Health Policy and Management — MCQs

Health Policy and Management Indian Medical PG Practice Questions and MCQs

Question 191: What is the goal of the National Tuberculosis Control Programme?

A. To eradicate tuberculosis
B. To decrease the transmission of tuberculosis
C. To treat all sputum-positive patients
D. To decrease the incidence of tuberculosis to such a low level that it is no longer a major public health problem (Correct Answer)

Explanation: **Explanation:** The primary goal of the **National Tuberculosis Control Programme (NTCP)**, launched in 1962, was to reduce the burden of TB to a level where it no longer posed a significant threat to public health. This objective acknowledges that while total elimination is difficult, reducing the **prevalence and incidence** of the disease is the immediate priority for public health management. **Why the correct answer is right:** In public health, the "control" of a disease implies reducing the incidence, prevalence, morbidity, or mortality to a locally acceptable level through deliberate efforts. For TB, the specific benchmark for it to no longer be a "major public health problem" is often defined as reaching an incidence of **less than 1 case per million population**. **Analysis of Incorrect Options:** * **A. To eradicate tuberculosis:** Eradication refers to the permanent reduction to zero of the worldwide incidence of an infection. Currently, this is not a feasible goal for TB due to the long latency of *M. tuberculosis* and the lack of a 100% effective vaccine. * **B. To decrease transmission:** While reducing transmission is a *strategy* (via early diagnosis and treatment), it is not the ultimate stated *goal* of the programme. * **C. To treat all sputum-positive patients:** This is an *operational objective* (specifically under the RNTCP/NTEP) to break the chain of infection, but it serves the broader goal of disease control. **High-Yield Clinical Pearls for NEET-PG:** * **NTEP (National TB Elimination Program):** The program was renamed from RNTCP to NTEP in 2020, shifting the focus from "Control" to **"Elimination"** by 2025 (5 years ahead of the Global SDG target of 2030). * **Elimination Definition:** Achieving <1 case per 100,000 population. * **Key Strategy:** The **DOTS** (Directly Observed Treatment, Short-course) strategy remains the cornerstone of the management protocol.

Question 192: Which of the following committees suggested training in preventive and social medicine for doctors?

A. Srivastava committee
B. Bhore committee (Correct Answer)
C. Kaar Singh committee
D. Mudaliar committee

Explanation: **Explanation:** The **Bhore Committee (1946)**, also known as the Health Survey and Development Committee, is the cornerstone of public health planning in India. Its primary recommendation was the integration of preventive and curative services at all levels. To achieve this, the committee emphasized that medical education must be reoriented to produce "social physicians." It specifically suggested the **creation of separate departments of Preventive and Social Medicine (PSM)** in medical colleges to ensure doctors were trained in the social aspects of health and disease. **Analysis of Incorrect Options:** * **Srivastava Committee (1975):** Known for the "Reorientation of Medical Education" (ROME) scheme and the creation of the **Village Health Guide** scheme. It focused on creating a cadre of health paraprofessionals (Multi-purpose workers). * **Kartar Singh Committee (1973):** Primarily recommended the introduction of **Multi-Purpose Workers (MPWs)** and suggested that ANMs be replaced by Female Health Workers. * **Mudaliar Committee (1962):** Also known as the Health Survey and Planning Committee. It focused on strengthening existing health services, improving the quality of care at the PHC level, and consolidating the gains of the first two Five-Year Plans. **High-Yield Facts for NEET-PG:** * **Bhore Committee:** Concept of **Primary Health Centre (PHC)** for a population of 40,000; 3-month internship in social medicine. * **Chadah Committee (1963):** Related to National Malaria Eradication Programme (NMEP) maintenance phase. * **Mukherjee Committee (1965/66):** Dealt with separate staff for Family Planning and Malaria activities. * **Jungalwalla Committee (1967):** Focused on the **Integration of Health Services** (Equal pay for equal work).

Question 193: The target year for the Millennium Development Goals was:

A. 2000
B. 2015 (Correct Answer)
C. 2017
D. 2020

Explanation: **Explanation:** The **Millennium Development Goals (MDGs)** were a set of eight international development goals established following the Millennium Summit of the United Nations in **September 2000**. All 191 United Nations member states committed to help achieve these goals by the **target year of 2015**. 1. **Why 2015 is correct:** The MDGs were designed with a 15-year timeframe (2000–2015) to tackle issues such as extreme poverty, child mortality (Goal 4), maternal health (Goal 5), and infectious diseases like HIV/AIDS and Malaria (Goal 6). In 2015, the MDGs were succeeded by the **Sustainable Development Goals (SDGs)**. 2. **Why other options are incorrect:** * **2000:** This was the year the Millennium Declaration was signed and the goals were *established*, not the target for completion. * **2017:** This year does not correspond to a major global health milestone; however, it was the year India launched its National Health Policy (NHP 2017). * **2020:** While many national programs (like Vision 2020 for blindness) used this as a target, it was not the MDG deadline. **High-Yield Facts for NEET-PG:** * **MDGs vs. SDGs:** MDGs had **8 goals**, while SDGs (target year **2030**) have **17 goals**. * **Health-related MDGs:** Goal 4 (Reduce Child Mortality), Goal 5 (Improve Maternal Health), and Goal 6 (Combat HIV/AIDS, Malaria, and other diseases). * **SDG 3:** This is the specific "Health Goal" under the current Sustainable Development framework (*"Ensure healthy lives and promote well-being for all at all ages"*). * **Under-5 Mortality:** The MDG 4 target was to reduce the Under-5 Mortality Rate by two-thirds between 1990 and 2015.

Question 194: All of the following are plans to strengthen the infrastructure of the National Rural Health Mission (NRHM), EXCEPT?

A. Promotion of Rogi Kalyan Samiti
B. Recruitment of ASHA
C. Formulation of state and district health programmes
D. Formulation of family planning and welfare societies (Correct Answer)

Explanation: **Explanation:** The **National Rural Health Mission (NRHM)**, launched in 2005, was designed to provide accessible, affordable, and quality health care to the rural population. Its core strategy focuses on **decentralization** and **community ownership**, rather than the creation of isolated vertical societies. **Why Option D is the Correct Answer:** The NRHM aimed to **merge** existing vertical societies (like those for TB, Blindness, and Family Welfare) into a single **Integrated District Health Society**. Therefore, the *formulation* of separate family planning and welfare societies is contrary to the NRHM's goal of integration and streamlining health management. **Analysis of Incorrect Options:** * **A. Promotion of Rogi Kalyan Samiti (RKS):** These are Hospital Management Committees that ensure accountability and community participation in hospital affairs. Strengthening RKS is a key pillar of NRHM infrastructure. * **B. Recruitment of ASHA:** The Accredited Social Health Activist (ASHA) is the cornerstone of NRHM, acting as the link between the community and the health system. * **C. Formulation of state and district health programmes:** NRHM decentralized planning by allowing states and districts to formulate their own **Project Implementation Plans (PIPs)** based on local needs. **High-Yield Facts for NEET-PG:** * **NRHM Launch:** April 12, 2005 (Now part of National Health Mission/NHM). * **Core Strategy:** Decentralized planning through the **District Health Action Plan (DHAP)**. * **ASHA Norm:** 1 per 1000 population (in plain areas) and 1 per habitation (in hilly/tribal areas). * **Village Health Sanitation and Nutrition Committee (VHSNC):** The grassroots level organization for community monitoring under NRHM.

Question 195: Which of the following is NOT included in the Human Development Index (HDI)?

A. Mean years of schooling
B. Life expectancy at birth (Correct Answer)
C. Real GDP per capita
D. Life expectancy at birth

Explanation: **Explanation** The **Human Development Index (HDI)** is a composite statistical tool used by the UNDP to measure a country's overall achievement in its social and economic dimensions. It is based on three dimensions and four specific indicators. **Why the correct answer is "Real GDP per capita":** The HDI uses **GNI (Gross National Income) per capita (PPP $)** to measure the standard of living, rather than **Real GDP per capita**. While both are economic measures, GNI accounts for foreign trade and net income from abroad, making it the preferred metric for the current HDI formula (updated in 2010). *(Note: In the provided options, "Life expectancy at birth" was marked as correct, but technically, it is a core component of HDI. Real GDP per capita is the traditional "distractor" because it was replaced by GNI per capita).* **Analysis of Options:** * **Life Expectancy at Birth:** This is the indicator for the **"Long and Healthy Life"** dimension. It is the sole indicator for health in HDI. * **Mean Years of Schooling:** This is one of the two indicators for the **"Knowledge/Education"** dimension (for adults aged 25+). * **Expected Years of Schooling:** (Often paired with Mean years) This is the second indicator for Education (for children of school-entry age). **High-Yield NEET-PG Pearls:** * **Components of HDI:** 1. Life Expectancy at Birth (Health), 2. Mean & Expected years of schooling (Education), 3. GNI per capita (Standard of Living). * **Range:** HDI values range from **0 to 1**. * **PQLI (Physical Quality of Life Index):** Often confused with HDI. PQLI includes: 1. Infant Mortality Rate (IMR), 2. Life Expectancy at age 1, and 3. Literacy. **Note: PQLI does NOT include income.** * **India's Status:** Always check the latest HDR (Human Development Report) for India’s current rank (typically in the "Medium Human Development" category).

Question 196: What did the Bhore Committee advise?

A. Integration of health services (Correct Answer)
B. 100% immunisation
C. Eradication of poverty
D. Minimum needs programme

Explanation: The **Bhore Committee (1943)**, also known as the Health Survey and Development Committee, is the cornerstone of modern public health planning in India. Its primary philosophy was the **Integration of Health Services** at all administrative levels. ### Why Option A is Correct: The committee emphasized that curative and preventive services should not be separate entities. It proposed a comprehensive health system where a single organization handles both aspects. Key recommendations included: * **Integration of services:** Merging curative and preventive wings. * **Concept of the Primary Health Centre (PHC):** Establishing a 3-tier system for rural coverage. * **Social Physicians:** Training doctors to be "social physicians" who understand the community's socio-economic context. ### Why Other Options are Incorrect: * **Option B (100% Immunization):** While the committee focused on preventive medicine, universal immunization targets were specific to later programs like the Expanded Programme on Immunization (EPI, 1978) and Universal Immunization Programme (UIP, 1985). * **Option C (Eradication of Poverty):** This is a broad socio-economic goal. While health is linked to poverty, it was not a specific recommendation of the Bhore Committee. * **Option D (Minimum Needs Programme):** This was introduced during the **5th Five-Year Plan (1974-78)** to provide basic services to the poor; it is not associated with the 1943 Bhore report. ### High-Yield Clinical Pearls for NEET-PG: * **Chairman:** Sir Joseph Bhore (Report submitted in 1946). * **Short-term measure:** One PHC per 40,000 population. * **Long-term measure (Million Plan):** Setting up secondary units and district hospitals with 2,500 beds. * **Mudaliar Committee (1962):** Known for recommending "Integration of Medical Care" and strengthening the district-level administration. * **Kartar Singh Committee (1973):** Introduced the concept of "Multipurpose Workers."

Question 197: During program planning, which of the following terms most appropriately defines the desired end result that is not operationally measurable?

A. Goal (Correct Answer)
B. Target
C. Objective
D. Mission

Explanation: In program planning and health management, understanding the hierarchy of outcomes is crucial for NEET-PG. ### **Why "Goal" is the Correct Answer** A **Goal** is the ultimate desired state or end result towards which an effort is directed. It is defined as a broad, non-specific statement of intent. The key characteristic of a goal is that it is **not operationally measurable** in its raw form; it provides the direction but lacks a specific timeframe or numerical value (e.g., "To eliminate Leprosy from India"). ### **Analysis of Incorrect Options** * **B. Target:** A target is a discrete, specific logical step towards an objective. It is highly specific and fixed within a precise time limit (e.g., "Achieve 90% immunization coverage by 2025"). * **C. Objective:** Unlike a goal, an objective is a **planned end result** that is specific, measurable, and time-bound. It is often described using the **SMART** acronym (Specific, Measurable, Achievable, Relevant, Time-bound). * **D. Mission:** A mission is a broad statement of the organization’s purpose and philosophy. While it guides the goals, it is a higher-level organizational concept rather than a specific program planning outcome. ### **High-Yield Clinical Pearls for NEET-PG** * **Hierarchy of Planning:** Mission → Goal → Objective → Target. * **Goal vs. Objective:** If the statement has a number and a date, it is an **Objective/Target**. If it is a broad vision, it is a **Goal**. * **Evaluation:** Goals are evaluated through long-term impact, while objectives are evaluated through process and outcome indicators. * **Key Definition:** "Health for All" is a classic example of a **Goal**.

Question 198: Rashtriya Swasthya Bima Yojana is:

A. A government-run insurance scheme for its employees
B. A government-run insurance scheme for all citizens
C. A government-run insurance scheme for the poor (Correct Answer)
D. A private insurance company scheme for the poor

Explanation: **Explanation:** **Rashtriya Swasthya Bima Yojana (RSBY)** was launched in 2008 by the Ministry of Labour and Employment to provide social security to workers in the unorganized sector. The correct answer is **Option C** because the scheme was specifically designed to provide health insurance coverage to **Below Poverty Line (BPL) families** and 11 other defined categories of unorganized workers (the "poor"). * **Why Option C is correct:** RSBY provides a paperless, cashless service through a Smart Card. It covers hospitalization expenses up to ₹30,000 per family (on a floater basis) per year for five members. It was the first scheme to utilize biometric-enabled smart cards for large-scale healthcare delivery. * **Why Options A & B are incorrect:** RSBY is not a universal scheme for all citizens, nor is it for government employees (who are covered under CGHS or state-specific schemes). It is a targeted social welfare program. * **Why Option D is incorrect:** While private hospitals can be "empanelled" to provide services, the scheme itself is **government-run** and funded (75:25 ratio between Central and State governments). **High-Yield Facts for NEET-PG:** * **Successor:** RSBY has now been subsumed into **Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PM-JAY)**, which increased the coverage from ₹30,000 to **₹5 lakh per family per year**. * **Smart Card:** A unique feature of RSBY was the biometric smart card, which allowed for portability (beneficiaries could use it in any empanelled hospital across India). * **Transport Allowance:** It provided a fixed transport allowance of ₹100 per visit (max ₹1,000 annually) within the overall limit.

Question 199: Sickness benefit under ESI is available for a maximum period of how many days in a year?

A. 30 days
B. 46 days
C. 56 days
D. 91 days (Correct Answer)

Explanation: **Explanation:** The **Employees' State Insurance (ESI) Act, 1948**, provides social security and health insurance for Indian workers. The **Sickness Benefit** is a key cash benefit paid to an insured person during periods of certified sickness when they are unable to attend work. 1. **Why 91 days is correct:** Under current ESI regulations, an insured worker is entitled to receive cash compensation (Sickness Benefit) for a maximum of **91 days** in any two consecutive benefit periods (which effectively means 91 days in a year). The benefit is paid at approximately **70% of the average daily wages**. To qualify, the worker must have contributed for at least 78 days in the corresponding 6-month contribution period. 2. **Why other options are incorrect:** * **30 days:** This is not a standard duration for ESI sickness benefits. * **46 days:** This was the historical limit for sickness benefits when the ESI Act was first implemented; however, it was increased to 56 days and subsequently to 91 days in 1977. * **56 days:** This was the intermediate limit before the 1977 amendment. Currently, 56 days is not the standard for general sickness but is sometimes confused with the duration of certain maternity benefits (though maternity is now 26 weeks). **High-Yield Facts for NEET-PG:** * **Extended Sickness Benefit:** For 34 specific long-term diseases (e.g., TB, Cancer, Leprosy), the benefit can be extended up to **2 years** at a higher rate (80% of wages). * **Enhanced Sickness Benefit:** Provided for undergoing sterilization (Vasectomy: 7 days; Tubectomy: 14 days) at **100% of wages**. * **Funeral Expenses:** A lump sum of **₹15,000** is paid to the eldest surviving member. * **Maternity Benefit:** Payable for **26 weeks** (182 days), extendable by one month on medical advice.

Question 200: Integration of health services was first proposed by which committee?

A. Bhore committee
B. Jungallwalla committee (Correct Answer)
C. Mudaliar committee
D. Srivastava committee

Explanation: **Explanation:** The concept of **Integration of Health Services** was first proposed by the **Jungallwalla Committee (1967)**, also known as the "Committee on Integration of Health Services." The committee defined integration as a unified health service organization from the highest to the lowest level, replacing separate departments for specific programs (like malaria or TB) with a single multipurpose health worker and administrative structure. **Why the other options are incorrect:** * **Bhore Committee (1946):** Known as the "Health Survey and Development Committee." It laid the foundation for India's health system by proposing the **Primary Health Centre (PHC)** concept and "Social Physicians," but it did not focus on the administrative integration of existing services. * **Mudaliar Committee (1962):** Known as the "Health Survey and Planning Committee." It is famous for recommending the strengthening of District Hospitals and observing that the Bhore Committee's targets were too ambitious. * **Srivastava Committee (1975):** Known as the "Group on Medical Education and Support Manpower." It recommended the creation of **Village Health Guides** and the "Reorientation of Medical Education" (ROME) scheme. **High-Yield Clinical Pearls for NEET-PG:** * **Jungallwalla Committee's 5 Principles of Integration:** Unified administration, Common seniority, Single cadre, Specialized pay, and No private practice. * **Kartar Singh Committee (1973):** Introduced the term **"Multipurpose Workers" (MPW)**, which was the practical implementation of the integration proposed by Jungallwalla. * **Mukherjee Committee (1965/66):** Famous for recommending that the Family Planning program should be separate from the general health services (de-linking).

Practice by Chapter

Health Systems and Models

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Health Planning Process

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Health Program Implementation

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Health Economics

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Health Financing Methods

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Healthcare Resource Allocation

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Quality Assessment in Healthcare

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Health Insurance Models

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Public-Private Partnerships

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Universal Health Coverage

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Healthcare Leadership

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Health Policy Evaluation

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