Report of the Health Survey and Development Committee: Vol. IV – Summary
The Health Survey and Development Committee was appointed by the Government of India in October 1943 to make a broad survey of 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 the integration of curative and preventive medicine at all levels, the development of primary healthcare centres, and major changes in medical education. Volume I describes the status of public health in British India in 1941 and the preceding 10 years. Volume II makes recommendations to improve national health and suggests ways to do so. Volume III is a compendium of the reports, correspondence and documents consulted by the Committee, and volume IV summarises volumes I and II.
In its report, the Committee emphasised the need for affordable and accessible healthcare for all; the integration of consultations and laboratory/institutional facilities; and a focus on the rural population, which constituted the majority of British India. It said that preventive work could reduce the incidence of disease and suggested that people’s participation be sought while developing national health programmes.
The Committee’s health survey showed that the prevalence of disease and death was high among children (and also among women in the reproductive age, as discussed in Volume I). In 1937, the death rate for the general population was 22.4 per 1,000 inhabitants and for children under one, it was 162 per 1,000 live births. In 1941, the corresponding rates were 21.8 and 158, respectively.
The survey attributed the low levels of health to poor sanitary conditions, malnutrition, undernutrition, inadequate health services and a lack of health education, among other reasons.
A large-scale expansion of the national health services was planned through a comprehensive long-term programme and two short-term schemes of five years each. The long and short-term programmes involved setting up health units of varying size and technical efficiency across the country. The five-year schemes would also ensure health services, education, nutrition, disease prevention, town and village planning, and sanitation, among other services.
For all the programmes, the central government would plan the health services and provide technical assistance and grants to provincial governments, which would have autonomy in the administration of these services.
The Committee recommended improving diet standards throughout the country, with a focus on proteins, vitamins and minerals. Agriculture, animal rearing and fisheries could adopt the latest scientific methods, and health publicity bureaus could educate the general public.
Physical education and awareness of health and hygiene, along with a practical component for children, had to become compulsory in all schools. Given the dearth of qualified physical educators, at least one or two physical training colleges were needed in every province.
Other suggestions included posting women doctors and female support staff in maternity/child welfare centres in each primary health unit, and providing beds for 'maternity cases' in all health units and centres.
Maternity and child welfare centres would provide a range of services such as encouraging pregnant women to get regular checkups, promoting institutional deliveries, visiting new mothers and their children at home, helping to improve their nutritional status and so on.
The medical officers of primary health units would be in charge of school health services, which should give importance to preventive and curative services. Two teachers from each school would be trained in providing elementary health services.
Special organisations should be set up and integrated services introduced to combat widely prevalent infectious diseases such as malaria, tuberculosis and cholera, to name a few.
The Committee also recommended a reduction in the cost of medicines, equal access to drugs, home treatment wherever required, and no delays in the production of drugs.
A sufficient number of medical, nursing and allied health professionals had to be trained to adequately staff medical colleges. Legislations could be formulated to permit only qualified professionals to practice medicine, dentistry, nursing and pharmacy.
Focus and Factoids by Gomathi Sundar.
Health Survey and Development Committee
Manager of Publications, Delhi
13 Jan, 1946