PADMASHREE INSTITUTE OF NURSING

SEMINAR ON
Five year PLANNING & various committee reports on health
SUBMITTED TO: Mr. DINESH SELVAM PROFFESSOR & PRINCIPAL PADMASHREE INSTTUTE OF NURSING

SUBMITTED BY: Mr. SARATH CHANDRAN.C II YEAR M.Sc NURSING PADMASHREE INSTTUTE OF NURSING

SUBMITTED ON : 8 dec 2010

INTRODUCTION Good health is a pre requisite to human productivity &development processes, A nation development is depends on the health of its people. Therefore, promotion of health is basic to national progress. To provide proper health to the people & to utilise the available resources to maximum extent health care planning is very essential OBJECTIVES

General Objectives: On completion of the class the group will have in depth knowledge regarding health care planning. Specific Objectives: After completion of the session, the group will be able to

Explain the meaning of 5 year plan Discuss the 5 year Plans Explain various committee reports on health

TERMINOLOGIES
1. HEALTH: Health is a state of complete physical, mental, social & spiritual wellbeing not merely the absent of diseases. 2. PLANNING: Planning is the logical decision making processes used to design an orderly, detailed series of actions for accomplishing specific goals & objectives 3. CARE: Concern 4. POLICIES: Course of action

5. BUDGET: Annual estimate of revenue & expenditure 6. LEGISLATION: The enacting of law 7. ORGANIZATION: Organized body of system 8. ADMINISTRATIVE: Concerned with administration 9. CONCEPTUAL: Pertaining to conception 10. MODELS: Pattern 11. STATISTICS: Numerical facts systematically collected 12. ATTITUDE: Settled behaviour as showing opinion 13. MONITORING: Observation

14. EVALUTION; Assessment of outcome 15. ECONOMICAL: Saving 16. COMISSION: Command, authority 17. PROJECT: Design 18, AUTHORITIES: Legal power of right 19. OBJECTIVES: Pre-determined goals 20. INTERPRET: Explain. Translate 21. GOALS: Object of ambition or efforts 22. EVIDENCE: Fact available as proof

HEALTH IN FIVE YEARS PLANS

INTRODUCTION Five years plan is mechanism to bring about uniformity in policy formulation in programmes of national importance The specific objectives of the health programme, during Five years plan, are as follows: 1. 2. 3. 4. Control & eradication of major communicable diseases. Strengthening of basic health services through the establishment of the PHC & sub enters. Population control. Development of health manpower resources.

For the purpose of planning the health sectors has been divided in to following sub sectors. 1. 2. 3. 4. 5. 6. 7. Water supply & sanitation. Control of communicable diseases. Medical education, training & research. Medical care including hospitals, dispensaries & PHCs. Public health services. Family planning. Indigenous system of medicine.

FIRST FIVE YEAR PLAN (1951 1956)

The first Indian Prime Minister, Jawaharlal Nehru presented the first five-year plan to the Parliament of India on 8 December 1951. The first plan sought to get the country's economy out of the cycle of poverty. The plan addressed, mainly, the agrarian sector, including investments in dams and irrigation. The agricultural sector was hit hardest by the partition of India and needed urgent attention.[2] The total planned budget of 206.8 billion was allocated to seven broad areas: 1.irrigation and energy 2. agriculture and community development 3. transport and communications 4. industry 5. social services 6. land rehabilitation 7 other sectors and services
The specific objectives were; 1. 2. 3. 4. 5. 6. 7. Provision of water supply & sanitation. Control of malaria. Preventive health care of the rural population. Health services for mother & children. Education & training in health. Self sufficiency in drug & equipments. Family planning & population control.

During this plan period the public sector outlay was Rs. 2356 crores of which Rs. 140 crores were allotted for health programs.

SECOND FIVE YEAR PLAN (1956-1961)

The second five-year plan focused on industry, especially heavy industry. Unlike the First plan, which focused mainly on agriculture, domestic production of industrial products was encouraged in the Second plan, particularly in the development of the public sector. The plan followed the Mahalanobis model, an economic development model developed by the Indian statistician Prasanta Chandra Mahalanobis in 1953. The plan attempted to determine

the optimal allocation of investment between productive sectors in order to maximise long-run economic growth .
The specific objectives were; 1. Establishment of institutional facilities to serve as a basis from which service could be render to the people both locally & surrounding territory. 2. Development of technical man power through appropriate training programmes. 3. Intensifying measures to control widely spread communicable disease. 4. Encouraging active campaign for environmental hygiene. 5. Provision of family planning and other supporting services. During this plan period the public sector outlay was Rs. 4,800 crores of which Rs. 225 crores were allotted for health programs.

THIRD FIVE YEAR PLAN (1961-1966)

The third plan stressed on agriculture and improving production of rice Many primary schools were started in rural areas. In an effort to bring democracy to the grassroot level, Panchayat elections were started and the states were given more development responsibilities. State electricity boards and state secondary education boards were formed. States were made responsible for secondary and higher education.

The specific objectives were in tuned with the 1st & 2nd five years plan except that integration of public health with maternal & child welfare, nutrition & health education was planned. During this plan period the public sector outlay was Rs. 7,500 crores of which Rs. 341.8 crores were allotted for health programs.

FOURTH FIVE YEAR PLAN ( 1969-1974)

At this time Indira Gandhi was the Prime Minister. The Indira Gandhi government nationalised Green Revolution in India advanced agriculture

Certain objectives of the Mudaliar committee were the base for this plan in relation to health. 1. To provide an effective base for health services in rural areas by strengthening the PHCs. 2. Strengthening of sub-division & district hospitals to provide effective referral services for PHCs,

3. Expansion of medical & nursing education & training of Para medical personnel to meet the minimum technical man power requirements. During this plan period the public sector outlay was Rs. 16,774 crores of which Rs. 1,156 crores were allotted for health programs.

FIFTH FIVE YEARS PLAN (1974-1979)

Stress was laid on employment, poverty alleviation, and justice. The plan also focused on selfreliance in agricultural production and defense. In 1978 the newly elected Morarji Desai government rejected the plan. Electricity Supply Act was enacted in 1975,

The emphasis of the plan was on removing imbalance in respect of medical facilities & strengthening the health infrastructure in rural areas. Specific objectives to be pursued during the plan were: 1. 2. 3. 4. 5. Increase accessibility of health services to rural areas. Correcting regional imbalance. Further development of referral services. Integration of health, family planning & nutrition. Intensification of the control & eradication of communicable diseases especially malaria & smallpox. 6. Quantitative improvement in the education & training of health personnel. During this plan period the public sector outlay was Rs. 37,250 crores of which Rs. 3,277 crores were allotted for health programs.

The sixth plan also marked the beginning of economic liberalization. Price controls were eliminated and ration shops were closed. This led to an increase in food prices and an increase in the cost of living. Family planning was also expanded in order to prevent overpopulation. In contrast to China's strict and binding one-child policy, Indian policy did not rely on the threat of force. More prosperous areas of India adopted family planning more rapidly than less prosperous areas, which continued to have a high birth rate.

SEVENTH FIVE YEAR PLAN (1985-89)

The main objectives of the 7th five year plans were to establish growth in the areas of increasing economic productivity, production of food grains, and generating employment opportunities.

The thrust areas of the 7th Five year plan have been enlisted below:

Social Justice Removal of oppression of the weak Using modern technology Agricultural development Anti-poverty programs Full supply of food, clothing, and shelter Increasing productivity of small and large scale farmers Making India an Independent Economy

The objectives were 1. Eliminate poverty & illiteracy by 2000 2. Achieve near full employment secure satisfaction of the basic needs of food, cloth, shelter and provide health for all. 3. To provide an effective base for health services in rural areas by strengthening the PHCs. 4. universal immunisation programme 5. Promotion of voluntary acceptance of contraceptives During this plan period the public sector outlay was Rs. 1.80.000 crores of which Rs. 3,392 crores were allotted for health programs.

Period between 1989-91

P.V. Narasimha Rao was the twelfth Prime Minister of the Republic of India and head of Congress Party 1989-91 was a period of political instability in India and hence no five year plan was implemented. Between 1990 and 1992, there were only Annual Plans.

EIGHTH FIVE YEAR PLAN (1992-97)

India became a member of the World Trade Organization on 1 January 1995.This plan can be termed as Rao and Manmohan model of Economic development. The major objectives included, containing 1. 2. 3. 4. population growth, poverty reduction, employment generation, strengthening the infrastructure,

5. Institutional building,tourism management, 6. Human Resource development, 7. Involvement of Panchayat raj, 8. Nagarapalikas, 9. N.G.Os and 10. Decentralization and people's participation.

It is based on the national health policies. 1. Human development is the ultimate goal of this plan. 2. Employment generation, population control literacy, education, health, drinking water & provision of adequate food &basic infrastructure. 3. Towards health for the underprivileged was the of the aim of this plan . The PHCs were strengthened staff vacancies, by supplying essential equipment &drugs. AIDS control program was initiated during this plan.

NINTH FIVE YEAR PLAN (1997-2002)

Ninth Five Year Plan India runs through the period from 1997 to 2002 with the main aim of attaining objectives like speedy industrialization, human development, full-scale employment, poverty reduction, and self-reliance on domestic resources. Background of Ninth Five Year Plan India: Ninth Five Year Plan was formulated amidst the backdrop of India's Golden jubilee of Independence. The main objectives of the Ninth Five Year Plan India are:

to prioritize agricultural sector and emphasize on the rural development to generate adequate employment opportunities and promote poverty reduction to stabilize the prices in order to accelerate the growth rate of the economy to ensure food and nutritional security to provide for the basic infrastructural facilities like education for all, safe drinking water, primary health care, transport, energy to check the growing population increase to encourage social issues like women empowerment, conservation of certain benefits for the Special Groups of the society to create a liberal market for increase in private investments

During this plan, vertical health program were integrated horizontally with general health services.

The Reproductive & child health program was improved under following guidelines; 1. 2. 3. 4. Decentralize RCH to the level of PHCs. Base planning for RCH services on assessment of the local needs. Meet the needs of contraceptives Involve the general practitioners & industries in family welfare work.

The other measure undertaken during this plan was development of integrated control programme against non-communicable diseases.

TENTH FIVE YEAR PLAN(2002-2007)

Reduction of poverty ratio by 5 percentage points by 2007; Providing gainful and high-quality employment at least to the addition to the labour force;*All children in India in school by 2003; all children to complete 5 years of schooling by 2007; Reduction in gender gaps in literacy and wage rates by at least 50% by 2007

This plan has laid down the following targets Bring down the decadal growth rate by 16.2% in the decade from 2001 to 2011. Reduce infant mortality rate to 35/1000 live births by 2007 & to 28/1000 live births by 2012 Reduce maternal mortality rate to 2/1000 live births by 2007 & 2/1000 live births by 2012.

To achieve the above, the government is planning to do the following 1. 2. 3. 4. 5. 6. Restructure existing health infrastructure. Upgrade the skills of health personnel Improve the quality of reproductive & child health Improve logistic supplies. carry out the research on nutritional deficiency Promote rational drug use.

ELEVENTH PLAN (2007-2012)

1. Income & Poverty o Create 70 million new work opportunities. o Reduce educated unemployment to below 5%. o Raise real wage rate of unskilled workers by 20 percent. 2. Education o Reduce dropout rates of children from elementary school from 52.2% in 2003-04 to 20% by 2011-12

o o

Develop minimum standards of educational attainment in elementary school, and by regular testing monitor effectiveness of education to ensure quality Increase literacy rate for persons of age 7 years or above to 85% Reduce infant mortality rate to 28 and maternal mortality ratio to 1 per 1000 live births Reduce Total Fertility Rate to 2.1 Provide clean drinking water for all by 2009 and ensure that there are no slipbacks Reduce malnutrition among children of age group 0-3 to half its present level Reduce anemia among women and girls by 50% by the end of the plan

3. Health
o o o o o o

4. Women and Children o Raise the sex ratio for age group 0-6 to 935 by 2011-12 and to 950 by 2016-17 o Ensure that at least 33 percent of the direct and indirect beneficiaries of all government schemes are women and girl children o Ensure that all children enjoy a safe childhood, without any compulsion to work 5. Infrastructure o Ensure electricity connection to all villages and BPL households by 2009 and round-the-clock power. o Ensure all-weather road connection to all habitation with population 1000 and above (500 in hilly and tribal areas) by 2009, and ensure coverage of all significant habitation by 2015 o Connect every village by telephone by November 2007 and provide broadband connectivity to all villages by 2012 o Provide homestead sites to all by 2012 and step up the pace of house construction for rural poor to cover all the poor by 2016-17 6. Environment o Increase forest and tree o Attain WHO standards of air quality in all major cities by 2011-12. o Treat all urban waste water by 2011-12 to clean river waters. o Increase energy efficiency by 20 percentage points by 2016-17.

I.

VARIOUS HEALTH AND FAMILY WELFARE COMMITTEES

1. Bhore committee In 1946, the recommendations and guidance provided by the Bhore Committee formed the basis for organization of basic health services in India. The report was submitted to the government.-side was the focal point of these recommendation The Bhore Committee made two types of recommendations; a) A Comprehensive blue print for the distant future (20 to 40 years from then) and the smallest service unit was to be Primary Health Unit, serving a population of 10,000 to 20,000 b) A short-term scheme covering 2 to 5 years period from then with emphasis on setting up 30 bedded hospitals, one for every two Primary Health Care The country side was the focal point of these recommendations. Other recommendations were: Formation of village health committee to secure active cooperation and support in the development of health program. Provision of Doctors of future who should be Social Doctor, combines both curative and preventive of the public. Formation of District Health Board for each district with district health officials and representatives of the public. To ensure suitable housing, sanitary surroundings, safe drinking water supply, elimination of unemployment and lay special emphasis on preventive work. Intersectoral approach to health services development.

2. Mudaliar committee 1962

In 1959, the Government of India appointed another committee known as Health Survey and Planning Committee popularly known as Mudaliar Committee under the Chairmanship of Dr. A.L mudaliar. Recommendations: a) Consolidation of advances made in the first two-year plans

b) Strengthening of the district hospital with specialist services c) Regional organizations in each state d) Each primary health centre not to serve more than 40,000 populations. e) To improve the quality of health care provided by primary health centres f) Integration of medical and health services on the pattern of Indian Administrative service.

3. Chadah Committee, 1963

Under the chairmanship of Dr. M.S. Chadah, Government of India appointed a committee to study the arrangement necessary for the maintenance phase of the National Malaria Eradication Programe. Recommendations 1. Vigilance operations in respect of the NMEP should be the responsibility of the general health services (e.g.) PHC. 2. The vigilance operations should be should be done through monthly home visits by basic workers (Junior Health Assistant male) 3. Now each Junior Health Assistant Male to cover 3 5000 population 4. Mukherjee Committee, 1965 Under the chairmanship of Shri Mukerji, the then secretary of health to the Government of India was appointed to review the strategy for the family planning program. The recommendations of the Chadha Committee, when implemented, were found to be impracticable because the basic health workers, with their multiple functions could do justice neither to malaria work nor to family planning work. The Mukherjee committee headed by the then Secretary of Health Shri Mukherjee, was appointed to review the performance in the area of family planning. The committee recommended separate staff for the family planning programme. The family planning assistants were to undertake family planning duties only. The basic health workers were to be utilised for purposes other than family planning. Recommendations To have separate staff for the family planning program.

The family planning assistants were to undertake family planning duties only

The basic health workers were to be utilized for purposes other than family planning. To delink the malaria activities from family planning of its that the later would receive undivided attention of its staff. Mukherjee Committee, 1966 Multiple activities of the mass programmes like family planning, small pox, leprosy, trachoma, etc. were making it difficult for the states to undertake these effectively because of shortage of funds. A committee of state health secretaries, headed by the Union Health Secretary, Shri Mukherjee, was set up to look into this problem. The c ommittee worked out the details of the Basic Health Service which should be provided at the Block level, and some consequential strengthening required at higher levels of administration.

5. Jungalwalla Committee, 1967 Under the Chaimanship of Dr. Jungalwalla Director, National Institute of Health Administration and Education, New Delhi was appointed to examine the various problems of service conditions of doctors. This committee is known as the committee on integration of Health Services. Recommendation 1. 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) No private practice and good service conditions 6. Kartar Singh committee, 1973 The Government of India constituted a committee in 1922, known as the committee on multipurpose workers under Health and Family Planning, under the Chairmanship of kartar Singh, Additional Secretary, Ministry of Health and Family Planning, Government of India.

Recommendations The Present Auxiliary Nurse Midwives to be replaced by the newly designated Female Health Workers and the present day Basic Health Workers, malaria surveillance workers, vaccinators, health education assistants (Trachoma)and the family planning health assistants to redesignated by Male Health Workers. The program has to be introduced in areas where malaria is in maintenance phase and smallpox has been controlled and later to other areas. One primary health centre for 50,000 populations. Each PHC should be divided into 16 sub centers and each covers 3,000 to 35,00 population. Each sub centre to be staffed by a male and female health worker. One male health supervisor to supervise 3 to 4 male health workers and one female health supervisor to supervise the work of 4 female health workers. The lady health visitors to be designated as female health supervisors. The doctor in charge of a primary health centre should have the overall in charge of all the supervisors and health workers in the area.

7. Shrivastav Committee, 1975 The Government of India in the Ministry of Health and Family Planning had in November 1974 set up a Group on Medical Education and Support Manpower popularly known as Shrivastav Committee. Recommendations Creation of bands of paraprofessional and semiprofessional health workers from within the community itself (e.g. school teachers, postmasters, gram sevaks) to provide simple promotive, preventive and curative health services needed by the community. Establishment of 2 cadres of health workers, namely multipurpose health workers and health assistants between the community level workers and doctors at PHC. Development of a Referral Services Complex by establishing proper linkages between PHC and higher level referral services. Establishment of a Medical and Health Education Commission for planning and implementing the referrals needed in health and medical education on the lines of the University Grants Commission.

8. Balaji Committee 1986-19877 The Ministry of Health and Family welfare, Government of India, following the adoption of the National Policy on education, 1986, set-up a committee on Health Manpower, Planning, Production and Management in 1986 under the chairmanship of Prof. JS Balaji, Professor of Medicine, AIIMS, and New Delhi Recommendations To formulate a National Policy on education in Health Services To prepare curriculum for schoolteachers which should constitute a holistic approach including social, moral, health and physical education. Health service statistics needs to be improved in quality To utilize the services of Indian system of medicine viz. Homeopathy, in the area of National Health Program. Health related components to be included in IX, X Grades Continuing education program for the health personnel. Health manpower requirements for nursing personnel.

BIBLOGRAPHY

1.K.Park Preventive & Social medicine,18th edition M/S Banarsidas Bhanot Publishers,Jabalpur, Pp 666-670 2. Dr B.T.Basavantappa community health nursing, 2nd edition, Japee publishers, New Delhi Pp 872874 3. Stanhope Lancaster community health nursing, 4th edition Mosby Publishers,Missouri Pp 156-160. 4. Allender Spradley community health nursing 6th edition , lippincott Williams & willkins, London. Pp 375-377