The need for an Indian Medical Service Cadre has been highlighted and discussed multiple times in recent years. The Covid-19 pandemic has reinforced the urgent importance of the cadre. An Indian Medical Service, comparable to the Indian Administrative Service (IAS), Indian Police Service (IPS), and Indian Foreign Service (IFS), is necessary to administrate and encourage the delivery of healthcare services across the country.
The 15th Finance Commission has also proposed that the cadre be organised along the lines of the IAS. The development of such a service for public health administration was advocated by a parliamentary committee on health in March 2021. Later, the Indian Medical Association demanded the establishment of the Indian Medical Service (IMS) too.
With a severe shortage of health administrators in the country, the IMS will be able to close the long-standing gap between public health information and decision-making. The goal now is to make significant progress in this direction before it is too late.
A defunct IMS in British India
An Indian Medical Service is something that the country has seen before. It was founded during the British colonial rule to ameliorate the state of public health on the ground. Although the cadre was primarily intended and organised to undertake military responsibilities, it was sometimes used to perform civic functions. It assisted in the treatment of chronic ailments such as cholera and glaucoma at the time. In addition, the IMS sought to promote and manage sanitation.
Apart from that, the service’s efforts were recognised around the world after they assisted the establishment of hospitals in a number of presidency towns. The IMS ceased to exist after Independence for a variety of reasons, including Indian officials being restricted to temporary and emergency commissions, officers of the IMS being offered paid leave until retirement, and lastly, the country’s Partition. The idea of bringing the IMS back into force has been raised multiple times since then. However, due to persistent opposition, little progress has been made.
But the last 20 months of Covid pandemic has made the requirement of an IMS prominent. The mobilisation of PPE kits, beds, health personnel, ventilators, and oxygen cylinders was severely hampered in the pandemic. An extraordinary crisis resulted from a lack of administration, putting the lives of millions of people in jeopardy. Bureaucrats were deployed for administrative responsibilities at health facilities to control the situation on the ground, but the situation plainly slipped out of their hands because they lacked the technical skills and domain understanding on how to manage a health emergency.
The administrators failed to improve the accessibility of health services because they had little to no expertise in public health initiatives. The pandemic taught us a lot of valuable things, and perhaps the most significant of them was that an IMS cadre is more important now than ever before.
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Where do India’s healthcare workers lie?
Currently, for medical services, the Combined Medical Services (CMS) Examination is conducted by the Union Public Service Commission (UPSC). The CMS exam qualifiers are selected as medical officers but are limited to several organisations functioning under the Government of India, such as Railways, Delhi Municipal Corporation, and Indian Ordnance Factories. In a similar vein, an Indian Medical Service cadre is required to manage and supervise the country’s health issues.
In India, health issues are mostly taken into consideration only during times of crises. These are usually remedies that have been accepted after the problem has arisen. The majority of them are actually damage mitigation. The development of an IMS cadre would work towards bringing experts into managerial positions and approaching health from a more holistic perspective.
It’s not only about having access to services and equipment when it comes to health. It also includes action on water and sanitation, environmental health, socioeconomic determinants of health, disease transmission in the area, and health finance. Currently, IAS officers are in charge of a district’s health issues. Their education does not include any health-related knowledge. Primary, secondary, and tertiary health services would be better organised with a small but effective cadre. Apart from that, an IMS might be utilised to develop more effective and positive health policies.
It is impossible to deny that the cadre will be employed not just for knowledge support but also for technical and administrative support. Concerns require immediate and competent attention for a variety of reasons, including promotional efforts, surveillance, and the availability of facilities and equipment. India is far too huge and diverse to be handled without a formal health administration for all of its districts, from the largest to the smallest.
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Roadblocks for an IMS
Many major stakeholders have voiced their objection to the development of an IMS cadre. One of the main points of contention is that there is no need for a new cadre when district collectors and other administrators are in charge of health issues. Others argue that doctors’ inability to manage and administer should be accepted as a universal truth. Another source of concern is that establishing a medical cadre will bureaucratise the health-care system. In India, health is currently a state subject. There is concern that a change will make it more of a central subject.
Apart from the opposition, the implementation of the cadre has experienced other difficulties. One question is, what structure will it be based on? Who will be qualified to take the exam? Should only MBBS graduates and public health professionals be allowed to sit for it? Should the health sector be administered by enthusiastic people from various professional domains? Furthermore, how should they be trained? Is it necessary for the training to be identical to that received by other cadres? All of these are essential concerns that must be addressed before a solution can be devised.
The current administrative structure fails to recognise and respond to the country’s health requirements. Long-standing roadblocks must be tackled immediately, with a more forward-looking and present perspective. A small but effective IMS cadre has the capacity to bring about the significant changes that India’s healthcare system requires.
The author is an Assistant Programme Manager at The Takshashila Institution. She tweets at @maheknankani. Views are personal.
(Edited by Humra Laeeq)