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1. The Government of India in 1943 appointed the Health Survey and Development Committee with Sir Joseph Bhore as Chairman, to survey the then existing position regarding the health conditions and health organization in the country, and to make recommendations for the future development.
2. The Committee observed “if the nation’s health is to be built, the health programme should be developed on a foundation of preventive health work and that such activities should proceed side by side with those concerned with the treatment of patients.”
3. Some of the important recommendations of the Bhore Committee were
a. Integration of preventive and curative services at all administrative levels;
b. The development of primary health centres in 2 stages
i. as a short—term measure, it was proposed that each primary health centre in the rural areas should cater to a population of 40,000 with a secondary health centre to serve as a supervisory, coordinating and referral institution. For each PHC, two medical officers, 4 public health nurses, one nurse; 4 midwives, 4 trained dais, 2 sanitary inspectors, 2 health assistants, one pharmacist, and 15 other class IV employees were recommended .
ii. a long—term programme (also called the 3 million plan) of setting up primary health units with 75—bedded hospitals for each 10,000 to 20,000 population and secondary units with 650—bedded hospitals, again regionalized around district hospitals with 2,500 beds.
4. Major changes in medical education which includes 3 month’s training in preventive and social medicine to prepare “social physicians”.
1. In 1959, the Government of India appointed another Committee known as “Health Survey and Planning Committee”, popularly known as the Mudaliar Committee (after the name of its Chairman, Dr. A.L. Mudaliar) to survey the progress made in the field of health since submission of the Bhore Committee’s Report and to make recommendations for future development and expansion of health services.
2. The main recommendations of the Mudaliar Committee were
a. consolidation of advances made in the first two five year plans;
b. strengthening of the district hospital with specialist services to serve as central base of regional services;
c. regional organizations in each state between the headquarters organization and the district in charge of a Regional Deputy or Assistant Directors — each to supervise 2 or 3 district medical and health officers;
d. each primary health centre not to serve more than 40,000 population;
e. to improve the quality of health care provided by the primary health centres;
f. integration of medical and health services as recommended by the Bhore Committee;
g. Constitution of an All India Health Service on the pattern of Indian Administrative Service.
1. In 1963, a Committee was appointed by the Government of India, under the Chairmanship of Dr. MS. Chadah, the then Director General of health Services to study the arrangements necessary for the maintenance phase of the National Malaria Eradication Programme.
2. The main recommendations of the Chadah Committee were
a. The “vigilance” operations in respect of the National Malaria Eradication Programme should be the responsibility of the general health services, i.e., primary health centres at the block level.
b. The vigilance operations through monthly home visits should be implemented through basic health workers.
c. One basic health worker per 10,000 populations was recommended. These workers were envisaged as “multipurpose” workers to look after additional duties of collection of vital statistics and family planning, in addition to malaria vigilance.
d. The Family Planning Health Assistants were to supervise 3 or 4 of these basic health workers.
1. A committee known as “Mukerji Committee, 1965” under the Chairmanship of Shri Mukerji, the then Secretary of Health to the Government of India, was appointed to review the strategy for the family planning programme.
2. The main recommendations of the Committee were:
a. Separate staff for the family planning programme.
b. The family planning assistants should undertake family planning duties only.
c. The basic health workers should be utilized for purposes other than family planning.
d. Delink the malaria activities from family planning so that the latter would receive undivided attention of its staff.
1. As the states were finding it difficult to take over the whole burden of the maintenance phase of malaria and other mass programmes like family planning, smallpox, leprosy, trachoma, etc. due to paucity of funds, the matter came up for discussion at a meeting of the Central Council of Health held in Bangalore in 1966.
2. The Council recommended that these and related questions may be examined by a committee of Health Secretaries, under the Chairmanship of the Union Health Secretary, Shri Mukerji. The Committee worked out the details of the BASIC HEALTH SERVICE which should be provided at the block level, and some consequential strengthening required at higher levels of administration.
1. The Central Council of Health at its meeting held in Srinagar in 1964, taking note of the importance and urgency of integration of health services, and elimination of private practice by government doctors, appointed a Committee known as the “Committee on Integration of Health Services” under the Chairmanship of Dr. N. Jungalwalla, Director, National Institute of Health Administration and Education, New Delhi to examine the various problems those of service conditions.
2. The Committee defined “integrated health services” as;
a. a service with a unified approach for all problems instead of a segmented approach for different problems; and
b. medical care of the sick and conventional public health programmes functioning under a single administrator and operating in unified manner at all levels of hierarchy with due priority for each programme obtaining at a point of time.
3. The main steps recommended towards integration were;
a. unified cadre
b. common seniority
c. recognition of extra qualifications
d. equal pay for equal work
e. special pay for specialized work
f. no private practice, and
g. good service conditions.
1. The Government of India constituted a Committee in 1972 known as “The Committee on Multipurpose Workers under Health and Family Planning” under the Chairmanship of Kartar Singh, Additional Secretary, Ministry of Health and Family Planning, Government of India.
2. The terms of reference of the Committee were to study and make recommendation on ;
a. he structure for integrated services at the peripheral and supervisory levels;
b. the feasibility of having multipurpose, bipurpose workers in the field;
c. the training requirements for such workers; and
d. the utilization of mobile service units set up under family planning programme for integrated medical, public health and family planning services operating in the field.
3. Its main recommendations were:
a. the present Auxiliary Nurse Midwives to be replaced by the newly designated “Female Health Workers”, and the present—day Basic Health Workers, Malaria Surveillance Workers, Vaccinators, Health Education Assistants (Trachoma) and the Family Planning Health Assistants to be replaced by “Male Health Workers”.
b. The Programme for having multipurpose workers to be first introduced in areas where malaria is in maintenance phase and smallpox has been controlled, and later to other areas as malaria passes into maintenance phase or smallpox controlled.
c. For proper coverage, there should be one primary health centre for a population of 50,000;
d. Each PHC should be divided into 16 subcentres each having a population of about 3,000 to 3,500 depending upon topography and means of communications;
e. each sub centre to be staffed by a team of one male and one female health worker
f. There should be 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
g. The present—day lady health visitors to be designated as female health supervisors
h. The doctor in charge of a primary health centre should have the overall charge of all the supervisors and health workers in his area.
1. The Government of India in the Ministry of Health and Family Planning had in November 1974 set up a ‘Group on Medical Education and Support Manpower’ popularly known as the Shrivastav Committee.
2. The main objectives of this committee were to :
a. devise a suitable curriculum for training a cadre of health assistants.
b. improve the existing medical educational processes.
3. The main recommendations of the Committee were:
a. creation of bands of paraprofessional and semiprofessional health workers from within the community itself (e.g., school teachers, postmasters, gram sevaks) to provide simple, promotive, preventive and curative health services needed by the community;
b. establishment of 2 cadres of health workers, namely — multipurpose health workers and health assistants between the community level workers and doctors at the PHC;
c. development of a ‘Referral Services Complex’ by establishing proper linkages between the PHC and higher level referral and service centres, viz taluka/tehsil, district, regional and medical college hospitals, and
d. Establishment of a Medical and Health Education Commission for planning and implementing the reforms needed in health and medical education on the lines of the University Grants Commission.
1. The most important recommendation of the Shrivastav Committee was that PHC should be provided within the community itself through specially trained workers so that the health of the people is placed in the hands of the people themselves.
2. The basic recommendations of the Committee were accepted by the Government in 1977, which led to the launching of the Rural Health Scheme.
3. The main recommendations of the Committee were:
a. for involvement of medical colleges in the total health care of selected PHCs with the objective of reorienting medical education to the needs of rural people; and
b. Reorientation training of multipurpose workers engaged in the control of various communicable disease programs into unipurpose workers.
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