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RECOMMENDATIONS OF VARIOUS
HEALTH COMMITTEES
Dr Himanshu ChauhanAssistant Professor
Important health committees
1. Bhore committee, 19462. Mudaliar committee, 19623. Chadah committee, 19634. Mukerji committee, 19655. Mukerji committee, 19666. Jungalwalla committee, 19677. Kartar Singh committee, 19738. Shrivastav committee, 1975
Bhore Committee, 1943
Sir Joseph Bhore, British civil servant in India Chairman, Health survey & development
committee GoI appointed HSDC is 1943 to make:
A. A broad survey of the health situation
B. Recommendations for improvement 5 subcommittees:
1. Public health
2. Medical relief
3. Professional education
4. Medical education
5. Industrial health
The output
A 1128 page report 3 volumes Volume1: Survey Volume 2: Recommendations Volume 3: Appendices
Some key findings
Country Death Rate IMR LE at birth MMR
India 22.4 162 26.91 2000
England 12.4 58 58.74
Japan 17.0 106 44.82
USA 11.2 54 59.12
Germany 11.7 64 59.86
Major causes of death
Fevers58%
Others26%
Respi-ra-tory diseases8%
Diarrhea4%
Cholera2%
Smallpox1%
Plague0% Fevers
OthersRespiratory diseasesDiarrheaCholeraSmallpoxPlague
Causes of low level of health in India
Prevalence of insanitary conditions Nutrition (Inadequate & inappropriate mix) Inadequacy of existing medical & preventive
health organizations
*Bhore committee estimated that the population in 1971 would be 300 million (Actual population was: 548 million !!)
Health personnel
Number (1948)
Ratio UK ratio (1948)
Suggested ratio (1971)*
Doctors 47400 (13000 in Govt sector)
1: 6300 1: 1000 1: 2000
Nurses 7000 1: 43000 1: 300 1: 500
Dentists 1000 1: 300000 1: 2700 1: 4000
Causes (contd.)
Quality of medical care: 1 patient per 48 seconds – OPD load Inadequate design of facilities Attitude of doctor / para-medical staff Vast distances Abject poverty
Recommendations
An enormously uphill task Major changes required A short-term and a long-term program
Modern trends in the organization of health services
A progressive health service (Preventive & Curative) required
Social medicine concept given Examples of the national health services of Britain,
USA, Australia, Canada, Russia & New Zealand - Their application to India
Free or paid medical care ? Salaried as against a service of private practitioners ? Prohibition of private practice by government doctors Part-time medical men Freedom to choose doctor
Health services for the people: The long term program
A well developed health service – Central, Provincial & local area health organizations aka “The three million plan”
3 million referred to a district Primary units, secondary units & district
headquarter proposed To be achieved in 15-20 years
The long term program
Units Population Doctors Non-medical staff
Beds
Primary 20,000 6 78 75
Secondary 600,000 140 358 650
District headquarter
30,00,000 239 1398 2500
Short-term program
Immediate commencement Primary units: 1 per 40,000 population
with 30 beds and 2 medical officers Will be referred to as the primary health
centers Village committees to be established –
Community participation Secondary units: 1 per district with 200
beds and 47 doctors
Other areas 3 months training in preventive & social
medicine to prepare social physicians Nutrition Health education Physical education Maternal & child health School health Occupational & Industrial health Environmental hygiene Housing – Urban & Rural Public health engineering Quarantine Vital statistics
Mudaliar Committee, 1962 Arcot Lakshmanaswami
Mudaliar Vice-chancellor, Madras
University Health survey & planning
committee Appointed to survey the progress
made since the Bhore committee
Recommendations
Consolidation of advances made in the first two five-year-plans
Strengthening of district hospital with specialist services
Regional organizations between state headquarter and districts
PHC not to serve more than 40000 Improve the care provided by PHCs Integration of medical & health services All-India Health Service (like IAS)
Chadha Committee
Dr MS Chadha, DGHS Committee to study the arrangements
under the maintenance phase of the NMEP Recommendations:1. The vigilance operations of the NMEP
should be the responsibility of PHC staff2. One basic health worker for 10000
population for this3. In addition to the vigilance, these basic
workers to act as multipurpose workers
Mukerji Committee, 1965 Health secretary to GoI Basic workers could not function effectively
as multipurpose workers Separate staff for family planning
recommended Delink malaria activities from family planning
activities Recommendations accepted
Mukerji Committee 1966
Separation & intensification of family planning and malaria activities combined with other programs resulted in funds shortage
Basic health service at block level recommended
Strengthening of services at higher levels
Jungalwalla Committee, 1967
Dr N Jungalwalla, Director, NIHAE Terms of reference:1. Need for integration of health services2. Elimination of private practice by govt doctors Recommendations: Integration from the highest to lowest levels,
organization & personnel1. Unified cadre, 2. Common seniority, 3. Recognition of extra qualifications, 4. Equal pay for equal work
Kartar Singh Committee, 1973
Karar Singh, Additional Secretary, MoHFP To study & make recommendations on:1. The structure for integrated services at
the peripheral & supervisory levels2. The feasibility of having MPWs in the
field3. Training requirements of such MPWs4. The utilization of mobile service units set
up under family planning prog
Recommendations1. ANMs to be replaced by the newly
designated Female health workers2. Male workers to be replaced by Male health
workers3. MPWs to be first introduced in areas where
malaria is in maintenance phase and smallpox has been controlled
4. One PHC / 50,000 population5. Each PHC to be divided into 16 sub-centres6. Each sub-center to be staffed by 1 male & 1
female MPW
Srivastava Committee, 1975
Dr J B Srivastava, DGHS Group on medical education & support
manpower TORs:1. To devise a suitable curriculum for
training a cadre of health assistants (Link b/w Doctors & MPWs)
2. Improving medical education making it more relevant to national requirements
Recommendations1. Creation of para-professional and semi-
professional health workers from the community itself
2. MPWs and HAs between CHWs & Doctors3. Development of a referral service complex4. Establishment of a medical & health
education commission
To summarizeCommittee Year Most important recommendation(s)
Bhore 1946 Long term (3 million) & short term program
Mudaliar 1962 PHC @ 40000; All India Health service
Chadah 1963 1 basic health worker @ 10,000; Link FP & Malaria
Mukerji 1965 Delink FP & Malaria
Mukerji 1966 Basic health service at block level
Jungalwalla 1967 Integrated health services (Organization & personnel)
Kartar Singh 1973 Multipurpose workers
Srivastava 1975 Group on medical education & support manpower; ROME scheme; Village health guides
Thank you for your patient hearing
For further information contact:Dr Himanshu Chauhan
Assistant Professor, Room No. 341