Health planning and expenditure in India

The decline in health expenditure since the mid-1980s, and the steady withdrawal by the state from provision of public health services, has resulted in diminished capacity of the health system to respond to the basic health needs of communities. This presentation elaborates on the various health planning commissions and health expenditure in India.

1. HEALTH PLANNING AND
EXPENDITURE IN INDIA
Presented By
Dr.Sindhu R
IIIrd Year Postgraduate
Department of Public Health
Dentistry

2. CONTENTS
Introduction
Types of health planning
Organization of health planning
Evolution of health planning in India
History of planning commission
Five year plans (I –XI)
Planning committees
Achievements of Five year plans
NITI Aayog
GDP of India
Current Healthcare expenditures
State-wise public health expenditure
Conclusion
References

3. INTRODUCTION
HEALTH PLANNING
DEFINITION
“Theorderlyprocessofdefiningcommunityhealthproblems,identifying
unmetneedsandsurveyingtheresourcestomeetthem,establishing
prioritygoalsthatarerealisticandfeasibleandprojectingadministrative
actionconcernednotonlywiththeadequacy,efficacyandefficiencyof
healthservicesbutalsowiththosefactorsofecologyandofsocialand
individualbehaviourthataffectthehealthoftheindividualandthe
community"
Hogarth J. Glossary of health care terminology. Copenhagen, World Health Organization, Regional
Office for Europe, 1975.

4. Why planning?
Objectives
Targets
Resource
Programs
Health needs
and demands
Policy
Goals
To match the limited resources
with many problems
To eliminate wasteful expenditure
and avoid duplication
To develop the best course of
action to accomplish a defined
objective.

5. Types of Health planning
Problem-solving
planning
Program planning
Coordination of efforts
and activities planning
Planning for resource
allocation

6. PLANNING CYCLE

7. ORGANIZATION OF
HEALTH PLANNING

8. Planning organization in India

9. EVOLUTION OF HEALTH
PLANNING IN
INDEPENDENT INDIA

10. HISTORY OF PLANNING IN INDIA
National Planning Committee by Indian National
Congress –1938
Bombay Plan –1944
Peoples Plan –1945
SarvodayaPlan -1950

11. PLANNING COMMISSION

12. BHORE COMMITTEE(1946)
1943-Government of India appointed Sir Joseph Bhore
(Chairman) for “Health survey and Development
committee”
Recommendations:
I. Integration of preventive and curative services at all
administrative levels
II. Development of PHCs in 2 stages:
•Short-term measure
Each Primary health centre –40,000 population
Secondary health centre –supervisory
coordinating and referral instituition
2 medical officers
4 Public health nurses
1 nurse
4 midwives
4 trained dais
2 sanitary inspectors
2 health assistants
1 pharmacist
15 other class IV
employees
PHC

13. •Long-term measure(3 million plan)
PHC units with 75-bedded hospitals
(10,000-20,000 population)
Secondary units with 650-bedded hospitals
2,500-bedded District hospitals
III. In medical education: 3 months training in Preventive
and social medicine to prepare “Social physicians”
BHORE COMMITTEE(1946)

14. FIVE YEAR PLANS
PHASE I(1947-72)
PHASE IV (1991 onwards)
PHASE III (1977-91)
PHASE II (1972-77)

15. PHASE I (1947-1972)
Highlight
1950

16. FIRST FIVE YEAR PLAN(1951-56)
Indigenous systems of medicine
1954
752 PHCs were established
Harrod
Domar
model

17. SECOND FIVE YEAR PLAN(1956 -61)
Objectives
Establishment of institutional facilities that offers services to the local
people and surrounding areas
Development of technical manpower through appropriate training
programs
Development of institutions to control widely prevalent communicable
diseases
Improvement of environmental hygiene through active campaign
Family planning and other supportive programs for raising the
standard and health of the people
Proposal: To set up another 3000 PHCs
Mahalanobis
plan

18. THIRD FIVE YEAR PLAN(1961-66)
Gadgil
Yojna

19. MUDALIAR COMMITTEE(1962)
1959-Government of India appointed “Health survey and Planning
committee” / “Mudaliarcommittee” after Dr.A.L.Mudaliar(chairman)
Quality of services provided by PHCs were inadequate
Requires strengthening of the existing PHCs
Recommendations:
Consolidation of advances made in FYP I & II
Strengthening of District hospitals with specialist services
Each PHC –40,000 population
Improve quality of healthcare
Integration of medical and health services(Bhorecommittee)
Constituitionof All India Health Service

20. CHADAH COMMITTEE(1963)
•1963-Government of India appointed the committee under Dr.
M.S.Chadah( chairman) of “Director general of Health services”
Recommendation:
oVigilance operations for “National Malaria
Eradication Programme”
oMonthly home visits by “Basic health workers” (10,000 population)
Multipurpose worker ( collection of vital
statistics & family planning)
Family planning health assistant 3 or 4 MPWs
Supervise

21. Mukerji Committee(1965 & 1966)
•Appointed at a meeting of Central Health Council, Bangalore under
the Chairmanship of Shri Mukerji(Secretary of Health)
•To review strategies for “family planning programme”
Recommendations:
Separate staff for family planning programme
Delink malaria activities from family planning
Family planning health assistant: undertake only family
planning activities
Basic health workers: other purposes

22. JUNGALWALLA COMMITTEE(1967)
Appointed at a meeting of Central Health Council,
Bangalore under the Chairmanship of
Dr.N.Jungalwalla
(Director, National instituiteof health administration
administration and education, New Delhi)
Recommendations: “Integrated Health
oUnified cadre
oCommon seniority
oRecognition of extra qualifications
oEqual pay for equal work
oSpecial pay for specialized work
oNo private practice and good service conditions

23. FOURTH FIVE YEAR PLAN(1969 -74)
•In 1959, Dr.A.L.Mudaliar(Health survey and planning committee)
was appointed
•In 1961-Committee submitted the report
•By 1969-Some work has been done at central level
Fourth five year plan was set
Goals:
Health manpower development by training different categories of
medical personnel
Strengthening the available health infrastructure
Consolidation of advances made so far
Chairman

24. PHASE II (1972-1977)
MAJOR HEALTH EVENTS BETWEEN 1972 -77

25. KARTAR SINGH COMMITTEE(1973)
•Appointed under the Chairmanship of Kartarsingh
( Additional secretary, Ministry of Health and Family planning)
Recommendeations :
Replacement
Present ANM Female Health Workers
Basic Health workers,
Malaria surveillance
workers, Vaccinators,
Health education assistants,
Family planning health
assistants
Male Health Workers

26. KARTAR SINGH COMMITTEE(1973)
i.MPWs-placed first in areas where Malaria is in maintenance
phase and smallpox controlled
ii.PHC-50,000 population
iii.Each PHC-divided into 16 sub-centres (3000-3500 population)
iv.Each sub-centre: 1 Male & 1 female health worker
v.Male health supervisor: 3-4 MHW
vi.Female health supervisor: 4 FHW
vii.Lady health visitors: designated as female health supervisors
viii.PHC’s doctor should have overall charge of the staffs in the area.

27. FIFTH FIVE YEAR PLAN(1974-79)
•Multipurpose workers scheme
•Minimum needs Program
•Medical education and support manpower
•Many maternal and child health components
Family planning
Family Welfare Program

28. SHRIVASTAV COMMITTEE(1975)
“Group on Medical Education and Support Manpower”
Recommendations:
I.Creation of para and semi-professional health workers from the
Community itself
II.Establishment of 2 cadres of health workers: MPW & health
assistants
III.Development of “Referral Services Complex”
IV.Establishment of Medical and Education Committee for
planning and implementing reforms

29. RURAL HEALTH SCHEME(1977)
Involvement of medical colleges in health care of selected PHCs
Reorienting medical education to the needs of rural people
Reorienting training of multipurpose workers unipurpose workers,
by engaging in communicable disease programs

30. PHASE III (1977-1991)
•1977-Smallpox eradication
–Reorientation of Medical Education(ROME)
Scheme
•1978-Alma Ata Declaration
–Expanded Program of Immunization
•1982-National Health Policy(announced)
•1983-National Health Policy(launched)

31. SIXTH FIVE YEAR PLAN(1980-85)
oHealth care delivery in rural and urban areas
oPopulation stabilization and MCH activities
oControl of communicable, non-communicable diseases and
blindness
oMedical/health research and development
oMedical education, training and manpower planning
oHealth education, information and communication
oIndigenous systems of medicine and homeopathy

32. SEVENTH AND EIGHTH FIVE YEAR PLAN(1985 -90,
1992-97)
Goals to achieve by 2020:
i.Virtual elimination of poverty
ii.Virtual elimination of illiteracy
iii.Ensuring near full employment
iv.Ensuring basic needs of food, clothing and shelter for all
To accomplish fully operational health infrastructure in
Community health volunteers
Health workers
Sub-centers
PHCs
Basic sanitation
80% urban
25% rural population

33. Universal coverage of vaccination against 6 vaccine
preventable diseases of children
Achieve “Couple Protection Rate”
42%-by end of VII FYP
56%-by end of VIII FYP
SEVENTH AND EIGHTH FIVE YEAR PLAN(1985 -90,
1992-97)

34. NINTH FIVE YEAR PLAN(1997-2002
NEW INITIATIVES
MCH services under a re-designated RCH program
Integration of vertical programs(eg: NLEP), with primary care system
system
Develop a disease surveillance system at district level
Develop integrated NCD control program
Apply management systems for emergency, disaster and accidents

35. TENTH FIVE YEAR PLAN(2002-2007)
Extension of ninth plan
No major shift
Efforts were made to bring better quality of
health care
Identifying & Filling
critical gaps –Infrastructure
Manpower
Material

36. ELEVENTH FIVE YEAR PLAN(2007 -12)
Horizontal integration of healthcare and reduction of inequities
Strengthening of health systems and Public private partnership
Improve equity in health
•Rapid expansion of NRHM & NUHM
•Insurance schemes
•Improving access and quality of
primary care
GOALS
Decentralizing the system of
governance by increasing the
role of Panchayat Raj
Institutions, NGOs and Civil
society

39. NITI AAYOG

40. NITI AAYOG -ACHIEVEMENTS
Reforms in Agriculture
Reforming Medical Education
Digital Payments Movement
Atal Innovation Mission
Indices Measuring States Performance in Health, Education and
Water Management
Task Force on Elimination of Poverty in India
Task Force on Agriculture Development
Transforming India Lecture Series
http://pib.nic.in/newsite/PrintRelease.aspx?relid=161229

41. HEALTH EXPENDITURE IN
INDIA

42. GDP INDIA
https://data.worldbank.org/

43. CURRENT HEALTH EXPENDITURE (% OF GDP)
Countries % GDP(2016)
Marshal Islands 23.29
UnitedStates 17.07
Sierra Leone 16.53
Tuvalu 15.45
Cuba 12.19
India 3.66
https://data.worldbank.org/

44. KEY HEALTH FINANCING INDICATORS
FOR INDIA: NHA ESTIMATES 2014-15

45. KEY HEALTH FINANCING INDICATORS
FOR INDIA ACROSS NHA ROUNDS

46. Distribution Of Current Health Expenditure (2015-16) By Healthcare Financing
Schemes, Revenues Of Healthcare Financing Schemes, Healthcare Providers
And Healthcare Functions (%)

47. CURRENT HEALTH EXPENDITURES (2015 -16) BY
HEALTHCARE FINANCING SCHEMES (%)

48. CURRENT HEALTH EXPENDITURES (2015 -16) BY
PROVIDERS OF HEALTHCARE (%)

49. CURRENT HEALTH EXPENDITURES (2014 -15) BY
HEALTHCARE FUNCTIONS (%)

50. Percentage Distribution of Public Health Outlay on Revenue &
Capital during 2015-16 (RE)
National Health Accounts Cell
Ministry of Health & Family Welfare

52. MAJOR HEALTH EVENTS BETWEEN 1946 -1971

53. MAJOR HEALTH EVENTS SINCE 1991
PHASE IV (1991 ONWARDS)

54. CONCLUSION
ThoughHealthisimportantforoverallwell-beingofthe
populationinacountry,Indiaspendsonly3.66%ofGDPfor
healthcarewhichislesserthanmanylowermiddleincome
countries.
Currentpaceofslowincreaseinthehealthcarebudgetwillmakeit
difficulttoachievetargetslikereducingMMRto100in2018-2020
andIMRto28bythisyear.

55. REFERENCES
Gupta P, GhaiO. Textbook of preventive and social
medicine. New Delhi: CBS Publishers; 2007.
Park K. Park's textbook of preventive and social
medicine. Jabalpur. BanarasidasBhanot. 2017;463.
india.health.info/
http://planningcommission.nic.in/plans/planrel/fiveyr
/11th_vol2.pdf
https://data.worldbank.org/
www.undp.org.in/ihdg.htm
•NHA Estimates Report
•https://www.mohfw.gov.in/sites/default/files/GATS-FactSheet.