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M Cs I t , I °/ S'

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ICS’
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A.

M LuduO
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NATIONAL

health policy

CONTENTS
Pages

I

1.

i

Introduction

2. Health Conditions in India at the time of Independence .

3.

I

I

2

4

Development of Vertical Programmes

12

4.

Five Year Plans and the Health Sector .

5.

National Health Policy

G.

Discussion of National Health Policy in Parliament .

7.

Outlook for the Seventh Plan

’3

20

Appendices

I. A.
B.

: and Water
Pattern of Investment on1 Health. Family WelfarePubb’c Sector.
Supply ami Sanitation in <different Plan periods in P

22

Sixth Plan Outlays—Health Sector .

C. S’xth Plan Outlays- States/L’Ts-wise
Health Sector
•

1

21

distribution of outlay for

Health and Family
D. Fv.
Per capita (Public Sector) expenditure on
Welfare durng 1977-78 to 1979-80.
and Achievements under
E. Statement shosvmg Phys’cal Targets
Rural Health Programme.
II. Establishment of Primary Health Centres and Sub-centres in India

23
25

27
28

since First Plan.

and Sub-Centres required and in position in Tribal
III. Number of PHC’s
Areas.
IV. fopulalivn pet bed, Pl.yskinn and Midwife/Xurse for sekc.ed coonV.

tries.
Government Health Expenditures in diflerent countries. .

VI.

Statement on National Health Policy.
, rfC-M tf-"- -

Conduct of
:e General
•elhi.

.

29

3>
32

33

u.

NATIONAL HEALTH POLICY
INTRODUCTION
According to the World Health Organisation health is a “state
of complete physical, mental and social well-being and not merely
the absence of disease or deformity”. One of the fundamental
rights of every human being without distinction of race, religion,
political belief, etc. is the enjoyment of the highest attainable
standard of health.1 Owing to a variety of factors like lack of
health consciousness, low per capita income, lack of adequate edu­
cation, non-availability of proper sanitary conditions and safe
drinking water, unhealthy social taboos and the like, the health
status of the average Indian leaves much to be desired. It has
been the endeavour of successive Governments in India to improve
the_ situation. This is especially so after Independence. The
National Health Policy, which has recently been announced by the
Government, is a logical culmination of the consistent efforts,
aimed at securing a healthy life for all Indians, pursued by the
Governments in the recent decades. While many are the achieve­
ments in the past, more needs to be done now and in the near
future.

Since the attainment of Independence, the country has made
significant progress in improving the health status of its people.
Plague and smallpox have been
.' ' \ eradicated, cholera
- -i <completely
has been successfully contained, and considerablej headway has
been made in the control of malaria, leprosy, tuberculosis, blindness,
filariasis and several other diseases. However, the planning pro­
cess has also contributed to the development of a
nationwide
primary health care infrastructure, reversing the kind of largely
hospital based services.
While addressing the World Health Assembly in May 1981. the
late Prime Minister Smt. Indira Gandhi observed:

“Tn India we should like health to go to homes instead of large
numbers gravitating towards
Centralised
Hospitals.
Services must begin where people are and where pro­
blems arise.”
Also, India is a signatory to the Alma Ata Declaration of 1978
which is aimed at the attainment by all people of the world by the
’Nfudaliar Committee Report, igfii. p. 53.

I

I
I!

2

year 2000 of a level of health that will permit them to lead socially
and economically productive lives. The objective is sought to be
secured through the primary’ health care approach.2 The National
^Health Policy is a blue print for such concerted action by the
Government, the private voluntary agencies and the people for the
attainment of the ideal of health for all.

I

4

i

In this context it would be appropriate if we look back at the
rapid strides the country has made in strengthening the health
care system.
1. HEALTH CONDITIONS IN INDIA AT THE TIME OF
INDEPENDENCE
The Health Survey & Development Committee (Shore Com­
mittee), which was appointed by the Government of India in Octo­
ber 1943 to make a survey of the existing position in regard to
health conditions and health organisation in what was then known
as British India and to make recommendations for future develop­
ments, found that they had to confines themselves mainly tc
statistics of ill-health and death, in the absence of data on positive
health.

|
I

i

The Bhore Committee which submitted their Report in 1946.
found that the general death rate in “British India” was 22.4, the
infant mortahty rate was 162, and the expectation of life at birth
was 26.91 for males and 26.56 for females. Nearly half the total
number of deaths were among children under 10 years of age and
in this age group one-half of the mortality’’ took place within the­
ft rst year of life.
Although vaccination had been in vogue for nearly eighty’- years.
India continued to be a reservoir of smallpox.
Endemic diseases like leprosy, filariasis, guineaworm and hook­
worm, though not contributing to a large extent to the mortality
figures, caused considerable morbidity.
The Bhore Committee found that the low state of public health,
as reflected in the high mortality and morbidity (particularly
among mothers and children), was preventible and was mainly
due to the absence of environmental hygiene, adequate nutrition,
adequate preventive and curative health services and intelligent
co-operation from the people themselves. To these causes may be
added illiteracy, unemployment, poverty, purdah system and early
marriages.

!

IL.S. Deb., 16-12-83, Col. 356.

I

There
and rural
drainage
vzas both
The ci
adquate.
health vis

Rough!
service, th
practition*
medical 0
child wel

Hospit
people, pc
the qualit
per 1,000

Some
mittee in
“Nc

“H*
“T1
“A

“H

The s
the raisbthe end

3
‘ i urban
There was a wide prevalence of insanitary conditions in
’
1
water
supply
ancl
and rural areas. The provision for protected ....
consumed by millions
drainage was totally inadequate. The food C-vzas both insufficient and ill-balanced.
' The curative and preventive h-lth services
nHnuitP There were 1 doctor for 6,300, 1 nurse lor ‘to, ,
health visitor for 400.000 and 1 midwife for 60,000 people.

j lead socially
sought to be
The National
iction by the
people for the

Roughly one-fourth the number of doctors were “
service, the rest being mostly settled m ur an area
practitioners. Again there were only a iota of ™ t0 U
and ■
medical officers in public service engaged purely n ,mate
child welfare work. Very few of these were medreal graduates.

: back at the
ng the health
TIME OF

Hospitals and dispensaries for providing medical relief to the
people particularly in the rural areas, were grossly msufficien: an
ffie quality of such services was very poor. There was only 0.24 beu

(Shore ComIn'dia in Octo­
in regard to
as then known
uture developes mainly to
ata on positive

per 1,000 population.
Some of the important recommendations made by
mittee in their Report were the following:

the

Com-

“No individual should fail to secure adequate medical care

because of inability to pay for it.

eport in 1946.
was '22.4. the
of life at birth
half the total
Bars of age and
lace within the

“Health service should provide all consultant, laboratory and
institutional facilities for proper diagnosis and treatmen .
“The health programme must, from the very beginning, lax
special emphasis on preventive work.

ly eighty years

“As much medical relief and preventive health care as possible
should be provided to the vast rural population of the

mrm and hook0 the mortality

as
country. Health services should be placed as close
possible to the people in order to ensure the maximum
benefit to the communities to be served.

providing
“Health consciousness should be stimulated by
health education on a wide basis as well as by providing
opportunities for the individual participation in local
health programmes.3

)f public health,
jr (particularly
1 was mainly
jquate nutrition.
and intelligent
i causes may be
/stem and early
I
I

I

The short term measures suggested by the Committee included
the raising of bed population ratio from 0.24 per 1000 io 1.03 at
the end of 10 years, provision for travelling dispensaries to suppleCommittee

Report,

pp.

15-20

r
4

J

II

ment the health services rendered by primary health centres, promo­
tion of hygienic life, etc. The longer term aims included raising
the bed-population ratio to 2 per 1000, establishment of more
medical colleges, training centres for nurses, etc.4

Program
gramme
pose.

2. DEVELOPMENT OF VERTICAL PROGRAMMES

The J
in 1943.
the inch
populate
incidenc
Program
were es*

The report of the Health Survey antf Development Committee
•m 1946 and India gaining independence in 1947 led to intensive
efforts by the new National Government for controlling of certain
important communicable diseases. It was thought that
as
the
development of the organisation recommended by the Shore Com­
mittee will take a long time, it would be desirable to make special
efforts for the control of smallpox, malaria, filaria, tuberculosis, and
leprosy through special efforts directed specifically on these diseases.
Smallpox

The Shore Committee brought out that the incidence of small­
pox was highest in India and was responsible for about 70.000
deaths per year. The vaccination facilities were provided to a
united population and wherever such facilities were available the
coverage was unsatisfactory.

Tu^ercul

Leprosy

The
cent of
al Leprt
Year Pl
teams i
team co

The
brought
leprosy

The Government of India appointed an Expert Committee
on
Smallpox and Cholera. The Committee in its report in 1958
> recommended launching of National Smallpox Eradication
Programme and training and recruitment of 20.000 vaccinators
for
smallpox and cholera vaccination.

Duri
Leprosy
Eradic?

Malaria

In F
Health,
draw u
State
san­
in 19.

It was estimated that nearly 75 million
people suffered from
malaria every year. Considering it as the
major health problem,
the National Malaria Control Programme
was launched in 1953-54
in selected areas which gradually went on
i expanding to cover the
whole country,
, -/ with
- a vertical organisation with separate malaria
officers, malaria inspectors, health inspectors and malaria workers.
Filaria

Experimental projects for the control of filaria was started
in
1950 by the Indian Council of
Medical Research and based on the
report of the experimental project,, the National Filaria
Control
iIbid. pp. 19—20.

Report

The
grated
Dire
Service
Individ

Distof He?

5
Programme was initiated in 195-5. The National Filaria Control Programme established separate survey and control units for this pirrpose.

i centres, promoncluded raising
nent of more

Tuberculosis

-- —
The BCG Vaccination Programme
was started on a pilot basis
Sample Survey in 1955 indicated
in 1948. A National Tuberculosis
b-----------tuberculosis
varying
from 13 to 25 per thousand
the incidence of
' . Considering the high
population in different parts of the country,
’ » <country,
incidence of tuberculosis in the
„, 'the National Tuberculosis
launched
in
1958
and
a
large number of BCG teams
Programme was 1.------------------were established.

AMMES

lent Committee
2d to intensive
tiling of certain
that as
the
he Bhore Comto make special
uberculosis, and
i these diseases.

Leprosy
i

dence of smallabout 70,000
provided to a
'e available the

The Report of the Committee for the Control of Leprosy (1955)
brought out that nearly 2.5 million people were suffering from
lenrosy and 205 million people live in endemic zones.
During the Third Five Year Plan, starting in 1961, the National
Lepcosv Control Programme was changed to the National Leprosy
Eradication Programme.

Committee on
)ort in 1958• rcadication Pro’
vaccinators for

Report of the Cova.mit.tee on Public Health Act, 1955

In pursuance of a resolution passed by the Central Council of
Health, the Government of India appointed a Committee in 1953 to
draw up a model comprehensive Public Health Act which the various
States in India might enact with such modifications as may be neces­
sary to suit local conditions. The Commitee submitted its report
in 1955.

suffered from
health problem,
ched in 1953-54
ig to cover the
eparate malaria
ilaria workers.

was started in
i based on the
^ilaria Control

The Bhore Committee brought out that leprosy affected 2.5 per
cent of the population in different parts of the country. The Nation­
al Leprosy Control Programme was 1launched' during the First FiveYear Plan (1951—56) by the establishment of survey and treatment.
teams in areas where incidence was more than 1 per cent, Each'
team covered a population of 80,000.

The Committee in its report recommended a unified and inte­
grated health organisation at various levels to be operated through:
I

I

Directorate, of Health Services under the Director of Health
Services assisted by the required number of Deputy Directors for
individual pvogrammes/activities.
District Headquarters Organisation: The Under Medical Officer
of Health shall be rhe Chief Administrative Officer in charge of

rtl
6

health services in the district. He would be assisted by one or more
Deputy Medical Officers of Health.

Sub.Divisional Headquarters Organisatio^i
The Under Sub-divisional Medical Officer of Health shall be in
charge of medical and health services in the sub-division, and would
oe supported by necessary medical and para-medical personnel.
.

J

The ma
health o
“1

rIh(mc Health Centre Organisation (in urban areas)

arJhe I?ana ^efth Centre

would be located in urban

of Heahh T m
Charge °f the Thana Medical
of Health who will also supervise the Rural Health Centres.

saries^^nfmT311011
°f
f°r the hospitaIs and disPenanitary inspectors, one health aSSiStant
assistant SUPP°rted by tbree
or
or mo^e
mmre field
fiGld worker, and Lady
Y
“Pc

Rural Health Centre

II

i

The Rural Health Centre \
’
would have, besides the medical OffiOfficer, health visitors with ANMI (Auxiliary Nurse Midwife) for midtion XoTu'la?’1'1 r'T6 services and health assistants for
vaccinaon, inoculation, disinfection and other sanitation works.
Health survey and Planning Committee
(Mudaliar Committee
1959—61)

“Th

tee
°f Health’ Set up a
had taken place since the nubr et.reV!ew of the developments that
Survey and DeveCent 0™°”
EePOTt °f the HeaItb

“The

with a view to formulatin? further health or Committee) in 19't6
try in the third and subsequent Five
P™grammes in the counof reference of this co^^Xe^e:
"
PeriOdS' The te™

c

C

“The
A

Famity Pl

aSS®SSm?nt of deveI°pnients in r ‘ "
re­
Survey and
CenlreS’ submissi°n of the' Health
Development Committee Report;
- (n) review of the second Five-Year Plan heatlh
projects;
(iii) formulaticon of all the recommendations for
the future
Plan of health <development in the country.
The Committee known
t as the Health Survey and Planning o
rniitee (Mudaliar
; subuutted its report in October 1961.

■

XIX mediCal

India
the very i
Programme
programme.
Planning Pi
not made m
been achieve

In 1962, ]
visit the cau
tance of the
Nations of the

ne or more

7
The major recommendations of the committee in respect of future
health organisation in the country were as follows:

i

!

shall be in
and would
onnel.

“The attempt to start mass campaign against certain diseases
like tuberculosis, smallpox, cholera, leprosy and iilariasis
is commendable but the method of dealing with these
diseases individually will not be conducive to the organi­
sation of unified efforts needed for the promotion of total
health care. The health personnel engaged in such mass
campaigns must be trained to tackle all health problems
in any area while the overall supervision for particular
disease may require special attention through specialists:
in rural areas it is neither possible nor desirable, to have
separate agencies to deal with separate diseases .

d in urban
ical Officer
res.

nd dispen1 by three
*d by mid-

i

jdical Offi) for mid>r vaccina-

ittee

a Commitnents that
le Health
) in 1946
the counThe terms
nedical rehe Health

projects;
the future

ning Com'
ober 1961.

“Para medical personnel recruited at present for individual
diseases such as BCG, leprosy, malaria and filariasis should
be given further necessary training in other diseases in
order to make them multi-purpose personnel and allocate
them to urban and rural centres, otherwise there is likely
to be immense loss of manpower”.
“There should be one Auxiliary Nurse Midwife for every
5,000 population and an auxilliary health worker for double
that population”.
“The problem cf integration of medical and health services
should not be postponed because of certain initial diffi­
culties”.
“The technical set up at state level should be headed by DHS
with a number of Deputy Directors”.
Family Planning Programme

India recognized the importance of controlling population from,
the very beginning of its development plans. The Family Planning
Programme up to 1961 was being implemented as a part of the health
programme. However the census of 1961 revealed that the Family
Planning Programme, though being run for nearly a decade, has
not made much headway and hardly any appreciable reduction has
been achieved during the last decade in the growth rate.

In 1962, India imnted a UN Mission on Population Activities to
visit the country and advise the steps to be taken for greater accep­
tance of the small family norms by the population. The recommen­
dations of the UN Mission were -oiftidered by a committee appointed

di
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8
by the Government of India. Based on the recommendations of
ihis committee it was decided to have the Family Planning Prog­
ramme as a vertical programme with a separate hierarchy at the
central level in the form of a separate Department of Family Plan­
ning to the most peripheral level with separate workers of Family
Planning. Considering the direct relationship between infant mortality and acceptance of small family norms, it was also
decided to integrate the Mother and Child Health (MCH) pro­
gramme with Family Planning.

I

Comm'.ctee on multi-purpose workers under Health and Family
Planning Programmes (1972-73)

The national programmes in the field of Health and Family Plan­
ning and Nutrition have been in operation in the country for many
years. In general these programmes were being run almost inde­
pendently of each other by the staff recruited under each program­
me. There was little or no coordination between the field workers
or supervisory personnel of these programmes. They were separate
and independent functionaries. This state of affairs came into exist­
ence because the various health programmes and later on family
planning programme, were launched at different times and each was
conceived to run vertically with its own staff. A question was raised
in many quarters whether the same objectives could be achieved bv
coordinating these programmes and pooling the personnel. Accord­
ingly the first meeting of the Executive Committee of Central Family
Planning Council held on 20 September 1972 recommended:
)

‘‘Sleps should be taken for the integration of medical, public
health and family planning services at the peripheral
level. A Committee should be set up to examine and
make detailed recommendations on: (i) structure of in­
tegrated services at the peripheral and supervisory levels;
(ii) feasibility of having multi-purpose/bipurpose workers
in the field; (hi) training requirements for such workers:
and (iv) utilization of mobile service units set up under
family planning for integrated medical, public health and
family planning services.”
In ]pursuance
--------”
of" Jhe
above recommendations of the Executive
Committee of the Central Family Planning Council, 1the Government of India appointed a Committee in^October 1972.. Tire Commi t tee on Multi-purpose Workers under Health and Family Planning Programme (also knowni as Kartar Singh Committee) submittod its report in September 1973.

’T

The Comr
views of heal
stated that thcentres canno
vfequirements
each worker
visited. The
not happy wi
their homes a
out being in e
of its findings
for the delive
vices are both

The Comm
multi-purpose
areas where n
been contrclle
as malaria pas
controlled. T
in cholera consuch for the ttmue as such,
purpose workt

I

The ComrniThe doctors a
not only to re
the work or 11
visors. AU th.
linked with it.
lation on a geo
is on field visi

Better coorf’ospital and a<
level agencies
these and the
Similar is the
machinery.

I

I he Commi
times conflictin
c
it is not
-i r-_
surpri
inadequacies
* — -S p^

9

The Committee while reporting its findings after eliciting the
views of health experts, health administrators and the community,
stated that the existing staff of the primary health centres and sub­
centres cannot adequately deal with the health and family planning
requirements of the population involved. The population given to
each worker is too large to be adequately covered and frequently
visited. The community leaders were of "the view that people are
not happy with the services, that so many workers were coming to
their homes and making enquiries ter individual programmes with­
out being in a position to tackle their health needs. On the basis
of its findings the Committee recommended: “multi-purpose workers
for the delivery of health and family planning and nutritional ser­
vices are both feasible and desirable.”

ions of
ig Progy at the
ily Planf Family
2en in/as also
=H) pro'amiVij

lily Plan­
ter many
tost indeprogrami workers
; separate
nto existm family
each was
/as raised
nieved bv
Accordal Family
d:

?al, public
-peripheral
imine and
ure of inary levels:
:e workers
i workers:
up under
nealth and

Executive
e GovernThe Commily Plane) submit-

I

I
<

I

The Committee recommended that the programme of having
multi-purpose workers should be introduced in the first phase in
areas where malaria is in the maintenance phase and smallpox has
been controlled. The programme can be extended to other areas
as malaria passes into the maintenance phase or where smaUpox is
controlled. This will be the second phase. The workers engaged
in caolera control, filaria and leprosy programmes may continue as
auch for the time being. Similarly, BCG vaccinators may also con«^ue as such. However, all these workers will be made multi­
purpose workers in the third phase of the programme.

The Committee also recommended integration at different levels.
The doctors at the PHC (Primary Health Centre) should be able
not only te render health care to the population but also to check
the work of the health workers at the sub-centres and their super­
visors. All the dispensaries in the jurisdiction of a PHC should be
linked with it. Also the doctors of the PHC should divide the popu­
lation on a geographical basis for their field visits. While one doctor
is on field visit, another should be available at the PHC.
Better coordination between the PHCs. and Taluk/Tehsil level
^ospital and administration and between the latter and the district
level agencies concerned with health is essential. The links between
nose and the medical colleges are also to be established/improved
Similar is the case for a revamping of the health administration
machinery.

timI!lep^pmtrnittee obser''ed ‘hat with the diverse, diffuse and

at

it is"n0t ,‘,C ,?.g.array o£ medical ^ties available in the country.
inndPH
rP1ISing that there is*a constant cry of neglect and of
■nadequac.es particularly for the under privi^ged sections of the

-

10
society which constitute the vast majority. Even though the country
has a poorer doctors-population ratio, as compared to the developed
societies, it is an inescapable fact that a proper harnessing of the
available resources and a reorganisation of the entire system can go
a long way to solving the health problems of the country7.

If proper bridges could be built between the medical college
hospitals on one side and the primdry health centres on the other,
with taluq and district hospitals in between, a much closer liaison
can be established between all the workers engaged in the health
and family planning programmes. Graded facilities of specialist
skills and investigative techniques can then be made available at
different levels.

i

The existing practice of separating curative and preventive me­
dicine also needs to be reviewed. The old departments of hygiene
in medical colleges and their more recent prestigious replacements
(Department of Preventive and Social Medicine) have to be evalua­
ted. Whereas some divisions in the field of medicine like general
medicine, surgery, obstetrics, opthalmology, etc., have to be there,
it is questionable if divisions between preventive medicine, curative
medicine and family planning need to be continued.

The time is ripe for a reappraisal of the whole organisation ol
medical services in the country. The existing divisions both on
account of historical developments and of borrowed ideas from the
West need to be reviewed and the entire system overhauled.

f ,I

The recommendations of the Comm^tee on Multi-purpose Workers
on Health and Family Planning Programme were accepted by the
Government of India and it was decided that the recommendations
should be implemented from the beginning of the Fifth Five-Year
Plan, 1974—79.
The problems faced in the implementation of multi-purpose workers
scheme
The Multi-rurpose Wotkers’ Committee while recommending the
introduction of the multi-purpose workers at the peripheral level
and integration of services at all levels foresaw the difficulties and
problems which were likely to be faced in the implementation of
its recommendations. Certain new problems/difficulties also came
to notice during the actual implementation ol the recommendations.
The various types of problems and difhculiics faced car. be divided
into:

(i) administration (ii) training (iii) attitude

Admin

0)
the intworker
these v
It beca
grating
worker
claims
given ;
Trainn

Wo:
have d
ing. P
workei
As
workei
PHCs
threw
ber of
availat

Attituc

Unc
levels,
and tu
apprec
nisatio
joyed
of the
the hit
mental
affect
The
integrz
budget
a mor
which

1
11

the country
e developed
sing of the
stem can go
y.
ical college
n the other,
loser liaison
i the health
of specialist
available at
jventive mes of hygiene
replacements
.o be evalualike general
to be there,
tine, curative

ganisation o[
ons both on
eas from the
•hauled.
pose Workers
epted by the
>mmendations
’th Five-Year

•pose workers

nmen di ng the
ipheral level
lifficulties and
ementation of
ies also came
imrnendations.
ar. be divided

Adminsitratwe problems

,

(i) mtroduction of the
the integration of the cadres

recruitment
ii
i

Jatin^various cadres
cadres and
and fixing inter

3 making

workers and supervisors
claims regarding the seniority they should be
claims and counter c—
given in the service.

Training
Workers and supervisors recruited under different programmes
havYd fferent educational qualifications and different types of team­
ing As such, working out a common training curriculum for these
workers and supervisors poses a much greater pro e

scheme required reorientation training not only of the
x\s the
workers and their supervisors but also of the medical officers at the
and the training of trainers, the scheme
PHCs and district level
threw uo a large training load for which neither an adequate num­
bed of training Institutions nor the required number of trainers were

available.

Attitude problems
Under the vertical programme, officers at the State and district
levels particularly in respect of malaria, family planning, leprosy
and tuberculosis programmes, had their own hierarchy and enjoyed
appreciable administrative and financial powers. With the reorga­
nisation and integration, the financial and administrative powers en­
joyed by these officers were transferred to the Chief Medical Officer
of the district. These officers saw in this change the crumbling of
the hierarchy and loss of powers for which they were, not prepared
mentally, and opposed the scheme as impracticable and likely to
affect the vertical programme implementation adversely.

The workers and supervisors under different programmes, though
Integrated, continued to draw their salaries and benefits from the
budget of the individual programme and as such continued to have
a more favourable attitude to the programme from the budget of
which they drew their salaries.

12

The result of these operational problems have been that while it
was envisaged that the whole scheme will be implemented in the
country by 1982, there are still many States where the scheme has
not been eifectively implemented so far?

started. Cc
malaria, tub
It may b
health, fam
3.86 per cen
Plan, only 4
in the Thirc

4. FIVE YEAR PLANS AND THE HEALTH SECTOR

Soon after the publication of the Report of the Bhore Committee
the country became independent. The new Constitution was adopted
and the country embarked on a planned economic development. The
First Five Year Plan of 1951—56 provided Rs. 65.2 crores for health
development schemes. The main objectives of the First Five Year
Health Plan were provision of water supply and sanitation, control
of malaria, preventive health care, health care for mothers and chil­
dren, education and training and health education.

j

“Health” (including water supply and sanitation) was allocated
Rs. 217 crores out of the total plan outlay of Rs. 4672 crores in the
2nd Five Year Plan. In the Third Plan a sum of Rs. 361.00 crores,
out of a total of Rs. 8576.5 crores was earmarked for Health. (Of
this, the provision for water supply and sanitation in the urban and
rural areas was of the order of Rs. 110.2 crores).0 The corresponding
Plan provisions during the Annual Plans 1966-1969. Fourth. Fifth
and Sixth Five Year Plans were of the order of Rs. 313.3 crores,
1261.5 crores, 2360.1 crores, and 5753.1 crores respectively, (Vor details regarding Plan outlays please see Appendix 1 A).

During the first decade of plan activity, it may be justifiably
claimed that, training facilities had been considerably expanded;
facilities for treatment of the sick had improved; the groundwork
for the fight against small pox. tuberculosis, leprosy and filariasis
had been laid, the framework for planning and developing a national
water supply and sanitation had been brought into existence and a
movement for family planning on a mass scale had been set in motion.
The infant and maternal mortality rate started declining.

In physical terms, the first 10 years of planned development saw
the establishment of 2565 primary health centres, hospital beds had
gone upto 18500, making a bed-patient ratio of 0.4 per thousand. Tn
regard to mother and child health, more than 3500 centres were
started in this period. Besides several colleges for nursing degree
courses, centres for training health visitors, midwives, etc. were also
5. S^igal, M.D. : Development of Health Services in India, 1984.

e. Health statistics of India, 1983, p. 71.

I

I

In the th
family welf
-of water sup
the health s
allocation fc
the Fifth Pl
Plan provisi
4 per cent n
Rs. 2831.1 er

While th*
documents a
needs of the
prehensive a
-education, re
■shed to serve
It was in thi
evolved by
The NHP
of the people
the health de
quality of th
status must 1
be viewed as
ment. Conse
lished among
tected water
lion, housing
blems associa
■and frontal a
’■ Nfudaliar C

’. Health Stat
’. Ibid.

13

achieved in the fight against
•started, Considerable progress was
malaria, tuberculosis and leprosy.7
connection that while the outlay on
It may be mentioned in this
supplv and sanitation represented
health, family welfare, water
and 4.59 in the Second
3.86 per cent of the total outlay m the First
was earmarked for health
Plan, only 4.2 per cent of the total outlay
in the Third Plan.8
In the three Annual Plans of 196^-69 health sector
family welfare) received 3.2 per cent of the funds while the share
-of water supply and sanitation was 1.6 per cent. In the Fo"r^ anthe health sector received 3.9 per cent of the outlay whereas the
allocation for water supply and sanitation rose to 35 per cent n
the Fifth Plan the respective figures were 3.2 and 2.8. In the bixtn
Plan provisions for these items are of the order of 2.9 per cent and
4 per cent respectively. In terms of actual size these come to
Rs. 2831.1 crores and Rs. 3922 crores respectively.0

that while it
aented in the
e scheme has
ECTOR

.re Committee
i was adopted
^lopment. The
res for health
rst Five Year
tation. control
hers and chil-

was allocated
1 crores in the
. 361.00 crores,
r Health. (Of
the urban and
corresponding
Fourth. Fifth
s. 313.3 crores,
/ely. (For dc-

5. NATIONAL HEALTH POLICY
!

V).”

’ be justifiably
-bly expanded;
-he groundwork
y and filariasis
jping a national
existence and a

?n set in motion,
■ning,.

evelopment saw
jspital beds had
sr thousand. In
00 centres were
nursing degree
s, etc. were also

1

While the broad approaches contained in the successive Plan
documents and discussions thereon might have generally served[ the
needs of the situation in the past, it was felt that an integrated com­
prehensive approach towards the future development of medical
■education, research and health services was required to be establi­
shed to serve the actual health needs and priorities of the country.
It was in this context that the National Health Policy (NH ) was
evolved by the Government.
The
The NHP
NHP aims
aims at
at taking
taking the Services nearest to the door-steps
2
__
___________
1 J fuller
participation of the community in
of the people and ensuring
j
the health developmeni process. It has been recognised that if the
quality of the lives of the people is to be improved, their health
status must be raised. In this perspective, health development is to
be viewed as an integral part of overall human resources develop­
ment. Consequently, a coordinated approach is sought to be estab­
lished among all the health-related programmes, for example, pro­
tected water supply, environmental sanitation and hygiene, nutri­
tion, housing and education. To be successful, an attack on the pro­
blems associated with diseases must be accompanied by a direct
■and frontal attack on poverty, ignorance and superstition.
———_.
_
-———
’. Mudaliar Committee Report, op-cit., pp. 30—33.
*. Health Statistics of India, 1983, p. 71.

14

’

j

.0’

The National Health Policy points to the need, of restructuring
the health services on the preventive, promotive and rehabilitative
aspects of health care and brings out the need for establishing comprehensive services to reach the population in the remotest areas.
The Programmes are being implemented through the fullest involve­
ment of the communities. It views health and human development
as a vital component of over-all socio-economic development. For
the realisation of the various objectives the policy indicates speci­
fied goals to be achieved by 1985, 1990,. 1995 and the year 2000.

o
.st

Some of the major steps taken towards, this direction are
following:

ii:

the

(i) To shift the emphasis from the curative to the preventive
and promotive aspetes of health care as well as to take
services and supplies nearest to the doorsteps of the people,
the following changes have been brought about:

(a) It has been decided to establish one Sub-Centre for
every 5000 rural population (3000 in Tribal and Hilly
Areas) with one male and one female worker.
21135new Sub-Centres have been opened during the four
years, 1981-1984. The total number of Sub-Centres, as
on 31-3-84 stood at 74307. A target of setting up 9071
more Sub-Centres during 1984-85 had been fixed by the
Planning Commission.

p

H.

(b) In place of the Primary Health Centre for every Com­
munity Development Block it has been decided to have
one Primary Health Centre for every 30,000 rural popu­
lation (for every 20000 in Hilly and Tribal areas). 172bNew Primary Health Centres have been establishedduring the four years, 1981-84. As on 31-3-84, the coun­
try had a total of 7210 Primary Health Centres. ThePlanning Commission had fixed a target of setting up
197 more PHCs during the year 1984-85.
(ii) To further the Primary Health Care approach and
secure community involvement, a centrally sponsored
programme is being evolved to train Health Guides
selected by the community for every village or every
1000 rural population 3.13 lakh village Health Guides
had been trained till 1-4-84.

(iii) The Leprosy Control Programme has been converted'
into a 100 per cent Centrally funded programme and the-

I

0’

h
gi

si
N
b
ti

ir
Ir
m
re
of
la
m
br
in
co
pc
ur
sc

i(iv) N.

co
Er
ly
se«
pe
tai
be
toi<
me
inc
Th
mi
in
she

15

.outlays in the current year make a five-fold mcrea
over those in 1979-80. Following the late Prune Mau
ster Smt Indira Gandhi’s call for eradication of leprosy
tn a ume bound basis, the Leprosy Control Programme
has now been taken up as a 'Leprosy^“ cotxLsgramme’ and a National Leprosy Eradication Commis
Sion has been set up for providing policy guidelines
National Leprosy Eradication Board has also been e
blished for effectively implementing the recommenda­
tions of the Commission. Similar policy guidance and
implementation Bodies will be set up in the States hav-

, of restructuring
ind rehabilitative
establishing come remotest areas,
le fullest involveman development
evelopment. For
y indicates specihe year 2000.

irection are

the

ing high incidence of leprosy.

i

1
intensive case detection and treatment, application of
multi-drug regimen, extensive health education n
rehabilitation of cured patients are the main teatu
of the new strategy. Of the estimated 3.2 million popu­
lation in the country suffering from leprosy, about 2.9
million have already been detected and 2.74 million
brought under treatment. The activities in this sphere
include establishment of various leprosy control units/
centres, survey, education and
J- ■ treatment centres, ternreconstructive surgery
porary hospitalisation wards,
.
The
ultimate
object
is to eradicate the
units, etc.
scourage of
c leprosy by the year 2000 A.D.

to the preventive
s well as to take
teps of the people,
it about:
.e Sub-Centre for
Tribal and Hilly
3 worker.
21135'
during the four
>f Sub-Centres, as
jf setting up 9071
been fixed by the

i

'e for every Com■n decided to have
30,000 rural popuribal areas).
been established31-3-84, the coun■ilth Centres. Therget of setting up
-85.
■re approach and
entrally sponsored
n Health Guides
y village or every
4ge Health Guides

; been converted1
jrogramme and the

j-

Jiv) Malaria has been a major public health problem in
i the
country, To
k combat this disease, the National Malaria
* Programme is being implemented vigorousEradication
’ ". Surveillance and spray of in­
ly all over the country.
secticides, alongwith health
education on sanitation,
personal protection measures, etc. are being under­
taken under this programme. Research activities are
being continued regarding effect of insecticides on vec­
tor control and resistance of malaria parasites to com­
mon antimalarial medicines. As a result of all this the
incidence of malaria has been showing a steady decline.
The incidence of this disease showed a decline from 6.5
million cases in 1976 to 2.8 million cases (provisional)
in 1982. Similarly the incidence of p. falciparum cases
showed a decline from 7.5 lakhs 'n 1976 to 4.7 lakhs
(orovsional) in 1982.

i

I

16
The declining trend in the incidence of the disease conti­
nued in 1983 also. It has been decided by the Central
Government to provide 100 per cent assistance to toe
States for the cosf of malathion required for.spray m
the areas where the vector mosquitoes for
been found to have developed resistance to B.H.C. and

I

D.D.T.
(V) A new strategy has been adopted for tack i g
losis by detecting as many cases as possible and
-»
cases
ing them under effective treatment. 10.0 lakhs
were detected and brought under treatment during
1982-83. During 1983-84 the target for detecting T.B.
cases is nxea
fixed at 12.5 lakh cases and the Pr°gress in
this regard is satisfactory. At present 354 fully equipcountry. bt p
ned T B Centres are functioning in the country,
are also under way to ensure that at least 50
examinations per month at each Primary Health Centre
are earned out to provide easy case detection facility

in the rural areas.

(vi) A national programme for the control of blindness has
been launched to reduce the incidence of blindness from
the present level of 1.3 per cent to 0.3 per cent by the
year' 2000 AD. Cataract has been identified as the
major cause for blindness. Sample surveys of the popu­
lation have indicated 55 per cent of the 9 million blind
in the country are suffering from cataract. Efforts have
been stepped up to detect and control visual impair­
ments. The National Programme for Control of Blind­
ness envisages the development of various services at
the peripheral and intermediate levels. Mobile units
provide comprehensive eye care including surveys in
villages and screening of school-going children, besides
providing out-patient and surgical treatment. During
the three years 1981-82 to 1983-84 the number of cataract
operations^ performed in the country were 5.5 lakhs,
8.5 lakhs and 10.25 lakhs respectively. A target of 12.78
lakh operations has been fixed for 1984-85. Opthalmic
care facilities have been strengthened in 540 Primary
Health Centres, 250 District Hospitals and 30 medical
colleges. All assistance and encouragement is being

(

17
provided to the non-governfaental organisations engag­
ed in the conduct of mobile eye camps. A scheme to
prevent blindness caused by Vitamin ‘A’ deficiency
among children through oral administration of massive
dose of Vitamin ‘A’ is also in operation. This scheme
is implemented in all States and Union territories.

3 disease contioy the Central
istance to the
i for spray in
r malaria have
to B.H.C. and

(vii) Diagnostic and treatment facilities for Cancer are
being augmented especially at the Regional Centres ioi
Cancer research at Ahmedabad. Bangalore, Calcutta,
Cuttack, Delhi. Gauhati. Gwalior. Madras and Trivan­
drum. The Sixth Plan has allocated Rs. 11.50 croies for
cancer control and treatment

•kling tubercu-ble and bring. lakhs cases
ment during
detecting T.B.
2 progress in
4 fully equipountry. Steps
ast 50 sputum
Health Centre
.ection facility

blindness has
blindness from
2r cent by the
ntified as the
s of the popuI million blind
■t. Efforts have
visual impairitrol of Blindus services at
Mobile units
ig surveys in
ildren, besides

-nent. During
■ber of cataract
2re 5.5 lakhs,
.arget of 12.78
35. Opthalmic
540 Primary
id 30 medical
ent is being

Efforts for dealing with diarrhoeal diseases and control
of goitre have been intensified. No state in the country
can be called goitre free. 12 iodization plants have
been installed for the supply of iodized salt to the goitre
endemic areas. There is a proposal to ensure that all
salt used for human consumption is iodized by the
year 1990.

t

(viii) A Medical Education Review Committee was set
up
to review the content, quality and relevance of teaching
and training in medical institutions. The Committee
has already submitted its Report and efforts are under
way to evolve a National Medical and Health Educa­
tion Policy.
tix) In furtherance of objectives of the Health 1Policy,
efforts have been initiated to generate the jrequired
medical and health manpower at various levels.

(x) Community involvement and participation is~the cor­
ner-stone of the National Health Policy. The Health
Guide Scheme, under which a volunteer selected by the
community becomes responsible to it for organising
promotive and preventive measures, is the first step
m this direction. It envisages the formation of Health
Committees in every village to project the health needs
of the community and be involved in the functioning
of health services, A programme of training of Cominunity leaders and preparing them for assuming higher
responsibilities is already being implemented.

I

18

(xi) Voluntary organisations play an important ro e 1
providing Health and Family Welfare services supple­
menting the efforts of the Government, the Health
Policy envisages active support and involvement o
voluntary organisations. Financial assistance is provi
ded by the Government to the voluntary organisations
as in the following categories’(i) To T.B., Leprosy, Cancer and other medical institu­
tions on a non-recurring basis for purchase of essen­
tial equipment and for additions and alterations to
the existing hospital buildings to enable them to
expand and improve the existing facilities, and

(ii) Organisations which promote and undertake blood
donations.
Indian systems
(xii) While recognising the importance of
of medicine and Homoeopathy, the Policy lays emphasis
on the development of these systems and their involve­
ment in Primary Health Care. Various schemes have
been undertaken for improving the quality of educa­
tion, promotion of research programmes and production
of herbal and other medicines. In order to facilitate
the availability of genuine and effective Ayurvedic and
Unani medicines. Government have established the
Indian Medicine Pharmaceutical Corporation Limited.
It has already gone into commercial production^ Con­
siderable progress has been made in the preparation of
separate pharmocopcias for some of these systems.
(xiii) With a view to checking adulteration of food stuffs and
making the enforcement of the Prevention of Food
Adulteration laws more effective, State Governments
have been advised to establish separate Departments for
prevention of food adulteration and strengthen labora­
tories and food inspection units.

j

I'

I
«

l

(xiv) To ensure availability of reliable and effective drugs
to the people, the Drugs and Cosmetic Act has been
amended providing for severe punishment to those en­
gaged in the import, manufacture’and sale of spurious
and substandard drugs. The Government have also
banned the import of certain drugs and prohibited the
manufacture and sale of other therapeutically irrational
combinations.

(xv) Th
va

6. DISCUSS

The Raj ya
the 2nd, 3rd l
Health Ministthe policy war
drawn attenti<
be achieved b
20 members p
Sidhu, Smt. N
Shri Jagadam
Krishna Hand
iah. Dr. Rudr
Shri Mirza E
Shri Chand I
Narayan Yada
Jha, and Dr.
nand said that
keen interest
visaged the ta
ving the targ<
the House rejmotion that “

On 15 Dec
fare, Shri B.
for the approx
laid on the T
Initiating t
said that the
was aimed at

people and e>

health develo
19 L.S. Dfx. i
R?p>rt, 198'
ti R. S. Deb.

19
The Policy stresses the need of medical research rele­
(xv)
vant to the needs of the society.10
DISCUSSION OF THE NATIONAL HEALTH POLICY OF 67
PARLIAMENT
The Rajya Sabha had discussed the National Health Policy on
the 2nd, 3rd and 4th August 1983. Initiating the discussion, t
Health Minister Shri B. Shankaranand, said that the objective f
the policy was to achieve health for all by 2000 AD. He had a
drawn attention to the specific targets, set by the Government to
be achieved by the years 1985, 1990, 1995 and 2000. The
20 members participated in the three-day discussion. Dr.
• •
Sidhu Smt. Margaret Alva, Smt. Ila Bhattacharya, Shri T Basheer,
Shri Jagadambi Prasad Yadav, Km. Saroj Khaparde, Shri Vijoy
Krishna Handique, Shri Dinesh Goswami, Dr. Malcolm S. Adises iah, Dr. Rudra Pratap Singh, Shri S. W. Dhabe, Shri P. N. u ’
Shri Mirza Ershad Beg Ayub Beg, Shri B. Satyanarayan Red Y,
Shri Chand Ram, Prof. B. Ramachandra Rao, Shri Hukum Dev
Narayan Yadav, Prof. Sourendra Bhattacharjee. Shri Shiv Chandra
Jha. and Dr. Bhai Mahavir. Replying to the debate Shri Shankara­
nand said that he was happy that all sections of the House had shown
keen interest in the health policy. He added that the policy en­
visaged the targets, indicated the infra-structure required for achie­
ving the targets, the manpower planning, etc. After the discussions
the House rejected the two amendments proposed and adopted the
motion that “the House approves the National Health Policy.

nt role in
zices suppleFhe Health
dvement ot
ice is proviirganisations

dical instituase of essendterations to
de them to
ties, and
^ertake blood

dian systems
ays emphasis
.heir involvechemes have
ty of educaid production
• t0 facilitate
yurvedic and
ablished the
=tion Limited,
duction. Conjreparation ot
systems.

On 15 December, 1983. the Minister of Health and Family Wel­
fare, Shri B. Shankaranand, moved a resolution in the Lok Sabha
for the approval of National Health Policy contained in a statement
laid on the Table of the House on 2 November, 1982.
Initiating the discussion on 16 December, 1983, Shri Shankaranand
said that the National Health Policy evolved by the Government
was aimed at taking the services nearest to the doorsteps of the
people and ensuring fuller participation of the community in the
health development process. Steps had already been initiated under

jod stuffs and
tion of Food
Governments
jpartments for
igthen laboraiffective drugs
Act has been
t to those ende of spurious
mt have also
prohibited the
cally irrational

L.S. D-'o., t6-<2-83. c>1s. 356-35?. Ministry of Health & Family Welfare, Annual
R’pjrt, 1983—81.. Introduction and Chapter i, and R.S. USQ., No. 35» f ■ 25-7-.

11 R. S.

»
■1

Deb. 2-8-83, 3-8-83, and 4-8-83.

I

I

!

I

20

S)xth Five Year Plan and the New 20-Point Programme of the Prime
Minister for implementation of the policy.

•
•

The 17 Members who took part in the discussion which lasted
two days were: Sarvashri Rupchand Pal, Neelalohithadasan Nadar
Ra0’
KUmar Singh’ K™Pasindhu Bhoi, Deen
v
J' S' Pati'’ Ram Pyare Panika, S.T.K. Jakkayan,
nhandn tain’ Nathu Ram Mirdha’ P' K- Kodiyan, Mool
Chand Daga, Bishnu Prasad, Smt. Kishori Sinha, Smt. Jayanti Patnaik and Smt. Pramila Dandavate. Replying to the debate the Mini^doctors^^t G0V™nt was Alving a scheme of incentives
ter seeMn. th®
, “f33' The Resoluti™ “oved by the Minisbv
hS
aPPr°Val Of ‘he NatiOnal Health Policv was adopted
•\v the House on 22-12-1983.12
“

Pattern oj Ini

Period

i.

7. OUTLOOK FOR THE SEVENTH PLAN
The Approach Paper to the Seventh Five Year Plan takes note
healtZ'S°
> ,‘h f°r 311 by 2000 A-D' 14 is ProP°sed that primary
nealth care would continue as the main instrument of action to
wfflereceW
■ PreVCnt;.VC and P™™tive aspects of health care
would trv ! SpeClal atientioii The Minimum Needs Programme
health and henlr’i™1'') < T effeCtiVe c°°rdina‘ion exists between
drinking tate
" >
T''*65
activities likc nutrition, sate
Jnnkrng water supply and sanitation, housing and education

First PI a
('95 '-ofactuals
Second
(1956-61
actuals

training and education.
Of doctors and paramedical personnel, medical
-1 research related to
common health problems, standardisation
and integration of Indian
systems of medicine, etc. are the other
areas,
which have attracted
special attention in the Plan Paper.

particularly sterilisations, IUDs and' oral nfn^
X1'7 pIann!nS'
» this regard. Mother and child health nX
bemg
d0Wn
adequate importance.33
P grammes are also given

32 L.s. dTk?> 15-12-83, 16-12-83 and 22-12-83.
’ Approach tto the Seventh Five Year Plan, pp. 22_23>

3-

Third P
(1961-6
actuals

4-

Annual
(ig66-6<
actuals

5-

Fourth
(1969-74
actuals

6.

Fifth Pla
('974-79
actuals

7-

1979- 80
(actuals)

8.

Sixth ?•
(joR
outla

9-

1980- 81
(actuals)

io.

1981- 82
anticipat

11.

1982- 83
outlay

Source :
/

■■

I

II.

H

@ Including

-2 of the Prime
appLnehx i-a

which lasted
idasan Nadar,
Bhoi, Deen.
K. Jakkayan,
odiyan, Moot
. Jayanti Patjate the Miniof incentives
by the Minis7 was adopted

Pattern of Investment on Health, Family Welfare and Water Supply and Sanitation (Plan outlays') in
different Plan periods in Public Sector—Centre, States and U.Ts.
(Rs. in crores)

of reaching a
-mily planning,
ing laid down
are also given

Family
Welfare

Sub­
Total

Water
Supply

&
Sanita­
tion

19600
(too)

65-2
(3-3)

o- r

653

(-)

(3 3)

Second Plan
(1956-61)
actuals

4672-O

140-8
(3-o)

2-2
(o-1)

1430
(3-1)

Tliird Plan
(1961-66)
actuals

8576-5

225-9
(2-6)

24-9
(0-3)

250-8

I IO- 2

(2-9)

('•3)

4-

Annual Plan
(1966-69)
actuals

6625-4

140-2
(2- I)

70-4

210-6

102-7

(i->)

(3-2)

d-6)

5-

Fourth Plan
(1969-74)
actuals

15778-3
(too)

335-5

278-0
(i-8)

613-5
(3-9)

543-0/7
(3-5)

6.

Fifth Plan
(■974-79)
actuals

39426-2

760-8
(i-9)

491-3
(i-3)

1252-6
(3-2)

1107-5

(100)

/•

1979-80
(actuals)

12601•o
(100)

275-4

118-5
(0'9)

393'9
(3- 1)

395'3
(3-3)

8.

Sixth Plan
(1980-85)
outlay

975oo-o
(too)

1821• J
(>■9)

1010-0

2831-1
(2-9)

3922-0
(4-0.)

1980-81

14832-4
(too)

269-6
(■-8)

‘41-9

(actuals)

(i->)

4H-5
(2-9)

524-2
(3’5)

1981-82
anticipated

18210-9
(100)

346- 5
(i-9)

183-9
(t-o)

530-4

661-4
(3-6)

1982-83
outlay

21081-7
(100)

388-8
(i-8)

245 0

633-8

(1-2)

(30)

N

i containment
ary heart dismd education,
ch related to
tion of Indian
•have attracted

Health

First Plan
(i95>-56)
actuals

i.

an takes note
that primary
of action to
of health care
s Programme
xists between
nutrition, sate
education.

Total
Plan
Investment/
outlay
fall heads
of develop­
ment)

Period

2.

3-

9-

io.

11.

Sjvrce :

(100)

(100)

fl 00)

(2- I)

(2- l)

(i-o)

(2’9)

Health Statistics of India, 1983, p. 71.

-g) Including LIC loans assistance which was not reflected in the State Plat. .

•

I

/

21

{falibrary

11 -o

(0-56)

74-0
(1-58)

(2-8)

692-6
(3-3)

III
I
APPENDIX I-B
Sixth Plan Outlays-^ Health Sector

(Rs. crores)
SI
No.

Programme

SI.

1980-85

1974-79

States &
U.Ts.

No.

Total

Centre

St»

States &
U.Ts.

Centre

Total
(1)

2

3

5

4

6

7

8
State

Andhra

1. Minimum Needs
Programmes for
Rural He; 1th]

(a) Centrally
Sponsored
Schemes

I

(b) Other schemes}
Total

102.62

120.30

120.30

3°5-84

120.30

120.30

408.46

2. Control of Com­
municable Diseases

268.17

268.17

235.00*

3. Hospitals and
Dispensaries .

I
I .

'I

4. Medical Education
& Research .

168.50

168.50

289.00

225.53

67.66

293->9

576-59

62.00

29.00

6. Others

7-50

345-83

335-83

681.66

♦This includes Rs. 195.30 crores towards 50%
gramme.

Source : Sixth Five Year Plan 1980-85, p. 382.

22

1220.05*

601.00

Assam

3-

Bihar

4-

Gujarat

5.

Haryan

3°5-84

6.

Himach

576.96

7. Jammu

524.00

45-o°

5. Traditional Systems
of medicine and
Homoeopathy

Total

271 .12

e.

720.09

8.

KarnaU

9-

Kerala

10.

Madhy;

11.

Mahara

12.

Manipu

13. Mcghal
14.

Nagalar

15.

Orissa

16.

Punjab

17.

Rajasth

18.

Sikkim

i9-

Tamili

20.

Tripura

21.

Uttar P

22.

West Be

1821.0 5

State share for Malaria Control Pro-

appendix i-c
Sixlh Hcn-SlalHlUT.ub, dMbutwn ,f .ullv f” »‘M S‘cU"
(Rs. in Crores)

MNP
Remaining.including ProgCHV and rammes
MPW
Schemes

Total

>res)

States/U.Ts.

SI
No.
0-85
.re

Total

7

(4)

(5)

65.00

24-39

40.61

32.00

12.00

20.00

82.40

36.27

46.13;

70.00

20.09

49-91

48.00

8-53

39-47

16.18

5.00

11 .18

48.00

9-°3

65-53

so.03

45-So­

36-55

9-54

27.01

94.00

36-07

57-93'

89-46

30.00

59-46

9-70

5-27

4-43-

7.10

4-43

2.67

8.00

2-97

5-03-

29.60

16.00

13.6 c-

49-00

>3-77

35-23

40.98

17-43

23-55

4-35

J -39

67.80

21 .82

45 -9&

8.56

3-36

5-20-

I34-98

74-89

60.09.

84.00

25.88

58-12

1091.19

398..5

693.03.

(3)
(2)

(1)

8

States
Andhra Pradesh.

58.50

68.50

89.00

Assam

3-

Bihar

4-

Gujarat

271 • 12

5-

305-84

6.

576.96

7-

524.00

S-oo

62.00

K.

720.09

29.00

1821.0 5

.

Himachal Pradesh
38-97

Jammu & Kashmi*

8.

Karnataka

9-

Kerala

10.

Madhya Pradesh

11.

Maharashtra

12.

Manipur .

i3-

Meghalaya

14-

Nagaland .

IS-

Orissa

16.

Punjab

i7-

Rajasthan

18.

Sikkim

i9-

Tamil Nadu

20.

Tripura

2i.

Uttar Pradesh

22.

West Bengal

7-50

601.00

Haryana

alaria Control
Total States

23

2.96

i.
24
(■)

(2)

(s)

(4)

(5)

Union Territories

PjrCapia {Public Su

I

23.

A & N Islands

24.

Arunachal Pradesh

25.

Chandigarh

26.

Dadra & Nagar Haveli

27.

Delhi

28.

Goa, Danian & Diu

29.

Lakshadweep

30.
3>-

i -85

0.44

1 .41

8.05

4.00

4 05

6.10

0.85

5-25

0.65

o-37

0.28

87.66

0.12

8?-^

14.00

0-55

13-45

°-55

0.22

°-33

Mizoram

7.00

3-26

3-74

Pondicherry

3-oo

o-49

2.51

128.86*

10.30*

1i8.56*

1220.05

408.46

811.59

Total UTs

Total States & UTs.

SI.
No.

State/U.Ts.

2

States

1.

Andhra Prades

2.

Assam includin
Mizoram .

3-

Bihar

4.

Gujarat

5.

Haryana .

6. Himachal Prad
*KHnist^'n^ °Ut'a^ °n <^ -ntr3^y Sponsored Schemes borne on the budget of the Health

Source : Sixth Plan, 1980—1985, p. 383.

i

’I'

7. Jammu &
Kashmir .
8.

Karn’. ■.

9-

Kerala

JO.

Madhya Prade

11.

Maharashtra

12.

Manipur .

13-

Meghalaya

14.

Nagaland

15-

Orissa

16.

Punjab

17.

Rajasthan

18.

Sikkim

*9-

Tamil Nadu

20.

Tripura

•21.

Uttar Pradesh

22.

West Bengal

.

(5)

4)

APPENDIX I-D
P.-r Cabia (PMis Siehr') Eepinditure 01 Hulth {Mutual ail Public Hialth) a i I Fa-nily Welfare
during the Years 1977-78 h ig79'8o

0.44

1.41

4.00

4 05

0.85

5-25

o-37

0.28

0.12

87-54

o-55

13-45

0.22

o-33

3-26

3-74

o-49

2.51

10.30*

408.46

State/U.Ts.

SI.
No.

1979-80 (Rs.)

1978-79 (R5-)

1977-7° (R1;-)
F. W.

Health

F. W.

Health

F. W.

3

4

5

6

7

8

Andhra Pradesh

,3-49

1.71

16.07

1 .90

17.26

1.98

Assam including
Mizoram .

12.24

o-93

14.28

I .01

14.08*

I .02*

3-

Bihar

6-94

o-93

8.86

t .26

9.61

1 .06

4-

G ajar at

17.06

2.28

20.00

2.65

21 -57

2-93

18.91

1 -ss

25-29

1 -57

23-17

1 .84

Health

a

1

States

2.

118.56*
811.59

Haryana

6.

Himachal Pradesh

30.41

2 -98

51.40

2.94

61 -93

3-17

7-

Jammu &
Kashmir .

38.57

1 .12

53-20

1.61

66.82

1.65

8.

Kxraataka

12-64

2.08

«4-5O

2.28

’5-43

225

9-

Kerala

19.26

i-77

21 .20

1 .86

25-20

2.23

10.

Madhya Pradesl

10.76

« -37

11 .61

1 -55

>7-05

1.74

11.

Maharashtra

16.88

1 .13

21 .41

1 -55

25-34

2.06

12.

Manipur .

22.98

1 -5’

35-73

2.67

73-86

3-65

13.

Meghalaya

39-98

1 .85

51 -49

1.78

81 .22

2-93

151-54

1.62

et of the Health

i

.

5-

14.

Nagaland

15-

Orissa

119-98

0.26

171 -35

0.58

11 -31

1 .78

13.65

1 .90

16.52

1 -99

1.58

16.

Punjab

20.94

1 .42

23.80

1 -45

25.69

17.

Rajasthan

19.69

1 -24

23.21

1 -39

19-74

1 .58

18.

Sikkim

68.50

1 -54

82.10

2.72

71 -42

3-69

19-

Tamil Nadu

14-73

1 -52

16.72

1 .78

16.83

1 .63'

20.

Tripura

21 .2t

0.76

25.86

0-90

3032

1 .00

•21.

Uttar Pradesh

8.11

1 -33

9-92

1.40

n-73

1 -43

22.

West Bengal

16.54

fi-75

17-73

1.01

20.12

1 .42

25

r
26
3

4

5

6

7 »

8

Arunachal
Pradesh

56.15

0.17

79-53

0.28

9> -49

o .6&

Goa, Daman
& Diu

65-’9

1.67

72.07

1.66

81.09

1.71

25.

Pondicherry

65-77

2.12

7°-76

2.23

129.70

2-54

26.

Mizoram .

107.70

0-03.

19.91

I .84

i

2

23-

Union Territories

24.

Total

Nolu :

’5.O5

1 -51

17.29

All India total includes Central Govt. & Expenditure in respect of U.Ts. of
A.& N.Islands, Chandigarh, D. & N, Havcli, Delhi and Lakshadweep.

•Excluding Mizoram.
Source ‘Health Statistics of India, 1983, pp. 75-76.

1

*•79

-

I

' -2

5

<£>

I 2.

P1

s | is
CD

» »
■g 5

o

o

I

$

1

-

I o

>0

co

'

o

L3

I w

co

J
■HUH II ,

I

I
APPENDIX-I-E
Statement shotting Physical Targets anti Aeh’evements under Rural Heal'f. Programme

SI.

Norm

Programm-

Unit

No.

Position obtaining
as on 1-4-80

1980-85
Target
(Additional)

Likely
Position by
3' -3-1985

Community Health Volun­
teers

1 for every village of a po­
pulation of 1000.

Lakh

1.40

2.20

3-6o

2.

Sub-centres

1 : 5000 population in pla­
ins and 1 : 3000 in tribal
and hilly areas.

Nos.

50,000

10,000

90,000

3-

Primary Health Centres

1

600 additional primary
health centres 4- upgradation of 1000 dis­
pensaries into subsi­
diary health centres.

6,000

4-

Upgraded Primary Health
Centres to be converted to
Community Health Cen­
tres.

1 : 1,00,000 or 1 per CD
Flock.

: 30,000

Nos.

Nos.

Source : Sir'h Five Y^ar P'ac, 1980-85, p. 384.

5,400 (in addition 1000
subsidiary health cen­
tres were also set up).

34°

*74

5'4

II
;■

APPENDIX II
Establishment of Primary Health Centres and Sub-centres in India since First Plan

PHCs

First Plan

L

SI. Name c
No. State/U

725

Second Plan 1

2,565

Third Plan .

4,631

INTER-PL.XN PERIOD 3 YEARS

PHCs

Sub-Cent res

As on 31-3-1967

.

4,793

17,521

As on 31-3-1968

.

4>94c

21.539

4,9'9

22,826

1

As on 31-3-1969

.

Andhra

2.

Assam

3-

Bihar

4-

Gujarat

5-

Himach

6.

Karnata

7-

Kerala

8.

Madhya

9-

Maharas

10.

Manipur

11.

Meghala

12.

Nagalanc

12.

Orissa

14.

Rajasthai

15-

Sikkim

16.

Tamil N;

17-

Tripura*

18.

Uttar Pn

'9.

West Ben

20.

Arunacha
Pradesh

21

Goa, Dan
Diu .

4TH FIVE YE.AR PLAN

As on 31-3-1970

•

5,015

23.-527

As on 31-3-1971

.

5,"2

28,489

As on 31-3-1972

.

5,'«3

28,167

As on 31-3-1973

.

5,246

3',O34

As on 31-3-1974

.

5-283

33.509

5TH FIVE YEAR PLAN

i

As on 31-3-1975

.

5,293

33,6i6

As on 31-3-1976

.

5,328

3I.o88

As on 31-3-1977

.

5,38o

38,110

/\s on 31-3-1978

.

5.400

38,115

6TH FIVE YEAR PLAN
As on 31-3-1979

•

5,423

40,124

As on 31-3-1980

.

5,484

49,049

5,568

5'>'92

As on 31-3-1981
As on 31-3-1982

.

5,739

59,5'1

As on 31-3-1983

.

5,955

65,643

Source : Health Statistics of India, 1983, p. 149.

28

•

APPENDIX III

since First Plan

Number of PHC's and sub centres required and in position in Tribal Areas

SI. Name of the
No. State/UTs.

Sub-Ccntrcs

2

r

Tribal
PHCs
Population
Required in
(1971
Census)
20,000
position
in lakhs population

' ■’

Sub-Centres
Required
3>ooo
population

in
position

Refe­
rence
Period

6

7

8

3

4

5

Andhra Pradesh

16 ■ 6

83

29

•/

553

’9'9

. 309-82

Assam

'9-2

96

32

640

216

3'-3-33

3-

Bihar

49 3

247

NA

1644

4.

Gujarat

37'3

186

65
(31-3-82)

1245

486

3'-3-83

5-

Himachal Pradesh

'■4

7

9

47

48

31-3-83

6.

Karnataka

23

12

55

77

788

31-3-83

7-

Kerala

2’7

‘3

5

90

43

31-3-83

8.

Madhya Pradesh

839

4'9

185

2796

2358

31-3-83

9-

Maharashtra

29 5

147

12 x

985

720

31-3-83

10.

Manipur

3 3

'7

NA

111

11.

Meghalaya

8 1

4'

26

271

101

30-9-82

12.

Nagaland .

4'6

23

18

153

116

31-3-83

12.

Orissa

5°-7

253

118

1691

1046

31-3-83

14.

Rajasthan

S’ 3

156

23

1042

249

31-12-83

15.

Sikkim

°’5

3

2

17

II

31-3-83

16.

Tamil Nadu

3’ '

16

16

104

100

309-82

17.

Tripura**

45

23

12

150

57

31-3-83

18.

Uttar Pradesh

20

10

NA

66

1420

31-3-33

19-

West Bengal

253

127

NA

844

NA

20.

Arunachal
Pradesh

37

18

45*

123

NA

Goa, Daman &
Diu .

008

17.521

2 1-539

1.

22,826

23>527

NA

28,489
28,167
3I.O34

33-5°9

33.6'6

NA

3bo88

38,11”

38,115

40,124
49,O49

5','92

59,5'1
65,643

21.

1

29

3

5

3'-3-33

Lil!
i

30
2

Popl

G

3

4

5

17

>8

111

I

6

3

21

7

10

79’

12800

22.

Mizoram .

3’3

23-

A & N Islands

0-2

24.

D & N Havcli

o-6

25-

Lakshadweep

03

7

8

290

31-3-83

SI. Name of
No.
countr

1

2

1.

Afghanist

2.

Argentin;

3-

Austr.-.lia

4-

Banglade

•Health Units

5-

Brazil

••Dispensaries are treated as sub-centres.

6.

Burma

Sovrce : Health Statistics cf India, 1983, p. 157.

7-

Ca nada

8.

Egypt

TOTAL

.

3

1920

30-9-82
14

31-12-82

31-3-83

9987

9.. France
to.

German (

it.

Germany

12.

India

13.

Indonesia

’4- Japan
15.

Kenya

16.

Libya

’7-

Malaysia
(Peninsula

’8.

Mexico

’9'

Nepal

20.

Pakistan

2’-

Srihnka

22.

Thailand

23-

U.K. (Enf
and Wales

24.

U.S.S.R.

»5.

U.S.A.
+ Not
Source

APPENDIX IV
Population per bed, Physician and Midwife/nurse for selected countries

G

11

7

290

8

SI. Name of the
No.
country

Population

Year

Bed

Year

Physician

Year

Mid-wife/
Nurse

3

4

5

6

7

8

3 >-3-83

2
30-9-82

6
21

>4

00

31-12-82

3»-3-83

10

9987

Per

Afghanistan

1981

3700

1981

J 3467

1981

9111

2.

Argentina

1969

180

>975

530

'973

93

3-

Austrr.lia .

1980

150

1980

556

1980

146

4-

Bangladesh

1981

4545

1981

8908

1981

15005

5-

Brazil

1976

245

'974

'650

■974

2280

6.

Burma

1981

1226

'981

494°

1981

'649

7-

Canada

'978-79

70

'979

548

'978

130

8.

Egypt

1981

500

'981

815

1981

77'

9-. France

'977

82

'977

580

>977

'5«

10.

German (D.R.)

1978

94

1980

494

+

+

11.

Germany (F.R.)

1980

87

1980

442

1980

181

12.

India

1981

1265

1981

2545

1981

'857

'3-

Indonesia .

'979

1787

■979

"973

■979

1070

'4-

Japan

1981

86

1981

761

■981

209

15.

Kenya

■978

601

>978

10136

'978

1039

16.

Libya

1981

20!

1981

660

1981

3'9

17.

Malaysia
(Peninsular)

1981

37°

1980

3267

1980

54'

860

'974

'250

'974

1400

28768

1980

7448

18.

Mexico

■974

19.

Nepal

>980

5477

■ 980

20.

Pakistan

1981

1746

■ 981

3172

1981

4492

21.

Srilanka

>981

34°

'981

7G3'

1981

‘453

22.

Thailand .

1980

658

1980

6870

1980

1104

23-

U.K. (England
and Wales)

■ 980

■27

'979

7"

■979

207

24.

U.S.S.R. .

'978

82

‘979

274

+

+

«5-

U.S.A.

■ 980

171

1980

549

1980

196

.

+ Not available.

Source : Health Statistics of India, 1983, p. 262.

31

LIBRARY "X*'\
library

(1\\ * (

AN0

OOCUMENTAnn»

A Oxk

APPENDIX V

Goot. Health Expenditure in different countries

si.Na.

1

I
‘I
-

N?me of Country

Percent of Govt. Health Expendi­
ture to total Govt. Expcditure

*978

1979

1.

Argentina

2.24

1.73

5

2.

Australia

10.36

10.14

187

3.

Brazil .

7-83

8-5°

21

4.

Burma

6-73

+

5-

Canada .

7 .62

7.56

6.

Egypt .

3-55

7.

France

14.82

+

406

8.

Germany (FR)

19-33

18.99

437

9-

Ghana

7.26

5-9g

IO.

India .

1 -97

1.64

+
+

1.1.

Kenya

7-45

7-23

5

12.

Malaysia

6-39

6.41

15

13-

Mexico

3-97

3-90

10

14.

Nepal .

5-33

5-«5

15-

Pakistan

1 .64

1 -35

+

16.

Sri Lanka

+

5

17.

Thailand

4-33

3

12-73

12.78

219

10.15

10.48

183

18. U.K.
19-

U.S.A.

Source :

4.38

W.H.O.
+ Not available

Source ; Health Statistics of India, 1983, p. 263.

32
i

Per capita
Expenditure on
Health 197g
dn terms of
>975 dollars)

126

8

mtroduct*

1. The
social orc
the indiv
ill-health
nutrition
ment of
health an­
that chile
healthy 1

1.2. Si
the succe
within wl
ture, facil
had sejg
arrived aHealth ai
Besides, *
of medictof stands-

1.3. Vr
Plan doci
1-2 may 1it is felt
future de
vices ieq
and piioihas been

1

AJT/,

LdX^

- jXftS Cb^J)^ —

J6l A^T//"' f

_____ <lLo, %^0
^4st*
p-xopiz/ iS-Y
p'K jp-TZy
4A-<p o J'

K^y'** Q-*»<^jQ>Cky

C>m > Q f, fyT

fyy;

XJA CjQwJL
o

TTvMfc-P

U^>pt

*4^

A-mS-q-I g.\gnR

^Lqja

Vt<

*« Zip n

(

^-vjQcLxa

/?£%

ib^L-i.

c-Uxh^y f

b

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