[op-ed snap] The case for a public health cadre

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Mains Paper 2: Governance | Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

From the UPSC perspective following things are important:

Prelims Level: Not much

Mains Level: Specially mentioned in the Mains Syllabus


News

Context

  1. The article talks about a service, on the lines of the IAS, which can improve India’s health-care delivery

Different committees in the past supporting dedicated personnel for public health management

  1.  Mudaliar Committe(1959): It had observed that “personnel dealing with problems of health and welfare should have a comprehensive and wide outlook and rich experience of administration at the state level”
  2. Kartar Singh Committee(1973): It had said 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, with no exposure to rural environments and their social dynamics, nor having been trained to manage a facility or draw up budget estimates, were ill-equipped and misfits to work in public facilities”
  3. Other observations: It was also felt that “the medical education that [a doctor] receives has hardly any relevance to the conditions in which he would be required to work, either in the state-run health programme or even in private practice
  4. Since medical education is based almost entirely on the western model, and where he is more suitable for the conditions that prevail in western countries than in his own

12th Five Year Plan and the National Health Policy, 2017

  1. They have also strongly advocated establishing a public health management cadre to improve the quality of health services
  2. How: by having dedicated, trained and exclusive personnel to run public health facilities

Public health cadre by Odisha

  1. It has notified the establishment of a public health cadre in the hope of ensuring vast improvement in the delivery of health care

Why India’s Health care system should have a cadre?

  1. Doctors with clinical qualifications and even with vast experience are unable to address all these challenges, thereby hampering the quality of our public health-care system
  2. Doctors recruited by the States and the Ministry of Health and Family Welfare (through the UPSC) are to implement multiple, complex and large public health programmes besides applying fundamental management techniques
  3. In most places, this is neither structured nor of any quality
  4. In the absence of a public health cadre in most States, doctors with hardly any public health knowledge is required to implement reproductive and child health or a malaria control programme
  5. Further, at the Ministry level, the highest post may be held by a person with no formal training in the principles of public health to guide and advise the country on public health issues
  6. With a public health cadre in place, we will have personnel who can apply the principles of public health management
  7. And may avoid mistakes such as one that led to the tragedy in UP as well as deliver quality services

The Way Forward

  1. Such an exclusive department of public health will help in developing the recruitment, training, implementation and monitoring of public health management cadre
  2. Doctors recruited under this cadre may be trained in public health management on the lines of the civil service
  3. Financial support for establishing the cadre is also to be provisioned by the Central government under the Health Ministry’s budget
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
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