The analysis of the present health care situation in Chapters 1-2 explains why we need change in the health care system. Health care systems in India need to become more accessible and affordable to the poor and the unreached. The process of seeking health has to become a liberating process and not a dependency-creating one. This process also requires prioritising plans, funds, activities, etc., in accordance with the needs of the health of the poor and the marginated.

The major mode of delivery in allopathic health care has been through hospital based curative systems. However, any rational analysis of third world health care systems would lead one to conclude that hospitals and the medical culture they promote are quite at variance from the goals of community health. Nevertheless it is a fact that that enormous amounts of health resources have been ( and continue to be) invested in the hospital system. Therefore instead of abandoningthe hospitals as useless it seemed possible that through a process of planned chnge at the personal, interpersonal, organizational and community levels, hospitals can be made more community health oriented. It was envisioneed that through this process, hospitals would devote ultimately a major part of their resources to the community health approach of transferring medical skills and management of resources as much as possible and necessary to the community. (Even in a community health care system, we do need hospitals as referral centres for secondary and tertiary care). Also on a prioritised basis community health care emphasis will be onprecention of disease, and with prevention an enquiry into the roots of the disease-poverty cycle would be undertaken by those in charge of medicl care.

OD was seen by the Health Care Administration Education (HCAE) team 2 as a useful tool for this change, especially as OD literature tended to focus on operationalisation of concepts like collaboration, confrontation, authenticity, trust, support,and openness. For instance, one author defined OD objectives as :

1. To increase the level of trust and support among organizational members.
   
2. To increase the incidence of confrontation of organizational problems, both within groups and among groups, contrast to "sweeping problems under the rug".
   
3. To create an environment in which authority of assigned role is augmented by authority based on knowledge and skill.
   
4. To increase the openness of communications laterally, vertically, and diagonally.
   
5. To increase the level of personal enthusiasm and satisfaction in the organization.
   
6. To find synergistic solutions to problems with great frequency.
   
7. To increase the level of self and group responsibility in planning and implementation.

A typical OD process would start with the external/internal consultant assessing the readiness of the organization for change (phase-I), followed by formal entry, diagnosis of the problem (phase-II), implementation, termination and self-renewing phases (phases III, IV& V).

The range of planned programmatic activities that client organizations and OD consultants participate in during the course of an OD programme are called OD interventions. Two days of classifying OD interventions are given in Tables 1 and 2.