PLANNING PROCESS

INTRODUCTION-

'Planning is preparing a blueprint". Planning is a future-oriented process. It decides in

advance 'what' is to be done. 'How it is to be done, 'when' to do it, 'who' is to do it and 'where'
it is to be done. A manager first decides on the jobs he wants to do. Thereafter, he sets long-
and short-term objectives for the organization and decides on the means or develops
strategies that will be used to achieve these objectives. Planning refers to thinking ahead of
time and formulating preliminary thoughts. It is a continuous, intellectual process of
determining philosophy, objectives, policies, procedures, and rules and standards. It involves
long- and short-term projections and the fiscal course of actions. Planning is the preliminary
and most important step in the management process.

Definitions of planning

1. Alfred and Beatty: Planning is a thinking process, the organized foresight, the vision based
on facts and experience that is required for an intelligent action.

2. Koontz and O'Donnell: Planning is essentially decision making since it involves choosing
from among alternatives.

3. Millet: Planning is a process of determining the objectives of administrative effort and

devising the means calculated to achieve them.

Health Planning-

Health planning is an aid to political and administrative authorities to decide how health
services can be modernized and improved to provide and improved to provide affective
decent health care to the community.

FIVE YEARS PLANS

Five years plan is mechanism to bring about uniformity in policy formulation in programmes
of national importance.

The specific objectives of the health programme, during Five years plans-

1. Control & eradication of major communicable diseases.

2. Strengthening of basic health services through the establishment of the PHC & sub centers.

3. Population control.

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4. Development of health manpower resources.

Sub health sectors under five year plans-

1. Water supply & sanitation.

2. Control of communicable diseases.
3. Medical education, training & research.
4. Medical care including hospitals, dispensaries & PHCs.
5. Public health services.
6. Family planning.
7. Indigenous system of medicine.

FIRST FIVE YEAR PLAN (1951-1956)

The first Indian Prime Minister, Jawaharlal Nehru presented the first five-year plan to the
Parliament of India on 8 December 1951. The first plan sought to get the country's economy
out of the cycle of poverty. The plan mainly addressed, the agrarian sector, including
investments in dams and irrigation. The agricultural sector was hit hardest by the partition of
India and needed urgent attention. The total planned budget of 206.8 billion was allocated to
seven broad areas-

1) Irrigation and energy

2) Agriculture and community development

3) Transport and communications

4) Industry

5) Social services

6) Land rehabilitation

7) Other sectors and services

The specific objectives were

1. Provision of water supply & sanitation.

2. Control of malaria.

3. Preventive health care of the rural population.

4. Health services for mother & children.

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5. Education & training in health.

6. Self sufficiency in drug & equipments.

7. Family planning & population control.

During this plan period the public sector outlay was Rs. 2356 crore of which Rs. 140 crore
were allotted for health programs.

SECOND FIVE YEAR PLAN (1956-1961)

The second five-year plan focused on industry, especially heavy industry. Unlike the First
plan, which focused mainly on agriculture, domestic production of industrial products was
encouraged in the Second plan, particularly in the development of the public sector.

The plan followed the Mahalanobis model, an economic development model developed by
the Indian statistician Prasanta Chandra Mahalanobis in 1953. The plan attempted to
determine the optimal allocation of investment between productive sectors in order to
maximize long-run economic growth.

The specific objectives were-

1. Establishment of institutional facilities to serve as a basis from which service could be

render to the people both locally & surrounding territory.

2. Development of technical man power through appropriate training programmes.

3. Intensifying measures to control widely spread communicable disease.

4. Encouraging active campaign for environmental hygiene.

5. Provision of family planning and other supporting services.

During this plan period the public sector outlay was Rs. 4,800 crore of which Rs. 225 crore
were allotted for health programs.

THIRD FIVE YEAR PLAN (1961-1966)

The third plan stressed on agriculture and improving production of rice. Many primary
schools were started in rural areas. In an effort to bring democracy to the grassroots level,
Panchayat elections were started and the states were given more development responsibilities.
State electricity boards and state secondary education boards were formed. States were made
responsible for secondary and higher education. This plan was interrupted by the Chines
aggression (1962), Indo- Pak War(1965), severe drought in 1965-1966. The main objectives

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were defense, price stabilization, construction of dams, cement and fertilizers plants,
education etc.

The plan focused on water supply environmental sanitation( rural and urban) health care,
control of communicable diseases, medical education, research and training, other services-
health education, school health, Mental health, health insurance, integrated system of
medicine and family planning.

Problems-
Sino Indian War, India witnessed increase in price of products. During this plan period the
public sector outlay was Rs. 7,500 crore of which Rs. 341.8 crores were allotted for health
programs.

THREE ANNUAL PLANS (1966-68)

During these plans a whole new agricultural strategy involving wide spread distribution of
High Yielding varieties of seeds, the extensive use of fertilizers, exploitation of irrigation
potential and soil conservation was put into action to tide over the crisis in agricultural
production. The economy basically absorbed the shocks given during the Third plan, making
way for a planned growth.

FOURTH FIVE YEAR PLAN (1969-1974)

The fourth five year plan is called for greater expenditure in the public sector, but was not
able to meet its national income growth target. At this time Indira Gandhi was the Prime
Minister. The Indira Gandhi government nationalized Green Revolution in India advanced
agriculture. Main emphasis on agriculture’s growth rate so that a chain reaction can start. It
fared well in the first 2 years with record production, last three years failure because of poor
monsoon.

OBJECTIVES-

 Certain objectives of the mudhaliar committee were the base for the fourth five year
plan in relation to health. The objectives are:
 To provide an effective base for health services in rural areas by strengthening the
primary health centers,

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  Strengthening of sub divisional and district hospitals to provide effective referral
services for primary health centre
 Expansion of the medical and nursing education and training of paramedical
personnel to meet the minimum technical manpower requirements.

During this plan period the public sector outlay was Rs. 16,774 crore of which Rs. 1,156
crore were allotted for health programs.

FIFTH FIVE YEARS PLAN (1974-1979)

Stress was laid on employment, poverty alleviation, and justice. The plan also focused on
self-reliance in agricultural production and defense. In 1978 the newly elected Morani Desai
government rejected the plan. Electricity Supply Act was enacted in 1975. The emphasis of
the plan was on removing imbalance in respect of medical facilities & strengthening the
health infrastructure in rural areas.

Specific objectives to be pursued during the plan were-

1. Increase accessibility of health services to rural areas

2. Correcting regional imbalance.

3. Further development of referral services.

4. Integration of health, family planning & nutrition

5. Intensification of the control & eradication of communicable diseases especially malaria &
smallpox.

6. Quantitative improvement in the education & training of health personnel.

7. Development of referral services by providing specialists attention to common diseases in

rural areas.

Problems-
The world economy was in a troublesome state. This had a negative impact on the Indian
Economy. Prices in the energy and food sector skyrocketed and as a consequence inflation
became inevitable. During this plan period the public sector outlay was Rs. 37,250 crore of
which Rs. 3,277 crores were allotted for health programs.

ROLLING PLAN- 2 plans. One by Janta Govt (1978-83) which was in operation for 2 years
only. Other by the congress government when it returned to power in 1980.

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 THE SIXTH FIVE YEAR PLAN (1980 - 84)

The Janatha government plan. This plan is marked a reversal of the Nehruvian Model.

Objectives-
 To increase in national income.
 Population control through family planning.
 Ensuring continuous decrease in poverty and unemployment.
 Modernization of technology etc.

Problems-
The industrial development was the emphasis of this plan some opposed it specially the
communist groups, this slowed down the pace of progress.

SEVENTH FIVE YEAR PLAN (1985-89)

The main objectives of the 7th five year plans were to establish growth in the areas of
increasing economic productivity, production of food grains, and generating employment
opportunities.

The thrust areas of the 7th Five year plan have been enlisted below

 Social Justice
 Removal of oppression of the weak
 Using modern technology
 Agricultural development
 Anti-poverty programs

The objectives were-

1. Eliminate poverty & illiteracy by 2000.

2. Achieve near full employment secure satisfaction of the basic needs of food, cloth, shelter
and provide health for all.

3. To provide an effective base for health services in rural areas by strengthening the PHCS.

4. Universal immunization programme.

5. Promotion of voluntary acceptance of contraceptives.

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During this plan period the public sector outlay was Rs 1.80.000 crores of which Rs. 3,392
crores were allotted for health programs.

ANNUAL PLANS (1990 and 1991)

1989-91 was a period of political instability in India and hence no five year plan was
implemented. Between 1990 and 1992, there were only Annual plans. In 1991, India faced a
crisis in foreign exchange (Forex) reserves. P.V.Narasimha Rao also called Father of Indian
Economic reforms was the twelfth Prime minister of the republic of India and Head of
Congress Party and led one of the most important administrations in India’s modern history
overseeing a major economic transformations and several incidents affecting national
security. It was the beginning of privatization and liberalization in India.

EIGHTH FIVE YEAR PLAN (1992-97)

India became a member of the World Trade Organization on 1 January 1995. This plan can
be termed as Rao and Manmohan model of Economic development.

The major objectives included.

1. Population growth,

2. Poverty reduction,

3. Employment generation,

4. Strengthening the infrastructure,

5. Institutional building, tourism management,

6. Human Resource development,

7. Involvement of Panchayati raj,

8. Nagarpalikas,

9. N.GO's and

10. Decentralization and people's participation.

It is based on the national health policies.

1. Human development is the ultimate goal of this plan.

2. Employment generation, population control literacy, education, health, drinking water &
provision of adequate food & basic infrastructure.

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3. Towards health for the underprivileged was the aim of this plan.

The PHCS were strengthened staff vacancies, by supplying essential equipment &drugs.

AIDS control program was initiated during this plan.

NINTH FIVE YEAR PLAN (1997-2002)

In ninth Five Year Plan India runs through the period from 1997 to 2002 with the main aim of
attaining objectives like speedy industrialization, human development, full-scale
employment, poverty reduction, and self-reliance on domestic resources.

Background of Ninth Five Year Plan India: Ninth Five Year Plan was formulated amidst the
backdrop of India's Golden jubilee of Independence.

The main objectives of the Ninth Five Year Plan India are to prioritize agricultural sector and
emphasize on the rural development

 To generate adequate employment opportunities and promote poverty reduction.

 To stabilize the prices in order to accelerate the growth rate of the economy.
 To ensure food and nutritional security.
 To provide for the basic infrastructural facilities like education for all, safe drinking
water, primary health care, transport, energy.

During this plan, vertical health programs were integrated horizontally with general health
services.

The Reproductive & child health program was improved under following guidelines-

1. Decentralize RCH to the level of PHCs.

2. Base planning for RCH services on assessment of the local needs.

3. Meet the needs of contraceptives.

4. Involve the general practitioners & industries in family welfare work.

TENTH FIVE YEAR PLAN (2002-2007)

It is devised to complement and meet the United Nations Millennium Development Goals
(MDG) targets. The MDG were issued in 2000 to achieve eight targets to eradicate hunger
and poverty and raise the standards of living worldwide by the year 2015 through global
cooperation. This plan highlighted the need for reduction of poverty ratio, increase in literacy

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rates, reduction in infant mortality rate, economic growth, increase in forest and tree cover etc
providing gainful high quality employment.

Targets-

 To achieve the growth rate of GDP @ 8% and reduction of poverty to 20 % by 2007

and to 10% in 2012.
 Increased employment generation.
 Universal access to primary education by 2007 and literacy rate to 72% within the
plan period and to 80% by 2012.
 Reduction in gender gaps in literacy and wage rates by atleast 50% by 2007.
 Reduction in population growth between 2001 and 2011 to 16.2%,
 Reduction in infant mortality to 45/1000 live birth by 2007 and to 28 by 2012 and
maternal mortality to 2/1000 live births.
 Universal availability of drinking water, cleaning of all major polluted rivers and,
 Increase in forest cover to 25 percent and a lot of work still needs to be done in the
health sector.

ELEVENTH FIVE YEAR PLAN (2007-2012)

The major objectives are-

 Income generation, poverty alleviation, education, health, infrastructure, environment.

 Income and poverty.
 Lower gender gap in literacy to 10 percentage points.
 Increase literacy rate for persons of age 7 yrs or more to 85%
 Reduce dropout rates of children from elementary school.
 Create 70 million new work opportunities Education.
 Increase agriculture GDP growth rate to 4%/ year.
 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.

Health-

 Reduce infant mortality rate to 28 and maternal mortality ratio to 1 per 1000 live
births.

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  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.

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.

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.

Environment-

 Increase forest and tree

 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 2016-17.

TWELVETH FIVE YEAR PLAN (2012 – 2017)

The Twelfth Five-Year Plan of the Government of India has been decided to achieve a
growth rate of 8.2%. The Strategies are Strengthening of public sector health care,
substantially increase in health care expenditure, efficient Financial and managerial systems,
coordinated delivery of services, cooperation between the public and private sector,

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 expansion of skilled human resource, prescription drugs reforms, Effective regulation through
a Public Health Cadre, Inclusive agenda and Pilots on Universal Health Care.

Goals-
 Reduce Maternal Mortality from 212 to 100,
 Reduce IMR from 44 to 25,
 Reduce underweight children below 3 years from 40% to 23%.
 Reduce poor households out-of-pocket expenditure on health.
 Reduce Total Fertility Rate from 2.5 to 2.1
 Reduce levels of anemia among women from 55% to 28%.
 Increase child sex ratio from 914 to 950.

Objectives-
 To provide access to banking services to 90% of households.
 To increase green cover by 1 million hectare every year.
 To ensure that 50% of the rural population have accesses to proper drinking water.
 To provide electricity to all villages.
 To reduce malnutrition among children aged 0-3 years.
 To enhance access to higher education.
 To remove gender and social gap in school enrolment.

VARIOUS COMMITTEES REPORTS ON HEALTH

 The goal of National Health Planning in India is to attain Health for all by the year 2000.
 The reports of these committees have formed an important basis of health planning in India.

1. BHORE COMMITTEE, 1946

The Health Survey & Development Committee. It appointed Sir Joseph Bhore as its
Chairman, 1943. It laid emphasis on integration of curative and preventive medicine at all
levels. It made comprehensive recommendations for remodeling of health services in India.
The report, submitted in 1946, had some important recommendations like:-
1. Integration of preventive and curative services of all administrative levels.
2. Development of Primary Health Centres in 2 stages:

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 Short-term measure-
 One primary health centre as suggested for a population of 40,000.
 Each PHC was to be manned by 2 doctors, one nurse, four public health nurses, four
midwives, four trained dais, two sanitary inspectors, two health assistants, one
pharmacist and fifteen other class IV employees.
 Secondary health centre was also envisaged to provide support to PHC, and to
coordinate and supervise their functioning.

A long-term-
 programme (also called the 3 million plan) To set up primary health units with 75 – bedded
hospitals for each 10,000 to 20,000 population and secondary units with 650 – bedded
hospital, again regionalised around district hospitals with 2500 beds. 3 Major changes in
medical education which includes 3- month training in preventive and social medicine to
prepare “social physicians”.

2. MUDALIAR COMMITTEE, 1962

“Health Survey and Planning Committee” Dr. A. L. Mudaliar, was appointed to assess the
performance in health sector since the submission of Bhore Committee report.
Recommendations-
• Strengthening of existing PHC before opening of new ones.
• Strengthening of sub divisional and district hospitals was also advised. • A PHC should not
be made to cater to more than 40,000 population.
• PHC should provide the curative, preventive and promotive services.
• An All India Health service should be created to replace the erstwhile Indian Medical
service.

3. CHADAH COMMITTEE, 1963

Under the chairmanship of Dr. M.S. Chadah, Government of India appointed a committee to
study the arrangement necessary for the maintenance phase of the National Malaria
Eradication Programe

Recommendations-

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1. Vigilance operations in respect of the NMEP should be the responsibility of the general
health services (eg) PHC.

2. The vigilance operations be should be done through monthly home visits by basic workers
(Junior Health Assistant male).

3. Now each Junior Health Assistant Male to cover 3000-5000 population.

4. MUKHERJEE COMMITTEE, 1965

Under the chairmanship of Shri Mukerji, the secretary of health to the Government of India
was appointed to review the strategy for the family planning program.

Recommendations-

 To have separate staff for the family planning program The family planning assistants
were to undertake family planning duties only
 The basic health workers were to be utilized for purposes other than family planning.
 To delink the malaria activities from family planning of it's that the later would
receive undivided attention of its staff.

Mukherjee Committee, 1966 Multiple activities of the mass programmes like family
planning, small pox, leprosy, trachoma, etc. were making it difficult for the states to
undertake these effectively because of shortage of funds. A committee of state health
secretaries, headed by the Union Health Secretary, Shri Mukherjee, was set up to look into
this problem.

5. JUNGALWALLA COMMITTEE, 1967

Under the Chaimanship of Dr. Jungalwalla Director, National Institute of Health

Administration and Education, New Delhi was appointed to examine the various problems of
service conditions of doctors. This committee is known as the committee on integration of
Health Services.

Recommendation-

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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. No private practice and good service conditions.

6. KARTAR SINGH COMMITTEE, 1973

The Government of India constituted a committee in 1922, 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

Recommendations-

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 redesignated by "Male Health Workers".

The program has to be introduced in areas where malana is in maintenance phase and
smallpox has been controlled and later to other areas. One primary health centre for 50,000
populations.

Each PHC should be divided into 16 sub centers and each covers 3,000 to 3,500 population.
Each sub centre to be staffed by a male and female health worker.

One male health supervisor to supervise 3 to 4 male health workers and one female health
supervisor to supervise the work of 4 female health workers. The lady health visitors to be
designated as female health supervisors. The doctor in charge of a primary health centre
should have the overall in charge of all the supervisors and health workers in the area.

7. SHRIVASTAV COMMITTEE, 1975

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
Shrivastav Committee.

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Recommendations-

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.

Establishment of 2 cadres of health workers, namely multipurpose health workers and health
assistants between the community level workers and doctors at PHC. Development of a
'Referral Services Complex' by establishing proper linkages between PHC and higher level
referral services. Establishment of a Medical and Health Education Commission for planning
and implementing the referrals needed in health and medical education on the lines of the
University Grants Commission.

8. BALAJI COMMITTEE 1986-19877

The Ministry of Health and Family welfare, Government of India, following the adoption of
the National Policy on education, 1986, set-up a committee on Health Manpower, Planning,
Production and Management in 1986 under the chairmanship of Prof. JS Balaji, Professor of
Medicine, AIIMS, and New Delhi

Recommendations-

 To formulate a National Policy on education in Health Services

 To prepare curriculum for schoolteachers, this should constitute a holistic approach
including social, moral, health and physical education.
 Health service statistics needs to be improved in quality To utilize the services of
Indian system of medicine viz. Homeopathy, in the area of National Health Program.
 Health related components to be included in IX, X Grades
 Continuing education program for the health personnel.
 Health manpower requirements for nursing personnel.

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 NATIONAL HEALTH POLICIES

1. National Health Policy (1983)

After the goal of health for all by 2000 AD national health policy was implemented in 1983.
Approved by parliament primary health care approach is essential for National Health Policy
1983.

Objective-

 To attain the goal of health for all by 2000 AD.

2. National Health Policy (2001)

The department of Ministry of Health and Family welfare is necessary to formulate a new
health policy framework as NHP 2001 for the achievement of public health goals in the
context of prevailing socioeconomic circumstance.

Objective-

 To achieve acceptable standard of good health amongst the general population of the
country.

3. National Health Policy (2002)

It has been formulated and accepted by central government in September 2002. It emphasizes
the importance of 'Health for all by year 2000AD' through the universal provision of
comprehensive Primary Health Care Services.

Objectives of National Health Policy

 The need to establish comprehensive primary health care services within the reach of
population even in the remotest areas of the country.
 The need to view health and human development as vital component of overall
integrated socioeconomic development.
 Decentralized system of health care delivery with maximum community and
individual self-reliance and participation.

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 NATIONAL POPULATION POLICY

History-

 National population policy was drafted on 1976; Family Welfare Programme was also
prepared in 1977.
 In 1993-94, Dr.M.S. Swaminathan expert group was accepted by cabinet but not by
parliament.
 In 1998, another draft of National Population Policy (NPP) was finalized by deputy
chairman of planning commission and group of ministers the draft is discussed in the
parliament on November. 19, 1999. It was adopted by Government of India on 15th
February 2000.

Objective of National Population Policy 2000

1. Immediate objectives
 To fulfill the needs of contraception, healthcare infrastructure and health personnel.
 To provide integrated services delivery for basic reproductive child health care.
2. Medium term objective.
 To bring Total Fertility Rate (TFR) down by 2010.
3. Long-term objective.
 To achieve a stable population by 2045, at a level consistent with the requirements of
sustainable sacio economic growth and development, environmental protection.

Goals-

 Fulfill the medical needs for basic RCH, supplies and infrastructure.
 Free school education up to 14 years.
 Reduce IMR to below 30/1000.
 Reduce MMR below 100/1,00,000.
 Achieve universal immunization of children through all vaccine.
 Marriage age for girls 20 years.
 80% institutional delivery with 100% trained persons.
 100% registration of birth, death, marriage and pregnancy.
 Prevent the spread of AIDS, RTI and STD.

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  Prevent and control communicable diseases.
 Integrate ISM.
 Promote small family norm.

Strategies of NPP 2000:

 Decentralized planning and program.

 Delivery service at village level.
 Empowering women for improved health and nutrition.
 Child survival and child health.
 Meeting the unmet needs for family welfare services.
 Organize health care providers.
 Collaboration with and commitments from Non-Government organizations and
private sector.
 Main streaming Indian system of medicine and homeopathy.
 Contraceptive technology and research on Reproductive Child Health.
 Service for older people.
 Information Education and Communication.

NATIONAL POLICY ON AYUSH AND PLANS

The Indian Systems of Medicine and Homoeopathy (External website that opens in a new
window) (ISM&H) were given an independent identity in the Ministry of Health and
Family Welfare in 1995 by creating a separate Department of Ayurveda, Yoga and
Naturopathy, Unani, Siddha and Homoeopathy (External website that opens in a new
window) (AYUSH) in November 2003.

The infrastructure under AYUSH sector consists of 1355 hospitals with 53296 bed
capacity, 22635 dispensaries, 450 Undergraduate colleges, 99 colleges having Post
Graduate Departments, 9,493 licensed manufacturing units and 7.18 lakh registered
practitioners of Indian Systems of Medicine and Homoeopathy in the country.

Budget: An outlay of Rs.775 crore has been allocated for the Department during the
Tenth Five-year Plan. The Plan allocation for 2006-07 is Rs. 381.60 crore.

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Subordinate Offices:

 Pharmacopoeial Laboratory for Indian Medicine (PLIM)

 Homoeopathic Pharmacopoeial Laboratory (HPL)
 Ayurved Hospital, Lodhi Road, New Delhi

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