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B Subha Sri, MPS course, July 2010. Components of a health care delivery system. Components of a functioning health care delivery system. Attitudes Technical competence Referral systems Infrastructural requirements Access Organisation of services Supplies and Equipment systems

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Components of a health care delivery system

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B Subha Sri,

MPS course, July 2010

Components of a health care delivery system

Components of a functioning health care delivery system


Technical competence

Referral systems

Infrastructural requirements


Organisation of services

Supplies and Equipment systems

Accountability mechanisms


Client provider interaction


Cultural appropriateness

Response to gender / poverty issues




Health care delivery systems can reinforce prevailing gender norms.

Negative attitudes can infringe on the reproductive and sexual rights of the people.

Negative attitudes affect quality of care – perceived quality of care can affect health seeking.

Affects women much more than men.

Eg. Adolescent girl asking for contraceptives

How can you bring about a change in attitude?

“Attitude, like water, flows from top to below” - Role models

Training to change attitudes

Better working atmosphere


Performance appraisal – to probe into provider attitudes and gender biases

Gender mainstreaming into medical / paramedical education

Technical competence


Evidence based

Standard treatment protocols

Technical competence

Technical incompetence leads to failure in providing appropriate care and unnecessary / inappropriate referral.

Leads to low self esteem and low morale among the staff and puts them under stress.

Inadequate services impact differentially and detrimentally on women and men.

How can you bring about a change in level of competence?

Staff training

Standard protocols and guidelines

Based on problems, relevant to local context

Continuous monitoring

Multi skilled people who can stand in for each other

Training to handle difficult situations with tact

Training in inter personal skills

Appropriate allocation of adequately trained staff – prime responsibility of managers

Referral systems- common issues

Unnecessary / inappropriate referral

Lack of ambulances

Referral note

Follow up of referred patients

Reverse referral

Lack of awareness about the time constraints and gender issues in the patient’s real life context

How can change happen in referral systems?

Referral protocols needs to be worked out

Referral system needs to be developed

Development of systems should be based on practical and systematic thinking process – Accompanied transfers

Staff at each level needs to be trained in using the protocols and monitored.

Follow up and reverse referral

Infrastructural requirements

Ensuring privacy


Ancillary services

Enabling environment to put into practice the training and skill up gradation

Should look into all factors of operational difficulties and not leave the clients to make their own arrangements

Health providers in helpless situations and at the receiving end



Socio cultural barriers


Organisational barriers

Perceived quality of care

Staff related

System's responsibility to provide for overcoming barriers

Organisation of health services


Waiting time

Interdepartmental referrals – multiple queues

Staffing patterns

How to improve organization of services?


Better organisation of services

Training in managerial skills

Quality of service indicators

Integration of services to meet client needs

Multiple services by trained providers under one roof

Inform the people about the facilities and the services they deliver.

Information about where and what each level of facility provides

Supplies and equipments

In spite of all training lack of supplies will be a barrier to effective services

Demoralise providers

Lose interest in taking forward initiatives

Investment in training is lost

Ordering and supply mechanisms and sometimes simple transport is non functional

Local purchase from untied funds

Accountability mechanisms

To community

To system



Health care delivery system wheel

Functioning health care delivery system

The generic components of the health care delivery system needs to be in place and working for any health service intervention to be effective. They are like spokes on a wheel – the health system wheel.

The role of health managers is to think through each of the components and to make them function

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