More than five and a half decades after a central committee had recommended the setting up of an All India Medical Service cadre along the lines of the Indian Administrative Service (IAS) or the Indian Police Service (IPS), the central government has moved a proposal to create such a cadre. Health being a state subject, the union health secretary has written to the chief secretaries of all states soliciting the views of the states.
“The creation of an All India Medical Service under the All India Service Act 1951, like IAS, IPS, etc. for creating a body of professional doctors across the country has been under the consideration of the government for quite some time. Considering the fact that health is a state subject and the major requirement of health professionals is at the state level, it has been decided to solicit the views of all state governments on this issue,” stated the letter sent to the states.
The letter, dated June 9, went on to state that doctors of the Central Health Service (a Group A service under the health ministry dealing with monitoring of various health programmes/schemes) have never worked in the states and hence “do not have an appropriate perspective of the problems being faced by the state governments”. Creating the All India Medical Service could help bridge this gap and “improve technical leadership and management both at the Centre and state levels,” the letter said.
The Health Survey and Planning Committee, better known as the Mudaliar Committee, which submitted its report in 1961 had observed that three areas — provisioning of adequate medical care, both preventive and curative; training of medical and paramedical personnel; and those for dental care and for research — were interlinked and that it was only through a coordinated programme of action in which centre and states cooperated “satisfactory and speedy results” could be achieved. Hence it had recommended the formation of a central health cadre in which senior posts in the Central and state health ministries would be included.
Such a central cadre, which existed before independence, the Indian Medical Service (IMS), was abolished in August 1947. The committee’s report noted that most of the highest administrative and specialist posts in the states were manned by officers of IMS, the Women’s Medical Service and the Medical Research Department, who were officers of an all-India cadre, thus “providing a certain measure of coordination between the Centre and states in spite of the fact that health was a ‘transferred subject’ under the Government of India Act 1935”.
More recently, in 2005, the report of the National Commission on Macroeconomics and Health (NCMH) chaired jointly by then finance minister P Chidambaram and health minister A Ramadoss had stated that it was necessary to take a bold decision “to constitute an All India Cadre of Public Heath Services, on lines like the IAS/IPS”.
“It is a great move if the government can pull it off. This is much needed, as those in the existing Central Health Services have no experience in the states and are often restricted to Delhi postings or to central government institutions in the states. They have no clue about rural health or how public health is delivered through the various tiers of the government health system. They get no training or an all-India perspective like the IAS or IPS officers receive in Mussoorie followed by their postings to rural districts. We need a complete revamp of the Directorate of Health Services so that they can function like they are meant to, as the technical and policy advisory wing for the health ministry,” said former health secretary Sujatha Rao, who was also a member of the NCMH.