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Health organizational level at district level

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Health Organizational Level at the District Level (India)

Source: Park's Textbook of Preventive and Social Medicine

The District as an Administrative Unit

The district is the principal unit of administration in India, headed by a Collector. As of 2020, there are 718 districts in India. Each district contains 6 types of administrative areas:
  1. Sub-divisions
  2. Tahsils (Talukas)
  3. Community Development Blocks
  4. Municipalities and Corporations
  5. Villages
  6. Panchayats
A Community Development Block covers approximately 100 villages and 80,000-1,20,000 population, under a Block Development Officer (BDO).

District Health Organization

The Bhore Committee (1946) recommended integrated preventive and curative services at all levels and a unified health authority in each district. Since "health" is a state subject, there is no single uniform model - each state developed its own pattern.

Key Administrative Head

DesignationResponsibility
Chief Medical Officer (CMO) / Chief Medical and Health Officer (CM&HO) / District Medical and Health Officer (DM&HO)Overall control of all health care programmes in the district
The district serves as a link between the State/regional structure on one side and peripheral structures (PHC/Sub-centre) on the other.
Under the Multi-Purpose Workers Scheme, the recommended integrated district set-up consists of:
  • 1 Chief Medical Officer (CMO)
  • 3 Deputy CMOs (each in charge of one-third of the district), covering:
    • Civil Surgeon functions
    • District Health Officer functions
    • District Family Planning Officer functions

Tiered Health Infrastructure at the District Level

The peripheral health system follows a clear hierarchy, all under the district umbrella:

1. District Hospital (Apex)

  • Serves the entire district population
  • Provides specialist and referral services
  • Recommended to be converted into District Health Centres (Working Group recommendation) to monitor all preventive, promotive, and curative services for 1 million population

2. Community Health Centre (CHC) - Secondary Level

  • One CHC per 80,000-1,20,000 population
  • 30 indoor beds with OT, X-ray, labour room, and laboratory
  • Staffed by 4 medical specialists: surgeon, physician, gynaecologist, paediatrician + 21 paramedical staff
  • As per IPHS: 6 specialists (including anaesthetist and eye surgeon) + 24 paramedical staff
  • Functions as a First Referral Unit (FRU) and referral centre for 4 PHCs
  • As of March 2018: 5,624 CHCs functional in India

3. Primary Health Centre (PHC) - Primary Level

  • Serves a population of 20,000-30,000 (plain areas) / 3,000-5,000 (tribal/hilly areas)
  • Headed by a Medical Officer
  • Has a Rural Family Welfare Centre integrated within it
  • Supervises 6 Sub-Centres
  • Acts as the referral unit for Sub-Centres

4. Sub-Centre - Grass-root Level

  • Covers 3,000-5,000 population (plains) / 800-1,200 (tribal/hilly areas)
  • Provides the primary interface with the community
  • Staffed by: 1 Auxiliary Nurse Midwife (ANM) / Lady Health Visitor (LHV) + 1 Health Assistant (Male)
  • Provides promotive, preventive, and basic curative primary health care

5. ASHA (Accredited Social Health Activist)

  • Village-level link worker
  • Reports to Sub-Centre/PHC
  • Promotes institutional delivery, immunization, DOTS (TB), basic first aid, ORS distribution

District Family Welfare Organization

At the district level, the District Family Welfare Bureau consists of 3 divisions:
  • Administrative Division - District Family Welfare Officer
  • Mass Education and Media Division - District Mass Education and Media Officer
  • Evaluation Division - Statistical Officer
Urban areas are served by Urban Family Welfare Centres (3 types based on population) and Urban Health Posts (Types A-D based on population size from <5,000 to >50,000).

Panchayati Raj at District Level (Health Governance)

The Zilla Parishad (Zilla Panchayat) is the rural local self-government agency at the district level. It is primarily a supervisory and coordinating body for health and development activities. In some states (e.g., Gujarat), the District Health Officer and District Family Planning/MCH Officers are directly under the Zilla Parishad.
Under NRHM/NHM, a District Health Mission functions at the district level, chaired by the District Collector/DM, with the Chief Medical Officer (CMHO/Civil Surgeon) as a member.

Summary Hierarchy (District Level Health System)

District Hospital
      ↑
Community Health Centre (CHC)  [1 per 80,000-1,20,000 pop]
      ↑
Primary Health Centre (PHC)    [1 per 20,000-30,000 pop]
      ↑
Sub-Centre                     [1 per 3,000-5,000 pop]
      ↑
ASHA / Village Level Worker
  • Park's Textbook of Preventive and Social Medicine, pp. 982-984 (District Level Health Organization)
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