National Health planning ( 5 year plans)

NHP

1. SEMINAR ON: National health planning FIVE YEAR PLANS Presenter by: Nadish Manzoor 1 st year NPCC M V J college of nursing

2. Introduction The  economy of India  is based in part on  planning  through five-year plans , which are developed, executed and monitored by the  Planning Commission . In 1950, planning commission was constituted to help Government to plan out integrated development plan for the entire country within the available resources for a defined period of five years for its socio economic progress.

3. PLANNING DEFINITION:Planning is the iterative process of making decisions about theeffective tasks to achieve the objectives Planning is a process ofdetermining the objectives of administrative efforts and devising themeans calculated to achieve them.(Millet )Planning is a process of setting formal guidelines and constraints forthe behaviour of the firm.( Assoff and Brudinharg

4. Why to Plan ? After independence, India was in dire conditions and needed to startacting soon.Some of the problems necessitated need for an immediate plan:• Vicious circle of povertyForeign Trade• Need for Rapid industrialisation Population pressure• Development of Natural resources• Capital Deficiency & Market imperfections

5. HEALTH AND FIVE YEAR PLAN Recognising the health as an important contributory factor in theutilisation of manpower and in the uplifting of the economiccondition of the country, the Planning commission gaveconsiderable importance of health programmes in the five yearplans .

6. OBJECTIVES The broad objectives of the health programme during five- year-plansare as follows:• Control and eradication of major communicable diseases• Strengthening of basic health services through the establishment ofprimary health centres and sub-centres ,• Population• Development of health manpower resources

7. PURPOSES For the purposes of planning, health sector has been divided into thefollowing sub-sectors:• Water supply and sanitation• Control of communicable diseases• Medical education, training and research• Medical care including hospitals ,dispensaries and PHCs• Public Health Services• Family planning and• Indigenous system of medicine

8. COMMUNITY DEVELOPMENT PROGRAMME The community programme was launched in India during 1952. It isthe process which is designed to promote better living of wholecommunity ,with active participation by the community itself alongwith government efforts.

9. First five year plan (1951-1956) The Aim: The aim of first five year plan was to fight against diseases, malnutrition, and unhealthy environment and to build up health services for population and for mothers and children in order to improve general health status of people.

10. The Major Developments: The Year 1951 The B.C.G vaccination programme launched. The Year 1952 The pilot project of community development programme was launched Primary Health centres were set up Auxiliary Nurse Midwife training was started

11. The Year 1953 The National Malaria Control Programme was launched. The National Family Planning Programme was launched. The Year 1954 The central social welfare board was set up. The national leprosy control programme was launched. The Prevention of Food Adulteration Act was enacted. The national water supply and sanitation programme was launched. The Antigen Production Centre was set up at Kolkata. The Year 1955 The national filaria control programme was launched. The minimum marriage age of 18 years for boys and 15 years of girls was prescribed by Hindu Marriage Act.

12. Second five year plan (1956-1961) The Aim: The aim of the second Five Year Plan was expand existing health services to bring them within in the reach of all people so as to promote progressive improvement of nation’s health.

13. The Priorities: Establishment of institutional facilities for rural as well as for urban population. Development of technical manpower. Intensifying measures to control widely spread communicable disease. Encouraging active campaign for environmental hygiene, water supply and sanitation. Provision of family planning and other supporting services.

14. The Major Developments The Year 1956 Director, family planning was appointed at the centre. The centre health education bureau was set up at the centre. The Tuberculosis Chemotherapy centre setup at Chennai. The pilot project of Trachoma Control program was launched . The Year 1957 The Demographic Research Centre were established in Delhi Kolkata and Chennai. The Year 1958 The national Malaria Control Program was converted in to National Malaria Eradication Program. The Leprosy Advisory committee of the government of India was launched.

15. The Year 1959 The Mudaliar committee was setup by the government of India. The National Institute of Tuberculosis was established at Bangalore. The Year 1960 Pilot project of Small Pox Eradication were started. The Nutrition Advisory committee was formed The School Health Committee was appointed by the Union Ministry of Health

16. Third five year plan(1961-1966) The Aim The main aim of the third five year plan was to remove the shortages and deficiencies, which were observed at the end of second five year plan in the field of health.

17. Priorities Safe water supply in villages and sanitation especially the drainage facilities in urban area 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 health status of people Development of man power

18. Major Developments The Year 1961 The Mudaliar Committee Report was submitted and published. The central bureau of health intelligence established The Year 1962 The National Small Pox Eradication Program and The National Goitre Control program was launched . The School Health Program was started.

19. The Year 1963 The Applied Nutrition Program was started by government of India with the support of UNICEF, WHO and FAO. The Drinking Water Board was established. The Chadha Committee was appointed The Year 1964 The National Institute of health Administration and Education was established in the collaboration with Ford foundation. The Year 1965 Lippes Loop was recommended as a safe and effective family planning device by the Director ,ICMR. BCG vaccination without Tuberculin Test was introduced on house to house basis .

20. The Year 1966 Separate department of family planning was setup in the Union Ministry health The Year 1967 The committee was setup on small family norm The Year 1968 The Medical Education Committee was appointed to study the various aspects of medical education within the framework of national need and resources.

21. Fourth five year plan (1969-1974) The Aim The main of this plan was to strengthen primary health centre network in the rural areas for undertaking preventive, curative family planning services and to take over the maintenance phase of communicable diseases.

22. The Priorities The Family planning Program to strengthen primary health centre strengthening . sub divisional district hospital to provide effective referral support to primary health centre. Intensification of control programmes Expansion of medical and nursing education training of paramedical personnel to meet the minimum technical manpower requirement .

23. The Major Developments The Year 1969 The central births and deaths registration act was promulgated. The report of Medical Education Committee was submitted. Nurtritional research laboratory –National institute of nutrition The Year 1970 The population council of India was setup. Registration Act of Birth and death came in to force. The Year 1971 The family pension scheme for industrial workers was introduced.

24. The Medical Termination of Pregnancy Bill was passed by parliament. The Year 1972 The MTP Act was implemented. The Committee on “Multipurpose Workers Under Health and Family Planning” headed by Kartar Singh, The Additional Secretary of health was setup . The Year 1973 The scheme of setting 30 bedded rural hospitals serving 4 primaries Health Centre was conceptualise. The Kartar Committee submitted its report.

25. Fifth five year plan(1974-1979) The Aim The main aim of the fifth five year plan was to provide minimum level of well integrated health, MCH and FP, nutrition and immunization services to all the people with especial reference to vulnerable groups especially children, pregnant women and nursing mother .

26. The Priorities Increasing accessibility of health services to rural areas Correcting regional imbalance Further development of referral services Integration of health, family planning and nutrition. Intensification of the control and eradication of communicable diseases especially malaria and small pox. Qualitative improvement of the education and training of health Development of referral services

27. The Major Developments The Year 1974 world population year by the United nation . Srivastava Committee was setup in November. The Year 1975 India became small Pox free on 5 th July 1975 . The revised strategy of national Malaria Eradication Program was accepted by the government. Children Welfare board was setup.

28. Integrated Child Development Scheme ESI Act was amended. The Year 1976 Indian Factory Act of 1948 was amended. The prevention of Food Adulteration Act A new population policy The Year 1977 The training of community health worker was initiated. “Goal of Health for All” was adopted WHO.

29. The Year 1978 The Child Marriage Restrained Bill 1978 fixing the minimum marriage age that is 21 years for boys and 18 year for girl was passed. Alma Ata declared “Primary Health Care Strategy” to achieve the goal of “Health for All” by the year 2000. Extended program of immunisation was started. The Year 1979 The declaration of Alma Ata on primary health care strategy was endorsed by WHO.

30. Sixth five year plan(1980-1985) The Aim The main aim of sixth five year plan was to workout alternative strategy and plan of action for primary health care as a part of national health system which is accessible to all section of society and especially those living in tribal hilly , remote rural areas and urban slums.

31. The Priorities Rural health services control of communicable and other diseases . Development of rural and urban hospitals. Improvement in medical Education Medical Research. Population control and family welfare including MCH. Drug control and prevention of food adulteration.

32. The Major Development The Year 1980 WHO declared eradication of Small Pox from the world . The Year 1981 The 1981 census was undertaken The control of pollution act of 1981 was enacted. The Year 1982 The national health policy was announced and placed in parliament.

33. The Year 1983 National Leprosy control programme was changed to National Eradication Programme. National health policy was approved by the parliament. National gunia worm eradication Programme was started. The Year 1984 The ESI Bill 1984 was passed by the parliament.

34. Seventh five year plan(1985-1989) The Aim The main aim for the seventh five year Plan was to plan and provide primary health care and medical services to all with special consideration of venerable groups and those who are living in tribal, hilly and remote rural areas so as to achieve to achieve goal of health for all 2000 AD.  

35. The Priorities Health Services in rural , tribal and hilly areas under Minimum Need Program. Medical Education and Training Control of emerging health problems especially in the area of non communicable diseases . MCH and family welfare Medical Research Safe water supply and sanitation Standardisation .integration and application of Indian system of medicine .

36. The Major Development The Year 1985 The Universal Immunisation Program was launched on 19 th November, the birth date of Late PM Shrimati Indira Gandhi. The Year 1986 Environment Protection was promulgated Mental health bill passed Juvenile Justice Act started working. National AIDS Control program was started. The Year 1987 Worldwide Safe Motherhood Campaign was started by world bank . National Diabetes Control Program was launched .

37. A high power committee on Nursing and Nursing Profession was setup by the government of India on 29 th July. The Year 1988-91 The ESI (Amendment Act) came in to force. Acute Respiratory Infection Program was started as a pilot project in 14 districts in 1990. The 1991 census was conducted. The high power committee on Nursing and Nursing profession published its report in 1989.

38. 1989-91 was a period of political instability in India and hence no five year plan was implemented. Between 1990 and 1992, there were only Annual Plans.

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

40. The priorities: Developing rural health infrastructure Medical education and training Control of communicable disease Strengthening of health services. Universal immunisation Safe water supply and sanitation MCH and Family Welfare

41. The Major Development The Year 1992 Child survival safe mother hood programme was started on 20 th August. The infant milk substitute, Feeding bottles and infant foods Act 1952 came in to operation. The Year 1993 A revised strategy for National Tuberculosis Programme with Direct Observed Therapy, a community based TB treatement and care strategy was introduced as a pilot project in phased manner. The Year 1994 The panchayati Raj Act came into operation. Outbreak of Plague epidemic.

42. The first Pulse Polio Immunisation Programme for children under 3 years was organised on 2 nd October and 4 th December by Delhi government. Post basic B.Sc nursing programme was launched through distance education by IGNOU. The Year 1995 ICDS was changed to Integrated mother and child Development services. Transplantation of Human organs Act was enacted. The Year 1996 National wide Pulse polio Immunisation was conducted on 9 th December 1995 and 20 th January 1996 which was repeated on 7 th December 1996 and 18 th January 1997. Family Planning Programme was made target free from 1 st April.

43. Ninth five year plan(1997-2002) The Aim The main aim of ninth five year plan continued with the same aim as that eighth plan which was mainly concern with reorganization and strengthening of infrastructure so as to provide primary health care services accessible to all especially those living in remote rural, hilly, and tribal areas.

44. The priorities Control of communicable and non communicable diseases Efficient Primary Health Care System Strengthening of existing infrastructure. Improvement of referral linkage. Development of human resources, Disaster and emergency management. Involvement of practitioners from indigenous system of medicine, Voluntary and private organizations.

45. Significant events RCH programme launched Government of India announced National Population Policy 2000 National Malaria eradication Programme renamed as National Anti malarial Programme in 1999 National Family Health Survey -2 was undertaken Phase 2 of National AIDS Control Programme started Census 2001 was completed Government of India Announced National Health Policy 2002 Government of India announced National AIDS Prevention and Control Policy 2002

46. Tenth five year plan(2002-2007) Aim The focus of planning has shifted from expansion of services to the enhancement of human well being

47. The priorities Restructuring of existing health infrastructures Upgrade the skills of health personnel Improve the quality of reproductive and child health Improve logistic supplies Ensure effective intersect oral cooperation Increase affectivity of IEC activities Carry out research on nutritional deficiencies and on optimum daily requirements of nutrients for Indian men and women Promote rational drug use

48. The Major Development State Health Missions have constituted in all states ASHA training modules revised Over 1500 management professional appoints in programme management units RCH II launched &under implementation IMNCI started in 142 districts AYUSH doctors in PHC Village health and sanitation committee SC- 2 ANM PHC -3 staff nurse

49. Eleventh Five Year Plan (2007-2012) Aim Plan provides an opportunity to restructure policies to achieve a new vision based on faster broad based and inclusive growth .

50. Main goals Reducing Maternal Mortality Ratio (MMR) to 1 per 100 live births. Reducing infant Mortality Rate (IMR) to 28 per 1000 live births. Reducing Total Fertility Rate (TFR) to 2.1. Providing clean drinking water for all by 2009 and ensuring no slip-backs. Reducing malnutrition among children of age group 0-3 to half its present level. Reducing anemia among women and girls by 50%. Raising sex ratio for age group 0-6 to 935 by 2011-12 and 950 2016-17

51. Priorities Improving health equity Adopting a system –centric approach rather than a diseases-centric approach Increasing survival Taking full advantages of local enterprises for solving local health problems. Preventing indebtedness due to expenditure on health/protecting the poor from health insurance. Decentralizing governance Establishing e-Health Increasing focus on health human resources. Focusing on excluded/neglected areas

52. Time bound goals for 11 th 5 year plan

53. Twelfth Five year Plan (2012-2017) The 12 th five year plan was formulated based on the recommendation of a high level expert group and other stakeholder consultations . Objective : To establish a system of universal health coverage in the country

54. Vision of 12th Five Year Plan(2012-17) Twelfth Five Year Plan focuses on  Growth –  Growth which is Faster Inclusive Sustainable

55. Enhancing the Capacity for Growth Enhancing Skills and Faster Generation of Employment Managing the Environment Markets for Efficiency and Inclusion Decentralization, Empowerment and Information Technology and Innovation

56. 7. Securing the Energy Future for India 8. Accelerated Development of Transport Infrastructure 9. Rural Transformation and Sustained Growth of Agriculture 10. Managing Urbanization 11. Improved Access to Quality Education 12. Better Preventive and Curative Health Care

57. Target at least 4% growth for agriculture. Cereals are on target for 1.5 to 2% growth. Land and water are the critical constraints. Technology must focus on land productivity and water use efficiency. Farmers need better functioning markets for both outputs and inputs. Also, better rural infrastructure, including storage and food processing

58. Investment and capacity additions are critical for sustained industrial growth. Need to grow at 11-12% per year to create 2 million additional jobs per year. Growth in 11th Plan is in 8%. Indian industry must develop greater domestic value addition.

59. Must aim at universalisation of secondary education by 2017 Must aim at raising the Gross Enrolment Ratio (GER) in Higher Education to 20 percent by 2017 and 25 percent by 2022 Must focus on quality of education. Must invest in faculty development and teachers’ training Must aim at significant reduction in social, gender and regional gaps in education. Targets to be set for this purpose

60. Better health is not only about curative care, but about better prevention, Clean drinking water, sanitation and better nutrition, childcare, etc. Convergence of schemes across Ministries is needed. Expenditure on health by Centre and States to increase from 1.3% of GDP to at least 2.0%, and perhaps 2.5% of GDP by end of 12th Plan Desperate shortage of medical personnel. Need targeted approach to increase seats in medical colleges, nursing colleges and other licensed health professionals Health insurance cover should be expanded to all disadvantaged groups Focus on women and children; ICDS needs to be revamped

61. India’s urban population is expected to increase from 400 million in 2011 to about 600 million or more by 2030 Critical challenges are basic urban services especially for the poor: water, sewerage, sanitation, solid waste management, affordable housing, public transport Investment required in urban infrastructure is estimated at `60 lakh crore over the next 20 years We need to develop and propagate innovative ways of municipal financing, through Public-Private Partnerships (PPPs) Land management strategies key for good urban development as well as financing urban infrastructure development

62. Railways’ Western and Eastern Dedicated Freight Corridors must be completed by the end of the Twelfth Plan High Speed Rail link between Delhi-Mumbai and Delhi-Kolkata in the Twelfth Five Year Plan Complete the linkages between the ports and the existing road and rail network. Need to deepen existing ports. Increase bulk/container capacity Ensure sufficient provision for maintenance of the already-built roads Invest in unified tolling and better safety on highways Improve bus services/public transport in smaller cities, towns and districts.

63. CONCLUSION The Five-Year Plans have played a crucial role in shaping India's health sector, addressing public health challenges, and improving healthcare access and quality. Each plan has built upon the achievements of its predecessors, focusing on different aspects of health to achieve holistic development. Moving forward, the lessons learned from these plans can guide future health policies and strategies to achieve better health outcomes for all.