Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
Issues relating to development and management of Social Sector/Services relating to Health
Public Health Management Cadre: Need of the hour
The 12th Five Year Plan and the National Health Policy, 2017 have strongly advocated establishing a public health management cadre to improve the quality of health services by having dedicated, trained and exclusive personnel to run public health facilities.
Recommended by various committees:
The idea of having dedicated personnel for public health management goes back to 1959 when advocated by the Mudaliar Committee, which observed that “personnel dealing with problems of health and welfare should have a comprehensive and wide outlook and rich experience of administration at the state level”.
It was echoed too, in 1973, by the Kartar Singh Committee, which said that “doctors with no formal training in infectious disease control, surveillance systems, data management, community health related problems, and lacking in leadership and communication skills, with no exposure to rural environments and their social dynamics, nor having been trained to manage a facility or draw up budget estimates, were ill-equipped and misfits to work in public facilities”.
In 2011, a High Level Expert Group on Universal Health Coverage recommended creation of an All India Public Health Service Cadre “that should be responsible for all public health functions starting at the block level and going up to the state and national level. This cadre should be supported by a state public health cadre. This would be akin to civil services.
Why have such a cadre?
The idea is on the lines of the civil service — of having dedicated, professionally trained personnel to address the specific and complex needs of the Indian health-care delivery system which is grappling with issues such as a lack of standardisation, financial management, appropriate health functionaries and competencies including technical expertise, logistics management, and social determinants of health and leadership.
Doctors with clinical qualifications and even with vast experience are unable to address all these challenges, thereby hampering the quality of our public health-care system.
Doctors recruited by the States and the Ministry of Health and Family Welfare (through the Union Public Service Commission) are to implement multiple, complex and large public health programmes besides applying fundamental management techniques. In most places, this is neither structured nor of any quality. 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.
As most states have no public health cadres, theoretically, a district medical officer, required to implement public health programmes such as vector borne diseases or TB control, could be a radiologist or an orthopaedic doctor with scanty knowledge of public health principles and management.
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 a public health cadre in place, we will have personnel who can apply the principles of public health management to avoid mistakes such as one that led to the tragedy in Uttar Pradesh as well as deliver quality services. 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.
In the process, we will also be saving the precious resources of specialists from other branches by deploying them in areas where they are definitely needed.
Filling the post of director general in the Health Ministry from this cadre with similar arrangements at the State level including the posts of mission directors will go a long way in improving planning and providing much-needed public health leadership.
Another benefit will be the freeing up of bureaucrats and their utilisation in other much needed places.
What does All India Health Cadre imply?
Instituting an AIHC would imply that doctors (and other non medical personnel) desirous of working in government would require to undergo training in health policy and work in district level hospitals for a period of time as a pre-qualification for promotions.
Steps being taken:
Tamil Nadu took the lead in this and there has been a great difference in the way health delivery is done there vis-à-vis Uttar Pradesh. For example, in U.P., even in a tertiary hospital, according to media reports, simple record keeping of oxygen cylinders is not followed.
Recently, 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.
Despite the creation of a public health cadre finding mention in various reports and Plan documents, such a service at the all-India level has still to translate itself into reality any time soon due to a series of complex factors.
The way forward:
The All India Health Cadre will need to be contextualised within a holistic and comprehensive institutional reform that must begin with making health a concurrent subject (as was done in the case of education) and restructuring the administrative ministeries into two distinct departments – one devoted to public health. and the other to medical education and long term care/hospital services.
An exclusive department of public health at both the levels of the Ministry and the States is required, this 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.
Financial support for establishing the cadre is also to be provisioned by the Central government under the Health Ministry’s budget.
A service, on the lines of the IAS, will improve India’s health-care delivery. An all India health cadre is the need of the hour. However, it should be brought after adopting a wide consultative process and evidence – not on knee jerk or narrow political considerations.
Connecting the dots:
Various committees have recommended for the creation of All India Health Cadre. There are various administrative challenges being faced in the health sector which could be resolved by having a specialised cadre. Analyze.
TOPIC: General Studies 3:
Indian Economy and issues relating to planning, mobilization of resources, growth, development and employment.
Strengthening state level enterprises
Given the downturn in economic growth and the daunting challenge of creating jobs for those already in and those about to enter the workforce in the country, the need to boost the manufacturing sector has become exceedingly urgent. The government at the Centre is committed to reviving manufacturing with initiatives such as the “Make in India” and “Digital India” programmes. It has correctly identified burdensome regulations as a major culprit for lagging manufacturing, resulting in a focus on easing regulatory hurdles in order to improve the “ease of doing business”.
The issue is that many of the regulations that affect businesses fall within the jurisdiction of State governments. For instance, starting construction of any kind requires getting no-objection certificates (NOCs) and approvals from various departments of the municipality and State government. Firms that employ more than 10 workers are subject to meeting compliance requirements under State labour laws. The task of providing adequate water and proper roads falls to respective State government departments. Thus, the ultimate responsibility for easing regulations and improving the business environment lies with States even more than the Centre.
Steps taken by the state governments:
State governments are making earnest efforts to improve the ease of doing business. They have undertaken reforms across different areas of doing business, such as labour, environment, setting up a business, among others, in order to reduce the time and costs of meeting compliances. A majority of States have introduced single window clearance systems along with the necessary laws to make it simpler to start a business. Many now allow self-certification as well as third-party certification for granting various permits. The Department of Industrial Policy and Promotion (DIPP) of the Union government introduced a detailed survey of State governments and it publishes a real-time annual ranking of States. This ranking reflects the number of reforms that states have implemented. This initiative has fostered competition among States in order improve their ranking and is taken very seriously by bureaucrats and politicians alike.
What needs to be done?
To fully understand how business is actually done and whether reforms by States are being implemented, it is necessary to ask enterprises or firms themselves – who bear the burden of compliance – about their experience in meeting mandated requirements. This will provide direct feedback to State governments about how their actions are helping the situation on the ground. This would be a complement, not a substitute, to DIPP’s survey.
Variations in performance across the states:
Along the lines of these World Bank Enterprise Surveys, NITI Aayog, in collaboration with IDFC Institute, published a report based on a State-level enterprise survey of more than 3,000 manufacturing firms across India. The survey reveals a wide variation in the time taken for getting various approvals and cost of doing business across States. It also shows that although States have implemented reforms and instituted improved processes, enterprises are often unaware of them. The results shows that: States that experience high growth have a better climate for doing business, suggesting a virtuous circle between a better regulatory environment and more rapid growth.
What needs to be done?
Repeated surveys of enterprises at the State level will provide sufficient data to reasonably measure whether States that have a better doing business climate as reported by firms also see better outcomes over time.
They will also allow States to check whether their reforms are yielding results, how far they have come, how they fare in relation to other states, and recalibrate the measures undertaken.
These State level report cards could not only be a means for getting feedback but also help build political and public consensus around reforms at the State level.
An improved doing business climate due to reforms could deliver real gains in terms of increased investment in manufacturing and creating a large number of good jobs. India needs no less if we are to jumpstart growth and eradicate poverty.
Connecting the dots:
Analyzing the performance of state level enterprises and working on strengthening them is required if manufacturing sector is to be given a boost as many of the regulations that affect businesses fall within the jurisdiction of State governments. Discuss.
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