FIVE YEAR PLANS IN COMMUNITYHEALTHNURSING.pptx

Five year plan in community health nursing

1. FIVE YEAR PLANS

2. HISTORY The planning commission was set up in march 1950. • The main objective of the Government :- - To promote a rapid rise in the standard of living of the people by – efficient exploitation of the resources of the country – increasing production and – offering opportunities to all for employment in the service of the community • The Planning Commission was charged with the responsibility of making assessment of all resources of the country, augmenting deficient resources, formulating plans for the most effective and balanced utilization of resources and determining priorities. • Jawaharlal Nehru was the first Chairman of the Planning Commission.

3. FUNCTIONS :-  • To make an assessment of the resources of the country and to see which resources are deficient. • To formulate plans for the most effective and balanced utilization of country's resources. • To indicate the factors which are hampering economic development. • To determine the machinery, that would be necessary for the successful implementation of each stage of plan. • Periodical assessment of the progress of the plan. • The commission is seeing to maximize the output with minimum resources with the changing times.

4. • The Planning Commission has set the goal of constructing a long term strategic vision for the future. • It sets sectoral targets and provides the catalyst to the economy to grow in the right direction. • The Planning Commission plays an integrative role in the development of a holistic approach to the formulation of policies in critical areas of human and economic development.

5. FIVE YEAR PLANS • First Plan (1951– 55) • Second Plan (1956 – 60) • Third Plan (1961 – 66) • Fourth Plan (1969 -74) • Fifth Plan (1974 –79) • Sixth Plan (1980 –85)

6. • Seventh Plan (1985 – 90) • Eighth Plan (1992 – 97) • Ninth Plan (1997 – 2002) • Tenth Plan (2002 – 2007) • Eleventh plan (2007-2011) • Twelth plan (2012-2016)

7. FIRST FIVE YEAR PLAN (1951-1956) The first Indian Prime Minister, Jawaharlal Nehru presented the first five-year plan to the Parliament of India on December 8, 1951. AIMS 1. To fight against disease, malnutrition and unhealthy environment 2. To build up health services for rural population mothers and children's to improve general health status of peoples.

8. PRIORITIES :- Safe water supply and sanitation 2. Control of malaria 3. Health care of rural population 4. Health services for mother and children 5. Health Education and training 6. Self sufficiency in drugs and equipment's 7. Family planning and population control

9. MAJOR DEVELOPMENT 1951  • B.C.G vaccination programmes was started in India 1952 • PHC (primary health center) was setup • Delhi community development programme started on 2nd October 1952 for rural development. • The central council of health was constituted • Virus research center was setup in PUNE • ANM (auxiliary nurse midwife) training was started

10. 1953  • National malaria control programme was started. • National small pox eradication programme launched • National family planning programme was launched. • The community development programme was extended to national level on 2nd October. 1954 • National water supply and sanitation programme was initiated. • National leprosy control programme was launched. • Central government health scheme (CGHS)started at Delhi • Prevention of adult act passed by parliament • SHETTY committee was constituted by the government of India.

11. 1955 • The national filaria control programme was launched. • Central leprosy research institute started in madras • TB sample survey started • Hindu marriage act fixed marriage age for boys 18 yrs. and for girls 15 years.

12. SECOND FIVE YEAR PLAN (1956-1961) AIMS 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 the nation’s health.

13. Priorities Establishment of institutional facilities for rural as well as urban population. Development of technical manpower. Control of communicable diseases. Water supply and sanitation. Family planning and others supporting programmes.

14. Major Development :- 1956 • Public health act was prepared by committee and published • Central health education bureau was established under the ministry of health. • Family planning director appointed in union health ministry. • Trachoma control pilot project was initiated. • Demography training and research centers was started in Bombay.

15. 1957 • Demography training and research centers started in Delhi Calcutta and Thiruvananthapuram 1958 • National TB survey was completed • National malaria control programme was changed to national malaria eradication programme. • Leprosy advisory committee was constituted.

16. 1959 • Mudaliar committee was appointed to survey of Bhore committee and suggestion for future development and extension of health programme . • The first Panchayati Raj was introduced in Rajasthan • National TB institute was started in Bangalore

17. 1960 • School health committee was formed to assess the existing health and nutritional status of school children and to improve them. • Pilot project of small pox eradication was started • National nutritional advisory committee (NNAC) was constituted.

18. Third five year plan (1961-1966) Aims :- 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.

19. Priorities :- Safe water supply in villages and sanitation, especially the drainage programme in 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 the health status of people. Development of manpower.

20. Major developments :- 1961 • The central bureau of health intelligence was established • The MUDALIAR COMMITTEE report was submitted and published • National goiter programme were launched. 1962 • School health programme was started. • District TB programme was conceptualized • Central family planning institute was established in Delhi.

21. 1963 • Applied nutrition programme started by government of India with the help of WHO, UNICEF and FAO. • National institute of communicable disease was established in Delhi • Safe drinking water branch (SDWB) was setup • Extended family planning programme was initiated • National trachoma control programme was initiated

22. 1964 National institute of health administration and education was started. SHANTI LAL SHAH COMMITTEE was setup to study the legalization of abortion. 1965 Reinforced extended family planning was launched. Direct home to home BCG vaccination was initiated.

23. 1966  • MUKHERJEE COMMITTEE was formulated to look into the minimum man power required for primary health centers. • Ministry of family planning was appointed under the ministry of health and family planning Programme for better result in controlling of population 1967 • MUKHERJEE COMMITTEE was appointed to review the working of national malaria eradication programme and to suggest the further improvement. • Small family norms was encouraged to provide suitable incentive to peoples who were willing to the small family norms

24. 1968 • Birth and death registration act was reinforced by RAJYA SABHA for compulsory registration of birth within 15 days and death within 7 days.

25. The fourth five year plan The fourth five year plan did not start soon after the third five year plan due to some political reasons. It was started in 1969. AIMS :-The main aim of this five year plan was 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.

26. Priorities Family planning programme. Strengthening of primary health centres. Strengthening of sub-divisional and district hospitals to provide effective referral support to primary health centres. Expansion of medical and nursing education training.

27. Major development 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 dropped • The control of births and deaths registration act was prolonged.

28. 1970 The population council of India was setup • All Indian hospital family planning programme was launched. • The programme demographic training and research center at Mumbai was changed to international institute for population studies. • Registration of births and deaths was came into the force .

29. 1971 • Medical termination of pregnancy bill was passed by the parliament. • Expert committee was appointed for control of air pollution • Family pension scheme was launched

30. 1972 • Medical termination act came in to the force • National institute of nutrition was setup in Hyderabad it was set up by the ICMR • The committee of multipurpose worker under health and family planning headed by KARTAR SINGH • The additional secretary of health was setup

31. 1973 A scheme of setting up a 30 bedded rural hospital serving for primary health centres. The kartar singh committee submitted its report. Have chief medical officers In charge of district health who should be assisted by deputy chief medical officers.

32. The fifth five year plan (1974-1979) AIMS :- The main aim of the fifth five year plan was to provide minimum level of well integrated health, MCH and family planning nutrition and immunization services to all the people with special reference to vulnerable groups, especially children, pregnant women.

33. PRIORITIES :- Increasing accessibility of health services in the rural areas. Referral services. Family planning and nutrition. Eradication of communicable diseases. Qualitative improvement in the education and training of health personnel.

34. Major development :- 1974:- Revised strategy for malaria control was suggested. The water (prevention & 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.

35. 1975 :- India became smallpox free on 5 th July 1975. The revised strategy of National malaria eradication programme accepted by the Government. ICDS scheme was launched on 3 rd October 1975. Children’s welfare board was set up. Developing indigenous system of medicine.

36. 1976 Indian factory act of 1948 was amended. The prevention of food adulteration. A new population policy was announced by the government. 1977 Rural health scheme was launched on the basis of kartar Singh committee. Revised modification plan of malaria eradication was implemented.

37. The goal of health for all was adopted by WHO. 1978 The child marriage restraint bill 1978 fixing the minimum age 21 year for boys and 18 year for girls. Alma Ata declared “primary health care strategy” to achieve the goal of “health for all” by the year of 2000.

38. 1979 :- The declaration of Alma Ata on primary health care strategy was enclosed by WHO.

39. The sixth five year plan ( 1980-1985) Aims :- The main aim of the sixth five year plan was to work out 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, urban, remote, hilly areas.

40. Priorities :- Rural health services. Control of communicable diseases. Development of rural and urban hospitals. Medical research. Prevention of food adulteration. Water supply.

41. Major Development (1980) WHO declared the eradication of small pox from the world. The working group on health was constituted by the planning commission under the chairmanship of health secretory shri kripa Narain.

42. 1981 :- The 1981 census was taken. The air prevention and control of pollution act of 1981 was enacted. The working group on the health for all published her reports.

43. 1982 :- The NHP was announced and place in the parliament. The 20 point programme was announced.

44. 1983 :- National leprosy control programme was changed to national leprosy eradication programme. NHP was approved by the parliament. National guinea worm infection eradication programme was started.

45. 1984 :- Bhopal gas tragedy, a devasting industrial accident, occurred. The ESI act bill was passed by the parliament.

46. The seventh five year plan (1985-1990) Aims :- The aim of seventh five year plan was provide primary health care services 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.

47. Priorities :- Health services in rural, tribal and hilly areas under minimum need programme. Medical education and training. Control of emerging health problems. MCH and family welfare. Medical research.

48. Major Developments :- (1985) The universal immunization programme was launched on the 19 th of November. A separate department for women and child development was established by the ministry of human resources development.

49. 1986 The environment protection 1986. The 20 point programme was modified. National AIDS control programme was started. 1987 World wide safe motherhood campaign was started by world bank. The factories act 1987 started working. National Diabetes control programme was launched.

50. 1988-1991 The ESI act 1989 came into force. Acute respiratory infection programme was started a pilot project in 14 district in 1990. The 1991 census was conducted.

51. The Eighth five year plan (1992-1997) Aim :- The main aim of this five year plan was to continue reorganization and strengthening of health infrastructure and medical services accessible to all, especially to vulnerable groups and those who living in tribal areas, remote, rural areas.

52. Priorities :- Developing rural health infrastructure. Medical education and training. Control of communicable diseases. Medical research. MCH and family welfare.

53. Major Development :- 1992 Child survival and safe motherhood programmes started on 20 th august. The infant milk substitute, feeding bottles and infant foods act 1952 came into operation. 1993 A revised strategy for National Tuberculosis programme with DOT’S was introduced as a pilot project in phased manner.

54. 1994 The PRI act came into operation. Outbreak of plague epidemic and its control programme was launched. The first pulse polio immunization programme for children under 3 years was organized on 2 nd October and 4 th December by Delhi Govt. PBBSC Nursing programme was launched through distance education by Indira Gandhi National open university.

55. 1995 :- ICDS was change to IMCD services. Transplantation of human organs act was enacted. Expert committee on malaria submitted its report. 1996 Nation wide pulse polio immunization was conducted on 9 th December 1995 and 20 th January 1996 which was repeated on 7 th December 1996 and January 1997. Prenatal Diagnostic Technique.

56. The Ninth five year plan :- (1997-2002) Due to some political reasons the Ninth five year plan couldn’t commence on the 1 st of April 1997. it could commence on the 19 th February 1999. AIMS :- The ninth plan continued with the same as that of the eighth plan.

57. Priorities :- Control of communicable disease and non-communicable diseases. Strengthening of existing infrastructure. Improvement of referral linkage. Development of human resources. Disaster and emergency management. Inter-sector coordination.

58. Events :- RCH was launched. The Govt. of India announced NPP 2000. Phase II of National AIDS control was started. Census was completed in 2001. Govt. announced NHP 2002.

59. The Tenth five year plan (2002-2007) AIM :- To develop efficient and effective health care system (including Indian system of medicine and homeopathy) with appropriate two-way referral system at all levels (primary care to tertiary care). Objectives :- - IMR reduction by 2007 :- 45/1000 births. - MMR reduction by 2007 :- 2/1000 live births.

60. Priorities :- Reorganization, restructuring and strengthening of health care system in rural areas and urban areas. Development of appropriate two-way referral system. Development HMIS (health management information system). Strengthening of occupational health services. Drugs production, Quality and supply. Improving IEC.

61. The Eleventh Five year plan :- (2007-2012) The major aim of Eleventh five year plan was to provide essential primary health care services. Objectives :- - To restructure policies to achieve new vision based on faster, broad-based and inclusive growth. - To provide special health attention on adolescent girls, women of all ages.

62. Targets Reduce MMR to 1/1000 live births. Reduce IMR to 28/1000 live births. Malnutrition among children of age-group 0-3 years to half its present level. Anaemia among women and girls by 50%. Improving quality health care NRHM NUHM

63. The Twelfth Five Year plan (2012-2017) Aim :- To strengthen initiatives taken in the eleventh plan to expand the reach of health care and work towards the long term objectives of establishing a system of universal health coverage in the country. Objectives :- Each individual to have assured access to a defined essential range of medicines and treatment at an affordable price and free of cost for a large percentage of population. Steady expansion and coverage of services to provide assured services to all considering budgetary constraints.

64. Targets :- Infant mortality rate IMR of 25 per 1000. Maternal mortality rate 100per lakh. Anaemia among women (15-19 years) 28%. Reducing under nutrition among children under 3 years. Reducing annual incidence and mortality due rate to T.B. by half. Reducing the prevalence of leprosy to 1/10,000 population in all states. Reducing mortality rate due to Japanese Encephalitis by 30%.

65. Health and welfare committee :-   INTRODUCTION :-  Health planning in India is an integral part of national socio – economic planning.  The guidelines for national health planning were provided by a number of committees dating back to the Bhore committee in 1946.  These committees were appointed by the Government of India from time to time to review the existing health situation and recommended measures for further action.

66.  The Alma Ata Declaration on primary health care and the National Health Policy of the Government gave a new direction to health planning in India making primary health care the central function and main focus of its national health system.  The goal of national health planning in India was to attain Health for All by the year 2000.

67. BHORE COMMITTEE 1946  Bhore committee (Health Survey and Development Committee) was appointed by the British India government in 1943 under the chairperson of Sir Joseph Bhore, an Indian civil servant.  The secretary of the committee was Roa Bahadur KCKE Raja, the then Director General of Health Services.  The committee was asked to review the health services in the country and make recommendations for their improvement.

68. COMMITTEE DEALING WITH THE SUBJECTS Public health Medical relief Professional education Medical research Industrial health

69. BHORE COMMITTEE’S RECOMMENDATIONS-  Health should be made a state subject.  The government should provide “comprehensive health care” to the people; comprehensive health is defined as the integrated curative, preventive and promotive care that is made available to every individual without distinctions of caste, creed and economic status.

70. Comprehensive health care comprising a package ❑Medical relief, ❑communicable disease control ❑environmental sanitation ❑maternal and child health care ❑school health services ❑health education ❑ vital statistics

71.  In the rural areas the government should set up “primary health centers”. These centers will act as the nodal center for providing comprehensive health care for rural population. Some of the important recommendations were:-  Integration of preventive & curative services of all administrative levels.  Development of PHC in two stages: Short term measures 2. Long term measure

72. DEVELOPMENT OF PHC IN TWO STAGES  The government should establish 1 primary health center for every 40,000 population. This should be staffed by  2 doctors,  1 nurse,  4 public health nurses,  4 midwives,  4 trained dais,  2 sanitary inspectors

73.  2 health assistants  1 pharmacist.  Government should set up the following ( termed as ‘3 million plan’)  A 75 bedded primary health center for 10,000-20,000 rural population.  A 65 bedded regional hospital.  A 2,500 bedded hospital at the district level. Short term measures long term measure

74.  The central government should establish national medical centers of excellence to train highly qualified medical manpower.(The All India Institute of Medical Sciences, New Delhi and the National Institute of Mental Health and Neurosciences, Bangalore, were subsequently established).  The government should set up 100 training centers all over the country for the training of nurses. Ultimately there should be 1 nurse available for every 500 population. It should also provide training for hospital based social workers  The government should make 3 months posting in the subject of preventive and social medicine compulsory for the house surgeons

75. Shetty Committee :-  This committee was appointed with the objective of reviewing the salary and the working conditions of nurses in the country.  The committee found a great shortage of nurses. It further noted the following deficiencies in their working conditions:  Their pay scales were very low.  They were over-worked. Most of them worked for 50-90 hours a week.  They were made to bear the cost of breakages of hospital articles.

76. Great shortage of nurses Very low pay scales Over-worked (50-90 hours/week) Bear the cost of breakages of hospital articles Report.

77. Chadda committee  It is also known as “Special Committee on the Preparation of Entry of National Malaria Eradication Program into Maintenance Phase”.  The committee was headed by Dr M.S.Chadda, the then Director General of Health Services.

78. CHADDA COMMITTEE’S RECOMMENDATIONS-  Hand over malaria vigilance to general health service.  Train the malaria surveillance workers to do basic health work and re-designate them as Basic Health Workers. Ensure there is 1 Basic Health Worker for every 10,000 population.  Appoint a laboratory technician at each primary health center.  Appoint 1 health inspector for every 20,000-25,000 rural population.  Strengthen the district health organization.

79. MUDALIAR COMMITTEE  It was appointed in 1962.it was headed by Dr. A Lakshmnaswamy Mudaliar, the then Vice-chancellor of Madras University.  It was asked to review the progress in the health field since Bhore committees and to take a fresh look at health needs and resources of the country.  The committee presented its report to the government of India in 1965.

80. The Committee was sub-divided into different sub-committees to deal with different subjects like: 1.Medical care 2.Public health 3.Control of communicable diseases 4.Population control 5.Professional education and research.

81. The Committee was sub-divided into different sub-committees to deal with different subjects like: 6.Indigenous system of medicine 7.Drugs and medical supplies 8.Legislation 9.Health administration 10.Medical research

82. 5. MUKHERJEE COMMITTEE MUKHERJEE COMMITTEE, 1965 & 1966 Headed by Sri. Mukherjee, then Secretary, Department of Health, Union of India.  The first presented its report to government in 1965. It recommended –  Delink malaria from family planning so that the later receives undivided attention of health staff.  Revise the family planning strategy: Appoint exclusive staff for family planning by way of Family planning Health Assistants for carrying out family planning.

83. RECOMMENDATIONS  Appoint Basic Health Workers (BHWs) at the rate of 1/10,000 rural population. In urban areas, appoint 1 BHW for 15,000 slum dwellers. Appoint 1 Health Inspector to supervise the work of 4 BHWs.  Appoint 1 Health Visitor to supervise the work of 4 Auxiliary Nurse Midwives.   Make family planning a vertical program. Fix targets for contraceptives distribution and for sterilizations. Provide incentives to the acceptors of contraceptives/ sterilization.  Establish strong administrative machinery from the Center down to the block level.  At the District headquarters, appoint a Nursing Supervisor.

84. JAIN COMMITTEE JAIN COMMITTEE, 1966 One bed per 1000 population 50 beds hospital at taluka level Enhancing maternity facilities at each level Health insurance for larger population coverage Recommendations

85. JUNGALWALA COMMITTEE  This committee also known as Committee on Integration of Health Services.  Dr N. Jungalwala, the then Director of National Institute of Health Administration and Education (National Institute of Health and Family Welfare), New Delhi, headed the committee.

86. The committee stressed the need for providing integrated curative, preventive promotive services from the highest to the lowest level. It advocated a united approach to health problems- not segmental solutions to individual problems.

87. COMMITTEE’S RECOMMENDATIONS ARE-  Uniform for health workers.  The preparation and maintenance of a common seniority list of health personnel.  Sanctioning of equal pay for equal work and special pay for special work.  Provision of good working conditions for government doctors.  Banning private practice by the government doctors.

88.  One primary health center for every 50,000 population There should be 16 sub- centers at the rate of 1/3000 to 1/3500 population under each primary health center. Each sub-center should be manned by 1 Female Health Worker and 1 Male Health Worker.

89. KARTAR SINGH COMMITTEE KARTAR SINGH COMMITTEE, 1973 It is called “Committee on multipurpose worker under health and F.P.”. In the year 1972, the government of India constituted a committee under the chairmanship of Kartar Singh, Additional Secretary, Ministry of Health and Family Planning, to study the structure for integrated services at the peripheral and supervisory levels, and the feasibility of having multipurpose workers in the field. This committee report is a milestone in the history of public health nursing service administration.

90. KARTAR SINGH COMMITTEE RECOMMENDATIONS 1 . ANMs should be replaced by the "Family Health Workers" 2 . Basic Health workers (BHW), Malaria Surveillance worker (MSW), Vaccinators, Health Education Assistant of Trachoma (HEAT) and FPHAs to be replaced by "Male Health workers . 3 . In the beginning where Malaria and Smallpox were under control, MPW(M & F) scheme were to be initiated and later to other areas 4 . P.H.C for 50,000 population 5.Each P.H.C. - 16 sub centers(3000 population)

91. 6 .Each sub center should have M.P.W (M) and M.P.W (F) 7 .Health supervisor (F) should supervisor 3-4 female MPW 8 .Health supervisor (M) should supervisor 3-4 male MPW

92. SHRIVASTAV COMMITTEE SHRIVASTAV COMMITTEE, 1975 Also known as “Group on Medical Education and Support Manpower” Headed by Dr J B Shrivastava, the then Director General of Health Services.

93. COMMITTEE’S RECOMMENDATIONS ARE-  Center should create a new brand of Health auxiliaries (Para-professional or semi- professional workers) as a link between the doctor of primary health center and the multipurpose workers.  Create a auxiliaries from out of the educated members of the community such as the school teacher, postman or gram sevika.  Give them training and post them back to the village as “community Health Guides (CHG)”. CHG provide basic curative and preventive services to the community. Multipurpose workers would be responsible for supervision of CHG.

94. There would be three tiers between the community and medical officer of the primary health center i.e. Medical Officer of Primary Health Center Health Assistant Health Worker, Male/Female Community Health Guide Community

95. RAMALINGASWAMI COMMITTEE 1980 ICMR-ICSSR JOINT PANEL 1980 (RAMALINGASWAMI COMMITTEE)-  This committee includes formulation of comprehensive national health policy.  The basic objectives of the policy should be-  Development of health system should be integrated with overall plans of socioeconomic development.  To ensure access to adequate food, provide environment conducive to health and adequate immunization where necessary.  Devise an educational programme for health.

96. OBJECTIVES OF THE COMMITTEE  To replace the existing model of health care which will be: 1 . Village or community health voluntary/ health guide for 1000, 1. Sub center for 5000 population, 2 . Community health center for 10,000 population, 3 . District health center for 1 million population. 4 . The specialist center for 5 million population.

97.   2 .Combining the best element in the tradition and culture of the people with modern science and technology. 3 .Integrating promotive, preventive and curative functions. 4 .Democratic, decentralization and participatory model. 6 .Oriented to the people i.e. providing adequate health care to every individual and taking special care of the vulnerable group. 7 .Firmly rooted in the community and involving people. 8 .To train the personnel, to produce drugs and materials and to organize research needed for this alternative health care system. 9 .A detailed time bounded programme should be prepared, the needed administrative machinery created and finance provided on priority basis so that this new policy will be fully implemented and the goal of “Health for All” be reached by the end of 2000 A.D.

98. HIGH POWER COMMITTEE ON NURSING AND NURSING PROFESSION (1987-1989) Set up by the Government of India in July 1987, under the chairmanship of Dr Jyothi former vice-chancellor of SNDT Women University. Mrs. Rajkumari Sood, Nursing Advisor to Union Government as the member-secretary and CPB Kurup, Principal, Government College of Nursing, Bangalore and the then President, TNAI also one of the prominent members of this committee. Later on due to some reasons, the committee was headed by Smt Sarojini Varadappan, former Chairman of Central Social Welfare Board

99. Recommendations 1 .To look into the existing working conditions of nurses with particular reference to the status of the nursing care services both in the rural & urban areas. 2 .To study & recommend the staffing norms necessary for providing adequate nursing personnel to give the best possible care, both in the hospitals & community.   3 .To look into the training of all categories & levels of nursing, midwifery personnel to meet the nursing manpower needs at all levels of health services & education. 4 .To study & clarify the role of nursing personnel in the health care delivery system including their interaction with other members of the health team at every level of health service management.

100.   5 .To examine the need for organized nursing services at the national, state, district & local levels with particular reference to the need for planning service with the overall care system of the country at the respective levels. 6 .To look into all other aspects, the Committee will hold consultations with the State governments.

101. BAJAJ COMMITTEE BAJAJ COMMITTEE, 1986- Also known as “Expert Committee on Health Manpower Planning Production and Management”. Headed by Dr S Bajaj, a professor of All India Institute of Medical Sciences, New Delhi.

102. RECOMMENDATIONS 1.Express a National Health Manpower Policy. 2.Formulate a National Policy on Education in Health Sciences. 3.Conduct a country wide survey of health manpower Appoint nurses as follows: 4.1 staff outpatient nurse/100 outpatients. 5. 1 staff nurse/10 hospital beds + 30% extra as leave reserve. 6. 1 ward sister/25 beds + 30% extra as leave reserve. 7. 1 NS for hospital with 200 beds or more. 8. 1 DNS for hospital with 300 beds or more

103.  9.Upgrade & improve medical & health educational infrastructure & technology. 10.In rural areas, establish a “Community Health Center” for every 1,00,000 population. 11.Establish “Educational Commission for Health Services” on the lines of the University Grants Commission

104. 12.Set up “Health Sciences University” in all states & union territories. 13.Establish “Health Manpower Cell” at the center and in the states. 14.Vocationalisation education at 10+2 level as regards health related fields. This will lead to the availability of good quality paramedical personnel.

105.  Agenda to be discussed National AIDS control programme Tuberculosis Control of tobacco National alcohol control policy Ayush Cancer research & treatment National rural health mission Medical education.

106. Central Council Of Health • It as set by presidential order on 9th Aug 1952 • Purpose is to promote the coordination between the Centre and States in the implementation of national programmes and measures pertaining to health • Union Minister of Health is the chairman and State Health Ministers are its members

107. Functions of CCH • Preparing proposals for making laws in areas of medicine and health • Making plans for development of health in entire nation • Preparing recommendations for providing grants and financial assistance to state for medical services and also review the activities in the light of grants provided  • Considering policies and recommendations related to medical care, environment, nutrition and medical education and preparing draft • Encouragement of medical education and training • Cooperation between center and state in health administration and also to establish necessary organizations for better functioning

108. Introduction Healthcare has become one of India’s largest sectors - both in terms of revenue and employment. Healthcare comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment. To providing good health for people, especially the poor and the underprivileged.

109. History Of Family Welfare Programme It was started in year 1951 In 1977, the govt. of India redesignated the “national family planning programme “ as the “national family welfare programme “, and also changed the name of the ministry of health and family planning to ministry of health and family welfare. It is a reflection of the govt’s. anxiety to promote family planning through the total welfare of the family. 4 . It is aimed at achieving a higher end, i.e., to improve the quality of life of the people. 5. India is the first country in the world, that implemented the family welfare programme at Govt. level. 6 . Health is a part of concurrent list but center provides 100% assistance to states for this programme.

110. Concept Of Family Welfare Programme The concept of welfare is basically related to quality of life. As such it includes Education, Nutrition, Health, Employment, Women’s welfare and rights, Shelter, Safe drinking water –all vital factors associated with the concept of welfare. It is a Centrally sponsored programme. For this, the state receive 100% assistance from Central Government.

111. Aim & Objectives Of Family Welfare Programme The Govt. if India in the ministry of health & family welfare have started the operational aims, and objectives of family welfare programme as follows: To promote the adoption of small family size norm, on the basis of voluntary acceptance. To promote the use of spacing methods. To ensure adequate supply of contraceptives to all eligible couples within easy reach.

112.  4 To arrange for clinical and surgical services so as to achieve the set targets. 5 Participations/ local leaders/ local self government, in family welfare programme at various levels.

113. Government Initiatives:  The major initiatives taken by the Government of India to promote Indian healthcare industry are as follows: 1. Provisions made in the Union Budget 2016-17: 2. A new health protection scheme for health cover up to 1 lakh per family. 3. Setting up 3,000 medical stores across the country to provide quality medicines at affordable prices. 4. Senior citizens will get additional healthcare cover of Rs 30,000 (US$ 441) under the new scheme.

114.  5 Pradhan Mantri Jan Aushadhi Yojana to be strengthened, 3000 generic drug store to be opened. 6 Mr. J P Nadda, Union Minister for Health & Family Welfare, Government of India has launched the National Deworming initiative aimed to protect more than 24 corer children in the ages of 1-19 years from intestinal worms, on the eve of the National Deworming Day. 7 The E-health initiative, which is a part of Digital India drive launched by Prime Minister Mr. Narendra Modi, aims at providing effective and economical healthcare services to all citizens.

115. Strategies of family welfare programme Integration with health services: FWP has been integrated with other health services instead of being a separate services. Concentration in rural areas: FWP are concentrated more in rural areas at the level of subentries and primary health centers. This is in addition to hospitals at district, state and central levels. Literacy : There is a direct correlation between illiteracy and fertility. So stress and priority is given for girl’s education . Fertility rate among educated females is low. 4. Raising the age for marriage: Under the child marriage restraint bill(1978), the age of marriage has been raised to 21 years for males and 18 years for females. This has some impact on fertility.

116.   Here 5 things about India’s healthcare systems : 1. Rural v/s Urban Divide: India still spend only around 4.2% of its national GDP towards healthcare goods & services( compare to 18% by the US). A staggering 70% of the population still lives in rural areas & has no or limited access to hospitals & clinics. 2. Need for Effectives Payment mechanism: India's healthcare landscape is the high out-of-pocket expenditure(70%). According to the World Bank & National Commission's report on Macroeconomics, only 5% of Indians are covered by health insurance polices.

117. 3. Demand for Basic Primary Healthcare & Infrastructures: children under five are born underweight and roughly 7% (compare to 0.8% in the US) of the die before their fifth birthday. Only a small percentage of the population has access to quality sanitation. For primary healthcare, the Indian Govt. spends only about 30% of the country’s total healthcare budget. 4. Growing Pharmaceutical Sector: According to the IBEF, India is the third-largest exporter of pharmaceutical Products in term of volume. Around 80% of market is composed of generic low-cost drugs which seem to be the major driver of the industry. The Govt. has already taken some liberal measures by allowing foreign direct investment in this area which force behind the growth of Indian pharma.

118. 5. Underdeveloped Medical Devices Sector: The Govt. has been positive on clearing regulatory hurdles related to the import-export of medical devices, and has set a few standards around clinical trials. According to Economic Times, the medical devices sector is seen as the most promising area for future development by foreign & regional investors; they are highly profitable and always in demand in other countries. .  The cost of surgery in India is about one-tenth of that in the US or Western Europe.

119. Future planning: • India requires 600,000 to 700,000 additional beds over the next five to six years, indicative of an investment opportunity of US$ 25-30 billion. • The average investment size by private equity funds in healthcare chains has already increased to US$ 20-30 million from US$ 5-15 million. • A total of 3,598 hospitals and 25,723 dispensaries across the country offer AYUSH treatment, thus ensuring availability of alternative medicine and treatment to the people

120. National Health Policy :- (1983, 2002 ) National : National is used to describe something that belongs to or is typical of a particular country or nation. Health : Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. POLICY : - A course or principle of action adopted or proposed by an organization or individual.

121. NATIONAL HEALTH POLICY  National health policy in India was not framed and announced until 1983.  The ministry of health and family welfare evolved a National Health Policy in 1983, keeping in view the national commitment to attain the goal health for all by 2000 A.D.  The policy lays stress on the preventive, promotive, public health and rehabilitation aspects of health care.

122. Objectives  NATIONAL HEALTH POLICY (1983):- To attain the objectives “Health for all by 2000 AD”, the Union Ministry of Health and Welfare formulated National Health Policy 1983.

123. KEY ELEMENTS OF NATIONAL HEALTH POLICY 1983  Creation of greater awareness of health problems in the community and means to solve the problems by the community.  Supply of safe drinking water and basic sanitation using technologies that people can afford.  Reduction of existing imbalance in health services by concentrating more on the rural health infrastructure.

124.  Establishing of dynamic health management information system to support health planning and health program implementation.  Provision of legislative support to health protection and promotion.  Concerned actions to combat wide spread malnutrition.  Research in alternative method of health care delivery and low cost health technologies.  Greater co-ordination of different system of medicine.

125. FACTORS INTERFERING WITH THE PROGRESS TOWARDS HEALTH FOR ALL:-  Insufficient political commitment to the implementation on Health for All.  Failure to achieve equity in access to all primary health care elements.  The continuing low status of women.  Slow socio-economic development.

126.  Difficulty in achieving intersectoral action for health.  Unbalanced distribution of and weak support for human resources.  Widespread inadequacy of health promotion activities.  Weak health information system and no baseline data.  Pollution, poor food, safety, and lack of water supply and sanitation.  Rapid demographic and epidemiological changes.  Inappropriate use of and allocation of resources, high-cost technology.  Natural and man-made disasters.

127. National health policy (2002)  NATIONAL HEALTH POLICY-2002 • A revised health policy for achieving better health care and unmet goals has been brought out by government of India- National Health Policy 2002. • According to this revised policy, government and health professionals are obligated to render good health care to the society. • Optimizing the use of health service to a large group rather than a small group is a foreseen event by the NHP 2002.

128. National Health Policy 2002 Objectives:  • Achieving an acceptable standard of good health of Indian Population. • Decentralizing public health system by upgrading infrastructure in existing institutions. • Ensuring a more equitable access to health service across the social and geographical expanse of India. • Enhancing the contribution of private sector in providing health service for people who can afford to pay. • Emphasizing rational use of drugs. • Increasing access to tried systems of Traditional Medicine

129. POLICY PRESCRIPTIONS 1. Financial Resources: 2 . Equity : 3.Delivery Of National Public Health Programs 4. The state of public health infrastructure : 5 . Extending public health services:

130. National population policy :-  A population is a summation of all the organisms of the same group or species, which live in the same geographical area, and have the capability of interbreeding. Policy:-  Set of Ideas or Plans that is used as a basis for decision making;  Attitude and actions of an organization regarding a particular issue;  General Statement of understanding which guide decision making.

131.   The need for National Population Policy was felt since 70’s. It was drafted in 1976. Policy statement on family welfare program was also prepared in 1977. Both these statements were tabled in the parliament but were never discussed or adopted.  The National Health Policy of 1983 emphasized the need for securing the small family norm through voluntary efforts and moving towards the goal of population stabilization.

132. Features:-  Increase the age of marriage from 15 to 18 years for girls and from 18 to 21 years for boys.  Freeze the population figures at the 1971 level until 2001.  Make some portion of central assistance provided to the states dependent upon their performance in family planning.

133.  Give greater attention to education of girls.  Ensure a proper place for population education in the total system of education.  Involve all ministries and departments of the government in the family planning program.  Increase the monetary compensation for sterilization.  Institute group awards as incentives for various organizations and bodies representing the people at local levels, including Zillah Parishad and Panchayat Samiti.

134.  Encourage intimate association of voluntary organizations. Particularly those representing women, with implementation of program.  Impart more importance to research activities in the field of population control.  Use mass media for motivation, particularly in rural areas, to increase the acceptance of family planning methods.

135. NPP-2000 In 1998, a draft of National Population Policy was finalized after consultation it was approved by the cabinet and was examined by groups of ministers. The draft was discussed in cabinet on 19th Nov.1999. The suggestions were incorporated and the final draft of National Population Policy was placed before the parliament. It was adopted by the government of India on 15th Feb. 2000.

136. Objectives:- The immediate objectives are:  To address the unmet needs for contraception, health care infrastructure, and health personnel.  To provide integrated service delivery for basic reproductive and child health care. 2 . The medium term objective is:  To bring the Total Fertility Rate to replacement levels by 2010, through vigorous implementation of Intersectoral operational strategies. 3 . The long term objective is:  To achieve a stable population by 2045, at a level consistent with the requirements of sustainable socio economic growth and developments and environmental protection.

137. National socio-demographic goals for 2010:-  Address the unmet needs for basic reproduction and child health services, supplies and infrastructure.  Make school education up to age of 14 free and compulsory and reduce drop outs primary and secondary schools levels below 20 % for both girls and boys.  Reduce infant mortality rate to below 30 per 1000 live births.  Reduce maternal mortality ratio to below 100 per 10,000 live births.

138.  Achieve universal immunization of children against all vaccine preventable diseases.  Promote delayed marriage for girls, not earlier than age 18 and preferably after 20 years of age.  Achieve 80 % institutional deliveries and 100 % deliveries by trained persons.  Achieve universal access to information / counseling and services for fertility regulation and contraception with a basket of choice.  Achieve 100% registrations of births, death, marriage and pregnancy.

139.  Achieve universal immunization of children against all vaccine preventable diseases.  Promote delayed marriage for girls, not earlier than age 18 and preferably after 20 years of age.  Achieve 80 % institutional deliveries and 100 % deliveries by trained persons.  Achieve universal access to information / counseling and services for fertility regulation and contraception with a basket of choice.  Achieve 100% registrations of births, death, marriage and pregnancy.

140.  Contain the spread of AIDS and promote greater integration between the management of reproductive tract infection and sexually transmitted infections and the national AIDS control organizations.  Prevent and control communicable diseases.  Integrate Indian system of medicine in the provision of reproductive and child health services and in reaching out to the levels of total fertility rate.  Promote vigorously the small family norm to achieve replacement levels of total fertility rate.  Bring about convergence in implementation of related social sector programs so that family welfare becomes a people centered program.

141. Strategic themes:- Decentralized planning and program implementation. 2. Convergence of service delivery at village levels. 3. Empowering women for improved health and nutrition. 4. Child survival and Child Health. 5. Meeting the unmet needs for family welfare services. 6. Under-served population groups:  Urban slums  Tribal communities, hill area population and displaced and migrant populations  Adolescents  Increased participation of men in Planned Parenthood.

142. 7. Diverse health care’s providers. 8. Collaboration with and commitments from non- government organizations and the private sector. 9. Mainstreaming Indian Systems of Medicine and Homeopathy. 10. Providing for the Older Population. 11. Information, Education 12. Communication.

143. Assignment:- Major health problems in India.