Chapter 8: Summary and Conclusions
2.1 INSTITUTIONAL SET UP OF MEDICAL AND PUBLIC HEALTH ADMINISTRATION IN ASSAM
Medical and public health services and Family Welfare are considered as direct health services. Direct health services are both preventive and curative in nature while indirect health services are only curative in nature. Preventive health care implies measures for control of diseases while curative healthcare is related to treatment of diseases. Indirect health services include expenditure on water supply and sanitation. Thus direct healthcare services are broader in concept and they have implications for provisioning of various healthcare services and have a direct effect on the health outcome of the state (Hooda, 2013). The secondary data considered here relate only to direct health services. Indirect health services such as water and sanitation and electricity are however used as variables in the cross section study of households in Chapters 5 and 6.
Medical and public health expenditure in Assam is carried under the Department of Health and Family Welfare, Government of Assam. There are three branches under the Department of Health and Family welfare. They are Directorate of General Health Services (GHS), Directorate of Health Services, family welfare (FW), and Directorate of Medical Education Research and Training (MERT).Total budgetary expenditure comprise resources spent under revenue account and capital account. As far as total budgetary expenditure on health is concerned, there are three heads: (a) medical (b) public health and (c) family
welfare. In the budget accounts of Government of Assam, (a) and (b) are clubbed together under the head medical and public health expenditure (M&PH) which is administered under the supervision of Directorate of General Health Services (GHS) and MERT, while the second category family welfare (FW) which runs under the supervision of Directorate of Health Services, Family welfare.
More than 90 percent of total budgetary expenditure on health is made in the category M&PH. Medical and Public Health has two major components: urban health services and rural health services. The sub-heads included under urban health services are allopathic and other systems of medicine, direction and administration, training of employees, employees state insurance schemes, departmental drug manufacture, school health schemes and expenditure on hospitals and dispensaries. Likewise, rural health services include allopathic and other systems of medicine, primary health centres, community health centres, and hospitals and dispensaries. Some sub heads are expenditure on direction and administration, prevention and control of diseases, prevention of food adulteration, drug control, public health laboratories and public health education. Under the category rural health services, expenditure on primary health centre (PHC) and community health centre (CHC) take the largest share. The various components under medical and public health has been depicted in Table 2.1.
The core functions of Directorate of MERT (also a part of M&PH) include research in the field of medical sciences, establishment of fully-equipped hospitals, sustenance of medical education through proper training, provide quality health care facilities, improve the functioning of the various streams of medicine like allopathy, homeopathy, ayurveda and paramedical science and establish of quality educational institutions and to hold administrative control over all medical colleges and hospitals under it. Expenditure heads under MERT also comprise direction and administration, ayurveda, homeopathy, allopathy and hospitals and dispensaries.
The Department of Health and Family Welfare, also known as the Directorate of Health Services (family welfare) mostly coordinates the central government sponsored programmes.
Family welfare being a fully central government funded programme, the state is only an implementing agency through a network of rural and urban family welfare centres2.
2 The Family Welfare programme was introduced in 1952. During the fourth five year plan, maternal and child
health care services, which was mainly concerned with the health of mothers and children were also integrated into the family planning programme. The Programme was renamed as Family Welfare Programme in 1977-78.
Table 2.1 Components of Medical and Public Health and Family Welfare
Medical and Public health Family Planning
A. Urban health services (Allopathy)
B. Rural Health services- (Allopathy)
Medical education training
and research Public health Family planning
Direction and
administration Health sub centres Direction and
administration Direction and administration Maternity and child health
Training Subsidiary health centres Ayurveda Prevention and control of
diseases
Centrally sponsored schemes, direction and administration Employees state
insurance schemes Primary health centres Homeopathy Prevention of food
adulteration Training
District medical stores Community health centres Allopathy Drugs control Rural family Welfare services Departmental drug
manufacture Hospitals and dispensaries Hospitals and
dispensaries Public health laboratories Urban family welfare services School health schemes Other expenditure Other expenditure Public health education Transport
Hospitals and
dispensaries C. Rural health services- other
system of medicine Compensation
Other health schemes Ayurveda Mass education
Other expenditure Homeopathy Other services and
supplies B. Urban health services,
Other system of
medicine Other expenditure
Ayurveda Homeopathy
Expenditure on family welfare comprise spending on direction and administration, training, rural family welfare services, urban family welfare services, maternity and child health, transport, communication, mass education and other services and supplies. Direction and administration comprise expenditure on state secretariat cell, state family welfare bureau and district family welfare bureau.
The training component includes expenditure on health and family welfare training centre, training of auxiliary nurse midwives, training of lady health visitors, orientation of private medical practitioners, homoeopathy and Indian system of medicine, training of employment of multipurpose workers scheme, training of traditional birth attendants and community health workers. Rural family welfare services comprise expenditure on rural family planning centre. Expenditure on maternity and child health includes among other things immunization of infants and children. Transport includes expenditure incurred on state health transport organization, funds for major repairs and procurement of vehicle for rural family welfare planning centre, state and district family welfare bureau. Under mass education expenditure is on orientation camps. Other services and supplies include expenditures on supply of surgical equipments of family welfare planning centre, sterilizations beds, post mortem centre etc. The Directorate of medical education, research and training was established in 1984 under the Department of Health and Family Welfare.
2.2 EXTENT AND PATTERN OF PUBLIC HEALTH EXPENDITURE IN ASSAM