Health planning and health committees

1. HEALTH PLANNING
Ms. Namita Batra Guin
Professor, Community
Health Nursing

2. PLANNING
 Every country has its own plan for the
development of the nation.
 Purpose is to achieve rapid, balanced,
economic and social development of the
country.
 National plan is the combination of sectoral
plans.
 All the sectors compete for national resources.
 National development planning is defined as
continuous, systematic, coordinated, planning
for the investment of the resources of a country
in programs aimed at achieving the most rapid

3. Purposes of Planning
 Match the limited resources
 Eliminate the wasteful expenditure or
duplication of the expenditure
 Develop the best course of action to
accomplish the defined objective.

4. Health Planning
 It is a part national planning
 Purpose is to improve health services.
 National Health Planning is defined as
orderly process of defining community
health problems, identifying unmet
needs and surveying the resources to
meet them, establishing priority goals
that are realistic and feasible and
projecting administrative action to
accomplish the purpose of the
proposed program.

5. Health Needs and Demands
 Health needs are the deficiencies in
health that call for preventive, curative,
control or eradication measures.
 Some needs may not be perceived by
all.
 In democratic society, people’s needs
may be presented as demands.

6. Resources
 It implies manpower, money,
materials, skills, knowledge,
techniques and time needed or
available for the performance or
support of action directed towards
specified objectives.

7. Objectives, targets and goals
 Objective: It is planned end point of all
the activities.
 Target: Refers to discrete activity. It
permits the concept of degree of
achievement
 Goal: Ultimate desired state towards
which objectives and resources are
directed.

8. Objectives of Health Planning
 To clarify nature of existing health problems
 To clarify inter-relationship between health
sector and its components and various
social and economic factors
 To identify national objectives, as far as
possible.
 To identify new and existing program areas.
 To help elaborate alternative strategies and
to produce feasible programs for choice by
decision making
 To define mechanism for the formulation

9. PLAN
 It consists of five major elements:
◦ Objectives: planned end point activities
◦ Policies: guiding principles
◦ Programs: sequence of activities/ step by
step approach.
◦ Schedules: time sequence of the work
◦ Budget: Finance needed

10. PRE-PLANNING
 Preparation for planning.
 Important pre-condition are:
◦ Government interest: political will is necessary
for any plan. It is manifested in forms of various
policies or directives given by govt. bodies.
◦ Legislation: Health policies may be translated
into legislation.
◦ Organization for planning: Planning
commission in India serves the function of
national level planning.
◦ Administrative capacity: For proper
coordination of activities and implementation at
levels. For health plans administrative capacity

11. PLANNING CYCLE

13. PLANNING CYCLE
 Analysis of health situation
◦ First step in planning, involves condition
assessment and interpretation of
information.
◦ Helps in formulation of health problems
 Establishment of objectives
◦ Objectives must be established at all
levels.
◦ May be long term or short term
◦ Time and resources are important
factors in objectives.
◦ Also acts as yardstick to measure the

14. PLANNING CYCLE
 Assessment of resources
◦ Resources implies: manpower, money,
materials, skills, knowledge and
techniques needed or available for the
implementation of health programs.
 Fixing priorities
◦ Factors considered in priority fixing are:
financial constraints, mortality, morbidity,
cost-benefit etc.
◦ Once the priorities are established,
alternate plans for achieving them are
also formulated and are assessed in
terms of practicability and feasibility.

15. PLANNING CYCLE
 Write up of formulated plan
◦ Plan must be complete in all respects.
◦ Each stage of plan is defined, cost and time
needed to implement the plan is specified.
◦ It must also contain the built in system to
evaluate
 Programming and implementation
◦ For program implementation, organization
structure is needed.
◦ Well defined procedures, sufficient delegation
must be incorporated to achieve the goals.
◦ It involves: definition of roles, supervision,
selection, training and motivation.
Communication and organization are also

16. PLANNING CYCLE
 Monitoring
◦ It is day-to day follow up of activities during
their implementation to ensure the activities are
proceeding as per the plan
◦ It is a continuous process of observing,
recording and reporting on activities of the
organization or project.
 Evaluation
◦ Purpose is to assess the achievement the
stated objectives of a program, its adequacy,
efficiency and its acceptance.
◦ Evaluation is mostly concerned with the final
outcome and factors associated with it.
◦ It makes possible reallocation of priorities and

17. HEALTH COMMITTEES

18. Bhore committee
 Bhore committee,1943
 Also known as health survey and
development committee.
 Sir Joseph bhore
 To survey the then existing position
regarding the health condition and
health organisations
 To make future recommendations
 Submitted report in 1946

19. Bhore committee
 The committee observed that….
 “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”

20. Guiding principles
 No individual should be denied to
secure adequate medical care
because of inability to pay
 Facilities for proper diagnosis and
treatment.
 Health programme must lay special
emphasis on preventive work.
 As much medical relief and preventive
health care should be provided to the
vast rural population

21. Guiding principles
 Health services should be located
close to the people to ensure
maximum benefit to the community.
 Doctor should be a social physician
protecting the people.
 Medical services should be free to
all,without distinction.

22. Observations made by
committee
 Health status of the country as
indicated by various indicators was
poor.
 Mortality rates were very high.
 Life expectancy at birth was about
27yrs.
 Incidence of communicable diseases
was very high.
 Many of the health problems were
preventable.

23. Observations made by
committee
 Committee stated that health and
development are interdependent.
 Improvement in sector other than
health will also lead to improvement in
health like water supply ,sanitation
improvement ,nutrition ,elimination of
unemployment.

24. Recommendations
 Integration of preventive and curative
services at all administrative levels.
 Minimum required ratio 567 hospital
beds,62 doctors,151 nurses per
1,00,000 population.
 The committee visualised the
development of PHC in 2 stages:

25. Recommendations
 1.A short term measure
 Each PHC-40,000 POP,2 MOs,4 PHN,1 nurse,2
midwives,4 trained dais, 2 sanitory inspectors,2
health assistants 1 pharmacist and 15 other class
Iv employees.
 2.A long term programme (3 million plan)
consist of health care system in 3 tiers

26. Recommendations
 PRIMARY UNIT
◦ 10000-20000 pop,75 hosp beds,6 MOs,6
PHN,2 sanitory inspectors,2 health
assistants and 6 midwives.
◦ 25-med ,10-sur ,10-obs&gyn, 20-infect ds,
6-malaria & 4-TB.
◦ Highly dense province - 20,000/PU
◦ Highly dispersed province - 10,000/PU

27. Recommendations
 Secondary UNIT
◦ 60 primary units under a secondary unit
◦ 650 hosp bed,140 doc,180 nurses, 178
other staffs,15 hosp social workers,50
ward attendants and 25 compounders.
◦ 150-med , 200-sur ,100-obs&gyn , 20-inf
ds, 10-malaria ,120-TB , 50-ped.
◦ First level referral hospital.

28. Recommendations
 District Hospital
◦ 2500 beds,269 doc,625 nurses,50 hosp
social workers and 723 other workers.
◦ 300-med, 350-sur,300-obs, 54-TB, 250-
ped, 300-lep,40-inf ds,20-malaria,400-
mental illness.
◦ Nutrition ,health education ,
professional/UG/PG education ,population
problem.
◦ 2 grades in nursing profession.

29. Recommendations
 District Hospital
◦ Village health committee, medical
research.
◦ Special attention to diseases like malaria
,TB ,small pox ,leprosy ,plague ,cholera ,
veneral ds , filariasis ,mental illness.
◦ Special programmes for health of mothers
and children, environmental hygiene and
occupational health for industrial workers.

30. SIGNIFICANCE & IMPORTANCE
OF REPORT
 Imp landmark in public health in india.
 Initiated the concept of integrated
development & comprehensive health
care.
 Idea of primary health care.
 The three tier pattern of health care
services.

31. Health Survey and planning
committee
 Mudaliar committee gave its report in
1962.
 Terms of reference of the committee
were:
◦ The assessment (or evaluation) in the field of
medical relief and public health since the
submission of the Health Survey and
Development Committee's Report (the Bhore
Committee)
◦ Review of the First and Second Five-Year Plan
Health projects and
◦ Formulation of recommendations for the future
plan of health development in the country.

32. Observations:
 Basic health facilities had not reached
at least half the nation.
 Gross mal distribution of hospitals and
beds in favour of urban areas.
 Quality of services provided by PHCs
were grossly inadequate with poor
functioning, lack of referral system,
and gross under staffing due to
insufficient resources

33. RECOMMENDATIONS
 Consolidation of 1st two 5 yr plans
 Strengthening DH to serve as central base
for specialist services
 Regional organisation between state and
district headquarters
 PHC - 40,000 population
 1 BHW per 10,000 population
 Improve secondary services
 Integration of Medical and Health services
 All India Health Service constitution on
patterns of IAS

34. CHADAH COMMITTEE
 A committee of health administrators
and malariologists reviewed the
National Malaria Eradication
programme and recommended that a
special Committee should study in
detail the preparations that are to be
made for the entry into the
maintenance phase and formulate a
plan.
 Constitued in 1963 by GOI under Dr.
MS. Chadah, Director General of

35. Terms of reference
 The committee should go into the details of
the requirement related to the primary
health centers, their planning, the
necessary priority required according to the
needs of the maintenance phase of the
Malaria Eradication programme.
 The committee should also consider the
Staffing pattern required for the malaria
eradication programme but also for other
health activities and the manner in which
the technical and supervisory staff of the
N.M.E.P. organization should be utilised
after malaria eradication has been achieved

36. RECOMMENDATIONS
 Maintenance to be done by general health
services (block and district level)Through
basic health worker per 10,000 population
 Basic health workers should visit house to
house once in a month to implement
malaria activities.
 BHW to serve as MPHW for family planning
and vital statistics
 FPHA to supervise 3-4 BHW
 1 FPHA per 30,000 population

37. MUKHERJI COMMITTEE
 Following the Central Family Planning
Council meet at Madras
 Constitued in 1965
 Headed by ShriMukerji, Secretary,
Ministry of Health and Family
Planning.
 Basic health workers could not
function effectively as MPHW, as a
result malaria vigilance activities
suffered.

38. Terms of reference
 In 1965, the ICMR Director pronounced that
Lippe’s Loop was safe.
 So, IUCD was introduced into the family
planning programme and reorganisation of
the FP programme was needed.
 CBR was 41 per thousand and was aimed
at reducing to 25 per thousand in a period
of 10 years.
 To review what additions and changes are
necessary as a result of the greatly altered
situation due to the IUCD having come in
the forefront of the programme, in the
staffing pattern, financial provisions, etc.

39. RECOMMENDATIONS
 Target oriented programming
 Strengthening of education and publicity efforts and
involvement of other organisations
 Strong executive agency in Health Directorate of
each state government to exclusively deal with
family planning
 Approved the existing Urban Family Welfare
Planning centre
 At Rural Family Planning Centre - BHW to be
utilised as MPW for general services - FPHA to
undertake only FP work without having to
supervise BHW
 Delink malaria and FP activity

40. MUKHERJI COMMITTEE 1966
 1966Following 13th Meeting of the
Central Council of Health held at
Bangalore in June, 1966 - state finding
it difficult to take burden of
maintenance phase of malaria and
other prog. like small pox, leprosy, FP,
trachoma
 Formed in 1966By GOIHeaded by
Shri B. Mukerji, Union Health
Secretary

41. Terms of reference
 To review the staffing pattern of the primary
health centre complex and to recommend
the minimum staff of various categories
required at different levels within the district
so as to provide an integrated health
service capable of fully catering to the
needs of the vigilance services in the
maintenance phase of National Malaria
Eradication Programme, smallpox
eradication, tuberculosis, leprosy and
trachoma control, etc.
 To recommend the pattern of Central
assistance for the States

42. RECOMMENDATIONS
 Basic Health Services to be provided at block level
 Strengthening required at higher level
 Any attempt to give the basic health worker more
work under the family planning programme would
either endanger malaria vigilance work or would
need a larger number of basic health workers per
block than what the Committee has recommended.
 Integrated approach in the entire health field -
Programmes of public health and medical care
should be integrated to the maximum extent
possible and so also the programmes within each
field.
 Health workers at the lower levels should become
increasingly multipurpose workers.

43. RECOMMENDATIONS
 In certain phases of any large national programme
it may be necessary to have separate staff, at the
maintenance stage the activities under the
programme should get integrated more and more
with the basic health services and to the extent
possible should be taken care of through the
domiciliary services.
 One basic health worker for a population of 10,000
 At the District level there should be as much
integration of the general health programme with
the family planning programme as possible,
ensuring at the same time however, that the family
planning programme continues to receive
adequate attention and profits from such
integration

44. RECOMMENDATIONS
 The Committee did not attempt to work out any
details of the organisation that would be needed
above the District level, i.e. at the Zonal, the State
and the Central levels
 They also felt that the State Government could
themselves work out better the strength and
pattern and method of functioning of the health
organisation at the Zonal and State levels.

45. JUNGALWALA COMMITTEE
 1964 Srinagar Dr. N. Jungalwalla,
Addl. Director General of Health
Services“Committee on Integration of
Health Services”
 Submitted report in 1967

46. Terms of reference
 To study the problems of the health
services
 Service conditions
 Elimination of Private practice

47. RECOMMENDATIONS
 Integration from highest to lowest level
in services
 Integration of preventive and curative
services
 Integration of medical services and
public health(rotation of personnel)
 Integration of Health Services has 3
main components - Health services of
functions and methods of delivery -
Their organisation - The personnel
providing these services & their

48. RECOMMENDATIONS
 The main steps recommended
towards integration were:unified
cadre, common seniority, recognition
of extra qualifications, equal pay for
equal work, special pay for specialized
work, no private practice, and good
service conditions
 Left states to work out their own
strategy.

49. KARTAR SINGH COMMITTEE
 Programmes are being run almost independently of
each other by staff recruited under each
programme.
 There is little or no coordination between the field
workers of these programmes and even at the
supervisory level there are separate and
independent functionaries.
 Growing demand for increase of staff under each
programme.
 Need to reduce population/area covered by each
worker. Whether the same objective cannot be
achieved by coordinating these programmes and
pooling the personnel. Could not such an
integration reduce the population/area of each
worker, thus making his coverage smaller and

50. KARTAR SINGH COMMITTEE
 Meeting of the Central Family
Planning Council 1972
 By GOI in 1972“The committee on
Multipurpose workers under Health
and Family Planning”Kartar Singh,
Addl. Sec., MOHFP
 Report in 1973

51. Terms of reference
 Structure for integrated services the
peripherals and supervisory levels
 Feasibility of MPW
 Their training requirements
 Utilisation of mobile services for
integration

52. RECOMMENDATIONS
 Multipurpose workers - feasible and
desirable
 Redesignation ANMs replaced by
FHWs BHW, Malaria surveillance
workers, vaccinators, FPHAs replaced
by MHWs
 LHV designated as FH supervisorTo
be first introduced in malaria
maintenance phase areas and small
pox controlled areas
 Clearly spelt out the job functions of

53. RECOMMENDATIONS
 1 PHC – 50,000 population
 1 PHC –16 SHC (2000 – 3500)
 1 SHC – 1 MHW n 1 FHW
 1 male supervisor – 4 MHWs
 1 female supervisor – 4 FHWs
 Doctor incharge of all supervisors
 To be impemented in 5th 5yr plan

54. SRIVASTAV COMMITTEE
 GOI observed that urban orientation of medical
education in India, which relies heavily on curative
methods and sophisticated diagnostic aids the
failure of the programmes of training in the fields of
nutrition, family welfare planning, and maternal and
child because of their development in isolation from
medical education, the deprivation of the rural
communities of doctors
 The need to re-orient undergraduate medical
education with emphasis on community rather than
on hospital care the importance of integrating
teaching of various aspects of family planning with
medical education

55. SRIVASTAV COMMITTEE
 In 1974“ Group on Medical Education
and Support Manpower”
 Submitted report in 1975

56. Terms of reference
 To devise a suitable curriculum for
training a cadre of Health Assistants
 To suggest steps for improving the
existing medical educational
processes as to provide due emphasis
on the problems particularly relevant
to national requirements
 To make any other suggestions to
realise the above objectives and
matters incidental thereto

57. RECOMMENDATIONS
 Organization of the basic health services
(including nutrition, health education and
family planning) within the community itself
and training the personnel needed for the
purposes; - Creation of Village Health
Guide (VHG) or community health
volunteers from the community itself like
teachers, postmasters, gram sevaks who
can provide comprehensive health services
as paraprofessionals.
 Primary health care be provided within the
community itself through specially trained
workers so that the health of the people is
placed in the hands of people themselves

58. RECOMMENDATIONS
 Organization of an economic and
efficient programme of health services
to bridge the community with the first
level referral Centre, viz., the PHC –
 Creation of MPW and Health
Assistants (HA) in between the VHG
and MO at PHC

59. RECOMMENDATIONS
 The creation of a National Referral Services
Complex by the development of proper
linkages between the PHC and higher level
referral and service centres;
 To create the necessary administrative and
financial machinery for the reorganization of
the entire programme of medical and health
education from the point of view of the
objectives and needs of the proposed
programme of national health services -
Establishment of ‘The Medical and Health
Education Commission’