2. Unit II
HEALTH COMMITTEES
BY:
MR. J.C. FRANK M.Sc (N)
ASSISTANT PROFESSOR

3. Sir JosephWilliam Bhore

4. Bhore Committee
- Constituted by pre independent GOI
- Under Sir Joseph William Bhore, Indian Civil
Servant
- Formed in 1943
- “Health Planning and Development
Committee”

5. Terms of Reference
• A survey of existing conditions and organisation
• Secondly suggestions for future development
• Consider short term objectives which might
reasonably be expected to be reached within a
period of four to five years
• Objectives which will necessarily require a longer
period for attainment.

6. Bhore Committee Report
• Submitted in 1946
• Runs into 4 volumes
• Volume I A survey of the State of the Public
Health and the existing health organisation
• Volume II Recommendations
• Volume III Appendices
• Volume IV Summary

7. Observations
• CDR : 22.4/1000
• IMR : 162/1000 live births
• MMR : 20/1000 live births
• Life expectancy at birth : 27 years.

8. Observations
• Incidence of communicable disease also was very
high.
• Diseases like chicken pox, cholera etc occurred in
epidemics.
• Many of the health problems were preventable.
• Investment made in preventing these problems
would give high returns in the forms of increased
productivity and development.

9. Recommendations
Short term plan:
- To be implemented within 5-10 years.
- Each primary health centre in the rural area to cater to a
population of 40,000
- Secondary health centre to serve as a supervisory, coordinating
and referral institution
- For each PHC 2 medical officers, 4 public health nurses, one
nurse, 4 midwives, 4 trained dais and 15 class IV employees

10. Recommendations
Long term plan (3 million plan):
Health care system in three tires.
• First tier: primary health units with 75 bedded hospital for each 10,000 –
20,000 population with staff of 6 medical officers, 6 public health nurses, 2
sanitary inspectors, 2 health assistants and other supportive staff.
• Second tier: 650 bedded Regional Health Unit (RHU) to serve as a referral
centre for 30 – 40 PHUs.
• Third tier: district hospitals with 2,500 beds to serve the needs of about 3
million.

11. Recommendations
• 3 months training in preventive and social medicine to
prepare ‘SOCIAL PHYSICIANS’
• Special emphasis on preventive work (Integration of
curative and preventive services)
• Village Health Committee consisting of 5 to 7 individuals
for procuring the active participation of the people in the
local health programme.
• Inter-sectoral Coordination

12. Sir A Lakshmanaswamy Mudaliar

13. Mudaliar Committee
• Constituted in 1959
• By GOI
• Under Dr. A Lakshmanswamy Mudaliar, Vice
Chancellor, Madras University
• “Health Survey and Planning Committee”

14. Terms of Reference
1. 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)
2. Review of the First and Second Five-Year Plan Health
projects and
3. Formulation of recommendations for the future plan
of health development in the country.

15. 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

16. Recommendations
• Consolidation of 1st two 5 yr plans
• Strengthening DH to serve as central base for specialist
services
• PHC - 40,000 population
• 1 BHW per 10,000 population
• Improve secondary services
• Integration of Medical and Health services

17. Chadha Committee
• A committee of health administrators and
malariologists reviewed the National Malaria
Eradication programme.
• Constituted in 1963
• By GOI
• Under Dr. MS. Chadha, Director General of Health
Services

18. Terms of Reference
1. 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 progrmme.
2. The committee should also consider the Staffing pattern
required for the malaria eradication programme.

19. Recommendations
• One basic health worker per 10,000 population
• Basic health workers should visit house to house once
in a month to implement malaria vigilance activities.
• BHW to serve as MPHW for family planning and vital
statistics and malaria vigilance.
• FPHA to supervise 3-4 BHW

20. Mukerji Commitee
• Following the Central Family Planning
Council meet at Madras
• Constituted in 1965
• Headed by Shri Mukerji, Secretary, Ministry of
Health and Family Planning

21. Terms of Reference
• In 1965, the ICMR Director pronounced that Lippes
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.

22. Terms of Reference
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.

23. Recommendations
• 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 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 D
• Delink malaria and FP activity

24. Mukerji Committee,1966
• Following 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 1966
• By GOI
• Headed by Shri B. Mukerji, Union Health Secretary

25. 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

26. 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.

28. Jungalwalla Committee
• Central Council of Health, 1964 Srinagar
• Dr. N. Jungalwalla, Addl. Director General of
Health Services
• “Committee on Integration of Health Services”
• Submitted report un 1967

29. Terms of Reference
• To study the problems of the health services
• Service conditions
• Elimination of Private practice

30. Recommendation
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.

31. Kartar Singh Committee
• Growing demand for increase of staff under
each programme.
• Need to reduce population/area covered by
each worker.

32. 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

33. Terms of Reference
• Structure for integrated services the
peripherals and supervisory levels
• Feasibility of MPW
• Their training requirements
• Utilisation of mobile services for integration

34. Recommendations
• Multipurpose workers - feasible and desirable
• Redesignation
- ANMs replaced by FHWs
- BHW, Malaria surveillance workers, vaccinators, FPHAs
replaced by MHWs
- LHV designated as FH supervisor
• To be first introduced in malaria maintenance phase areas and
small pox controlled areas
• Clearly spelt out the job functions of HWs and Supervisors

35. 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

36. Shrivastav 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

37. Shrivastav Committee
• MOHFP,GOI
• In 1974
• “ Group on Medical Education and Support
Manpower”
• Submitted report in 1975

38. 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

39. Recommendations
(1) 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 sevikas 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

40. Recommendations
(2) 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 in PHC

41. Recommendations
(3) The creation of a National Referral Services
Complex by the development of proper
linkages between the PHC and higher level
referral and service centres.
(4) Establishment of ‘The Medical and Health
Education Commission’

42. Rural health Scheme
“Rural Health Scheme” was launched by the government in 1977-78. The
major steps initiated were :
a) Involvement of medical colleges in health care of selected with the
objective of reorienting medical education according to rural population
called Re Orientation of Medical education (ROME). It led to teaching
and training of undergraduate students and Interns at PHCs.
b) Training of Village Health Guides and utilising their services in the
general health service system.