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emedial and preventive services within the
reach of the people, particularly of that vast
sections of the community which lies scat-
tered over the rural areas and which has, in
the past, been largely neglected from the
point of view of health protection on modern
lines. Considerations based on inadequacy
of funds and insuffi ciency of trained
workers have naturally necessitated the suggestion
that the new organization should
fi rst be established over a limited area in
each district and later extended as
and when funds and trained
personnel become increasingly
available. Even
with such limitations
the proposed health
service is intended to fulfi ll,
from the beginning and in
an increasing measure as it
expands, certain requirements,
which are now generally
accepted as essential
characteristics of modern
health administration. These
are that curative and preventive
work should dovetail into each other and
that, in the provision of such a combined
service to the people, institutional and
domiciliary treatment facilities should be so
integrated as to provide the maximum benefi
t to the community. There should also be
provision in the health organization for
such consultant and laboratory services as
are necessary to facilitate correct diagnosis
and treatment. Our proposals incorporate
these requirements of a satisfactory health
service.
We have drawn attention to these aspects
of the health programme because we feel
that it is highly desirable that the plan
should be accepted and executed in its entirety.
We would strongly deprecate any attempt,
on the plea of lack of funds, to isolate
specifi c parts of the scheme and to give effect
to them without taking into consideration
the interrelationships of the component
parts of the programme. Our conception of
the process of the development of the
national health services
is that it will be a
D EVELOPMENTAL PLANNING
Planned failure gave ascendancy to
the private health sector to emerge
and conquer and exploit
cooperative effort in which the Centre, acting
with imagination and sympathy, will
assist and guide a coordinated advance in
the provinces. We therefore look forward to
a pooling of resources and personnel, as far
as circumstances permit, in the joint task
that lies before the governments. 6
The above was a good head start in
planning India’s health care system which
our fi rst Independent government inherited
but the tragedy is that the warning in
the preceding paragraph was ignored as
the 5-Year Plans only picked up small
pieces from the Bhore Committee Report,
diluted its recommendations and
implemented a plan which was doomed to
fail from the start. Each 5-Year Plan had
its own priority schemes — disease specifi
c programs, family planning, MCH,
training paramedics, setting up PHCs and
subcentres in rural areas, universal immunization,
community health volunteers,
RCH and the latest being NRHM.
The schemes not only segmented the
public healthcare system and developed
parallel structures which could
not work in unison but actually led
to scheming towards continued
failure of the public health system.
This is not to deny limited successes
of the public health system
— small pox eradication, malaria
control in the sixties, PHC network,
leprosy control, immunization, fertility
control, medical education – but in retrospect
these small successes appear like
sops when we look at what happened to
the larger health system. Infact it is this
planned failure which gave ascendancy to
the private health sector in India to
emerge and conquer and exploit.
Apart from the 5-Year Plans there were
also various committees over the years
like the Mudaliar Committee, Jain Committee,
Mukherjee Committee, Shrivastava
Committee, Kartar Singh Committee,
Chadha Committee, Chopra
Committee, Shah Committee, Simon
Committee, Hathi Committee etc and
each made its own specifi c and narrow
recommendations which only added to
the problem of segmentation and moving
further away from the comprehensive approach
of the Bhore Committee. And
then we had the two National Health
Policies of 1982 and 2003 which should
have been an opportunity to put a check
on the planned failure processes but they
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