History in India
Health situation in India
Dr. Sandeep A. Chavan
• If the disease condition is avoided, the
probability or the chance of death or
disability can be reduced.
• Public Health is therefore described as the
science and art of preventing diseases,
prolonging life and promoting health (of
individuals) through organised efforts and
Components of Public Health
– Measurement of disease conditions in relation to
the population at risk.
– Collection, presentation, analysis and
interpretation of epidemiological data.
• Health Services
– Services directed towards meeting the health
needs of the people.
• Public Health deals with the group of people
rather than individuals.
• Dimensions of public health
– Health promotion
– Disease prevention
– Early diagnosis and prompt treatment
– Disability limitation
Evolution of health care services in India
• Christian Era – civilization started in Indus Valley
– Environmental sanitation, houses with drainage
• 1400 B.C. – Ayurveda and Siddha system
– Developed a comprehensive concept of health
• Post vedic – teaching of buddhism and Jainism
• Moghul empire – Arabic system of medicine (Unani)
• British Gov – British nationals, armed forces, civil servants.
Traditional Indian Approach
• The Indian approach to health is enshrined in
the concepts and principles of Ayurveda which
means the ‘science of life’.
• Ayurveda is one of the oldest system of health
care in the World.
• Ayurveda deals with both preventive and
curative aspects of health.
• Health defined by WHO is very similar to
concepts of Ayurveda
• The western approach of avoiding diseases,
death and disability, traditionally focused on
personal hygiene and public sanitation during
the 19th Century.
• This approach, combined with better food
availability, paid rich dividend in the
developed countries in reducing morbidity
Public Health before the Colonial
• Little is known about public health activities
before the colonial period
• Main stream system of health care was
• Home-based care appeared to be the
• There appeared little organised efforts or
institutional care to treat diseases and prevent
Public Health during the British Period
• Although, public health efforts were restricted
to British civilian and military establishment,
they had impact on Indian masses.
– Mortality spikes were sharply reduced.
– Mortality from cholera and plague was sharply
– Diseases like malaria and gastro-enteritis
continued to take heavy toll.
Public Health in Independent India
• Evolution of public health care system in
Independent India was shaped by two
– The Report of First Health Survey and
Development Committee (Bhore Committee)
constituted during the colonial rule.
– Emergence of modern medical technology for the
prevention and control of diseases, especially
• Mass production of antibiotics.
• Availability of vaccines for diseases having
high mortality and disability rates
– Pertussis (Whooping Cough)
Role of different committees
• 1946 – Bhore Committee (Health survey and development committee)
o Integration of preventive and curative services
o Development of PHC
o 3 months training in PSM – Social Physician
• 1962 – Mudaliar committee (Health survey and planning committee)
o Strengthening of PHC and district hospital
o Regional organization
o Constitution of all India Health Services (like IAS)
• 1963 – Chaddah committee
o Malaria program services to be part of primary healthcare
o Basic health worker – for 10,000 population
o Family planning health assistant – for 3-4 BHWs
Role of different committees cont….
• 1965 – Mukerji committee
o Separate staff for the family planning programme
o De-link malaria activities from FP services
• 1967 – Jungalwala committee
o Committee on Integration of health services
o Elimination of private practice by Gov. doctor
o Special pay for specialized work
• 1973 – Kartar singh
o Committee on multipurpose worker
o ANM replaced by female health worker. AT SC – 1 Male & 1 Female Healthworker
o Basic health worker - replaced by male health worker – M H Supervisor
o Lady health visitors designated as female health supervisor.
1975: Srivastava Committee ( On med education & support manpower)
o Cadre of Health Assistant ( link between med. Practitioner and MPW)
o Referral service complex
o Creation of a para-professinal health workers
o Setting up medical and health education commission (Like UGC)
1977 : Rural Health Scheme
o Training of CHWs
o Reorienting medical education to the needs of rural poor
1981 – Report of the working group for Health For All
Progress from 1st Five year plan to
12th Five year plan
Parameters First Plan
Total SCs 725 25,020
Total PHCs NA 1,52,326
Total CHCs - 5,363
Total Bed strength 1,25,000 9,14,543
Medical colleges 42 356
Dental colleges 7 297
Allopathic doctors 65000 9,18,303
Nurses 18500 12,37,964
ANMs 12,780 6,02,919
Crude Birth rate 21.6/1000 population per year
Crude death rate(SRS 2012) 7/1000 population per year
Infant mortaility rate(SRS 2012) 42/1000 live births
Maternal mortality ratio(2012) 178/100000 live births
Expectation of life at birth
Male: 67.3 years & Ffemale: 69.6 years
Nutritional Status Indicators
Positive health indicator
of pre-school children
iii. Mid-arm circumference
Growth Monitoring of
Prevalence of low
Health Care Delivery Indicators
Equity of distribution of health resources in
different parts of the country and of the provision
of health care
• Doctor-population Ratio – 1/1700 (Norm 1/1000)
• Nurse-population ratio – 0.8/1000 (Norm 1/500)
• Population-bed Ratio – 8.9/10000
The present doctor-population ratio is 0.5 per 1,000 and the target
by 2025 is 0.8 per 1,000.
India produces 30,000 doctors, 18,000 specialists, 30,000
AYUSH graduates, 54,000 nurses, 15,000 ANMs and 36,000
Health ministry claims that there are about 6-6.5 lakh doctors
available. But India would need about four lakh more by 2020 to
maintain the required ratio of one doctor per 1,000 people.
Organizational structure in India
• Health system has 3 main links
– Central, state and local or peripheral.
• India is a Union of 29 states and 7 territories.
• Health is the responsibility of state.
• Central responsibility
– Policy making
– Coordinating the work of state health ministries.
At the centre
• The union ministry of health and family welfare
Headed by Cabinet minister
Minister of state
Deputy health minister
ministry of health
general of health
At the state level
• The state health administration was started in the year 1919.
• The state list which become the responsibility of the state included
– Provision of medical care
– Preventive health services
– Piligrim within the state
State - management sector
health and family
State ministry of
At the district level
• Principal unit of administration in India - District
• District health organization
– identifies and provide the needs of expanding rural health and
family welfare programme
• Within each district again, there are administrative areas
• No uniform model of district health organization
Panchayati Raj –
• 3 tier structure of rural local self government
• Linking the village to the district
Panchayat Panchayat Samiti Zilla Parishad
Gram Sabha Gram Panchayat
Widespread existence of
preventable diseases and
deaths is a disgrace to the
society which tolerates it...