It is established that the future of developing countries like India is decided by the investments in human resources, the two key elements in the latter being health and education. I wish to focus on health issues here. The purpose of this paper is to identify and present the opportunities in improving the public health system, and hope that substantial investments shall be made there for greater rewards in the near future.
To begin with, there is an urgent need to implement the practice of evidence based public health spending. Without getting impressed by planned advocacy campaigns of donor agencies for vertical programs, countries like India should focus on indigenous public health needs’ assessment. This would require the constitution of a public health task force at the level of central government, with several subgroups at the state levels, which focus on conducting research to provide evidence based public health priorities. However, in the long run autonomous research-funding organizations have to be established in the country, similar to the National Institutes of Health (NIH) in United States. Public health system does not necessarily mean that it has to be wholly run by Government alone; however, most of the funding earmarked for research by Government of India is allotted to Indian Council of Medical Research (ICMR). The policy of bestowing grants upon competitive independent research organizations or public health researchers should be implemented.
Secondly, as a country we need to shift our focus from vertical program management to an integrated management. Despite of ambitious intent, India’s Integrated Disease Surveillance Project (IDSP) does not match in performance to any of the integrated surveillance programs such as those run by Centers’ for Disease Classification (CDC) either in China or United States. We need to pass new Indian Public Health legislation laws to create a CDC like institution in India, and bestow it with statutory and economic powers to allow it to successfully plan and implement integrated surveillance for diseases. This will be a crucial step not only from the health perspective, but also to prepare the country against the threat of biological weapons.
Thirdly, unfortunately, private health system in India is totally deregulated including reported dichotomy of consultation and diagnostic fees, which in turn adds on to an extra burden of expenditure on the common man. Health related services should have uniform guided prices throughout the country. Governments at central and state level can hold consultations to publish such guiding prices for health services, which need to be followed by private health industry. Also, private health systems need to made more accountable for using high safety and quality parameters while providing health services, along with mandatory reporting of notified diseases to government agencies.
Fourthly, it was sad to see that the erstwhile Medical Council of India (MCI) had become more like a defunct organization due to lack of a modernized approach, and refused permission for setup of new medical institutes and colleges which do not play by its rules. Currently, interim board of Governors runs MCI. It is high time that MCI recruits more professional managers and people who can genuinely work to improve the quality of medical education in the country. Also, the setup of a single head organization, like Public Health Council of India, would ensure the integration of services offered by different branches of health profession. At the same time, it is pertinent that all health care professionals keep themselves updated and try to stay at the forefront in their respective fields. This can be done by implementing a system of scheduled annual or timely examinations for professional license renewal, and continuing medical education programs (CMEs), which would be compulsory for the professionals to attend and participate in.
Fifth, public health training and public health research, being two important aspects require immediate attention. There is a clear and strong need for establishing public health institute in every State, to focus and help in alleviating the varied challenges plaguing the regions. Unlike Indian Institute of Technology (IIT) and Indian Institute of Management (IIM), the institutes for public health would have immediate obligations to serve within each state. These would include training of the public on important matters on general health, as well as conducting a research on the important concerns of public health in a state-wise manner, and reporting them to the central government, so that the required changes can be immediately implemented.
Sixth, it is critical that management of public health system is done at the hands of a trained and professionally skilled manpower. A new service such as the “Indian Health Service” should be created with high priority, which should be equated to Indian Administrative Service (IAS) in terms of implementation powers’ and economic structure. A detailed draft of such service can be prepared and discussed in detail by public health experts. Government of India has already taken efforts to create a dedicated cadre of legal service termed as Indian Legal service.
India was the first country to have started with programs for national blindness and family planning. The launch of National Rural Health Mission has been the recent success story in health reforms underway in India. However, such a program is rarity, and the need is much more intense. We cannot allow Indian children to suffer from measles, adults to get cardiovascular diseases or elders to succumb to cancer. All these conditions are very common in our country and very little is being done; yet we claim ourselves to be one of the fastest growing and developing nations. It is high time that we focus on fixing the health system, and take steps that will improve the picture of the public health in the country.