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FIVE YEAR PLANS India has been in planning its requirements quite well, not only at the time

of independence but even earlier, even though those efforts were not as extensively worked upon as is reflected by five-year-plans. DEFINITION Five-year-plans are mechanisms to bring about uniformity in policy formulation in programmes of national importance. Recognizing the health as an important contributory factor in the utilization of manpower and in the uplifting of the economic condition of the country, the Planning Commission gave considerable importance of health programmes in the five-year plans OBJECTIVES The broad objectives of the health programme during the five-year plans are as follows 1. Control and eradication of major communicable diseases 2. Strengthening of basic health services through the establishment of primary health centers and sub-centres 3. Population control 4. Development of health manpower resources For the purpose of planning, the health sector has been divided into the following sub sectors: 1. 2. 3. 4. 5. 6. 7. Water supply and sanitation Control of communicable diseases Medical education, training and research Medical care including hospitals,dispensaries and PHCs Public health services Family planning, and Indigenous system of medicine.

FIRST FIVE-YEAR-PLAN Prior to the commencement of the first five-year-plan, the health status of the people of India was very low, which includes: Lack of hygienic environment sanitation conducive to healthy living Low resistance power due to lack of adequate diet Prevalence of malnutrition and poor nutrition Lack of proper housing, supply of pure drinking water and proper disposal of human wastes

Lack of medical care Lack of general and health education Low socio economic status And inadequate financial resources and lack of trained personnel the whole programe of health developments was tied with a broader programme of social development. While considering the above facts, a seven point public health programme with the following priorities formed the basis of the first-five year plan: 1. 2. 3. 4. 5. 6. 7. Provision of water supply and sanitation. Control of malaria Preventive health care of the rural population through health units and mobile units Health services for mothers and children. Education and training and health education Self- sufficiency in drugs and equipment Family planning and population control During this plan period the public sector outlay was Rs.2,356 crores of which RS.140 crores (5.9%) were allotted for health programmes. The actual expenditure, however, amounted to Rs.1960 crores and Rs.101 crores respectively

SECOND FIVE YEAR PLAN[1956-61] The second five-year-plan was continuation of the development efforts commenced in the first plan. It include all communicable diseases in addition to control of malaria. The specific objectives were: Establishment of institutional facilities to serve as a basis from which services could be rendered to the people both locally and in surrounding territories. Development of technical manpower through appropriate training programmes Intensifying measures to control widely spread communicable diseases Encouraging active campaign for environmental hygiene. Provision of family planning and other supporting services for raising Health standard of the people. The different areas emphasized during the second Five-year-plans I. II. III. Health care services in rural and urban areas Medical education and training Medical research


Indigenous systems of medicine Control of communicable diseases MCH and family planning and Health education During the period the public sector outlay was Rs.4,800 crores, of which 225 crores were allotted to the health progrmmes. The actual expenditure, however, amounted to Rs.4,672 crores and 215 crores respectively.

THIRD FIVE YEAR PLAN[1961-66] The objectives of the third five-year-plan were in tune with the first and second five-year-plans except that the integration of public health wlth maternal and child welfare,nutrition and health education was planned. In general, the third five year plan focused on the following areas: Water supply environmental sanitation (rural and urban) Health care (hospitals and dispensaries) Control of communicable diseases Medical education and training Other services- health education, school health, MCH, mental health health insurance ISM and family planning While continuing the programme initiated in the previous plan period, greater emphasis was placed on the preventive health services and on the eradication and control of communicable diseases. During the period the public sector outlay was Rs.7500 crores , of which , Rs. 341.80 crores allotted for health programmes. The actual expenditure, however, amounted to Rs.8,577 crores and Rs.357 crores respectively. ANNUAL PLANS The fourth FYP which was to commence from April 1966 was postponted till 1969 due to uncertain economic condition in the country (due to Indo-Pak war). During this intervening period, (1966 to 69) was covered by Annual plans with an outlay of Rs.6,756 crores in the public sector of which the expenditure on health programmes was Rs.316 crores FOURTH FIVE YEAR PLAN During this period the revised estimate of public sector outlay was 16,774 crores, of which Rs.1,156 crores(7.2%) were allotted to health sector. Certain objectives of the Mudaliar committee were the base of the fourth five-year-plan in relation to health. These are as follows:

To provide an effective base for health services in rural areas by strengthening the primary health centres, Strengthening of sub-divisional and district hospitals to provide effective referral services for primary health centre, and Expansion of the medical and nursing education and training of paramedical personnel to meet the minimum technical manpower requirements. In the 4th five year plan, public health and medical programmes had been divided into the following broad categories: Medical education, training and research, Control of communicable diseases Medical care including hospitals, dispensaries and PHCs Other public health services, and Indigenous system of medicine. FIFTH FIVE YEAR PLAN[1974-79] The fifth five year plan was launched on April 1, 1974, with an outlay of Rs.37,250 crores in the public sector, of which 3277 crores were allotted to the health sector. The primary objective of this plan period was to to provide minimum public health facilities integrated with the family planning and nutrition for vulnerable groups especially children, pregnant women and fedding mothers. The emphasis of plan was on removing imbalance inrespect of medical facilities and strengthening the health infrastructure in rural areas, specific objectives to be pursued during the plan were: Increasing accessibility of health services to rural areas, Correcting regional imbalance, Further development of referral services by removing deficiencies, in district and sub-divisional hospitals. Integration of health, family planning and nutrition, Intensification of the control and eradication of communicable diseases especially malaria and small pox,

Quantitative improvement in the education and training of health personnel by converting unipurpose workers to multipurpose workers, Development of referral services by providing specialists attention to common diseases in rural areas. During this plan period minimum needs programme[MNP] to be operated through the State Government is considered to be of great importance and field certain targets like one PHC for 100000 population, one sub-centre for 10000 population, correcting deficiencies related to establishment of these health centers and upgradation of one in every 4 PHC to the status of a 30 bedded rural hospital with specialized services. SIXTH FIVE YEAR PLAN[1980-85] In the beginning the sixth five-yeat-plan was formulated against the background of a perspective covering a period of 15 years from 1980-81 to 1994-95. The main objectives were : Progressive reduction in the incidence of poverty and unemployment. To set up the rate of growth of the Indian economy Promoting policies for controlling the population growth through voluntary acceptance of the small family norm. To improve the quality of life of the people in general through minimum needs programme. The 6th plan laid emphasis on health care, control of communicable diseases, hospital and dispensaries in urban/rural areas, medical education, research , training , ISM and homeopathy, other programmes and family welfare. Minimum needs programme[MNP] MNP was first introduced in 5th FYP to combat poverty. The state has duty to provide the basic needs of life to every citizen-needs in terms of health, food, education, water, shelter, etc. MNP is the expression of the commitment of the Government for the socio economic development of the community particularly the under-served and under privileged segment of population. Governments considers investment in health as investment in human resources development and as such primary health care forms are essential and integral component of the MNP. It is a broad intersectorial master plan for providing the minimum basic needs of the people of the land including the following in revising MNP 1978. Elementary education, Adult education,

Rural health, Rural water supply, Rural road, Rural electrification, House sites/houses for rural landless labourers Environmental improvement of slums, Nutrition The basic principles to be observed in the implementation of the minimum needs programme are: The facilities under MNP are provided on the priority basis first only in those areas which are at present under-served, so that disparities from area to area are eliminated and every segment of the population is assured to minimum essential facilities Intersectorial area project so that all the facilities under the MNP are provided as a package to a broad area. This would ensure a greater impact of the facilities provided. For this purpose, it is necessary to develop an effective interdependent co-ordination mechanism at State and District levels to ensure that the various departments get responsibility for the implementation of MNP for selected area. HEALTH SECTOR MINIMUM NEEDS PROGRAMME The various programmes/schemes covered under the health sector MNP were conveyed to State Government by the Central Govt. Since then, there has been certain modification in the pattern of assistance of various schemes which have been conveyed to the State Govts separately with the changes made the following schemes/ programmes include in the health sector MNP 100% centrally sponsored scheme Health guide scheme Establishment of Sub-centres Basic training of male-multipurpose workers. Training of specialists, technical and other paramedical staff required for rural medical services. Training of community health services.

Centrally assisted schemes (50-50 basis) Multipurpose workers scheme State sponsored schemes. Subsidiary health centres Primary health centres Community health centres/upgraded primary health centers. SEVENTH FIVE YEAR PLAN [1985-90] The objectives of the 7th FYP have been formulated as a part of the long term strategy which seeks by the year 2000 to virtually eliminate poverty and illiteracy, achieve near full employment, secure satisfaction of the basic needs of food, clothing, shelter and provide health for all. Against the above background, the current objective of the State and National Health Plan is to continue the reorganization of the health services infrastructure, already begun in the State FYP (1980-85) and strive towards the goal of health care to all sections to the sections of the society. By the end of 7th FYP, it is envisaged ( as laid down in the NHP) that infrastructure of primary health care as required on present population norms would be fully operational with regard to village health guides, primary health centres and sub-centres used multipurpose health workers In keeping with the objectives of the International Drinking Water Supply and sanitation decades (1988-91) the 7th plan aims to provide adequate drinking water facilities for the entire population both in Urban and in rural areas and sanitation facilities for 80 per cent of the Urban population and 25 per cent of the rural population. The public sector outlay of Rs.180000 crores represent a massive public investment. Out of this national cake, nearly Rs.3392 crores are earmarked for health, Rs.3256 crores for family Welfare programme, Rs.3922 crores for water supply and sanitation. The targets to be achieved are laid down in National Health policy. EIGHTH FIVE-YEAR-PLAN[1992-97] The ultimate goal of the eighth plan is the Human Development, in many facets. It is towards fulfilling this goal that the eighth plan accords priority to the generation of adequate employment opportunities to achieve near-full employment opportunities to achieve near-full employment by the turn of the centuary building up of the peoples institutions, control of population growth, universalisation of elementary education , eradication of illetracy, provision of safe drinking water and primary health facilities to all, growth and diversification of agriculture to achieve

self-sufficiency in food grains and generate surpluses for exports. So in this five-year-plan, employment generation , population control, literacy, provision of adequate food and basic infra structure are listed as priorites. In relation to health, this plan period has the following: The health facilities should reach the entire population by the end of the 8th plan. The Health for All paradigm must take into account not only the high risk vulnerable groups,i.e. mother and child, but also must also focus sharply on the underprivileged segments within the vulnerable groups. Towards Health for the Underprivileged may be key strategy for the health for all by the year 2000. The structural framework for the delivery of health, programmes must undergo a meaningful reorientation, is a way that the under privileged themselves become the subjects of the process and not merely its objects. Child Survival and Safe Motherhood Programme (CSSM) was launched on 20th August National Cancer Control programme National AIDS control Programme The following new schemes have been initiated starting from the year 1990-91. Scheme of District project. During the year 1990-91 to 1992-93, 17 district projects have been under taken. Development of oncology wings in medical college/hospital Scheme for financial assistance to voluntary organizations. National AIDS control programme NINTH FIVE YEAR PLANS(1997-2002) The ninth five year plan is unique in a way that, although the plan commenced on 1st April 1997, but still the formal 9th plan document finally received all the necessary clearance and was started only on February 1999. Today India has a vast network of governmental, voluntary and private health infrastructure manned by large number of medical, nursing and paramedical persons. During this plan, efforts will be further intensified to improve the health status of the people by optimizing coverage and quality of care by identifying and rectifying the critical gaps in infrastructure, man power, equipment, essential diagnostic reagents and drugs.

The approach during the ninth plan will be to improve the quality pf the primary health care, to increase the accessibility and to enhance quality care in Urban and rural primary health centres. The existing health care infra structure at primary, secondary and teritiary care setting are to be strengthened and the referral linkages improved. The new initiatives in Ninth Plan Care are as follows: Horizontal integration of vertical programmes. Development in disease surveillance and response mechanism at district level. Development and implementation of integrated non-communicable disease control programe Health impact assessment as a part of environmental impact assessment in developmental projects. Implementation of appropriate management systems for emergency, disaster and accident. Screening for common nutritional deficiencies and initiate appropriate remedial measures Reduction in the population growth Reduce infant and maternal morbidity and mortality Implementation of reproductive child health programme TENTH FIVE-YEAR-PLAN[2002-2007] The approach during the tenth plan will be to improve access to, enhance the quality of primary health care in urban and rural areas by providing an optimally functioning PHC as a part of Basic Minimum Services and to improve the efficiency of existing health care infrastructure at primary, secondary and teritiary care settings through appropriate institutional strengthening and improvement of referral linkages The monitorable targets for the tenth five year plan and beyond are as follows Reduction of poverty ratio by 5 per cent points by 2007, and by 15 per cent points by 2012 All children in school by 2003; all children to complete 5 years of schooling by 2007 Reduction in gender gaps in literacy and wage rates by at least 50% by 2007 Reduction in decadal rate of population growth between 2001 to 2011 to 16.2% Increase in literacy rate to 75% within the plan period Reduction of infant mortality rate to 45 per 1000 live births by 2007 and to 28 by 2012

Reduction of MMR to 2 per 1000 live births by 2007 and to 1 by 2012 All villages to have sustained access to potable drinking water within the plan period. ELEVENTH FIVE-YEAR-PLAN [2007-12] The eleventh Five-Year-Plan will provide an opportunity to restructure policies to achieve a new vision based on the faster, broad-based, and inclusive growth Main objectives To achieve good health for people, especially the poor and the underprivileged Development of public health systems and services that are responsive to health needs and aspirations of people. Reduction of disparities in health across regions and communities by ensuring access to affordable health care. To give special attention to the health of marginalized groups like adolescent girls, women of all ages, children below the age of three, older persons, disabled, and primitive tribal groups The monitorable, time bound goals for the eleventh Five Year Plan are as follows: Reducing maternal mortality ratio [MMR] to 1 per 1000 live births Reducing Infant Mortality Rate [IMR] to 28 per 1000 live births Reducing Total fertility Rate [TFR] to 2.1 Providing clean drinking water for all by 2009 and ensuring no slip-backs Reducing malnutrition among children of age-group 0-3 to half of its present level Reducing anaemia among women and girls by 50% Reducing the sex ratio for age group 0-6 to 935 by 2011-12 and 950 by 2016-17 The thrust areas to be pursued during the eleventh Five Year Plan are summarized below: Improving health equity NRHM NUHM Adapting a systemic-centric approach rather than a disease-centric approach o Strengthening health system through upgradation of infrastructure and PPP o Converging all programmes and not allowing vertical structures below district level under different programmes.

Increasing survival

Reducing maternal mortality and improving child sex ratio through gender responsive health care Reducing infant and child mortality through HBNC and IMNCI

Taking full advantage of local enterprise for solving local health problems Integrating AYUSH in health system Increasing the role of RMPs Training the TBAs to make them SBAs Propagating low cost and indigenous technology Preventing indebtedness due to expenditure on health/protecting the poor from health expenditures Creating mechanisms for health insurance Health insurance for the unorganized sector. Decentralizing governance Increasing the role of PRIs, NGOs, and civil society. Creating and empowering health committees at various levels. Establishing e-Health Adapting IT for governanace Establishing e-enabled HMIS Increasing role of telemedicine Improving access to and utilization of essential and quality health care Implementing flexible norms for health care facilities (based on population, distance, and terrain) Reducing travel time to two hours for EmOC. Implementing IPHS for health care facilities and providers Re-developing hospitals/institutions. Mirroring of centres of excellence like AIIMS Increasing focus on health human resources

Improving medical, paramedical, nursing, and dental education and availability Re-orienting AYUSH education and utilization Reintroducing licentiate course in medicine Making India a hub for health care and related tourism Focusing on excluded /neglected areas Taking care of the older persons Reducing disability and integrating disabled Providing humane mental health services Providing oral health services. Enhancing efforts at disease reduction Reversing trend of major diseases Launching new initiatives (rabies, flurosis, leptospirosis) Providing focus to health system and bio-medical research Focusing on conditions specific to our country Making research accountable Translating research into application for improving health Understanding social determinants of health behaviour, risk taking behavior, and health care seeking behavior.

HEALTH COMMITTEE REPORTS Health planning in India is an integral part of national socio economic planning. The guidelines for National Health planning were provided by a number of committees dating back to the Bhore Committee in 1946. These committees were appointed by the Government of India in 1946. These committees were appointed by the Government of India from time to time to review

the existing health situation and recommend measures for further action. A brief review of the recommendations of these committees, which are important landmarks in the history of public health in India. Is given below. BHORE COMMITTEE, 1946 The Government of India in 1943, appointed the Health Survey and Development Committee with Sir Joseph Bhore as Chairman, to survey the then existing position regarding the health conditions and health organization in the country, and to make recommendations for the future development. The committee which had among the members some of the pioneers of public health, met regularly for 2 years and submitted in1946 its famous report which runs into 4 volumes. The committee put forward, for the first time, comprehensive proposals for the development of a national programme of health services for the country. RECOMMENDATIONS Integration of preventive and curative services at all administrative levels. Development of primary health centres in 2 stages. In short term measure PHC in rural area should cater to a population of 40,000 with a secondary health centre to serve as a supervisory, co-ordinating and referral institution. For each PHC two medical officers, 4 public health nurses, one nurse, 4 midwives, 4 trained dais, 2 sanitary inspectors, 2 health assistants, one pharmacist and 15 other class IV employees. In long term programme of setting up PHC with 75 bedded hospital, for each 10,000-20,000 population and secondary units with 650-bedded hospitals with 2500 beds Major changes in medical education which includes 3 months training in preventive and social medicine to prepare social physicians. The details of the short term and long term programme as follows Short term programme Personal and impersonal health services should be provided. A progressive improvement of public health depends largely on the promotion of the hygienic mode of life among the people In each village, a Health committee consisting of 5-7 individuals should be established by procuring the active participation of the people in the local health programmes The bed-population ratio should be raised from 0.24 per 1000 to 1.03 at the end of 10 years Dental sections should be established in the hospitals at secondary health centres Provision should also be made for traveling dental units for service in rural areas

Provision of housing accommodation for health staff is essential in the interests of efficiency Village communications should be developed in order to enable health organization to provide efficient service Traveling dispensaries should be provided to supplement the health services rendered by primary health centres in sparsely populated areas THE LONG TERM PROGRAMME The smallest administrative unit should be the primary unit serving an area with a population of about 10,000 to 20,000. About 15 to 25 primary units will together constitute a secondary unit. At the primary, secondary and district health units there will be a health centre as the focal point for radiating different types of health activity The objectives to be kept in view after the first 10 years should be as follows. Raising of hospital accommodation to 2 beds per 1000 of population Creation of 18 new medical colleges in addition to the 43 to be established during the first 10 years. Establishment of 100 training centres for nurses Nursing training of 500 hospital social workers

Nutrition Provision of an optimum diet for all . eight ounces of milk per day should be included in the average Indian diet. Expectant and nursing mothers and children upto 14 years will need much more. For improving the diet of people there should be an increase in milk production to the extent of atleat 110 percent Health education The instruction of school children in hygiene should begin at the earliest possible stage. The responsibility for health education of the general Physical education Should include indigenous games, sports and folk dances. Health services for mothers and children School health services Occupational health

Environmental hygiene Public health personnel Professional education Undergraduate education Post graduate education Dental education Pharmaceutical education Medical research Drugs and medical requisities Population problem Doctor for the future Stipends to medical and nursing students Nurse,midwives, and dais Male nurses Public health nurses Midwives IMPLICATIONS OF BHORE COMMITTEE To bring together all educational facilities of high order for training of the more important type of health perssonel To promote highest type of research in all branches To provide advanced post-graduate training in an atmosphere fostering the true scientific out look and spirit of initiative To co-ordinate training& research To inspire ideals of profession To promote a community outlook

HEALTH SURVEY AND PLANNING COMMITTEE[1962] The government of India in the Ministry of Health set up a Committee in 1959 to undertake the review of the developments that have taken place since the publication of the Report of the Health Survey and the Development Committee (Bhore committee) in 1946 with a view to formulate further Health programmes for the country in the 3rd and subsequent five-year-plan The terms of reference of this committee were: Assessment (or evaluation) in medical relief and public health since the admission of the Health survey and Development Review the first and second five-year-plans health plan projects Formulations of recommendations for the future plan of the health development in the country Dr. A Lakshminarayanaswami Mudaliar, Vice Chancellor, Madras University, was appointed Chairman of the Committee. The main Committee was divided into 6 committees to look into various aspects: Professional education and research Medical relief Public health including Environmental Hygiene Communicable Diseases Population problem and family planning Drugs and medical stores RECOMMENDATIONS Consolidation of advanced efforts and acheivemnts made in the first two five-year-plans in the field of health Equipping district hospitals with specialized services Need for regionalization of health services,i.e. setting up of regional structures between the state and district head quarters Each primary health centre should serve not more than 40,000 people. The quality of care provided by the primary health centre needs improvement

Integration of medical and health services should be achieved as already suggested by the Bhore committee Constitution of an All India Administrative Health Services on the pattern of Indian Administrative Services Recommendations related to nursing sectors are as follows; There should be three grades of nurses, viz, the basic nurses ( with 4 years training) , the Auxilary Nurse Wife (2 years training) and the nurse with a degree qualification Candidates admitted to the General Nursing course should have the minimum qualification of matriculation or equivalent; and the candidates for the degree course should have passed the higher secondary or pre-university examination In view of the need for securing a larger number of recruits for the nursing profession the age of admission can be relaxed to 16 in suitable cases as a transitional measure particularly in states where there are difficulties in recruiting candidates at the age of 17. The medium of instruction should preferably be English for the General nursing Course, while the degree course should be taught only in English Nurse pupils should not be over-burdened with the routine duties in hospitals but more attention should be given to training and practical experience. They should not be subjected to too many spells of night duties in hospitals To train more nurses a large number of hospitals in the country could be utilized for nursing schools. District headquarters hospitals with a bed strength of 75 to 100 should also be utilized for this purpose The minimum of admission to the course should be 12. Student nurses should be provided free furnished accommodation in hospitals, free board, free supply of uniforms, laundry arrangements, free books, free medical services, medical check-up twice a year and suitable recreational facilities. The stipend during training should be a minimum of Rs.35 increasing by Rs.10 every year. The recommendations of the Committee set up by the central Council of Health in regard to pay scales and ratio of nurses to hospital beds, etc. are enclosed There should be a nursing advisory committee in each school for advising on admission and welfare of the trainees Each Nursing School should have its own separate budget The training of Auxillary Nurse midwives should be continued and extended

Any person trained in one category of nursing should get an opportunity of being trained in the next higher grade, under conditions to be specified by the Indian Nursing Council Promotion of Degree CourseNurses and of Basic Nurses to posts of higher responsibility should be considered only after a minimum of 3 to 5 years of practical experience after qualification has been obtained. Male nurses should be trained for certain types of work, eg; mental hospitals, rehabilitation centres CHADHA COMMITTEE (1963) The government of India appointed a committee under the chairmanship of Dr.M S Chadha, then Director General of Health Services to study the arrangements necessary for the maintenance phase of the NMEP. The Committee known as special committee on the preparation of entry of the NMEP into maintenance phase. The committee recommended that the vigilance operations in respect of the NMEP should be the responsibility of the general health services, i.e. primary health services at the block level and monthly home visits should be implemented through basic health workers Existing malaria surveillance worker (MSW) may be changed into auxillary health worker/basic health workers, one per 10,000 population supported and supervised by health inspectors at the rate of 20-25,000 population for which an additional post of health inspector was to be created in each of the blocks Creation of the post of laboratory technicians at the PHC and the post of family planning field worker [FPFW] and family planning health assistant [FPHA] at the rate of population growth and therefore, intensifying family planning measures Basic health workers envisaged as multipurpose workers to look after additional duties of collection of vital statistics and family planning in addition to malaria vigilance MUKHERJEE COMMITTEE (1965) A committee was appointed by the Government of India during 1965 to review the strategy of family planning assistants (FHA) were to undertake family planning duties only. The BHWs were to be utilized for the purpose of family planning The committee also delink the malaria activities from family planning so that the latter would receive undivided attention of its staff, the recommendation accepted by the Government of India

MUKHERJEE COMMITTEE (1966) The Mukherjee committee 1966 was appointed by the Government of India to review what additions and changes were necessary as a result of the greatly altered situation due to the IUCD having come in fore front of the family planning programme, in the staffing pattern, financial provisions The recommendations of the committee were: There should be one FPFW for every two sub centres That an extra post of LHV should be created so that one LHV is available for 40,000 population That part-time workers for motivating population for the acceptance of IUD should be appointed with honarium That at the block and district levels, education leaders be appointed for intensifying motivational campaign and be paid honarium of Rs.600 per annum Government doctors may be provided incentives which should also be available to part-time private medical practitioners in terms of honorarium of Rs.100 per month JUNGALWALIA COMMITTEE[1967] The central council of Health at its meeting held at Srinagar in1964, taking note of the importance and urgency of integration of health services and elimination of private practice by government doctors, appointed a committee known as the committee on integration of Health services under the chairman ship of Dr.N Jungalwalla, director , NIHAE, New Delhi, to examine the various problems including those of service conditions and submit a report to the Central government in the light of these consideration The committee defined integrated health services as A service with an unified approach for all problems instead of a segmented approach for all problems instead of a segmented approach for different problems The medical care of the sick and conventional public health programmes functioning under a single administrator and operating in unified manner at all levels of hierarchy with due priority for each programe obtaining appoint of time The main steps recommended integration from the highest to the lowest level in the services, organization and personnel Unified care Common seniority

Recognition of extra qualifications Equal pay for equal work Special pay for specialized work No private practice Good service conditios KARTAR SINGH COMMITTEE (1974) Government of India constituted a committee in1972 known as the committee on multi purpose workers under the Health and Family planning under the chairmanship of Shri Kartar Singh, Additional Secretary, ministry of Health and family planning of the Union Government. Main recommendations were Present day ANMs to be replaced by the newly designated Family Health workers and present day Basic Health workers (BHW), malaria Surveillance Inspectors, vaccinators, health education assistant of Trachoma(HEAT) and FPHAs to be replaced by male health workers. The present-day LHVs to be replaced by the newly designated female Health Supervisor and creation of such additional posts and clubbing of the posts of Health Inspectors, Sub-inspectors, Malaria Surveillance inspectors, supervisors together to make them into; male health Supervisors For proper coverage, there should be one primary health centre for a population of 50,000 Each primary health centre should be divided into 16 sub centres each having a population of about 3000 to 3500 depending upon toptography and means of communication Each subcentre to be staffed by team of one male and one female worker There should be a male supervisor to supervise the work of 3 to 4 male health workers and a female health supervisor to supervise the work of 4 female health workers The doctor in-charge of the PHC should have the overall charge of all the supervisors and health workers in his area The programme for having MPWs first to be introduced in areas where malaria is in the maintenance phase and small pox has been controlled and later to other areas as malaria passess into maintenance phase or small pox controlled

SHRIVASTAVA COMMITTEE The government of India in the ministry of health and Family planning had in November 1974 set-up a group on Medical Education and Support Manpower under the chairmanship of Dr JB Shrivastav, then the DGHS was established to focus on this issue Recommendations A nationwide network of efficient and effective services suitable for our conditions, limitations and potentialities should be evolved Steps should be taken to create bands of paraprofessional health workers from the community itself to provide simple,protective, preventive and curative services which are needed by the community Between the community and the primary health centre there should be two cadres , health workers and health assistants. The PHC should be provided with an additional doctor and nurse to look after the maternal and child health services The possibility of utilizing the services of senior doctors at the medical college, regional, district/taluk hospitals for brief periods at PHC should be explored The PHC as well as taluk hospital, district hospital, regional institution or medical college hospitals should each develop living and direct links with the committee around them, as well as with one another within a total referral services complex The government of India should constitute under an Act of parliament a Medical and Health Education Commission for co-ordinating and maintaining standards in Medical and Health education on the patterns of University Grants commission NATIONAL HEALTH POLICY The ministry of health and family welfare , Govt of India, evolved a National Health Policy in1983 keeping in view the national commitment to attain the goal of Health for All by the year 2000. Since then there has been significant changes in the determinant factors relating to the health sector, necessitating revision of the policy , and a new National Health policy-2002 was evolved Eradication of polio and yaws by 2005 Eliminate leprosy by 2005 Eliminate Kala-azar by 2010

Eliminate lymphatic filariasis by 2015 Achieve zero level growth of HIV/AIDS by 2007 Reduce mortality by 50% on account of TB, malaria and other vector and water borne diseases Reduce prevalence of blindness to 0.5% Reduce IMR to 30/100 and MMR to 100/lakh Increase utilization of public health facilities from current level of <20% to>75% by 2010 Establish an integrated system of surveliance, National Health Accounts and Health Statistics by 2005 Increase health expenditure by Government as a % of GDP from the existing 0.9% to 2.0% by 2010 Increase share of central grants to constitute at least 25% of total health spending by 2010 Increase state sector health spending from 5.5% to 7% of the budget by 2005 Further increase to 8% of the budget by 2010

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3. TomeyAM. Guide to nursing management and leadership.7 thed.USA:library of congress cataloging in-publication data.2004.