MAMATA COLLEGE OF NURSING

KHAMMAM
SUBJECT: Nursing Management
TOPIC: COMMITTEE REPORTS
GUIDED BY: Dr. Mrs. Ratna Philip, Principal
DATE:
PRESENTED BY: Mrs. Udaya Sree.G, M.Sc. (N) II year
TIME:

SEMINAR ON COMMITTEE REPORTS

INTRODUCTION
Health planning in India is an integral part of national socioeconomic planning. The guidelines for national health planning were
provided by a number of committees dating back to the Bhore
committee in 1946. The committees were appointed by the government
of India from time to time to review the existing health situation and
recommended measures for these committees, which are important land
marks in the history of public health in India
The Amla 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
1. BHORE COMMITTEE, 1946
The Health Survey and Planning Committee in 1943. Sir Joseph
Bhore the chairman. To survey the then existing position regarding the
health conditions and health organization in the country to make
recommendations for the future development.
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).
The incidence of communicable disease also was very high.
Diseases like chicken pox, cholera etc occurred in epidemics.
The committee also observed that many of the health problems
were preventable.
It also observed that the investment made in preventing these
problems would give high returns in the forms of increased
productivity and development.

 The committee stated that, health and development are

interdependent. 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.
IMPORTANT RECOMMENDATIONS
Integration of preventive and curative services at all administrative
levels. The committee visualized the development of primary health
centres in two stages:
Short term plan: this plan was implemented within 5-10 years. Each
primary health centre in the rural area should cater to a population of
40,000 with a 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 were recommended.
A long term plan (3 million plans): It consists of health care system in
three tires.
First tier: - Setting up primary health units with 75 bedded
hospital for each 10,000 20,000 population with staff of 6 medical
officers, 6 public health nurses, 2 sanitary inspectors, 2 health
assistants and other supportive staff.
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. Major changes in medical
education which includes 3 months training in preventive and social
medicine to prepare social physicians
THE SHORT TERM PROGRAMME
The bed population ratio should be raised from 0.24/1000 to 1.03
at the end of 10 years.
Dental sections should be established in the hospitals at the
secondary health centres.
Provision of accommodation for health staff is essential in the
interest of efficiency.
Village communication should be developed.
For each 30 bed hospital there should be 2 motor ambulances
and one animal drawn ambulance.

 Travelling dispensaries should be provided to supplement the

health services rendered by primary health centres.
THE LONG TERM PROGRAMME
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.
The objectives to be kept in view after the first 10 years should be:
The raising of hospital accommodation to 2 beds/ 1000
population.
The creation of 18 new medical colleges in addition to the 43 to
be established during the first 10 years.
The establishment of 100 training centres for nurses.
The nursing training of 500 hospital workers.
2. MUDALIAR COMMITTEE
Mudaliar Committee Constituted in 1959 By GOI Under Dr. A
Lakshmanswamy Mudaliar, Vice Chancellor, Madras University Health
Survey and Planning Committee
TERMS OF REFERENCE
1. The assessment (or evaluation) in the field of medical relief and
public health since the submission of the Health Survey and
Development Committee's Report (The Bhore Committee)
2. Review of the First and Second Five-Year Plan Health projects and
3. Formulation of recommendations for the future plan of health
development in the country.
OBSERVATIONS
Observations Basic health facilities had not reached at least half
the nation Gross mal distribution of hospitals and beds in favour
of urban areas.
Quality of services provided by PHCs were grossly inadequate
with poor functioning, lack of referral system, and gross under
staffing due to insufficient resources
RECOMMENDATIONS
Consolidation of 1st two 5 yr plans
Strengthening district hospitals to serve as central base for
specialist services
Regional organisation between headquarters and the district in
charge of a regional deputy or assistant director-each supervise 2
or 3 district medical and health officers
Each PHC not to serve more than 40,000 populations

 To improve the quality of health care provider by the primary

health centres
Integration of medical and health services as recommended by
the Bhore committee
Constitution of an all India health services on the pattern of
Indian administrative services

3. CHADHA COMMITTEE
A committee of health administrators and Malariologists reviewed
the National Malaria Eradication programme and recommended that a
special Committee should study in detail the preparations that are to be
made for the entry into the maintenance phase and formulate a plan.
Constituted in 1963 by government of India under Dr. MS. Chadha,
Director General of Health Services
TERMS OF REFERENCE:
The committee should go into the details of the requirement related
to the primary health centres, their planning, the necessary priority
required according to the needs of the maintenance phase of the Malaria
Eradication programme.
The committee should also consider the Staffing pattern required
for the malaria eradication programme but also for other health
activities and the manner in which the technical and supervisory staff of
the National Malaria Eradication programme organization should be
utilised after malaria eradication has been achieved
RECOMMENDATIONS
Maintenance to be done by general health services (block and
district level)
Through basic health worker per 10,000 population
Basic health workers should visit house to house once in a month to
implement malaria activities.
Basic health worker to serve as MPHW for family planning and vital
statistics Family Planning Health Assistance to supervise 3-4 basic health
worker
4. MUKERJI COMMITEE:
Following the Central Family Planning Council meet at Madras
Constituted in 1965 Headed by Shri Mukerji, Secretary, Ministry of Health
and Family Planning

OBSERVATION:
It was realised that the basic health worker could not function effectively
as multi -purpose worker.
RECOMMENDATIONS:
The committee recommended separate staff for family
programme
The family planning assistance were to undertake family
planning duties only
The basic health worker were to be utilised for purpose other
than family planning
The committee also recommended to delink the malaria
activities from family planning so that the later would receive
undivided attention of its staff

5. MUKERJI COMMITTEE, 1966

Following 13th Meeting of the Central Council of
Bangalore in June, 1966 - state finding it difficult to
maintenance phase of malaria and other programme
leprosy, Family Planning, trachoma Formed in 1966 By
India Headed by Shri B. Mukerji , Union Health Secretary

Health held at
take burden of
like small pox,
Government Of

TERMS OF REFERENCE
To review the staffing pattern of the primary health centre complex and
to recommend the minimum staff of various categories required at
different levels within the district so as to provide an integrated health
service capable of fully catering to the needs of the vigilance services in
the maintenance phase of National Malaria Eradication Programme,
smallpox eradication, tuberculosis, leprosy and trachoma control, etc. To
recommend the pattern of Central assistance for the States
RECOMMENDATIONS
Basic Health Services to be provided at block level
Strengthening required at higher level
Integrated approach in the entire health field - Programmes of
public health and medical care should be integrated to the
maximum extent possible and so also the programmes within
each field.
Health workers at the lower levels should become increasingly
multipurpose workers.

 In certain phases of any large national programme it may be

necessary to have separate staff, at the maintenance stage the
activities under the programme should get integrated more and
more with the basic health services and to the extent possible
should be taken care of through the domiciliary services.
One basic health worker for a population of 10,000
At the District level there should be as much integration of the
general health programme with the family planning programme
as possible, ensuring at the same time however, that the family
planning programme continues to receive adequate attention
and profits from such integration
The Committee did not attempt to work out any details of the
organisation that would be needed above the District level, i.e. at
the local, the State and the Central levels
They also felt that the State Government could themselves work
out better the strength and pattern and method of functioning of
the health organisation at the local and State levels.

JUNGALWALLA COMMITTEE
Central Council of Health, 1964 Srinagar Dr. N.Jungalwalla, Director
General of Health Services Committee on Integration of Health
Services Submitted report under 1967
TERMS OF REFERENCE
To study the problems of the health services Service conditions
Elimination of Private practice
Definition of Integrated Health Services:
A service with a unified approach for all problems instead of segmented
approach for different problems
Medical care of the sick and conventional public health programmes
functioning under a single administrator and operating in unified manner
at all levels of hierarchy with due priority for each programme obtaining
at a point of time
RECOMMENDATION:
Integration from highest to lowest level in services
Integration of preventive and curative services

 Integration of medical services and public health(rotation of

personnel)
The main steps recommended towards integration were:
a) unified cadre
b) common seniority
c) recognition of extra qualifications
d) equal pay for equal work
e) special pay for specialized work
f) no private practice, and
g) good service conditions
6. KARTAR SINGH COMMITTEE:
Meeting of the Central Family Planning Council 1972 By GOI In 1972 The
committee on multipurpose workers under Health and Family Planning
Kartar Singh, Additional. Secretary, Ministry Of Health and Family
Planning, government of India, Report submitted in 1973
TERMS OF REFERENCE:
Structure for integrated services the peripherals and supervisory
levels
Feasibility of Multipurpose, bi-purpose Workers in the field.
The training requirements
Utilisation of mobile services for integration
RECOMMENDATIONS:
Re-designation of ANMs replaced by FHW s
Lady health visitor to be designed as female health supervisor
BHW, Malaria surveillance workers, vaccinators, FPHAs replaced
by MHW s
For proper coverage, there should be 1 PHC 50,000 population
1 PHC 16 sub-centers (3000 3500)
1 Sub center to be staffed by a team of 1 MHW and 1 FHW
1 male supervisor look after 4 MHWs
1 female supervisor supervise 4 FHWs
Doctor in charge of PHC should have the all supervisors and
health workers in his area
These all to be implemented in 5th 5yr plan
7. SHRIVASTAV COMMITTEE
Ministery of Health and Family welfare Programme, Government Of India.
In 1974 Group on Medical Education and Support Manpower Submitted
report in 1975

TERMS OF REFERENCE:
To devise a suitable curriculum for training a cadre of Health
Assistants
To suggest steps for improving the existing medical educational
processes as to provide due emphasis on the problems particularly
relevant to national requirements
To make any other suggestions to realise the above objectives and
matters incidental thereto
RECOMMENDATIONS
Organization of the basic health services (including nutrition,
health education and family planning) within the community
itself and training the personnel needed for the purposes; Creation of Village Health Guide (VHG) or community health
volunteers from the community itself like teachers, postmasters,
gram sevaks who can provide comprehensive health services as
paraprofessionals. - Primary health care be provided within the
community itself through specially trained workers so that the
health of the people is placed in the hands of people themselves
Creation of MPW and Health Assistants (HA) in between the VHG
and MO at PHC to bridge the community with the first level
referral Centre
The creation of a National Referral Services Complex by the
development of proper linkages between the PHC and higher
level referral and service centres;
Establishment of The Medical and Health Education Commission
for planning and implementing the reforms needed in health and
medical education
The committee recommended that by the end of 6 th five year
plan, 1 male and 1 female health worker should be available for
every 5000 population
There should be 1 male and 1 female health assistant for 2 male
and 2 female health worker
8. RURAL HEALTH SCHEME
Based on these recommendations Rural Health Scheme was launched
by the government in 1977-78.
The major steps initiated were:
a) Involvement of medical colleges in health care of selected with the
objective of reorienting medical education according to rural population
called Re Orientation of Medical education (ROME). It led to teaching and
training of undergraduate students and Interns at PHCs.
b) Training of Village Health Guides and utilising their services in the
general health service system.

REPORT OF THE WORKING GROUP ON HEALTH FOR ALL BY 2000

A.D.:
As India was party to the universal commitment of Health for All by
2000 A.D. By Planning Commision In 1980 Kripa Narain, Sec., MOHFW &
President, AIIMS Report submitted in 1981
TERMS OF REFERENCE:
To review current health status, implementation of programmes and
measures for rectifying them Evolve plan outlines for 1980 1986 for
health sector so that foundation for HFA can be laid Specific programmes
for rural, tribal and weaker sections & to review health component on
minimum needs programme
RECOMMENDATIONS
Revised Minimum Needs Programme:
Each District - Health Centre with specialised curative and Public
Health experts)
Each Sub-division (5 lakh population)- Sub divisional Health
centre with epidemiological wing
Each block (1 lakh population) -CHC with specialist services
30,000 population
15,000 in hilly area -PHC providing preventive, promotive and
curative services 5,000 population
2,500 in hilly area - Sub centre with one MPW(F), MPW(M)
one part time attendant (One health volunteer) -1 village
9. SOKHEY COMMITTEE (1947):
Prescribing standards of dietary and nutrition for all classes of
population;
Investigation into the volume and causes of infant mortality, as
well as mortality among women; and suggestion of ways and
means of reducing such mortality;
Provision of the necessary health units, comprising physician,
nurses, surgeons, hospitals and dispensaries, sanatoria and
nursing homes;
Health insurance
Medical training and research;
compilation of vital statistics, including those of birth and death
rates;
cultivation of the necessary drugs and production of medicines to
preventive or curative aid, scientific and surgical appliances and
accessories of the national Health Services
10. CHOPRA COMMITTEE (1948)

Promotion of indigenous and modern medicine through integration in

education and multi-disciplinary research
11. MEHTA COMMITTEE (1957)
Balwant Rai Mehta - To assess performance of Community
Development Programme started in 1952 - concluded programme was
a failure due to lack of local initiative
12. RENUKA ROY COMMITTEE (1960) School Health committee recommended promotion of preventive care through schools,
provision of mid day meals, health education as part of curricular and
integration of school health and primary health network
13. JAIN COMMITTEE (1966) - To review the working of different
hospitals and central health services
14. KRISHNAN COMMITTEE (1982) - Headed by S.V. Krishnan - to
study health services in urban areas and cities
15. MEHTA COMMITTEE (1983) - Dr. Shantilal J. Mehta, Chairman
Medical Education Review Committee
16.

BAJAJ COMMITTEE (1987) - Prof. J.S. Bajaj, Professor of Medicine

Health Manpower Planning, Production And Management
Procedures relating to admissions to under-graduate courses
Procedures relating to admissions to the post-graduate course
Duration of the under-graduate course and Internship
Duration of the post-graduate courses and thesis
Measures to bring about overall improvement in the undergraduate and post-graduate education

17. REPORT
OF
THENATIONAL
COMMISSION
ON
MACROECONOMICS AND HEALTH (2005)
Under chairmanship of P. Chidambaram, Finance Minister and Dr.
Anbumani Ramadass, Health Minister
promoting equity by reducing household expenditure on total
health spending and experimenting with alternate models of
health financing;
restructuring the existing primary health care system to make it
more accountable;
reducing disease burden and the level of risk;
establishing institutional frameworks for improved quality of
governance of health;
Investing in technology and human resources for a more
professional and skilled workforce and better monitoring.

SUMMARY
The participation of nurses is essential in the local governments
decision-making and in the direction of community health services-in
health centres, clinics, hospitals and other settings of nursing practice.
The placement of nurses in policy making, administrative and
managerial posts will eliminate the inadequate knowledge of nursing
potential in the health care delivery system.
BIBLIOGRAPHY
Park. K (2009), Preventive and Social Medicine 20th edition,
Banrsidas Bhanot; Jabalpur.
Kamalam. S. (2005), Essentials in community health nursing
practices 1st edition. New Delhi: Jaypee brothers
BT.Basavanthappa (2008), Community Health Nursing2nd edition,
Bangalore (India): Jaypee publications
Baride. J. P. and Kulkarni. A. P. (2006), Text book of community
medicine 3rd edition, Mumbai: Vora medical publications