If India has to ensure that no more Gorakhpur-like incidents happen, the establishment of a professionally and prudently run health system must be the first step in this direction. Equally, it is important have a roadmap on the creation, delineation of roles and deployment mechanism
The heart-wrenching tragedy that continues to unfold in Gorakhpur with unabated deaths of more than 50 children, has left our nation stunned. The Prime Minister, during his Independence Day speech, paid homage to the young children who lost lives. The tragedy is nothing but callous apathy of the system. While the State Government keeps arguing on the exact nature and cause of the events that unfolded on the intervening night of August 10 and 11, there is a stark truth that has emerged from this most horrific of tragedies.
For far too long, our public health institutions have been mismanaged, primarily driven by a lack of professional managerial structure. This lack of management and expertise has seen multiple incidents of malfeasance, corruption and subversion of citizen’s rights to access healthcare.
Conventionally, most public health institutions have followed the seniority principle for appointing heads of departments and institutions. These, while effective for clinical management of services, are adequate, but for overall management of an institution, have more often fallen short of expectations. The Government must desist from equating seniority from managerial acumen.
In line with this thinking, the Union Government is exploring the possibility of creating a cadre-based health service corps on the lines of the Indian Administrative Service and allied services. The Government has embarked on a series of health reforms since it came to office.
From the expansion of health infrastructure through the creation of new AIIMS across the country, to reforming medical education and bringing in price controls. The Government has made its intention clear to radically transform the existent health system. However, as the incidents of Gorakhpur and previous scandals in the National Health Rural Mission (NRHM) have pointed out, the Government does find itself stymied in the face of systemic and structural problems that need resolution at the fundamental level.
Experts have highlighted chronic underfunding of the health system as a major contributor to all that ails this sector. However, what is not so often reported is the fact that institutional capacity, to absorb funds and to use them efficiently, is a far greater cause of worry. Funds, limited as they are, to begin with, are spent without adequate planning or guidance.
Numerous controversies in health spends that have periodically been reported lay testament to this fact. The need for a dedicated workforce that can structurally change the way the health systems are managed can benefit the taxpayer, the citizen and the patient.
Currently, most States do run a health services cadre from which public institutions are run and managed. However, this cadre has been saddled with multiple roles, which range from patient care to resource planning to inventory management to ensuring legal compliances. This has often led to neither the administration of patient care being adequate nor the optimum management of health resources that are available in any hospital or health centre.
Therefore, the need to clearly delineate clinical and administrative roles will be crucial. The new health services cadre could be tasked with the responsibility of managing resources, ensuring optimum utilisation, managing and collecting data and surveillance and overall administration of health services. The clinical health services division can manage purely clinical services, thereby effectively utilising human resources available at hand.
Examples from other cadre-based specialist services like those in railways, telecom and engineering services are available as a useful benchmark to create the proposed health service. As we know, the writ of the Union Government in health is limited since it is a State subject.
The creation of an all-India cadre service is managed by the Union Department of Personnel and Training but operating at the State level, like for existing services, will need clear role definition and outlining of responsibilities. Also, the need to have a well-defined career path for cadre officers would need to be embedded into the charter. The officers would also need to have a medical degree in order to qualify for such a service, which would also mean further dwindling of available trained doctors for clinical services.
lastly, for the service to be fully efficient, the need for training in skills not imparted in medical school — economics, general business management, human resource planning and financial management — would all need to be part of their preparation as officers.
The underlying attempt to reform the management of public health institutions is welcome. And if India is to ensure that no more Gorakhpur-like incident happen, then a professionally and prudently run health system would be the first and most important step. Equally important is to have a clear roadmap on the creation, delineation of roles and their deployment mechanism, which would need prudent planning from policy makers.
If India is to create a health system built for the 21st century, an effective and efficient cadre to manage it would be an imperative. We owe this to our citizens and to our children.
(The writer is general manager, Operation and Public Affairs, Indraprastha Apollo Hospitals. He can be reached at dr.karanthakur@gmail.com)