Health Planning in India...

Health planning:
National Health Planning has been
defined as the orderly process of defining
community health problems, identifying unmet
needs & surveying the resources to meet
them, establishing priority goals that are
realistic
&
feasible
and
projecting
administrative action to accomplish the
purpose of the proposed programme.

Health needs & demands:

The community health needs
includes need for medical care, safe
water
supply,
adequate
nutrition,
immunization, family planning etc.

Resources:
The manpower money material
skills knowledge techniques & time

Objectives, Targets & Goals:

Describes the end results of
planning

Plan:
Plan Planning results in the formulation
of a plan. Plan is a blue print for taking
action 5 major elements
Objectives
Policies
Programmes
Schedules
budget

Planning cycle:
The process of analysing a system,
or defining a problem, assessing the extent to
which the problem exists as a need,
formulating goals & objectives to alleviate
those identified needs, examining & choosing
from
among
alternative
interventions
strategies, initiating the necessary action for its
implementation& monitoring the system to
ensure proper implementation of the plan &
evaluating the results of intervention in the
light of stated objectives.

Planning process - 8 steps:

Planning process - 8 steps
Analysis of the health situation
Establishment of objectives & goals
Assessment of resources
Fixing priorities
Write-up of formulated plan
Programming &
implementation
Evaluation

History of health planning

in
India:

Planning commission (1950):

Health planning in India is an integral
part of national socioeconomic planning.
Planning commission was set up by Govt. of
India on 15th March 1950, to raise the
standard of health & living of the people by
efficient exploitation of the resources of the
country, increasing production and offering
opportunities to all for employment in the
service of the community .

National
Council(1952):

Development

It is headed by Prime minister,

constitutes chief ministers & members of
planning commission. Main objective is to
formulate the five year plans for development of
the National economy. Priorities during FYP were
fixed based on the individual schemes &
availability of resources.

Organizational set up::

Chairmen Dy. Chairmen Minister of
State and Dy. Minister Members of Planning
Commission Member Secretaries/ Secretaries
of Planning Commission

Organizational set up:

The Prime Minister is the Chairman of
the Planning Commission, which works under the
overall guidance of the National Development
Council. The Deputy Chairman and the full time
Members of the Commission, as a composite
body, provide advice and guidance to the subject
Divisions for the formulation of Five Year Plans,
Annual Plans, State Plans, Monitoring Plan
Programmes, Projects and Schemes

The planning process:

The planning commission lays
down long term goals which are approved by the
Govt. 5yr goals are tentatively formulated by
planning commission The sector-wise working
groups, headed by secretary/ add sec/ Director
general/advisor planning commission, are set up
& work out detail policies & programmes to
achieve goals & targets PC prepares a short
memorandum of 5 year plan in the form of
Approach paper

The planning process:

This paper is placed before the
cabinet & NDC where it is discussed & approved
The guidelines are sent to the states to develop
state plans The planning dept. of each state
prepares its plan on the basis of plan of each
sectors in the state Each sectors get input from
the districts & blocks The complete plan is
submitted to the planning commission The PC
discusses & scrutinizes the plans in detail

The planning process:

The priorities are decided &
funds are recommended The final allocation of
funds is decided in a meeting bet the Dy.
chairman & the chief minister of a respective
state The draft FYP is prepared which states the
objectives, essential resources, targets &
programmes The draft is placed before NDC for
approval It is placed in & presented before the
parliament Then it becomes an official plan to be
implemented by various depts. of central & state
Govt.

Five Year Health Plans in

India:

Five Year Plans:

The first Five-year Plan was launched
in 1951 and two subsequent five-year plans were
formulated till 1965, when there was a break
because of the Indo-Pakistan Conflict
.Two successive years of drought, devaluation of
the currency, a general rise in prices and erosion
of resources disrupted the planning process and
after three Annual Plans between 1966 and
1969, the fourth Five-year plan was started in
1969.

Five Year Plans:

The Eighth Plan could not take off in
1990 due to the fast changing political situation
and the years 1990-91 and 1991-92 were treated
as Annual Plans. The Eighth Plan was finally
launched in 1992. For the first eight Plans the
emphasis was on a growing public sector with
massive investments in basic and heavy
industries For Ninth Plan in 1997, the emphasis
on the public sector has become less pronounced
and the current thinking on planning in the
country, in general, is that it should increasingly
be of an indicative nature.

Broad objectives of the health

programmes during the five year
plans are: :

Control or eradication of major communicable

diseases
Strengthening of the basic health services
through the establishment of PHCs and Sub
centres
Population control
Development of health manpower resources.

1st five year plan: (1951 - 1956)

Aim :
To fight against diseases, malnutrition, and
unhealthy environment
To build up health services for rural population
and for mothers & children in order to improve
general health status of the people.
Outlay: Total- 2356 crores For health sector140 crores (5.9%)

Achievements during 1st FYP :

The central council of health was constituted

-1952
National malaria control programme-1953
National family planning programme-1953
National leprosy control programme- 1954
National water supply & sanitation programme1954
National filarial control programme-1955
The prevention of food adulteration act -1954
Contributory health services scheme-1954

2nd five year plan (1957 - 1961) : :

Aim: to expand existing health services to bring
them with in the reach of people so as to
promote progressive improvement of nations
health.
Outlay: Total 4800 crores
programmes 225crores (5%)

For

health

Achievements during 2nd FYP:

National malaria control programme was

switched over to national malaria eradication
programme-1958
Institutions established1. Central health education bureau-1956,
2. National Tuberculosis institute, Bangalore1956

3rd five year plan (1961 - 1966) : :

Aim: to remove the shortages & deficiencies
which were observed at the end of the 2nd five
year plan in the field of health.
These were pertaining to institutional
facilities especially in rural areas, shortages of
trained personnel & supplies, lack of safe
drinking water in rural areas and inadequate
drainage system
Outlay: Total- 7500 crores For health
programmes- 342 crores( 4.3%)

Achievements during 3rd FYP: :

National small pox eradication programme -1962
National goitre control programme -1962
School health programme- 1962
District TB control programme- 1962
National Trachoma control programme- 1963
Institutes:
1. Central bureau of health intelligence (1961),
2. National Institute of Communicable diseases
(1963),
3. National institute of health administration &
Education (1964)

Annual Plans 1966-69:

The 4th FYP which was to commence from 1966
was postponed till 1969 due to uncertain
economic situation in the country due to IndoPak War. This intervening period was covered by
annual plans with an outlay of 6756cores, of
which 316 crores (4.7%) were allotted for health
programmes

4th five year plan (1969 - 1974) : :

Aim: To strengthen PHC network in the rural
areas for undertaking preventive, curative,
family planning services & to take over the
maintenance phase of communicable diseases.
Outlay: Total -16774 crores
programmes- 1156 crores (7.2%)

For

health

Achievements during 4th FYP: :

Chittaranjan mobile hospitals (1970)

Postpartum family planning programme (1970)
Medical termination of pregnancy facility
(1971)
Multipurpose health workers scheme (1973)
National programme of minimum needs (1973)

5th five year plan (1974 - 1979) : :

Aim: To provide minimum level of well integrated
health, MCH & FP, nutrition & immunization to all the
people with special reference to vulnerable groups
especially children, pregnant women, & nursing
mothers, through a network of infrastructure in all
the blocks & well structured referral system.
Outlay: Total- 37250 crores For health programmes3277 crores (8.8%)

Achievements during 5th FYP: :

Rural health scheme (1977)

Integrated child development scheme (1975)
Community health workers scheme (1977)
National malaria eradication programme was
replaced by modified plan of operation (1977)
20 point programme (1975)
National programme for prevention of blindness
(1976)
Reorientation
of
medical
education
scheme(1977)
Expanded programme of immunization(1978)
Parliament approved child marriage restraint
act (1978)

6th five year plan (1980 - 1985): :

Aim: To work out alternative strategy & plan of
action for primary health care as part of national
health system, which is accessible to all section
of society.
Outlay:
Total97500
crores
programmes- 1822 crores (5.4%)

For

health

Achievements
FYP: :

during

6th

Alma Ata Declaration on PHC -1979

HFA/2000 AD -1981
National health policy 1983
The national drinking water & sanitation
decade -1981
Leprosy control programme switched over to
leprosy eradication programme 1983
Guinea worm eradication programme -1983

7th five year plan (1985 - 1989) ::

Aim : To plan & provide primary health care&
medical services to all with special consideration
of vulnerable groups and to attain health for all by
2000AD.
Outlay: Total- 180,000 crores
programmes- 3392 crores (1.9%)

For

health

Achievements during 7th FYP: :

Universal immunization programme -1985

National Diabetes control programme 1987
National AIDS control programme 1987
Control of acute respiratory infection
programme 1990

8th five year plan (1992 - 1997) : :

Aim: To continue organization & strengthening of
health
infrastructure
&
medical
services
accessible to all especially to vulnerable groups
and those living in tribal, hilly, remote rural areas
etc.
Outlay: Total- 79,800 crores
programmes- 7576 crores (9.5%)

For

health

Achievements during 8th FYP: :

Child survival & safe motherhood programme
-1992
Reproductive & child health programme 1994
Announcement of revised National Drug Policy
1995
Revised national TB Control programme 1997
Act on infant feeding & Infant foods- 1992

9th five year plan (1997 - 2002) : :

Aim: "Growth with Social Justice and Equity" Same
as 8th FYP. Nursing education and nursing services
have been given a high priority in order to bridge
the large gap between requirement and availability
of nurses and ensure quality of nursing training.
Efforts are made to meet the increasing demand
for nurses with specialised training in speciality
and sub-speciality areas intensive medical and
surgical care in hospitals and for public health
nurses in health care system.
Outlay:
Total859,200
crores
programmes- 10818 crores (1.25%)

For

health

Achievements during 9th FYP::

Intensive Pulse Polio immunization programme

-1999
National Population Policy 2000
National health policy-2000
Guinea worm disease was eradicated.

10th five year plan (2002 - 2007) ::

Aim: To improve the efficiency of existing health
care infrastructure at primary, secondary and
tertiary care setting Attain universal primary
education Gender equality
Outlay: Total- 9,21,291 crores
programmes- 9,253 crores (1%)

For

health

New Initiatives in the Tenth Plan: :

The Reproductive and Child Health Programme,

Phase II (2005-10),
Janani Suraksha Yojana Support for six tertiary-level
institutions on the lines of AIIMS, Delhi in the six
backward states of Bihar, Madhya Pradesh, Orissa,
Rajasthan, Chhattisgarh and Uttaranchal
Integrated Disease Surveillance Project
National Mental Health Programme
A Capacity Building Project Expanding outreach of
AYUSH
Two new national programmes - National
Programme on Diabetes and Cardiovascular
Diseases & National Programme on Hearing and
Speech Impairment

Recommendations :

Implement a National Rural Health Mission

Implement a National Mission on Sanitation
and Public Health
Provide access to maternity health Insurance
and community risk pooling Systematise
insurance at secondary health care levels
through reform of the CGHS Institutionalise
public private partnerships in health care
Set up a Public Health Development Authority
Set up a National Authority for Drugs and
Therapeutics

11th five year plan (2007 - 2012) ::

Aim:
To achieve an overall growth rate of 7.6%.
To reduce poverty levels from 38% to 25%
To achieve the literacy rate of 84% by the end of
the Plan and reduce gender gap in literacy to
14%.
To achieve reduction in drop out rate from 46.8%
in 2003-04 to 20% by 2011-12 and eliminate
gender disparity in elementary education.
To bring down population growth rate to 1.62%
by 2012.
To improve health parameters-reduce MMR to
125, IMR to 40

11th five year plan: 2007 2012 :

To improve the sex ratio (06 years) to 950 females

per 1000 males.
To reduce malnutrition to 30% and anaemia to 30%.
To provide sustainable access to safe portable
drinking water to all independent habitations.
To empower women through their socio-economic
development
To strengthen social, economic and political
empowerment of weaker sections of the society
through welfare of SCs/STs, OBCs, minorities and
poor.
Outlay: Total - Rs. 69,33,800 crores For Health Rs 2,24,030 crore

INTERVENTIONS RECOMMENDED
FOR IMPLEMENTATION DURING
THE ELEVENTH PLAN:
Launch a Sarwa Swasthya Abhiyan
National Authority for Drugs and Therapeutics
(NADT)
Public Health Development Authority (PHDA)

Recommendations
engendering the 11th FYP:

for

Promote the idea of Women-Governance Better

accountability and monitoring mechanisms -Sex
desegregated
data
Strong
enforcement
mechanisms Reconstruct poverty line to reflect
reality - goal of "a hunger-free India" or "food and
nutrition security for all. Eliminate all forms of
Violence against Women (VAW) Redefine work
and recognise women in the workforce

12th FIVE YEAR PLAN (2012- 2017)

In 12th five year plan
Healthcare conditions are improving in the country
but its affordability and accessibility is still an area
to be focused on
Curative and preventive healthcare would help in
increasing general quality of life.
Focus on women and children is essential but
importance to elderly class and handicaps in order
to achieve inclusive healthcare development is
essential.
Shortage of qualified medical personnel at all
levels is a major hurdle in improving the outreach of
the healthcare system, especially the public health
facilities

Bajaj committee (1986):

An Expert Committee for Health Manpower
Planning, Production and Management was
constituted in 1985 under Dr. J.S. Bajaj, the then
professor at AIIMS.

Major recommendations:

Formulation of national medical & health

education policy.
Formulation of national health manpower
policy-staffing norms for nursing services &
requirements for CHCs & PHCs.
Establishment of an educational commission
for health sciences (ECHS) on the lines of
UGC.
Establishment of health science universities
in various states and union territories.

Major recommendations:
Establishment of health manpower cells at
centre and in the states.
Vocationalization of education at 10+2 levels
as regards health related fields with
appropriate incentives, so that good quality
paramedical personnel may be available in
adequate numbers.
Carrying out a realistic health manpower
survey.

Hospital nursing services:

NS 1:2000 beds
DNS 1:300 beds
Dept Nsg supervisors 7:1000 beds + 1 add
for every 100 bed
Ward Nsg supervisors 8:200 + 30%leave
reserve
Staff nurse for wards 1:3(1:9 / shift)
Staff, OPD 1:100
Staff, ICU 1:1 (1:3/shift)
Staff special dpt OT, LR 8:200

Community infrastructure:
1CHC 1,00,000 population
1PHC 30,000 in plains area
1PHC 20,000 in hilly area
1SC 5000 in plain area
1SC 3000 in hilly area

High power committee on nursing &

nursing profession (1989):
Recommendations:
To have 2 levels of nsg personnel, viz. professional
nurse with university degree & auxillary nurse /
vocational nurse to work both in community setting
To have higher education in nursing which include
MSc & PhD in nursing and also specialized courses at
postgraduate level.
To have definite policy of continuing education &
staff development Strengthening of nursing structure
at the central, state & district level with adequate no
of well qualified nursing personnel.

National population policy (2000):

1983 - Parliament emphasized the need for a
separate National Population Policy.
1991 -The National Development Council appointed
a Committee on Population with Shri Karunakaran
as Chairman Recommended that "a National Policy
of Population should be formulated by the
Government and adopted by Parliament
1993 - An Expert Group headed by Dr. M.S.
Swaminathan was asked to prepare a draft of a
national population policy Final draft is adopted by
GOI on 15th Feb 2000.

Objectives of NPP 2000:

The intermediate objectives:
To address the unmet needs of contraception,
health care infrastructure & health personnel
To provide integrated service delivery for basic
reproductive & child health care
The medium term objectives:
To bring the TFR to replacement levels by 2010 The
long term objectives:
To achieve a stable population by 2045

Health related Millennium

Development Goals in India:

Eradicate extreme poverty and hunger

Achieve universal primary education
Promote gender equality
Reduce child mortality
Improve maternal health
Combat HIV/AIDS, malaria & other communicable
diseases
Ensure environmental sustainability Develop a
global partnership for development

New
National
Policy(2002):

Health

Objective: to achieve a level of health that will

enable every individual a productive life.
Priority areas of policy:
Small family norm
MCH
Immunization
Improvement of nutritional status
Water supply & sanitation
Environmental protection

Goals of NHP by 2010 AD:

Indicators By 2000 By 2010
IMR
60
30
CBR
21
18
MMR
<2
1
Life expectancy 64
70
NRR
1
<1
Annual growth rate 1.2 1
TFR
2.3
2.1

Other goals of NHP 2002:

Eradicate polio -2005
Eliminate leprosy -2005
Eliminate kala-azar -2010
Eliminate lymphatic filariasis - 2015
Achieve zero level growth of HIV/ AIDS -2007
Reduce the prevalence of blindness to 0.5%
-2010

National Rural health mission in

India (2005-2012):
Recognizing the importance of Health, the Govt.
of India has resolved to launch the NRHM to
carry out necessary architectural correction in
the basic health care delivery system The Goal
of the Mission is to improve the availability of
and access to quality health care It seeks to
provide effective health care to rural population
through out the country with special focus on 18
states.

GOALS :

Reduction in IMR &MMR

Universal access to public health services such as
Womens health, child health, water, sanitation &
hygiene, immunization, and Nutrition
Prevention &control of communicable &non
communicable diseases
Access to integrated comprehensive primary
health care
Population stabilization,
gender & demographic balance
Revitalize local health traditions & mainstream
AYUSH
Promotion of healthy life styles

Public
India:

health

foundation

of

The central Govt established PHFI with the

support of private sector in March 2006.
Aim:
To strengthen public health system in India by
establishing new institutes of public health &
enhancing capacity & output of the existing
institutes.
To promote research in key areas of public health
& facilitate suitable policy development

Research inputs :
Shiffman J, Ved RR. The state of political priority
for safe motherhood in India . BJOG. 2007
Jul;114(7):785-90. By 2005, evidence had
accumulated that maternal mortality in India
was stagnating and that existing initiatives were
not addressing the problem effectively. Also in
that year, national government officials and
donors came to a consensus on a strategy to
address the problem. This paper draws on public
policy theory to analyse the Indian experience
and to develop guidance for safe motherhood
policy communities.

Research Inputs:
Dhillon GP. NLEP--current situation and strategy
during the 11th plan period (2007-2012). J Indian
Med Assoc. 2006 Dec;104(12):671-2. The
prevalence rate of leprosy was found to be
0.95/10,000 population by December 2005, a
success in the elimination of leprosy. On 30th
September 2006 the rate on record is 0.89/10,000
population During 2005-06 the annual new case
detection rate was 14.27 per 100,000 population
which was 23.4 during 2004-05 During the 11th
plan period the government proposes to carry on
the leprosy programme with the same intensity
further to achieve annual new case detection rate
less than 10 cases per 100,000 population

References :
1. K. Park, preventive & social Medicine, 16th edn., pg:613-630 Lakshmi Kant,
Principles & Practice of preventive & social Medicine, 1st edn, 368-371
2. Mahajan B K, text book of preventive & social Medicine 2nd ed., 476-488
3. Ghai,
Essential
preventive
medicine,
pg:
845-874
http://planningcommission.nic.in/midterm/english-pdf/chapter-02b.pdf
http://planningcommission.nic.in/plans/planrel/11thf.htm
4. http://
www.southasianmedia.net/cnn.cfm?id=416597&category=Social%20Sectors&Co
untry=INDIA
www.mohfw.nic.in www.pubmed.com

Thank you