India should have dedicated public health cadre by incorporating high quality training, appropriate career structure and recruitment policy to attract young and talented multi-disciplinary professionals committed to prevention and health promotion. In addition, rewarding good performance and offering continuing professional development are necessary.
Keywords: Public Health cadre
India has made substantial progress in provision of health services during the past century and particularly after independence in 1947. The country has eradicated small pox, plague, and guinea worm infection, and is almost on the verge of stopping polio transmission. In recent years, implementation of the National Rural Health Mission (NRHM), which was launched in 2005, has started demonstrating gradual but clear progress in terms of reducing Infant and maternal mortality. , Nevertheless, several gaps remain, such as large rural-urban differences in health indicators  and inter-state and regional disparities. Infant and maternal mortality, under-nutrition in children under 5, and anemia in women continue to remain unacceptably high. Important health issues such as women’s health, mental health, and disability care are still relatively neglected. In addition to India is phasing an epidemiological transition and as a consequence, has to manage dual burden of communicable as well as NCDs.
These problems have been compounded by the lack of training in Public health as well as the lack of a public health cadre in the health workforce.  There is a pressing need to understand and address the underlying reasons for these gaps. It needs to be recognized that progress made by the NRHM may not be sustained, as it is a time-bound program. Hence, structural reforms are necessary, to ensure a better balance between preventive and curative public health priority and sustain swift and effective local responses to Health problems.
According to India’s National Health Policy-2002,  India is committed to ensure the availability of adequate numbers of public health professionals. In reality, the current workforce lacks capacity (headcounts) and the competence (capability) to meet current public Health needs. , The Indian Public Health Association (IPHA) has recommended the creation of a specialized cadre of Public Health managers to address the current public health challenges and to upgrade the status of public health services. The creation of a new public health cadre has the potential to result in an efficient public health management system delivered by teams of well-qualified and competent workers who are otherwise not burdened with providing treatment and care services. The good news is that the Government of India and several state Governments such as that of Karnataka are planning introduce a dedicated cadre of Public Health Professionals into their health workforce.
All the new entrants in health system should have had spend at least 3-4 years of rural service, after which, can get to choose whether to continue in Public Health cadre or to continue in medical cadre. Medical officers opting for public health cadre should undergo postgraduate courses in public health offered by recognized institutes of excellence. A 2 year MPH, 1 year DPH, or 1 year postgraduate diploma in Public Health, MSc (Public Health), MD (Community Medicine), DNB (community Medicine), MRC (Public Health), PhD in any discipline of Public health and other such courses will be recognized as relevant Public health degrees. The number of years spent in Public health education and research should be counted towards further promotional opportunities. For the purposes of recognizing institutes and degrees, guidelines formulated by Public Health Foundation of India can be followed.
After completing pre-determined years of service and acquiring relevant post-graduate qualification in Public Health, eligible candidates on the basis of seniority can be promoted at the block level. A list of seniority for all officers should be constantly updated and published on departmental websites for ensuring transparency. Every officer promoted should spend a month in “Induction Training” in Public health management at block level at the state level accredited Public Health institutes. After completing at least 3 years at block level, people with relevant post-graduate qualifications and based on performance can enter a list for District level Program Officers.
All the program officers at district level can be selected from the seniority list maintained by departments. After completing at least 3 years as District level Program Officers (DLPO), officer can be eligible to enter a list for promotion to Deputy Director (Public Health). Deputy Director (DDD, Public health) may be the new designation of District Health and Family Welfare officer. Deputy Director (Medical Services) can be the corresponding designation for District Surgeon. Number of positions of DD (Public health) can be consolidated based on the number of districts and those that are available at the state level. An officer with relevant postgraduate qualifications after completing at least 18 years of service can be chosen as Joint Director. Additional Director (Public Health) can be selected only among those from Joint Directors (Public health) who have spent at least 2 years as Joint Director. Director (public health) can be selected only from among Additional directors (public health), who have spent at least 1 year as Additional Director.
The proposed public health cadre needs to be offered high quality training and appropriate career structure and recruitment policy to attract young and talented multi-disciplinary professionals committed to health promotion.  In addition, an appropriate career structure, which appropriately rewards good performance and offers continuing professional development, is necessary. Lateral entry recruitment of appropriate professionals who have demonstrated leadership in public health may be an appropriate method to fill senior and middle level management positions, until the newly trained cohorts have progressed up the career ladder.
Policy makers in India need to take several steps including relevant government orders and legal actions to create and strengthen Public health specialty. It is imperative that India moves from implementing narrowly defined vertical programs towards management of efficient health system at all levels. With NRHM, India has made a good beginning but will have to be complemented by creation of uniform Public health cadre for sustaining the progress. ,,
Source of Support: None, Conflict of Interest: None