Unit II

HEALTH COMMITTEES

BY:

MR. J.C. FRANK M.Sc (N)

ASSISTANT PROFESSOR

Sir JosephWilliam Bhore

Bhore Committee

- Constituted by pre independent GOI

- Under Sir Joseph William Bhore, Indian Civil

Servant

- Formed in 1943

- “Health Planning and Development

Committee”

Terms of Reference

• A survey of existing conditions and organisation

• Secondly suggestions for future development

• Consider short term objectives which might

reasonably be expected to be reached within a

period of four to five years

• Objectives which will necessarily require a longer

period for attainment.

Bhore Committee Report

• Submitted in 1946

• Runs into 4 volumes

• Volume I A survey of the State of the Public

Health and the existing health organisation

• Volume II Recommendations

• Volume III Appendices

• Volume IV Summary

Observations

• CDR : 22.4/1000

• IMR : 162/1000 live births

• MMR : 20/1000 live births

• Life expectancy at birth : 27 years.

Observations

• Incidence of communicable disease also was very

high.

• Diseases like chicken pox, cholera etc occurred in

epidemics.

• Many of the health problems were preventable.

• Investment made in preventing these problems

would give high returns in the forms of increased

productivity and development.

Recommendations

Short term plan:

- To be implemented within 5-10 years.

- Each primary health centre in the rural area to cater to a

population of 40,000

- Secondary health centre to serve as a supervisory, coordinating

and referral institution

- For each PHC 2 medical officers, 4 public health nurses, one

nurse, 4 midwives, 4 trained dais and 15 class IV employees

Recommendations

Long term plan (3 million plan):

Health care system in three tires.

• First tier: primary health units with 75 bedded hospital for each 10,000 –

20,000 population with staff of 6 medical officers, 6 public health nurses, 2

sanitary inspectors, 2 health assistants and other supportive staff.

• Second tier: 650 bedded Regional Health Unit (RHU) to serve as a referral

centre for 30 – 40 PHUs.

• Third tier: district hospitals with 2,500 beds to serve the needs of about 3

million.

Recommendations

• 3 months training in preventive and social medicine to

prepare ‘SOCIAL PHYSICIANS’

• Special emphasis on preventive work (Integration of

curative and preventive services)

• Village Health Committee consisting of 5 to 7 individuals

for procuring the active participation of the people in the

local health programme.

• Inter-sectoral Coordination

Sir A Lakshmanaswamy Mudaliar

Mudaliar Committee

• Constituted in 1959

• By GOI

• Under Dr. A Lakshmanswamy Mudaliar, Vice

Chancellor, Madras University

• “Health Survey and Planning Committee”

Terms of Reference

1. The assessment (or evaluation) in the field of medical

relief and public health since the submission of the

Health Survey and Development Committee's Report

(the Bhore Committee)

2. Review of the First and Second Five-Year Plan Health

projects and

3. Formulation of recommendations for the future plan

of health development in the country.

Observations

• Basic health facilities had not reached at least half the

nation

• Gross mal distribution of hospitals and beds in favour of

urban areas.

• Quality of services provided by PHCs were grossly

inadequate with poor functioning, lack of referral

system, and gross under staffing due to insufficient

resources

Recommendations

• Consolidation of 1st two 5 yr plans

• Strengthening DH to serve as central base for specialist

services

• PHC - 40,000 population

• 1 BHW per 10,000 population

• Improve secondary services

• Integration of Medical and Health services

Chadha Committee

• A committee of health administrators and

malariologists reviewed the National Malaria

Eradication programme.

• Constituted in 1963

• By GOI

• Under Dr. MS. Chadha, Director General of Health

Services

Terms of Reference

1. The committee should go into the details of the requirement

related to the primary health centers, their planning, the

necessary priority required according to the needs of the

maintenance phase of the Malaria Eradication progrmme.

2. The committee should also consider the Staffing pattern

required for the malaria eradication programme.

Recommendations

• One basic health worker per 10,000 population

• Basic health workers should visit house to house once

in a month to implement malaria vigilance activities.

• BHW to serve as MPHW for family planning and vital

statistics and malaria vigilance.

• FPHA to supervise 3-4 BHW

Mukerji Commitee

• Following the Central Family Planning

Council meet at Madras

• Constituted in 1965

• Headed by Shri Mukerji, Secretary, Ministry of

Health and Family Planning

Terms of Reference

• In 1965, the ICMR Director pronounced that Lippes

Loop was safe.

• So, IUCD was introduced into the family planning

programme and reorganisation of the FP programme

was needed.

• CBR was 41 per thousand and was aimed at reducing to

25 per thousand in a period of 10 years.

Terms of Reference

To review what additions and changes are

necessary as a result of the greatly altered

situation due to the IUCD having come in the

forefront of the programme, in the staffing

pattern, financial provisions, etc.

Recommendations

• Strengthening of education and publicity efforts and involvement of other

organisations

• Strong executive agency in Health Directorate of each state government to

exclusively deal with family planning

• Approved the existing Urban Family Welfare centre

• At Rural Family Planning Centre

- BHW to be utilised as MPW for general services

- FPHA to undertake only FP work without having to supervise BHW D

• Delink malaria and FP activity

Mukerji Committee,1966

• Following 13th Meeting of the Central Council of

Health held at Bangalore in June, 1966 - state finding it

difficult to take burden of maintenance phase of malaria

and other prog. like small pox, leprosy, FP, trachoma

• Formed in 1966

• By GOI

• Headed by Shri B. Mukerji, Union Health Secretary

Terms of Reference

• To review the staffing pattern of the primary health centre

complex and to recommend the minimum staff of various

categories required at different levels within the district so as to

provide an integrated health service capable of fully catering to

the needs of the vigilance services in the maintenance phase of

National Malaria Eradication Programme, smallpox eradication,

tuberculosis, leprosy and trachoma control, etc.

• To recommend the pattern of Central assistance for the States

Recommendations

• Basic Health Services to be provided at block level

• Strengthening required at higher level

• Any attempt to give the basic health worker more work

under the family planning programme would either

endanger malaria vigilance work or would need a larger

number of basic health workers per block than what the

Committee has recommended.

Jungalwalla Committee

• Central Council of Health, 1964 Srinagar

• Dr. N. Jungalwalla, Addl. Director General of

Health Services

• “Committee on Integration of Health Services”

• Submitted report un 1967

Terms of Reference

• To study the problems of the health services

• Service conditions

• Elimination of Private practice

Recommendation

The main steps recommended towards integration were:

• Unified cadre

• Common seniority

• Recognition of extra qualifications

• Equal pay for equal work

• Special pay for specialized work

• No private practice, and good service conditions

• Left states to work out their own strategy.

Kartar Singh Committee

• Growing demand for increase of staff under

each programme.

• Need to reduce population/area covered by

each worker.

Kartar Singh Committee

• Meeting of the Central Family Planning Council 1972

• By GOI

• In 1972

• “The committee on Multipurpose workers under Health

and Family Planning”

• Kartar Singh, Addl. Sec., MOHFP

• Report in 1973

Terms of Reference

• Structure for integrated services the

peripherals and supervisory levels

• Feasibility of MPW

• Their training requirements

• Utilisation of mobile services for integration

Recommendations

• Multipurpose workers - feasible and desirable

• Redesignation

- ANMs replaced by FHWs

- BHW, Malaria surveillance workers, vaccinators, FPHAs

replaced by MHWs

- LHV designated as FH supervisor

• To be first introduced in malaria maintenance phase areas and

small pox controlled areas

• Clearly spelt out the job functions of HWs and Supervisors

Recommendations

• 1 PHC – 50,000 population

• 1 PHC –16 SHC (2000 – 3500)

• 1 SHC – 1 MHW n 1 FHW

• 1 male supervisor – 4 MHWs

• 1 female supervisor – 4 FHWs

• Doctor incharge of all supervisors

• To be impemented in 5th 5yr plan

Shrivastav Committee

GOI observed that

• Urban orientation of medical education in India, which relies heavily on curative methods

and sophisticated diagnostic aids

• The failure of the programmes of training in the fields of nutrition, family welfare planning,

and maternal and child because of their development in isolation from medical education,

• The deprivation of the rural communities of doctors

• The need to re-orient undergraduate medical education with emphasis on community rather

than on hospital care

• The importance of integrating teaching of various aspects of family planning with medical

education

Shrivastav Committee

• MOHFP,GOI

• In 1974

• “ Group on Medical Education and Support

Manpower”

• Submitted report in 1975

Terms of Reference

• To devise a suitable curriculum for training a cadre of

Health Assistants

• To suggest steps for improving the existing medical

educational processes as to provide due emphasis on

the problems particularly relevant to national

requirements

• To make any other suggestions to realise the above

objectives and matters incidental thereto

Recommendations

(1) Organization of the basic health services (including nutrition, health

education and family planning) within the community itself and training

the personnel needed for the purposes;

- Creation of Village Health Guide (VHG) or community health volunteers

from the community itself like teachers, postmasters, gram sevikas who

can provide comprehensive health services as paraprofessionals.

- Primary health care be provided within the community itself through

specially trained workers so that the health of the people is placed in the

hands of people themselves

Recommendations

(2) Organization of an economic and efficient

programme of health services to bridge the

community with the first level referral Centre,

viz., the PHC

- Creation of MPW and Health Assistants (HA) in

between the VHG and MO in PHC

Recommendations

(3) The creation of a National Referral Services

Complex by the development of proper

linkages between the PHC and higher level

referral and service centres.

(4) Establishment of ‘The Medical and Health

Education Commission’

Rural health Scheme

“Rural Health Scheme” was launched by the government in 1977-78. The

major steps initiated were :

a) Involvement of medical colleges in health care of selected with the

objective of reorienting medical education according to rural population

called Re Orientation of Medical education (ROME). It led to teaching

and training of undergraduate students and Interns at PHCs.

b) Training of Village Health Guides and utilising their services in the

general health service system.