Health planning in india

Dr Lipilekha Patnaik
Dr Lipilekha PatnaikProfessor um Siksha 'O' Anusandhan University
HEALTH PLANNING IN
INDIA
Dr Lipilekha Patnaik
Professor, Community Medicine
Institute of Medical Sciences & SUM Hospital
Siksha ‘O’ Anusandhan deemed to be University
Bhubaneswar, Odisha, India
Email: drlipilekha@yahoo.co.in
Planning :
*An organized, conscious & continuous
attempt to select the best available
alternatives to achieve specific goals .
Health Planning :
*The orderly process defining national
Health problems, identifying the unmeet
needs, surveying the resources to meet
them, and establishing the priority goals to
accomplish the purpose of proposed
Programme.
Bhore Committee (Health survey and
Development Committee,1946)
• Chairman : Sir Joseph Bhore
• To survey the existing health condition.
Submitted report – 1948
RECOMMENDATION :
1. Integration of preventive & curative services at
all administrative level.
2. Dev. Of Primary health centres in 2 stages
*short term measures in rural area &
*long term measures
3.Change in Medical education - 3 month
trainining in SPM –Social Physicians
Short term measures :
*Each PHC should cater a population of 40,000
and a sec. health centre as supervisory,
coordinating and referral institution.
*In PHC 2 medical officer,4 public health nurses,
one nurse, 4 midwives, 4 trained dhais, 2 sanitary
inspectors, 2 health assistants, one pharmacist &
15 class IV employees.
Long term measures:
*Primary health units with 75 bedded hospital for
each 10,000-20,000 population
*Secondary units with 650 bedded hospital
Mudaliar Committee (Health survey
and planning committee,1962)
• Chairman : Dr. A. L. Mudaliar
• To survey progress made in health since
submission of Bhore Committee report
Recommendations
• Consolidation of First Two Five Year Plan
activities.
• Strengthening district Hospitals with
specialists.
• Regionalizing State Health Organization
• Each PHC with maximum of 40,000
population.
• Integration of Medical and Health Services.
• Formation of All India Health service on the
pattern of Indian Administrative Services.
Chadah Committee,1963
• Chairman: Dr.M.S.Chadah
• the arrangement for maintenance phase of
National Malaria Eradication Programme.
RECOMMENDATION:
1.vigilance of NMEP-PHC at Block level
2.Monthly home visit- basic health worker
3.One Multipurpose worker – 10,000
population
4.They work in Malaria EP , also in vital
statistics and Family Planning work.
Mukerji Committee, 1965
• Separate staff for family planning Programme
and separate staff for Malaria Eradication
Programme. Delink Malaria Activities from
Family Planning
• The Family planning assistant were to do the
family planning duties only.
• Basic health workers were to be utilized for
purposes other than Family planning like
maintenance phase of Malaria, smallpox,
leprosy and trachoma.
Jain Committee 1966
• One bed per 1000 population.
• One 50 beds hospital at Taluka level.
• Enhancing maternity facilities at each
level.
• Health insurance for larger population
coverage.
Jungalwalla Committee, 1967
• To examine problems of service condition in
health.
• Defined “Integrated health service” i.e a
service with a unified approach for all problem
instead of segmented approach for different
problems.
Recommendations
Unified approach for Medical Care and
conventional public health
• Unified cadre
• Common Seniority
• Recognition of extra qualification
• Equal pay for equal works
• Special pay for specialized works
• No private practice and good service
conditions
Kartar Singh Committee,1973
Committee on Multipurpose workers under
Health & FP
To study
- the Structure for integrated services
- Feasibility of multipurpose and bi-purpose
workers.
- Training requirement of such workers.
- utilization of mobile services for integrated
medical, public health,& family planning
Recommendations
1. ANM newly designated as “female health
workers” and Malaria worker, vaccinator etc.
as “male health workers”.
2. 1 PHC for 50,000 population & each PHC is
devided into 16 subcentre with 3000-3500
3. Each sub-center should have 1 MPHW female
+ 1 MPHW male.
4. Multipurpose Health Supervisor to be created.
5. The Doctor incharge of PHC is the overall
charge of all workers &supervisors.
Shrivastav Committee, 1975
Group on Medical Education & Support Manpower
- To devise curriculum for Health Assistant
- To suggest improving existing medical education
process.
Recommendations
• Creation of bands of para-professionals and semi-
professional health workers (School Teacher, Gram
Sevak, Post Master)
• Two cadres of Health Workers – MPHW and Health
Assistant between community and PHC doctor.
• To develop referral services complex.
• Establishment of Medical and Health Education
commission in line with UGC.
Rural health scheme,1977
• Primary health care should be provided within
the community through Specially trained
worker ,so that the health of the people is
placed in hand of people themselves.
• Reorientation Training of multipurpose
workers engaged in communicable disease
program.
• Involvement of Medical colleges in the
selected PHC with objective of re-orienting
medical education to the need of rural people.
Health for all by 2000 AD
(Report of working group 1981)
To identify goals for health for all by 2000
AD and to outline specific programs for the
VIth Five years plan.
Five Year Plan
• Formulated by Planning Commission.
• To re-build rural India, to secure balanced
development of all parts of India.
BROAD OBJECTIVES:
• Control or eradication of major communicable
diseases
• Strengthening of basic health services through
establishment of PHC & SCs.
• Population control
• Development of health manpower resources
Five year Plan
Planning Commission of India – 1950
àAssessment of Material, capital, Human Resource
à Draft Development plans for effective utilization of
resources.
à Different Planning divisions with Program advisors,
Technical Divisions of Planning Commission.
à First Five Year Plan 1951 – 56.
• Health Sector Planning includes following sectors.
– Water supply and sanitation
– Control of Communicable disease
– Medical Education Training and Research
– Medical Care including Hospitals, Dispensaries and PHCs
– Public Health Services
– Family Planning
– Indigenous system of Medicine
Eleventh Five Year Plan (2007- 2012)
Goals :-
MMR – 1 per 1000 live births
IMR – 28 per 1000 live births
Total Fertility Rate – 2.1
Providing clean Drinking Water for all by 2009
Reducing Malnutrition (0 – 3 yrs) by half.
Reducing Anaemia (women and girls) by 50%
Raising sex ratio à 0 – 6 yrs – 935 by 11 – 12
-- 950 by 16 – 17
Thrust Areas during Eleventh Plan
• Improving Health Equity (NRHM, NUHM)
• Adopting system-centric approach then disease centric.
• Increasing survival by improving maternal and child health
• Taking advantage of local enterprise for solving health
problems
• Protecting poor from health expenditure
• Decentralizing governance
• Establishing E-health
• Improving access to and utilization of essential and quality
health care.
• Focus on health human resources
• Focus on excluded/ neglected areas
• Enhancing efforts at disease reduction
• Health system and Bio-medical research
Achievements during the plan periods
ACHIEVEMENTS 1st plan (1951-56) 11th plan (2007-12)
PHCs 725 23,887
Subcentres NA 148,124
CHCs - 4,809
Total beds (2002) 125,000 914,543
Medical colleges 42 335
Annual admissions in MCs 3,500 41,569
Dental Colleges 7 290
Allopathic doctors 65,000 757,377
Nurses 18,500 1,237,964
ANMs 12,780 602,919
Health Visitors 578 52,653
Health workers(F) - 207,868
Health workers(M) - 2,480
BEE - 2,480
References
• Park’s Textbook of preventive and
social Medicine – 17th edition
• Textbook of PSM, by B.K. Mahajan – 3rd
edition
• National Programme of India, J.
Kishore
Health planning in india
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Health planning in india

  • 1. HEALTH PLANNING IN INDIA Dr Lipilekha Patnaik Professor, Community Medicine Institute of Medical Sciences & SUM Hospital Siksha ‘O’ Anusandhan deemed to be University Bhubaneswar, Odisha, India Email: drlipilekha@yahoo.co.in
  • 2. Planning : *An organized, conscious & continuous attempt to select the best available alternatives to achieve specific goals . Health Planning : *The orderly process defining national Health problems, identifying the unmeet needs, surveying the resources to meet them, and establishing the priority goals to accomplish the purpose of proposed Programme.
  • 3. Bhore Committee (Health survey and Development Committee,1946) • Chairman : Sir Joseph Bhore • To survey the existing health condition. Submitted report – 1948 RECOMMENDATION : 1. Integration of preventive & curative services at all administrative level. 2. Dev. Of Primary health centres in 2 stages *short term measures in rural area & *long term measures 3.Change in Medical education - 3 month trainining in SPM –Social Physicians
  • 4. Short term measures : *Each PHC should cater a population of 40,000 and a sec. health centre as supervisory, coordinating and referral institution. *In PHC 2 medical officer,4 public health nurses, one nurse, 4 midwives, 4 trained dhais, 2 sanitary inspectors, 2 health assistants, one pharmacist & 15 class IV employees. Long term measures: *Primary health units with 75 bedded hospital for each 10,000-20,000 population *Secondary units with 650 bedded hospital
  • 5. Mudaliar Committee (Health survey and planning committee,1962) • Chairman : Dr. A. L. Mudaliar • To survey progress made in health since submission of Bhore Committee report
  • 6. Recommendations • Consolidation of First Two Five Year Plan activities. • Strengthening district Hospitals with specialists. • Regionalizing State Health Organization • Each PHC with maximum of 40,000 population. • Integration of Medical and Health Services. • Formation of All India Health service on the pattern of Indian Administrative Services.
  • 7. Chadah Committee,1963 • Chairman: Dr.M.S.Chadah • the arrangement for maintenance phase of National Malaria Eradication Programme. RECOMMENDATION: 1.vigilance of NMEP-PHC at Block level 2.Monthly home visit- basic health worker 3.One Multipurpose worker – 10,000 population 4.They work in Malaria EP , also in vital statistics and Family Planning work.
  • 8. Mukerji Committee, 1965 • Separate staff for family planning Programme and separate staff for Malaria Eradication Programme. Delink Malaria Activities from Family Planning • The Family planning assistant were to do the family planning duties only. • Basic health workers were to be utilized for purposes other than Family planning like maintenance phase of Malaria, smallpox, leprosy and trachoma.
  • 9. Jain Committee 1966 • One bed per 1000 population. • One 50 beds hospital at Taluka level. • Enhancing maternity facilities at each level. • Health insurance for larger population coverage.
  • 10. Jungalwalla Committee, 1967 • To examine problems of service condition in health. • Defined “Integrated health service” i.e a service with a unified approach for all problem instead of segmented approach for different problems.
  • 11. Recommendations Unified approach for Medical Care and conventional public health • Unified cadre • Common Seniority • Recognition of extra qualification • Equal pay for equal works • Special pay for specialized works • No private practice and good service conditions
  • 12. Kartar Singh Committee,1973 Committee on Multipurpose workers under Health & FP To study - the Structure for integrated services - Feasibility of multipurpose and bi-purpose workers. - Training requirement of such workers. - utilization of mobile services for integrated medical, public health,& family planning
  • 13. Recommendations 1. ANM newly designated as “female health workers” and Malaria worker, vaccinator etc. as “male health workers”. 2. 1 PHC for 50,000 population & each PHC is devided into 16 subcentre with 3000-3500 3. Each sub-center should have 1 MPHW female + 1 MPHW male. 4. Multipurpose Health Supervisor to be created. 5. The Doctor incharge of PHC is the overall charge of all workers &supervisors.
  • 14. Shrivastav Committee, 1975 Group on Medical Education & Support Manpower - To devise curriculum for Health Assistant - To suggest improving existing medical education process. Recommendations • Creation of bands of para-professionals and semi- professional health workers (School Teacher, Gram Sevak, Post Master) • Two cadres of Health Workers – MPHW and Health Assistant between community and PHC doctor. • To develop referral services complex. • Establishment of Medical and Health Education commission in line with UGC.
  • 15. Rural health scheme,1977 • Primary health care should be provided within the community through Specially trained worker ,so that the health of the people is placed in hand of people themselves. • Reorientation Training of multipurpose workers engaged in communicable disease program. • Involvement of Medical colleges in the selected PHC with objective of re-orienting medical education to the need of rural people.
  • 16. Health for all by 2000 AD (Report of working group 1981) To identify goals for health for all by 2000 AD and to outline specific programs for the VIth Five years plan.
  • 17. Five Year Plan • Formulated by Planning Commission. • To re-build rural India, to secure balanced development of all parts of India. BROAD OBJECTIVES: • Control or eradication of major communicable diseases • Strengthening of basic health services through establishment of PHC & SCs. • Population control • Development of health manpower resources
  • 18. Five year Plan Planning Commission of India – 1950 àAssessment of Material, capital, Human Resource à Draft Development plans for effective utilization of resources. à Different Planning divisions with Program advisors, Technical Divisions of Planning Commission. à First Five Year Plan 1951 – 56. • Health Sector Planning includes following sectors. – Water supply and sanitation – Control of Communicable disease – Medical Education Training and Research – Medical Care including Hospitals, Dispensaries and PHCs – Public Health Services – Family Planning – Indigenous system of Medicine
  • 19. Eleventh Five Year Plan (2007- 2012) Goals :- MMR – 1 per 1000 live births IMR – 28 per 1000 live births Total Fertility Rate – 2.1 Providing clean Drinking Water for all by 2009 Reducing Malnutrition (0 – 3 yrs) by half. Reducing Anaemia (women and girls) by 50% Raising sex ratio à 0 – 6 yrs – 935 by 11 – 12 -- 950 by 16 – 17
  • 20. Thrust Areas during Eleventh Plan • Improving Health Equity (NRHM, NUHM) • Adopting system-centric approach then disease centric. • Increasing survival by improving maternal and child health • Taking advantage of local enterprise for solving health problems • Protecting poor from health expenditure • Decentralizing governance • Establishing E-health • Improving access to and utilization of essential and quality health care. • Focus on health human resources • Focus on excluded/ neglected areas • Enhancing efforts at disease reduction • Health system and Bio-medical research
  • 21. Achievements during the plan periods ACHIEVEMENTS 1st plan (1951-56) 11th plan (2007-12) PHCs 725 23,887 Subcentres NA 148,124 CHCs - 4,809 Total beds (2002) 125,000 914,543 Medical colleges 42 335 Annual admissions in MCs 3,500 41,569 Dental Colleges 7 290 Allopathic doctors 65,000 757,377 Nurses 18,500 1,237,964 ANMs 12,780 602,919 Health Visitors 578 52,653 Health workers(F) - 207,868 Health workers(M) - 2,480 BEE - 2,480
  • 22. References • Park’s Textbook of preventive and social Medicine – 17th edition • Textbook of PSM, by B.K. Mahajan – 3rd edition • National Programme of India, J. Kishore