healthcommitteesp Communitypt-201119093104.pptx

COOMUNITY HEALTH NURSING

1. HEALTH & FAMILY WELFARE PLANNING COMMITTEES IN INDIA -PRAKASH S

2. OUTLINE Introduction Various health and welfare committees Bhore committee Mudaliar committee Chadha committee Mukherji committee Jungalwalla committee Kartar Singh committee

3. OUTLINE Shrivastav committee Rural Health Scheme Shivaraman Committee Ramalingaswamy Committee Bajaj Committee Krishnan Committee Health For All

4. 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 recommend measures for further action.

5. INTRODUCTION More recently 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.  

6. VARIOUS HEALTH COMMITTEES BHORE COMMITTEE (1946) MUDALIAR COMMITTEE (1962) CHADHA COMMITTEE (1963) MUKERJI COMMITTEE (1965) MUKERJI COMMITTEE (1966)

7. VARIOUS HEALTH COMMITTEES JUNGALWALLA COMMITTEE (1967) KARTAR SINGH COMMITTEE (1973)   SHRIVASTAV COMMITTEE (1975) RURAL HELTH SCHEME (1977) Shivaraman Committee (1979)

8. VARIOUS HEALTH COMMITTEES HEALTH FOR ALL by 2000AD- Report of the working group, 1981   Krishnan Committee (1992) Ramalingaswamy Committee (1980) Bajaj Committee (1986)

9. BHORE COMMITTEE (1946) This committee, known as the Health Survey & Development Committee , was appointed in 1943 with Sir Joseph Bhore as its Chairman. It laid emphasis on integration of curative and preventive medicine at all levels. Comprehensive recommendations were made by him for remodelling of health services in India.

10. BHORE COMMITTEE (1946) The committee observed: “ if the nation’s health is to be built, the health programme should be developed on a foundation of preventive health work and that such activities should proceed side by side with those concerned with the treatment of patients” .

11. Comprehensive healthcare comprising a package of:- Medical Relief, Communicable Disease Control Environmental Sanitation Maternal and Child Health Care School Health Services Health Education Vital Statistics

12. BHORE COMMITTEE (1946) The report, submitted in 1946, had some important recommendations like :- 1.) Integration of preventive and curative services of all administrative levels. 2.) Development of Primary Health Centres in 2 stages: Short-term measures Long-term measures

13. DEVELOPMENT OF PHC IN TWO STAGES: Short term measures long term measures Government should establish 1 primary health centre for every 40,000 population staffed by 2 doctors, 1 nurse, 4 public health nurses, 4 midwives, 4 trained dais, 2 sanitary inspectors, 2 health assistants 1 pharmacist. Government should setup the following (termed as ‘3 million plan’) 75 bedded primary health centre for 10,000-20,000 rural population. 65 bedded regional hospital. 2,500 bedded hospital at the district level.

14. BHORE COMMITTEE (1946) 3) Major changes in medical education which includes 3 - month training in preventive and social medicine to prepare “social physicians”. The committee’s Report continues to be a major national document, and has provided guidelines for national health planning in India.

15. MUDALIAR COMMITTEE(1962) This committee known as the “Health Survey and Planning Committee” , headed by Dr. A.L. Mudaliar, was appointed in 1959 to assess the performance in health sector since the submission of Bhore Committee report and to make recommendations for future development and expansion of health services. This committee found the conditions in PHCs to be unsatisfactory and suggested that the PHC, already established should be strengthened before new ones are opened. Strengthening of sub divisional and district hospitals was also advised.

16. Medical Care Public Care Control of Communicable Disease Population Control Professional education and research Indigenous system of medicine Drugs and Medical supplies Legislation Health Administration Medical Research The Committee was sub-divided into different sub-committees to deal with different subjects like:

17. MUDALIAR COMMITTEE (1962) The main recommendations of the Mudaliar Committee were: Consolidation of advances made in the first two five year plans Strengthening of the district hospitals with specialist services to serve as central base of regional services Regional organizations in each state is placed between the headquarter organization and the district as Regional Deputy or Assistant Directors to supervise 2-3 District Medical and Health Officer.

18. MUDALIAR COMMITTEE (1962) Integration of medical and health services as recommended by Bhore Committee It was emphasized that a PHC should not be made to serve to more than 40,000 populations and that the curative, preventive and promotive services should be all provided at the PHC. The Mudaliar Committee also recommended that an All India Health service should be created to replace the erstwhile Indian Medical service.

19. CHADHA COMMITTEE (1963)  

20. CHADHA COMMITTEE (1963) This committee was appointed under the chairmanship of Dr. M.S. Chadha, the then Director General of Health Services, in 1963, to advise about the necessary arrangements for the maintenance phase of National Malaria Eradication Programme. The committee suggested that the vigilance activity in the NMEP should be carried out by primary health centres at block level

21. CHADHA COMMITTEE (1963) The committee also recommended that vigilance operations through monthly home visits should be implemented through basic health workers. One basic health worker per 10,000 populations, also function as “multipurpose workers” and would perform, in addition to malaria work, the duties of family planning and vital statistics data collection under supervision of family planning health assistants. The Family Planning Health Assistants were to supervise 3 to 4 of these basic health workers.

22. MUKERJI COMMITTEE (1965) & (1966)

23. MUKERJI COMMITTEE (1965) The recommendations of the Chadha Committee, when implemented, were found to be impracticable because the basic health workers, with their multiple functions could do justice neither to malaria work nor to family planning work. The Mukherjee committee headed by then Secretary of Health Shri Mukerji, was appointed in 1965, to review the performance in the area of family planning. The committee recommended separate staff for the family planning programme

24. MUKERJI COMMITTEE (1965) After committee recommendation, the family planning assistants were to undertake family planning duties only. The basic health workers were to be utilized for purposes other than family planning. The committee also recommended delinking the malaria activities from family planning so that the latter would receive undivided attention of its staff.

25. MUKERJI COMMITTEE (1966) Multiple activities of the mass programmes like family planning, small pox, leprosy, trachoma, NMEP (maintenance phase), etc. was making it difficult for the states to undertake these effectively because of shortage of funds. A committee of state health secretaries, headed by the Union Health Secretary, Shri Mukherjee, was set up to look into this problem. The committee worked out the details of the BASIC HEALTH SERVICES which should be provided at the Block level, and some consequential strengthening required at higher levels of administration.

26. MUKERJI COMMITTEE (1966) Make family planning a vertical program. Fix targets for contraceptives distribution and for sterilizations. Provide incentives to the acceptors of contraceptives /sterilization.

27. JUNGALWALLA COMMITTEE (1967) This committee, known as the “Committee on Integration of Health Services” was set up in 1964 under the chairmanship of Dr. N. Jungalwalla, the then Director of National Institute of Health Administration and Education, New Delhi (currently NIHFW). It was asked to look into various problems related to integration of health services, abolition of private practice by doctors in government services, and the service conditions of Doctors.

28. JUNGALWALLA COMMITTEE (1967) The committee defined “integrated health services” as:- (a.) A service with a unified approach for all problems instead of a segmented approach for different problems. (b.) Medical care and public health programmes should be put under charge of a single administrator at all levels of hierarchy with due priority for each programme obtaining at a point of time.

29. JUNGALWALLA COMMITTEE (1967) Following steps were recommended for the integration at all levels of health organization in the country- Unified Cadre Common Seniority Recognition of extra qualifications Equal pay for equal work Special pay for special work Abolition of private practice by government doctors Improvement in their service conditions The committee stated that “integration should be a process of logical evaluation rather than revolution.”

30. KARTAR SINGH COMMITTEE (1973)

31. 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.

32. KARTAR SINGH COMMITTEE (1973) References of the committee are as follows: The structure for integrated services at the peripheral and supervisory levels The feasibility of having multipurpose, bipurpose workers in the field The training requirements for such workers Utilization of mobile service unit which is set-up under Family Welfare Programme

33. KARTAR SINGH COMMITTEE (1973) Recommendations are as follows:- The present Auxillary Nurse Midwives to be replaced by newly designated “Female Health Workers” Multipurpose workers to be first introduced in areas where Malaria is in maintenance phase and small pox has been controlled and later to areas where malaria passes into maintenance phase or small pox controlled. 1 PHC cover 50,000 population.

34. KARTAR SINGH COMMITTEE (1973) Every PHC divided in 16 sub- centres, each covering 3,000- 3,500 population, depending upon topography and means of communication 1 Male Health Worker (MHW) and Female Health Worker (FHW) to be staffed at each sub-centre 3 to 4 MHW and FHW are supervised by 1 Male and Female Health Supervisor respectively. Recommendations are as follows:-

35. KARTAR SINGH COMMITTEE (1973) The present- day lady health visitors to be designated as female health supervisors The doctor in charge of a PHC should have the overall charge of the supervisors and health workers in his area. Recommendations are as follows:-

36. SHRIVASTAV COMMITTEE (1975)

37. SHRIVASTAV COMMITTEE (1975)

38. SHRIVASTAV COMMITTEE (1975) This committee was set up to determine steps needed to- (a.) Reorient medical education in accordance with national needs & priorities (b.) to suggest steps for improving the existing medical educational processes as to provide due to emphasis on the problems particularly relevant to national requirements (c.) to make any other suggestions to realise the above objectives and matters incidental thereto.

39. SHRIVASTAV COMMITTEE (1975) It recommended immediate action for:- 1. Creation of bonds of paraprofessional and semi-professional health workers from within the community itself. 2. Establishment of 3 cadres of health workers namely– multipurpose health workers and health assistants between the community level workers and doctors at PHC. 3. Development of a “Referral Services Complex”

40. SHRIVASTAV COMMITTEE (1975) 4. Establishment of a Medical and Health Education Commission for planning and implementing the reforms needed in health and medical education on the lines of University Grants Commission. Acceptance of the recommendations of the Shrivastava Committee in 1977 led to the launching of the Rural Health Service.

41. RURAL HELTH SCHEME (1977) The basic recommendations of the Committee were accepted by the Govt. in 1977, which led to the launching of the Rural Health Scheme. The Programme of training of community health workers was initiated during 1977-78.  

42. RURAL HELTH SCHEME (1977) Steps were also initiated- (a) For involvement of medical colleges in the total health care of selected PHCs with the objective of reorienting medical education to the needs of rural people. (b) Reorienting training of multipurpose workers engaged in the control of various communicable disease programmes into uni-purpose workers. This "Plan of Action" was adopted by the Joint Meeting of the Central Council of Health and Central Family Planning Council held in New Delhi in April 1976.

43. Shivaraman Committee (1979) A Committee on Basic Rural Doctors was framed under the guidance of Shri Shivaraman, the then Member of Planning Commission. The committee recommended establishment of countrywide cadre of basic rural doctors consisting of trained paraprofessionals to extend comprehensive health care delivery to rural community.

44. Ramalingaswamy Committee (1980) This committee under the chairmanship of Dr V Ramalingaswamy, the then DGHS, recommended: •Involvement of community for health planning and health program implementation •30 bedded hospital for every 1 lakh population •Integration of health services at all levels •Redefined the role of doctor in the community •Recommended that PHC and District Health Centers should be under the control of three tier Panchayat Raj System.

45. Bajaj Committee (1986) An expert committee for ‘health manpower planning, production and management’ is constituted under the Chairmanship of Dr JS Bajaj, the then Member of Planning Commission, to tackle the problem of health manpower planning, production and management. "Important recommendations of the Bajaj committee are: •Recommended for Formulation of National Health Manpower planning based on realistic survey. •Educational Commission for health sciences should be developed on the lines of UGC.

46. Bajaj Committee (1986) Recommended for National and Medical education policies in which teachers are trained in health education science technology. Uniform standard of medical and health science education by establishing universities of health sciences in all states. Establishment of health manpower cells both at state and central levels. Vocational courses in paramedical sciences to get more health manpower.

47. Krishnan Committee (1992) The committee under the chairmanship of Dr Krishnan reviewed the achievements and progress of previous health committee reports and also made comments on shortfalls. The committee addresses the problems of urban health and devised the health post-scheme for urban slum areas.

48. Krishnan Committee (1992) "The committee had recommended :- one voluntary health worker (VHW) per 2,000 population. Its report specifically outlines which services have to be provided by the health post. These services have been divided into outreach, preventive, family planning, curative, support (referral) services and reporting and recordkeeping. Outreach services include population education, motivation for family planning, and health education. In the present context, a very few outreach services are being provided to urban slums.

49. HEALTH FOR ALL by 2000AD- Report of the working group, 1981 A working group on Health was constituted by the Planning Commission in 1980 with the Secretary, Ministry of Health and Family Welfare, as its Chairman, to outline with that perspective, the specific programmes for the sixth Five Year Plan. The Working Group, besides identifying and setting out the broad approach to health planning during the sixth Five Year Plan, has also evolved fairly specific indices and targets to be achieved in the country by 2000 A.D.

50. CONCLUSION These committees are appointed from time to time to look in to the issues of the health care administration. Recommendations made by these committees were very helpful to make an excellent change in our health care delivery system.

51. SUMMARY Introduction Various health and welfare committees Bhore committee Mudaliar committee Chadha committee Mukherji committee Jungalwalla committee Kartar Singh committee Shrivastav committee Rural Health Scheme Shivaraman Committee Ramalingaswamy Committee Bajaj Committee Krishnan Committee Health For All

52. ASSIGNMENT Ques. Enlist all the health committees and their objectives.

53. REFERENCES K. Park, Park’s Textbook of Preventive and Social Medicine, 23 rd Edition, Health Planning and Management(873-875) K.K.Gulani , Community Health Nursing (Principles & Practices), 2 nd Edition, Health Care Administration in India(627-628) Ghosh J.M., Community Health Nursing, Planning Committees in India(Chapter-18) Health Planning in India. Last updated on 4/28/2011. http://business.mapsofindia.com/india-planning/health.html. Health for All. World Health Organization Belarus, http://undp.by/en/who/healthforall/