Report of the Expert Committee on Public Health System
The Ministry of Health & Family Welfare, government of India, constituted the Expert Committee on Public Health System on March 8, 1995. Its chair, Professor J. S. Bajaj, was a member of the Planning Commission at the time.
The committee was set up to review the public health system in India, and to
especially focus on the quality of
epidemic surveillance and control strategies; the effectiveness of health
schemes, institutional arrangements and the role of state and local authorities
in improving the public health system; the status of primary health centres and
sub-centres in rural areas (especially their ability to respond to outbreaks of
disease, and the effectiveness of the district administration in taking timely
remedial action); and the capability of the existing Health Management
Information System to provide intelligence for surveillance, prevention and
The report defines ‘public health’ as “the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community efforts.” The eight chapters of this report cover the status of the public health system in India, epidemiological surveillance systems, the status of control strategies for epidemic diseases, existing health schemes, the National Family Welfare Programme, environmental health and sanitation, the role of state and local authorities in providing remedial measures for epidemics, and the Health Management Information System. The report includes recommendations and an ‘Action Plan for Strengthening of Public Health System’.
There were 4.05 lakh practitioners of Indian systems of medicine (Ayurveda, Siddha and Unani, among others) and 1.56 lakh practitioners of homeopathy in India at the time of preparing this report.
Public expenditure on the health sector in the centre and states, at the time, had been a little over 1.5 per cent of the GDP.
The committee notes that the Report of the Committee on Drugs and Pharmaceutical Industry, 1975 (or the Hathi Committee report) was a historical landmark in the field of drug development in India. It recognised that ensuring the availability of medicines required a listing of essential drugs, and it recommended minimal profitability for essential and life-saving drugs.
Data on the National Malaria Eradication Program for the years 1985, 1992, and 1995, obtained through a vast network of district health offices, community health centres, primary health centres and sub-centres, indicated that the ‘problem of malaria’ was grossly underestimated, surveillance was inadequate in many areas, and laboratory services lacked supervision.
There were 606 ‘kala-azar’ (visceral leishmaniasis) deaths in 1990, 838 in 1991, 1419 in 1992, 710 in 1993, and 364 in 1994.
Citing the Bulletin on Rural Health Statistics in India, the report states that across India, there were 220,545 village health committees, 2,377 community health centres, 3,568 rural hospitals, 11,670 rural dispensaries, 22,156 Primary Health Centres and 1,31,900 sub-centres as on March 1995.
The Universal Immunization Programme was launched in 1985 to reduce infant and maternal mortality in India. The vaccine coverage levels for BCG rose every year, from 28.84 per cent in 1985-86 to 89.04 per cent in 1989-90. For DPT, they increased from 41.12 per cent in 1985-86 to 82.93 in 1989-90.
The report states that oral rehydration therapy (ORT) was introduced in 1986-87 to control diarrhoea and prevent deaths due to dehydration among children. Considering the population of children below five years was 135 million (in 1993-94, says the report), and each child would have two or three episodes of diarrhea each year, oral rehydration salts in India were in insufficient supply in India.
The report estimates that in-patient hospital services in India generate between one and two kilograms of solid waste per person, per day. Over 85 per cent of hospital waste is non-hazardous, but there is no standardised system of segregating it from hazardous waste in a majority of hospitals. Mixing the two types results in an increased quantity of hazardous waste which requires safe disposal.
The committee recommends setting up at least four regional schools of public health in central, northern western and southern India.
It also recommends establishing a National Disease Surveillance Programme – as a centrally sponsored scheme within the existing health infrastructure – for strengthening health surveillance and support services.
Focus and Factoids by Shuchi Shah.
Expert Committee on Public Health System (Chair: Prof. J. S. Bajaj)
Ministry of Health and Family Welfare, Government of India, New Delhi