https://www.researchgate.

net/publication/290447383_Historic
al_Development_of_Health_Care_in_India
Abstract
In India, hospitals have existed from ancient times. Even in 6th
century BC, during the time of Buddha, there were a number of
the hospitals to look after the handicapped and the poor. The
outstanding hospitals in India at that time were those built by
King Ashoka (273–232 BC). Books written by Arabian and
European travellers (around AD 600) reveal that the study of
medicine in India was in its bloom. The zeal of the native
vaidyas for the investigation of the Indian flora slackened for
want of encouragement. The invasion of foreigners in the 10 th
century AD brought with them their own physicians called
Hakims. The use of the Allopathetic system of medicine
commenced in the 16th century with the arrival of European
missionaries. It was during the British rule that there was
progress in the construction of hospitals. Organized medical
training was started in the 19th. Century

Historical Development of Health Care in India In India,

hospitals have existed from ancient times. Even in 6th century
BC, during the time of Buddha, there were a number of the
hospitals to look after the handicapped and the poor. The
outstanding hospitals in India at that time were those built by
King Ashoka (273–232 BC). Books written by Arabian and
European travellers (around AD 600) reveal that the study of
medicine in India was in its bloom. The zeal of the native
vaidyas for the investigation of the Indian flora slackened for
want of encouragement. The invasion of foreigners in the 10th
century AD brought with them their own physicians called
Hakims. The use of the Allopathetic system of medicine
commenced in the 16th century with the arrival of European
missionaries. It was during the British rule that there was
progress in the construction of hospitals. Organized medical
training was started in the 19th century. Ancient Period VEDIC
PERIOD Indus valley culture was so developed that it
assimilated the Aryan culture, although the Aryans brought
their own gods and medical knowledge. The chief sources of
knowledge of the Aryan culture and medicine are the four
Vedas (Rig, Sama, Yajusa, and Atharva Veda). Atharva Veda is
full of hymns and prayers, indicating ways and means to protect
people against many kinds of diseases and natural disasters.
Physical and mental ingredients of positive health were a
genuine concern of people in the Vedic period as is evident
from Yajur Veda (16/4), meaning that the world should be free
from diseases and (every body) should have a healthy mind.
The Ayur Veda (Ayush means life, Veda means knowledge)
means science of life. How to prolong life figures in the Ayur
Veda. Traditional medicine is based on Ayur Veda. Charaka, a
court physician of King Kanishka, further developed it.
Dhanvantari, the patron god of Indian Medicine, also initiated
many methods of healing and passed it to Sushruta, who was
the celebrated surgeon of his time. THE BUDDHIST PERIOD
(563–477 BC) Lord Buddha himself took very keen interest in
supporting the science of medicine. However, Indian surgery
received a setback during this period because of the doctrine of
Ahinsa. Lord Buddha used to attend to the sick himself. To look
after the sick was treated as a noble cause. During the course of
his travel for propagating Buddhism, Buddha created Buddhist
Viharas (monasteries) in different places, and in all the Viharas,
care of the sick and medical education was given special
attention. 24 ‹ Health Planning: Past, Present and Future
Medieval Period POST-BUDDHA AND MUSLIM PERIOD Emperor
Ashoka established many hospitals throughout the country.
With the advent of Muslim rule from the 10th century onwards,
middle east physicians trained in the Unani system created
their impact. The
main impact was curative approach. Emperor Akbar (1555–
1605), during his period, encouraged the amalgamation of the
Unani and Ayurvedic systems. The most significant
achievement was the translation of medical texts in Arabic,
then into Persian and later into Urdu. The impact of Muslim
dominance was very apparent. It started declining after the
Portuguese conquered Goa in 1510. CHRISTIANITY AND
MEDICAL CARE Hospitals became an integrated part of church
and monasteries. Medicine was treated as a religious practice,
and all missionaries like nuns and monks used to be trained to
take care of the sick. Between AD 1100–1300 as many as
19,000 hospitals were founded in Europe to cater to those
suffering from war injuries and diseases. During 1300–1800,
although the knowledge of medicine was broadened, care in
hospitals was not of high standard. Crowding and infection
were prevalent in hospitals till the middle of the 19th century.
Florence Nightingale revolutionized the working of hospitals
and this was the beginning of the era of ‘Better Patient Care’.
Modern Period of Medicine The Portuguese founded the Royal
Hospital in Goa between 1510 and 1515, and later the Jesuits
introduced basic general medical training programme at the
hospital. In 1842 this was converted into school of medicine
and surgery. Although the Portuguese first brought modern
medicine to India, it was the French and the British who later
established the first hospitals in 1664 and 1668, respectively.
The first medical school was started in Calcutta, followed by
Madras in 1846. Along with the spread of British rule over the
country, local government encouraged establishment of
dispensaries at sub-division and district level. At provincial
levels the hospitals were converted into teaching hospitals
attached to medical colleges. In 1885, there were 1250
hospitals and dispensaries in British India. Slow progress
continued, and on the eve of independence there were 7400
hospitals and dispensaries in the country with 1,13,000 beds,
that is, a bed population ratio of 0.24 per 1000 population.
There were 47,000 doctors and 7000 nurses, 19 medical
schools, and 28 medical colleges in the country at that time. In
1943, the Government of India appointed a Committee called
the Health Survey and Development Committee headed by Sir
Joseph Bhore and having nineteen other members. This is the
only authentic record depicting hospital development and
health care system in pre-independence India, that is, before
1947. The report was submitted in 1946. The report
recommended upgrading of medical care in various forms, such
as medical relief in the form of primary health centre at the
village level, secondary health centre at sub-division level
(Taluka level), and district hospitals at district headquarters,
with all the specialist services. It was anticipated that the bed
population ratio could rise to 1.3 per 1000 population in 10
years and to 5.6 in 25 years. Bhore Committee had stated in
their report that the health service should be available to all
citizens, irrespective of their ability to pay for it and it should be
complete medical service, domiciliary and institutional, in which
all the facilities required for the treatment and prevention of
disease as well as for the promotion of positive health are
provided. The efforts of health administrations at earlier stages
were directed towards the alleviation of suffering and
rehabilitation of the sick. The idea of prevention came later,
partly as a result of the observation that diseases were often
communicated from a patient to those in close association with
him. The concept of segregation of the sick and infection
control started. The development of modern sciences, such as
bacteriology, parasitology, and pathology in the later half of the
last century, brought to the forefront the importance of specific
organisms as the causative agents
for individual diseases. Similarly, the importance of
environmental hygiene was felt. The coordinated effort of
prevention, treatment, and rehabilitation brought out more
desired results. The then Government took certain steps which
are important landmarks in the history of health administration
in India. They are as follows: 1. The appointment of Royal
Commission to enquire into the health of the Army in India in
1859. 2. The report of Plague Commission in 1904 following the
outbreak of plague in 1896. 3. Reforms introduced by
Government of India Act for Health, 1919. 4. Reforms
introduced by Government of India Act for Health, 1935. The
above reports and Acts created top posts of various categories
in the central and state governments, respectively. The
Government of India Act of 1919 gave statutory sanction to
decentralize the health administration to provinces which
included medical administration, hospital administration, etc.
The Act of 1935 further granted larger autonomy to provincial
legislatures. The Centre further passed some legislation, such as
the Quarantine Act 1825, Vaccination Act 1880, Medical Act
1886, Epidemic Diseases Act 1897, Indian Factories Act 1911,
Poisons Act 1919, Indian Red Cross Act 1922, Dangerous Drugs
Act 1930, Indian Port Health Rules 1938, Indian Air Craft Public
Health Rules, etc., to streamline health administration. Health
Administration in Provinces Provincial health administration,
under normal condition, was under the charge of a minister
responsible to the legislature. He had two technical advisors
who were responsible for hospitals and for the administration
of the medical and public health departments, respectively.
They used to be called Surgeon General or Inspector General of
Civil Hospitals and Officer Incharge of the Public Health
Department, also known as the Director of Public Health. In
some places the Director of Public Health had to look after
prisons also. Thus, the officer used to be called Director of
Health and Prison Services. Local bodies were responsible for
health administration in their respective territories. District
boards constituted the local authorities for the non-municipal
areas in the districts. The power conferred on these authorities
in respect of health matters related to general sanitation,
control of infectious disease, control of the purity of food and
water supplies, etc. During the British period, hospital care was
mainly provided for army personnel, and public health never
went beyond sanitation and hygiene work in larger cities.
However, it is an accepted fact that the British had left a good
framework for developing a health care delivery system. Post-
Independent India India became an independent nation in 1947
after remaining under foreign domination for more than 150
years. The economic, social, religious, and political exploitation
during this period was beyond comprehension. On one side
independence brought delight and joy but on the other hand it
faced problems like population explosion, retarded economic
development, mass illiteracy, and multilingual problems, etc.
The Government of India set up the Planning Commission in
1950 to prepare a plan for the most effective and balanced
utilization of the country’s resources. In all plan periods, health
had a separate allocation, but it always received a low priority.
Health being a state subject led to every state having its own
plan. However, the main thrust of Centre was to start the
community development programme and national extension
movement. The community development programme pledged
itself towards self help. The concept of democratic
decentralization
adopted by the government theoretically shifted the
responsibility for health to the people themselves, through the
Panchayatraj system. In actual practice it was a failure, except
for the opening of 725 Primary Health Centres, and some effect
on control of communicable disease. In course of time, when
the government found that recommendations of Bhore
Committee (1946) were too ambitious, it set up The Health
Survey and Planning Committee, popularly known as Mudaliar
Committee, in 1959. This Committee was set up with the
following aims: 1. To assess the progress in the field of medical
relief and public health service since the submission of the
Bhore Committee report. 2. To review the progress of First and
Second Five Year Plans (Health Projects). 3. To formulate
recommendations for the future plan of Health Development in
the Country. The Health Survey and Planning Committee
submitted its report in 1961. This report was submitted some
15 years after the Bhore Committee, 10 years after the
introduction of programmed systematic development in the
form of Five Year Plans. The result of systematic approach
towards health care development programme has paid
dividends in the field of control of epidemic diseases such as
plague, cholera, malaria, and eradication of smallpox. Study
Group on Hospitals—1966 After independence, under three
Five Year Plans Rs 770 crores were spent but the results were
not all that spectacular. This led the Ministry of Health and
Family Planning, Government of India to set up the study group
on hospitals in August, 1966. The study group was required to
take into consideration the findings of previous committees
that had examined different aspects of hospital administration,
shift the material already available in those reports, and
demarcate the fields to be further strengthened. Its
ecommendations were to be made with due regards to the
financial position and the known insufficiency of manpower.
More specifically, the recommendations of the group were
invited on the following: 1. The future pattern of development
of hospital services at the regional, district, and peripheral
levels in terms of size and facilities to be provided; the
requirements of specialist hospital facilities, such as infectious
diseases, tuberculosis, mental diseases, paediatrics, chronic and
convalescent homes; and phased programme of development
to achieve the recommended targets. 2. Measures required for
integrated development of hospital services so that peripheral
units like health centres, dispensaries, M.C.H. centres work in
close coordination with the hospital, which acts as the referral
centre; specialist coverage of the peripheral units and referral
hospitals by the teaching hospital in the region so that two or
three districts have the medical college as a final referral
centre. 3. Appropriate standards of staffing, drugs, diets, linen,
etc., for hospitals of various sizes. 4. Provision of hospital
pharmacies, central sterilization facilities and other services like
proper kitchens, mortuaries, medical record system, sanitation,
and security arrangement, etc. 5. Measures for the
augmentation of resources available for medical care facilities,
including those of pay clinics, system of graded charges for
services rendered, health care, etc. 6. Facilities for family
planning. 7. Any other matter relevant to the objectives and
purpose of the study. Summary of Report Public Health and
allied subjects developed in state governments under the
Government of India Act, 1935, remained as they were even
after India became independent. Thus, to ensure a coordinated
approach to the problem of health and medical care, Central
Council of Health, with the Union Minister of Health as its
Chairman and State Health Ministers as its members, was set
up by the President under
article 263 of the Constitution of India in August, 1952. It was
required to: • consider and recommend broad lines of policy in
regard to matters concerning health in all aspects, such as the
provision of remedial and preventive care, environmental
hygiene, nutrition, health education, and the promotion of
facilities for training and research; • make proposals for
legislation in fields of activities relating to medical and public
health matters, laying down the pattern of development for the
country as a whole; • examine the whole field of possible
cooperation on a wide basis in regard to inter-state quarantine
during times of festivals, outbreaks of epidemic diseases and
serious calamities, such as earthquakes, famines, and draw up a
common programme of action; • make recommendations to
the Central Government regarding distribution of available
grants-in-aid for health purposes to the states, and to review
periodically the work accomplished in different areas through
the utilization of these grants-in-aid; and • establish
organization or organizations invested with appropriate
functions for promoting and maintaining cooperation between
the Central and State Health Administration. Findings and
Recommendations 1. The Committee found that the
recommendations of the Bhore and Mudaliar Committees were
not related to the availability of the financial resources of the
country. Although the proposals of the Mudaliar Committee
were modest as compared to those of the Bhore, but owing to
the paucity of resources the results achieved were nowhere
near the prescribed targets. To quote an instance: the Bhore
Committee had recommended that a district hospital should
have a minimum of 500 beds under the short-term plan and
2500 beds under the long-term plan. The Mudaliar Committee
recommended 300–500 beds for a district hospital. The
Committee found that only 125 district hospitals (the teaching
hospitals are excluded) had 200 beds or more while the
remaining 210 district hospitals had less than 200 beds. The
hospitals with 200 beds or less suffered from inadequacy of
nursing staff, equipment, drugs, and diet. 2. The Committee
recommended the following pattern of development for
hospital beds and suggested that it be attained by the year
1971: Teaching Hospitals 500 (to be increased according to the
number of students) District Hospitals 200 (may be raised upto
300 beds depending on population) Tehsil/Taluq Hospitals 50
(may be raised depending on population) Primary Health
Centres 6 (may be increased to 10 depending on needs) 3. The
committee recommended that in each of the 210 district
hospitals having less than 200 beds, the strength should be
raised to minimum 200 beds. In the remaining 125 districts, the
bed strength, depending upon the population served, may be
raised upto 300. Ordinarily, the distribution of these beds
should be on the following pattern: Medical 60 Surgical 40
Gynaecology and Obstetric, including Maternity 35 Paediatrics
15 Orthopaedics 5 Eye 10 ENT 5 Skin 5 Emergency 5 Isolation 10
Psychiatry 5 Others 5 200 4. The Committee recommended
support to Voluntary Health Organizations. It also made the
following recommendations: • Introduction of referral system
in true sense is essential. • Convalescent homes to be set up in
cities whose population is more than 5 lakhs. • Medical inns
may be set up in the vicinity of bigger hospitals, preferably by
private bodies, where patients and their relatives from rural
areas may stay on payment during the period of diagnosis of
disease. 5. Apart from the above, the Committee also
suggested establishing 5080 Primary Health Centres, and
specific recommendations were made on the pattern of staffing
of various services in hospitals. For augumentation of
resources, levy charges and health cess on various facilities
were suggested. During the second half of the twentieth
century, many more concerted efforts have been made to
improve the health care delivery system in India. To further
improve the working of hospitals, K. N. Rao Committee (1968)
and Dr Siddhu Committee (1979) were formed. A separate cell
is pursuing the follow-up in Ministry of Health and Family
Welfare, Government of India. India is also one of the signatory
of Alma Ata declaration for achieving the global goal of ‘Health
for All by AD 2000’. Health Committees Though all Committees
have contributed towards improving health services delivery in
India, the reports of the Bhore Committee, Mudaliar
Committee, Jain Committee, Kartar Singh Committee,
Srivastava Committee, Sidhu Committee, and Bajaj Committee
will continue to guide the national health policy. The era of
scientific planning in India started with the establishment of the
Planning Commission in 1950. Health is fundamental to
national progress. Health programmes contribute directly to
the socio-economic growth of the nation. The Government of
India has, therefore, been giving due attention to health in its
Five Year Plans, which has led to considerable improvement in
the health of its people. There has been progressive increase in
the outlay of health plans since 1950–1 till date (Ninth Plan:
1998–2002). Through the plans, specific programmes were
formulated, health care institutions were built, health
professionals were trained, logistics were provided, etc. Though
health is largely the responsibility of states, the Central
Government is responsible for higher education, research, and
national health programmes, for example, family welfare,
primary health care; and prevention, control, and eradication of
major diseases which form the main plank of development
efforts. Apart from these, the Union Ministry of Health also
takes special care for preventing the spread of diseases
assuming the dimension of epidemic. In addition to the
schemes sponsored by the Centre, the Ministry has various
World Bank sponsored projects such as District Health System
Projects and control of various diseases such as AIDS,
tuberculosis, malaria, blindness, and leprosy, which are
implemented through the states. The Centre organizes facilities
for health care of its employees and pensioners living in the
capital and other major cities through Central Government
Health Scheme and public hospitals. The health of the people is
not only a desirable goal, but is also an essential investment in
human resources. The National Health Policy (1983) reiterated
India’s commitment to attain HFA by the year 2000. Primary
Health Care has been accepted as the key to achieve this
objective. The National Health Policy affirmd that the effective
delivery of health care services depends largely on the nature
of education,
training, and appropriate orientation towards community
health of health professionals. It is imperative that the entire
basis and priorities are reviewed and medical education
restructured accordingly. Perspective Good health of people is
not only a desirable goal, but also an essential investment in
human resources. India has achieved many spectacular results
in the field of health since Independence and statistics
substantiate it. The crude mortality rate has declined from 27.4
per 1000 population during 1947 to 8.9 in 1996, and infant
mortality rate has been brought down from 134 per 1000 live-
births to 72 over the same period. Life expectancy has risen
from a mere 32 years to 62 years. These health improvements
have done much to enhance human welfare. A series of
activities have been organized since 15 August 1997 in various
health care institutions as part of observance of fiftieth
anniversary of Independence. Special health check-ups were
conducted for mothers, children, the elderly, the hearing
impaired, and other physically handicapped persons in various
institutions across the country. The Department of Health has
made strategic interventions to ensure more vigorous
implementation and to improve the effectiveness of different
National Health Programmes aimed at combating
communicable and non-communicable diseases. A model
citizen’s character has been drawn up for the Central
Government Hospitals to raise the quality of their services,
introduce transparency and accountability, and to provide
services with courtesy and efficiency to the patient. The
National Population Policy was approved by cabinet on 20
November 1997. The overall strategy of Government of India is
to simultaneously strive for obtaining Reproductive and Child
Health arrangements for the whole of country’s population;
and make available quality contraceptive methods. The
Constitution of India envisages the establishment of a new
social order based on equality, freedom, justice, and the dignity
of the individual. It aims at the elimination of poverty,
ignorance, and ill-health and directs the state to regard the
raising of the level of nutrition and the standard of living of its
people and the strength of its workers, men and women,
specifically ensuring that children are given opportunities and
facilities to develop in a healthy manner. All health and human
development must ultimately constitute an integral component
of the overall socio-economic development process. It is
essential to ensure effective coordination between the health
services and its related sectors. REFERENCES Central Bureau of
Health Intelligence (1998). Health Information of India, Ministry
of Health and Family Welfare, New Delhi. Goyal R. C. (1993).
Handbook of Hospital Personal Management, Prentice Hall of
India, New Delhi, 17–41. Ministry of Health and Family Welfare
(1984). National Health Policy, Annual Report (1983–4),
Government of India, New Delhi