Relevance: GS-2: Issues relating to development and management of Social Sector/Services relating to Health, Education, and Human Resources.

Key Phrases: Public Health and Management Cadre, Indian Public Health Standards, Perennial Shortage of Trained Public Health Workforce, Medicalised Care System, Pradhan Mantri Ayushman Bharat Health Infrastructure Mission, Universal Health Coverage

Why in News?

• 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.
• The ‘public health and management cadre’ is based on the recommendations made in India’s National Health Policy 2017.

Background:

• In 2017, India’s National Health Policy 2017 proposed the formation of a public health cadre and enacting a National Public Health Act. Yet, progress on these fronts was too slow.
• The reason was the limited understanding of the roles and the functions of public health specialists and the relevance of such cadres, especially at the district and sub-district levels.
• Epidemiologists were equated with public health specialists, failing to recognise that the latter is a much broader and inclusive group of specialists. However, the last decade and a half were eventful.
• The initial threat of avian flu in 2005-06, the Swine flu pandemic of 2009-10; the increasing risks and emergence of new viruses and diseases (Zika, Ebola, Crimean-Congo Haemorrhagic fever, Nipah viruses, etc.) in animals and humans, resulted in increased attention on public health.
• The COVID-19 pandemic exposed the reality of an acute shortage of public health infrastructure and professionals trained in public health having field experience in the country.
• It became clear that ‘epidemic’ and ‘pandemic’ required specialised skills in a broad range of subjects such as epidemiology, biostatics, health management and disease modelling, to list a few.

What are the issues with Indian Health Care System?

1. Limited Career Progression Opportunities:
   • At present, most Indian States (with exceptions such as Tamil Nadu and Odisha) have a teaching cadre (of medical college faculty members) and a specialist cadre of doctors involved in clinical services.
   • This structure does not provide similar career progression opportunities for professionals trained in public health.
2. Lack of Public health Infrastructure:
   • Limited interest in public health as a career choice by healthcare professionals has resulted in a perennial shortage of trained public health workforce which was witnessed during the pandemic.
   • The health focus has traditionally been on medical care or attention to treating the sick.
   • A country or health system that has a shortage of a public health workforce and infrastructure is likely to drift towards a medicalised care system.
3. Bureaucracy led Decision-Making:
   • In the absence of trained public health professionals at the policy and decision-making levels, India’s pandemic response ended up becoming bureaucrat steered and clinician-led.
4. Poor Quality of Health Services:
   • Limited attention is paid to ensuring the quality of health services.
   • Increasing access to health services and improving the quality of care are perceived as a sequential process where the first focus is on increasing access and then thought on ensuring the quality is given which rarely happens.

Relevance of Public Health Services:

• The proposed public health cadre and the health management cadre have the potential to address some of the above challenges.
• With the release of guidance documents, the States have been advised to formulate an action plan, identify the cadre strengths, and fill up the vacant posts in the next six months to a year.

Challenges:

• The revised IPHS is an important development but not an end itself. In the 15 years since the first release of the IPHS, only a small proportion — around 15% to 20% — of government healthcare facilities meet these standards.
• The IPHS implementation in the last 15 years is one such example. Thus, it is difficult to predict the outcome of the PHMC guidance document.

Way Forward:

1. Centre of Excellence:
   • A centre of excellence in every State should be designated to guide the process.
   • States which are likely to show reluctance need to be nudged through appropriate incentives.
2. Mapping and Training of Workforce:
   • The mapping and analysis of human resources for public health and then scaling up recruitment are to be done.
   • However, it needs to be ensured that in an overzealous attempt to achieve numbers, the quality of training of the required workforce is not compromised.
   • The availability of a trained workforce is the most critical.
   • Even the most well-designed policies with sufficient financial allocation may falter because of the lack of a trained workforce.
   • As States develop plans for setting up the PHMC, all potential challenges in securing a trained workforce should be identified and actions initiated.
   • Setting up these two new cadres should be used as an opportunity to improve and standardise the quality of training in public health institutions.
3. Equitable Distribution of Health Staff:
   • The success of the PHMC would be dependent upon the availability and the equitable distribution of health staff for all other categories at government health facilities.
   • Therefore, as new cadres are being set, efforts need to be made to fill vacancies of health staff in all other positions as well.
4. Financial allocation:
   • 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 available for strengthening public health services.
   • They can be used as catalytic funding which should be used in the interim as States embark upon implementing the PHMC and a revised IPHS.
5. Accelerated interventions:
   • If the pace of achieving IPHS is any criteria, there is a need for more accelerated interventions.
   • Quality Standards need to be considered seriously for policy formulation, programmatic interventions and for corrective measures.
   • Revision of the IPHS should be used for an independent assessment of how the IPHS has improved the quality of health services.
   • It would take a few years before the PHMC becomes fully functional in the States. However, the implementation process needs to be started in the next few months to avoid the risk of it becoming a low priority.

Conclusion:

• Three years before the COVID-19 pandemic had started, the Indian government had committed, through NHP 2017, to achieve the goal of universal health coverage which envisages access to a broad range of preventive, promotive, curative, diagnostic, rehabilitative healthcare services which meet specific quality standards, at a cost which people can afford.
• The public health and management cadres and the revised IPHS can help India progress towards the NHP goal.
• To ensure that State governments need to act urgently and immediately.

Source: The Hindu

Mains Question:

Q. The government has released a new guidance document on setting up a Public Health and Management Cadre as well as revised editions of the Indian Public Health Standards for ensuring quality health care in government facilities. In this respect, discuss the issues with the Indian Healthcare system and the role the new policy document can play in transforming the public health system. (250 words).