HEALTHCARE

Cadre Health Service a much needed boost for health system

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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 move comes in the wake of a felt need to inject a formal cadre of medical officers that can help manage and transform the health delivery mechanism across the country.

The government has embarked on a series of health reforms since coming into office. From the expansion of health infrastructure through 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, the government does find itself stymied in the face of systemic and structural problems that need resolution at the more fundamental level.

Experts have highlighted chronic under-funding of the health system as a major contributor to all that ails the sector. However, what is not so often reported is the fact that the 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 and the 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 health systems are managed can benefit the taxpayer, citizen and patient.

Most states currently 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 compliance. 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 could manage purely clinical services, thereby effectively utilising human resources available at hand.

Examples from other cadre-based specialist services like those in the Railways, Telecom and Engineering services are available as a useful benchmark to create the proposed health service. As we know, the writ of the Central government in health is limited since it is a state subject. The creation of an all-India cadre service managed by the Union department of personnel and training, but operating at the state level as it is for existing services, will need clear role definition and outlining of responsibilities. Also, the need to have a well-defined career path for the 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, there is a 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 move to create a new cadre of health service officers holds much promise. Their need is felt in our health system at all levels. However, it will also be equally important 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.

Dr Karan Thakur is the general manager of strategy and public affairs at Apollo Hospitals. Views expressed by the writer are personal.

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Topics : #Healthcare

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