SEMINAR ON VARIOUS HEALTH COMMITTEES

CENTRAL OBJECTIVE: By the end of the class the students gain knowledge regarding various health committes,appreciate their importance and use this knowledge in future practice. SPECIFIC OBJECTIVES: At the end of the class the students will; 1.recognize the importance of various committes 2.list down the various health committes in India. 3.explain regarding Bhore committee. 4.describe about Mudaliar committee. 5.explain regarding chadha committee. 6.outline regarding Mukherjee committee. 7.describe about Jungalwalla committee. 8.explain about Kartar Singh committee. 9.describe regarding Shrivastav committee.

INTRODUCTION Every ministry appoints from time to time committees, including expert committees to advise the government on a particular issue or issues. The views of these committees have important influence on the formulation of policies. Wherever the advice of these bodies is accepted by the government, it may take the form of a policy either through the legislative enactment or by the executive orders. The Governmenthave examined recommendations of various committees constituted from time to time. No one can deny the utility of these committees. THE FACTS AND SUGGESTIONS CONSIDERED WHILE CONSTITUTING A COMMITTEE. 1.The membership of the committee should not be given for a long period.

2.It is not good to appoint eminent persons who are extremely busy as member, as they tend to shift from one committee to another, seldom knowing about the business of these committees. Whereas it is suggested that the best advice can often be obtained from persons of less eminence, as they are able to master fully one branch of knowledge or activity. It must be ensured that only such members may be appointed for these committees who are not only competent but who can also devote sufficient time. ShriramMaheshwari in his paper on Advisory Committees in the Central Government (India) suggests that while appointing persons on these committees, the primary consideration should be their qualifications, experience and probity. 3.It is always better to associate an expert from public administration who can help the committee in designing the administrative structure required to implement the policy decisions. Most of the policy decisions produce no result for lack of proper administrative apparatus. 4.The committees must submit their report within the specified time, otherwise, their recommendations may not yield good results as the circumstances may change after sometime and the recommendations may not suit the changed socioeconomic environment. 5.The government must give top priority in examining the feasibility and utility of these recommendations so that these recommendations (if accepted) may be duly processed through the formal machinery of government and be converted into policy decisions.

Various committees of experts have been appointed by the government from time to time to render advice about different health problems. The reports of these committees have formed an important basis of health planning in India. The goal of National Health Planning in India was to attain Health for all by the year 2000. THE IMPORTANT AMONG THEM ARE BHORE COMMITTEE. 1946. MUDALIAR COMMITTEE. 1962. CHADHA COMMITTEE, 1963. MUKHERJEE COMMITTEE. 1965. MUKHERJEE COMMITTEE. 1965. JUNGALWALLA COMMITTEE, 1967 KARTAR SINGH COMMITTEE. 1973. SHRIVASTAV COMMITTEE. 1975.

1.BHORE COMMITTEE (1946) Health survey and development committee

The Health Survey and Planning Committee was set up in 1943. Sir Joseph Bhore was the chairman. The aim was to survey the then existing position regarding the health conditions and health organization in the country and to make recommendations for the future development. The committee submitted its famous report in 1946 which had four volumes. The committee observed that.... : 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. 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. 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. 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.

OBSERVATIONS MADE BY THE COMMITTEE : The health status of the country as indicated by various indicators was poor. The mortality rates were very high (CDR 22.4/1000; IMR 162/1000 live births; MMR 20/1000 live births). Life expectancy at birth was about 27 years. 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.

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.

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 plan: 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. Long term plan (3 million plan): It consists of health care system in three tires. First tier:- Setting up primary health units with 75 bedded hospital for each 10,000 20,000 population with staff of 6 medical officers, 6 public health nurses, 2 sanitary inspectors, 2 health assistants and other supportive staff. Second tier:-This consists of 650 bedded Regional Health Unit (RHU) to serve as a referral centre for 30 40 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 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 is essential in the interest of efficiency. Village communication should be developed. 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 rendered by primary health centres.

THE LONG TERM PROGRAMME : The smallest administrative unit should be the primary unit serving an area with a population of about 10,000 to 20,000. About 15 t0 25 primary units will together constitute a secondary unit. The objectives to be kept in view after the first 10 years should be: The raising of hospital accommodation to 2 beds/ 1000 population. The creation of 18 new medical colleges in addition to the 43 to be established during the first 10 years. The establishment of 100 training centres for nurses. The nursing training of 500 hospital workers.

Other significant recommendations Nutrition: 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 education: 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. Physical education: 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 mother and children: Measures directed towards a reduction of sickness and mortality among mothers and children must have the highest priority in the health development programmes.

School health services:It should focus on preventive services, nutritional services and health education. Occupational health including industrial health: special measure should be taken to protect the health of employees. Environmental hygiene: legislation should be enacted in all provinces on a uniform basis including within its scope both urban and rural areas. Public health personnel: the diploma courses in public health should be integrated with the undergraduate and post graduate courses. Professional education: at the end of the first 10 years the population of doctors should be at the annual rate of 4,000 to 4,500. 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 education: post graduate education should develop specialists who can work in one specialized areas. Dental education: provisions should be made in medical and dental colleges for training dental surgeons, dental hygienist and dental mechanics. Pharmaceutical education: 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. Drugs and medical requisites: The Drug Act of 1940 should be brought into operation throughout the country and rigidly enforced. Population problem: birth control through positive means should be given importance as limitation of families through self control may not be possible. Doctor of the future: the highly trained type of physician whom we have termed basic doctors should be the focus. Stipends to the medical and nursing students: 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.

Nurses, midwives 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. 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. Male nurses: 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. Public health 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. 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 women is inevitable for some period. The committee has advocated the training of dais as an interim measure until an adequate number of midwives become available. Other recommendations are:- Formation of village health committee to secure active cooperation and support in the development of health programme. Formation of district health board for each district with district health officials and representatives of the public. To ensure suitable housing, sanitary surroundings, safe drinking water supply elimination of unemployment and lay special emphasis on preventive work.

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. 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. Although the Bhore Committees recommendations did not form a part of a comprehensive plan for socio economic development ,the committees report still continues to be a major national document and has provided guide lines for national planning in India.

2.MUDALIAR COMMITTEE

Appointment of the Health Survey and Planning Committee: The Government of India in the Ministry of Health set up a Committee on the 12th June, 1959 to undertake the review of the developments that have taken place since the publication, of the report of the Health Survey and Development Committee (Bhore Committee) 'in 1946 with a view to formulate further health programmes for the country in the third and subsequent five-year plan periods. The terms in reference of this Committee were as follows: Terms of Reference 1. The assessment (or evaluation) in the field of medical relief and public health since the submission of the Health Survey and Development Committee's Report (the Bhore Committee) 2. Review of the First and Second Five-Year Plan Health projects and 3. Formulation of recommendations for the future plan of health development in the country.

The Committee had six sub-committees for the following purposes: Professional Education, and Research Medical Relief (Urban and Rural) Public Health including Environmental Hygiene Communicable diseases Population problem and family planning Drugs and medical stores.

The main recommendations of the Mudaliar Committee were: The committee recommended that the success of the programmes will depend upon ; The speed with which primary Health Centres of the type we have in view are set up. The provision of the necessary facilities for mobility of the touring teams and for ambulances. etc The raising of the district hospitals to the bed strength of the 250 to 500 with all requisite specialties. The linkage on a regional basis of the district hospitals with the teaching hospitals in the area for the purpose of expert assistance in specialized diagnostic and curative techniques.

Primary Health Centres 1. The primary health centres which were opened have no resemblance to actual proposal of Bhorecommittee.So it was suggested that further opening of PHCs should be discontinued and the already existing PHCs should be upgraded by stages to reach the pattern as suggested by Bhore committee(1 PHC for 40000). 2. Provide medical services to the rural population through mobile health units in mobile vans,eg,those requiring hospitalization and specialist services can be brought in ambulances to the taluk or district hospitals.

3. PHC should provide residential accommodation to all personnel of the centre and should have a bed strength of 10 including 2 beds for emergency care.There should be suitable communication facilities including an ambulance and a geep at every centre.

4. Training should be given to prepare a large number of medical and nursing students.

5. Medical officers in PHC should not be allowed private practice and should be given non practicing allowences. 6. Taluk hospitals should have a minimum bed strength of 50 and should have 3 medical officers dealing with medicine,surgery,obstetrics and gynecology.

7. The district hospitals should occupy key position with regard to medical care and should be expanded and strengthened.The bed strength should be expanded from 300 to 500 beds out of which 75 beds should be set apart for maternity services and 50 for pediatrics.There should be isolation unit with 50 beds attached to district hospitals. Medical facilities in railway,factories and plantations The Director( Medical and Health) Railways Board Ministry of Railways is the head of the medical and health services and directs co-ordinates and determines the policy for the control of planning and development of these services on a uniform basis on all Indian railways. Special services should be available for hospital, domiciliary and clinic care of workers. As far as possible, there should be separate hospitals for the Insurance patients except when specialist treatment is required. There should be no discrimination whatsoever in the existing government institutions between a Government servant, insured patient, or a civilian patient. The obligation to provide housing, medical care and other facilities to the labour population has been made mandatory by the Plantation Labour `Act 1951.Effective arrangements are required to be made by the employer to provide and maintain at convenient places sufficient supply of wholesome drinking water for all workers, a sufficient number of latrines and urinals of prescribed types are also required to be provided and maintained in a sanitary condition. Tribal and Backward Areas

The major public health problems are water supply,sanitation,malaria,TB,veneral diseases and nutritional disorders.Training facilities should be expanded for training medical and paramedical people.Suitable candidates should be selected from tribal population itself so that they can serve the tribal area after qualifying.

PUBLIC HEALTH Water supply and sanitation: 1.Utilization of river water by storing and supplying it through conduits in villages.Incostal areas desalination of sea water is suggested. 2.In urban areas ,the drainage and sewerage schemes should run parallel to water supply schemes should run parallel to water supply schemes. 3.It is suggested that for every state a pilot project should be set up to study various methods of disposal of sewage and human excreta in rural areas. 4.The block development organization in each area should take the responsibility to design appropriate rural latrines and to supervise periodically the servicing of the latrines. Maternal and child health: The committee observed that there is no agency to ensure systematic follow-up of antenatal, midwifery, postnatal, infant and child welfare services. They suggested Within a period of 10 years a midwife should be available for a population of 5,000-6,000 in rural areas supported by a public health nurse. An auxiliary health works department of social and preventive medicine should give due importance to maternity and child health. Undergraduate students should have more experience and practical training in antenatal, postnatal care, midwifery and domiciliary midwifery training. Orientation and refresher courses should be arranged for medical officers and for other health workers. Public health nurses, lady health visitors should register all the antenatal mothers and should provide them with all the necessary services. The services should include immunization, nutrition education, health education and family planning services. School health: Each directorate of health services should have a bureau of school health services to plan and initiate school health service programmes and to co-ordinate the activities of the

government, the local bodies and the voluntary organization. It should also help to establish close liaison with the education departments in the states. General hygiene and sanitation in school premises should be improved. Every school must have a source of wholesome water supply, sanitary facilities, regular and proper cleaning up of the classrooms and the school campus Production of birth and vaccination certificate should be made compulsory for admission in schools. School staff should actively assist in inoculation of pupils at the time of an epidemic. School health services should be looked after by the primary health centre in the area.

Nutrition: Eventhough priority was given to agriculture in the first two five vear plans, major emphasis was laid on the increase of food production only. Adequate attention was not given to increase the output of nutritious food for the vulnerable group of the population, i .e. mothers and children. More nutrition sections should be opened in the state health departments and qualified nutritionist and dietitians should be employed in public institutions. Iron supplements, protein rich foods and vitamins etc. should be supplied to the vulnerable groups in the rural areas through rural health centres, schools etc. Housing: As far as possible, housing accommodation should be made available to all the employees of the state and the central governments and also to the industrial workers. Slums should be removed and alternative accommodation should be provided for slum dwellers. The type of houses in urban and rural areas should be considered carefully from the point of view of public health and sanitation. Importance should be given to the collection of vital statistics, and training centres should be established for training of officers. Health education: All states should establish health education bureau which must work in co-operation with the central health education bureau in order to promote health education of the people and to make them health conscious. Professional education: Important recommendations regarging starting aand various crieteria for running all the medical,nursing and allied courses were provided.Another important recommendation was the constituition of an All India Health service on the pattern of Indian Administrative service.

3.CHADHAH COMMITTEE In 1963 a committee was appointed by government of India under the chairmanship of Dr.M.S.Chadah the then DGHS to study the arrangements necessary for the maintenance phase of National malaria eradication prograamme. The committee recommended that the vigilance operations in respect of the National Malaria Eradication Programme should be the responsibility of the general health services ie primary health centres at the block level. RECOMMENDATIONS Vigilance through institutions Institutional case detection should continue more extensively and intensively than ever before. All states should be directed to activate all existing medical institutions; Government and non-Government. All private medical practitioners, irrespective of the system of medicine they profess, and all professional and other healthy workers should be harnessed The members block development committees, panchayats, taluk boards,, gram panchayats, panchayatsamithis, mahilamandals, youth clubs and any other voluntary local body, school teachers and other should participate and efforts must be made to enlist their cooperation so that every village or locality has one Voluntary Collaboration.

Domiciliary services Domiciliary service is a recognised, well tried practice that has stood the test of time. It is this service that brings a health organisation into close touch with the community and ultimately reduces burden on the health organisation itself. It brings services to the people at home through a regular system of visits to villages and houses. The consensus of view is that, in the present situation of the country, institutional detection of cases cannot alone be depended upon for the detection of all cases and as such multipurpose domiciliary services are absolutely necessary. Screening criteria

For institutional vigilance all over, cases should be screened for at least 2-3 years and subsequently only suspected malaria including all intermittent and inadequately explained fever cases. Notification An early notification is essential. Statutory notification helps in bringing forth the awareness of the situation in the minds of the people and also help the workers Medical Institutions. All efforts should be made to establish medical institutions particularly dispensaries and primary health centres planned during the third plan period, specially in the areas entering the maintenance phase. Primary Heath Centre Level: The Committee vas of the view that the basic unit to have effective control over communicable diseases and to provide preventive health care through basic health workers should cover a population of not more than 5,000. However, in view of the limitations of financial and material resources, such a unit should cover not more than 10,000 population, though the ultimate target should be 5,000. These basic health workers were called multipurpose workers with additional duties of collection of vital statistics and family planning services.

Remedial measures Remedial measures that may be required on the notification of a confirmed case include a) epidemiological investigation, b) radical treatment, c) Focal spray, d) mass blood survey in as short a period as possible, but in no case, beyond one week, e) parasitological follow-up and f) health education Other anti-mosquito measures Since malaria is being eradicatedthen,it was suggested that no organisation must be allowed to endanger or undo what has been achieved on such grounds as shortage of funds, etc. In fact, all anti-mosquito measures should be strengthened. Health education. Success of vigilance operations depends to a large extent on the co-operation of the various categories of people, government officials, medical professions both in Government and the private practice and above all the public.

Unfortunately many of the recommendations of the committee was unrealistic and the Government later appointed the Mukherji committee to review the situation.

4.MUKERJI COMMITTEE,1965 Within a couple of years of implementation of the Chadah committees recommendations by some states ,it was realized that the basic health workers could not function effectively as multipurpose workers and as a result the malaria vigilance operations had suffered and also the work of family planning programme was not satisfactory.This subject came up for discussion at a meeting of the Central Health Council in 1965.A committee known as Mukherjee committee 1965 , under the chairmanship of Mr.Mukherji,the then Secretary of health to government of India was appointed to review the strategy for the family planning programme.The committee recommended separate staff for the family planning programme.The family planning assistants were to undertake family planning duties only.The basic health workers were to be utilized for purposes other than family planning. MUKERJI COMMITTEE,1966 As the states were finding it difficult to take over the whole burden of the maintenance phase of malaria and other mass programmes like family planning,smallpox,leprosy,trachomaetc due to insufficient funds the matter came up for a discussion at a meeting of the central council of health held in Bangalore in 1966.The council set up a committee under Mr.Mukherji. The committee worked out the details of basic health sevicewhich should be provided at the block level and some consequential strengthening required at higher levels of administration. RECOMMENDATIONS 1.There should be one basic health worker for a population of 10000 in normal areas but in areas with difficult terrain or very sparse population the the population coverage by basic health worker can be suitabily reduced.

2.The committee recommended that the leave and training reserve of 5 % of the health workers should be provided. 3.The committee recommended that for every 4 basic health workers there should be a health inspector to supervise and guide the workers. 4.A clerk to be provided for primary health centre who would relieve the medical officer of all clerical job. 5.The medical officer of the PHC should devote sufficient time to supervise the functions of basic health workers. 6.The committee recommended that if for a block a lady medical officer is not available for MCH services the same can be handled by a male doctor or if he is also unavailable the post may be temporarily filled by a public health nurse.

5.JUGALWALLA COMMITTEE 1967(committee on integration of health services) The Central council of health at its meeting in held in Srinagar in 1964 ,taking note of the importance and urgency of intergration of health services and elimination of private practice by government doctors,appointed a committee known as the committee on integration of hralth services under the chairmanship of Dr.N.Jungalwalla,Director ,National Instituite of health administration and education ,NewDelhi to examine the various problems including those of service conditions and submit a report to the central Government in the light of these considerations.The report was submitted in 1967. The committee defined integrated health services as 1.A service with a unified approach for all problems instead of a segmented approach for different problems 2.Medical care of sick and conventional public health programmees functioning under a single administrator and operating in unified manner at all levels of hierarchy with due priority for each programme obtaining at a point of time. RECOMMENDATIONS 1.Unifiedcadre:The committee recommended unification of cadre is very essential.Same remuneration for same work in all the states was recommended. Four scales of salary viz juniorscale,seniorscale,selection grade and special posts according to seniority in all states were suggested.

2.Commonseniority:There should be a common seniority which automatically follows recruitment. 3.Recognition of extra qualifications:Special allowances to be allowed for qualifications such as M.D,M.S,D.P.H,M.P.H etc. 4.Equal pay for equal work:Basic pay to be the same in all grades everywhere. 5.Special pay for specialized work:Specialists,those doing research in respective fields,those in teaching instituitions and those in public health or specialized programmes entailing intensive and extensive field work are to be given special pay. 6.No private practice:The committee recommended no private practice for doctors and should be given non practicing allowences.50% of the pay to be given as non practicingallowances.The committee also recommended that the states can take decision if they want to stop private practice in a phased manner.The committee also recommended that certification of fitness,sick,insurance medical certificates etc constitute normal duties of a medical officer and cannot be considered as private practice. 6.KARTAR SINGH COMMITTEE 1973 The Government of India constituted a committee in 1972 known as Committee on Multipurpose Workers under Health and Family Planning, under the Chairmanship of Kartar Singh, Additional Secretary, Ministry of Health and Family Planning, Governmentof India. The terms of reference of the Committee were to study and make recomendations on: 1. the structure for integrated services at the peripheral and supervisory levels. 2. the feasibility of having multipurpose, bi-purpose workers in the field. 3. the training requirements for such workers. 4. the utilization of mobile service units set up under family planning programme for integrated medical, public health and family planning services operating in the field. The committee submitted its report in September 1973. Its main recommendations were:
1.

2.

Present auxiliary nurse midwives to be replaced by the newly designated female health workers, and the present- day basic health workers, malaria surveillance workers, vaccinators, health education assistants (trachoma) and the family planning health assistants to be redesignated as male health workers. The programme for having multipurpose workers to be first introduced in areas where malaria is in maintenance phase and smallpox has been controlled and later to other areas as malaria passes into maintenance phase or smallpox is controlled.

For proper coverage, there should be one primary health centre for a population of 50,000. 4. Each primary health centre should be divided into 16 subcentres each having a population of about 3,000 to 3,500 depending upon topography and means of communications. 5. Each subcentre should be staffed by a team of one male and one female health worker. 6. There should be 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. 7. The present-day health visitors to be designated as female health supervisors. 8. The doctor in charge of the primary health centre should have overall charge of all the supervisors and health workers in the area. The recommendations of the Kartar Singh Committee were accepted by the Government of India to be implemented in a phased manner during fifth five year plan. 7.SHRIVASTAVA COMMITTEE The Shrivastava group also known as Group on Medical Education and Support Manpower was appointed by the Govt, of India in 1974 under the chairmanship of Dr JB Shrivastava, the Director General of Health Services, Government of India. The terms of reference of the group were: To devise a suitable curriculum for training a cadre of health assistants conversant with basic medical, preventive and nutritional services, family welfare, maternity and child welfare activities so that they serve as a link between the qualified medical practitioners and multipurpose workers, thus forming an effective team to deliver healthcare, family welfare and nutritional services to the people. 2. Keeping in view the recommendations made by earlier committees on medical education, especially the Medical Education Committee (1968) and Medical Education Conference (1970) to suggest suitable ways and means for implementation of these recommendations and to suggest steps, for improving the existing medical education processes so as to provide due emphasis on the problems particularly relevant to the national requirements. 3. To make any other suggestions that help to realise the above objectives. After carefully examining various reports and papers relevant to the subject including recommendations of as many as 12 conferences and committees held earlier, the committee submitted its report in April 1975.
1.

3.

The recommendations were:

1.Nationwide network of efficient and effective services suitable for our conditions, limitations and potentialities should be evolved. 2.Steps should be taken to create bands of paraprofessional or semi-professional health workers from the communityitself to provide simple, protective, preventive and curative services which are needed by the community. 3.Between the community and the primary health centre, there should be two cadres, healthworkers and health assistants.
(a) (b)

Health workers should be trained and equipped to give simple specified remedies for day-to-day illness. Health assistants would work as intermediaries between the health workers and the primary health centre. The health assistants should be located at the subcentres. Like the health workers, they should also be trained and equipped to give specific remedies for simple day-today health problems. Apart from having a supervisory role over the health workers, they would also function as health worker in their own areas and carry out the same duties and responsibilities, but at a higher level of technical competence.

4.The primary health centre should be provided with an additional doctor and a nurse to look after the maternal and child health services. 5.The possibility of utilizing the services of senior doctors at the medical college, regional, district ortalukhospitals for brief periods at primary health centre should be explored. 6.The primary health centre as well astaluk, tehsil, district, regional and medical college hospitals should each develop direct links with the community around them, as well as with one another within a total referral service complex. 7.The Government of India should constitute under an Act of Parliament, a Medical and Health Education Commission for co-ordinating and maintaining standards in medical and health education on the pattern of university grants commission (UGC).

CONCLUSION The recommendations of the various committees on health have been accepted by the Government and most of them have been implemented. But the fact remains that, no matter how commendable the recommendations of the committees/groups may be, these will be of no use until we have proper administrative machinery to put them into effect.

BIBLIOGRAPHY