The Covid-19 pandemic has shown humanity all its vulnerabilities. There is no cure in sight and the virus seems to be mutating faster, than the humanity can catch up. The popular saying, "Prevention is better than cure" best describes our situation.
With the virus exposing the deficiency of our health care system, what is the solution? The Indian parliament's standing committee on health went through ways of improving the war against Covid-19. The chairman Shri Ramgopal Yadav suggested the setting up of the Indian Medical Service as a national service on the lines of the All India Services in March of 2021.
British India had a civil service known as the Indian Medical Service. It was a service with both military and civilian medical function. This service was responsible for pioneering advances in setting up our country’s public health system. After Independence, policymakers did away with the service leaving medical service policy to the state governments. Successive governments gave priority in decision making to civil servants with no special knowledge or training in public health. Indian healthcare systems to this day are administered by non-medical personnel.
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It is a crisis like Covid-19 that has exposed all the flaws of the current system. Medicine and public health are extremely complex subjects even for experts. America had to turn to the chief medical advisor a medical doctor, Doctor Fauci to provide leadership decisions during the initial stages of Covid-19. A gentleman who without fear or favor could take informed decisions in interest of public based on science, not on politics or administrative ease. The good doctor was even able at times to publicly correct mistakes that President Trump made. Concerned by the devastation Covid has brought, Maharashtra and Karnataka have set up active and empowered Medical expert committees to guide the war against Covid-19. The health minister in the Centre as well as in many states of our country is a medical doctor. Bureaucrats with medical backgrounds are increasingly being preferred for postings in the health ministry in various states.
The present health care system in Odisha gives neither a voice nor any authority to doctors. Policy decisions are made with no reference to the stakeholders. With all of us having a lot to learn of lessons everyday from Covid, feedback from all healthcare workers is of paramount importance. Yet in the name of cadre seniority and civil service rules, a health care worker conveying his views and advise would be taken as indiscipline and insubordination. The fear of administrative punishment thus silences the very voices of experts, which Odisha badly needs to hear.
The Odisha state medical services ought to be brought on par with other civil servants. Doctors and public health experts have no administrative power to implement or enforce norms and regulations in interest of public health. Precious time is delayed in seeking the permission of collectors, tehsildars and police station in-charges. To make matters worse in the absence of clear inter cadre norms of precedence, a doctor in the state government medical services in practice ends up below the local inspector and revenue official in administrative priority. In other states, a state government doctor is accorded Class-I gazetted employee status in theory and practice.
This puts them far above the tehsildars and inspectors in administrative hierarchy. This is a demoralizing situation for doctors of our state who face the risk of death from Covid on a daily basis.
Health and health services is a state subject. Reforming Odisha’s medical services is in our state government’s jurisdiction. Odisha should provide doctors a voice in health policy and planning. It would also give a chance to medical experts to administer the healthcare system of our state. Make no mistake, Odisha is in a state of war. Our enemy is the virus Covid-19. Wars are won by knowledgeable and experienced leaders. Giving health care experts a say in our war against Covid-19 is the need of the hour.
Is it proven that giving leadership of a state's healthcare system to medical experts will improve healthcare? The answer is YES. We have scientific evidence to back this assertion. Dr Sanjeev Kumar et al in their scientific study published in the Indian Journal of Public health way back in 2016 noted that a dedicated public health service was the need of the hour to improve healthcare in India. Countries like England and Thailand with dedicated medical services had the most comprehensive and best performing health systems in the world. Odisha’s health system neither empowers doctors to take policy decisions nor implement public healthcare laws. What was true in 2016, is now all the more urgent in 2021.
(DISCLAIMER: This is an opinion piece. The views expressed are the author’s own and have nothing to do with OTV’s charter or views. OTV does not assume any responsibility or liability for the same. The author is an Orthopedic Surgeon and can be reached at sidusahu@gmail.com)
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