Report of the Health Survey and Development Committee: Vol. III
The Health Survey and Development Committee was appointed by the Government of India in October 1943 to survey the health conditions and services in British India. Its chairman was Joseph William Bhore, an Indian Civil Service officer.
In its four-volume report, the Committee recommended integrating curative and preventive medicine at all levels, developing primary healthcare units in rural areas, and major changes in medical education. Volume III is a compendium of the reports, correspondence and other documents consulted for the report. It contains 57 annexures and a list of 206 memoranda, items of personal communication, notes by experts and sub-committee reports (appendix 57) that informed the survey.
The Bhore Committee, as it was also known, consulted the 1941 population census and the survey reports of 11 administrative provinces to make its recommendations. These documents were used to estimate the extent of healthcare coverage, the personnel needed, and the healthcare services required for the national health plan that the Committee had proposed.The highlight of these reports was the inclusion of the social determinants of health, including child care and nutrition, town planning, and environmental conditions. The Committee made its recommendations on the basis of its own studies and surveys as well as the experience of countries such as the UK, the USA and the former Soviet Union.
Appendix 1 of the report provides the district-level population and the acreage of the 11 provinces surveyed. According to the 1941 census, Bengal had the largest population (60 million), followed by the United Provinces (55 million) and Madras (48.5 million).
The Committee recommended that by the end of the first year of its national health plan, 55 primary healthcare units (19 of them 30-bed hospitals) and 11 secondary healthcare units (200-bed hospitals) be set up in the 11 provinces surveyed (appendix 5). By the end of the plan’s 10th year, there should be 258 primary healthcare units, the number of 30-bed hospitals should go up to 114, the 200-bed hospitals to 11, and 500-bed hospitals to 5.
Appendix 39, which details a syllabus for senior nursing certificate, states that malaria, leprosy, tuberculosis, venereal diseases, maternity and child welfare, school health and industrial health problems were the major issues that should be studied.
For the prevention of malaria, the Committee consulted an ordinance of the U.S. Public Health Service (appendix 15), the Straits Settlements (appendix 16), and the Bombay Municipal Act (appendix 17). These documents spelled out measures to be taken by the public to prevent water stagnation and mosquito breeding.
A 1941 report on leprosy and its control in India (appendix 19), by a special committee appointed by the Central Advisory Board on Health, recommended compulsory but confidential notification of those infected with the disease. It also said they should be isolated, their maintenance should be at the public’s expense, and health officers should be allowed to inspect dwellings and isolate patients.
A public health engineering diploma was proposed for engineers aged 25-40, who were already involved in public health work in the provinces, such as water supply, sewage works, refuse disposal, housing, malaria control and so on (appendix 33). For students already enrolled in an engineering degree, a course on public health engineering was proposed (appendix 34).
A report by Colonel M. Taylor (appendix 21), on his tour of the 25 major mental hospitals at the Committee’s behest, stated that they were designed more for the ‘detention’ of patients than for their treatment. It also said that a majority of patients deteriorated in ‘custodial care’, hospitals were grossly understaffed and staff underpaid, and most mental health professionals were not adequately qualified.
Taylor also suggested speciality training for all psychiatric care professionals. He underlined the importance of community support for mental hospitals, and said that mental health institutions be brought under government supervision through legislation.
The memorandum on undergraduate medical education (appendix 28) advocated pedagogical reforms. It said that rather than thrusting a large number of facts on students, they should be encouraged to inculcate medical principles and methods. It emphasised the promotion of health and the prevention of disease and not only the treatment of disease. It also suggested that applied public health be taught throughout an undergraduate’s clinical years.
A report on town and village planning in India (appendix 24) observed that town planning was a neglected science and suggested introducing courses on the subject. It also said that village planning should be consistent with the maintenance of agriculture, employment, the well-being of rural communities and preservation of rural amenities.
Focus and Factoids by Gomathi Sundar.
Health Survey and Development Committee
Manager of Publications, Delhi
18 Dec, 1945