Describe the important health committees of India and their recommendations.

Health Committees in India

• The BHORE committee (1946) — the Health Survey and Development Committee, the foundation document of Indian health planning
• Its recommendations — integration of preventive and curative services at all levels; development of primary health centres in two stages, with a short-term plan of one PHC per 40,000 population with 2 doctors, 4 public health nurses, 1 nurse, 4 midwives, 4 trained dais, 2 sanitary inspectors, 2 health assistants, 1 pharmacist and 15 other staff; and a long-term (3 million) plan of primary health units with 75-bedded hospitals
• Also — major changes in medical education, including three months of training in preventive and social medicine; and the concept of the "social physician"
• The social physician concept is the committee’s most quoted idea — that the doctor should be oriented to the health of the community and not only to the treatment of individuals, and that the basic doctor should be a social physician rather than a technician
• The committee also stated the principle that "nobody should be denied health care for inability to pay", which anticipates universal health coverage by seventy years
• The mudaliar committee (1962) — the Health Survey and Planning Committee, appointed to review progress since Bhore
• Its findings and recommendations — it found PHCs overburdened and unable to serve 40,000 people adequately, and therefore recommended limiting each PHC to 40,000 and strengthening existing centres rather than opening new ones; improvement of sub-divisional and district hospitals to serve as referral centres; strengthening of regional organisations between state and district; and constitution of an all-INDIA health service on the pattern of the Indian Administrative Service
• The "consolidate rather than expand" recommendation recurs throughout Indian health planning, and remains the correct diagnosis today
• The CHADHA committee (1963) — on malaria maintenance; recommended that malaria vigilance be carried out by basic health workers, one per 10,000, combining malaria work with family planning and vital statistics
• The mukerji committee (1965) — found that the Chadha arrangement had failed, because the basic health worker could not do both jobs and malaria work suffered
• It therefore recommended separating family planning from malaria, with separate staff for family planning
• The sequence Chadha to Mukerji is the most instructive pair — combining functions overloaded the worker, so functions were separated; and separation then produced the very fragmentation that Kartar Singh later had to reverse
• This oscillation between integration and separation recurs, and the lesson is that integration works only if the workload and supervision are adjusted with it
• The mukerji committee (1966), a second committee of the same name, reviewed the working of the basic health service
• The jungalwalla committee (1967) — on integration of health services; defined integrated health service as one with a unified approach to all problems, medical care for all, no distinction between intramural and extramural work, and a unified cadre with common seniority, recognition of extra qualifications, equal pay for equal work, and no private practice
• The KARTAR SINGH committee (1973) — on multipurpose workers; recommended converting single-purpose workers into multipurpose workers, one male and one female per 5,000 population, with one supervisor per four such pairs
• The srivastava committee (1975) — the Group on Medical Education and Support Manpower
• Its recommendations — creation of bands of para-professional and semi-professional health workers from within the community itself; development of a referral services complex; and establishment of a medical and health education commission
• Its significance is that it led directly to the community health worker scheme of 1977, which is the intellectual ancestor of the ASHA
• The BAJAJ committee (1986) — on health manpower planning, production and management; recommended a National Medical and Health Education Policy, a national health manpower cell, and educational commissions
• Later documents rather than committees — the national health policies of 1983, 2002 and 2017; and the high level expert group on universal health coverage (2011), which recommended raising public health expenditure substantially, a National Health Package, and provision through a strengthened public system rather than through insurance
• The national health policy 2017 targets public health expenditure of 2.5% of GDP, free drugs and diagnostics in public facilities, and Health and Wellness Centres delivering comprehensive primary care
• Read Chadha and Mukerji as one lesson, since combining functions overloaded the worker and separation then fragmented the service
• Integration needs workload adjusted with it, or it simply reappears as overload under a different name
• Bhore said nobody should be denied for inability to pay, which anticipated universal health coverage by seventy years
• The social physician is Bhore most quoted idea, orienting the doctor to the community rather than only to individuals
• Bhore introduced three months of preventive medicine into the medical curriculum, which is why this subject exists
• Mudaliar said consolidate rather than expand, which recurs throughout Indian health planning and remains correct
• Srivastava led directly to the ASHA, through the community health worker scheme of 1977
• Kartar Singh recommended one pair per five thousand, with one supervisor for every four such pairs
• Jungalwalla defined integration precisely, including a unified cadre, equal pay and no private practice
• The High Level Expert Group preferred public provision over insurance, which is a live policy disagreement
• The 2017 policy targets two and a half per cent of GDP, which remains well above actual public health spending
• Mudaliar wanted an all-India health service, on the pattern of the administrative service, which was never created