Unit:-2. Health and welfare committees

HEALTH AND WELFARE
COMMITTEES
PREETI THAKUR
SMVDCoN

INTRODUCTION
Health planning in India-integral
part of national socio-economic
planning.
 The guidelines for national health
planning were provided by a
number of health and welfare
committees.

INTRODUCTION
 Health planning in India is an integral part of national
socio – economic planning.
 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 recommended measures for further action.

 The Alma Ata Declaration on primary health
care and the National Health Policy of the
Government gave a new direction to health
planning in India making primary health
care the central function and main focus of its
national health system.
 The goal of national health planning in India
was to attain Health for All by the year 2000.

VARIOUS HEALTH COMMITTEES
1.BHORE COMMITTEE
(1946)
2. SHETTY COMMITTEE
(1954)
3.CHADHA COMMITTEE
(1963)
4.MUDALIAR COMMITTEE
(1962)
5.MUKHERJI COMMITTEE
(1965) 6.JAIN COMMITTEE 1966

VARIOUS HEALTH COMMITTEES contd…
7.JUNGALWALLA
COMMITTEE
(1967)
8.KARTAR SINGH
COMMITTEE
(1973)
9.SHRIVASTAVA
COMMITTEE
10.RAMALINGASWAMI
COMMITTEE
(1980 )
11.HIGH POWER
COMMITTEE ON
NURSING AND NURSING
PROFESSION (1987-1989)
12.BAJAJ COMMITTEE
(1986)

1.BHORE COMMITTEE 1946
 Bhore committee (Health Survey and Development
Committee) was appointed by the British India
government in 1943 under the chairperson of Sir Joseph
Bhore, an Indian civil servant.
 The secretary of the committee was Roa Bahadur KCKE
Raja, the then Director General of Health Services.
 The committee was asked to review the health services
in the country and make recommendations for their
improvement.

COMMITTEE DEALING WITH THE SUBJECTS
Public health
Medical relief
Professional
education
Medical research
Industrial health

COMMITTEES
CONSIDERED
Directors of
public health
institution - 3
Public health
specialists - 4
Representatives
from the
Medical Council
of India - 7

BHORE COMMITTEE’S RECOMMENDATIONS-
 Health should be made a state subject.
 The government should provide
“comprehensive health care” to the people;
comprehensive health is defined as the
integrated curative, preventive and
promotive care that is made available to every
individual without distinctions of caste, creed
and economic status.

Comprehensive health care
comprising a package of :-
❑Medical relief,
❑communicable disease control
❑environmental sanitation
❑maternal and child health care
❑school health services
❑health education
❑ vital statistics

 In the rural areas the government should set up
“primary health centers”. These centers will act as the
nodal center for providing comprehensive health care
for rural population. Some of the important
recommendations were:-
 Integration of preventive & curative services of all
administrative levels.
 Development of PHC in two stages:
1. Short term measures
2. Long term measure

DEVELOPMENT OF PHC IN TWO
STAGES:
 The government should
establish 1 primary health
center for every 40,000
population. This should be
staffed by
 2 doctors,
 1 nurse,
 4 public health nurses,
 4 midwives,
 4 trained dais,
 2 sanitary inspectors,
 2 health assistants
 1 pharmacist.
 Government should set up the
following ( termed as ‘3 million plan’)
 A 75 bedded primary health center for
10,000-20,000 rural population.
 A 65 bedded regional hospital.
 A 2,500 bedded hospital at the district
level.
Short term measures long term measure

 The central government should establish national medical
centers of excellence to train highly qualified medical
manpower.(The All India Institute of Medical Sciences, New
Delhi and the National Institute of Mental Health and
Neurosciences, Bangalore, were subsequently established).
 The government should set up 100 training centers all over
the country for the training of nurses. Ultimately there
should be 1 nurse available for every 500 population. It
should also provide training for hospital based social workers
 The government should make 3 months posting in the subject
of preventive and social medicine compulsory for the house
surgeons.

SHETTY COMMITTEE, 1954
 This committee was appointed
with the objective of reviewing the
salary and the working conditions
of nurses in the country.
 The committee found a great
shortage of nurses. It further
noted the following deficiencies in
their working conditions:

 Their pay scales were very low.
 They were over-worked. Most of
them worked for 50-90 hours a
week.
 They were made to bear the
cost of breakages of hospital
articles.

Great
shortage of
nurses
Very low pay
scales
Over-worked
(50-90
hours/week)
Bear the cost
of breakages
of hospital
articles
Report

Shetty committee’s
recommendations
At the state
level, the
government
concerned
should appoint
a
Superintendent
of Nursing
Services.
It should also
create
additional posts
of nursing staff
in hospitals.
It should
provide decent
living
accommodation
to the nursing
students.

CHADDA COMMITTEE, 1963
 It is also known as “Special
Committee on the Preparation of
Entry of National Malaria
Eradication Program into
Maintenance Phase”.
 The committee was headed by
Dr M.S.Chadda, the then
Director General of Health
Services.

CHADDA COMMITTEE’S RECOMMENDATIONS-
 Hand over malaria vigilance to general health service.
 Train the malaria surveillance workers to do basic health
work and re-designate them as Basic Health Workers.
Ensure there is 1 Basic Health Worker for every 10,000
population.
 Appoint a laboratory technician at each primary health
center.
 Appoint 1 health inspector for every 20,000-25,000 rural
population.
 Strengthen the district health organization.

MUDALIAR COMMITTEE, 1962
 It was appointed in 1962.it was headed by Dr. A
Lakshmnaswamy Mudaliar, the then Vice-chancellor
of Madras University.
 It was asked to review the progress in the health field
since Bhore committees and to take a fresh look at
health needs and resources of the country.
 The committee presented its report to the
government of India in 1965.

The Committee was sub-divided into different
sub-committees to deal with different subjects
like:
1.Medical care 2.Public health
3.Control of
communicable
diseases
4.Population
control
5.Professional
education and
research.

The Committee was sub-divided into different
sub-committees to deal with different subjects
like:
6.Indigenous
system of
medicine
7.Drugs and
medical
supplies
8.Legislation
9.Health
administration
10.Medical
research

1.MEDICAL CARE
 Ensure that a primary health center serves no more than 40,000
rural population.
 Improve the health services in the existing primary health centers.
 Ensure the primary health center provides not just curative but
comprehensive medical care.
 Appoint medical specialists at the level of district hospitals.
 Create an “All India Health Service” on the pattern of the
Indian Administrative Service.
 Increase the number of public health nurses, lady health visitors
and auxiliary nurse midwives so as to render effective maternal
and child services.

2.Public
health
Water
supply &
sanitation
Housing
School
health
Nutrition
Vital
statistics
Air
pollution
MCH

3.COMMUNICABLE DISEASE
Malaria
Filariasis
Tuberculosis
Leprosy
Small pox
Cholera

4. POPULATION PROBLEM
To solve the population
problem, family planning
services provided to the people.
Strengthening of educational
& propaganda aspects of FP
movement
Each & every health worker
should be oriented in method
of family planning..

5.MEDICAL EDUCATION
One medical college at
least 5 million
population.
Teacher –students ratio
should be 1:5.
Integrated method of
teaching involving
professors of both
clinical & para clinical
subjects.

6.MEDICAL RESEARCH
Research unit in
every medical college
should be set up and
one statistics unit in
every research
institute.

7.INDIGENOUS SYSTEM OF
MEDICINE

9.LEGISLATION
Universities should
accept standard laid
down by Indian
Medical Council.
Registration is must
before starting the
practice.

10.HEALTH ADMINISTRATION
At central level
State health
District level
Peripheral level

5. MUKHERJEE COMMITTEE, 1965 &
1966

MUKHERJEE COMMITTEE, 1965 & 1966
Headed by Sri. Mukherjee, then Secretary, Department of
Health, Union of India.
 The first presented its report to government in 1965. It
recommended –
 Delink malaria from family planning so that the later
receives undivided attention of health staff.
 Revise the family planning strategy: Appoint exclusive
staff for family planning by way of Family planning
Health Assistants for carrying out family planning.

RECOMMENDATIONS OF SECOND
COMMITTEE(1966)
 Appoint Basic Health Workers (BHWs) at the rate of
1/10,000 rural population. In urban areas, appoint 1
BHW for 15,000 slum dwellers.
 Appoint 1 Health Inspector to supervise the work of 4
BHWs.
 Appoint 1 Health Visitor to supervise the work of 4
Auxiliary Nurse Midwives.

 Make family planning a vertical
program. Fix targets for
contraceptives distribution and for
sterilizations. Provide incentives to
the acceptors of contraceptives/
sterilization.
 Establish strong administrative
machinery from the Center down to
the block level.
 At the District headquarters,
appoint a Nursing Supervisor.

JAIN COMMITTEE, 1966
One bed per 1000
population
50 beds hospital at
taluka level
Enhancing maternity
facilities at each level
Health insurance for
larger population
coverage
Recommendations

JUNGALWALA COMMITTEE, 1967
 This committee also known as Committee on
Integration of Health Services.
 Dr N. Jungalwala, the then Director of National
Institute of Health Administration and
Education (National Institute of Health and
Family Welfare), New Delhi, headed the
committee.

The committee stressed the
need for providing
integrated
curative,
preventive
promotive services from
the highest to the lowest
level.
It advocated a united
approach to health
problems- not segmental
solutions to individual
problems.

COMMITTEE’S RECOMMENDATIONS ARE-
 Uniform cadre of health workers.
 The preparation and maintenance
of a common seniority list of
health personnel.
 Sanctioning of equal pay for equal
work and special pay for special
work.
 Provision of good working
conditions for government
doctors.
 Banning private practice by the
government doctors.

One primary health
center for every 50,000
population
There should be 16 sub-
centers at the rate of
1/3000 to 1/3500
population under each
primary health center.
Each sub-center should be
manned by 1 Female
Health Worker and 1
Male Health Worker.

8. KARTAR SINGH COMMITTEE,
1973

KARTAR SINGH COMMITTEE, 1973
It is called
“Committee on
multipurpose
worker under
health and
F.P.”.
In the year 1972, the
government of India
constituted a
committee under the
chairmanship of
Kartar Singh,
Additional Secretary,
Ministry of Health
and Family Planning,
to study the structure
for integrated services
at the peripheral and
supervisory levels,
and the feasibility of
having multipurpose
workers in the field.
This committee
report is a milestone
in the history of
public health
nursing service
administration.

KARTAR SINGH COMMITTEE
RECOMMENDATIONS(1973)
1. ANMs should be replaced by the "Family Health Workers"
2.Basic Health workers (BHW), Malaria Surveillance worker
(MSW), Vaccinators, Health Education Assistant of Trachoma
(HEAT) and FPHAs to be replaced by "Male Health workers .

3.In the beginning where Malaria and
Smallpox were under control, MPW(M & F)
scheme were to be initiated and later to other
areas
4.P.H.C for 50,000 population
5.Each P.H.C. - 16 sub centers(3000 population)

6.Each sub centre should have M.P.W
(M) and M.P.W (F)
7.Health supervisor (F) should
supervisor 3-4 female MPW
8.Health supervisor (M) should
supervisor 3-4 male MPW

9.The concept of medical colleges integrating all health
,family planning ,nutrition & training programmes were
put forword.
10.This committee report is a milestone in the history of
Public Health Nursing Service administration.

SHRIVASTAV COMMITTEE, 1975
Also known as
“Group on Medical
Education and
Support Manpower”
Headed by Dr J B
Shrivastav, the then
Director General of
Health Services.

COMMITTEE’S RECOMMENDATIONS ARE-
 Center should create a new brand of Health
auxiliaries (Para-professional or semi-
professional workers) as a link between the
doctor of primary health center and the
multipurpose workers.
 Create a auxiliaries from out of the educated
members of the community such as the school
teacher, postman or gram sevika.

Give them training and post them back
to the village as “community Health
Guides (CHG)”.
CHG provide basic curative and
preventive services to the community.
Multipurpose workers would be
responsible for supervision of CHG.

There would be three tiers between the
community and medical officer of the primary
health center i.e.
Medical Officer of
Primary Health Center
Health Assistant
Health Worker,
Male/Female
Community Health
Guide
Community

RECOMMENDATIONS
• Steps to create bands of
paraprofessionals or semi professional
health workers from the community
itself to provide simple, protective,
preventive and curative services
• Between the community and the
primary health center, there should be
two cadres, health workers and health
assistants.

• Health workers should be trained and
to give simple, specified remedies for
day-to-day illness.
• Health assistants should be trained and
equipped to give simple specified
remedies for simple illnesses
according to their level of technical
competence.

RURAL HEALTH SCHEME, 1977
 The most important recommendations of the Shrivasav
Committee was that primary health care should be
provided within the community itself through specially
trained workers so that the health of the people is placed
in the hands of the people themselves.
 The “Plan of Action” was adopted by the Joint Meeting
of the Central Council of Health and Central Family
Planning Council held in New Delhi in April 1976.

• The primary health center should be
provided with an additional doctor
and nurse to look after MCH
services
• The primary health center , taluka
hospital, district hospital, regional
institution or medical college hospitals
should develop direct links with the
community around them, as well as
with one another

10. RAMALINGASWAMI COMMITTEE
1980

ICMR-ICSSR JOINT PANEL 1980
(RAMALINGASWAMI COMMITTEE)-
 This committee includes formulation of comprehensive
national health policy.
 The basic objectives of the policy should be-
 Development of health system should be integrated with
overall plans of socioeconomic development.
 To ensure access to adequate food, provide environment
conducive to health and adequate immunization where
necessary.
 Devise an educational programme for health.

OBJECTIVES OF THE COMMITTEE
 To replace the existing model of health care which will
be:
1. Village or community health voluntary/ health guide
for 1000,
1. Sub center for 5000 population,
2. Community health center for 10,000 population,
3. District health center for 1 million population.
4. The specialist center for 5 million population.

• 2.Combining the best element in the
tradition and culture of the people with
modern science and technology.
• 3.Integrating promotive, preventive and
curative functions.
• 4.Democratic, decentralization and
participatory model.

 6.Oriented to the people i.e. providing adequate health care to
every individual and taking special care of the vulnerable group.
 7.Firmly rooted in the community and involving people.
 8.To train the personnel, to produce drugs and materials and to
organize research needed for this alternative health care system.
 9.A detailed time bounded programme should be prepared, the
needed administrative machinery created and finance provided
on priority basis so that this new policy will be fully
implemented and the goal of “Health for All” be reached by the
end of 2000 A.D.

HEALTH FOR ALL BY 2000 AD- REPORT
OF THE WORKING GROUP, 1981
 A working group on Health was constituted by the
Planning Commission in 1980 with the Secretary,
Ministry of Health and Family Welfare, as the
Chairman, to identify, in programme terms, the goal
for Health for All by 2000 AD and to outline with
that perspective, the specific programmes for the
sixth Five Year plan.

11.HIGH POWER COMMITTEE ON NURSING
AND NURSING PROFESSION (1987-1989)

HIGH POWER COMMITTEE ON NURSING &NURSING
PROFESSION/ VARDHARAIN COMMITTEE (1987-1989)
Set up by the Government of India in July
1987, under the chairmanship of Dr Jyothi
former vice-chancellor of SNDT Women
University.
Mrs Rajkumari Sood, Nursing Advisor to
Union Government as the member-secretary
and CPB Kurup, Principal, Government
College of Nursing, Bangalore and the then
President, TNAI also one of the prominent
members of this committee.

Later on due to some
reasons, the committee was
headed by Smt Sarojini
Varadappan, former
Chairman of Central Social
Welfare Board

Terms of
Reference of the
Committee Are:-

1.To look into the existing working
conditions of nurses with particular
reference to the status of the nursing
care services both in the rural & urban
areas.
2.To study & recommend the staffing
norms necessary for providing adequate
nursing personnel to give the best
possible care, both in the hospitals &
community.

3.To look into the training of all categories &
levels of nursing, midwifery personnel to meet the
nursing manpower needs at all levels of health
services & education.
4.To study & clarify the role of nursing personnel
in the health care delivery system including their
interaction with other members of the health team
at every level of health service management.

5.To examine the need for organized nursing services
at the national, state, district & local levels with
particular reference to the need for planning service
with the overall care system of the country at the
respective levels
6.To look into all other aspects, the Committee
will hold consultations with the State
governments.

APPOINTMENT OF ANM/LHV/HS/PHN
ANM for 2500 population (2 per sub center),
1 ANM for 1500 population in hilly areas,
1 health supervisor for 7500 population (for 3
ANMs),
1 PHN for 1 PHC (30,000 population and 4
health supervisor),
2 district PHN officers in each district.

Simplification of recording
system.
Adequate provision of supplies,
drugs, etc, is made.
Gazetted rank for the post of
PHN and above grade.
Specific standing orders be
made available to ANM/LHV/HS

WORKING GROUP ON MEDICAL
EDUCATION AND MANPOWER PLANNING,
1984-
Initiate a scheme to induct in
medical students a liking for
rural health service. For this
purpose the Reorientation of
Medical Education (ROME)
Scheme was launched.
Provide advance training in
public health management to
doctors.
Accord high priority to the
training of nurses and other
paramedical personnel.
Establish a University of Health
Sciences and through it,
establish a network of health
care institutions.
Recommendations

BAJAJ COMMITTEE, 1986-
Also known as “Expert
Committee on Health
Manpower Planning
Production and
Management”.
Headed by Dr S Bajaj, a
professor of All India
Institute of Medical
Sciences, New Delhi.

RECOMMENDATIONS
1.Express a National Health
Manpower Policy.
2.Formulate a National Policy on
Education in Health Sciences.
3.Conduct a country wide survey
of health manpower

Appoint nurses as follows:
4.1 staff outpatient nurse/100 outpatients.
5. 1 staff nurse/10 hospital beds + 30% extra as leave reserve.
6. 1 ward sister/25 beds + 30% extra as leave reserve.
7. 1 NS for hospital with 200 beds or more.
8. 1 DNS for hospital with 300 beds or more

9.Upgrade & improve medical & health
educational infrastructure & technology.
10.In rural areas, establish a “Community
Health Center” for every 1,00,000 population.
11.Establish “Educational Commission for
Health Services” on the lines of the University
Grants Commission

12.Set up “Health Sciences University”
in all states & union territories.
13.Establish “Health Manpower Cell”
at the center and in the states.
14.Vocationalisation education at 10+2 level
as regards health related fields. This will
lead to the availability of good quality
paramedical personnel

Agenda to
be
discussed
National AIDS
control
programme
Tuberculosis
Control of
tobacco
National
alcohol
control policy
Ayush
Cancer
research &
treatment
National rural
health mission
Medical
education

CONCLUSION
These committees are appointed from
time to time to look into the issues of
the health care administration.,
Recommendations made by these
committees were very helpful to make
an excellent change in our health
care delivery system

SUMMARY
Intoduction
 Various health and welfare committes
❖ Bhore committee
❖ Shetty committee
❖ Chadha committee
❖ Mudaliar committee
❖ Mukherjee committee
❖ Jain committee
❖ Jungalwala committee
❖ Kartar singh committee
❖ Shrivastav committee

❖Rural health scheme
❖Ramalingaswami committee
❖Report of the working group
❖Working group on medical
education and manpower
planning
❖Bajaj committee
❖High power committee on
nursing and nursing profession

Unit:-2. Health and welfare committees

Unit:-2. Health and welfare committees

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