MoH recommendations have fallen short of expectations, health policy not be adequate for controlling future pandemics in the present century, say heath experts
The booklet highlighted that the country needs about 77 to 80 health workers per 10,000 population to achieve 80 per cent coverage of the population. Representation pic
It took nine long years and the two biggest global pandemics — swine flu in 2009 and Covid-19 in 2020 — for the Ministry of Health to release the Public Health Management Cadre (PHMC) 2022 blue booklet. However, health experts say health policy may not be adequate for controlling future pandemics in the present century.
Dr Santosh Kadam, Vice-president, Indian Medical Association (IMA) Maharashtra, said, “Health sector is big like railways, education etc, involving 130 crore people. IMA has been constantly demanding a bigger portion of GDP be spent on the health sector. The public health sector in India should be developed like the National Health Service (NHS) in the UK. To achieve this, IMA has demanded that IMS (Indian Medical Services), like IAS, IPS, IRS etc, should be part of UPSC. This IMS cadre should work independently,” said Dr Kadam.
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What booklet states
The booklet states, “Amidst the ongoing pandemic, the delivery of essential healthcare services were disrupted globally. The findings of the committee highlighted that the country needs about 77 to 80 health workers per 10,000 population to achieve 80 per cent coverage of the population for delivering an essential basket of healthcare services.”
“To address all the above issues, it is envisaged to strengthen the management of both, health, and hospital services in the public health sector and demarcate the clinical and public health functions. Adding more dedicated and professionally trained personnel to address the specific and complex needs of the Indian healthcare delivery system and strengthening capacities for managerial functions are required,” it adds.
Experts unhappy
“After nine years of incubating the policy documents of IMA, PHFI (Public Health Foundation of India), WHO, and several other agencies, the Indian Ministry of Health (MoH) has finally released the ‘Public Health Management Cadre: Guideline for Implementation by States’ on April 14, 2022,” said Dr Subhash Hira, Professor of Global Health, University of Washington-Seattle and an advisor to WHO-TDR-Geneva.
“The MoH recommendations have fallen short of expectations of most public health experts who were otherwise looking forward to the Indian Public Health cadre on similar lines as the coveted IAS, IPS services. Many institutions in India have worked on Health Systems Strengthening (HSS) documents for over nine years. Many experts feel that MD (Community Medicine) does not provide wider expertise in multiple disciplines of public health, hence the public health management cadres recruited for state services should have a master’s or a doctorate in public health,” said Dr Hira. Dr Wiqar Shaikh, Professor of Medicine, Grant Medical College and Sir J.J. Group of Hospitals said that a huge lacuna in the booklet is about who would administer public health cadre.
“PHMC includes the public health, specialists, health management and teaching cadres. So it is very important to club all under one roof to access, deliver in time and provide quality health services to the needy not only during a pandemic but also otherwise,” said Dr Santosh Kulkarni, Joint Secretary, IMA, State of Maharashtra. Dr Kulkarni added, “The state and district level PHMC cadre chief or in charge administrative authority should be from medical cadre or doctor only. No IAS person should be made in charge of PHMC. During the pandemic, it had become difficult to update non-medico in charge regarding public health issues. In state, the DHS and DMER have no power to implement health strategy because Chief Administrative Officer of State Public health and Medical Education is an IAS officer. So many departments viz Haffkine Institute, Maharashtra Aids Control Society and National Health Mission, are headed by IAS bureaucrats.”
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