Introduction

Various committees of experts have been appointed by the government from time to time to render advice about different health problems in India.

BHORE COMMITTEE

It was set up in 1943, under the chairmanship of Sir Joseph Bhore by the british government of India.

The Government of India appointed this committee, to make broad survey of the existing health conditions

Members of the committee• 1.B Shiva Rao,member,Medical council of

India• 2.LK Maitra,Member, Medical council of India• 3.PN Sapru, Member, Medical council of India• 4.NM Joshi, Member, Medical council of India• 5.Dr BC Roy, Member, Medical council of

India• 6.Dr Viswanath, Member, Medical council of

India• 7.Prof MA Hameed, Member, Medical council

of India

• 8.Dr.JB Grant,Director,All India Institute of Public Health

• 9.Dr Henry Sigerist,Hohn Hopkins society of Hygiene and Public health

• 10.Dr.Ognev,Soviet union• 11.Dr.AC Banerjee,Public Health

Specialist• 12.Dr AH Butt, Public Health Specialist• 13.Dr.KCKE Raja, Public Health Specialist• 14.Dr Jungalwalla, Public Health

Specialist

PRINCIPLES• No individual should be denied to secure

adequate medical care

• The health services should provide,all the consultant, laboratory and institutions facilities necessary for proper diagnosis and treatment.

• The health program must from the very beginning, lay special emphasis on preventive work.

• Medical relief and preventive care to the vast rural population .

• Health services should be located as close to the people

• Essential to secure the active cooperation of the people in the development of the health program

• Health development must be entrusted to ministries of Health

• The basic training to the doctor should be designed to equip him for social duties(protecting and guiding the people)

• Suffering and mortality in the country mainly the result of an inadequate provision of certain fundamental factors.

• 1. Integration of preventive and curative services at all administration level

• 2. Development of Primary health centres in 2 stages.

In short-term measure PHC in

rural area should include population of 40,000 with a secondary health centre to serve as a supervisory, coordinating and referral institution.

• 2 medical officer• 4 public health nurses• one nurse• 4 midwives• 4 trained dais • 2 sanitary inspectors• 2 health assistants • one pharmacist • 15 other class IV

employees

• Provision of hospitals and dispensaries in rural areas , less than that in urban areas

• Medical service should be free to all without distinction and that should be through the proper channel .It should ultimately decided by the government

In long-term program (also called 3 million plan) -setting up PHC with 75 bedded hospital, for each 10,000- to 20,000 population and secondary units with 650-bedded hospitals with 2500 beds

3 months training in preventive and social medicine to prepare social physicians.

SHORT TERM PROGRAMME-DETAILS

Short term programme--details• Combined preventive and curative health

work by ---a number primary,secondary and district health units and special health services for mothers and children,school children and industrial wookers

• Impersonal health services .

• Promotion of the hygienic mode of life style

• In each village,a health committee consisting of 5-7 individuals should be established

• Dental section should be established in the hospitals at secondary health services,provision should be made for ‘travelling dental units’ for service in rural areas.

• Provision of housing accommodation for health staff is essential

• 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 in sparsely populated areas

Long term programme-- Details

• Provision of optimum diet for all

• 8 ounces of milk per day should be included in the average diet, Nursing and expectant mothers ,children need much more.

Health education• Health education must promote

health and health consciousness

• Instruction of school children on hygiene should begin at the earliest possible stage

• Responsibility of health education rest on health departments of Governments

• There should be 1 or 2 physical training colleges in each province

• National Physical Education programme should include games,sports,and folk dances

Health services for mothers and children

• Measures directed to reduce the sickness and mortality among mothers and children must have priority

The functions of the school health services should be

• Preventive and curative health measures,including,detection and treatments and creation and maintenance of hygienic environment in and around the school

• Improvement of the nutritional state of the child

• Occupational healthOccupational health

• Special measures should be taken to counteract the adverse effects associated with the occupation

Environmental hygiene

• Legislation should be enacted in all provinces on a uniform basis both urban and rural area

Professional education• At the end of the first 10 years the

production of doctors should be4000-4500 per year

• New medical colleges with suitable teachers

• All India institutes should provide teachers with high quality,selected persons should be send abroad for training

Undergraduate education• There should be a reorganization in teaching

• Establishment of Preventive and Social Medicine in every college and inclusion of internship

• Stressing the importance of research

• Expansion of facilities in existing colleges

• Conversion of medical schools into colleges and the establishment of new colleges

• Post graduate education• Post graduate education should be

devised to provide training for consultants and specialists

• A special organization called the central committee should be established for laying down standards in respect of post graduate training in particular subjects

• There should be refresher course for general practitioner

Dental education• Provision should be made in

medical and dental colleges for training dental surgeons,dental hygienists and dental mechanics

• Legislation for compulsory registration of dentists

• Prohibition of practice by unregistered dentists

Pharmaceutical education

• Educational facilities for licentiate pharmacists ,graduate pharmacists and pharmaceutical technologists

Medical research• A statutory central research

organization should be constituted

• Provision of laboratory services in all provinces

• Development of research in various subjects like malaria and nutrition

Drugs and medical requisites• Drugs and other

medical requisites requirement of the country should be examined by a small committee

• Drug act of 1940 should be brought into operation throughout the country

Population problem

•Birth control through positive

means

Stipends to medical and nursing students• In medical profession,Who are willing to

enter into public service after completing the course,should be given annual stipend of Rs.1000

• Provision of stipends of Rs.60 per month for pupil nurses

Nurse midwives and dais

• Number of nurses available in the country was 7,000 but short term progranne itself requires 80,000

• The committee suggested that,by 1971the number of trained nurses available in the country should be raised to 740000

Establishment of preliminary training school

There should be two grades in the nursing profession,junior grade and senior grade

Establishment of nursing colleges

Male nurses• Male nurses and male staffs should be trained

and employed in male wards and male OPD Public health nurses• Committee has suggested specific proposals

with regard to training of public health nurses,they are fully qualified nurses with training in midwifery

• Their educational programme should stress throughout preventive point of view

Midwives• Number of midwives available for midwifery duties

in the country is 5000.100000,midwives are required to provide 1 midwife for every 100 births

• Existing training schools required considerable improvement

• Suggested certain fundamental requirements necessary for a training centre for midwives and made detailed recommendation for the training courses

Dais• Committee advocated the training of dais,

until an adequate number of midwives will become available

Health Survey and Planning Committee (1962)

The Government of India in the Ministry of Health set up this Committee in 1959

Dr A

Lakshminarayanaswami Mudaliar : Chairman of the committee

Terms of references• To review the developments

• Evaluation in medical relief and public Health.

• Review the first and second five year plans

• Formulation of recommendations

Six sub-committees • Professional Education and Research, • Medical Relief

• Public Health including Environmental Hygiene

• Communicable Diseases

• Population problem and Family planning • Drugs and Medical stores.

Recommendations• Strengthening of efforts and

achievements made in the first two 5 year plans in the field of health.

• Equipping district hospitals with specialist services.

• Need for regionalization of health services.

• Each primary health center: 40,000 people & have all compliment staff recommended by the committee

• The quality of care provided by the primary health center needs improvement.

• In planning hospital one bed for every 1000 population should be taken for each district.

-Taluk hospitals will provide 600-800 beds -PHCs will provide 10 beds each

• Integration of medical and health services should be achieved as already suggested by the Bhore Committee

• Greatest attention should be given to the health of the children

• The LHV and midwife posted in health centers is responsible for health education,personal hygiene and nutrition.

Recommendation related to Nursing sectors

• There should be three grades of nurses ,the basic nurses(with 4 years training)the auxillary nurse wife(2 years Of training )and the nurse with a degree qualification

• The qualification of nursing candidates GNM- matriculation or

equivalent Degree - higher secondary or

Pre university examination

• Age of admission can be 16 years of age in states where there are difficulties in recruiting candidates at the age of 17

• Medium of instruction- Preferably be English for the GNM

courses Degree courses --only in English

• Nurse pupils should not overburdened with the routine duties in the hospital

• District hospitals with a bed strength of 75-100 should be utilized to train more nurses

• Student nurses should be provide,free accommodation,,free supply of uniforms,laundry arrangements,free books,free medical services and medical check ups

• The recommendations of the committee set up by the central council of health

• There should be a nursing advisory committee in each school for advising on admission and welfare of the trainees

• Each nursing school have its own separate budget

• One auxillary nurse midwives for 5000 population by the end of 15 years,sufficient number of midwives are trained to replace dais

• Male nurses should be trained for certain types of work

• There should be higher training for the general sick nurse,public health nurse,paediatric health nurse,mental diseases nurse,theatre sister,nursing administrator

• Chadha Conmmittee(1963)• The Government of India appointed a

committee under the chairmanship of Dr MS Chadha

• Study the arrangements necessary for the maintenance phase of the NMEP.

• The Committee known as "special committee on the preparation of entry of the NMEP into maintenance phase."

RECOMMENDATIONS• "Vigilance" operations in respect of the NMEP

should be the responsibility of the general health services

• “ Vigilance operations by basic health workers

• Existing malaria surveillance worker (MSW) may be changed into auxiliary health workers/basic health workers

-- Supervision by One sanitary inspector/health inspector for 20-25000population

• Creation of the post of laboratory technicians at the PHC and a post of a FPFW and FPHA

• Basic health workers envisaged as "multipurpose" workers to look after additional duties

• A committee was appointed by the Government of India during 1965 to review the strategy of family planning.

• Chairman - Shri Mukherjee

• Recommended separate staff for

the family planning programme

RECOMMENDATIONS

• Creation of post of LHV

• There should be one FPFW for every two subcenters

• Part-time workers for motivating population for acceptance of IUD

• Block and district levels, education leaders be appointed for intensifying motivational campaign and be paid honorarium of Rs. 600/- per annum.

• Government doctors may be provided incentives which should also be available to part-time private medical practitioners in terms of honorarium of Rs. 100

Jungalwalla Committee (1967 • A committee was appointed, " under

the chairmanship of Dr N Jungalwalla.

• Committee is known as "Committee on integration of health services’’

• To integrate the health services and

elimination of private practice by government doctors

Integrated approach• A service with an unified approach for all

problems instead of a segmented approach for different problems, medical care of the sick and conventional public health programs functioning under a single administrator and operating in unified manner at all levels of hierarchy with due priority for each program

Recommendations • Unified care • Common seniority • Recognition of extra qualifications • Equal pay for equal work • Special pay for specialized work • Abolition of private practice by government

doctors• Improvement in their service conditions

Kartar Singh Committee(1974)

• Government of India constituted a committee in 1972 known as "The committee on multipurpose workers under health and Family Planning"

• Chairmanship of Sri Kartar Singh--Additional Secretary, Ministry of Health Family planning of the Union Government

The terms of reference of the committee were

• Structure for integrated services at the peripheral and supervisory levels,

• The feasibility of having

multipurpose / bipurpose workers and the training requirement of such workers

• The utilization of mobile service units set-up under family planning program

Recommendations• ANMs should be replaced by the "Family

Health Workers"

• Basic Health workers (BHW), Malaria Surveillance worker (MSW), Vaccinators, Health Education Assistant of Trachoma (HEAT) and FPHAs to be replaced by "Male Health workers .

• There should be one PHC for a populationof 50000.

---Each PHC should be divided into 16

subcenters each having a population of about 3000 to 3500 depending .

--Each subcenters should be staffed by by team of one male and one female health worker

• LHV should be replaced by the newly designated "Female Health Supervisor"

Creation of such additional posts (to supervise the female health workers)

clubbing of the posts of Health Inspectors, Sub- Inspectors, Malaria Surveillance Inspectors, Vaccinators, Supervisors together to make them into; "Male Health Supervisors"

• -- A male health supervisor to supervise

the work of 3 to 4 male health workers

and a female health supervisor to

supervise the work of 4 female health

workers. eg. The doctor in charge of a

primary health centre should have the

overall charge.

--- The program for having MPWs first to be introduced in areas where malaria is in maintenance phase and small pox has been controlled and later to other areas as malaria passes into maintenance phase or small pox controlled.

Shrivastav Committee (1975)

The Govt. of India in the Ministry of Health and Family Planning November 1974 set-up a "Group on Medical Education and Support Manpower" under the chairmanship of Dr JB Shrivastav.

TERMS OF REFERENCES• To devise a curriculum for training of

health assistants

• To suggest suitable ways and means for implementation of recommendations by the earlier committees (Medical Education Committee (1968)

• To make any other suggestions

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.

• The primary health center should be provided with an additional doctor and nurse to look after MCH services

• The primary health center , taluk hospital, district hospital, regional institution or medical college hospitals should develop direct links with the community around them, as well as with one another

Mehta Committee

• The "Medical Education Review Committee" was headed by Shri Mehta, known as Mehta Committee1983.

• Part I of the report deals with medical education in all its aspects

• Part-Il of the report specifically deals with the lack of availability of health manpower data in India,

Recommendations

• Training and development of auxillary personnel• Training and development of paraprofessional

personnel• Basic and induction training in public health

management• Continuing education in health and public health • Undergraduate medical education• Post graduate medical education

COMMITTEE CONSTITUTED BY GOVENRMENT OF INDIA WITH REGARD TO NURSING AND NURSING PROFESSION

Shetty committee (1954)

Report of the nursing committees to review the conditions of the nursing profession(Shetty committee 1954)

Government of India constituted a

committee on may 19th,1954 under the chairman ship of Mr.Shetty and Ms.Adranvala as the member secretary

Recommendations• Appointment of superintendent of nursing

services in each state

• Combining the nursing services with the public health

• One midwife to 100 births in rural area in towns and cities,one midwife to 150 births

• One public health nurse or Health visitor to 10000 of population

• Recruitment of necessary staffs for supervision and teaching in the existing training centers

• Creation of posts of nursing staffs in institution and public health aspect

• Improvement in condition of training of nurses

• Married women,unless widowed and separated from husbands not be admitted for training

• Minimum requirements for admission to training schools to be in accordance with the regulations of INC

• Medium if instruction should be decided by each state

• Setting up of a system of counseling of students,by an experienced sister

• Students required to be resident during training

• Selection of nursing personnel by qualified nurses

• Provision of adequate quarters for nurses• Improvement in working condition by an

increase in staff .provision of supplies necessary to carry out good nursing.

• Proper provision for a periodical physical examination and the treatment during illness.

• Provision of pension or PF

• Establishment of refresher courses for all categories of the nursing staff

• Provide part time work for married woman who have household responsibilities

• Exchange of nurses between different states to be encouraged

• Recruitment of men as student nurses be in proportion with the job opportunities

• Reduction in the period of training from 2 years to 18 months

• Setting up of a training division at the Ministry of Health and family welfare for looking after training requirements for Health and family planning

Report of Expert committee on HealthManpowerplanning,Production and Management ,Ministry of health andFW,,Govt of India,New Delhi(Bajaj committee,1986)

Bajaj committee(1986-1987)

• The Ministry of Health and Family welfare, Government of India set-up a committee on Health Manpower, Planning, Production and Management in 1986

• Chairmanship : Prof. JS Bajaj , Professor of Medicine, AIIMS, and New Delhi.

Recommendation• To formulate a National policy on education

in Health services

• To prepare curriculum for school teachers

• To utilize the services of Indian system Of Medicine

• Continuing education programme for the health personnel

Manpower requirement for Hospital Nursing Services

CATEGORIES BASIS OF CALCULATION MANPOWWER REQUIREMENT(2001)

Nursing Supdts 1:200 beds 4955

Dy nursing Supdts 1:300 beds 3003Departmental nursing 7:1000+1 Addl:1000 beds 7928Ward nursing supervisors 8:2000 51532Staff nurse for wards 1:3(1:9 for each shift) 429432For OPD,Blood bank,X ray,Diabetic clinics

1:100 opt 64415

For ICU (8 beds ICU) 1:8(1:3 for each shiftshift) 51530

For specialized deptts and clinics,OT,Labour

room

8:200 51530

Manpower requirements for community nursing services by 2000

Infrastructure requirement

Community Health centers 7436 Primary Health services 26439 *30000 population for plain area *20000 population for difficult area Sub centers 163941 *5000 population for plain area *3000population for difficult area

MIDWIVES ANM

Primary health centers

26439 26439

Community Health centers

52052

Total manpower requirement in nursing services

Nurse midwives - 664623

Sub centers ANM/FH worker 323882

Health supervisor 107960

Community Health centers Nurse midwives 26439

Primary Health Center PH Nurse 26439

Public Health Nurse supervisor 7436

District Public health nursing officer 900

• Sarojini Varadapan committee report (1989)

A high power committee on Nursing and Nursing profession was set up by the Govt of India in july,1987 under the chairman ship of Smt Sarojini varadapan, Smt Rajkumari Sood,nursing advisor to Govt of india as the member secretary

RECOMMENDATIONS• Working conditions of nursing personnel• Employment • Job description. • Working hours• working facilities• Pay and allowances • Special allowance for nursing personnel, ie; uniform

allowance, washing, mess allowance etc should be uniform

• Promotional opportunities Promotion is based on merit cum seniority. Promotion to the senior most administrative teaching

posts is made only by open selection.

• Career development • higher studies after 5 years of regular

service. • 8. Accommodation • allotment of accommodation near to

work place. • 9. Transport During odd hours, calamities etc

arrangements for transport must be made

• 10. Special incentives• in terms of awards, special increment

for meritorious work for nurses working in each state/district/PHC to be worked out.

• 11. Occupational hazards Medical facilities should provided by the

central govt. it should be free to all the nursing personnel.

• 12. Other welfare services• Hospitals should provide welfare

services

There should be 2 levels of nursing personnel

* Professional nurse (degree level) :12 yrs of schooling with science( 4 yrs –duration)

* Auxiliary nurse (vocational nurse) :10 yrs of schooling

( 2 yrs-duration)

• All school of nursing attached to medical college hospitals

• All ANM schools and school of nursing attached to district hospitals be affiliated with senior secondary boards.

• Post certificate BSc Nursing degree to be continued

• Master in nursing programme to be increased and strengthened.

• Doctoral programmes

• Central assistance be provided for all levels of nursing education institutions in terms of budget

• Each school should have separate budget . The principal of the school be the drawing and the disbursing officer.

• Selection of students completely based on merit. Aptitude test is introduced for selection of candidates.

• All schools to have adequate budget for libraries and teaching equipments.

• School Of Nursing ::As per the requirements of INC.

• Adequate accommodations are provided to students

• Students should learn under supervision in the wards. Tutors/clinical instructors must go to the ward with students..

• Community nursing experience should be as per INC requirements. Necessary transport

• INC requirements for staffing the schools are followed by all schools

• Speciality courses at post-graduate: at certain special centres of excellence eg; AIIMS.

• Institutes like National Institute of Health and Family welfare, RAK College of Nursing and several others may develop courses on nursing administration for senior nursing

• Provision for higher training abroad

Continuing education

• Definite policies of deputing 5-10% of staff for higher studies are made by each state. Provision for training reserve is made in each institution.

• Deputation for higher study is made compulsory after 5 yrs.

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

References-…………………………………….

• Basavanthappa BT.Nursing AdministrationJayppee publication.New Delhi:171-198

• Park K.Park’s Text book of Preventive and Social Medicine..Bhanot publication. 19th edition. Jabalpur:726

• Swarnakar K.Community Health Nursing.N.R Brothers.2nd edu.Indore.535

• Lucita M.Nursing:Practice and public Health Administration,current concepts and trends.Elsevier publications.2nd edition:369-374

• www.nrhm-mis.nic.in• www.nihfw.org• www.nursingplanet.com