PLANNING PROCESS

I. A REVIEW OF PLANNING

i. Introduction
Planning is one of the major functions of administration, in the planning
stage, decisions are made about what needs to be done, how and when it has to be
done, by whom and with what resources. For any work, planning is very essential. So
planning is a process of making decisions in the present to affect future outcomes. The
planning sets the future framework to guide the future behaviour of an organization
or/and its constituents.

ii. Definitions of Planning

Planning is a continuous process of making present entrepreneurial
decisions systematically and with the best possible knowledge of their futurity,
organising systematically the effort needed to carry out these decisions and measuring
the results of the decisions against expectations through systematic feedback

(Drucker 1959).

Planning is a process of setting formal guide- and constraints for the behavior of
the firm

(Ansoff and Bmndinburg, 1967).

Planning is a process of determining the objectives of administrative effort and

devising the means calculated achieve them

(Millet).

Planning is the process of analyzing and understanding system,

formulating its goals and objective, assessing its capabilities, designing alternative
course of actions or plans for the purpose of achieving these goals and objectives,
evaluating the effectiveness of these plans, choosing the preferred plan, initiating
necessary actions for its implementation and engaging in continuous surveillance
 of the system in order to arrive at an optical relationship between the plan and
systems

(Samuel Levels and Paul N, Loomba, 1973).

Thus, planning is the exercise of intelligence to deal with facts and solution
as they are and find way to solve problems. So, it is in process of making choice
between available alternatives at all levels of decision making.

iii. Purposes of Planning

The main purpose of planning is to develop process (creative aspects),
mechanisms (implementation aspects) and managerial attitudes (motivational aspects)
in order to make today’s decisions with a better understanding of the future and to
make future decisions, more rapidly, more economically and without disruption to the
ongoing business.

iv. Characteristics of Planning

a) Planning must focus on purpose; it always start with a statement of goals and
objectives.

b) Planning is a continuous and iterative process, which includes series of steps;

so continuity and flexibility, should be maintained in the planning cycle.

c) Planning is an integral part of the process of the administrative system, there

should be a good harmony with organization and environment— political,
economical, etc.

d) Planning is hierarchical in nature. Planning must have an organizational

identification.

e) Planning should be a pervasive activity covering the entire organization with

all its departments, sectors and different levels of administration.

f) Planning must be precise in its objective, scope and nature.

g) Planning should always be documented so that all concerned are fully

committed to the implementation of the program. The document also serves as
 a blue print for implementation

v. Advantages of Planning
1) Planning saves time in the long run because where know where we are going
and how we are going to get there.

2) Planning leads to more effective and faster achievements because everyone

involved is clear about what is to be done, how, when and why.

3) Planning ensures unity of purpose, clear cut methods of doing things and
focuses on the objectives and targets to be achieved

4) Planning minimizes the cost of doing a job and helps to ensure that resources
are used carefully to achieve objectives

II. PLANNING COMMISSION

The Planning Commission in India was set up in March 1950 by resolution of

the Indian government to promote a rapid rise n the standard of living of the people by
exploiting the resources of the country, increasing production in the agricultural as
well is industrial sectors and offering employment opportunities to all. In 2014 the
planning commission was replaced by NITI Aayog. It helps in the better utilization of
the country's resources for the common good of the citizens. Many consider the
Planning Commission as the backbone of the country's progress and all- round
development The Planning Commission has the responsibility for formulating plans as
to how the resources can be used in the most effective way. In 1951 the 1st 5-year
plan was announced and the then Prime Minister. Jawaharlal Nehru was the chairman
of that India Planning Commission.

i. Structure of the Planning Commission

The composition of the India Planning Commission has changed a lot since its
inception. The Prime minister acts as an ex-officio chairman of the Planning
Commission. The Deputy Chairman is nominated and the cabinet members are part-
time members whereas the full time members of the Indian Planning Commission are
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experts from various fields such as industry. Science, general administration, and
economics who give advice and guidance for the formulation of Five Year Plan,
Annual plans. State Plans, Projects and Schemes, etc.

ii.
Currently the structure of the planning commission is like this:

Functions of the Planning Commission of India

Following are the functions of the Planning Commission of India:

 To make an assessment of the resources of the country and to see which

resources are deficient?

 To formulate five-year plans for the most effective and balanced utilization of
country’s resources.

 To indicate the factors, which are hampering economic development?

 To determine national priorities and allot resources to the plans.

 To determine the machinery, which will be necessary for the successful

implementation of each stage of plan?

 Periodical assessment and appraisal of the progress of the plan.

 With the changing times, the Planning commission is preparing itself for
long-term vision for the future. The commission is seeing to maximize the output with
minimum resources.

III. HEALTH PLANNING

i. Introduction
A health plan is a predetermined course of action that is firmly based on
the nature and extent of health problems from which priority goals are devised
(WHO).

Health planning is an aid to political and administrative authorities to

decide how health services can be modernized and improved to provide effective
decent health care to the community. The planning of community health services
means the careful analysis, intelligent interpretation and orderly development of these
services, in accordance with modem knowledge, techniques and experience to meet
the health needs of a nation within its resources.

Health planning is the phase of the total process, which leads from the
policy statements to the concrete identification of the populations whose needs and
demands will be served, the indication of the types of activities that will be performed
for those population, with their general attributes and the specification of the type of
instruments that will be required to carry out the activities (Montoya).

ii. Concept of health planning

Health planning is a process to produce health. It does this by creating an
actionable link between health needs and resources, Its nature and scope will depend
upon time allowable, number of answerable questions to be addressed within the
process (The answerable questions comprise questions that are worth asking and for
which there is evidence to allow them to be answered), resources available to support
the process, and the broader political and social environment.
 Health planning occurs within the pressured environment of political direction,
changing public expectation, new information and evidence about outcomes, and on
occasion, media headlines. A solid and well-designed health planning process will be
resilient enough to accommodate these pressures and to use them as levers to go
forward to dialogue and solutions for improved health care provision and health
outcome's in the population.

iii. Objectives of Health Planning

Health planning is an integral part of the overall socioeconomic
development. It is in essence an organized, conscious and continual exercise to select
the best available alternatives, which can meet the health needs of the people.

The health planning varies from country to country, but it should be based
on collective thinking and expertise, must be associated with health experts,
economists, administrators and public representative at union and federal state level.
So health planning needs to use more and more quantitative methods and modern
techniques to make it effective.

The recently developed technique known as country health programming

(CHP), which helps to provide simple, flexible and scientific method of health
planning based on modern concepts of management. Country health planning is
essentially a national effort. It has been successfully employed in Burma, Nepal and
Thailand. The CHP's main objectives are:

1. To clarify the nature of existing health problems within the total social,
cultural, economic and political context,
2. To clarify inter-relationships between the health sector, its components and
various social and economic factors.
3. To identify national objectives as far as possible in quantifiable terms,
4. To identify new and existing program areas.
5. To help elaborate alternative strategies and to produce feasible programs for
choice by decision making.
 6. To define mechanism for the formulation and implementation of projects and
to suggest procedures as a long-term goal, for a more rational allocation of
resources in the field of health.
7. To identify the program areas suitable for external assistance.

Health care entities are complex and dynamic systems, always subjected to
a mixture of strong political, economic, social and technological forces. Such systems
do not run by themselves; they must be understood / designed, improved, administered
and controlled. This requires planning, either formal or informal, but conscious and
deliberate.

iv. National health planning

National health planning is ‘the orderly process of defining national health problems,
identifying unmet needs and surveying the resources to meet them, establishing the
priority goals that are realistic and feasible and projecting administrative action to
accomplish the purpose of accomplished programme1 (WHO, 1971

v. Planning Process

A plan is defined as a map, as preparation, as an arrangement. A health plan is

predetermined course of action that is firmly based on the nature and extent of health
problems, from which priority goals are derived. Health Planning defines where one
wants to go, how to get there and the timetable for the journey in context with health
problems, Planning can also identify the journey’s milestones. Complete Health
planning sets out indicators for tracking progress in health sector and ways to measure
it. Effective planning helps an organization adapt to change by identifying
opportunities and avoiding problems, It sets the direction for the other functions of
management and for teamwork. Planning improves decision-making, All levels of
management engage in planning.
Planning Process

Establish objectives

↓
Develop strategies

↓
Determination of premises

↓
Determination of alternatives

↓
Evaluation of alternatives

↓
Selecting a course of action

↓
Formulation of derivative plans

↓
Implementation of plans

↓
Reviewing the planning process
 vi. Elements in a Health Planning Process

1. Identifying the health vision and development goals,

2. Undertaking the strategic health plans, and

3. Monitoring and Evaluation,

vii. Purposes of Health Planning

1. To improve the health services

2. To match limited resources with many problems

3. To eliminate wasteful expenditure and to avoid the duplication of expenditure

4. To develop the best course of action to achieve defined objectives

1. Steps in Health Planning

An effective health planning must start before the actual planning. There should be
clear-cut policies, legislations and interest of the government, Usually planning
involves various steps as given below:

 Analysis of health situation (What is)

 Setting directions, objectives and goals (What ought to be)

 Assessment of resources in term of Problems and challenges (Differences

between what is and what ought to be)

 Range of solutions and setting of priorities (Ways to get from what is, to what
ought to be)

 Selection of best alternative solution(s) and preparation of plans (Preferred ways

to get to what ought to be)
 Implementation of prepared plan (Putting in place the best solutions)

 Monitoring (Is everything going on as per plan)

 Evaluation (Did we get from what is to what ought to be)

 Re-planning (Overcoming the deficiencies).

Step One- Identify the health problem

This involves collection, assessment and interpretation of extensive health

information to determine the health or illness profiles and experiences of the
population of interest. It should include demographic data (what are the characteristics
of a population?), epidemiological and social indicator data (what

are the characteristics of social problems and health disorder within a population?),
inventory data (what are the numbers types and characteristics of human service
resources for a population including the cost of these resources and the linkages
among the resources?), utilization data (how does a population use those resources?)
and outcome data (what changes in social and health status do these resources produce
for population. It is meant to identify the current health situation.

Step Two - Setting objectives and goals or establish objectives

This involves setting goals and objectives, and it also involves establishing the
targets against which current health/illness profiles, or current organizational or
system performance will be compared. This step is important to identify the desirable
future outcome may be in the form of short term or long term goals. The time,
resources along with the objectives are the important factors to keep in mind while
planning. The objectives are not only guiding to action but also yard sticks to measure
the output after implementation the plan.

Step Three –Planning to develop strategies

This is an important step involves identifying and quantifying the shortfalls of

resources (if any) between what is and what ought to be. Resources include the
manpower, money, materials, and methods of monitoring, skills and knowledge that
are required to implement the health programmes.

Step Four – Determination of premises

Set the priorities and identify the range of solutions or alternatives to each
identified the magnitude of health problem or challenge. This step should also include
assessing each possible solution in terms of its feasibility, cost and effectiveness so
alternate solutions can be compared with each other. Develop alternate plans to
achieve the formulated goals and objectives. This step often requires significant
creativity and thinking process, since no readymade solutions be available for some
problems and challenges.

Step Five - Selection of Best Alternative Solution(s) and Preparation of Plans

This step involves a choice of the solutions, or set of solutions, that should be
implemented to address the problems or challenges identified in step three. The choice
may need to take into account fiscal, political and other limitations, Prepare a detailed
operational and strategic health plan for the execution. Input, process and output and
method of evaluation is defined very clearly

Step Six - Implementation of Prepared Plan

This step involves implementation of the chosen solutions, and often begins
with development of an implementation plan and approved by the policy-making
authorities. This phase requires cooperation from all the levels.

Step Seven-Monitoring

Various ongoing managerial or monitoring methods are prepared to

continuously identify and assess the intended and unintended consequences of
implementation actions well in advance. These can also be helpful to keep the track
that everything is going on as per plan or schedule, what are the hindrances and how
those can be corrected in due course of time.

Step Eight – Evaluation of alternatives

This is the final step of planning process involves evaluation of results of

implementation to determine whether the implemented solutions are effective in
achieving their health goals and targets. It also involves evaluating the environment to
see. If it has changed or as expected, thereby rendering the solutions less effective,
more effective or irrelevant. Development an evaluation plan is required well before
evaluation actually takes place.

Step Nine - Re-planning

Based on the deficiencies or shortcoming reveals during any P of planning process,

the goals, strategies can be reassessed, ibdified and planned in order to achieve the
targets.

2. Levels of Planning
Planning and policies are inter-related. Policy determines the principle for
action and planning provides the instruments for the application of policy and review,
Policy decisions are needed in the planning process and in defining its goals and
limitations. The planning process has various possible feedback effects on policy.

The planning process:

1. Requires explicit policy statements, thus bringing certain subjects to the political
arena.

2. Should reflect the rationale of the policies, show how they can be implemented
and indicate their financial and other implications.

3. Provides the policy making with instruments for dialogue, coordination,

mobilization of resources and continuity of action.

4. Impact on the national situation should influence future policy making.

There are mainly three levels in planning, namely central level,

intermediate level and peripheral level

Central Level

At central level, authorities will lay down the directional planning, often
called policy planning. It is concerned with setting of the framework of an intent
philosophy within which the program will function. The authority of central level is
responsible for:

 Laying down broad policies and guidelines for socioeconomic development

 Defining overall goals and objectives

 Giving rough indication of the allocation of available funds and other resources
to the various government departments or sectors of economy.

 Coordmating the planning activities of these departments and sectors as well as

the plans submitted by them. This authority should be strong enough to have its
decisions adapted by the government.

For the health plan, administrative capacity at the central level is generally
vested in planning committee in the Ministry of Health. Usually, the committee has a
wide range of responsibilities as follows:

 Establishing policies, goals and standards relating to overall health planning

 Reviewing the overall health plan developed by the national health planning
unit.

 Coordinating the implementation of the health plan.

Input Political system and processes

Classification Policy Policy Changes

coordination etc

Basic decisions of framework, which enables

and guides the process of following

Plan formulation

Implementation

Impact on reality
 Relationship between policy and plan

 Collaborating with national planning authorities and with responsible persons

in that social and health services, universities and public works departments.

 Cost analysis, budgeting and acquiring adequate funds related to it.

 Establishing standards relating to services, personnel equipment, architectural

design of health institution, etc.

 Coordinating research related to health and health planning.

 The continuing evaluation of progress.

 Advising administrative authorities at the intermediate and peripheral levels

Intermediate Level

At intermediate level, authorities will lay down the administrative

planning. Administrative planning is concerned with the overall implementation of the
policies developed and with the mobilization and coordination of the personnel and
material available in the administrative unit for the effectuation of the service. It is for
this goal that general objectives, procedures and regulations are usually set. Hence, the
responsibility of the authorities of this level are mainly managerial and technical. One
of their principal tasks being the expression in cooperation with development planners
of the centrally established standards in terms of the detailed requirements of the
situation at that level.

They will also involve some or all of the following:

 Detailed budgeting

 Assessment of planning initiative of the peripheral level

 Estimation of supplies and equipment required for implementation of health

plan at the intermediate level

 Coordination of the purchase and supply of the equipment

 Determination of staff requirements for health institutions and services

  The training and provision of adequate number of essential personnel.

Peripheral Level

The operational planning is carried out at peripheral level. It is concerned

with the actual delivery of the services to the public. In general this responsibility is
one of the field rather than office staff, although supervisory, consultative and
administrative staff serves in an advisory and to some extent in a controlling capacity.
Although field staff do planning that is integral to their own responsibilities, the
administrative staff must assure a sound agency plan that allows for local variations
without subverting the policies established by the policy planning group or failing to
comply with reasonable directions and general objectives established by the
administrative planning group agency as a whole.

At the peripheral level, planning authorities will be responsible for:

 Informing the authorities at the intermediate level of local problems that must
be taken into account in detailed planning.

 Securing the cooperation of local bodies

 Coordinating health activities carried out by basic health services, health

centers and general practitioners.

The authorities also are involved in the design and on-site supervision of
the construction of local health services facilities and of accommodation for service
personnel and students. This is done with the preparation of detailed lists of necessary
supplies and equipment, with the listing of staff requirements and the selection and
training of intermediate and junior staff with the preparation of job descriptions,
standards, working procedures and programs of operational research.

3. Constraints of Health Planning

There are a number of factors, which stand on the way of effective health
planning as follows:

 Lack of adequate health information system for planning and monitoring, and
 ultimately for evaluation.

 Natural resistance to change.

 The relatively low priority often accorded to health by political decision

makers and the public.

 Absence of trained health administrators and health planners.

 Time lag between planning and implementation.

 Lack of adequate interprofessional communication.

 The inflexibility of educational system.

 Inefficient administrative practices.

 Inadequate coordination of planning between the different sectors of

socioeconomic development

VI. LEVELS OF PLANNING IN INDIA

All knew that 'health' is an important contributory factor in the utilization
of manpower. The Planning Commission of India gave considerable importance to
health programs in the five year plans. For purposes of planning, the health sector has
been divided into the following subsectors:

1. Water supply and sanitation.

2. Control of communicable diseases.

3. Medical education, training and research.

4. Medical care including hospitals, dispensaries and primary health centers

(PHCs).

5. Public health services.

6. Family planning.

7. Indigenous systems of medicine.

All the above subsectors have received due consideration in the five year
plans. However, the emphasis has changed from plan to plan depending upon the felt-
needs of the people and technical considerations. To give effect to a better
coordination between the central and state governments, a bureau of planning was
constituted in 1965 in the Ministry of Health, Government of India. The main function
of this bureau is compilation of national health five year plans. The health plan is
implemented at various levels, e.g. center, state, district, block and village.

Central Level

At the Union Level, we have Planning Commission and associated bodies,

which look into all the aspects of planning in India as follows.

Planning Commission

The basic economic and social policies of the country were set forth by the
constitution, which came into force in January 1950, in its directive principles of state
policy.

In order to implement the economic and social policies of the government,

a competent organization was needed. The Planning Commission was thus established
on 15th March, 1950 by cabinet resolution with its functions defined as follows:

1. Make an assessment of the materials, capital and human resources of the

country, including technical personnel and investigate the possibilities of
augmenting such of these resources as are found to be deficient in relation to
the nation's requirements.

2. Formulate a plan for the most effective and balanced utilization of the
country's resources.

3. On a determination of priorities, define the stages in which the plan should be

carried out and propose the allocation of resources for due completion of
each stage.

4. Indicate the factors, which are tending to retard economic development and
determine the conditions, which in view of the current social and political
situation, should be established for the successful execution of the plan.
Role of the planning commission

Commission is essentially an advisory body of the government. It has

neither constitutional nor even statutory authority. It is only when the plan formulated
by the Commission is approved by the cabinet that it receives the necessary sanction.

The Government of India set up a Planning Commission in 1950 to make

an assessment of the material, capital and human resources of the country and to draft
developmental plans for the most effective utilization of these resources. In 1957, the
Planning Commission was provided with a perspective planning division, which
makes projections into the future over a period of 20-25 years. The Planning
Commission consists of a Chairman, Deputy Chairman and five members. The
Planning Commission works through three major divisions; Program Advisors,
General Secretariat and Technical Divisions, which are responsible for scrutinizing
and analyzing various schemes and projects to be incorporated in the five year plans.
Over the years, the Planning Commission has been formulating successive five year
plans. By its terms of reference, the Planning Commission also reviews from time to
time the progress made in various directions and to make recommendations to
Government on problems and policies relevant to the pursuit of rapid and balanced
economic development. The planning process was decentralized toward Decentralized
District Planning by the year 2000.

One notable achievement of the Indian Planning Commission is that it has

developed the process of planning into a great cooperative endeavor. In this process,
conventions and informal understanding play no less an important role than formal
legislation and orders.

It is essentially a staff agency; its main functions being advisory and

coordinating rather than executive. It is a via media between an administrative
department, which is too closely involved in day-to-day problems and lacks the
perspective and detachment that planning requires and a purely research institute,
which works too much in an ivory tower and is out of touch with the various political,
economic and administrative problems.

It must be taken fully into consideration if the plan is to be realistic and

effective. Its composition and status in the government are such that it is in a position
to maintain an effective liaison with the Central Ministries and the Governments of
States.

Since its inception, the Prime Minister of India has been the Chairman of
the Planning Commission. The Prime Minister however, attends only the most
important meetings of the Commission and maintains a certain amount of detachment
from its day-to-day work. The day-to-day work of the Commission is looked after by
a Deputy Chairman of the rank of the Cabinet Minister. The other members of the
Commission are Union Ministers for Finance, Defense and Human Resource
Development, and six full-time members, who have the rank of the Minister of State.
There is normally a full-fledged Secretary to the Planning Commission, but sometimes
he is designated as member secretary of the rank of the Minister of State.

The Commission has a collective responsibility and works as a collective

body, but for convenience, each member has been given charge of a group of subjects.
All important cases involving policy and all cases, where there is a difference of
opinion between two members of the Commission, are considered by the Commission
as a whole.

Office of the commission

The office of the Planning Commission consists of three types of branches:

1. General branches.

2. Subject branches.

3. Housekeeping branches.

The general branches either carry out studies related to the plan as a whole,
rather than to any particular sector of it or coordinate the work of the various subject
branches. There are altogether 10 general branches in the Planning Commission
perspective planning, statistics and surveys, economic plan coordination and program
administration, resources and scientific research international trade and development,
labor and employment, public cooperation, and information and publicity.

The subject branches are altogether 12 in number, e.g. agriculture,

community development and cooperation, local works, irrigation and power, oil and
minerals, village and small industries, transport and communication, education, health,
housing and social welfare.

The main housekeeping branches are administration and general

coordination. The staff of the planning commission comprises of administrators,
technical officers and secretarial and other junior personnel. Most of them are
economists and statisticians, but there are also a number of physical scientists.

Bulk of the technical work is, however, done in the ministries and their
attached offices, and technical institutes. But their technical officers are used to
looking at a problem from a limited sectorial angle only. Technical officers in the
Planning Commission, on the other hand, have to examine the same matter from a
broader national point of view.

Working group

Planning Commission has found it advantageous to set up a number of

working groups, comprising of selected administrators, economists and technicians
from the various central ministries and divisions of the Planning Commission. This
works out well in co-coordinating the work of ministries with its own, in formulating
plans for different sectors of the economy. Some of these working groups have a
number of subgroups and the steering group.

The system of appointing a number of working groups at the stage of the

formulation of a plan is a very important part of the Indian planning procedure.
Theoretically, it is conceivable that a team of planning experts working all by
themselves can formulate a plan, which may be technically very sound. But chances
are that some very important administrative or social points may not be given due
consideration by this small body of planning experts. Their plan may also suffer in
relation to acceptance, as well as implementation, because it may not be responsive to
the sense merit in the practice . evolved in India, which seeks to associate with the
planning exercise, right from the very beginning, some of the people who are to later
implement the plan through the system of working groups. This leads to their greater
participation in the formulation of the plan.

Advisory bodies

In an economy of the size and complexity of India there is a need to

consult, from time to time, other knowledgeable people, especially non-official
experts, at various stages of formulation as well as implementation of the plans in
regard to general policy at different levels—technical, administrative and political.
This objective is sought to be achieved through a number of standing bodies in the
form of panels, advisory committees or consultative committees. Unlike the working
groups, which are appointed on ad-hoc basis and work intensively for a period and
prepare detailed programs, these consultative bodies are usually of a standing nature,
meet occasionally during the year and give their general advice on the policies and
programs referred to them.

The most important advisory bodies, however, are:

1. Consultative committee of Members of Parliament for the Planning

Commission.

2. The Prime Minister's informal consultative committee for planning.

The first committee, which is presided over by the Minister of Planning consists
of about 30 members, 20 from the Lok Sabha (lower house) and 10 from the Rajya
Sabha (upper house). But there is no rigidity about the strength of this committee or
the composition of its membership, housewise or partywise. The main object of this
committee is to provide a forum for detailed discussions between Members of
Parliament and the Members of the Planning Commission on the principles and prob-
lems of planning in a manner, which is not practicable on the floor of Parliament. The
second committee is a much smaller body and comprises representatives of the
political groups in Parliament and is presided over by the Prime Minister himself. It
gives an opportunity to the opposition leaders to take an intimate part in the work of
planning and thus helps in making the plan something more than a document prepared
merely by the government.

Associated bodies

Associated bodies is obviously impossible for a single organization to deal

effectively. The Planning Commission has, therefore to take continuous help from a
number of associated bodies.

The most important associated bodies are, of course, the Central

Ministries. These Ministries are closely associated with work of planning not only
through their various executive departments but also through research institutes and
advisory committees, on many of which the Planning Commission itself is represented
and this facilitates a two-way interaction of ideas.

Of all the Ministries, the Ministry of Finance has naturally closest relation
with the Planning Commission as finance plays a most important role in any planning
exercise. Not only is the Minister for Finance ex officio member in charge of finance
in the Planning Commission but also the Secretary of the Ministry of Finance is the
chairman of the resources working group and the Chief Economic Adviser to the
Ministry of Finance is also ex officio economic adviser to the Planning Commission.

Apart from the Central Ministries, there are two official organizations, e.g.
the Reserve Bank of India and the Central Statistical Organization, which are closely
associated with the work of the Planning Commission. There is an economics
department in the Reserve Bank, which keeps a close touch with the work of the
Commission and undertakes a number of important studies on financial and banking
matters for the Commission.

The Central Statistical Organization (CSO) is responsible for organizing the

collection of all statistical data required for the purpose of planning. The Director
General of the CSO is also the ex officio Head of the Statistics and Survey Division of
the Planning Commission.
Research and evaluation

Much of the research, as has been seen, is done in the Commission itself,
the ministries, the Reserve Bank of India and the CSO. A great deal, however, is
necessarily contracted out to university bodies and to non-official organizations such
as the Indian Statistical Institute, the National Council of Applied Economic Research
and the Institute of Economic Growth. To guide and coordinate all these official and
non-official efforts and to ensure that research funds are employed as effectively as
possible, the Commission has established the Research Programs Committee
comprising of eminent social scientists in the country from different universities and
research institutes under the leadership of the Deputy Chairman.

One of the most important functions of the Planning Commission is to

keep watch over and evaluate the actual working of the various programs and projects
included in the plan. There is a progress unit in the plan coordination section of the
Planning Commission, which collects all key data about the progress of various
programs and projects and makes them available in the form of reports and charts for
the information of members and senior officers of the commission. For the evaluation
of specific projects, there are two organizations, namely Committee on Plan Projects
(COPP) and Program Evaluation Organization (PEO). Although both are connected
with the Commission, they act with a considerable degree of independence. The
Program Evaluation Organization was established in October 1952 to assess the
progress of community projects and other intensive development schemes in rural
areas.

The COPP was established on the recommendations of the Planning

Commission and was created by a resolution of the National Development Council
(NDC) of May 1956. The COPP consists of the Minister for Home Affairs, who is the
Chairman, the Deputy Chairman of the Planning Commission and the Ministers of
Finance and Planning. To these are added, when a particular class of project is being
investigated, two Chief Ministers of the States nominated by the Prime Minister and
the interested Central Minister, The Committee's central staff, however, is on the
strength of the Planning Commission.

It is, however, the administrative departments at the Center and the States,
which have the main responsibility for supervision of programs and projects included
in the plan ensuring that they are implemented efficiently and according to schedule.
The Planning Commission takes care not to interfere with the responsibility and
confines itself only to general appraisal made in dose collaboration with the
administrative departments concerned.

National Development Council

The NDC is the advisory body, which could be said to rival the Planning
Commission itself in importance. Its creation was suggested by the Commission in the
draft outline of the first five year plan, where it is said that the need had arisen for a
forum at which, from time to time, the Prime Minister of India and the Chief Ministers
of the States can review the working of the plan and of its various aspects. Its
establishment (6 August, 1952) was effected by cabinet resolution, which defined its
functions as follows:

1. To review the working of the national plan from time to time.

2. To consider important questions of social and economic policy affecting

national development.

3. To recommend measures for the achievement of the aims and targets set out in
the National Plan, including measures to secure the active participation of the
administrative services, ensure the fullest development of the less advanced
regions and sections of the community and through sacrifices borne equally by
all citizens, build up resources for national development.

It consists of the Prime Minister, the Chief Ministers of the States and the
members of the Planning Commission, but its meetings are usually attended by others
as well. Ministers of the Central Government with an interest in the items included on
its agenda invariably attend, States sometimes send one or two Ministers in addition to
Chief Ministers and 'outsiders' such as eminent economists or the Governor of the
Reserve Bank of India are often called on to give advice.
 The NDC is, de facto, more than an advisory body, but it is also less than
an executive one. It may'best be described as the most important organized gathering
where plans undergo adjustments in the light of needs, pressures, prejudices and
capacities of the states. Further, the general coordination with the states is secured at
the highest political level through the NDC,

State Level

At the state level, there is state planning department directly under the
control of Chief Minister. This department undertakes liaison with the Central
Planning Commission and various departments including health and family welfare of
the state to coordinate their development programs and formulates the development
plan for the state.

District and Block Levels

Next to the state level are district and block levels. This is done jointly by
the officers of the various development departments including health and family
welfare. Working at these respective levels are the members of the district councils or
block councils and/or the non-official representatives. District Collectors and Block
Development Officers are responsible for necessary coordination at the district and
block levels, respectively. An attempt is being made to carry the process of planning
further down to the village level and it has been also tried out in certain areas.

VII. HEALTH AND FIVE YEAR PLANS

Introduction
India has been a pioneer in planning its requirements quite well, not only at
the time of independence but also even earlier, even though those efforts were not as
extensively worked upon as is reflected by five year plans.

Five year plans are mechanisms to bring about uniformity in policy

formulation in programs of national importance. Recognizing the 'health' as an
important contributory factor in the utilization of manpower and in the uplifting of the
economic condition of the country, the Planning Commission gave considerable
importance of health programs in the five year plans.

The broad objectives of the health program during five year plans are as follows:

 Control and eradication of major communicable diseases.

 Strengthening of basic health services through the establishment of PPICs and

sub centers.

 Population control.

 Development of health manpower resources.

For the purposes of planning, the health sector has been divided into the following
subsectors:

 Water supply and sanitation

 Control of communicable diseases

 Medical education, training and research

 Medical care including hospitals, dispensaries and PHCs

 Public health services

 Family planning

 Indigenous system of medicine.

All the above subsectors have received due consideration in the five year
plans. To give effective, better coordination between central and state governments, a
Bureau of Planning was constituted in 1965 in the Ministry of Health, Government of
India. The main responsibility of the Bureau is compilation of national health five year
plans. It is necessary to review briefly the health policy and targets, investments and
achievements during the planning period. The national five year plans are
implemented through the community development program, which includes the health
plans of the nation. Let us know briefly Community Development Program prior to
review of five year plans Community Development The term 'community
development' is of recent origin in India. It is a process, which is designed to promote
better living of whole community with active participation by the community itself
along with government efforts.

According to United Nations Organization (UNO), 'community

development' is the process by which the efforts of the people themselves are united
with those governmental authorities to improve the economic, social and cultural
conditions of communities, to integrate those communities with the life of the nation
and to enable them to contribute fully to nation's progress.

Thus, community development may be defined as “a process designed to

create conditions of economic and social progress of the whole community with its
active participation and the fullest possible reliance upon the community's initiatives”.

Community development is a method to facilitate social, economic and

cultural progress of the rural people through a multidisciplinary approach of availing
the manpower, material, leadership and other resources of the community itself.

The main aim of the program is to improve all aspects of rural life, which
means all-around upliftment of the rural people. Community Development Program is
an integrated program trying to cover major areas, which include agriculture, animal
husbandry, irrigation, education, public health, rural industries communication, etc.

The main objective of the Community Development Program is to bridge

the gap between poverty, disease and ignorance through the community efforts, thus
awakening the interest and enthusiasm of the millions of people in improving their
own conditions.

Thus, the community development was described as a program of the

people, for the people and by the people to exterminate the triple enemies, viz.
poverty, ill-health and ignorance.

The program of community developments was launched in India during 1952 (2-10-
1952),-because India can be still regarded as 'land of villages', currently about 80% of
people live in 5.76 lakhs villages. They form the backbone of the society and are the
mainstay for the all- around social and economic development of the country. They
are the real wealth of the nation to the extent they are fit enough to produce wealth.
Unfortunately, their general welfare including 'health' had been very much neglected
in the past.

Community Development Program is a multipurpose scheme consisting of

the certain activities related to health field as follows:

1. Integration of the health needs of villagers to the authorities responsible for

planning and implementing the health programs.

2. Development of agriculture.

3. Improvement of communication.

4. Improvement of education.

5. Improvement of health.

6. Improvement of rural sanitation.

7. Improvement of housing arts, crafts and cottage industries.

8. Improvement of animal husbandry.

9. Improvement of cooperative marketing.

10. Special programs for women and children.

11. Enhance the community participation in all programs.

FIVE YEAR PLANS

The five year plans were conceived to rebuild rural India, to lay the
foundations of industrial progress and to secure the balanced development of all parts
of the country. Recognizing 'health' as an important contributory factor in the
utilization of manpower and the uplifting of the economic condition of the country,
the Planning Commission gave considerable importance to health programs in the five
year plans. The broad objectives of the health programs during the five year plans
have been:

 Control or eradication of the major communicable diseases.

 Strengthening of basic health services through the establishment of primary

 health centers and sub- centers.

 Population control.

 Development of health manpower resources.

First Five Year Plan (1951-1956)

Prior to the commencement of the first five year plan, the health status of
the people of India was very low, which includes:

 Lack of hygienic environment sanitation conducive to healthy living.

 Low resistance power due to lack of adequate diet.

 Prevalence of malnutrition and poor nutrition.

 Lack of proper housing, supply of pure drinking water and proper disposal of
human wastes.

 Lack of medical care.

 Lack of general and health education.

 Low economic status, inadequate financial resources and lack of trained health
personnel.

The whole program of health developments was tied with a broader

program of social development. While considering the above facts, a seven-point pub-
lic health program with the following priorities formed the basis of the first five year
plan.

1. Provision of water supply and sanitation.

2. Control of malaria.

3. Preventive health care of the rural population through health units and mobile
units.

4. Health services for mothers and children.

5. Education, training and health education,

 6. Self-sufficiency in drugs and equipment.

7. Family planning and population control.

During this plan period the public sector outlay was Rs. 2,356 crores of
which Rs.140 crores (5.9%) were allotted for health programs. The actual expenditure,
however, amounted to Rs.1,960 crores and HOI crores respectively.

Second Five Year Plan (1956-1961)

The second five year plan was continuation of the development efforts
commenced in the first plan. It included all communicable diseases in addition to
control of malaria.

The specific objectives were:

 Establishment of institutional facilities to serve as a basis.from which services

could be rendered to the people both locally and in surrounding territories.

 Development of technical manpower through appropriate training programs.

 Intensifying measures to control widely spread communicable diseases.

 Encouraging active campaign for environmental hygiene.

 Provision of family planning and other supporting services for raising health
standard of the people.

The different areas emphasized during the second five year plan were:

 Health care services in rural and urban areas.

 Medical education and training.

 Medical research.

 Indigenous systems of medicine.

 Control of communicable diseases.

 Maternal and child health (MCH), and family planning.

 Health education.
 During this period, the public sector outlay was Rs. 4,800 crores of which
Rs. 225 crores were allotted to the health programs. The actual expenditure, however,
amounted to Rs. 4,672 crores and Rs. 215 crores respectively.

Third Five Year Plan (1961-1966)

The objectives of the third five year plan were in tune with the first and
second five year plans except that integration of public health with maternal and child
welfare, nutrition and health education was planned. In general, the third five year
plan focused on the following areas:

 Water supply, environmental sanitation (rural and urban)

 Health care (hospitals and dispensaries)

 Control of communicable diseases

 Medical education, research and training

 Other services—health education, school health, MCH, mental health, health

insurance.

 Indian System of Medicine (ISM) and family planning.

While continuing the program initiated in the previous plan period, greater
emphasis was placed on preventive health services and on the eradication and control
of communicable diseases.

During this period, the public sector outlay was Rs. 7,500 crores of which,
Rs. 341.80 crores allotted for health programs. The actual expenditure, however,
amounted to Rs. 8,577 crores and Rs. 357 crores respectively.

Annual Plans (1966-1969)

The fourth five year plan, which was to commence from April 1966 was
postponed till 1969 due to uncertain economic situation in the country (due to Indo-
Pak war). During: this intervening period (1966-1969) was covered by annual plans
with an outlay of Rs. 6,756 crores in the public sector of which the expenditure on
health programs was Rs. 316 crores (4.7%).
 Fourth Five Year Plan (1969-1974)

During this period, the revised estimate of public sector outlay was Rs. 16,774 crores
of which Rs.1,156 crores (7.2%) were allotted to health sector. Certain objectives of
the Mudaliar Committee were the base for the fourth five year plan in relation to
health. These are as follows:

 To provide an effective base for health services in rural areas by strengthening

the PHCs.

 Strengthening of subdivisional and district hospitals to provide effective

referral services for PHC.

 Expansion of the medical and nursing education and training of paramedical

personnel to meet the minimum technical manpower requirements.

In the fourth plan, public health and medical programs had been divided
into the following broad cats egories:

 Medical education, training and research

 Control of communicable diseases
 Medical care including hospitals, dispensaries and PHCs
 Other public health services
 Indigenous systems of medicine.
In this period, efforts were made to strengthen the PHC complex in the
rural areas for undertaking preventive and curative health services and for ensuring the
maintenance phase of the communicable diseases control and eradication programs.

Achievements from First to Fourth Five Year Plans

During the past 2 decades, commendable improvements have taken place

in the health indices of the country. The mortality rate has declined from 27.4/1,000 in
the year 1949-1950 to 15.1 /1,000 in 1971. Life expectancy at birth has gone up from
32 years (1951) to 50 years (1971). Infant mortality rate has dropped to 140/1,000
from 183/1,000 in the last 20 years. The number of hospital beds is expected to
increase from 113,000 in 1950-1951 to 281,600 in 1973- 1974. The bed: population
ratio has gone up to 0.49/1,000 from 0.32/1,000. Over 100 medical colleges with an
annual admission capacity of nearly 12,500 undergraduates functioning in
collaboration with 30 medical colleges with an annual admission capacity of 2,500
students in 1950-1951.

Despite all these achievements, the status of health in India is

unsatisfactory, for example, the recommended Mudaliar Committee norm of one bed
per 1,000 population and one doctor per 1,000 population to 3,500 population is still
not within reach, There are considerable regional disparities in the country in the
availability of medical services. About 80% of population, which live in rural areas
have only 30% of the hospital bed and 20% of the doctors in the country. The
nurse:bed ratio is far below the recommended norms in certain regions of the country.

Fifth Five Year Plan (1974-1979)

The fifth plan was launched on April 1, 1974, with an outlay of

Rs. 37,250 crores in the public sector, of which Rs. 3,277 crores were allotted to
health sector. The primary objective of this plan period was "to provide minimum
public health facilities integrated with family planning and nutrition for vulnerable
groups, especially children, pregnant women and feeding mothers", it was hoped to
consolidate the gains so far achieved in the various fields of health such as
communicable diseases, medical education and provision of the infrastructure in the
rural areas.

The emphasis of the plan was on removing imbalance in respect of medical

facilities and strengthening the health infrastructure in rural areas. Specific objectives
to be pursued during the plan were:

 Increasing accessibility of health services to rural areas

 Correcting regional imbalance

 Further development of referral services by removing deficiencies in district

and sub divisional hospitals.

 Integration of health, family planning and nutrition.

  Intensification of the control and eradication of communicable diseases,
especially malaria and small pox.

 Quantitative improvement in the education and training of health personnel by

converting unipurpose workers to multipurpose workers.

 Development of referral services by providing specialists attention to common

diseases in rural areas.

During this plan period minimum needs program. (MNP) to be operated

through the state government is considered to be of great importance and field
certain targets like one PHC for 100,000 population, one subcenter for 10,000
population, correcting deficiencies related to establishment of these health
centers and upgradation of one in every four PHC to the status of a 30 bedded
rural hospital with specialized services. These targets of the MNP could not be
achieved due to changes in national political systems.

Sixth Five Year Plan (1980-1985)

In the beginning, the sixth five year plan was formulated against the
background of a perspective covering a period of 15 years from 1980-1981 to 1994-
1995. The main objectives were:

 Progressive reduction in the incidence of poverty and unemployment.

 To step up the rate of growth of the Indian economy.

 Promoting policies for controlling the population growth through voluntary

acceptance of the 'small family norm.

 To improve the quality of life of the people in general through 'MNP'. The sixth
plan laid emphasis on health care, control of communicable diseases, hospital
and dispensaries in urban/rural areas, medical education, research, training,
ISM and homeopathy, other programs and family welfare.

Minimum needs program, which was started during fifth plan continued
with same objective as follows.
Minimum Needs Program

Minimum needs program was first introduced in fifth five year plan to
combat poverty. The state has a duty to provide the basic needs of life to every citizen
—needs in terms of health, food, education, water, shelter, etc. The MNP is the
expression of the commitment of the government for the socioeconomic development
of the community particularly the underserved and underprivileged segment of
population.

Government considers investment in health as investment investment in

human resource development and as such primary health care forms are essential and
integral component of the MNP. It is a broad intersectorial master plan for providing
the minimum basic needs of the people of the land including the following in revising
MNP 1978:

 Elementary education

 Adult education

 Rural health

 Rural water supply

 Rural road

 Rural electrification

 House sites / ho uses for rural landless laborers

 Environmental improvement of slums

 Nutrition.

The basic principles to be observed in the implementation of the MNP are:

 The facilities under MNP are provided on priority basis first only in those
areas, which are at present underserved so that the disparities from area to area
are eliminated and every segment of the population is assured of minimum
essential facilities.
  Intersectoral area project so that all the facilities under the MNP are provided
as a package to a broad area. This would ensure a greater impact of the
facilities provided. For this purpose, it is necessary to develop an effective
interdepartmental coordination mechanism at state and dstrict levels to ensure
that the various departments gel responsibility for implementation of MNP for
selected area.

Health Sector Minimum Needs Program

Health in its wider concept cannot be attained by the health sector alone.
Economic development, antipoverty measures, food production and distribution,
drinking water supply, sanitation, housing, environmental protection and education all
contribute to health and have the common goal of human development. Health service
is an integral part of overall social and economic development will of necessity rest on
proper coordination at all levels between the health and all other sectors concerned.
The initiative, if already such mechanism not existing, may be taken by the health
department of the state. Effective coordination with the other departments concerned
also ensured.

The various programs/schemes covered under the health sector MNP were
conveyed to state government by the central government. Since then, there have been
certain modifications in the pattern of assistance of various schemes, which have been
conveyed to the state governments separately with the changes made in the following
schemes/programs included in the health sector MNP:

1. Centrally sponsored scheme (100%):

a. Health guide scheme.

b. Establishment of subcenters.

c. Basic training of male multipurpose workers.

d. Training of specialists, technical and other paramedical staff required

for the rural medical services.

e. Training of community health officers.

 2. Centrally assisted schemes (50-50 basis):

a. Multipurpose workers scheme.

3. State sponsored schemes:

a. Subsidiary health centers.

b. Primary health centers.

c. Community health centers/Upgraded PHCs.

Seventh Five Year Plan (1985-1990)

The objectives of the seventh five year plan have been formulated as part
of the long-term strategy, which seeks by the year 2000 to virtually eliminate poverty
and illiteracy, achieve near full employment, secure satisfaction of the basic needs of
food, clothing, shelter and provide health for all.

Against the above background, the current objective of the state and
national health plan is to continue the reorganization of the health services
infrastructure, already begun in the state five year plan (1980-1985) and strive toward
the goal of Health for All by the year 2000 through provision of universal primary
health care to all sections of the society.

By the end of seventh five year plan, it is envisaged [as laid down in the
National Health Policy (NHP)] that the infrastructure of primary health care as
required on present population norms would be fully operational with regard to village
health guides, PHCs and subcenters used multipurpose health workers. Programs for
the control of communicable diseases, health services research and of health education
will be strengthened. The plan envisages universal immunization of expectant mothers
and all eligible children by the year 1990. The family welfare program will be
implemented with greater vigor so as to achieve couple protection rate of 42% by the
end of the seventh plan period with increased emphasis on female education and MCH
services.

In keeping with the objectives of the International Drinking water Supply

and Sanitation decades (1988-1991) the seventh plan aims to provide adequate
drinking water facilities for the entire population both in urban and in rural areas and
sanitation facilities for 80% of the urban population and 25% of the rural population.

The public sector outlay of Rs.180,000 crores represents a massive public

investment. Out of this national cake, nearly Rs. 3,392 crores are earmarked for
health, Rs. 3,922 crores for water supply and sanitation, and Rs. 3,256 crores for
Family Welfare Program. The targets to be achieved are laid down in NHP.

Eighth Five Year Plan (1992-1997)

The ultimate goal of the eighth plan is the human development, in many
facets. It is toward fulfilling this goal that the eighth plan accords priority to the
generation of adequate employment opportunities to achieve near-full employment by
the turn of the century building up of the people's institutions, control of population
growth, universalization of elementary education, eradication of illiteracy, provision
of safe drinking water and primary health facilities to all, growth and diversification of
agriculture to achieve self-sufficiency in food grains and generate surpluses for
exports. So, in this five year plan, employment generation, population control,
literacy, education, health, drinking water and provision of adequate food and basic
infrastructure are listed as priorities. All these aspects contribute to the health of the
people. In relation to health, this plan period has a number of priorities.

The health facilities should reach the entire population by the end of the
eighth plan. The Health for All paradigm must take into account not only the high risk
vulnerable groups, i.e. mother and child but also must focus sharply on the
underprivileged segments within the vulnerable groups. Towards health for the under-
privileged may be key strategy for the Health for All by the year 2000.

The structural framework for the delivery of health, programs must

undergo a meaningful reorientation. This is a way that the underprivileged themselves
become the subjects of the process and not merely its objects. This can only be done
through emphasizing the community-based system. Such systems must provide the
base and basis of health planning, recognizing health and education, as key entry
points for harnessing community development efforts. These systems must be
reflected in the planning of infrastructure with about 30,000 population as the Unit

By providing valid information’s and by associating the predefined

segments of population with not only the health planning process for social sectors but
also health, so that the people themselves bring about the solution of their problem.
The ethos and culture of communities must provide the scaffolding for such
community-based systems. In this context the traditional system of preventive medi-
cine including meditation, yoga and other health practices may find a better
acceptability amongst communities with distinct advantages of their cost-
effectiveness. The practitioners of ISM can play a major role in this direction.

The often repeated pattern of providing for health needs in terms of

curative services for those who are ill, must now give way to an approach in terms of
positive health with emphasis on disease prevention and health promotion. At the
other end of the spectrum, a responsiveness of the services toward rehabilitation of
those with physical or other handicaps, would contribute to development of a system
of comprehensive health care.

Major efforts shall be initiated to expand educational facilities for those

categories of healthcare providers where the existing numbers and the annual turnout
are far below the desired level. Incorporation of health- related courses on a part of
vocationalization of general education shall be pursued vigorously. Reorientation or
retargeting of the process of education for all categories of health professionals is
essential. The quality of services is directly related to the content and type of
education of the health professionals and their sense of commitment to respond with
sensitivity to the needs of the people.

Ninth Five Year Plan (1997-2002)

The morbidity due to common communicable and nutrition-related

diseases continues to be high. Morbidity due to non-communicable diseases was
showing a progressive increase because of increasing longevity and alterations in life
style. Efforts will have to be made to tackle this dual disease burden effectively so that
there is sustained improvement in the health status of the population.
Current problems faced by the healthcare services include:

 Persistent gaps in manpower and infrastructure, especially at the primary health

care level.

 Suboptimal functioning of the infrastructure; poor referral services.

 Hospitals not having appropriate manpower, diagnostic and therapeutic

services and drugs.

 Availability and utilization of services are poorest in the neediest

states/districts.

 Suboptimal intersectoral coordination.

 Increasing dual disease burden of communicable and non-communicable

diseases.

 Technological advances, which widen the spectrum of possible interventions

Increasing awareness and expectations of the population regarding healthcare
services.

 Escalating costs of health care.

The special action plan for health envisaged expansion and improvement
of the health services to meet the increasing healthcare needs of the population; no
specific targets were set. Efforts were directed to improve functional efficiency of the
healthcare system through:

 Creation of a functional reliable health management information system and

training and deployment of health manpower with requisite professional
competence.

 Multi professional education to promote team work.

 Skill upgradation of all categories of health personnel as a part of structured

continuing education.

 Improving operational efficiency through health services research.

  Increasing awareness of the community through health education.

 Increasing accountability and responsiveness to health needs of the people.

 Making use of available local and community resources.

Approach during Ninth Plan

 Horizontal Integration of vertical programs.

 Develop disease surveillance and response mechanism with focus on rapid

recognition, report and response at district level.

 Develop and implement integrated non-communicable disease control

program; health impact assessment as a part of environmental impact
assessment in developmental projects.

 Implement appropriate management systems for emergency, disaster, accident

and improve HM1S and logistics of supplies.

New Initiatives

New initiatives of ninth plan are:

1. An absolute and total commitment to improve access to and enhance the

quality of primary health care in urban and rural areas by providing an op-
timally functioning primary health care system as a part of the basic minimum
services.

2. To improve the efficiency of existing healthcare infrastructure at primary,

secondary and tertiary care settings through appropriate institutional
strengthening, improvement of referral linkages and operationalization of
health management information system (HMIS).

3. To promote the development of human resources for health in quantity and

appropriate in quality so that access to essential healthcare services is available
to all.

4. To improve the effectiveness of existing programs by horizontal integration of

ongoing vertical programs at the district and below district level; to strengthen
 the disease surveillance with the focus on rapid recognition, reporting and
response at district level; to promote production and distribution of appropriate
vaccines of assured quality at affordable cost; to improve water quality and
environmental sanitation; to improve hospital infection control and waste
management.

5. To develop and implement integrated non-communicable disease prevention

and control program within the existing healthcare infrastructure.

6. To undertake screening for common nutritional deficiencies, especially in

vulnerable groups and initiate appropriate remedial measures; to evolve and
effectively implement programs for improving nutritional status, including
micronutrient status of the population.

7. To strengthen programmes for prevention, detection and management of health

consequences of the continuing deterioration of the ecosystems.

8. To improve the safety of the work environment and worker's health in

organized and unorganized industrial and agricultural sectors.

9. To develop capabilities at all levels for emergency and disaster prevention and
management; to implement appropriate management systems for emergency,
disaster, accident and trauma care at all levels of health care.

10. To ensure effective implementation of the provisions for food and drug safety;
strengthen the food and drug administration both at the center and in the states.

11. To increase the involvement of .ISM and homeopathic practitioners in meeting

the healthcare needs of the population.

12. To enhance research capability with a view to strengthening basic clinical and
health systems, research aimed at improving the quality and outreach of
services at various levels of health care.

13. To increase the involvement of voluntary, private organizations and self-help

groups in the provision of health care and ensure intersectoral coordination in
implementation of health programs and health-
 14. To enable the Panchayati Raj institutions (PRI) in planning and monitoring of
health programs at the local so that there is greater responsiveness to health
needs of the people and greater accountability; to promote intersectoral
coordination and utilize local and community resources for health care.

Tenth Five Year Plan (2002-2007).

Today India has a vast network of governmental, voluntary and private

health infrastructure manned by large number of medical and paramedical persons.
During the 10th plan, efforts will be further intensified to improve the health status of
the population by optimizing coverage and quality of care by identifying and
rectifying the critical gaps in infrastructure, manpower, equipment, essential
diagnostic reagents and drugs.

The approach during the 10th plan will be to improve access to and
enhance the quality of primary health care in urban and rural areas by providing an
optimally functioning primary healthcare system as a part of basic minimum services
and to improve the efficiency of existing health care infrastructure at primary,
secondary and tertiary care settings through appropriate institutional
strengthening and improvement of referral linkages.

These targets reflect the concern that economic growth alone may not lead
to the attainment of long term sustainability and adequate improvement in social
justice. Earlier plans have had many of these issues as objectives, but in no case
specific targets were set. As a result, these were viewed in terms of being desirable,
but not essential. However, in the 10th plan, these targets are considered to be as
central to the planning framework as the growth objective.

Technological improvements and increased access ‘to health care have

resulted in a steep fall in mortality, but the disease burden due to communicable
diseases and non-communicable diseases/ environmental pollution and nutritional
problems continues to be high. In spite of the fact that norms for creation of
infrastructure and manpower are similar throughout the country/ there remains
substantial variation between states and districts, within the states/ in availability and
utilization of health care services and health indices of the population. During 10th
plan there is continued commitment to provide essential primary care, emergency life
saving services, services under national disease control program free of cost to
individuals, based on their needs and not on their ability to pay.

Government has set targets in the 10th five year plan to control certain
disease like H1V/AIDS, tuberculosis, leprosy, malaria and blindness, etc.

Eleventh Five Year Plan

The 11th five year plan will provide an opportunity to restrictive policies to
achieve a new vision based on faster, broad based and inclusive growth

Objective: To achieve good health for people, especially the poor and
underprivileged.

Approach: The comprehensive approach is needed that encompass individual health

care, public health, sanitation, clean drinking water, access to food, and knowledge of
hygiene and feeding practices. The plan will facilitate the convergence and
development of public health systems and services that are responsible to health needs
and aspiration of people. Importance will be given to reduce the disparities in health
across regions and communities by ensuring access to affordable care.

VIII. VARIOUS COMMITTEE REPORTS ON HEALTH

NATIONAL HEALTH COMMITTEES

Before the National Health Policy (NHP) framed in 1983, and various
committees of experts appointed from time to time, the Constitution, the Planning
Commission, the Central Council of Health and Family Welfare, and Consultative
Committees attached to the Ministry of Health and Family Welfare render advice on
initiating health programmes, requirement of health manpower and other resources
in government, voluntary and private sectors based on health needs and demands of
the people through health surveys. The reports of these committees have formed an
important basis of health planning in India, National Health Planning in India based
on the National Health Policy (NHP) 1983 aimed at to attain ‘Health for All by the
 year 2000. The main objective of the revised National Health Policy, 2002 is to
achieve an acceptable standard of good health among the general population of the
country and has set goals to be achieved by the year 2015.

Chadah Committee, 1963

This committee was appointed in 1963, under chairmanship of Dr. M.S.

Chadah who was the Director General of Health Services. This committee was
appointed to advise about the necessary arrangements for the maintenance phase of
National Malaria Eradication Programme (NMEP).

The committee made the following suggestions:

 Basic health workers {one per 10,000 population) should carried out the NMEP
activity.

 Basic health workers would function as multipurpose workers (and would

perform, in addition to malaria work, the duties of family planning and vital
statistics data collection).

 They would work under supervision of family planning health assistants.

Mukherjee Committee, 1965

This committee was appointed in 1965 under chairmanship of Shri

Mukherjee who was then Secretary of Health to Government of India. This committee
was appointed to review the performance and develop strategy in the area of family
planning, as the recommendations of the Chadah Committee, when implemented,
were found to be impracticable as the basic health workers, could neither do justice to
malaria work nor to family planning work, discussed in a meeting of the Central
Health Council in 1965.

The following were the committee recommendations:

 There should be a separate staff for the family planning programme.

 The family planning assistants were to undertake family planning duties only.

 The basic health workers were to be utilized for purposes other than family
planning.
  To separate the malaria activities from family planning

Mukherjee Committee, 1966

The committee of Health Secretaries was appointed in 1966 under

chairmanship of Shri Mukherjee who was then Union Health Secretary. This
committee was appointed to work out the details of Basic Health Service that should
be provided at the Block level, and some consequential strengthening required at
higher levels of administration since multiple activities of the mass programmes like
family planning, small pox, leprosy, trachoma, NMEP (maintenance phase), etc. were
making it difficult for the states to undertake these effectively because of shortage of
funds, discussed in a meeting of the Central Health Council held at Ban galore in
1966.

Jungalwalla Committee, 1967

This committee is known as the “Committee on Integration of Health

Services”. It was appointed in 1964 under the chairmanship of Dr. N Jungalwalla, the
then Director of National Institute of Health Administration and Education to examine
into various problems related to integration of health services, abolition of private
practice by doctors in government services, and the service conditions of Doctors.

I. The committee defined “integrated health services” as a service with a unified

approach for all problems instead of a segmented approach for different
problem and suggested the following steps that should be taken for the
integration at alt levels of health organization in the country:

 Unified Cadre

 Common Seniority

 Recognition of extra qualifications

 Equal pay for equal work

 Special pay for special work

 Abolition of private practice by government doctors

 Improvement in their service conditions

II. Medical care and public health programmes should be put under charge of a
single administrator at all levels of hierarchy,

Kartar Singh Committee, 1973

This committee is known as “Committee on multipurpose workers under

Health and Family Planning". Government of India constitutes it in 1972 under the
Chairmanship of Kartar Singh, then the Additional Secretary, Ministry of Health and
Family Planning, Government of India to form a framework for integration of health
and medical services at peripheral and supervisory levels.

The main recommendations of the committee were:

 Various categories of peripheral workers should be amalgamated into a single

cadre of multipurpose workers (male and female).

 Auxiliary nurse midwives were to be converted into Multi Purpose Health

Workers Females {MPW (F)} and

 The basic health workers, malaria surveillance workers etc. were to be

converted to Multi Purpose Health Workers Male {MPW (M)K

 The work of 3-4 male and female MPWs was to be supervised by one health
supervisor {male or female respectively).

 The existing lady health visitors were to be converted into female health
supervisor.

 One Primary Health Centre should cover a population of 50,000. It should be

divided into 16 sub centres (one for 3000 to 3500 population).

 Each Primary Health Centre to be staffed by a male and a female health

worker.

Shrivastava Committee, 1975

This committee is known as “Group on Medical Education and Support

Manpower”. Government of India, Ministry of Health and Family Planning to
determine steps needed to:
  Reorient medical education in accordance with national needs and priorities
and

 Develop a curriculum for health assistants who were to function as a link

between medical officers and MPWs constituted it in 1974.

The following were the recommendations:

1. Creation of bands of paraprofessional and semiprofessional health workers

from within the community itself

2. Establishment of 3 cadres of health workers namely - multipurpose health

workers and health assistants between the community level workers and
doctors at PHC,

3. Development of a ‘Referral Services Complex’

4. Establishment of a Medical and Health Education Commission for planning

and implementing the reforms needed in healffi and medical education on the
lines of University Grans* Commission.

Acceptance of the recommendations of the Shrivastay Committee in 1977

led to the launching of the Rural Health Service.

Bajaj Committee, 1986

An ‘Expert Committee for Health Manpower Planning, Production and

Management’ was constituted in 1985 under the Chairman- ship of Dr. J.S. Bajaj, the
then professor at A11MS, New Delhi.

The followings are the major recommendations of this committee:

 Formulation of national medical and health education policy

 Formulation of national health manpower policy.

 Establishment of an educational commission for health sciences (ECHS) on the

lines of UGC.

 Establishment of health science universities in various states and union

territories.

 Establishment of health manpower cells at centre and in the states.

  Vocationalization of education at 10-1-2 levels as regards health related fields
with appropriate incentives, so that good, quality paramedical personnel may
be available in adequate numbers.

 Carrying out a realistic health manpower survey

IX. SUMMARY
Health planning being the part of national development planning comprises a range of
activities that share the goal of improving health outcomes, or improving the efficiency of
health services provision, or both. Health and Socio-economic developments are so closely
intertwined that is impossible to achieve one without the other. Health is a priority goal in
its own right, as well as a central input into economic development and poverty reduction.
Health sector is complex with multiple goals, multiple products, and different
beneficiaries.

Health planning is a process to produce health. It does this by creating an actionable

link between health needs and resources, Its nature and scope will depend upon time
allowable, number of answerable questions to be addressed within the process (The
answerable questions comprise questions that are worth asking and for which there is
evidence to allow them to be answered), resources available to support the process,
and the broader political and social environment.

Health planning occurs within the pressured environment of political direction,

changing public expectation, new information and evidence about outcomes, and on
occasion, media headlines. A solid and well-designed health planning process will be
resilient enough to accommodate these pressures and to use them as levers to go
forward to dialogue and solutions for improved health care provision and health
outcome's in the population.

National health planning is ‘the orderly process of defining national health

problems, identifying unmet needs and surveying the resources to meet them,
establishing the priority goals that are realistic and feasible and projecting
administrative action to accomplish the purpose of accomplished programme .
X. CONCLUSION
Five year plans were first introduced in the erstwhile Soviet Union in 1928 for
controlled and rapid economic development. Much of the Soviet industrial successes
are a result of the implementation of its five-year plans. The five years plan in India is
framed, executed and monitored by the Planning Commission of India, After India
gained independence when the British had left the Indian economy crippled, the
fathers of development formulated 5 years plan to develop the Indian economy. In
1950, India’s Prime Minister JawaharLal Nehru, impressed by the Soviet system,
adopted five-year plans as a mode! for economic development. He established the
Planning Commission that was to act independent of any cabinet and was answerable
only to the prime minister, who is also chairperson of the commission.

Planning Commission of India is the Government body that is responsible for

analyzing priorities for investment and policies and drafting the nation’s five year-
plans (http:// planningcommission.nic.in/) Draft plans were to be approved by the
National Development Council, comprising the Planning Commission and the chief
ministers of all states. An approved plan is then passed by the cabinet and then in
Parliament. In the first 8 plans emphasis has been laid on the public sector, with huge
investments being made in heavy and basic industries. But in 1997, with the launch of
the 9th five-year plan, the emphasis shifted from the public sector and became more
indicative in nature, the tenth plan completed its term in March 2007 and the eleventh
plan is currently underway.
XI. BIBLIOGRAPHY

1. Basavanthappa BT, Text book of nursing administration, 3rd edition,

jaypee publication, page no: 576-583
2. Gulani K K, Text book of community health nursing( principles and
practices), 2nd edition, kumar publishing house, page no: 65-81
3. K. Deepak. Text book of A comprehensive text book on nursing
management, emmess publications, page no: 33-40
4. Vati jogindra, principles and practice of nursing management and
administration, 1st edition, jaypee publications, page no: 225-231

Net sources

https://www.slideshare.net/FIROZQURESHI/five-year-plan-64020134

https://www.slideshare.net/aliyasidish/5-year-plan-ppt-2
 INDEX

SL NO CONTENT PAGE NO
I A REVIEW OF PLANNING 1-3
i. Introduction
ii. Definition of planning
iii. Purpose of planning
iv. Characteristics of planning
v. Advantages of planning
II PLANNING COMMISSION 3-4
i. Structure of planning commission
ii. Functions of the planning commission
III HEALTH PLANNING 4-15
i. Introduction
ii. Concept of health planning
iii. Objectives of health planning
iv. National health planning
v. Planning process
vi. Elements in a health planning process
vii. Purpose of health planning
viii. Steps in health planning
ix. Levels of planning
x. Constraints of health planning
IV LEVELS OF PLANNING IN INDIA 15-24
V HEALTH AND FIVE YEAR PLANS 24-27
VI FIVE YEAR PLANS 27-43
VII VARIOUS COMMITTEE REPORTS ON HEALTH 43-48
VIII SUMMARY 48
IX RESEARCH ABSTRACT
X CONCLUSION 49
XI BIBLIOGRAPHY 50

VIJAYA COLLEGE OF NURSING

 COURSE–IIND YEAR M.SC (N)

Subject : nursing MANAGEMENT

Unit : unit III
Topic : PLANNING PROCESS
Name of the student : Mrs Merin Solomon
Name of the HOD : Mrs SMITHA MOHAN
Name of the Evaluator : Mrs SMITHA MOHAN
Hours Allotted : 2 HRS
Submitted to : Mrs SMITHA MOHAN
Date of Submission : 24-10-2019