Essay --

ISSUES, CHALLENGES AND WAY FORWARD There remains considerable gap between the health HR in position and that required for public health sector. This shortage is attributed to delays in recruitment and postings not being based on work-load or sanctions. Lack of sound HR management policies has also resulted in irrational distribution of available HR and suboptimal motivation. The envisioned public health cadre to manage NRHM and NUHM (or now National Health Mission) is not yet in place. Insufficient focus on public health is a major weakness of the system and must be urgently corrected. Effective public health management requires a certain degree of expertise and it calls for an urgent real need for a dedicated public health cadre (with support teams comprising of epidemiologists, entomologists, public health nurses, inspectors and male multipurpose workers) backed by appropriate regulation at the state level. Availability of skilled HR remains a key constraint in expanding health service delivery. A mere expansion of financial resources devoted to health will not deliver results if health manpower is not available. An expansion of public sector medical schools and public health institutions is necessary in this process. The norms for public health service providers were set long ago and are considered very inadequate according to today’s requirements and expectations. Even those under IPHS also need to be revised periodically based on the rapidly changing modern times. The shortfall of doctors and specialists is a serious issue. Availability of public health functionaries is very low. The doctors and specialists in position do not necessarily mean that they are physically present at their respective centres and performing their du... ...the convergence and development of public health systems that are responsive to the health and well being of the people, it is important to recognise the need for a comprehensive strategy that must include the public health HR (both professional and auxiliary health personnel). In India, availability of health HR in the public sector is quantitatively inadequate and most of the States/UTs lack a dedicated public health cadre. To develop a robust public health cadre in our country, the public health HR needs to be strengthened in a systematic, organised and well-planned manner. Though there are certain issues and challenges, yet the creation of a new public health cadre would result in an efficient public health management system delivered by teams of well-qualified and competent workers who would be able to deal with changing public health priorities in the country.