from docx import Document
from docx.shared import Pt, Inches, RGBColor
from docx.enum.text import WD_ALIGN_PARAGRAPH
from docx.enum.table import WD_TABLE_ALIGNMENT
from docx.oxml.ns import qn
from docx.oxml import OxmlElement

doc = Document()

# Base style
style = doc.styles["Normal"]
style.font.name = "Calibri"
style.font.size = Pt(11.5)

NAVY = RGBColor(0x1F, 0x3B, 0x57)
ACCENT = RGBColor(0x2E, 0x74, 0xB5)

def set_cell_shading(cell, color_hex):
    tcPr = cell._tc.get_or_add_tcPr()
    shd = OxmlElement('w:shd')
    shd.set(qn('w:val'), 'clear')
    shd.set(qn('w:color'), 'auto')
    shd.set(qn('w:fill'), color_hex)
    tcPr.append(shd)

def add_heading(text, level=1, color=NAVY):
    h = doc.add_heading(text, level=level)
    for run in h.runs:
        run.font.color.rgb = color
    return h

def add_para(text, bold=False, italic=False, size=11.5):
    p = doc.add_paragraph()
    r = p.add_run(text)
    r.bold = bold
    r.italic = italic
    r.font.size = Pt(size)
    p.alignment = WD_ALIGN_PARAGRAPH.JUSTIFY
    return p

def add_bullets(items, level=0):
    for it in items:
        p = doc.add_paragraph(it, style='List Bullet')
        p.paragraph_format.left_indent = Inches(0.25 + 0.25*level)

def add_table(headers, rows, widths=None):
    table = doc.add_table(rows=1, cols=len(headers))
    table.style = 'Light Grid Accent 1'
    table.alignment = WD_TABLE_ALIGNMENT.CENTER
    hdr_cells = table.rows[0].cells
    for i, h in enumerate(headers):
        hdr_cells[i].text = h
        for p in hdr_cells[i].paragraphs:
            for r in p.runs:
                r.font.bold = True
                r.font.color.rgb = RGBColor(0xFF, 0xFF, 0xFF)
        set_cell_shading(hdr_cells[i], "2E74B5")
    for row in rows:
        cells = table.add_row().cells
        for i, val in enumerate(row):
            cells[i].text = str(val)
    doc.add_paragraph()
    return table

# ---------------- TITLE PAGE ----------------
title_p = doc.add_paragraph()
title_p.alignment = WD_ALIGN_PARAGRAPH.CENTER
title_p.paragraph_format.space_before = Pt(150)
run = title_p.add_run("HEALTH CARE DELIVERY SYSTEM IN INDIA")
run.font.size = Pt(28)
run.font.bold = True
run.font.color.rgb = NAVY

sub_p = doc.add_paragraph()
sub_p.alignment = WD_ALIGN_PARAGRAPH.CENTER
sub_p.paragraph_format.space_before = Pt(20)
run2 = sub_p.add_run("An Academic Assignment")
run2.font.size = Pt(16)
run2.italic = True
run2.font.color.rgb = ACCENT

doc.add_page_break()

# ---------------- TABLE OF CONTENTS (manual) ----------------
add_heading("Table of Contents", level=1)
toc_items = [
    "1. Introduction",
    "2. Concept and Definition of Health Care Delivery System",
    "3. Historical Background: The Bhore Committee (1946)",
    "4. Levels of Health Care",
    "5. Health Care Infrastructure in Rural India (Three-Tier System)",
    "   5.1 Sub-Centre (SC)",
    "   5.2 Primary Health Centre (PHC)",
    "   5.3 Community Health Centre (CHC)",
    "   5.4 Sub-Divisional and District Hospitals",
    "6. Urban Health Care Delivery System",
    "7. National Health Policy, 2017",
    "8. National Health Mission (NRHM & NUHM)",
    "9. Ayushman Bharat and Health Care Financing",
    "10. Private Sector, AYUSH and Medical Pluralism",
    "11. Referral System and Continuum of Care",
    "12. Challenges Facing the Health Care Delivery System",
    "13. Way Forward / Recommendations",
    "14. Conclusion",
    "15. References",
]
for item in toc_items:
    doc.add_paragraph(item)
doc.add_page_break()

# ---------------- 1. INTRODUCTION ----------------
add_heading("1. Introduction", level=1)
add_para(
    "Health is a fundamental human right and a key indicator of a nation's development. In India, health care "
    "is largely a governmental responsibility, delivered through a vast, multi-layered network of public and "
    "private institutions. The Health Care Delivery System refers to the organised network of people, "
    "institutions, and resources that deliver health services to meet the health needs of individuals, "
    "families, and communities. India's system is built on the principle of providing accessible, equitable, "
    "and affordable care, moving progressively from the village level to specialised tertiary institutions."
)
add_para(
    "Given India's size, population diversity, and rural-urban divide, the delivery system has been structured "
    "as a graded network so that common health problems are managed close to where people live, while complex "
    "problems are referred upward to centres with greater expertise and technology."
)

# ---------------- 2. DEFINITION ----------------
add_heading("2. Concept and Definition of Health Care Delivery System", level=1)
add_para(
    "A health care delivery system can be defined as the organised response of a society to the health needs "
    "of its people, encompassing organisation, financing, and provision of health services. Health services "
    "are delivered by the 'health system', which constitutes the management sector and involves organisational "
    "matters. Two major themes underpin modern health service delivery:"
)
add_bullets([
    "Health services should be organised to meet the needs of entire populations, not merely selected groups, "
    "covering the full range of preventive, curative, promotive, and rehabilitative services.",
    "The most effective way to reach the vast majority of underserved rural and urban poor populations is "
    "through strong primary health care services, backed by an efficient referral system."
])
add_para(
    "Community participation is now recognised as a major component of this approach, reflecting a shift "
    "from mere medical care to comprehensive health care, and from an urban bias to rural outreach."
)

# ---------------- 3. HISTORICAL BACKGROUND ----------------
add_heading("3. Historical Background: The Bhore Committee (1946)", level=1)
add_para(
    "The modern foundation of India's health care delivery system dates to the Health Survey and Development "
    "Committee (1943-46), popularly known as the Bhore Committee, which first introduced the concept of "
    "'comprehensive health care'. The Committee defined comprehensive health services as the provision of "
    "integrated preventive, curative, and promotive services from 'womb to tomb' for every individual residing "
    "in a defined geographic area. According to the Bhore Committee, comprehensive health care should:"
)
add_bullets([
    "Provide adequate preventive, curative, and promotive health services.",
    "Be located as close to the beneficiaries as possible.",
    "Have the widest cooperation between the people, the health services, and the medical profession.",
    "Be available to all, irrespective of their ability to pay.",
    "Give special attention to vulnerable and weaker sections of the community.",
    "Create and maintain a healthy environment in homes and workplaces.",
])
add_para(
    "This concept formed the basis of national health planning in India and led directly to the establishment "
    "of the network of Primary Health Centres (PHCs) and Sub-Centres that still forms the backbone of rural "
    "health care today (Park's Textbook of Preventive and Social Medicine)."
)

# ---------------- 4. LEVELS OF HEALTH CARE ----------------
add_heading("4. Levels of Health Care", level=1)
add_para(
    "India's health care delivery system is customarily organised into three levels, representing increasing "
    "degrees of specialisation and complexity."
)
add_table(
    ["Level", "Description", "Institutions in India"],
    [
        ["Primary care", "First level of contact between individuals/community and the health system; deals with common, everyday health problems close to where people live.",
         "Sub-Centres, Primary Health Centres, Health & Wellness Centres, ASHA/ANM/Anganwadi workers"],
        ["Secondary care", "Intermediate level; deals with more complex problems requiring specialist attention and acts as the first referral level.",
         "Community Health Centres, Sub-divisional and District Hospitals"],
        ["Tertiary care", "Highly specialised care requiring advanced facilities and specialist manpower.",
         "Medical College Hospitals, AIIMS, Regional/Specialised Hospitals, Apex Institutes"],
    ],
)
add_para(
    "A functioning referral system - a two-way exchange of information between levels, with patients being "
    "referred up for specialised care and returned for follow-up - is essential to continuity of care. This "
    "remains one of the weaker links in India's health system."
)

# ---------------- 5. RURAL INFRASTRUCTURE ----------------
add_heading("5. Health Care Infrastructure in Rural India (Three-Tier System)", level=1)
add_para(
    "Rural health care in India is delivered through a three-tier system of Sub-Centres, Primary Health "
    "Centres, and Community Health Centres, supported by Sub-divisional and District Hospitals at the apex."
)

add_heading("5.1 Sub-Centre (SC)", level=2)
add_para(
    "The Sub-Centre is the most peripheral outpost of the rural health delivery system and the first point of "
    "contact between the community and the health system. Norms:"
)
add_bullets([
    "One Sub-Centre per 5,000 population in general areas; one per 3,000 population in hilly, tribal, and "
    "backward areas.",
    "Staffed typically by an Auxiliary Nurse Midwife (ANM)/Health Worker (Female) and a Health Worker (Male); "
    "supervised by a Lady Health Visitor (LHV) and Health Assistant (Male) at the PHC level.",
    "Provides essential promotive, preventive, and limited curative services under Indian Public Health "
    "Standards (IPHS): maternal and child health, immunisation, family planning, nutrition, health education, "
    "and outreach activities such as the Village Health and Nutrition Day (VHND).",
    "Categorised into Type A (no delivery facility) and Type B/MCH Sub-Centres (equipped to conduct normal "
    "deliveries).",
])

add_heading("5.2 Primary Health Centre (PHC)", level=2)
add_para(
    "The PHC is the first contact point between the village community and a Medical Officer, envisaged by the "
    "Bhore Committee as the basic health unit providing integrated curative and preventive care with emphasis "
    "on promotive and preventive aspects."
)
add_bullets([
    "One PHC per 30,000 population in the plains and per 20,000 population in hilly, tribal, and backward areas "
    "(each PHC typically supervises about 6 Sub-Centres).",
    "Staffed by a Medical Officer (MBBS), Pharmacist, Nurse-Midwives, Laboratory Technician, Health "
    "Assistants, and support staff (about 13-14 personnel under IPHS norms).",
    "Functions as a referral unit for 6 Sub-Centres and refers serious cases to CHCs/District Hospitals.",
    "Runs national health programmes at the field level - immunisation, RCH services, communicable disease "
    "control, and non-communicable disease screening.",
])

add_heading("5.3 Community Health Centre (CHC)", level=2)
add_para(
    "CHCs are established by upgrading PHCs and act as the first referral unit (FRU) for a cluster of PHCs."
)
add_bullets([
    "Each CHC covers a population of about 80,000 to 1,20,000 (one per Community Development Block), with 30 "
    "beds.",
    "Staffed with specialists in Surgery, Medicine, Obstetrics & Gynaecology, and Paediatrics, along with X-ray "
    "and laboratory facilities.",
    "A Community Health Officer post supports preventive and promotive functions.",
    "CHC specialists may refer patients directly to a State-level or Medical College Hospital when required, "
    "without routing through the District Hospital.",
])

add_heading("5.4 Sub-Divisional and District Hospitals", level=2)
add_para(
    "The District Hospital is the apex referral institution for a district, offering secondary-level "
    "specialist care with diagnostic, surgical, obstetric, and inpatient facilities, and links the district's "
    "rural network to tertiary care institutions such as Medical Colleges and AIIMS."
)

# ---------------- 6. URBAN ----------------
add_heading("6. Urban Health Care Delivery System", level=1)
add_para(
    "Urban health care is delivered through Urban Primary Health Centres (UPHCs), Urban Health & Wellness "
    "Centres, dispensaries, municipal and government hospitals, and a large private and corporate hospital "
    "sector. The National Urban Health Mission (NUHM), launched in 2013 as a sub-mission under the National "
    "Health Mission, specifically targets the urban poor and slum populations, who often fall outside the "
    "reach of formal municipal health services, through a network of ANMs, ASHAs, and Mahila Arogya Samitis."
)

# ---------------- 7. NHP 2017 ----------------
add_heading("7. National Health Policy, 2017", level=1)
add_para(
    "The National Health Policy (NHP) 2017 - following those of 1983 and 2002 - was framed to address changing "
    "health priorities (rising non-communicable diseases alongside persisting infectious diseases), the growth "
    "of the private health care industry, catastrophic out-of-pocket health expenditure, and India's rising "
    "fiscal capacity. Its primary aim is to strengthen the Government's role in shaping health systems across "
    "investment, organisation of services, disease prevention, technology access, human resources, financial "
    "protection, and regulation."
)
add_table(
    ["Goal area", "Key targets"],
    [
        ["Life expectancy", "Increase life expectancy at birth from 67.5 to 70 years by 2025; reduce Total Fertility Rate to 2.1 by 2025."],
        ["Mortality reduction", "Reduce Maternal Mortality Ratio to 100 by 2020; Under-5 Mortality to 23 and Infant Mortality Rate to 28 by 2019; Neonatal Mortality to 16 and stillbirth rate to single digits by 2025."],
        ["Disease control", "Achieve the 90:90:90 global target for HIV/AIDS and TB control by 2020."],
        ["Health system strengthening", "Increase state health spending to >8% of state budget; ensure availability of two beds per 1,000 population; establish Health and Wellness Centres as the platform for comprehensive primary health care."],
    ],
)

# ---------------- 8. NHM ----------------
add_heading("8. National Health Mission (NRHM & NUHM)", level=1)
add_para(
    "The National Rural Health Mission (NRHM), launched in 2005, aimed to provide accessible, affordable, and "
    "accountable quality health services to the rural population, especially the vulnerable sections, by "
    "strengthening the public health delivery system. In 2013 it was subsumed, along with the newly launched "
    "NUHM, under the umbrella National Health Mission (NHM). Key strategies include:"
)
add_bullets([
    "Deployment of Accredited Social Health Activists (ASHAs) as community health volunteers in every village.",
    "Strengthening of Sub-Centres, PHCs, and CHCs to Indian Public Health Standards (IPHS).",
    "Janani Suraksha Yojana and Janani Shishu Suraksha Karyakram for maternal and child health.",
    "Rogi Kalyan Samitis and Village Health Sanitation and Nutrition Committees for community participation and "
    "decentralised planning.",
    "Free diagnostics, drugs, and referral transport under the Free Diagnostics and Free Drugs Service "
    "Initiatives.",
])

# ---------------- 9. AYUSHMAN BHARAT ----------------
add_heading("9. Ayushman Bharat and Health Care Financing", level=1)
add_para(
    "Launched in 2018, Ayushman Bharat has two components that operationalise the NHP 2017 vision of Universal "
    "Health Coverage:"
)
add_bullets([
    "Health and Wellness Centres (now branded Ayushman Arogya Mandirs) - upgrading existing Sub-Centres and "
    "PHCs to deliver Comprehensive Primary Health Care (CPHC), including screening and management of "
    "non-communicable diseases. Over 1.75 lakh such centres have been operationalised nationwide.",
    "Pradhan Mantri Jan Arogya Yojana (PM-JAY) - the world's largest government-funded health assurance scheme, "
    "providing cover of Rs. 5 lakh per family per year for secondary and tertiary hospitalisation to "
    "about 12 crore vulnerable families, later extended to all citizens aged 70 and above. Over 42 crore "
    "Ayushman cards have been issued and more than 33,000 public and private hospitals are empanelled "
    "(as of late 2025).",
])
add_para(
    "According to the Economic Survey 2024-25, government health expenditure as a share of total health "
    "expenditure rose from 29.0% in FY 2015 to 48.0% in FY 2022, and PM-JAY has helped save households over "
    "Rs. 1.5 lakh crore in out-of-pocket expenditure, reflecting a shift towards greater financial protection."
)

# ---------------- 10. PRIVATE / AYUSH ----------------
add_heading("10. Private Sector, AYUSH and Medical Pluralism", level=1)
add_para(
    "India's health care delivery system is a mixed economy of care. The private sector - ranging from small "
    "nursing homes to large corporate hospitals - provides a substantial share of outpatient and inpatient "
    "care, particularly in urban areas, and is regulated in part through mechanisms such as the Consumer "
    "Protection Act, 1986, which gave patients a forum for redress against deficient medical services. "
    "Alongside allopathic medicine, India formally recognises AYUSH systems (Ayurveda, Yoga & Naturopathy, "
    "Unani, Siddha, and Homoeopathy), integrated into the public system through AYUSH wings at PHCs/CHCs and a "
    "dedicated Ministry of AYUSH, reflecting the policy of encouraging medical pluralism."
)

# ---------------- 11. REFERRAL ----------------
add_heading("11. Referral System and Continuum of Care", level=1)
add_para(
    "A sound referral system is fundamental to an effective health care delivery system. It should function as "
    "a two-way exchange: patients move upward from Sub-Centre to PHC to CHC/District Hospital to tertiary "
    "institutions for specialised care, and are returned to the referring facility for follow-up once "
    "stabilised. This ensures continuity of care and builds public confidence in the system. In practice, "
    "referral linkages remain one of the weakest components of health service delivery in India and many other "
    "developing countries."
)

# ---------------- 12. CHALLENGES ----------------
add_heading("12. Challenges Facing the Health Care Delivery System", level=1)
add_bullets([
    "Shortfall in health infrastructure: many states still report shortages of Sub-Centres, PHCs, and CHCs "
    "against required norms, especially in tribal and hilly areas.",
    "Shortage and uneven distribution of human resources - doctors, specialists, and nursing staff concentrated "
    "in urban areas.",
    "High out-of-pocket expenditure and catastrophic health spending despite recent gains from PM-JAY.",
    "Double burden of disease - persisting infectious diseases alongside a rising burden of non-communicable "
    "diseases (cardiovascular disease, diabetes, cancer).",
    "Weak referral linkages and poor continuity of care between primary, secondary, and tertiary levels.",
    "Rural-urban and inter-state disparities in access to and quality of care.",
    "Quality assurance gaps - variable adherence to Indian Public Health Standards (IPHS) across states.",
    "Rising costs and regulatory challenges associated with the growing private health care industry.",
])

# ---------------- 13. WAY FORWARD ----------------
add_heading("13. Way Forward / Recommendations", level=1)
add_bullets([
    "Full and uniform implementation of Indian Public Health Standards across all Sub-Centres, PHCs, and CHCs.",
    "Strengthening Ayushman Arogya Mandirs to deliver comprehensive primary health care, including NCD "
    "screening, close to the community.",
    "Expanding PM-JAY coverage and improving empanelment of quality hospitals, especially in underserved "
    "districts.",
    "Investing in human resource development, task-shifting, and rural retention incentives for health "
    "personnel.",
    "Strengthening bidirectional referral and health information systems (digital health records) for "
    "continuity of care.",
    "Increasing public health expenditure towards the NHP 2017 target of at least 2.5% of GDP.",
])

# ---------------- 14. CONCLUSION ----------------
add_heading("14. Conclusion", level=1)
add_para(
    "India's health care delivery system has evolved from the comprehensive care vision of the Bhore Committee "
    "in 1946 into a graded three-tier rural network, a growing urban health mission, and a rapidly expanding "
    "framework for universal health coverage under Ayushman Bharat. While significant progress has been made "
    "in extending infrastructure, reducing out-of-pocket expenditure, and improving maternal and child health "
    "indicators, persistent challenges of infrastructure shortfalls, human resource shortages, weak referral "
    "linkages, and the rising burden of non-communicable diseases mean that the goal of accessible, equitable, "
    "and affordable health care for all remains a work in progress. Continued strengthening of primary health "
    "care, backed by adequate financing and governance, is central to achieving Universal Health Coverage in "
    "India."
)

# ---------------- 15. REFERENCES ----------------
add_heading("15. References", level=1)
refs = [
    "Park, K. Park's Textbook of Preventive and Social Medicine. Bhanot Publishers - chapters on Health System "
    "and Health Care of the Community, Health Care Infrastructure, and National Health Programmes.",
    "Ministry of Health and Family Welfare, Government of India. National Health Policy, 2017.",
    "National Health Mission, Ministry of Health and Family Welfare, Government of India (NRHM/NUHM "
    "framework documents).",
    "Press Information Bureau, Government of India. Progress update on Ayushman Bharat - Pradhan Mantri Jan "
    "Arogya Yojana (AB-PMJAY), 2025.",
    "Economic Survey of India, 2024-25, Ministry of Finance, Government of India.",
    "Indian Public Health Standards (IPHS) guidelines for Sub-Centres, Primary Health Centres, and Community "
    "Health Centres, Ministry of Health and Family Welfare.",
]
for r in refs:
    p = doc.add_paragraph(style='List Number')
    p.add_run(r)

doc.save('/tmp/workspace/healthcare-delivery-india/Health_Care_Delivery_System_in_India.docx')
print("Saved successfully")