The healthcare delivery system in India is structured in three main levels: primary, secondary, and tertiary care. Each level has a unique role in providing health services, designed to meet the varying needs of the population across different regions, from urban to remote rural areas.

1. Primary Health Care

Primary healthcare is the first point of contact between individuals and the health system. It focuses on essential, community-based services, including preventive, promotive, curative, and rehabilitative care, especially for rural and underserved areas. The key institutions involved at this level include:

Sub-centers (SCs): Sub-centers are the most peripheral health units, typically covering a population of around 5,000 in plains and 3,000 in hilly or tribal areas. They are staffed by Auxiliary Nurse Midwives (ANMs) who provide maternal and child health services, immunizations, and basic treatment.
Primary Health Centers (PHCs): A PHC typically serves 30,000 people in rural areas and 20,000 in hilly areas, staffed by a Medical Officer, nurses, and other health professionals. They offer preventive care, health education, and basic outpatient services.
Community Health Centers (CHCs): CHCs serve larger rural populations and function as referral centers for PHCs, handling minor surgeries, emergency care, and maternity services. They are staffed by a range of medical professionals, including doctors and nurses, and have basic diagnostic and inpatient facilities.
Health and Wellness Centers (HWCs): Launched as part of the Ayushman Bharat scheme, HWCs aim to expand primary healthcare services, including screening for non-communicable diseases and ensuring universal health coverage.

2. Secondary Health Care

Secondary care involves more specialized services and facilities to manage cases referred from primary health institutions. It includes hospitals at the district or sub-district level with specialist services. Key facilities at this level are:

District Hospitals: District hospitals serve as the primary referral point for all PHCs and CHCs in the district. They are equipped with specialists in pediatrics, gynecology, surgery, and medicine and provide both inpatient and outpatient services, including emergency and intensive care.
Sub-District/Taluk Hospitals: Smaller than district hospitals, these facilities handle cases referred from the CHCs and PHCs. They focus on more common medical procedures and treatments.
Private Sector Participation: In secondary care, the private sector often plays a significant role, especially in urban areas, offering additional options for services that may not be as readily available in public facilities.

3. Tertiary Health Care

Tertiary healthcare provides highly specialized services and caters to more complex cases that cannot be managed at the secondary level. This includes advanced diagnostic, therapeutic, and surgical interventions. Facilities providing tertiary care include:

Medical Colleges and Super-Specialty Hospitals: These institutions provide advanced care in fields like cardiology, neurology, oncology, nephrology, etc. They also serve as teaching and research centers, often affiliated with universities.
All India Institutes of Medical Sciences (AIIMS) and Specialized National Centers: Institutes like AIIMS offer cutting-edge healthcare and research and act as referral centers for cases across the country. Specialized institutes like the National Cancer Institute, NIMHANS (for mental health), and others cater to specific needs.
Private and Corporate Hospitals: These hospitals contribute significantly to tertiary care, particularly in urban and metropolitan areas, with facilities for complex surgeries, organ transplants, and high-end diagnostic services.

Challenges and Developments

The healthcare delivery system in India faces challenges like resource shortages, especially in rural areas, unequal access, high out-of-pocket expenses, and infrastructure limitations. However, reforms such as the National Health Mission, Ayushman Bharat for universal health coverage, digital health initiatives, and increased private-public partnerships aim to address these gaps and enhance the healthcare infrastructure across all levels.

Each level of care is essential to the overall system, providing a structured pathway from primary preventive services to highly specialized treatments. The evolving focus on primary healthcare and wellness, particularly through Ayushman Bharat, seeks to make healthcare in India more accessible, affordable, and integrated across these three levels.