Farewell to Free Universal Healthcare in India
Farewell to free Universal HealthCare in India
Free Universal Health Care has being a slogan much used and misused since the time of Independence of India.
one another have struggled for number of years to come up with some good suggestions. But one of the best ways to postpone action used to appoint another committee to look into the committee’s report.
Bhore Committee (1943-1946) During pre independence era, to improve the preventive, promotive and curative health services of country, a National Planning Commission was set up by the Indian National Congress in 1938. The rulers of that time, the British Empire realised the importance of Public Health and instituted the ‘Health Survey and Development Committee,’ in the year 1943 under the chairmanship of Sir Joseph Bhore. The committee was tasked to survey the then health conditions and health organisations in the country, and to make recommendations for future development. The committee submitted its report in 1946. The integration of preventive, promotive and curative health services and establishment of Primary Health Centres in rural areas were the major recommendations made by this committee. Important recommendations of the Bhore Committee
1. Integration of Preventive, Promotive and Curative services at all administrative levels.
2. The development of Primary Health Centres for the delivery of comprehensive health services to the rural India. Each PHC should cater to a population of 40, 000 with a Secondary Health Centre (now called Community Health Centre) to serve as a supervisory, coordinating and referral institution.
3. In the long term (3 million plan), the PHC would have a 75 bedded hospital for a population of 10,000 to 20,000.
4. It also reviewed the system of medical education and research and included compulsory 3 months training in Community Medicine. 5. Committee proposed the development of National Programmes of health services for the country. The details of the Long term plan recommended by Bhore Committee are as follows: The district health scheme, also called the three million plan, which represented an average districts population was to be organized in a 3-tier system within a period of 30 to 40 years. At the periphery will be the primary unit, the smallest of these three types. A certain number of these primary units will be brought under a secondary unit, which will perform the dual function of providing a more efficient type of health service at its headquarters and of supervising the work of these primary units. The headquarters of the district will be provided with an organization which will include, within its scope, all the facilities that are necessary for modern medical practice as well as the supervisory staff who will be responsible for the health administration of the district in its various specialized types of services.
NO WONDER MY GRANDPA missed the colonial rulers
Woh Acche din the. वोः अच्चे दिन थे
Primary Unit Every 10,000 to 20,000 population (depending on density from one area to another) would have a 75-bedded hospital served by six medical officers including medical, surgical and obstetrical and gynaecological specialists. This medical staff would be supported by 6 public health nurses, 2 sanitary inspectors, 2 health assistants and 6 midwives to provide domiciliary treatment. At the hospital there would be a complement of 20 nurses, 3 hospital social workers, 8 ward attendants, 3 compounders and other non-medical workers. Two medical officers along with the public health nurses would engage in providing preventive health services and curative treatment at homes of patients. The sanitary inspectors and health assistants would aid the medical team in preventive and promotive work. Preferably at least three of the six doctors should be women. Of the 75 beds, 25 would cater to medical problems, ten for surgical, ten for obstetrical and gynaecological, twenty for infectious diseases, six for malaria and four for tuberculosis. This primary unit would have adequate ambulatory support to link it to the secondary unit when the need arises for secondary level care. Each province was given the autonomy to organize its primary units in the way it deemed most suitable for its population, but there was to be no compromise on quality and accessibility.
Mind you these recommendations were made before India’s independence .
We have not been able to achieve any one of these goals to full extent till today.
Secondary Unit About 30 primary units or less would be under a secondary unit. The secondary unit would be a 650-bedded hospital having all the major specialities with a staff of 140 doctors, 180 nurses and 178 other staff including 15 hospital social workers, 50 ward attendants and 25 compounders. The secondary unit besides being a first level referral hospital would supervise, both the preventive and curative work of the primary units. PGCHSM 2013 Health Planning Page 3 The 650 beds of the secondary unit hospital would be distributed as follows: Medical 150, Surgical 200, Obs. & Gynae 100, Infectious Disease 20, Malaria 10, Tuberculosis 120, and Paediatrics 50. Total 650. District Hospital Every district centre would have a 2500 beds hospital providing largely tertiary care with 269 doctors, 625 nurses, 50 hospital social workers and 723 other workers. The hospital would have 300 medical beds, 350 surgical beds, 300 obs. & gynae beds, 540 tuberculosis beds, 250 pediatric beds, 300 leprosy beds, 40 infectious diseases beds, 20 malaria beds and 400 beds for mental diseases. A large number of these district hospitals would have medical colleges attached to them. However, each of the three levels would have functions related to medical education and training, including internship and refresher courses.
The Mudaliar Committee (1961),
Noteworthy recommendations
1. Regional organisations in each state between headquarter organisation & the district incharge of a Regional deputy or assistant directors each to supervise 2 or 3 district medical & health officers
2. Constitution of an All India Health Service on pattern of Indian Administrative Service
( you think the ICS and IAS Babus liked this? )
The Chaddah committee (1964) community workers
Mukerjee committee was formed in 1965 & it recommended separate staff for Family planning activities so that malaria activities could receive undivided attention of its staff
Jungalwalla Committee in 1967
a. Unified cadre b. Common seniority c. Recognition of extra qualification d. Equal pay for equal work e. Special pay for specialised work f. No private practice
The Kartar Singh Committee on Multipurpose workers in 1973
one primary health centre to be established for every 50,000 population. Each primary health centre to be divided into 16 sub-centres each for a population of 3,000 to 3,500. Each sub-centre to be staffed by a team of one male and one female health worker. The work of 3-4 health workers to be supervised by one health assistant. The doctor in charge of the PHC should have the overall charge of all supervisors & health workers in his area.
The Shrivastav Committee on Medical Education and Support Manpower \
A. Creation of bands of Para-professional and semi-professional health workers from within the community (e.g. school teachers, post masters, gramsevak, etc.) to provide simple health services needed by the community. B. the development of a "Referral Service Complex" by establishing linkages between the primary health centre and higher level referral and service centres, viz taluka/ tehsil, district, regional and medical college hospitals. C. establishment of a medical & health education commission for planning & implementation of reforms needed in health & medical education on the lines of university grant commission. D. One male & female HW should be available for every 5000 population. E. The Health Assistants for every two HWs should be located at SC & not at PHC
Shivaraman Committee health report A Committee on Basic Rural Doctors was framed under the guidance of Shri Shivaraman, then member of planning commission.
( could not find dates and required info,first Google fail)
Bajaj Committee health report 1986
1. Recommended for Formulation of National Health Manpower planning based on realistic survey. 2. Educational Commission for health sciences should be developed on the lines of UGC. PGCHSM 2013 Health Planning Page 6 3. Recommended for National and Medical education policy in which teachers are trained in health education science technology. 4. Uniform standard of medical and health science education by establishing universities of health sciences in all states. 5. Establishment of health manpower cells both at state and central level. 6. Vocational courses in paramedical sciences to get more health manpower.
Krishnan Committee Health Report 1992 The committee under the chairmanship of Dr Krishnan reviewed the achievements and progress of previous health committee reports and also made comments on shortfalls. The committee address the problems of urban health and devised the health post scheme for urban slum areas. The committee had recommended one voluntary health worker (VHW) per 2,000 population with an honorarium of Rs 100. Its report specifically outlines which services have to be provided by the health post. These services have been divided into outreach, preventive, family planning, curative, support (referral) services and reporting and record keeping. Outreach services include population education, motivation for family planning, and health education. In the present context, very few outreach services are being provided to urban slums
High Level Experts Group
Ensuring equitable access for all Indian citizens, resident in any part of the country, regardless of income level, social status, gender, caste or religion, to affordable, accountable, appropriate health services of assured quality (promotive, preventive, curative and rehabilitative) as well as public health services addressing the wider determinants of health delivered to individuals and populations, with the government being the guarantor and enabler, although not necessarily the only provider, of health and related services.
Their report was so comprehensive that the executive summary is 48 pages long
Recommendation 3.1.9: Do not use insurance companies or any other independent agents to purchase healthcare services on behalf of the government
the private sector and insurance companies under schemes such as the Rashtriya Swasthya Bima Yojana (RSBY) have been able to achieve expected enrolment, utilisation levels and fraud control. However, we believe that for a number of reasons, this mechanism is not appropriate for the UHC system.
The present Ayushman Bharath is the final nail in the coffin of UHC free Universal Healthcare in India
"This report is dedicated to the people of India whose health is our most precious asset and whose care is our most sacred duty" hleg
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