Expert stresses the need for a public health division in the government which is independent, without creating a public health division under the Ministry of Health
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The Ministry of Health's Public Health Management Cadre (PHMC) 2022 blue booklet has invited a backlash from the healthcare fraternity across the country.
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A well-known Virologist Dr Jacob John, retired professor and Head of Clinical Virology and Microbiology Department at Christian Medical College (CMC), Vellore, Tamil Nadu, said, "We are creating a Public Health Management Cadre (PHMC), without having a public health department, which is an oxymoron. We need a public health division in the government independent of healthcare, without creating a public health division under the Ministry of Health, which is nothing but the ministry of ‘diseases’ and that is where people are misled."
Speaking exclusively with mid-day, Dr John said, “Are avoiding facing real problems – tuberculosis (TB), malaria, leptospirosis, encephalitis etc. Why haven’t we been able to manage these diseases to date? Imagining a system for handling a future pandemic is wishful thinking, the moot question is: have we managed to handle the present pandemic well? By coming up with new names for the cadres like Public Health Management Cadre (PHMC), the virus will not get scared. Instead of designing the short-term and long-term solutions, a booklet titled PHMC is released, which won’t change anything in reality."
Healthcare management needs
“It was in 1943, under the chairmanship of Sir Joseph Bhore, the Health Survey and Development Committee was formed emphasizing the integration of curative and preventive medicine at all levels. The report was submitted in 1946, which had made important recommendations including 1) integration of preventive and curative services at all administrative levels, 2) development of primary health centres viz. a) Short-term measure – one primary health centre as suggested for a population of 40,000.
Each PHC was to be manned by 2 doctors, one nurse, four public health nurses, four midwives, two sanitary inspectors, two health assistants, one pharmacist and 15 other class IV employees. A secondary health centre was also envisaged to provide support to PHC, and to coordinate and supervise their functioning. b) A long-term programme (also called the 3 million plan) of setting up primary health units with 75 – bedded hospitals for each 10,000 to 20,000 population and secondary units with 650 – bedded hospitals, again regionalised around district hospitals with 2,500 beds and 3) Major changes in medical education which includes 3-month training in preventive and social medicine to prepare social physicians."
"The subsequent Dr A L Mudaliar committee formed in 1962 had found the conditions in PHCs to be unsatisfactory and suggested that the PHC, already established should be strengthened before new ones are opened strengthening of sub-divisional and district hospitals was also advised, but unfortunately those recommendations could never see the light of the day in totality," he added.
Not data-driven
A lot of developments have occurred in the fields of Public Health and Healthcare since then. So we need a comprehensive look at what we need today vis-a-vis what is available in both public health and healthcare. Today there is a controversy about the number of COVID-related fatalities. We have a count of 52,000 whereas international experts say the reality is some 4 million. This illustrates that our health management is not modern and data-driven. Tinkering and minor incremental changes or naming a new cadre are not going to modernise our health management capability. We need to bring in a transformational change in the system. This tinkering change is nothing but an excuse to delay finding solutions to handle the core issues- define the problem and then design the solution, a 20 pages booklet on Public Health Management Cadre (PHMC) will not solve any problem, said Dr Jacob John.
“We must understand that we cannot treat a disease without diagnosing the same and we need to have a case history of diseases that needs to be assessed by an expert group for coming up with short and long term solutions, without doing that a little bit of paint on the face, may brighten our face, but can’t hide the wrinkles. We are not bold enough to make the change,” he said.
What is public health?
“How do you define public health? The fact is we do not have public health in India, because it would cost 3 per cent of the Gross Domestic Product (GDP) in addition to the overall healthcare budget. We are avoiding constructing public health and instead, we are creating a PHMC, without having a public health department, which is an oxymoron. We need a Public health division in the Government independent of healthcare, without creating a public health division, under the Ministry of Health, which is nothing but the ministry of ‘diseases’ and that is where people are misled. The division of public health and its management has to do with disease prevention. Since prevention must need prediction or at least early detection so we must have radar systems looking at all the health events happening in different regions within the country as well as around the world and making sense out of it, that need specialised people with scientific training, who should be given free hand to analyse, report and control. Healthcare bureaucrats should be kept out of the Public Health Management System from a long-run perspective,” Dr John concluded.
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