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Committees rule

  • 14/07/2006

The lack of focus on public health is a result of faulty planning in the initial years after independence when the colonial system, weighted heavily in favour of the privileged, was allowed to continue. In time-honoured style, moreover, the government set up a series of committees but the state of public health did not undergo significant changes.

In 1946, a health survey and development committee was set up with Joseph Bhore, a member of the Indian Civil Service, as its chairperson. The Bhore committee made a global review of developments in health care services, especially in the UK, Australia, New Zealand, Canada, the USSR and the US and found that the role of the state was increasing. The committee suggested including preventive and social medicine in medical education with a three-month training course to prepare "social physicians'. It proposed setting up primary health centres (PHCs) in rural areas to ensure that health services were as "close to the people as possible in order to ensure the maximum benefit to the community to be served'.

But experts now say the recommendations were faulty. "The plan that was finally developed depended on the existing infrastructure and extrapolated it in the rural areas but failed to take the specific needs of these areas into account,' says Debabar Banerji, emeritus professor at the Centre for Social Medicine and Community Health, Jawaharlal Nehru University, Delhi. The main reason for this, he says, was that members of the Indian Medical Service, trained in western systems, were part of the committee. There were 30,000 licentiate physicians in the country and these people could be trained to provide health care in rural areas but the three-year licentiate course was abolished to ensure that only highly trained doctors staffed the system. At that time there were just 18,000 such doctors.

On the recommendations of the Bhore committee, the department of prevention and social medicine was made part of medical colleges. But over half a century down the line, these departments attract only those who cannot get admission into more paying lines of specialisation. The field did not have either prestige or financial rewards.

Also, there was a definite bias in favour of elite institutions. Work on the All India Institute of Medical Sciences, a recommendation of the committee, began immediately but recommendations on setting up PHCs languished. Those that were set up did not meet the basic staff requirement prescribed by the committee. The focus on social and community medicine was further diluted when family planning became the dominant concern.

The Health Survey and Planning Committee of 1961 was appointed to assess the performance of the health sector since the submission of the Bhore committee report. The committee also voted against the licentiate course, because it did not meet WHO standards. It recommended that an all-India health service should be created to replace the Indian Medical Service, but no steps were taken to do this.

Another committee, called the Group on Medical Education and Support Manpower was set up in 1975 to determine how medical education could be reoriented in accordance with national needs and develop a curriculum for health assistants who were to function as a link between medical officers and multipurpose workers. It recommended the establishment of a medical and health education commission for planning and implementing the reforms needed in health and medical education on the lines of the University Grants Commission (UGC). Compulsory national service of two years in PHCs by every doctor between the fifth and fifteenth years of their career was also recommended.

An Indian Council of Medical Research-Indian Council for Social Science Research joint panel suggested in 1980 that there was no further need for expansion of medical education, but stressed rationalisation and reorientation.

Another committee

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