HEALTH COMMITTEES Shah Dr Mohammad Salman MD MIPHA

HEALTH COMMITTEES Shah Dr. Mohammad. Salman MD. , MIPHA. , Fellow FAIMER (USA) Assistant Professor Saturday, October 24, 2020

Health System of a District Saturday, October 24, 2020

LEVELS OF HEALTH CARE Primary Health Care • First level of contact between the individual and the health system where essential health care is provided. • Majority of health complaints and problems can be satisfactory dealt. • Care is provided by primary health centre & subcentres. Saturday, October 24, 2020

LEVELS OF HEALTH CARE Secondary level Tertiary level Offers super speciality care Regional & central More Complex problems are Hospitals dealt Supports and Compliments CHC & District Hospital the actions taken by lower levels Saturday, October 24, 2020

، CHC District Hospital Saturday, October 24, 2020

Indian Rural Health Care • 700 million people live in 636000 villages • Preventable and curable diseases dominate the morbidity pattern eg diarrhoea, typhoid, measles • 66% of indians do not have access to critical care • 31% of the rural population travel more than 30 Km seeking health care in rural India • A third of symptoms presented at the primary health setting might be psychomotor in nature “holistic care is absent” Saturday, October 24, 2020

HEALTH SURVEY AND DEVELOPMENT COMMITTEE Saturday, October 24, 2020

Sir Josef William Bhore (1878 -1960) Saturday, October 24, 2020

BHORE COMMITTEE (1946) The Health Survey and Development Committee in 1943. Sir Joseph Bhore the chairman. To survey 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 four volumes. Saturday, October 24, 2020

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. ” Saturday, October 24, 2020

• GUIDING PRINCIPLES ADOPTED Ø No individual should be denied to secure adequate medical care because of inability to pay. Ø There should be facilities for proper diagnosis and treatment. Ø The health programme must lay special emphasis on preventive work. Saturday, October 24, 2020

Ø As much medical relief and preventive health care should provide to the vast rural population. Ø The health services should be located/ placed as close to the people as possible to ensure maximum benefits to the community. Ø 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. • Medical services should be free to all without distinction. Saturday, October 24, 2020

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. Saturday, October 24, 2020

Observations made by the committee • The incidence of communicable disease also was very high. Diseases like chicken pox, cholera etc occurred in epidemics. • Many of the health problems were preventable. • The investment made in preventing these problems would give high returns in the forms of increased productivity and development. Saturday, October 24, 2020

Ø The committee stated that, health and development are interdependent. Ø 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. Saturday, October 24, 2020

Important recommendations • Integration of preventive and curative services at all administrative levels. • The committee visualized the development of primary health centres in two stages. Saturday, October 24, 2020

Short term plan To be implemented within 5 -10 years. Each primary health centre 40, 000 population 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 Saturday, October 24, 2020

Long term plan (3 million plan) First tier: - primary health units 75 bedded hospital for 10, 000 – 20, 000 population staff of 6 medical officers, 6 public health nurses, 2 sanitary inspectors, 2 health assistants and other supportive staff. Saturday, October 24, 2020

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. Saturday, October 24, 2020

• Major changes in medical education which includes 3 months training in preventive and social medicine to prepare “Social physicians” Saturday, October 24, 2020

THE SHORT TERM PROGRAMME Ø Dental sections should be established in the hospitals at the secondary health centres. Ø Provision of accommodation for health staff is essential in the interest of efficiency. Ø Village communication should be developed. Ø Travelling dispensaries should be provided to supplement the health services rendered by primary health centres. Saturday, October 24, 2020

THE LONG TERM PROGRAMME Ø The smallest administrative unit should be the primary unit serving an area with a population of about 10, 000 to 20, 000. About 15 to 25 primary units will together constitute a secondary unit. Ø The objectives to be kept in view after the first 10 years should be: Ø The creation of 18 new medical colleges in addition to the 43 to be established during the first 10 years. Ø The establishment of 100 training centres for nurses. Ø The nursing training of 500 hospital workers. Saturday, October 24, 2020

Nutrition Health education Nutrition Physical Education Health services for mother and children School health services Occupational health including industrial health Environmental hygiene Public health personnel Professional education Undergraduate education Dental education Pharmaceutical education Medical research Drugs and medical requisites Population problem Saturday, October 24, 2020

Other recommendations Ø Formation of village health committee to secure active cooperation and support in the development of health programme. Ø Formation of district health board for each district with district health officials and representatives of the public. Saturday, October 24, 2020

The significance and importance of Bhore Committee Report. Ø It is an important land mark in public health in India. Ø It initiated the concept of “integrated development” i. e. simultaneous development of health and other sectors. Saturday, October 24, 2020

ØThe committee also initiated the concept of “comprehensive health care”. ØThe essence of the report has in it the very idea of primary health care. ØBut the three tier pattern of PHC, Rural hospitals and District hospital is largely based on the recommendations. Saturday, October 24, 2020

• The dreams of Nehru and Amrit Kaur and the recommendations of the Bhore Committee converged to create a proposal which found favor with the government of New Zealand. • A generous grant from New Zealand made it possible to lay the foundation stone of All India Institute of Medical Sciences (AIIMS) in 1952. • The AIIMS was finally created in 1956, as an autonomous institution through an Act of Parliament , to serve as a nucleus for nurturing excellence in all aspect of health care. Saturday, October 24, 2020

MUDALIAR COMMITTEE. 1962. “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. Saturday, October 24, 2020

CHADHA COMMITTEE (1963) This committee was appointed under chairmanship of Dr. M. S. Chadha, then Director General of Health Services, to advise about the necessary arrangements for the maintenance phase of National Malaria Eradication Programme. Saturday, October 24, 2020

MUKHERJEE COMMITTEE (1965) • To review the performance in the area of family planning. • The committee recommended separate staff for the family planning programme. Saturday, October 24, 2020

MUKHERJEE COMMITTEE. 1966. • 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. Saturday, October 24, 2020

JUNGALWALLA COMMITTEE (1967) “Committee on Integration of Health Services” 1 Unified Cadre 2 Common Seniority 3 Recognition of extra qualifications 4 Equal pay for equal work 5 Special pay for special work 6 Abolition of private practice by government doctors 7 Improvement in their service conditions Saturday, October 24, 2020

KARTAR SINGH COMMITTEE (1973) • 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. Saturday, October 24, 2020

SHRIVASTAV COMMITTEE (1975) the 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. 3. Development of a “Refferal 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. Saturday, October 24, 2020

ROME Scheme Saturday, October 24, 2020

“Those who fail to read history are destined to suffer the repetitions of its mistakes” Saturday, October 24, 2020