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1. HEALTH PLANNING
-Cycle, Elements & Steps
DR. RAJESH R. KULKARNI
ASSOCIATE PROFESSOR
DEPT. OF COMMUNITY MEDICINE,
J. N. MEDICAL COLLEGE,
KAHER, BELAGAVI
2/7/2024 DEPT. OF COMMUNITY MEDICINE 1
KAHER
J.N. MEDICAL COLLEGE, BELAGAVI
DEPARTMENT OF COMMUNITY MEDICINE

2. Content
• Definition
• Elements of planning
• Steps of planning
• Health planning cycle
• Health planning in India
• Planning commission
• Health sector planning
• Five year plans
• NITI AAYOG
• References
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3. Definition
HEALTH PLANNING
“The orderly process of defining community health problems,
identifying unmet needs and surveying the resources to meet them,
establishing priority goals that are realistic and feasible and
projecting action to accomplish the purpose of the proposed
programme.”
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WHO (1971). Planning and Programming for Nursing Services, Public Health Papers 44.

4. Elements:
HEALTH NEEDS :
The deficiencies in health that call for preventive, curative, control or eradication measures.
HEALTH DEMANDS :
Demands represent a subset of the wants that individuals are willing to act upon.
RESOURCES :
MANPOWER, MONEY, MATERIALS, MINUTES (TIME), METHODS (SKILLS-STRATEGIES) AND
KNOWLEDGE & TECHNIQUE.
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OBJECTIVE: Precise and it’s the planned end-point of all activities.
GOAL : The ultimate desired state towards which objectives and resources are directed.
PLAN : It’s the blueprint for taking action.
PROGRAMME : Sequence of activities designed to implement policies and accomplish
objectives.
SCHEDULE : Time sequence for the work to be done.
PROCEDURE : Set of rules carrying out work which, when observed by all, help to ensure the
maximum use of resources and efforts.
POLICY : The guiding principles stated as an expectation, not as a commandment.

6. STEPS IN HEALTH PLANNING
1. Pre-planning
2. Analysis of health situation
3. Establishment of objective and goals
4. Assessment of resources
5. Fixing priorities
6. Writing up of formulated plan
7. Programming
8. Implementation
9. Monitoring
10. Evaluation
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8. Pre-planning :
Preparation for planning.
• The important preconditions are:
1. Government interest
2. Legislation
3. Organization for planning
4. Administrative capacity
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9. Analysis of Health situation
• Involves collection ,assessment and interpretation of information
• Minimal essential requirements for health planning
1. Population – Age and sex structure
2. Statistics of morbidity and mortality
3. Epidemiology and geographical distribution of different diseases.
4. Medical care facilities
5. Man power
6. Training facilities
7. Attitude and beliefs of the population toward disease ,its cure and prevention
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10. Establishment of objective and goals
• Objective and goals are needed to guide efforts
OBJECTIVE: Precise and it’s the planned end-point of all activities.
GOAL : The ultimate desired state towards which objectives and resources are directed.
• All objectives should be “SMART”
• (specific, measurable, achievable, relevant, and time-bound)
•Otherwise it may lead to haphazard activity, uneconomical use of funds and poor performance.
• Short term or long term
• Important factors – Time and resource
• Modern management techniques – Cost benefit analysis, and input output study are used for defining goals,
objectives and targets in more definite.
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11. Assessment of resources
• Implies manpower, money, minutes, materials, skills, knowledge and techniques for
implementation of health programme
• Resources are assessed and balanced between what is required and what is available
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12. Fixing priorities
• Most important step in planning cycle is establishment of priorities
• For fixing priorities, number of factors are needed i.e., economical, technical, financial, social,
political, administrative, ethical etc.
• Three important aspects taken into considerations
1. Importance of public health
2. Availability of effective interventions
3. Cost of interventions
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13. Write up of formulated plan
• Plan should be complete in all aspects for the execution of a project.
• Plan means developing alternate ways of achieving the objective and selection of a most
appropriate ways.
• Planner should know the cause, effect, should be creative and understanding
• Write up should contain time sequence for the plan to be implemented, set of rules( procedure)
for implementing the plan, use of resources, monitoring and evaluating etc.
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14. Programing
• Plan execution depends upon the existence of effective organization.
• The organizational structure must include
1. Well defined procedure
2. Sufficient delegation of authority
3. Fixing responsibility for different workers for achieving the objective
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15. Implementations
• Main considerations at implementations stage include
1. Definition of roles and tasks
2. Selection, training, motivation and supervision of the manpower involved
3. Organization and communication
4. Efficiency of individual institutional
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16. Monitoring
• Continuous process of observing, recording, reporting on various indicators i.e., tasks and activities
• Framework of monitoring includes
1. What to be monitored ?
2. Who will be monitored ?
3. How it will be monitored ?
4. How frequently it will be monitored ?
• Thus monitoring consists of keeping track of the course of activities, identifying deviations and
corrective action.
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17. Evaluation
• To assess the achievement of the stated objective of a programme, adequacy, efficiency and
acceptance.
• Good planning will have a built in evaluation to measure the performance, effectiveness and
feedback to correct deficiencies
• WHO expert committee on National Health Planning in Developing Countries – “Measure the
degree to which objectives and targets are fulfilled”.
• Measures the productivity of available resources in achieving clearly defined objectives and
how much cost effectiveness is achieved.
• Helps in reallocation of priorities and resources on the basis of changing health needs.
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18. STEPS IN HEALTH PLANNING
1. Pre-planning
2. Analysis of health situation
3. Establishment of objective and goals
4. Assessment of resources
5. Fixing priorities
6. Writing up of formulated plan
7. Programming
8. Implementation
9. Monitoring
10. Evaluation
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19. Health Planning of India
1. Bhore committee, 1946
2. Mudaliar committee, 1962
3. Chadah committee, 1963
4. Mukherjee committee, 1965
5. Mukherjee committee, 1966
6. Jungalwalla committee, 1967
7. Kartar Singh committee, 1973
8. Shrivastav committee, 1975
9. Rural health scheme, 1977
10. Health for all by 2000 AD - Report of the working group, 1981
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20. Bhore committee, 1946
Chairman : Sir Joseph Bhore.
• Health survey and Development Committee
Primary recommendation –
• Integration of preventive and curative services at all administrative levels.
• Short term measures : Development of PHC for 40,000 population.
• Long term measures : 3 million plan.
• 3 month rural posting during internship in preventive and social medicine to prepare - “Social
physicians".
• Drawbacks – Based only on the allopathic system of medicine & has limited resources.
• Bhore committee became important landmark in public health in INDIA –
Initiation of concept of Comprehensive health care
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21. Mudaliar committee, 1962
Chairman : Dr. A.L.Mudaliar
• Health survey and planning committee.
• Proposed to launch All India Health Services.
• Based on Indian Administrative services.
• Committee expressed dissatisfaction over the quality of health care provided by PHCs and
advised strengthening of existing PHCs before opening new PHCs.
• The recommendations of Mudaliar committee formed the basis of establishing PHC’s in the 3rd
and 4th FIVE YEAR PLANS
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22. Chadah committee, 1963
Chairman : Dr. M.S.Chadah , Director General of Health services
• Objective : To advise arrangements for maintenance phase of National Malaria Eradication
Program.
• Linked malaria worker and family planning worker and renamed them as Basic Health Workers
for 10,000 population
• Drawbacks :
 Basic health worker could not function effectively as MPW’s.
 As a result malaria vigilance operations suffered and also the work of the family planning
programme was not satisfactory.
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23. Mukherjee committee, 1965
Chairman : Shri Mukherjee, Secretary of Health of the Government.
Objective – To review the performance and strategy for the family planning programme.
• Proposed delinking of malaria and family planning workers, undivided attention and focus on
each.
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24. Mukherjee committee, 1966
• Shortage of funds was making it difficult for the states to undertake multiple activities
• Recommended creation of a network of rural family planning centers attached to each PHC to
integrate the maternal health services and family planning
• The Committee worked out the details of the BASIC HEALTH SERVICE - provided at the block
level.
• Strengthening of the administrative set up at different levels
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25. Jungalwalla committee, 1967
Chairman: Dr. N.Jungalwalla, Director of National Institute of Health Administration and Education.
• Known as the Committee on Integration of Health Services.
• The main steps recommended towards integrated health services:
i. Unified cadre
ii. Recognition of extra qualifications
iii. Equal pay for equal work
iv. Special pay for specialized work
v. No private practice by government doctors and good service conditions.
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26. Kartar Singh committee, 1973
Chairman : Kartar Singh, Additional Secretary, MOHFW.
 Known as The Committee on Multipurpose Workers under Health and Family Planning.
 Objectives –
• To suggest structure for integrated services at peripheral & supervisory levels,
• To assess the feasibility of having MPW’s in the field,
• To require training requirements for the personnel.
 Recommendations -
• PHC for every 50,000 population.
• Auxillary nurse midwife (ANM) was renamed as Multipurpose worker.
• Basic health worker (BHW) was renamed as multi purpose worker (male).
• Lady health visitor (LHV) was renamed to Health supervisor.
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27. Shrivastava committee, 1974
Chairman : Dr. J.B. Shrivastava
• Group on Medical Education and Support Manpower
• The concept of “people’s health in people’s hand”
• Recommendations :
 ROME scheme : Reorientation of medical education.
 Development of a National Referral services complex.
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28. Rural health scheme, 1977
• Training of community health workers - initiated.
• Steps were also initiated for
a. Involvement of medical colleges by reorienting medical education to the needs of rural
people,
b. Reorientation training of multipurpose workers into unipurpose workers.
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29. Health for all by 2000 AD
• Working Group on Health - constituted by Planning Commission in 1980.
• Identify and set out the broad approach to health planning during the 6th Five Year Plan.
• Evolved specific indices and targets to be achieved in the country by 2000 AD.
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30. PLANNING COMMISSION
• Set up in 1950 - The Government of India.
• To make an assessment of resources of country and to draft developmental plans for most
effective utilization.
• In 1957, Perspective Planning Division - projections into future over a period of 20 - 25 years.
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31. PLANNING COMMISSION
• Consists of a Chairman, Deputy Chairman and 5 members.
• Works through 3 major divisions - Programme Advisers, General Secretariat and Technical
Divisions
• Responsible for scrutinizing/ analyzing various schemes and projects to be incorporated in the
Five Year Plans.
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32. HEALTH SECTOR PLANNING
1. Water supply and sanitation
2. Control of communicable diseases
3. Medical education, training and research.
4. Medical care – hospitals, dispensaries & primary health centres
5. Public health services
6. Family planning
7. Indigenous system of medicine.
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33. FIVE YEAR PLANS
• Conceived to re-build rural India
• To lay foundations of industrial progress
• To secure balanced development of all parts of the country.
• Broad objectives of health programmes during five year plans:
1. Control or eradication of major communicable diseases.
2. Strengthening of the basic health services through the establishment of primary health
centres and subcentres.
3. Population control.
4. Development of health manpower resources.
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34. TWELFTH FIVE YEAR PLAN (2012-2017)
• Two parallel steps to realize goal of Universal Health Coverage (UHC):
1. Clinical services at different levels, defined in an Essential Health Package.
2. Universal provision of high impact, preventive and public health interventions within the
12th Five Year Period.
• Outcome indicators –
1. Reduction of IMR to 25/1000LB
2. Reduction of MMR to 100/100,000LB
3. Prevention and reduction of undernutrition in children under 3years to half of NFHS-3 Levels
4. Prevention and reduction of anemia among women aged 15-49years to 28%.
5. Raising child sex ratio in 0-6years age group from 914 to 950
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35. NITI AAYOG
•National Institute for Transforming India (NITI Aayog) – January 1
2015
•Replaced Planning Commission.
•Premier policy ‘Think Tank’ of the Govt. of India.
•Designs strategic long term policies and programmes, provides
relevant technical advice.
•Aim – To achieve Sustainable Development Goals with
cooperative federalism by fostering the involvement of state
governments in India, in the economic policy making process
using a “Bottom-up approach”
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36. New initiatives by NITI Aayog
• Model land leasing law.
• Reforms the agricultural produce market committee (APMC) act.
• Reforming medical education
• Digital payments movement
• Atal innovation mission
• Transforming India lecture series
• South Asian regional conference on urban infrastructure
• Agreement with Microsoft for Artificial Intelligence – to address challenges in agriculture and
healthcare.
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37. Three Year Action Agenda of NITI AAYOG
(2017-18 to 2019-2020)
SPECIFIC HEALTH GOALS to be achieved by 2020
Reduce Maternal mortality ratio to 120/ 1,00,000 live births,
(103/ 1,00,000 live births)
Reduce Infant mortality rate to 30/ 1,000 live births,
( 27/ 1,000 live births )
Reduce Under 5 mortality rate to 38/ 1,000 live births,
( 33 / 1,000 live births )
Reduce Total Fertility rate to 2.1,
( 2.05 )
Reduce incidence of TB to 130/1,00,000
(77/ 1,00,000)
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38. Three Year Action Agenda of NITI AAYOG
(2017-18 to 2019-2020)
6. Reduce incidence of malaria (API) to less than 1/ 1,000 in 90% of districts.
7. Eliminate Kala-azar and Lymphatic Filariasis.
8. Reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic
respiratory diseases by 1/4th of NFHS-4 data.
9. Reduce out-of-pocket spending to 50% of the total health expenditure
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39. Common Questions asked in the exams
1. Enumerate and describe briefly the Steps in Planning Cycle.
2. Describe the salient features of report given by Bhore Committee
3. Define the terms - Objective, Goal and Target in Healthcare Planning.
4. Explain role of Pre-planning in the Planning Cycle.
5. Define the terms - Plan, Programme and Schedule in Healthcare Planning
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40. Common MCQ’s asked in the exams
Recommendations of Bhore committee include:
1.constitution of all India health service on the pattern of IAS
2. separate staff for family planning programmes
3.creation of bands of para-professionals and semi professional health workers
4. Integrated preventive & curative services at all levels of health care
Ans : 4. Integrated preventive & curative services at all levels of health care
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41. 3 month's training in preventive and social medicine during internship after
MBBS is recommended by:
1.Bhore committee
2. Chadah committee
3. Mudaliar committee
4. Mukerji committee
Ans : 1.Bhore committee
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42. In management goal refers to
1.planned end point of all activity
2. discrete activity
3. ultimate desired state towards which objectives and resources are directed
4. analysis of health situation
Ans : 3. ultimate desired state towards which objectives and resources are
directed
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43. References
• Park’s Textbook of Preventive and Social Medicine – 27th Edition
• PV Sathe Epidemiology and Management for Health Care for All – 6th Edition
• IAPSM’s Textbook of community medicine – 2nd Edition
• AH Suryakantha Textbook of community medicine with recent advances, 6th Edition
• https://niti.gov.in
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44. Failing to Plan Planning to Fail
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45. 2/7/2024 DEPT. OF COMMUNITY MEDICINE 45
Thank you