Health Care Planning in

UNIT 2 HEALTH CARE PLANNING IN India

INDIA
Structure
2.0 Objectives
2.1 Introduction
2.2 Concepts and Meaning of Health Planning
2.3 Health Care Planning Process
2.4 Health care management (Network analysis)
2.5 Health Planning in India
2.5.1 Health Committees
2.5.2 Planning Commission
2.5.3 Five Year Plans

2.6 National Health Policy and Goals

2.7 Planning System
2.7.1 Planning System at Centre Level
2.7.2 Planning System at State Level
2.7.3 Planning System at District Level
2.7.4 Planning System at Block Level
2.8 The Planning Procedure
2.9 Nurses in Health Care Planning
2.10 Let Us Sum Up
2.11 Answers to Check Your Progress

2.0 OBJECTIVES
 After completing this unit, you should be able to:
 define the concept of health care planning;
 describe the process of health care planning;
 know the guidelines for health care planning;
 describe national health policy and goals;
 explain the reports of various health committees;
 describe five year plans in relation to health planning;
 discuss planning system at central, state, district and block level;
 explain rural health mission; and
 how the functions of nurse in health care planning

2.1 INTRODUCTION
Administration of health care services is an enabling process for the attainment of
constitutional right of health by all and also the goal of “Health for All”. India has
a comprehensive system of planning for its socio-economic development. Health
planning is a part of socio-economic development planning system. Health is a

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Community Health Nursing major segment of the social development sector. Health planning is based on the
Adminstration statistical information derived through various committees appointed by the
government from time to time.
The Committees’, Recommendation has been and is still the basis for health
planning in India even after independence.
The planning machinery in India comprises the planning commission and various
associated bodies at central, state, district and block level. Overall responsibility
for health of people falls on central government who is responsible for
formulation of policies and plans; assisting and guiding state government in
planning; implementing, monitoring and evaluation of health care services;
planning and implementation of National Health Programmes, etc. Since health is
a state subject because health needs and problems differ from state to state. Each
state has its own planning machinery for providing health care to its people at
state, district and block level depending upon their health needs and problems.
National Institution for Transforming India, (NITI Aayog) was formed via a
resolution of the Union Cabinet on 1 January, 2015. NITI Aayog is basically a
think tank or advisery body.
Health care planning is done democratically involving people at every stage of
planning from grass root level to state and central level. The planning process in
India was initiated in April 1951 with the launching of 1stfive year plan.
The nurses working in community health care setting need to know and understand
the planning and delivery of health care services to the people at various levels.
There has been considerable achievement in health status of people due to improved
health care delivery system. But, still there are many targets (set for the goal of
“Health for All”) which have not been achieved due to inequitable distribution of
services, inaccessible and inadequate services, lack of coordination and referral
system and many problems related to management and financial resources.
Revised national health policy and goals (to be achieved by 2010 and some by
2015) were declared in 2002. Rural Health Mission is gaining momentum. In this
unit we shall discuss about concepts and meaning of health planning, health
planning process, health planning in India, National Health Policy, planning
system and planning procedures, etc.

2.2 CONCEPTS AND MEANING OF HEALTH

PLANNING
Planning is the foremost and pervasive function of administration and
management. Planning is a decision making process which helps in developing a
framework for allocation of resources. While planning, the planner makes
decision in advance about what is to be done, when, where, how and by whom it
is to be done. A plan determine course of action. Planning process involves
analytical and critical thinking, imagination, foresight and sound judgment.
Health planning is a part of national development planning. It is necessary for
economic utilization of material, manpower and financial resources. The purpose
of health planning is to improve the health services. In this context, National
Health Planning has been defined as “the orderly process of defining community
health problems, identifying unmet needs and surveying the resources to meet
them, establishing priority goals that are realistic and feasible and projecting
administrative action to accomplish the purpose of the proposed programme”.
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Definition and Meaning of Terms Used in Planning Health Care Planning in
India
The following terms are used in planning:
Policies -policies are general statements that guide decision making. Policies
define boundaries within which decisions can be made. ‘The basic purpose of
policies is to secure consistency of purpose and directions for accomplishing
objectives. Policies may be either written statements or oral understanding.
Purpose - it refers to aim or mission which the organization has for its existence
Objectives - objectives are predetermined intensions which an organization
desires to achieve through relevant actions. These are also referred as end points
to which actions are planned or aimed. The objectives may be general and
specific, short term or long term. But these should be tangible, clear and
informative.
Goals -goal is defined as the ultimate desired state towards which objectives and
resources are directed. Goals formulated at the highest level are generally broad.
A goal is usually described in term of (1) what is to be attained; (2) the extent to
which it is to be attained; (3) the population or section of the environment
involved; (4) the geographic area in which the proposed programme will operate;
and (5) the length of time required for attaining the goal.
Programme - programme is a sequence or plan of integrated activities designed
to implement policies and accomplish objectives.
Procedure - procedures indicate the specific manner in which certain activities
are to be performed. Procedures are developed to avoid chaos of random activities
and mark a fixed path through the defined area of policy. Thus, procedure shows
the way to implement policies.
Rules -rules are specific statements of what, may or may not be done.
Budget - budget refers to financial plan i.e. the plan of expenditure and the
expected results in numerical terms.
Strategies - strategies are the plans or methods to achieve the objectives
Plan - Planning results in the formulation of plan. A ‘plan’ is a blue print for
taking action. It consists of all the above mentioned elements such as policies,
purpose, goals, objectives, programme, procedure, rules, budget and strategies.
Preplanning
Preplanning is preparation for planning. The important preconditions are:
a) Government Interest: Any plan for the health and welfare of the country
must be based on a strong “political will” as manifested by clear directives
or policies given by the political authority.
b) Legislation: The social and health policies formulated may have to be
translated into legislation, for example the enactment of MTP Act, 1971, by
the Indian Parliament to protect the health of mothers.
c) Organization for Planning: There should be an organizational structure for
the preparation of various parts of the plan. The planning commission of
India serves this function. It is composed of full time planners who are
advised by representatives and technical experts in the field of social and
economic development as well as political leaders.

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Community Health Nursing d) Administrative Capacity: One of the essential pre-conditions of planning is
Adminstration administrative capacity for proper coordination of activities and
implementation of the plan at all levels. For the health plan, administrative
capacity is vested in the hands of the Central and State Ministries of Health.

Let us look into the planning cycle or planning process.

2.3 HEALTH CARE PLANNING PROCESS

Health care planning is the broad foundation on which most of the management
and administration is based. It is the process of analyzing a system, or defining a
problem, assessing the extent to which the problem exists as a need, formulating
goals and objectives to alleviate those identified needs, examining and choosing
from among alternative intervention strategies, initiating the necessary action for
its implementation and monitoring the system lo ensure proper implementation of
the plan and evaluating the results of intervention in the light of stated objectives.
Planning thus involves a succession of steps as shown in (Fig. 2.1).

General Information

 Political commitment
 Health legislation
 Planning Machinery
 Administrative setup
 Infrastructure
Tabulate Gather
Analyze Health
Interpret Data

Formulate
Health
Problems
No
Assign Priorities
Among Problems
Evaluate Results
Goals Achieved?
Goals Satisfactory? Formulate Individual
Priority Problems for
Planning Solutions
Collect Data for
Evaluation Yes
Define Programme
Objectives & How to
Measure Achievement
Operate
Programme
Assign Priorities
Among Objectives
Initiate Integrated
Programme Design Alternative
Programme to Solve
Problems
Orient & Train
Personnel
Select Best Programme
(Feasibility cost/
Plan Implementation of Combine Programme & Effectiveness)
Integrated Programme Develop Integrated Plan

Fig. 2.1 Planning Cycle

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1) Information Gathering Health Care Planning in
India
Information about pre-conditions essential to planning are gathered, such as
political commitment, health policies, health legislation, planning machinery,
administrative set up and infrastructure available. This information is
necessary to initiate planning process.

2) Analysis of Health Situation

The next step in health planning is analysis of health situation. It involves

the collection, assessment, analysis and interpretation of information in such
a way as to provide a clear picture of the health situation of a country. The
following data are essential for health planning:

a) The population, its age and sex structures

b) Statistics of morbidity and mortality
c) The epidemiology and geographical distribution of different diseases
d) Medical care facilities such as hospitals, health centres and other health
agencies which include both public and private
e) The technical manpower of various categories and levels
f) Training facilities available to train professionals and para-
professionals
g) Attitude and beliefs of the population towards disease, its cure and
prevention

The analysis and interpretation of the above data brings out the health problems,
the health needs and health demands of the population.

3) Establishment of Objectives and Goals

Objectives and goals are needed to guide efforts to achieve effective results.
Objectives must be established at all levels, from top and down to the smallest
organizational units. At upper levels; objectives are general; at successively
lower levels, they become more specified and detailed. The objectives may be
short-term or long term. In setting these objectives, time and resources are
important factors to be considered. Objectives are not only a guide to action,
but also a yard stick to measure work after it is done. Modem management
techniques such as cost benefit analysis and “input-output” study of health
services are being used for defining goals and objectives.

4) Assessment of Resources

The resources include manpower, money, materials, skills, knowledge and

techniques needed or available for the implementation of the health
programme. These resources are ‘assessed and a balance is struck between
what is required and what is available or likely to be available in terms of
resources.

5) Fixing Priorities

Once you have identified the problems, resources and formulated objectives,
the next most important step in planning is establishment of priorities in
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Community Health Nursing order of importance or magnitude, since the resources are always scarce. In
Adminstration fixing priorities, attention is paid to financial constraints, mortality and
morbidity data, diseases which can be prevented at low cost and also
political and community interests and pressures. Once priorities have been
established, alternate plans for achieving them are also formulated and
assessed in order to determine whether they are practicable and feasible.
Alternate plans with greater effectiveness are chosen.

6) Write-up of Formulated Plan

Preparation of the detailed plan or plans is an important step in planning

process. The plan must be complete in all respects for the execution of a
project. For each proposed health programme, the resources (inputs) required
are related to the results (output) expected. Each stage of the plan is defined
and costed and the time needed to implement is specified. The plan must
contain working guidance to all those responsible for execution. It must also
contain a “built-in” system of evaluation. Modifications of the plan relating
to allocation of resources me left to the central planning authority and the
Government.

7) Programming and Implementation

Once the health plan has been selected and approved by the policy making
authority, programming and implementation me begun. Execution of plan
depends upon the effectiveness of an organization. The organizational structure
must incorporate well defined procedures to be followed and sufficient
delegation of authority to and fixation of responsibility of different workers for
achieving the pre-determined objectives during the period prescribed.

It is at the implementation stage that shortcomings often appear in practice.

Many well-considered plans have fallen down because of delay in critical
supplies, inappropriate use of staff. The main consideration at the
implementation stage includes: (a) definition of roles and tasks of workers,
(b) the selection, training, motivation and supervision of the manpower
involved, (c) organization and communication, and (d) the efficiency of
individual institutions such as hospitals and health centres.

8) Monitoring

Monitoring is the day-to-day follow up of activities during their

implementation to ensure that they are proceeding as planned and are on
schedule. It is continuous process of observing, recording and reporting on
the activities of the organization. Monitoring, thus, consists of keeping track
of the course of activities and identifying deviations taking corrective action
if excessive deviations occur.

9) Evaluation

The purpose of evaluation is to assess the achievement of the stated

objectives of a programme, its adequacy, its efficiency and its acceptance by
all parties involved. Evaluation is concerned with the final out-come and
with factors associated with it. Good planning will have a built-in evaluation
to measure the performance and effectiveness and for feed back to correct

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 deficiencies or fill up gaps discovered during implementation. Evaluation Health Care Planning in
measures the degree to which objectives and targets are fulfilled and the India
quality of the results obtained. It measures the productivity of available
resources in achieving clearly defined objectives. It measures how much
output or cost effectiveness is achieved. It makes possible the reallocation of
priorities and of resources on the basis of changing health needs.

Check Your Progress 1

1) Define National Health Planning

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2) Name the steps involved in planning process

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2.4 HEALTH CARE MANAGEMENT

Management is an activity which involves the determination of objectives &
putting them into action. Management has been defined as the creation and
maintenance of internal environment in an enterprise where individuals working
together in groups can perform efficiently and towards the attainment of group
goals- (Koontz and O’ Donell)

Important reasons for the management concept

 To increase managerial efficiency

 To develop a science of management and to crystallize the nature of
management
 To prepare and study research projects every year
 To acquire social achievement

Management, Organization and Administration

According to GE Millswork, all the three are defined as follows:

 Administration is primarily process and the agency used to establish the

objective or purpose which is undertaking and its staff members are to
achieve. Secondly, administration has to plan and stabilize the broad lines of
principles which will govern action. These broad lines are called ‘Policies’.
 Management is the process through which the execution of policy is planned
and supervised.
 Organization is the process of dividing work into convenient tasks of duties,
of grouping such duties in the form of posts of delegating authority to each
post and of appointing staff to be responsible that the work is carried out as
planned.

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Community Health Nursing Planning
Adminstration
Planning is a process of determining the organizational goal and formulation of
policies and programs for achieving them

Organizing

Organization is the process by which the structure and allocation of job are
determined

Staffing

Staffing is a process of matching the job with the individuals.

Directing

Directing involves determining the course of action giving orders and instructions
& providing dynamic leadership.

Coordination

Coordination is the orderly synchronization of the efforts of the subordinate to

provide the proper amount and quality.

Recruitment

Recruitment is the creation of a pool of the available labor upon whom the
organization can depend when it needs additional employees.

STEPS OF EVALUATION PROCESS

Standards and criteria must be developed in accordance with the form of the
evaluation of the structure criteria, eg physical facilities and equipment.
Evaluation steps involves as shown in (Fig. 2.2)

Determine what is to be evaluated

Establishment of standards & Criteria

Planning the methodology

Gathering information

Analysis the result taking action

Re evaluation

Fig. 2.2 Evaluation steps

2.5 HEALTH PLANNING IN INDIA

Health planning in India is an integral part of national socio-economic planning.
The guidelines for national health planning were provided by a number of
committees dating back to Bhore Committee in 1946. These committees were
appointed by the Government India from time to time to review the existing
health situation and recommend measures for action. A brief review of the
recommendations of these committees, which are important landmarks in the
history of community health in India is given below.
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2.5.1 Health Committees Health Care Planning in
India
1) Bhore Committee, 1946

In 1943, the Government of India appointed the health survey and development
committee with Sir Joseph Bhore as Chairman, to survey the then existing
position regarding health conditions and health organization in the country. The
committee members met regularly for two years and submitted their reports in
1946. Some of the important recommendations of the Bhore Committee were:

i. Integration of preventive and curative services at all administrative levels;

ii. The committee visualized the development of primary health centers in two
stages: (a) as a shorter term measures, it was proposed that each primary
health centre in the rural areas should cater to a population of 40, 000 with a
secondary health centre to serve as a supervisory, coordinating and referral
institution, (b) a long term programme of setting up primary health units
with 75 bedded hospitals for each 10,000 to 20,000 population and
secondary units with 650 bedded , hospitals, again regionalized around
district hospitals with 2500 beds.
iii. Major changes in medical education which includes 3 months training in
preventive and social medicine to prepare “social physicians”.
iv. The Committee’s report even till today continues to be a major national
document and has provided guidelines for National Health Planning.

2) Mudaliar Committee, 1962

In 1959 by the end of 2nd Five Year Plan the Government of India appointed
another committee known as “Health survey and planning committee” under the
chairmanship of Dr. A. L. Mudaliar to survey the progress made in the field of
health since submission of the Bhore Committee’s report and to make
recommendations for future development and expansion of health services.

Mudaliar Committee found the quality of services provided by primary health

centres inadequate, and advised strengthening of the existing primary health
centres before new centres were established. It also suggested the strengthening of
sub-divisional and district hospitals for effective referral services.

The main recommendations of Mudaliar Committee were:

i. Consolidation of advances made in the first two five year plans

ii. Strengthening of the district hospitals with specialist services to serve as a
central base of regional services
iii. Regional organizations in each state
iv. Primary health centre not to serve more than 40,000 population
v. To improve the quality of health care provided by primary health centres
vi. Integration of medical and health services as suggested by Bhore Committee

3) Chadha Committee, I963

In 1963, Government of India appointed Chadha Committee under the

chairmanship of Dr. M. S. Chadha, the then Director General of Health Services
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Community Health Nursing to study the arrangement necessary for the maintenance phase of the National
Adminstration Malaria Eradication Programme.

The main recommendations of Chadha Committee were:

i. Vigilance operations in respect of the National Malaria Eradication

Programme should be the responsibility of the general health services is
Primary health centres at the block level. Vigilance operations through
monthly home visits should be carried out through basic health workers.

ii. The existing Malaria Surveillance Workers (MSW) may be changed into
auxiliary health worker to look after additional duties of collection of vital
statistics and family planning, in addition to malaria vigilance. These
workers were envisaged as multipurpose workers.

iii. The family planning health assistants were to supervise 3 or 4 of basic health
workers.

iv. At the district level, the general health services were to take the
responsibility for the maintenance phase of Malaria Eradication Programme.

4) Mukherji committee, 1965

During the implementation of the Chadha Committee’s recommendations by some

of the 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 the family planning programme
could not be carried out satisfactorily.

In 1965, this matter was brought to the notice of Central Health Council for
discussion.

A committee was appointed by the Government of India during 1965 to review the
strategies for family planning programme under the chairmanship of Shri
Mukherji, the then Secretary of Health to Government of India.

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 purpose other than family planning.

The committee also recommended delinking the malaria activities from family
planning so that the latter would receive undivided attention of its staff. The
recommendations were accepted by Government of India.

5) Mukherji 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, trachoma etc. due to paucity of funds, the matter came up for
discussion at a meeting of the Central Council for Health in Bangalore in 1966.
The committee was appointed under the chairmanship of Shri Mukherji the then
Union Health Secretary. The committee worked out the details of the BASIC
HEALTH SERVICE which should be provided at the block level, some
consequential strengthening required at higher levels of administration.

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6) Jungalwalla Committee, 1967 Health Care Planning in
India
The Central Council of Health at its meeting held in Srinagar in 1964, taking note
of the important and urgency of integration of health services, and elimination of
private practice by government doctors, appointed a committee known as
committee on integration of “Health Services” under the chairmanship of Dr. N.
Jungalwalla, Director, National Institute of Health Administration and Education,
New Delhi 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:

 A service with a unified approach for all problems instead of a segmented

approach for different problems

 Medical care of the sick and conventional public health programmes

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.

The committee recommended integration from the highest to the lowest level in
the services, organization and personnel. The main steps recommended towards
integration were:

i. Unified cadre

ii. Common seniority

iii. Recognition of extra qualifications

iv. Equal pay for equal work

v. Special pay for specialized work

vi. No private practice, and good service conditions

The committee gave sufficient indications for action but did not spell out steps
and programmes for integration and left the matter to states to work out the set up
hosed on the experience of West Bengal, Punjab and Defence Forces. The
committee states that “integration should be a process of logical evolution rather
than revolution”.

7) Kartar Singh Committee, 1973

The Government of India constituted a committee in 1972 known as “The

committee on multipurpose workers under health and family planning” under the
chairmanship of Kartar Singh, Additional Secretary, Ministry of Health and
Family Planning, Government of India. The committee was formed to study and
make recommendation on (a) the structure for integrated services at the peripheral
and supervisory levels; (b) 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 (c) the training requirement for
multipurpose workers in the field.

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Community Health Nursing The committee submitted its report in 1973, its main recommendations were:
Adminstration
i. That the present Auxiliary Nurse Midwives to be replaced by the newly
designated “Female Health Workers”
ii. The present day Basic Health Workers, Malaria Workers, Family Planning
Health Assistants to be replaced by Male Health Workers”.
iii. 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 controlled
iv. One primary health centre for 50,000 population
v. Each prime health centre should be divided into 16 sub-centres each having
population of about 3000 to 3500 depending upon topography and means of
communication
vi. Each sub-centre to be staffed by a team of one male and one female health
worker
vii. There should be male health supervisor to supervise the work of 3-4 male
health workers; and a female health supervisor to supervise the work of 3 - 4
female health workers
viii. The present day lady health visitors to be designated as female health
supervisors
ix. The doctor in charge of a primary health centre should be the overall in
charge of all supervisors and health workers in his area
The recommendations of Kartar Singh Committee were accepted by the
Government of India to be implemented in a phased manner during Fifth Five
Year Plan.
8) Shrivastava Committee, 1975
The issue of developing alternative strategy for the delivery of health services and
rationalization of health manpower both in terms of number of personnel as well
as categories of personnel had been the attention of the Government from time to
time. In November 1974 ‘a group on medical education and support manpower’
was set up by Government of India, Ministry of Health under the chairmanship of
Dr. J. B. Shrivastav Directorate General Health Services (DGHS) to focus on this
issue. The committee made following recommendations terms of bridging gap
between community and organized health services.

i. Creation of bands of paraprofessionals and semi-professionals health

workers from within the community itself (e.g. school teachers, post masters,
gram sevaks) to provide simple promotive, preventive and curative services
needed by the community
ii. Establishment of two cadres of health workers namely, multipurpose health
workers and health assistants between the community level workers and
doctors at the primary health centre
iii. Development of a “Referral service complex” by establishing proper
linkages: between PHC and higher level referral and service centres viz
taluk/tehsil, district, regional and medical colleges hospitals
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iv. A conscious and deliberate decision to be taken to abandon the model of Health Care Planning in
western medicine and replace with a model which have to place a greater India
emphasis on human efforts for which we have a large potentials

v. Health is essentially an individual responsibility in the sense, that, if the

individual cannot be trained to take proper care of his health, no community
or state programme of health services can keep him healthy.

vi. The community responsibility in health is even more important. It is the duty
of the community to provide a proper environment for helping each
individual to be healthy

vii. The group recommended a four-tier structure given below:

a) The members from community chosen by the community themselves

and trained by the health departments to function as community health
guides. They will work at grass root level to bridge the gap between the
community and organized health sector

b) The multipurpose health worker (male and female) belonging to the

organized health sector at grass root level for a defined population

c) The medical officers and other paramedical at level of primary health

centres

d) The health assistants who would be functioning in the primary health

centres

viii. Establishment of a medical and health education commission for planning

and implementing reforms needed in health and medical education on lines
of the University Grants Commission

The committee felt that by the end of sixth five year plan, one male and one
female health worker should be available for every 5000 population. Also, there
should be one male and one female health assistant for 2 male and 2 female health
workers respectively. The health assistants should be located at the sub-centre and
not at the PHC.

9) Rural Health Scheme, 1977

The most important recommendations of the Shrivastav Committee was that

primary health care should be provided within the community itself through
specially trained workers so that the health of the people is placed in people’s hand.

The basic recommendation was accepted by the Government in 1977, which lead to
the launching of Rural Health Scheme, The programme of training of community
health workers was initiated during 1977-78. Steps were also initiated for:

a) Involvement of medical colleges in the total health care of selected PHCs with
objective of re-orienting medical education to the needs of rural people; and

b) Re-orientation training of multipurpose workers engaged in the control of

various communicable disease programmes into unipurpose workers. This
plan of action was adopted by the joint meeting of the Central Council of
Health and Central Family Planning Council held in New Delhi in April
1976.
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Community Health Nursing 10) Primary Health ‘care and Health for All, 1978
Adminstration
The concept of Primary Health Care (PHC) was introduced at the international
level jointly by WHO and UNICEF at Alma Atta conference in 1978 to achieve
the goal of ‘HFA’ by the year 2000 AD. This was due to the growing concern
about low level of health status of majority of the world’s population especially
rural and poor people and gross disparity between rich and poor, rural and urban
population both among and within the countries.

Primary health care as stated by Alma Atta conference is as under:

“Primary health care is essential health care made universally accessible to

individuals and acceptable to them through their full participation and at the cost
the community and the country can afford”.

The primary health care concept is accepted by all the members’ countries and
alternative strategies are developed to implement primary health care on the basis
of their countries’ needs and requirement. In India a working group on health was
constituted by the planning commission in 1980 with the Secretary, Ministry of
Health and Family Welfare, as its chairman to identify in programmes terms, the
goal for Health for All by 2000 AD and to outline with that perspective, the
specific programmes for the sixth five year plan. The report of the working group
was take out in the year 1981. First National Health Policy came into force in the
year 1982 and National health goals were declared to be achieved by 2000 AD.

11) Rural Health Mission (2005-2012)

Recognizing the importance of health in the process of economic and social

development and improving the quality of life of our citizens, the Government of
India has resolved to launch the National Rural Health Mission to carry out
necessary architectural correction in the basic health care delivery system. The
mission adopts a synergistic approach by relating health to determinants of good
health viz. segments of nutrition, sanitation, hygiene and safe drinking water. It
also aims at mainstreaming the Indian system of medicine to facilitate health care.
The plan of action includes increasing public expenditure on health, reducing
regional imbalance in health infrastructure, pooling resources, integration of
organizational structures, optimization of health manpower, decentralization
(bottom-up planning) and district management of health programmes, community
participation and ownership of assets, induction of management and financial
personnel into district health system, and operationalizing community health
centres into functional hospitals, meeting Indian Public Health Standards in each
Block of the country.

The goal of the mission is to improve the availability of and access to quality
healthcare by people, especially for those residing in rural areas, the poor, women
and children.

Goals
 Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Rate
(MMR)

 Universal access to public health services such as women’s health, child

health, water, sanitation and hygiene, immunization, and nutrition
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 Prevention and control of communicable diseases and non-communicable Health Care Planning in
diseases, including locally endemic diseases India

 Access to integrated comprehensive primary health care

 Population stabilization, gender and demographic balance

 Revitalize local health traditions and mainstream AYUSH (Ayurveda, Unani,

Sidha, Homeopathic)

 Promotion of healthy life styles

Strategies

 Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own,

control and manage public health services

 Promote, access to improved health care at household level through the

health activist (ASHA)
 Health plan for each village through village health committee of the
panchayat
 Strengthening sub-centres through united fund to enable local planning and
action and more Multipurpose Workers (MPWs)
 Strengthening existing PHCs and CWCs, and provision of 30-50 bedded
CHC per lakh population for improved curative care to a nonnative standard
(Indian Public Health standards defining personnel, equipment and
management standards)
 Preparation and implementation of an inter-sectoral District Health planning
prepared by the District Health Mission, including drinking water, sanitation
and hygiene and nutrition
 Integrating vertical health and family welfare programmes at National, State,
Block and District levels
 Technical support to National, State and District Health Missions for Public
Health Management
 Formulation of transparent policies for deployment and career development
of human resources for health
 Strengthening capacities for data collection, assessment and review for
evidence based planning, monitoring and supervision
 Developing capacities for preventive health care at all levels for promoting
healthy life styles, reduction in consumption of tobacco and alcohol, etc.
 Promoting non-profit sector in underserved area
 Regulation of private sector including the informal rural practitioners to
ensure availability of quality service to citizens at reasonable cost
 Promotion of public private partnership for achieving public health goals
 Mainstreaming AYUSH - revitalizing local health traditions
 Reorientation of medical education to support rural health issues including
regulation of medical care and medical ethics
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Community Health Nursing  Effective and viable risk pooling and social health insurance to provide
Adminstration health security to the poor by ensuring accessible, affordable, accountable
and good quality hospital care.

12. Vision 2020 Report (2000)

A committee headed by Dr. S.P Gupta was constituted in the year 2000 to
recommend health care goals to be achieved by 2020. It made the following
recommendation;

1. Improving access to health services to meet the health care needs of women
and children.
2. Placing greater emphasis on public health education and prevention.
3. Innovative insurance products and programs by panchayats with reinsurance
backup by companies and the government to extend coverage to much larger
sections of the population.
4. Increasing the level of public expenditure on health care by about four-fold
from the current level of 0.8% of gross domestic product (GDP) to 3.4%.
5. Formulation of competence and quality standards for the healthcare system.

13. National Commission on Macroeconomics and Health (2005)

The National Commission on Macroeconomics and Health (2005) was a high-

level committee under the joint chairmanship of Shri P.Chidambaram (Finance
Minister) and Dr. A. Ramadoss (Health Minister). The report was submitted in
2005 and addressed, in detailed, the various areas which our country needs to
focus upon from the economic angle while planning for community health care.
The report has formed an important basis for the health sector planning in
subsequent five-year plans.

14. NITI Aayog

The NITI Aayog (Hindi for Policy Commission) also known as National Institute
for Transforming India, is a policy think tank of the government of India,
established with the aim to achieve Sustainable Development Goals and to
enhance cooperative federation by fostering policy-making process, using a
bottom-up approach. It was established in 2015, to replace the planning
commission which followed a top-down model. The prime Minister is the ex-
officio chairman. The permanent members of the governing council are chief
ministers of all states, along with the chief Ministers if Delhi and Puducherry, the
Lieutenant Governor of Andaman and Nicobar, and a Vice-chairman nominated
by the Prime Minister. In addition, temporary members are selected from leading
universities and research institution. This, member includes a Chief executive
officer, for ex-officer member, and part-time members.

15. National Health Policy 2017

The National health policy 2017 was approved by the Union Cabinet, Government
of India, on March 16th, 2017. This is India’s third National Health policy (NHP);
earlier NHP’s were released in 1983 and 2002.

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2.5.2 Planning Commission Health Care Planning in
India
In 1950 the Government of India set up a Planning Commission to make an
assessment of the material, capital and human resources of the country and to
draft development plans for the most effective utilization of these resources. In
1957, the planning commission was provided with a perspective planning division
which makes projections into the future over a period of 20-25 years. The
planning commission consists of a Chairman, Deputy Chairman and five
members. The planning commission works through three major divisions -
Programme Advisers, General Secretariat and Technical Divisions which are
responsible for scrutinizing and analyzing various’ schemes and projects to be
incorporated in the five year plans. Over The years, the planning commission has
been formulating successive five year plans. The planning commission also
reviews from time to time the progress made in various directions and to make
recommendations to Government on problems and policies relevant to the pursuit
of rapid and balanced economic development. The planning process is now being
decentralized towards Decentralized District Planning by the year 2000.

The planning commission gave considerable importance to health programmes in

the five year plans because “health” is an important contributory factor in the
utilization of manpower. For the purpose of planning, the health sector has been
divided into the following sub-sectors:

1) Water Supply and Sanitation

2) Control of Communicable Diseases

3) Medical Education, Training and Research

4) Medical Care including Hospitals, Dispensaries and Primary Health Centres;

5) Public Health Services

6) Family Planning; and

7) Indigenous System of Medicine

All the above sub-sectors have received due consideration in the Five Year Plans.
To give effect to a better coordination between the Centre and State Governments,
a Bureau of Planning was constituted in 1965 in the Ministry of Health,
Government ofIndia. The main functions of this bureau are compilation of
National Health Five Year Plans. The health plan is implemented at various levels
e.g. centre, state, district, block and village.

2.5.3 Five Year Plans

The five year plans were conceived to re-build rural India, to lay the foundation of
industrial progress and to secure the balanced development of all parts of the
country. The planning commission gave considerable importance to health
programmes in the five year plans. India has had 12 Five Year Plan uptill now.
The first five year plan was launched in 1951. The decades old five year plan is
now replaced with the new three-year action plan, which will be a part of the
seven-year strategy paper& 15 year vision document. The NITI-Aayog, which
replaced the planning commission, had launched a three-year action plan on

291
Community Health Nursing April 1, 2017, which is valid till 2020. The broad objectives of the health
Adminstration programmes during the five year plans have been:

1) Control and eradication of major communicable diseases

2) Strengthening of the basic health services through the establishment of

primary health centres and sub-centres;

3) Population control; and

4) Development of health manpower resources.

The targets to be achieved during 10th Five Year Plan are laid down in the revised
National Health Policy 2002. The achievements during the past 55 years of
planned development are given in Table 2.1

Table 2.1 Achievements during the Plan Periods

1st Plan 6th Plan 8th Plan 10th Plan

1951-56 1980-85 1992-97 2002-2007

1 Primary Health Centres 725 11000 21854 229367

2 Sub-centres NA 83000 132730 138368

3 Community health centres - - - 3076

4 Total beds 125000 514989 596203 908168 (2001)

5 Medical Colleges 42 106 146 122

6 Annual admission in 3600 8000 11241 18000

medical colleges

7 Dental colleges 7 25 54 142

8 Allopathic doctors 65000 - 410800 575600 (2001)

9 Nurses 18500 164421 449351 839862

10 ANMs 12780 85630 203451 502503

11 Health visitors 578 13612 22144 40536

12 Health workers (F) - 80000 124680 137407

13 Health workers (M) - 80000 63871 71053

14 Village Heath Guide - 372190 410904 3.23 lakh

2.6 NATIONAL HEALTH POLICY AND GOALS

Health policy is the expression of what the health care system should be so that it
can meet the health care needs of the people. Political forces play a major role in
determining of decision making authority on issues and strategies like allocation
of funds, manpower, infrastructure, geographical accessibility, alternative medical
technology etc.

After independence the health services in India were based on the directions
suggested by Bhore Committee and later on got modified on the basis of,
292
recommendations given by subsequent committees and the Planning Commission Health Care Planning in
through the process of “Five Year Plans”. In fact, until 1983 there was no formally India
developed and written policy.

The formal National Health Policy was evolved after global acceptance of
“Health for All by 2000 AD in 1976-77 through Primary Health Care Strategy”
and on the recommendations of ICMR-ICSSR joint panel. It is known as National
Health Policy1983, since it was formally approved by the Parliament in 1983.

The primary objective of National Health Policy 1983 was to attain the goal of
“Health for All” by 2000 AD, by establishing an effective and efficient health care
system which is accessible to all the citizens, especially vulnerable groups like
women, children and under privileged.

The National Health Policy strongly stressed the creation of primary health care
infrastructure, coordination with health related services, the active involvement of
voluntary organizations, the provision of essential drugs and vaccines, qualitative
improvement in health and family welfare services, the provision of adequate
training, and medical research on common health problems of the people. The
National Health Policy has the following key elements:

 Creation of greater awareness of health problems in the community and

means to solve the problems by the community

 Reduction of existing imbalance in health services by concentrating more on

the rural health infrastructure

 Supply of safe drinking water and basic sanitation using technologies that
people can afford

 Establishing dynamic health management information system11 to support

health planning and health programme implementation

 Provision of legislative support to health protection and promotion

 Combat wide spread malnutrition

 Research in alternative methods of health care delivery system and low cost
health technologies

 Greater coordination of different system of medicine

2.6.1 National Health Policy 2017

The National Health Policy, 2017 goal is to reach everyone comprehensively and
integrated way to move towards wellness. It aims at achieving universal health
coverage and delivering quality health care services to all at affordable cost.

Goal

The policy envisages as its goal the attainment of the highest possible level of
health and well-being for all at all ages, through a preventive and promotive
health care. , and universal access to good quality health care services without
anyone having to face financial hardship as a consequence. This would be
achieved through increasing access, improving quality and lowering the cost of
healthcare delivery.

293
Community Health Nursing Objectives
Adminstration
Improve health status through concerted policy action in all sectors and expand
preventive, promotive, curative, palliative and rehabilitative services provided
through the public health sector with focus on quality.

Specific Quantitative Goals and Objectives

Health Status and Programme Impact

1. Life Expectancy and healthy life

 Increase Life Expectancy at birth from 67.5 to 70 by 2025.

 Establish regular tracking of Disability Adjusted Life Years (DALY)

Index as a measure of burden of disease and its trends by major
categories by 2022.

 Reduction of TFR to 2.1 at national and sub-national level by 2025.

2. Mortality by Age and/ or cause

 Reduce Under Five Mortality to 23 by 2025 and MMR from current

levels to 100 by 2020.

 Reduce infant mortality rate to 28 by 2019.

 Reduce neo-natal mortality to 16 and still birth rate to “single digit” by

2025.

3. Reduction of disease prevalence/ incidence

 Achieve global target of 2020 which is also termed as target of 90:90:90,

for HIV/AIDS i.e., - 90% of all people living with HIV know their HIV
status, - 90% of all people diagnosed with HIV infection receive
sustained antiretroviral therapy and 90% of all people receiving
antiretroviral therapy will have viral suppression.

 Achieve and maintain elimination status of Leprosy by 2018, Kala-Azar

by 2017 and Lymphatic Filariasis in endemic pockets by 2017.

 To achieve and maintain a cure rate of >85% in new sputum positive

patients for TB and reduce incidence of new cases, to reach elimination
status by 2025.

 To reduce the prevalence of blindness to 0.25/ 1000 by 2025 and disease

burden by one third from current levels.

 To reduce premature mortality from cardiovascular diseases, cancer,

diabetes or chronic respiratory diseases by 25% by 2025.

Salient Features, Indicators and Targets

The salient features of NHP 2017 and the indicators and targets are given in Table
2.4

294
 Table 2.4: Indicators and Targets Laid Down in NHP, 2017 Health Care Planning in
India
Indicator Target Year by
Which
to be
Achieved

1. Targets related to health status and program impact

 Life expectancy at birth 70years 2025

 Total fertility rate 2.1 2025

 Under-5 mortality 23 2025

 Maternal mortality ratio (MMR) 100 2020

 Infant mortality rate (IMR) 28 2019

 Neonatal mortality rate 16 2025

 Still birth rate <10 2025

 Global target for HIV/AIDSa 90:90:90 2020

 Maintain elimination status for leprosy - 2018

 Maintain elimination status for kala-azar - 2017

 Maintain elimination status for lymphatic - 2017

filariasis

 Cure in new sputum +ve patients for TB >85% 2025

 Reduce incidence of new cases of TB, to - 2025

reach elimination status

2. Targets related to health systems performance

 Increase in utilization of public health By 50% 2025

facilities

 Sustain antenatal care coverage Above 90% 2025

 Sustain skilled attendance at birth Above 90% 2025

 Complete immunization Increase of Above 90% 2025

newborn by 1 year of age

 To meet the need of family planning Above 90% 2025

 Maintain “controlled disease status” 80% 2025

among known hypertensive and diabetic
individuals at a household level

 reduction in prevalence of current By 15% of 2020

tobacco use present level

By 30% of
present level
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Community Health Nursing
 Reduction in prevalence of stunting of By 40% of 2025
Adminstration
under -5 children present level
 Access to safe water and sanitation 100% 2020
(Swachh Bharat Mission)
 Reduction of occupational injury from By 50% 2020
current levels among agricultural workers
3. Targets related to health systems strengthening
 Health expenditure by government as 2.5% 2025
percent of GDP (present level is 1.15%)
 Increase state sector health budget spending >8% 2020
 Decrease in proportion of households Reduction by 2025
facing castrophic health expenditure 25%
 Availability of paramedics and doctors as
per the Indian public Health Standards
(IPHS) norm in high priority districts - 2020
 Achieve community health volunteers to - 2025
population ratio as per IPHS norm and
establish primary and secondary care
facility as per norms (in high priority
districts)
 Ensure district-level electronic database of 2020
information on health system components.
 Strengthening the health system and
establish registries for disease of public
health importance
This target of “90:90:90” means that 90% of all people living with HIV know
their status, 90% of all people diagnosed with HIV infection receive sustained
antiretroviral therapy will have viral suppression. The current level is 334 per lakh
agricultural workers.
Factors Interfering with the Progress towards Health for All
The progress towards Health for All is hampered by:
 Insufficient political commitment to the implementation of Health for All
 Failure to achieve equity in access to all primary health care elements
 The continuing low status of women
 Slow socio-economic development
 Difficulty in achieving inter-sectoral action
 Unbalanced distribution of and weak support for human resources
 Inadequacy of health promotion activities
 Pollution, poor food, safety and lack of water supply and sanitation
 Rapid demographic and epidemiological changes
 Natural and man-made disasters
296
Considering the kind and level of progress, the barriers and the change in health Health Care Planning in
problems and the circumstances, the department of health and family welfare felt India
it necessary to formulate a new policy framework as National Health Policy
2001(NHP 2002).

The main objectives of National Health Policy 2002 are to achieve acceptable
standard of good health amongst the general population of the country. The
approach would be to:

 Increase the access to the decentralized public health system by establishing

new infrastructure in deficit areas
 Ensure equitable access to health services across the country
 Increase contribution by Central Government to strengthen the capacity of
public health administration at state level
 Enhance the contribution of private sector in providing health services to the
population who can afford
 Rational use of drugs within allopathic system and traditional system of
medicine

By keeping these approaches in mind, National Health Policy 2001 was

formulated to achieve the time bound goals to be achieved by 2005, 2010, 2015
and 2017 (Table 2.4).

The health targets have also been addressed by the population policy which is
approved by the Parliament on 19 November, 1999, Population policy 2000 has
set these targets to be achieved by 2010.

Table 2.4: Goals to be achieved by 2000-2001 to 2015

Goals Target Time
 Eradication of Polio and Yaws 2005
 Eliminate Leprosy 2005
 Eliminate kala-Azar 2010
 Eliminate Lymphatic filariasis 2015
 Achieve zero level growth of HIV/AIDS 2007
 Reduce mortality by 50% an account of TB, Malaria 2010
 Other Vector born and water born disease, prevalence of 2010
blindness to 0.5%
 Reduce IMR to 30/1000 & MMR to 100/Lakh 2010
 Improve nutrition & reduce LBW babies form 30% to 10% 2010
 Increase utilization of Public Health facilities from current 2005
level of <20 to >75%
 Establish an integrated system of surveillance National Health 2010
Accounts and health statistics
- Increase health expenditure by Government as a % GDP 2005
from 0.9 to 2%
- Increase share of Central giants to constitute at least 25% of 2010
total health spending
 Increase State Sector health spending from 5.5% to 7% of the budget
 Further increase to 8%

Source: Draft NHP 2002

297
Community Health Nursing The major issue which is being addressed by population policy is stabilization of
Adminstration population growth at a level of replacement i.e. NRR of one so as to make
progress in all the areas of developments which the country is striving for:

Major issues being addressed by NMP 2002 area as under:

 Increasing aggregate outlays for the Primary Health sector to strengthen

existing facilities and opening additional Public Health Service outlets,
consistent with the norms of such facilities. This would be done to reduce
various types of inequities and imbalances.
 The Central Government to continue to perform a key role in designing
National Programmes with active participation of State Government till
moderate levels of prevalence of diseases like TB, Malaria, HIV/AIDS, etc. is
reached. However, the ultimate aim is the coverage of all health programmes
under a single administration for optimal use of public health structure at the
primary level.
 Reviving primary health system by providing some essential drugs under
Central Government funding through decentralized system. This is believed to
promote recipients interest in the public health system. This in turn would
create a demand for other professional services.
 Strengthening of primary health care infrastructure to provide quality services.
 Levying of reasonable user-charges for certain Secondary and Tertiary Public
Health care services, for those who can afford to pay.
 Implementing Public Health programmes through local self Government. The
State Government to consider and decentralize implementation of health
programmes by 2005. Financial incentive will be provide by the Central
Government.

2.7 PLANNING SYSTEM

The planning system in India comprises the planning commission and various
associated bodies at the Centre, State, District and Block level.

2.7.1 Planning System at Centre Level

The planning system at the centre level comprises of planning Commission, the
National Development Council and Union Council of Ministers.

1) Planning Commission

The planning commission is a competent and complex organization which was set
up by the Government on 15th March 1950 by Cabinet resolution in order to
implement its economic and social policies. The functions of planning
commission are as under:

 Make an assessment of material, capital and human resources of the country.

 Formulate a plan for the most effective and balanced utilization of the
resources.
 Determine priorities and define the stages of plan and allocate resources to
implement plans.
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 Identify factors responsible for retarding economic development. Health Care Planning in
India
Planning commission, act as an advisory body to the Government. It assists the
Government in formulating five year plans through active involvement of various
Ministries and their technical departments both at Centre and Spates. The plans
formulated by planning commission have to be approved by the cabinet to be
implemented.

The composition and status of planning commission is such that it is in a position

to maintain an effective liaison with the Central Ministries and the Government of
State. The Prime Minister is the Chairman of Planning Commission. The Minister
of planning is the Deputy Chairman who looks after the day-to-day work of the
Commission. The members include part time members and these are Union
Ministers of Finance, Defence and Human Resource Development and six full
time members who are Minister of State rank. The work is assisted by full-fledged
Secretary. All the members of planning commission function collectively. The
staff of the planning commission includes administrators, technical officers and a
complement of secretarial and other subordinate personnel.

To facilitate democratic approach to planning process, Central Ministers work

through the working group of planning commission. Finance Ministry makes
financial decisions. The Secretary, Ministry of Finance is the Chairman of
working group for resources in the planning commission.

The Reserve Bank of India keeps a close touch with the planning commission
through its Department of Economics. It undertakes many important studies on
financial and banking matters for the commission.

The Central Statistical Organization (CSO) is responsible for dealing with

statistical data required for the purpose of planning. The Director General of
Central Statistical Organization is also the ex-officio head of the Statistics and
Survey Division of the Planning commission.

2) National Development Council (NDC)

The National Development Council was established on 6th August, 1952 by the
Cabinet resolution on the basis of suggestions by Planning Commission. It is
headed by Prime Minister and Chief Ministers, Members of the Commission
comprise its members.

The meetings of NDC are attended by others as per requirement of the agenda
items. These members can be Ministers from Central and State Government,
eminent Economist, Governors, Reserve Bank of India.

It is the advisory body and serves the following functions as defined in the
resolution:
 To review the working of National Plan from time to time:

 To consider important questions of social and economic policy effecting

National Development.

 To recommend measures for the achievements of aims and targets set out in
the plan.

299
Community Health Nursing 2.7.2 Planning System at State Level
Adminstration
At the state level there is state planning Department directly under the Chief
Minister. This Department formulates the Development Plan for the State as a
whole by liasoning and coordinating with Planning Commission and the various
departments of the State.
2.7.3 Planning System at District Level
At the district level, the collectors in coordination with the office from various
departments and the members of district council (Zila Parishad) formulate
development plan for the district which is sent to the planning department of the State.
2.7.4 Planning System at Block Level
At the Block level, Block Development Officer (BDO) in coordination with the
various extension officers (8-10) and the members of the Block Council
(Panchayat Samiti) develop plan for the block which is submitted to the District
Collector.

2.8 THE PLANNING PROCEDURE

The Planning Commission lays down long-term general goals which are approved
by the Government. Within the framework of these goals, five year goals and
targets are tentatively formulated by the Planning Commission.
The sector-wise working groups are set up which includes officials born the
respected Central and State Ministries, non-officials from voluntary organizations,
experts from related fields and officers of the respective division in the Planning
Commission. The working groups are headed by Secretary/Additional Secretary/
Director General of the respective Ministries or Advisor Planning Commission.
The working groups work out the detail policies and programmes needed for
achieving five year goals and targets set by the Planning Commission.
On the basis of sectoral policies and programmes formulated by various working
groups, the Planning Commission prepares a short memorandum of Five Year
Plan and place before the National Development Council for approval.
After the approval the guidelines are sent to the States to develop State Plans. The
input is obtained from Districts and Blocks. The complete plan is now submitted
to the Planning Commission. The Planning Commission after receiving the plans
from States discuss the plans in detail with the respective States along with the
concerned officers of the concerned Central Ministry e.g. plan related to Health
aspect is discussed with health officers from Union Ministry of Health and Family
Welfare and the concerned divisional officers from the Planning Commission.
Priorities are declared and funds are recommended to the concerned states after
NDC’s approval. After NDC approval, it is placed before the Parliament for
approval. After it is approved by the Parliament, it becomes an official plan to be
implemented by various departments of Centre and State Government.
The planning process in India was initiated in the month of April 1951 with the
launching of First Five Year Plan. So far Nine Five Year Plans have been
completed the Tenth Five Year Plan is coming to an end and Eleventh Five Year
Plan is in the pipeline.
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 Health Care Planning in
2.9 NURSES IN HEALTH CARE PLANNING India

Nurse has a responsibility to participate in the overall planning of the total

nursing services at all level and coordinate nursing service plans with those of the
other health services.

There are mainly three levels in planning nursing services namely: Central level,
intermediate level and peripheral level as follows:

Central Level

At central level, the Nursing Adviser and Deputy Nursing Adviser/Assistant

Director General Nursing (ADG) to Government of India, Ministry of Health and
Family Welfare provide directional planning for nursing services and nursing
education in the country within the framework of National Health Policy and
goals of the country. They are responsible for:

 Formulating philosophy, broad policies and guidelines for socio-economic

development
 Defining overall goals and objectives
 Estimation of funds and other resources and give it to the Government
 Coordinating the planned activities with other health services
 Establishment of standards relating to nursing services (structure, process and
outcome)
 Continuing evaluation of nursing services
 Advising administrative authorities at the intermediate and peripheral level
 Planning continuing education programmes for nursing personnel

The nursing at the National level planning obtains inputs from Stats and Union
Territories and prepare comprehensive plan to be submitted to the Planning
Commission for approval.

Intermediate Level

At intermediate level, the administrative planning is done in each State by State

Director and Deputy Director nursing services. Administrative planning is
concerned with the overall implementation of the policies and programmes
developed and with the mobilization and coordination of the personnel and
material resources for providing quality health services to the people in the
hospitals and community setting. Health is a state matter. The nurse administrator
at State level formulate their own plans based on the state health problems and
needs and submit the same to the nursing adviser at centre level. The
responsibility of the nurse at this level is mainly managerial and/technical. They
are responsible to develop standards in terms of the detailed requirements of the
situation at their own level. They will also involve in some or all activities
mentioned below:

 Detail budgeting

 Assessment of planning initiative of the peripheral level

301
Community Health Nursing  Estimation of supplies, equipments required for implementation of health plan
Adminstration at intermediate level

 Coordination of the purchase and supply of equipment and materials with the
peripheral level staff

 Determination of staff requirement for health institutions and services

 The training and provision of adequate number of professional and

paraprofessional personnel.

Peripheral Level

The operational planning is carried out at peripheral level. It is concerned with the
actual delivery of the services to the public. The nurse will act as a supervisor,
consultant, educator and administrator at this level of planning. The planning at
this level must be done within the framework of National Health Planning. The
policies and general objectives developed by policy planning group at the
National level should not be subverted. The District Public Health Nursing
Officer, Public Health Nurse Supervisors and Public Health Nurses are the
peripheral level planning authorities and are responsible for:

 Informing the authority at the intermediate level of local problems that must
be taken into account in detailed planning

 Securing the coordination of local bodies (Panchayat leaders)

 Coordinating health activities carried out by basic Health Workers, ANM,

LHV’s Dais, VHG and AWW working in the Health Centres and in the
community. She also coordinates health activities carried out by general
practitioner and indigenous system of medicine.

 Onsite supervision for service personnel

 Provision of necessary supplies and equipment

 Selection, recruitment and training of staff

 Preparation of job description and standards, working procedures and

programmes of operational research

Constraints of Health planning

There are number of factors which stand on ‘the way of effective planning:

 Lack of adequate health information system for planning and monitoring and
ultimately for evaluation

 Natural resistance to change

 Low priority by political decision makers and the public

 Time lag between planning and implementation

 Lack of inter professional communication

 The inflexibility of education system

 Inefficient administrative practices

302
 Inadequate coordination of planning between different sectors of socio- Health Care Planning in
economic development India

Check Your Progress 2

1) List down five important health committees?

........................................................................................................................

........................................................................................................................

........................................................................................................................

2) List down the national goals set during the revised National Health Policy
2001?
........................................................................................................................

........................................................................................................................

........................................................................................................................

3) Health Planning is done at which of the four levels?

........................................................................................................................

........................................................................................................................

........................................................................................................................

2.10 LET US SUM UP

In this unit we have focused on health care planning in India. Attainment of health
is a constitutional right of every individual and this responsibility falls on the
Government of the country. India has a comprehensive system of health care
planning. Health care planning is a democratic process involving people at every
stage of planning process. Health planning has been defined as “the orderly
process of defining community problems, identifying unmet needs and surveying
the resources to meet them establishing priority goals and prepare programme for
accomplish objectives”.
So planning process consists of analysis of health situation, establishment of
goals, assess resources, fixing priority, plan formulation, programme
implementation, monitoring and evaluating.
Health planning guidelines are provided by various committees from time to time
such as Bhore Committee 1946, Mudaliar Committee 1962, Chadha Committee
1963, Mukherjee Committee 1965, Jungalwalla Committee 1967, Kartar Singh
Committee 1973, Shrivastav Committee 1975, Rural Health Scheme 1977,
Primary Health Care and Health for All declaration during Alma Ata Health
Policy came into force in the year 1983 and revised in 2001. Rural health mission
is aimed to strengthen the rural health services and rural health infrastructure.We
have also discussed health management system.
National Health planning is done at Central, State, District and Block level.
Planning procedure includes involvement of Planning Commission, National
Health Development Committee and Five Year Plans. Nurses play a very
important role in planning at National, State, District and Block level within the
framework of National Health planning.
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Community Health Nursing
Adminstration 2.11 ANSWERS TO CHECK YOUR PROGRESS
Check Your Progress 1

1) National health planning is “an orderly process of defining community health

problems, identifying unmet needs and surveying the resources to meet them,
establishing priority goals that are realistic and feasible and projecting
administrative action to accomplish the purpose of the proposed programme”.

2)  Gathering of information about pre-condition essential to planning

 Analysis of health situation
 Establishment of objectives and goals
 Assessment of resources
 Fixing priorities
 Write-up of formulated plan
 Programming and implementation
 Monitoring
 Evaluation

Check Your Progress 2

1)  Bhore Committee 1946

 Chadha Committee 1963

 Mukherjee Committee 1965

 Jungalwalla Committee 1967

 Kartar Singh Committee 1973

2) Goals to be achieved by 2000-2001 to 2015

Goals Target Time

 Eradication Polio and Yaws 2005

 Eliminate Leprosy 2005

 Eliminate Kala-Azar 2010

 Eliminate Lymphatic filariasis 2015

 Achieve zero level growth of HIV/AIDS 2007

 Reduce mortality by 50% on account of TB, Malaria 2010

 Other vector born and water born prevalence of blindness 2010

to 0.5%

 Reduce IMR to 30/1000 & MMR to 100/Lakh 2010

 Improve nutrition & reduce LBW babies from 30% to 10%

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  Increase utilization of Public Health facilities from current 2010 Health Care Planning in
India
level of <20 to >75%

 Establish an integrated system of surveillance, National 2010

Health Accounts and health statistics

- Increase health expenditure by Government as a % 2005

GDP from 0.9 to 2%

- Increase share of Central giants to constitute at least 2010

25% of total health spending

- Increase State Sector health spending from 5.5% to 2005

7% of the budget

- Further increase to 8% 2010

3) Health planning is done at:

 Central level

 State level

 District level

 Block level

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