Creating public health management cadre

Health management cadre is a positive deviation from traditional public healthcare system.

The recently released National Health Policy (NHP), 2017 aims at achieving universal health coverage and delivering quality health care services to all at affordable cost. The policy is an important step towards framing a healthy India.

The NHP is optimistic in suggesting quantifiable targets to reduce disease burden to strategic purchasing from non-government healthcare providers. It shows that the government’s priority is in the right place. However, it’s time to move from intent to action.

Among some of the key intentions, one that stands out is creation of public health management cadre in all states based on public health. This is a positive deviation from the traditional medical education-driven public healthcare system. It is not to belittle the contribution of medical professionals in containing disease burden in the society.

Public health is beyond medicine, and requires knowledge of sociology, financing, economics, anthropology, programme management, health communication, demography, logistic management, strategic purchasing – not part of a traditional medical education curriculum.

Greater success of health advances in developed countries has come with equal attention to medical education and public health management cadre. An important feature contributing to improved health outcomes not only in the developed world but also across select states in India is the presence of a dedicated, efficient and adequately resourced public health cadre.

Public health cadre are trained professionals responsible for population-wide preventive services to reduce exposure to disease through sanitary and health regulations, monitoring and averting health threats. With trained public health professionals and the support of robust public health regulations, these cadres have contributed to improved health, environment and development outcomes.

Following the example of Tamil Nadu and Maharashtra which have maintained a Public Health Directorate staffed by a trained cadre of public health managers and backed by a Public Health Act, several states including Gujarat and Chhattisgarh are mulling criterion of health system management cadre in their states.

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.”

By incorporating this recommendation, the National Health Policy 2017 has created an important career option in Public Health Management — one that incorporates key management concepts for improving health of its population. Such a career is nurtured through professional competency-based curriculum that includes knowledge of epidemiology, biostatistics, socio-behavioural science, health communication and promotion, programme management, research methods, programme evaluation, health management information system, quality of care, demography and human resource management.

New arena
The public health management education is new but fast evolving. The All India Institute of Hygiene and Public Health, Kolkata, is the oldest public health institute in India, which offers diploma, masters, and doctoral level programmes in various domains of public health. Of late, several institutes including the four Indian Institutes of Public Health set up by the Public Health Foundation of India offer masters level programme in public health. The need for professional course is more and should start from Bachelors level. 

However, mere statement of intent is not sufficient. Key issue is to create an enabling environment where such public health management cadre are accepted in the system. District program coordinator position under National Health Mission have met with varying success – in several states these positions are passed on as a glorified data entry operator. It is time that National Health Mission and Ministry of Health & Family Welfare work towards creating appropriate career structure and recruitment policy to attract young and talented multi-disciplinary professionals, with active involvement of states.

The public health practitioners are in great demand. The National Health Mission has opened up vast career opportunities for public health graduates. Many allied departments such as livelihood mission, tribal welfare departments look for skilled public health professionals to address the wider determinants of health.

Moreover, interest from national and international NGOs, industry-supported foundations, academic and research institutions, hospitals, health insurance companies, allied health organisations in recruiting public health and hospital management professionals embraced the possibility of living a completely different career path – one that is both socially and financially rewarding.

(The writer is Assistant Professor, Indian Institute of Public Health, Gandhinagar)

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