Sir Joseph Bhore was appointed the chairman of the Health Survey and Development committee in 1943 by the British colonial government to give recommendations about healthcare in colonial India. Three years later, Sir Joseph submitted a report which is known as the Bhore Committee Report. The committee recommended integration of preventive and curative services, and development of primary health centres in two stages; it also gave recommendations for medical education and the training of doctors.
As a short-term and immediate measure, the Bhore committee suggested developing one primary healthcare centre (PHC) for a population of 40,000 people. The proposed PHC was to be managed by two doctors, one nurse, four public health nurses, four midwives, four trained dais, two sanitary inspectors, two health assistants, one pharmacist, and 15 other class IV employees. It was recommended that the future secondary health centres would have a close coordination with the PHC. For the long-term, the Bhore committee report suggested a three-tiered healthcare system which featured a 75-bed hospital for 10,000 to 20,000 population; a 650-bed hospital at the secondary level; and a 2,500-bed hospital at the district level to provide health services to the people.
The committee also suggested some major changes in the medical curriculum, including three months of training in preventive and social medicine to prepare for what it called “social physicians”. It believed that doctors should realise their responsibilities by understanding the social and cultural aspects of the community they were serving.
A year before Partition, the British proposed radical changes to the healthcare system to deliver universal healthcare; 70 years later, the issues and shortcomings remain the same
The British colonial government left the country in 1947 without implementing the recommendations from the Bhore committee report. The new government of M.A. Jinnah in Pakistan was so busy in establishing the state that they didn’t have time to look at and implement the recommendations of the Bhore committee.
The successive governments lacked the necessary skills to run a new country in the best interest of the common people and deal with its dominant classes led by landlords, sardars, waderas and elites. The religious leaders were more interested in the Objectives Resolution than the miseries of farmers, labourers, women and the marginalised. They had no understanding of the suffering faced by the common man due to a lack of healthcare facilities nor did they have the political will to develop a system to address the health-related issues of the extremely poor population of Pakistan.
Unfortunately, the internal conflicts of the ruling classes and increasing religious intolerance gave a chance to the armed forces to intervene in politics and the first army rule was established in Pakistan in 1958. Under pressure from the US government, and on recommendation of the Harvard Group, the health managers of president Ayub Khan introduced a health structure in Pakistan probably on the lines of the Bhore committee report.
An infrastructure was suggested and established in the form of a basic health unit (BHU), rural health centre (RHC), taluka headquarter (THQ) and district general (DHQ) hospitals, and referral centres attached with medical colleges as tertiary healthcare centres. With massive funding from USaid, United States’ aid agency, a preventive programme was started in schools with the distribution of milk for children, vaccination against tuberculosis and other preventable diseases. The World Health Organisation (WHO) started a campaign to eradicate small pox and malaria as part of its global programme. Additionally, a ministry of family planning was established to deal with the challenge of over-population, especially in the then East Pakistan (now Bangladesh).