'IMS needed for administrative decisions on healthcare'

Health experts and doctors say the healthcare system will collapse if IAS officers, who are not medically qualified, continue to take decisions on health management

A lot of confusion over experiments with drugs and administrative decision-making has once again brought to the fore the importance of bringing the Indian Medical Services (IMS) under the purview of the UPSC stream of studies. Health experts are of the opinion that if IAS officers, who do not have medical qualifications, continue to take decisions related to health management and services, sooner or later the healthcare system would collapse.

Dr Subhash Hira, professor of Global Health, University of Washington, USA, and former technical advisor of Ministry of Health, New Delhi, said, "The Indian Health Systems (IHS) have been fragmented since 1947. Before that it was organised as Indian Medical Services (IMS) that existed even during the first and second World Wars. The IMS cadre was dismantled soon after Independence. Hence, the IHS was under the purview of the general IAS administration, both at the national and state levels. Consequently, IHS went through intense experimentation, including the bifurcation of preventive, curative and promotive health. The IAS babus treated the IHS medical professionals distantly to the extent that up to 1983, no MBBS doctor was even eligible to sit for the UPSC examination. Such discrimination led to complete neglect of the healthcare sector till the end of the 20th century."

Dr Hira added, "Towards the beginning of the 21st century, which saw pandemics of HIV/AIDS, tuberculosis, malaria, dengue, NIPAH, ebola, swine flu, SARS, MERS, zika among others, the world leaders started to pay attention to the health sector. This led to more funding and health experts talking about the need of re-establishing the IMS cadre to face the emerging health crisis."

He further said, "With the emergence of the COVID-19 pandemic in November 2019, it became clear to the world leaders that their health systems lacked intelligence and the administrations had no capacity to understand and collate what caused pandemics and how to respond to these national emergencies. A classical example of a public health disaster was seen in January 2020 when one ICMR scientist blindly followed WHO's advice against use of facemasks to prevent the early spread of COVID-19. It took ICMR 4-5 months to correct the basic principle of respiratory infectious diseases to block droplet transmission. This is how it became clear that the establishment of the IMS under the UPSC cadre is urgently required and should be associated with scaling up the health sector budget to 2-3 per cent of the GDP from the current 1.3 per cent."

Dr Wiqar Shaikh, senior allergy and asthma specialist, said, "For the India of 2020 it is essential to have IMS on the lines of the IFS, IRS, IAS and IPS. Directives from the ICMR and state task force have only been experimental tools to fight the COVID-19 pandemic. The same is done using public money – for instance, setting up quarantine units at several grounds lying unused, getting doctors from other states and providing them with five-star lodging and boarding and exorbitant salaries and using drugs that are clinically not proven. All of this raises concern about the system's failure. Therefore, under the above circumstances, having a dedicated administrative post like IMS is mandatory."

Dr Shaikh added, "Medicine is a specialised area of work. The government requires professionals trained in medicine and also those who have sound administrative knowledge. An IAS officer, who is not trained in medicine, may not be able to efficiently handle the medical administrative work. However, even medically qualified administrators need to be sensitised about the requirements of various government and civic-run medical colleges and hospitals." He further said, "The IMS will need to look into the requirements of patients, both indoor and outdoor, which need to be carefully assessed and fulfilled. The focus needs to be on proper patient care, availability of beds, drugs and investigations, all of which have emerged as shortcomings of the healthcare system in handling the pandemic. The IMS will also need to look into the requirement of hospital personnel and closely monitor their salaries, living conditions, food, etc. And such a post will only help to understand pandemics and the requirement of healthcare systems better, and faster decisions can be taken."

Meanwhile, Dr Ketan Vagholkar, professor of surgery at DY Patil Medical College said, "In our country there is an immediate need of officials who understand both the expectations of the patients and challenges of the medical community. Hence, there is a need to develop a new concept of IMS, which would solely have individuals who've worked in the healthcare sector. This sector has its own inherent problems and challenges, which can be best understood by individuals who have actively worked as medical professionals."

He further said, "If the IMS branch is to be created, then it should solely have experienced healthcare professionals. This will enhance the quality of healthcare and will also satisfy the growing expectations of the patient community. In the event of such pandemics, these medical administrators will be in a better position to develop and manage the healthcare needs of the society."

"The basic eligibility to qualify for IMS should be a graduate or postgraduate degree with minimum clinical experience. This will help in developing an efficient and patient-centric healthcare system both in rural and urban settings. The healthcare department should be handled by these IMS professionals, right from the taluka level to the corporation and national levels. This will also help in enhancing the quality of primary healthcare. The IMS cadre should be in par with the traditional civil services such as IFS, IRS, IAS and IPS," Dr Vagholkar added.

Speaking to mid-day, neurosurgeon Dr Shashank Joshi said, "It is high time the government realises that the healthcare sector needs to be handled by professionals who understand the requirements of the system. It is important to have medical professionals in administrative positions as medical service is beyond hospital management and patient care, especially when it comes to tackling pandemics."

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