Health Five-Year Plans in India

Health Five-Year Plans in India

 

Introduction

• After independence in 1947, India adopted planned economic development to ensure balanced progress in all sectors, including health.
• The Planning Commission (1950) was established to formulate, implement, and monitor Five-Year Plans.
• The health sector was seen as a state subject, but the Union Government played a key role in policy-making, financing, and national health programs.
• The approach evolved over time from basic health infrastructure building (1st–3rd Plans), to disease control and family planning (4th–6th Plans), to universal coverage and health system strengthening (7th–12th Plans).
• With the abolition of the Planning Commission in 2015, NITI Aayog replaced centralized planning.

Overview of Health Sector in Different Five-Year Plans

1st Five-Year Plan (1951–1956)

• Focus: Laying foundation of health services, especially in rural India.
• Key Elements:
• Development of Primary Health Centres (PHCs) and Community Development Program (1952).
• Strengthening of medical education and training institutions.
• National programs for malaria control, tuberculosis, leprosy, and maternal & child health (MCH).
• Approach: Building a basic infrastructure for preventive and curative health.

2nd Five-Year Plan (1956–1961)

• Focus: Expansion of health services and integration with community development.
• Key Elements:
• Strengthening PHCs and sub-centres.
• Family planning introduced as a national program (1952 → expanded in this plan).
• Development of district hospitals and training of multipurpose health workers.
• Emphasis on rural healthcare to meet community needs.

3rd Five-Year Plan (1961–1966)

• Focus: Consolidation of gains and greater emphasis on family planning.
• Key Elements:
• Creation of district extension services in health and family planning.
• Expansion of hospital facilities at state and district levels.
• Programs for water supply, sanitation, and communicable disease control.
• Indo-China war (1962) and Indo-Pak war (1965) diverted funds, limiting achievements.

Plan Holiday (1966–1969)

• Three annual plans due to financial crisis.
• Focus remained on family planning and disease control.

4th Five-Year Plan (1969–1974)

• Focus: Consolidation of health infrastructure and control of communicable diseases.
• Key Elements:
• Integrated health and family planning services.
• Emphasis on population stabilization.
• Urban hospitals expanded but rural gaps persisted.
• First major attempt to integrate vertical health programs.

5th Five-Year Plan (1974–1979)

• Focus: Equity in health services and poverty alleviation.
• Key Elements:
• Launch of Minimum Needs Programme (MNP, 1974) – provided rural health services, nutrition, water supply, electrification.
• Emphasis on training of village health guides and multipurpose workers.
• ICDS (Integrated Child Development Services, 1975) launched to improve nutrition and child health.
• Focus shifted toward primary health care and community participation.

6th Five-Year Plan (1980–1985)

• Focus: Health for All by 2000 (as per Alma-Ata Declaration, 1978).
• Key Elements:
• Strengthening of primary health care system.
• Expansion of ICDS and universal immunization.
• National Malaria Eradication Programme redesigned as malaria control.
• Special programs for blindness control, leprosy, TB.

7th Five-Year Plan (1985–1990)

• Focus: Consolidating primary health care.
• Key Elements:
• Launch of Universal Immunization Programme (UIP, 1985) → later became part of CSSM and NRHM.
• Greater emphasis on maternal and child health.
• Strengthening of health manpower training.
• Progress toward Health for All (2000) continued.

8th Five-Year Plan (1992–1997)

• Focus: Population stabilization and strengthening health infrastructure.
• Key Elements:
• Child Survival and Safe Motherhood (CSSM, 1992) launched.
• Reproductive and Child Health (RCH) program evolved.
• Control of communicable diseases like AIDS (National AIDS Control Programme launched in 1992).
• Emphasis on health system decentralization.

9th Five-Year Plan (1997–2002)

• Focus: Health as a fundamental human right.
• Key Elements:
• Reproductive and Child Health Programme (RCH Phase I) strengthened.
• National Population Policy (2000).
• Launch of National Health Policy 2002.
• Programs for HIV/AIDS, TB, malaria, blindness control.
• Decentralization through Panchayati Raj institutions.

10th Five-Year Plan (2002–2007)

• Focus: Reducing IMR, MMR, TFR; achieving Millennium Development Goals (MDGs).
• Key Elements:
• National Rural Health Mission (NRHM, 2005) launched → focused on rural healthcare, especially for poor states.
• RCH Phase II.
• Emphasis on disease surveillance (IDSP, 2004).
• More PPP in health sector.

11th Five-Year Plan (2007–2012)

• Focus: "Inclusive growth" – reduce disparities in health access.
• Key Elements:
• Consolidation of NRHM.
• Expansion of health insurance schemes – Rashtriya Swasthya Bima Yojana (RSBY, 2008).
• National programmes for non-communicable diseases (NCDs) launched.
• Emphasis on universal access to health care.

12th Five-Year Plan (2012–2017)

• Focus: Universal Health Coverage (UHC).
• Key Elements:
• NRHM expanded to National Health Mission (NHM, 2013) – included both NRHM (rural) and NUHM (urban).
• Strengthening secondary and tertiary care.
• PPP in diagnostics and service delivery.
• Emphasis on NCD prevention, mental health, elderly care.
• Focus on equity, affordability, and quality of health services.

Shift after 2015

• With abolition of Planning Commission → NITI Aayog introduced 3-Year Action Agenda, 7-Year Strategy, and 15-Year Vision.
• Continued focus on National Health Policy 2017 and Ayushman Bharat (2018) for universal health coverage.

Summary

• 1st–3rd Plans: Infrastructure building, communicable disease control.
• 4th–6th Plans: Family planning, population control, MCH.
• 7th–9th Plans: Immunization, CSSM, RCH, decentralization.
• 10th–12th Plans: NRHM → NHM, UHC, PPP, NCD control.
• Transition from curative to preventive and promotive health, with growing role of insurance and private sector.

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