Bhore Committee 1946

8/11/2019 Bhore Committee 1946

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HE LTH SURVEY

ND

DEVELOPMENT

COMMITTEE


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HEALTH PLANNING IN INDIA

India has been pioneer in planning itsrequirements both in pre-independentand post-independent era.

The planning started in India in 1938,when National Planning Committee ofIndian National Congress was set up.

In 1943 the Bhore Committee was setup.


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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 futuredevelopment.

The committee submitted its report in 1946 its

famous report which had for volumes.


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THECOMMITTEEOBSERVEDTHAT....

If the nations health is to be built, the health

programme should be developed on a

foundation of preventive health work and that

such activities should proceed side by side

with those concerned with the treatment of

patients.


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GUIDING PRINCIPLES ADOPTED

No individual should be denied to secure adequate

medical care because of inability to pay.

There should be facilities for proper diagnosis and

treatment.

The health programme must lay special emphasis on

preventive work.


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As much medical relief and preventive health care

should provide to the vast rural population.

The health services should be located/ placed as

close to the people as possible to ensure

maximum benefits to the community.

Health development must be entrusted to

ministries of health who enjoy the confidence of

the people.


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The doctor of the future should be a social

physician protecting the people.

The extent of provision of hospital and

dispensaries in rural areas has been

considerably less than that in urban areas.

Medical services should be free to all without

distinction.


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OBSERVATIONS MADE BY THE

COMMITTEE

The health status of the country as indicatedby various indicators was poor.

The mortality rates were very high (CDR

22.4/1000; IMR 162/1000 live births; MMR20/1000 live births).

Life expectancy at birth was

about 27 years.


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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.


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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.


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A long term plan (3 mil l ion plan):It consists

of health care system in three tires.

First tier:- Setting up primary health units with

75 bedded hospital for each 10,00020,000

population with staff of 6 medical officers, 6

public health nurses, 2 sanitary inspectors, 2

health assistants and other supportive staff.


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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 p lan: 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.


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Second tier:-This consists of 650 bedded Regional Health

Unit (RHU) to serve as a referral centre for 3040 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


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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 isessential in the interest of efficiency.

Village communication should be developed.For each 30 bed hospital there should be 2motor ambulances and one animal drawnambulance.

Travelling dispensaries should be provided tosupplement the health services rendered byprimary health centres.


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THE LONG TERM PROGRAMME The smallest administrative unit should be the

primary unit serving an area with a population ofabout 10,000 to 20,000. About 15 t0 25 primaryunits will together constitute a secondary unit.

The objectives to be kept in view after the first10 years should be:

The raising of hospital accommodation to 2 beds/1000 population.

The creation of 18 new medical colleges in additionto the 43 to be established during the first 10 years.

The establishment of 100 training centres fornurses.

The nursing training of 500 hospital workers.


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Nutr i t ion: food planning should have the provision of an optimum

diet for all. Eight ounces of milk should be included in the average

Indian diet. For improving the diet of people there should be an

increase in milk production to the extent of at least 110%

Health educat ion: health education must promote health

consciousness and these are best achieved when health practices

become part of an individuals daily life. The instruction of school

children in hygiene should begin at the earliest possible stage.


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Physical educat ion :there should be one or two

physical training colleges in each province. The National

Physical Education Programme should include

indigenous games, sports and folk dances.

Health services for m other and chi ldren: measure

directed towards a reduction of sickness and mortality

among mothers and children must have the highest

priority in the health development programmes.


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Publ ic heal th personnel: the diploma

courses in public health should be integrated

with the undergraduate and post graduate

courses.

Professional educat ion :at the end of the

first 10 years the population of doctors should

be at the annual rate of 4,000 to 4,500.


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Schoo l heal th services:it should focus on preventive

services, nutritional services and health education.

Occupat ional heal th inc luding industr ial heal th:

special measure should be taken to protect the health of

employees.

Environm ental hyg iene: legislation should be enacted

in all provinces on a uniform basis including within its

scope both urban and rural areas.


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Undergraduate education : there should be a

reorganisation of teaching in the pre-clinical fields,

compulsory internship for a period of one year. Up

gradation of existing medical colleges and

establishment of new medical colleges.

Post graduate educat ion: post graduate

education should develop specialists who can work

in one specialized areas.


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Dental educat ion : provisions should be made in medical

and dental colleges for training dental surgeons, dental

hygienist and dental mechanics.

Pharmaceutical educat ion: education facilities for

licentiate pharmacist, graduate pharmacist and

pharmaceutical technologist should be provided.

Medical research : a statutory central research

organization should be constituted. Development research

activities in special subjects like

malaria are also recommended.


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Drugs and medical requ is i tes:The Drug

Act of 1940 should be brought into

operation throughout the country and rigidly

enforced.Populat ion prob lem : birth control through

positive means should be given importance

as limitation of families through self control

may not be possible.


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Nurses, m idw ives and Dais:

By 1971, the number of trained nurses in the country should

be raised to 740,000 from the existing number of 7000.

The nursing education conditions should be improved.

100 training centres at the first step, each taking 50 pupil

should be started two years before the health organization

is being established

Another set of 100 institutions should be established during

the first two years of the scheme

A third group of the same number of centres should be

established before the third year.


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Doctor o f the future: the highly trained type of

physician whom we have termed basic doctors

should be the focus.

Stipends to the medical and nursing stud ents:

the student those who complete their medical

course should be given an annual stipend of Rs.

1000. The need for nurses is higher in the country.

The committee recommended Rs. 60 per month for

pupil nurses.


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The committee has suggested that there should be two

grades in the nursing profession:-

A junior grade and a senior grade.

The entrance qualification for the former should be a

completed course of middle school

For the latter a completed course of matriculation.

The committee also recommended the establishment of

nursing colleges in order to provide a five year degree

course in nursing.


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Male nurs es:male nurses and male staff nurses should

be trained should be trained and employed in large

numbers in the male wards and male outpatient

departments.

Publ ic heal th nurses:the committee also made

recommendations with regard to the training of public

health nurses. They are fully qualified nurses with training

in public health and midwifery.


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Midwives:there is a shortage in the availability of

midwives in the country. Existing training schools for

midwives require considerable improvement. There

should be improvement in the conditions of training

centres.

Dais:the continuing employment of these womenis

inevitable for some period. The committee has

advocated the training of dais as an interim measure

until an adequate number of midwives become

available.


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Other recommendat ions are:-

Formation of v i l lage health comm ittee to secu re act ive

cooperat ion and su ppo rt in the development of heal th

programme.

Format ion of d is t r ic t heal th board for each d is tr ic t with

distr ic t health off ic ials and representat ives of the publ ic .

To ensure suitable hous ing , sanitary surrounding s, safe

dr ink ing w ater supply el iminat ion of unemploym ent and

lay special emphasis on prevent ive wo rk.

4. Intersectoral approach to health s ervices.


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The significance and importance of Bhore

Committee Report.

It is an important land mark in public health

in India.

It initiated the concept of integrated

development i.e. simultaneous

development of health and other sectors.


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The committee also initiated the concept of

comprehensive health care.

The essence of the report has in it the very idea of

primary health care.

The recommendations of the committee could not

be implemented immediately. But the three tier

pattern of PHC, Rural hospitals and District hospital

is largely based on the recommendations.


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REFERENCES

Park. K. Preventive and Social Medicine. 20th

edition. Banrsidas Bhanot.; Jabalpur. 2009.

Kamalam. S. Essentials in community health

nursing practices. 1stedition. New Delhi: Jaypee

brothers; 2005

BT Basavanthappa. Community Health Nursing. 2nd

edition. Bengaluru (India): Jaypee publications;

2008

Baride. J. P. and Kulkarni. A. P. Text book of

community medicine. 3rdedition. Mumbai: Vora

medical publications;2006

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Bhore Committee 1946

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