The case for a public health cadre: 

The case for a public health cadre

Context

  • A dedicated personnel cadre for public health management shall improve India’s health-care delivery system

Why have a dedicated Cadre?

  • A dedicated, professionally trained personnel to address the specific and complex needs of the Indian health-care delivery system
  • 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

National health policy,2017

Other objectives of the NHP,2017

  • It aims to raise public healthcare expenditure to 2.5% of GDP from current 1.4%, with more than two-thirds of those resources going towards primary healthcare.
  • It envisages providing a larger package of assured comprehensive primary healthcare through the ‘Health and Wellness Centers’.
  • It is a comprehensive package that will include care for major non-communicable diseases (NCDs), geriatric healthcare, mental health, palliative care and rehabilitative care services.
  • It proposes free diagnostics, free drugs and free emergency and essential healthcare services in all public hospitals in order to provide healthcare access and financial protection.
  • It seeks to establish regular tracking of disability adjusted life years (DALY) Index as a measure of burden of disease and its major categories trends by 2022.
  • It aims to improve and strengthen the regulatory environment by putting in place systems for setting standards and ensuring quality of healthcare.
  • It also looks at reforms in the existing regulatory systems both for easing drugs and devices manufacturing to promote Make in India and also reforming medical education.
  • It advocates development of mid-level service providers, public health cadre, nurse practitioners to improve availability of appropriate health human resource.
  • Targets: It aims to ensure availability of 2 beds per 1000 population to enable access within golden hour. It proposes to increase life expectancy from 67.5 to 70 years by 2025.
  • It aims to reduce total fertility rate (TFR) to 2.1 at sub-national and national level by 2025.
  • It also aims to reduce mortality rate (MR) of children under 5 years of age to 23 per 1000 by 2025 and maternal mortality rate (MMR) to 100 by 2020.
  • It also aims to reduce infant mortality rate to 28 by 2019 and reduce neo-natal mortality to 16 and still birth rate to ‘single digit’ by 2025.

What is the present state of the health care system in India?

Lack of infrastructure : Lack of continuous water supply in many PHC’S, some government building is being used as a primary health center at some places etc.

Inefficient workforce : we need to introduce an efficient check on working of medical officers and the auxillary staff.

Awareness of the people : A lot of primary health problems can be solved if we provide effective training and the knowledge to the local population.

There is only one doctor per 1,700 citizens in India.

  • If shortage of doctors is one problem, their unwillingness to work in the rural hinterland is another. Generic medicines are highly underrated in country where doctors sometime prescribe expensive medicine.

Creating artificial scarcity in the area and high concentration in another causing hardship for the rural poor people increasing the out of pocket expenditure.

we can put up a surveillance system to prevent the rampant absenteeism of the health care providers , also we should have an frictionless model that transfers enquiry and complaints of the population efficiently to the concerned authorities.

Corruption at high level institutions such as MCI,etc.

Apart from this there are many challenges that rural healthcare is facing. Among them the main challenge for rural healthcare in India is lack of knowledge and awareness.

Set precedents

  • Tamil Nadu took the lead in this and there has been a discernible difference in the way health delivery is done there vis-à-vis Uttar Pradesh.
  • Odisha, with the support of the Public Health Foundation of India, has notified the establishment of a public health cadre in the hope of ensuring vast improvement in the delivery of health care.

What is the significance of this proposal?

  • 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.
  • 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.
  • With the introduction of the public health cadre, personnel with principles of public health management shall only be eligible.
  • 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.

What is the way forward?

  • Such an exclusive department of public health at both the levels of the Ministry and the States will help in developing the recruitment, training, implementation and monitoring of public health management cadre.
  • Doctors recruited under this cadre may be trained in public health management on the lines of the civil service with compulsory posting for two-three years at public health facilities.
  • Filling the post of director general in the Health Ministry from this cadre shall improve planning and providing much-needed public health leadership.
  • Financial support for establishing the cadre is also to be provisioned by the Central government under the Health Ministry’s budget.
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