five year plans
TRANSCRIPT
FIVE YEAR PLANS AND COMMITTEE
REPORTS ON HEALTH
SUBMITTED TO SUBMITTED BY
MRS. SULEKHA A.T AJEESH P. MANI
ASSO:PROFESSOR 2ND YEAR MSC
NURSING
GOVT.COLLEGE OF NURSING GOVT.COLLEGE OF
NURSING
KOTTAYAM KOTTAYAM
INTRODUCTION
India has been a pioneer in planning it’s requirements quite well , not only at the time of independence but even earlier, even though those efforts were not as extensively worked up on as is reflected by five year plans. The economy of India is based in part on planning through its five-year plans, which are developed, executed and monitored by the Planning Commission. The tenth plan completed its term in March 2007 and the eleventh plan is currently underway.
Five-year-plans are mechanisms to bring about uniformity in policy formulation in programmes of national importance. Recognising the "health" as an important contributory factor in the utilisation 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.
The broad objectives of the health programme during five-year-plans are as follows:
• control and eradication of major communicable diseases
• strengthening of basic health services through the establishment of primary health centres and sub-centres,
• population control, and
• development of health manpower resources.
For the purposes of planning, the health sector has been divided into the following sub-sectors:
1. Water supply and sanitation
2. Control of communicable diseases
3. Medical education, training and research
4. Medical care including hospitals, dispensaries and PHCs
5. Public Health Services
6. Family planning, and
7. Indigenous system of medicine.
All the above sub-sectors have received due consideration in the FYP. To give effective, better co-ordination between Centre and State Governments, a Bureau of Planning was constituted in 1965 in the Ministry of Health, Government of India. The main responsibility of the Bureau is compilation of National Health five-year-plans. It is necessary to review briefly the health policy and targets, investments and achievements during the planning period. The national five-year-plans are implemented through the community development programme which includes the health plans of the nation. Let us know briefly Community Development Programme prior to review five-year-plans (FYP).
Community Development
According to UNO, "Community Development" is the process by which the efforts of the people themselves are united with those governmental authorities to improve the economic, social and cultural conditions of communities, to integrate those communities with the life of the nation and to enable them to contribute fully to nation's progress.
Community development programme is an integrated programme trying to cover major areas which includes, agriculture, animal husbandry, irrigation, education, public health, rural industries communication etc.
The main objective of the community development programme is to bridge the gap between poverty, disease and ignorance through the community efforts, thus awakening the interest and enthusiasm of the millions of people in improving their own conditions. The programme of community developments was launched in India during 1952 (2-10-1952), because India can be still regarded as "land of villages", currently about 80 per cent of people live in 5.76 lakhs villages.
Community development programme is a multipurpose scheme consisting of the certain activities related to health field as follows:
1. Integration of the health needs of villagers to the authorities responsible for planning and implementing the health programmes
2. Development of agriculture
3. Improvement of communication
4. Improvement of education
5. Improvement of health
6. Improvement of rural sanitation
7. Improvement of housing arts, crafts and cottage industries
8. Improvement of animal husbandry
9. Improvement of co-operative marketing
10. Special programmes for women and children
11. Enhance the community participation in all programmes.
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 and
• Low economic status.
And inadequate financial resources and lack of trained health personnel the whole programme 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. Provision of water supply and sanitation.
2. Control of malaria.
3. Preventive health care of the rural population through health units and mobile units.
4. Health Services for mothers and children.
5. Education and training & health education
6. Self –sufficiency in drugs and equipments.
7. Family planning and population control.
THE FIRST FIVE YEAR PLAN (1951-1956)
The Aim : The aim of the First Five Year Plan was to fight against diseases, malnutrition, and unhealthy environment and to build up health services for rural population and for mothers and children in order to improve general health status of people.
The Priorities : The areas in order of priorities included
• Safe water supply and sanitation.
• Control of Malaria.
• Health care of rural population.
• Health services for mothers and children.
• Education and training and health education.
• Self sufficiency in drugs and equipments.
• Family planning and population control.
The Health Outlay : A. sum of Rs. 140 crores was allocated for health programmes during the First Five Year Plan which was 5.9 percent of the total outlay (Rs. 2356 crores) for the entire development plan.
The Major Developments : The major developments which took place to meet the identified priority areas and objectives are presented below according to year wise sequence.
The Year 1951
The B.C.G. vaccination programme to prevent and control tuberculosis was launched.
The Year 1952
• A pilot project of community development programme was launched in 55 project areas on 2nd October, the birthday of Mahatma Gandhi to get rid of three ills from the society namely poverty, ill health and ignorance through overall development of the rural areas. The programme was based on the philosophy of self help and working together. The provision of medical and public health services were the part of this programme.
• The Central Council of health was constituted.
• Primary Health Centres were set up to render health services in rural areas.
• **Auxiliary Nurse Midwife" (ANM ) training was started to train ANM to function in a network of subcentre and primary health centers in the rural areas and provide comprehensive Maternal Child Health (MCH) and Family Welfare Services under the direct supervision of Lady Health Visitors/Public Health Nurses at the block level.
The Year 1953
• The Community Development Programme was extended to National level on 2nd October and was called as Community Development and National Extension Service Programme.
• The National Malaria Control Programme was launched.
• The National Family Planning Programme was launched.
• A Committee was set up to draft a model Public Health Act for the country.
The Year 1954
• The contributory Central Government Health Scheme was started at Delhi.
• The Central Social Welfare Board was set up.
• The National Leprosy Control Programme was launched.
• The National Water Supply and Sanitation Programme was launched.
• The Prevention of Food Adulteration Act was enacted.
• VDRL Antigen Production Centre was set up at Kolkata.
• Shetty Committee was constituted by the Government of India on 19th May 1954 to survey the existing facilities for nursing services and emoluments available to nurses, to assess minimum requirements of nurses in the country and to make recommendations to overcome shortages of nurses and improve service conditions and emoluments. The findings of the committee revealed a grim picture with regard to working conditions, emoluments, status of nursing education and nursing services in the hospital and the community. The committee recommended to
-create a post of Nursing Superintendent in each State and to combine hospital nursing services and Public Health Nursing service into one service.
-Integrate Public Health Nursing in basic general nursing and midwifery course.
-Have I nurse (including students) for 3 patients in hospital with School of Nursing, 1 nurse for 5 patients in non teaching hospitals, 1 midwife for 100 births in rural areas, 1 midwife for 150 births in towns and cities, 1 public health nurse or health visitor for 10.000 population.
- Improve conditions of training of nurses like proper accommodation, proper facilities for practical work, qualified tutors and ward sisters. proper health care of students, shorter working hours.
- The committee also made recommendations for admission criteria, compulsory hostel stay for students and two years of service bond.
- The Committee made various recommendations in general to improve nursing care and nursing service condition of nurses.
The Year 1955
• The National Filaria Control Programme was launched.
• A Filaria Training Centre was set up at Ernakulum. Kerala
. • The Central Leprosy Teaching and Research Institute was started at Chingelput, Madras (Chennai now).
• National TB sample survey was started.
• The minimum marriage age of 18 years for boys and 15 for girls was prescribed by Hindu Marriage Act.
With all these developments, health and medical facilities improved. Health services were rendered to rural population from the Primary Health Centres (PHC). The standard of these centers varied from State to State and even within a State. The uniformity of PHC was done by laid down standards under Community Development and National Extension Service Programme.
THE SECOND FIVE YEAR PLAN (1956-1961)
The Aim : The aim of the Second Five Year Plan was to expand existing health services to bring them within the reach of all people so as to promote progressive improvement of Nation's health.
The Priorities : The priorities of the Second Five Year Plan were
• Establishment of institutional facilities for rural as well as for urban population.
• Development of technical manpower.
• Control of communicable diseases.
• Water supply and sanitation.
• Family Planning and other supporting programmes
The Health Outlay : An outlay of Rs. 225 crores was allocated for the Second Five Year Plan for health programmes which was 5.0 percent of the entire outlay for the total development plan. This proportionate outlay was less than the First Five Year Plan by .9 percent.
The Major Developments : The major developments of the Second Five Year Plan in accordance to priority areas were as under :-
The Year 1956
• Draft Model Public Health Act was prepared by the Committee and published.
• Director, Family Planning was appointed at the Centre.
• The Demographic Training and Research Centre was established in Mumbai.
• The Central Health Education Bureau was set up at the Centre.
• The Immoral Traffic act was enacted.
• The Tuberculosis Chemotherapy Centre was set up at Madras (Chennai).
• The R.C.A. Project was launched by the Central Government with the support of Ford Foundation. .
• The pilot project of Trachoma Control Programme was launched.
The Year 1957
• The demographic research centers were established in Delhi, Kolkata and Madras (Chennai).
The Year 1958
• The National Malaria Control Programme was converted into National Eradication Programme.
• The National Tuberculosis Survey was completed.
• The Leprosy Advisory Committee of the Government of India was launched.
• A three tier structure of local self-governing bodies from the village to the district level was recommended for decentralized power and responsibilities by Balwant Rai Mehta Committee on Panchayati Raj. These recommendations were endorsed by Naticnal Development Council.
The Year 1959
• The Mudaliar Committee was set up by the Government of India to undertake the review of developments that have taken place since the submission of Bhore Committee's report and to make recommendations from further developments and expansions of health services.
• Panchayati Raj was introduced in Rajasthan.
• The Nutrition Research Laboratory at Coonoor was shifted to Hyderabad.
• The National Institute of Tuberculosis was established at Bangalore.
• A central expert committee was constituted under the ICMR to study the problem of Small Pox and Cholera in India. The committee recommended programmes for their eradication.
The Year 1960
• Pilot projects of Small Pox eradication were started.
• Vital statistics were transferred from Directorate General of Health Services (D.G.H.S.) to the Registrar General of India, Ministry of Home Affairs.
• A National Nurtition Advisory Committee was formed to render advice on nutrition policies.
• The school health committee was appointed by the Union Ministry of Health to assess the existing health and nutrition status of school children and recommend measures to improve them..
THE THIRD FIVE YEAR PLAN (1961-66)
The Aim : The main aim of the Third Five Year Plan was to remove the shortages and deficiencies which were observed at the end of the Second Five Year Plan in the field of health. These were pertaining to Institutional facilities especially in rural areas, shortages of trained personnel, and supplies, lack of safe drinking water in rural areas and inadequate drainage system.
The Priorities : The priorites of the third Five Year Plan were as under
• Safe water supply in villages and sanitation especially the drainage programme in the urban areas.
• Expansion of Institutional facilities to promote accessibility especially in the rural areas.
• Eradication of Malaria and smallpox and control of various other communicable diseases.
• Family planning and other supporting services for improving health status of people.
• Development of manpower.
The Health Outlay :
An outlay of Rs. 342 crores was allocated for the Third Five Year Plan which was 4.3 percent of the overall layout for the entire development plan. Though the layout for health plan in crores is more than the layout for previous plan but the proportionate percentage of the total layout for the development plan was much less than the previous plan.
The Major Developments : The major developments during the Third Five Year Plan were as under:
The Year 1961
• The Central Bureau of Health Intelligence was established.
• The Mudaliar Committee report was submitted and published. The Committee reported significant developments and progress made in all the areas of health in terms of infrastructure, manpower, institutional facilities and quality of services etc.
The recommendations of the committee were considered by the Government and implemented in some manner through the successive five year plans.
The Year 1962
• The National Smallpox Eradication Programme and the National Goitre Control Programme were launched.
• The school health programme was started.
• The District Tuberculosis Programme was conceptualised.
• The Family Planning Training Centre and Family Planning Communications and Action Research Centre were amalgamated to form The Central Family Planning Institute in Delhi
The Year 1963
• The Applied Nutrition Programme was started by the Government of India, with the support of UNICEF. WHO and FAO.
• The Malaria Institute at Delhi was converted to National Institute of Communicable Diseases.
• The National Trachoma Control Programme was initiated.
• The name of "Contributory Health Service Scheme" was changed to "Central Government Health Scheme".
• Extended Family Planning Programme was introduced, the emphasis in this programme shifted from clinical approach to extended approach.
• The Defence Institute of Physiology and Allied Sciences were established.
• A drinking water board was established.
• The Chadha Committee was appointed by the Government to study the arrangements necessary for the maintenance phase of the National Malaria Eradication Programme.
The Year 1964
• The National Institute of Health Administration and Education was established in collaboration with Ford Foundation.
• A committee under the chairmanship of Shri Shanti Lal Shah was set up to study legislation of abortion.
The Year 1965
• Lippes Loop was recommended as a safe and effective Family Planning device by the Director. ICNI R.
• Reinforced extended Family Planning Programme was launched.
• B.C.G. Vaccination without tuberculin test was introduced on house to house basis.
• A committee under the chairmanship of Shri Mukharji. the Health Secretary, Government of India was set up to study the implementation of Chadha Committee recommendation and to review the strategy for Family Planning programme.
The Year 1966
• A separate department of Family Planning was set up in the Union Ministry of Health to co-ordinate Family' Planning Programme at the Centre and States.
• The postpartum Family Planning Programme was started in two hospitals one each in Delhi and Trivandrum by the Population Council under International Postpartum Family Planning Programme.
• A committee under the chairmanship of Health Secretary to the Government of India (Mukarji Committee 1966) was constituted to study the difficulties encountered by the State Government in taking over the burden of maintenance phase of various communicable diseases and to work out the strategy for the same.
The Year 1967
• A committee was set up on small family norm
• The Central Council of Health recommended compulsory payment by patients attending hospital i.e. a minimum charge of 10 paise per patient and a minimum charge of 25 paise per day of hospital stay.
• Madhok Committee was appointed to review the working of Malaria Eradication Programme and to recommend measures to improve its functioning.
The Year 1968
• A medical education committee was appointed to study the various aspects of medical education within the framework of national needs and resources.
• A Bill on registration of births and deaths was passed by the Parliament.
THE FOURTH FIVE YEAR PLAN (1969-1974)
The Fourth Five Year Plan did not start soon after the Third Five Year Plan due to some political reasons. It started in 1969. Annual plans were made having the same objectives from 1966 to 1969.
The Aim : The main aim of this plan was to strengthen Primary Health Centre network in the rural areas for undertaking preventive, curative and family planning services and to take over the maintenance phase of communicable diseases.
The Priorities : The priority area for the Fourth Five Year Plan were as follows
• Family Planning Programme.
• Strengthening of Primary Health Centres
. • Strengthening of subdivisional and district hospitals to provide effective referral support to Primary Health Centres.
• Intensification of control programmes.
• Expansion of medical and nursing education training of para medical personnel to meet the minimum technical manpower requirements.
The Health Outlay : Of the total outlay of Rs. 16.774 crores on the entire development plan, Rs 840 crores were allocated to health and Rs. 315 crores to family planning.
The Major Developments : The major developments during the Fourth Five Year Plan period were as below.
The Year 1969
• The Nutritional Research Laboratory was expanded to National Institute of Nutrition.
• Comprehensive Legislation for control of river water pollution from domestic and industrial wastes was drafted.
• The Central Births and Deaths Registration Act (1969) was promulgated.
• The report of Medical Education Committee (1969) was submitted. The Committee recommended –
The duration of MBBS course should be 4 1/2 years and one year for internship which should include 3 months of placement in rural field.
The teaching and training programme should be able to prepare basic doctor who are able to deal with basic health problems of rural and urban communities and who are able to provide preventive and curative services effectively.
The Year 1970
• The Population Council of India was set up.
• All India Hospital (Post-partum) Family Planning Programme was launched.
• The Demographic Training and Research Centre at Mumbai was changed to International Institute for Population Studies.
• Registration Act of the Births and Deaths (1969) came into force.
• Mobile training cum service units scheme was launched on the bitrth centenary of Late Shri Chiranjan Das on 5th November.
• The Drugs (Price Control) Order was promulgated.
The Year 1971
• The Family Pension Scheme (FPS) for Industrial workers was introduced
. • The Medical Termination of Pregnancy (MTP) Bill (1969) was passed by the Parliament.
• A committee was set up to draft legislation on air pollution.
The Year 1972
• The MTP Act was implemented.
• The National Nutrition Monitoring Bureau was set up by the ICMR at the National Institute of Nutrition at Hyderabad. Regional units were also established in the states.
• The National Service Bill to compel medical personnel below 30 years to work in the villages was passed.
• The Committee on "Multipurpose workers under Health and Family Planning" headed by Kartar Singh, the Additional Secretary of Health was set up.
The Year 1973
• The National Programme of Minimum Need Programme (MNP) was formulated.
• A scheme of setting 30 bedded rural hospital serving four Primary Health Centres was conceptualised.
• The Kartar Singh Committee submitted its report.
The recommendations of Kartar Singh Committee were considered and implemented in its modified form by the Government of India in successive Five Year Plans.
THE FIFTH FIVE YEAR PLAN (1974-79)
The Aim : The main aim of the Fifth Five Year Plan was to provide minimum level of well integrated health, MCH & FP. Nutrition and immunisation services to all the people with special reference to vulnerable groups especially children, pregnant women and nursing mothers. through a network of infrastructure in all the blocks and well structured referal system. The emphasis of the plan was on removing imbalance in respect of medical faciliteis and strengthening the health infrastructure in the rural and tribal areas.
The priorities : The priorities of the Fifth Five Year Plan were based on the minimum need programme and were as under
• Increasing accessibility of health services in rural areas.
• Correcting regional imbalance.
• Further development of referral services by removing deficiencies in district and subdivision hospitals.
• Integration of health, Family Planning and nutrition.
• Intensification of the control and eradication of communicable diseases especially Malaria and Smallpox.
• Qualititative improvement in the education and training of health personnel.
The Health layout : The total outlay for the over all development plan was Rs 37, 382 crores out of which a sum of Rs. 682 crores were allocated for Health programmes and Rs. 497 crores were allocated to Family planing programmes.
The Major Developments : The major developments during the fifth five year plan were as under
The Year 1974
• Revised strategy for Malaria control was suggested by "Second indepth Evaluation committee and the Consultative Committee of experts on Malaria Eradication Programme."
• The year 1974 was declared as World Population Year by the United Nations.
• The Water (Prevention and Control of Pollution) Act 1974 was enacted by the Parliament.
• "A group on medical education and support manpower" popularly known as the Shrivastava Committee was set up in November 1974 to
- Device suitable curriclum for training a cadre of health assistants conversant with basic medical aid, preventive and nutritional services, MCH and Family Welfare activites so as to serve as a link between Medical officer and health workers (male and female) and to form an effective team to deliver service to people.
- Suggest steps for improving medical education that fits into the national requirements.
-To make any other suggestion to realise the above mentioned objectives and matters incidental thereto.
The Year 1975
• India became small pox free on 5th July 1975.
• The revised strategy of National Malaria Eradication Programme was accepted by the Governmment.
• Integrated Child Development Scheme was launched on 3nd October 1975
. • Children's Welfare Board was set up.
• The ESI Act was ammended.
• The Cigaratte Regulation Act 1975 was enacted by the Parliament.
• Shrivastav Committee, "the group on medical education and support manpower submitted its report.
The Year 1976
• Indian Factory Act of 1948 was amended.
• The Prevention of Food Adulteration (Ammendment) Act 1975 came into force on 1"Apri11976.
• The Central Council of Health proposed a 3 tier plan for medical care in villages.
• A New Population Policy was announced by the Government.
The Year 1977
• Rural Health Scheme was launched on the basis of Kartar Singh and Shrivastav Committee report.
• The training of community health workers was initiated.
• Revised modified plan of Malaria Eradication was implemented.
• The 42nd Ammendment of the Constitution i.e."Population Control and Family Planning" the subject of concurrent list was made.
• The "Goal of Health for All (HFA) was adopted by World Health Organization. India was one of the member countries in that assembly. • The ROME Scheme was start_:
The Year 1978
• The Child Marriage Restraint (ammendment) Bill 1978 fixing the minimum marriage age i.e. 21 years for boys and 18 years for girls was passed.
• Alma Ata declared "Primary Health Care Strategy" to achieve the goal of "Health for All" by the year 2000. India was one of the signatories to this declaration.
• Extended programme of immunization was started.
The Year 1979
• The declaration of Alma Ata on primary health care strategy was endorsed by WHO.
Minimum Needs Programme
MNP was first introduced in fifth five year plan to combat poverty. The state has a duty to provide the basic needs of life to every citizen – needs in terms of health ,education , food , water, shelter etc.
1. Eementary education,
2. Adult education,
3. Rural health,
4. Rural water supply,
5. Rural road,
6. Rural electrification.
7. House sites/houses for rural landless labourers,
8. Environmental improvement of slums,
9. Nutrition.
Health Sector Minimum Needs Programme
Health in its wider concept cannot be attained by the health sector alone. Economic development, antipoverty measures, food production and distribution, drinking water-supply, sanitation, housing. environmental protection and education all contribute to health and have the common goal of human development. Health services is an integral part of overall social and economic development will of necessity rest on proper co-ordination at all levels between the health and all other sectors concerned. The initiative if already such mechanism does not exist, may be taken by the health department of the State to ensure effective co-ordination with the other departments concerned. 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 modifications in the pattern of assistance of various schemes which have been conveyed to the State Governments separately with the changes made the following schemes/programmes included in the health sector MNP
.1. 100 per cent 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 officers
2. Centrally assisted scheme
Multi pupose workers scheme.
3.State sponsered scheme
Subsidiary health centers PHC CHC
THE SIXTH FIVE YEAR PLAN (1980-1985)
The Aim : The main aim of the Sixth Five Year Plan was to workout alternative strategy and plan of action for Primary Health Care as part of national health system, which is accessible to all sections of society and especially those living in tribal, hilly, remote rural areas and urban slums.
The Priorities : The priorities of the Sixth Five Year Plan were listed as under
• Rural health services.
• Control of communicable and other diseases.
• Development of rural and urban hospitals/dispensaries.
• Improvement in medical education and training.
• Medical research.
• Drug control and prevention of food adulteration.
• Population control and Family welfare including MCH. Water supply and sanitation. Nutrition.
The Health Outlay : The over all layout for the sixth development plan was Rs. 97, 500 crores. Out of this amount. Rs. 1,821.05 crores was allocated for health programmes and Rs. 1,010.00 crores was given for family welfare programmes.
The Major Developments : The major developments during the Sixth Five Year Plan are enumerated year wise.
The Year 1980
• WHO declared eradication of small pox from the World
. • The working group on health was constituted by the Planning Commission under the Chairmanship of Health Secretary Shri Kirpa Narain on 18th of July.
The Year 1981
• The 1981 census was under taken.
• The Primary health care strategy for Health for All was evolved by WHO and adopted by member countries of WHO
• India committed itself to the goal of providing safe drinking water and adequate sanitation for all, by 1990, under the International Drinking Water Supply and Sanitation Decade 1981- 1990.
• The Air Prevention and Control of Pollution Act of 1981 was enacted.
THE SIXTH FIVE YEAR PLAN (1980-1985)
The Aim : The main aim of the Sixth Five Year Plan was to workout alternative strategy and plan of action for Primary Health Care as part of national health system, which is accessible to all sections of society and especially those living in tribal, hilly, remote rural areas and urban slums.
The Priorities : The priorities of the Sixth Five Year Plan were listed as under
• Rural health services.
• Control of communicable and other diseases.
• Development of rural and urban hospitals/dispensaries.
• Improvement in medical education and training.
• Medical research.
• Drug control and prevention of food adulteration.
• Population control and Family welfare including MCH.
Water supply and sanitation.
Nutrition.
The Health Outlay : The over all layout for the sixth development plan was Rs. 97, 500 crores. Out of this amount. Rs. 1,821.05 crores was allocated for health programmes and Rs. 1,010.00 crores was given for family welfare programmes.
The Major Developments : The major developments during the Sixth Five Year Plan are enumerated year wise.
The Year 1980
• WHO declared eradication of small pox from the World.
• The working group on health was constituted by the Planning Commission under the Chairmanship of Health Secretary Shri Kirpa Narain on 18th of July.
The Year 1981
• The 1981 census was under taken.
• The Primary health care strategy for Health for All was evolved by WHO and adopted by member countries of WHO
• India committed itself to the goal of providing safe drinking water and adequate sanitation for all, by 1990, under the International Drinking Water Supply and Sanitation Decade 1981- 1990. • The Air Prevention and Control of Pollution Act of 1981 was enacted.
o The working group on Health for All, published its report..
o The Centre and States/Union Territories to achieve the indicators of Health for All
by 2000 AD, identified by the group. o Under the Minimum Need Programme, each State/Union Territory to review its
health service structure and to adopt the model health service structure as recommended so as to promote decentralised and participatory approach involving the community in planning. implementation and maintenance of health services.
o To establish health post in urban slums of 5000 population as extension of nearest
hospital to provide primary health care services.o States/ Union Territories to evolve a phased action plan by taking into view what
already exists and what would be required to be established by 2000 AD. o The Government of India must evolve and issue policy statements in regard to :
National Medical and Health Administration Policy, and National Population Policy.
The Year 1982
• The National Health Policy was announced and placed in the Parliament.
• The 20 point programme was announced.
The Year 1983
• National Leprosy Control Programme was changed to National Leprosy Eradication Programme.
• National Health Policy was approved by the Parliament.
• National Guinea Worm Eradication Programme was started.
• A National Plan of Action against Avoidable Disablement was started.
• Medical education review committee submitted its report.
The Year 1984 • Bhopal Gas tragedy, a devastating industrial accident occurred.
• The ESI (ammendment) Bill 1984 was passed by the Parliament. • The Workmen's Compensation (ammendment) Act 1984 came into force.
THE SEVENTH FIVE YEAR PLAN (1985-1990)
The Aim : The aim for the Seventh Five Year Plan was to plan and provide primary health care and medical services to all with special consideration of vulnerable groups and those who are living in tribal, hilly and remote rural areas so as to achieve the Goal of Health for All (HFA) by 2000 A.D. The plan emphasised on community participation, inter sectoral co-ordination and co-operation.
The Priorities : The priorities of the Seventh Five Year Plan were
• Health services in rural, tribal and hilly areas under Minimum Need Programme.
• Medical education and training
. • Control of emerging health problems especially in the area of non communicable diseases.
• MCH and Family welfare.
• Medical research.
• Safe water supply and sanitation.
• Standardisation, integration and application of Indian system of medicine.
The Health Outlay : The total amount of funds which were allocated to the development plan was Rs. 180,000 crores. 89.00 crores (1.9%) was allocated for health and Rs. 3256.25 crores (1.8 %) was allocated to family welfare, out of Rs. 3392.00 crores.
The Major Development : The major developments during the Seventh Five Year Plan was as under :
The Year 1985
• The Universal Immunization Programme was launched on 19th of November, the birth day
of Late Prime Minster Sint. Indira Gandhi.
• The Lepers Act 1898 was repealed (revoked) by the Parliament.
• A separate department of women and child development was established by the Ministry of Human Resource Development.
The Year 1986
• The Enviroment Protection (ammendment) 1986 was promulgated.
• The 20 point programme was modified.
• Parliament passed Mental Health bill.
• Juvenile Justice Act started working.
• National AIDS Control Programme was started.
The Year 1987
• World-wide Safe Motherhood Campaign was started by World Bank.
• New 20 point programme was launched.
• The Factories (ammendment) Act 1987 started working.
• National Diabetes Control Programme was launched
. • A high power committee on nursing and nursing profession was set up by the Government of India on 29th July 1987 under the chairmanship of Smt. Sarojini Vardapan.
The Year 1988 to 1991
• The ESI (ammendment) Act 1989 came into force.
• Acute Respiratory Infection (ARI) programme was started as a pilot project in 14 districts in 1990.
• The 1991 census was conducted.
• The high power committee on nursing and nursing profession published its report in 1989.
THE EIGHTH FIVE YEAR PLAN (1992-1997)
The Aim : The main aim of this plan was to infrastructure and Medical services accessible to tribal, hilly, remote rural areas etc.
The Priorities : The priority areas for the Eight
• Developing rural health infrastructure
• Medical education and training.
• Control of communicable diseases.
• Strengthening of health services.
• Medical research.
• Universal Immunization
. • MCH and Faimily Welfare.
• Safe water supply and sanitation.
The Health Outlay : The over all amount of funds which was allocated to development plan was Rs. 79800 crores, out of this fund Rs. 7,575.92 crores was allocated to health and Rs. 6,500 crores was allocated to family welfare.
Major Developments : The major developments during Eighth Five Year Plan were listed year wise as under
The Year 1992
• Child survival and Safe Motherhood Programme (CSSM) was started on 20th August.
• The Infant milk substitute, Feeding bottles and Infant foods (Regulation of production, supply and distribution) Act 1952 came into operation.
The Year 1993
• A revised strategy or National Tuberculosis Programme with Direct Observed Therapy (DOTS)- a community based TB treatment and care strategy was introduced as a pilot project in phased manner.
The Year 1994
• The Panchayati Raj Act came into operation.
• Outbreak of Plague epidemic.
• The first Pulse Polio Immunization Programme for children under 3 years was organized on 2nd October and 4th December by Delhi Government.
• Post basic Three year B. Sc. Nursing Programme was launched through distance education by Indira Gandhi National Open University (1GNOU).
The Year 1995
• Integrated Child Development Scheme (ICDS) was changed to Integrated Mother and Child Development (IMCD) services.
• Transplantation of Human Organs Act was enacted.
• Expert Committee on Malaria submitted its report.
The Year 1996
• Nation wide Pulse Polio Immunization was conducted on 9th December 1995 and 20th January 1996 which was repeated on 7th December 1996 and 18th January 1997.
• Family Planning Programme was made target free from 1st April
. • Pre-natal Diagnostic Technique (Regulation and Prevention of Misuse) Act 1994 came into force from January.
THE NINTH FIVE YEAR PLAN (1997-2002)
Due to some political reasons the Ninth Five Year Plan couldn't commence on 1st of April 1997. It could commence on 19th of February 1999. In the mean time yearly plans were planned and implemented..
The Aim : The ninth plan continued with the same aim as that of eighth plan which was mainly concerned with reorganization and strengthening of infrastructure so as to provide primary health care services accessible to all especially those living in remote rural, hilly and tribal areas.
The Objectives : The objectives of the Ninth Five Year Plan were as under :
• To tackle both communicable and non-communicable diseases effectively so that there is sustained improvement in the health status of the population.
• To further intensify the efforts to improve the health status of the population by optimising coverage and quality care by identifying the critical gaps in infrastructure, manpower. equipments. essential diagnostic reagents and drugs etc.
The Priorities : The major priorities of the Ninth Five Year Plan were :
• Control of communicable and non-communicable diseases.
• Efficient Primary Health care system as part of basic health care services to optimise accessibility and quality care.
• Strengthening of existing infrastructure.
• improvement of referral linkages.
• Development of human resources, meeting increasing demands of nurses in speciality and super speciality areas.
• Strengthening of existing national vertical programmes.
• Disaster and emergency management.
• Strengthening of health research.
• Involvement of practitioners from indigenous system of medicine. Voluntary and private organizations
. • Inter-sector co-ordination.
The Approach During the Ninth Five Year Plan
• Providing efficient Primary Health Care system as part of basic services to improve accessibility and quality services.
• Strengthening of existing infrastructure at primary, secondary and tertiary care settings and improvement of referral linkage.
• Development of human resources for health. Meeting the increasing demands for trained nurses in specialised areas.
• Strengthening of MCH and Family Welfare Programme.
• Strengthening of existing programmes.for control of communicable diseases and horizontal integration of ongoing vertical programmes at the district and below district level.
• Develop and implement integrated non-communicable disease prevention and control programmes.
• Screening for common nutrition deficiencies especially in vulnerable groups and render , remedial services. Gic
• Strengthening of environmental health programme for better management of health ' consequences.
• Strengthening of occupational and industrial health programmes.
•Disaster and emergency management at all levels of health care.
• Strengthening of food and drug safety programme.
• Increasing the involvement of practitioners from indigneous systems of medicine in meeting health care needs of the people.
• Strengthening of basic, clinical and health system research.
• Increasing the involvement of voluntary, private organizations and self help groups in the provision of health care.
• Intersector co-ordination in implementation of health programmes.
Significant Events were as Under
• Reproductive and Child Health Programme was launched.
• Government of India announced National Population Policy 2000.
• National Malaria eradication programme was renamed as National Anti Malaria Programme in 1999.
• National Family Health Survey -2 was undertaken in 1998-1999.
• Phase ff of National AIDS Control programme started.
• Census 2001 was completed.
• Govt. of India announced National Health Policy 2002.
• Govt. of India announced National AIDS Prevention and Control Policy 2002.
TENTH FIVE-YEAR PLAN (2002–2007)
On the eve of the 10th Plan, the draft National Health Policy 2001 has been announced and for the
first time feedback invited from the public. "Universal, comprehensive, primary health care services",
the NHP 1983 goal, is not even mentioned in the NHP 2001 but the latter bravely acknowledges that
the public health care system is grossly short of defined requirements, functioning is far from
satisfactory, that morbidity and mortality due to easily curable diseases continues to be unacceptably
high, and resource allocations generally insufficient.
During the 10th plan, efforts were further intensified to improve the health status of the population by
optimizing coverage and quality of care by identifying and rectifying the critical gaps in infrastructure
manpower, equipment, essential diagnostic reagents and drugs. The approach during the 10th plan
were to improve the access to and enhance the quality of primary health care in urban and rural areas
by providing and optimally functioning primary health care system as a part of basic minimum
services and to improve the efficiency of existing health infrastructure at primary, secondary and
tertiary care settings through appropriate institution strength and improvement of referral linkages.
Target changed from expansion of services to enhancement of human well being
Monitarable targets are:
Reduction in poverty ratio by 5% ,by 2007,and 15%points by 2012
All children in school by 2003,and to complete 5 years schooling by 2007
Reduction in gender gap literacy and wage rates by at least 50%by 2007
Reduction in decadal rate of population growth between 2011and 2011 to 16.2%
Reduction in M.M.R to 2/1000 LIVE Births by 07 and to 1 by 2012
All villages have sustained access to potable drinking water with in plan period
Reduction in I.M.R to 45/1000 live births 2007 and 28 by 2012
Attain 8% GDP growth per year.
Providing gainful and high-quality employment at least to the addition to the labour force;
Increase in Literacy Rates to 75 per cent within the Tenth Plan period (2002 - 2007)
ELEVENTH FIVE-YEAR PLAN (2007–2012)
The eleventh plan has the following objectives:
Income & Poverty
Accelerate GDP growth from 8% to 10% and then maintain at 10% in the 12th Plan in order double
per capita income by 2016-17
1. Increase agricultural GDP growth rate to 4% per year to ensure a broader spread of benefits
2. Create 70 million new work opportunities.
3. Reduce educated unemployment to below 5%.
4. Raise real wage rate of unskilled workers by 20 percent.
5. Reduce the headcount ratio of consumption poverty by 10 percentage points.
6. Education
7. Reduce dropout rates of children from elementary school from 52.2% in 2003-04 to 20% by 2011-12
8. Develop minimum standards of educational attainment in elementary school, and by regular testing
monitor effectiveness of education to ensure quality
9. Increase literacy rate for persons of age 7 years or above to 85%
10. Lower gender gap in literacy to 10 percentage point
11. Increase the percentage of each cohort going to higher education from the present 10% to 15% by the
end of the plan
Health
12. Reduce infant mortality rate to 28 and maternal mortality ratio to 1 per 1000 live births
13. Reduce Total Fertility Rate to 2.1
14. Provide clean drinking water for all by 2009 and ensure that there are no slip-backs
15. Reduce malnutrition among children of age group 0-3 to half its present level
16. Reduce anaemia among women and girls by 50% by the end of the plan
17. Women and Children
18. Raise the sex ratio for age group 0-6 to 935 by 2011-12 and to 950 by 2016-17
19. Ensure that at least 33 percent of the direct and indirect beneficiaries of all government schemes are
women and girl children
20. Ensure that all children enjoy a safe childhood, without any compulsion to work
21. Infrastructure
22. Ensure electricity connection to all villages and BPL households by 2009 and round-the-clock power.
23. Ensure all-weather road connection to all habitation with population 1000 and above (500 in hilly and
tribal areas) by 2009, and ensure coverage of all significant habitation by 2015
24. Connect every village by telephone by November 2007 and provide broadband connectivity to all
villages by 2012
25. Provide homestead sites to all by 2012 and step up the pace of house construction for rural poor to
cover all the poor by 2016-17
26. Environment
27. Increase forest and tree cover by 5 percentage points.
28. Attain WHO standards of air quality in all major cities by 2011-12.
29. Treat all urban waste water by 2011-12 to clean river waters.
30. Increase energy efficiency by 20 percentage points by 2016-17.
Approach to the Twelfth Five-Year Plan (2012-2017)
The Planning Commission has two alternative targets for economic growth in the Twelfth Plan. The first
being a repetition of the previous Plan target of 9% growth, that is yet to be achieved. The second is, however an
even higher target of 9.5% average growth for the Twelfth Five Year Plan. Numerous macro‐economic
techniques have been used to examine the feasibility of these targets in terms of internal consistencies and inter‐sectoral balances. The sectoral growth rates broadly consistent with the 9% and 9.5% alternatives are presented
in the table below. The 9% target requires a significant acceleration in growth in agriculture, electricity, gas,
water supply and also manufacturing. Agricultural growth has always been an important component for
inclusiveness in India, and recent experience suggests that high GDP growth without such agricultural growth is
likely to lead to accelerating inflation in the country, which would jeopardise the larger growth process.
However, even if such agricultural growth is achieved, it is unlikely that the agricultural sector will absorb
additional workers. Thus, the main onus for providing additional jobs to the growing labour force will rest on
manufacturing and construction and on the services sectors. The target set for the mining sector, mainly
reflecting additional production of coal and natural gas, is also very demanding, but is necessary to meet the
primary energy requirements without resorting to excessive imports. As shown in the table below, taking the
growth rate to 9.5% would require much faster growth in the manufacturing, as well as in electricity, gas and
water supply sectors. The feasibility of achieving such large acceleration in key sectoral performance needs to be
considered carefully before the growth targets for the Twelfth Plan are fixed. This is particularly true for the
energy sector where supply constraints could be severe.
.Achievements during the Plan periods
1st Plan 1951-56
10th Plan 2002-2007 (March 2007)
Primary Health Centres 725 22,370Subcentres NA 145,272Community health centres : 4,045Total beds (2002) 125,000 914,543Medical colleges 42 270Annual admissions 3,500 30,408in medical colleges
Dental colleges 7 ; 205Allopathic doctors 65,000 767,500Nurses 18,500 928,149ANMs 12,780 526,242Health visitors 578 50,393Health Workers (F) - 147,439
(in position)
Health Workers (M) - : 62,881
(in position)
Block Extension Educator 4,068
Health Assistant (M) 20,234
(in position)
Health Assistant (F)/LHV 17,919
(in position)Village Health Guides (2002) 323,000
Investment in different plan periods (in Rs. Crores)
Period Total plan Health Family Water supplyInvestment Welfare & sanitation
I Plan (1951-56) 1960.00 65.20 0.1 NAII Plan (1956-61) 4672.00 140.80 2.20 NAIII Plan (1961-66) 8576.00 225.00 24.90 10.70Annual Plans (1966-69)
6625.40 140.20 70.50 102.70
IV Plan (1969-74) 15,778.80 335.50 284.40 458.90V Plan (1974-79) 39,322.00 682.00 497.40 971.001979-80 Outlay 11,650.00 268.20 116.20 429.50VI Plan (1980-85) 97,500.00 1,821.05 1,010.00 3,922.02VII Plan (1985-90) 180,000.00 3,392.89 3,256.26 6,522.47Annual Plan (1990-91) 61,518.10 960.90 784.90 1,876.80Annual Plan (1991-92) 72,316.80 1,185.50 749.00 2,514.40VIII Plan (1992-97) 798,000.00 7,575.92 6,500.00 16,711.03IX Plan (1997-02) 859,200.00 10,818.40 15,120.2
0-
X Plan (2002-07) 1,484,131.30 31,020.30 27,125.00
-
XI Plan (2007-12) .. - 46,669.00 89,478.00
175,000.00
.
Research Studies
1. Jean – Frederic Levesque conducted a study regarding the outpatient care utilization in urban kerala, find out that few inequalities in access was found out. Escalation of post of private services and reduced public investments generated some inequalities in access for the poor.
2. In 1996, Kerala Govt bought primary health centers under the control of panchayats. D.Varadarajan conducted a study to assess the performance of primary health centres under decentralized government in Kerala. Study revealed decentralization bought no significant change to the health sector. Active panchayat support to PHCs existed in only few places.
CONCLUSION
The economy of India is based in part on planning through its five-year plans, which are developed, executed and monitored by the Planning Commission. The tenth plan completed its term in March 2007 and the eleventh plan is currently underway. Five year plan helped us to • control and eradication of major communicable diseases ,strengthening of basic health services through the establishment of primary health centres and sub-centres,population control, and development of health manpower resources.
HEALTH PLANNING IN INDIA
Health planning in India is an integral part of national socio economic planning. The
guide-lines for national health planning were provided by a number of committees dating back to Bhore
committee in 1946. These committees were appointed by the Government of India from time to time to
review the existing health situations and recommend measures for further action.
1. BHORE COMMITTEE, 1946
The health service in India were developed after Bhore Committee Report. A definite plan for health
services upto village levels were developed.
The Government of India in 1943 appointed the Health Survey and Development Committee with
Joseph Bhore as chairman, to survey regarding the existing position regarding the health conditions and
health organizations in the country and to make recommendations for the future development.
The committees dealing with subjects
Public health
Medical relief
Professional education
Medical research
Industrial health
The committee met regularly 2yrs and submitted report in1946 which was presented in four volumes.
Some important recommendations were:
Integration of preventive and curative services of all administrative levels
Development of PHC in two stages
a) Short term measures
b) Long term measures
Short term measures: one primary health centre will cater to a population of
40000. Each PHC was to be manned by:
Doctor -2
Nurse -1
Public health nurses -4
Midwives -4
Trained dais -4
Sanitary inspectors -2
Health assistance -2
Pharmacist -1
Class IV employees -15
Secondary health centre was also envisaged to support to PHC and to co-ordinate and supervise
their functioning.
Long term programme : it was proposed to set up primary health units with 75 bedded hospitals
for each 10,000 to 20,000population and secondary unit with 650 bedded hospital, again regionalized
around district hospitals with 2500 beds.
It was proposed to have major changes in medical education which include:
Three month training in preventive and social medicine to prepare “ social physician”.
Although the Bhore Committee’s recommendations did not form part of a comprehensive plan for
national socio-economic development, the Committee’s report continues to be a major national document,
and has provided guidelines for national health planning in India.
MUDALIAR COMMITTEE, (1962)
Government of India appointed MudalLar Committee also known as Health Survey
and planning on 12th June 1959. Dr. A. Lakshmanaswami was the Chairman and submitted the report in
October 27th 1961r Six Sub Committees was set up for analysing the condition of public health, medical
relief, population problem, communicable disease, professional education and drugs and medical appliance.
Recommendations of Mudaliar Committees
- Medical care
- Public health
- Communicable diseases
- Imputation problem
- Professional education
- Medical research
- Indigenous system of medicine
- Drugs and medical supplies
- Legislation
- Health administration
1)Medical Care : It was recommended to further open Primary Health Centres on the existing pattern
and new PHCs that are to be opened should be on a pattern suggested to serve a population of 40,000 and
with complete staff.
Provide medical services to the rural population through mobile units in mobile vans eg: those
requiring hospitalization and specialist services can be brought in ambulance to the talukas or the district
hospital.
Residential accommodation to all personnel of the centre should, be provided. And there should
be suitable communication facilities including an ambulance and a jeep at every centre.
Training should be given to prepare large number of medical and nursing students.
Medical officers should be given non-practicing allowance and should not be allowed to
practice privately.
On rotation basis all medical officers should be given rural assignments and preference for post-
graduate training should be given to those who have served in the rural areas.
Taluka hospitals should have a minimum bed strength of 50 and should have 3 medical officers
dealing with medicine, surgery, obstetrics and gynecology.
The district hospitals should occupy key position with regard to medical care & should be
expanded from 300 to 500 beds out of which 75 bed should be set apart for maternity services and so far
paediatrics. All specialist services should be provided. There should be an isolation unit with 50 beds
attached to the district hospitals. Also district hospitals should be linked with teaching hospitals to give
assistance and guidance in matter of investigation, diagnosis & treatment.
Each taluk hospital should have 10-15 beds in isolation for TB cases. District hospitals should
have psychiatric clinic and 5 to 10 beds for psychiatric cases.
Medical care facilities should be made available to all employees, in the railway factories &.
Plantations.
Services for handicapped children should be organized.
Private practitioners can be utilized in providing public health services like mass immunizations,
school health, family planning & health education.
2)Public health
a) Water supply and Sanitation -.
Water supply to every village with a population of 5000 before the end of 4'h plan should be
provided.
In every State, a pilot project should be set up to study various methods of disposal of sewage &
human excreta. Block development organization in each area should take the responsibility to fabricate
appropriate rural latrines.
b) Housing ;
Housing accommodation should be made available to all employees.
Air Pollution ■
Establish monitoring machinery to assess the degree of contamination &to determine the
permissible levels of different contaminants.
Legislative measures should be taken to control arc pollution occuring from. industrial
smoke.
Safe limits, of various pollutants and effects of human physiology should be studied.
d) Maternal & Child Health :
Maternal and-child health services in hospitals should be co-ordinated with maternal & child
health centres.
The services such as immunisation, nutrition, education apart from mother and child care
should be provided.
MCH centres should serve as integrated units.
MCH staff should give talks, demonstrations,film shows, family planning education, home
visitsand health educations in the homes of people
Under graduate should have more experience and practical training in antenatal and
poslnatal care.
e) School Health :
PHC should act as a base for school health service and one MO. should serve for 5000 children.
Medical check up at the time of entrance and again after an interval of 4 years is required.
All health directorates should establish school health bureau.
Immunization and sanitary services should be provided in the schools.
Mid day meals should be provided in all schools.
Birth and vaccinations certificates should be made compulsory for admission to schools.
General hygiene and sanitation in school premises and their surroundings should be improved.
f ) Nutrition :
There was still gap in the production of protective foods. Sixty million acres of cultivable land
still to be developed and seventy million acres of fallow land should be fully utilized,
Milk, production, poultry farming and fish production should be increased.
Special attention should be paid to the production of vegetables and fruits.
More nutrition sections in the state health departments should be opened.
Qualified nutritionists and dieticians should be employed.
Iron supplements, protein rich food and vitamins should be supplied to vulnerable groups in
rural areas.
Prevention of food adulteration needs to be enforced more rigorously.
g)Vital Statistics :
There should be co-ordination between vital and health statistical units in states and registrar -
general and international agencies.
A central health statistics act should be enacted to bring out uniformity in the collection
reporting.
Vital statistics should also include information on the socioeconomic and cultural pattern of he
community.
3) Communicable Diseases :
In each zone, an organizational set up is required representing the central and state government.
Laws to be enforced in regard to notification of CDs
Isolation blocks for suspected cases.
In each state there should be a chain laboratories and a fully equipped mobile epidemiological
unit.
a) Malaria : It was hoped that malaria eradication programme of India will achieve the target in
course of 4lh plan period. Attention lo be drawn towards following aspects or problems:
- Development of resistance in mosquitoes to insecticides, possibility of insects other than
malaria vectors becoming resistance to the insecticide in use and careful consideration of
routine use of insecticide to insect home diseases of man and animals.
b) Filariasis :
- In each, there should be separate section for filariasis in the epidemiological bureau.
- One research cum raining unit should be established in each stale when it is a major
problem.
- Adequate drainage facilities need to be provided for long term solution of the problem.
c) Tuberculosis
It was recommended to continue mass BCG vaccination during 3rd five year plan.
Tuberculosis schemes should be integrated with other vaccination programme.
In each state, one demonstration and training centre should be set up.
In each state exclusively there should be an incharge of tuberculosis programme in DHS.
Facilities or rehabilitation & after care should be provided
c) Leprosy :-
Segregation cannot considered as a practical approach for eradication of leprosy.
Emphasis should be laid on the early detection and treatment of cases.
Training of personnel involved for treatment of leprosy should be given.
Centre for reconstructive surgery should be established.
Facilities for rehabilitation of leprosy patients should be provided.
Research on the possible use of chemoprophylaxis in contacts as well as the use of BCG
vaccination since no positive data are yet available regarding adequacy of these methods
e)Small pox:
On termination of small pox eradication programme, follow up by a sustained programme of
revaccination and primary vaccination of new born babies.
Need to have improvement in the method of reporting vital statistics, and adequate supervision
of vaccination.
There is need to form district anti epidemiology committees and state epidemiological units.
f)Cholera :
Government of India, in 1958 appointed expert committee for early detection and notification
of cases, vaccination for control of epidemic chlorination for disinfection of water, establishment of
epidemiological Units and spread of health education. Recommendations made by the expert
committee were fully endorsed.
g) Veneral diseases :
It was recommended to:
Collect information i.e. monthly reports from all States on the type of different VD treated.
Serological survey in selected groups of population.
Free supply of pencillin.
Strengthen training centres.
Take measures to discourage prostitution.
National VD control programme should be instituted.
4) Population Problem ;
To solve the population problem, family planning services to be provided to people.
During 1st five year plan, 21 rural and 126 urban family planning clinics were sett up and in 2nd five
year plan, there were 1079 rural & 421 urban family planning clinics. Advice and appliances related to
birth control was given to over 10 lakh. About 1.32 lakh sterilization operations have been carried out
till June 1961- The recommendations made were.
_ Demographic, sociological and anthropological studies need to be carried out for decid ing
methods suited to each area.
_ All the centre, to establish an independent ministry.
_ Setting up of plants for the indigenous manufacture of contraceptive appliances.
_ Strengthening of educational and propaganda aspects of FP movement.
_ Each and every health worker should be oriented in methods of family planning
5) Medical education
The recommendations for undergraduate education:
One medical college for at least 5 million populations.
Number of admissions should not ordinarily exceed 100.
Teacher-student ratio should be 1:5
Integrated method of teaching involving professors of both clinical and paraclinical
subjects.
b) For Post-graduation education :
Establishment of 6 regional centres besides AIMS during 3rd plan.
30
At least one will develop PG centre of training in each state.
6)Medical Research
The research institute should be the source for two types of research activity -
Fundamental & Field research. ICMR should be a central organization to collect information
from international centres.
_ Research unit in every medical college should be set up and one statistics unit in
every research institute.
7) Indigenous system of medicine :
It was recommended to integrate modem medicine and Ayurveda. The students of
Ayurveda should have a good knowledge in Sanskrit. PG centres in Ayurveda should be set up
and opportunities should be given to be trained in modern medicine. The central and state
Government should provide sufficient financial support to trainees in Indian system of
medicine.
8) Drugs and Medical Appliances : Recommendations made related to drug and medical
appliances were
Stringent measures should be taken to enforce the conditions of licensing
Fully equipped analytical labs should be established in states where substantial drug
manufacture is going on. Research wing should be attached to selected laboratories.
The import, manufacture, distribution, and sales of drugs should be confined to the list
prepared by expert committee.
9)Legislation
Universities should accept standards laid down by Indian Medical Council.
Recognition of degrees should be with reference to universities
There is no need for Indian Medical Council to seek approval of medical councils of
other countries in regard to recognition of degrees awarded in India.
Registration is must before starting the practice
10) Health Administration
At central level.
Establishment of health intelligence bureau in central health organization.
31
Formation of separate division on medical education in DGHS
Separate section dealing with international health matters in the directorate
Health education bureau should be set up in the central and state health directorates
At the state level
Each state should have a health ministry headed by DHS. In addition, there should be
a state health advisory board.
At district level
District medical and health officer will be responsible
At peripheral level
PHC medical officers should belong to the state cadre under DHS.
CHADHA COMMITTEE,1963
A sub committee formed by Government of India under the chairmanship of the Director
General of health Services, meeting on 3rd and 4th september 1962, gave consideration to
a ) The absorption of the activities of the maintenance phase into the general health services
b) Strngthening of basic rural health services
c) Training of personal engaged in specialized mass campaigns to become multipurpose
workers to that they can continue to follow up the measures required for the maintenance phase
as a part of the routine health activities.
d) On the basis of recommendations of the subcommittee, a special committee was consti-
tuted in April 1963 under the chairmanship of Director General of Health services. The
committee met thrice. It considered that the maintenance is the responsibility of the general
health services, which should be adequately strengthened, particularly the rural health ser-
vices.
The recommendations of the committee are :
1) Vigilance through medical institutions must be developed to the fullest extent- All medical
institutions Government or non Government, private, medical practitioners & Other health
workers should be harmessed. The members of Panchayats, block development committees,
mahila mandal youth clubs, other voluntary agencies, to teachers etc. should participate and
efforts should be made so that every village halmet or locality has one voluntary collaborator.
32
2) All efforts should be made to establish primary health centres provided for in the current
plan period particularly in the areas entering the maintenance phase.
3) In urban areas, institutional case detection should be the mainstay.
4) There should be facility for detection of fever case and for taking blood smears from all
suspected malaria and inadequately explained fever cases through domocillary case detection
and special investigation.
5) Domiciliary services should be developed for all health programmes including malaria, smal1
pox, control of other communicable diseases, health education etc.
6) The basic service unit should over not more than 5000 population. However, owing to
limitations of financial and material resources at present the basic service unit should cover
about 10000 population.
7) It should be staffed by a midwife, A.N.M and a Health assistant or auxiliary health worker.
There should be a midwife or A.N.M. for every 5000 population. However, in view of limited
number availably as an interim measure, only one is recommended for every 10,000 population.
8) The extension educator (Family planning) should be utilized in strengthening education aspects of
all programmes.
9) The existing one sanitary inspector at the block level is very Inadequate. Although it should
have one sanitary health inspector for 10,000 population, this may not be feasible at present. In
addition to existing one at block level there should be at least one sanitary health inspector for
20,000-25000 population. He will provide supervision to all health activities including
domicillary services. The senior most of them may be designated as senior sanitary/health
inspector.
10) Each primary health centre should have a microscope and laboratory technician who shall
conduct all simple laboratory examinations giving, particular attention to examination of blood
smears for malaria parasites. In block, where there no PHC, suitable dispensary may be selected
to have facilities of a microscope and a laboratory technician until such time a PHC is
established.
11) Wherever possible, there should be an extra medical officer for a PHC.
12) Existing state Regional or division Health officers should be strengthened by a officer
trained in epidemiology and malaria.
33
13) The laboratory at the state level should have at least one medical officer for epidemiological
work, one entomologist, 2 or 3 entomologist assistants and a number of microscopists for
undertaking special investigations and serves as the central intelligence bureau for malaria in the
state.
14) The central organisation of National Malaria Eradication programme on a modified scale
should be retained for least 2 to 8 years after the eradication has been achieved ever the whole
country.
15) Equipment & Stores should remain at the district level under the direct control of the
District Health Officer.
16) There should be a direct line of command from the State Health Directorate downwards.
MUKERJEE COMMITTEE, 1965
The recommendations of committee are :-
Strengthening of state health department by providing additional staff sanctioned by
central government
There should be a separate cell in the state secretarial for dealing exclusively with family
planning programme. The cell should be headed by under secretarial/assistant secretary
with a small supporting staff so that all proposals relating to the family planning
programme can be processed quickly and put up lo appropriate authorities for
expeditious decisions. The committee recommend that the cell should have following
staff.
Under secretariat/asit. secretary - 1
U.D. Assistant - 1
Stenotypist - 1
Orderly peon - 1
The committee recommended that a strong executive agency should be created in the
health directorate of each state government to deal exclusively with family planning
programme. This agency should have full support of various branches of the directorate
whose support is necessary for implementation of family planning programme.
Emphasis was given on Stale Family Planning Bureau as the state headquarters
organisation responsible for the implementation of the programme has to be regarded
34
more as administrative agency than one providing clinical services and should he
structured and staffed accordingly. The State Family Planning Bureau should have two
major divisions :
A) Administrative
B) Operational
The Administrative Division should be headed by an administrative officer not be-
low the rank of a Senior Deputy Collector of the provincial Civil Service
The operational division should be headed by an Assistant Director of health services
and will be divided into two section :-
One to deal with education & information
Other lo look after planning, field operation, evaluation and training.
The education and information section, will be headed by a health education officer who
will be responsible for the educational & publicity campaign in the state.
Strengthening State Family Planning Bureau
It is the responsibility Of health education officer to ensure that for the family
planning programme, intensive and sustained publicity and educational programmes are kept
going in the whole state.
District Family Planning Bureau will have three divisions:
-Administrative division
-Education and information division
-Field operation and evaluation division. Administrative division will be in charge of
an administrative officer of the rank of the Sub Deputy Collector/Tahasildar of the state civil
service and should look after general administration, stores & accounts.
The education and information division should be headed by education and administration
officer and field operation and evaluation division by a statistical investigator. The head of the
bureau would be the District Family Planning officer who should be a class I medical officer.
To each District Family Planning Bureau should be attached a mobile
sterilisation unit and a mobile education and publicity unit
Committee suggested that for each mobile unit a detailed programme, for one or
two months at a time should be prepared by District bureau, sufficiently in
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advance & circulated to all workers concerned at sub-centres to village leaders
& voluntary organisations, who may be brought into programme, so that all the
promotional work would have been done in advance of the arrival of the unit at
any centre.
Committee strongly recommended that some flexibility would be allowed in matter of
qualification of different categories of personnel.
Committee also considered the existing organisational set up for static and mobile
sterilization units attached to the Urban Family Welfare Planning Centres as adequate.
Basic health workers should be a multipurpose worker for the general health services
but for family planning, he can provide some information to people. The health assis-
tant (family planning) who should have some experience of community health work,
can do adequate justice to the family planning work, i f he is not required to supervise
the work of the Brain Health worker. There should be one Health Assistant for 20,000
population.
There should be one health visitor for each unit of 40,000 population to supervise the
work of 4 A.N.M.
The committee recommended that wherever district authorities consider that it would
be useful to have part time workers for motivating & bringing cases for vasectomy and
1UCD insertions, such worker may be appointed on payment of an honorarium of Rs.
50p.m.
Honorary education leaders should be appointed one for each block, such block level
leader should be given an all inclusive honorarium of Rs. 6OO per annum to meet the
incidential expenses inclusive of the expenses of their touring.
The committee recommended that that whole time government doctors engaged in
sterlisation campes should be paid Rs. 5- per vasectomy & Rs.10/- per tubectomy, if
they work over & above their full normal duties. Similarly in IUCD camps, they should
be paid Rs 2 per insertion
Part time private medical practitioners who work in family planning centres should be
paid a fixed allowance of Rs. 100/- per month for working 2 hours per day, three days
in a week or for three hours in a day, two days in the week.
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Committee recommend lo fill up the gaps or make up deficiencies which exist such as
cost of drugs, dressing etc. payable to state government, local bodies or voluntary
agencies.
There is need for training of paramedical personnel, nurses, A,N.M etc required For the
Family Planning Programme.
Multiple activities of the mass programmes like famity planning, srnall pox,
leprosy, trachoma,etc. were making i t difficult for the states lo undertake these effectively
because of shortage of funds. A committee of state health secretaries, headed by the Union
Health Secretary, Shri Mukherjee was set up to look into this problem.
The committee worked out the details which should be provided at the block level
and some consequential strengthening required a t higher levels of administration.
JUGALWALA COMMITTEE, 1967
The committee was also known as committee on integration o f health services.
This was set up in 1964 under the chairmanship of Dr,N.Jugalwala (Director of
National institute of Health Administration and Education, currently known as
NIHFW).
The integrated services as per committee is defined as-
= A service with a unified approach for all problems instead of a segmented
approach for different problems.
= Medical care & public health programmes should be put under charge of a single
administrator at all levels of hierarchy-
The committee recommended that district level should be strengthened sufficiently to
undertake comprehensive health work on regionalized basis. The head of district
health organizations may be from Curative, preventive or teaching, specialty, but
they must have sufficient re-orientation or training in complicated technical and ad-
ministrative science of planning & management of inter. Arated medical and health
care services so as at to provide intelligent educative supervision and guidance in
both fields. They should have experience in community organization.
The committee discussed the various, aspect including the pay, service
conditions, and the process by which unification of cadre can be affected.
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The committee drew the attention to the example provided by Army and
by the state government of WestBengal, Punjab and Mysore. The details
may vary but the greatest common measure of agreement should be in
terms of
Single portal of entry.
Common seniority.
Recognition of extra qualification by provision of ante-date or financial
advancement.
Equal pay for equal work,
Special pay for specialized work special programme research, teaching,
public health
• On private practice the committee felt that no Government Medical Officer should
normally be allowed private practice,
• The committee recommended that additional steps are necessary to build up a dynamic,
flexible organization capable o f absorbing present and future responsibilities in an
efficient manner. In the reorganisation recent trends should be taken into consideration.
• The committee discussed the various aspects, of integration and is firmly of the opinion
that services should be integrated right from the highest to the lowest level in service
organisation and personnel. Responsibilities for health of different sections of the
community should be unified in one authority at central and state levels and medical
education be integrated with service. The committee also felt that in developing
countries like India entire health services have to be reorganized. The administration
should be more scientifically guided.
Following were recommended for the integration at all levels of health organisation in the
country.
Unified cadre.
Common seniority.
Recognition of extra qualification.
Equal pay for equal work.
Special pay for special work.
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Abolition of private practices by government doctors.
Improvement in their service conditions.
KARTAR SINGH COMMITTEE, 1973
The committee was headed by Additional secretary of health and titled
'Committee on multipurpose workers under Health and Family Planning was constituted to
form a framework for Integration of health and medical services at peripheral & supervisory
levels, Its recommendations were :
- A new designation was proposed for multipurpose worker health worker (male/female). The
newly designated female health worker will be present ANM and the newly designated male
health worker will present day Basic health workers, Malaria surveillance workers,
vaccinators, health education assistance ('Trachoma) and the family planning health
assistance. The programme of having multipurpose workers should be introduced in the
first phase, in areas where malaria is in maintenance phase and small pox has been controlled,
The programme can be extended to other areas as malaria passes into maintenance phase or
where small pox is controlled. This will be the second phase.
- There should be a team of two health workers one male and one female at the sub centre
level.
- After training i n all programmes each health workers male and female should be given a
first aid kit and also some medicines for minor ailments costing up to Rs. 2000 for annum for
each sub centre. These medicines should be replenished at regular intervals.
- It was recommended that when adequate facilities of man, material and money are made
available the number of PHCs should be increased. It was felt that for a proper coverage there
should be a PHC for 50,000 population. Each PHC should have at least two doctors, one of them
would be a female.
- The population in each PHC would be divided into 16 subcentres, each having a population
of about 3000-3500 population depending on topography and means of communication.
- It was recommended that a male health worker should have to look after a population of 6 to
7 thousands.
- It was recommended that emphasis should be placed on 5th five year plan on increasing the
training facilities of female health workers.
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- It was recommended that a small group consisting of health administrators, trainers and
technical experts be constituted to go into the details of the training that is to be imparted to the
future multipurpose workers and their supervisors.
- All dispensaries in the jurisdiction, of PH centre should be linked with PHC and each
dispensary doctor should render referral services to the cases referred by the health workers.
- The concept of medical colleges integrating all health, family planning, nutrition and training
programmes were put forwarded.
SHRIVASTAV COMMITTEE, 1975
The committee was set up in 1974 as "Group on Medical education and Support Man power".
Recommendations have been briefly summarized:
A nationwide network of efficient and effective health services. It was recommended
that government should undertake the task of evolving a national consensus on the
nationwide network of efficient and effective health services.
It was recommended that steps should be taken to create bands of paraprofessional or
semi professional health workers from the community itself to provide simple
promotive, preventive and curative health services which are needed by community.
They will include dais, family planning workers, persons who could provide a simple
curative services and persons trained in promotional and preventive health activities
including the control of communicable diseases. The responsibility of government in
their regard will be to make careful selection, to provide training and retraining and
guidance and counseling.
It was recommended that every health worker should be trained and equipped to give
simple specified remedies for day to day illnesses.
The PHC should be strengthened by addition of one more doctor especially to look after
maternal and child health.
It was recommended that Primary Health Centres, as well as taluk/tehsils, district, re-
gional and medical college hospitals should each develop living and direct links with
the community around them as well as with one another within a total referral services
complex.
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It was recommended to establish medical and health education commission and it was
recommended to include : The determination of the objectives of under-graduate medi-
cal education and giving a positive community orientation to the entire programme the
reorganization of paramedical education in the 10+2+3 pattern; revision of undergradu-
ate curriculum including the preparation of teachers, production of teaching and learning
materials, adoption of suitable methods of teaching and evaluation the creation of
necessary physical facilities in all medical colleges and consequent reform of the
hospitals attached to them; determining the duration of the course and reducing it if
possible, by six months to one year, even while improving the standards; reorganization
of internship programme and of post-graduate teaching and research, evaluation of a
national system of medicine and so on.
The medical and health education commission should be broadly patterned after the
UGC and a whole time chairman who should be a non official and a leading personality
in the field of health services and education.
The medical and health education commission should function as an apex co-ordinating
agency and in close effective collaboration with the national councils.
Reorient medical education in accordance with national needs and priorities.
Develop a curriculum for health assistance who were to function as a link between
medical officers and MPWs. It recommended immediate action:
= creation of bonds of paraprofessional and semi professional health workers
within the community itself.
= Establishment of 3 cadres of health workers namely-MPHW and HA between
community workers and doctors at PHC.
=Development of “ Referral service”
=Establishment of a medical and health education commission for planning and
implementing the reforms needed in health and medical education on the lines of UGC
Acceptance off recommendations of Srivastava Committee in 1977 led to the launching of
Rural Health Service.
In brief:
Various categories of peripheral workers should be amalgamated into a single cadre of
multipurpose worker. The basic health worker malaria surveillance workers were converted into
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MPW(M). The work of 3-4 male and female MPWs was to be supervised by one health
supervisor male and female. The existing lady health visitor were to be converted into female
health supervisor.
6. One primary health center should cover a population of 50000. It should be divided
into 16 subcenters (one for 3000-3500 population) each to be staffed by male and
female health worker.
Rural Health Scheme, 1977
The most important recommendations of the Shrivastava committee was that the primary health care
should be provided within the community itself through specially trained workers so that the
health of the people is placed in the hands of the people themselves.
The basic recommendations of the committee were accepted by the government in 1977, which
led to the launching of the Rural Health Scheme. The programme of training of community
health workers was initiated during 1977 to 78. Steps were also initiated (a) for involvement of
medical colleges in the total health care of selected PHCs with the objective of reorienting
medical education to the needs of rural people and (b) Reorientation training of multipurpose
workers engaged in the control of various communicable disease programs in to unipurpose
workers.
Health for All by 2000 AD – Report of the working group, 1981
A working group on health was constituted by the planning commission in 1980 with the secretary,
ministry of health and family welfare as its chairman to identify in programme terms, the goal
for health for all by 2000 AD and to outline with that perspective, the specific programs for the
6th five year plan.
The working group besides identifying and setting out the broad approach to health planning
during the 6th five year plan had also evolved fairly specific indices and target to be achieved in
the country by 2000 AD.
High power committee on Nursing and Nursing profession - 1990
Chairman : Mrs,Sarojini Vardappan
No of members : 10
A high power committee was appointed by the Govt. of Inida under the chairmanship of
Mrs.Sarojini Vardappan, social worker and former chairman, central social welfare board. The
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objectives were to review the roles, functions, status, preparation of the nursing personnel,
nursing services and other issues related to the development of the profession and to make
suitable recommendations to the Government.
Recommendations
The findings of the committee gave a very gloomy picture of the conditions of nurses,
RECOMMENDATIONS OF HIGH POWER COMMITTEE ON NURSING AND NURSING PROFESSION
Working conditions of nursing personnel
1. Employment
Uniformity in employment procedures to be made.
2. Job description
Job description of all categories of nursing personnel is prepared by the central government to provide guidelines.
3. Working hours
The weekly working hours should be reduced to 4o hrs per week..
4. Work load/ working facilities
Nursing norms for patient care and community care to be adopted as recommended by the committee.
5. Pay and allowances
Uniformity of pay scales of all categories of nursing personnel is not feasible. However special allowance for nursing personnel, ie; uniform allowance, washing, mess allowance etc should be uniform throughout the country.
6. Promotional opportunities
For promotion to the post of ward sister, post basic Bsc Nursing is made an essential qualification.
7. Career development
-provision of deputation for higher studies after 5 yrs of regular services be made by all states. The policy of giving deputation to 5 -10 % of each category be worked out by each state. Every nursing personnel must have an opportunity to attend at least one refresher course every 2 years.
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8. Accommodation
As far as possible, the nursing staff should be considered for priority allotment of accommodation near to work place.
9. Transport
During odd hours, calamities etc arrangements for transport must be made for safety and security of nursing personnel.
10. Special incentives
Scheme of special incentives in terms of awards, special increment for meritorious work for nurses working in each state/district/PHC to be worked out.
11. Occupational hazards
Medical facilities as provided by the central govt to be extended by the state govt to nursing personnel. Risk allowance to be paid to nursing personnel working in the rural $ urban area.
12. Other welfare services
Hospitals should provide welfare measures like crèche facilities for children of working staff, children education allowance, as granted to other employees, be paid to nursing personnel.
Additional Facilities For Nurses Working In The Rural Areas
NURSING EDUCATION
Nursing education to be fitted into national stream of education to bring about uniformity, recognition and standards of nursing education. The committee recommends that;
1. There should be 2 levels of nursing personnel - professional nurse (degree level) and auxiliary nurse (vocational nurse)..
2. All school of nursing attached to medical college hospitals is upgraded to degree level in a phased manner.
3. All ANM schools and school of nursing attached to district hospitals be affiliated with senior secondary boards.
4. Post certificate BSc Nursing degree
5. Master in nursing programme to be increased and strengthened.
6. Doctoral programmes in nursing have to be started in selected universities.
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7. Central assistance be provided for all levels of nursing education
8. Up gradation of degree level institutions
9. Each school should have separate budget
10. Selection is based completely on merit. Aptitude test is introduced for selection of candidates.
11. All schools to have adequate budget for libraries and teaching equipments.
Continuing Education And Staff Development
Definite policies of deputing 5-10% of staff for higher studies are made by each state. Provision for training reserve is made in each institution.
Deputation for higher study is made compulsory after 5 yrs.
Each nursing personnel must attend 1 or 2 refresher course every year.
Necessary budgetary provision be made,
A National Institute for Nursing Education Research and Training needs to be established like NCERT, for development of educational technology, preparation of textbooks, media, / manuals for nursing.
NURSING SERVICES: HOSPITALS/INSTITUTIONS (URBAN AREAS)
1. Definite nursing policies regarding nursing practice be available in each institution .These policies include:
a) Qualification/recruitment rules
b) Job description/job specifications
c) Organisational chart of the institutions
d) Nursing care standards for different categories of patients.
Community nursing services
Appointment of ANM/LHV to be recommended.
ANM/LHV promoted to supervisory posts must undergo courses in administration and management..
Posts of public health nurses and above are given gazetted status.
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Norms recommended for nursing service and education hospital setting.
1. Nursing Supdt -1: 200 beds (hospitals with 200 or more beds).
2. Dy. Nsg. Supdt. - 1: 300 beds ( wherever beds are over 200)
3. Asst. Nsg . Supdt - 1: 100
4. Ward sister/ward supervisor - 1:25 beds 30% leave reserve
5. Staff nurse for wards -1:3 ( or 1:9 for each shift ) 30% leave reserve
6. For nurses OPD and emergency etc - 1: 100 patients ( 1 bed : 5 out patients) 30% leave reserve
7. For ICU -1:1(or 1:3 for each shift) 30% leave reserve
For specialised depts such as operation theatre, labour room etc- 1: 25 30% leave reserve.
Community nursing services
1 ANM for 2500 population ( 2 per sub centre)
1 ANM for 1500 population for hilly areas
1 health supervisor for 7500 population( for supervision of 3 ANM's)
1 public health nurse for 1 PHC ( 30000 population to supervise 4 Health Supervisors )
1 Public Health Nursing Officer for 100000 population ( community health centre)
2 district public health nursing for each district.
Teaching staff for schools/colleges of Nsg as per INC
1 Nurse Teacher to 10 students for post graduate programmes.
NURSING LEGISLATION
1. INC and state nursing council acts be amended to provide for control by INC on states nursing councils.
2. Provision of more nurse members.
3. Provision for regulation of nursing education & nursing practice
4. Provision of approval of INC before opening a SON or CON.
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5. Provision of renewal of registration every 5 yrs.
6. Provision of independent practice of nursing by nurses.
7. INC to set up a national examination system in about 10 yr time to regulate standards of nursing education.
ORGANISATION OF NURSING SERVICES
The position and status of nursing personnel working in the directorates need up gradation and expansion of the nurse to enable the nurses to participate in policy making and decision making. Total nursing components, i.e., nursing education, nursing service and community nursing should be under the control of nursing personnel at all the levels. I.e. At centre, stateand district level.
NATIONAL NURSING POLICY
There is a need for national nursing policy within the framework of national health policy and national health planning.
BAJAJ COMMITTEE, 1986
The ministry of health and family welfare, government of India set up on expert review
committee for health manpower planning and development with major emphasis on creation of
additional facilities.
An expert committee for health man power planning, production and management was
constituted in 1995 under Dr. J.S Bajaj, Major recommendations are:
1. Formulation of national medical ad health education policy
2. Formulation of national health man power policy
3. Establishment of an educational commission for health science on lines of UGC.
4. Establishment of health science universities in various states and union territories
5. Establishment of health man power cells at center and in the states.
6. Vocationalisation of education at 10+2 levels as regards health related fields with
appropriate incentives, so that good quality paramedical personnel may be available
in adequate numbers.
7. Carrying out a realistic health man power survey.
Bajaj Committee 1996
An "Expert Committee on “Public Health system" was constituted in 1995 under the chairmanship
of Dr. J.S. Bajaj, the then professor at AIIMS. Major recommendations are:-
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Review of national health policy
Establishment of health impact assessment cell.
Surveillance of critically polluted areas
Search for alternative strategy/ strengthening of health services/system research
Uniform adoption of public health Act by the local health authorities
Establishing national notification system/national health regulation
Join council of health, family welfare and ISM and homeopathy
Establishing an apex technical advisory body
CONCLUSION
A health plan is predetermined course of action that is firmly based on the nature and extent of
health problems, from which are derived priority goals. The heart of planning process is the
analysis of alternative means of achieving the preselected goals in the phase of a variety of
constraints. It is the function of health planners to determine how health services can be
improved and to make proposals for the consideration of political and administrative authorities.
REFERENCES
1) Basavanthappa , B.T, Text Book of Nursing Ad,ministration , Jaypee Brothers.2) Park. K(21st edn), Park’s Text Book Of Preventive And Social Medicine, Banarsidas
Bhanot Publishers; Jabalpur3) Gulani K.K , Principles & Practices Community Health Nursing, Kumar publishing
House , Delhi.
4) Neelam Kumari, A text book of Community Health Nursing, S.Vikas and company (medical publishers ) India,Jalandhar city, 2011 edition, Page no:77-90
5) Lucita M (2007) “Nursing Practice and Public Health Administration, Current concepts and trends” 2nd edition, Elsevier pages 262 – 325
6) Indian journal of preventive and social medicine, 1994
7) www.planning commission.nic.in
8) www.nihfw.org
9) http.nrhm-mis.nic
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