India has made significant progress in the field of public health over the last couple of years, as witnessed in the increase in declining infant mortality rates, under-five mortality rates, and maternal mortality ratios, all significant indicators of health system performance in any economy. In addition, recent reforms and innovations under the government's flagship programme, the National Health Mission have resulted in significant improvements in access to key health care indicators including institutional deliveries, antenatal care, complete immunization, and disease control programmes, to name a few. Further, with respect to the pandemic, the country has fared particularly well in vaccine deliveries and limiting the contractions of the coronavirus.
However, despite the above there still exists immense scope to enhance the country's health system and further the planned health goals to fuel the rapid economic growth of our country.
Amidst several discourses regarding the enhancement of the public health frameworks in the country, various national committees and expert groups since 1946 have recommended the establishment of a public health cadre across states:
- The High Level Expert Group on Universal Health Coverage (2012) recommends the creation of an All-India public health cadre.
- The Steering Committee on the 12th 5-year plan (2012) also calls for the establishment of public health cadres and their empowerment under the Public Health Act.
- A meeting of health secretaries (October 9, 2014) chaired by the Union Minister for Health approved an action point to strengthen public health cadres in states through innovative means.
- The draft National Health Policy (2016) recommends that adequately trained professionals hold senior leadership positions in public health.
- The 43rd Annual Conference of Indian Association of Preventive and Social Medicine at Ahmadabad (7-9 January 2016) strongly recommended establishment of public health cadre to expedite improvement in health in India.
- A recommendation, for establishing all-India and state-level Public Health Service Cadres and a specialised state-level Health System Management Cadre, was made in a 2011 report of the High Level Expert Group (HLEG) on Universal Health Coverage (UHC) constituted by the Planning Commission of India.
Experts highlight that the establishment of a public health cadre would utilise an efficient mix of doctors with pre-existing public health qualifications, in addition to providing in-service public health training to existing doctors. Moreover, social scientists and health communication experts, should be included in such public health programmes, at least contractually.
Following suit, in a recent 'Chintan Shivir' (brainstorming session) in Gujarat, held to discuss the challenges faced owing to the persisting pandemic, the Centre has planned to establish a central public health cadre in the country. The plan was approved by the Health Minister Mansukh Mandaviya. The public health cadre will be instrumental in helping the authorities in implementing healthcare policies. The cadre would be the implementing arm of the public health policies. Hence, the framework is being constituted within the health ministry. The central cadre will strengthen the design, delivery, monitoring and evaluation of the countries health policies and programmes.
The medical professionals for the cadre would be recruited along the lines of central services officers recruited through the Union Public Service Commission (UPSC). As part of the plan, all health professionals, including those working for the directorate general of health services (DGHS), will be recruited through the permanent cadre and will help the government implement healthcare policies.
While a public health cadre is not new to all of India, it has remained uncommon. The state of Tamil Nadu maintained a public health cadre ever since Independence, with many analysts crediting the cadre for the commendable performance of the state’s health system. Furthermore, Odisha established a dedicated public health cadre. A few other states require public health qualifications for certain positions in health administration, but did not have a demarcated cadre. However, as a part of the central health services, there was no distinct public health cadre.
Public health is a multi-disciplinary knowledge platform that must provide scope and skills for multi-sectoral action on the many determinants of health. If such cadres with representation from various fields and philosophies are implemented early and in earnest, the creation of these cadres would greatly strengthen the public health policies and programmes. It would also contribute extensively in ensuring impact assessment of the existing and emerging policies and programmes in other sectors that have may have implications for the health determinants. The central public health cadre will be imperative for the country, especially given the dense population, to maintain efficient public health indicators and safeguard the citizens against future global health shocks and vulnerabilities.
This is co-authored by Ishita Sirsikar and Srijata Deb.