VARIOUS COMMITTEES REPORTS ON HEALTH

Prepared By: Rashmi Goswami

S.Y. MSc Nursing
C.M.P.C.O.N
 INTRODUCTION:
• Health planning in India is an integral part of national socioeconomic planning. The
guidelines for national health planning were provided by a number of committees. These
committees were appointed by government of India from time to time to review the existing
health situation & recommend measures for further action.

• Various committees of experts have been appointed by the government from time to time to
render advice about different health problems. The reports of these committees have formed
an important basis of health planning in India. The goal of National Health Planning in India
is to attain Health for all by the year 2000.

• More recently the Alma Ata Declaration on primary health care and the National Health
Policy of the Government gave a new direction to health planning in India, making primary
health are the central function and main focus of its national health system.
 VARIOUS HEALTH COMMITTEES

Jungal
Bhore Mudaliar Chadah Katar Singh Mukherji
wala
committee committee committee committee committee
committee
 Ramalingasw Rural
Shivaraman Shrivastav Bajaj Krishnan
committee
amy health
committee committee committee committee
scheme
 BHORE COMMITTEE (1946)
• This committee, known as the Health Survey & Development Committee, was
appointed in 1943 with Sir Joseph Bhore as its Chairman.

• It laid emphasis on integration of curative and preventive medicine at all levels.

Comprehensive recommendations were made by him for remodelling of health
services in India.
• The committee observed that, “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.”
The report, submitted in 1946, had some important
recommendations like:-
• Integration of preventive and curative services of all administrative
levels.
• Development of Primary Health Centres in 2 stages:

Short term measures

Long term measures

• Major changes in medical education which includes 3-month training in preventive
and social medicine to prepare “social physicians”.

The committee’s report continues to be a major national document, and has provide guidelines for
national health planning in India.

 Comprehensive healthcare comprising a package of:

1. Medical relief
2. Communicable disease control
3. Environmental sanitation
4. Maternal and Child Health care
5. School health services
6. Health education
7. Vital statistics
 Guidelines principles adopted:

- No individual should be denied to secure adequate medical care because of inability

to pay.
- Facilities for proper diagnosis and treatment.
- Health programme must lay special emphasis on preventive work.
- As much medical relief and preventive health care should be provided to the vast
rural population.
- Health services should be located close to the people to ensure maximum benefit to
the community.
- Doctor should be a social physician protecting the people.
- Medical services should be free to all, without distinction.
 Observation made by the committee:
- Health status of the country as indicated by various indicators was poor.
- Mortality rates were very high.
- Life expectancy at birth was about 27 yrs.
- Incidence of communicable diseases was very high.
- Many of the health problems were preventable.
- Committee stated that health and development are interdependent.
- Improvement in sector other than health will also lead to improvement in health like
water supply, sanitation improvement, nutrition, elimination of unemployment.
MUDALIAR COMMITTEE (1962)
• In 1959, the Government of India appointment another Committee known as “Health
Survey and Planning Committee”, popularly known as the Mudaliar Committee.

• Dr, A.L. Mudaliar as chairman - 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.

• The Mudaliar Committee found the quality of services provided by the primary
health centres inadequate, Advised strengthening of the existing primary health
centres before new centres were established. It also advised strengthening of sub
divisional and district hospitals-function as referral centres.
 Recommendations:

- Consolidation of advances made in the first two five year plans.

- Strengthening off the district hospitals with specialist services to serve as central base of
regional services.
- Regional organizations in each state is placed between the headquarter organization and
the district as Regional Deputy or Assistant Directors to supervise 2-3 District Medical and
Health Officer.
- Integration of medical and health services as recommended by Bhore Committee.
- It was emphasized that a PHC should not be made to serve to more than 40,000
populations and that the curative, preventive and promotive services should be all provided
at the PHC.
- The Mudaliar Committee also recommended that an all India service should be created to
replace the erstwhile Indian Medical Service.
 CHADAH COMMITTEE (1963)
• This committee was appointed under the chairmanship of Dr. M.S. Chadah, the
Director General of Health Services, in 1963 to advise about the necessary
arrangements for the maintenance phase of National Malaria Eradication
Programme.
• The committee suggested that the vigilance activity in the NMEP should be carried
out by primary health centres at block level.
• The committee also recommended that vigilance operations through monthly home
visits should be implemented through basic health workers.
• One basic health worker per 10,000 populations, also function as “multipurpose
workers” and would perform, in addition to malaria work, the duties of family
planning and vital statistics data collection under supervision of family planning
health assistants.
• The Family Planning Health Assistants were to supervise 3 to 4 of these basic health
workers.
 MUKHERJEE COMMITTEE, (1965)
• The recommendations of the Chadha Committee, when
implemented, were found to be impracticable because the basic
health workers, with their multiple functions could do justice
neither to malaria work nor to family planning work.

• The Mukherjee Committee headed by then Secretary of Health

Shri Mukherjee, was appointed in 1965, to review the
performance in the area of family planning.
 Recommendations:
- The committee recommended separate staff for the Family Planning Programme.
- The basic health workers were to be utilized for purposes other than family planning.
- The committee also recommended delinking the malaria activities from family planning so
that the latter would receive undivided attention of its staff.
- Multiple activities of the mass programmes like family planning, small pox, leprosy,
trachoma, NMEP (maintenance phase), etc. was 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.
- The committee worked out the details of the BASIC HEALTH SERVICES which should be
provided at the Block level.
- Make family planning a vertical program.
- Fix targets for contraceptives distribution and for sterilizations. Provide incentives to the
acceptors of contraceptives/sterilization.
 JUNGALWALLA COMMITTEE (1967)
• 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.
• 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.
b) Medical care and public health programmes should be put under charge of a single
administrator at all levels of hierarchy with due priority for each programme obtaining at a point
of time.
Following steps were recommended for the integration at all levels of health
organization in the country-
• Unified Cadre
• Common Seniority
• Recognition of extra qualifications
• Equal pay for equal work
• Special pay for special work
• Abolition of private practice by government doctors
• Improvement in their service conditions

The committee stated that "integration

should be a process of logical evaluation
rather than revolution.
 KATAR SINGH COMMITTEE (1973)
• 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, to study the structure for integrated services at
the peripheral and supervisory levels, and the feasibility of
having multipurpose workers in the field.
References of the committee are as follows:
a)The structure for integrated services at the peripheral and
supervisory levels
b)The feasibility of having multipurpose, bi – purpose workers in
the field:
c)The training requirements for such workers
d)The utilization of mobile service units set up under Family
Planning Programme
 Recommendations:
The present Auxillary Nurse Midwives to be replaced by newly designated “Female Health
Workers”
Multipurpose workers to be first introduced in areas where Malaria is in maintenance phase and
small pox has been controlled and later to areas where malaria passes into maintenance phase or
small pox controlled.
1 PHC cover 50,000 population.
Every PHC divided in 16 sub-centres, each covering 3,000-3,500 population, depending upon
topography and means of communication.
1 male health worker (MHW) and Female Health Worker (FHW) to be staffed at each sub-
centre.
3 to 4 MHW and FHW are supervised by 1 male and female health supervisor respectively.
The present-day lady health visitors to be designated as female health supervisors.
The doctor in charge of a PHC should have the overall charge of the supervisors and health
workers in his area.
 SHRIVASTAV COMMITTEE (1975)
• Also known as “Group on Medical Education and Support Manpower”, headed by
Dr. J B Shrivastav, the Director General of Health Services.

• This committee was set up to determine steps needed to-

a)Reorient medical education in accordance with national needs & priorities
b)To suggest steps for improving the existing medical educational processes as to
provide due to emphasis on the problems particularly relevant to national requirements
c)To make any other suggestions to realise the above objectives and matters
incidental.
It recommended immediate action for:-

1.Creation of bonds of paraprofessional and semi- professional health workers from

within the community itself.
2.Establishment of 3 cadres of health workers namely- multipurpose health workers
and health assistants between the community level workers and doctors at PHC.
3.Development of a "Referral Services Complex"
4.Establishment of a Medical and Health Education Commission for planning and
implementing the reforms needed in health and medical education on the lines of
University Grants Commission.

Acceptance of the recommendations of the Shrivastava Committee in 1977 led to the

launching of the Rural Health Service.
 RURAL HEALTH SCHEME (1977)
• The basic recommendations of the Committee were accepted by the Govt. in 1977,
which led to the launching of the Rural Health Scheme.

• The Programme of training of community health workers was initiated during 1977-
78.

• The Rural Health Scheme of 1977, also known as the Comprehensive Rural Health
Services Project (CRHSP), was an initiative launched by the Government of India to
address healthcare needs in rural areas. The project aimed to improve healthcare
infrastructure, provide basic health services, and increase access to healthcare
facilities for people residing in rural regions.
 Steps were also initiated-
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.

b)Reorienting training of multipurpose workers engaged in the

control of various communicable disease programmes into uni-
purpose workers. This "Plan of Action" was adopted by the Joint
Meeting of the Central Council of Health and Central Family
Planning Council held in New Delhi in April 1976.
 Key features of the Rural Health Scheme of 1977 included:

Primary Health Centers (PHCs):

The scheme focused on strengthening and expanding the network of Primary
Health Centers in rural areas. PHCs were meant to provide essential healthcare
services, including maternal and child health, immunization, family planning,
and treatment for common ailments.

Sub-Centers:
It emphasized the establishment and functioning of Sub- Centers that served as
the first point of contact between the community and healthcare system. These
sub-centers were staffed with trained health workers to deliver basic healthcare
services at the grassroots level.
Health Education and Awareness:
• The scheme placed importance on health education and raising awareness among
rural communities regarding hygiene, sanitation, nutrition, and preventive healthcare
practices.
Infrastructure Development:
• It aimed to improve healthcare infrastructure by constructing and upgrading
healthcare facilities, providing medical equipment, and ensuring a consistent supply
of essential medicines.

The Rural Health Scheme of 1977 was a significant step in addressing the healthcare
needs of the rural population in India. However, over time, several other health
programs and schemes have been introduced and implemented by the Indian
government to further enhance healthcare delivery in rural areas, aiming for more
comprehensive and inclusive coverag
 SHIVARAMAN COMMITTEE (1979)

A Committee on Basic Rural Doctors was framed under the

guidance of Shri Shivaraman, the then Member of Planning
Commission. The committee recommended establishment of
countrywide cadre of basic rural doctors consisting of trained
paraprofessionals to extend comprehensive health care delivery to
rural community.
 RAMALINGASWAMY COMMITTEE (1980)
This committee under the chairmanship of Dr V Ramalingaswamy, the then
DGHS, recommended:

• Involvement of community for health planning and health program

implementation
• 30 bedded hospital for every 1 lakh population
• Integration of health services at all levels
• Redefined the role of doctor in the community
• Recommended that PHC and District Health Centers should be under
the control of three tier Panchayat Raj System.
 BAJAJ COMMITTEE (1986)
An expert committee for 'health manpower planning, production and management' is constituted under
the Chairmanship of Dr JS Bajaj, the then Member of Planning Commission, to tackle the problem of
health manpower planning, production and management.

“Important recommendations of the Bajaj committee are”:

• Recommended for Formulation of National Health Manpower planning based on realistic survey.
• Educational Commission for health sciences should be developed on the lines of UGC.
• Recommended for National and Medical education policies in which teachers are trained in health
education science technology.
• Uniform standard of medical and health science education by establishing universities of health
sciences in all states.
• Establishment of health manpower cells both at state and central levels.
• Vocational courses in paramedical sciences to get more health manpower.
 KRISHNAN COMMITTEE (1992)
The committee under the chairmanship of Dr Krishnan reviewed the achievements and progress of
previous health committee reports and also made comments on shortfalls. The committee addresses the
problems of urban health and devised the health post-scheme for urban slum areas.

"The committee had recommended :-

• One voluntary health worker (VHW) per 2,000 population.

• Its report specifically outlines which services have to be provided by the health post.
• These services have been divided into outreach, preventive, family planning, curative, support
(referral) services and reporting and recordkeeping.
• Outreach services include population education, motivation for family planning, and health education.
• In the present context, a very few outreach services are being provided to urban slums.