Health Care Levels of System in India: Structure, Examples, and Importance
Introduction
India has one of the largest and most complex health care systems in the world, catering to over 1.4 billion people spread across rural and urban regions. To ensure universal health coverage, India’s health care is organized into three hierarchical levels – Primary, Secondary, and Tertiary Care. Each level plays a crucial role in delivering preventive, promotive, curative, and rehabilitative health services.
This structured approach ensures that common health issues are treated at the basic level, while complex and specialized treatments are handled at advanced centers. In this article, we will cover:
• The three levels of the health care system in India
• Their structure and functions
• Examples at each level
• The challenges and importance of an integrated health care system
1. Levels of Health Care System in India
The health care delivery system in India is broadly divided into three levels:
1.1 Primary Health Care Level
The primary health care level is the first point of contact between individuals and the health system. It focuses on preventive, promotive, and basic curative care.
Features of Primary Health Care
• Accessible at the village and block level
• Provides maternal and child health services
• Focuses on health education, vaccination, nutrition, sanitation, and prevention of diseases
• Handles common illnesses and minor injuries
Components of Primary Health Care in India
1. Sub-Centers (SCs):
The most peripheral unit of the health system
• Covers a population of 3,000–5,000 (in hilly/tribal areas 3,000; in plain areas 5,000)
• Staffed by an Auxiliary Nurse Midwife (ANM) and sometimes a male health worker
• Provides family planning, immunization, health education, and disease prevention services
Example: Sub-Centers under the National Health Mission (NHM) in rural India.
2. Primary Health Centers (PHCs):
• Covers about 20,000–30,000 people
• Staffed by a medical officer, nurses, pharmacist, lab technician
• Provides outpatient services, basic laboratory investigations, maternal and child health care
• Acts as a referral unit for 5–6 Sub-Centers
Example: PHCs under Ayushman Bharat – Health and Wellness Centers.
3. Community Health Centers (CHCs):
• Covers about 80,000–1,20,000 population
• Acts as a referral unit for 4 PHCs
• Staffed with specialists like surgeon, physician, gynecologist, and pediatrician
• Provides 30-bedded inpatient care, emergency services, and diagnostic facilities
Example: District-level CHCs functioning under NHM.
1.2 Secondary Health Care Level
The secondary health care level deals with specialist care and more advanced medical facilities. Patients referred from PHCs and CHCs are treated here.
Features of Secondary Health Care
• Provides specialist services including internal medicine, surgery, obstetrics, gynecology, and pediatrics
• Offers inpatient care, laboratory, radiology, and emergency services
• Acts as a bridge between primary and tertiary health care
Components of Secondary Health Care in India
1. District Hospitals:
• Located at the district headquarters
• Equipped with multiple specialties
• Provides inpatient care, surgeries, diagnostic services, and emergency care
• Handles both preventive and curative functions
Example: District Hospital, Lucknow (Uttar Pradesh).
2. Sub-District Hospitals (SDHs):
• Established at sub-divisional levels
• Equipped with essential specialists
• Provides services in surgery, obstetrics, pediatrics, and other specialties
Example: Sub-District Hospital, Dharamshala (Himachal Pradesh).
1.3 Tertiary Health Care Level
The tertiary level represents the highest and most advanced level of health care. It provides super-specialty services and handles complex cases referred from primary and secondary levels.
Features of Tertiary Health Care
• Highly specialized services
• Advanced diagnostic and treatment facilities
• Research and training centers
• Teaching hospitals attached to medical colleges
Examples of Tertiary Care in India
1. All India Institute of Medical Sciences (AIIMS), New Delhi
• Offers super-specialty services and advanced surgeries
• Functions as a teaching and research institute
2. Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
Provides advanced patient care and conducts medical research
3. Tata Memorial Hospital, Mumbai
Renowned for oncology (cancer care) services
4. National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru
Specialized in mental health and neurosciences
2. Integration of Health Care Levels in India
The Indian health care system functions in a referral chain:
Sub-Center → PHC → CHC → District Hospital → Medical College/Tertiary Hospital
This ensures that patients receive care at the appropriate level without overburdening tertiary hospitals with minor cases.
3. Challenges in India’s Health Care System
Despite its structured framework, the Indian health care system faces several challenges:
• Shortage of health workforce in rural areas
• Inadequate infrastructure in Sub-Centers and PHCs
• Overcrowding in tertiary hospitals
• Inequitable distribution of health services between rural and urban areas
• Financial burden on patients due to out-of-pocket expenditure
4. Importance of a Strong Health Care System in India
• A well-functioning health care system:
• Ensures universal health coverage
• Reduces disease burden through prevention and early treatment
• Provides equitable access to all citizens
• Supports national health programs (e.g., RMNCH+A, Ayushman Bharat)
• Improves maternal and child health outcomes
• Strengthens the economy by maintaining a healthy workforce
5. Government Initiatives to Strengthen Health Care Levels
India has launched several initiatives to improve each level of health care:
• Ayushman Bharat – Health and Wellness Centers (HWCs): Strengthening PHCs and Sub-Centers
• Pradhan Mantri Jan Arogya Yojana (PM-JAY): Provides financial protection for secondary and tertiary care hospitalization
• National Health Mission (NHM): Focuses on rural and urban health service delivery
• National Digital Health Mission (NDHM): Digitization of health records for better coordination
Conclusion
The health care system in India is structured into primary, secondary, and tertiary levels, ensuring comprehensive coverage for all citizens. From preventive care at the village Sub-Center to advanced surgeries in AIIMS, this system provides a referral-based, integrated framework. However, challenges like infrastructure gaps and unequal access must be addressed to achieve universal health care. With ongoing government initiatives, India is moving closer toward building a robust, accessible, and affordable health care system for all.
FAQs on Health Care Levels in India
Q1. What are the three levels of health care in India?
The three levels are Primary Health Care (Sub-Centers, PHCs, CHCs), Secondary Health Care (District and Sub-District Hospitals), and Tertiary Health Care (Medical Colleges, AIIMS, Super-specialty Hospitals).
Q2. What is an example of primary health care in India?
A Primary Health Center (PHC) in a rural block providing maternal care, immunization, and treatment for common illnesses.
Q3. What is the difference between secondary and tertiary health care?
• Secondary health care deals with specialist services like surgery, pediatrics, and obstetrics at district hospitals.
• Tertiary health care provides super-specialty services like cardiac surgery, oncology, neurology at medical colleges and advanced institutes.
Q4. Why is primary health care important in India?
Primary health care is important because it is the first point of contact for the majority of people, ensures early detection, reduces burden on higher facilities, and is cost-effective.
Q5. Which government program is strengthening health care delivery in India?
The Ayushman Bharat scheme with its two components – Health and Wellness Centers (HWCs) and Pradhan Mantri Jan Arogya Yojana (PM-JAY) – is currently strengthening India’s health system.
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Writer: Vandita Singh, Lucknow (GS India Nursing Group)