INTRODUCTION

 Disease : is a condition of the body or some part or

organ of the body which its functions are disrupted or
deranged. Ie. Psychological or psychological dysfunction.
 Illness : is a subjective state of the person who feels
aware of not being well
 Sickness : is a state of social dysfunction ie. A role that
the individual assumes when ill
 Handicap : is a social disadvantage or loss of role
associated with disease individual , resulting from
impairment or disability that limits or prevents the
fulfillment of a role that is normal. ( Depending on age ,
sex, social and cultural factors )
CHALLENGES IN HEALTHCARE SERVICES

QUALITY HEALTHCARE SERVICES

INCREASE IN COST OF HEALTHCARE SERVICES
AFFORDABILITY & ACCESSIBILITY OF HEALTHCARE SERVICES
Large population
High fertility
Declining death rate
Illiteracy
Dependency ratio
CHALLENGES IN HEALTHCARE SERVICES
Poverty – 25.9% ,
Inequity – Value of maintaining fairness or justice
Public Demands or population
Marginalizing public health services
Public health delivery
CHALLENGES IN HEALTHCARE SERVICES
Health communication
Communicable disease
Nutritional problems
Environmental and sanitation
Climate change
New Psychological issues
Challenges of Public Health….

•Increasing public demand due to huge population

and widening gaps within population
Challenges of public health…
Epidemiological transition and triple burden

Socio-Economic Transition
Agrarian Industrialization

Health Transition

Under Nutrition Communicable Non-Communicable

Diseases Diseases

Is this true for India and other developing countries?

 Challenges of public health…

Gap in service delivery

Available
Services

Victims
Needs

•Public health delivery: quality of services, privatization,

newer technology
WHAT IS HEALTH PROGRAM?

Health Program is a series of inter-related

actions aimed at attaining a defined objective.
For example the improvement of child health or
mothers.
Program should include specific objectives and
related quantifiable targets, manpower,
technology, physical and financial estimates a
calendar of action, and ways of ensuring
appropriate correlation among all of the them
HOW PROGRAM IS DIFFERENT FROM
POLICY AND PROJECT?

Policy is a set of statement and decisions defining

health priorities and main directions for attaining
health goals.
Project is a planned budgeted event with realizable
goals within a specified time period.
Relationship of Policy, Program &
Legislation

Policy

Program Legislation

Project Actions Rules

WHO DEFINES
Health is a state of
Physical
Mental and
Social Well being
No merely an absence of disease or infirmity and
person should be able to lead a social and economic productive
life.
 WHAT IS PUBLIC HEALTH?
“the science and art of preventing disease, prolonging life, and promoting health
and efficiency through organised community efforts for sanitation of the
environment, control of communicable infections, education of individual in
personal hygiene, organization of medical and nursing services for early diagnosis
and preventive treatment of disease, and the development of social machinery to
ensure everyone a standard of living adequate for the maintenance of health”
 Economical Chemical Biological

Cultural Physical Vacational

Political

Environmental Social
Dimensions of
Health
Philosophical Bubbles Spiritual

Religious Nutrition
Mental Emotional Educational

Mythological
DIMENSIONS OF HEALTH
Health is multidimensional.
According to WHO 3 SPECIFIC DIMENSIONS, which are Physical,
Mental and Social.
Others are spiritual, emotional, vocational and political dimensions.
These dimensions function and interact with one another, each has its
own nature
PHYSICAL DIMENSION
Easiest to understand.
It conceptualizes health biologically as a state in which every cell and
every organ is functioning at optimum capacity and in perfect
harmony with the rest of body.
Perfect functioning of the body
Evaluation of Physical Health :
 Self assessment of overall health , inquiry into symptoms of ill-health and risk factors ,
inquiry into medications , inquiry into levels of activity , inquiry into use of medical
services,
SIGN OF PHYSICAL HEALTH
A good complexion, a clean skin, bright eyes, lustrous hair, with a
body well clothed with firm flesh, not too fat, a sweet breath, a good
appetite, sound sleep, regular activity of bowels and bladder and
smooth, easy, coordinated bodily movements.
PHYSICAL DIMENSION
Easiest to understand.
It conceptualizes health biologically as a state in which every cell and
every organ is functioning at optimum capacity and in perfect
harmony with the rest of body.
SIGN OF PHYSICAL HEALTH
A good complexion, a clean skin, bright eyes, lustrous hair, with a
body well clothed with firm flesh, not too fat, a sweet breath, a good
appetite, sound sleep, regular activity of bowels and bladder and
smooth, easy, coordinated bodily movements
CONTINUE
All the organs of body are of unexceptional size.
All the special senses are intact.
The resting pulse rate, blood pressure and exercise tolerance are all
within the range of “normality’’
MENTAL DIMENSION
Mental Health is defined as “a state of balance between the
individual and the surrounding world, a state of harmony between
oneself and others, a coexistence between the realities of the self and
that of other people and that of environment.’’
Mental health is not mere absence of mental illness. Its ability to
respond to the many varied experiences of life with flexibility and
sense of purpose.
Decades ago , Body and mind were considered independent entities ,
researchers found that , psychological factors induce a all kind of
illness, not simply mental ones.
ACCORDING TO PSYCHOLOGISTS
A mentally healthy person is free from internal conflicts
He is well adjusted, means he/she is able to get along well with
others. Accepts criticism and is not easily upset.
He searches for identity.
He has a strong sense of self esteem.
Self Actualization.
Good self control balances.
Faces problems and tries to solve them intelligently, coping with stress
and anxiety.
Assessment – mental status questionnaires by trained interviewers
SOCIAL DIMENSION
Social well being implies harmony and integration within the
individual, between each individual and other members of society
and between individuals and the world in which they live.
Defined as ‘Quantity and quality of an individual’s interpersonal ties
and the extent of involvement with the community”
It includes the levels of social skills one possesses, social functioning
and the ability to see oneself as a member of a larger society.
Positive human environment which is concerned with the social network
of the individual.
SPIRITUAL DIMENSION
Includes integrity, principles and ethics, the purpose in life, commitment
to some higher being and belief in concepts that are not subject to
“state of the art “ explanation.
Meaning and purpose of life
EMOTIONAL DIMENSION
Mental and emotional dimensions – two closely related elements.
It relates to feeling.
VOCATIONAL DIMENSION
New DIMENSION
When work is fully adapted to human goals, capacities and
limitations, work often plays a role in promoting both physical and
limitations, work often plays a role in promoting both physical and mental health.
OTHERS
Philosophical dimension
Cultural Dimension
Socioeconomic dimension
Environmental dimension
Educational dimension
Nutritional Dimension
Curative Dimension
Preventive Dimension
MENTAL DIMENSION
Mental Health is defined as “a state of balance between the
individual and the surrounding world, a state of harmony between
oneself and others, a coexistence between the realities of the self and
that of other people and that of environment.’’
ACC TO PSYCHOLOGISTS
A mentally healthy person is free from internal conflicts
He is well adjusted, means he/she is able to get along well with
others. Accepts criticism and is not easily upset.
He searches for identity.
He has a strong sense of self esteem.
Self Actualisation.
CONT
Good self control balances.
Faces problems and tries to solve them intelligently, coping with stress
and anxiety.
Assessment – mental status questionnaires by trained interviewers
SOCIAL DIMENSION
Social well being implies harmony and integration within the
individual, between each individual and other members of society
and between individuals and the world in which they live.
Quantity and quality of an individual’s interpersonal ties and the
extent of involvement with the community”
It includes the levels of social skills one possesses, social functioning
and the ability to see oneself as a member of a larger society.
SPIRITUAL DIMENSION
Includes integrity, principles and ethics, the purpose in life, commitment
to some higher being and belief in concepts that are not subject to
“state of the art “ explanation.
EMOTIONAL DIMENSION
Mental and emotional dimensions – two closely related elements.
It relates to feeling.
VOCATIONAL DIMENSION
New DIMENSION
When work is fully adapted to human goals, capacities and
limitations, work often plays a role in promoting both physical and
limitations, work often plays a role in promoting both physical and mental health.
OTHERS
Philosophical dimension
Cultural Dimension
Socioeconomic dimension
Environmental dimension
Educational dimension
Nutritional Dimension
Curative Dimension
Preventive Dimension
 HOW HEALTHY OUR POPULATION IS?

Health should be assessed in terms of quality of life

It has Individual phenomenon and social outlook,
Healthy people are those who do not have disease or
infirmity and able to lead a socially and productive life.
So, Disease, disability and death is important.
Disease and death is countable by simple methods but health
is difficult to count.
Disease and death is apparent and coming to
hospital/clinic/mortuary/burial or cremation ground/ etc.
However healthy need to be traceable.
What are the measured of health of the community?
 INDICATORS
To measure mortality:
 Mortality indicators: death rate, infant mortality rate
To measures morbidity
 Disease Rates and Proportions: prevalence and incidence of diseases, e.g.
TB, leprosy, HIV, etc
 Admission rates, OPD attendance, etc.
Disability Indicators: Disability, handicap due to polio, injury, etc.
Nutritional indicators: low birth weights, weight to age,
Health care delivery indicators: doctor/nurses/ population
Other indicators: Socioeconomic, health system research,
utilization, etc.
Comprehensive Indicators: DALYs loss
 DALYs Loss due to Specific Diseases
Diseases India % World %

Communicable & MCH 50.3 44.0

-Infectious & Parasite Disease 34.7 31.4

Respiratory Infections, TB,HIV

-Maternal & Perinatal Disorders 11.6 8.9

-Nutritional Deficiencies 4.0 3.7

Non-Communicable Diseases- 33.0 40.9

Diabetes, Cancers, Neuro-psychiatric,
Nutritional Problems
Nutritional Problems
TOP RISK FACTORS PREVALENT IN INDIA

Underweight
High Cholesterol
High BP
Obesity
 Unsafe Sex

STDs
HIV
Pregnancy
Unsafe
Water &
sanitation
Environmental
Pollution
FACILITIES
Characteristics Curernt

Public Expenditure on Health /GDP 1.28

Per capita Expenditure on Health 1657

IMR 34/000 LB

MMR 167/lac

Population 121 crore

Sex Ratio 943

% Urban Population 31.14%

BR 20.4
DR 6.4
DEFINITION OF HEALTH
Acc to WHO
“Health is a state of complete physical, mental and social well being
and not merely an absence of disease or infirmity”
DETERMINANTS OF HEALTH
Multifactorial
Influences internally and externally.
DETERMINANTS OF HEALTH
DETERMINANTS OF HEALTH
BIOLOGICAL DETERMINANTS

Nature of genes
Number of diseases chromosomal anamolies, errors of metabolism,
mental retardation, some types of diseases.
CONTINUE
Behavioural and sociocultural conditions:-
Lifestyle
Lifelong personal habits
Lack of sanitation, poor nutrition, personal hygeine,
Adequate nutrition, enough sleep, sufficient physical activity
ENVIRONMENT
Internal – every tissue , organ , organ system , harmonious functioning
within the system
External-
SOCIOECONOMIC CONDITIONS
Percapita GNP
Education
Nutrition
Employment
housing
CONT
Economic Status:-
Standard of living, quality of life, family size and the pattern of
disease.
Education
Occupation
HEALTH SERVICES
Immunisation
Provision of safe water
Care of pregnant women and children
CONT
Ageing of population
2020
The world will have more than one billion people
Increased prevalence of chronic diseases and disabilities.
NEW PHILOSOPHY OF HEALTH

Fundamental right
Essence of productive life
Integral part of development
Measure the Quality of life
It involves individuals , state and international
responsibility
Major social investment
World wide social goal
INDICATORS OF HEALTH
Indicators are variable which help to measure changes
They give an indication or reflection of a given situation
Every health programmes we are using Indicators, which help to
measure changes
USES

Measure health status of a community

Compare the health status between two countries
Assessment of health care needs
Allocation of scarce resources
Monitoring and evaluating health services,
activities, and programmes
Planning
Priororites
CHARACTERISTICS OF INDICATORS
Valid - actually measure what they are supposed to measure
Precise – reliability , reproducibility, repeatability
Reliable – answer should be same , if two person measure in same
circumstances
Specific – only in the situation concerned,
Feasible – ability to obtain data needed
Relevant -
3. DISABILITY RATES
(a) Event- type Indicators and
(b) Person – type indicators
EVEN TYPE INDICATORS
 Numbers of days of restricted activity
 Bed disability days.
 Work – loss days (or school loss days) within a specific period
(B) PERSON- TYPE INDICATORS
Limitation of mobility:- Confined to bed, confined to the house, special
aid in getting around either inside or outside the house.
Limitation of activity:- For example, limitation to perform the basic
activities of daily living
E.g eating, washing, dressing, going to toilet, moving about etc,
limitation in major activity, e.g ability to work at a job, ability to
housework, etc.
NUTRITIONAL STATUS INDICATORS
Anthrometric meassurements of preschool children, e.g weight and
height, mid arm circumference.
Heights of children at school entry and
Prevalence of low birth weight.
HEALTH CARE DELIVERY INDICATORS
Doctor- population ratio
Doctor- nurse ratio
Population-bed ratio
Population per health/subcentre
Population per traditional birth attendant
UTILIZATION RATES

It is expressed as the proportion of people in need of a service who

actually receive it in a given period, usually a year.
EXAMPLES
Proportion of infants who are fully immunised against the 6 EPI
diseases.
Proportion of pregnant women who receive antenatal care, or have
their deliveries supervised by a trained birth attendant.
Percentage of the population using various methods of family
planning.
CONTINUE
Bed- occupancy rates.
Average length of stay.
Bed turn – over ratio
INDICATORS OF SOCIAL AND MENTAL
HEALTH
Suicide
Homicide
Other acts of violence and other crime
Road traffic accidents
Juvenile delinquency.
Alcohol and Drug abuse
smoking
ENVIRONMENTAL INDICATOR
Indicators relating to pollution of air & water.
Radiation
Solid waste
Noise
Exposure to toxic substances in food and drink
Consumption of tranquilizer
SOCIOECONOMIC INDICATORS

Rates of population increase

Level of unemployment
Dependency ratio
Literacy rates, especially female literacy rates
Family size
Housing the number of persons per room
HEALTH POLICY INDICATORS
Proportion of GNP spent on health services
Proportion of GNP spent on health related activities (including water
supply and sanitation, housing and nutrition, community development)
Proportion of total health resources devoted to Primary Health Care.
INDICATORS OF QUALITY OF LIFE
Infant mortality
Life expectancy at age one
Literacy.
https://www.youtube.com/watch?v=deQ5-TIpQk0
SPECTRUM OF DISEASE
Graphic representation of variations in the manifestations of disease
 Lowest point of healthcare – death
 Highest point – positive health

Positive health
Better health
Freedom from diseases
____________________________
Unrecognized sickness
Mild sickness
Severe sickness
Death
POSITIVE HEALTH
 Harmonious balance of this state of the human individual integrated into his state of
the human individual integrated into his environment
 State of positive health implies the notion of ‘perfect functioning’ of the body and
mind.
 It conceptualizes health biologically , as a state in which every cell and every organ
is functioning at optimum capacity and in perfect harmony with rest of the body
 Psychologically , as a state in which the individual feels a sense of perfect well-being
and of mastery over his environment.
 Socially , as a state in which the individuals capacities for participation in the social
system are optimal.
 The concept of perfect positive health cannot become reality because man will never
be so perfectly adapted to his environment that his life will not involve struggles ,
failures and sufferings. - Dubos
 Positive health will, therefore, always remain a mirage , because everything in our
life is subject to change.
 Positive health depends not only on medical action, but on all the other economic ,
cultural and social factors operating in the community.
CONCEPT OF WELL-BEING
There no satisfactory definition of the term ‘well-being’.
Standard of living – refers to the usual scale of our expenditure , the
goods we consume and services we enjoys, it includes the level of
education, employment status , food , dress, house etc
WHO – Income and occupation , standards of housing , sanitation and
nutrition , the level of provision of health , educational , recreational
and other services may all be used individually as measures of social-
economic status and collectively as an index of the ‘standard of living’
Level of Living – parallel term used by UN – ‘Level of living’ – it
consists of nine components – health, food consumption , education,
ocuupation and working condition , housing , social security , clothing ,
recreation and leisure and human rights.
CONCEPT OF WELL-BEING
Quality of Life – subjective component of well being
WHO defined the condition of life resulting from the combination of
the effects of the complete range of factors such as those determining
health, happiness, education , social and intellectual attainment ,
freedom of action, justice and freedom of expression.
RIGHT TO HEALTH
Historically , the right to health was one of the last to be proclaimed in
the constitutions of most countries of the world.
At the international level, the universal declaration of Human rights
established a breakthrough in 1948 , by stating article 25 its states,
everyone has the right to a standard of living adequate for the health
and well-being of himself and his family.
Fundamental right to every human being to enjoy ‘ the highest
attainable standard of health’
Some countries – ‘right to health protection’ – comprehensive system of
social insurance
RIGHT TO HEALTH
Right to health has generated so many questions, right to medical care
, right to responsibility for health , right to healthy environment , right
to food, the right to not to procreate (FP, abortion , sterilization ), right
to deceased person, right to die
RESPONSIBILITY OF HEALTH
Health is on one hand a highly personal responsibility and on other
hand a major public concern.
Individual responsibility – self-care of health
It refers to those activities individuals undertake in promoting their own health,
preventing their own health
Without professional help/ assistance

Community Responsibility
Never be protected without the active participation of community
Healthcare for the people to healthcare by the people
The concept of primary health centres round the people’s participation
Three ways community can participate 1. the community can shape of facilities
,manpower , logistics , fund planning 2. actively involved in planning , management ,
and M & E 3. by joining and using health services. Eg. ASHA , USHA
RESPONSIBILITY OF THE HEALTH

State Responsibility
State list
State assumes responsibility for the health and welfare of the citizen
India is signatory to the Alma Ata Declaration of 1978 and MDG of 2000
NHP 1983 and 2002 have greater resulted greater degree of state involvement

International Responsibility
International organizations – UN – achieveing health goals
International cooperation covers such subjects as exchange of experts , provision of
drug and supplies, control communicable diseases
TCDC ( Technical cooperation in Developing countries , ASEAN ( Association of south
East Asian Nation ) , SAARC ( South Asia Association for regional cooperation )
Eg. HFA , Eradication of small pox , MDG, SDG, The global strategy for women’s
children’s and adolcent’s Health campaign agaist smoking and HIV /AIDS
WHAT THE WORLD ORGANIZATION IS DOING?
Why the Goals are important?
1. They are fulcrum of international development
policy to reduce poverty, to improve health, human
rights, gender equalities and environmental
sustainability.
2. Advancing means to a productive life
3. Goals are critical for global security

• The 8 MDGs break down into 18 quantifiable

targets that are measured by 48 indicators.
• 3 goals, 8 targets and 18 indicators relate to
health.
CHALLENGES OF MDG
Government failure
Some area or countries are more prone to poverty
Heavy morbidity and mortality
WHAT ARE GOVERNMENT ACTIONS TO HANDLE
PUBLIC HEALTH PROBLEMS?
Five Year Plans since 1950 onward
Various Committees recommendations starting Sir Bhore Committee report
1946
Programs starting with National Family Planning program 1951 till NRHM
Policies
Legislations
Working with and fulfilling mandate of International Body and United
Nations
REVISED NATIONAL TUBERCULOSIS CONTROL
PROGRAM (RNTCP): DOTS STRATEGY

National TB Control Program

Components of DOTS
Multi-Drug Resistant (MDR) Tuberculosis
DOTS Plus
Pediatrics Tuberculosis
BCG (Bacille Calmette-Guerin)
International Standard for TB Care
 NATIONAL AIDS CONTROL PROGRAM PHASE III
(2006-2009)
Epidemiology, National Response
Sexual Transmitted Diseases Control Program, Syndromic Approach

Integrated Voluntary Conseling and Testing (VCT)

Universal Precautions
Safe Blood Program
Condom Programing
Care, Support and Treatment
Anti-Retroviral Therapy
Monitoring and Evaluation
Surveillance
IEC and Social Mobilization
NATIONAL VECTOR BORNE DISEASE
CONTROL PROGRAM
National Malaria Eradication Program
Urban Malaria Scheme, Modified Plan of Operation, Malaria Action
Program, Enhanced Malaria Control Project
Malaria Surveillance,
National Drug Policy for Malaria 2008
Insecticide Policy, Insecticide Treated Bed nets Program
OTHER VECTOR BORNE DISEASES
Kala-azar Control Program
Elimination of Filariasis
Japanese Encephalitis
Dengue & Dengue Hemorrhagic Fever
Chilungunya Fever
Leptospirosis
OTHER NATIONAL PROGRAMS ON
INFECTIOUS OR COMM. DISEASES
Yaws Eradication Program
National Leprosy Eradication Program
Guinea Worm Eradication Program
Rabies Control Program
 NUTRITIONAL PROGRAMS
Integrated Child Development Service (ICDS) Scheme,
Scheme for Adolescent Girls (Kishori Shakti Yojna)
Mid-Day Meal Program
National Nutritional Anemia Prophylaxis Program
National Program for Prophylaxis against Blindness in
Children caused due to Vitamin A Deficiency
National Iodine Deficiency Disorders Control Program
OTHER IMPORTANT PROGRAMS
National Program for Control & Treatment of Occupational
Diseases
National Mental Health Program and Drug De-addiction
Program
National Program for Control of Blindness
National Oral Health Program
School Health Services
School Health Program in India
Basic Minimum Service Program
National Prevention and Control of Fluorosis
National Program of Health Care for the Elderly
National Program for Prevention and Control of Deafness
National Cancer Control Program
National Cancer Registry Program
Comprehensive Anti-Tobacco Program
Tobacco Free Initiatives and Cancer Vaccine
National Program for Prevention and Control of
Diabetes, Cardiovascular Diseases and Stroke
The Environment Improvement in Urban Slums scheme
Programs for Water and Sanitation
Accelerated Rural Water Supply Program (ARWSP)
Accelerated Urban Water Supply Program
Urban Sanitation Program
POLICIES RELATED TO HEALTH
NATIONAL POLICIES RELATED TO HEALTH
Policy is system which provides the logical framework and rationality
of decision making for the achievement of intended objectives.
Policy is a guide to action
A decision about amounts of and allocation of resources
Statement of commitment to certain area of concern
NATIONAL POLICIES RELATED TO HEALTH
Termed as public policy
Set by head of government , legislatures , and regulatory agencies or
constituted authorities
Health – development have two way realtionship
1. National Health Policy
2. National Population Policy
3. National AIDS Prevention and Control Policy
2002
4. National Blood Policy 2002
5. National Policy For the Empowerment of Women
(2001)
6. National Policy & Charter for Children 2003
7. National Youth Policy 2003
8. National Policy for Old Person 1999
9. National Policy for Person with Disablities
10. National Nutrition Policy 1993
11. National Health Research Policy Draft
12. National Policy on Education
13. National Pharmaceutical Policy
14. National Policy on Indian System of Medicine
& Homeopathy 2002
15. National Water Policy
16. National Environment Policy 2006
17. National Housing and Habitat Policy 1998
18 National Conservation Strategy & Policy
Statement on Environment & Development 1992
19. National Policy on Resettlement and
Rehabilitation for Project affected families 2006
PUBLIC HEALTH LEGISLATIONS
A. To Improve and Maintain High Standards in the
Medical Education and Services:

· The Indian Medical Council Act, 1956 and

Regulations 2002
· The Indian Nursing Council Act, 1947
· The Dentists Act, 1948
· The Pharmacy Act, 1948
· The Rehabilitation Council of India Act, 1992
· The Indian Medicine Central Council Act, 1970,
· The Homeopathy Central Council Act, 1973
· The Consumer Protection Act (CPA), 1986
B. Public Registration to Assess Mortality and
Enumeration of Population
· The Registration of Births and Deaths Act, 1969
· The Census Act 1948
C. To Prevent Public Health Problems:
· The Epidemic Diseases Act, 1897
· The Delhi Antismoking & Nonsmoking Health Protection Act,
1996
· The Transplantation of Human Organ Act, 1994
· The Prevention of Food Adulteration Act, 1954
· The Food Safety Act 2006
· The Indian Air Craft (Public Health), Act 1934, and Rules, 1954
· Public Liability Insurance Act, 1991
· National Commission Proceeding Rights Act, 1994
· Essential Commodity Act, 1955
· The International Health Regulation
D. To Achieve Maternal Health and to Empower the
Women:

· The Medical Termination of Pregnancy (MTP) Act, 1971

· The Maternity Benefit Act, 1961
· The Dowry Prohibition Act, 1961
· The Dowry Prohibition (Maintenance of List of Presents to the
Bride and Bridegroom) Rules, 1985
· The Immoral Traffic (Prevention) Act, 1956
· The Prenatal Diagnostic Techniques (Regulation and prevention of
misuse) Act, 1994
· The Hindu Succession Act, 1956
· Indecent Representation of Women (Prohibition) Act, 1986
· Commission of Sati (Prevention) Act, 1987
E. To Safeguard the Children and Young:

· The Infant Milk Substitutes, Feeding Bottlers &Infant Foods

(Regulation of Production, Supply & Distribution) Act, 1992
· The Juvenile Justice Act, 1986
· The Child Labor (Prohibition & Regulation) Act, 1986
· The Child Marriage Restraint Act, 1929
· The Adoption and Maintenance Act 1956
F. To rehabilitate and provide equal
opportunity to disabled and
disadvantaged groups

• The Persons with Disabilities (Equal

opportunity,
• Protection of Rights and Full Participation) Act,
1995
• The Mental Health Act, 1987
• The SCs & the STs (Prevention of Atrocities)
Act, 1989
G. To Prevent Drug Addiction and Substance
Abuse and Safe Manufacturing of drugs,
Distribution and Storage

• The Delhi Antismoking & Nonsmoking

Health Protection Act, 1996
• The Narcotic Drugs and Psychotropic
Substances Act, 1985
• The Drugs and Cosmetics Act, 1940
• The Drugs (Control) Act, 1948
• The Drugs & Magic Remedies
(Objectionable Advertisements) Act, 1954
 H. To Protect Workers and to
Provide Social Security:
• The Minimum Wages Act, 1948
• The Dangerous Machine (Regulation) Act,
1983
• The Plantation Labor Act, 1951
• The Factories Act, 1948
• The Mines Act, 1952
• The Employees State Insurance (ESI) Act,
1948
• The Workmen’s Compensation Act, 1923
• The Bonded Labor System (Abolition) Act
• The Trade Union Act, 1926
• The Dock Workers (Safety, Health and Welfare)
Act, 1986
• The Mines Labor Welfare Fund Act, 1972
• The Bidi Workers Welfare Fund Act, 1972
• The Cigar Workers (Conditions of Employment)
Act, 1966
• The Contract Labor (regulation & Abolition) Act,
1970
• The Boiler Act, 1923
• Payment of Wages Act, 1936
 I. Environmental Legislation
• The Environment (Protection) Act, 1986
• The Biomedical Waste (Management & Handling)
Rules, 1998
• The Municipal Solid Waste (Management & Handling)
Rules, 2000
• The Hazardous Waste (Management & Handling)
Rules, 1989
• The National Environmental Tribunal Act, 1995
• The Air (Prevention and Control of Pollution) Act,
1981
• The Water (Prevention and Control of
Pollution) Act, 1974
• The Atomic Energy Act, 1962
• The Insecticides Act, 1988
• The Delhi Municipal Corporation Act, 1957
• The Motor Vehicles Act, 1988
• Wild Life (Protection) Act, 1942
• Destructive Insect & Pest Act, 1914
J. To Promote Voluntary Work

• The Red Cross Society (Allocation of

Property) Act, 1936
• The Societies Registration Act, 1860
SYSTEM

Health Services –
 Sector which is Direct effect on people’s health
 Health promotion and disease prevention, through curative service, long
term care, rehabilitation etc
System –
 Has a mission and purpose
 Decision making processes
 Resources
 Guarantee of continuity
 Its performance can be measured
SYSTEM

Input –
 Are the resources needed for healthcare
Processes
 The use of resources or the activity within the system
Outcomes
 Is change in health status as result of those processes
 Focus is on outcome as result of inputs and processes
Outputs
 In healthcare its combination of processes and outcomes of the services
 Total impact
HEALTHCARE

Healthcare is a complex
Health system is intended to deliver health services, eg .
Planning , determining priorities , mobilizing and
allocating resources , translating policies into services ,
valuation and health education
Challenges from
 Government
 Local interest
 Organization representing staff
 Medical industrial complex
LEVEL OF CARE

Formal care
 Provided by trained , paid professionals usually in a
formal setting
Lay care
 Care provided by lay people who have received no
formal training and not paid.
 Included self care, care by relatives, friends
LEVEL OF CARE
Primary care
 First point of contact of people,
 General rather than specialized
 Provided in the community
Secondary care
 Specialized care which referred by Primary health care worker
 Provided in local hospitals
Tertiary care
 Highly specialized care
 Referral from secondary care
Self –help group
 Groups of unpaid,
 self taught people
 Mutual support
FORMAL AND LAY CARE
Tertiary care

Secondary care

Primary care

Lay care
CONTD.
Primary health care

The “first” level of contact between the individual and the health
system.
Essential health care (PHC) is provided.
A majority of prevailing health problems can be satisfactorily
managed.
The closest to the people.
Provided by the primary health centers.
 CONTD.
Secondary health care

More complex problems are dealt with.

Comprises curative services
Provided by the district hospitals
The 1st referral level
Tertiary health care

Offers super-specialist care

Provided by regional/central level institution.
Provide training programs
HEALTH FOR ALL CONCEPT
PRIMARY HEALTH CARE (PHC) BECAME A
CORE POLICY FOR THE WORLD HEALTH
ORGANIZATION WITH THE ALMA-ATA
DECLARATION IN 1978 AND THE ‘HEALTH-FOR-
ALL BY THE YEAR 2000’ PROGRAM.
THE COMMITMENT TO GLOBAL
IMPROVEMENTS IN HEALTH, ESPECIALLY FOR
THE MOST DISADVANTAGED POPULATIONS,
WAS RENEWED IN 1998 BY THE WORLD
HEALTH ASSEMBLY.
THIS LED TO THE ‘HEALTH-FOR-ALL FOR THE
TWENTY-FIRST CENTURY’ POLICY AND
PROGRAM, WITHIN WHICH THE COMMITMENT
TO PHC DEVELOPMENT IS RESTATED .
 WHAT IS PRIMARY HEALTH CARE
PRIMARY HEATLH CARE IS ESSENTIAL
HEALTH CARE MADE UNIVERSALLY
ACCESSIBLE TO INDIVIDUALS AND
ACCEPTABLE TO THEM, THROUGH FULL
PARTICIPATION AND AT A COST THE
COMMUNITY AND COUNTRY CAN AFFORD
 ELEMENTS OF PRIMARY HEATH CARE
Education concerning prevailing health problems and the methods of preventing
an controlling them
Promotion of food supply and proper nutrition
An adequate supply of safe water and basic sanitation
Maternal and child health care including FP
CONTD.
Immunization against major infections diseases
Prevention and control local endemic diseases
Appropriate treatment of common diseases
Provision of essential drugs
 PRINCIPLES OF PRIMARY HEALTH CARE

EQUITABLE DISTRIBUTION

COMMUNITY PARTICIPATION

INTERSECTORAL COORDINATION

APROPRIATE TECHNOLOGY

DECENTRALISATION
HEALTH PROMOTION
The first international conference on health promotion was held in
Ottawa in November, 1986, which resulted in proclamation of the
Ottawa Charter for health promotion
Ottawa Charter incorporates five key action areas in health promotion:-
1. Build healthy public policy – Health policy goes beyond health care, it puts health
on the agenda of policy makers in all sectors and at all levels.
2. Create supportive environment for health – systematic assessment of the health
impact of rapidly changing environment eg. Technology , work , energy production
and urbanization
3. Strengthen community action for health – empowerment of communities
4. Develop personal skills : health promotion supports personal and social
development through providing information , education for health and enhancing
skills.
5. re orient health ervices : feedback
Why the Goals are important?
1. They are fulcrum of international development
policy to reduce poverty, to improve health, human
rights, gender equalities and environmental
sustainability.
2. Advancing means to a productive life
3. Goals are critical for global security

• The 8 MDGs break down into 18 quantifiable

targets that are measured by 48 indicators.
• 3 goals, 8 targets and 18 indicators relate to
health.
SUSTAINABLE DEVELOPMENT GOALS
The 2030 SDG agenda is of unprecedented scope and ambition,
applicable to all countries.
Goes beyond the MDG –
The sustainable development goals (SDGs) comprise a broad range of
economic , social and environmental objectives.
Out of 17 goals 3rd goal devoted to specially to the health and 13
targets.
SUSTAINABLE DEVELOPMENT GOALS
Paragraph 26 of 2030 agenda for SDG addresses health as follows:-
 To promote physical and mental health and well being and to extend life expectancy
for all , universal health coverage , access to quality health care.
 Committed to reducing newborn, child, maternal mortality by ending all such
preventable deaths before 2030.
 Committed to ensuring universal access to sexual an reproductive health care services
including for FP and information and education.
 Fighting against malaria . HIV/AIDS , tuberculosis , hepatitis , ebola and other
communicable diseases.
 Fighting against problems of unattended diseases affecting developing countries
 Committed to the prevention and treatment of non-communicable diseases including
behavioral , developmental and neurological disorders which constitute major
challenge for sustainable development.
2030 AGENDA FOR SUSTAINABLE DEVELOPMENT

• 10 targets, 15 indicators (available

at https://unstats.un.org/)
• Covering housing (including slum
upgrading) and basic services
• Transport systems
• City & settlement planning
• Cultural and natural heritage
• Climate change, disaster resilience
and preparedness
• Environmental impact of cities
• Access to green, public spaces
• Urban-rural linkages
NEED
Felt needs
 A person’s subjective assessment of their need for better health
 Person’s need for health

Normative needs
 A professional assessment of a person’s need for healthcare based on objective
measures.
 Professional or biomedical need
HEALTHCARE SERVICES
Improve the health status of the population.
HFA by 2000
 Scope of health services varies widely from country to country, Influenced by national,
state and local health problems.
 Health services should be 1. comprehensive 2. accessible 3. acceptable 4. provide
scope for community participation 5. available at a cost the community and country
can afford.
HEALTHCARE SERVICES
 The term health and FW services covers a wide spectrum of personal and community
services for treatment of disease, prevention of illness and promotion of health
 Purpose of healthcare is to improve the health status of population e.g. Immunization
influence I & P rate, women care, safe water
 Termed Primary Health Care
 HS is essential for social and economic development
HEALTHCARE SERVICES
Strong correlation between GNP & expectation of life at birth
HEALTHCARE VS MEDICAL CARE
Healthcare defined as a ‘ multitude of services rendered to
individuals , families or communities, by the agents of the health
services or professions for the purpose of promoting , maintaining,
monitoring or restoring the health.
 ‘Cared’ or ‘served’
 is expression of concern for fellow human being.
HEALTHCARE
Healthcare characteristics
 Appropriateness (relevance) – Human needs, priorities and policies
 Comprehensive – mix of preventive , curative or promotional services
 Adequacy – proportionate to requirement
 Availability – population and health facility
 Accessibility - geographic , economic , or cultural
 Affordability - cost
 Feasibility – operational efficiency , logistics, manpower ,materials
HEALTH CARE VS MEDICAL CARE
Healthcare includes ‘Medical care’
Subset of a health care system.
Ranges from domiciliary care to resident hospital care
Refer to Personal services or care provided directly by physicians or
physicians instructions.
HEALTHCARE SERVICES – SYSTEM
APPROACH
Purpose of the healthcare services
 Improve the health status of the population
 In light of HFA 2000 –
 mortality and morbidity reduction
 Increase of expectancy of life
 Decrease of population growth
 Improvement of nutritional growth
 Sanitation and health manpower development
 scope varies from state to state , country to country – needs and attitude as well as
the available resources
HEALTHCARE SERVICES – SYSTEM
APPROACH
A comprehensive list of health services may be found in report of
WHO Expert committee (1961) on “Planning of public Health
services”.
Health Services should be
 Accessible
 Comprehensive
 Acceptable
 Provide scope for community participation
 Available at the cost of community and country can afford

These are ingredients of PHC

STRUCTURE OF HEALTH CARE SYSTEM
National Level
State Level
Regional Level
District Level
Sub divisional level / Taluka level
Community level
PHC level
Sub centre level
Village level
CENTRAL LEVEL INSTITUTION
CBHI ( Central Bureau of Health Intelligence)
NICD ( National Institute of Communicable Diseases)
NIHFW ( National Institute of Health and Family Welfare)
HEALTHCARE SYSTEM
2. Private Sector
 Private hospitals, polyclinics , NH, and dispensaries
 General practitioners and clinics

3. Indigenous Systems of Medicine

 AYUSH
 RMP
 Unregistered Practitioners

4. Voluntary Health Services

5. National Health Programmes
THREE LISTS
Union List
State List
Concurrent List
PRIMARY HEALTH CARE
Placing people’s health in people’s hand
Three tier system
 Based on srivastava committee in 1975
 By 2000 HFA , through PHC approach
 Alma Ata 1978
 Universal comprehensive health care
 Evolved NH Policy based on PHC Approach
 Specific objectives set under 6th & 7th Five Year plan
PRIMARY HEALTHCARE
Essential components
 Education about prevailing health problems and method of controlling
 Promotion of food supply and proper nutrition
 Adequate supply of water and basic sanitation
 MCH and
 Family planning
 Immunization against major infectious diseases
 Prevention and control of locally endemic diseases
 Appropriate treatment of common diseases and injuries
 Provision of common drugs
PRIMARY HEALTHCARE
Other societal forces required for PHC
 Community involvement and participation
 Inter sectorial coordination
 Development of referral system / services
 Managerial processes
 Appropriate manpower development
HFA - 2000
In 1981 WHA ( world Health assembly) adopted the global strategy
for HFA.
Strategy based on the following fundamental policies
 health is a fundamental human right
 Gross inequality in the health
 People have the right and the duty to participate individually and collectively in the
planning
 Governments have responsibility for their people
 Coordinated efforts with other sector
 Fuller and better use of world’s resources
 Technical and economic cooperation among countries
HFA-2000
The main thrust area of this strategy
 Development of health infrastructure
 Specifying measures to be taken by individual, families, communities,
 Involved selecting appropriate technology
 Community involvement
 International action to support national activities
HEALTHCARE SYSTEM
Village Level
 Universal coverage and equitable distribution of Health resources.
 Village health guides – not a full time , people’s participation , mostly women,
 chosen from the community
 Serves link between community and govt infrastructure
 First contact
 Permanent resident of local community , 2-3 hours,
 Local Dais
 Training under Rural health scheme, delivery kit
 They are more acceptable to community, FP, FW services
 Anganwadi worker
 Under ICDS ( Integrated Child Development Services ) scheme
 Every 1000 population
 Training for 4 months, part time
 Take care of health check up, immunization, supplimentary nutrition , non formal pre school education , referral
services
HEALTHCARE SYSTEMS
 Sub centre level
 Peripheral outpost of the existing health care delivery system in rural areas
 5000 population , one Male & Female MHW ( Multi Health worker)
 IUD insertion , simple lab investigations, early detection of complicated pregnancy
 Supervised by Health Assistants , 6 MHW are under one one HA
 Primary health centre level
 Bhore committee 1946
 Integrated curative , preventive
 Medical care
 MCH includes FW/FP
 Sanitation and water supply
 Prevention and control of local endemic diseases
 Health education
 Referral services
 Training of health guides , HW, local Dais, HA
 Lab services
 30000 for rural , 20000 for hilly
HEALTHCARE SERVICES
Community Health centers
 Every 80000 to 1.20 lacs
 30 beds and specialist in Surg, Med, Obs & Gyn, Paed, Radiology, and Lab
 Community Health Officer ( supervisory )
 Direct Referral to state level or medical college
Hospitals HEALTHCARE SERVICES
 Rural Hospitals
 District Hospitals
 Mostly curative, hospital have no catchment area,
 Health Centre Vs Hospital

Health Insurance
 ESI
 Act of parliament 1948
 Contribution from employer and employees
 CGHS
 Comprehensive health care
 Started from Delhi and extended to other cities
HEALTHCARE SERVICES
Defense Medical Services
Railway Employees health scheme
Private agencies
ISM
Voluntary Health Agencies
 Supplementing the work of Govt
 Pioneering - New things Eg Research
 Education
 Demonstration and experimental projects
 Guarding the work of Government agencies
 Advancing health Legislation – public opinion

VHS in India
 Indian Red Cross Society
 Hind Kusht Nirvaran Sangh
 Indian Council for child welfare
 TB association of India
VERTICAL VS. INTEGRATED HEALTH CARE
PROGRAMMES
Vertical Programmes Integrated Healthcare
Clear objectives and targets Allows delivery of a range of
services selected to suit national
Operational planning of health policies and local needs.
activities
Incorporate with other
Performance incentives leading to components of the system
higher quality of care
Multi concept of health
Ability to monitor the restricted
outputs and outcomes related to More holistic approach
programmes
NATIONAL HEALTH COMMITTEES:

Various committees of experts have been

appointed by the government from time to time to
render advice about different health problems. The
reports of these committees have formed an
important basis of health planning in India. The goal
of National Health Planning in India is to attain
Health for all by the year 2000.
 PLANNING OF PUBLIC HEALTH IN INDIA
National Health Planning has been defined as the
orderly process of defining national health problem,
identifying unmet needs and surveying the resources
to meet them, establishing priority goals that are
realistic and feasible and projecting administrative
action to accomplish the purpose of the proposed
program.
1. BHORE COMMITTEE(1943-1946):
•This committee, known as the Health Survey & Development
Committee, was appointed in 1943 with Sir Joseph Bhore as its
Chairman.
•It laid emphasis on integration of curative and preventive medicine at
all levels. It made comprehensive recommendations for remodelling of
health services in India.
The report, submitted in 1946, had some important recommendations
like :
THE COMMITTEE OBSERVED THAT…..

1-Development of Primary Health Centres in 2 stages :

a. Short-term measure – one primary health centre as
suggested for a population of 40,000. Each PHC was to be
manned by 2 doctors, one nurse, four public health
nurses, four midwives, four trained dais, two sanitary
inspectors, two health assistants, one pharmacist and fifteen
other class IV employees. Secondary health centre was also
envisaged to provide support to PHC, and to coordinate
and supervise their functioning.
b. A long-term programme (also called the 3 million plan) of
setting up primary health units with 75 – bedded hospitals
for each 10,000 to 20,000 population and secondary units
with 650 – bedded hospital, again regionalised around
district hospitals with 2500 beds.
2. Major changes in medical education which
includes 3 - month training in preventive and
social medicine to prepare “social physicians”.
3. Doctors should behave as ‘social doctors’.
4. Formation of district board for each district with
district health officials and representative of the
public.
5. Ensure suitable housing, sanitary surrounding,
safe drinking water supply, and elimination of
unemployment.
BUT AFTER INDEPENDENCE 1947,
The Indian government set up a planning commission in
1950 under Indian constitution and started Five Year Plans
system of planning for socioeconomic development of the
country.
The health plan has also been an important component of
these plan.
Beside the Five Year Plan, the government from time to time
set up various committees to examine health situation or any
important problem facing the country to sought suggestion
for reform.
2. MUDALIAR COMMITTEE(1962):
This committee known as the “Health Survey and Planning Committee”,
headed by Dr. A.L. Mudaliar, was appointed to assess the
performance in health sector since submission of Bhore Committee
report.
This committee found the conditions in PHCs to be unsatisfactory and
suggested that the PHC, already established should be strengthened
before new ones are opened.
Following major recommendation were made by the committee:
THE COMMITTEE OBSERVED THAT…..

Upgrading and strengthening of PHCs.

It was emphasised that a PHC should not be made to cater to more
than 40,000 population and that the curative, preventive and pro-
motive services should be all provided at the PHC.
The Mudaliar Committee also recommended that an All India Health
service should be created to replace the erstwhile Indian Medical
service.
Mobile service teams for rural areas.
Institute of National Program in regard to Malaria Eradication, small
pox, cholera, Leprosy, Tuberculosis and Filariasis.
3.CHADHA COMMITTEE(1963)
This committee was appointed under chairmanship of Dr. M.S. Chadha,
the then Director General of Health Services, to advise about the
necessary arrangements for the maintenance phase of National
Malaria Eradication Programme.
The committee suggested that the vigilance activity in the NMEP should
be carried out by basic health workers (one per 10,000 population),
who would function as multipurpose workers and would perform, in
addition to malaria work, the duties of family planning and vital
statistics data collection under supervision of family planning health
assistants.
 THE COMMITTEE OBSERVED THAT…..
Maintenance of Malaria is the responsibility of the general health
services.
Vigilance through medical institutions must developed.
Multipurpose domiciliary health services should be developed for all
health program including malaria, small pox, control of other
communication disease, health education, etc.
4. MUKHERJEE COMMITTEE(1965)
The recommendations of the Chadha Committee, when implemented,
were found to be impracticable because the basic health workers, with
their multiple functions could do justice neither to malaria work nor to
family planning work.
The Mukherjee committee headed by the then Secretary of Health
Shri Mukherjee, was appointed to review the performance in the area
of family planning.
The committee also recommended to delink the malaria activities from
family planning so that the latter would received undivided attention
of its staff
 THE COMMITTEE OBSERVED THAT…..
Strengthening of administrative set up at different levels from primary
health unit to the state headquarters.
Delinking malaria maintenance activities from family planning could
receive undivided attention of its staff and carried through as a crash
mass program.
A committee of state health secretaries, headed by the Union Health
Secretary, Shri Mukherjee, was set up to look into this problem.
5.JUNGALWALLA COMMITTEE(1967):
This committee, known as the “Committee on Integration of Health
Services” was set up in 1964 under the chairmanship of Dr. N
Jungalwalla, the then Director of National Institute of Health
Administration and Education (currently National Institute Of Health
and Family Welfare).
It was asked to look into various problems related to integration of
health services, abolition of private practice by doctors in government
services, and the service conditions of Doctors.
The committee defined “integrated health services” as :-
a. A service with a unified approach for all problems instead of a
segmented approach for different problems.
b. Medical care and public health programmes should be put under
charge of a single administrator at all levels of hierarchy.
Following steps were recommended for the integration at all levels of
health organisation in the country:
Common Seniority
Recognition of extra qualifications
Equal pay for equal work
Special pay for special work
Abolition of private practice by government doctors
Improvement in their service conditions
 6.KARTAR SINGH COMMITTEE(1973):
This committee, headed by the Additional Secretary of Health and titled
the "Committee on multipurpose workers under Health and Family
Planning" was constituted to form a framework for integration of health
and medical services at peripheral and supervisory levels. Its main
recommendations were :-
1. One Primary Health Centre should cover a population of 50,000. It
should be divided into 16 sub-centres (one for 3000 to 3500
population) each to be staffed by a male and a female health
worker.
2. At least one female worker(ANM) should be available for
population of 10,000 to 12,000.
3. Training for all workers engaged in the field of health, family
planning and nutrition should be integrated.
4. Multipurpose workers for the delivery of health, family planning and
nutrition services to the rural communities are both feasible and
desirable.
5. To begin with, one male health worker should be available for a
populations of 6,000 to 7,000.
 7.SHRIVASTAV COMMITTEE (1974-75):
Under the chairmanship of Dr. JB Shrivastav This committee was set up in
1974 as "Group on Medical Education and Support Manpower" to
determine steps needed to
(i) reorient medical education in accordance with national needs &
priorities
(ii) develop a curriculum for health assistants who were to function as a
link between medical officers and MPWs
 IT RECOMMENDED IMMEDIATE ACTION FOR :
Creation of bonds of paraprofessional and semi-professional health
workers from within the community itself.

Establishment of 3 cadres of health workers namely – multipurpose health

workers and health assistants between the community level workers and
doctors at PHC.

Development of a “Refferal Services Complex”.

Establishment of a Medical and Health Education Commission for planning

and implementing the reforms needed in health and medical education on
the lines of University Grants Commission.

Acceptance of the recommendations of the Shrivastava Committee in 1977

led to the launching of the Rural Health Service.
8. BAJAJ COMMITTEE (1986)
An "Expert Committee for Health Manpower Planning, Production and
Management" was constituted in 1985 under Dr. J.S. Bajaj, the then
professor at AIIMS. Major recommendations are :-
1. Formulation of National Medical & Health Education Policy.
2. Formulation of National Health Manpower Policy.
3. Establishment of an Educational Commission for Health Sciences
(ECHS) on the lines of UGC.
4. Establishment of Health Science Universities in various states and
union territories.
5. Establishment of health manpower cells at centre and in the
states.
7. Vocationalisation of education at 10+2 levels as regards health
related fields with appropriate incentives, so that good quality
paramedical personnel may be available in adequate numbers.
8. Carrying out a realistic health manpower survey.
9. Establishment of health manpower cells at centre and in the states.
PANCHAYATI RAJ
3 tier structure of rural local self- government in India - linking the
village to the district.
1. Panchayat - at the village level.
2. Panchayat Samiti – at the block level
3. Zila Parishad - at the district level.
CONT
Accepted as agencies of publicvwelfare.
All the development programmes are channelled through these
bodies.
It srengthen democracy at its root.
It ensures more effective and better participation of the people in the
government.
1. AT THE VILLAGE LEVEL
Consists of:-
I. The Gram Sabha
II. The Gram Panchayat
GRAM SABHA
Assembly of all the adults of the village, which meats at least twice a
a year.
Consideration of proposals for taxation, discusses the annual
programme and elects members of the gram panchayat.
GRAM PANCHAYAT
Executive organ of the gram sabha and an agency for planning and
development at the village level.
Its strength varies from 15 to 30 and coverage of population is widely
from 5,000 to 15,000 or more.
Members hold office for a period of 3 to 4 years.
CONTINUE:-
Every panchayat has an elected President( Sarpanch or Sabhapati or
Mukhiya ), Vice President and a Panchayat Secretary.
FUNCTIONS OF PANCHAYAT SECRETARY
Coverage of the entire field of civic administration, including
sanitation and public Health and of social and economic development
of the village.
2.AT THE BLOCK LEVEL
Consists about 100 villages and population of about 80,000 to
1,20,000.
The panchayati raj agency at the block level is the Panchayat
Samiti/Janpada panchayat.
Consists of all Sarpanchas or heads of the village panchayats in the
block, MLA’s , MPs residing in the block area , representatives of
women , schedule castes, scheduled tribes and cooperative societies.
CONTINUE
Block development officer BDO is the ex- officio secretary of the
Panchayat Samoti.
Prime function of Panchayat Samiti is the execution of the community
development programme in the block.
The BDO and his staff give technical assistance and guidance to the
village panchayats engaged in development work.
3. AT THE DISTRICT LEVEL
Zila Parishad /Zila Panchayat is the agency of rural local self-
government at the district level.
The members of the Zila Parishad include all heads of the Panchayat
Samitis in the district, MPs, MLA s of the district , representatives of
scheduled castes, scheduled tribes and women and 2 persons of
experience in administration , public life or ruler development.
CONTINUE
Zila Parishad is primarily supervisory and coordinating body.
Its functions and powers vary from stste to state.
In some states, the Zila Parishads are vested with administrative
functions.
In Gujrat, the district Health Officer and the District Family Planning
and MCH officers are under the control of Zila Parishad.