CHRISTIAN COLLEGE OF NURSING

NEYYOOR

SEMINAR
ON

PLANNING PROCESS

Submitted To; Submitted By;

Mrs. A. Femila, M.Sc(N) J. Asir Dhayani
Lecturer M.Sc Nursing II Year
Mental Health Nursing Medical Surgical Nursing
Christian College of Nursing, Neyyoor. Christian College of Nursing, Neyyoor.

PLANNING PROCESS

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INTRODUCTION:

“Planning is For Tomorrow”

“He Who Fails to Plan, Plans to fail…..”

Planning is a process for accomplishing purposes. “If you do not

know where you are, it is impossible to determine how you can get to

where you want to be”. If you know where you are and is you know

where you want to go, the task is to find the best route to go there”. It

is a blueprint of business growth and a road map of development. It

helps in deciding objectives both in quantitative and qualitative terms.

It is setting of goals on the basis of objectives and keeping in the

resources.

TERMINOLOGY:

1. Modernization:

Modernization is a concept in the sphere of social sciences that

refer to process in which society goes through industrialization.

2. Strategy:

Strategy is the direction and scope of an organization over the

long term.

DEFINITION:

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HEALTH:

1. Health is a state of complete physical, mental and social well

being and not merely the absence of disease or infirmity.

- World Health Organization, 1946.

PLANNING:

1. Planning is going from known to unknown.

2. Planning is deciding in advance what to do, how to do it, when to

do it and who is to do it.

3. Planning is the process of deciding the objectives or goals of the

organization and preparing for how to meet them through
suitable strategies.

4. Planning is a process of determining the objectives of

administrative and devising the mean calculated to achieve them.

PLANNING PROCESS:

The planning process can be further subdivided into several

activities.

1. Goal formulation

2. Identification of strategies and objectives.

3. External environmental analysis.

4. Internal environmental analysis.

5. SWOT analysis

6. Gap analysis.

GOAL FORMULATION (STRATEGIC PLANNING)

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 The focus is on four aspects

1. Vision

2. Mission

3. Goals

4. Objectives

Vision:

It is the short declaration describing what an organization aspires

to be tomorrow. It describes how the future will look if the

organization achieve its mission.

Mission:

Mission derives from the vision of the organization. Mission

statement answers who we are, who are our customers, what do we do

and how do we do.

Goals:

Long term goals.

These refers to open ended statements of what one wants

to accomplish with no time criteria for completion.

Short term goals

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 These refers to specific short term targets for which

measurable results can be obtained. It is intended to achieve within a

given period of time. It should be

S - Specific

M - Measurable

A - Achievable

R - Rational

T - Time bound

ENVIRONMENTAL SCAN

Environmental scan comprises both internal and external

environmental scan. It has to include the SWOT matrix.

S - Strengths

W - Weekness

O - Opportunities

T - Threats

GAP ANALYSIS

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 The performance gap is basically the difference between the

objectives established in the goal formulation and the results likely to

be

TYPES OF PLANNING

1. Passive Planning:

Passive planning happens when leadership allows the raft to

travel downstream at the meraf of the current rather than steering,

rowing, and turning This kind of non-planning eventually leaves

unprepared to face white water rapids. Worse yet, in the absence of a

plan, the current may take the raft over the edge of a dreaded waterfall.

2. Panic planning

Panic planning happens only after the raft is in trouble. At this

point, all of the organization’s resources are scrambled in a reactionary

pattern in an attempt to solve the problem. With panic planning, may or

may not come out alive and well, but guaranteed some bumps and

bruises.

3. Scientific planning:

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 Scientific planning is viable, but can be laborious, mechanical

and often ends up abandoned in the process. Imagine is a raft guide

constantly tried to measure the depth of the water, the distance between

rocks, the wind speed, and the water current. Although the information

might be helpful oftentimes, the water would be moving too swiftly to

take the measurements. In a like manner, leaders often have to respond

to change in an instant. There’s no limit to collect scientific data on all

of the variables before deciding which course of action is best.

4. Principle-Centered Planning:

Principle-centered planning is the key to effectiveness. It is the

artistic or leadership approach. Principle-centered planning recognizes

that life in general land people in particular can’t be graphed on a chart,

but sees that planning still remains essential achieved if the existing

strategy is to be continued.

TYPES OF PLANNING:

To make any plan successful, planning is to be done at different

stages, such that the expected objectives are attained. The planning is

of

1. Directional planning:

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 It is also known as policy planning. It is defined as a framework

of intent and philosophy within which the programs proceed.

2. Administrative planning:

It is defined as the overall implementation of policies,

mobilization and co-ordination of resources in terms of men, material

and money in a scheduled time frame.

3. Operational planning:

It is defined as the actual delivery of services or programs to the

people based on local conditions needs and attitudes. It is a short-range

planning that deals with day-to-day maintenance activities. It is

performed at a unit or departmental level. It is done as part of the

overall strategic planning.

4. Intermediate Planning:

A planning that is usually done in the middle of the fiscal year.

5. Contingency Planning:

It refers to managing the problems that interfere with getting

work done.

6. Strategic planning:

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 It is defining and prioritizing long-term plans that includes

examining an organizations purpose, mission, philosophy and goals in

the light of its external environment.

PLANNING CYCLE:

Planning is the broad foundation on which much of the

management is based. Planning may be defined as a process of

analysing a system, or defining a problem, assessing the extent to which

the problem exists as a need, formulating goals and objectives to

alleviate or ameliorate those identified needs, examining and choosing

from among alternative intervention strategies, initiating the necessary

action for its implementation and monitoring the system to 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.

Tabulate Analyze 9 Gather Health

interpret Data
 Formulate Health
Problems

THE PLANNING CYCLE

1. Analysis of the Health situation:

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 The first step in health planning is analysis of the health

situation. It involves the collection, assessment and interpretation of

information in such a way as to provide a clear picture of the health

situation. The following items of data are the minimum essential

requirements for health planning.

(a) The population, its age and sex structure

(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-both public and private.

(e) The technical manpower of various categories.

(f) Training facilities available.

(g) Attitudes and beliefs of the population towards disease, its cure

and prevention.

2. Establishment of objectives and goals

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 Objectives and goals are needed to guide efforts. Unless

objectives are established, there is likely to be haphazard activity,

uneconomical use of fands and poor performance. Objectives must be

established at all levels, down to the smallest organizational unit. 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. Objectives are not only a guide to action, but also a

yard-stick to measure work after it is done. Modern management

techniques such as “cost-benefit” analysis, and “input-output” study of

health services are being used for defining goals, objectives and targets

in more definite term.

3. Assessment of Resources:

The term resources implies the manpower, money, materials,

skills, knowledge and techniques needed or available for the

implementation of the health programmes. 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.

4. Fixing priorities:

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 Once the problems, resources and objectives have been

determined, the next most important step in planning is establishment

of priorities in order of importance or magnitude, since the resources

always fall short of the total requirement. In fixing priorities, attention

is paid to financial constraints, mortality and morbidity data, diseases

which can be prevented at low cost, saving the lives of younger people

in whom there has been considerable social investment, 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.

5. Write-up of formulated plan:

The next major step in the planning process is the preparation of

the detailed plan or plans. 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 (outputs) 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

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of evaluation. It will be left to the central planning authority and the

government to consider modifications of the plan relating to allocation

of resources.

6. Programming and implementation:

Once the health plan has been selected and approved by the

policy making authorities, programming and implementation are began.

Plan execution depends upon the existence of effective 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 predetermined

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 delays in critical supplies,

inappropriate use of staff and similar factors. The main considerations

at the implementation stage include.

(a) definition of roles and tasks

(b) the selection, training, motivation and supervision of the

manpower involved

(c) organization and communication and

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 (d) the efficiency of individual institutions such as hospitals or health

centres.

7. 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 a continuous process of observing, recording and

reporting on the activities of the organization or project. Monitoring,

thus consists of keeping track of the course of activities and identifying

deviations and taking correction action if excessive deviations occur.

8. 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. While monitoring is confined to

day-to-day or ongoing operations, evaluation is mostly concerned with

the final outcome and with factors associated with it. Good planning

will have a built-in evaluation to measure the performance and

effectiveness and for feedback to correct deficiencies or fill up gaps

discovered during implementation. In the words of the WHO Expert

Committee On Health Planning in Developing countries, evaluation

“measures the degree to which objectives and targets are fulfilled and

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the quality of the results obtained. It measures the productivity of

available resources in achieving clearly defined objectives. It measures

the productivity of available resources in achieving clearly defined

objectives. It measures the productivity of available resources in

achieving clearly defined objectives. It measures how much output for

cost-effectiveness is achieved. It makes possible the reallocation of

priorities and of resources on the basis of changing health needs.

9. Replanning:

Based on the deficiencies or shortcoming reveals during any step

of planning process, the goals, strategies can be reassessed.

ELEMENTS OF PLANNING:

1. Objectives

2. Policies

3. Procedures

4. Rules

5. Budget

6. Programs

7. Strategies

PURPOSE OF PLANNING:

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 1. To achieve the organizational goals

2. To minimize the cost of performance and eliminate unproductive

efforts.

3. To help the management in adopting and adjusting according to

the changes that takes place in the environment.

4. It also provides a basis for team work as when the goals are

properly defined assignments can be fixed.

5. It gives a sense of direction and ensured that efforts are being put

to useful purpose instead of being wasted.

6. It facilitate control because without planning.

NATIONAL HEALTH PLANNING IN INDIA FIVE YEAR PLAN

“Planning is for tomorrow”

First year plans were introduced in 1928 for controlled and rapid

economic development. The National health planning is an integral

part of general socio-economic planning. A health plan is a

predetermined course of action, based on nature and extent of health

problems. Health planning should be used as an instrument for the

improvement of services. Planning is a matter of team work and

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consultation. The planning team consists of not only specialists within

the field, but also specialized in other fields, (ie) economics, statistics,

sociology, management etc. Planning should be recognized by both the

public and its leaders.

Definition:

Health planning is 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.

Complete and effective plan:

Data - Needed relevant, accurate, correctly selected and related

data will have to be available.

Analysis - Problem analysis of the identified problem.

Action - Feasible and satisfactory action, alternative action if

needed.

Understanding and accepting - Understanding and accepting the

projected actions.

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Steps:

Planning has 3 steps

1. Plan formulation

2. Plan execution

3. Plan evaluation

Planning Commission:

In 1950, planning commission was constituted to help

government to plan out integrated development plan for the entire

country within the available resources for a defined period of five years

for its socio-economic progress.

The planning commission is an advisory body to formulate a plan

for their most effective utilization, to determine the action needed to

implement the plan, to evaluate the performance of the plan from time

to time and make proposals for its improvement and to make

recommendations on specific problems.

Chairman of planning commission:

The prime minister is the chairman of planning commission.

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Divisions of planning commission:

Divisions

General Subject

Deal with broad matters, Deal with particular sectors

macroplanning, survey and Agriculture, health and
perspective planning education.

Junctions of Planning Unit in Ministry of Health:

Submission of
Co-ordination
Progress
with states
report
related to plans

Planning
Unit in Compilation
Ministry of five year
of plans
Health

Preparation
of central Development
annual health of strategies for
plans getting plans

Areas to be focused in Health Planning:

Women’s20health
 Increasing health
care programmes
Disease control
Areas to Increase public
be health infrastructure
focused
in Health
Planning
Health research Efficient doctors
and nurses

Low cost drugs Family medicine

and vaccines

Subsectors of Health sectors:

These sub sectors have received due consideration in the five

year plans.

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.

7. Indigenous system of medicine.

Five year plan:

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 Our leader Jawaharlal Nehru has said the community project are

bright, vital and defnamic sparks all over India from which radiate rays

of energy, hope and enthusiasm. Health forms an integral part of

community projects. Therefore it is needless to say that community

health nurse is an integral part of the whole team of health and welfare

services.

Five year plan were evolved to solve the country’s health as well

as social welfare problems. The planning commission gave

considerable importance to health programmes in the five year plans.

Objectives of five year plans:

1. Control or eradication of major communicable diseases.

2. Strengthening of the basic health services through the

establishment of primary health centres and subcenters.

3. Population control.

4. Development of health man power resources.

First five year plan (1951-1956)

Jawaharlal Nehru presented the first five-year plan in 1951

(December 8). The first plan sought to get the country’s economy out

of the cycle of poetry. The plan addressed, mainly, the agrarian sector

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including investments in dams and irrigation. It was based on

Harrod-Domar Model. Community Development program.

Areas included in first five year plan:

1. Irrigation and energy

2. Agriculture and community development

3. Transport and communications

4. Industry

5. Social services

6. Land rehabilitation

7. Other sectors and services.

Specific objectives:

1. Provision of water supply and sanitation.

2. Control of Malaria.

3. Preventive health care of the rural population.

4. Health services for mother and children.

5. Education and training in health.

6. Self sufficiency in drug and equipments.

7. Family planning and population control.

During this plan period the public sector outlay was Rs.2356

crore of which Rs.140 crore were alloted for health programs.

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Second five year plan (1956-1961)

The second five year plan is also called Mahalanobis plan after

its chief architect. (economic development model) (Indian statistician

prasanta chandra Mahalanobis in 1953. The second five year plan

focused on industry, especially heavy industry (hydroelectric projects,

steel, milks, production of coal, railway tracks). The plan attempted to

determine the optimal allocation of investment between productive

sectors in order to maximize dong ran-economic growth.

Specific objectives:

1. Establishment of institutional facilities to serve as a basis from

which service could be render to the people both locally and

surrounding territory.

2. Development of technical man power through appropriate

training programmes.

3. Intensifying measures to control widely spread communicable

disease.

4. Encouraging active compaign for environmental hygiene.

5. Provision of family planning and other supporting services.

During this plan period the public sector outlay was Rs.4,800

crore of which Rs.225 crore were allotted for health programs.

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The third five year plan (1961-66)

The third plan stressed on agriculture and improving production

of rice. Many primary schools were started in rural areas. In an effort

to bring democracy to the grossroot level, panchayat elections were

started and the states were given more development responsibilities.

State electricity towards and state secondary education boards were

formed. States were made responsible for secondary and higher

education.

Specific objectives:

In were in tuned with the 1st and 2nd five years plan except that

integration of public health with maternal and child welfare, nutrition

and health education was planned.

The main objectives were defense, price stabilization,

construction of dams, cement and fertilizers, plants, education etc.

This plan was interrupted by the chinese aggression (1962), Indo-

Pak War (1965), severest drought in 100 years (1965-66). This was

followed by three annual plans between 1966 and 1968, Once again

emphasizing on agriculture and also on stimulating exports, in the

process also devaluating the rupee in 1966.

During this plan period the public sector Outlay was Rs.7,500

crore of which Rs.341.8 crores were allotted for health programs.

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Three Annual Plans (1966-68)

Due to the prevailing crisis in agriculture and serious food

shortage, emphasis was on agriculture during the Annual plans. During

these plans a whole new agricultural strategy involving wide-spread

distribution of high-yielding varieties of seeds, the extensive use of

fertilizers, exploitation of irrigation potential and soil conservation was

put into action to tide-over the crisis in agricultural production.

The fourth five year plan (1969-1974)

The fourth five year plan is called greater expenditure in the

public sector, but was not able to meet its national income growth

target. This was the time when the so-called “Green Revolution”.

Main emphasis on agriculture’s growth rate so that a chain reaction can

start. It fared well in the first two years with record production, last

three years failure because of poor monsoon. At this time Indira

Gandhi was the Prime Minister and she nationalized of 19 major banks.

The funds raised for industrialization was used in the Indo-Pak War of

1971 when India had to tackle the influx of Bangladeshi refugees

before and after 1971 Indo-Pak War India also conducted nuclear tests

in 1974.

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Objectives:

1. To provide the effective base for health services in rural areas by

strengthening the PHCs.

2. Strengthening of sub-division and district hospitals to provide

effective referral services for PHC’s.

3. Expansion of Medical and nursing education and training of

Paramedical personnel to meet the minimum technical manpower

requirements.

During this plan period the public sector outlay was Rs.16,774

crore of which Rs.1,156 crore were alloted for health programs.

Fifth five year plan (1974-79)

The fifth plan prepared and launched by D.D. Dhar proposed to

achieve two main objectives viz, removal of poverty and attainment of

self reliance through promotion of high rate of growth, better

distribution of income and a very significant growth in the domestic

rate of savings. This plan was only passed in 1976 after a series of

revisions due to the global crisis over crude oil prices, but it had to be

prematurely terminated in 1978 (instead of 1979) when Fanta Govt

(Moraji Desai) came into power. There were two more annual plans in

1978 and 1979. The fifth five year plan period ensured food security

and adequate butter stocks for India.

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Specific objectives:

1. Increase accessibility of health services to rural areas.

2. Correcting regional imbalance.

3. Further development of referral services.

4. Integration of health, family planning and nutrition.

5. Intensification of the control and eradication of communicable

diseases especially Malaria and small pox.

6. Quantitative improvement in the education and training of health

personnel.

During this plan period the public sector outlay was Rs.37,250

crore of which Rs.3,277 crores were alloted for health programs.

Rolling plan (1978-80)

There were 2 sixth plans. One by Fanta Govt (for 78-83) which

was in operation for 2 years only and the other by the congress Govt

when it turned to power in 1980.

The sixth five year plan (1980-84)

The sixth plan is called the fanata government plan. This plan is

marked a reversal of the Nebourian model. The main objectives of this

plan were to increase in national income, modernization of technology,

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ensuring continuous decrease in poverty and unemployment, population

control through family planning etc. It focused on information

technology, Indian national highway system, tourism, economic

liberalization, price control, family planning, etc. family planning was

expanded to prevent over population. In contrast to China’s harshly-

enforced one-child policy, Indian policy did not rely on the threat of

force. Most prosperous areas of India adopted family planning more

rapidly than less prosperous areas which continued to have a high birth

rate.

The seventh five year plan (1985-89)

The objectives of the seventh five year plan were improving

productivity by upgrading technology, increasing economic

productivity, production of food grains and generating employment

opportunities. The thurst areas of the 7th five year plan have been

enlisted below.

Social justice

Removal of the oppression of the weak

Using modern technology

Agricultural development

Antipoverty programs
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Objectives:

1. Eliminate poverty and illitracy by 2000.

2. Achieve near full employment secure satisfaction of the basic

needs of food, cloth, shelter and provide health for all.

3. To provide an effective base for health services in rural areas by

sstrengthening the PHC’s.

4. Universal immunization programme.

5. Promotion of voluntary acceptance of contraceptives.

During this plan period the public sector outlay was

Rs.1,80,000 crores of which Rs.3,392 crores were alloted for Health

programs. It was a great success, the economy recorded 6% growth

rate against the targeted 5%. It laid greater emphasis on energy and

social development.

Annual plans (1990-1991)

Period between 1989-91 P.V. Narasimha Rao was the twelfth

prime minister of the Republic of India and head of congress party

1989-91 was a period of political instability in India and hence no five

year plan was implemented. Between 1990 and 1992, there were only

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Annual plans. In 1991, India faced a crisis in Foreign Exchange

(Forex) reserves, left with reserves of only about $ 1 billion (US). Thus

under pressure, the country took the risk of reforming the socialist

economy. P.V. Narasimba Rao (28 June 1921-23 December 2004) also

called father of Indian economic reforms and head of congress party,

and led one of the most important administration in India’s modern

history overseeing a major economic transformation and several

incidents affecting national security. At that time Dr. Manmohan Singh

(currently Prime Minister of India) launched India’s free market

reforms that brought the nearly bankrupt nation back from the edge. It

was the beginning of privatization and liberalization in India.

The Eighth five year plan (1992-97)

Eight five year plan was launched in 1992, setting of economic

liberalization and market based reforms, the fruits of which are still

being enjoyed today. This plan can be termed as Rao and Manmohan

Model of Economic development. India became a member of the

World Trade Organization on 1 January 1995.

It was a landmark in the sense that it encouraged private

investment in major public sector undertakings, greater rural and

agricultural development and anti-poverty and anti-illiteracy measures.

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It also continued the emphasis on food security and food grains were

also being expooted during this period Modernization of industries was

the main target of the eight five-year plans.

Objectives:

The major objectives included, containing

1. Population growth

2. Poverty reduction

3. Employment generation

4. Strengthening the infrastructure

5. Institutional building, tourism management

6. Human resource development

7. Involvement of panchayatraj

8. Nagarapalikas

9. NGO’s

10.Decentralization and people’s participation.

It is based on national health policies.

1. Human development is the ultimate goal of this plan

2. Employment generation, population control literacy, education,

health, drinking water and provision of adequate food and basic
infrastructure.
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 3. Towards health for the underprivileged was the aim of this plan.

The PHCs were strengthened staff vacancies, by supplying

essential equipment and

AIDS control program was initiated during this plan.

The plan undertook various drastic policy measures to combat

the bad economic situation and to undertake an annual average growth

of 5.6%.

Some of the main economic performances during eighth plan

period were rapid economic growth, high growth of agriculture and

allied sector, and manufacturing sector, growth in exports and imports,

improvement in trade and current account deficit.

The ninth five year plan (1997-2002)

Ninth five year plan India runs through the period from 1997 to

2002 with the main aim of attaining objectives like speedy

industrialization, human development, full-scale employment, poverty

reduction, and self-reliance on domestic resources. Ninth Five year

plan was formulated amidst the backdrop of Indias Golden jubilee of

Independence.

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Objectives:

1. To prioritize agricultural sector and emphasize on the rural

development.

2. To generate adequate employment opportunities and promote

poverty reduction.

3. To stabilize the prices inorder to accelerate the growth rate of the

economy.

4. To ensure food and nutritional security.

5. To provide for the basic infrastructural facilities like education

for all, safe drinking water, primary health care, transport, energy.

During this plan, vertical health program were integrated

horizontally with general health services.

The reproductive and chief health program was improved under

following guidelines.

1. Decentralize RCH to the level of PHCs.

2. Base planning for RCH services on assessment of the local

needs.

3. Meet the needs of contraceptives.

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 4. Involve the general practitioners and industries in family welfare

work.

Tenth five year plan (2002-2007)

India’s tenth five year plan has been devised to complement and

meet the United Nations Millennium Development Goals (MDG)

targets The MDG was issued in 2000 to achieve eight targets to

eradicate hunger and poverty eight targets to eradicate hunger and

poverty and raise the standards of living worldwide by the year 2015

through global co-operation.

The Millennium Development Goals are

- Eradicate Extreme poverty and hunger

- Achieve universal primary education

- Promote gender equality and empower women

- Reduce child mortality

- Improve maternal health

- Combat HIV/AIDS Malaria and other diseases

- Ensure environmental sustainability.

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 - Global partnership for development.

The target of tenth five year plan is

Reduction of poverty ratio to 20% by 2007 and to 10% by 2012.

Providing gainful and high-quality employment atleast to the

addition to the labour force.

All children in India in school by 2003 all children to complete 5

years of schooling by 2007 and raising the literacy rate to 72%. Within

the plan period and to 80% by 2012.

Reduction in gender gaps in literacy and wage rates by atleast

50% by 2007.

Bring down the decadal growth rate by 16.2% in the decade from

2001 to 2011.

Reduction of Infant Mortality Rate to 35/1000 live births by 2007

and 28/1000 live births by 2012.

Reduce Maternal Mortality Rate to 2/1000 live births by 2007

and 2/1000 live births by 2012.

Universal Availability of drinking water clearing of all major

polluted rivers and increase in forest lover to 25 percent.

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 To achieve the above the government ie planning to do the

following.

1. Restrictive existing health infrastructure

2. Upgrade the skills of health personnel

3. Improve the quality of reproductive and child health.

4. Improve logistic supplies

5. Carry out the reach on nutritional deficiency.

6. Promote rational drug use.

Eleventh Plan (2007-2012)

Income and Poverty

Create to million work opportunities

Reduce educated unemployment to below 5%

Raise real wage rate of unskilled workers by 20 percent.

Education

In education- Reduce dropout rates of children from elementary

school from 52.2% in 2003-2004 to 26% by 2001- 2012.

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 Develop minimum standards of education attainment in

elementary school, and by regular testing monitor effectiveness of

education to ensure quality.

Increase literacy rate for persons of age of years or above to 85%.

Health

Reduce infant mortality rate to 28 and maternal mortality ratio to

1 per 1000 live births.

Reduce fertility rate to 2.1.

Provide clean drinking water for all by 2009 and there are no slip

backs. For rural poor to lover all the poor by 2016-2017.

Environment

Increase forest and tree

Attain WHO standards of air quality in all major cities by 2011-

12.

Treat all urban waste water by 2011- 12 to clean river wasters.

Increase energy efficiency by 20 percentage points by 2016-

2017.

38
NATIONAL HEALTH COMMITTEES

INTRODUCTION

Before the National Health Policy (NHP) framed in 1983, and

various committees of experts appointed from time to time, the

constitution, the planning commission, the central council of health and

family welfare and consultative committees attached to the Ministry of

Health and family welfare render a drive on initiating health

programmers, requirement of health manpower and other resources in

government, voluntary and private sectors based on health needs and

demands of the reduce malnutrition among children of age group o-3 of

half its present.

Women and children

Raise the sex ration for age group o-6 to 935 by 2011- 2012 and

to 950 by 2016- 17.

Ensure that at least 33 percent of the direct and indirect

beneficiaries of all government schemes are women and girl children.

Ensure that all children enjoy a safe childhood, without any

compulsion to work.

Infrastructure
39
 Ensure electricity connection to all villages and BPL households

by 2009 and round – the – clock power.

Ensure all- weather road connection to all habitation with

population 1000 and above (500 in hilly and tribal areas) by 2009, and

ensure coverage of all significant habitation by 2015.

Connect every village by telephone by November 2007 and

provide broadband connectivity to all villages by 2012.

Provide homestead sites to all by 2012 and step up the pace of

house construction people through health surveys. The reports of these

committees have formed an important basis of health planning if India.

National Health Planning in India based on the National Health Policy

(NHP) 1983 aimed to attain “Health for All” by the year 2000. The

main objective of the revised National Health Policy, 2002 is to achieve

an acceptable standard of good health among the general population of

the country and has set goals to be achieved by the year 2015.

1. BHORE COMMITTEE, 1946 (Health Survey and Development

Committee)

The Government of India in 1943 appointed the Health Survey

and Development committee with Sir. Joseph Bhore as chairman to

40
survey the existing position regarding the health conditions and health

organization in the country and to make recommendations for the future

development. The committee which had among its members some of

the pioneers of public health, met regularly for 2 years and submitted in

1946 its famous report which runs into 4 volumes. The committee

observed: “if the nation’s health is to be built, the health programme

should be development on a foundation of preventive health work and

that such activities should proceed side by side with those concerned

with the treatment of patients”. Some of the important

recommendations of the Bhore committee were,

1. Integration of preventive and curative services at all

administrative levels.

2. The committee visualized the development of primary health

centers in 2 stages.

a. As a short- term measure it was proposed that each primary

health centre in the rural areas should later to a population of

40,000 with a secondary health centre to serve as a supervisory,

co-ordinating and referral institution. For each PHC, two medical

officers, 4 public health nurses, one nurse, 4 midwives, 4 trained

41
 dais, 2 sanitary inspectors, 2 health assistants, one pharmacist

and 15 other class 1IV employees were recommended.

b. A long term programme (also called the 3 million plan) of setting

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 2,5000

beds. Major changes in medical education which include 3

months training in preventive and social medicine to prepare

social physicians.

The other recommendations were

1. Formation of village health committee to secure active

cooperation and support in the development of health

program.

2. Provision of doctors of future who should be- social doctoral,

combines both curative and preventive of the public.

3. Formation of District Health Board for each district with

district health officials and representations of the public.

4. To ensure suitable housing, sanitary surroundings, safe

drinking water supply elimination of unemployment and lay

42
 special emphasis on preventive work. It deals with various

aspects of health.

 Industrial health

 Public health

 Medical Relief

 Professional salutation

 Medical Research

Mudaliar Committee, 1962 (Health Survey and Planning

Committee)

The Government of India in 1959 appointed another Committee

to provide guidelines for the fire year plans. This committee is known

as “Health survey and planning committee Dr. A.L. Mudaliar, Vice

chancellor of Madras University headed it. This committee was

appointed to assess the performance in health sector based on

recommendations made in Bhore committee report. This committee

found the conditions in PHC to be unsatisfactory and suggested the

following recommendations.

1. Consolidation the following made in the first two year plans.

43
 2. Strengthening of the sub divisional hospitals and district

hospital with specialist services.

3. Strengthening of existing PHC before opening of new ones.

4. PHC should not be made to cater to more than 40,000

population

5. PHC should provide the curative, preventive and primitive

services.

6. Improve the quality of health care provided by primary health

centers.

7. Integration of medical and health services on the pattern of

Indian Administrative service.

Chadah Committee, 1963

This committee was appointed in 1963, under chairmanship of

Dr. M.S. Chadah who was the Director General of Health services. This

committee was appointed to advice about the necessary arrangements

for the maintenance phase of National Malaria Eradication Programme

(NMEP). The committee made the following suggestions.

44
 1. Basic health workers (Junior Health Assistant Male) one per

10,000 populations should carried out the NMEP activity. Now

each Junior Health Assistant Male to cover 3-5000 population.

2. Basic health workers would function as multipurpose workers

(and would perform, in addition to malaria work, the deities of

family planning and vital statistics data collection).

3. They would work under supervision of family planning health

assistants.

Mukherjee Committee, 1965

Within a couple of years after the implementation of chadah

committee, it was realized that the basic health workers could not

function effectively as multipurpose workers. So it came to discussion

at a meeting of central health council in 1965.

The committee was appointed in 1965 under chairmanship of

shri. Mukherjee who was then secretary of Health to Government of

India. This committee was appointed to review the performance and

develop strategy in the area of family planning.

The following were the committee recommendations.

45
 1. There should be a separate staff for the family planning

programme.

2. The family planning assistants were to undertake family planning

duties only.

3. The basic health workers were to be utilized for purposes other

than family planning.

4. Top separate the malaria activities from family planning.

5. Strengthening of state health department by providing additional

staff sanctioned by central Government.

The state family planning bureaus should have two major

divisions.

 Administrative

 Operational

The administrative division should be headed by the

administrative officer, and has look after the administrative works

including budgets and should have small unit which deal with grants to

voluntary organization.

46
 The administrative section also have a store section under a store

officer which will be concerned with supply of all types of

contraceptives, training, materials, charts, hospital equipments for

I.U.C.D. Sterilization.

The operational division should be headed by assistant director of

health services and will be divided into two sections.

One to deal with education and information should be headed by

education and administration officer.

Other to look after planning, field operation, evaluation and

training by statistical investigator.

Need of training of paramedical Personnel, nurses, AMM etc

required for the family planning programme.

Mukherjee Committee, 1966

The committee of health secretaries was appointed in 1966 under

chairmanship of shri Muckherjee who was then Union Health Secretary.

This committee was appointed to work out the details of Basic Health

Service that should be provided as the Block level and some

consequentional strengthening required at higher levels of

administration since multiple activities of the mass programmes like

47
family planning, small pox, leprosy, trachoma, NMEP (Maintenance

Phase) etc, were making it difficult for the states to undertake these

effectively because of shortage of finds, discussed in a meeting of the

central Health council held at Bangalore in 1966.

Fungalwala Committee 1967 (or) Committee on Integration of

Health Services

The central council of health at its meeting held in 1964, taking

note of the importance of integration of health services and elimination

of private practice by government doctors appointed a committee

known as the “committee on Integration of Health Services under the

chairmanship of Dr. N. Iungalwalla, the then Director of National

Institute of Health Administration and Education to examine into

various problems related to integration of health services, abolition of

private practice of doctors in government services and the service

conditions of Doctors. The report was submitted in 1967.

The Recommendations towards integration are

1. Unified cadre

2. Common seniority

3. Recognition of extra qualifications.

48
 4. Equal pay for equal work

5. Special pay for specialized work

6. Abolition of private practice by government doctors.

7. Improvement in their service conditions.

A. The committee defined “integrated health services as a service

with a citified approach for all problems instead of a sequenced

approach for different problem and suggested the followed steps

that should be taken for the integration at all levels of health

organization in the country.

B. Medical care and Public health programmes should be put under

charge of a single administrator at all levels of hierarchy.

Kartar Singh Committee, 1973 Committee on Multi Purpose

Workers.

This committee is known as “committee on multipurpose

workers under Health and Family planning Government of India

Constitutes it in 1972 under the chairmanship of kartar Singh, then the

additional secretary, Ministry of Health and Family planning,

Government of India to form a framework for integration of health and

medical services at peripheral and supervisory levels.

49
The main recommendations of the committee were,

1. Various categories of peripheral workers should be amalgamated

into a single cadre of multipurpose workers (Male and Female).

2. Auxiliary Nurse Midwives were to be converted into Multi

Purpose Health Workers Females MPW (F) and

3. The basic health workers, malaria surveillance workers etc were

to be converted to Multi Purpose Health Workers Male MPW

(M).

4. The work of 3-4 male and female MPWs was to be supervised by

one health supervisor (male or female respectively).

5. The existing lady health visitors were to be converted into female

health supervisor.

6. One Primary Health Centre should cover a population of 50,000.

It should be divered into 16 sub centres (one for 3000 to 35000

population).

7. Each primary Health Centre to be staffed by a male and female

health worker.

50
Shrivastar Committee, 1975, Group on Mewdical Education and

Support Man Power

This committee is known as “Group on Medical Education and

support Manpower” Government of India, Ministry of Health and

Family Planning to determine steps needed to

i. Reorient medical education in accordance with national needs

and priorities and.

ii. Develop a curriculum for health assistants who were to function

as a link between medical officers and MPWs constituted it in

1974.

The following were the recommendations,

i. Creation of bands of paraprofessional and semiprofessional

health workers from within the community itself.

ii. Establishment of 3 cadres of health workers namely-

multipurpose health workers and health assistants between the

community levee workers and doctors at PHC.

iii. Development of a “Referral Services complex.

51
iv. Establishment of a Medical and Health Education Commission

for planning and implementing the reforms needed in health and

Medical Education on the lines of University Grants

Commission.

Acceptance of the recommendations of the strivaster committee

in 1977 led to the launching of the Rural Health Service.

Bajaj Committee, 19086 – Expert Committee for Health Man

Power Planning, Production and Management

An Expert committee for Health Man Power Planning,

Production and Management was constituted in 1985 under the

chairmanship of Dr. I.S. Bajaj, the then professor at ATIMS, New

Delhi:

The following are the major recommendations of this committee.

1. Formulation of national medical and health education policy.

2. Formulation of national health man power policy.

3. Establishment of an educational commission for health sciences

(ECHS) on the lines of UGC.

52
 4. Establishment of health science universities in various states and

union territories.

5. Establishment of health man power cells at centre and in the

states.

6. Vocationalization of education at 10+2 levels as regards health

related fields with appropriate incentives, so that good quality

paramedical personnel may be available in adequate numbers.

7. Carrying out a realistic health manpower survey.

Mehta Committee 1983

The “Medical Education Review Committee” was headed by

Shri Mehta, Known as Mehta committee 1983. The part I of the report

deals with medical education in all its aspects, but there is a major

recommendation regarding the establishment of Universities of Medical

Sciences and Medical and Health Education Commissions.

Part- II of the report specifically deals with the lack of

availability of health man power data in India, recommendations

regarding the methods of updating such data and man power projections

for doctors, nurses and pharmacists.

Shetty Committee (1954)

53
 The initial move for the appointment of the Nursing Committee

was made by the then Union Minister for Health, Rajkumari Amrit

kaur, in her inaugural speech at the second meeting of the central

council of Health held at Rajkot on 8 th , 9th, 10th February, 1954. She

emphasized the importance of good nursing and drew attention to the

many factors that hindered its development. In pursuance of this

resolution, the Government of India Constituted a committee on 19 th

May, 1954 under the chairmanship of shri Shetty and Ms. TK.

Adranvala, Nursing Advisor to Govt. of India as the Member Secretary.

The Recommendations are,

i. The appointment of a superintendent of nursing services in

each state.

ii. Combining the Nursing service for hospitals and that of the

public health and Domiciliary Nursing in the basic course for

nurses and midwives.

iii. In planning to provide an adequate nursing service, the

immediate goal to be the provision of a minimum standard of

Nursing in the existing hospitals and public health services.

The number required to be assessed on the following basis.

54
 One Nurse (also qualified in Midwifery for women’s and

maternity services) including students to 3 patients in hospitals used for

the training of Nurses and Midwives. One nurse also qualified in

Midwifery for women’s and maternity services to 5 patients in all other

hospitals.

One Midwife to 100 births in rural areas. In towns and cities in

compact areas one Midwife to 150 births.

One public Health Nurse or Health visitor to 10,000 of the

population.

Sarojini Varadapan Committee Report (1989)

A high power committee on Nursing and Nursing Profession was

set up by the Govt of India in July, 1987 under the chairmanship of

Smt. Sarojini Varadapan, in eminent social worker and former

chairperson of central social welfare Board with Smt. Rajakumari

stood, Nursing Advisor to Govt. of India as the Member Secretary. The

terms of the reference of the committee were as follows.

a. To look into the existing working conditions of nurses with

particular reference to the status of the Nursing care

services both in the rural and urban are as.

55
b. To study and recommend the staffing norms necessary for

providing adequate nursing personnel to give the best

possible care, both in the hospitals and community.

c. To look into the training of all categories and levels of

Nursing Midwifery personnel to meet the nursing man

power needs at all levels of health services and education.

d. To study and clarify the role of nursing personnel in the

health care delivery system including their interaction with

other members of the health team at every level of health

services management.

e. To examine the need for organization of the nursing

services at the National, State, District and Lower levels

with particular reference to the need for planning and

implementation of comprehensive nursing care service

with the overall health care system of the country at their

respective levels.

f. To look into all other aspects which the committee may

consider relevant with reference, to their terms of

reference, and

56
 g. While considering the various issues under the above

norms of reference, the committee will hold consultations

with the state Government.

PRINCIPLES OF PLANNING

1. The Principle of Passion

57
 When were passionless, we procrastinate on the plan or burnout

trying to execute it. With passion, we approach our plans with

excitement and a sense of urgency. Passion gives planning energy.

Passion also gives planning focus. As Tim Redmond says, “There

are many things that will each my eye, but there are only a few things

that will catch my heart. It is those I consider to purpose. Passion

narrows our vision so that the plan dominates our attention and

distractions fade into the background.

2. The Principle of Creativity

Of the seven planning principles, we violate the principles of

creativity the most. By granting to convergences, we sacrifice

creativity. We settle for what’s easy to wrap out minds around, and we

neglect to wrestle with larder, more difficult dilemmas. Leaders are too

busy doing to think and provide ideas. Even the rare leaders who think

creatively often neglect to encourage the people around them to do the

same. Consequently, a majority of teams rely on person for creative

though and end up starred for good ideas.

3. The Principles of Influence

58
 When you prepare your plans, ask yourself the question. “Am I

able to influence the resources needed to fulfill my planning and

mission?. “To accomplish your plan you” need influence over people,

finances, and your schedule.

The support of people, especially other influences, can make or

break your plan. Make a priority to build relationships with them. In

particular, find the key to their lives by learning what matters most to

them. If you continually add, value to the influencers around you in

meaningful ways, then you’ll be more likely to receive their assistance

when you need it.

4. The Principle of Priorities

Before taking the time to plan their careers, take time to prioritize

their lives. You have no right, nor any reason, to start planning your life

until you know what you’re living for and you’re willing to die for. Its

important to find the purpose so that you run, not on the fast track, but

on your track.

The key to a prioritized life is concentration followed by

elimination. As Peter Drucker Observed “Concentration is the key to

economic results. No other principle of effectiveness is violated as

constantly today as the basic principles of concentration. Our motto

59
seems to be, let’s do a little bit of everything. We must cease to dabble

in everything we can become excellent at anything.

5. The Principle of Flexibility

In leadership, be mentally prepared that not everything will go

according to your plans. Then, when plans unfold unexpectedly, you’ll

be prepared to see new opportunities.

When plans go away, don’t just stand there. By staying in

motion, you create movement. Be resourceful enough to improvise

when circumstances push you off course.

6. The Principle of Timing

Most of the time, our decisions are based on opur emotional

environment rather than reality. When we’re in the valleys of life, we

don’t see clearly. Our perspective is limited, and all we see are the

problems around us. In the valleys we make decisions, not to better

ourselves, but to escape our problems.

Never make a major decision in the valleys. Wait until you get to

the peak where you can see clearer and farther. You’ll avoid making

rash decisions that you’ll regret later.

7. The Principle of Teamwork

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 A Worthwhile plan ought to be bigger than your abilities. You

shouldn’t be able to accomplish it alone. Each of

61