8/11/2019 Bhore Committee 1946
1/32
8/11/2019 Bhore Committee 1946
2/32
HE LTH SURVEY
ND
DEVELOPMENT
COMMITTEE
8/11/2019 Bhore Committee 1946
3/32
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.
8/11/2019 Bhore Committee 1946
4/32
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.
8/11/2019 Bhore Committee 1946
5/32
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.
8/11/2019 Bhore Committee 1946
6/32
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.
8/11/2019 Bhore Committee 1946
7/32
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.
8/11/2019 Bhore Committee 1946
8/32
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.
8/11/2019 Bhore Committee 1946
9/32
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.
8/11/2019 Bhore Committee 1946
10/32
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.
8/11/2019 Bhore Committee 1946
11/32
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.
8/11/2019 Bhore Committee 1946
12/32
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.
8/11/2019 Bhore Committee 1946
13/32
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.
8/11/2019 Bhore Committee 1946
14/32
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
8/11/2019 Bhore Committee 1946
15/32
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.
8/11/2019 Bhore Committee 1946
16/32
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.
8/11/2019 Bhore Committee 1946
17/32
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.
8/11/2019 Bhore Committee 1946
18/32
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.
8/11/2019 Bhore Committee 1946
19/32
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.
8/11/2019 Bhore Committee 1946
20/32
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.
8/11/2019 Bhore Committee 1946
21/32
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.
8/11/2019 Bhore Committee 1946
22/32
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.
8/11/2019 Bhore Committee 1946
23/32
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.
8/11/2019 Bhore Committee 1946
24/32
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.
8/11/2019 Bhore Committee 1946
25/32
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.
8/11/2019 Bhore Committee 1946
26/32
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.
8/11/2019 Bhore Committee 1946
27/32
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.
8/11/2019 Bhore Committee 1946
28/32
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.
8/11/2019 Bhore Committee 1946
29/32
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.
8/11/2019 Bhore Committee 1946
30/32
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.
8/11/2019 Bhore Committee 1946
31/32
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.
8/11/2019 Bhore Committee 1946
32/32
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