Health committees


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Health committees

  1. 1. Introduction Various committees of experts have been appointed by the government from time to time to render advice about different health problems in India.
  3. 3.  It was set up in 1943, under the chairmanship of Sir Joseph Bhore by the british government of India.  The Government of India appointed this committee, to make broad survey of the existing health conditions
  4. 4. Members of the committee • 1.B Shiva Rao,member,Medical council of India • 2.LK Maitra,Member, Medical council of India • 3.PN Sapru, Member, Medical council of India • 4.NM Joshi, Member, Medical council of India • 5.Dr BC Roy, Member, Medical council of India • 6.Dr Viswanath, Member, Medical council of India • 7.Prof MA Hameed, Member, Medical council of India
  5. 5. • 8.Dr.JB Grant,Director,All India Institute of Public Health • 9.Dr Henry Sigerist,Hohn Hopkins society of Hygiene and Public health • 10.Dr.Ognev,Soviet union • 11.Dr.AC Banerjee,Public Health Specialist • 12.Dr AH Butt, Public Health Specialist • 13.Dr.KCKE Raja, Public Health Specialist • 14.Dr Jungalwalla, Public Health Specialist
  6. 6. PRINCIPLES • No individual should be denied to secure adequate medical care • The health services should provide,all the consultant, laboratory and institutions facilities necessary for proper diagnosis and treatment. • The health program must from the very beginning, lay special emphasis on preventive work.
  7. 7. • Medical relief and preventive care to the vast rural population . • Health services should be located as close to the people • Essential to secure the active cooperation of the people in the development of the health program • Health development must be entrusted to ministries of Health
  8. 8. • The basic training to the doctor should be designed to equip him for social duties(protecting and guiding the people) • Suffering and mortality in the country mainly the result of an inadequate provision of certain fundamental factors.
  9. 9. • 1. Integration of preventive and curative services at all administration level • 2. Development of Primary health centres in 2 stages. In short-term measure PHC in rural area should include population of 40,000 with a secondary health centre to serve as a supervisory, coordinating and referral institution.
  10. 10. • 2 medical officer • 4 public health nurses • one nurse • 4 midwives • 4 trained dais • 2 sanitary inspectors • 2 health assistants • one pharmacist • 15 other class IV employees
  11. 11. • Provision of hospitals and dispensaries in rural areas , less than that in urban areas • Medical service should be free to all without distinction and that should be through the proper channel .It should ultimately decided by the government
  12. 12. In long-term program (also called 3 million plan) -setting up PHC with 75 bedded hospital, for each 10,000- to 20,000 population and secondary units with 650- bedded hospitals with 2500 beds 3 months training in preventive and social medicine to prepare social physicians.
  13. 13. SHORT TERM PROGRAMME-DETAILS Short term programme--details • Combined preventive and curative health work by ---a number primary,secondary and district health units and special health services for mothers and children,school children and industrial wookers • Impersonal health services .
  14. 14. • Promotion of the hygienic mode of life style • In each village,a health committee consisting of 5-7 individuals should be established • Dental section should be established in the hospitals at secondary health services,provision should be made for ‘travelling dental units’ for service in rural areas.
  15. 15. • Provision of housing accommodation for health staff is essential • For each 30 bed hospital, there should be 2 motor ambulances and one animal drawn ambulance • Travelling dispensaries should be provided to supplement the health services in sparsely populated areas
  16. 16. Long term programme-- Details
  17. 17. • Provision of optimum diet for all • 8 ounces of milk per day should be included in the average diet, Nursing and expectant mothers ,children need much more.
  18. 18. Health education • Health education must promote health and health consciousness • Instruction of school children on hygiene should begin at the earliest possible stage • Responsibility of health education rest on health departments of Governments
  19. 19. • There should be 1 or 2 physical training colleges in each province • National Physical Education programme should include games,sports,and folk dances
  20. 20. Health services for mothers and children • Measures directed to reduce the sickness and mortality among mothers and children must have priority
  21. 21. The functions of the school health services should be • Preventive and curative health measures,including,detection and treatments and creation and maintenance of hygienic environment in and around the school • Improvement of the nutritional state of the child
  22. 22. • Occupational health Occupational health • Special measures should be taken to counteract the adverse effects associated with the occupation
  23. 23. Environmental hygiene • Legislation should be enacted in all provinces on a uniform basis both urban and rural area
  24. 24. Professional education • At the end of the first 10 years the production of doctors should be4000-4500 per year • New medical colleges with suitable teachers • All India institutes should provide teachers with high quality,selected persons should be send abroad for training
  25. 25. Undergraduate education • There should be a reorganization in teaching • Establishment of Preventive and Social Medicine in every college and inclusion of internship • Stressing the importance of research • Expansion of facilities in existing colleges • Conversion of medical schools into colleges and the establishment of new colleges
  26. 26. • Post graduate education • Post graduate education should be devised to provide training for consultants and specialists • A special organization called the central committee should be established for laying down standards in respect of post graduate training in particular subjects • There should be refresher course for general practitioner
  27. 27. Dental education • Provision should be made in medical and dental colleges for training dental surgeons,dental hygienists and dental mechanics • Legislation for compulsory registration of dentists • Prohibition of practice by unregistered dentists
  28. 28. Pharmaceutical education • Educational facilities for licentiate pharmacists ,graduate pharmacists and pharmaceutical technologists
  29. 29. Medical research • A statutory central research organization should be constituted • Provision of laboratory services in all provinces • Development of research in various subjects like malaria and nutrition
  30. 30. Drugs and medical requisites • Drugs and other medical requisites requirement of the country should be examined by a small committee • Drug act of 1940 should be brought into operation throughout the country
  31. 31. Population problem •Birth control through positive means
  32. 32. Stipends to medical and nursing students • In medical profession,Who are willing to enter into public service after completing the course,should be given annual stipend of Rs.1000 • Provision of stipends of Rs.60 per month for pupil nurses
  33. 33. Nurse midwives and dais • Number of nurses available in the country was 7,000 but short term progranne itself requires 80,000 • The committee suggested that,by 1971the number of trained nurses available in the country should be raised to 740000
  34. 34.  Establishment of preliminary training school  There should be two grades in the nursing profession,junior grade and senior grade  Establishment of nursing colleges
  35. 35. Male nurses • Male nurses and male staffs should be trained and employed in male wards and male OPD Public health nurses • Committee has suggested specific proposals with regard to training of public health nurses,they are fully qualified nurses with training in midwifery • Their educational programme should stress throughout preventive point of view
  36. 36. Midwives • Number of midwives available for midwifery duties in the country is 5000.100000,midwives are required to provide 1 midwife for every 100 births • Existing training schools required considerable improvement • Suggested certain fundamental requirements necessary for a training centre for midwives and made detailed recommendation for the training courses
  37. 37. Dais • Committee advocated the training of dais, until an adequate number of midwives will become available
  38. 38. Health Survey and Planning Committee (1962)  The Government of India in the Ministry of Health set up this Committee in 1959  Dr A Lakshminarayanaswami Mudaliar : Chairman of the committee
  39. 39. Terms of references • To review the developments • Evaluation in medical relief and public Health. • Review the first and second five year plans • Formulation of recommendations
  40. 40. Six sub-committees • Professional Education and Research, • Medical Relief • Public Health including Environmental Hygiene • Communicable Diseases • Population problem and Family planning • Drugs and Medical stores.
  41. 41. Recommendations • Strengthening of efforts and achievements made in the first two 5 year plans in the field of health. • Equipping district hospitals with specialist services. • Need for regionalization of health services. • Each primary health center: 40,000 people & have all compliment staff recommended by the committee
  42. 42. • The quality of care provided by the primary health center needs improvement. • In planning hospital one bed for every 1000 population should be taken for each district. -Taluk hospitals will provide 600-800 beds -PHCs will provide 10 beds each • Integration of medical and health services should be achieved as already suggested by the Bhore Committee
  43. 43. • Greatest attention should be given to the health of the children • The LHV and midwife posted in health centers is responsible for health education,personal hygiene and nutrition.
  44. 44. Recommendation related to Nursing sectors
  45. 45. • There should be three grades of nurses ,the basic nurses(with 4 years training)the auxillary nurse wife(2 years Of training )and the nurse with a degree qualification • The qualification of nursing candidates GNM- matriculation or equivalent Degree - higher secondary or Pre university examination
  46. 46. • Age of admission can be 16 years of age in states where there are difficulties in recruiting candidates at the age of 17 • Medium of instruction- Preferably be English for the GNM courses Degree courses --only in English
  47. 47. • Nurse pupils should not overburdened with the routine duties in the hospital • District hospitals with a bed strength of 75-100 should be utilized to train more nurses • Student nurses should be provide,free accommodation,,free supply of uniforms,laundry arrangements,free books,free medical services and medical check ups
  48. 48. • The recommendations of the committee set up by the central council of health • There should be a nursing advisory committee in each school for advising on admission and welfare of the trainees • Each nursing school have its own separate budget
  49. 49. • One auxillary nurse midwives for 5000 population by the end of 15 years,sufficient number of midwives are trained to replace dais • Male nurses should be trained for certain types of work • There should be higher training for the general sick nurse,public health nurse,paediatric health nurse,mental diseases nurse,theatre sister,nursing administrator
  50. 50. • Chadha Conmmittee (1963) • The Government of India appointed a committee under the chairmanship of Dr MS Chadha • Study the arrangements necessary for the maintenance phase of the NMEP. • The Committee known as "special committee on the preparation of entry of the NMEP into maintenance phase."
  51. 51. RECOMMENDATIONS • "Vigilance" operations in respect of the NMEP should be the responsibility of the general health services • “ Vigilance operations by basic health workers • Existing malaria surveillance worker (MSW) may be changed into auxiliary health workers/basic health workers -- Supervision by One sanitary inspector/health inspector for 20- 25000population
  52. 52. • Creation of the post of laboratory technicians at the PHC and a post of a FPFW and FPHA • Basic health workers envisaged as "multipurpose" workers to look after additional duties
  53. 53. • A committee was appointed by the Government of India during 1965 to review the strategy of family planning. • Chairman - Shri Mukherjee • Recommended separate staff for the family planning programme
  54. 54. RECOMMENDATIONS • Creation of post of LHV • There should be one FPFW for every two subcenters • Part-time workers for motivating population for acceptance of IUD
  55. 55. • Block and district levels, education leaders be appointed for intensifying motivational campaign and be paid honorarium of Rs. 600/- per annum. • Government doctors may be provided incentives which should also be available to part-time private medical practitioners in terms of honorarium of Rs. 100
  56. 56. Jungalwalla Committee (1967 • A committee was appointed, " under the chairmanship of Dr N Jungalwalla. • Committee is known as "Committee on integration of health services’’ • To integrate the health services and elimination of private practice by government doctors
  57. 57. Integrated approach • A service with an unified approach for all problems instead of a segmented approach for different problems, medical care of the sick and conventional public health programs functioning under a single administrator and operating in unified manner at all levels of hierarchy with due priority for each program
  58. 58. Recommendations • Unified care • Common seniority • Recognition of extra qualifications • Equal pay for equal work • Special pay for specialized work • Abolition of private practice by government doctors • Improvement in their service conditions
  59. 59. Kartar Singh Committee(1974) • Government of India constituted a committee in 1972 known as "The committee on multipurpose workers under health and Family Planning" • Chairmanship of Sri Kartar Singh--Additional Secretary, Ministry of Health Family planning of the Union Government
  60. 60. The terms of reference of the committee were • Structure for integrated services at the peripheral and supervisory levels, • The feasibility of having multipurpose / bipurpose workers and the training requirement of such workers • The utilization of mobile service units set-up under family planning program
  61. 61. Recommendations • ANMs should be replaced by the "Family Health Workers" • Basic Health workers (BHW), Malaria Surveillance worker (MSW), Vaccinators, Health Education Assistant of Trachoma (HEAT) and FPHAs to be replaced by "Male Health workers .
  62. 62. • There should be one PHC for a populationof 50000. ---Each PHC should be divided into 16 subcenters each having a population of about 3000 to 3500 depending . --Each subcenters should be staffed by by team of one male and one female health worker
  63. 63. • LHV should be replaced by the newly designated "Female Health Supervisor" Creation of such additional posts (to supervise the female health workers) clubbing of the posts of Health Inspectors, Sub- Inspectors, Malaria Surveillance Inspectors, Vaccinators, Supervisors together to make them into; "Male Health Supervisors"
  64. 64. • -- A male health supervisor to supervise the work of 3 to 4 male health workers and a female health supervisor to supervise the work of 4 female health workers. eg. The doctor in charge of a primary health centre should have the overall charge.
  65. 65. --- The program for having MPWs first to be introduced in areas where malaria is in maintenance phase and small pox has been controlled and later to other areas as malaria passes into maintenance phase or small pox controlled.
  66. 66. Shrivastav Committee (1975) The Govt. of India in the Ministry of Health and Family Planning November 1974 set-up a "Group on Medical Education and Support Manpower" under the chairmanship of Dr JB Shrivastav.
  67. 67. TERMS OF REFERENCES • To devise a curriculum for training of health assistants • To suggest suitable ways and means for implementation of recommendations by the earlier committees (Medical Education Committee (1968) • To make any other suggestions
  68. 68. Recommendations • Steps to create bands of paraprofessionals or semi professional health workers from the community itself to provide simple, protective, preventive and curative services • Between the community and the primary health center, there should be two cadres, health workers and health assistants.
  69. 69. • Health workers should be trained and to give simple, specified remedies for day-to-day illness. • Health assistants should be trained and equipped to give simple specified remedies for simple illnesses according to their level of technical competence.
  70. 70. • The primary health center should be provided with an additional doctor and nurse to look after MCH services • The primary health center , taluk hospital, district hospital, regional institution or medical college hospitals should develop direct links with the community around them, as well as with one another
  71. 71. Mehta Committee • The "Medical Education Review Committee" was headed by Shri Mehta, known as Mehta Committee1983. • Part I of the report deals with medical education in all its aspects • Part-Il of the report specifically deals with the lack of availability of health manpower data in India,
  72. 72. Recommendations • Training and development of auxillary personnel • Training and development of paraprofessional personnel • Basic and induction training in public health management • Continuing education in health and public health • Undergraduate medical education • Post graduate medical education
  74. 74. Shetty committee (1954) Report of the nursing committees to review the conditions of the nursing profession(Shetty committee 1954) Government of India constituted a committee on may 19th,1954 under the chairman ship of Mr.Shetty and Ms.Adranvala as the member secretary
  75. 75. Recommendations • Appointment of superintendent of nursing services in each state • Combining the nursing services with the public health • One midwife to 100 births in rural area in towns and cities,one midwife to 150 births
  76. 76. • One public health nurse or Health visitor to 10000 of population • Recruitment of necessary staffs for supervision and teaching in the existing training centers • Creation of posts of nursing staffs in institution and public health aspect
  77. 77. • Improvement in condition of training of nurses • Married women,unless widowed and separated from husbands not be admitted for training • Minimum requirements for admission to training schools to be in accordance with the regulations of INC
  78. 78. • Medium if instruction should be decided by each state • Setting up of a system of counseling of students,by an experienced sister • Students required to be resident during training
  79. 79. • Selection of nursing personnel by qualified nurses • Provision of adequate quarters for nurses • Improvement in working condition by an increase in staff .provision of supplies necessary to carry out good nursing. • Proper provision for a periodical physical examination and the treatment during illness. • Provision of pension or PF
  80. 80. • Establishment of refresher courses for all categories of the nursing staff • Provide part time work for married woman who have household responsibilities • Exchange of nurses between different states to be encouraged
  81. 81. • Recruitment of men as student nurses be in proportion with the job opportunities • Reduction in the period of training from 2 years to 18 months • Setting up of a training division at the Ministry of Health and family welfare for looking after training requirements for Health and family planning
  82. 82. Report of Expert committee on HealthManpowerplanning,Produc tion and Management ,Ministry of health andFW,,Govt of India,New Delhi(Bajaj committee,1986)
  83. 83. Bajaj committee(1986-1987) • The Ministry of Health and Family welfare, Government of India set-up a committee on Health Manpower, Planning, Production and Management in 1986 • Chairmanship : Prof. JS Bajaj , Professor of Medicine, AIIMS, and New Delhi.
  84. 84. Recommendation • To formulate a National policy on education in Health services • To prepare curriculum for school teachers • To utilize the services of Indian system Of Medicine • Continuing education programme for the health personnel
  85. 85. Manpower requirement for Hospital Nursing Services
  86. 86. CATEGORIES BASIS OF CALCULATION MANPOWWER REQUIREMENT (2001) Nursing Supdts 1:200 beds 4955 Dy nursing Supdts 1:300 beds 3003 Departmental nursing 7:1000+1 Addl:1000 beds 7928 Ward nursing supervisors 8:2000 51532 Staff nurse for wards 1:3(1:9 for each shift) 429432 For OPD,Blood bank,X ray,Diabetic clinics 1:100 opt 64415 For ICU (8 beds ICU) 1:8(1:3 for each shiftshift) 51530 For specialized deptts and clinics,OT,Labour room 8:200 51530
  87. 87. Manpower requirements for community nursing services by 2000 Infrastructure requirement Community Health centers 7436 Primary Health services 26439 *30000 population for plain area *20000 population for difficult area Sub centers 163941 *5000 population for plain area *3000population for difficult area
  88. 88. MIDWIVES ANM Primary health centers 26439 26439 Community Health centers 52052
  89. 89. Total manpower requirement in nursing services Nurse midwives - 664623 Sub centers ANM/FH worker 323882 Health supervisor 107960 Community Health centers Nurse midwives 26439 Primary Health Center PH Nurse 26439 Public Health Nurse supervisor 7436 District Public health nursing officer 900
  90. 90. • Sarojini Varadapan committee report (1989) A high power committee on Nursing and Nursing profession was set up by the Govt of India in july,1987 under the chairman ship of Smt Sarojini varadapan, Smt Rajkumari Sood,nursing advisor to Govt of india as the member secretary
  91. 91. RECOMMENDATIONS • Working conditions of nursing personnel • Employment • Job description. • Working hours • working facilities • Pay and allowances • Special allowance for nursing personnel, ie; uniform allowance, washing, mess allowance etc should be uniform • Promotional opportunities Promotion is based on merit cum seniority. Promotion to the senior most administrative teaching posts is made only by open selection.
  92. 92. • Career development • higher studies after 5 years of regular service. • 8. Accommodation • allotment of accommodation near to work place. • 9. Transport During odd hours, calamities etc arrangements for transport must be made
  93. 93. • 10. Special incentives • in terms of awards, special increment for meritorious work for nurses working in each state/district/PHC to be worked out. • 11. Occupational hazards Medical facilities should provided by the central govt. it should be free to all the nursing personnel. • 12. Other welfare services • Hospitals should provide welfare services
  94. 94. There should be 2 levels of nursing personnel * Professional nurse (degree level) :12 yrs of schooling with science( 4 yrs –duration) * Auxiliary nurse (vocational nurse) :10 yrs of schooling ( 2 yrs-duration) • All school of nursing attached to medical college hospitals
  95. 95. • All ANM schools and school of nursing attached to district hospitals be affiliated with senior secondary boards. • Post certificate BSc Nursing degree to be continued • Master in nursing programme to be increased and strengthened.
  96. 96. • Doctoral programmes • Central assistance be provided for all levels of nursing education institutions in terms of budget • Each school should have separate budget . The principal of the school be the drawing and the disbursing officer.
  97. 97. • Selection of students completely based on merit. Aptitude test is introduced for selection of candidates. • All schools to have adequate budget for libraries and teaching equipments. • School Of Nursing ::As per the requirements of INC.
  98. 98. • Adequate accommodations are provided to students • Students should learn under supervision in the wards. Tutors/clinical instructors must go to the ward with students.. • Community nursing experience should be as per INC requirements. Necessary transport
  99. 99. • INC requirements for staffing the schools are followed by all schools • Speciality courses at post-graduate: at certain special centres of excellence eg; AIIMS. • Institutes like National Institute of Health and Family welfare, RAK College of Nursing and several others may develop courses on nursing administration for senior nursing • Provision for higher training abroad
  100. 100. Continuing education • Definite policies of deputing 5-10% of staff for higher studies are made by each state. Provision for training reserve is made in each institution. • Deputation for higher study is made compulsory after 5 yrs.
  101. 101. CONCLUSION These committees are appointed from time to time to look into the issues of the health care administration.Recommendations made by these committees were very helpful to make an excellent change in our health care delivery system
  102. 102. • Basavanthappa BT.Nursing AdministrationJayppee publication.New Delhi:171-198 • Park K.Park’s Text book of Preventive and Social Medicine..Bhanot publication. 19th edition. Jabalpur:726 • Swarnakar K.Community Health Nursing.N.R Brothers.2nd edu.Indore.535 • Lucita M.Nursing:Practice and public Health Administration,current concepts and trends.Elsevier publications.2nd edition:369-374 • • •
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