India’s Health Policy

• PHCs began in 1952, one in each Community Development block
• 725 PHCs by 1956
• 2,013 PHCs by February 1960
• Each served 65,000–75,000 people, with one doctor
• Bhore had asked for 40,000 people and two doctors

Health Survey and Planning Committee. It looked at ten years of PHCs.

• Stop opening new PHCs on the old, weak pattern
• Upgrade existing PHCs: up to 40,000 people, 2 doctors, 10 beds
• Make the district hospital the hub of the network
• Create an All-India Health Service

• 1958: National Malaria Eradication Programme (NMEP)
• DDT spraying in every house
• 1965: only 99,667 cases in India
• 1976: malaria came back, with 6.47 million cases
• 1977: the Modified Plan of Operation

Committee on Multipurpose Workers.

• In 1973, India had 5,197 PHCs. Each covered 80,000 to 150,000 rural people
• Replace single-purpose workers with multipurpose workers
• One male and one female worker per sub-centre of 3,000–3,500 people
• 16 sub-centres per PHC; one PHC per 50,000 people

Group on Medical Education and Support Manpower.

• Train health workers from the community itself
• One male and one female health worker per 5,000 people
• A cadre of Health Assistants to supervise them
• A referral services complex linking PHC and hospitals

2 October 1977: the Community Health Workers scheme began in 733 PHCs, one worker per village of about 1,000 people

• 1952: India launched a national family planning programme. The Government of India calls it the first in the world
• The red triangle and Nirodh became national symbols
• Over time, the programme came to rely on targets for sterilisation

Sterilisations in 1975–76, and then in 1976–77

• Targets were enforced with pressure and force
• Public anger helped bring down the government in 1977
• The new government renamed it the family welfare programme (1977)

• Teams searched every house. People got a cash reward for reporting a case
• India’s last case: Saiban Bibi, Karimganj railway station, Assam, May 1975. She had come from Bangladesh
• India certified smallpox-free: 23 April 1977
• World declared free: 8 May 1980

• International Conference on Primary Health Care, Alma-Ata (now Almaty, Kazakhstan)
• Primary health care as the key to Health for All
• Communities take part in their own health care
• Health is linked to food, water, education and housing

• 1991: a balance-of-payments crisis led to liberalisation
• Public health spending fell from 1.3% of GDP (1990) to 0.9% (1999)
• States’ share of their budgets spent on health fell from 7.0% to 5.5%
• The private sector grew. The gap between rich and poor in using health care widened

• In 2002, only 17% of all health spending was public
• Total health spending was 5.2% of GDP; most of it from people’s own pockets
• Welcomed the private sector in all areas
• 55% of public health spending for primary care
• Critics noted it dropped the 1983 goal of universal, comprehensive care