Context: Recently, the Union government has released a guidance document on the setting up of a ‘public health and management cadre’ (PHMC) as well as revised editions of the Indian Public Health Standards (IPHS) for ensuring quality health care in government facilities.  

Background 

• The health sector has been facing multiple challenges of handling an epidemic and pandemic in the last few decades like avian flu in 2005-06, the Swine flu pandemic of 2009-10 etc. 
• There has been emergence and re-emergence of new viruses and diseases (Zika, Ebola, Crimean-Congo Hemorrhagic fever, Nipah viruses, etc.) 
• The National Health Policy 2017 recommended for the ‘public health and management cadre’ in India.  

Key issues in India’s health care system

• Traditionally, the focus of public health services has been on medical care or attention on treating the sick. 
• At present, most Indian States have a teaching cadre involved as faculty in the medical colleges and a specialist cadre of doctors involved in clinical services in clinics and hospitals.  
• The above structure restricts similar career progression opportunities to two teaching cadres and specialist’s cadre.  
• Therefore, health-care professionals have limited interest in opting for public health as a career choice.  
• India has a perennial shortage of trained public health workforce and infrastructure. This shortage is likely to drift India towards a medicalised care system. 
• Despite the first release of the IPHS 15 years ago, only a small proportion around 15% to 20% of government health-care facilities meet the Indian Public Health standards (IPHS). 
• There has not been much attention on public health services and workforce in India. There was little policy attention on a need for a public health cadre and services in India.  

Importance of the revised guidance documents, PHMC etc. 

• The public health and management cadres and the revised IPHS can help India to make progress towards the NHP goal. 
• The proposed public health cadre and the health management cadre have the potential to address the weaknesses in our health care system.  
• India’s pandemic response failed because there was an absence of trained public health professionals at the policy and decision making-levels in India. The doctors/clinicians or a bureaucrat could not fulfil the role of the epidemiologists and public health specialists who are in a better position to deal with a pathogen and its behaviour. 
• The revised version focuses on increasing access and then ensuring quality health services through public health facilities, 

Key challenges ahead

• The implementation of the previous versions of the guidance documents has not been up to mark. For example, the IPHS has not been implemented properly in the last 15 years. Therefore, it is difficult to predict the outcome of the PHMC guidance document. 
• This has been thwarted due to inadequacy in the two primary factors in effective implementation: (1) Inadequate financial allocations and  (2) Inadequate trained workforce.  

Road Ahead

• The revised IPHS is an important development but not an end itself. There should be an independent assessment on how the IPHS has improved the quality of health services. 
• The Fifteenth Finance Commission grant for the five-year period of 2021- 26 and the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) allocations are the new assured sources of funding for public health services. They can be used to strengthen the public health services. 
• A centre of excellence in every State should be designated to guide the process for implementation of the public health and management cadres. The reluctant states should be nudged through appropriate incentives.  
• The government can do mapping and an analysis of human resources available for recruitment for public health. They should be well trained. Setting up these two new cadres should be used as an opportunity to improve and standardise the quality of training in public health institutions.  
• The implementation of PHMC should start in the next few months to avoid the risk of it becoming a low priority.  
• The health staff available should be equally distributed for all other categories at government health facilities. Further, the vacancies of health staff should be filled up fast. 

By: Shubham Tiwari