The Bhore Committee, officially known as the Health Survey and Development Committee, was appointed by the Government of India in 1943 under the chairmanship of Sir Joseph William Bhore, a civil servant and former Secretary to the Government of India. The primary aim of the committee was to assess the existing health conditions and infrastructure in India and recommend a comprehensive framework for the development of public health services in the country. It was a landmark effort that laid the foundation for modern health planning in independent India.
At the time of the committee’s formation, India was under British colonial rule and was facing severe public health issues—widespread poverty, malnutrition, high maternal and infant mortality rates, rampant communicable diseases like malaria and tuberculosis, and a lack of organized medical services, especially in rural areas. The Bhore Committee was tasked with not just evaluating these problems but also formulating a plan that could ensure equitable access to health care for all sections of the population, irrespective of their socio-economic status.
The committee’s work was exhaustive and involved detailed surveys and consultations with Indian and British medical experts. In 1946, the Bhore Committee submitted its final report, which became a cornerstone of health policy and planning in post-independent India. The report strongly advocated for a state-sponsored, publicly funded health care system, emphasizing the importance of universal access, preventive care, and integration of medical services at all levels.
Aims of the Bhore Committee (Health Survey and Development Committee)
The Bhore Committee was formed in 1943 with a clear and ambitious vision to reform and develop the health system of India, which was in a severely underdeveloped state during colonial rule. The main aims of the Bhore Committee were rooted in the idea of universal access to healthcare, integration of preventive and curative services, and ensuring the health of the population as a national priority. Below are the key aims of the committee explained in detail:
1. To Conduct a Comprehensive Survey of Health Conditions in India
One of the primary aims of the Bhore Committee was to conduct a nationwide survey of the existing health infrastructure, facilities, and services. The government needed a detailed understanding of the actual conditions of public health, disease burden, and medical resources across rural and urban areas. The committee was tasked with collecting data on hospitals, dispensaries, manpower, sanitation, nutrition, and maternal and child health services. This survey was to serve as the foundation for planning a structured and efficient health system.
2. To Propose an Integrated System of Healthcare
A major aim of the Bhore Committee was to recommend an integrated healthcare system that would combine both preventive and curative services at every level of care. At the time, curative care (treating diseases) dominated the system, while preventive services (like vaccinations, hygiene promotion, and disease prevention) were neglected. The committee wanted to shift this model by building a three-tier structure — Primary Health Centres, secondary district-level hospitals, and tertiary-level teaching and referral hospitals — where both types of care would be equally emphasized. This integration was intended to improve health outcomes and reduce the overall disease burden.
3. To Ensure Accessible and Equitable Healthcare for All Citizens
The Bhore Committee strongly advocated for universal access to free and quality healthcare. One of its core aims was to make medical services available to every individual, regardless of socio-economic status, caste, religion, or geographic location. It proposed a publicly funded health system, where healthcare would be a right, not a privilege. The committee emphasized that rural populations, which comprised the majority of India at the time, had very limited access to health services, and this inequality had to be addressed by expanding infrastructure in rural areas and training health workers to serve in those regions.
4. To Recommend Reforms in Medical and Nursing Education
Another important aim of the Bhore Committee was to reform the system of medical education in India. The committee felt that medical training at the time was largely based on urban hospitals and had little relevance to the public health needs of the country. It recommended a curriculum that would be socially oriented and would train doctors and nurses to work in rural and underserved areas. It also aimed to improve the quality and quantity of medical and nursing professionals and suggested the creation of one medical college per one million population to meet the growing health demands.
5. To Lay the Foundation for a Long-Term National Health Policy
The committee aimed to provide a blueprint for a long-term health development plan in India. It was not just concerned with short-term relief or temporary measures, but with building a sustainable and comprehensive health system for the future. Its recommendations were intended to shape health policy and planning in post-independence India, including infrastructure development, health financing, and human resource planning.
Recommendations of the Bhore Committee (1946) – In Detail
The Bhore Committee made a number of far-reaching and visionary recommendations to transform the Indian healthcare system. These recommendations were guided by the principles of equity, universality, and integration of healthcare services. The committee proposed reforms not only in healthcare delivery but also in medical education, public health, and health financing. Below is a detailed account of the major recommendations:
1. Development of a Three-Tier Healthcare System
The committee proposed a three-tier system of healthcare services to ensure organized and equitable distribution of services:
- Primary Health Centres (PHCs):
- One PHC for every 10,000 to 20,000 people in rural areas.
- Each PHC to include a team of general practitioners, nurses, public health nurses, and midwives.
- Designed to provide comprehensive preventive, promotive, and curative services.
- Secondary Health Units (District Hospitals):
- Larger hospitals with bed capacity of 650 or more.
- To provide specialist care and to serve as referral centers for PHCs.
- Also responsible for supervision and training of staff in primary units.
- Tertiary Health Units (Teaching Hospitals and Medical Colleges):
- Advanced hospitals for specialized treatment, research, and training of medical personnel.
- These institutions were to be linked with universities and involved in national-level health planning.
2. Integration of Preventive and Curative Services
At the time, preventive and curative services were operated separately. The committee recommended that these should be integrated at all levels:
- Medical officers should be trained and responsible for both preventing disease and treating illness.
- Every health center should offer maternal and child health services, sanitation, vaccination, and health education, along with outpatient and inpatient treatment.
3. Universal Health Coverage – Free for All
The committee strongly recommended that health services should be made available to all citizens without any cost. Key points:
- Free, state-funded medical care for everyone, rich or poor.
- The government should bear the responsibility for providing comprehensive healthcare.
- Financial barriers to accessing healthcare must be eliminated.
4. Emphasis on Rural Healthcare
Since the majority of the Indian population lived in rural areas, the committee prioritized the development of rural health services:
- A network of rural health units to reach even remote villages.
- Training of village-level health workers and midwives to support local health needs.
- Creation of mobile health units to serve underserved areas.
5. Reforms in Medical and Nursing Education
The Bhore Committee strongly advocated for a socially oriented medical education system, with these recommendations:
- The curriculum must include training in preventive and social medicine.
- More emphasis on community health and rural service.
- Establish one medical college per one million population to meet future manpower needs.
- Encourage production of multipurpose health workers who can deliver basic health services across multiple domains.
6. Long-Term Health Planning and Policy Framework
The Bhore Committee envisioned a long-term, phased development of health services in India:
- Short-Term Program (10 years):
- Strengthen existing services.
- Start building primary health units.
- Train more doctors, nurses, and health workers.
- Long-Term Program (30–40 years):
- Establish full three-tier structure nationwide.
- Create adequate medical colleges and public health schools.
- Achieve universal health coverage for all citizens.
7. Health Manpower Planning
- Increase the number of doctors, nurses, midwives, and other health workers.
- Set up new training institutions.
- Provide incentives to serve in rural areas.
8. Health Administration and Supervision
- Strengthen the role of the central and state governments in health policy and management.
- Establish local health authorities for decentralized management.
- Build an efficient administrative structure with trained personnel at all levels.
9. Public Health Research and Statistics
- Promote research in epidemiology, nutrition, and social medicine.
- Establish a central health intelligence bureau to collect and analyze health statistics for planning and evaluation.
10. Emphasis on Health Education and Awareness
- Introduce health education programs in schools and communities.
- Use mass media and public campaigns to promote hygiene, nutrition, vaccination, and family planning.
Implementation of Bhore Committee Recommendations
Although the Bhore Committee Report (1946) was a visionary document that laid the foundation of India’s public health system, its implementation was gradual and faced several challenges, especially in the post-independence period when the country was struggling with economic constraints, partition, and the need for nation-building. However, several key recommendations were adopted and became the cornerstones of India’s healthcare policy over the following decades.
1. Introduction of Primary Health Centres (PHCs)
One of the major successes of the Bhore Committee’s implementation was the establishment of Primary Health Centres (PHCs).
- In 1952, during the First Five-Year Plan, the Indian government launched the Community Development Programme, which included setting up PHCs as the first point of contact for rural populations.
- These PHCs were designed to provide integrated preventive, promotive, and curative services.
- Initially, the target was one PHC per 30,000 people (higher than the Bhore Committee’s recommendation of 10,000–20,000), but it was a major step toward rural health outreach.
- Over time, Sub-Centres and Community Health Centres (CHCs) were also added to strengthen the three-tier structure.
2. Rural Health and Family Welfare Services
The committee’s emphasis on rural healthcare led to several national-level programs:
- National Extension Service (1953) aimed to expand health services to villages.
- Family Welfare Programme (1950s onwards) was introduced to control population growth and improve maternal and child health.
- Rural Health Training Centres (RHTCs) and Urban Health Training Centres (UHTCs) were started for training health workers and medical students in community health.
3. Integration of Preventive and Curative Services
The idea of integrating preventive and curative healthcare was accepted in principle and partially implemented:
- PHCs and CHCs were designed to provide both types of services.
- Vertical disease control programs (like malaria, tuberculosis, and leprosy control) were launched as standalone units initially but were later merged into the general health system.
- The National Rural Health Mission (NRHM) launched in 2005 further emphasized integration by strengthening infrastructure and bringing disease control programs under a single framework.
4. Development of Health Manpower
In line with the committee’s vision of expanding medical education:
- A large number of medical and nursing colleges were established after independence.
- Special focus was given to training auxiliary nurse midwives (ANMs) and multipurpose health workers (MPHWs) to serve at the grassroots level.
- In 1983, the National Health Policy reiterated the need for trained health personnel in rural areas and encouraged rural postings.
5. Free and Universal Healthcare – Partial Realization
While the Bhore Committee recommended free and universal health coverage, its full implementation has not been achieved:
- Government hospitals and PHCs do provide free treatment, but there are limitations in terms of availability of medicines, staff, and equipment.
- Many people continue to seek care in the private sector, leading to out-of-pocket expenditure.
- Recent initiatives like Ayushman Bharat (2018) aim to move closer to universal healthcare by offering free secondary and tertiary care to economically weaker sections.
6. Health Planning through Five-Year Plans
The recommendations of the Bhore Committee were reflected in India’s Five-Year Plans, especially in the early decades:
- First Five-Year Plan (1951–56) focused on building PHCs and launching community development programs.
- Subsequent plans emphasized maternal and child health, disease control, rural health infrastructure, and health education.
- Planning bodies like the Planning Commission and Central Council of Health were established to oversee health planning.
7. Establishment of Public Health Institutions
To support research, policy, and training, several national-level institutions were established:
- All India Institute of Medical Sciences (AIIMS) – 1956, for advanced medical education and research.
- National Institute of Health and Family Welfare (NIHFW) – for training and health planning.
- Indian Council of Medical Research (ICMR) – strengthened to conduct health research and disease surveillance.
8. Medical Education Reforms – Limited Progress
Although some reforms were undertaken:
- The integration of preventive and social medicine into the MBBS curriculum was started.
- However, the committee’s idea of socially oriented medical education and compulsory rural service for doctors is still only partially enforced.
- The shortage of doctors and reluctance to serve in rural areas remains a challenge.
9. Health Financing – Gaps Remain
- The committee recommended that health should be financed by the state, and services should be free.
- In reality, government health expenditure remained low for decades (often below 2% of GDP).
- High out-of-pocket expenditure persists, though Ayushman Bharat and state insurance schemes are now trying to reduce this burden.