The decline in health expenditure since the mid-1980s, and the steady withdrawal by the state from provision of public health services, has resulted in diminished capacity of the health system to respond to the basic health needs of communities. This presentation elaborates on the various health planning commissions and health expenditure in India.
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Health planning and expenditure in India
1. HEALTH PLANNING AND
EXPENDITURE IN INDIA
Presented By
Dr.Sindhu R
IIIrd Year Postgraduate
Department of Public Health
Dentistry
2. CONTENTS
Introduction
Types of health planning
Organization of health planning
Evolution of health planning in India
History of planning commission
Five year plans (I – XI)
Planning committees
Achievements of Five year plans
NITI Aayog
GDP of India
Current Healthcare expenditures
State-wise public health expenditure
Conclusion
References
3. INTRODUCTION
HEALTH PLANNING
DEFINITION
“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 administrative
action concerned not only with the adequacy, efficacy and efficiency of
health services but also with those factors of ecology and of social and
individual behaviour that affect the health of the individual and the
community"
Hogarth J. Glossary of health care terminology. Copenhagen, World Health Organization, Regional
Office for Europe, 1975.
4. Why planning?
Objectives
Targets
Resource
Programs
Health needs
and demands
Policy
Goals
To match the limited resources
with many problems
To eliminate wasteful expenditure
and avoid duplication
To develop the best course of
action to accomplish a defined
objective.
5. Types of Health planning
Problem-solving
planning
Program planning
Coordination of efforts
and activities planning
Planning for resource
allocation
10. HISTORY OF PLANNING IN INDIA
National Planning Committee by Indian National
Congress – 1938
Bombay Plan – 1944
Peoples Plan – 1945
Sarvodaya Plan - 1950
12. BHORE COMMITTEE(1946)
1943- Government of India appointed Sir Joseph Bhore
(Chairman) for “Health survey and Development
committee”
Recommendations:
I. Integration of preventive and curative services at all
administrative levels
II. Development of PHCs in 2 stages:
• Short-term measure
Each Primary health centre – 40,000 population
Secondary health centre – supervisory
coordinating and referral instituition
2 medical officers
4 Public health nurses
1 nurse
4 midwives
4 trained dais
2 sanitary inspectors
2 health assistants
1 pharmacist
15 other class IV
employees
PHC
13. • Long-term measure(3 million plan)
PHC units with 75-bedded hospitals
(10,000- 20,000 population)
Secondary units with 650-bedded hospitals
2,500-bedded District hospitals
III. In medical education: 3 months training in Preventive
and social medicine to prepare “Social physicians”
BHORE COMMITTEE(1946)
14. FIVE YEAR PLANS
PHASE I(1947-72)
PHASE IV (1991 onwards)
PHASE III (1977-91)
PHASE II (1972-77)
16. FIRST FIVE YEAR PLAN(1951-56)
Indigenous systems of medicine
1954
752 PHCs were established
Harrod
Domar
model
17. SECOND FIVE YEAR PLAN(1956-61)
Objectives
Establishment of institutional facilities that offers services to the local
people and surrounding areas
Development of technical manpower through appropriate training
programs
Development of institutions to control widely prevalent communicable
diseases
Improvement of environmental hygiene through active campaign
Family planning and other supportive programs for raising the
standard and health of the people
Proposal: To set up another 3000 PHCs
Mahalanobis
plan
19. MUDALIAR COMMITTEE(1962)
1959- Government of India appointed “Health survey and Planning
committee” / “Mudaliar committee” after Dr. A.L.Mudaliar(chairman)
Quality of services provided by PHCs were inadequate
Requires strengthening of the existing PHCs
Recommendations:
Consolidation of advances made in FYP I & II
Strengthening of District hospitals with specialist services
Each PHC – 40,000 population
Improve quality of healthcare
Integration of medical and health services(Bhore committee)
Constituition of All India Health Service
20. CHADAH COMMITTEE(1963)
• 1963- Government of India appointed the committee under Dr.
M.S.Chadah( chairman) of “Director general of Health services”
Recommendation:
o Vigilance operations for “National Malaria
Eradication Programme”
o Monthly home visits by “Basic health workers” (10,000 population)
Multipurpose worker ( collection of vital
statistics & family planning)
Family planning health assistant 3 or 4 MPWs
Supervise
21. Mukerji Committee(1965 & 1966)
• Appointed at a meeting of Central Health Council, Bangalore under
the Chairmanship of Shri Mukerji (Secretary of Health)
• To review strategies for “family planning programme”
Recommendations:
Separate staff for family planning programme
Delink malaria activities from family planning
Family planning health assistant: undertake only family
planning activities
Basic health workers: other purposes
22. JUNGALWALLA COMMITTEE(1967)
Appointed at a meeting of Central Health Council,
Bangalore under the Chairmanship of
Dr.N.Jungalwalla
(Director, National instituite of health administration
administration and education, New Delhi)
Recommendations: “Integrated Health
o Unified cadre
o Common seniority
o Recognition of extra qualifications
o Equal pay for equal work
o Special pay for specialized work
o No private practice and good service conditions
23. FOURTH FIVE YEAR PLAN(1969-74)
• In 1959, Dr. A.L.Mudaliar (Health survey and planning committee)
was appointed
• In 1961- Committee submitted the report
• By 1969- Some work has been done at central level
Fourth five year plan was set
Goals:
Health manpower development by training different categories of
medical personnel
Strengthening the available health infrastructure
Consolidation of advances made so far
Chairman
25. KARTAR SINGH COMMITTEE(1973)
• Appointed under the Chairmanship of Kartar singh
( Additional secretary, Ministry of Health and Family planning)
Recommendeations:
Replacement
Present ANM Female Health Workers
Basic Health workers,
Malaria surveillance
workers, Vaccinators,
Health education assistants,
Family planning health
assistants
Male Health Workers
26. KARTAR SINGH COMMITTEE(1973)
i. MPWs- placed first in areas where Malaria is in maintenance
phase and smallpox controlled
ii. PHC- 50,000 population
iii. Each PHC- divided into 16 sub-centres (3000- 3500 population)
iv. Each sub-centre: 1 Male & 1 female health worker
v. Male health supervisor: 3-4 MHW
vi. Female health supervisor: 4 FHW
vii. Lady health visitors: designated as female health supervisors
viii. PHC’s doctor should have overall charge of the staffs in the area.
27. FIFTH FIVE YEAR PLAN(1974-79)
• Multipurpose workers scheme
• Minimum needs Program
• Medical education and support manpower
• Many maternal and child health components
Family planning
Family Welfare Program
28. SHRIVASTAV COMMITTEE(1975)
“Group on Medical Education and Support Manpower”
Recommendations:
I.Creation of para and semi-professional health workers from the
Community itself
II.Establishment of 2 cadres of health workers: MPW & health
assistants
III.Development of “Referral Services Complex”
IV.Establishment of Medical and Education Committee for
planning and implementing reforms
29. RURAL HEALTH SCHEME(1977)
Involvement of medical colleges in health care of selected PHCs
Reorienting medical education to the needs of rural people
Reorienting training of multipurpose workers unipurpose workers,
by engaging in communicable disease programs
30. PHASE III (1977-1991)
• 1977- Smallpox eradication
– Reorientation of Medical Education(ROME)
Scheme
• 1978- Alma Ata Declaration
– Expanded Program of Immunization
• 1982- National Health Policy(announced)
• 1983- National Health Policy(launched)
31. SIXTH FIVE YEAR PLAN(1980-85)
o Health care delivery in rural and urban areas
o Population stabilization and MCH activities
o Control of communicable, non- communicable diseases and
blindness
o Medical/health research and development
o Medical education, training and manpower planning
o Health education, information and communication
o Indigenous systems of medicine and homeopathy
32. SEVENTH AND EIGHTH FIVE YEAR PLAN(1985-90,
1992-97)
Goals to achieve by 2020:
i.Virtual elimination of poverty
ii.Virtual elimination of illiteracy
iii.Ensuring near full employment
iv.Ensuring basic needs of food, clothing and shelter for all
To accomplish fully operational health infrastructure in
Community health volunteers
Health workers
Sub-centers
PHCs
Basic sanitation
80% urban
25% rural population
33. Universal coverage of vaccination against 6 vaccine
preventable diseases of children
Achieve “Couple Protection Rate”
42%- by end of VII FYP
56%- by end of VIII FYP
SEVENTH AND EIGHTH FIVE YEAR PLAN(1985-90,
1992-97)
34. NINTH FIVE YEAR PLAN(1997-2002
NEW INITIATIVES
MCH services under a re-designated RCH program
Integration of vertical programs(eg: NLEP), with primary care system
system
Develop a disease surveillance system at district level
Develop integrated NCD control program
Apply management systems for emergency, disaster and accidents
35. TENTH FIVE YEAR PLAN(2002-2007)
Extension of ninth plan
No major shift
Efforts were made to bring better quality of
health care
Identifying & Filling
critical gaps – Infrastructure
Manpower
Material
36. ELEVENTH FIVE YEAR PLAN(2007-12)
Horizontal integration of healthcare and reduction of inequities
Strengthening of health systems and Public private partnership
Improve equity in health
• Rapid expansion of NRHM & NUHM
• Insurance schemes
• Improving access and quality of
primary care
GOALS
Decentralizing the system of
governance by increasing the
role of Panchayat Raj
Institutions, NGOs and Civil
society
40. NITI AAYOG - ACHIEVEMENTS
Reforms in Agriculture
Reforming Medical Education
Digital Payments Movement
Atal Innovation Mission
Indices Measuring States Performance in Health, Education and
Water Management
Task Force on Elimination of Poverty in India
Task Force on Agriculture Development
Transforming India Lecture Series
http://pib.nic.in/newsite/PrintRelease.aspx?relid=161229
43. CURRENT HEALTH EXPENDITURE (% OF GDP)
Countries % GDP(2016)
Marshal Islands 23.29
United States 17.07
Sierra Leone 16.53
Tuvalu 15.45
Cuba 12.19
India 3.66
https://data.worldbank.org/
46. Distribution Of Current Health Expenditure (2015-16) By Healthcare Financing
Schemes, Revenues Of Healthcare Financing Schemes, Healthcare Providers
And Healthcare Functions (%)
50. Percentage Distribution of Public Health Outlay on Revenue &
Capital during 2015-16 (RE)
National Health Accounts Cell
Ministry of Health & Family Welfare
54. CONCLUSION
Though Health is important for overall well-being of the
population in a country, India spends only 3.66% of GDP for
healthcare which is lesser than many lower middle income
countries.
Current pace of slow increase in the healthcare budget will make it
difficult to achieve targets like reducing MMR to 100 in 2018-2020
and IMR to 28 by this year.
55. REFERENCES
Gupta P, Ghai O. Textbook of preventive and social
medicine. New Delhi: CBS Publishers; 2007.
Park K. Park's textbook of preventive and social
medicine. Jabalpur. Banarasidas Bhanot. 2017;463.
india.health.info/
http://planningcommission.nic.in/plans/planrel/fiveyr
/11th_vol2.pdf
https://data.worldbank.org/
www.undp.org.in/ihdg.htm
• NHA Estimates Report
• https://www.mohfw.gov.in/sites/default/files/GATS-FactSheet.