National population Policies

Population policy is refer to decrease the birth rate or growth rate. In april 1976 India formed its
first National population Policies. In it increase the minimum age of marriage from 15 to 18 for
females,and 18 to 21 years for males. In 1977 policy is modified with the imporyance of small
family norm without compulsion. The new NPP2000 is more then just a matter of fertility and
mortality rates. It deal with :

 Women education; improving women for improved health and nutrition

 Child survival and health
 The unmet need for family welfare services
 Health care for the under served population group like urban slums,tribal community
 Increase participation of men in planned parenthood

Objectives:

1. Achieve universal access to counselling and services for fertility regulation and contraception
with a wide basket of choice.
2. Our real enemy is poverty, and it is a frontal assault on the citadels of poverty that the fifth
five year plan has included the minimum need programme. One of its five item is integrated
package of health, family planning and nutrition. For the remove this initiated to the trust of
medical education so as to strengthen the community medicine and rural health aspect and
restructure the health care delivery system on three tier basis going down in rural area where
majority of mortality , mobility and illiteracy rate. So the nation will be able to move forward
toward its desirable ideas.
3. Rising the age of marriage will not only have a demonstrable demographic impact, but will
also lead to more responsible parenthood and help to safeguard the health of the mother and
the child. It is well known that early pregnancy lead to higher maternal and infant mortality. It
has been decide that the minimum age of marriage should be raised to 18 for girls and 21 for
boys, and suitable legislation to this effect will be passed. The question of making registration
of marriages compulsory is under active consideration.
4. Make school education up to the age 14 free and compulsory, and reduce primary and
secondary school level to below 20 present for both boys and girls.
5. Achieve the 80 percent institution deliveries and 100 % deliveries of trained person.
6. My ministry is also close touch with the education ministry with regard to the introduction of
population values in the education system, and NCERT is made a text book that younger
generation should grow up with an adequate awareness of the population problem and a
realisation of their national responsibility in this regard. Indeed, if I may venture to say so,
exhortations to plan families are more imported for the younger generations then for those who
have already made their contribution to our demographic profile.
7. The adaptation of small family norm is too important a matter to be considered the
responsibility of only one ministry. It is essential that all minister ‘s of India and state should
take up as an integral part of their normal programme and budgets the motivation to citizens to
adopt responsible reproductive behaviour both in their own as well as the national interest.
 This effect is being issued by the prime minister and other minister of India, and letter issued
by the all chief minister. The performance of family planning in the state will be more
carefully and intensively monitored then in the past, and the union cabinet will review the
situation in depth at least once a year.
8. In addition to individual compensation ,government is to view that group incentive should now
be introduced in a bold and imaginative manner so as to make family planning a mass
movement with greater community involvement. It has been decided that suitable group
intensive will be interdicted for the medical profusion, for zila and panchayat samities,for
teachers, at various levels, for co- operative societies and labour in the organised sector are
being worked out in consultation with the concerned organisations.
9. Despite government efforts at union, state and municipal level, family planning cannot
succeed unless voluntary organization are drawn into its permotion in an increasing measure,
particularly youth and women organisation. There is all ready a scheme of aiding voluntary
organization. And it has been decided that this will be expended. Also, full rebate allowed in
the income tax assessment of the amount given as donation for family planning purpose to
government, local bodies or any registered voluntary organization approved for this purpose
by the union ministry of health.
10. Research in reproduction biology and contraception is under way in several of our scientific
institution, and there are some very promising development which we hope will lead to a
institution and there are some very promising development which we hope will lead to a major
breakthrough before too long. This is a great challenge to our scientific and efforts in this
direction will receive special attention so that necessary research input are ensured on a long
range and continuing basis.
11. Some state have introduced a series of measure directed toward their employees and other
citizen in the matter of preferential allotment of houses, loans etc.for those who have accepted
family planning. in this sphere also we have decide to leave it to each individual state to
introduce such measure as they consider necessary and desirable. Employees of the union
government will be expected to adopt the small family norm and necessary changes will be
made in their services rules to ensure this.
12. In order to spread the message of family planning throughout the nation, a new multimedia
multination strategy is being evolved which will utilise al l the available media channel
including the radio, TV, the press films, visual display and also include traditional audiences
folk media such as puppet, show, folk, songs and folk dances. The attempt is to move from the
ministry of information and broad casting and is also trying to draw media talent available in
the country into the structuring of the new programme.
13. Prevent and control of communicable disease.
14. Integrate system of medicine (ISM) in the provision of reproductive and child health services.
 FIVE YEAR PLAN
Indian has been a pioneer in planning its requirement quite well, not only at the time of independence
but even earlier, even through those efforts were does not as extensively worked upon as is reflective by
five year plan.

Five year plans are mechanisms to bring about uniformity in policy formation in programme of nation
importance. Recognising the health as an important contributory factor in the utilization of the men
power and in the uplifting of the economic condition of the country

The broad objective of the health programme during five year plan are as follow:

 Control and eradication of major communicable disease

 Strengthening of basic health services through establishment of primary health centres and sub
centres.
 Population control
 Development of the manpower recourses
 Drug control \

Priorities:

For the purpose of planning ,the health sector has been divided into the following sub sectors

1. Water supply and sanitation.

2. Control of communicable disease
3. Medical education training and research
4. Medical care including hospitals, dispensaries and PHCs
5. Public health services
6. Family planning
7. Indigenous system of medicine.
First five year plan
Prior to the commencement of the first five year plan ,the health status of the people of india was
very low, which includes:
 Lack of hygienic envierment sanitation conductive to healthy living
 Low resistance power due to lack of adequate diet.
 Prevalence of mal nutrition and poor nutrition
 Lack of proper housing, supply of poor drinking water and proper disposal of
human wastes.
 Lack of medical care
 Lack of general and health education
 Low economic status

Priorities

While considering the above facts, a seven point public health programme with the following priorities
formed the basis of the first five year plan:
  Provision of water supply and sanitation
 Control of malaria
 Preventive health care of the rural population through health unit and
mobile units.
 Health services for mother and children.
 Education and training and health education
 Self sufficiency in drugs and equipments
 Family planning and population control.

During this plan period the public sector outlay was rs.2,356 crore of which rs.140 crore were allotted
for health programmes. The actual expenditure, however, amounted to rs.1960 crore and rs.101 crore
respectively.

Development

 The B.C.G. vaccination programme was launched.

 Primary health centers were set up to render health services in rural area.
 Malaria control programme was launched
 Water supply and sanitation programme was launched.
 Minimum marriage age of 18 years for boys and 15 for girls was prescribed by Hindu marriage
act.

Second Five Year Plan 1956-61

The second five year plan was continuation of the development efforts commenced in the first plan. It
includes all communicable disease in addition to control of malaria. The specific objectives are:

1. Establishment of institutional facilities to serve as basis from which services could be rendered
to the people both locally and in surrounding territories.
2. Development of technical manpower through appropriate training programme
3. Intensify measure to control widely spread communicable disease
4. Encouraging active campaign for environmental hygiene
5. Provision of family planning and other supportive services for raising health standard of the
people.

The different areas emphasised during the second FYP were:

1. Health care services in rural and urban areas

2. Medical education and training
3. Medical research
4. Indigenous system of medicine
5. Control of communicable disease
6. MCH and family planning
7. Health education
 During this period, the public sector outlay was rs.4,800 crores, of which 225 crores were allotted to
the health programmes. The actual expenditures, however,amounted to rs.4,672crores and 215 crores
respectively.

Development

• T.B. chemotherapy centers was set up at Madres.

• Demography research center was establish in Delhi, Kolkata and Madres.

• Pilots project of small pox were started.

The pilot project on Trachoma control programme was launched

Third five year plan1961-66

The objectives of the third five year plan were in tune with the first and second five year plan except that
integration of public health with material and child welfare, nutrition and health education was planned.
In general, the third five years plans focussed on the following areas:

I. Water supply environmental sanitation(rural and urban)

II. Health care (hospital and dispensaties)
III. Control of communicable disease
IV. Medical education, research and training
V. Other services- health education, school health, MCH, mental health, health insurance
VI. ISM and family planning

While continuing the programme initiated in the previous plan period,greater emphasis was placed on
preventive health services and on the eradication and control of communicable disease. During the
period of the sector outlay was rs. 7,500 crores, of which ,rs.341.80 crores allotted for health
programmes. The actual expenditure,however,allotted to rs.8,577 crores and rs.357 crores respectively.

ANNUL PLAN1966-69

The fourth FYP which was to competence from april1966 was postponed till 1969 due 59 uncertain
economic situation in the country (due to indo pak war ).during the interviewing period,was covered by
annual plan with an outlay of Rs. 6,756 crores in the public sector of which the expenditure on health
programme was Rs.316 crores.

Fourth Five year plan 1969 - 74

During this period the received of public sector outlay was 16,774 crores of which Rs.1,156 crores were
allotted to health sector. Certain objective of the Mudaliar committee was the four five year plan in
relation health. These are :
 1. To provide an effective base for health services in rural areas by strengthening the primary
health centres.
2. Strengthening of sub divisional and district hospitals to provide effective referral services for
primary health centres
3. Expansions of the medical and nursing education and training of paramedical personnel to meet
the minimum technical manpower requirements.

In this plan, public health and medical programme had been divided into the following categories:

 Medical education, training and research,

 Control of communicable disease
 Medical care including hospitals, dispensaries and PHCs,
 Other public health services
 Indigenous system of medicine

In this period, efforts were made to strengthen the primary health centres complex in this rural area for
undertaking preventive and curative health services and for insuring the maintenance phase of the
communicable disease control and eradication programmes.

Fifth Five year Plan 1974-79

The fifth five year plan was launched on april 1,1974 with an outlay of Rs.37,250 crores in the public
sector, of which 3277 crores allotted to health sector. The primary objective of this plan period was “to
provide minimum public health facilities integrated with family planning and nutrition for vulnerable
group especially childeran,pregnant women and feeding mothers”.it was hoped to consolidate the gains
so far achieved in the various field of health such as communicable disease,medical education and
provision of the infrastructure in the rural areas.

The objective of the plan were:

 Increasing accessibility health services to rural areas

 Correcting regional imbalance
 Further development of referral services by removing deficiencies, in district and sub-divisional
hospitals
 Integration of health , family planning and nutrition
 Intensification of the control and eradication of communicable disease specially malaria and
small pox
 Development of referral services by providing specialist attention to common disease in rural
area

During plan period (minimum need program) to be operated through the state government is
considered to be the great importance and field certain targets like one P.H.C. for 1 lakh population,
one sub-centre for ten thousand population, correcting deficiencies related to establishment of these
 health centres .These targets of the MNP could not be achieved due to changes in national political
system.

Development:

 India become small pox free.

 Children's welfare Board was set up.

 A new population policy was announced by the government.

 Water act was enacted by the Government.

Sixth Five year plan1980-1985

In the beginning of the sixth five year plan was formulated against the background of a perspective
covering a period of 15 year from 1980/81 to 1994-95. The main objectives were

 Progressing reduction in the incidence of poverty and unemployment

 To set up the rate of growth of the Indian economy
 Promoting policies for controlling the population growth voluntary acceptance of the small
family norms

Minimum Need Program (MNP)

MNP was first introduced in fifth FYP to combat poverty. The state has duty to provide the basic
needs of life to every citizen needs in terms of health, food, education, water, etc. MNP is the
expression for the community particularly the under served and under privileged segment of
population. The basic need of the people of the land including following in revising MNP1978.
 Elementary education
 Adult education
 Rural health
 Rural water supply
 Rural road
 Rural electrification
 Houses for rural landless labourers
 Environment improvement of slums
 Nutrition

Development

• WHO declared eradication of small pox from the world.

• The air prevention control of pollution act was enacted.
• The national health policy was approved by the parliament.
• The ESI bill was passed by the parliament.
 SEVENTH FIVE YEAR PLAN 1985-90

The objective of the seventh FYP have been formulated as part of the long term strategy which seek by
the year 2000 to virtually eliminate poverty and illiteracy, achieve near full employment, secure
satisfaction of the basic needs of food, clouting, shelter and provide health for all.

The priorities:

 Health services in rural, tribal and hilly areas under minimum need programme
 Medical education and training
 MCH and family welfare
 Medical research
 Safe water supply and sanitation
 Standardisation, integration and application of Indian system of medicine

The total amount of funds which were allotted to the development plan was Rs.180,000 crores.89.00
crores was allotted for health for health and Rs.3256.25 crores was allotted to family welfare, out of
Rs.3392.00 crores. The major development was

 The immunization programme was launched

 The leprosy act was replaced by the parliament
 The 20 point programme was modified
 Parliament passed mental health bill
 World wide safe motherhood campaign was started by world bank

EIGHTH FIVE YEAR PLAN (19921997)

The aim of this plan was to continue reorganisation and strengthening of health strengthening of health
infrastructure and medical services assessable to all especially in venerable group and those living in
tribal, hilly, remote rural areas etc.

The priorities:

 Developing rural health infrastructure

 Medical education and training
 Control of communicable diseases
 Medical research
 Universal immunization
 MCH and family planning
 Safe water supply and sanitation

The health outlay : the overall amount of funds which was allocated to development plan was
Rs.79800 crores,out of this fund Rs.7,575.92 crores was allocated to health and Rs.6,500 crores was
allocated to family welfare
 Major development: child survival and safe motherhood programme was started on 20th august.

 The infant milk substitute, feeding bottles and infant food act 1952 come into operation.
 The panchayati raj act come into operation.
 ICDS was changed to integrated mother and child development services.
 Post basic 3year programme was launched through distance education by Indira Gandhi national
open university ( IGNOU)

THE NINTH FIVE YEAR PLAN (1997-2002)

Due to some political reasons the ninth five year plan couldn’t commence on 1st of April1997.it could
commerce on 1999. During this period it was found that mobility due to communicable diseases and
nutrition related disease continued to be high. It was because of lack of appropriate manpower, suitable
equipment, supply of referral services.

Objectives: to tackle both communicable and non communicable diseases so that there is sustain
improvement in the health status of the population.

 Further the intensify the efforts to improve the health status of the population by optimising
coverage and quality care by identify the critical gap in infrastructure, manpower, equipment,
and drugs etc.
The priorities: control of communicable and non communicable diseases
 Strengthening of existing infrastructures
 Improvement of referral linkages
 Disaster and emergency management
 Strengthening of health research
 Intersectoral co-ordination
The approaches
 Provide efficient primary health care system as part of basic services to improve accessibility
and quality services.
 Development of human recourses for health meeting the increasing demand for trained nurse in
specialised areas.
 Strengthening of MCH and family welfare programme.
 Development and implement integrated non communicable disease prevention and control
programmes.
 Disaster and emergency management at all levels of health care.
 Strengthening of food and drug safety programme.
 Strengthening of basic, clinical and health system research.

Tenth Five-Year Plan (2002–2007)

In this improve the health status of population by optimizing coverage and quality of care by
identifying the critical gaps in infrasture, manpower, equipment, diagnostic regards and drugs.
 Attain 8% GDP growth per year.
  Reduction of poverty ratio by 5 percentage points by 2007.
 Providing gainful and high-quality employment at least to the addition to the labour force;*All
children in India in school by 2003; all children to complete 5 years of schooling by 2007.
 Reduction in gender gaps in literacy and wage rates by at least 50% by 2007;*Reduction in the
decadal rate of population growth between 2001 and 2011 to 16.2%;*Increase in Literacy Rates
to 75 per cent within the Tenth Plan period (2002 - 2007)

Eleventh Five-Year Plan (2007–2012)

The eleventh plan has the following objectives:
1. Income & Poverty
• Accelerate GDP growth from 8% to 10% and then maintain at 10% in the 12th Plan in
order to double per capita income by 2016-17
• Increase agricultural GDP growth rate to 4% per year to ensure a broader spread of
benefits
• Create 70 million new work opportunities.
• Reduce educated unemployment to below 5%.
• Raise real wage rate of unskilled workers by 20 percent.
• Reduce the headcount ratio of consumption poverty by 10 percentage points.

2. Education
• Reduce dropout rates of children from elementary school from 52.2% in 2003-04 to 20%
by 2011-12
• Develop minimum standards of educational attainment in elementary school, and by
regular testing monitor effectiveness of education to ensure quality
• Increase literacy rate for persons of age 7 years or above to 85%
• Lower gender gap in literacy to 10 percentage point
• Increase the percentage of each cohort going to higher education from the present 10% to
15% by the end of the plan
3. Health
• Reduce infant mortality rate to 28 and maternal mortality ratio to 1 per 1000 live births
• Reduce Total Fertility Rate to 2.1
• Provide clean drinking water for all by 2009 and ensure that there are no slip-backs
• Reduce malnutrition among children of age group 0-3 to half its present level
• Reduce anaemia among women and girls by 50% by the end of the plan
4. Women and Children
• Raise the sex ratio for age group 0-6 to 935 by 2011-12 and to 950 by 2016-17
• Ensure that at least 33 percent of the direct and indirect beneficiaries of all government
schemes are women and girl children
• Ensure that all children enjoy a safe childhood, without any compulsion to work
5. Infrastructure
• Ensure electricity connection to all villages and BPL households by 2009 and round-the-
clock power.
• Ensure all-weather road connection to all habitation with population 1000 and above (500
in hilly and tribal areas) by 2009, and ensure coverage of all significant habitation by
2015
• Connect every village by telephone by November 2007 and provide broadband
connectivity to all villages by 2012
 • Provide homestead sites to all by 2012 and step up the pace of house construction for
rural poor to cover all the poor by 2016-17
6. Environment
• Increase forest and tree cover by 5 percentage points.
• Attain WHO standards of air quality in all major cities by 2011-12.
• Treat all urban waste water by 2011-12 to clean river waters.
• Increase energy efficiency by 20 percentage points by 2
•
NATIONAL HEALTH POLICY
Policy is a system, which provides the logical framework and rationality of decision making for the
achievement of intended objectives. It is statements that guides and provide discretion within limited
boundaries. policy sets priorities and guide resources.

The minister of health and family welfare Govt of India,evolved a NHP in 1983 keeping in view the
national commitment to attain the goal of health for all the year 2000. Since then has been significant
changes in the determinant factors relating to the health sectors necessitating revision of the policy,and a
new NHPM- 20002 evolved.

Objectives

 To achieve an acceptable standards of good health amongst the general population of the country.
 To increase access to the decentralized public health system by establishing new infrastructure in
deficient areas, and by upgrading the infrastructures in the existing institution.
 To insuring a more equitable access to health services across the social and geographical expanse of
the country
 To insure the aggregate public health investment through a substantially increased contribution by the
center Govt.
 To strengthen the capacity of the public health administration of the state level to render effective
services delivery
 To inhance the contribution of the private sector in providing health services for the population
group which can afford to pay for services
 To rationalize use of drugs within the allopathic system
 To increase access to tried and tested system of traditional medicine.

GOALS TO BE ACHIVED BY 2000 – 2005

2003: Enactment of legislation for regulating mimimum standards in clinical establishment/ medical
institution.

2005: Eradicate poliomyelitis and yaws: eliminate leprosy,establish an integrated system of

surveillance,national health accounts and health statistics, decentralization of implementation of public
health programs.

2007: Achieve zero level growth of HIV/AIDS

2010:
  Eliminate Kala azar
 Reduce mortality by 50% on account of T.B, malaria and others
 Reduce prevalence of blindness to 0.5%
 Reduce IMR to 30/ 1000 and MMR to 1/ 1000
 Increase utilization of public health facilities from current level of less than 20 to more than 75
%

2015: Eliminate lymphatic filariasis

POLICY PRESCRIOTION

1. Financial resources:
 To increase health sector expenditure to 6% of GDP,with 2% of GDP being contributed as
public health investment, by the year 2010
 State govt, expected to increases health contribution about 7% of the budget by 2005 and 8% of
the budget by2010
 Central govt contribution to public health would rise to 25% from the existing 15% by 2010
2. Equity

NHP – 2002, set out an increased allocation 55% of the total public health investment for primary health
sector, the secondary and tertiary health sector being targeted for 35% and 10% respectively.

3. Delivery of national health programme

It is done through horizontal manner. It mean giving responsibility to state government foe scientific
designing of public health projects through village and dist health administration, depending upon the
local needs. Policy ensure for provisioning of financial recourses, in additions to technical support,
monitoring and evaluation NHP at the national level by the centre.
4. The state of public health infrastructure:

It measure strengthening Public health infrastructure. It is by creation of a decentralization health

system, will ensure a more effective supervision of the public health personal through the regular
administration line of controls. provisions of essential recourses and drugs to strengthen primary health
structure for the attaining of improved public health out come on an equitable basis.

5. Extending public health services:

It includes private & Indian system of medicine and homeopathy. The number of medical paramedical
and practitioners of other system of medicine permitted, after adequate training. stressed on two – year
rural posting before the awarding of the graduate degree.

6. Role of local self – govt institutions:

Great emphasis upon the implement of public health programme through local self govt intuitions the
policy urges all states govt to considers decentralizing the implementation of the programme by transfer
power to such institutions by 2005.

7. Norms for health care professionals:

Minimal statutory norms with constant reviewing for the development of doctors and nurses in medical
institutions need to be introduced urgently under the provision of the IMC Act and INC act,
respectively.

8. Education of health care professionals:

The setting up of a medical grants commission for funding new govt medical and dental colleges in
different part of the country and also fund for the up gradation of the infrastructure of the existing
colleges, to improve standard of medical education. Need based and skill oriented syllabus,CME,UG
curriculam need to concern for geriatric disorders,forensic medicines, medical research.

9. Need for specialists in public health and family welfare:

To raise proportion of PG seats in these discipline in medical training to reach a stage where in 1/4th of
the seats are earmarked for these discipline. Specializations in public health may be encouraged for both
medical doctors and non medical graduates from the allied field like public health engineering and
microbiology.

10. Nursing personal:

Need for an improvement in the ratio of nurses vis – a vis doctors/ beds in Govt and private sector. Need
for establishing training causes for super speciality nurses required for training care intuitions.

11. Use of generic drugs and vaccine:

It emphasizes on a limited number of essential drugs of a generic nature,need to based both public and
private domain. The list of essential drugs would no doubt have to be reviewed periodically. The
production and sale of irrational combinations of drugs would be prohibited through the drug standards.

12. Urban health:

Setting up of an organized urban primary health care structure which a two – tiered system.PHC is the
first tier,and second tier the urban health organization at the level of the Govt general hospital,where
references is made from the primary centre.

13. Mental health

A network of decentralized mental health services for ameliorating categories of disorders starting
from PHC where general duty doctor would be able to prescribed medicine. upgrading of the physical
infrastructures of such institutions at central govt expense is also emphasized.

14. Information, education and communication:

Maximizes IEC to these population group can be achieved not only by mass media ,but also by in
terpersonal communication, folk media involving PRIs/ NGOs/Trusts.
 15. Health research:

Increases ingovt funded health research to level of 1% the total health spending by 2005. Up to 2% by
2010 for domestic medical research focusing on new therapeutic drugs and vaccine for tropical
disease, such as T.B, malaria,HIV/AIDS.

16.Role of the private sector:

The policy welcome participation of the private sector in all areas of health activities.established
legislation for regulating minimum infrastructure and quality standard in clinical establishment of
medical institions by 2003

Other prescriptions are:

 National disease servillance network
 Health statistics
 Women’s health
 Medical ethics
 Enforcement of quality standards for food and drugs
 Regulation of standards in paramedical disciplines
 Envierment and occupational health
 Providing medical facilities to users from overseas

Achievements: 2003: Enactment of legislation for regulatory minimum standard in clinical

establishment/ medical institution

2005:

 Eradication poliomyelitis is missed ,zero reporting of Yaws since 2004

 Leprosy has been declared eliminated according to the criteria fixed by WHO. However,more
efforts are required.
 Budget for medical research is not much increased as 1% of the total health budget for medical
research has been targeted
 Spending of state sector health has not much increased as planned from 5.5% to 7% of the
budget
 Decentralization of implementation of public health programs; national rural health mission has
been launched in this direction.

2007: Achieve zero level growth of HIV/AIDS has not been achieved and may required some
more years.

SWOT ANALYSIS

Strength:
  Policy identify many gross deficiencies of the existing health care scenario, proposes a
substantial changes. Justification provided for the new policy are convincing and attempt to
accelerated achievement for the set public health goals
 Commitment to enhance the budget on health expenditure from 5.2% to 6% of GDP with the
Govt contribution increasing from 0.9% to 2% by 2010
 Availability of advance technology and proven health strategies

Weakness:

 Lack of monitoring and evaluation

 Lack of Govt expenditure on public heath
 Gap in situation analysis and policy prescription

Opportunity:

 Based on past experiences of NHP1983 and long history of implication of various programs,
India got this opportunity to move ahead through health policy 2002
 Supportive envierment and absence of obvious threat of war, unrest etc,
 Policy initiatives will provided a new impetus to the development of the health sector
 Health tourism will drain the trained manpower to private sector and will encourage
privatization. In absences of regulations on private sector the encouragement could be dangerous
for the public sector the encouragement could be dangerous for public health

 Occurrence of unexpected natural calamities and catastrophe

 Negative involvement of religious fundamentalists for eg; polio sterility myth impending pulse
polio program
 Financial autonomy of dist societies may lead to corruption and need to be put under strict outer
regulation and accountability

HEALTH COMMITTEE
The guide line for national health planning were provided by a number of committee. So committee was
appointed by the Government of India from time to time to review the existing health situation and
recommend measures for further action. A brief review of the recommendation of these committees, is
given below.

Bhore committee 1946

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 conditiotion and
health organization in the country, and to make recommendation for the further development . The
committee which had among its members some of the pioneer of public health, meet regularly for 2
 year and submitted in 1946 its famous report which run into 4 volumes. The committee put forward,
for the first time, comprehensive proposal for the development of a national programme of health
services for the country. The committee observed “if the nation health to be build , 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 patient.”

Some of important recommendation of the committee were:

1. Integration of preventive and curative services at all administrative
2. The committee visualised the development of primary health centres in 2 stages:
(A) It was purposed that each primary health centres in the rural areas should cater to population of 40,000
with a secondary health centres to serve as a supervisory, coordinating and referral institutions.

(B) A long term programme of setting up primary health unit with 75 beded hospital for each 10000 to
20000 population and secondary unit with 650 beded hospital, again regionalized around district
hospital with 20500 beds
(C) Major changes in medical education which include 3 month training in preventive ans social medicine
to prepare “social physicians “

3.For each PHC ,two medical officers, four public health nurse, one nurse,4 midwifwives,4 trained
dias,2 sanitary inspectors, 2 health assistants, one pharmacist ,and 15 other class four employees were
recommended

Mudaliar committee 1962

By the close of the second 5 year plan 1956 -61 ,a fresh look at the health needs and resources was
called for to provide guidelines for national planning in the context of the 5 year plans .In 1959 the
government of india appointed another committee known as “health survey and planning committee”
and as known as Mudaliar committee. (after the name of its chairman Dr. A .L .Mudaliar) to survey
the progress made in the field of health science submission of Bohare committee reports and to make
recommendation for further development and expansion of health services
The Mudaliar committee found the quality of services provided by the primary health centre
inadequate ,and advice strengthen of existing primary health centre before new centre were
established . it also advise strengthen of sub divisional and district hospital so that they may effectively
function as referral centre.
The main recommendation
1. Consolidation of advance made in first 2 5year plan
2. Strengthening of the district hospital with specialist services to serve as central base of regional
services .
3. Regional organisation in each state between headquarter organisation and district in charge of regional
deputy each to supervise 2 or 3 district medical and health officers
4. Each primary health centres not to serve more then 40,000 population.
5. To improve the quality of the heath care provided in the primary health centres
6. Integration of medical and health services as recommitted by the bhore committee
7. Constitution of an all India health services on the pattern of Indian Admenstration services.

CHADAH COMMITTEE 1963

IN 1963 chadah committee was appointed by the government of India, under the chairmanship of the
Dr. M.S. chadah, the then director general of health services to study the arrangements necessary for
the maintained phase of the National Malaria eradication programme.
The committee recommended that the “vigilance” operations in respect of the national Malaria
Eradication programme should be responsibility of the general health services i.e primary health
centres at the block level The. committee also recommended that the vigilance operation through
monthly home visits should be implemented through basic health workers. One basic health worker
per 10,000 population was recommended. These worker were envisaged as “ multipurpose” worker to
look after additional duties of collection of vital statics and family planning health assistants were to
supervise 3 or 4 these basic health workers. At the district level, the general basic health workers. At
the district level, the general health services were to be take the responsibility for the maintenance
phase

MUKERJI COMMITTEE 1965

Within the cuple of the years of implementation of the chadah committee’s recommendations by some
states,it was realised that the basic health worker could noyt function effectively as multipurpose
worker. As the result the malaria vigilance operation had suffered and also the work of the family
planning programme could not be carried out satisfactory. The subject come up for discussion at the
meeting of the central health council in 1965. 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. The committee recommended
separate staff for the family planning programme. TChe family planning assistants were to undertaken
family planning duties only. The basic health worker were to be utilised for purpose other then family
planning. The committee also recommended to delink the malaria activities from family planning so
that the latter would receive undivided attention of its staff. The recommendations were accepted by
the Government of India.

KARTAR SINGH COMMITTEE 1973

The Government of India constituted a committee in 1972 known as “The committee on Multipurpose
worker under Health and family planning under the chairmanship of Kartar singh, additional
secretary, Ministry of health and family planning,government of India.the term of reference of the
committee were to study and make recommendation on:
1. The structure for integrated services at the peripheral and supervisory levels.
2. The feasibility of having multipurpose, bipurpose worker in the field
3. The training requirement for such worker
4. The utilization of mobile services unit set up under family planning programme for integrated
medical,public health and family planning services operating in the field
 The committee submitted its report in September 1973. Its main recommendation were :
- That the present Auxiliary Nurse Midwives to be replaced by the newly designated “Female Health
Workers” and the present day Basic health worker, Malaria surveillance workers, vaccinators, health
education assistance and family planning health assistants to be replaced by” Male health Workers”
- The programme for having multipurpose worker to be first introduced in areas where Malaria is
in maintenance phase and small pox has been controlled, and later to other areas as malaria passes into
maintenance phase or smallpox controlled .
- For proper coverage, there should be one primary health center for a population of 50,000
- Each primary health centre should be divided into 16 sub centre each having a population of
about 3,000 to 3,500 depending upon topogeaphy and means of communications
- Each sub centre to be staffed by a team of one male and one female health worker
- There should be a male health supervision to supervise the work of 3 to 4 male health worker
and female health supervisor to supervise the work of 4 female health workers
- The present day lady health visitor to be designated as female health supervisors
- The doctor in charge of a primary health centre should have the overall charge of all the
supervisors and health worker in his area. The recommendation of the Kartar singh committee we
reaccepted by the government of India to be implemented in a phased manner during the first five year
plan.

Shrevastav committee (1975)

The issue of developing alternative strategy for the delivery of health services and rationalization of
the health manpower both in term of number of personal as well as categories of personal had been
engaging the attention of the govt. of India from time to time. The Govt of India establishes the
committee under the chairman of shrevastav.
The terms of references of this committee were as follow :
 To devise a suitable curriculum for training a cadre of health assistant conversant with basic
medical aid preventive and nutritional services,family welfare,maternity and child welfare
activities so they can serve as link between the qualified medical practitioners
and the multipurpose worker, thus forming an effective team to deliver health care,family
welfare and nutritional services to the people.
 Keeping the view the recommendation made by the earlier committees on Medical
education,specially the medical education committee and conference,to suggest steps for improving
the existing medical educational processes so as to provide due emphasis on the problem particularly
relevant to national requirements.
The committee should make recommendations in term to bridging gap between community and
organized health services as follow:
 Creation of bands of works ( paraprofessionals and semi professional health worker) from within the
community itself (e.g. school teachers,postmaster) to provide simple,promotive,preventive services
needed by the community.
 Establishment of 2 cards of health workers namely,multipurpose health worker and health assistants
between the community level worker and doctors at the primary health centres.
 Development of a Referral services complex by establishing proper linkage between PHC and higher
level and services centres viz. tehsil,district,medical collage hospital
 A deliberate and conscious decision should be taken to abandon the modal of western medicine and
replace with in a modal which has to place a greater emphasis on human efforts for which we have a
large potential.
 Health is a essentially an individual cannot be trained to take proper care of his health, no community or
state programme of health services can kept him healthy.

BIBLIOGRAPHY:

 Gulani K.K.(2005) “Community health nursing principles and practices” kumar publishing
house ltd, New Delhi 65 – 80, 571 -574
 James sharyn et.al, (2001) “Community health nursing – caring for the public health” Tones
&Bartlett,Bostan, 200 – 202
 Kamalam (2005) “Essentials in community health nursing practice” Jaypee New Delhi,173 –
174
 Kishore .j (2007) National health programme of India; National policies and legislation related to
health,7th, century,new delhi,474 – 482
 Mohaja BKet.al, (2000) “Textbook of preventive and social medicines,3rd,jaypee brothers, SNew
Delhi,460 -482
 Park. K(2007) “ Test book of preventive medicines” 19th,M/S Bhanarsidas, Jabalpur, 337, 391,
726 – 729
 Basvanthapa B.T., Text book of Nursing Administration, publishing by Jaypee brothers,
reprinted 2008, 183 – 188, , 232 – 240.
 . WWW.Google. com