Health Policy Planning in India

P.R. Sodani, PhD, MPH

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