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Barriers to Establishing a Dedicated Public Health Cadre
The efforts to develop a public health cadre have not seen much progress in most of the Indian states, despite the recommendations of several committees appointed by the union government, and the 2022 guidelines issued for establishing them. This paper, by drawing on the views of experts in the field, examines the epistemic, structural, systemic, and administrative barriers to the establishment of such a cadre in the south Indian states. It notes that the dominance and perpetuation of biomedical view of health, poor understanding of what public health is, privatisation of healthcare, the vested interests of clinicians, consultancy firms, international funding institutions and the existing hierarchies and binaries within the system, act as major barriers to the establishment of the cadre. The paper suggests that the proposed public health management cadre needs a critical revisit in light of these impediments and concerns.
The study was funded by the Thakur Family Foundation. The authors are thankful to Dinesh Thakur and Prashant Reddy for their support. They are also thankful to the experts who participated in the interviews.
Healthcare delivery in India is constrained by factors, such as lack of sufficiently trained human resource, adequate physical infrastructure, corruption, poor health management systems, absenteeism, etc (Acharya 2010; Hazarika 2013; Saikia 2018). One major consequence of the COVID-19 pandemic in India is the widespread realisation that public health in the country has suffered from long-standing neglect and that the pandemic might provide an opportunity to do something about it (Chetterje 2020; Baru 2020).
Several committees appointed by the union government have reiterated the need for strengthening the healthcare delivery system across the Indian states and one of the important recommendations was a dedicated public health cadre. For instance, the Bhore Committee appointed in 1943 recommended the integration of prevention and curative service at all the administrative levels, development of primary health centres (PHCs) in two stages, and three-month training in preventive and social medicine in medical education. The suggestion for an all-India health services came from the Mudaliar Committee (Health Survey and Planning Committee, chaired by A L Mudaliar), which was appointed in 1959, to assess the status of the healthcare and the progress achieved after implementing the suggestions of the Bhore Committee.
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