The pre independence era Bhore committee reforms that could have saved a modern day India

The ravaging crisis that the coronavirus pandemic has unfolded as over the past one year and a half in different parts of the globe have bring into focus such quintessential aspects of the human existence that still remain appallingly rooted in the what could have beens rather than the whats that are being. With even the most advanced of healthcare systems thrown into disarray by the COVID 19 disease, the effectiveness of the extent of thrust placed on health by the modern society was left glaringly desirous of some serious review. But while most countries managed to crawl back to a decent state of survival from the mayhem unleashed when the virus started doing the international rounds, not every nation of the world has been fortunate enough to have things more or less on track. India in particular has been reeling under the second wave of the modern day pandemic for more than a month now in its peak, that came across as quite a blow to the country’s healthcare mechanism that had been somewhat efficient in its response to the maiden outbreak. It perhaps has been that one long year of enduring immense pressure that had made India’s health system vulnerable enough to be caught totally unawares when the country suddenly found itself embroiled in a more intense second wave of the virus, overwhelmed as it had been by the lack of adequate facilities and apathy on the part of the administration as well as the public. Shaken, disrupted and almost in shambles now over unavailability of critical but basic means of assistance that left thousands across the country dead, India’s present day healthcare system seems to be more a farce than a modern day robust exercise of fruition designated to save precious human lives, unraveling across its seemingly lofty premises as an account of a land that sought to build on the recommendations of a committee worked out more than half a century back on idealistic modern lines, the vision of which remains still relevant but still ignored, disregarded and maybe even looked down upon as a document not set in the highly scientific realisations of the 21st century.

Way back in the 1940’s, between the years of 1943- 46 to be precise, when India wasn’t even an independent country yet, the country had its first encounter with something as essential as a health policy, with the British administration yielding in to demands that called for a holistic approach to address health concerns of the subjugated Indian population after decades of criticism directed towards their neglect of the same. In the absence of any leading Indian nationalist leaders who by that time were confined to jails after the Quit India Movement of 1942, a committee was set up by the then Viceroy under the chairmanship of Indian civil servant Sir Joseph William Bhore and named after him as the Bhore Committee, to assess the health condition of the country. With members of the Indian Medical Services and a number of foreign experts on board, the Health Survey and Development Committee set about work to bring into place a structured health policy that would be based on the notions of free universal healthcare for all Indians by the government, without leaving much at stake for the private players. The committee met consistently over a period of two years from 1944 to 1946 deliberating and contending healthcare measures that would best serve the interests of the common Indian people with pioneers of the field putting forward several recommendations and suggestions that was presented as a four volume report a year prior to India securing her independence.

Even then, with a comprehensive health plan in place, it still took the Indian government some thirty five years to come up with a concrete health policy statement sometime in 1982- 83. That even when, the government had for reference the well studied and minutely documented plan put forward by the Bhore committee that was surprisingly progressive and thereby well ahead of its times. Drawing a detailed plan of a countrywide National Health Service that required structural changes to be brought about to the existing healthcare system to attain a decent minimum standard, the committee found favor also with leaders of an independent India, particularly with the Indian National Congress, despite its seed having been sown by the British owing largely due to its realistic presentation of facts. In fact, with the National Planning Committee of the Indian National Congress preparing its own report on the health scenario of the country and the modifications needed to be effected therein, both these two substantial documents of public health requirements were in sync with their focus on developing a health service that would be modern in every sense of the term.

Ambitious even when being rooted in the core requirements of the general public, most of whom dwelled in rural areas with not sufficient access to even the basic healthcare provisions, the recommendations by Bhore and his team of renowned health officials stressed immensely on devising and free and fair scheme of universal health care, in line with what had been the norm in other advanced countries of the world, including Britain. But while the committee did indeed suggest a slew of reforms to be enacted into the existing healthcare mechanism of India of that time, at the centre of all these proposals was their Three Million Plan, a figure that was chosen arbitrarily to represent a district and around which the introduction of the whole set of reforms revolved. A District Health Center was envisaged to be put in place for each district with provisions to set up primary and secondary health centers also planned in accordance with the purview of the population. Another revolutionary module that the Bhore Committee worked into the health system was the creation of a new class of health workers or Health Assistants as well as introducing major changes in the sphere of medical studies in the country. But finding not so much favor with the committee was the traditional Indian medical alternative of ayurveda, with references yet to the prevailing notions in other countries. Nevertheless however, the proposals of the committee were accepted by the Government of India in 1952 though most of the reforms were not effected immediately. A couple of recommendations were enacted right away, like the establishment of the first Primary Health Centre as well as the abolition of the Licentiate in Medical Practice to replace it with the single medical qualification of an MBBS degree as the requirement to become a doctor in 1952 and the setting up of the All-India Institute of Medical Sciences in 1956.

Taking cues from the Welfare State movement in the U.K. and the socialist developments in the USSR, the Bhore Committee report therefore emerged as a consciously comparative account of what the health care system in India should be all about in order to ensure the all round development of a healthy Indian population, not discriminated on basis of either the prevailing urban- rural divide nor on the stark differentiation of economic status and income. Committed to the vision of a comprehensive health service that would take into consideration both the preventive and curative aspects of medical facilities, the Bhore committee also took into cognizance the working in such fields of diverse social background that are intricately related to the growth and development of a healthy population. But despite such self evident measures for correcting the wrongs ailing the healthcare system of India at a time when she had been under the rule of a foreign power having been prescribed since long, it is quite a dismal reality that the current state of affairs governing what is otherwise a fast developing nation is not very different from what it had been at the time of independence. While efforts to boost the health of the economy have been spurred by very active mode of working, not the same can be said about the public healthcare scenario of the country that continues to suffer from gross anomalies. In stark contrast to the breakthrough sought to be achieved under the Bhore committee recommendation, what the Indian healthcare system has been led into is a scenario that resides in appalling government apathy on one hand and rampant private exploitation on the other. And in the midst of all these, thus we continue to languish in a state of affairs that is deplorable and gloom, with no one to hold responsible for, for a fiasco that is today a grave national problem all right but more than that a gross understatement of the value of precious human lives.