Why India's governance needs to delink public health from bureaucracy

Public health is too large a problem to be managed by the Indian Administrative Services. Therefore, identifying new and emerging talent, voices, and thoughts than sticking to the old guard is more than necessary now to inject fresh energy into the national veins

Dr. Edmond Fernandes
Updated: May 24, 2021 06:51:56 PM UTC

Dr. Edmond Fernandes is a community health physician and CEO, CHD Group – a public health organization headquartered at Mangalore, India. He is also a Senior Fellow at the Atlantic Council in Washington DC and a Consultant – United Nations Economic and Social Commission for the Asia and the Pacific in Bangkok. Being an Alumnus of the US Department of State, Dr. Edmond has published several books, written columns in national press and travels around the world on commitments of global health and development. He can be reached on office@edmond.in

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Image: Uma Shankar MISHRA / AFP

I have some of the finest friends in the bureaucracy across Karnataka, at the national capital and those flying our flags around the world. I admire them and have a fond affection for them. Bureaucracy holds up the complex fort of noisy politics and delivers results despite it, albeit sometimes at a snail's pace, it does a good job overall.

However, I also feel public health is too large a problem to be managed by the Indian Administrative Services. Covid-19 has exposed the hiccups that the civil service has stumbled upon, much of it because the nation is run by a bureaucracy that is not trained in public health.

I would recommend in broad strokes a three-pronged solution to this problem. Mind you it is going to get worse from herebeyond Covid-19and the IAS will not be able to hold guard. India faces a cascading risk emerging from natural disasters, extreme weather events, climate change, and future pandemics. The public health consequences of this nature will be beyond the comprehension of the bureaucracy.

Give it a thoughta bureaucrat who moves from department to department can only grasp as much. A secretary in shipping moves to become the secretary in finance and then to women and child or as secretary to the top boss. How can you establish competency and creativity? This is equal to a jack-of-all-trades-master-of-none model.

Here’s what we must do:

Create lateral entries in the ministry of 'Public Health'
Identifying new and emerging talent, voices, and thoughts than sticking to the old guards will inject fresh energy into the national veins. Swami Vivekananda had stressed on the need to engage new and fresh talent and to have the ability and wisdom to listen to them. His teachings back then, hold good today. Do we have the ability and humility to listen? Only time can tell.

You may be the best captain of the ship, but in a tsunami, you will still lose the battle to the shores. There are too many good officers in the IAS system, but they may not be well-equipped to handle public health problemsa prerogative of public health professionals.

Therefore bringing in public health competent secretaries to the government or joint secretary to the department or ministry is very necessary now.

Permanent commission for public health
The judiciary should direct the state and central government to establish a permanent commission for public health, where members to the commission have a three-year term and tangible outcomes to meet.

Alternately, visionary governments of the day can set this up and champion community development in a structured manner by bringing public health into all policies through the permanent commission. This is a small investment that will reap 100X rewards over the years. After all, life is all about planting trees under whose shade we may never sit. Right?

Bring back Indian Medical Services
I spoke about this many years ago and a video to this effect remains on my YouTube channel. But I would like to reiterate it to snap us our of the lethargy that drives us. Bring back Indian Medical Services which existed in British India and let all District Health Offices and the Ministry of Health be championed by such cadres.

If after decades of mid-day meal programs, we still haven’t eradicated malnutrition, it is not a fault in the stars, but the glaring fault lines of our approach, strategy, and persuasion to innovate and delink the clutches of caste and oppression that still reigns supreme.

If the politics of motherhood kills mothers today, it is a public health problem. If years of development get wiped out with a disaster, it is a public health problem. For this and much more, we need to act now.

Train new recruits to IAS into specialised cadres
Civil servants come from different backgrounds. It is a celebration of diversity and democracy at the highest levels. What we must do is help them select sectors of their choice, which have line ministerial value, and train, build competence, and have two or three departments where they are rotated for the want of natural administrative importance. Imagine, if I as a doctor was given the textile or finance ministry What would I do? Also imagine a mechanical-engineer-turned-civil-servant now running the health or women and child ministry. The answer lies in the questions I have raised.

These initiatives, if pursued with utmost seriousness, will set India rolling on the right path and secure generations that will come after us. The time to implement is now.

The writer is a community health physician and CEO of CHD Group 

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