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Unit II
HEALTH COMMITTEES
BY:
MR. J.C. FRANK M.Sc (N)
ASSISTANT PROFESSOR
Sir JosephWilliam Bhore
Bhore Committee
- Constituted by pre independent GOI
- Under Sir Joseph William Bhore, Indian Civil
Servant
- Formed in 1943
- “Health Planning and Development
Committee”
Terms of Reference
• A survey of existing conditions and organisation
• Secondly suggestions for future development
• Consider short term objectives which might
reasonably be expected to be reached within a
period of four to five years
• Objectives which will necessarily require a longer
period for attainment.
Bhore Committee Report
• Submitted in 1946
• Runs into 4 volumes
• Volume I A survey of the State of the Public
Health and the existing health organisation
• Volume II Recommendations
• Volume III Appendices
• Volume IV Summary
Observations
• CDR : 22.4/1000
• IMR : 162/1000 live births
• MMR : 20/1000 live births
• Life expectancy at birth : 27 years.
Observations
• Incidence of communicable disease also was very
high.
• Diseases like chicken pox, cholera etc occurred in
epidemics.
• Many of the health problems were preventable.
• Investment made in preventing these problems
would give high returns in the forms of increased
productivity and development.
Recommendations
Short term plan:
- To be implemented within 5-10 years.
- Each primary health centre in the rural area to cater to a
population of 40,000
- 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
Recommendations
Long term plan (3 million plan):
Health care system in three tires.
• First tier: primary health units with 75 bedded hospital for each 10,000 –
20,000 population with staff of 6 medical officers, 6 public health nurses, 2
sanitary inspectors, 2 health assistants and other supportive staff.
• Second tier: 650 bedded Regional Health Unit (RHU) to serve as a referral
centre for 30 – 40 PHUs.
• Third tier: district hospitals with 2,500 beds to serve the needs of about 3
million.
Recommendations
• 3 months training in preventive and social medicine to
prepare ‘SOCIAL PHYSICIANS’
• Special emphasis on preventive work (Integration of
curative and preventive services)
• Village Health Committee consisting of 5 to 7 individuals
for procuring the active participation of the people in the
local health programme.
• Inter-sectoral Coordination
Sir A Lakshmanaswamy Mudaliar
Mudaliar Committee
• Constituted in 1959
• By GOI
• Under Dr. A Lakshmanswamy Mudaliar, Vice
Chancellor, Madras University
• “Health Survey and Planning Committee”
Terms of Reference
1. The assessment (or evaluation) in the field of medical
relief and public health since the submission of the
Health Survey and Development Committee's Report
(the Bhore Committee)
2. Review of the First and Second Five-Year Plan Health
projects and
3. Formulation of recommendations for the future plan
of health development in the country.
Observations
• Basic health facilities had not reached at least half the
nation
• Gross mal distribution of hospitals and beds in favour of
urban areas.
• Quality of services provided by PHCs were grossly
inadequate with poor functioning, lack of referral
system, and gross under staffing due to insufficient
resources
Recommendations
• Consolidation of 1st two 5 yr plans
• Strengthening DH to serve as central base for specialist
services
• PHC - 40,000 population
• 1 BHW per 10,000 population
• Improve secondary services
• Integration of Medical and Health services
Chadha Committee
• A committee of health administrators and
malariologists reviewed the National Malaria
Eradication programme.
• Constituted in 1963
• By GOI
• Under Dr. MS. Chadha, Director General of Health
Services
Terms of Reference
1. The committee should go into the details of the requirement
related to the primary health centers, their planning, the
necessary priority required according to the needs of the
maintenance phase of the Malaria Eradication progrmme.
2. The committee should also consider the Staffing pattern
required for the malaria eradication programme.
Recommendations
• One basic health worker per 10,000 population
• Basic health workers should visit house to house once
in a month to implement malaria vigilance activities.
• BHW to serve as MPHW for family planning and vital
statistics and malaria vigilance.
• FPHA to supervise 3-4 BHW
Mukerji Commitee
• Following the Central Family Planning
Council meet at Madras
• Constituted in 1965
• Headed by Shri Mukerji, Secretary, Ministry of
Health and Family Planning
Terms of Reference
• In 1965, the ICMR Director pronounced that Lippes
Loop was safe.
• So, IUCD was introduced into the family planning
programme and reorganisation of the FP programme
was needed.
• CBR was 41 per thousand and was aimed at reducing to
25 per thousand in a period of 10 years.
Terms of Reference
To review what additions and changes are
necessary as a result of the greatly altered
situation due to the IUCD having come in the
forefront of the programme, in the staffing
pattern, financial provisions, etc.
Recommendations
• Strengthening of education and publicity efforts and involvement of other
organisations
• Strong executive agency in Health Directorate of each state government to
exclusively deal with family planning
• Approved the existing Urban Family Welfare centre
• At Rural Family Planning Centre
- BHW to be utilised as MPW for general services
- FPHA to undertake only FP work without having to supervise BHW D
• Delink malaria and FP activity
Mukerji Committee,1966
• Following 13th Meeting of the Central Council of
Health held at Bangalore in June, 1966 - state finding it
difficult to take burden of maintenance phase of malaria
and other prog. like small pox, leprosy, FP, trachoma
• Formed in 1966
• By GOI
• Headed by Shri B. Mukerji, Union Health Secretary
Terms of Reference
• To review the staffing pattern of the primary health centre
complex and to recommend the minimum staff of various
categories required at different levels within the district so as to
provide an integrated health service capable of fully catering to
the needs of the vigilance services in the maintenance phase of
National Malaria Eradication Programme, smallpox eradication,
tuberculosis, leprosy and trachoma control, etc.
• To recommend the pattern of Central assistance for the States
Recommendations
• Basic Health Services to be provided at block level
• Strengthening required at higher level
• Any attempt to give the basic health worker more work
under the family planning programme would either
endanger malaria vigilance work or would need a larger
number of basic health workers per block than what the
Committee has recommended.
Jungalwalla Committee
• Central Council of Health, 1964 Srinagar
• Dr. N. Jungalwalla, Addl. Director General of
Health Services
• “Committee on Integration of Health Services”
• Submitted report un 1967
Terms of Reference
• To study the problems of the health services
• Service conditions
• Elimination of Private practice
Recommendation
The main steps recommended towards integration were:
• Unified cadre
• Common seniority
• Recognition of extra qualifications
• Equal pay for equal work
• Special pay for specialized work
• No private practice, and good service conditions
• Left states to work out their own strategy.
Kartar Singh Committee
• Growing demand for increase of staff under
each programme.
• Need to reduce population/area covered by
each worker.
Kartar Singh Committee
• Meeting of the Central Family Planning Council 1972
• By GOI
• In 1972
• “The committee on Multipurpose workers under Health
and Family Planning”
• Kartar Singh, Addl. Sec., MOHFP
• Report in 1973
Terms of Reference
• Structure for integrated services the
peripherals and supervisory levels
• Feasibility of MPW
• Their training requirements
• Utilisation of mobile services for integration
Recommendations
• Multipurpose workers - feasible and desirable
• Redesignation
- ANMs replaced by FHWs
- BHW, Malaria surveillance workers, vaccinators, FPHAs
replaced by MHWs
- LHV designated as FH supervisor
• To be first introduced in malaria maintenance phase areas and
small pox controlled areas
• Clearly spelt out the job functions of HWs and Supervisors
Recommendations
• 1 PHC – 50,000 population
• 1 PHC –16 SHC (2000 – 3500)
• 1 SHC – 1 MHW n 1 FHW
• 1 male supervisor – 4 MHWs
• 1 female supervisor – 4 FHWs
• Doctor incharge of all supervisors
• To be impemented in 5th 5yr plan
Shrivastav Committee
GOI observed that
• Urban orientation of medical education in India, which relies heavily on curative methods
and sophisticated diagnostic aids
• The failure of the programmes of training in the fields of nutrition, family welfare planning,
and maternal and child because of their development in isolation from medical education,
• The deprivation of the rural communities of doctors
• The need to re-orient undergraduate medical education with emphasis on community rather
than on hospital care
• The importance of integrating teaching of various aspects of family planning with medical
education
Shrivastav Committee
• MOHFP,GOI
• In 1974
• “ Group on Medical Education and Support
Manpower”
• Submitted report in 1975
Terms of Reference
• To devise a suitable curriculum for training a cadre of
Health Assistants
• To suggest steps for improving the existing medical
educational processes as to provide due emphasis on
the problems particularly relevant to national
requirements
• To make any other suggestions to realise the above
objectives and matters incidental thereto
Recommendations
(1) Organization of the basic health services (including nutrition, health
education and family planning) within the community itself and training
the personnel needed for the purposes;
- Creation of Village Health Guide (VHG) or community health volunteers
from the community itself like teachers, postmasters, gram sevikas who
can provide comprehensive health services as paraprofessionals.
- Primary health care be provided within the community itself through
specially trained workers so that the health of the people is placed in the
hands of people themselves
Recommendations
(2) Organization of an economic and efficient
programme of health services to bridge the
community with the first level referral Centre,
viz., the PHC
- Creation of MPW and Health Assistants (HA) in
between the VHG and MO in PHC
Recommendations
(3) The creation of a National Referral Services
Complex by the development of proper
linkages between the PHC and higher level
referral and service centres.
(4) Establishment of ‘The Medical and Health
Education Commission’
Rural health Scheme
“Rural Health Scheme” was launched by the government in 1977-78. The
major steps initiated were :
a) Involvement of medical colleges in health care of selected with the
objective of reorienting medical education according to rural population
called Re Orientation of Medical education (ROME). It led to teaching
and training of undergraduate students and Interns at PHCs.
b) Training of Village Health Guides and utilising their services in the
general health service system.
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Health committees in community health nursing

  • 1.
  • 2. Unit II HEALTH COMMITTEES BY: MR. J.C. FRANK M.Sc (N) ASSISTANT PROFESSOR
  • 4. Bhore Committee - Constituted by pre independent GOI - Under Sir Joseph William Bhore, Indian Civil Servant - Formed in 1943 - “Health Planning and Development Committee”
  • 5. Terms of Reference • A survey of existing conditions and organisation • Secondly suggestions for future development • Consider short term objectives which might reasonably be expected to be reached within a period of four to five years • Objectives which will necessarily require a longer period for attainment.
  • 6. Bhore Committee Report • Submitted in 1946 • Runs into 4 volumes • Volume I A survey of the State of the Public Health and the existing health organisation • Volume II Recommendations • Volume III Appendices • Volume IV Summary
  • 7. Observations • CDR : 22.4/1000 • IMR : 162/1000 live births • MMR : 20/1000 live births • Life expectancy at birth : 27 years.
  • 8. Observations • Incidence of communicable disease also was very high. • Diseases like chicken pox, cholera etc occurred in epidemics. • Many of the health problems were preventable. • Investment made in preventing these problems would give high returns in the forms of increased productivity and development.
  • 9. Recommendations Short term plan: - To be implemented within 5-10 years. - Each primary health centre in the rural area to cater to a population of 40,000 - 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): Health care system in three tires. • First tier: primary health units with 75 bedded hospital for each 10,000 – 20,000 population with staff of 6 medical officers, 6 public health nurses, 2 sanitary inspectors, 2 health assistants and other supportive staff. • Second tier: 650 bedded Regional Health Unit (RHU) to serve as a referral centre for 30 – 40 PHUs. • Third tier: district hospitals with 2,500 beds to serve the needs of about 3 million.
  • 11. Recommendations • 3 months training in preventive and social medicine to prepare ‘SOCIAL PHYSICIANS’ • Special emphasis on preventive work (Integration of curative and preventive services) • Village Health Committee consisting of 5 to 7 individuals for procuring the active participation of the people in the local health programme. • Inter-sectoral Coordination
  • 13. Mudaliar Committee • Constituted in 1959 • By GOI • Under Dr. A Lakshmanswamy Mudaliar, Vice Chancellor, Madras University • “Health Survey and Planning Committee”
  • 14. Terms of Reference 1. The assessment (or evaluation) in the field of medical relief and public health since the submission of the Health Survey and Development Committee's Report (the Bhore Committee) 2. Review of the First and Second Five-Year Plan Health projects and 3. Formulation of recommendations for the future plan of health development in the country.
  • 15. Observations • Basic health facilities had not reached at least half the nation • Gross mal distribution of hospitals and beds in favour of urban areas. • Quality of services provided by PHCs were grossly inadequate with poor functioning, lack of referral system, and gross under staffing due to insufficient resources
  • 16. Recommendations • Consolidation of 1st two 5 yr plans • Strengthening DH to serve as central base for specialist services • PHC - 40,000 population • 1 BHW per 10,000 population • Improve secondary services • Integration of Medical and Health services
  • 17. Chadha Committee • A committee of health administrators and malariologists reviewed the National Malaria Eradication programme. • Constituted in 1963 • By GOI • Under Dr. MS. Chadha, Director General of Health Services
  • 18. Terms of Reference 1. The committee should go into the details of the requirement related to the primary health centers, their planning, the necessary priority required according to the needs of the maintenance phase of the Malaria Eradication progrmme. 2. The committee should also consider the Staffing pattern required for the malaria eradication programme.
  • 19. Recommendations • One basic health worker per 10,000 population • Basic health workers should visit house to house once in a month to implement malaria vigilance activities. • BHW to serve as MPHW for family planning and vital statistics and malaria vigilance. • FPHA to supervise 3-4 BHW
  • 20. Mukerji Commitee • Following the Central Family Planning Council meet at Madras • Constituted in 1965 • Headed by Shri Mukerji, Secretary, Ministry of Health and Family Planning
  • 21. Terms of Reference • In 1965, the ICMR Director pronounced that Lippes Loop was safe. • So, IUCD was introduced into the family planning programme and reorganisation of the FP programme was needed. • CBR was 41 per thousand and was aimed at reducing to 25 per thousand in a period of 10 years.
  • 22. Terms of Reference To review what additions and changes are necessary as a result of the greatly altered situation due to the IUCD having come in the forefront of the programme, in the staffing pattern, financial provisions, etc.
  • 23. Recommendations • Strengthening of education and publicity efforts and involvement of other organisations • Strong executive agency in Health Directorate of each state government to exclusively deal with family planning • Approved the existing Urban Family Welfare centre • At Rural Family Planning Centre - BHW to be utilised as MPW for general services - FPHA to undertake only FP work without having to supervise BHW D • Delink malaria and FP activity
  • 24. Mukerji Committee,1966 • Following 13th Meeting of the Central Council of Health held at Bangalore in June, 1966 - state finding it difficult to take burden of maintenance phase of malaria and other prog. like small pox, leprosy, FP, trachoma • Formed in 1966 • By GOI • Headed by Shri B. Mukerji, Union Health Secretary
  • 25. Terms of Reference • To review the staffing pattern of the primary health centre complex and to recommend the minimum staff of various categories required at different levels within the district so as to provide an integrated health service capable of fully catering to the needs of the vigilance services in the maintenance phase of National Malaria Eradication Programme, smallpox eradication, tuberculosis, leprosy and trachoma control, etc. • To recommend the pattern of Central assistance for the States
  • 26. Recommendations • Basic Health Services to be provided at block level • Strengthening required at higher level • Any attempt to give the basic health worker more work under the family planning programme would either endanger malaria vigilance work or would need a larger number of basic health workers per block than what the Committee has recommended.
  • 27.
  • 28. Jungalwalla Committee • Central Council of Health, 1964 Srinagar • Dr. N. Jungalwalla, Addl. Director General of Health Services • “Committee on Integration of Health Services” • Submitted report un 1967
  • 29. Terms of Reference • To study the problems of the health services • Service conditions • Elimination of Private practice
  • 30. Recommendation The main steps recommended towards integration were: • Unified cadre • Common seniority • Recognition of extra qualifications • Equal pay for equal work • Special pay for specialized work • No private practice, and good service conditions • Left states to work out their own strategy.
  • 31. Kartar Singh Committee • Growing demand for increase of staff under each programme. • Need to reduce population/area covered by each worker.
  • 32. Kartar Singh Committee • Meeting of the Central Family Planning Council 1972 • By GOI • In 1972 • “The committee on Multipurpose workers under Health and Family Planning” • Kartar Singh, Addl. Sec., MOHFP • Report in 1973
  • 33. Terms of Reference • Structure for integrated services the peripherals and supervisory levels • Feasibility of MPW • Their training requirements • Utilisation of mobile services for integration
  • 34. Recommendations • Multipurpose workers - feasible and desirable • Redesignation - ANMs replaced by FHWs - BHW, Malaria surveillance workers, vaccinators, FPHAs replaced by MHWs - LHV designated as FH supervisor • To be first introduced in malaria maintenance phase areas and small pox controlled areas • Clearly spelt out the job functions of HWs and Supervisors
  • 35. Recommendations • 1 PHC – 50,000 population • 1 PHC –16 SHC (2000 – 3500) • 1 SHC – 1 MHW n 1 FHW • 1 male supervisor – 4 MHWs • 1 female supervisor – 4 FHWs • Doctor incharge of all supervisors • To be impemented in 5th 5yr plan
  • 36. Shrivastav Committee GOI observed that • Urban orientation of medical education in India, which relies heavily on curative methods and sophisticated diagnostic aids • The failure of the programmes of training in the fields of nutrition, family welfare planning, and maternal and child because of their development in isolation from medical education, • The deprivation of the rural communities of doctors • The need to re-orient undergraduate medical education with emphasis on community rather than on hospital care • The importance of integrating teaching of various aspects of family planning with medical education
  • 37. Shrivastav Committee • MOHFP,GOI • In 1974 • “ Group on Medical Education and Support Manpower” • Submitted report in 1975
  • 38. Terms of Reference • To devise a suitable curriculum for training a cadre of Health Assistants • To suggest steps for improving the existing medical educational processes as to provide due emphasis on the problems particularly relevant to national requirements • To make any other suggestions to realise the above objectives and matters incidental thereto
  • 39. Recommendations (1) Organization of the basic health services (including nutrition, health education and family planning) within the community itself and training the personnel needed for the purposes; - Creation of Village Health Guide (VHG) or community health volunteers from the community itself like teachers, postmasters, gram sevikas who can provide comprehensive health services as paraprofessionals. - Primary health care be provided within the community itself through specially trained workers so that the health of the people is placed in the hands of people themselves
  • 40. Recommendations (2) Organization of an economic and efficient programme of health services to bridge the community with the first level referral Centre, viz., the PHC - Creation of MPW and Health Assistants (HA) in between the VHG and MO in PHC
  • 41. Recommendations (3) The creation of a National Referral Services Complex by the development of proper linkages between the PHC and higher level referral and service centres. (4) Establishment of ‘The Medical and Health Education Commission’
  • 42. Rural health Scheme “Rural Health Scheme” was launched by the government in 1977-78. The major steps initiated were : a) Involvement of medical colleges in health care of selected with the objective of reorienting medical education according to rural population called Re Orientation of Medical education (ROME). It led to teaching and training of undergraduate students and Interns at PHCs. b) Training of Village Health Guides and utilising their services in the general health service system.