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Public Health Cadre in the state of Karnataka,

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Public Health Cadre in the state of Karnataka,

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Creation of Public Health Cadre in Karnataka
State, India
Giridhara R Babu1, TN Sathyanarayana2, Suresh S Shapeti3, Srikanthi4, PN Halagi5,
HN Raveendra6
Abstract
Background: Public Health is the science and art of promoting Health, preventing diseases and prolonging
life through organized efforts of Society. The Government of Karnataka constituted a committee to revive
the Public health system in state of Karnataka to provide recommendations for creation of Public health ca-
dre. Objectives: To provide recommendations for creation of efficient public health system through creation
of public health cadre. Methods: We reviewed several documents for studying the history and current struc-
ture of the department regarding creation of public health cadre/department. We conducted 35 brainstorm-
ing sessions involving in-depth discussions. We also conducted field visits and administered a pre-designed
format for collecting the feedbacks from the officials of different levels. Results: The reviewed documents
had a common finding of implementing public health cadre. Our analysis of current human resources in
health department indicates that there is shortfall of qualified public health professionals in the department
to opt and continue in public health cadre. Among the existing staff, 51% of the respondents wanted to up-
date their skills through continued professional education. Our results from the study demonstrated to create
a Public health directorate and public health cadre in Karnataka state. Conclusions: We recommend that
there can be three levels in Public Health Cadre namely, Taluk level officers, District level officers and State
level officers. We recommend time bound promotions of medical officers in accordance with published and
updated common seniority list, which is the basis for all service matters.
INTRODUCTION
The public health scenario in
India is shadowed by overwhelm-
ing public health problems com-
pared to reasonable accomplish-
ments(1, 2). India has made substan-
tial progress in provision of health
services during the past century in-
cluding eradication of small pox,
plague, and guinea worm infec-
tion, and is almost on the verge of
stopping polio transmission.(3) In
recent years, implementation of
the National Rural Health Mission
(NRHM) has resulted in gradual
progress in terms of reducing in-
fant and maternal mortality.(4)
There are several public health
challenges including large rural-
urban inter-regional differences in
health indicators,(5,6) high infant
and maternal mortality in some re-
gions, under-nutrition in children,
women's health, mental health,
and disability care. In addition, In-
dia is passing through epidemio-
logical transition managing dual
burden of communicable as well as
Non Communicable Diseases.
These problems have been com-
pounded by the lack of training in
public health as well as the lack of
a public health cadre in the health
workforce.(7) In spite of the massive
advancements in technology, pub-
lic health essentially remains a
highly human resource intensive
process(6, 8-10).
There are deficiencies of requi-
site manpower at different levels,
gaps in training status, weak pro-
gram management and weak sur-
veillance at district, block and
community levels. In order to for-
mulate and implement the public
health activities in the country, a
uniform public health cadre is the
need of the day.(3, 6, 8-13)
Karnataka had Mysore state
Public Health Act, due to which
public health department of the
state was renowned as one of the
best in the country.(14-16) However,
over decades following independ-
ence there was gradual decline in
public confidence in public sector
health services.(4-6, 18, 19) One of the
reasons for low confidence on pub-
lic health sector service is, lack of
credibility and quality of services
was quoted as main factor and
which in turn adversely affecting
the functioning of all national
health programmes.(4-6,19) This
problem has been compounded by
1Associate Professor, Public Health Foundation of India, IIPH-H, Bangalore campus, SIHFW premises, Magadi road. Bangalore
2Assistant Professor, Public Health Foundation of India, Indian Institute of Public Health-Hyderabad
3Joint Director (H&P) -Member Secretary on the committee
4Indian Institute of Public Health-Hyderabad
5Former Director, H&FWS
6President, Karnataka Government Medical Officers Association, Bangalore.
Correspondence to Dr Giridhara R Babu (giridhar@iiphh.org)
Received: 08-04-2014 Accepted: 28-05-2014
ANNALS OF COMMUNITY HEALTH | VOL 2 | ISSUE 2 | APR - JUNE 2014 | Page: 4
Spotlight
ANNALS OF COMMUNITY HEALTH | VOL 2 | ISSUE 2 | APR - JUNE 2014
5
the lack of training in public health
to various officials in the depart-
ment of health & family welfare
services (H&FWS).(8, 9, 11, 17, 20, 21) The
state government of Karnataka
constituted a committee to review
all the earlier reports, study the
current status and further recom-
mend strategies for implementing
public health cadre in the state.
The objectives of the committee
were to provide implementable
recommendations on health work
force to match the aspirations of
Government for efficient delivery
of health care services and to rec-
ommend the strategic approach for
creation of efficient public health
system through public health ca-
dre.
Sl. No
Particulars
Frequency
1
Number of policy documents reviewed
2
2
Number of committee reports/recommendations reviewed
10
3
Regulations/ Legislations/acts/rules
16
4
Other documents reviewed
5
5
Number of deliberations
35
Table.1 depicts the summary of total number, type of documents and deliberations being undertaken to
propose the balanced recommendations to create public health cadre.
Table 2: Displaying the type of documents used for the review
Sl. No
Type of documents reviewed
Relevance*
1
Government order No. HFW (PR) 144 WBA 2002, Bangalore, dated 10-2-2004;
++
2
Proposed draft of Public Health Directorate for department of H&FWS,
Government of Karnataka, Palekar committee (2009);
++++
3
Report of Task force of Health for Karnataka;
+++++
4
Karnataka Gnana Ayoga report regarding Public Health Directorate;
+++
5
Ferguson report;
+++
6
Establishment of Public health cadre in state by Dr.K.K.Dutta;
++++
7
Study of Public health directorates of other states in India- Advantages and
limitations;
++++
8
Report of Independent commission on Health of India, by VHAI
+++
9
Present need of Preventive public health care;
++++
10
Mysore Public Health services Act, 1936;
+++++
11
Relevant legislations/rules and regulations and other documents (such as
Atomic Energy Regulation Board) AERB rules,.
++++
12
Consumer Protection Laws:- The COPRA, Indian Penal Code- Section 269,
++
13
Acts of commission, omission and Medical negligence,
++++
14
Biomedical Waste management,
++++
15
Pollution control Act,
++
16
Private Medical Establishments Act Karnataka,
+++
17
Clinical establishments Act, Government of India,
+++
18
Mysore Public Health Act,
+++++
19
Food Safety Act,
++
20
Notifiable Diseases Act,
++
21
Epidemic Diseases Act,
++
22
Proposed Karnataka Prevention of Diseases Bill, 2010,
++
23
Karnataka Public Health services, Recruitment rules of 1960,
+++++
24
Social legislations affecting Health: Physically handicapped Act,
Minimum wages Act ,
+
25
Time bound promotion of Assistant surgeons/ Health officers, 1991.
+++
26
Cadre & Recruitment rules, 1991
++++
*(1+ min-5+ maximum)
6
ANNALS OF COMMUNITY HEALTH | VOL 2 | ISSUE 2 | APR - JUNE 2014
MATERIALS AND
METHODS
Stage-1, Review of the relevant
documents:
The committee initially exam-
ined the existing organizational
structure of department of
H&FWS and reviewed the several
documents for studying the his-
tory and current structure of the
department regarding creation of
public health cadre/department
and to address the task of restruc-
turing of the health workforce. The
key documents reviewed were:
The Karnataka State Integrated
Health Policy-2001- Government
order No. HFW (PR) 144 WBA
2002, Bangalore, dated 10-2-2004;
Proposed draft of Public Health
Directorate for department of
H&FWS, Government of Karna-
taka, Palekar committee (2009); Re-
port of Task force of Health for
Karnataka; Karnataka Gnana
Ayoga report regarding Public
Health Directorate; Ferguson re-
port; Establishment of Public
health cadre in state by
Dr.K.K.Dutta; Study of Public
health directorates of other states
in India- Advantages and limita-
tions; Report of Independent com-
mission on Health of India, by
VHAI; Present need of Preventive
public health care; Mysore Public
Health services Act, 1936,; Rele-
vant legislations/rules and regula-
tions and other documents (such
as Atomic Energy Regulation
Board) AERB rules, Consumer
Protection Laws:- The COPRA, In-
dian Penal Code- Section 269, Acts
of commission, omission and Med-
ical negligence, Biomedical Waste
management, Pollution control
Act, Private Medical Establish-
ments Act Karnataka, Clinical es-
tablishments Act, Government of
India, Mysore Public Health Act,
Food Safety Act, Notifiable Dis-
eases Act, Epidemic Diseases Act,
Proposed Karnataka Prevention of
Diseases Bill, 2010, Karnataka Pub-
lic Health services, Recruitment
rules of 1960, Social legislations af-
fecting Health: Physically handi-
capped Act, Minimum wages Act ,
Time bound promotion of Assis-
tant surgeons/ Health officers,
1991.Cadre & Recruitment rules,
1991.)
Stage 2, Brainstorming sessions
The committee conducted 35
brainstorming sessions involving
in-depth discussions. Each mem-
ber had submitted individual re-
ports and feedbacks on the objec-
tives. Further, the committee delib-
erated on each member’s sugges
tions. The process was independ-
ent with clear expression of differ-
ent views on several topics were
captured. The proceedings of these
meetings are recorded and availa-
ble with the Karnataka State
Health Systems Development and
Reforms Project (KHSDRP).
Stage 3, Field health staff inter-
view:
The committee conducted field
visits and has administered format
for collecting the feedbacks from
the officials of different levels. A
total of 47 staff, from ANM to the
Director, health and family welfare
(HFW), have been involved to cap-
ture the requests for feedback on
pre-defined format. The results of
the interviews with DHFWS work-
ers is provided in annexure.
RESULTS/ RECOM-
MENDATIONS
Public Health Cadre:
The committee made the fol-
lowing recommendations regard-
ing Public Health Cadre.
Recommendation-1:
Three levels of health cadre
The committee recommends
that there shall be three levels in
Public Health Cadre namely, Ta-
luk level officers (block level), Dis-
trict level officers and State level
officers. The entry level for Public
health cadre shall be at the level of
Taluk health officer. Cadre-wise
common feeder seniority list shall
be published and updated every
year, which shall be the basis for all
service matters. All the promotions
will have to be based on cadre-
wise feeder list and required post-
graduate qualifications. (Figure.2)
Recommendation-2: Entry level
For the long-term management
of public health cadre, general
duty medical officers (GDMOs)
shall be given an option after com-
pleting three years of rural service
to pursue post-graduation in pub-
lic health or clinical services or hos-
pital administration. However, to
address the immediate shortfall of
public health trained workforce,
the state government can prioritize
and offer post graduate (PG) train-
ing by preparing a comprehensive
list of officers who have undergone
training in both clinical and public
health cadre. Proposed Deputy Di-
rector (HR) should update the list
regularly and Deputy Director
(HR) shall report directly to pro-
posed position of DGHS.
Recommendation-3:
First level of public health cadre
The post of Taluka Health Of-
ficer shall be filled up by a Medical
Officer who has completed a mini-
mum of 6yrs of rural service, with
Public Health Specialization. In
case of non-availability of such a
candidate, an MBBS qualified
Medical Officer, based on seniority
and 6 years of rural service, shall
be sent to complete a recognized
post-graduate diploma or Masters
ANNALS OF COMMUNITY HEALTH | VOL 2 | ISSUE 2 | APR - JUNE 2014
7
course in Public Health and be
posted as Taluka health Officer.
There should not be one-person
holding charge of both Taluka
Health Officer and Administrative
Medical Officer, at one time, in a
Taluka/block.
Mandatory qualifications as
minimum requirements to be qual-
ified as a Public health specialist:
Should be eligible as per
common seniority list in the feeder
cadre (with at least six years of ru-
ral service including rural service
in the contract period) and post-
graduate qualification in public
health.
A degree /diploma in public
health would be a mandatory qual-
ification
A recognized MD in preven-
tive and social medicine
Masters in Public Health
(MPH)/ Master of Science (Public
Health)/ or recognized as equiva-
lent by universities/ Government.
Post-graduate diploma in
public health or equivalent offered
by recognized universities or rec-
ognized institutions.
Short-term measures: At pre-
sent, there is shortfall of qualified
public health professionals in the
department to continue in public
health cadre. Therefore, state gov-
ernment can conduct counseling
with immediate effect to identify
medical officers interested in pur-
suing public health cadre/clinical
services and should allow to pur-
sue public health qualifica-
tion/clinical courses/hospital ad-
ministration. At the counseling, list
of medical officers (who have com-
pleted six years of rural service
and based on seniority) should be
prepared based on the common
seniority, and be given option to
complete post-graduation in pub-
lic health. Counseling should pro-
vide options of both public health
training and post graduate courses
in clinical branches.
The committee further
recommends that deputation of
medical officers is to be done in
batches of 30-50 to recognized
public health institutions in the
state/country to complete the
backlog of training. After the
successful completion of post-
graduate training, these officers
should be posted as Taluk
Health Officers and they shall
continue in public health cadre
for the remaining service pe-
riod.
The committee feels that
public health is predominantly
field-based discipline with as-
sociated administrative, tech-
nical and management skills.
Hence, no dilution should be
accepted by the government in
providing highest quality of
post-graduate training and ori-
entation in imparting public
health skills.
However, those who do
not opt for post-graduate quali-
fications in either clinical or
public health specialties and
those do not attend counseling
(after the notification on de-
partmental website), shall be
deemed to have foregone all the
promotional opportunities in
the department. Such officers
would continue as medical of-
ficers for the rest of their career
with time bound financial ben-
efits. The age for the above shall
Figure 1 illustrates the proposed organogram of the public health cadre
at state level; the director general of health may be overall in charge of
technical and administrative authority for major technically intensive
wings of the health services. Figure 2 shows the recommended state
level director of public health services organogram.
8
ANNALS OF COMMUNITY HEALTH | VOL 2 | ISSUE 2 | APR - JUNE 2014
be as in Karnataka state civil
service rules.
All the above points are also be-
ing suggested by several earlier
committees such as; The Karna-
taka State Integrated Health Pol-
icy-2001; Karnataka State Task
Force on Health, Ferguson report
and Dr. Palekar Committee and
Karnataka Gnana Ayoga and Kar-
nataka Public Health Act (2010-
draft under discussion by KIL-
PAR).
Recommendation - 4:
Second level of Public Health Ca-
dre- District level
The Committee recommends
that the second level of public
health cadre be at district level as a
unit comprising of District Health
Officer (DHO) and all the district
level program officers.
District Health Officers: The
Committee recommends that the
eligibility for the post of District
Health Officer should be that of
seniority cum merit and public
health specialization. (Table 3, 4)
(Figure 3).
The officer should be eligi-
ble as per common seniority list in
the feeder public health cadre. The
officer should have completed a
minimum of 15 years of regular
service inclusive of 6 years of rural
service, with a recognized public
health degree/diploma. The officer
should possess management and
supervisory skills demonstrated
either as Taluk health officer/Ad-
ministrative Officer at CHC and/or
as a district level program officer.
The officer should have a good
track record.
A degree /diploma in public
health would be a mandatory qual-
ification. The committee recom-
mends the following post-gradu-
Table 3: General overarching recommendations
I.
Createastatelevel‘technicalcoregroup‘withrepresentativesfromvariedhealthfieldswho
work as health system/policy think tanks.
II.
Director general health services should come from the medical and public health services back-
ground, and he/ she should be supported by Deputy Directors and Joint Directors
III.
Drug logistics society is recommended for drug planning, procurement, replacement and disposal
of sub-standard drugs
IV.
The position of training officer to be shifted under the administrative control of Director, SIHFW
V.
One Additional Deputy Director post is created for medical and health planning.
VI.
In SIHFW, Future Faculty Programs need to be conducted through Public Private partnership
VII.
Special Needs positions in the cadres of Deputy Director, Additional Director in Human Re-
sources, Social Legislation, Disaster Management, PPP, Procurements and Nutrition.
VIII.
Additional Directors for RCH and Malaria to be renamed under Immunization and communicable
diseases. Another position of Planning and Medical services to be created.
IX.
Re-designate the posts of Additional Directors from Primary Health and KHSDRP into Regional
Additional Director,
X.
Senior most RMO in the district hospital to be designated as the DCHS (District Coordinator of
Hospital Services)
XI.
Staff who are repatriated after working at Medical Colleges should be relocated against the vacan-
cies of H&FW departments without any dichotomy
XII.
There should not be (strongly condemned) the posting of AYUSH doctors against the sanctioned
posts of Medical Officers (MBBS)
XIII.
Ten district hospitals which are under the management of Director Medical Education should be
handed over to the H&FW dept.
XIV.
Revive and restructure the wings of the control units for plague, cholera, leprosy, non-functional
TB units, Vaccine Institutes and Filaria control unit, and relocate its resources by disbanding these
units.
XV.
Disease units which were set up for localized endemics like Handigodu disease, KFD (Kyasanur
Forest disease) were recommended to be continued
The above table shows comprehensive matrix of the proposed health cadre along with designation and
number of years of experience for each level and position. This recommendation matrix has been taken into
consideration both public health administration and hospital services administration. The career escalator
proposed the medical doctors to decide to move towards public health administration or hospital service
administration after 6 years of service at PHC level. This option expected to provide adequate time, experi-
ence and skills sets to acquire and execute to meet the upper ladder of positions eventually.
ANNALS OF COMMUNITY HEALTH | VOL 2 | ISSUE 2 | APR - JUNE 2014
9
ate courses as minimum require-
ments to be qualified as a Public
health specialist
A recognized MD in com-
munity Medicine or preventive
and social medicine
Masters in Public Health
(MPH)/ Master of Science (Public
Health)/ or recognized as equiva-
lent by universities/ Government.
Post-graduate diploma in
public health or equivalent offered
by recognized universities or rec-
ognized institutions
District Program Of-
ficers:
These Officers shall
be Senior Special-
ists/Deputy Chief Medi-
cal Officers who
are eligible as per senior-
ity cum merit, who have
completed 6yrs of rural
service and a total of at
least 10 years of service,
as depicted in the organ-
ogram. In the present
scenario if such a candi-
date is not available, then
a Medical Officer in the
cadre of Senior Special-
ist/Deputy Chief Medical
Officer who has eligibil-
ity as per seniority and
has undergone a
course/training in Public
Health should be consid-
ered. (Table.4) (Figure 3).
Further, if such a can-
didate is not available,
then a medical officer as
per common seniority
list in the feeder public
health cadre applicable
should be deputed to
pursue post-graduate
courses in public health
as mentioned in recom-
mendations above. The
committee strongly rec-
ommends that only on
successful completion of
post-graduate courses in
public health, the eligible
officers be posted as Dis-
trict Program Officers.
Short-term measures
To address immedi-
ate shortage of qualified
public health profession-
als in the department, a
Figure 3: Proposed Career Progression of Public Health Physicians
10
ANNALS OF COMMUNITY HEALTH | VOL 2 | ISSUE 2 | APR - JUNE 2014
Table.4: Recommended criteria for Career Progression of Public Health
workforce at different levels in Department of Health
ANNALS OF COMMUNITY HEALTH | VOL 2 | ISSUE 2 | APR - JUNE 2014
11
One time intensive course is to be
offered for the eligible doctors as
per the following recommenda-
tions. This measure is recom-
mended ONLY for district and
state level to address immediate
shortfall. A Public health institu-
tion recognized by Government,
preferably in Karnataka, must be
requested to design and offer a
customized course to suit the re-
quirements of the public health
needs of Karnataka state such as;
a) The proposed course shall
be module and assignment based;
b) The course shall have two
modules of
three months each and assign-
ments to be carried out in the place
of work;
c) The candidate shall take
qualifying examination on com-
pletion of both modules; the suc-
cessful candidates shall be con-
ferred Post-graduate diploma in
public health and a cluster of 10
DHOs, 10-15 District level pro-
gram officers and 30 Taluk health
officers (THOs) should be posted
for in-service training of three
months duration.
Recommendation-5:
Third level of Public Health Cadre
State level and establishment of
public health directorate to pro-
vide coordination, data integration
and technical supervision across
the department. In addition there
should be a position for coordina-
tion, to be occupied by an officer
with technical qualification with
management training. Health sec-
tor is a fast growing sector with ex-
ponential increase in content and
scope of services being rendered. It
needs better technical and man-
agement coordination and conver-
gence across several technical
functions. (Table 4) (Figure 3).
Therefore, the Committee rec-
ommended that-
The third level of public
health cadre shall be at the state /
regional level as a unit comprising
of Director of Public Health, addi-
tional directors, joint directors and
deputy directors. This level pro-
vides leadership for the entire state
for efficient public health delivery
system so as to ensure the goals set
by national health plans such as
millennium development goals for
health.
A post of Director is to be
created to exclusively head the
public health directorate. In total,
there will be two posts of Director;
one for Public health and another
for medical services.
The Director (Public Health)
shall be head of the directorate of
public health. The officer will be in
charge of all administrative and fi-
nancial matters related to the cadre
of public health and programs im-
plemented in public health activi-
ties, and will be supervising officer
for additional director reproduc-
tive and child health (AD-RCH),
additional director communicable
diseases (AD-CMD) and addi-
tional director AIDS (AD-AIDS).
Recommendation-6:
Director of Public Health Position
The post of Director of Public
Health shall be selected with
guided criteria of;
a) A senior Public health Spe-
cialist, with minimum 20 years of
service in the department as per
seniority cum merit;
b) Must have completed post-
graduate courses in public health
as per recommendations given ear-
lier in this report;
c) Has shown exemplary
achievement in upholding the
principles of public health and
d) Has shown good leadership
skills in earlier positions held.
Recommendation-7:
General overarching recommenda-
tions
In addition to the present posts
and suggested cadres at the state,
district, taluk and PHC levels, the
following recommendations were
arrived through consensus. (Ta-
ble.3)
DISCUSSION AND
FUTURE DIRECTION
The health professionals who
have been serving in clinical ser-
vices at different levels may not be
possible to automatically switch
and master the set of health man-
agement skills that are integral
part of health administration.
Therefore, public health manage-
ment competencies acquirement
should be part of systemic ap-
proach to apply, develop, evaluate
and recognize the health cadres.
Health management competencies
among consciously chosen health
professionals may be rigorously
trained and assessed. Further legit-
imize the qualified health adminis-
trators through system public
health cadre process through as-
sisted career framework for appro-
priate workforce planning.
A good foundation of public
health is considered as compli-
mentary to curative medicine, as a
part of “Comprehensive Health
Care”.Theconcept ofreorganiza
tion of the department and crea-
tion of public health cadre is an
earnest step towards realizing var-
ious goals. The suggested recom-
mendations are meant for reorgan-
ization of the public health cadre in
Karnataka state by way of rede-
signing, revamping, and relocating
of posts, which came up through
dynamic thought process sup-
ported by wealth of evidence from
the state. Such context specific re-
organization of health systems to
12
ANNALS OF COMMUNITY HEALTH | VOL 2 | ISSUE 2 | APR - JUNE 2014
be conducted in a periodic manner
helps in bringing about changes in
the aspirations and goals of the
health care professionals, espe-
cially medical officers who can
plan their career in public health
sector. Such reorganization can
help bring novelty of approach in
dealing with current public health
scenario in Karnataka state. This
step will only be start and the state
has to implement several steps to-
wards ensuring provision of ade-
quate public-health services for the
people of Karnataka.
The process of reaching these
recommendations was challenging
given that major reforms could not
have been done in the immediate
period of the committee. Best prac-
tices from other states in India
were incorporated, wherever pos-
sible.(22-25) We have to admit that
there was not ideal ‘model’ that
states in India can easily emulate
from. However, the report itself is
a testimony that the thinking is
shifting from an individual-based
approach to a population-based
approach with an aim to make eq-
uitable and universal provision of
public health services. Efforts to in-
corporate and address local re-
quirements and challenges within
our state were an additional focus
of this public health approach. The
reality is that, human resources
(HR) are a weak component in our
health system and this has been re-
flected throughout the experiences
of policy makers for the last few
decades. We infer that the key
principles in improving HR in-
clude standardization and simpli-
fication of procedures to support
efficient recruitment, promotion
and sustenance in different posi-
tions, provision of appropriate and
adequate training to these profes-
sionals and sustain motivation lev-
els. Earlier evidence suggests our
finding that Human resources is an
important determinant of the effi-
ciency of health system.(26, 27) The
goal is to create a competent work-
force that can independently man-
age routine activities and can be
very efficient in accomplishing the
best results even under public
health emergencies such as SARS
outbreak.(28-31)
Recently the call for universal
health coverage by Lancet group
(32) and further recommendations
of HLEG (33) have set in renewed vi-
sion and strategy for the creation
of public health cadre in India. In
particular, HLEG recommends for
introducing all India and state
level Public Health Service Ca-
dres.(33) The process of develop-
ment of report on public health ca-
dre in the state of Karnataka was
occurring concurrently. Most of
the findings in this report are in
line with recommendations of
HLEG report. As‘Health’isastate
subject, the infrastructure and or-
ganization varies from state to
state. A strong public health organ-
ization in the state is an important
requisite for improvement of
health standards, which further
contributes towards overall socio-
economic development of the
state.
Some of the recommendations
in this report were focused on task
shifting and task capacity build-
ing. These recommendations are in
conformity with results from coun-
try consultations by World Health
Organization (WHO) in 2006, in-
volving Ethiopia, Haiti, Malawi,
Namibia, Rwanda and Uganda.(34)
This helped to identify the themes
that needed to be addressed by the
recommendations and guidelines
on task shifting. It also established,
that the development of the recom-
mendations and guidelines would
be a process led by countries with
direct experience of implementing
the task shifting approach to in-
crease access to health services.
The role of a public health man-
ager is extremely complex and
needs dedicated training. The
tasks of a public health department
would include managing health
programmes, incorporating pre-
vention into the ambit of health
programs, addressing health
needs of the population as a whole,
reducing the burden of disease, re-
ducing premature death and dis-
ease produced discomfort and dis-
ability in the population, promot-
ing healthy life styles among the
population and helping to create
supportive environment for health
in communities.(35) Hence, the
training provided to create the ca-
dre of PHPs should enable them to
function as a multi- dimensional
manager addressing health protec-
tion, health promotion, rehabilita-
tion, and sustenance and through
collective and social action.(36) As
per Karnataka state integrated
health policy-2001, incorporating
research into decision-making and
implementation of programs
should be the next step would be
useful for providing evidence-
based solutions to existing prob-
lems.(37)
The final goal of any progres-
sive state is to ensure efficient ser-
vice delivery. The current report
covers only the overarching struc-
ture and lays the foundation for se-
ries of action points towards suc-
cessful implementation of the pro-
posed cadre. Future work has to
concentrate on improving the per-
formance of PHPs in the public
health cadre through improving
inclusion of paramedical workers
and thereby ensuring wider cover-
age. It is also vital to identify ways
and methods through which the
motivation of the workers is sus-
tained. Building knowledge, skills
and improving efficiency to pro-
mote the competencies of workers
is a continuous process. Future
work should concentrate towards
ANNALS OF COMMUNITY HEALTH | VOL 2 | ISSUE 2 | APR - JUNE 2014
13
these goals.(38) We consider that
through dissemination of this re-
port, the experts, different stake-
holders; Governmental agencies
and public provide important con-
structive inputs to further
strengthen the process of policy-
making and implementation.
LIMITATIONS
The public health specialist
functions are combination of mul-
tiple disciplines ranging from de-
mography, social science, econom-
ics, epidemiology and bio-statistics
etc. Though public health work-
force comprises of health adminis-
trators to public health nurse, la-
boratory personnel, water quality
analysts etc, but this is beyond the
scope of this review to address ca-
reer path for range of allied public
health professionals. Therefore,
this report focuses on Karnataka
state specific distinct core public
health cadre/administrators who
are likely to be trained as public
health specialists.
ACKNOWLEDGEMENT
We would like to thank Shri.
Madan Gopal, IAS, Secretary, Dept
of Health and Family Welfare ser-
vices, Government of Karnataka
for valuable guidance and support
towards public health cadre. We
would like to thank public health
foundation of India for providing
institutional support for carrying
out this work. We thank
Dr.S.C.Dharwad who was member
on the committee and provided
valuable feedback. We also thank
Dr.Sridhar, KHSDRP and con-
vener of all the meetings of the
committee. We also thank Dr.Ra-
mana Reddy, IAS for constitution
of committee for creation of public
health cadre.
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