Health Planning in India - Park's SPM (Complete University SAQ Guide)

HEALTH COMMITTEES IN INDIA (Health Planning Committees)

"The guidelines for national health planning were provided by a number of committees dating back to the Bhore Committee in 1946. These committees were appointed by the Government of India from time to time to review the existing health situation and recommend measures for further action." - Park's SPM

1. BHORE COMMITTEE (1946)

Key Recommendations:

1. Integrated health services - recommended integrated preventive and curative services at all levels (not vertical/separate programmes)
2. Comprehensive health care - the term "comprehensive health care" was first used by the Bhore Committee in 1946. By this they meant provision of integrated preventive, curative and promotional health services
3. Primary Health Centre concept - gave the concept of a PHC as a basic health unit to provide, as close to the people as possible, integrated curative and preventive care (short-term plan: 1 PHC per 40,000 population; long-term plan: 1 PHC per 10,000-20,000 population with 75 beds)
4. Unified health authority - recommended setting up a unified health authority in each district with integrated medical and public health organizations
5. Director of Health Services should also be Secretary to the State Government (not implemented)
6. Single administrative officer for curative and preventive services at state level
7. "Social physician" concept - doctors should be trained with a social orientation
8. No economic barrier should prevent any person from getting medical care
9. 3-million plan and short-term plan for health services development
10. Recommended integration of health services at all administrative levels

Significance:

2. MUDALIAR COMMITTEE (1962)

Key Recommendations:

1. Consolidation before expansion - existing PHCs should be strengthened before creating new ones
2. Population ratio scaled down - the population to be served by PHCs should be scaled down to 40,000 (from Bhore's higher numbers)
3. Subcentres - each PHC should have subcentres
4. Hospital beds - recommended increase in hospital beds
5. Reported water/sanitation status - the Mudaliar Committee (1962) reported that not more than 15% of the urban population in India had water carriage sewage systems
6. Specialist services - recommended provision of specialist services at district level

Important Distinction from Bhore:

• Bhore: expand - set up new PHCs across the country
• Mudaliar: consolidate - strengthen existing PHCs first, reduce population per PHC to 40,000

3. KARTAR SINGH COMMITTEE (1973)

Key Recommendations:

1. Multipurpose Worker (MPW) concept - the most important contribution. Recommended replacing vertical, single-purpose health workers with Multipurpose Workers who could handle all health and family planning services
2. Male and Female MPWs - each subcentre to be staffed by one Male MPW (erstwhile Male Health Worker/Vaccinator) and one Female MPW (previously ANM)
3. One subcentre per 5,000 population in plains; one per 3,000 in hilly/tribal/difficult areas
4. One PHC per 1,00,000 population (plains); per 50,000 (hilly areas)
5. Integration of all vertical health workers (malaria, smallpox, leprosy, family planning) into a single multipurpose cadre
6. Lady Health Visitor (LHV) to supervise 4-6 female MPWs

Significance:

4. SRIVASTAV COMMITTEE (1975)

Key Recommendations:

1. Community Health Worker (CHW)/Village Health Guide - recommended training of a community volunteer from the village itself to serve as a link between community and health services (later became the Village Health Guide scheme, and conceptually the precursor to ASHA)
2. Medical education reform - recommended reorganisation of medical education to orient doctors towards social medicine and community health
3. Support manpower - emphasis on training of para-professional and support health workers
4. Health manpower development - rural areas should have locally trained community-level health workers
5. Social orientation of medical education

Significance:

SUMMARY TABLE: HEALTH COMMITTEES (SAQ Memory Aid)

PLANNING COMMISSION

NITI AAYOG

• Established: 1st January 2015 by Government of India
• Full form: National Institution for Transforming India
• Replaced: Planning Commission
• Nature: A "think-tank" providing critical directional and strategic input into the development process
• Functions:
  • Provide strategic and technical advice to Central and State governments across key policy elements
  • Monitor and evaluate implementation of programmes
  • Focus on technology upgradation and capacity building
  • Unlike Planning Commission, it has no power to allocate funds - it is purely advisory

FIVE YEAR PLANS - BROAD OBJECTIVES FOR HEALTH

1. Control or eradication of major communicable diseases
2. Strengthening of basic health services through PHCs and subcentres
3. Population control
4. Development of health manpower resources

Health Sector Sub-divisions (for planning purposes):

1. Water supply and sanitation
2. Control of communicable diseases
3. Medical education, training and research
4. Medical care including hospitals, dispensaries and PHCs
5. Public health services
6. Family planning
7. Indigenous systems of medicine

12th FIVE YEAR PLAN (2012-2017)

Core Objective:

UHC Definition (HLEG definition):

Two Parallel Steps for UHC:

1. Clinical services at different levels defined in an Essential Health Package - government to finance and ensure provision through public health system (+ contracted-in private providers)
2. Universal provision of high-impact preventive and public health interventions which government would universally provide

Key Health Goals (12th Plan - Disease-wise):

Government-Funded Preventive Interventions (12th Plan, Table 2):

1. Full immunization for under-3 children and pregnant women
2. Full antenatal, natal and postnatal care
3. Skilled birth attendance with emergency obstetric care facility
4. Iron and Folic Acid supplementation for children, adolescent girls and pregnant women
5. Regular treatment of intestinal worms in children and reproductive age women

NATIONAL HEALTH POLICY - 2017

Context (4 Major Changes that Necessitated the Policy):

1. Changing health priorities - maternal and child mortality declined, but rising NCD burden and some infectious diseases
2. Robust healthcare industry - estimated growing at double digit
3. Catastrophic health expenditure - growing incidences of catastrophic expenditure; a major contributor to poverty
4. Rising economic growth - enables enhanced fiscal capacity

Primary Aim:

Specific Quantitative Goals (NHP 2017):

• Increase Life Expectancy at birth from 67.5 to 70 by 2025
• Establish regular tracking of DALY index by 2022
• Reduce TFR to 2.1 at national and sub-national level by 2025

• Reduce Under-5 mortality to 23 by 2025
• Reduce MMR to 100 by 2020
• Reduce IMR to 28 by 2019
• Reduce neonatal mortality to 16 and still birth rate to single digit by 2025

• HIV/AIDS: Achieve 90:90:90 target by 2020:
  • 90% of all PLHIV know their HIV status
  • 90% of those diagnosed receive sustained ART
  • 90% of those on ART achieve viral suppression
• Achieve global TB targets (2020)

MDG (Millennium Development Goals)

Key Facts:

• Adopted at UN Millennium Summit, September 2000
• 8 Goals, 18 targets, 48 indicators
• Timeline: 2000 to 2015 (15 years)
• In December 2015, the MDGs came to the end of their term
• Replaced by SDGs (Sustainable Development Goals) - post-2015 agenda

8 MDGs (All, for completeness):

Health-Related MDGs (Most Important for SAQs):

• Target: Reduce under-5 mortality rate by two-thirds between 1990 and 2015

• Target 5A: Reduce MMR by three-quarters between 1990 and 2015
• Target 5B: Achieve universal access to reproductive health

• Target 6A: Halt and reverse spread of HIV/AIDS by 2015
• Target 6B: Achieve universal access to HIV/AIDS treatment by 2010
• Target 6C: Halt and reverse incidence of malaria and other major diseases

MDGs to SDGs:

QUICK RECALL / SAQ MNEMONICS

• Bhore = PHC + Comprehensive + Integrated services
• Mudaliar = Consolidate PHCs; 1 PHC per 40,000
• Kartar Singh = MPW (Multipurpose Worker); 1 subcentre per 5,000
• Srivastav = Community Health Worker / Village Health Guide