Do we really need a new cadre of Indian Medical Service?

Thursday, July 24, 2014

by Dr Kamal Mahawar

There is a belief amongst certain masterminds in India that creation of a new separate “Indian Medical Service” will solve all our healthcare woes just like Indian Police Service has brought complete law and order into the country! When are we going to realise that creating more bureaucratic layers is not the solution of the problem; it is the problem itself. Our entire public sector machinery is crumbling under the weight of the bureaucracy, functioning without any sense of duty or accountability. We need to make existing public servants more accountable; not multiply the unaccountable, inefficient, self-serving lords we have at the moment.

Dr Kamal Mahawar

Dr Kamal K Mahawar

Indian healthcare needs massive investment, private-public partnership, careful planning, reforms with Medical Council of India, accountable professionals, and stronger patient voice. None of this will be guaranteed by a separate layer of officialdom. We know what happens with more layers in decision making. Every decision making will take more and more time and the system will become even more corrupt and inefficient. The person at the bottom of the hierarchy always does all the work and takes all the blame, while all the rewards and the loot will go up the chain.

We don’t need “smart” ideas by some very clever people to fix Indian healthcare; we just need to implement robustly the “ordinary” ones. Currently all government medical colleges and hospitals are in a lamentable condition. The services are poor and the standards are pathetic. There is little accountability and patient care is not central to the agenda of staff and management. Internal politics and lack of transparency in the processes means even the best minds can’t do anything. You rise to the top in these institutions depending on whose backing you have rather than what you have published in last 10 years and how many physicians and surgeons you have actually trained for the future. How will Indian Medical Service solve all this?

Medical Colleges and Hospitals are currently almost entirely state-funded, which means that even students from very rich families receive free medical education. Institutions are allowed to decay in absence of adequate funding, but they have no freedom to generate their own revenue. We need to decentralise these institutions and make them semi-autonomous. The management in these institutions should be free to take local decisions without any political interference, raise part of their own revenue, and make local expenditure choices. There are a number of ways how a medical college or hospital working for the local public can raise at least part of its running expenses. In return for this freedom, these local managers should be held accountable for the standards of their infrastructure and services. None of this, I would argue, needs an Indian Medical Service.

Dr Kamal Mahawar
Senior Consultant in Bariatric and Metabolic Surgery
Indraprastha Apollo Hospitals, New Delhi

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1 Comment »

Comment by Dr. A. K. Singh
2014-09-16 14:53:23

Apropos “Need for IMS”: agreed that public healthcare is in bad shape. But so is private sector. Most of it is in unorganized sector. Organized sector is too heavily focused on EBITA & profit margins. Currently, health sector is divided in 2 parts: medical education & healthcare delivery. The second is entirely a state subject while education is in concurrent list. Resurrecting IMS will bring doctors ar par with other services. It will provide better national integration and obtain a more secure working environment to healthcare professionals. It will also lead to more uniformity. In conclusion this is a positive step on the whole.

Dr. A. K. Singh, Director, Neurosciences, Max Hospital, Dehradun

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