SEMINAR ON PHILOSOPHY,

PURPOSR, ELEMEMTS,
PRINCIPLES AND SCOPE OF
ADMINISTRATION & INDIAN
CONSTITUTION, INDIAN
ADMINISTRATIVE SYSTEM,
HEALTH CARE DELIVERY SYSTEM
NATIONAL, STATE AND LOCAL

SUBMITTED TO SUBMITTED BY
Mrs. M. P. Lilly kamala A. Malleshwari
Assistant professor Msc ( N) 2nd year
GCON GCON

SUBMITTED ON :14/01/2021
 ADMINISTRATION

Introduction
Administration derived from the Latin word -ad + ministraired to care for or to
look after people to manage affairs, Administration is the activities of groups
co-operating to accomplish common goals-
Administration, on a planned and scientific basis, is a necessary for the
smooth running of every institution. Administration plays a vital role in
functioning of hospital
Administration may be defined as the management of affairs with the use of
well thought out principles and practices and rationalized techniques to achieve
certain objectives
As administration is universal in nature, its scope is wide. It covers all the
areas like school, hospital, business etc.
Definition
Administration
Administration is the organization and direction of human and material
resources to achieve desired ends
-According to pfiffner and presthus
Administration has to do with getting things done with the accomplishment of
defined objectives.
-According to Luther Gullick.
Administration is a process involving human beings jointly engaged in
working towards common goals
- According to George E-Berkley

The art of administration is the direction, co-ordination and control of many

persons to achieve some purpose or objective
- According to L.D White Nursing
administration
“Nursing Administration is primarily the process and agency used to establish the
nursing objectives or purposes, which an undertaking or staffs are to achieve. It also has
to plan and to stabilize, the broad lines or principles that will govern nursing action.
These broad lines are usually called policies. Whereas the nursing management is the
process and agency through which execution of nursing policy is planned and
supervised.
Definition;
“Nursing Administration may be best defined as the strategic management of
nursing personnel, patient care, and facility resources through the support of
regulating polices” An example of administration is the act of the manager in
the hospital managing the nursing staff and employing the rules of the health
system
PHILOSOPHIES OF ADMINISTRATION
Philosophy is based on the following key points: Administration believes in:
• Cost effectiveness
• Execution and control of work plans
• Delegation of responsibility
• Human relations and good morale
• Effective communication
• Flexibility in certain situation
PRINCIPLES OF ADMINISTRATION
Meaning of management principles: Management principles are statements of
fundamental truth
which act as guidelines for taking managerial action.
Management principles are derived and developed in the following two steps.

(a) Deep Observations

(b) Repeated experiments

PURPOSES OF ADMINISTRATION
 It is a life blood of organization.
 It is a shoulder of an organization.
 Its main function is to achieve the objectives.
 Without good administration is a house built on sand or castle in the air.
 There is no substitute of good administration.
   Good administration brings out the organizational growth by effective
and efficient performance.
 Good administration brings team together to work.
 It gives new ideas, through imagination, vision to an organization.
 It is considered as a brain of organization
ELEMENTS OF ADMINISTRATION
•planning
• organizing
•Reporting
• staffing
• Directing
• Coordinating
• Budgeting
•Supervision
• Evalution

• Planning is decision making for future events. The process of

organization implies to the arrangement of human and non-human
resources in an orderly fashion to accomplish organizational objectives.

• Staffing is the process of “personnelizing” the organization, by hiring

the right type and adequate number of workers to each unit for the time
required.

 Directing means giving instructions, guiding, counselling, motivating

and leading the staff in an organization in doing work to achieve
organizational goals
 Coordination brings different elements of a complex activity or
organization into relationship that will ensure efficiency and/or harmony.
 The reporting to management is a process of providing information to
enable in judging the effectiveness of their responsibility centres, for
taking corrective measures, and to facilitate future decision making.
 Budgeting is the process of forecasting the amount of money required to
accomplish a task, and creating a plan to spend the money efficiently.
 Supervision: Supervision refers to the day-to-day relationship between
an executive and his immediate subordinates. Supervision aims at
satisfying both: -Work –Workers
 Evaluation: Evaluation is analysis of completed or ongoing activities
that determine or support accountability, effectiveness, and efficiency.

SCOPE OF ADMINISTRATION
The scope of administration is very wide. It is not only restricted to
public administration that deals with three functionaries, i.e. legislative,
executive and judiciary. As administration is universal in nature, its scope
is wide. It covers all the areas like school, hospital, business etc., all the
managerial activities and functional areas of management and
administration like personnel, financial, material and production are
covered
 Political : Functions of the administration includes the executive –
Legislative Relationship
 Defensive : It covers the Hospital protective function
 Economic : Concerns with the vast area of the Health care activities
 Educational : Its involves educational administration in its Broadest
senses
 Legislative : It includes most not mealy delegated legislation, but the
preparatory work done by the administrative officials
 Financial : It includes the whole of financial, budget, inventory control
programme
  social: It includes the whole of financial, budget, inventory control
programme
 Local : It concerned with the activities of the Local bodies.

INDIAN CONSTITUTION

Introduction
The majority of the Indian subcontinent was under British colonial rule from
1858 to1947. This period saw the gradual rise of the Indian nationalist
movement to gain independence From the foreign rule. The movement
culminated in the formation of the on 15 August 1947,along with the Dominion
of Pakistan. The constitution of India was adopted on 26 January 1950,which
proclaimed India to be a sovereign democratic republic.

Evolution of the Constitution

Acts of British Parliament before 1935
After the Indian Rebellion of 1857, the British Parliament took over the reign of India
from the British East India Company, and British India came under the direct rule of the
Crown.The British Parliament passed the Government of India Act of 1858 to this
effect, which set up the structure of British government in India.
Government of India Act 1935

The provisions of the Government of India Act of 1935, though never implemented
fully, had a great impact on the constitution of India. The federal structure of
government, provincial autonomy, bicameral legislature consisting of a federal
assembly and a Council of States, separation of legislative powers between center and
provinces are some of the provisions of the Act which are present in the Indian
constitution.
The Cabinet Mission Plan
In 1946, at the initiative of British Prime Minister Clement Attlee, a cabinet mission to
India was formulated to discuss and finalize plans for the transfer of power from the
British Raj to Indian leadership and providing India with independence under
Dominion status in the Commonwealth of Nations. The Mission discussed the
framework of the constitution and laid down in some detail the procedure to be
followed by the constitution drafting body. Elections for the 296 seats assigned to the
British Indian provinces were completed by August 1946. The Constituent Assembly
first met and began work on 9 December 1946.
Indian Independence Act 1947
The Indian Independence Act, which came into force on 18 July 1947, divided the
British Indian territory into two new states of India and Pakistan, which were to be
dominions under the Commonwealth of Nations until their constitutions were in effect
Constituent Assembly
The Constitution was drafted by the Constituent Assembly, which was elected by the
elected members of the provincial assemblies. Jawaharlal Nehru, C. Rajagopalachari,
Rajendra Prasad, SardarVallabhbhai Patel, MaulanaAbulKalam Azad, Shyama Prasad
Mukherjee and NaliniRanjanGhosh were some important figures in the Assembly. In
the 14 August 1947 meeting of the Assembly, a proposal for forming various
committees was presented. Such committees included a Committee on Fundamental
Rights, the Union Powers Committee and Union Constitution Committee. On 29
August 1947, the Drafting Committee was appointed, with DrAmbedkar as the
Chairman along with six other members. A Draft Constitution was prepared by the
committee and submitted to the Assembly on 4 November 1947
Parts
Parts are the individual chapters in the Constitution, focused in single broad
field of laws, containing articles that address the issues in question.
Preamble
 Part I - Union and its Territory
 Part II - Citizenship.
 Part III- Fundamental Rights
 Part IV - Directive Principles and Fundamental Duties.
 Part V- The Union.
 Part VI- The States.
 Part XII - Finance, Property, Contracts and Suits
 Part XIII - Trade and Commerce within the territory of India
 Part XIV - Services Under the Union, the States and Tribunals
 Part XV - Elections
 Part XVI - Special Provisions Relating to certain Classes.
 Part VII - States in the B part of the First schedule (Repealed).
 Part VIII - The Union Territories
 Part IX - Panchayat system and Municipalities.
 Part X - The scheduled and Tribal Areas
 Part XI - Relations between the Union and the States.
 Part XVII - Languages
 Part XVIII - Emergency Provisions
 Part XIX - Miscellaneous
 Part XX - Amendment of the Constitution
 Part XXI - Temporary, Transitional and Special Provisions
 Part XXII - Short title, date of commencement, Authoritative text in Hindi and
Repeals
Federal Structure

The constitution provides for distribution of powers between the Union and the
States. It enumerates the powers of the Parliament and State Legislatures in
three lists, namely Union list, State list and Concurrent list. Subjects like
national defense, foreign policy, issuance of currency are reserved to the Union
list. Public order, local governments, certain taxes are examples of subjects of
the State List, on which the Parliament has no power to enact laws in those
regards, barring exceptional conditions. Education, transportation, criminal laws
are a few subjects of the Concurrent list, where both the State Legislature as
well as the Parliament has powers to enact laws.

Changing the constitution

In 2000 the National Commission to Review the Working of the Constitution

(NCRWC) was setup to look into updating the constitution of India.

Judicial review of laws

This section requires expansion. Judicial review is actually adopted in the

Indian constitution from the constitution of the United States of America. In the
Indian constitution, Judicial Review is dealt under Article 13. Judicial Review
actually refers that the Constitution is the supreme power of the nation and all
laws are under its supremacy. Article 13 deals that

1. All pre-constitutional laws, after the coming into force of constitution, if

in conflict with it in all or some of its provisions then the provisions of
constitution will prevail. If it is compatible with the constitution as
amended. This is called the Theory of Eclipse
2. In a similar manner, laws made after adoption of the Constitution by the
Constituent Assembly must be compatible with the constitution,
otherwise the laws and amendments will be deemed to be void-ab-initio.
In such situations, the Supreme Court or High Court interprets the laws as
if they are in conformity with the constitution.
HEALTH CARE DELIVERY SYSTEM IN INDIA

Introduction

Health is the birth right of every individual. Today health is considered more
than a basic human right; it has become a matter of public concern, national
priority and political action. Our health system has traditionally been a disease-
oriented system but the current trend is to emphasize health and its promotion.

Selected health care definitions:

 Health: According to WHO, health is defined as ―a dynamic state of

complete physical, mental and social well-being not merely an absence of
disease or infirmity.

 Health care services: It is defined as ―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
health.

Definitions of health care delivery:

1. Health care delivery system refers to the totality of resources that a

population or society distributes in the organization and delivery of health
population services. It also includes all personal and public services
performed by individuals or institutions for the purpose of maintaining or
restoring health.
- stanhope(2001)

2. It implies the organization, delivery staffing regulation and quality control.

 - J.c park(2001)

Philosophy of Health Care Delivery System:

 Everyone from birth to death is part of the market potential for health care
services.

 The consumer of health care services is a client and not customer.

 Consumers are less informed about health services than anything else they
purchase.

 Health care system is unique because it is not a competitive market.

 Restricted entry in to the health care system.

Goals/Objectives of Health Care Delivery System:

1) To improve the health status of population and the clinical outcomes of care.
2) To improve the experience of care of patients families and communities.

3) To reduce the total economic burden of care and illness.

4) To improve social justice equity in the health status of the population.

Principles of Health Care Delivery System:

1. Supports a coordinated, cohesive health-care delivery system.

2. Opposes the concept that fee-for-practice.

3. Supports the concept of prepaid group practice.

4. Supports the establishment of community based, community controlled

health-care system.

5. Urges an emphasis be placed on development of primary care

6. Emphasizes on quality assurance of the care

7. Supports health care as basic human right for all people.

8. Opposes the accrual of profits by health-care-related industries.

Functions of Health Care Delivery System:

1) To provide health services.

2) To raise and pool the resources accessible to pay for health care.

3) To generate human and physical sources that makes the delivery service
possible.

4) To set and enforce rules of the game and provide strategic direction for all
the different players involved.

Characters of Health Care Delivery System:

1) Orientation toward health.

2) Population perspective.

3) Intensive use of information.

4) Focus on consumer.

5) Knowledge of treatment outcome.

6) Constrained resources.

HEALTH CARE DELIVERY SYSTEM IN INDIA

In India it is represented by five major sectors or agencies which differ from

each other by health technology applied and by the source of fund available.
These are:

I. PUBLIC HEALTH SECTOR

A. Primary Health Care

-Primary health centres.

-Sub- centres.

B. Hospital/Health Centres Community health centres.

- Rural health centres.

- District hospitals/health centre.

- Specialist hospitals.

-Teaching hospitals.

C. Health Insurance Schemes

-Employees State Insurance.

-Central Govt. Health Scheme.

D. Other Agencies

-Defence services.

-Railways.

II. PRIVATE SECTOR

A. Private hospitals, polyclinics, nursing homes and dispensaries.

B. General practitioners and clinics.

III. INDIGENOUS SYSTEMS OF MEDICINE

 Ayurveda

 Sidda

 Unani

 Homeopathy

 Naturopathy
 Yoga

 Unregistered practioners.

IV. VOLUNTARY HEALTH AGENCIES

V. NATIONAL HEALTH PROGRAMMES

ORGANIZATION AND ADMINISTRATION OF HEALTH SERVICES

IN INDIA AT DIFFERENT LEVELS.
India is a union of 28 states and 7 Union territories. Under the constitution
states are largely independent in matters relating to the delivery of health care to
the people. Each State, therefore, as developed its own system of health care
delivery, independent of the Central Government.
Health system in India has 3 links
1. Central level.
2. State level
3. District level
Health administration at the central level
The official organs of the health system at the national level consist of 3 units:
1. Union Ministry of Health and Family Welfare.
2. The Directorate General of Health Services.
3. The Central Council of Health and Family Welfare.
I. Union Ministry of Health and Family Welfare
Organisation:
The Union Ministry of Health and Family Welfare is headed by a Cabinet
Minister, a Minister of State, and a Deputy Health Minister. These are political
appointment and have dual role to serve political as well as administrative
responsibilities for health.
Currently the union health ministry has the following departments:
1. Department of Health
2. Department of Family Welfare
3. Department of Indian System of Medicine and Homoeopathy
a. Department of Health:
It is headed by a secretary to the Government of India as its executive
head, assisted by joint secretaries, deputy secretaries, and a large administrative
staff.
Functions:
Union list
1. International health relations and administration of port-quarantine
2. Administration of central health institutes such as All India Institute of
Hygiene and Public Health, Kolkata; National Institute for Control of
Communicable Diseases, Delhi, etc.
3. Promotion of research through research centres and other bodies.
4. Regulation and development of medical, nursing and other allied health
professions.
5. Establishment and maintenance of drug standards.
6. Census, and collection and publication of other statistical data.
7. Immigration and emigration.
8. Regulation of labour in the working of mines and oil fields.
Concurrent list:
The functions listed under the concurrent list are the responsibility of
both the union and state governments. The centre and states have simultaneous
powers of legislation. They are as follows:
1. Prevention of extension of communicable diseases from one unit to another.
2. Prevention of adulteration of food stuffs.
3. Control of drugs and poisons.
4. Vital statistics.
5. Labour welfare.
6. Ports other than major.
7. Economic and social health planning
8. Population control and family planning.

Department of Family Welfare:

It was created in 1966 within the Ministry of Health and Family Welfare.
The secretary to the Government of India in the Ministry of Health and Family
Welfare is in overall charge of the Department of Family Welfare. He is assisted
by an additional secretary and commissioner, and one joint secretary.
The following divisions are functioning in the department of family welfare.
1. Programme appraisal and special scheme
2. Technical operations: looks after all components of the technical programme
viz. Sterilization/IUD/Nirodh, post partum, maternal and child health, UPI, etc.
3. Maternal and child health
4. Evaluation and intelligence: helps in planning, monitoring and evaluating the
programme performance and coordinates demographic research.
5. Nirodh marketing supply/ distribution
Functions
a. To organize family welfare programme through family welfare centres.
b. To create an atmosphere of social acceptance of the programme and to
support all voluntary organizations interested in the programme.
c. To educate every individual to develop a conviction that a small family size is
valuable and to popularize appropriate and acceptable method of family
planning
d. To disseminate the knowledge on the practice of family planning as widely as
possible and to provide service agencies nearest to the community.

3. The department of Indian system of medicine and homeopathy

It was established in March 1995 and had continued to make steady
progress. Emphasis was on implementation of the various schemes introduced
such as education, standardization of drugs, enhancement of availability of raw
materials, research and development, information, education and
communication and involvement of ISM and Homeopathy in national health
care.
Most of the functions of this ministry are implemented through an
autonomous organization called DGHS.
II. Directorate General of Health Services Organisation
The DGHS is the principal adviser to the Union Government in both
medical and public health matters. He is assisted by a team of deputies and a
large administrative staff.
The Directorate comprises of three main units:
i. Medical care and hospitals
ii. Public health
iii. General administration
Functions:
1. General functions: The general functions are surveys, planning,
coordination, programming and appraisal of all health matters in the country.
2. Specific functions:
a. International health relations and quarantine:
b. Control of drug standards
c. Medical store depots
d. Postgraduate training
e. Medical education
f. Medical research
g. Central Government Health Scheme.
Family welfare services:
h. National Health Programmes.
i. Central Health Education Bureau
j. Health intelligence.
k. National Medical Library
III. Central Council of Health
 The Central Council of Health was set up by a Presidential Order on
August 9, 1952, under Article 263 of the Constitution of India for promoting
coordinated and concerted action between the centre and the states in the
implementation of all the programmes and measures pertaining to the health of
the nation. The Union Health Minister is the chairman and the state health
ministers are the members.
Functions:
1. To consider and recommend broad outlines of policy in regard to matters
concerning health in all its aspects such as the provision of remedial and
preventive care, environmental hygiene, nutrition, health education and the
promotion of facilities for training and research.
2. To make proposals for legislation in fields of activity related to medical and
public health matters and to lay down the pattern of development for the
country as a whole.
3. To make recommendations to the Central Government regarding distribution
of available grants-in-aid for health purposes to the states and to review
periodically the work accomplished in different areas through the utilisation of
these grants-in-aid.
4. To establish any organisation or organisations invested with appropriate
functions for promoting and maintaining cooperation between the Central and
State Health administrations.
AT THE STATE LEVEL
Historically, the first milestone in the state health administration was the
year 1919, when the states (provinces) obtained autonomy, under the Montague-
Chelmsford reforms, from the central Government in matters of public health.
By 1921-22, all the states had created some form of public health organisation.
The Government of India Act, 1935 gave further autonomy to the states. The
state is the ultimate authority responsible for health services operating within its
jurisdiction.
State health administration:
At present there are 31 states in India, with each state having its own
health administration. In all the states, the management sector comprises the
state ministry of Health and a Directorate of Health.
1. State Ministry of Health:
The State Ministry of Health is headed by a Minister of Health and FW and a
Deputy Minister of Health and FW. In some states, the Health Minister is also
in charge of other portfolios. The Health secretariat is the official organ of the
State Ministry of Health and is headed by a Secretary who is assisted by Deputy
Secretaries, and a large administrative staff.
Functions:
 Health services provided at the state level
 Rural health services through minimum needs programme
 Medical development programme
 M.C.H., family welfare & immunization programme
 NMIP (malaria) & NFCP(filarial)
 NLEP, NTCP, NPCB, prevention and control of communicable diseases
like diarrheal disease, KFD, JE,
 School health programme, nutrition programme, and national goitre
control programme
 Laboratory services and vaccine production units
 Health education and training programme, curative services, national
Aids control programme
2. State Health Directorate:
The Director of Health Services is the chief technical adviser to the state
Government on all matters relating to medicine and public health. He is also
responsible for the organization and direction of all health activities. The
Director of Health and Family Welfare is assisted by a suitable number of
deputies and assistants.
The Deputy and Assistant Directors of Health may be of two types:
 Regional
 Functional.
Regional: The regional directors inspect all the branches of public health within
their jurisdiction, irrespective of their specialty.
Functional: The functional directors are usually specialists in a particular
branch of public health such as mother and child health, family planning,
nutrition, tuberculosis, leprosy, health education, etc.
AT THE DISTRICT LEVEL:
The district is the most crucial level in the administration and implementation of
medical /health services. At the district level there is a district medical and
health officer or CMO who is overall Subdivisions
i. Tehsils (talukas)
ii. Community development blocks
iii. Municipalities and corporations
iv. Villages
v. Panchayaths
Most of the districts in India are divided into two or more subdivisions, each
in charge of an assistant collector or sub-collector. Each division is again
divided into tehsils in charge of a Tehsildar. A tehsil usually comprises between
200 and 600 villages.
Finally, there are the village panchayaths, which are institutions of rural
local selfgovernment.
The urban areas of the district are organised into the following local self-
government:
 Town area committee – 5,000 – 10,000
 Municipal boards – 10,000 – 2,00,000
 Corporations – population above 2,00,000.
Town area committee: The towns‟ area committees are like panchayaths.
They provide sanitary services.
Municipal board: The municipal boards are headed by a chairman/president,
elected usually by the members.
Corporations: Corporations are headed by mayors. The councilors are elected
from different wards of the city. The executive agency includes the
commissioner, the secretary, the engineer, and the health officer. The activities
are similar to those of the municipalities but on a much wider scale.
PANCHAYATHI RAJ:
The panchayath Raj is a 3-tier structure of rural local self-government in
India linking the villages to the district. The three institutions are:
a. Panchayath – at the village level.
b. Panchayath samithi – at the block level.
c. Zilla parishad – at the district level.
The panchayathi Raj institutions are accepted as agencies of public
welfare. All development programmes are channelled through these bodies. The
panchayathi Raj institutions strengthen democracy at its root and ensure more
effective and better participation of the people in the government.
At the village level:
The panchayathi Raj at the village level consists of:
1. The gram sabha
2. The gram panchayath
3. The nyaya panchayath
At the block level The panchayathi raj agency at the block level is the
panchayath samithi. The panchayathi samithi consists of all sarpanchs of the
village panchayaths in the block. The block development officer is the ex-
officio secretary of the panchayath samithi.
The prime function of the panchayat samiti is the execution of the
community development programme in the block.
The block development officer and his staff give technical assistance and
guidance to the village panchayaths engaged in the development work.

At the district level:

The zilla parishad is the agency of rural local self-government at the
district level. The members of the zilla parishad include all leaders of the
panchayath samithis in the district, MPs, MLAs of the district, representatives
of SC, SD and women, and 2 persons of experience in administration. The
collector of the district is a non-voting member. Thus, the membership of the
zilla parishad is fairly large varying from 40 to 70.
The zilla parishad is primarily supervisory and coordinating body. Its
functions and powers vary from state to state. In some states, the zilla parishads
are vested with the administrative functions.
Healthcare systems:
The healthcare system is intended to deliver the healthcare services. It
constitutes the management sector and involves the organisational matters. It
operates in the context of the socioeconomic and political framework of the
country. In India, it is represented by five major sectors and agencies which
differ from each other by the health technology applied and by the source of
funds for the operation.
 Public health sector
 Private sectors
 Indigenous system of medicine
 Voluntary health agencies
 National health programmes
Primary healthcare in India:
It is a three-tier system of healthcare delivery in rural areas based on the
recommendations of the Shrivastav Committee in 1975.
1. Village level:
The following schemes are operational at the village level:
a) Village health guides scheme
b) Training of local dais
c) ICDS scheme
2. Sub-centre level:
This is the peripheral outpost of the existing health delivery system in rural
areas. They are being established on the basis of one sub-centre for every 5000
population in general and one for every 3000 population in hilly tribal and
backward areas. Each sub-centre is manned by one male and one feale
multipurpose health worker.
Functions:
a. Mother and child healthcare
b. Family planning
c. Immunization
d. IUD insertion
e. Simple laboratory investigations
3. Primary health centre level:
The Bhore committee in 1946 gave the concept of a primary health centre as
a basic health unit to provide as close to the people as possible. The Bhore
committee aimed at having a health centre to serve a population of 10,000 to
20,000. The national health plan, 1983 proposed reorganization of primary
health centres on the basis of one PHC for every 30,000 rural population in the
plains, and one PHC for every 20,000 population in hilly, tribal and backward
areas for more effective coverage.

Functions of the PHC:

a) Medical care.
b) MCH including family planning.
c) Safe water supply and basic sanitation.
d) Prevention and control of locally endemic diseases.
e) Collection and reporting of vital statistics.
f) Education about health.
g) National health programmes as relevant.
h) Referral services.
i) Training of health guides, health workers, local dais, and health
assistants.
j) Basic laboratory services.
Community health centres:
As on 31st March 2003, 3076 community health centres were established
by upgrading the primary health centres, each CHC covering a population of
80,000 to 1.20 lakh with 30 beds and specialist in surgery, medicine, obstetrics
and gynecology, and pediatrics‘ with x-ray and laboratory facilities.
Functions:
1. Care of routine and emergency cases in surgery.
2. Care of routine and emergency cases in medicine.
3. 24-hour delivery services including normal and assisted deliveries.
4. Essential and emergency obstetric cases including surgical interventions.
5. Full range of family planning services including laparoscopic services.
6. Safe abortion services.
7. Newborn care.
8. Routine and emergency care of sick children.
9. Other management including nasal packing, tracheostomy, foreign body
removal, etc.
10.All national health programmes should be delivered.
11.Blood shortage facility.
12.Essential laboratory services.
13.Referral services.
Planning and organizing nursing service at various levels – local, regional,
national, and international
Placement of nurses in the healthcare organization:
A high power committee on nursing and nursing profession was set up by
the Government of India in July 1987 under the chairmanship of Smt. Sarojini
Vasadapan, an eminent social worker and former chairperson of Central Social
Welfare Board with Smt. Rajkumari Sood, Nursing Advisor to Government of
India, as the member secretary. The terms of reference of the committee were as
follows:
a) Looking into the existing working conditions of nurses with particular
reference to the status of the nursing care services both in rural and urban
areas.
b) To study and recommend the staffing norms necessary for providing
adequate nursing personnel to give the best possible care, both in the
hospitals and community.
c) To look into the training of all categories and levels of nursing,
midwifery personnel to meet the nursing manpower needs at all levels of
health service and education.
d) To study and clarify the role of nursing personnel in the healthcare
delivery system including their interaction with other members of the
health team at every level of health services management.
e) To examine the need for organisation of the nursing services at the
national, state, district, and lower levels with particular reference to the
need for planning and implementing the comprehensive nursing care
services with the overall healthcare system of the country at their
respective levels.
f) To look into all other aspects which the committee may consider relevant
with reference to their terms of reference.
g) While considering the various issues under the above norms of reference,
the committee will hold consultations with the state governments.
The findings of this committee give a grim picture of the existing
working condition of nurses, staffing norms for providing adequate nursing
personnel, education of nursing personnel to meet the nursing manpower needs
at all levels and the role of nursing personnel in the healthcare delivery system.
 Their recommendations on the organisation of nursing services at central,
state and district levels, and the norms of nursing service and education are
given below.
Placement of nurses at the central level:
At the central level there is a post of nursing advisor in the medical
division of Directorate General of Health Services. The nursing advisor is
directly responsible to the Deputy Director General (Medical). The nursing
advisor is assisted by nursing officer and support staff for all his/her work.
She/he advises the DGHS, Ministry of Health and Family Welfare as well as
other ministries and departments, for example, railways, labour, Delhi
Administration, etc. on all matters of nursing services, nursing education, and
research. The nursing advisor also takes care of administration aspects of Raj
Kumari Amrit Kaur College of Nursing and Lady Hardinge Health School,
Delhi.
There is a post of deputy nursing advisor at the rank of Assistant Director
General (ADGNsg) in the training division of Department of F. W. Presently
the deputy nursing advisor deals with training of ANMs, dais, health supervisor,
etc. There is no direct linkage between the nursing advisor and deputy nursing
advisor as there are independent posts.
Placement of nurses at state level:
There is no proper and definite pattern of nursing structure in the state
directorates except the state of West Bengal. Usually one or two nurses are
posted with varying designations, e.g., in Tamilnadu there is one assistant
director nursing who is responsible to Director, Medical Services, and Director,
Medical Education.
In Maharashtra, two nurses work, one each in the office of the Director,
Medical Education, and Director, Health Services.
Note: The Principal, College of Nursing will be equal to the rank of ADNS and
will be eligible for promotion to the post of DDNS/DNS. The salary scales and
structure of the staff of colleges of nursing will be as per norms of the Indian
Nursing Council and the UGC.
Placement of nurses at district level:
Nurses, public health nurses, lady health visitors, auxiliary nurse
midwives, etc. have played vital role in providing healthcare services at various
levels in both urban and rural areas of the district. They have been the
mainstream in providing primary healthcare services in the rural and urban
areas from the very beginning.
The above recommended organisational set up will need full administrative
and financial support of the government. It will look after the overall nursing
components, development of nursing standards, norms, policies, ethics,
recruitment, selection and placement roles__ for both hospitals and community
health nursing, development in speciality nursing, higher education in nursing,
and research. These will promote professional autonomy and accountability.
NATIONAL RURAL HEALTH MISSION:
The National Rural Health Mission (NRHM) has been launched with a
view to bringing about dramatic improvement in the health system and the
health status of the people, especially those who live in the rural areas of the
country.. To achieve these goals NRHM will:
 Facilitate increased access and utilization of quality health services by all.
 Forge a partnership between the Central, state and the local governments.
 Set up a platform for involving the Panchayati Raj institutions and
community in the management of primary health programmes and
infrastructure.
 Provide an opportunity for promoting equity and social justice.
The Vision of the Mission:
 To provide effective healthcare to rural population throughout the country
with special focus on 18 states, which have weak public health indicators
and/or weak infrastructure.
  18 special focus states are Arunachal Pradesh, Assam, Bihar,
Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu and Kashmir,
Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa,
Rajasthan, Sikkim, Tripura, Uttaranchal and Uttar Pradesh.
 To rise public spending on health from 0.9% GDP to 2-3% of GDP, with
improved arrangement for community financing and risk pooling.
 To undertake architectural correction of the health system to enable it to
effectively handle increased allocations and promote policies that
strengthen public health management and service delivery in the country.
 To revitalize local health traditions and mainstream AYUSH into the
public health system.
The Objectives of the Mission:
 Reduction in child and maternal mortality.
 Universal access to public services for food and nutrition, sanitation and
hygiene and universal access to public health care services with emphasis
on services addressing women‘s and children‘s health and universal
immunization.
 Prevention and control of communicable and non-communicable
diseases, including locally endemic diseases.
 Access to integrated comprehensive primary health care.
 Population stabilization, gender and demographic balance.
 Revitalize local health traditions & mainstream AYUSH.
 Promotion of healthy life styles.
The core strategies of the Mission:
 Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own,
control and manage public health services.
 Promote access to improved healthcare at household level through the
female health activist (ASHA).
  Health Plan for each village through Village Health Committee of the
Panchayat.
 Strengthening sub-centre through better human resource development,
clear quality standards,better community support and an untied fund to
enable local planning and action and more Multi Purpose Workers
(MPWs).
 Provision of 30-50 bedded CHC per lakh population for improved
curative care to a normative standard. (IPHS defining personnel,
equipment and management standards, its decentralized administration by
a hospital management committee and the provision of adequate funds
and powers to enable these committees to reach desired levels).
District and Block levels.
 Programmes
 Reproductive and Child Health Programme – II (RCH-II) and the Janani
Suraksha Yojana (JSY) launched.
 Polio eradication programme intensified – cases reduced from 134 in
2004-05 to 63 (up to now).
 Accelerated implementation of the Routine Immunization programme
taken up. Catch up rounds taken up this year in the States of Bihar,
Jharkhand and Orisaa.
 Ground work for introduction of JE vaccine completed.
 Ground work for Hepatitis vaccines to all States completed.
 Auto Disabled Syringes introduced throughout the country.
 State Programme Implementation Plans for RCH II appraised by the
National Programme Coordination Committee set up by the Ministry.
Funds to the extent of 26.14% i.e. Rs. 1811.74 core have been released
under NRHM Outlay.
Mission on nursing education:
 The Mission would support strengthening of Nursing Colleges wherever
required, as the demand for ANMs and Staff Nurses and their development is
likely to increase significantly. Special attention would be given to setting up
ANM training centers in tribal blocks which are currently para-medically
underserved by linking up with higher secondary schools and existing nursing
institutions.
ORGANISATION OF THE HEALTH CARE SYSTEM:
Public sector: Public agencies are financed with tax monies, thus these are
accountable to the public. The public sector includes official (governmental)
agencies and voluntary agencies.
Organization of the public health system: The public health system is
organised in too many levels in the:
1. Federal
2. State
3. Local systems.
THE FEDERAL SYSTEM:
Federal Government has the responsibility for the following aspects of
health care. At the federal level, the primary agencies are concerned with health
are organized under the Department of Health and Human Services (DHHS).
 Providing direct care for certain groups such as Native Americans,
military personnel, and veterans.
 Safeguarding the public health by regulating quarantines and immigration
laws and the marketing food, drugs and products used in medical care.
 Prevents environmental hazards, gives grantsin aids to states, local areas
and individuals and supports research.
Administration of social security, social welfare and related programme.
BIBLIOGRAPHY

 A Text book of ‘Nursing management’ Mr. Deepak , 2nd edition,

Emmis medical publishers,2018
 A Text book of ‘principles of hospital administration and planning’
B M Sakharkar ,2009, Jaypee Brothers medical publishers.
 A Text book of community nursing K.Park,21st edition , M/s
Banarsidas Bhanot publishers
 www.srib.com
 www.Slideshare.com