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• There is an increased demand for a Public Health Cadre after the recent medical mishaps, similar to the one that took place in Gorakhpur. • Bhore Committee, 1946- The Health Survey and Development Committee offers a comprehensive assessment of the state of public health in India and makes recommendations for the training of the public health workforce. • Mudaliar Committee (1959)- This committee, for the first time, suggested that the personnel dealing with problems of health and welfare should have a comprehensive and wide outlook and rich experience of administration at the state level. • Kartar Singh Committee (1973)- The committee suggested that doctors with no formal training in infectious disease control, surveillance systems, data management, community health related problems, and lacking in leadership and communication skills, etc., were ill-equipped and misfits to work in public facilities. • The 12th Five Year Plan and the National Health Policy, 2017 have also strongly advocated establishing a public health management cadre to improve the quality of health services by having dedicated, trained and exclusive personnel to run public health facilities. • Despite the creation of a public health cadre finding mention in various reports, such a service at the allIndia level has yet not been formed.
Need for such a cadre
The idea is on the lines of the civil service — of having dedicated, professionally trained personnel to address the specific and complex needs of the Indian health-care delivery system. • Lack of an apt education model- The medical education (a concurrent subject) in India is completely based on the western model which does not address the needs of Indian conditions. • Lack of managerial & technical skills- Doctors with clinical qualifications and even with vast experience are unable to handle various challenges like technical expertise, logistics management, and social determinants of health and leadership, thereby hampering the quality of our public health-care system. • Varied demands of job- In the absence of a public health cadre in most States, even an anaesthetist or an ophthalmologist with hardly any public health knowledge and its principles is required to implement reproductive and child health or a malaria control programme. • Lack of expertise in public healthcare- There is a huge gap between planning, execution and follow up of specialized services and generalized services in the government. Both situations urgently need for special breed of administrators that specialize in healthcare, leading to better management and innovation. • Lack of regulatory authority to officials- The absence of a comprehensive Public Health Act in most states means that health officials lack the regulatory authority and powers to enforce public health legislation adequately. The lack of a separate public health directorate further compromises their independence, effectiveness, and efficiency.
Advantages
• A Public Health Cadre would mean doctors, who desire to work in Public Health Sector, would go through proper training in health policy and work in district level hospitals for a period of time as a prequalification for promotions. • With a public health cadre in place, we will have personnel who can apply the principles of public health management to avoid mistakes such as one that led to the tragedy in Uttar Pradesh as well as deliver quality services. This will definitely improve the efficiency and effectiveness of the Indian health system. • With quality and a scientific implementation of public health programmes, the poor will also stand to benefit as this will reduce their out-of-pocket expenditure and dependence on prohibitively expensive private health care. • In the process, we will also be saving the precious resources of specialists from other branches by deploying them in areas where they are definitely needed. • A dedicated cadre of healthcare professionals can detect state-specific health hazards and contain them before they spread. • The inclusion of professionals from sociology, economics, anthropology, nursing, hospital management and communication, as suggested by the NHP, is a recognition of a multi-disciplinary approach and an acknowledgment that cultural attitudes must be understood if public health strategies are to gain community acceptance. • Filling the higher posts in Ministry from this cadre with similar arrangements at the State level including the posts of mission directors will go a long way in improving planning and providing much-needed public health leadership.
Way Forward There are many challenges in the creation of such a cadre since health is a state subject 2/3rd of the states have to agree for the proposal to be finally accepted. However, given India’s position on the international health indexes and parameters a well-defined Public Health Cadre is the need of the hour.
By: ABHISHEK KUMAR GARG ProfileResourcesReport error
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