UNIT – 3
HEALTH PLANNING IN INDIA
A. National health planning
Planning means tomorrow and management for today.
When any work is to be done, tomorrow’s planning should be done today. So that the goal to be achieved can be achieved easily with less difficulty.
👉Purpose of planning
To solve more problems by making maximum use of limited resources.
To avoid duplication of work and expenses and to eliminate wrong expenses.
To take appropriate steps to meet the set objectives.
The following points are included in national health planning.
✅️Objectives
Planning is a new approach. The main purpose of national planning is economic and political independence.
Health planning is based on the health needs and health demands of a committee or population.
The goal of health planning is to achieve complete health for people.
➡️Planning commission
👉In March 1950, the planning commission was established by the government of India to plan the works.
This commission implemented the community development program in the first five-year plan in 1951.
This program was started on 2 October 1952.
55 community projects were completed in the designated areas of different states in India.
After that, another 55 projects were also covered and were completed by the assistant America for supervision.
Each project covered 300 villages and each project was divided into three blocks.
A block consisted of 100 villages and 90 to 97 thousand population.
Village level servants known as Gram Sevaks were placed in each village.
💫Purpose of planning
👉1. The planning commission makes great efforts to increase the country’s production so that other people can benefit from it as much as possible and raise their standard of living.
👉2. Since health is an important aspect of national development, the Planning Commission gave importance to health and included the health programme in the five-year plan.
👉3. In 1962, the Bureau of Planning was formed so that the work could be done with more cooperation between the state and the general.
For this, the health sector was divided into sub-centers,
and the following matters were emphasized.
✅️1. Water supply and sanitation
✅️2. Control of communicable diseases
✅️3. Medical education, training and research.
✅️4. Medical care which covers hospital, dispensary, PHC and sub-center.
✅️5. Public health service
✅️6. Family Welfare
✅️7. Indigenous system of medicine
All the above issues were included in the five-year plan,
and the needs of the people were emphasized.
Health plans are implemented at different levels such as national, state, district and block level
💜Planning Cycle
Planning is a broad foundation for management.
Management is based on planning itself.
Planning is a process in which, through analysis, it simplifies its goals and objectives according to the needs of the problem, makes advancement.
In addition to selecting and examining the needs identified and finding alternatives to the obstacles that arise, it is necessary to ensure that the objectives set are properly implemented or not, as well as evaluating and monitoring the planning.
The steps in planning are sequentially called the planning cycle.
➡️1. Analysis of the health situation
The first step of health planning is to analyze the health situation and collect information to get a clear picture of this situation.
The data required for its assessment is as follows:
✅️1. Population – age, sex, structure
✅️2. Statistics – mortality and morbidity
✅️3. Geographical and population-based prevalence of different diseases.
✅️4. Medical care facility including hospital, health center or other agencies
✅️5. Number of technical personnel of different categories
✅️6. Pending facility available
✅️7. People’s thoughts and perceptions about the disease as well as its prevention and cure can be known by analyzing the above statistics to understand the health issues and needs of the people.
➡️2. Establishment of objectives and goals
Objectives do not just guide but also evaluate the work after doing it.
Objectives and goals help to understand what kind of efforts to make.
Starting with setting the objective itself, so that details from large to small units, short and long term goals, time and resources can be known.
➡️3. Assessment of resources
Resources such as manpower, money, material, skill, knowledge and techniques should be available for the implementation of the health program.
In this, resources can also be optional.
➡️4. Fixing priorities
After finding the problem, need, resources and objectives, if the resources are not available as per the requirement, then further planning should be done and work should be arranged according to priorities.
In fixing priorities, attention should be paid to financial mortality and morbidity data that can be prevented at low cost, besides saving, taking the help of young people who are participating in social work, political work and welfare activities and taking interest.
First establish the priority and then make efforts to achieve the alternative plan.
➡️5. Write up formulated plan
The next main step of the planning process is to prepare the detail plan.
Complete the plan in a way that it can be implemented.
Find all the resources in it.
Show the guidelines of implementation in it and also inform about the working methods of evaluation and then send this plan to the authority and government for modification.
Everything should be completed in it.
➡️6. Planning and implementation
After the plan is selected by the policy-making authority, the program and implementation start.
Administrative plan is based on the current organization.
Organization, structure, procedures, well defined motivates to work according to which, inappropriate use of staff, seminars and other factors often fail down as well as,
Main consideration at the implementation stage improve
define of role
the selection, training, motivation, supervision and main power involved
organization and communication
the effectively of individual institution at Hospital and sub centre.
➡️B. Five Year Plan
As part of maintaining the health of the country and the purpose of social welfare, the five-year plan is included.
In which industrial improvement, agriculture, transportation, education and health oriented programs were given more support and the five year plan came into existence with the above purpose.
✅️Objectives
Control and eradication of major communicable diseases
Straightening of basic health services, through the establishment of primary health center and sub center (to strengthen basic health services by establishing PHC and sub center)
Development of health and manpower resources health worker (to increase and develop them and prepare workers)
To stop population growth
Each sub center of the five year plan was included in the five year plan, and changes were made in each plan as needed.
Each sub center was given importance and the health plan was placed at different levels.
For example, National, state, district, block etc..
The Health Bureau made separate planning for each health center in the five year plan, which is as follows.
👉1st five year plan(1951 – 1956)
In the first five year plan, the Government of India allocated Rs. 1960 crores for the public health sector, out of which Rs. 65.20 crores were allocated for health.
One crore allocated for Family Welfare
In the first five year plan, community development and national extension services were implemented, which provided a means for bringing about economic and social change, and the following main objectives were set for health centers.
water supply and sanitation
preventive care
control of malaria
MCH care
sufficient drug and instrument
family planning
👉2nd five year plan (1956-1961)
After the first five year plan, more importance was given to comprehensive health care in this second plan, in which ૱ 4672 crores were spent on the total plan.
Out of this, Rs. 140.80 crores were spent on health.
Also, Rs. 2.20 crores were spent on family welfare and the following objectives were set during that plan.
health services
control of communicable disease
increase technical work
environmental sanitation
universal pulse polio program
👉3rd five year plan (1961-1966)
The third five year plan started from April 1961 in which a total of Rs.8576 crore was allocated for the public sector. In which Rs. 225 crore was spent for health and Rs. 9.24 crore was spent for family welfare and out of this, the expenditure was made for the public health sector.
In the third plan, priority was given to the eradication of communicable disease as well as the control and prevention of disease.
The main objectives of this plan are as follows:
National goiter control program
National school health program
National T.B. control program
Annual plan (1966 – 1969)
The plan was extended during the period 1966 to 1969.
During this period, the annual plan was decided without starting the fourth five-year plan, in which Rs. 140.20 crores were spent on health and Rs. 70.50 crores on family planning and Rs. 102.70 crores were spent on water supply and sanitation.
👉4th year plan (1969 – 1974)
In the fourth five-year plan, a total of Rs. 15778.80 crores were spent, out of which Rs. 375.50 crores were spent on health sector and Rs. 284.40 crores were spent on family welfare.
Rs. 458.90 crores were spent on water and sanitation.
The objectives of this plan were set as follows,
control of Malaria
control of TB
control of smallpox
control of leprosy
control of trachoma
family planning
To make PHC attractive
👉5th five year plan (1974 – 1979)
In the fifth five year plan, more importance was given to primary education and health, besides, emphasis was laid on matters like safe drinking water and nutrition.
In which plan, Rs. 682 crores were allocated for health and Rs. 497.40 crores for family welfare and Rs. 971 crores for water supply and sanitation.
Its objectives are as follows:
Eradicate poverty
primary health education
safe drinking and water supply
proper nutrition
medical care and child welfare
👉Annual plan
During 1970 – 1980, an annual plan was made without implementing the sixth five year plan, in which Rs. 268 crores and for family planning Rs. 116.20 crores were spent and the same plan was taken forward with necessary amendments and additions in the next plan.
👉6th five year plan (1980 – 1985)
The sixth five year plan started from 1980 to 1985 and its objectives were as follows.
Primary health center to be established for a population of 50,000.
Sub center to be established for a population of 5000.
It was decided that trained dais can serve a population of 1,000.
In this plan, Rs. 1821.05 crores were allocated for health, Rs. 1010 crores for family welfare and Rs. 6522.47 crores for water supply and sanitation.
👉7th five year plan (1985-1990)
The seventh five year plan continued the planning of the sixth plan,
Its objectives were as follows,
To eliminate poverty, electricity and unemployment by the year 2000.
The aim was to provide basic necessities like food, clothing and housing. In this, Rs. 3392.89 crores were allocated for health, Rs. 3526.26 crores for family welfare, and Rs. 6522.47 crores for water supply and sanitation. Annual plan (1991 – 1991)
During this plan, Rs. 784.90 crores were allocated for family welfare, Rs. 1876.80 crores for water supply and sanitation, and Rs. 960 crores were allocated for health.
Annual plan (1991-1992)
During this plan, Rs. 1185.90 crore was allocated for health, Rs. 749 crore for family welfare and Rs. 2514.40 crore for water supply and sanitation.
8th five year plan (1992-1997)
In this eighth five year plan, Rs. 7575.92 crore was allocated for health, Rs. 6500 crore for family welfare and Rs. 16711.03 crore for water supply and sanitation, the objectives of which were as follows…
Improve employment
Population control
Literacy campaign
Education
Pure drinking water
For all-round development, emphasis was laid on the above-mentioned matters during this plan, in which special emphasis was laid on family welfare so that the population could be kept under control.
👉9th five year plan (1997-2002)
In this plan, 1170 crore rupees were allocated for family welfare, in which government voluntary and private sector as well as infrastructure and medical and paramedical and other healthy personal were taken into consideration.
Special emphasis was laid on improving the health of the population of the community,
The objectives of which were as follows,
To raise the quality of primary health care provided in urban and rural areas and to raise the health status.
To strengthen primary, secondary and tertiary health care.
To make the referral line more efficient.
To develop a disease surveillance response mechanism and to develop it in a way that it gets an appropriate response at the district level.
To pay more attention to the management system for emergency, disaster or accident.
To find out common nutritional deficiency and take preventive measures.
To stop population growth.
To emphasize on the RCH program.
👉10th five year plan (2002-2007)
✨️In India, the infrastructure for health is spread on a very large scale by government, non-government and private organizations, which are working through medical and paramedical.
The objectives of which are as follows:
✅️The desire to take the health study of the people to a higher level through the 10th Five Year Plan, for which things like infrastructure, manpower, equipment, essential diagnosis and drugs should be included and the discrepancies in it should be removed.
✅️There is a desire to provide proper quality care to every person in the society.
✅️The main approach during the 10th Five Year Plan is to improve the quality of primary health care by making proper assessment.
✅️To complete this approach, the infrastructure of primary, secondary and tertiary levels should be made more capable and strong and the referral link should be improved to provide health services in urban and rural areas.
👍Achievement during plan period
The National Health Policy was formulated in 1983 by the Ministry of Health and Family, keeping in mind health for all 2000 AD.
In view of the need for many agencies, a national policy was made in 2002, the main objective of which was to bring the health level of the people of the country to an appropriate level, in which the existing public health system was to be decentralised and more infrastructure was created and preventive care and curative aspects were given more importance at the primary level, in which more emphasis was placed on some specific diseases, such as…
AIDS, STD, T.B, materia etc. for which specific goals were also set.
C. Health committee and health report
Health services were established in India during the 18th century.
Which was actually started by the British administration.
Health services in India started in the true sense in 1921.
The initial medical and public health departments served differently and these different health services and health reports helped in planning.
✨️Bhore committee
The Bhore committee was established in 1946 and its founder was Sir Josef Bhore.
Therefore, it is called the Bhore Committee and is also known as the Health Survey and Development Committee.
✅️Objectives
The objective of this committee was to survey the health status of the people of the country and the facilities and health organizations for it and make recommendations to the next department.
Based on these objectives, the Bhore Committee prepared its report in four parts and returned it to the government in 1946.
👉1. There is a need to make services from the administrative level to infrastructure closer. (From central level to state level)
👉2. As a long term plan, to build a 75-bed hospital in a population of 10,000 to 20,000 and to build a primary health unit.
👉3. To build a 650-bed hospital as a secondary health unit and a 2500-bed hospital at the direct district level.
👉4. It is recommended to upgrade medical and nursing education
✨️Chadah committee
The Government of India appointed this committee in 1926 under the leadership of Dr. M.S. Chadah, hence this committee is called Chadah Committee.
During the establishment of this committee, the director of general health services found during the study that the maintenance of national malaria eradication
is very necessary.
Recommendation
In accordance with national malaria eradication, a vidulance operation was created which is also responsible for general health.
Health assistant for male worker
Basic health worker should have a population of 1000, that is, he should be at a sub center.
Family planning health assistant should supervise 3 to 4 basic health workers.
At the district level, the responsibility of the maintenance phase of the national malaria eradication program was handed over to the general health services.
✨️Mukherji committee
In 1965, basic health services should be provided at the block level.
For that, a detailed report should be prepared, in which more staff should be placed at PHC.
So that malaria and smallpox work can be done well.
The following suggestions were made in the report of Mukherji committee and the report was submitted in 1966.
For an area of 1,000 population, there should be one basic health worker to do malaria work and one supervisor for his supervision.
One LHV should be appointed to supervise four ANMs.
When the Central Council of Health met in Srinagar in 1964, they studied the issues of health services integration and practice done by government doctors, etc., and then submitted a report.
Recommendation
There should be common seniority.
The qualification of additional staff should be calculated.
Equal pay for equal work
Special pay for special work
Private practice should be stopped and good service conditions should be created.
✨️Kartar singh Committee
This committee was formed in 1972.
This committee was established in the post of traditional secretary in the health and family planning service of the Government of India, Shriman Kartar Singh, in which the question of MPW for health arose.
This committee submitted its report in 1973, in which the following recommendations were made.
It was said that MPW is more desirable for providing health services, family planning and nutrition services in rural areas.
To replace the name of ANM with FHW and basic health visitor and to replace malaria worker, vaccinator, health educator, family planning, health assistant with male health assistant.
To first place MPW where malaria is in maintenance phase and then to place other MPW in the remaining areas.
There should be a team of health workers at the sub center, which should include one female and one male health worker.
The population of each sub center should be 3000 to 3,500
There should be one male supervisor for four male health workers, similarly there should be one FHS for four female health workers and for this, LHV should be appointed as female health supervisor.
To recruit qualified PHN in place of lady health visitor.
To appoint a doctor for all the charge of PHC and supervision of health workers.
✨️Shree Vastav Committee
In 1974, the government of India set up a group whose main purpose was to work for medical education and supporting manpower.
This group was known as Shree Vastav Committee.
In 1974, this committee submitted its report to the government.
The recommendations were as follows…
To set up a group committee of professional and semi professional health workers. Such as, post master, teacher, gram sevak etc.…
Who can generally provide promotive, preventive and curative services according to the community needs.
Create two posts of health worker known as MPW, who is like a link between the worker and the doctor of PHC in the community.
Develop referral services in which PHC, district hospital and medical college should be organized in a link so that services up to bigger and higher level can be easily available from PHC.
Considering the need for health and medical education, appoint a medical and health education commissioner for its planning and implementation.
✨️Balaji committee
The following issues were included in the national policy for education in 1986 by the Ministry of Health and Family Welfare of the Government of India.
For this, a health manpower committee was formed, whose chairman was Balaji
Prepare a national policy for education in health service.
Prepare a curriculum for school teachers, which should include social moral health and physical education in a holistic approach.
Check the quality of statistical data of health service.
Use the services of indigenous system of medicine, in which help is taken in the national health program of homeopathy.
Include health related issues in standard 9 and 10.
Organize a continuing education program for health members.
If there is a need for manpower in health, help nursing personnel.
➡️ D. National health policy
In 1983, the government of India’s ministry of health and family welfare and national policy set specific goals for the years 1984, 1990, 1995 and 2000 to achieve specific goals.
The national health policy gave a new approach to health planning in India and a new path was found on a new foundation.
Primary health care is the central function in the national health care system.
The government of India in the ministry of health and family welfare decided on a national health policy, based on which in the year 2000, two themes were implemented in the health for all i.e. health for all by 2000 AD, in which necessary changes were made in the health sector and a new health policy was implemented in 2002.
✅️Objectives
To maintain the standard of health of the population of the country.
To maintain the structure of the decentralized public health system and to re-establish the infrastructure.
To make efforts so that the people of the country take advantage of maximum health services.
To give priority to preventive care and to emphasize on primary health level.
To focus more on some diseases that people find burdensome in life.. such as, TB, malaria, blindness and HIV, AIDS.
To use allopathic medicines.
To change the object of the above health policy in reality, the years 2005, 2007, 2010 and 2013 were decided. goal 2005
Polio eradication
Eliminate leprosy
National health account and health statistics
Increase state health budget goal 2007
Eliminate Kala Azar
Reduce mortality by 50% on account of TB, malaria, vector born disease
Reduce and prevention of blindness
Reduce IMR 1000 to 28, MMR below 1 and TFR to 2%. goal 2015
eliminate lymphatic filaria
Reduce death rate
➡️Rural health scheme
A very important recommendation of the Srivastava Committee was that community primary health care should be provided and for that, special training should be provided to the workers so that the health of the people remains in the hands of the people.
In 1977, the government accepted the committee that suggested the basic recommendations and it is known as the rural health scheme.
The training of community health workers started in 1977-78 in which the following steps were initiated.
To include medical colleges in the total health care medical of certain PHCs, so that medical education can be reoriented according to the needs of the community.
To provide reorientation training to MPWs who are involved in various communication disease control programs.
The above plan was adopted during the planning of the central council of health and central family welfare in April 1976.
➡️ Social welfare services
Social welfare services pay special attention to the weaker sections of the population, especially women, children, handicapped, aged, sc and st castes.
The Ministry of health and family welfare and government of India, keeping in mind the utilization issues, special programs are being prepared for welfare programs, disable programs and programs of social defense sc and st.
Similarly, a framework has been created for the welfare of women and children.
Health services for festival and fair
Religious festivals are celebrated in different ways at different places and periodically organizing different types of structures creates religiousness, for example, Kumbh Mela, Tarnetar Mela, Janmashtami Mela, Shivratri Mela. During such fairs, there are chances of epidemic or GI disease, so during such fairs, the health authority has the full responsibility to ensure the health of the people and prevent the disease.
The responsibility of the health authority during such fairs is as follows,
safe water supply
Environmental sanitation
Extra disposal
refuse disposal
control of fly
Control of infectious disease
To provide medical care and health education
Planning is done considering the above matters.
For which, keep additional preparation of medical team, hospital and emergency.
Keep a medical team ready with medical store in the fair or religious place where more people are going to gather.
💜Health education by Social welfare services
During such fairs or religious places, a health store is set up to create public awareness about health, in which printed poster material is placed for health education.
This allows the public coming to the fair to get information about health and in this way every facility created for the public is checked.
Apart from this, during the fair, other services are provided by NCC, home guard and other voluntary organizations.
In social welfare service, different social welfare activities are carried out, especially for the protection of the backward classes, which are as follows.
👉1. Welfare program
Welfare of disease
About 120 lakh people are disabled in our country. For such people, a program has been implemented by the Ministry of Health and Family Welfare, in which early detection, treatment, education and rehabilitation of such people as well as some diseased persons such as blind, handicapped, MR and leprosy have been implemented.
The role and responsibilities of CHN in this program are as follows:
To guide parents
To provide Occupational therapy
Vocational guidance
Preventive activity (polio)
Community education
👉2. Social defense services
Socially abandoned or involved in criminal activities, as well as living in orphanages and abandoned by society from different places are gathered and given shelter and given an opportunity to improve.
So that their lives can be improved systematically again, efforts are made to improve the activities of such people by giving them work in home industries, handicraft industries, spinning or jute industries.
👉3. Combined program for women and children welfare
Different development works are done for women and children welfare.
Such works are divided into two parts by the department of women and child development,
A. Nutrition and child development
In which works are done to ensure that children get adequate nutrition.
The growth and development chart of the child is maintained and if necessary, additional nutritional food is provided.
B. Women welfare and development
In which different works are done for the protection and welfare of women as well as for the all-round development of women.
The above institutions, with the cooperation of the society, different activities are done for the welfare of mothers and children, including home industry, handicraft industry, sewing work and its training for women.
Many of these above creative activities are taught.