Can India put an end to its public health crisis?
Reforms that could take place in government machinery are slow and often not easy. British India had the concept of Indian Medical Service (IMS) which addressed medical care among the military and also had civilian functions. IMS officers previously served two world wars and provided dedicated services in civilian hospitals with additional administrative responsibilities. Not much is heard about this in today’s digital age and today’s young doctors might not be even aware that something of this nature existed once upon a time.
The birth of the IMS was on October 20, 1763 for the Bengal Medical Service, with fixed guidelines for the service, established rules for promotion and fixed grades for the officers. Then Madras Presidency and Bombay Presidency established similar services in 1764. The IMS included eminent doctors like Sir Ronald Ross, who won the Nobel prize; Henry Vandyke Carter, who is known in history for his illustrations in 'Gray’s Anatomy' which is a reference book for anatomists and surgeons, and Sir Benjamin Franklin. However, the IMS was suspended in post-independent India for reasons best known to the powers that be at that time and moment.
Nevertheless, the IMS becomes increasingly relevant today and needs to be re-discovered in the context of a public health system of India going through acute crisis, chronic diseases showing an upward trend, inequity growing and escalating cost of healthcare and poor infrastructure. Starting the IMS once again will put Indian healthcare in perspective. Professional health universities should be run by IMS officers. IMS officers should not go through the process of the Union Public Service Commission (UPSC) but there should be a structured panel of interviews post MD/MS for the candidates who wish to run for this cadre of ranks in governments. District, regional and national health offices in the country should be run by IMS rank officers.
IMS rank should primarily be given to social medicine physicians who understand the intricacies of preventive medicine, who have a know-how of health policy and who have been participative actors in treating disease and understand the dynamics of disease processes. Social medicine physicians remain strategically positioned to address the many problems that public health offers today, their interactions with social scientists will help advance policy decisions that would leave lasting impacts.
India is among the countries housing the largest number of malnourished children in the world, by 2025 we are positioned to be the world’s diabetic capital, by 2030 we will move from the ninth spot to sixth spot in terms of road traffic injuries as a leading cause of death. These are just numbers, but when we look at it with a humane face, it reminds us of our commitment to perform, inspire and orchestrate change before our eyes. Re-starting the IMS will be a step in that direction. People have been living in denial, and we have been delayed sufficiently. Let IMS officers be the linchpin to connect governments and societies for health and development.
IMS officers should be charged with promoting awareness for preventing diseases, conducting research and also advance infrastructure for healthcare delivery. As India continues to face the burden of disease, its struggles are likely to increase. Disaster mainstreaming is yet to be understood according to the Sendai Report 2014, road safety is a far-fetched dream, organ transplantation is still new in India. The future of bailing out India’s healthcare lies in re-opening IMS ranks and taking in medical doctors with social acumen. Community medicine specialists are closest to it.