Health Planning in India.pptx
- 1. HEALTH PLANNING In INDIA Facilitator: Dr. NAVPREET Assistant Professor, Department of CommunityMedicine Govt. Medical College &Hospital, Chandigarh.
- 2. Introduction • Health and health care development has not been a priority of the Indian state. – low level of investment and resources to the healthsector – unregulated private healthsector allocation of
- 3. • The Central government has shaped health policy and planning inIndia. – through the Council of Health and Family Welfare and various Committeerecommendations • At the state government level there is no evidence of any policy initiatives in the health sector.
- 4. BHORE COMMITTEE,1946 • The most comprehensive health policy and plan document ever prepared in India was the `Health Survey and Development Committee Report' popularly referred to as the Bhore Committee. • This committee was appointed in 1943 with Sir Joseph Bhore as itsChairman. • It made comprehensive recommendations for remodelling of health services inIndia.
- 5. Objectives: 1. The services should make adequate provision for the medical care of the individual in the curative and preventive fields and for the active promotion of positivehealth; 2. These services should be placed as close to the people as possible, in order to ensure their maximum use by the community, which they are meant to serve; 3. The health organization should provide for the widest possible basis of cooperation between the health personnel and the people; 4. Provisions should be made for enabling the representatives of medical and auxiliary professions to influence the health policy of thecountry.
- 6. 5. “Group” practice, should be madeavailable – In view of the complexity of modern medical practice, from the standpoint of diagnosis and treatment, consultant, laboratory and institutional facilities of a varied character , which together constitute; 6. Special provision will be required for certain sections of the population, e.g. mothers, children, elderlyetc., 7. No individual should fail to secure adequate medical care, curative and preventive, because of inability to pay for it and 8. The creation and maintenance of as healthy an environment as possible in the homes of the people as well as at work.
- 7. Recommendations 1. Integration of preventive and curative services of all administrative levels. 2. Major changes in medical education which includes three months training in preventive and social medicine to prepare “social physicians”.
- 8. 3. Development of Primary Health Centres in 2 stages: a) Short‐term measure – One primary health centre • for a 40,000population. • 2 doctors, 1 nurse, 4 PHN, four midwives, four trained dais, two SI, two HA, one pharmacist and 15 class IV employees. • Secondary health centre provide support, coordinate and supervise PHC. b) 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 populationand • secondary units with 650 bedded hospital, again regionalised around district hospitals with 2500 beds.
- 9. • In the fifties and sixties the entire focus of thehealth sector in India was to manage epidemics. • Mass campaigns were started to eradicate the various diseases. – These separate countrywide campaigns with a technocentric approach were launched against malaria, smallpox, tuberculosis, leprosy, filaria, trachoma and cholera. – Cadres of workers were trained in each of the vertical programmes.
- 10. • The policy of going in for mass campaigns was in continuation of the policy of colonialists who subscribed to the percepts of modern medicine that health could be looked after if the germs which were causing it wereremoved. • But the basic cause of the various diseases is social, i.e. inadequate nutrition, clothing, and housing, and the lack ofa proper environment. These wereignored.
- 11. • National programs were launched to eradicate the diseases. • The NMEP was started in 1953 with aid from the Technical Cooperation Mission of the U.S.A. and technical advice of the W.H.O. Malaria at that period was considered an international threat. • The tuberculosis programme involved vaccination with BCG, T .B. clinics, and domiciliary services and after care. The emphasis however was on prevention through BCG. These programmes depended on international agencies like UNICEF , WHO and the Rockefeller Foundation for supplies of necessary chemicals and vaccines. • The policy with regard to communicable diseases was dictated by the imperialist powers as in the other sectors of the economy.
- 12. • During the first two Five Year Plans the basic structural framework of the public health care delivery system remained unchanged. • Urban areas continued to get over three‐fourth of the medical care resources whereas rural areas received "special attention" under (CDP). History stands in evidence to what this the Community Development Program special attention meant. • The CDP was failing even before the Second Five Year Plan began.
- 13. MUDALIAR COMMITTEE,1962 • This committee known as the “Health Survey and Planning Committee”,headed by Dr.A.L.Mudaliar, was set up in 1959: 1. To assess the performance in health sector since the submission of Bhore Committeereport. 2. To evaluate the progress made in the first 2 plans and 3. To make recommendation for the future path of development of health services.
- 14. • The report of the committee recorded that the disease control programmes had some substantial achievements in controlling certain virulent epidemicdiseases. • This committee found the conditions in PHCs to be unsatisfactory. – Most of the PHC's were understaffed, large numbers of them were being run by ANM's or public health nurses in charge.
- 15. Recommendations 1. Consolidation of advances made in the first two five years plans. 2. Strengthening of the district hospitals with specialists services to serve as central base of regional services. 3. 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 orhealth officers. 4. Each PHC not to serve more that 40000 population. 5. To improve the quality of health care provided by PHC. 6. Integration of medical and healthservices. 7. Constitution of an All India Health service on the pattern of Indian AdministrativeServices.
- 16. • The third Five Year Plan launched in 1961 discussed the problems affecting the provision of PHCs, and directed attention to the shortage of health personnel, delays in the construction of PHCs, buildings and staff quarters and inadequate training facilities for the different categories of staff required in the ruralareas. • Ignoring the Mudaliar Committee's recommendation of consolidation of PHC's this plan period witnessed a rapid increase in their numbers but their condition was the same as the Committee had found at the end of the second plan period.
- 17. • In case of the disease programme due to their vertical nature there was a huge army of workers. – The delivery of services continued to be done by special uni‐purpose health workers. Therefore in the same geographical area there was overlapping and duplication of work.
- 18. CHADAH COMMITTEE,1963 • This committee was appointed under chairmanship of Dr. M.S. Chadah, to advise about the necessary arrangements for the maintenance phase of National Malaria Eradication Programme. • Recommended the integration of health and family planning services.
- 19. • The committee suggested that the vigilance activity in the NMEP should be carried out by basic health workers who would function as multipurpose workers: • one per 10,000population, • would perform, in addition to malaria work, the duties of family planning and vital statistics datacollection • under supervision of family planning health assistants.
- 20. MUKHERJEE COMMITTEE, 1965 • The recommendations of the Chadah Committee, when implemented, were found to beimpracticable • the basic health workers, with their multiple functions could do justice neither to malaria work nor to family planning work. • The Mukherjee committee headed by the then Secretary of Health Shri Mukherjee, was appointed to Review the Staffing Pattern and Financial Provision under FamilyPlanning.
- 21. Recommendations • Separate staff for the family planningprogramme. • The family planning assistants were to undertake family planning dutiesonly. • The basic health workers were to be utilised for purposes other than familyplanning. • Delink the malaria activities from family planning so that the latter would received undivided attention of its staff.
- 22. MUKHERJEE COMMITTEE, 1966 • Due to shortage of funds, it was difficult for the states to undertake multiple activities of the mass programmes effectively • E.g family planning, small pox, leprosy, trachoma, NMEP (maintenance phase), etc. weremaking. • A committee of state health secretaries, headed by the Union Health Secretary, Shri Mukherjee, was set up to look into thisproblem. • The committee worked out the detailsof: • The Basic Health Service at the Block level, and • Some consequential strengthening required at higher levels of administration.
- 23. JUNGALWALLA COMMITTEE, 1967 • This committee, known as the “Committee on Integration of Health Services” was set up in 1964 under the chairmanship of Dr. N Jungalwalla, the then Director of National Institute of Health Administration and Education (currentlyNIHFW). • It was asked to look into various problems related to integration of health services, abolition of private practice by doctors in government services, and the service conditions of Doctors. • The committee defined “integrated health services” as :‐ a) A service with a unified approach for all problems instead of a segmented approach for differentproblems. b) Medical care and public health programmes should be put under charge of a single administrator at all levels of hierarchy.
- 24. • Following steps were recommended for the integration at all levels of health organisation in the country 1. Unified Cadre 2. Common Seniority 3. Recognition of extraqualifications 4. Equal pay for equalwork 5. Special pay for specialwork 6. Abolition of private practice by government doctors 7. Improvement in their serviceconditions
- 25. • The 4th Plan which began in 1969 continued on the same line as the 3rdplan. • It lamented on the poor progress made in the PHC programme and recognized again the need to strengthen it. • It pleaded for the establishment of effective machinery for speedy construction of buildings and improvement of the performance of PHCs by providing them with staff, equipment and other facilities.
- 26. KARTAR SINGH COMMITTEE, 1973 • This committee, headed by the Additional Secretary of Health and titled the "Committee on multipurpose workers under Health and Family Planning" was constituted to form a framework for integration of health and medical services at peripheral and supervisorylevels.
- 27. Recommendations a) Various categories of peripheral workers should be amalgamated into a single cadre of multipurpose workers (male and female). i. ANM MPW(F) Basic health workers MPW(M) LHV Female healthsupervisor. ii. The work of 3‐4 MPWs was to be supervised by one health supervisor. a) One PHC should cover a population of 50,000. It should be divided into 16 sub centres, each to be staffed bya male and a female healthworker.
- 28. SHRIVASTAV COMMITTEE 1975 • This committee was set up in 1974 as "Group on Medical Education and Support Manpower" to determine steps needed to: (i)reorient medical education in accordance with national needs & priorities; (ii)develop a curriculum for health assistants who were to function as a link between medical officers and MPWs.
- 29. Recommendations 1. Creation of bands of paraprofessional and semi professional health workers from within the community itself e.g. school teachers, postmasters etc. 2. Establishment of two cadres of health workers between the community level workers and doctors at PHC namely – multipurpose health workers and healthassistants. 3. Development of a “Referral Services Complex” by establishing proper linkage between PHC and higher referral services. 4. Establishment of a Medical and Health Education Commission for planning and implementing the reforms needed in health and medical education on the lines of University Grants Commission. • Acceptance of the recommendations of the Shrivastava Committee in 1977 led to the launching of the Rural Health Scheme.
- 30. • In the 5th Plan, the government ruefully acknowledged that the number of medical institutions, functionaries, beds, health facilities etc, were still inadequate in the rural areas despite advances in terms of infant mortality rate going down, life expectancy goingup, • The urban health structure had expanded at the cost of the rural sectors. • Major innovations took place with regard to the health policy and method of delivery of health care services. • Increasing the accessibility of health services to rural areas through the Minimum Needs Programme (MNP) and correcting the regionalimbalances.
- 31. • The 6th Plan was to a great extent influenced by the Alma Ata declaration of Health For All by 2000 AD (WHO, 1978) and the ICSSR ‐ ICMRreport (1980). • The plan conceded that "there is a serious dissatisfaction with the existing model of medical and health services with its emphasis on hospitals, specialization and super specialization and highly trained doctors which is availed of mostly by the well to doclasses. • It is also realized that it is this model which is depriving the rural areas and the poor people of the benefits of good health and medicalservices“ • The National Health Policy of 1983 was announced during the Sixth planperiod.
- 32. • The 7th Five Year Plan recommended that "development of specialties and super‐specialties need to be pursued with proper attention to regional distribution“ and such "development of specialised and training in super specialties would be encouraged in the public and the private sectors“. • This plan also talks of improvement and further support for urban health services, biotechnology and medical electronics and non‐communicablediseases. • Enhanced support for population control activities also continues. • The special attention that AIDS, cancer, and coronary heart diseases are receiving and the current boom of the diagnostic industry and corporate hospitals is a clear indication of where the health sector prioritieslie.
- 33. • On the eve of the Eighth Five Year Plan the country went through a massive economiccrisis. • The Plan got pushed forward by two years. But despite this no new thinking went into thisplan. • Infact, keeping with the selective health care approach the eighth plan adopted a new slogan – instead of Health for All by 2000 AD it chose to emphasize Health for the Underprivileged. • Simultaneously it continued the support to privatization.
- 34. • During the Eighth Plan resources were provided to set up the Education Commission for Health Sciences, and a few states have even set up the University for Health Sciences as per the recommendations of the Bajaj committeereport.
- 35. BAJAJCOMMITTEE, 1986 • An "Expert Committee for Health Manpower Planning, Production and Management" was constituted in 1985 under Dr. J.S. Bajaj, the then professor atAIIMS. • Major recommendations are:‐ 1. Formulation of National Medical & Health Education Policy. 2. Formulation of National Health ManpowerPolicy. 3. Establishment of an Educational Commission for Health Sciences (ECHS) on the lines ofUGC. 4. Establishment of Health Science Universities in various states and union territories. 5. Establishment of health manpower cells at centre and in the states. 6. Vocationalisation of education at 10+2 levels as regards health related fields with appropriate incentives, so that good quality paramedical personnel may be available in adequate numbers. 7. Carrying out a realistic health manpower survey.
- 36. • During the 8th Plan period a committee to review public health was set up. It was called the Expert Committee on Public HealthSystems. • This committee made a thorough appraisal of public health programs and found that we were facing a resurgence of most communicable diseases and there was need to drastically improve diseasesurveillance in the country.
- 37. • The 9th Five Year Plan by contrast provides a good review of all programs and has made an effort to strategise on achievements hitherto and learn from them in order to move forward. • There are a number of innovative ideas in the ninth plan. • Reference is once again being made to the Bhore Committee report. • Another unique suggestion is evolving state specific strategies because states have different scenarios and are at different levels of development and have different health care needs. • The Ninth Plan proposes to set up at district level a strong detection come response system for rapid containment of any outbreaks that mayoccur.
- 38. • On the eve of the 10th Plan, the draft National Health Policy 2001has been announced.
- 39. NATIONAL HEALTHPOLICYIN INDIA • It was not until 1983 that India adopted a formal or official National HealthPolicy. • Prior to that health activities of the state were formulated through the Five year Plans and recommendations of variousCommittees.
- 40. National Health Policy2002 Objectives: • Achieving an acceptable standard of good health of Indian Population, • Decentralizing public health system by upgrading infrastructure in existinginstitutions, • Ensuring a more equitable access to health service across the social and geographical expanse of India.
- 41. NHP 2002,Objectives…….. • Enhancing the contribution of private sector in providing health service for people who can afford to pay. • Giving primacy for prevention and first line curative initiative. • Emphasizing rational use ofdrugs. • Increasing access to tried systems of Traditional Medicine
- 42. Eradication of Polio &Yaws 2005 Elimination of Leprosy 2005 Elimination of Kala‐azar 2010 Elimination of lymphaticFilariasis 2015 Achieve of Zero level growth of HIV/AIDS 2007 Reduction of mortality by 50% on account of Tuberculosis, Malaria, Other vector and water borne Diseases 2010 Reduce prevalence of blindness to0.5% 2010 Reduction of IMR to 30/1000 & MMR to 100/lakh 2010 Increase utilization of public health facilitiesfrom current level of < 20% to > 75% 2010 Goals – NHP 2002
- 43. Establishment of an integrated system of surveillance, National Health Accounts and Health Statistics 2005 Increase health expenditure by government as a % of GDP from the existing 0.9% to 2.0% 2010 Increase share of Centralgrants to constitute atleast 25% of total health spending 2010 Increase State Sector Health spending from 5.5% to 7% of the budget 2005 Further increase of State sector Health spending from 7% to8% 2010
- 44. BHORECOMMITTEE FIRST(1951‐1956) SECOND(1956–1961) THIRD (1961–1966) FOURTH(1969–1974) FIFTH(1974–1979) SIXTH (1980–1985) MUDALIAR COMMITTEE OMMITTEE EE CHADAH C MUKHER J JUNGALWALLACOMMITTEE KARTAR SINGH COMMI TTEE SHRIVASTAV COMMITTEE NATIONAL HEALTHPOLICY1983 FIVE YEARPLAN SEVENTH(1985–1990) EIGHTH(1992–1997) NINTH(1997–2002) TENTH(2002–2007) BAJAJCOMMITTEE NATIONAL HEALTHPOLICY2002 ELEVENTH(2007–2012) TWELFTH(2012–2017)
- 45. THANKS