Thread by @kikumbhar

Some thoughts on #IndianMedicalServices

Ther hav been a lot of tweets on this in the past few days. Wheth we call it Indian Medical Service #IMS or All India Health cadre #AIHC etc, looks like ppl think that having doctors in charge of medical decisions is the need of the hour.

I even came across a little meme showing Anthony Fauci on one side, with his plethora of medical degrees, & the dull Lav Agarwal on the other, with (the meme said) a B. Tech degree. This obv makes for a compelling argument, esp for young medicos.

There's a lot to be unpacked here, and I think will be in the coming days by many others. Here r my two cents:

Firstly, lets not think of IAS as some kind of great model to be emulated. "All-India" services originated in the British colonial desire to have a highly centralized administration under a single authority. We must know by now that our great nation & its ppl deserve better.

Healthcare, of all things, absolutely cannot be administered from any central authority, as the needs and demands of people and communities are so very different in different parts of the country, and in different parts of a state and district too.

The way I see it, it is politically foolhardy to be offering something like this on a platter to the current govt in India, which has already set us on a nightmarish path of centralized, 'all-India' ruin. I sincerely urge folks to not do that.

The problems with healthcare in India are real, and highly complex. #IMS or #AIHC etc look like tempting solutions, but they are just that - tempting.

Importantly, it's not like there are no doctors or public health persons in decision-making. (Ever heard of one Harsh Vardhan?)

In fact doctors hav always dominated medical decision-making in India, almost always at the expense of other players including the public themselves. There are Directors of Health Services in every state & at the center, whose job it is to advise the govt on healthcare matters.

Besides, during cases of emergency, the govt can always form task forces and recruit healthcare advisors (ideally not just doctors but also other health professionals). We saw that during Covid too, with both the Center and many state govts doing that.

It is also extremely naive to think that something like an all India cadre will surely help us better manage crises better. In colonial India, crisis after medical crisis decimated the people of India - the existing and powerful IMS hardly made any difference.

In oth words, we seriously dont need yet anoth monopolistic, centralized, elite service or cadre.

We also don't need to reinvent the wheel. Therez already one fundamental solution - not a "magic" one of course - to our health crises. Universal healthcare.
harvardpublichealthreview.org/universal-heal…

If ppl really want to see the nation's healthcare services develop and be better than they are now, let's mobilize not to demand an elite service, but grassroots services: larger investments in primary and preventive healthcare, and in govt centers.
thewire.in/health/ayushma…