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 COLLEGE OF NURSING REGIONAL INSTITUTE OF MEDICAL SCIENCES

SUBMITTED TO SUBMITTED BY

Mr. L. JOHN SINGH MISS ANAMIKA SHARMA

LECTURER 2ND YEAR M.Sc. NURSING

CON, RIMS CON, RIMS

INTRODUCTION
India has grown up in health and education sectors. Many health programmes have
been co- ordinated to precede good status of health and health organization. For this many
health committees are responsible to produce different health planning according to the need
of public. Various committees of experts have been appointed by the government from time
to time to render advice about different health problems.

The reports of these committees have formed an important basis of health planning in
India. Health planning in India is an integral part of national socio- economic planning. The
guidelines for national health planning were provided by a number of committees dating back
to the Bhore Committee in 1946.
BHORE COMMITTEE (1946)

The Government of India appointed heath survey and development committee in 1943
whith Sir Joseph Bhore as chairman to survey the health organizations in the country. The
most comprehensive health policy and plan document ever prepared in India was the `Health
Survey and Development Committee Report' popularly referred to as the Bhore Committee.
The committee made comprehensive recommendations for remodelling of health services in
India

OBJECTIVES:

1. The services should make adequate provision for the medical care of the individual in the
curative and preventive fields and for the active promotion of positive health;

2. These services should be placed as close to the people as possible, in order to ensure their
maximum use by the community, which they are meant to serve;

3. The health organization should provide for the widest possible basis of cooperation
between the health personnel and the people;

4. Provisions should be made for enabling the representatives of medical and auxiliary
professions to influence the health policy of the country.

5. Special provision will be required for certain sections of the population, e.g. mothers,
children, elderly etc.,

6. No individual should fail to secure adequate medical care, curative and preventive, because
of inability to pay for it and

7. The creation and maintenance of as healthy an environment as possible in the homes of the
people as well as at work.

RECOMMENDATIONS

1) Integration of prevention and curative service of all administrative levels.

2) Major changes in medical education which included 3 months’ training in preventives and
social medicine to prepare social physician
3) The committee visualized the development of primary health centres in 2 stages.

A) Short-term programmes:
1. Personal and impersonal health services should be provided.

2. In each village, a health committee consisting of 5-7 individuals should be established for
procuring the active participation of people in local health programme.

3. Dental sections should be established in the hospital at secondary health centres.

4. Provision of housing accommodation for health staff is essential in interest of efficiency.

B) Long- term goals:

1. Raising of hospital accommodation to 2 beds/1000 populations.

2. Creation of 18 new medical colleges in addition to 43 to be established during the first 10

years.

3. Establishment of 100 training centres for nurses. 4. Training of 500 hospitals social
worker.

MUDALIAR COMMITTEE (1962)

In 1959, the Government of India appointed another committee known as Health Survey and
Planning Committee popularly known as Mudaliar Committee under the Chairmanship of Dr.
A.L mudaliar.

OBJECTIVE

1. To assess the performance in health sector since the submission of Bhore Committee
report.
2. To evaluate the progress made in the first 2 plans and
3. To make recommendation for the future path of development of health services.

It was found that the quality of services provided by primary health centres was
inadequate as most of the PHC's were understaffed, large numbers of them were being run by
ANM's or public health nurses in charge hence it advised strengthening of the existing
primary health centres before new centres were established. It also emphasised on
strengthening of sub-division and district hospitals.

RECOMMENDATIONS

1) Consolidation of advances made in the first two five year plans.

2) Strengthening of district hospitals with specialists services to serve as central base of
region services.
3) Regional organization in each state between the headquarters organization and the
district in charge of a regional deputy or assistant director each to supervise 2-3
district medical and health officers
4) Each PHC not to serve more than 40000 populations.
5) To improve the quality of health care provided by PHC.
6) Integration of medical and health services.
7) Constitution of an All India Health service on the pattern of Indian Administrative
Service.

CHADHA COMMITTEE (1963)

This committee was appointed under chairmanship of Dr. M.S. Chadah, to advise
about the necessary arrangements for the maintenance phase of National Malaria Eradication
Programme.

RECOMMENDATIONS

1. Prompt detection, radical treatment of parasite carriers and their follow up.

2. Epidemiological, investigation: of positive cases and measures to eliminate foci.

3. Periodic review of the status of ordination and the adequacy of the vigilance system.

4. Integration of health and family planning services.

MUKHERJEE COMMITTEE (1965)

The recommendations of the Chadah Committee, when implemented, were found to

be impracticable. The basic health workers, with their multiple functions could do justice
neither to malaria work nor to family planning work. So, the Government of India appointed
Shri Mukherjee to review the strategy for family planning programme.

RECOMMENDATION

1) 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 utilised for purposes other than family planning.
4) Delink the malaria activities from family planning so that the latter would receive
undivided attention of its staff.

MUKHERJEE COMMITTEE (1966)

Multiple activities of the mass programmes like family planning, small pox, leprosy,
trachoma, etc. were making it difficult for the states to undertake these effectively because of
shortage of funds. A committee of state health secretaries, headed by the Union Health
Secretary, Shri Mukherjee, was set up to look into this problem

JUNGALWALLA COMMITTEE (1967)

This committee, known as the “Committee on Integration of Health Services” was set
up in 1964 under the chairmanship of Dr. N Jungalwalla, the then Director of National
Institute of Health Administration and Education (currently NIHFW). It was asked to look
into various problems related to integration of health services, abolition of private practice by
doctors in government services, and the service conditions of Doctors.

The committee defined integrated health services as :

1. A service with a unified approach for all problems instead of a segmental approach for all
problems.

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

1. Unified cadre

2. Common seniority

3. Recognition of extra qualification

4. Equal pay for equal work

5. Special pay for specialized work

6. No private practice and good service conditions.

KARTAR SINGH COMMITTEE (1973)

This committee, headed by the Additional Secretary of Health and titled the
"Committee on multipurpose workers under Health and Family Planning" was constituted to
form a framework for integration of health and medical services at peripheral and supervisory
levels.

RECOMMENDATIONS

1) 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 redesignated by Male Health Workers.
2) The program has to be introduced in areas where malaria is in maintenance
phase and smallpox has been controlled and later to other areas.
3) One primary health centre for 50,000 populations.
4) Each PHC should be divided into 16 sub centers and each covers 3,000 to 35, 00
population.
5) Each sub centre to be staffed by a male and female health worker.
6) One male health supervisor to supervise 3 to 4 male health workers and one
female health supervisor to supervise the work of 4 female health workers.
7) The lady health visitors to be designated as female health supervisors.
8) The doctor in charge of a primary health centre should have the overall in
charge of all the supervisors and health workers in the area.

SHRIVASTAV COMMITTEE, 1975

This committee was set up in 1974 as "Group on Medical Education and Support
Manpower" to determine steps needed to:

1) Reorient medical education in accordance with national needs and priorities.

2) Develop a curriculum for health assistant who were to function as a link between
medical officers and MPWs.

RECOMMENDATIONS

1) Creation of bands of paraprofessional and semiprofessional health workers from

within the community itself (e.g. school teachers, postmasters, gram sevaks) to
provide simple promotive, preventive and curative health services needed by the
community.
2) Establishment of 2 cadres of health workers, namely multipurpose health
workers and health assistants between the community level workers and doctors
at PHC.
3) Development of a Referral Services Complex ‘by establishing proper linkages
between PHC and higher level referral services.
4) Establishment of a Medical and Health Education Commission for planning and
implementing the referrals needed in health and medical education on the lines
of the University Grants Commission.

BAJAJ COMMITTEE (1986-19877)

The Ministry of Health and Family welfare, Government of India, following
the adoption of the National Policy on education, 1986, set-up a committee on
Health Manpower, Planning, Production and Management in 1986 under the
chairmanship of Prof. JS Baja, Professor of Medicine, AIIMS, and New Delhi

RECOMMENDATIONS

1) To formulate a National Policy on education in Health Services

2) To prepare curriculum for schoolteachers this should constitute a holistic approach
including social, moral, health and physical education.

3) Health service statistics needs to be improved in quality

4) To utilize the services of Indian system of medicine viz. Homeopathy, in the
area of National Health Program.
5) Health related components to be included in IX, X Grades
6) Continuing education program for the health personnel.

7) Health manpower requirements for nursing personnel.

HIGH POWER COMMITTEE ON NURSING AND NURSING

PROFESSION (1987-1989)

It was set up by the Government of India in July 1987, under the chairmanship of Dr Jyothi
former vice-chancellor of SNDT Women University, Mrs Rajkumari Sood, Nursing Advisor
to Union Government as the member-secretary and CPB Kurup, Principal, Government
College of Nursing, Bangalore and the then President, TNAI also one of the prominent
members of this committee. Later on due to some reasons, the committee was headed by Smt
Sarojini Varadappan, former Chairman of Central Social Welfare Board

TERMS OF REFERENCE OF THE COMMITTEE ARE:-

1. To look into the existing working conditions of nurses with particular reference to the
status of the nursing care services both in the rural & urban areas.
2. To study & recommend the staffing norms necessary for providing adequate nursing
personnel to give the best possible care, both in the hospitals & community.
3. To look into the training of all categories & levels of nursing, midwifery personnel to
meet the nursing manpower needs at all levels of health services & education.
4. To study & 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 service management.
5. To examine the need for organized nursing services at the national, state, district &
local levels with particular reference to the need for planning service with the overall
care system of the country at the respective levels
 6. To look into all other aspects, the Committee will hold consultations with the State
governments.

RECOMMENDATIONS OF HIGH POWER COMMITTEE ON NURSING AND

NURSING PROFESSION
Working conditions of nursing personnel
1. Employment
Uniformity in employment procedures to be made
Recruitment rules are made for all categories of nursing posts. The qualifications and
experience required or these be made thought the country.
There should not be a bond for nursing students as some of the states do not give them
employment during the stipulated period. Keeping in view of the shortage of nurses in
hospitals and community health field states should create posts and appointment these nurses
in the appropriate positions.

2. Job description

 Job description of all categories of nursing personnel is prepared by the central

government to provide guidelines.

3. Working hours
The weekly working hours should be reduced to 4o hrs per week. Straight shift should be
implemented in all states. extra working hours to be compensated  either by leave or by extra
emoluments depending on the state policy. Nurses to be given weekly day off and all the
gazetted holidays as per the government rules

4. Work load/ working facilities

 Nursing norms for patient care and community care to be adopted as recommended by
the committee.
 Hospitals to develop central sterile supply departments, central linen services, and
central drug supply system. Group D employees are responsible for housekeeping
department.
 Policies for breakage and losses to be developed and nurses not are made responsible
for breakage and losses.
5. Pay and allowances
Uniformity of pay scales of all categories of nursing personnel is not feasible. However
special allowance for nursing personnel, ie; uniform allowance, washing, mess allowance etc
should be uniform throughout the country.

6. Promotional opportunities
For promotion to the post of ward sister, post basic B.Sc. Nursing is made an essential
qualification. The principle of possessing higher qualification than the category to be
supervised, should apply for all levels and categories of nursing personnel in the rural and
urban areas.  The committee recommends that along with education and experience, there is a
need to increase the number of posts in the supervisory cadre, and for making provision of
guidance and supervision during evening and night shifts in the hospital.
Each nurse must have 3 promotions during the service period.
Promotion is based on merit cum seniority.
Promotion to the senior most administrative teaching posts is made only by open selection.
In cases of stagnation, selection grade and running scales to be given.

7. Career development
-provision of deputation for   higher studies after 5 yrs of regular services be made by all
states.  The policy of giving deputation to 5 -10 % of each category be worked out by each
state. Every nursing personnel must have an opportunity to attend at least one refresher
course every 2 years.

8. Accommodation
As far as possible, the nursing staff should be considered for priority allotment of
accommodation near to work place. Hospitals should not build nurse's hostel for trained
nurses. Apartment type of accommodation is built where married/unmarried nurses can be
allowed to live. Housing colonies for hospital s must be considered in long run.

9. Transport
During odd hours, calamities etc arrangements for transport must be made for safety and
security of nursing personnel.

10. Special incentives
Scheme of special incentives in terms of awards, special increment for meritorious work for
nurses working in each state/district/PHC to be worked out

11. Occupational hazards
Medical facilities as provided by the central govt. by extended by the state govt. to nursing
personnel till such times medical services are provided free to all the nursing personnel. Risk
allowance to be paid to nursing personnel working in the rural and urban area

12. Other welfare services

Hospitals should provide welfare measures like crèche facilities for children of working staff,
children education allowance, as granted to other employees, be paid to nursing personnel.

Additional Facilities For Nurses Working In The Rural Areas

Family accommodation at sub centre is a must for safety and security of ANM's /LHV.
Women attendant, selected from the village must accompany the ANM for visits to other
villages.
The district public health nurse is provided with a vehicle for field supervision.
Fixed travel allowance with provision of enhancement from time to time.
Rural allowance as granted to other employees is paid to nursing personnel.

NURSING EDUCATION
Nursing education to be fitted into national stream of education to bring about uniformity,
recognition and standards of nursing education: The committee recommends that;

1. There should be 2 levels of nursing personnel - professional nurse (degree level) and
auxiliary nurse (vocational nurse). Admission to professional nursing should be with
12 years of schooling with science. The duration of course should be 4 years at the
university level. Admission to vocational /auxiliary  nursing should be with 10 years
of schooling .The duration of course should be 2 years in health related vocational
stream.
2. All school of nursing attached to medical college hospitals is upgraded to degree level
in a phased manner.
3. All ANM schools and school of nursing attached to district hospitals be affiliated with
senior secondary boards.
4. Post certificate BSc Nursing degree to be continued to give opportunities to the
existing diploma nurses to continue higher education.
5. Master in nursing programme to be increased and strengthened.
6. Doctoral programmes in nursing have to be started in selected universities.
7. Central assistance be provided  for all levels of nursing education institutions  in terms
of budget( capital and recurring)
8. Up gradation of degree level institutions be made in a phased manner as suggested in
report.
9. Each school should have separate budget till such time is phased to degree/vocational
programme. The principal of the school be the drawing and the disbursing officer.
10. Nursing personnel should have a complete say in matters of selection of students.
Selection is based completely on merit. Aptitude test is introduced for selection of
candidates.
11. All schools to have adequate budget for libraries and teaching equipment.
12. All schools to have independent teaching block called as School Of Nursing with
adequate class room facilities, library room, common room etc. as per the
requirements of INC.
13. Adequate accommodations are provided to students. A maximum of 3 students to
share a room. Rooms to be furnished   with light, study table, chair etc. Adequate
dining room, toilets and bathrooms facilities to be provided in each hostel as per
norms recommended.
14. Students should learn under supervision in the wards. Tutors/clinical instructors must
go to the ward with students. Students should not be used for the service of the
hospital.
15. Community nursing experience should be as per INC requirements. Necessary
transport and accommodation at PHC be made available for safety, security and
meaningful learning of students.
16. INC requirements for staffing the schools and meeting the minimum requirements are
followed by all schools as these are statutory requirements.
17. Speciality courses at post-graduate level be developed at certain special centres of
excellence eg; AIIMS.
18. Institutes like National Institute of Health and Family welfare, RAK College of
Nursing   and several others may develop courses on nursing administration for senior
nursing leading to doctorate level.
 19. Provision for higher training abroad and exchange programmes is made.

Continuing Education and Staff Development

 Definite policies of deputing 5-10% of staff   for higher studies are made by each
state. Provision for training reserve is made in each institution.
 Deputation for higher study is made compulsory after 5 yrs.
 Each nursing personnel must attend 1 or 2 refresher course every year.
 Necessary budgetary provision be made,
 A National Institute for Nursing Education Research and Training needs to be
established like NCERT, for development of educational technology, preparation of
textbooks, media, / manuals   for nursing.

NURSING SERVICES: HOSPITALS/INSTITUTIONS (URBAN AREAS)

1. Definite  nursing policies  regarding nursing practice be available in each

institution .These policies include:

a)    Qualification/recruitment rules

b)    Job description/job specifications
c)    Organisational chart of the institutions
d)    Nursing care standards for different categories of patients.

1. Staffing of the hospitals should be as per norms recommended.

2. District hospitals /non-teaching hospitals may appoint professional teaching nurses in
the ratio of 1; 3 as soon as nurses start qualifying from these institutions.
3. Students not to be counted for staffing in the hospitals
4. Adequate supplies and equipment’s, drugs etc. be made available for practice of
nursing. The committee strongly recommends that minimum standards of  basic
equipment needed  for each patient be studied , norms laid down  and provided to
enable nurses  to perform some of the basic nursing functions .  Also there should be a
separate budget head for nursing equipment and supplies in each hospitals/ PHC. The
NS and PHN should be a member of the purchase and condemnation committee.
5. Nurses to be relieved from non -nursing duties.
6. Duty station for nurses is provided in each ward.
 7. Necessary facilities like central sterile supplies, linen, drugs are considered for all
major hospitals to improve patient care. Also   nurses should not be made to pay for
breakage and losses. All hospitals should have some systems for regular assessment
of losses.
8. Provision of part time jobs for married nurses to be considered. (min 16-20hrs/week)
9. Re-entry by married nurses at the age of 35 or above may also be considered and
such nurse be given induction courses for updating their knowledge and skills before
employment.
10. Nurses in senior positions like ward sisters, Asst. nursing superintendents, Deputy
NS; N.S must have courses in management and administration before promotions.
11. Nurses working in speciality areas must have courses in specialities. Promotion
opportunities for clinical specialities like administrative posts are considered for
improving quality nursing services.

The committee recommends that Gazetted ranks be allowed for nurses working as ward sister
and above (minimum class II gazetted). Similarly the post of Health Supervisor (female) is
allowed gazetted rank and district public health nurse be given the status equal to district
medical/ health officers.

Community nursing services

 Appointment of ANM/LHV to be recommended.

 ANM/LHV promoted to supervisory posts must undergo courses in administration
and management.
 Specific standing orders are made available for each ANM/LHV to function
effectively in the field.
 Adequate provision of supplies, drugs etc are made.
 Recording system be simplified.
 Posts of public health   nurses and above are given gazetted status.

Norms recommended for nursing service and education hospital setting.

1. Nursing Superintendent -1: 200 beds (hospitals with 200 or more beds).
2. Deputy. Nursing Superintendent. - 1: 300 beds ( wherever beds are over 200)
3. Asst. Nursing Superintendent  - 1: 100
 4. Ward sister/ward supervisor - 1:25  beds 30% leave reserve
5. Staff nurse for wards -1:3 ( or 1:9 for each shift )  30% leave reserve
6. For nurses OPD and emergency etc - 1: 100 patients ( 1 bed : 5 out patients)   30%
leave reserve
7. For ICU -1:1(or 1:3  for each shift)    30% leave reserve

For specialised departments such as operation theatre, labour room etc- 1: 25 30% leave
reserve.
Community nursing services
 1 ANM for 2500 population (2 per sub centre)
 1 ANM for 1500 population for hilly areas
 1 health supervisor for 7500 population (for supervision of 3 ANM's)
 1 public health nurse for 1 PHC (30000 population to supervise 4 Health Supervisors)
 1 Public Health Nursing Officer for 100000 populations (community health centre)
 2 district public health nursing for each district.
Teaching staff for schools/colleges of Nursing as per INC
 1 Nurse Teacher to 10 students for post graduate programmes.

NURSING LEGISLATION

1. INC and state nursing council acts be amended to provide for control by INC on states
nursing councils.
2. Provision of   more nurse members.
3. Provision for regulation of nursing education standards by timely inspections and
follow up.
4. Provision of maintaining of minimum standards  of nursing practice
5. Provision of regulation for nursing care standards in private nursing homes.
6. Provision for regulation for private nursing bureaus and practice by unqualified
nurses.
7. Provision of approval of INC before opening a SON or CON.
8. Provision of renewal of registration every 5 yrs.
9. Provision of independent practice of nursing by nurses.
 10. INC to set up a national examination system in about 10 yr time to regulate standards
of nursing education.

 Also, the positions up to the DADG level are proposed to be at the office of the
Directorate General of Health Services. The positions below the level of DADG are to
exist at the institutions governed by the central govt.
 The Principal, College Of Nursing will be equal to the rank of ADG (N)   and will be
eligible for promotion to the post of DDG (N)/ Addl. (N). The salary scales and structure
of the staff of colleges of nursing will be as per norms of INC   and the UGC.

ORGANISATION OF NURSING SERVICES

The position and status of nursing personnel working in the directorates need up gradation
and expansion of the nurse to enable the nurses to participate in policy making and decision
making. Total nursing components, i.e., nursing education, nursing service and community
nursing should be under the control of nursing personnel at all the levels. I.e. At centre, state
and district level. At every level adequate provision of budget should be made for
development of nursing profession.
The organisational structure recommended for centre, state and district level is as follows.

1. Each ADG level nurse to deal with continuing education /research component for
specialised areas.
2. Selection to these posts is made on merit and not by seniority alone.
3. Nurses appointed these posts must have courses in administration, management and
fiscal management.
4. Railway board, state insurance (labour minister), post $ telegraph union, territories
(Delhi), municipal corporations etc to create such posts for control, co-ordination and
development of nursing personnel.

 The principal, college of nursing will be equal to the rank of ADG (N) and will be
eligible for promotion to the post of DDNS/ DNS. The salary and structure of college of
nursing will be as per as norms of INC and UGC.

CONCLUSION
These committees are appointed from time to time to look into the issues of the health care
administration. Recommendations made by these committees were very helpful to make an
excellent change in our health care delivery system

REFERENCE

1) Basavanthappa BT.Nursing Administration Jayppee publication. New Delhi:171-198

2) K. Park’s Text book of Preventive and Social Medicine.Bhanot publication. 19th
edition. Jabalpur:726-734

3) www.nrhm-mis.nic.in
4) www.nihfw.org