The document discusses the recommendations of various committees related to development of healthcare services in India. Some of the key recommendations include: - Integration of preventive and curative services at all levels of administration. - Establishment of a three-tier primary healthcare system with primary health units, regional health units, and district hospitals. - Training of community health workers to deliver primary healthcare services and act as a link between the community and primary health centers. - Creation of a unified health services cadre with common terms of service. - Involvement of medical colleges in rural healthcare delivery through programs like Reorientation of Medical Education.

2.  BHORE COMMITTEE
 MUDALIAR COMMITTEE
 CHADHA COMMITTEE
 MUKHERJI COMMITTEE
 JUNGALWALLA COMMITTEE
 KARTHAR SINGH COMMITTEE
 SHRIVASTAV COMMITTEE
 RURAL HEALTH SCHEME

4. RECOMMENDATIONS :-
 integration of preventive and curative services at all
administrative levels
 The Committee visualized the development of primary
health centers in 2 stages :
 as a short-term measure, it was proposed that each
primary health centre should cater to a population of
40,000 with a secondary health centre.
 long-term programme (also called the 3 million plan)
consisting of 3 tiers.

5.  First tier: primary health units with 75 bedded
hospital for each 10,000 – 20,000 population
with staff of 6 medical officers, 6 public health
nurses, 2 sanitary inspectors, 2 health
assistants and other supportive staff.
 Second tier: 650 bedded Regional Health Unit
(RHU) to serve as a referral centre for 30 – 40
PHUs.
 Third tier: district hospitals with 2,500 beds to
serve the needs of about 3 million
 Major changes in medical education which
includes 3 months training in preventive and
social medicine to prepare "social
physicians"

7. RECOMMENDATIONS :-
 Consolidation of advances made in the first
two five year plans
 Strengthening of the district hospital with
specialist services to serve as central base of
regional services
 Regional organizations in each state between
the headquarters organization and the district
in charge of a Regional Deputy or Assistant
Directors — each to supervise 2 or 3 district
medical and health officers

8.  Each primary health centre not to serve
more than 40,000 population;
 To improve the quality of health care
provided by the primary health centres;
 Integration of medical and health
services recommended by the Bhore
Committee; and constitution of an All
India Health Service on the pattern on
Indian administrative service.

9.  Dr. M.S. Chadah
 "vigilance" operations in respect of the
National Malaria Eradication Programme
should be the responsibility of the
general health services
 through monthly home visits should be
implemented through basic health
workers
 One basic health worker per 10,000
population

10.  ―multipurpose" workers to look after
additional duties of collection of vital
statistics and family planning, in addition
to malaria vigilance.
 The Family Planning Health Assistants
were to supervise 3 or 4 of these basic
health workers.

11.  under the Chairmanship of Shri Mukerji,
the then Secretary of Health to the
Government of India, was appointed to
review the strategy for the family
planning programme.
 The Committee recommended separate
staff for the family planning programme.
 To delink the malaria activities from
family planning

13. 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 sick and conventional
public health programmes functioning
under a single administrator and
operating in a unified manner at all levels of
hierarchy with due priority for each
programme obtaining at a point of time.

14.  unified cadre
 common seniority
 recognition of extra qualifications
 equal pay for equal work
 special pay for specialized work
 no private practice, and good service
conditions.

15.  The structure for integrated services at the
peripheral and supervisory levels:
 The feasibility of having multipurpose, bi
purpose workers in the field:
 The training requirements for such workers;
and
 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.

16. Recommendations :-
 That the present Auxiliary Nurse Midwives
to be replaced by the newly designated
"Female Health Workers", and the
present-day Basic Health
 Workers, Malaria Surveillance Workers,
Vaccinators, health education assistants
-trachoma and the family planning
health assistants to be designated as
male health workers.

17.  For proper coverage there should be
one primary health centre for
population of 50,000.
 Each primary health centre to be
divided into 16 sub centres each having
a population of 3000 to 3500 depending
upon topography and means of
communications

18.  Each sub centre to be staffed by a team of
one male and one female health worker
 There should be a male health supervisor to
supervise the work of 3 to 4 male health
workers; and a female health supervisor to
supervise the work of 4 female health
workers
 The present-day lady health visitors to be
designated as female health supervisors
 The doctor in charge of a primary health
centre should have the overall charge of all
the supervisors and health workers in his
area.

19.  'Group on Medical Education and Support
Manpower'
 Organization of the basic health services
(including nutrition, health education and
family planning) within the community
itself and training the personnel
 Organization of an economic and
efficient programme of health services to
bridge the community with the first level
referral Centre, viz., the PHC

20.  The creation of a National Referral
Services Complex by the development
of proper linkages between the PHC and
higher level referral and service centres;
 To create the necessary administrative
and financial machinery for the
reorganization of the entire programme
of medical and health education from
the point of view of the objectives and
needs of the proposed programme of
national health services

21.  Involvement of medical colleges in health
care with the objective of reorienting
medical education according to rural
population called Re Orientation of
Medical education (ROME). It led to
teaching and training of undergraduate
students and Interns at PHCs.
 Training of Village Health Guides and
utilising their services in the general health
service system.

22. Under the chairmanship of
Shri.P.Chidambaram and Dr. Anbumani
Ramadas

24.  The mission, initially planned for 7 years
(2005-2012), is run by the Ministry of
Health.
 Includes training local residents as
Accredited Social Health Activists
(ASHA), and the Janani Surakshay
Yojana (motherhood protection
program).
 special focus on 18 states

25.  Reduction of MMR to < 100 per 100000 live
births
 Reducing IMR to < 27 per 1000 live births
 Reduction in NMR to < 18 per 1000 live births
 Reducing TFR to 2.1
 Elimination of Filaria – in all 250 districts; Kala-
azar in all 514 Blocks and Leprosy in all
districts
 Reduction in TB prevalence and mortality by
50%
 Reduction in Annual Malaria incidence to
<1/1000 pop.
 Reduction in JE mortality by 50%

26.  Sustaining case fatality rate of less than
1% for Dengue
 Leprosy prevalence rate : reduce from
1.8/10,000 in 2005 to less than 1/10,000
 Upgrading CHC to Indian Public Health
Standards
 TB DOTS SERVICES : 85% Cure rate
 Increase utilisation of FIRST REFERRAL
UNITS from <20% to 75%
 Engaging 250,000 female ASHA in 10
states

27.  Upgradation of Health Institutions
 Quality Assurance
 HMIS
 School health
 Tribal health
 ASHA
 ARSH
 NCD
 RSBY

28.  JSY
 WHNDs
 Immunization strengthening
 Disease Control Programmes
 BCC/IEC
 AYUSH
 Capacity building
 Human resource management
 Finance
 Medical guidelines and protocols

29.  Geriatric care project
 Community based mental health project
 Cuban model health care
 Polyclinic services
 Radio Health
 Tele medicine
 Floating dispensary
 Palliative care project
 Menstrual hygiene project
 MCTS

30.  KMSCL
 PEMT
 SPARK
 KSWAN

31.  Creation Of ASHA (Accredited Social
Health Activist)
 Strengthening Of Sub Centres
 Strengthening Of PHC
 Strengthening Of CHC

33.  Urban poor population living in listed and
unlisted slums.
 All the other vulnerable population such as
homeless, rag- pickers, street children,
rickshaw pullers, construction and brick kiln
workers, sex workers, any other temporary
migrants.
 Public health thrust on sanitation, clean
drinking water and vector control.
 Strengthening public health capacity of
urban local bodies (ULBs).

34. GOALS
 To address the health concerns by facilitating
equitable access to available health facilities
by rationalizing and strengthening the
capacity of the existing health care delivery
system.
 Partnership with all efforts made for accessing
community buildings under various health
programmes to ensure full utilization of
created infrastructure.
 It aims to synergize the mission with the
existing progammes such as Jawahar Lal
Nehru National Urban Renewal Mission
(JNNURM), Swarn Jayanti Shahri Rozgar
Yojana (SJSRY) and ICDS which have similar
objectives to NUHM.

35.  Urban Social Health Activist (USHA)
 Mahila Arogya Samitee (MAS)
 Primary Urban Health Centre
 Rogi Kalyan Samiti and Referrals
 Community health Insurance
 IT enabled services (ITES) and e-
governance

36. ANY
DOUBTS????