HEALTH PLANNING IN INDIA

India has been pioneer in planning its

requirements both in pre-independent
and post-independent era.
The planning started in India in 1938,
when National Planning Committee of
Indian National Congress was set up.
In 1943 the Bhore Committee was set
up.

BHORE COMMITTEE (1946)


The Health Survey and Planning Committee in
1943.
Sir Joseph Bhore the chairman.
To survey the then existing position regarding
the health conditions and health organization in
the country
To make recommendations for the future
development.
The committee submitted its report in 1946 its
famous report which had for volumes.

THE COMMITTEE OBSERVED THAT....
If the nations 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.

GUIDING PRINCIPLES ADOPTED

No individual should be denied to secure adequate
medical care because of inability to pay.
There should be facilities for proper diagnosis and
treatment.
The health programme must lay special emphasis on
preventive work.

As much medical relief and preventive health care
should provide to the vast rural population.
The health services should be located/ placed as
close to the people as possible to ensure
maximum benefits to the community.
Health development must be entrusted to
ministries of health who enjoy the confidence of
the people.

The doctor of the future should be a social
physician protecting the people.
The extent of provision of hospital and
dispensaries in rural areas has been
considerably less than that in urban areas.
Medical services should be free to all without
distinction.

OBSERVATIONS MADE BY THE
COMMITTEE
The health status of the country as indicated
by various indicators was poor.
The mortality rates were very high (CDR
22.4/1000; IMR 162/1000 live births; MMR
20/1000 live births).
Life expectancy at birth was
about 27 years.
The incidence of communicable disease also was very
high. Diseases like chicken pox, cholera etc occurred in
epidemics.
The committee also observed that many of the health
problems were preventable. It also observed that the
investment made in preventing these problems would
give high returns in the forms of increased productivity
and development.

The committee stated that, health and development are
interdependent. An improvement in sectors other than
health will also lead to improvement in health. Some of
the identified sectors were housing, communication,
water supply, sanitation improvement in nutrition,
elimination of unemployment, improvement in
agriculture and industrial production.

A long term plan (3 million plan): It consists
of health care system in three tires.
First tier:- Setting up primary health units with
75 bedded hospital for each 10,000 20,000
population with staff of 6 medical officers, 6
public health nurses, 2 sanitary inspectors, 2
health assistants and other supportive staff.

IMPORTANT RECOMMENDATIONS

Integration of preventive and curative services at all administrative
levels.
The committee visualized the development of primary health centres
in two stages:
Short term plan: this plan was implemented within 5-10 years.
Each primary health centre in the rural area 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 2
medical officers, 4 public health nurses, one nurse, 4 midwives, 4
trained dais and 15 class IV employees were recommended.
Second tier:-This consists of 650 bedded Regional Health
Unit (RHU) to serve as a referral centre for 30 40 PHUs.
Third tier: -This consists of district hospitals with 2,500 beds
to serve the needs of about 3 million.
Major changes in medical education which includes 3
months training in preventive and social medicine to
prepare social physicians
THE SHORT TERM PROGRAMME

The bed population ratio should be raised from
0.24/1000 to 1.03 at the end of 10 years.
Dental sections should be established in the
hospitals at the secondary health centres.
Provision of accommodation for health staff is
essential in the interest of efficiency.
Village communication should be developed.
For each 30 bed hospital there should be 2
motor ambulances and one animal drawn
ambulance.
Travelling dispensaries should be provided to
supplement the health services rendered by
primary health centres.

THE LONG TERM PROGRAMME

The smallest administrative unit should be the
primary unit serving an area with a population of
about 10,000 to 20,000. About 15 t0 25 primary
units will together constitute a secondary unit.
The objectives to be kept in view after the first
10 years should be:
The raising of hospital accommodation to 2 beds/
1000 population.
The creation of 18 new medical colleges in addition
to the 43 to be established during the first 10 years.
The establishment of 100 training centres for
nurses.
The nursing training of 500 hospital workers.

Nutrition: food planning should have the provision of an optimum
diet for all. Eight ounces of milk should be included in the average
Indian diet. For improving the diet of people there should be an
increase in milk production to the extent of at least 110%
Health education: health education must promote health
consciousness and these are best achieved when health practices
become part of an individuals daily life. The instruction of school
children in hygiene should begin at the earliest possible stage.

Physical education: there should be one or two
physical training colleges in each province. The National
Physical Education Programme should include
indigenous games, sports and folk dances.
Health services for mother and children: measure
directed towards a reduction of sickness and mortality
among mothers and children must have the highest
priority in the health development programmes.

Public health personnel: the diploma
courses in public health should be integrated
with the undergraduate and post graduate
courses.
Professional education: at the end of the
first 10 years the population of doctors should
be at the annual rate of 4,000 to 4,500.
School health services: it should focus on preventive
services, nutritional services and health education.
Occupational health including industrial health:
special measure should be taken to protect the health of
employees.
Environmental hygiene: legislation should be enacted
in all provinces on a uniform basis including within its
scope both urban and rural areas.
Undergraduate education: there should be a
reorganisation of teaching in the pre-clinical fields,
compulsory internship for a period of one year. Up
gradation of existing medical colleges and
establishment of new medical colleges.
Post graduate education: post graduate
education should develop specialists who can work
in one specialized areas.



Dental education: provisions should be made in medical
and dental colleges for training dental surgeons, dental
hygienist and dental mechanics.
Pharmaceutical education: education facilities for
licentiate pharmacist, graduate pharmacist and
pharmaceutical technologist should be provided.
Medical research: a statutory central research
organization should be constituted. Development research
activities in special subjects like
malaria are also recommended.

Drugs and medical requisites: The Drug
Act of 1940 should be brought into
operation throughout the country and rigidly
enforced.
Population problem: birth control through
positive means should be given importance
as limitation of families through self control
may not be possible.

Nurses, midwives and Dais:
By 1971, the number of trained nurses in the country should
be raised to 740,000 from the existing number of 7000.
The nursing education conditions should be improved.
100 training centres at the first step, each taking 50 pupil
should be started two years before the health organization
is being established
Another set of 100 institutions should be established during
the first two years of the scheme
A third group of the same number of centres should be
established before the third year.
Doctor of the future: the highly trained type of
physician whom we have termed basic doctors
should be the focus.
Stipends to the medical and nursing students:
the student those who complete their medical
course should be given an annual stipend of Rs.
1000. The need for nurses is higher in the country.
The committee recommended Rs. 60 per month for
pupil nurses.

The committee has suggested that there should be two
grades in the nursing profession:-
A junior grade and a senior grade.
The entrance qualification for the former should be a
completed course of middle school
For the latter a completed course of matriculation.
The committee also recommended the establishment of
nursing colleges in order to provide a five year degree
course in nursing.

Male nurses: male nurses and male staff nurses should
be trained should be trained and employed in large
numbers in the male wards and male outpatient
departments.
Public health nurses: the committee also made
recommendations with regard to the training of public
health nurses. They are fully qualified nurses with training
in public health and midwifery.

Midwives: there is a shortage in the availability of
midwives in the country. Existing training schools for
midwives require considerable improvement. There
should be improvement in the conditions of training
centres.
Dais: the continuing employment of these women is
inevitable for some period. The committee has
advocated the training of dais as an interim measure
until an adequate number of midwives become
available.

Other recommendations are:-
Formation of village health committee to secure active
cooperation and support in the development of health
programme.
Formation of district health board for each district with
district health officials and representatives of the public.
To ensure suitable housing, sanitary surroundings, safe
drinking water supply elimination of unemployment and
lay special emphasis on preventive work.
4. Intersectoral approach to health services.

The significance and importance of Bhore
Committee Report.
It is an important land mark in public health
in India.
It initiated the concept of integrated
development i.e. simultaneous
development of health and other sectors.

The committee also initiated the concept of
comprehensive health care.
The essence of the report has in it the very idea of
primary health care.
The recommendations of the committee could not
be implemented immediately. But the three tier
pattern of PHC, Rural hospitals and District hospital
is largely based on the recommendations.

REFERENCES
Park. K. Preventive and Social Medicine. 20
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edition. Banrsidas Bhanot.; Jabalpur. 2009.
Kamalam. S. Essentials in community health
nursing practices. 1
st
edition. New Delhi: Jaypee
brothers; 2005
BT Basavanthappa. Community Health Nursing. 2
nd

edition. Bengaluru (India): Jaypee publications;
2008
Baride. J. P. and Kulkarni. A. P. Text book of
community medicine. 3
rd
edition. Mumbai: Vora
medical publications;2006