Make an assignment on public and Public Health Care Centres
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Answer:
Public health systems in the colonial period were focused on health care for British citizens who were living in India. The period saw research institutes, public health legislation, and sanitation departments, although only 3% of Indian households had toilets at this time.[2] Annual health reports were released and the prevention of contagious disease outbreaks was stressed. At the end of the colonial period, death rates from infectious diseases such as cholera had fallen to a low, although other diseases were still rampant.[2]
In modern day India, the spread of communicable diseases is under better control and now non-communicable diseases, especially cardiovascular diseases, are major killers.[2] Health care reform was prioritized in the 1946 Bhore Committee Report which suggested the implementation of a health care system that was financed at least in part by the Indian government.[1] In 1983 the first National Health Policy (NHP) of India was created with the goals of establishing a system with primary-care facilities and a referral system. In 2002, the updated NHP focused on improving the practicality and reach of the system as well as incorporating private and public clinics into the health sphere.[1] In the context of universal health coverage, the recent policy focus in India, there is an attempt to ensure that every citizen should have adequate access to curative care without any financial hardships. Equally relevant is the acknowledgement of social determinants of health as an important determinant of population health and the need to have a public health cadre within the existing health care system. This call for a need to distinguish[5] between 'Public health' system and 'Public' sector health care system as the latter uses public to indicate the primary role of government and not necessarily as population as used in public health.
Public health funding has been directed to helping the middle and upper classes, as it targets creating more health professional jobs, expanding research institutions, and improving training. This creates unequal access to health care for the lower classes who do not receive the benefits of this funding.[2] Today, states pay for about 75% of the public healthcare system but insufficient state spending neglects the public health system in India.[6] This results in the Out-of-pocket health expenditure by households comprising 60.6% of the total health expenditure of India.[7][8] Thus, a large number of households are pushed below poverty line every year.
Facilities
The healthcare system is organised into primary, secondary, and tertiary levels. At the primary level are Sub Centres and Primary Health Centres (PHCs). At the secondary level there are Community Health Centres (CHCs) and smaller Sub-District hospitals. Finally, the top level of public care provided by the government is the tertiary level, which consists of Medical Colleges and District/General Hospitals.[1] The number of PHCs, CHCs, Sub Centres, and District Hospitals has increased in the past six years, although not all of them are up to the standards set by Indian Public Health Standards.[4]
Sub Centres
A Sub Centre is designed to serve extremely rural areas with the expenses fully covered by the national government. Mandates require health staff to be at least two workers (male and female) to serve a population of 5000 people (or 3000 in a remote, dangerous location). Sub Centres also work to educate rural people about healthy habits for a more long-term impact.[1]
Primary Health Centres
Primary Health Centres exist in more developed rural areas of 30,000 or more (20,000 in remote areas) and serve as larger health clinics staffed with doctors and paramedics. Patients can be referred from local sub centres to PHCs for more complex cases.[1] A major difference from Sub Centres is that state governments fund PHCs, not the national government. PHCs also function to improve health education with a larger emphasis on preventative measures.[1]
Community Health Centres
A Community Health Centre is also funded by state governments and accepts patients referred from Primary Health Centres. It serves 120,000 people in urban areas or 80,000 people in remote areas.[1] Patients from these agencies can be transferred to general hospitals for further treatments. Thus, CHC's are also first referral units, or FRUs, which are required to have obstetric care, new born/childcare, and blood storage capacities at all hours everyday of the week.[1]