HEALTHCARE SERVICES THROUGH FIVE YEAR PLANS (FYPS) IN INDIA

Introduction India has Improvement in the standard of living and health status of the population has remained one of the important objectives in Indian planning. The five year plans had reflected long term vision consistent with the international aspirations of which India has also been a signatory. These long term goals have been stressed in National Population Policy, National Health Policy, etc. These goals have to be achieved through improving the access to and utilization of health services, family welfare and nutrition services with special focus on underserved and under privileged segments of population. 1st Five Year Plan (1951 - 1956) During the First Five Year Plans the basic structural framework of the public healthcare delivery system remained unchanged. Urban areas continued to get over three-fourth of the medical care resources whereas rural areas received Special Attention under the Community Development Program. 2nd Five Year Plan (1956 - 1961) The Second Five Year Plan draws up recommendations for the future path of development of health services the Mudaliar Committee was set up in 1959. The Primary Health Care (PHC) programme was not given the importance; it should have been given right from the start. There were only 2800 PHCs existing by the end of 1961. Instead of the Irreducible Minimum in Staff recommended by the Bhore Committee, most of the PHCs were understaffed, large numbers of them were being run by ANMs or public health nurses in charge (Mudaliar Committee, 1961). The fact was that the doctors were moving into private practice after training at public expense. The emphasis given to individual communicable diseases programme was given top priority in the first two plans. But primary health centres through which the gains of the former could be maintained were given only tepid support (Batliwala, Srilatha, 1978). 3rd Five Year Plan (1961 - 1966) The Third Five Year Plan discussed the problems affecting the provision of PHCs, and directed attention to the shortage of health personnel, delays in the construction of PHCs, buildings and staff quarters and inadequate training facilities for the different categories of staff required in the rural areas. 4th Five Year Plan (1969 - 1974) The Fourth Five Year Plan began in 1969 with a three year plan holiday continued on the same lines as the third plan. It quoted extensively from the FYP II concerning the socialist pattern of society but its policy decisions and plans did not reflect socialism. In fact the 4 th FYP is probably the most poorly written plan document. It does not even make a passing comment on the social, political and economic upheaval during the plan holiday period (19661969). These three years of turmoil indeed brought about significant policy changes on the economic front and this, the 4th FYP ignored completely. It lamented on the poor progress made in the PHC programme and recognised again the need to strengthen it. It pleaded for the establishment of effective machinery for speedy construction of buildings and improvement of the performance of PHCs by providing them with staff, equipment and other facilities. 5th Five Year Plan (1974 - 1979) In the Fifth Year Plan infant mortality rate going down and life expectancy going up, the number of medical institutions, functionaries, beds, health facilities etc., were still inadequate in the rural areas. This shows that the government acknowledged that the urban health structure had expanded at the cost of the rural sectors. This awareness is clearly reflected in the objectives of 5 th FYP which were as follow; 1. Increasing the accessibility of health services to rural areas through the Minimum Needs Programme (MNP) and correcting the regional imbalances.

2. 3. 4. 5.

Referral services to be developed further by removing deficiencies in district and sub-division hospitals. Intensification of the control and eradication of communicable diseases. Affecting quality improvement in the education and training of health personnel and Development of referral services by providing specialists attention to common diseases in rural areas.

Major innovations took place with regard to the health policy and method of delivery of healthcare services. The reformulation of health programmes was to consolidate past gains in various fields of health such as communicable diseases, medical education and provision of infrastructure in rural areas. 6th Five Year Plan (1980 - 1985) The Sixth Five Year Plan conceded that there is a serious dissatisfaction with the existing model of medical and health services with its emphasis on hospitals, specialisation and super specialisation and highly trained doctors which is availed of mostly by the well to do classes. It is also realised that it is this model which is depriving the rural areas and the poor people of the benefits of good health and medical services. 7th Five Year Plan (1985 - 1990) The Seventh Five Plan stated that Our emphasis must be on greater efficiency, reduction of cost and improvement of quality. This calls for absorption of new technology, greater attention to economies of scale and greater competition. The National Health Policy of 1983 was announced during the Sixth plan period. It was in no way an original document. It accepted in principle the ICMR ICSSR report (1981) recommendations as is evidenced from the large number of paragraphs that are common to both documents. But beyond stating the policy there was no subsequent effort at trying to change the health situation for the better. 8th Five Year Plan (1992 - 1997) In Eighth Five Year Plan the country went through a massive economic crisis. The Plan got pushed forward by two years. But despite this no new thinking went into this plan. In fact, keeping with the selective healthcare approach the eighth plan adopted a new slogan instead of Health for all by 2000 AD it chose to emphasise Health for the Underprivileged. Simultaneously it continued the support to privatisation, In accordance with the new policy of the government to encourage private initiatives, private hospitals and clinics will be supported subject to maintenance of minimum standards and suitable returns for the tax incentives. 8 th FYP encourage private stakeholders in promoting good healthcare services in India. 9th Five Year Plan (1997 - 2002) The Ninth Five Year Plan provides a good review of all programs and has made an effort to strategize on achievements attained and learn from them in order to move forward. There are a number of innovative ideas in the 9th FYP. It is refreshing to see that reference is once again being made to the Bhore Committee report and to contextualise todays scenario in the recommendations that the Bhore Committee had made, in its analysis of health infrastructure and human resources. 10th Five Year Plan (2002 - 2007) The Tenth Five Year Plan provides essential Primary Health Care, emergency lifesaving services, services under the National Disease Control Programmes and the National Family Welfare Programme totally free of cost to all individuals and essential health care service to people below poverty line based on their need and not on their ability to pay for the services, and reorganisation and restructuring the existing government health care system including The Indian System of Medicine and Homeopathy (ISM&H) infrastructure at the Primary, Secondary and Tertiary Care levels with appropriate referral linkages with Hospital Information System (HIS) to Improve the PHCs and Community Health Centers (CHCs). 11th Five Year Plan (2007 - 2012)

The Eleventh Five Year Plan will provide an opportunity to restructure policies to achieve a new vision based on faster, broad based, and inclusive growth. One objective of the 11 th FYP is to achieve good health for people, especially the poor and the underprivileged. In order to do this, a comprehensive approach is needed that encompasses individual healthcare, public health, sanitation, clean drinking water, access to food, and knowledge of hygiene, and feeding practices. The Plan will facilitate convergence and development of public health systems and services that are responsive to health needs and aspirations of people. Importance will be given to reducing disparities in health across regions and communities by ensuring access to affordable healthcare. 12th Five Year Plan (2012 - 2017) The Twelfth Five Year Plan includes a broad commitment to improving the health of the population, keeping principles of equity and democratic participation in mind. Such goals would, in turn, ensure that the guiding health policy is responsive to the expectations of the population, that it has an equitable position on financial contributions, and that it has strategies for both preventive and curative healthcare. Furthermore, only having fixed goals and a matching policy may not be enough. Progress towards the goals would eventually depend on how the three vital functions, namely, provision of healthcare services, its financing, and stewardship of intersect oral policies that may have a bearing on health are actually carried out. The processes that mould delivery systems, i.e. how democratic or responsive to local needs they are, would also have a bearing on the vital functions. There are also other dimensions that contribute to the overarching goals of healthcare system, which include quality efficiency, acceptability and equity'. Responsiveness of health systems is assessed by WHO on users perception of services on seven parameters, namely choice, communication, confidentiality, dignity, basic amenities, prompt attention and autonomy. Finally, while the goals of the health system are broad and more comprehensive, they may be summarily reflected in its health outcome indicators. The health system for the 12 th FYP should address the objectives listed above and aim to build a collaborative environment for their realization. It should prioritize the making of the system responsive to the needs of citizens, and the attainment of financial protection for the healthcare of households. Build a HIS, strength of private sector, subject to strict checks and balances. Hence, the five year plans (FYPs) aim at developing the Healthcare services in urban and rural areas for the welfare of the people as well as the Economic Development. References: Mudaliar Committee, (1961) Health Survey and Planning Committee, MoHFW, New Delhi. Bhore, Joseph, (1946) Report of the Health Survey and Development Committee (Bhore Committee), Volume I to IV, Govt. of India, New Delhi. Batliwala & Srilatha. (1978) The Historical Development of Health Services in India, FRCH Bombay. National Health Policy, (1983) Government of India, Ministry of Health and Family Welfare, New Delhi. ICSSR/ICMR (1981): Health for All: An Alternative Strategy, Indian Institute of Education, Pune. FYP, [First Five Year plan (1951-56) to Twelfth Five Year Plan (2012 -2017)], Government of India, Planning commission of India, New Delhi, (Retrieved from http://planningcommission.nic.in/plans/planrel /fiveyr/welcome.html. June 2012)