Health committees in community health nursing

VARIOUS HEALTH CARE COMMITTEES IN INDIA

1. Unit II HEALTH COMMITTEES BY: MR . J.C. FRANK M.Sc (N) ASSISTANT PROFESSOR

2. Sir JosephWilliam Bhore

3. Bhore Committee - Constituted by pre independent GOI - Under Sir Joseph William Bhore , Indian Civil Servant Formed in 1943 “Health Planning and Development Committee”

4. 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.

5. 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

6. Observations CDR : 22.4/1000 IMR : 162/1000 live births MMR : 20/1000 live births Life expectancy at birth : 27 years.

7. 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.

8. 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

9. 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.

10. 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

11. Sir A Lakshmanaswamy Mudaliar

12. Mudaliar Committee Constituted in 1959 By GOI Under Dr. A Lakshmanswamy Mudaliar , Vice Chancellor, Madras University “Health Survey and Planning Committee”

13. 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.

14. 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

15. Recommendations Consolidation of 1 st 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

16. 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

17. Terms of Reference 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 . The committee should also consider the Staffing pattern required for the malaria eradication programme.

18. 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

19. 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

20. 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.

21. 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.

22. 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

23. 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

24. 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

25. 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.

26. 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

27. Terms of Reference To study the problems of the health services Service conditions Elimination of Private practice

28. 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.

29. Kartar Singh Committee Growing demand for increase of staff under each programme. Need to reduce population/area covered by each worker.

30. 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

31. Terms of Reference Structure for integrated services the peripherals and supervisory levels Feasibility of MPW Their training requirements Utilisation of mobile services for integration

32. Recommendations Multipurpose workers - feasible and desirable Redesignation - ANMs replaced by FHW s - BHW, Malaria surveillance workers, vaccinators, FPHAs replaced by MHW s - 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

33. 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 5 th 5yr plan

34. 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

35.   Shrivastav Committee MOHFP,GOI In 1974 “ Group on Medical Education and Support Manpower” Submitted report in 1975

36. 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

37. Recommendations 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

38. 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

39. 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’

40. 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.