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Health Committee Reports

Health Committee Reports. Outline of the presentation. Need for a health committee Bhore Committee Mudaliar Committee Chadah Committee Mukherjee Committee Jungalwala Committee Kartar Singh Committee Shrivastava Committee. Introduction.

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Health Committee Reports

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  1. Health Committee Reports

  2. Outline of the presentation • Need for a health committee • Bhore Committee • Mudaliar Committee • Chadah Committee • Mukherjee Committee • Jungalwala Committee • Kartar Singh Committee • Shrivastava Committee

  3. Introduction • Objective of Health services - protect the health of the armed forces and European Civil servants • Western System of medicine - not accessible • Traditional systems of medicine - neglected • Stress - curative • Separate departments - medical relief and public health activities

  4. State of public health in British India • Death rate - 21.8 per 1000 • Infant Mortality Rate - 158 per 1000 live births • 200,000 women died every year - pregnancy and childbearing • Expectancy of life at birth - 26.46 Female, 26.91 Males • 100 million persons - malaria every year • 2.5 million active cases of TB & 500,000 deaths • Cholera, smallpox and plague - morbidity and mortality

  5. State of public health in British India • Beds available - 0.24 beds/1000 population • Doctors available - 1:6000 • Average time given to a patient - 48 seconds to 1 minute • Environmental conditions - not satisfactory

  6. Sokhey Committee • Indian National Congress in 1938 - National Planning Committee • Sub-committee on National Health under the chairmanship of Col. Sontok Singh Sokhey • To assess the health situation and services in the country • Recommended in interim report in 1940 • The integration of curative and preventive functions • Maintenance of health is the responsibility of the state • Final report in 1948 endorsed Bhore Committee recommendations

  7. BHORE COMMITTEE 1946 • Health Survey & Development Committee - 1943 • Sir Joseph William Bhore – Chairman • To survey the existing position regarding the health conditions and health organization in the country • Emphasis on integration of curative and preventive medicine at all levels

  8. Recommendations • Integration of preventive and curative services • Development of PHCs in 2 stages a. Short-term measure b. A long-term programme (the 3 million plan) • Major changes in medical education including 3 month training in PSM to prepare “social physicians”

  9. Recommendations Short term plan: • To be implemented within 5-10 years. • PHC - 40,000 population • 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): 3 tiers • First tier: PHUs with 75 bedded hospital for each 10,000 – 20,000 population • Second tier: 650 bedded Regional Health Unit (RHU) - referral centre for 30 to 40 PHUs. • Third tier: district hospitals with 2,500 beds - 3 million.

  11. Focused on • Health education • Physical training • Mothers and children • School health services • Industrial health services • Nutrition • Health services for important diseases • Environmental Hygiene

  12. MUDALIAR COMMITTEE 1962 • Health Survey and Planning Committee, headed by Dr. A.L. Mudaliar • To assess the performance in health sector since the submission of Bhore Committee report • Review of First & Second Five Year Health Projects. • Formulation of Recommendations for the future plan of Health Development in the country

  13. Sub Committee • Professional education and research • Medical relief (Urban and Rural) • Public Health Including Environmental Hygiene • Communicable disease • Population problem, Family Planning • Drugs and Medical stores

  14. Reported • Malaria was considered to be under control • Deaths from malaria, cholera, smallpox were greatly reduced • Death rate- 21.6/ 1000 • Infant mortality rate- 135/1000 live births • Expectancy of life at birth- 42 • Village and small town dwellers - least access to health services • Most PHCs were understaffed • 1/3rd of the total beds - 125 teaching hospitals

  15. Recommendations • Consolidation of advances made in first 2 five year plans • Strengthening of sub divisional and district hospitals with specialist services • To improve the quality of health care provided at PHC • PHC should not be made to cater to more than 40,000 population and that the curative, preventive and promotive services should be all provided at the PHCs

  16. Integration of Medical and Health services • All India Health service should be created to replace the erstwhile Indian Medical service • Mobile teams for rural areas • Levying user fees except for those really poor • Health insurance policy for all citizens • Institution of National programmes

  17. CHADAH COMMITTEE 1963 • Chairmanship of Dr. M.S. Chadah, the then Director General of Health Services • To advise about the necessary arrangements for the maintenance phase of National Malaria Eradication Programme

  18. Recommendations • The vigilance activity in the NMEP should be carried out by basic health workers (one per 10,000 population) • Function as multipurpose workers • Malaria work, and also the duties of family planning and vital statistics data collection under supervision of FP HAs.

  19. MUKHERJEE COMMITTEE 1965 • Recommendations of the Chadah Committee, when implemented, were found to be impracticable • Headed by the then Secretary of Health, Shri Mukherjee, was appointed to review the performance in the area of family planning

  20. Recommendations • Separate staff for the family planning program • Basic health workers were to be utilized for purposes other than family planning • Delink the malaria activities from family planning • Use of extension education approach in family planning

  21. JUNGALWALLA COMMITTEE 1967 • Committee on Integration of Health Services - 1964 • Chairmanship of Dr. N Jungalwalla, the then Director of National Institute of Health Administration and Education (currently NIHFW)

  22. Recommendations • Unified Cadre • Common Seniority • Recognition of extra qualifications • Equal pay for equal work • Special pay for special work  • Abolition of private practice by government doctors • Improvement in their service conditions

  23. KARTAR SINGH COMMITTEE. 1973 • Committee on multipurpose workers under Health and Family Planning, headed by the Additional Secretary of Health • To study and recommend on • Formulation of a framework for integration of health and medical services at peripheral and supervisory levels • The feasibility of having multipurpose, bipurpose workers • The training requirements • The utilization of mobile units setup under Family planning programme

  24. Recommendations • Various categories of peripheral workers should be amalgamated into a single cadre of multipurpose workers (male and female) • The ANM to be converted into MPW(F) and the basic health workers, malaria surveillance workers to be converted to MPW(M). • Training to make them MPWs to start in areas where small pox was controlled and malaria was in maintenance phase

  25. The work of 3-4 male and female MPWs to be supervised by one health supervisor (male or female respectively). • The existing lady health visitors to be converted into female health supervisor. • One Primary Health Centre should cover a population of 50,000. It should be divided into 16 subcentres (one for 3000 to 3500 population) each to be staffed by a male and a female health worker.

  26. Health worker female- • Family planning and MCH • Medical care • Nutrition education • Health education • Health worker male- • Malaria • Smallpox • Family planning • Immunization • Environmental sanitation • Nutrition education • Communicable diseases • Health education

  27. SHRIVASTAV COMMITTEE. 1975 • Set up in 1974 as “Group on Medical Education and Support Manpower” • To reorient medical education in accordance with national needs & priorities • To develop a curriculum for health assistants who were to function as a link between Medical officers and MPWs

  28. Recommendations • Creation of bands of paraprofessional and semiprofessional health workers from within the community itself • Establishment of 3 cadres of health workers namely – multipurpose health workers and health assistants between the community level workers and doctors at PHC • Development of a “Referral Services Complex”

  29. 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. • 1 male and 1 female health worker for 5000 population, 1 health assistant for 2 male and 2 female health workers

  30. Acceptance of the recommendations of the Shrivastava Committee in 1977 led to the launching of the Rural Health Service • Involvement of Medical colleges in the total health care of the selected PHCs with the objective of reorientation of Medical Education to the needs of the rural people • Reorientation of training of multipurpose workers engaged in the control of various communicable disease programmes into unipurpose

  31. Reorientation Of Medical Education (ROME) • Every Govt. medical college should accept the responsibility of comprehensive health care of 3 PHCs in 1st phase and then all the PHCs in the district • Every medical college staff to be involved in community health services • Rural orientation of medical students, interns and PGs and Faculty of SPM Dept. • 8 weeks annual postings in PHCs • Students, interns and faculty of all clinical dept. to be involved in camps

  32. 3 vehicles to be used for providing medical services to rural area • 6 months or entire internship training in rural area • Research in Medical colleges- community based • Faculty to be involved in training of Medical Officers and paramedical staff

  33. References • Report of the Health Survey and Development Committee - 1946, Volume – 4, Summary, Govt. of India Press, New Delhi. • Sathe and Sathe, 2003, Textbook of Epidemiology and Management for Health Care for All, Second Edition, Chapter 1, 3-12. Popular Prakasham Publishers, Mumbai. • Park and Park’s Text Book of PSM, 7th Edition, 632 – 6, Banarasi Das Bhanot Publishers, Jabalpur. • K. Park, 2002, Text Book of PSM, 18th Edition, 671 – 3, Banarasi Das Bhanot Publishers, Jabalpur. • Ravi Duggal “RESURRECTING BHORE – Re-emphasizing a universal health care system.”MFC Bulletin, No. 188-9, November-December1992,1-6.

  34. References • Report on Health status of the Indian people. Supplementary document to Health for All an alternative strategy. Sonya Gill. Dec 1987. • Report on Health for all: An alternative strategy 1981. ICSSR and ICMR • Suresh Chandra. Essentials of Community Medicine. New Central Book Agency. 225-7

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