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CM17.5-6 | CM17.5-6 | Healthcare Delivery and Health System Functioning — Summary & Reflection

KEY TAKEAWAYS

Key takeaways from this module:

  1. India's public healthcare delivery hierarchy runs from Sub-Centre (village, 3,000–5,000 population, plains) through PHC (20,000–30,000), CHC (80,000–1,20,000, 30 beds, 4 specialists), Sub-District Hospital, District Hospital, to Medical College — each tier with defined IPHS standards.
  1. CHC is the First Referral Unit (FRU), mandated to provide Comprehensive Emergency Obstetric Care 24×7; 70–80% CHC specialist vacancy is the most critical system gap.
  1. The community health worker triad — ASHA (community mobiliser, incentive-based, 1/1,000 rural), ANM (Sub-Centre clinical care, government employee), MPW (environmental health, vector control) — operationalises community participation.
  1. The WHO six health system building blocks — service delivery, health workforce, health information systems, medical products/technologies, health financing, leadership/governance — provide an analytical framework to diagnose where a system is failing and why.
  1. India's most critical building block failures: health financing (OOP ~47–50%; government health expenditure ~1.5% GDP vs 2.5% NHP target) and health workforce (CHC specialist vacancies; urban-rural maldistribution).
  1. Reform responses: Ayushman Bharat–HWC (comprehensive PHC upgrade); AB-PMJAY (Rs 5 lakh/family insurance for secondary/tertiary hospitalisation); Mission Indradhanush (immunisation catch-up) address specific building block gaps.

REFLECT

You are posted as the Medical Officer of a rural PHC serving 25,000 people. Your CHC referral unit 30 km away has no gynaecologist and no anaesthetist. Using the WHO building blocks framework, identify: (a) which two building blocks are most critically failing for your catchment population's obstetric care, (b) what interim actions you can take within your PHC's authority to partially compensate for the CHC gap, and (c) what you would write in your monthly report to the District Health Officer to escalate the CHC specialist vacancy as a system failure requiring urgent action.