Health Planning in India is an integral part oI national socio-economic planning. A number oI committees were appointed time to time to review the existing health situations and organizations and recommended measures Ior improvement.
Health Planning in India is an integral part oI national socio-economic planning. A number oI committees were appointed time to time to review the existing health situations and organizations and recommended measures Ior improvement.
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Health Planning in India is an integral part oI national socio-economic planning. A number oI committees were appointed time to time to review the existing health situations and organizations and recommended measures Ior improvement.
Copyright:
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Professor Health Systems, Health Economics and Financing Institute of Health Management Research, Jaipur $ession Plan BrieI review oI health planning eIIorts in India and how the Indian health care system evolved. Discuss the important recommendations oI various committees which are important landmarks in the history oI health policy planning in India. Health Planning in India Health planning in India is an integral part oI national socio-economic planning. A number oI committees were appointed time to time to review the existing health situations and organizations and recommended measures Ior improvement. Health Committees and National Health Policies gave a new direction to health planning in India time to time. IIorts Ior Health Policy Planning in India Bhore Committee 1946 Mudaliar Committee 1962 Chadah Committee 1963 Mukerji Committee 1965 Mukerji Committee 1966 Jungalwalla Committee 1967 Kartar $ingh Committee 1973 $rivastav Committee 1975 Rural Health $cheme 1977 ICMR-IC$$R Joint Panel 1980 National Health Policy 1983 National Population Policy 2000 National Health Policy 2002 Bhore Committee 1946 Health $urvey and Development Committee was appointed in 1943 $ir Joseph was appointed as chairman oI the committee. bjectives To review the health situation To review health services To recommend Ior the Iuture development Committee submitted its report which contains 4 volumes in 1946 State of Health. British India. Non-existence oI health care services Poor accessibility and availability Poor people were unable to pay Ior services Poor environmental sanitation and hygiene Communicable diseases were rampant High morbidity and mortality Human resources were grossly inadequate State of Health. British India. High incidence and prevalence oI communicable diseases Malaria 2 million cases and 0.8 million deaths every year Tuberculosis 2.5 million active cases and 500,000 deaths annually High morbidity Ior $mallpox, Plague, Cholera, Leprosy, Filariasis, Guinea worm and Hookworm diseases High nutritional deIiciency 30 Iamilies had insuIIicient nutrients Ior energy requirements High growth rate oI population High birth rate 41/1000 Population High Iertility rates No contraception services Bhore Committee Recommendations No individual should lack access to medical care because oI inability to pay Ior it $pecial emphasis should be placed on preventive methods and on communicable diseases Health services should be as 'close to the people as possible in order to ensure the maximum beneIit to the community to be served All Iacilities Ior diagnosis and treatment should be available in the public health services when it is Iully developed Bhore Committee. Integration oI preventive and curative services at all administrative levels. Committee suggested 3 months training in preventive and social medicine to prepare 'social physicians Committee suggested the development oI primary health centres in two stages: short term and long term programmes. Bhore Committee. $hort Term ne primary health centre in the rural areas should cater to a population oI 40, 000. For each PHC, 2 medical oIIicers, 4 public health nurses, 1 nurse, 4 mid-wives, 4 trained dais, 2 sanitary inspectors, 2 health assistants, 1 pharmacist and 15 other support staII were recommended. Bhore Committee. Long Term (also called the 3 million plan) ne primary health unit per 10,000-20,000 population with 75 beds, 6 doctors, and 6 public health nurses. $econdary unit with 650-bed hospital at taluka level (300,000 population) and one district hospital oI 2,500 beds Mudaliar Committee 1962 Government oI India appointed the Health $urvey and Planning Committee in 1959 also known as Mudaliar Committee. Committee was given Iollowing tasks: To survey the progress made in the Iield oI health since submission oI the Bhore Committee`s report To make recommendations Ior Iuture development and expansion oI health services Mudaliar Committee. Committee Iound the quality oI services provided by the primary health centers inadequate Committee advised strengthening oI the existing primary health centers beIore new centers were established Also advised strengthening oI sub-divisional and district hospitals to work as reIerral centers Mudaliar Committee Recommendations ne PHC per 40,000 population ne bed per 1,000 population ne doctor per 3,000 population ne 50-bed basic specialty hospital Ior each taluka and ne 500-bed district hospital Central government should control communicable diseases ne medical college per 5 million population No integration oI systems oI medicine Chadah Committee 1963 Government oI India appointed a committee under the chairmanship oI Dr.M.$.Chadah in 1963. Committee appointed to study the arrangements necessary Ior the maintenance phase oI the National Malaria radication Programme. Chadah Recommendations The 'Vigilance operations in respect oI the National Malaria Programme should be the responsibility oI the general health services, i.e., primary health centres at the block level. The vigilance operations through monthly home visits should be implemented through basic health workers. ne basic health worker per 10,000 population was recommended. Chadah Recommendations . Health workers should be redeIined as 'Multi- Purpose Workers to look aIter additional duties oI collection oI vital statistics and Iamily planning, in addition to malaria vigilance. The Family Planning Health Assistants should supervise 3-4 MPWs. Mukherji Committee 1965 AIter implementation oI the Chadah Committee`s recommendations by Iew $tates, it was realized that the basic health workers could not Iunction eIIectively as multipurpose worker. As a result, both the malaria and Iamily planning programmes suIIered. A committee was appointed known as 'Mukherji Committee, 1965 under the chairmanship oI $hri Mukherji, the then $ecretary oI Health to the Government oI India. Committee was appointed to review the strategy Ior the Iamily planning programme. Mukherji Committee Recommendations 1. The committee recommended separate staII Ior the Iamily planning programme. 2. The Family Planning Assistants were to undertake Iamily planning duties only. 3. The basic health workers were to be utilized Ior purpose other than Iamily planning, and 4. To de-link the Malaria activities Irom Iamily planning so that the latter would receive undivided attention oI its staII. Mukerji Committee-1966 $tates were Iinding it diIIicult to take over the whole burden oI the Malaria programme and other mass programmes due to paucity oI Iunds. ThereIore, a committee was appointed under the chairmanship oI $hri Mukherji in 1966. The committee worked out the details oI the 'Basic Health $ervices which should be provided at the block level. Committee also recommended Ior strengthening oI administration at higher levels. Jungalwalla Committee 1967 The Central Council oI Health at its meeting held in $rinagar in 1964, taking a note oI the importance and urgency oI integration oI health services, and elimination oI private practice by government doctors. A committee was appointed known as the 'Committee on Integration oI Health $ervices under the Chairmanship oI Dr.N. Jungalwalla, Director, National Institute oI Health Administration and ducation. Jungalwalla Committee. The Committee was appointed to examine the various problems including those oI service conditions and submit a report to the Central Government in the light oI these considerations. The Committee submitted its report in 1967. Jungalwalla Committee deIinitions The committee deIined 'Integrated health services as: 1. A service with a uniIied approach Ior all problems instead oI a segmented approach Ior diIIerent problems, and 2. Medical care oI the sick and conventional public health programmes Iunctioning under a single administrator and operating in uniIied manner at all levels oI hierarchy with due priority Ior each programme obtaining at a point oI time. Jungalwalla Committee Recommendations The committee recommended integration Irom the highest to the lowest level in the services, organization and personnel. The committee stated that 'integration should be a process oI logical evolution rather than revolution. Jungalwalla Committee Recommendations. The Committee recommended the Iollowing main steps towards integration oI services: UniIied cadre Common seniority Recognition oI extra qualiIications qual pay Ior equal work $pecial pay Ior specialized work No private practice and good service conditions Kartar $ingh Committee 1973 The Government oI India constituted a Committee in 1972 known as '%he Committee on Multipurpose Workers under Health and Family Planning under the Chairmanship oI Kartar $ingh, Additional $ecretary, Ministry oI Health and Family Planning, Government oI India. Committee submitted its report in $eptember 1973. Kartar $ingh Committee. Committee was appointed to study: The structure Ior integrated services at the peripheral and supervisory levels. The Ieasibility oI multi-purpose workers and their training requirement. The utilization oI mobile service units set-up under Family Planning Programme Ior integrated medical, public health and Iamily planning services operating in the Iield. Kartar $ingh Recommendations The Auxiliary Nurse Midwives (ANMs) to be replaced by the newly designated Female Health Workers. The Basic Health Workers, Malaria $urveillance Workers, Vaccinators, Health ducation Assistants (Trachoma) and the Family Planning Health Assistants to be replaced by Male Health Workers. The Lady Health Visitors (LHV) to be designated as Female Health $upervisors. Kartar $ingh Recommendations . ne PHC per 50,000 population. ach PHC should be divided into 6 $ub-Centres, each having a population oI about 3000 3500. ach sub-centre to be staIIed by a team oI one male health worker and one Iemale health worker ne health supervisor Ior every 4 health workers. The doctor in-charge oI PHC should have the overall charge oI all the supervisors. $hrivastav Committee 1975 The Government oI India set up a Group on Medical ducation and $upport Manpower` in 1974 popularly known as the $hrivastav Committee. The group submitted its report in April 1975. Tasks: 1. To devise suitable curriculum Ior training oI Health Assistants to serve as a link between the qualiIied medical practitioners and the multipurpose workers. 2. To suggest steps Ior improving the existing medical educational processes, and 3. To make any other suggestions to realize the above objectives and related matters. $hrivastav Committee Recommendations Committee recommended immediate action Ior: Creation oI bands oI para-proIessional and semi- proIessional health workers Irom within the community itselI (e.g., school teachers, postmasters, gram sevaks) to provide simple, promotive, preventive and curative health services needed by the community. $hrivastav Committee Recommendations . stablishment oI 2 cadres oI health workers, namely: multi-purpose health workers and doctors at the PHC. Development oI a ReIerral $ervices Complex by establishing proper linkages between the PHC and higher level reIerral centres. stablishment oI a Medical and Health ducation Commission Ior planning and implementing the reIorms needed in health and medical education on the lines oI the University Grant Commission. Rural Health $cheme 1977 The most important recommendation oI the $hrivastav Committee was that primary health care should be provided within the community itselI through specially trained workers. The recommendations oI the $hrivastav Committee were accepted by the Government oI India in 1977, which led to the launching oI the Rural Health $cheme. Rural Health $cheme The programme oI training oI community health workers was initiated during 1977-78. $teps were also initiated Ior (a) Involvement oI medical colleges in the health care service delivery oI selected PHCs with the objective oI reorienting medical education to the needs oI rural people; and (b) Reorientation training oI multipurpose workers engaged in the control oI various communicable disease programmes into unipurpose workers. ICMR-IC$$R Joint Panel, 1980 A village health unit per 1000 population with one male and one Iemale health worker. ne $ub-center per 5000 population with one male and one Iemale health worker. ne 30-bed CHC per 100,000 population with 6 general doctors and 3 specialists. A district health center Ior every 1 million population and a specialist center Ior every 5 million population No Iurther expansion oI medical education and drug production but only their rationalization and reorientation. 6 percent oI GNP must be ultimately spent on Health Care $ervices. National Health Policy, 1983 Provision oI universal, comprehensive primary health care services. Involvement oI private practitioners and NGs to expand coverage oI and access to services. volve a decentralized system oI health care and establish a reIerral systems. stablish a nationwide chain oI epidemiological stations. ncourage private investment in health sector to reduce government burden. $elected health and demographic targets to be achieved by 2000. National Population Policy, 2000 $eek a mix oI socio-demographic and health goals Ior 2010 with the primary aim oI bringing the total Iertility rate to replacement level. Increases outreach and coverage oI comprehensive package oI reproductive and child health services by government in partnership with NGs and private sector. National Population Policy, 2000. xpand public health inIrastructure by increasing number oI sub-centers,PHCs and CHCs. Decentralize planning and programme implementation with high involvement oI the Panchayati Raf Institutions (PRIs) and community groups. National Population Policy, 2000. Promote intersectoral approach among key government departments. stablish a national commission on population with equivalent structures at the $tate level. Create incentives to promote the small Iamily norms. Thank You .