HEALTH COMMITTEES.pptx HEALTH PLANNING

HEALTH PLANNING - HEALTH COMMITTEES......................UNIT II ....................V SEMESTER...................BSC NURSING

1. UNIT-II: HEALTH PLANNING TOPIC:HEALTH COMMITTEES 10/7/2024 1

2. INTRODUCTION Health planning –integral part of national socioeconomic planning in India. Guidelines of health planning-various health committees emerged. Government of India appointed these committees to review the existing health situation and recommend for further action. 10/7/2024 2

3. INTRODUCTION B rief recommendation of these committees provides important landmark in the history of public health. 10/7/2024 3

4. LIST OF HEALTH COMMITTEES 1.Bhore committee,1946 2.Mudaliar committee, 1962 3.Chadhah committee,1963 4.Mukerji committee,1965 5.Mukerji committee, 1966 6.Jungalwalla committee,1967 7.Kartar singh committee,1973 8.Shrivastav committee,1975 9.Rural health scheme,1977 10.Health for all by 2000 AD, 1981 11.Bajaj committee, 1986 10/7/2024 4

5. 1.BHORE COMMITTEE Constituted by pre independent Government of India Under Sir Joseph William Bhore , Indian Civil Servant Formed in 1943 . “ Health planning and development committee ” 10/7/2024 5

6. TERMS OF REFERENCE To survey of existing conditions and organization, Secondly suggestions for future development, Consider short term objectives which might reasonably be expected to be reached within a period of 4 to 5 years Objectives which will necessarily require a longer period for attainment. 10/7/2024 6

7. 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 organization Volume II Recommendation Volume III Appendics Volume IV Summary 10/7/2024 7

8. OBSERVATIONS Crude Death Rate:22.4/1000 Infant Mortality Rate: 162/1000 Live Births Maternal Mortality Rate:20/1000 Live Births Life expectancy at birth: 27 years 10/7/2024 8

9. OBSERVATION OF THE COMMITTEE Incidence of communicable disease also was very high. Disease 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 10/7/2024 9

10. contd OBSERVATION OF THE COMMITTEE : If the nation’s health is to be built The health programme to be developed on a foundation of preventive health work Such activities should proceed side by side with those concerned with the treatment of the patients. 10/7/2024 10

11. RECOMMENDATIONS Integration of preventive and curative services at all administrative levels. The committee visualized the development of primary health centre in 2 stages. 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. For each PHC 2 medical officers, 4 public health nurses, one nurse, 4 midwives, 4 trained dais,2 sanitary inspectors ,2 health assisstants,one pharmacist and 15 class IV employees was recommended. 10/7/2024 11

12. Cont … Long term plan(3 million plan): Health care system in 3 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 assistant and other supportive staff. 10/7/2024 12

13. Cont … Second tier : 650 bedded regional health unit(RHU) to serve as a referral centre for 30-40 PHUs. Third tier: district hospitals with 2500 beds to serve the needs of above 3 million.3 months Village health committee consisting of 5-7 individuals for procuring the active participation of the people the local health programme. 3.Major changes in the medical education which includes 3 months training in social and preventive medicine to prepare social physicians. 10/7/2024 13

14. 2.MUDALIAR COMMITTEE By the close of second five year plan ,a fresh look at the health needs and resources, Constituted Mudaliar committee in 1959. By government of India Under Dr. A Lakshmanswamy mudaliar , Vice Chancellor, Madras University “ Health Suvery And Planning Committee” 10/7/2024 14

15. TERMS OF REFERENCE The assessment( or evaluation) in the field of medical relief and public health sense the submission of the health survey and development committee’s report (the Bhore committee) Review of the first and second five year plan health projects Formulation of recommendations for the future plan of health development in the country. 10/7/2024 15

16. OBSERVATIONS Basic health facilities had not reached atleast of the nation. Gross misdistribution of hospitals and beds in favor 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. 10/7/2024 16

17. RECOMMENDATIONS 1.Consolidation of advances made in the first two five year plans 2.Strengthening district hospital with specialist service to serve as a central base of regional services. 3.Regional organizations in each state between the headquarters organization and the district in charge of a Regional Deputy Or Assistant Directors each supervise2to 3 district medical and health officers. 10/7/2024 17

18. RECOMMENDATIONS 4.Each primary health centre not to serve more than 40,000 population. 5.To improve the quality of health care provided by PHCS. 6.Intergration of medical and health servicesas recommended by Bhore committee. 7.Constitution of an All India Health Service on thePattern Of Indian Administrative Services. 10/7/2024 18

19. 3.CHADHAH COMMITTEE A committee of health administrators and malariologists reviewed the maintenance phase of National Malaria Eradication Programme . Constituted in 1963 by Government of India. Under Dr. MS. Chadhah ,then Director General Of Health Services . 10/7/2024 19

20. TERMS OF REFERENCE The committee should go into the details of the requirement related to the PHC, their planning ,the necessary priority required according to the needs of the maintenance phase of the malaria eradication programme. The committee should also considered staffing pattern required for the malaria eradication programme 10/7/2024 20

21. RECOMMENDATIONS One basic health worker per 10,000 population Basic health workers(BHW) should visit house to house once in a month to implement malaria vigilance activities. BHW to serve as Multi Purpose Health Worker(MPHW )for family planning and vital statistics and malaria vigilance. Family Planning Health Asisstants (FPHA) to supervise 3-4 BHW 10/7/2024 21

22. 4.MUKERJI COMMITTEE After the implementation of Chadah committee recommendation realized that BHW could not function effectively as MPHW .As a result ,malaria vigilance opertion affected and family planning programme could not be carried out satisfactorily. Following this, Central Health Council meet at Madras,Constituted in 1965 Headed by Sri Mukerji , secretary, ministry of health and family planning. 10/7/2024 22

23. TERMS OF REFERENCE In 1965 ICMR director pronounced that Lippes loop was safe. So, IUCD was introduced in to the family planning programme and reorganisation of the family planning programme was needed CBR was 41/1000 and was aimed at reducing to 25/1000 in a period of 10 years. 10/7/2024 23

24. Cont … To review what additions and changes are necessary as a result of the greatly altered situation due to the IUCD having come in then fore front of the programme in the staffing pattern, financial provisions, etc. 10/7/2024 24

25. RECOMMENDATIONS Strengthening of education and publicity efforts and involvement of other organisation Strong executive agencies In health directorate of each state government to exclusively deal with family planning Approved the existing urban family welfare centre At rural family planning center - BHW to be utilized as MPW for general services -FPHA to undertake only Family planning work without having to supervisors BHW 10/7/2024 25

26. Cont … BHW to be utilized as MPW for general services. FPHA to undertake only Family planning work without having to supervisors . Delink malaria activities from family planning activity. 10/7/2024 26

27. 5.MUKERJI COMMITTEE,1966 Following 13 th 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 programme like small pox, leprosy, FP, trachoma Formed In 1966 By government of india Headed by Sri B. Mukerji , Union Health Secretary 10/7/2024 27

28. TERMS OF REFERENCE To review the staffing pattern of the primary health center complex and to recommended the minimum staff of various categories Required different levels with in the district so as to provide and integrated health service capable of fully catering to the needs other vigilance services in the maintenance phase of national malaria eradication programme, small pox eradication programme 10/7/2024 28

29. Cont …. services in the maintenance phase of national malaria eradication programme, small pox eradication programme, TB ,leprosy and trachoma control,etc . To recommend the pattern of central assistance for the states 10/7/2024 29

30. RECOMMENDATION 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 then what the committee has recommended 10/7/2024 30

31. 6.JUNGALWALLA COMMITTEE Central council of health , 1964 Srinagar Dr.N . Jungalwalla , Additional Director General Health Services “Committee Of Integration Of Health Services” Submitted report on 1967. 10/7/2024 31

32. TERMS OF REFERENCE To study the problems of the health services Service conditions. Elimination of private practice. Integrated health services defined as 1.A service with unified approach for all problems instead of segmented approach for different problems. 2.Medical care of the sick and conventional public health programmes functioning under single administrator and operating in unified manner at all levels of hierarchy 10/7/2024 32

33. 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 10/7/2024 33

34. 7.KARTAR SINGH COMMITTEE,1973 Growing demand for increase of staff under each programme . Need to reduce population/ area coverd by each worker Meeting of the central family planning council 1972 by Government Of India under the chairmanship of Kartar Singh. “ The committee on multipurpose workers under health and family planning ” 10/7/2024 34

35. TERMS OF REFERENCE Structured for integrated services the peripherals and supervisory levels Feasibility of MPW Their training requirements Utilisation of mobile services for integration 10/7/2024 35

36. RECOMMENDATION Multipurpose workers- feasible and desirable Redesignation - ANMs replaced by FHWs - BHW, malaria surveillance workers, vaccinators, FPHAs replaced by MHWs - LHV designated as FH supervisor. The doctor in charge of PHC should have the overall incharge of all the supervisors and health workers in the area. 10/7/2024 36

37. Cont.. 1 PHC – 50,000 Population 1PHC – 16 SHC (2000-3500) 1 SHC-1MHC n 1 FHW 1 male supervisor- 4 MHWs 1 female supervisor-4FHWs 10/7/2024 37

38. 8.SHRIVASTAV COMMITTEE Government of India in 1974 “Group on medical education and support manpower” Submitted report in 1975. 10/7/2024 38

39. 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 suggestion to realise the above objectives and matters incidental thereto 10/7/2024 39

40. RECOMMENDATION 1.creation of bands of paraprofessional and semiprofessional health workers from within the community itself. 2.Establishment of 2 cadres of health worker namely MPHW and HA between the community level workers and doctors at PHC. 3.Development of referral services complex by establishing proper linkage between PHC and higher referral centre. 10/7/2024 40

41. Cont … Organization of an economic and efficient programme of health services to bridge the community with the first level referral centre,viz ., the PHC. The creation of a national referral services complex by the development of proper linkages between the PHC and higher level referral and service centers . Establishment of a medical health education commissionfor planning and implementing the reforms needed in health and medical educationon the lines of UGC. Committee felt the that one male and female worker for 50000 population. One male and female HA for 2 male and 2 female HW. HA should be located in suncentre not in PHC. 10/7/2024 41

42. 9.RURAL HEALTH SCHEME “Rural health scheme” was launched by the government in 1977-78. The major steps initiated were: a). Involvement medical colleges in healthcare of selected with the objective of reorienting medical education according to rural population called Re Orientation of medical education (ROME) and training of undergraduate students and interns at PHCs. b). Training of village health guides and utilizing their services in the general health service system 10/7/2024 42

43. 10.HEALTH FOR ALL -2000 AD A working group on health was constituted by the planning commission in1980 with the secretary, ministry of health and family welfare, as its chairman, to identify in programme. 10/7/2024 43

44. 11.BAJAJ COMMITTEE An expert committee for health manpower planning, production and management was constituted in 1985 under Dr. J.S . Bajaj, the then professor at AIIMS. 10/7/2024 44

45. RECOMMENDATION Formulation of national medical and health educational policy Formulation of national health manpower policy Establishment of an educational comission for health sciences(ECHS) on the lines of UGC. Establishment of health science universties in various states and union teritorries Establishment of health manpower cells at centre and in the states 10/7/2024 45

46. Cont … Establishment of health manpower cells at center and in the states Vocationalisation of education at 10+ 2 levels as regards health related fields with appropriate incentives Carrying out a realistic health manpower survey. 10/7/2024 46

47. BIBLIOGRAPHY Park k, “TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE”, 21 st edition, banarasidas bhanot, Jabalpur, 2010, page no.812-814. Kamalam. S, “ESSENTIALS IN COMMUNITY HEALTH NURSING PRACTICE”, 1 st edition, 2008 jaypee brothers, new Delhi, page no, 3-10,12-15. B. T. Basavanthappa “COMMUNITY HEALTH NURSING”, 1 st edition, 2008 jaypee brothers, Mumbai, page no 10-12 10/7/2024 47

48. THANK YOU 10/7/2024 48