HISTORICAL DEVELOPMENT OF

COMMUNITY HEALTH AND

COMMUNITY HEALTH NURSING-
WORLD AND INDIA, VARIOUS
HEALTH AND FAMILY WELFARE
COMMITTEES
 INTRODUCTION

• Community health nurses have been leaders

in improving the quality of health care for
people since the late 1800s.
• They have courageously tried, many new
approaches designed to improve the overall
health status of their communities.
 Definition of terms

Health (WHO)
• The United Nations' World Health
Organization defines health as "a state of
complete physical, mental and social well-
being and not merely the absence of disease
or infirmity
Public health (1920, C.E.A. Winslow)
• It is "the science and art of preventing
disease, prolonging life and promoting health
through the organized efforts and informed
choices of society, organizations, public and
private, communities and individuals."
 Community health nursing (WHO)

• “It combines the skills of nursing , public health and

some phases of social assistance and functions as a
part of the total public health programmes for the
promotion of health , the improvement of condition
in the social and physical , environmental the
prevention of illness and disability and rehabilitation.
It is concerned for the most part with the case of well
families and with non hospitalized sick person and
their families, with group of people and with health
problems that affect the community as a whole”
 Evolution of community health
Primitive medicine (before 5600 BC
• In the ancient time the medicine was practiced by
magical and religious beliefs which were part and
parcel of ancient civilizations and culture and it
was the primitive medicine born out of sympathy
towards mankind suffering from sickness.
• Remedy of disease also relayed upon appeasing
god by prayer, rituals and scarifies to drive out the
evil spirit by black magic, mantras etc.
 Indian systems of medicine (5000 BC)

• The medical system that initiated are truly

Indian in origin, and development are Ayurveda,
siddha systems. Ayurveda is the oldest medicine
in the world, since it evolved from Atharva veda.
• Siddha a contemporary system of medicine
practiced in Tamil speaking areas of south India
during ancient period
• Unani was introduced into India by Muslim ruler
by 10th century AD it enjoyed state support by
Muslims till 18th century.
 Chinese medicine (2700 BC)

• This is an organized system of medical knowledge

dating back to 2700 BC Chinese knowledge about
acupuncture is known worldwide.
• Chinese were pioneers of immunization and they
practiced variolation to prevent small pox.
• They have good faith in traditional medicine
which is integrated with modern medicine also ,
they are known for certain practices of medicine
like hydrotherapy, massage, hygiene,
acupuncture,etc.
 Egyptian medicine (2500 BC)

• The Egyptian believed that the disease was

due to absorption of harmful substance from
intestine and hence the treatment is based on
cathartic enema. They are known for
indigeneous ways of preserving dead bodies.
 Mesoptomain medicine (2100 BC)

• The basic concept of medicine is religious

practices by herb doctors and doctors similar
to surgeons and psychiatrist
 Greek medicine (460 – 136 BC)

• The greatest greek physician Hippocrates is often

called father of medicine. He studied and classified
the disease based on observation and reasoning
and thus the initiated new approach to medicine
has become the key stone of medical ethics and it
set high moral standards for medical profession
• In principle, he reasoned out disease with
reference to climate, water, habit diet etc. Greek
believed that matter was made up of four elements
(air, earth, water, fire)
 Roman medicine (100 BC)

• Roman made good roads, sewage systems and

established hospitals throughout their empire
• Galen out of the reputed Roman medical
teachers, contributed in the field of
comparative anatomy and experimental
factors he was the author of many books and
his writing influenced “European medicine”
 Middle ages (500-1500 AD)

• During which Roman empire collapsed and

roman medical schools also disappeared and
the practice of medicine revolved back to
primitive medicine, dominated by superstition
and consequently there was no development
of medicine.
• Europe was practically ravaged by diseases like
plague, small pox, leprosy, TB etc; here the
medieval age is called the Dark age of
medicine
 Conti…
• During the turbulent middle age, christianity
exerted a wholesome influence. The spread of
christianity led to the establishment of hospitals.
• The first hospital on record in England was build in
York in 937 AD.
• During the middle age religious institutions known
as “monasteries” headed by monks, saints and
abbotts also came up. They rendered active
medical and nursing care to the sick.
 Revival of scientific medicine
• Swiss born Paracelsus publicity criticized the
superstition in medicine and helped to turn
medicine towards rational research. Fracastorius an
Italian physician enunciated the theory of contagion
and he envisages the transfer of infection via
minute invisible particles and explained the cause
of epidemics.
• Andreas Vesalius of Brussels, dissected human body
and raised the study of anatomy
• Ambroise pare, a French army surgeon contributed
much in surgery and earned the title of father of
surgery.
 Birth of preventive medicine

• The holistic milestone in the evolution of medicine is

the great sanitary awakening took place in England
and it gradually spread to other countries
• Preventive medicine got a firm foundation only after
the discovery of causative agents of disease and the
establishment of the germ theory of disease.
• The development of laboratory methods for the
early detection of disease was a further advance.
• In its early years, preventive medicine was equated
with the control of infectious diseases.
 Health for all concepts

• With the adoption of the Alma – ata

declaration and the global strategy for health
for all by the year 2000, in 1978 and 1981
respectively, the broad vision of the PHC
approach was endorsed by all member states
of world health organization.
• The concept of providing care through
‘primary health centre’ was an outcome of the
bhore committee’s recommendations in 1946.
 Conti…
• It is very obvious that all efforts which go towards
prevention of disease and towards positive
approach values of health should be deemed as
primary aspects of health care and thus should
be the major concern in providing “health for all”
through the primary health care concept.
• The international conference of 1978 at USSR has
declared that primary health care is the key to
attaining “health for all by the year 2000.
Genesis of Modern public health (20th century)

• As the prevalence of
infectious diseases in the developed world dec
reased through the 20th century
, public health began to put more focus on
chronic diseases such as cancer and heart
disease. An emphasis on physical exercise was
reintroduced. In America, public health worker
Dr. Sara Josephine Baker lowered the infant
mortality rate using preventative methods.
She
 Conti…
• During the 20th century, the dramatic increase
in average life span is widely credited to public
health achievements, such as vaccination
programs and control of infectious diseases,
effective safety policies such as motor-vehicle
and occupational safety, improved
family planning, fluoridation of drinking water,
anti-smoking measures, and programs
designed to decrease chronic disease.
 The Public Health (21st Century)
• Traditionally, the government has been responsible
for providing public health services through a
network of federal, state, local, and tribal health
departments and clinics. Even as demands on the
public health infrastructure have increased, support
for public health in recent decades.
• Unlike personal health care, which directly and
visibly affects individuals, the roles that government
public health agencies and their private-sector
partners play in preventing injuries and illness and
keeping communities healthy often are less obvious
or take place behind the
EVOLUTION OF COMMUNITY HEALTH NURSING

• St Francis Desales (1567-1662) conceived a

voluntary association of friendly visitors to go
to the homes of the poor and care for the sick.
The organization was supported in time and in
terms of money by influential women, is early
form of visiting nursing.
 Conti…
• The cofounder and director of the association,
the order of the visitation of many, was
Madam De Chantal. She and the member of
her group visited the sick in their home,
cleaned and dressed their wounds made their
beds and gave them clothes.
 Conti…
1576-1669
• St Vincent Depaul is a prominent figure in the
history of nursing and social welfare. In 1617, he
organized the sisterhood of the Dames de Charity,
which systematically introduced the modern
principles of visiting nursing and social welfare.
• His aim was to help people learn to help
themselves. The sisterhood comprised a group of
women who went from cottage to cottage to
provide home care.
 Early home care nursing (before Mid – 1800s)

• The early roots of home care nursing began

with religious and charitable groups. Even
emergency care was provided. In 1244, a
group of monks in Florence, Italy, known as
the Misericordia provided first-aid care for
accident victims on a 24 hour basis.
 Conti…
• Much of the foundation for modern
community health nursing practice was laid
through Florence Nightingale’s remarkable
accomplishments. She has been referred to as
a reformer, a reactionary, and a researcher ,
born in 1820 into a wealthy English family, her
extensive travel, excellent education-including
training at the first school for nurses in
Kaiserwerth, Germany
 Conti…
• Her work during the Crimean war (1854-1856)
with the wounded in Scutari is well documented;
conditions in the military hospitals during the war
were unspeakable. Thousands of sick and
wounded men lay in filth, without beds, clean
coverings, food, water, or laundry facilities.
Florence Nightingale organized competent nursing
care and established kitchens and laundries that
resulted in hundreds of lives being saved.
 Conti…
• Florence also became a skillful lobbyist for
health care reform. Her exemplary influence
on English politics and policy improved the
quality of existing health care and set
standards for future practice. Furthermore she
demonstrated how population-focused
nursing works.
 HOME HEALTH CARE (RATHBONE, 1859)
• The nest significant era for community health
nursing is traced to William Rathbone in
Liverpool, England.
• Because of the outstanding care provided to his
dying wife, Rathbone in 1859 made the
instrumental in establishing a district nursing
service.
• Based on his experience, Rathbone concluded
that many people with long – term illnesses
could be better cared for in their own homed
than in a hospital.
 Conti…

• Rathbone ultimately founded the

Metropolitan Nursing Asssociation to provide
home health nursing .
• During this time the largest religious
organization in London, the Bible and
Domestic Mission, sent women to the slums
to read out the Bible and in 1868 added
nursing care to the programme.
 Conti…
• 1877- The women’s board of the New York
Mission hired Frances Root, a graduate of
Bellevue Hospital’s first nursing class, to visit
the sick, poor and provide nursing care and
religious instruction.
 Conti…
• Nurses at the first visiting the nursing society
in Philadelphia strictly followed physicians,
orders gave selected treatments and kept
temperature and pulse records. Since, their
visits were brief the nurses soon recognized
the need to teach family members about basic
elements of care. Thus from the very
beginning community health nursing included
teaching and prevention.
 Conti…
• 1886- In 19th century America, the first visiting
nursing society began in Philadelphia to
private home health care to the sick.
 Conti…
• 1886- the first district nurse was hired in
Boston. As the number increased- they
worked closely with physician to carry out
medical orders. Patients paid no fees and
initially two lay managers of the association
supervised the nurses.
 Conti…
• 1888- The instructor, District Nursing
Association became incorporated as an
independent voluntary agency to provide care
to the sick poor under the direction of a
trained physician and to instruct families to
take better care of themselves and their
neighbors by living a wholesome life
 SETTLEMENT HOUSES

• During the era, wealthy people became

interested in charitable activities and began to
fund settlement houses in the poorer section
of many larger cities.
• These settlement houses offered a variety of
services for member of the community.
• For example, in 1893, Kittian Wald and her
friend Brewster, both trained nurses and
wealthy women, did a visiting service for the
poor in New York.
 Conti…
• 1891- Lillian Wald was very far-sighted woman
who after graduating from New York Hospitals
Training School in 1891, attended classes at a
local Medical college .
• Wald’s concept was that the nurses visit
should be something that of a very interested
friend rather than that of an impersonal paid
visitor.
 Conti…
• 1898- public funds paid the first nurse to provide
nursing care at the home.
• 1909- Lillian Wald established the first community
health nursing programme for workers at the
metropolitan life insurance company.
• Believing that, keeping workers healthier meant
their productivity would increase, she urged that
nurses at agencies provide skilled nursing care to
ensure healthier worker.
• He provided fees to the nurses in the settlement
houses according to everybody’s financial capacity
to pay.
 CHILD WELFARE MOVEMENT

• The child welfare movement similar in

America and Europe emphasized the need for
clean milk, well child clinics and instruction to
mothers. The child health movement profited
from the establishment of a division of child
hygiene in the New York City Health
Department in 1880.
 Conti…
• 1880- Dr Josephine Baker proved that infant
deaths could be greatly reduced through
prevention. In a congested area of New York’s
lower east side, community health nurses visited
each mother and newborn on the day after birth
for healthy ways to keep the baby well.
• Simultaneously with the development of well baby
clinics, clean milk was provided by monitoring
services as and by requiring pasteurization.
 Conti…
• 1908- The pediatric department of the New
York outdoor medical clinic began the first
organized prenatal programme.
• 1909- Visiting nurses service for pregnant
women began in Bostonn in 1909 and in St
Lewis in 1912.
 Conti…
• 1924- A subsidized rural practitioner scheme
was introduced in Madras and ₨50 per month
was paid to doctors who would settle down in a
village and treat patients free of charge for
three hours a day.
• 1930- The educational institution provides
programmes for public health nursing by the All
India Institute of Hygiene and Public Health.
• 1935- Title of the social security Act re-enacted
the children’s bureau.
 WORLD WAR I AND COMMUNITY HEALTH
NURSING
• The great demand for nurses created by the onset
of world war I in 1915 threatened the role of
community health nurses whose numbers were
insufficient to meet the need.
• However, the American Red Cross helped to sustain
community health nursing by establishing a roster
of nurses who could be enlisted to supply health
care.
• The Red Cross emphasized educational programme
for the community as well as programmes directed
toward communicable diseases.
 Conti…
• During the war, the National Organization of
public health loaned a nurse to establish a
community health nursing programme for
military outposts, which led to the first
community health nursing programme
sponsored by the federal Government. After
World war I, many changes occurred that
subsequently affected community health
nursing.
 Conti…
• 1934- In this year, pearl mclver became the
first nurse employed by the United state of
public health service to provide consultation
services to state health departments. Initially
only a few states had budgeted community
health nursing position.
• 1936- All states included some type of
community health nursing consultation service
in their budgets.
 Conti…
• By the early 1960s, community health nursing
began to assume a more active role in society.
Practice in community health nursing became
a requirement of all baccalaureate
programmes in association defined a
community health nurse as a graduate from a
baccalaureate programme in nursing
accredited by the National League of Nursing.
 Conti…
• In 1966, the American public health
association and the national league nurse
jointly developed a programme for accrediting
community health nursing services.
 THE YEARS FOLLOWING WORLD WAR II

• During World War II many nurses joined the

Army and Navy Nurse Corps. To provide
sufficient nurses to meet demands in war
time, the Bolton Act of 1943, established the
cadre nurses corps, and authorized $60 million
to recruit and educate 70,000 cadets in 1125
schools between 1944 and 1946.
• During this time theses nurses constituted 90
percent of the enrollment in basic nursing
programmes. Lucile petri provided leadership.
 Conti…
• In 1952, there were major changes in nursing
profession. American nurses association and
National league of nursing became the two
major nursing organizations. The National
League of Nursing opened to both nurses and
lay people to strengthen the co-operation
between them and they established National
Student Nurses Association.
 VOLUNTARY ACTION FOR HEALTH

• Although the government retains a major

responsibility for the health and welfare of its
citizens, voluntary organization and voluntary
health agencies play key role in community
health.
• Rapid economic growth in the United States
helped to create many of the problems attracting
the affection of voluntary health agencies and
also provided the resources and leisure time
necessary for volunteers to start such
organization.
 PUBLIC HEALTH NURSING IN INDIA

• Public health nursing includes all nursing

services organized by a community or agency
to carry out nursing aspects of public health
programme in the homes, in the schools, in
the industry or in the health centers or such
other institutions.
 Conti…
• Until very recently, most of the health services in
the homes were provided by the health visitors,
midwives and trained dais whose activities were
and are still concerned primarily with maternity
and child welfare.
• The training of dais is being replaced in several
states by more suitable and adequately trained
personnel, the Auxiliary Nurse Midwife, who was
the key person to provide public health services in
the remotest parts of the village through the sub
centers of the primary health center.
 TRAINING

• In 1952, a post-certificate public health nursing

programme of study was instituted at the college
of nursing, New Delhi and later transferred to All
India Institute of Hygiene and public Health,
Kolkata.
• All the colleges of nursing are integration public
health in the basic curriculum from the very
beginning of the degree programme, so that the
graduated from these colleges are qualified to
function in public health, as well as hospital
services.
 Conti…
• Public health nursing is also now being integrated in the
basic curriculum of the general nursing course and every
nurse graduating from such school of nursing is expected
to work equally well in hospital and in the public health
field, but she/he is not registered as a public health
nurse.
• Public health orientation courses were introduced in
some states so that graduate nurses were orientated to
public health and assigned to rural areas.
• There are also supervisors training at All India Institute
of Hygiene and public health at Kolkata and also in other
places.
COMMUNITY HEALTH NURSING(1970-PRESENT)
• Many new kinds of community health services appeared
and demands on community health nurses expanded
their role.
• Furthermore, other community health training
professionals assumed responsibilities that had
traditionally been the domain of public health nursing.
• Some school counselors began coordinating home visits
previously done by school nurses and health educations,
who are part of discipline that has developed in the last
decade, took over large segments of client educators,
social workers, counselors, health educators came
prepared with different backgrounds.
 Conti…
• Further accelerated changes in health care
provision, technology and social issues made
increasing demands on community health
nurses ability to adapt to new pattern of
practice.
 HISTORICAL PERSPECTIVE OF COMMUNITY
HEALTH NURSING IN INDIA
DEFINITIONS OF PUBLIC HEALTH
• “The science and art of preventing disease, prolonging
life and promoting health and efficiency through
organized community efforts for the sanitation of the
environment, the control of communicable infections,
the education of the individuals in personal hygiene,
the organization of medical and nursing services for
early diagnoses and preventive treatment of disease
and the development of social machinery to ensure for
every individual a standard of living adequate for the
maintenance of health so organizing these benefits as
to enable every citizen to realize his birthright of health
and longevity.”
 Conti…
COMMUNITY HEALTH
• The WHO Expert committee on community
health nursing (1974) defined:
• “Community health refers to the health status
of the members of the community, to the
problems affecting their health, and to the
totality of health care provided to the
community.”
 Conti…
PUBLIC HEALTH NURSING
• A WHO Expert committee defined public health
nursing as:
• “Public health nursing combines the skills of nursing,
public health and some phases of social assistance
and functions as part of the total public health
programme for the promotion of health, the
improvement of conditions in the social and physical
environment, the prevention of illness, disability and
rehabilitation.”
 Conti…
DEFINITIONS OF COMMUNITY HEALTH
NURSING
• The American nurses association (ANA 1980)
defined community health nursing as follows:
• “Community health nursing is a synthesis of
nursing and public health practice applied for
promoting and preserving the health of
people.”
 CHRONOLOGICAL DEVELOPMENT OF COMMUNITY HEALTH
NURSING IN INDIA

• The preparation of nursing workers for public health

work was started in this country in 1981, when the
Lady Reading Health School was established in
Delhi. Later such school was established in other
parts of the country to train lady health visitors.
• 1919: The public health responsibilities were
transferred to an elected minister.
• 1920: Municipality and local boards act were
passed in several provinces.
 Conti…
• 1921: Providing legislation for the
advancement of public health
• 1930: At Kolkata, an All India Institute of
Hygiene and Public Health was established
with aid from the Rockefeller Foundation.
• 1931: A Maternal and Child Welfare Bureau
was established by the Indian Red Cross
Society.
 Conti…
• 1935: All the health activities in the country were
grouped us under the control of central and state
government.
• 1937: A Central Advisory Board of Health was set up.
• 1939: Madras public Health Act was passed. A Rural
Health Training Center(RHTC) at singur near Kolkata
was established with assistance from the Rockfeller
Foundation. Indian Tuberculosis Association was
started.
 Conti…
• 1940: The Drugs Act was passed and brought
under control.
• 1943: A health survey and development
committee was appointed by the Government
of India under the chairmanship of Sir Joseph
Bhore.
• 1946: Bore Committee’s Report was submitted
in three volumes.
 Conti…
• 1947: The National Government took up the
responsibility of improving the health of the people.
• Ministries of health were established at the central and
state levels.
• Public health was integrated into the post of Director
of Health Services.
• 1948: India joined as a member state of WHO. ESI Act
was passed.
• 1950: Planning Commission was set up by the
Government of India.
 Conti…
• 1951: BCG vaccination programme was
launched. This year was the beginning of First
Five Year Plan.
• 1952: Community Development programme
was launched on 2nd October for overall
development of the rural areas.
• 1953: A model Public Health Act Committee
was appointed to draw up a model
comprehensive Public Health Act.
 Conti…
• 1954: Central Social Welfare Board was set up.
• National Water Supply and sanitation scheme was
inaugurated.
• National leprosy Control Programme was started
• Food Adulteration Act was passed.
• 1955: National Filaria Control Programme was
started
• 1956: Central Health Education Bureau was
established.
 Conti…
• 1958: National Malaria Control Programme was
established.
• 1959:Mudaliar Committee was appointed to
review the progress made in health.
• 1960: School Health Committeewas formed. Pilot
projects in relation to smallpox Eradication
programme were initiated.
• 1962: Central Family Planning Institute was
established in Delhi.
 Conti…
• 1963: Applied Nutrition programme started.
• 1963: The Family planning programme was
changed to an extension approach scheme
rather than one with a clinic approach.
• 1964: National Institute for Health
Administration and Education(NIHAE) was
established in Delhi.
• 1965: IUD (Lippe’s Loop) was introduced.
 Conti…
• 1966: Minister for Family planning was
appointed under the Ministry of health.
• 1970: All India Hospital Family planning
programme was stated.
• 1971: MTP Act was passed by parliament.
• 1972: MTP Act came into force.
• 1973: Minimum needs programme was
incorporated with the health services.
 Conti…
• 1973: Multipurpose health worker scheme was
introduced by “Kartar Singh” committee report.
• 1975: On July 5th of this year, India was
declared free from smallpox.
• Integrated Child Development Scheme was
launched in India (ICDS)
• 1976: Indian Factories Act of 1948 was
amended.
 Conti…
• 1977: International Commission declared that India has
eradicated smallpox. National Institute of Health and
Family planning was formed.
• Community Health Workers scheme was begun by the
Union Ministry of Health.
• Rural Health scheme was introduced.
• 1978: The “Slogan Health for all by 2000 AD” came into
force at Alma Ata Declaration.
• 1979: World Health Assembly endorsed the Declaration
of Alma Ata on primary health care.
 Conti…
• 1980: On 8 May, smallpox was officially declared as
eradicated from the entire world.
• 1981: Report of the working group on “Health for All”
set up by the planning commission was published.
• 1982: The new 20-point programme was announced.
• The Government of India framed “National Health
Policy”
• The school health service started in India on a trial
basis.
 Conti…
• 1983: National Health Programme was approved by
the parliament.
• Guenea worm eradication programme was launched.
• 1984: The ESI (Amendment) Bill was approved by
parliament.
• 1985: Universal Immunization programme was
launched o 19th November Indira Gandhi’s Birthday.
• 1987: The new 20-point programme was launched.
 Conti…
• 1987: A world wide “safe motherhood”
campaign was launched by world bank.
• 1989: Blood safety programme was launched.
• 1990: ARI programme initiated as a pilot
project I 14 districts.
• 1992: Child survival and Safe Motherhood
(CSSM) programme was launched on 20th
August.
 Conti…
• 1995: Pulse polio Immunization programme
launched in December and January.
• 1996: Reproductive child health programme
was started in place of CSSM with slight
modification.
• 1997: Leprosy control programme was
integrated with health services. RCH
programme was launched.
 Conti…
• 1998: National Antimalarial programme
introduced.
• 2000: National population policy
• 2001: NH policy.
• National AIDS control policy
• 10th Five Year Plan
• Emergence of SARS.
 Conti…
• 2003: Prohibition of Tobacco Umbrella
programme for prevention of vector borne
disease e.g. Malaria, Filaria, Kala azar, dengue JE.
• 2005: RCH-II
• Janani suraksha yojana
• NRHM
• India achieved leprosy elimination.
• 2006: Released new growth chart by WHO ban
on child labor RNTCP covers whole country since
Nov. 2006.
 VARIOUS HEALTH AND FAMILY WELFARE COMMITTEES

BHORE COMMITTEE, 1946

• The Government of India in 1943 appointed the Health
Survey and Development Committee with Sir Joseph
Bhore as Chairman.
Some of the important recommendations of the Bhore
Committee were:
• Integration of preventive and curative services at all
administrative level;
• The Committee visualized the development of primary
health centers in 2 stages;
 Conti…
• As a short-term measure, it was proposed that each
primary health centre in the rural areas should
cater to a population of 40,000 with a secondary
health centre to serve as a supervisory, coordinating
and referral institution. For each PHC, two medical
officers, 4 public health nurses, one nurse, 4
midwives, 4 trained dais, 2 sanitary inspectors, 2
health assistants, one pharmacist, and 15 other
class IV employees were recommended.
 Conti…
• A long-term programme (also called the 3
million plan) of setting up primary health units
with 75-bedded hospitals for each 10,000 to
20,000 population and secondary units with
650-bedded hospitals, again regionalized
around district hospitals with 2,500 beds; and
• Major changes in medical education which
includes 3 month’s training in preventive and
social medicine to prepare “social physicians”.
 MUDALIAR COMMITTEE, 1962

• It 1959, the Government of India appointed

another Committee known as “Health Survey
and Planning Committee”, popularly known as
the Mudaliar Committee (after the name of its
Chairman, Dr. A.L. Mudaliar)
 Conti…
The main recommendations of the Mudaliar Committee
were:
• Consolidation of advances made in the first two five
year plans;
• Strengthening of the district hospital with specialist
services to serve as central base of regional services;
• Regional organizations in each state between the
headquarters organization and the district in charge of
a Regional Deputy or Assistant Directors-each to
supervise 2 or 3 district medical and health officers;
 Conti…
• Each primary health centre not to serve more
than 40,000 population;
• To improve the quality of health care provided
by the primary health centres;
• Integration of medical and health services as
recommended by the Bhore Committee; and
• Constitution of an All India Health Service on
the pattern of Indian Administrative Service.
 CHADAH COMMITTEE, 1963

• In 1963, a Committee was appointed by the

Government of India, under the Chairmanship
of Dr. M.S. Chadah, the then Director General
of health Services to study the arrangements
necessary for the maintenance phase of the
National Malaria Eradication Programme.
 Conti…
• The Committee recommended that the
“vigilance” operation in respect of the
National Malaria Eradication Programme
should be responsibility of the general health
services, i.e., primary health centers at the
block level.
 Conti…
• One basic health worker per 10,000 populations
was recommended.
• These workers were envisaged as
“multipurpose” workers to look after additional
duties of collection of vital statistics and family
planning, in addition to malaria vigilance.
• The Family Planning Health Assistants were to
supervise 3 or 4 of these basic health workers.
At the district level, the
 MUKERJI COMMITTEE, 1965

• A committee known as “Mukerji Committee, 1965” under

the Chairmanship of Shri Mukerji, the then Secretary of
Health to the Government of India, was appointed to
review the strategy for the family planning programme.
• The Committee recommended separate staff for the
family planning programme.
• The family planning assistants were to undertake family
planning duties only.
• The basic health workers were to be utilized for purposes
other than family planning.
 JAIN COMMITTEE (1966-67)

• The Government of India and Ministry of Health

and Family planning set-up the study group in
August 1966 under the chairmanship of Ajit Prasad
jain to look into medical care services. It
undertook.
• Study of working of different classes of hospitals in
the country with a view to improve the standards
of medical care and developing sound guidelines
for the future expansion of the hospital services.
 JUNGALWALLA COMMITTEE, 1967

• The Central Council of Health at its meeting

held in Srinagar in 1964, taking note of the
importance and urgency of integration of
health services, and elimination of private
practice by government doctors, appointed a
Committee known as the “Committee on
Integration of Health Services” under the
Chairmanship of Dr. N. Jungalwalla.
 Conti…
The Committee defined “integrated health services” as:
• A services with a unified approach for all problems
instead of a segmented approach for different
problems; and
• Medical care of the sick and conventional public
health programmes functioning under a single
administrator and operating in unified manner at all
levels of hierarchy with due priority for each
programme obtaining at a point of time.
 KARTAR SINGH COMMITTEE, 1973

• The Government of India constituted a

Committee in 1972 known as “the Committee
on Multipurpose Workers under Health and
Family Planning” under the Chairmanship of
Kartar Singh, Additional Secretary, Ministry of
Health and Family Planning, Government of
India.
 Conti…
The Committee submitted its report in September 1973. Its main
recommendations were:
• That the present Auxiliary Nurse Midwives to be replaced by the
newly designated “Female Health Workers”, and the present-day
Basic Health Workers, Malaria Surveillance Workers, Vaccinators,
Health Education Assistants (Trachoma) and the Family Planning
Health Assistants to be replaced by “Male Health Workers”.
• The Programme for having multipurpose workers to be first
introduced in areas where malaria is in maintenance phase and
smallpox has been controlled, and later to other areas as malaria
passes into maintenance phase into maintenance phase or
smallpox controlled.
• For proper coverage, there should be one primary health centre
for a population of 50,000;
 Conti…
• Each primary health centre should be divided into 16 sub-
centres each having a population of about 3,000 to 3,500
depending upon topography and means of communications;
• Each sub- centre to be staffed by a team of one male and
one female health worker
• There should be a male health supervisor to supervise work
of 3 to 4 male health workers; and a female health
supervisor to supervise the work of 4 female health workers
• The present-day lady health visitors to be designated as
female health supervisors and
• The doctor in charge of a primary health centre should have
the overall charge of all the supervisors and health workers
in his area.
 SHRIVASTAV COMMITTEE, 1975

• The Government of India in the Ministry of

Health and Family Planning had in November
1974 set up a ‘Group on Medical Education
and Support Manpower’ popularly known as
the Shrivastav Committee:
 Conti…
The Group submitted its report in April 1975. It
recommended immediate action for:
• Creation of bands of para-professional and semi-
professional health workers from within the community
itself (e.g., school teachers, postmasters, gram sevaks) to
provide simple, promotive, preventive and curative health
services needed by the community;
• Establishment of 2 cadres of health workers, namely-
multipurpose health workers and health assistants
between the community level workers and doctors at the
PHC;
 Conti…
• Development of a ‘Referrral Services Complex’ by
establishing proper linkages between the PHC
and higher level referral and service centres, viz
taluka/tehil, district, regional and medical college
hospitals, and
• Establishment of a Medical and Health Education
Commission for planning and implementing the
reforms needed in health and medical education
on the lines of the University Grants Commission.
 Conti…
• The committee felt that by the end of the
sixth Plan, one male and one female health
worker should be available for every 5,000
population. Also, there should be one male
and female health assistant for 2 male and 2
female health workers respectively. The
health assistants should be located at the sub
centre, and not at the PHC.
 MEHTA COMMITTEE (1983)

This committee is called as “Medical Education

Review Committee.” This committee submitted
their recommendations into two parts
SALIENT FEATURES
• Establishment of universities of Medical
Sciences, and Health Commission.
• Reveals the lack of availability of health
manpower in India.
 Conti…
This group was appointed by the planning
commission for formulating the 7th Five Year
plans
• Involvement of medical colleges in community
health problems and in direct delivery of health
care services to the rural population
• The entire field of internship training will be
spent in upgraded district hospital and primary
health centers
 Conti…
• 3 primary health centers have to be adopted
by each government medical college with all
the faculty members of the medical college
• Training in community health takes place in 4
phases. Students have to conduct survey of
morbidity, mortality and the prevalence of
disease
 Conti…
• Supply of mobile clinics and construction of
residential quarters, seminar halls at primary
health centers
• The medical universities should evaluate the
system for giving credit to the students on the
basis of programming in “ROME” scheme in
rural areas.
 Conti…
SALIENT FEATURES
• Restructuring of organizational set-up
• Management reformation
• Decentralized planning
• Establishment of health manpower development bureau
• Setting up of institutional objectives
• Postgraduate training programs for community health managers, and
administrators.
• Implication of “Reorientation of Medical Education” scheme selected
primary health centers attached to medical colleges.
• Training programs for male and female components especially at the
field level.
• Induction training for medical officer’s at the PHC level.
• Continue education/in-service education for all medical and
paramedical professionals in health institutions.
 BAJAJ COMMITTEE(1986)

• “An expert committee for health manpower

planning, production and management” was
constitutes by the ministry of health and
family welfare” government of India, in1985
under the chairmanship of Dr JS Bajaj,
professor at All India Institute of Medical
sciences and a member of planning
commission. The committee submitted its
report in December 1986.
 Conti…
SALIENT FEATURES
• Formulation of national health manpower, national medical
and health education policy.
• Establishment of an educational commission for health
sciences on the lines of UGC.
• Establishment of health science universities in various states
and union territories.
• Establishment of health manpower cells in India.
• Vocational group of education at +2 levels in related health
fields.
• Carrying out a realistic health manpower survey.