recommendations of various health committees

RECOMMENDATIONS OF VARIOUS

HEALTH COMMITTEES

Dr Himanshu ChauhanAssistant Professor

Important health committees

1. Bhore committee, 19462. Mudaliar committee, 19623. Chadah committee, 19634. Mukerji committee, 19655. Mukerji committee, 19666. Jungalwalla committee, 19677. Kartar Singh committee, 19738. Shrivastav committee, 1975

Bhore Committee, 1943

Sir Joseph Bhore, British civil servant in India Chairman, Health survey & development

committee GoI appointed HSDC is 1943 to make:

A. A broad survey of the health situation

B. Recommendations for improvement 5 subcommittees:

1. Public health

2. Medical relief

3. Professional education

4. Medical education

5. Industrial health

The output

A 1128 page report 3 volumes Volume1: Survey Volume 2: Recommendations Volume 3: Appendices

Some key findings

Country Death Rate IMR LE at birth MMR

India 22.4 162 26.91 2000

England 12.4 58 58.74

Japan 17.0 106 44.82

USA 11.2 54 59.12

Germany 11.7 64 59.86

Major causes of death

Fevers58%

Others26%

Respi-ra-tory diseases8%

Diarrhea4%

Cholera2%

Smallpox1%

Plague0% Fevers

OthersRespiratory diseasesDiarrheaCholeraSmallpoxPlague

Causes of low level of health in India

Prevalence of insanitary conditions Nutrition (Inadequate & inappropriate mix) Inadequacy of existing medical & preventive

health organizations

*Bhore committee estimated that the population in 1971 would be 300 million (Actual population was: 548 million !!)

Health personnel

Number (1948)

Ratio UK ratio (1948)

Suggested ratio (1971)*

Doctors 47400 (13000 in Govt sector)

1: 6300 1: 1000 1: 2000

Nurses 7000 1: 43000 1: 300 1: 500

Dentists 1000 1: 300000 1: 2700 1: 4000

Causes (contd.)

Quality of medical care: 1 patient per 48 seconds – OPD load Inadequate design of facilities Attitude of doctor / para-medical staff Vast distances Abject poverty

Recommendations

An enormously uphill task Major changes required A short-term and a long-term program

Modern trends in the organization of health services

A progressive health service (Preventive & Curative) required

Social medicine concept given Examples of the national health services of Britain,

USA, Australia, Canada, Russia & New Zealand - Their application to India

Free or paid medical care ? Salaried as against a service of private practitioners ? Prohibition of private practice by government doctors Part-time medical men Freedom to choose doctor

Health services for the people: The long term program

A well developed health service – Central, Provincial & local area health organizations aka “The three million plan”

3 million referred to a district Primary units, secondary units & district

headquarter proposed To be achieved in 15-20 years

The long term program

Units Population Doctors Non-medical staff

Beds

Primary 20,000 6 78 75

Secondary 600,000 140 358 650

District headquarter

30,00,000 239 1398 2500

Short-term program

Immediate commencement Primary units: 1 per 40,000 population

with 30 beds and 2 medical officers Will be referred to as the primary health

centers Village committees to be established –

Community participation Secondary units: 1 per district with 200

beds and 47 doctors

Other areas 3 months training in preventive & social

medicine to prepare social physicians Nutrition Health education Physical education Maternal & child health School health Occupational & Industrial health Environmental hygiene Housing – Urban & Rural Public health engineering Quarantine Vital statistics

Mudaliar Committee, 1962 Arcot Lakshmanaswami

Mudaliar Vice-chancellor, Madras

University Health survey & planning

committee Appointed to survey the progress

made since the Bhore committee

Recommendations

Consolidation of advances made in the first two five-year-plans

Strengthening of district hospital with specialist services

Regional organizations between state headquarter and districts

PHC not to serve more than 40000 Improve the care provided by PHCs Integration of medical & health services All-India Health Service (like IAS)

Chadha Committee

Dr MS Chadha, DGHS Committee to study the arrangements

under the maintenance phase of the NMEP Recommendations:1. The vigilance operations of the NMEP

should be the responsibility of PHC staff2. One basic health worker for 10000

population for this3. In addition to the vigilance, these basic

workers to act as multipurpose workers

Mukerji Committee, 1965 Health secretary to GoI Basic workers could not function effectively

as multipurpose workers Separate staff for family planning

recommended Delink malaria activities from family planning

activities Recommendations accepted

Mukerji Committee 1966

Separation & intensification of family planning and malaria activities combined with other programs resulted in funds shortage

Basic health service at block level recommended

Strengthening of services at higher levels

Jungalwalla Committee, 1967

Dr N Jungalwalla, Director, NIHAE Terms of reference:1. Need for integration of health services2. Elimination of private practice by govt doctors Recommendations: Integration from the highest to lowest levels,

organization & personnel1. Unified cadre, 2. Common seniority, 3. Recognition of extra qualifications, 4. Equal pay for equal work

Kartar Singh Committee, 1973

Karar Singh, Additional Secretary, MoHFP To study & make recommendations on:1. The structure for integrated services at

the peripheral & supervisory levels2. The feasibility of having MPWs in the

field3. Training requirements of such MPWs4. The utilization of mobile service units set

up under family planning prog

Recommendations1. ANMs to be replaced by the newly

designated Female health workers2. Male workers to be replaced by Male health

workers3. MPWs to be first introduced in areas where

malaria is in maintenance phase and smallpox has been controlled

4. One PHC / 50,000 population5. Each PHC to be divided into 16 sub-centres6. Each sub-center to be staffed by 1 male & 1

female MPW

Srivastava Committee, 1975

Dr J B Srivastava, DGHS Group on medical education & support

manpower TORs:1. To devise a suitable curriculum for

training a cadre of health assistants (Link b/w Doctors & MPWs)

2. Improving medical education making it more relevant to national requirements

Recommendations1. Creation of para-professional and semi-

professional health workers from the community itself

2. MPWs and HAs between CHWs & Doctors3. Development of a referral service complex4. Establishment of a medical & health

education commission

To summarizeCommittee Year Most important recommendation(s)

Bhore 1946 Long term (3 million) & short term program

Mudaliar 1962 PHC @ 40000; All India Health service

Chadah 1963 1 basic health worker @ 10,000; Link FP & Malaria

Mukerji 1965 Delink FP & Malaria

Mukerji 1966 Basic health service at block level

Jungalwalla 1967 Integrated health services (Organization & personnel)

Kartar Singh 1973 Multipurpose workers

Srivastava 1975 Group on medical education & support manpower; ROME scheme; Village health guides

Thank you for your patient hearing

For further information contact:Dr Himanshu Chauhan

Assistant Professor, Room No. 341