training across all health professions
Improve quality and quantity of human resources in health

📌 Status: The Bill was introduced but not enacted; however, it inspired the creation of the National Medical Commission (NMC) in 2019.

🔹 4. National Health Commission (Proposed in various forms)

While India does not have a single national health commission, several task forces and expert groups have played similar roles:

💡 Examples:

High-Level Expert Group on Universal Health Coverage (2010)
- Proposed free access to essential healthcare for all
- Recommended a National Health Package and health financing reforms
National Commission for Women (NCW) also addresses women’s health and reproductive rights as part of family welfare

📊 Summary Table

Commission	Year	Focus Area	Key Contributions
National Commission on Population	2000	Population policy	TFR goals, family planning
National Commission on Macroeconomics & Health	2005	Health financing & economics	Investment in health, UHC
National Commission on HRH (proposed)	2011	Health education regulation	Suggested unified council
High-Level Expert Group	2010	Universal health coverage	Suggested free healthcare for all

🎯 Significance of These Commissions

Guided major policy decisions and national health programs
Supported planning for health manpower, infrastructure, and financing
Strengthened family welfare services, especially in population control and maternal-child health
Helped align Indian health priorities with Sustainable Development Goals (SDGs)

🏛️ Planning Commissions in India

The Planning Commission of India was established to develop and implement national-level economic plans, including health and family welfare strategies, to promote balanced and inclusive growth.

📜 1. Planning Commission – Introduction

Established: 15 March 1950
By: Government of India
First Chairman: Jawaharlal Nehru, Prime Minister of India
Purpose: To formulate Five-Year Plans for economic and social development, including health planning
Functioned until 2014, later replaced by NITI Aayog

🎯 Objectives of the Planning Commission:

Assess country’s resources and plan for optimal utilization
Set national priorities and formulate Five-Year Plans
Focus on removal of poverty, improving living standards, and health infrastructure development
Coordinate state and central policies for balanced development

Five-Year Plans in India: Health Perspective (With Milestones & Budget)

🏛️ Introduction

India introduced the Five-Year Plans in 1951 under the Planning Commission to guide national development, including health and family welfare. Each plan set goals for healthcare delivery, disease control, infrastructure building, and public health programs.

📊 Summary Table of Five-Year Plans (Health Focus + Budget)

Plan	Years	Health Milestones	Health Budget (as % of Total Plan Outlay)
1st	1951–1956	PHCs established, NMCP launched	~3.3%
2nd	1956–1961	Family Planning Program begins	~3.4%
3rd	1961–1966	Smallpox eradication, focus on leprosy, MCH	~3.9%
Plan Holiday	1966–69	Annual Plans due to war/economic crisis	–
4th	1969–1974	Minimum Needs Programme, nutrition focus	~4.2%
5th	1974–1979	ICDS, Blindness Control Programme	~4.9%
6th	1980–1985	Health for All 2000, UIP started	~5.3%
7th	1985–1990	AIDS Control, mental health emphasis	~5.8%
Annual Plans	1990–92	Continued RCH & disease control	–
8th	1992–1997	CSSM launched, population policy revised	~5.2%
9th	1997–2002	RCH-I, pulse polio intensified	~6.0%
10th	2002–2007	RCH-II, NHP 2002	~6.1%
11th	2007–2012	NRHM scale-up, health equity focus	~7.0%
12th	2012–2017	NHM (NRHM+NUHM), UHC push	~8.0%

📘 Detailed Plan-Wise Breakdown

🟢 1st Five-Year Plan (1951–1956)

Health Focus: Disease control, rural health access
Budget Allocation: ₹140 crore for health (~3.3% of total plan)

🔹 Key Milestones:

Primary Health Centres (PHCs) established (one per 30,000–50,000 population)
Launch of National Malaria Control Programme (NMCP)
Initiation of B.C.G. vaccination, maternity and child health programs
Emphasis on water supply, sanitation, and health education

🟡 2nd Five-Year Plan (1956–1961)

Health Focus: Family planning, health workforce
Budget Allocation: ₹225 crore (~3.4%)

🔹 Key Milestones:

Launch of the world’s first National Family Planning Programme
Expansion of PHCs and training of auxiliary nurse midwives (ANMs)
Focus on health worker training and hospitals

🟠 3rd Five-Year Plan (1961–1966)

Health Focus: Epidemic control, infrastructure
Budget Allocation: ₹365 crore (~3.9%)

🔹 Key Milestones:

Launch of National Smallpox Eradication Programme
Focus on MCH, leprosy, and TB control
Rural health centres and district hospitals strengthened

🔴 Plan Holiday (1966–1969)

Political instability, wars, and droughts led to three Annual Plans
Health programs continued with limited resources

🔵 4th Five-Year Plan (1969–1974)

Health Focus: Nutrition, integration
Budget Allocation: ₹716 crore (~4.2%)

🔹 Key Milestones:

Minimum Needs Programme (MNP) launched (education, water, health)
Community health worker model strengthened
Nutrition programs for under-five children introduced

🟣 5th Five-Year Plan (1974–1979)

Health Focus: Integrated child services, eye care
Budget Allocation: ₹1,260 crore (~4.9%)

🔹 Key Milestones:

Launch of Integrated Child Development Services (ICDS)
National Programme for Control of Blindness (NPCB) initiated
Strengthened rural health services & family welfare efforts

🟤 6th Five-Year Plan (1980–1985)

Health Focus: Immunization and health manpower
Budget Allocation: ₹2,725 crore (~5.3%)

🔹 Key Milestones:

Adoption of “Health for All by 2000” (Alma Ata Declaration)
Launch of Universal Immunization Programme (UIP) in 1985
Strengthened community health worker schemes and PHCs

🟨 7th Five-Year Plan (1985–1990)

Health Focus: Disease prevention, AIDS, MCH
Budget Allocation: ₹4,420 crore (~5.8%)

🔹 Key Milestones:

Launch of National AIDS Control Programme (NACP) in 1987
Emphasis on school health services
Expanded UIP and nutrition interventions

🟫 8th Five-Year Plan (1992–1997)

Health Focus: Reproductive health & population
Budget Allocation: ₹6,765 crore (~5.2%)

🔹 Key Milestones:

Launch of Child Survival and Safe Motherhood Programme (CSSM)
Focus on reducing IMR, MMR, and TFR
Infrastructure development for PHCs and sub-centres

🟥 9th Five-Year Plan (1997–2002)

Health Focus: RCH & polio eradication
Budget Allocation: ₹11,180 crore (~6%)

🔹 Key Milestones:

Reproductive and Child Health Programme (RCH-I) launched
Pulse Polio Programme intensified
Renewed efforts for TB, leprosy, and malaria control

🟩 10th Five-Year Plan (2002–2007)

Health Focus: Public health targets, decentralization
Budget Allocation: ₹17,400 crore (~6.1%)

🔹 Key Milestones:

Launch of RCH Phase II
Introduction of National Health Policy 2002
Emphasis on decentralization, health education, and community participation
Laid groundwork for National Rural Health Mission (NRHM)

🟦 11th Five-Year Plan (2007–2012)

Health Focus: Rural outreach, equity, NRHM expansion
Budget Allocation: ₹45,554 crore (~7.0%)

🔹 Key Milestones:

Scaling up of NRHM
Focus on tribal health, gender equality, and maternal care
Establishment of ASHA workers, Janani Suraksha Yojana (JSY)

🟨 12th Five-Year Plan (2012–2017)

Health Focus: Universal Health Coverage (UHC), NHM
Budget Allocation: ₹90,600 crore (~8.0%)

🔹 Key Milestones:

NRHM + NUHM = National Health Mission (NHM)
Emphasis on preventive care, essential drugs & diagnostics
Strengthening primary and secondary care
Promoted free services for maternal and child care

🎯 Post-12th Plan: NITI Aayog Era (After 2017)

Five-Year Plans discontinued in 2017
NITI Aayog introduced 3-year action plans, 7-year strategies, and 15-year vision documents
Major initiatives:
- Ayushman Bharat (2018)
- Health and Wellness Centres (HWCs)
- Pradhan Mantri Jan Arogya Yojana (PM-JAY)
- Digital Health Mission

🧠 Conclusion

The Five-Year Plans of India played a pivotal role in shaping the country’s health system by:

Building infrastructure (PHCs, CHCs)
Launching disease control programs
Promoting maternal and child health
Integrating population control and family welfare
Preparing the foundation for universal health care

🏛️ NITI Aayog and Health in India

📘 What is NITI Aayog?

NITI Aayog stands for National Institution for Transforming India.
It is the policy think tank of the Government of India, established to replace the Planning Commission in 2015.

🗓️ Established: 1 January 2015
👤 Chairperson: Prime Minister of India
📍 Vice Chairperson: Appointed by the Prime Minister
🔧 Governing Council: Includes all state Chief Ministers and Lieutenant Governors of Union Territories

🎯 Objectives of NITI Aayog (Related to Health)

Promote cooperative and competitive federalism
Provide policy direction and strategy for national health programs
Encourage state-level innovation and decentralization
Align health goals with Sustainable Development Goals (SDGs)
Enhance public-private partnerships (PPP) in healthcare
Guide digital health transformation in India

🏥 NITI Aayog and Health Sector Reforms

NITI Aayog has been instrumental in transforming India’s health system through policy-making, innovation, evaluation, and collaborative models.

🩺 Key Health Contributions of NITI Aayog

🔹 1. Health Index (State Ranking)

“Healthy States, Progressive India” – Annual Report

Ranks states/UTs based on health outcomes, governance, and infrastructure
Encourages healthy competition among states
Parameters include:
- Neonatal & infant mortality rates
- Immunization coverage
- Institutional deliveries
- Healthcare workforce & infrastructure availability

📌 Example: Kerala, Tamil Nadu, and Telangana have consistently ranked high

🔹 2. Ayushman Bharat (2018)

Flagship health scheme guided by NITI Aayog

Two Pillars:
1. Health and Wellness Centres (HWCs) – Provide comprehensive primary care (target: 1.5 lakh HWCs)
2. PM-JAY (Pradhan Mantri Jan Arogya Yojana) – Free secondary and tertiary care for over 50 crore poor beneficiaries
Largest government-funded health insurance scheme in the world
Implemented via State Health Agencies (SHA) and empanelled hospitals

🔹 3. Digital Health Mission

NITI Aayog is a key stakeholder in the National Digital Health Mission (NDHM)

Creation of Ayushman Bharat Health Account (ABHA) ID
Digital health records, e-prescriptions, teleconsultations
Promotes paperless, efficient, and accessible health services

🔹 4. Public-Private Partnership (PPP) in Healthcare

Model guidelines for states to engage private hospitals
Encourages private investment in diagnostics, dialysis, and tertiary care
Pilot projects launched in Tier-2 and rural districts

🔹 5. Health System Strengthening

Emphasized investment in human resources (doctors, nurses, ASHAs)
Promoted universal health coverage (UHC)
Suggested reform in medical education, support for NMC, skill development

🔹 6. Nutrition and Women’s Health

Supports POSHAN Abhiyaan for reducing stunting, wasting, and anemia
Focus on maternal health, adolescent girls, and early childhood care

🔹 7. COVID-19 Response and Health Resilience

Played a central role in policy planning and data monitoring
Provided real-time COVID dashboards
Promoted telemedicine (eSanjeevani) and vaccine distribution planning

📈 NITI Aayog’s Long-Term Health Goals

Goal	Target Year	Remarks
Reduce IMR to 23 per 1,000 live births	Achieved by many states
Reduce MMR to <70 per 1 lakh live births	Under NHM focus
Achieve Universal Health Coverage (UHC)	Ongoing
Eliminate TB by 2025	National Strategic Plan
Digital health for all	Vision 2030	ABHA rollout

🧠 Conclusion

NITI Aayog has moved India’s health policy from centralized planning to evidence-based, state-led innovation, with strong focus on:

Primary care
Digital health
Health equity
Public-private collaboration

It plays a pivotal role in transforming India’s healthcare to be more inclusive, accessible, and futuristic.

👥 Participation of Community and Stakeholders in Health Planning

📘 Introduction

Community and stakeholder participation is the active involvement of individuals, families, local leaders, NGOs, and other sectors in identifying health needs, setting priorities, and implementing and evaluating health programs.

✅ It is a core principle of Primary Health Care (as per the Alma-Ata Declaration, 1978) and essential to ensure that health services are:

Relevant to local needs
Acceptable and accessible
Sustainable and effective

🎯 Objectives of Community & Stakeholder Participation

To identify real health needs of the community
To increase community ownership and accountability
To mobilize local resources and knowledge
To improve trust between the health system and people
To ensure sustainability and cultural appropriateness of health programs

🔗 Who Are the Stakeholders?

Type	Examples
🧍‍♂️ Individuals	Local residents, patients, health volunteers
🏘️ Community groups	Panchayati Raj Institutions (PRIs), Self-Help Groups (SHGs), youth clubs
🩺 Health professionals	Doctors, nurses, ASHAs, ANMs
🏥 Health administrators	PHC/CHC in-charges, district health officers
🧑‍🎓 Educational institutions	Schools, colleges, training centers
🤝 NGOs/CSOs	Non-profits involved in health, sanitation, nutrition
🏛️ Government departments	ICDS, Women and Child Development, Rural Development
💼 Private sector	Local clinics, labs, pharma companies

🛠️ Forms of Participation in Health Planning

🔹 1. Need Assessment

Community members help identify health problems, barriers, and local priorities
Use of household surveys, focus group discussions, and village health registers

📌 Example: Women’s groups identifying the need for menstrual hygiene supplies

🔹 2. Planning and Decision-Making

Involvement in setting health goals and strategies
Participation in Village Health Sanitation and Nutrition Committees (VHSNCs) and Rogi Kalyan Samitis (RKS)
Contribution to local health action plans

📌 Example: Panchayat leaders helping allocate land for a sub-centre

🔹 3. Resource Mobilization

Community donates land, labor, money, or materials
NGOs provide technical support, volunteers, and funds

📌 Example: Local carpenters building benches for a Health & Wellness Centre

🔹 4. Program Implementation

Participation in health camps, immunization drives, cleanliness campaigns
ASHAs and SHGs act as peer educators and mobilizers

📌 Example: Youth clubs organizing dengue awareness rallies

🔹 5. Monitoring and Evaluation

Communities track health indicators and service delivery
Social audits, feedback mechanisms, and grievance redressal
Active role in evaluating performance of PHC, ANMs, and outreach workers

📌 Example: Gram Sabha reviewing the functioning of their local sub-centre

🌍 Examples from Indian Health Programs

Program	Community Participation
National Health Mission (NHM)	Formation of VHSNCs, ASHAs, RKS
Swachh Bharat Abhiyan	People-led sanitation movement
Janani Suraksha Yojana (JSY)	ASHAs support institutional deliveries
Pulse Polio Campaign	Community volunteers, schoolchildren involvement
POSHAN Abhiyaan	Anganwadi workers and mothers’ groups

💡 Benefits of Participation

Services become more people-centered and need-based
Increases trust and transparency
Builds community leadership and empowerment
Reduces resistance to public health interventions (e.g., vaccination)
Encourages behavioral change and local innovation

⚠️ Challenges in Community Participation

Low awareness and education levels
Gender and caste-based exclusion
Lack of training and motivation
Inadequate support from officials
Poor coordination among departments

✅ Solutions to Improve Participation

Regular IEC (Information, Education, Communication) campaigns
Capacity building of local leaders and volunteers
Incentives and recognition for participation
Use of mobile technology and community radio
Strong supportive supervision and follow-up

🧠 Conclusion

Community and stakeholder participation is essential for responsive, equitable, and sustainable health systems.
It empowers people to take ownership of their health and enables the government to design context-specific, effective, and efficient health programs.

🏥 Health Care Delivery System in India: Infrastructure

📘 Introduction

India has a three-tier health care delivery system designed to provide universal, accessible, and affordable healthcare to its population, especially in rural and underserved areas.

This system is supported by both public and private sectors, along with voluntary organizations, and operates through a hierarchical structure from village level to tertiary hospitals.

🏛️ Three-Tier Structure of Public Health Infrastructure in Rural India

🔹 1. Sub-Centre (SC) – First Contact Point

Catering Population:
- 5,000 in plain areas
- 3,000 in hilly/tribal/difficult areas
Staff:
- 1 Female Health Worker (ANM)
- 1 Male Health Worker (MPW)
- Now being upgraded into Health & Wellness Centres (HWCs)

✅ Functions:

Antenatal, postnatal care, immunization
Family planning and contraceptive distribution
Health education and basic treatments
Reporting births, deaths, and disease outbreaks

📌 Total SCs in India (2023): ~158,000+

🔹 2. Primary Health Centre (PHC) – First Referral Unit

Catering Population:
- 30,000 in plain areas
- 20,000 in hilly/tribal areas
Staff:
- Medical Officer (MBBS)
- Pharmacist, Staff Nurse, Lab Tech, ANMs, MPWs
- Being upgraded to HWCs (Comprehensive Primary Care)

✅ Functions:

Treatment of minor illnesses and outpatient services
Maternal and child health (MCH) services
Implementation of national health programs (e.g., immunization, TB)
Disease surveillance and referral to CHCs

📌 Total PHCs (2023): ~31,000+

🔹 3. Community Health Centre (CHC) – Secondary Level

Catering Population:
- 120,000 in plain areas
- 80,000 in hilly/tribal areas
Staff:
- 4 Specialists (Physician, Surgeon, Gynecologist, Pediatrician)
- Nurses, Pharmacist, Lab & Radiology Technicians

✅ Functions:

24×7 emergency and inpatient care
Specialist outpatient and referral services
Minor surgeries, obstetric services, and newborn care
Laboratory, X-ray, and blood storage facilities

📌 Total CHCs (2023): ~6,000+

🏥 Urban Health Care Infrastructure

🔹 Urban Primary Health Centre (UPHC):

Serves urban population of 50,000
Provides OPD, immunization, antenatal care, etc.

🔹 Urban Community Health Centre (UCHC):

Serves population of 2.5–5 lakhs
Provides secondary care, specialist services

📌 Managed under National Urban Health Mission (NUHM)

🏨 Tertiary Care Infrastructure

These include specialized and super-specialized services at the district, state, and national levels.

🔹 District Hospitals

Provide comprehensive medical and surgical services
Equipped with multiple specialties (medicine, surgery, OBG, pediatrics)

🔹 Medical Colleges and Super-specialty Hospitals

Teaching, training, and research institutions
Advanced diagnostics and specialty services (e.g., cardiology, oncology)

🔹 National Institutes

AIIMS, NIMHANS, PGIMER, JIPMER, etc.

🧭 Support Systems

Support Area	Examples
🧪 Diagnostics	District labs, mobile labs
💉 Pharmaceuticals	Central Medical Services Society, State Drug Stores
🚑 Transport	Janani Express, 108 Ambulance services
🧑‍⚕️ Manpower	ANMs, ASHAs, doctors, paramedics
📋 Health Information	HMIS (Health Management Information System), IDSP

🏢 Private Sector in Health Infrastructure

Large hospitals, small clinics, labs, pharmacies
Provides major share of secondary and tertiary care
Often concentrated in urban areas
Plays role in insurance-based healthcare (PM-JAY)

🧱 Recent Infrastructure Initiatives

🩺 Ayushman Bharat – Health and Wellness Centres (HWCs):

Upgrade of Sub-Centres and PHCs to HWCs
Provide preventive, promotive, and curative care
Target: 1.5 lakh HWCs by 2025

🧑‍💻 Digital Infrastructure:

ABHA (Ayushman Bharat Health Account)
eSanjeevani (telemedicine portal)
National Digital Health Mission (NDHM)

🔁 Conclusion

The Indian health infrastructure is vast, diverse, and evolving — designed to ensure equity, accessibility, and quality care for all.

Its three-tier rural system, expanding urban health services, and emerging digital and wellness-based models together form the backbone of India’s journey toward Universal Health Coverage (UHC).

🏥 Health Care Delivery System in India: Health Sectors

📘 Introduction

The health care delivery system in India is composed of various health sectors, each contributing uniquely to the promotion, prevention, treatment, and rehabilitation of health.

These sectors include both public (government) and private components, and work together with voluntary, indigenous, and defense sectors to deliver services across the nation.

🧭 Classification of Health Sectors in India

India’s health care system includes the following main sectors:

S.No	Sector Type	Examples
1️⃣	Public Sector	Government hospitals, PHCs, CHCs
2️⃣	Private Sector	Corporate hospitals, clinics, diagnostic centers
3️⃣	Voluntary/NGO Sector	Red Cross, Rotary, SEWA, Missionaries
4️⃣	Indigenous Systems	Ayurveda, Siddha, Unani, Yoga, Naturopathy
5️⃣	Defense Sector	Armed Forces Medical Services
6️⃣	Railway & Industrial Sector	Health care for railway employees and factory workers
7️⃣	Insurance Sector	CGHS, ESIC, PM-JAY (Ayushman Bharat)

🟩 1. Public Sector

Run and funded by central, state, and local governments

🏥 Infrastructure Includes:

Sub-Centres, PHCs, CHCs
District Hospitals
Medical Colleges
National Institutes (AIIMS, NIMHANS, etc.)
Urban health centres (UPHCs, UCHCs)

✅ Services:

Maternal & child health, immunization
Disease control programs (TB, malaria, HIV)
Preventive, promotive, and curative services
Free/low-cost treatment

📌 Major Schemes:

National Health Mission (NHM)
Ayushman Bharat
Revised National TB Control Programme (RNTCP)

🟨 2. Private Sector

Includes for-profit and not-for-profit organizations

🏥 Comprises:

Corporate hospitals (Apollo, Fortis)
Nursing homes, clinics
Private practitioners (MBBS, BAMS, BHMS)
Diagnostic labs and pharmacies

✅ Characteristics:

Dominates urban areas
Provides majority of outpatient and secondary/tertiary care
Offers specialized and advanced technology services
Often expensive, not accessible to all

📌 Regulated through: Clinical Establishments Act, Insurance Schemes (PM-JAY)

🟦 3. Voluntary/NGO Sector

Includes non-governmental, charitable, and missionary organizations

🤝 Examples:

Indian Red Cross Society
SEWA (Self Employed Women’s Association)
CRY (Child Rights & You)
Missionaries of Charity

✅ Roles:

Health education & awareness
Support for MCH, nutrition, elderly care
Rehabilitation and palliative care
Operate mobile clinics, dispensaries in remote areas

🟫 4. Indigenous Systems of Medicine (AYUSH)

Recognized by Ministry of AYUSH, Government of India

🔹 Includes:

Ayurveda, Yoga, Unani, Siddha, Homeopathy, Naturopathy

✅ Contributions:

Low-cost, culturally acceptable therapies
Focus on preventive and holistic health
Growing integration with modern systems under Ayushman Bharat HWCs

📌 Over 7.5 lakh registered AYUSH practitioners in India

🟥 5. Defense Sector

Health services for armed forces, ex-servicemen, and their families

🏥 Includes:

Army, Navy, and Air Force medical corps
Base hospitals, field hospitals, research centers (AFMC, INHS Asvini)

🟧 6. Railway and Industrial Health Services

Health care to organized sector workers

🛠️ Examples:

Railway hospitals and dispensaries
ESI hospitals for factory/industrial workers
Occupational health centers in mines, plants, etc.

📌 Schemes like:

Employees’ State Insurance Corporation (ESIC)
Factory Act provisions for occupational health

🟪 7. Insurance Sector

Offers financial protection for health care needs

🔹 Government Schemes:

CGHS (Central Government Health Scheme)
ESIC (Employee State Insurance)
PM-JAY (Ayushman Bharat Yojana) – ₹5 lakh per year per family

🔹 Private Insurers:

Star Health, ICICI Lombard, LIC Health Plus

🔄 Integration and Coordination of Sectors

Public–private partnerships (PPP) promoted under NITI Aayog
NGO collaboration in disease surveillance, maternal health, HIV, TB
Mainstreaming AYUSH through HWCs and national programs

🧠 Conclusion

India’s health care delivery system is a multi-sectoral and pluralistic system, where public, private, and alternative medicine sectors work together to meet the diverse health needs of a growing and diverse population.

Strengthening coordination, regulation, and universal access remains key to achieving universal health coverage in India.

🏥 Delivery of Health Services at the Sub-Centre (SC)

📘 Introduction

A Sub-Centre (SC) is the first contact point between the community and the primary healthcare system in rural areas. It plays a vital role in delivering preventive, promotive, and limited curative healthcare services to the population.

✅ Sub-Centres are staffed primarily by Auxiliary Nurse Midwives (ANMs) and Multipurpose Workers (MPWs) and are now being upgraded as Health and Wellness Centres (HWCs) under Ayushman Bharat.

🧭 Population Coverage

Area Type	Population Covered per Sub-Centre
Plain Area	5,000
Hilly/Tribal/Difficult Area	3,000

👩‍⚕️ Staffing Pattern

1 Female Health Worker (ANM) – Key service provider
1 Male Health Worker (MPW-M)
In upgraded HWCs:
- Community Health Officer (CHO) (BSc Nursing/AYUSH)
- ASHA Facilitator (Supervisory role)
- Support Staff/Attendant

🩺 Key Health Services Delivered at Sub-Centre

🔹 1. Maternal and Child Health (MCH)

Antenatal care (ANC), Postnatal care (PNC)
Counseling on nutrition, danger signs, birth preparedness
Referral of high-risk pregnancies
Immunization of children and pregnant women
Newborn care and growth monitoring

📌 Programs: Janani Suraksha Yojana (JSY), Janani Shishu Suraksha Karyakram (JSSK)

🔹 2. Family Planning and Reproductive Health

Distribution of contraceptives (condoms, oral pills, IUCD)
Counseling on family planning methods
Follow-up for sterilization, spacing methods
Adolescent reproductive and sexual health services (ARSH)

📌 Program: Family Welfare Program

🔹 3. Immunization Services

Routine immunization under Universal Immunization Programme (UIP)
Vaccine storage, outreach sessions, and reporting
Management of cold chain and AEFI (Adverse Events Following Immunization)

🔹 4. Communicable Disease Control

Active surveillance and reporting of diseases:
- Malaria, TB, leprosy, diarrheal diseases, dengue
Vector control measures and health education
Referral of suspected TB, malaria, and leprosy cases

📌 Programs: RNTCP (TB), NVBDCP (malaria), IDSP (epidemics)

🔹 5. Non-Communicable Disease (NCD) Screening

Basic screening for:
- Hypertension
- Diabetes
- Breast, oral, and cervical cancer (for adults >30 years)
Counseling on diet, exercise, and lifestyle

📌 Under: National Programme for Prevention and Control of NCDs (NP-NCD)

🔹 6. Nutrition and Anemia Control

Distribution of Iron Folic Acid (IFA) tablets
Nutrition counseling for pregnant women, children, and adolescents
Coordination with Anganwadi workers for supplementary nutrition

📌 Programs: POSHAN Abhiyaan, Weekly Iron and Folic Acid Supplementation (WIFS)

🔹 7. Health Education and Behavior Change Communication (BCC)

IEC activities on:
- Hand hygiene
- Menstrual hygiene
- Family planning
- Vector control
- Nutrition
Observance of Village Health and Nutrition Days (VHNDs)

🔹 8. School Health Services

Participation in Rashtriya Bal Swasthya Karyakram (RBSK)
Deworming, anemia screening, health education in schools

🔹 9. Basic Curative and First-Aid Services

Management of minor ailments (fever, cough, wounds)
Dressing of wounds, administration of injections, ORS distribution
Referral to PHC for serious conditions

🔹 10. Monitoring and Record Keeping

Maintain family health records, immunization registers
Maternal and child tracking
Disease reporting to PHC and CHC
Digital entry in HMIS (Health Management Information System)

🌿 Upgradation to Health & Wellness Centre (HWC)

Under Ayushman Bharat, Sub-Centres are being upgraded into HWCs, which offer:

Expanded package of services (12 areas)
CHO-led care team
Telemedicine and digital health services
Yoga and wellness activities
NCD screening and mental health services

🎯 Goal: 1.5 lakh HWCs by 2025

🔄 Conclusion

The Sub-Centre is the foundation of India’s rural health care delivery system.
It plays a vital role in providing accessible, affordable, and community-based services, especially for women, children, and vulnerable populations. With the HWC model, it is being transformed into a hub of comprehensive primary health care.

🏥 Delivery of Health Services at Primary Health Centre (PHC)

📘 Introduction

A Primary Health Centre (PHC) is the first point of contact with a medical officer in the public healthcare system, serving as a referral unit for Sub-Centres and providing integrated curative, preventive, and promotive health care.

PHCs are a crucial part of India’s three-tier rural healthcare system and are being upgraded to Health & Wellness Centres (HWCs) under Ayushman Bharat.

🧭 Population Coverage

Area Type	Population Covered per PHC
Plain Areas	30,000
Hilly/Tribal/Difficult Areas	20,000

👨‍⚕️ Staffing at PHC (as per IPHS norms)

1 Medical Officer (MBBS)
1 AYUSH Medical Officer (in HWCs)
1 Pharmacist
3 Staff Nurses
1 Lab Technician
1 Health Educator
1 Block Extension Educator
1 Accountant and 1 Clerk
Support staff (attendants, cleaners)

🩺 Key Health Services Delivered at PHC

🔹 1. Outpatient and Minor Inpatient Services

Management of minor ailments, fever, infections, injuries
Diagnosis and treatment of common diseases
24×7 service in some PHCs with inpatient beds (usually 4–6 beds)
Management of normal deliveries

🔹 2. Maternal and Child Health (MCH) Services

Antenatal care (ANC), postnatal care (PNC), safe delivery
Childbirth services and newborn care
Immunization for children and pregnant women
Nutritional assessment and counseling
Growth monitoring

📌 Programs: JSY, JSSK, RMNCH+A

🔹 3. Family Welfare Services

Distribution of contraceptives (oral pills, condoms, IUCD)
Sterilization camps (in coordination with CHCs)
Counseling on birth spacing and reproductive health

📌 Program: Family Welfare Program

🔹 4. Immunization Services

Routine immunization under Universal Immunization Programme (UIP)
Management of vaccine storage and cold chain
Coordination with Sub-Centres for outreach sessions

🔹 5. Disease Control Programs

Case detection, treatment, and follow-up for:
- Tuberculosis
- Malaria
- Leprosy
- HIV/AIDS
- Vector-borne and waterborne diseases

📌 Programs: RNTCP (TB), NVBDCP (malaria), NLEP (leprosy), IDSP (surveillance)

🔹 6. Non-Communicable Disease (NCD) Services

Screening and management of:
- Hypertension
- Diabetes
- Common cancers (oral, breast, cervical)
Counseling for mental health, substance abuse, and lifestyle changes

📌 Program: National Programme for Prevention and Control of NCDs (NP-NCD)

🔹 7. Health Education and IEC/BCC Activities

Promoting awareness on:
- Sanitation and hygiene
- Breastfeeding and nutrition
- Family planning
- Vector control
Observance of health days (e.g., World Health Day, Nutrition Week)

🔹 8. School and Adolescent Health

Deworming, anemia screening, health talks in schools
Distribution of IFA tablets
Menstrual hygiene program for adolescent girls
Mental health awareness

📌 Programs: WIFS, RBSK, Menstrual Hygiene Scheme

🔹 9. Referral Services

PHCs refer complicated cases to Community Health Centres (CHCs) or District Hospitals
Maintain referral records and feedback

🔹 10. Monitoring and Supervision

Supervision of Sub-Centres and ASHA workers
Compilation of data from SCs and submission of HMIS reports
Maintain village-wise health records, drug inventory, and immunization coverage

🔹 11. Services under Ayushman Bharat – Health & Wellness Centres (HWCs)

PHCs are being transformed into Comprehensive Primary Care Centres offering:

Expanded package of 12 services, including:
- Elderly care
- Oral health
- Palliative care
- Mental health
Managed by Community Health Officers (CHOs)
Digital health records and telemedicine (eSanjeevani)
Yoga and wellness sessions

🧠 Conclusion

PHCs are the cornerstone of India’s rural health delivery system, bridging the gap between the community and higher healthcare facilities.

By offering comprehensive, affordable, and integrated care, PHCs contribute significantly to achieving Universal Health Coverage (UHC) and improving rural health outcomes.

🏥 Delivery of Health Services at Community Health Centre (CHC)

📘 Introduction

A Community Health Centre (CHC) is the first-level referral centre for four Primary Health Centres (PHCs) and forms the secondary level of healthcare in the three-tier rural healthcare delivery system in India.

It provides specialist outpatient and inpatient services, functioning as a Mini Hospital with a dedicated team of medical specialists.

📍 Population Coverage

Area Type	Population Coverage per CHC
Plain Areas	1,20,000
Hilly/Tribal/Difficult Areas	80,000

👨‍⚕️ Staffing Pattern (as per Indian Public Health Standards – IPHS)

4 Medical Specialists:
- Physician
- Surgeon
- Obstetrician/Gynecologist
- Pediatrician
1 General Duty Medical Officer (MBBS)
6–7 Staff Nurses
1 Pharmacist
1 Lab Technician, 1 Radiographer
1 Public Health Nurse
Support staff (ward boys, cleaners, data entry operator, etc.)

🩺 Key Health Services Delivered at CHC

🔹 1. Specialist Outpatient Services

General medicine, surgery, gynecology, pediatrics
Diagnosis and treatment of moderate to severe illness
Regular OPD services on all working days

🔹 2. Inpatient Care and Emergency Services

At least 30-bed indoor facility
24×7 emergency care, minor and elective surgeries
Management of accidents, injuries, poisonings
Emergency obstetric care (EmOC), assisted deliveries, and cesarean section services

🔹 3. Maternal and Child Health Services

High-risk pregnancy management
Institutional deliveries and Emergency Obstetric Care (EmOC)
Newborn and infant care
Family planning (IUCD insertion, sterilization camps)
Post-abortion care and MTP (as per law)

🔹 4. Surgical and Medical Services

Minor and major surgeries
Pre- and post-operative care
Treatment of chronic and acute medical illnesses
Blood storage unit (in some CHCs)
Wound suturing, fracture care (basic ortho support)

🔹 5. Diagnostic Services

Laboratory tests: Hemoglobin, urine test, malaria smear, blood sugar, etc.
Radiology: X-rays (with radiographer)
Availability of ECG, blood grouping, and HIV testing (under ICTC)

🔹 6. National Health Program Implementation

CHCs implement and support:

RNTCP (TB Control)
NLEP (Leprosy)
NVBDCP (Malaria, Dengue, etc.)
NACP (HIV/AIDS)
NPCBVI (Blindness)
NP-NCD (Diabetes, Hypertension, Cancer screening)

🔹 7. Referral and Emergency Transport

Acts as a referral link between PHCs and District Hospitals
Refers complicated and advanced cases to tertiary hospitals
Coordinates with 108 ambulance services for transport

🔹 8. Health Education and Counseling

IEC/BCC activities related to:
- MCH, immunization, nutrition, sanitation, and disease prevention
Mental health counseling, adolescent health support
Counseling for family planning, HIV, and lifestyle diseases

🔹 9. Training and Supervision

Serves as a training centre for health workers, ANMs, ASHAs
Supervises implementation of programs at PHC and SC levels
Supports Village Health Sanitation and Nutrition Committees (VHSNCs)

🔹 10. Record Maintenance & Reporting

Reporting of vital events, notifiable diseases
Monthly HMIS (Health Management Information System) updates
Monitoring of maternal deaths, infant deaths, and adverse events

🏥 CHCs Under Ayushman Bharat – Health & Wellness Centres (HWC-CHC)

Some CHCs upgraded to HWCs with:
- Comprehensive primary & secondary care
- Digital health records, telemedicine
- Expanded package of services (including mental health, ENT, geriatrics)

🔄 Conclusion

Community Health Centres (CHCs) serve as critical link institutions in rural health care delivery.
They offer specialist and emergency services, support national programs, and bridge the gap between primary care (PHCs) and tertiary hospitals, especially in remote and underserved regions.

🏥 Delivery of Health Services at the District Level

📘 Introduction

The District Health System is the third tier in the rural health care delivery pyramid and plays a key role in delivering secondary and some tertiary-level health services. It serves as the link between primary care institutions (PHCs, CHCs) and state-level referral hospitals.

Every district has a District Health Society (DHS) under the National Health Mission (NHM) to manage and monitor public health services.

🗺️ Health Infrastructure at District Level

🏨 1. District Hospital (DH)

🏥 Functions:

Acts as a referral centre for CHCs and PHCs
Provides specialist and emergency care
Performs surgeries, deliveries, blood transfusions, and critical care
Provides inpatient (IPD) and outpatient (OPD) services

👨‍⚕️ Specialists Available:

Medicine, Surgery, Obstetrics & Gynecology, Pediatrics, Orthopedics
ENT, Ophthalmology, Dermatology, Psychiatry (as per IPHS)
Anesthetist, Pathologist, Radiologist

🛏️ Capacity:

100–500 beds depending on the population size
Minimum: 1 bed per 1,000 population

🧪 2. District-Level Diagnostic and Laboratory Services

Fully functional laboratories with:
- Hematology, biochemistry, serology, pathology
- X-ray, ECG, ultrasonography, CT scan (in many DHs)
- Blood banks/blood storage units
Diagnostics under Free Diagnostics Scheme in NHM

🚑 3. Emergency and Specialized Care Units

24×7 Emergency Obstetric Care (EmOC)
Newborn Stabilization Units (NBSUs) and Sick Newborn Care Units (SNCUs)
Intensive Care Units (ICUs), High Dependency Units (HDUs)
Trauma care units in district hospitals

🔬 4. Program Implementation & Supervision

District-level authorities implement and monitor:

National Health Programs (e.g., TB, HIV, malaria, leprosy, blindness, NCDs)
Maternal & child health programs
Family planning and reproductive health initiatives
Nutrition, adolescent health, and elderly care programs

📌 Programs supervised:

RNTCP, NLEP, NVBDCP, NPCBVI, NACP, RMNCH+A, NP-NCD, etc.

🧑‍💼 5. District Health Administration

👤 Key Officials:

Chief Medical and Health Officer (CMHO) or District Health Officer (DHO)
District Program Manager (NHM)
District Immunization Officer
District Surveillance Officer (DSO)
District RCH/FP/NCD Officers
District AYUSH Medical Officer

🗂️ Responsibilities:

Planning and implementation of health programs
Monitoring of CHCs, PHCs, Sub-Centres
Managing health staff recruitment, training, supervision
Disease outbreak control, data collection, and reporting (HMIS, IDSP)

🧾 6. Administrative and Support Units

District Health Society (DHS) under NHM: Coordinates all health schemes
District Programme Management Unit (DPMU): Handles HR, finance, logistics
District Drug Store: Supplies medicines and vaccines to all public facilities
District ASHA Coordination Unit

🧑‍🏫 7. Training and Capacity Building

Conducts training for:
- ASHAs, ANMs, MPWs, nurses, and medical officers
- Orientation on national health programs, immunization, outbreak response
- Use of technology like telemedicine, e-HMIS

💡 8. Innovations and Digital Health at District Level

eSanjeevani: Teleconsultation for remote populations
HMIS, IDSP, MCTS: For real-time health data reporting
ABHA (Ayushman Bharat Health Account): Digital health ID for patients

🔁 Referral Chain at District Level

vbnetCopyEditSub-Centre → PHC → CHC → District Hospital → Medical College/Tertiary Centre

🧠 Conclusion

The district health care system plays a central role in delivering specialist, emergency, and referral services, while also coordinating the implementation of national health programs.

It serves as the hub for supervision, planning, capacity building, and health system governance, supporting India’s goal of Universal Health Coverage (UHC).

🏛️ Delivery of Health Services at the State Level

📘 Introduction

The State Health System is responsible for the planning, administration, and coordination of healthcare services in the state. It forms the backbone of the public health infrastructure, overseeing all district-level and lower-level facilities and ensuring the effective implementation of national and state health policies and programs.

🧭 Key Functions of State-Level Health Delivery

Planning and policy-making for health and family welfare
Monitoring and supervision of district health systems
Recruitment and training of health personnel
Allocation of resources and budgeting
Implementation of state-specific health schemes
Coordination with central government and NITI Aayog

🧑‍⚕️ State-Level Health Infrastructure

🏥 1. State Directorate of Health Services

👤 Headed by:

Director of Health Services (DHS)
Director of Medical Education (DME) – for medical colleges
Director of AYUSH – for alternative systems of medicine

📋 Key Responsibilities:

Implementation of national health programs (e.g., RNTCP, UIP, NHM)
Monitoring of PHCs, CHCs, and district hospitals
Planning and budgeting for health infrastructure
Recruitment and posting of doctors, nurses, and support staff
Disease surveillance, epidemic control, and public health campaigns

🏫 2. State Health and Family Welfare Training Institutions

Train doctors, nurses, ANMs, MPWs, and other paramedical staff
Organize refresher training and capacity building
Support implementation of health programs through skilled manpower

📌 Examples:

SIHFW (State Institute of Health and Family Welfare)
Regional Training Centres (RTCs)
Nursing schools and paramedical institutes

🏛️ 3. State Health Society (SHS) – NHM

Functions as the nodal agency for implementing the National Health Mission (NHM) at the state level

🔹 Components:

State Programme Management Unit (SPMU)
Finance, Procurement, HR, Monitoring & Evaluation cells
Coordinates with District Health Societies (DHS)

📌 Programs Handled:

NHM (includes RCH, NCD, Urban Health, Child Health, etc.)
Ayushman Bharat (PM-JAY + HWCs)
Disease control programs, e.g., NACP, NVBDCP

🏥 4. Tertiary Care Institutions

State-run Medical Colleges and Teaching Hospitals
Provide super-specialty and referral care
Serve as centres for:
- Clinical care
- Medical and nursing education
- Research and training

📌 Examples:

Government Medical Colleges (GMCs), PG institutions
Cancer institutes, cardiac hospitals, and mental health centres

🧪 5. State-Level Diagnostic & Surveillance Facilities

State Public Health Laboratories
Integrated Disease Surveillance Programme (IDSP) units
State Vaccine Stores and Drug Warehouses
Cold chain monitoring and logistics for immunization

🧾 6. Policy Implementation and Monitoring

Rollout of state-specific health missions or insurance schemes
- Example: Mukhya Mantri Amrutam Yojana (Gujarat), Aarogyasri (Telangana)
Oversight of:
- Maternal and child health services
- Family planning and reproductive health
- Nutrition and adolescent programs
Annual and quarterly state health reviews

🤝 7. Coordination with Other Departments

Women and Child Development (ICDS)
Education (school health)
Rural Development (sanitation, drinking water)
Municipal bodies for urban health services

🧠 Conclusion

The State Health System acts as the link between national policies and grassroots implementation. It is responsible for managing health services across all districts, ensuring the availability of human resources, infrastructure, logistics, and monitoring outcomes.

State-level health governance is essential for achieving equity, universal health coverage, and the goals of National Health Policy.

🏛️ Delivery of Health Services at the National Level

📘 Introduction

The national level health care system in India plays a vital role in policy-making, planning, financing, regulation, and coordination of health services across the country.
It oversees the implementation of national health programs, disease control initiatives, and public health campaigns through central institutions, ministries, and autonomous bodies.

🧭 Key Roles at the National Level

Formulation of health policies and national health plans
Development of health infrastructure and manpower
Design and funding of national programs
Monitoring, evaluation, and research
International collaboration and health regulations

🏥 Main Bodies Responsible for Health at the National Level

🔹 1. Ministry of Health and Family Welfare (MoHFW)

Apex ministry responsible for health services in India

Departments:

Department of Health and Family Welfare
Department of Health Research
Department of AYUSH (Now a separate Ministry)

🔧 Functions:

Develops National Health Policy
Designs and monitors national health programs
Regulates public health laws, food safety, drug control
Allocates budget and coordinates with states and UTs
Implements flagship schemes like:
- National Health Mission (NHM)
- Ayushman Bharat (PM-JAY + HWCs)
- Universal Immunization Programme (UIP)

🔹 2. NITI Aayog

Think tank of the Government of India (replaced Planning Commission)

Functions:

Strategic planning for universal health coverage (UHC)
Evaluation of national programs
Development of three-year action plans and health index rankings
Promotion of digital health and telemedicine

🔹 3. National Health Mission (NHM)

Umbrella program launched in 2005 for strengthening public health

Components:

National Rural Health Mission (NRHM) – for rural areas
National Urban Health Mission (NUHM) – for urban poor

Goals:

Reduce IMR, MMR, and disease burden
Strengthen PHCs, CHCs, Sub-Centres
Deploy ASHA workers, improve maternal and child health services

🔹 4. National Health Programs

Implemented through MoHFW with technical support from national institutes

Area	Key Programs
Communicable Diseases	RNTCP (TB), NLEP (Leprosy), NVBDCP (Malaria/Dengue), NACP (HIV/AIDS)
Non-Communicable Diseases	NP-NCD, National Cancer Control, Mental Health Program
RMNCH+A	Janani Suraksha Yojana, JSSK, RBSK
Nutrition	POSHAN Abhiyaan, IFA supplementation, Mid-Day Meal

🔹 5. Apex National Health Institutions

Institution	Role
AIIMS	Tertiary care, medical education, research
ICMR	Medical research and public health studies
NCDC	Disease surveillance and epidemic control
NIHFW	Health training and education
CDSCO	Drug regulation and control
DGHS	Director General of Health Services – technical wing of MoHFW

🔹 6. Ministry of AYUSH

Promotes Ayurveda, Yoga, Unani, Siddha, Homeopathy, and Naturopathy
Oversees AYUSH colleges, hospitals, and traditional medicine programs
Integration of AYUSH services in Health & Wellness Centres

🔹 7. National Health Insurance & Financial Schemes

Scheme	Features
PM-JAY (Ayushman Bharat)	₹5 lakh/year/family for 50 crore beneficiaries
CGHS	Central Government employees and pensioners
ESIC	Health coverage for factory/organized sector workers

🔹 8. Regulatory and Coordinating Bodies

Agency	Function
National Medical Commission (NMC)	Regulates medical education and ethics
INC (Indian Nursing Council)	Regulates nursing education
FSSAI	Food safety and quality control
NABH	Hospital accreditation and quality assurance

🔬 Monitoring and Evaluation Tools at National Level

Health Management Information System (HMIS)
Integrated Disease Surveillance Programme (IDSP)
National Family Health Survey (NFHS)
Sample Registration System (SRS)
National Health Accounts (NHA)

🌍 International Collaboration

The central government collaborates with:

WHO, UNICEF, UNFPA, GAVI, Global Fund, World Bank
For funding, vaccines, technical support, and global health policies

🧠 Conclusion

The national health system provides the vision, direction, and coordination for India’s health sector.
It ensures the implementation of health policies, mobilizes resources, and supports states in delivering affordable and equitable healthcare, ultimately aiming for Universal Health Coverage (UHC).

🌍 Sustainable Development Goals (SDGs)

📘 Introduction

The Sustainable Development Goals (SDGs) are a set of 17 global goals adopted by 193 member countries of the United Nations in 2015, as part of the 2030 Agenda for Sustainable Development.

✅ They aim to end poverty, protect the planet, and ensure prosperity, health, and peace for all — by the year 2030.

🧭 Key Features of SDGs

Replaced the earlier Millennium Development Goals (MDGs)
Applicable to all countries — developed and developing
Focus on integration of economic, social, and environmental dimensions
Contains 17 goals, 169 targets, and 230 indicators

🎯 List of 17 Sustainable Development Goals (SDGs)

Goal No.	Goal Title
1️⃣	No Poverty – End poverty in all its forms everywhere
2️⃣	Zero Hunger – End hunger, achieve food security and improved nutrition
3️⃣	Good Health and Well-being – Ensure healthy lives and promote well-being for all
4️⃣	Quality Education – Ensure inclusive and equitable quality education
5️⃣	Gender Equality – Achieve gender equality and empower all women and girls
6️⃣	Clean Water and Sanitation – Ensure availability of water and sanitation for all
7️⃣	Affordable and Clean Energy – Ensure access to sustainable energy
8️⃣	Decent Work and Economic Growth – Promote inclusive and sustainable economic growth
9️⃣	Industry, Innovation, and Infrastructure – Build resilient infrastructure and innovation
🔟	Reduced Inequalities – Reduce inequality within and among countries
1️⃣1️⃣	Sustainable Cities and Communities
1️⃣2️⃣	Responsible Consumption and Production
1️⃣3️⃣	Climate Action
1️⃣4️⃣	Life Below Water – Conserve oceans, seas, and marine resources
1️⃣5️⃣	Life on Land – Protect ecosystems, forests, and biodiversity
1️⃣6️⃣	Peace, Justice, and Strong Institutions
1️⃣7️⃣	Partnerships for the Goals – Strengthen global cooperation and partnerships

❤️ SDG 3: Good Health and Well-being (Health Focus)

Goal 3 is directly related to health and aims to ensure healthy lives and promote well-being for all at all ages.

📌 Key Targets under SDG 3:

Reduce maternal mortality to below 70 per 100,000 live births
End epidemics of AIDS, TB, malaria, and neglected tropical diseases
Reduce under-5 and neonatal mortality
Ensure universal access to reproductive and sexual healthcare
Achieve universal health coverage (UHC)
Reduce deaths due to non-communicable diseases (NCDs)
Strengthen health workforce and financing
Promote mental health and well-being

🩺 SDGs Related to Health (Indirectly)

Although SDG 3 is the main health goal, several other SDGs also impact health:

SDG	Impact on Health
1 – No Poverty	Poverty is linked to poor health and limited access to care
2 – Zero Hunger	Malnutrition leads to stunted growth, anemia, maternal deaths
4 – Quality Education	Health education improves hygiene, awareness, and prevention
5 – Gender Equality	Reduces maternal deaths, improves access to care for women
6 – Clean Water & Sanitation	Prevents waterborne diseases like diarrhea, cholera
13 – Climate Action	Addresses environmental health risks (heatwaves, air pollution)

📊 India’s Progress on SDGs (Health)

IMR reduced to 28/1,000 live births (2023)
Maternal Mortality Ratio (MMR) down to 97/100,000 live births
Ayushman Bharat launched to support UHC and financial protection
Digital Health Mission, POSHAN Abhiyaan, and Mission Indradhanush are aiding progress

📌 Yet, challenges remain in NCDs, mental health, and health equity between states.

🧠 Conclusion

The Sustainable Development Goals provide a unified global framework to improve human health, reduce inequality, and protect our planet.
Health is both a goal and a driver of sustainable development.

India’s achievement of SDG 3 is essential for its vision of “Health for All” and equitable development by 2030.

🏥 Primary Health Care (PHC)

📘 Definition

Primary Health Care is defined as essential health care made universally accessible to all individuals and families in the community through their full participation and at a cost that the community and country can afford. It is based on methods that are practical, scientifically sound, socially acceptable, and culturally appropriate.

The concept of PHC was introduced in the Alma-Ata Declaration of 1978, jointly organized by the World Health Organization (WHO) and UNICEF. The declaration recognized PHC as the key to achieving the goal of “Health for All” by the year 2000 and beyond.

🎯 Objectives of Primary Health Care

The main objective of PHC is to provide accessible, affordable, and equitable health services to all, especially the underserved and marginalized groups. The key objectives include:

Universal access to essential health care services, regardless of geographical or socio-economic differences.
Promotion of equity in health services by reaching rural, tribal, and poor populations.
Encouragement of community involvement and responsibility in planning, delivery, and evaluation of health services.
Focus on preventive, promotive, curative, and rehabilitative care, delivered at the grassroots level.
Integration of health with other sectors, such as nutrition, education, agriculture, water, and sanitation.
Use of appropriate technology and low-cost interventions suited to local needs.

🧱 Essential Elements of Primary Health Care

The Alma-Ata Declaration outlined eight essential components that should be included in primary health care delivery. These are:

Health Education: Providing individuals and communities with knowledge about common health problems and ways to prevent and control them. This includes education about hygiene, nutrition, immunization, and communicable diseases.
Promotion of Food Supply and Proper Nutrition: Ensuring access to adequate food and improving nutritional status through awareness and supplementation programs.
Provision of Safe Water and Basic Sanitation: Encouraging safe drinking water practices and promoting sanitary methods of waste disposal to prevent waterborne diseases.
Maternal and Child Health Services including Family Planning: Offering antenatal and postnatal care, safe deliveries, child health services, and education about family planning methods.
Immunization Against Major Infectious Diseases: Protecting children and pregnant women through regular vaccination services against diseases like polio, measles, diphtheria, tetanus, and tuberculosis.
Prevention and Control of Endemic Diseases: Taking active measures to prevent and manage locally prevalent diseases like malaria, leprosy, tuberculosis, and dengue.
Appropriate Treatment for Common Diseases and Injuries: Providing basic curative services for ailments such as fever, infections, diarrhea, and minor injuries at local health facilities.
Provision of Essential Drugs: Ensuring regular availability of life-saving and commonly used medicines at every health centre.

🧭 Principles of Primary Health Care

Primary Health Care is guided by a set of core principles which form the foundation of an effective and people-centered health system:

1. Equitable Distribution
Health services must be made available and accessible to everyone, especially to those in rural and underserved communities. PHC promotes fairness and justice in health care delivery.

2. Community Participation
The people must be involved in identifying their health needs and in planning and implementing health services. This increases community ownership, responsibility, and sustainability of health interventions.

3. Intersectoral Coordination
Health cannot be achieved by the health sector alone. It requires the collaboration of other sectors like education, agriculture, water supply, sanitation, housing, and women and child welfare. This coordinated approach addresses the wider determinants of health.

4. Appropriate Technology
The methods and equipment used in health care should be scientifically valid, culturally acceptable, and affordable. Examples include the use of oral rehydration solution (ORS), handpumps for safe drinking water, and manual delivery kits.

5. Emphasis on Prevention and Health Promotion
Primary health care focuses on keeping people healthy by promoting good hygiene, nutrition, immunization, and early disease detection, rather than only treating illness after it occurs.

6. Self-Reliance and Sustainability
PHC aims to build the capacity of individuals and communities to take responsibility for their own health through awareness, behavioral change, and mobilization of local resources.

🌱 Conclusion

Primary Health Care is the cornerstone of an equitable and effective health system. It brings health services closer to where people live and work and focuses on preventing disease, promoting health, and involving the community in their own care. In India, programs like the National Health Mission, Health and Wellness Centres under Ayushman Bharat, and the work of ASHA workers are excellent examples of PHC in action. By strengthening PHC, countries can move closer to achieving Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs).

🏥 Comprehensive Primary Health Care (CPHC)

📘 Introduction

Comprehensive Primary Health Care (CPHC) is an expanded model of Primary Health Care that provides holistic, equitable, and accessible services for prevention, promotion, treatment, rehabilitation, and palliative care — close to where people live.

In India, CPHC is being delivered through Health and Wellness Centres (HWCs) under the Ayushman Bharat Programme, launched in 2018. It aims to strengthen the first level of health care delivery by ensuring that primary care is not only curative, but also preventive and promotive.

🎯 Goals of CPHC

Achieve Universal Health Coverage (UHC)
Ensure continuum of care across all levels
Reduce out-of-pocket expenditure
Improve health outcomes through early diagnosis and community-based care

🧱 12 Essential Components/Services of CPHC (India’s Model)

Care in Pregnancy and Childbirth
- Antenatal and postnatal care
- Safe delivery and birth preparedness
- Referral for high-risk pregnancies
Neonatal and Infant Health Care Services
- Early newborn care, breastfeeding support
- Management of neonatal illnesses
- Immunization and growth monitoring
Child and Adolescent Health Care
- Immunizations, deworming, anemia prevention
- Menstrual hygiene and adolescent counseling
- School health services under RBSK
Family Planning, Contraceptive Services and Reproductive Health Care
- Distribution of oral pills, condoms, IUCDs
- Sterilization referrals
- Management of reproductive health issues
Management of Communicable Diseases
- Active surveillance, early detection, and treatment
- Diseases like TB, malaria, dengue, leprosy
- Support for outbreak control
Management of Non-Communicable Diseases (NCDs)
- Screening and early diagnosis of hypertension, diabetes, cancers (oral, breast, cervical)
- Lifestyle counseling and referrals
Basic Ophthalmic (Eye) Care
- Vision testing and treatment of common eye conditions
- Referral for cataract and other eye surgeries
Basic ENT (Ear, Nose, Throat) Care
- Management of infections and minor conditions
- Ear irrigation, wax removal, sore throat treatment
Basic Oral Health Care
- Screening for dental caries, gum disease
- Oral hygiene education
- Referral for dental procedures
Elderly and Palliative Health Care Services

Geriatric checkups and chronic disease care
Supportive and palliative care for terminally ill

Emergency Medical Services

First aid, stabilization of patients
Immediate referral and ambulance services

Mental Health Care

Counseling for stress, anxiety, depression
Referral for psychiatric care
Awareness on substance abuse and suicide prevention

🧠 Conclusion

Comprehensive Primary Health Care ensures that health services are people-centered, inclusive, and delivered as close to home as possible. Through the 12 essential service packages, India is moving toward achieving universal health coverage, reducing health inequities, and improving quality of life.

Certainly! Here’s a refined, detailed explanation of the principles of Comprehensive Primary Health Care (CPHC) — ideal for nursing students, public health learners, and academic writing or presentations.

🧭 Principles of Comprehensive Primary Health Care (CPHC)

📘 Introduction

The principles of Comprehensive Primary Health Care guide how health services should be designed, delivered, and evaluated to ensure that they are equitable, inclusive, people-centered, and aimed at achieving universal health coverage (UHC).

These principles expand upon the core ideas of Primary Health Care (as laid out in the Alma-Ata Declaration) and are adapted to meet the modern health needs of communities across India and the world.

🌟 Key Principles of CPHC

1️⃣ Universal Access and Equity

Health services must be available to everyone, regardless of income, gender, location, or social status.
Special efforts must be made to reach vulnerable and marginalized populations, such as tribal communities, urban slum dwellers, and the elderly.

✅ Example: Establishing Health & Wellness Centres (HWCs) in rural and tribal areas.

2️⃣ Community Participation and Empowerment

Communities should be actively involved in identifying their health needs, planning services, and evaluating outcomes.
This promotes ownership, sustainability, and responsiveness of the health system.

✅ Example: ASHA workers and Village Health Sanitation & Nutrition Committees (VHSNCs) helping identify local health issues.

3️⃣ Comprehensive and Integrated Services

CPHC provides a broad package of services, covering preventive, promotive, curative, rehabilitative, and palliative care.
Services should be integrated across departments (health, nutrition, education, sanitation) and across levels (SCs, PHCs, CHCs).

✅ Example: A Health & Wellness Centre screening for NCDs, offering MCH care, and mental health services under one roof.

4️⃣ Continuity of Care

Health care must not be fragmented. Patients should be able to receive care throughout their life cycle — from infancy to old age — and through all stages of illness.
Referral and follow-up systems must be strong.

✅ Example: A pregnant woman referred from a sub-centre to PHC for delivery, and followed up postnatally at home by ASHA.

5️⃣ Health Promotion and Disease Prevention

Emphasis should be on keeping people healthy through awareness, education, and preventive actions rather than only treating illness.

✅ Example: IEC activities on diet, exercise, handwashing, and immunization.

6️⃣ Use of Appropriate Technology

Technologies used must be scientifically sound, culturally acceptable, low-cost, and easy to use in the local setting.

✅ Example: Use of rapid diagnostic kits for malaria or oral rehydration salts (ORS) for diarrhea.

7️⃣ Intersectoral Coordination

Health outcomes are influenced by sectors like education, water supply, sanitation, nutrition, and housing.
CPHC requires coordination with these sectors for a holistic approach to health.

✅ Example: Linking malnourished children with Anganwadi nutrition programs.

8️⃣ Accountability and Transparency

Health systems must be accountable to the people they serve.
Data should be transparently shared, and services should be monitored and evaluated regularly.

✅ Example: Monthly health progress reports shared with Panchayats and community members.

9️⃣ Cultural Sensitivity and Respect

Services should be delivered in a respectful, inclusive, and culturally appropriate manner.
Language, beliefs, and customs of the community must be considered.

✅ Example: Using local language during counseling sessions or health education.

1️⃣0️⃣ Financial Protection and Affordability

CPHC must reduce out-of-pocket expenses and ensure that health care is not a financial burden on families.

✅ Example: Free essential drugs and diagnostics provided at HWCs and PHCs.

🧠 Conclusion

The principles of Comprehensive Primary Health Care ensure that health services are people-centered, equitable, and sustainable. By following these principles, countries like India can strengthen their health systems, achieve health equity, and move toward Universal Health Coverage (UHC).

🏥 Comprehensive Primary Health Care (CPHC) through Sub-Centres/Health & Wellness Centres (HWCs)

📘 Introduction

Comprehensive Primary Health Care (CPHC) aims to provide a broad range of health services that go beyond curative care to include preventive, promotive, rehabilitative, and palliative services — made accessible and affordable at the grassroots level.

In India, this is implemented through the transformation of Sub-Centres (SCs) and Primary Health Centres (PHCs) into Health & Wellness Centres (HWCs) under the Ayushman Bharat Programme, launched in 2018.

🎯 Objective of HWCs at SC Level

Deliver comprehensive primary health services close to the community
Reduce out-of-pocket expenditure by offering free essential services
Promote health-seeking behavior and early diagnosis
Strengthen community trust and engagement in the public health system

🧱 Transformation of Sub-Centre to HWC

A Sub-Centre (SC) becomes a Health & Wellness Centre (HWC) when it is upgraded with:

Trained Human Resources
- Community Health Officer (CHO) – A nurse or AYUSH graduate trained in primary care
- Existing ANMs and MPWs (Male/Female)
- ASHA workers – Act as link between community and the health system
Expanded Service Package
- Delivery of the 12 essential CPHC services (e.g., NCD care, MCH, mental health, palliative care)
Infrastructure Upgradation
- Improved space, basic amenities, examination rooms, equipment
Availability of Medicines and Diagnostics
- Provision of essential drugs and diagnostic tests at no cost
Use of Digital Health Technology
- Use of tablet-based reporting, eSanjeevani telemedicine, and ABHA IDs
Health Promotion Activities
- Organizing wellness and yoga sessions, behavior change communication (BCC), and community awareness events

🩺 Services Provided at HWC–SC Level (Aligned with CPHC)

Maternal and child health care – ANC, PNC, immunization
Family planning and reproductive health – Contraceptives, counseling
Management of communicable diseases – TB, malaria, leprosy
Screening and management of NCDs – BP, diabetes, cancers
Mental health counseling – Depression, anxiety, referral
Elderly and palliative care – Home-based care and follow-up
Oral, eye, ENT care – Basic screening and first-level management
Emergency and minor ailments – First aid, referrals
School and adolescent health care – Menstrual hygiene, nutrition
Health education and wellness activities – Yoga, lifestyle advice
Community engagement – Through ASHAs and local events
Free essential drugs and diagnostics

👥 Role of the CHO and Team at HWC–SC

CHO leads the team and ensures service delivery
Supervises ANMs and MPWs
Maintains digital health records and referrals
Conducts screening camps, wellness activities, and community outreach

📌 Benefits of Delivering CPHC through HWCs

Brings comprehensive services closer to people
Reduces burden on higher-level facilities
Promotes preventive and promotive health practices
Builds trust in public health systems
Enables early detection of NCDs and chronic conditions
Helps in achieving Universal Health Coverage (UHC) and SDG targets

🧠 Conclusion

The transformation of Sub-Centres into Health & Wellness Centres marks a major shift from selective to comprehensive primary health care. By equipping SCs with trained CHOs, expanded services, and digital tools, India is empowering its frontline health system to deliver affordable, accessible, and holistic care — right where people live.

👩‍⚕️ Role of MLHP / CHO in Health & Wellness Centres (HWCs)

📘 Introduction

The Mid-Level Health Provider (MLHP), officially known as the Community Health Officer (CHO) in India, is a key functionary at the Health & Wellness Centre (HWC).
Their role is to lead the primary health care team and ensure the delivery of comprehensive primary health services under the Ayushman Bharat Programme.

Appointed at Sub-Centres upgraded to HWCs, CHOs serve as team leaders, service providers, coordinators, and community advocates.

🎯 Primary Responsibility

To implement and supervise the 12 service packages under Comprehensive Primary Health Care (CPHC) and ensure holistic health service delivery at the community level.

🩺 Key Roles and Responsibilities of MLHP / CHO

1️⃣ Clinical Care Provider

Diagnose and manage common illnesses, minor injuries, and non-communicable diseases (NCDs)
Provide maternal and child health services – ANC, PNC, immunization
Screen for oral, eye, ENT, and mental health conditions
Offer palliative and elderly care
Initiate emergency care and refer severe cases to PHC/CHC

2️⃣ Leader of the HWC Team

Supervise and guide the ANMs, MPWs, and ASHA workers
Distribute tasks and ensure coordination among the frontline workers
Conduct team meetings, reviews, and capacity building sessions

3️⃣ Implementation of Public Health Programs

Ensure delivery of services under:
- National Health Mission (NHM)
- RMNCH+A, NP-NCD, RNTCP, NLEP, NACP, etc.
Organize outreach sessions, screening camps, and VHNDs

4️⃣ Health Promotion and Behavior Change Communication (BCC)

Conduct awareness activities on hygiene, nutrition, breastfeeding, substance abuse, family planning, etc.
Organize Yoga and Wellness sessions
Educate the public about preventive health measures

5️⃣ Data Management and Digital Reporting

Use tablet or mobile-based tools to enter patient data
Maintain electronic health records and update ABHA IDs
Submit reports to PHC and District Health Officials via HMIS

6️⃣ Referral and Continuum of Care

Refer complicated cases to PHC/CHC/District Hospital
Ensure follow-up of referred patients
Support continuity of care through coordination with other levels of the health system

7️⃣ Inventory and Logistics Management

Maintain stock of essential medicines and diagnostics
Ensure availability of equipment and infection prevention supplies
Monitor cold chain and vaccine logistics (with ANMs)

8️⃣ Community Mobilization and Engagement

Build trust and rapport with the community
Engage community leaders and Village Health Committees
Promote ownership of health programs at local level

9️⃣ Support for Mental Health and Counseling

Provide basic counseling for depression, anxiety, and emotional stress
Promote mental well-being through screening, referrals, and community support

🔟 Training and Capacity Building

Participate in ongoing training programs (Bridge Course/CPHC certification)
Update knowledge about clinical guidelines, national programs, and digital tools

👥 Key Competencies Expected from CHO / MLHP

Clinical decision-making
Communication and leadership
Community relationship building
Record keeping and data analysis
Team coordination and supervision

🧠 Conclusion

The Community Health Officer (CHO) plays a crucial role in bridging the gap between the community and the health system.
As a multi-skilled leader and frontline service provider, the CHO/MLHP is central to the success of Comprehensive Primary Health Care and Health & Wellness Centres (HWCs) in achieving Universal Health Coverage (UHC).

🏛️ National Health Policy of India – 1983, 2002, 2017

📘 Introduction

The National Health Policy (NHP) is a government framework aimed at guiding the planning, implementation, and evaluation of health services in India.
Three major policies have been launched so far — in 1983, 2002, and 2017, each reflecting the health needs, challenges, and priorities of its time.

🟩 1. National Health Policy, 1983

📌 Context

India was facing a high burden of communicable diseases, maternal and child mortality, and lacked equitable access to health services.
Based on the Alma-Ata Declaration of 1978 (Health for All by 2000 AD).

🎯 Objectives

Achieve Health for All by the year 2000
Provide universal, comprehensive primary health care
Emphasize preventive, promotive, and rehabilitative services
Integrate AYUSH systems with modern medicine

🎯 Targets

Reduce IMR below 60 per 1,000 live births
MMR reduction through expanded maternal services
Ensure safe drinking water and basic sanitation for all
Establish a PHC for every 30,000 population and SC for 5,000

✅ Key Achievements

Launch of Universal Immunization Programme (UIP) in 1985
Establishment of Primary Health Centres (PHCs) and Sub-Centres (SCs)
Integration of national disease control programs
Increased focus on rural health infrastructure
Inclusion of health as a right-based approach in planning

🟨 2. National Health Policy, 2002

📌 Context

Rising burden of non-communicable diseases (NCDs)
Increasing urban-rural health disparities
Inadequate public health spending

🎯 Objectives

Achieve an acceptable standard of good health for all
Increase access to decentralized and participatory healthcare
Promote alternative systems of medicine (AYUSH)
Encourage public-private partnerships (PPP) in healthcare

🎯 Targets

Increase public health expenditure to 2% of GDP
IMR below 30 per 1,000 live births
MMR below 100 per 1 lakh live births
Achieve total fertility rate (TFR) of 2.1
Eliminate leprosy, kala-azar, lymphatic filariasis

✅ Key Achievements

Launch of National Rural Health Mission (NRHM) in 2005
Strengthening of Reproductive and Child Health (RCH) program
Increased institutional deliveries through Janani Suraksha Yojana (JSY)
Introduction of National Health Accounts and health data systems
Improved health insurance coverage for the poor

🟦 3. National Health Policy, 2017

📌 Context

Rising costs of health care and poor financial protection
High out-of-pocket expenditure (OOPE)
Rapid increase in lifestyle-related diseases and mental health burden
Need for universal health coverage (UHC)

🎯 Vision

“To attain the highest possible level of health and well-being for all at all ages.”

🎯 Objectives

Achieve universal access to quality health care services
Strengthen public health systems, especially primary health care
Promote wellness and prevention over cure
Ensure financial protection through free essential services
Integrate digital health technology into service delivery

🎯 Targets (by 2025)

Increase life expectancy to 70 years
Reduce IMR to 28 per 1,000 live births
Reduce MMR to 100 per 1 lakh live births
Reduce TFR to 2.1
Reduce under-five mortality rate to 23
Increase government health expenditure to 2.5% of GDP
Achieve 90% immunization coverage
Ensure free essential drugs and diagnostics in all public hospitals
Screen 80% of population >30 years for NCDs

✅ Key Achievements (Till Date)

Launch of Ayushman Bharat (2018):
- Health and Wellness Centres (HWCs) – over 1.6 lakh operational
- PM-JAY – Free hospitalization for 50 crore people
National Digital Health Mission – ABHA IDs, eSanjeevani telemedicine
Increased focus on mental health, palliative care, elderly care
Decline in OOPE due to increased access to medicines and diagnostics
Integration of AYUSH services in public healthcare

🧠 Summary Comparison

Aspect	NHP 1983	NHP 2002	NHP 2017
Focus	Health for All	Equity & Decentralization	Universal Health Coverage
Key Issue	Infrastructure gap	Urban-rural disparity	NCDs, OOPE
Milestone	PHCs, UIP	NRHM, RCH	Ayushman Bharat
Health Spending Target	Not specified	2% of GDP	2.5% of GDP
Target IMR	<60	<30	28
Target MMR	Not specified	<100	100
Innovations	Primary care	PPP, RCH	UHC, digital health

🔚 Conclusion

The National Health Policies of 1983, 2002, and 2017 reflect India’s evolving health challenges and priorities.
From focusing on basic services and disease control, the policies have shifted towards universal, equitable, and technology-driven care.
The 2017 policy is a landmark step towards achieving Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs).

🚩 National Rural Health Mission (NRHM) – In Detail

📘 Introduction

The National Rural Health Mission (NRHM) was launched by the Government of India on 12th April 2005, under the Ministry of Health and Family Welfare (MoHFW).
It aimed to provide accessible, affordable, accountable, and quality health care to the rural population, especially vulnerable groups such as women, children, and the poor.

NRHM was later incorporated into the broader National Health Mission (NHM) in 2013, along with the National Urban Health Mission (NUHM).

🎯 Main Goal of NRHM

To achieve universal access to equitable, affordable, and quality health care services, with a special focus on maternal and child health, disease control, and strengthening of rural health infrastructure.

✅ Objectives of NRHM

Reduce Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR)
Ensure universal access to public health services
Strengthen existing health infrastructure and human resources
Promote community ownership of health systems
Ensure convergence of all health-related programs
Increase public health expenditure and reduce out-of-pocket spending

🧱 Key Components of NRHM

1. Accredited Social Health Activists (ASHA)

One ASHA per 1,000 population
Acts as a link between the community and health system
Provides health education, mobilizes for immunization, deliveries, and checkups

2. Strengthening Sub-Centres, PHCs, CHCs

Upgradation of infrastructure, supply of drugs, diagnostics
Hiring of additional doctors, nurses, and paramedical staff
Provision of 24×7 delivery services at PHCs and CHCs

3. Village Health Sanitation & Nutrition Committees (VHSNCs)

Empower communities to participate in planning and monitoring health services
Conduct Village Health and Nutrition Days (VHNDs)

4. Untied Funds and Flexible Financing

Financial support directly to Sub-Centres, PHCs, and CHCs for local needs
Funds to Panchayati Raj Institutions for village health activities

5. Janani Suraksha Yojana (JSY)

A safe motherhood intervention
Cash incentives for institutional deliveries, especially for BPL women
Encourages ANC and postnatal checkups

6. Mainstreaming of AYUSH

Co-location of Ayurveda, Yoga, Unani, Siddha, Homeopathy doctors at PHCs/CHCs
Promoting alternative systems alongside allopathic care

7. Public–Private Partnerships (PPP)

Partnering with NGOs, private hospitals, and charitable organizations
Mobile Medical Units (MMUs), diagnostics, and training

8. Rogi Kalyan Samitis (RKS)

Hospital-level patient welfare committees
Manage untied funds and ensure accountability

🛠️ Strategic Focus Areas

Reproductive and Child Health (RCH)
Immunization (UIP)
Nutrition programs (ICDS, Anemia control)
Disease control – TB, malaria, leprosy, HIV/AIDS
Health education and awareness through IEC/BCC
Monitoring and Evaluation via HMIS (Health Management Information System)

📈 Key Achievements of NRHM

Deployment of over 10 lakh ASHA workers across India
Significant decline in IMR and MMR
Increase in institutional deliveries and ANC coverage
Upgradation of thousands of PHCs and CHCs
Introduction of free drug and diagnostic services in many states
Greater involvement of Panchayati Raj Institutions (PRIs) and communities in health governance

🔁 Transition to National Health Mission (NHM)

In 2013, NRHM was merged with the National Urban Health Mission (NUHM) to form the National Health Mission (NHM). While NRHM continues to focus on rural health, it is now a sub-mission under NHM.

The NHM (2013 onwards) expanded the scope of services to include:

Non-communicable diseases (NCDs)
Mental health, elderly care, and palliative care
Health and Wellness Centres (HWCs) as a part of Ayushman Bharat (2018)

🧠 Conclusion

The National Rural Health Mission marked a historic shift in India’s approach to rural healthcare.
It brought health services closer to people, empowered communities, and strengthened the health system at the grassroots level.
NRHM laid the foundation for Universal Health Coverage in rural India and continues to impact health outcomes through the National Health Mission framework.

🏙️ National Urban Health Mission (NUHM) – In Detail

📘 Introduction

The National Urban Health Mission (NUHM) is a flagship program of the Government of India launched in May 2013 under the Ministry of Health and Family Welfare.
It is a sub-mission of the National Health Mission (NHM) and focuses specifically on providing quality primary health care services to the urban poor and vulnerable population.

NUHM complements the National Rural Health Mission (NRHM) and together, they form the umbrella National Health Mission (NHM).

🎯 Aim and Vision

To improve the health status of the urban population, particularly slum dwellers and the vulnerable sections, by facilitating equitable access to essential health services.

✅ Objectives of NUHM

To ensure equitable and universal access to quality health care for urban poor, especially women, children, the elderly, and the marginalized.
To strengthen the urban public health system for better outreach and service delivery.
To improve the availability of skilled health human resources in urban areas.
To reduce out-of-pocket expenses by providing free essential services.
To strengthen convergence with other departments like urban local bodies, ICDS, sanitation, and housing.

🧱 Key Components of NUHM

1️⃣ Urban Primary Health Centres (UPHCs)

One UPHC for every 50,000 urban population
Provides OPD care, maternal-child health, family planning, immunization, and NCD screening
Staffed with Medical Officer, ANMs, Lab Technician, Pharmacist, and support staff

2️⃣ Urban Community Health Centres (UCHCs)

One UCHC for every 2.5–5 lakh urban population
Provides specialist services, minor surgeries, emergency care, and referrals

3️⃣ Outreach Services

Urban Health and Nutrition Days (UHNDs) for underserved slums
Mobile Medical Units (MMUs) for remote urban areas
Health camps and door-to-door visits by ASHA-like workers (Urban ASHAs)

4️⃣ Urban ASHAs / Link Workers

One per 2,500–5,000 population
Mobilizes slum dwellers for services, follow-ups, awareness, and counseling
Supports immunization, antenatal care, TB, and NCD tracking

5️⃣ Mahila Aarogya Samitis (MAS)

Community groups of urban poor women
Promote awareness and local health action
Receive untied funds for sanitation drives, community mobilization

🔧 Strategies for Implementation

City Health Plans prepared with urban local bodies (ULBs)
Public–Private Partnerships (PPP) for diagnostics, training, MMUs
Convergence with schemes like:
- ICDS (Anganwadi centres)
- SBM (Swachh Bharat Mission)
- AMRUT (Urban Rejuvenation)
- Urban housing schemes

🩺 Services Provided Under NUHM

Maternal and child health services
Family planning and reproductive health
Routine immunization and outreach services
Screening and management of non-communicable diseases (NCDs)
Diagnosis and treatment of common illnesses
Referrals to secondary/tertiary care
Health education and counseling

📈 Achievements of NUHM (Till Date)

Over 5,000 Urban Primary Health Centres (UPHCs) established
Functioning of Urban CHCs and MMUs in major cities
Deployment of Urban ASHAs and Mahila Arogya Samitis
Integration of NCD services, mental health, and elderly care in UPHCs
Strengthened public health system in urban slums
Improved institutional delivery rates, immunization, and disease detection

🏙️ Challenges in NUHM Implementation

Shortage of health personnel in urban facilities
High urban migration, leading to shifting populations
Limited awareness among urban poor about services
Need for stronger convergence with other urban programs
Limited budget allocation compared to NRHM

🔁 Integration with Ayushman Bharat

Under Ayushman Bharat (2018), UPHCs and UCHCs are being upgraded to Urban Health and Wellness Centres (HWCs)
These centres now deliver expanded services, including:
- NCD screening
- Elderly care
- Mental health support
- Palliative care
- Free medicines and diagnostics

🧠 Conclusion

The National Urban Health Mission (NUHM) has significantly strengthened the urban health infrastructure, especially for the urban poor and slum dwellers.
Through the establishment of UPHCs, community outreach, and convergence, NUHM plays a key role in advancing urban primary health care and is now integrated into the broader Universal Health Coverage (UHC) vision through the National Health Mission and Ayushman Bharat.

🚩 National Health Mission (NHM) – In Detail

📘 Introduction

The National Health Mission (NHM) is a flagship health program launched by the Government of India in 2013, by merging two major health missions:

National Rural Health Mission (NRHM) (launched in 2005)
National Urban Health Mission (NUHM) (launched in 2013)

NHM aims to provide universal access to equitable, affordable, and quality health care services to all, especially to rural and urban poor, with a focus on strengthening primary health care.

🧭 Vision of NHM

“To achieve universal access to equitable, affordable, and quality healthcare services that are accountable and responsive to people’s needs.”

🎯 Main Goals of NHM

Reduce maternal and infant mortality
Control communicable and non-communicable diseases
Strengthen health infrastructure and human resources
Promote universal health coverage (UHC)
Ensure financial protection through free essential services
Enhance community participation and accountability in health care

✅ Key Objectives

Strengthen health systems in rural and urban areas
Ensure universal access to public health services
Promote prevention and early detection of diseases
Provide free essential drugs, diagnostics, and emergency care
Address social determinants of health through convergence

🧱 Main Components of NHM

🟩 1. National Rural Health Mission (NRHM)

Focuses on rural health care
Covers 18 high-focus states with poor health indicators
Strengthens Sub-Centres, PHCs, CHCs
Introduced ASHA workers, JSY, and community participation models

🟦 2. National Urban Health Mission (NUHM)

Targets urban slum and vulnerable populations
Establishes Urban Primary Health Centres (UPHCs)
Appoints Urban ASHAs and Mahila Aarogya Samitis (MAS)
Offers preventive and curative services in cities

🛠️ Key Strategies under NHM

Infrastructure Strengthening
- Upgradation of SCs, PHCs, CHCs, and District Hospitals
- Setting up of Health and Wellness Centres (HWCs)
Human Resource Development
- Recruitment of doctors, nurses, ANMs, lab technicians
- Capacity building and training programs
Community Participation
- Accredited Social Health Activist (ASHA) program
- Village Health Sanitation and Nutrition Committees (VHSNCs)
- Rogi Kalyan Samitis (RKS)
Free Drugs and Diagnostics Initiative
- Ensure zero out-of-pocket expense for essential services
Strengthening of National Health Programs
- TB (RNTCP), HIV (NACP), Leprosy (NLEP), Malaria (NVBDCP), etc.
Maternal and Child Health Services
- Programs like Janani Suraksha Yojana (JSY), Janani Shishu Suraksha Karyakram (JSSK)
- Immunization and Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) approach
Control of Non-Communicable Diseases (NCDs)
- NP-NCD, National Cancer Control Program, Mental Health Program
Monitoring and Evaluation
- Use of HMIS, IDSP, Family Health Surveys (NFHS)

🩺 Key Programs under NHM

Ayushman Bharat – Health & Wellness Centres (2018)
- Upgrade of SCs and PHCs to deliver comprehensive primary health care
- Screening for NCDs, mental health, elderly care
PM-JAY (Pradhan Mantri Jan Arogya Yojana)
- ₹5 lakh insurance coverage per family per year for secondary and tertiary care
Mobile Medical Units (MMUs)
- Provide services in remote and underserved areas
eSanjeevani
- Telemedicine platform for remote consultations

📈 Major Achievements of NHM

Over 1.6 lakh Health & Wellness Centres operational (as of 2023)
Significant reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR)
More than 10 lakh ASHA workers deployed
Increase in institutional deliveries and immunization coverage
Strengthened primary health infrastructure across India
Expansion of free drugs and diagnostics services
Integration of digital health systems and telemedicine

📉 Challenges Faced by NHM

Shortage of skilled health personnel, especially in rural areas
Infrastructure gaps and supply chain issues
Variability in state-level implementation and funding
Growing burden of non-communicable diseases and mental illness
Need for stronger urban health focus

🔄 Current Status and Way Forward

NHM remains India’s largest health mission, with continued expansion under the 15th Finance Commission
Emphasis on:
- Strengthening Health & Wellness Centres
- Digital health transformation through Ayushman Bharat Digital Mission
- Improving mental health, elderly care, and universal screening
- Greater community participation and local governance

🧠 Conclusion

The National Health Mission (NHM) is a cornerstone of India’s efforts to ensure health for all.
By improving health infrastructure, workforce, and service delivery, NHM has made significant strides in maternal and child health, disease control, and universal health coverage (UHC).
Moving forward, its integration with digital health, focus on preventive care, and strengthening of primary health systems will play a key role in meeting the Sustainable Development Goals (SDGs).

Here is a comprehensive and refined explanation of the National Health Protection Mission (NHPM) — including its objectives, features, components, implementation, and current status. This version is ideal for nursing students, public health learners, and academic presentations.

🛡️ National Health Protection Mission (NHPM)

(Also known as: Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana / PM-JAY)

📘 Introduction

The National Health Protection Mission (NHPM), launched in 2018 as part of the Ayushman Bharat Programme, is now officially known as the Pradhan Mantri Jan Arogya Yojana (PM-JAY).
It is the world’s largest government-funded health insurance scheme, providing financial protection for secondary and tertiary care hospitalization to India’s most vulnerable families.

🎯 Objectives of NHPM / PM-JAY

Reduce financial burden of poor and vulnerable families due to hospitalization
Provide free access to quality health services at the point of care
Prevent catastrophic health expenditure
Improve health-seeking behavior and access to care
Promote equity and inclusiveness in health service delivery

🧾 Key Features of NHPM / PM-JAY

✅ Insurance Coverage: ₹5 lakh per family per year
✅ Beneficiaries: ~50 crore individuals (10 crore families)
✅ No enrollment required: Based on Socio-Economic Caste Census (SECC) 2011 data
✅ Portability: Benefits available across India in any empanelled hospital
✅ Cashless and paperless at the point of service
✅ Covers: Pre-existing conditions, 3 days pre- and 15 days post-hospitalization expenses
✅ Hospitals: Public and private hospitals empanelled under PM-JAY

🧱 Target Beneficiaries

Families listed in SECC 2011 database (Rural & Urban deprivation criteria)
Vulnerable groups: SC/STs, landless laborers, manual scavengers, families with no adult earning member, disabled members
No cap on family size or age

🏥 Services Covered

Over 1,500 medical and surgical packages including:
- Cardiology, oncology, nephrology, neurosurgery
- Maternity care, joint replacement, trauma care
- Diagnostics, surgery, ICU, anesthesia, OT charges

🧑‍⚕️ Implementation Mechanism

Administered by the National Health Authority (NHA) at the central level
State Health Agencies (SHAs) manage implementation at state level
Hospitals must be empanelled under PM-JAY to provide services
Ayushman Mitras assist patients at hospitals for claim processing and support

💡 Components under Ayushman Bharat (2018)

Health and Wellness Centres (HWCs)
- Deliver Comprehensive Primary Health Care
- Screening for NCDs, mental health, elderly care, and free medicines/diagnostics
Pradhan Mantri Jan Arogya Yojana (PM-JAY)
- Provides financial protection for secondary and tertiary hospitalization under NHPM

📈 Achievements of NHPM / PM-JAY (Till 2023)

Over 5 crore hospital admissions authorized
26,000+ empanelled hospitals across India
More than 40 crore Ayushman Cards generated
Access to services improved for SC/ST and tribal communities
Encouraged public–private partnership in healthcare delivery
Supported gender equity (nearly 49% beneficiaries are women)

📊 Digital Health Integration

Linked with Ayushman Bharat Digital Mission (ABDM)
Beneficiaries can access care through their ABHA health ID
Use of e-cards, digital claim processing, and teleconsultations

🧠 Conclusion

The National Health Protection Mission (NHPM) under PM-JAY represents a transformative step toward achieving Universal Health Coverage (UHC) in India.
It protects the poor from catastrophic health expenses and ensures access to quality healthcare without financial hardship, while promoting equity, dignity, and empowerment.

Ayushman Bharat – In Detail

📘 Introduction

Ayushman Bharat, meaning “Long Live India,” is a flagship health initiative of the Government of India, launched in 2018 under the Ministry of Health and Family Welfare.
It aims to transform India’s health care system by moving from selective care to comprehensive health coverage, especially for the poor and vulnerable sections of society.

Ayushman Bharat is a step toward achieving Universal Health Coverage (UHC) as part of the Sustainable Development Goals (SDG 3: Good Health & Well-being).

🧭 Vision of Ayushman Bharat

“To provide accessible, affordable, and quality health care to all, especially the poor and marginalized.”

🛠️ Two Main Components of Ayushman Bharat

1️⃣ Health & Wellness Centres (HWCs)

Transforming existing Sub-Centres and Primary Health Centres into Health & Wellness Centres (HWCs)
Delivering Comprehensive Primary Health Care (CPHC) close to homes
Provide services for:
- Maternal & child health
- Non-communicable diseases (NCDs)
- Mental health, palliative and elderly care
- Oral, ENT, and eye care
- Free essential drugs and diagnostics
- Wellness activities: yoga, counseling, lifestyle modification

📌 Target: 1.5 lakh HWCs by 2025
📌 Progress: ~1.6 lakh operational as of 2024

2️⃣ Pradhan Mantri Jan Arogya Yojana (PM-JAY)

(Also known as National Health Protection Mission – NHPM)

Provides health insurance coverage up to ₹5 lakh per family per year
Covers 50 crore beneficiaries (over 10 crore families)
Cashless & paperless treatment in public and empanelled private hospitals
Covers secondary and tertiary care hospitalization
Based on Socio-Economic Caste Census (SECC) 2011 data

✅ Covers:

Surgery (cardiac, neuro, ortho, oncology)
Medical conditions requiring hospitalization
Pre-existing diseases, pre & post-hospitalization expenses

📌 Portability: Beneficiaries can avail services across India
📌 No age, family size, or gender restriction

🎯 Objectives of Ayushman Bharat

Strengthen primary healthcare infrastructure
Provide financial protection against catastrophic health expenses
Improve access to quality healthcare for poor and vulnerable families
Promote preventive, promotive, curative, and palliative health services
Integrate digital health and wellness into service delivery

💡 Key Features

Largest government-funded health scheme in the world
Administered by the National Health Authority (NHA)
Implemented by State Health Agencies (SHAs)
Supported by Ayushman Mitras in hospitals for patient assistance
Linked to Ayushman Bharat Digital Mission (ABDM) and ABHA Health ID

📈 Major Achievements (as of 2024)

Over 5 crore hospital admissions authorized
26,000+ empanelled hospitals (public + private)
More than 40 crore Ayushman Cards issued
Significant reduction in out-of-pocket expenditure
Better access to care for SCs/STs, women, elderly
Strengthening of primary healthcare through HWCs
Enabled digital health transformation

🔁 Convergence with Other Programs

National Health Mission (NHM)
PM-POSHAN (nutrition)
Janani Suraksha Yojana (JSY)
TB Elimination Program
Swachh Bharat Abhiyan (for sanitation)

🧠 Conclusion

Ayushman Bharat is a landmark reform in India’s health system, combining primary care access through Health & Wellness Centres with financial protection for hospitalization via PM-JAY.
It moves the nation closer to Universal Health Coverage, ensuring “no one is left behind”, and sets an example for other countries in achieving people-centered healthcare.

Here is a refined, easy-to-understand, and comprehensive explanation of Universal Health Coverage (UHC) — including its definition, goals, key components, significance, challenges, and India’s progress. This is ideal for nursing students, public health learners, and academic assignments.

🌍 Universal Health Coverage (UHC)

📘 Definition

Universal Health Coverage (UHC) means that all people have access to the health services they need — including prevention, promotion, treatment, rehabilitation, and palliative care — without suffering financial hardship.

UHC was endorsed by the World Health Organization (WHO) and is a key target under the Sustainable Development Goal 3 (SDG 3.8):

“Achieve universal health coverage, including financial risk protection, access to quality essential health care services and access to safe, effective, affordable and quality medicines and vaccines for all.”

🎯 Goals of Universal Health Coverage

Equity in access to health services — everyone should receive the services they need.
Quality of services — services should be safe, effective, and people-centered.
Financial protection — no one should be pushed into poverty due to medical expenses.

🧱 Key Components of UHC

Comprehensive Health Services
- Includes preventive, promotive, curative, rehabilitative, and palliative care.
- Covers all stages of life and all disease conditions.
Health System Strengthening
- Requires trained human resources, health infrastructure, essential medicines, and technology.
Financial Risk Protection
- Eliminating out-of-pocket expenses that lead to poverty.
- Promoting insurance schemes, free services, and subsidies.
Community Participation and Awareness
- Health services should be inclusive, participatory, and culturally appropriate.
Monitoring and Accountability
- Regular evaluation, transparency, and data systems to ensure progress and responsiveness.

🩺 UHC Service Coverage Includes

Maternal and child health (ANC, delivery, immunization)
Infectious disease control (TB, HIV, malaria)
Non-communicable diseases (hypertension, diabetes, cancer)
Mental health care
Emergency and trauma care
Essential medicines and diagnostics
Health promotion and education

🧠 Why is UHC Important?

Reduces poverty and health inequalities
Improves health outcomes and life expectancy
Strengthens economic development by keeping people healthy and productive
Promotes social justice and dignity

🇮🇳 Universal Health Coverage in India: Progress

India is committed to achieving UHC by:

Implementing Ayushman Bharat (2018), which includes:
1. Health & Wellness Centres (HWCs) – Comprehensive primary care
2. PM-JAY (Pradhan Mantri Jan Arogya Yojana) – ₹5 lakh insurance cover for secondary and tertiary care
Strengthening National Health Mission (NHM) for rural and urban populations
Promoting Digital Health Mission, ABHA ID, and eSanjeevani teleconsultation
Offering free drugs and diagnostics in many states
Expanding public health insurance schemes (e.g., CMCHIS, Aarogyasri, etc.)

⚠️ Challenges to Achieving UHC in India

Shortage of health workers, especially in rural areas
Inadequate health infrastructure and funding
High out-of-pocket expenditure in private sector
Weak health insurance coverage for outpatient care
Inequity in access between urban and rural/tribal areas

📊 India’s UHC Index & Global Ranking

India’s UHC service coverage index (as per WHO) has been improving but still lags behind many countries.
Continued efforts are needed to achieve the 2030 SDG targets.

🔄 Way Forward

Increase public health expenditure to 2.5% of GDP
Strengthen primary health care through HWCs
Expand financial protection for outpatient and chronic care
Invest in digital health systems and human resources
Ensure inclusive policies for vulnerable populations

🧠 Conclusion

Universal Health Coverage (UHC) is the foundation for a healthy, inclusive, and economically strong nation.
By expanding access to affordable and quality health care, UHC ensures that no one is left behind — regardless of income, gender, or geography.
India’s commitment through Ayushman Bharat and NHM is a major step toward achieving this vision of health for all by 2030.

Published March 29, 2025By mynursingapp

Categorized as CHN-1-B.SC-NOTES, Uncategorised

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CHN-1-UNIT-2-B.SC-Health Care Planning and Organization of Health Care at various levels

📘 Definition of Planning

✅ Key Features:

🏥 Definition of Health Planning

✅ Key Features:

🔄 Comparison

🏥 Steps of Health Planning

🧭 1. Analysis of the Health Situation

🎯 2. Setting Goals and Objectives

🛠️ 3. Assessing Resources

🧠 4. Formulating the Plan

🔧 5. Implementing the Plan

📈 6. Monitoring and Evaluation

✅ Summary Table: Steps of Health Planning

Health Planning in India – Introduction

📋 Major Health Committees in India (Chronological Order)

🔹 1. Bhore Committee (1946)

✳️ Key Recommendations:

🔹 2. Mudaliar Committee (1962)

✳️ Key Recommendations:

🔹 3. Chadha Committee (1963)

✳️ Key Recommendations:

🔹 4. Mukherjee Committee (1965 & 1966)

✳️ Key Recommendations:

🔹 5. Jungalwalla Committee (1967)

✳️ Key Recommendations:

🔹 6. Kartar Singh Committee (1973)

✳️ Key Recommendations:

🔹 7. Shrivastava Committee (1975)

✳️ Key Recommendations:

🧠 Why These Committees Matter:

📝 Summary Table of Health Committees

Commissions on Health and Family Welfare in India

🧭 Key Commissions on Health and Family Welfare (Post-Independence)

🔹 1. National Commission on Population (2000)

✳️ Objectives:

📌 Key Focus Areas:

🔹 2. National Commission on Macroeconomics and Health (NCMH, 2005)

✳️ Purpose:

📌 Key Recommendations:

🔹 3. National Commission on Human Resources for Health (NCHRH) – Proposed 2011

✳️ Key Objectives:

🔹 4. National Health Commission (Proposed in various forms)

💡 Examples:

📊 Summary Table

🎯 Significance of These Commissions

🏛️ Planning Commissions in India

📜 1. Planning Commission – Introduction

🎯 Objectives of the Planning Commission:

Five-Year Plans in India: Health Perspective (With Milestones & Budget)

🏛️ Introduction

📊 Summary Table of Five-Year Plans (Health Focus + Budget)

📘 Detailed Plan-Wise Breakdown

🟢 1st Five-Year Plan (1951–1956)

🟡 2nd Five-Year Plan (1956–1961)

🟠 3rd Five-Year Plan (1961–1966)

🔴 Plan Holiday (1966–1969)

🔵 4th Five-Year Plan (1969–1974)

🟣 5th Five-Year Plan (1974–1979)

🟤 6th Five-Year Plan (1980–1985)

🟨 7th Five-Year Plan (1985–1990)

🟫 8th Five-Year Plan (1992–1997)

🟥 9th Five-Year Plan (1997–2002)

🟩 10th Five-Year Plan (2002–2007)

🟦 11th Five-Year Plan (2007–2012)

🟨 12th Five-Year Plan (2012–2017)

🎯 Post-12th Plan: NITI Aayog Era (After 2017)

🧠 Conclusion

🏛️ NITI Aayog and Health in India

📘 What is NITI Aayog?

🎯 Objectives of NITI Aayog (Related to Health)

🏥 NITI Aayog and Health Sector Reforms

🩺 Key Health Contributions of NITI Aayog

🔹 1. Health Index (State Ranking)

🔹 2. Ayushman Bharat (2018)

🔹 3. Digital Health Mission

🔹 4. Public-Private Partnership (PPP) in Healthcare

🔹 5. Health System Strengthening