COVID-19 mismanagement asks for Indian Medical Services
There is an urgent need to create such a cadre who will be holding the administrative responsibilities
Dr. Vinay Aggarwal
India is second largest populated country and now third highest in number of active Corona Virus cases worldwide. Exponential rise of COVID cases, existence of widespread community transmission, stressed health services, Increased costs involved in treatment by the private sector despite the pandemic situation expose vulnerability of India’s healthcare system to any major health Emergency; casting a doubt on policy making regarding health care delivery services in our country.
‘Health’ – Being a broader concept and to achieve good health, there needs to be a proper orientation on all development policies towards people, an overwhelming proportion of whom are deprived of even the most basic necessities of life. While the three-tier organisation of healthcare (Primary/Secondary/Tertiary) has been recognised world over that are demarcated to provide appropriate level of preventive and curative technologies, institutions and personnel required at the respective levels.
But over the years Governments and bureaucrats have ignored the need for a structured and strong health management system. IAS lobby without the involvement of the necessary stakeholders have always tried to only implement their decisions without any consideration or discussion with the healthcare sector.
Even during the testing times of COVID19 pandemic, ground level decisions were made or dictated by the Administrative officers, that has exposed the loophole of the existing healthcare structure.
The Governments also expressed their helplessness in reviving this three-tier system whereas bureaucrats only see health as a medical subject. While the policy makers miss out the important role of preventive health that focuses on preventing illness, there are clearly visible gaps between the ground realities and the policies framed to address them.
Since the COVID19 being a new virus, a change in approach is mandatory with the development of knowledge along the way. But the current policy decisions due to lack of ground reality are subjected to change too frequently and that too within 1 or 2 days. This being done without consultations with health experts has created confusion in public, frustration in healthcare workers and reduced the faith and credibility in the Government.
There are clearly visible gaps between the ground realities and the policies framed to address them. For example, more than four thousand changes have been made in policy matters in last four months of Pandemic. We have seen far too many changes in policies regarding testing, isolation, quarantine, admission, discharges, beds status, management of COVID vs non-COVID Health problems, human resources etc.
More than thousand doctors are infected and around hundreds lost their lives to COVID19 besides the rising number of concerns raised regarding lack of Personnel protective equipment [PPEs], lack of clarity over approach & management of COVID patients, unregulated duty hours, testing and quarantine facilities for healthcare workers and so on.
Certain erratic decisions like sealing the hospitals, filing cases against the treating doctors, stigmatizing the healthcare workers in the society to refrain from any social activity and the decision to allocate 20% of the beds for COVID treatment etc in smaller Hospitals were not only contradictory but also irrelevant to the situation which has now thrived towards community spread.
1. Since there does not exist a separate cadre for the healthcare delivery system for addressing the public health & medical needs; there has been mismanagement of the situation in these COVID times due to the lack of expertise/ experience in this field of health-crisis management.
2. Poor GDP Allocation by the Government of 1 to 1.2% towards Healthcare has led to the lack of adequate infrastructure, technology, facilities & resources in the public sector.
3. Skewed Geo-Distribution – Due to poor developments in villages & smaller towns, healthcare workers are not inclined towards working in the peripheral areas resulting in an urban centric curative care and disoriented/ skewed healthcare services at an additional out of the pocket expense.
4. Resource management issues – human and financial, enforcement of protocols and accountability frameworks, procurement and inventory management, building systems for hygiene and sanitary conditions – continue to plague the health sector. Unlike other sectors, health management has vital technical dimensions that have to be appropriately married to general management principles.
Since all these points out to the lack of professionalism in the healthcare administration giving rise to the need and scope of a special cadre in the healthcare structure – the Indian Medical Services.
The inadequate knowledge of public health and management capabilities, calling for an IMS to be established, was commented upon in the report of the Administrative Staff College of 1995 and more recently in the report by the National Commission on Macroeconomics and Health in 2005. In 2017 medical council of India also recommended to the govt of India for the formation of Indian Medical services.
Health administrators who are usually medical officers and are in charge of the health of the public although have medical knowledge but will be thoroughly lacking in administrative caliber. This gap is raising the needs for Indian medical services [IMS] cadre similar to IAS, IPS where medical professionals are trained in administrative roles and provided power to frame policies.
There is an urgent need to create such a cadre who will be holding the administrative responsibilities right from district medical officer, project officers of various disease control programs, and various ranks of secretaries in union and state health ministry and head all other relevant positions in the health sector.
IMS provides an opportunity to medical professionals to become a part of policy making and take active leadership roles in administration which will stabilise our healthcare system which looks very skewed at present. For any developed Nation – Health is the indicator of its development and to make our society healthy, IMS will be proven cornerstone for Nation Building.
(Dr. Vinay Aggarwal, is the Past National President, Indian Medical Association)