Report of the Committee on Multipurpose Workers under Health and Family Planning Programme
The government of India constituted the Committee on Multipurpose Workers under Heath and Family Planning Programme in October 1972, under the chairmanship of Kartar Singh – then, additional secretary at the Ministry of Health and Family Planning. Its report was released on September 15, 1973.
The Committee’s tasks included examining and making recommendations on the structure of health services in India, training and deploying multipurpose health workers for distributing such services, and utilising existing ‘mobile service units’ for integrated medical, public health and family planning services.
Members of the Committee visited primary health centres (PHCs) and sub-centres in Bihar, Haryana, Himachal Pradesh, Orissa, Punjab, Tamil Nadu and West Bengal to collect information for this report.
This 49-page report contains nine chapters: Introduction (Chapter I); Existing Facilities (Chapter II); Findings of the Committee (Chapter III); Job Functions of the Multipurpose Health Workers – Female (Chapter IV); Job Functions of Supervisors (Chapter V); Integration at Different Levels (Chapter VI); Problems to be Faced (Chapter VII); Mobile Units (Chapter VIII) and Summary of Recommendations (Chapter X).
The Committee notes that there were 5,197 PHCs in India when this report was published. These catered to a rural population of 435.8 million people (as per Census 1971). On average, there was a PHC for every 80,000 to 110,000 people in rural India. In certain parts – such as tribal, hilly and desert areas – PHCs provided services to much fewer people.
There should be a PHC for every 50,000 people in India – states the Committee – and each PHC should have at least two doctors, of whom one is female.
At the time of the report, there was one male health worker for every 6,000 to 7,000 people, and one female health worker for every 10,000 to 15,000 people. Ideally, the Committee states, there should be one female worker for a population of 3,000 to 3,500 people.
There were 40,225 auxiliary nurse midwives (ANMs), counting those working in sub-centres, PHCs, health centers in urban areas, and in district and other hospitals. Of these, 20,000 to 25,000 worked in sub-centres.
There were 23 schools – eight centrally aided and 15 state-run – for lady health visitors (LHVs) with a total admission capacity of 1,045 people annually.
The total number of LHVs and public health nurses (PHNs) employed in 1973 was 7,462, counting those working at sub-centres, PHCs, health centers in urban areas, and in district and other hospitals. The report notes that the government of India sanctioned two LHVs or PHNs for each PHC.
The Committee recommends that each ‘mobile sterilisation unit’ has a female doctor so that they can be used as ‘IUD [intra-uterine device] units’ as well. If this doctor has training and experience in performing tubectomies, she could also assist PHCs with adequate facilities in conducting operations. “The continuance of these [mobile sterilisation and IUD] units, the Committee recommends, should be linked with the completion of fixed targets with proper follow-up action.”
The Committee states that there should be a team of two health workers – one male and one female – at each sub-centre.
Due to the shortage of female health workers, the report recommends that ANMs who work at PHCs or are stationed at district hospitals should be posted at sub-centres. The posts vacated by the ANMs should be filled by nurse-midwives.
Multipurpose health workers should initially be trained to carry out the government’s programmes on malaria, smallpox, trachoma and family planning – says the report. Health workers engaged in treating filaria, leprosy and cholera could continue as ‘uni-purpose’ workers as fewer people are trained for such programmes, and some of these diseases have only ‘zonal importance’.
The report recommends that the Fifth Five-Year Plan (1974-79) should focus on increasing the number of training facilities for female health workers, particularly for ANMs.
Focus and Factoids by Flavia Lopez.
Committee on Multipurpose Workers under Heath and Family Planning Programme (Chairman: Kartar Singh)
Ministry of Health and Family Planning, Government of India, New Delhi
15 Sep, 1973