An Overview of Health Planning in India

Health planning forms the backbone of a nation’s socio-economic development. In India, the journey of health planning has been shaped by expert committees, national policies, and systematic initiatives spanning over seven decades. From the foundational Bhore Committee Report of 1946 to the National Health Policy 2017, India’s approach to healthcare has undergone significant transformation. Understanding this evolution is essential for nursing professionals who serve as the frontline workforce in implementing these health plans across communities.

What is health planning? 🔗

Health planning is an integral part of national socio-economic planning that aims to achieve the best possible health outcomes using available resources efficiently. It involves defining community health problems, identifying unmet needs, surveying resources, establishing realistic priorities, and implementing administrative actions to achieve health objectives. In India, health planning has evolved through multiple committees and policies, each building upon previous recommendations while addressing emerging challenges.

Why health planning matters 🔗

Systematic health planning ensures that healthcare resources reach every section of society, particularly vulnerable populations in rural and underserved areas. It helps governments allocate budgets effectively, train adequate healthcare personnel, and build necessary infrastructure. Without structured planning, healthcare delivery becomes haphazard, leading to inequities in access and quality of care.

The Bhore Committee: Foundation of Indian health planning 🔗

The Health Survey and Development Committee, commonly known as the Bhore Committee, was appointed in 1943 under the chairmanship of Sir Joseph Bhore. This committee submitted its landmark report in 1946, which became the cornerstone of health planning in independent India. The committee surveyed existing health conditions and made comprehensive recommendations for restructuring health services.

Key recommendations of the Bhore Committee 🔗

The Bhore Committee introduced several revolutionary concepts that continue to influence Indian healthcare today. Its primary recommendations included the integration of preventive and curative services at all administrative levels. The committee proposed a two-stage development plan for Primary Health Centres. In the short-term, each PHC was suggested for a population of 40,000, staffed by two doctors, one nurse, four public health nurses, four midwives, and other support personnel. The committee also proposed a long-term programme known as the “3 million plan,” consisting of a three-tier healthcare system with primary, secondary, and tertiary facilities.

The committee emphasized that health programmes should be developed on a foundation of preventive health work alongside curative treatment. It also recommended a minimum ratio of 567 hospital beds, 62 doctors, and 151 nurses per 100,000 population. The first PHC based on these recommendations was established in 1952, marking the beginning of organized primary healthcare in India.

The Planning Commission and Five Year Plans 🔗

India’s planned economic development began in 1951 with the establishment of the Planning Commission. The Five-Year Plans implemented from 1951 to 2017 shaped the nation’s economic trajectory, including significant investments in healthcare. The Planning Commission, chaired by the Prime Minister, conceptualized and monitored these plans until its replacement by NITI Aayog in 2015.

Health initiatives in the Five Year Plans 🔗

The First Five Year Plan (1951-1956) focused on rebuilding the country after independence, with significant attention to agriculture and providing affordable healthcare. This period saw the launch of the National Family Planning Programme, National Malaria Control Programme, and National Water Supply and Sanitation Programme. The World Health Organization collaborated with the Indian government to address children’s health and reduce infant mortality.

Subsequent plans expanded healthcare infrastructure progressively. The Second Plan (1956-1961) emphasized establishing institutional facilities, while the Third Plan stressed the Community Development Programme. Over the years, the plans incorporated disease control programmes, family planning initiatives, immunization programmes, and improvements in maternal and child health services.

The Eleventh Five Year Plan (2007-2012) focused on horizontal integration of healthcare and reduction of inequities, while the Twelfth Plan (2012-2017) aimed to reduce malnutrition among children, increase life expectancy, and enhance access to higher education. These plans allocated increasing percentages of GDP to health, though challenges in achieving targets persisted.

Important health committees after the Bhore Committee 🔗

Following the Bhore Committee, the Government of India constituted several expert committees to address specific health challenges and review progress. These committees were aimed at reviewing India’s health situation and recommending measures to strengthen primary healthcare, integrate services, and achieve health for all.

Mudaliar Committee (1962) 🔗

The Health Survey and Planning Committee, headed by Dr. A.L. Mudaliar, was appointed in 1959 to assess progress since the Bhore Committee. It found that health conditions remained unsatisfactory and recommended strengthening existing PHCs rather than creating new ones. The committee emphasized that a PHC should serve no more than 40,000 population and provide comprehensive curative, preventive, and promotive services.

Chadha Committee (1963) 🔗

Under the chairmanship of Dr. M.S. Chadha, then Director General of Health Services, this committee advised on arrangements for the maintenance phase of the National Malaria Eradication Programme. It recommended that vigilance activities should be carried out by basic health workers functioning as multipurpose workers, with one worker serving every 10,000 population.

Kartar Singh Committee (1973) 🔗

This committee, known as the “Committee on Multipurpose Workers under Health and Family Planning,” formed a framework for integrating health services at peripheral and supervisory levels. Its major recommendation was amalgamating various categories of peripheral workers into a single cadre of multipurpose workers, both male and female. The committee proposed one PHC for 50,000 population with 16 sub-centres, each sub-centre serving 3,000-3,500 people and staffed by one male and one female health worker.

Shrivastav Committee (1975) 🔗

This committee focused on medical education and support manpower, recommending measures to align healthcare workforce development with national health needs.

National Health Policies 🔗

India’s National Health Policies have provided strategic direction for the health sector. The first National Health Policy was formulated in 1983, followed by another in 2002. The National Health Policy 2017 aims to achieve the highest possible level of good health and well-being through a preventive and promotive healthcare orientation, ensuring universal access to quality healthcare services without financial hardship.

Goals of National Health Policy 2017 🔗

The policy targets increasing life expectancy at birth from 67.5 to 70 years by 2025, reducing infant mortality rate to 28 per 1,000 live births, and achieving a Total Fertility Rate of 2.1 at national and sub-national levels. It advocates raising public health expenditure to 2.5% of GDP and emphasizes strengthening public health institutions to provide universal access to free drugs, diagnostics, and essential healthcare.

From Planning Commission to NITI Aayog 🔗

In 2015, the Planning Commission was replaced by NITI Aayog (National Institution for Transforming India). Unlike the centralized planning approach of its predecessor, NITI Aayog aims to foster cooperative federalism and involvement of state governments in economic policy-making. The organization functions as a think-tank, providing strategic policy vision while respecting state-specific needs and resources.

NITI Aayog’s health-related functions include providing strategic advice, developing credible plans, focusing on disadvantaged sections of society, and monitoring programme implementation. This shift acknowledges that planning should be more relevant and specific to local contexts rather than centrally commanded.

Structure of health planning in India 🔗

Health planning in India operates at multiple levels, ensuring coordination from national to grassroots level.

Central level 🔗

The Union Ministry of Health and Family Welfare oversees national health programmes, policy formulation, and coordination with states. It regulates clinical establishments, professional education, food safety, and medical technologies.

State level 🔗

State health directorates implement central policies and programmes while addressing state-specific health priorities. States prepare their own draft plans and allocate resources according to local needs.

District and block levels 🔗

District Health Officers coordinate healthcare delivery, supervise PHCs and Community Health Centres, and implement national health programmes at the grassroots level. Block-level health infrastructure includes PHCs that serve as the first point of contact for rural populations seeking healthcare.

Achievements and continuing challenges 🔗

India has made significant progress in health indicators over the decades. Life expectancy has increased substantially, infant and maternal mortality have declined, and several epidemic diseases have been controlled or eliminated. The establishment of an extensive network of PHCs, sub-centres, and Community Health Centres has improved healthcare access in rural areas.

However, challenges remain. Regional disparities in healthcare access persist, and the private sector dominates curative care while preventive and promotive services remain largely in the public domain. Achieving the ambitious targets set by the National Health Policy 2017 requires sustained investment, workforce strengthening, and continued focus on equity.

What do you think? How can nursing professionals contribute more effectively to implementing health plans at the community level? What changes in health planning might better address the healthcare needs of underserved populations in your region?

References

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC11414765/
2. https://en.wikipedia.org/wiki/Bhore_Committee
3. https://en.wikipedia.org/wiki/Five-Year_Plans_of_India
4. https://www.slideshare.net/slideshow/health-committees-ppt/239332313
5. https://www.pib.gov.in/newsite/Printrelease.aspx?relid=159376
6. https://www.slideshare.net/slideshow/health-planning-in-india-and-niti-aayog/232249610