4. PUBLIC AND PRIVATE HEALTH SYSTEM IN INDIA, NATIONAL HEALTH MISSION

PUBLIC AND PRIVATE HEALTH SYSTEM IN INDIA & NATIONAL HEALTH MISSION: A TEACHER’S COMPREHENSIVE GUIDE

Welcome, future pharmacists and healthcare professionals!

The supply of medicine, medical or surgical treatment, nursing hospital service, dental service, optometric service, and complementary health services are referred to as healthcare services or health system. Generally, these healthcare services are provided by various healthcare systems in India. Understanding the structure and functioning of the health system is essential for every pharmacist because it determines where and how we practice, who we serve, and how we contribute to public health.

As a pharmacy educator with years of experience teaching Social Pharmacy, I have observed that students often find the Indian health system complex due to its multi-layered structure. However, understanding the public and private health systems and the National Health Mission is crucial for pharmacists who wish to serve the community effectively. In this comprehensive guide, I will walk you through the rural and urban health services, health insurance schemes, private healthcare, and the National Health Mission with its sub-missions. Let us begin our journey.

Dpharmguru’s exam insights:

The health system in India is frequently tested in social pharmacy exams. Remember: The public health system has a three-tier structure in rural areas—Sub-Centre, Primary Health Centre (PHC), and Community Health Centre (CHC). The National Health Mission (NHM) comprises NRHM and NUHM. NRHM was launched on 5th April 2005. Pay special attention to the roles of ASHA, ANM, and the functions of PHCs and CHCs!

PUBLIC HEALTH SYSTEM IN INDIA

The sponsored system of government is called the public sector, which is funded by public funds generated through general taxes. In large rural and urban areas, services are provided to the people by promoting a three-tier system at the block, district, and state levels.

1. Rural Health Services

A network of infrastructure developed within villages and up to the block levels helps to provide health services in rural areas. Its main aim is to promote and prevent healthcare services and to provide primary healthcare.

The healthcare infrastructure in rural areas has been developed as follows:

• Village Health Posts
• Sub-Centres
• Primary Health Centres (PHCs)
• Community Health Centres (CHCs)

1.1 Village Health Posts

Trained village health guides, birth attendants (local Dais), and anganwadi workers work to provide elementary services at the village level.

Village Health Guides: Village health guides are capable of offering social services but are not full-time government functionaries. On 2nd October 1977, the village health guides scheme was initiated with the objective of securing the involvement of people in their own healthcare. Simple treatment for common minor ailments, first aid during accidents and emergencies, mother and child care along with family planning, health education, etc., are maintained by the village health guide.

Anganwadi: Anganwadis are the workplace for anganwadi workers. They carry out the responsibility of health check-up, additional nutrition, vaccination, and non-formal education of children who have registered in anganwadi. Some of their functions, e.g., immunisation and health check-up of children, are coordinated with the ANMs in the area. A population of 1000 in the village is served by the anganwadi workers.

ASHA (Accredited Social Health Activist): ASHA is a trained female community health activist, selected from the community and responsible for community health. She creates awareness and provides information to the community on health determinants—nutrition, basic sanitation and hygienic practices, healthy living and working conditions, information on existing health services, and the need for utilisation of health and family welfare services.

Functions of Village Health Posts:

• Counsels women on birth preparedness, safe delivery, breastfeeding, complementary feeding, immunisation, contraception, prevention of RTIs/STIs, and care of the young child.
• Mobilises the community and facilitates access to health and health-related services available at the village/sub-centre/PHC.
• Works with the Village Health and Sanitation Committee of the Gram Panchayat to develop a comprehensive village health plan.
• Accompanies pregnant women and children who need treatment or admission to the nearest PHC, CHC, or first referral unit.

1.2 Sub-Centres

The sub-centre is the outermost post of the Indian healthcare system.

Staffing Pattern:

• 1 female health worker — Auxiliary Nurse Midwife (ANM)
• 1 male health worker — Multipurpose worker
• 1 voluntary worker to help the ANM
• 1 Female Health Assistant (Lady Health Visitor)
• 1 Male Health Assistant at the PHC level for supervision of 6 sub-centres

Functions of Sub-Centre:

• Antenatal, natal, and postnatal care
• Family planning and counselling
• Treatment of common health problems like respiratory tract infections, diarrhoea, fever, worm infestation
• Prevention of malnutrition
• Implementation of several national health programmes

1.3 Primary Health Centres (PHCs)

PHC is the first contact point between the village community and the medical officer. In the current scenario, a PHC is operated by a Medical Officer supported by 14 paramedical and other staff. It functions as a referral unit for 6 Sub-Centres having 4–6 beds for patients. Curative, preventive, primitive, and family welfare services are the activities of the PHC.

Functions of PHCs:

• Medical care
• Mother and child health comprising family planning
• Safe water supply and basic sanitation
• Prevention and control of locally endemic diseases
• Collection and reporting of vital statistics
• Education about health
• National Health Programmes as relevant
• Referral services
• Training of health guides, health workers, local dais, and health assistants
• Basic laboratory services

1.4 Community Health Centres (CHCs)

As per minimum norms, a CHC is required to be operated by four medical specialists—surgeon, physician, gynaecologist, and paediatrician—supported by 21 paramedical and other staff. It has 30 in-door beds with one OT, X-ray, labour room, and laboratory facilities.

Functions of CHCs:

• Care of Routine and Emergency Cases in Surgery: Dressings, I&D, hernia/hydrocele/appendicitis surgery, emergency care, nasal packing, tracheostomy, foreign body removal, fracture reduction, and splints/plaster cast.
• Care of Routine and Emergency Cases in Medicine: Daily OPD services, handling emergency and regular cases.
• Maternal Health: At least 4 ANC check-ups, 24-hour delivery services (normal, assisted, and caesarean section), labour management using partograph, 48 hours stay after delivery, 3–7 days stay for complications.
• New-born Care and Child Health: Crucial new-born care and resuscitation, infant and young child feeding guidance, daily and emergency care of sick children, complete vaccinations against VPDs, malnutrition case regulation.
• Family Planning: Counselling, provision of contraceptives, NSV, laparoscopic sterilisation services, safe abortion services.
• Other Functions: Convey all National Health Programmes, school health services, blood bank facility, essential laboratory services, reference (transport) services, Maternal Death Review (MDR).

Dpharmguru’s exam insights:

The rural health infrastructure is frequently tested. Remember the hierarchy: Village Health Posts (ASHA, Anganwadi) → Sub-Centre (ANM) → PHC (Medical Officer, 6 beds) → CHC (4 specialists, 30 beds). ASHA was introduced under NRHM in 2005. PHCs are the first contact point with a medical officer. CHCs have 30 beds and 4 specialists. These details are often asked in exams!

2. Urban Health Services

District hospitals and medical college hospitals provide services in urban areas. Hospitals and institutes of higher education and research are incorporated under the Central Government and provide general as well as referral services.

• Dispensaries: For diagnosis and treatment of minor diseases, helping to minimise the load from district hospitals and medical college hospitals.
• District Hospital: Set up at district level, now transformed into district health centres providing specialised IPD and OPD healthcare facilities.
• Urban Health Post: Established in 1983, under which urban health centres are set up in slums. Currently nearly 871 urban health posts are running, providing RCH, family planning, contraceptive, and first aid healthcare services.
• Urban Family Welfare Centre: Established in 1950 for serving family welfare services in urban areas. Currently nearly 1083 operational centres provide family welfare services and distribute contraceptive material.
• Satellite Hospital: Established with modern techniques to minimise pressure on district hospitals and medical college hospitals. Includes trauma centres, ICU, and other emergency services.
• Maternal and Child Health Centres: Provide maternal and child healthcare services to reduce mortality and morbidity and promote health status.
• Teaching Hospital/Medical College: Set up in big cities, providing education to medical students and specialised health services, and participating in health research.
• Super Speciality Hospital: Established under particular law by Parliament, providing super speciality services like neurosurgery, cardiac surgery, vascular surgery, surgical oncology, and health research.

3. Health Insurance

Health insurance policy is a lawful agreement between a person or group of persons and a company or any government programme, which shows the way medical bills of the individual or group are paid. Health or medical insurance offers monetary protection for hospitalisation and medication at the time of accidents and some illnesses for a specific limit.

Classification of Health Insurance

• Health Expense Insurance: Covers hospitalisation, surgical expenses, physician expenses, and dental expenses.
• Disability Income Insurance: Provides income when earnings are lost due to illness or accident—can be short-term or long-term.

Health Insurance Schemes in India

Employees State Insurance Scheme (ESIC): Initiated in Kanpur on 24th February 1952 by Prime Minister Pandit Jawahar Lal Nehru for serving medical benefits and cash during sickness, employment injury, maternity, etc.

Benefits of ESIC:

• Medical Benefits: Medical expenses are satisfied by ESIC through appropriate medical care.
• Disability Benefit: Monthly wages paid during temporary disablement or for life in case of permanent disablement.
• Maternity Benefit: 100% of average daily wages for 26 weeks (6 weeks in case of miscarriage).
• Sickness Benefit: 70% of average daily income during medical leave for up to 91 days.
• Unemployment Allowance: Monthly cash allowance for up to 24 months due to permanent invalidity or involuntary loss of employment.
• Dependent’s Benefit: Monthly payments to surviving dependents in case of death due to injury at the workplace.

Central Government Health Scheme (CGHS): Comprehensive medical care is provided to central government employees and pensioners. Launched in Delhi in 1954.

Facilities under CGHS:

• OPD treatment including dispensing of drugs
• Specialist consultation at polyclinic/government hospitals
• Treatment within government and empanelled hospitals
• Cashless facilities for treatment in empanelled hospitals for pensioners
• Refund of expenses for treatment in government/private hospitals under emergency
• Family welfare, maternity, and child health services

Dpharmguru’s exam insights:

Health insurance schemes are frequently tested. Remember: ESIC was launched in 1952 in Kanpur; CGHS was launched in 1954 in Delhi. ESIC provides 26 weeks of maternity benefit at 100% wages; 70% sickness benefit for 91 days; dependent’s benefit for workplace deaths. CGHS provides OPD, specialist consultation, and cashless treatment for pensioners.

4. Other Agencies

• Railway Hospitals: Specialised hospitals for cancer (Varanasi), heart diseases (Chennai), orthopaedics (Kolkata), and plastic surgery (Mumbai). Indian Railways have separate family planning and family welfare centres.
• Military Hospitals: Provide medical care to active duty military employees, eligible military retirees, and eligible dependents. Includes medical testing, emergency treatment, and maintenance of physical standards.

PRIVATE HEALTH SYSTEM IN INDIA

Private individuals, organisations, or corporations own and run private healthcare services. Patients directly pay for their treatment, and revenue is generated by taking fees, insurance, and other means. The government does not own these services, so they are operated for profit and have a high cost of treatment.

1. Private Hospitals and Clinics

Hospitals and clinics are included in the private or independent healthcare sectors, operated independently of the National Health Service (NHS). NHS does not subsidise any private healthcare costs, so patients must pay fees for private services. Some NHS hospitals may have private sectors or clinics serving as private care at lower prices.

2. Private Consultation Centres

Out Patient Departments (OPD) and clinics provide diagnostic, therapeutic, or preventive outpatient services. They may be referred to as specific sub-divisions and often cover an entire medical teaching centre, including the hospital and outpatient facilities.

3. Public Private Partnership (PPP)

Public Private Partnerships comprise an alliance between a government agency and a private-sector company that can be used to finance, build, and operate projects. The advantage of a PPP is that the management skills and financial acumen of private businesses may result in increased quality, efficiency, infrastructure development, and affordability of public services.

Dpharmguru’s exam insights:

Private health system and PPP are frequently tested. Remember: Private healthcare is operated for profit, has high costs, and is not subsidised by the government. PPPs combine government oversight with private sector efficiency. These concepts are important for understanding the mixed healthcare system in India.

NATIONAL HEALTH MISSION (NHM)

Strengthening of the health system in rural and urban areas, Reproductive Maternal Neonatal Child and Adolescent Health (RMNCH+A), and communicable and non-communicable diseases are the main components of the programme. The National Health Mission (NHM) comprises two sub-missions—the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM). This mission was launched in the year 2013 and is implemented by the Ministry of Health and Family Welfare.

Role of Pharmacist in National Health Mission

• Advocate for sound legislation, regulations, and public policy related to disease prevention and management.
• Collaborate with other healthcare professionals to develop treatment guidelines.
• Develop, evaluate, and document pharmaceutical care practices.
• Establish professional standards and check procedures.
• Establish and maintain a well-qualified pharmacy workforce.
• Educate all healthcare professionals involved in pharmaceutical care.

National Rural Health Mission (NRHM)

The Indian government launched the NRHM on 5th April, 2005 for 7 years (2005–2012) after realising the importance of health in the process of economic and social development. This mission was later extended up to the year 2017 to improve the quality of life of the Indian population and to improve the system of rural healthcare delivery.

Objectives of NRHM:

• To promote the availability of improved healthcare at household level through the female health activist (ASHA).
• To create a health plan for each village through the Village Health Committee of the Panchayat.
• To improve existing PHCs and CHCs and make them 30–50 bedded.
• To ensure the availability of one CHC per lakh population for providing standard therapeutic care.
• To prepare and implement an inter-departmental District Health Plan including drinking water, sanitation, hygiene, and nutrition.
• To incorporate vertical health and Family Welfare Programmes at national, state, block, and district levels.
• To facilitate technical support to National, State, and District Health Mission for Public Health Management.
• To increase capacities for data collection, evaluation, and review for evidence-based planning, monitoring, and supervision.
• To improve capacities for preventive healthcare and promoting healthy lifestyles by reducing tobacco and alcohol consumption.
• To promote the non-profit sector particularly in under-serviced areas.

Components of NRHM:

• Ensuring involvement and leadership of PRIs (Panchayati Raj Institutions) for the Health Sector.
• Forming a cadre of ASHA in a sequential manner.
• Establishing village health teams and creating village health plans.
• Implementing Indian Public Health Standards (IPHS).
• Integrating AYUSH at all levels of primary healthcare.
• Supply of additional generic drugs—Allopathic and AYUSH to SC/PHC/CHC.
• Conducting multiple health insurance models.
• Promoting the private sector for achieving public health goals.
• Strengthening immunisation.
• Implementing Janani Suraksha Yojana (JSY) for improving institutional delivery.

National Urban Health Mission (NUHM)

The NUHM aims to improve the health status of the urban population, mainly the slum-dwellers and other vulnerable people, by allowing them to access quality healthcare.

Focus of NUHM:

• Urban poor population living in listed and unlisted slums.
• Other vulnerable populations like homeless, rag pickers, street children, rickshaw pullers, construction workers, sex workers, and temporary migrants.
• Public health thrust on sanitation, clean drinking water, vector control, etc.
• Strengthening public health capacity of urban local bodies.

Components of NUHM:

• Population Policy (NPP 2000): Focuses on contraception, combined service delivery for reproductive and child health, TFR to replacement levels, IMR less than 30 per 1000, MMR less than 100 per 100,000.
• Jansankhya Sthirata Kosh (JSK): National Population Stabilisation Fund established in July 2000, transferred to Department of Health and Family Welfare in April 2002, renamed as JSK in June 2003.
• Geographical Information System (GIS) Mapping: 450 districts mapped through exclusive combination of GIS maps and Census data, focusing on inequalities at village level for resource allocation.

Dpharmguru’s exam insights:

NRHM and NUHM are frequently tested. Remember: NRHM was launched on 5th April 2005; ASHA was introduced under NRHM; JSY is for institutional delivery; NPP 2000 targets include IMR <30 and MMR <100; JSK is the National Population Stabilisation Fund; GIS mapping is used for resource allocation. The role of pharmacists in NHM is also important—advocacy, collaboration, and education!

COMPARISON: PUBLIC VS PRIVATE HEALTH SYSTEM

FREQUENTLY ASKED QUESTIONS (FAQs)

1. What is the three-tier rural health infrastructure in India?

The three-tier rural health infrastructure consists of: Sub-Centres (outermost post), Primary Health Centres (PHCs) (first contact with medical officer), and Community Health Centres (CHCs) (referral hospitals with 30 beds).

2. What is the role of ASHA under NRHM?

ASHA (Accredited Social Health Activist) is a trained female community health activist who creates awareness on health determinants, mobilises the community, and facilitates access to health services. She also accompanies pregnant women and children to health facilities.

3. When was NRHM launched?

NRHM was launched on 5th April, 2005 by the Indian government for 7 years (2005–2012) and later extended up to 2017.

4. What is the staffing pattern of a Sub-Centre?

A Sub-Centre has: 1 female health worker (ANM), 1 male health worker, 1 voluntary worker, 1 Female Health Assistant, and 1 Male Health Assistant for supervision of 6 sub-centres.

5. What is the difference between ESIC and CGHS?

ESIC (Employees State Insurance Scheme) covers factory/industrial workers and their families, launched in 1952 in Kanpur. CGHS (Central Government Health Scheme) covers central government employees and pensioners, launched in 1954 in Delhi.

6. What is the National Health Mission?

The National Health Mission (NHM) was launched in 2013 and comprises two sub-missions—NRHM (rural) and NUHM (urban). It focuses on strengthening the health system, RMNCH+A, and communicable and non-communicable diseases.

7. What is Janani Suraksha Yojana (JSY)?

JSY is a scheme implemented under NRHM for improving the level of institutional delivery. It provides financial incentives to pregnant women for delivering in institutional facilities.

SUMMARY

The health system in India is a complex mix of public and private sectors. The public health system provides affordable healthcare through a well-defined infrastructure—from village health posts to super speciality hospitals. The rural health infrastructure consists of Sub-Centres, PHCs, and CHCs, supported by ASHA and Anganwadi workers. The urban health system includes dispensaries, district hospitals, urban health posts, and medical college hospitals.

The National Health Mission (NHM) launched in 2013 combines NRHM (2005) and NUHM to strengthen health systems in both rural and urban areas. Health insurance schemes like ESIC and CGHS provide financial protection to workers and government employees. The private health system complements the public system but is profit-oriented and costly.

As I always tell my students: “The health system is the platform on which we practice pharmacy. Understanding its structure, strengths, and weaknesses is essential for every pharmacist who wishes to serve the community effectively and contribute to the National Health Mission.”

REFERENCES AND FURTHER READING

• Ministry of Health and Family Welfare. (2022). National Health Mission Guidelines. Government of India.
• Ministry of Health and Family Welfare. (2022). National Rural Health Mission Framework. Government of India.
• Employees State Insurance Corporation (ESIC). (2022). ESIC Benefits and Services. Government of India.
• Central Government Health Scheme (CGHS). (2022). CGHS Facilities and Services. Government of India.
• World Health Organization (WHO). (2022). Health Systems and Services. Retrieved from https://www.who.int.
• Park, K. (2022). Park’s Textbook of Preventive and Social Medicine (25th ed.). Banarasidas Bhanot Publishers.

Disclaimer: This article is for educational purposes only and does not constitute medical advice. Always consult qualified healthcare professionals for medical concerns.

written by:
Dr. N. Sujith Kumar

Dr. N. Sujith Kumar is a pharmacy educator, Pharm.D graduate, and academic content creator from Jawaharlal Nehru Technological University Kakinada (JNTUK), where he completed his Doctor of Pharmacy (Pharm.D) degree between 2015 and 2021. He has more than 7 years of experience creating pharmacy educational content, writing study materials, and reviewing academic articles for pharmacy students. He has also contributed guest articles to pharmacy education platforms, including PharmD Guru. At D.PharmGuru, his work focuses on simplifying complex Diploma in Pharmacy (D.Pharmacy) subjects into easy-to-understand notes, practical explanations, and exam-oriented educational resources for students across India. His areas of focus include Human Anatomy and Physiology, Pharmaceutics, Pharmacology, Pharmaceutical Chemistry, Hospital and Clinical Pharmacy, and other core D.Pharmacy subjects.

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