Reports Committee & Commission

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.

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. It made comprehensive recommendations for remodeling of health services in India. The report, submitted in 1946, had some important recommendations like :-

(i) 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.

(ii) A long-term programme (also called the 3 million plan) of setting 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.

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

This committee known as the “Health Survey and Planning Committee”, headed by Dr. A.L. Mudaliar, was appointed to assess the performance in health sector since the submission of Bhore Committee report. This committee found the conditions in PHCs to be unsatisfactory and suggested that the PHC, already established should be strengthened before new ones are opened.

Strengthening of sub divisional and district hospitals was also advised. It was emphasised that a PHC should not be made to cater to more than 40,000 population and that the curative, preventive and promotive services should be all provided at the PHC. The Mudaliar Committee also recommended that an All India Health service should be created to replace the erstwhile Indian Medical service.

This committee was appointed under chairmanship of Dr. M.S. Chadha, the then Director General of Health Services, 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 basic health workers (one per 10,000 population), who would 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 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 the then Secretary of Health Shri Mukherjee, was appointed to review the performance in the area of family planning. The committee recommended separate staff for the family planning programme. The family planning assistants were to undertake family planning duties only. The basic health workers were to be utilised for purposes other than family planning. The committee also recommended to delink the malaria activities from family planning so that the latter would received undivided attention of its staff.

Multiple activities of the mass programmes like family planning, small pox, leprosy, trachoma, NMEP (maintenance phase), 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. The committee worked out the details of the Basic Health Service which should be provided at the Block level, and some consequential strengthening required at higher levels of administration.

This committee, known as the “Committee on Integration of Health Services” was set up in 1964 under the chairmanship of Dr. N Jungalwalla, the then Director of National Institute of Health Administration and Education (currently NIHFW). It was asked to look into various problems related to integration of health services, abolition of private practice by doctors in government services, and the service conditions of Doctors. The committee defined “integrated health services” as :-

Following steps were recommended for the integration at all levels of health organisation in the country

This committee, headed by the Additional Secretary of Health and titled the "Committee on multipurpose workers under Health and Family Planning" was constituted to form a framework for integration of health and medical services at peripheral and supervisory levels. Its main recommendations were :-

a. Various categories of peripheral workers should be amalgamated into a single cadre of multipurpose workers (male and female). The erstwhile auxiliary nurse midwives were to be converted into MPW(F) and the basic health workers, malaria surveillance workers etc. were to be converted to MPW(M). The work of 3-4 male and female MPWs was to be supervised by one health supervisor (male or female respectively). The existing lady health visitors were to be converted into female health supervisor.

b. One Primary Health Centre should cover a population of 50,000. It should be divided into 16 subcentres (one for 3000 to 3500 population) each to be staffed by a male and a female health worker.

This committee was set up in 1974 as "Group on Medical Education and Support Manpower" to determine steps needed to (i) reorient medical education in accordance with national needs & priorities and (ii) develop a curriculum for health assistants who were to function as a link between medical officers and MPWs. It recommended immediate action for :

1. Creation of bonds of paraprofessional and semiprofessional 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.

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.

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 are :-