Jungalwala Committee ReportIntegrationHealthServices1967.Unlocked

 

REPORT OF THE COMMITTEE ON INTEGRATION OF HEALTH SERVICES,

DIRECTORATE GENERAL OF HEALTH SERVICES  NEW DELHI

March 1967

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PARTICIPA NTS

1.   Dr . N. J ungal wal l a, Addi t i onal Di r ector Gener al of Heal t h Servi Servi ces*ces*-

Chai r man

2.   Dr . D. Bhat i a, Di r ect or of Heal t h S Se er vi ces, ces, Punj ab.

Member .

3. Dr . D. N. Sharm ar ma, Di r ector of Medi edi cal & Heal eal t h Ser vi ces, ces, Ut t ar Pr adesh sh..

Member .

4. Dr . ( Mr s. ) H. M. Shar ma, Di r ect or of

Member .

Publ i c Hea eall t h, Madr as. 5.   Dr . C. L. Muker ker j ee. Di r ector of Heal t h Servi ces, ces, West Beng engal .

Member .

6.   Dr. T. B. Pat el , Di r ect ect or of Heal eal t h & Medi edi ca call Ser vi ces, ces, Guj er at .

Member ,

7. Dr . Ved Prakash Prakash,, Hony. ony. General eneral Secr ecr etar y, I ndi an Medi cal cal Asso ssoci ci at i on.

Member .

8. Dr . P. R. Dut t Asst . Di r ect or G Ge ener al Of Heal t h ser ser vi ces ces

Secr ecr etor y

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(i) SUMMARY: 1. The Cent r al Counci l of Heal t h, i n i t s meeti ng i n 1964, r ecommende ended d t he const const i t uti ut i on o off a commi t t ee t o exa exam mi ne tthe he var var i ous p prr obl ems i ncl udi ng t hose of ser ser vi ce con condi t i ons, el i mi nat i on of pr i vat vat e pr pr act i ce and su sub bmi t t he repo repor t t o the Gover overn nment ent of I ndi a. A quest i onn onnai r e was pr pr epared epared a an nd c cii r cul cul at ed t o t he S Stt at es. The The Commi t t ee met and and al al so vi si t ed some of of t he S Stt at es. 2.

For For

t he pur pose of

t hi s

report report ,

t he com commi t t ee def i ned

i nt egr at ed he heal t h s se er vi ce ces s as: i) a ser ser vi ce wi t h a u un ni f i ed ap appr oach f or al l pr obl ems i nst ead ead o off a seg segm ment ent ed app appr oach oach f or di f f eren er entt pr obl obl ems an and d i i ) medi cal cal car car e of t he si ck and and con conven vent i onal publ i c h he eal t h pr og ogrr ammes f unct i on onii ng under a si ngl e a ad dmi ni st r at or and and.. oper at i ng i n a uni f i ed mann anner at al l l evel vel s of of hi er ar chy chy wi t h du due p prr i ori t y f or each each pr pr ogr ogr amme o ob bt ai ni ng a att a p poi oi nt of t i me. Adv dvan antt ages ages of an i nt egr egr at ed heal eal t h se serr vi ce a arr e many. any. The The heal eal t h of t he co com mmuni t y i s l ooke ooked d af t er more ef f ect ect i vel vel y a an nd econ econom omi cal l y t han othe otherr wi se. A basi s f or com compr ehen ehensi si ve h hea eall t h ca carr e f or ever ver y f ami l y i s e est st abl i sh she ed t he si ngl e admi ni st r at or has a bet t er over ver al l per spe spect i ve an and d i nsi ght i nt o pr obl ems, Sol ut i ons an and d pr prog ogrr ammes andand- st r eng engt hens ens heal eal t h ad adm mi ni st r at i on compet i t i vel vel y a am mon ong g al l gover overn nmen entt al agen agenci ci es. Prev Pr even entt i on avoi avoi d unnecessa ecessarr y i l l ness, i t i s che cheap aper er t han are an and da all so com compl ement ent ary t o cur cur e. 3. Par al l el servi ce ces s ar e wast ef ul an and d ar e pr i mar i l y t he r esul esul t of l ack' ck' of pl an ann ni ng or bad pl anni ng. Heal t h car car e ser ser vi ces ces sho shoul d n no ot onl y be be i nt egr at ed but di st r i but ed o on n reg regii onal basi s. The The co con ncept cept of r egi egi onal onal i sat i on has ex extt end ended beyon eyond d t he i dea of of co coo or di nat ed syst syst em f or del i ver i ng heal t h car car e s se er vi ces ces t o co con nnote cont cont i nui ng edu educati on of heal eal t h car car e p prr of essi on and and t he devel evel opm opment ent of t he t echn echni cal con consci sci ousne ousness ss of t he con consum sumer publ i c. An. admi ni st r at i ve d dii st r i ct f or ms a co conveni ent "ba "basi s f or - or gani si ng l ocal cal heal t h admi ni str at i on. Heal t h admi ni st r at i on, l i ke al l admi ni st r at i ons, i s a means to a an n end, not an end i n i t se sell f . Though onl y a t ool , i t i s an an esse ssen nt i al t ool ool . The The t est of good ood heal eal t h adm admi ni st r at i on must be p prr agm agmati c. 4. Hi st or i ca call Revi ew:  Ther  Th ere e are ar e hi st or orii cal r eason easons s f or t he hi ear ear chy whi ch exi exi st ed i n medi edi ca call and and p pu ubl i c h hea eall t h d dep epart art ment ent s. I n the

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(ii) ear ear l y d day ays s of deve devell opm opment ent of moder odern n medi edi ci ne i n I ndi a d dii sease pr even eventt i on was scarcel y at t empt ed exce excep pt i n t he ca case se of vacci vacci nati on agai agai nst smal l - pox. ox. Medi edi ca call ef f ort was c con once cen nt r ated on t he est abl i shm shment of hosp ospii t al s a an nd di sp spe ensari es f or t r eatment of t he si ck. When publ i c h hea eall t h began egan t o recei ve i t s due due sh share are of att ent ent i on, on, t he p phy hysi si ci ans ans and and su surr geon eons were er e al r ead eady st r ong ongl y en entt r ench enched ed and and publ i c h he eal t h worke orkerr s f ound i t di f f i cul cul t t o aw awaken ken any e en nt husi asmf or pr even eventt i ve medi edi ci ne a am mon ong g tth he ad admi ni st r at i ve medi edi cal of f i cers cer s who were er e i nt er est ed i n t hei r own sp spe eci al i t i es. I t was t her ef or e necessa cessarr y f or t he pu pub bl i c hea heall t h worke or kerr s t o pu putt up a vi go gorr ous ous f i ght t o secur secur e aut aut onom onomy and and gener eneral al l y sp spea eaki ki ng, t he r esu esull t ha has s bee been n an undesi ndesi r abl abl e cl eava eavag ge bet wee een n t he n no odi cal cal r el i ef and publ i c he heal t h. However ever,, i t was so soon on r eal eal i sed t hat pr even eventt i on of di sea sease se was a bet t er ai mo moff medi cal cal wor k rathe rather t han r el i ef i t sel sel f and al so t hat i t was i n t he i nt erest er est of ef f i ci ency ency a an nd eco econ nomy t hat medi edi cal men are ar e t o eng engage age bot h i n medi edi cal r el i ef and and pub ubll i c h hea eall t h work. or k. The The Heal eal t h Sur vey vey and and t he Devel op opm ment Commi t t ee recom r ecommen ende ded d i nt egr egrat at i on as pr prel el i mi nar nar y st ep t owar ards ds co com mpr eh ehen ensi si ve heal eal t h car care e ser ser vi ces. I t was rer e- emphasi sed by Heal t h S Sur urvey vey a and nd Pl anni anni ng Commi t t ee. 5. The The Heal eal t h Ser Ser vi ces i n t he worl d showan unm unmi st akea akeabl bl e evi evi de dence nce of tr end end t owards, compr eh ehen ensi si ve a an nd i nt eg egrr ated se serr vi ces. ces. There There w were ere cert ai n t r end ends, whi ch j ust i f y the theii r r eco ecog gni t i on as t he ba backg ckgrr oun ound agai agai nst whi ch f ut ur e pr ogr ogr ess i n t he p pu ubl i c h he eal t h ser ser vi ce ces s i s l i kel kel y to t ake pl ace. ce. They ar ar e:

1. Br oa oad deni ng of t he ou outt l oo ook k o on n soci al wel f are a an nd cl ose ser r r el at i on bet ween heal t h an and d soc socii al wel f ar e. 2,  Ther e dece ecen nt r al i sat i t he c r i t er i dec e en nt r al i sat sat i

ar e no mer i t s in cent r al i zat i on or on i n t hem sel ve ves s as aca acad dem i c con concep ceptt s an and d f or t he degr ee of ce en nt r al i s a att i on or on must be t he ef f i c i enc y of t he ser ser vi c e e--

3. Spec i al i sat sat i on: spe spec i al i sed sed ser ser vi c e es s sh sho oul d be deve vell oped at pr op ope er l eve vell s, but exce xcessi ve sp spe eci al i sati on or   c r ea eat i on of s pe pec i al i s at at i on wi t hi n a s pe pec i al i t y shou sho ul d b be e g gu uar ded agai agai nst t o av avoi oi d - com par par t men entt al i sm.

4.   Chan hangi gi ng  co con nce cep pt of pr even vent ab abll e di sea sease: se: Appl i cat cat i on of epi demi ol ogi cal cal   met hod ods( s( nat ur al l evel s of appl i c a att i on of pr event i v e medi c i ne f or a di s e ea as e e)) to c co ondi t i ons o ott her t han t he st r i ctl y communi uni cabl e di seases 5.   I nt egr ati on of pr even vent i ve an and d cur cur at i ve ser ser vi c e es: s: I nt egr at i on i s a f undament al pr i nc i pl e of publ i c h he eal t h. Pr event i ve a an nd c cu ur at i ve se ser r vi c e es s arc one one a an nd i n- di vi si bl e wi t h t he co com mmon ob objj ec ectt i ve of pr event i on.

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(iii) 6.  Better mental health: A fresh orientation on mental health is promising a wide field of opportunity in the prevention of mental disease as a part of the public health services. 7.  Health Education: The indispensable role of health- education in health  programmes is being, recognised more and. more with the result that emphasis is placed for extension and development of health education. 8.  Biostatistical approach: Biostatistical approach to the solution of various health  problems is widening rapidly-.9 Coordination of service contributions in its varied spheres of aaction ction towards the total national health effort. 10.

International collaboration and inter-dependence,.

11.

Organisation: a)  Organisation will in future put greater stress on the. dignity of the individual.  b)  Improved channels of communications and cooperation. A trend towards fewer l evels of hierarchy and an expansion in the c) span of control of executives. d) Participative manageme management nt and dynamic management management e)

 

Programme budgeting rather than organisational budgeting.

f)

Research as an integral part of each programme.

The committee also noted emergence of undesirable trends of fragmentation and a tendency to create a special authority or commission to handle a singly problem. 6. 6.1.  1947.

The present position: Central Level: Directorate General of Health Services has been integrated in August ,

6.2.  State Level Integration has been carried out in all state health headquarters except in Andhra Pradesh, and Maharashtra, They are likely to follow suit shortly. Madras has issued orders. 6.3. 

Regional Level

Regional level -health administration does not exist in all states.

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( i v) _ 6. 4. Di st r i ct l evel vel : Some of t he st at es wi t h i nt egr at ed heal t h di r ec t o rat rat e ar e yet yet t o i nt egr at e di st r i c t he hea al t h orga rgan ni sat sat i on. 6. 5. At s ub ub- di vi s i onal l evel : I t i s onl y an ef f ec t i ve l evel vel of admi ni st r at i ve hi er ar chy chy i n one st at e. 6.6.  Pri mary Hea Heall t h Cent ent r e l evel evel : I nt egr egr at i on i s sai d t o have ave bee een n c ar ar r i ed out i n al l s t a t e es s . However , f unc t i onal i nt egr a t i on i s sti l l i nco ncom mpl ete to a l arge ex extt ent ent .   6.7. 

Uni f i ca catt i on of ca cad dr e o off doc octt or s ha has s no nott been car car r i ed o ou ut ex exce cep pt in A Assam ssam. Ker al a, Mad adhy hya a Pr Pr ad adesh esh an and d West Ben enga gall . The The t r en end d i s gai ni ng   gr ound i n sep separ at i ng t eachi chi ng. f r om i nt egr at ed ser ser vi ce. ce. I n t he matt er of of pr i va vatt e pr ac actt i ce ce,, vi ews ar ar e wi del y di ve verr gent .  

7. Hea eall t h servi ce ces s hav have e gr eatl y i ncr ease ased d but f ewer do doct ct ors are j oi ni ng t he ser vi ce i nspi t e o off ph phen enom omenal enal i nc ncrr ease ease i n the n num umber of doctor s every every ye year ar I mprove provem ment ent of ser vi ce c con ondi di t i on ons s i s t he cryi ng nee eed d of t he day not on onll y to a att t r act and r etai n per son sonn nel of t he r i ght t ype ype' but al so t o mai nt ai n an and d "i mpr ov ove e" qual qual i t y o off en entt r ant ant s t o t he pr of essi on on..  The uni f i ed cadr e i s consi der ed t he si ngl e, most i mpor t ant st ep t owar ds i nt egr egr at i on. Th The e co con nce cep pt of uni f i cat cat i on of cad cadr e i s ea easi si l y u un nder st o o od d b bu ut t he t r ansl at i on of t he i dea i nt o re rea al i t y pose ses s som some d dii f f i cu cull t i es. Th The e fi r st desed seder at umi s a p psyc sych hol ogi cal cal one, namel y a all l ay o off t he f ear ear among publ i c h hea eall t h doc octt ors t hat t hey wi l l be sw swam ampe ped" d" by t he bi gger gger med edii cal group group.. Then Then t her her e a arr e a adm dmi ni st r at i ve pr obl ems c co once cerr ned wi t h cl assi f i ca catt i on and f i xat xat i on of . sen seni or i t y. Or i ent at i on i n publ i c he heal t h wi l l ease i nt egr at i on and hel p t he st af f t o f al l i n l i ne wi t h t he a avo vow wed obj ecti ve and t hought . of i nt egr at ed se serr vi ce. ce. I nt egr at i on sho shoul d be a pr ocess cess of l ogi cal cal evol vol ut i on r at her t han rev revo ol ut i on Whi l e i t may n not ot bo ne necessary cessary t o e evo voll ve a u uni ni f orm method f or al l t he st at es, ce cerr t ai n norms wi l l be of he hell p t o ensur sur e a f ai r measu asurr e of un unii f or mi t y. Ar med For ces, West Ben enga gall , Punj Punj ab an and d Mysor e provi de some gui dan dance. ce. 8.

Recommendat i ons

 The Commi t t ee not ed t he t end endency ency t o r et ai n or gani gani sat i onal st r ucture w we e h ha ad i nher i t ed. A f i xe xed d or or gani sa satt i on h ha as i t s i nher ent weakn eakness ess i n t hat i t def eat eat s i t s own p purpo urpose se i n t he presence presence of of a d dyn ynam ami c si t uati on. Some st ates h ha ave r eor eor gani sed sed,, t hei r ad adm mi ni st r ati ve or gani sati ons. Addi t i on ona al st eps eps are nec nece essary t o b bu ui l d u up p a dyn yna ami c, f l ui d a an nd f l exi bl e o orr gani sat sat i on, cap capabl e of of absor sor bi ng p prr esen sent and f ut ur e r esp spo ons i bi l i t i es i n an ef f i c i ent manner . I n t he reo reorr gani sat sat i on r ec ece ent t r end ends sho shou ul d be take taken n I nt o c co onsi derat i on on..  The Commi t t ee di sc uss ussed ed t he var i ous aspect s of i nt egr at i on and i s f i r ml y o off t he opi ni on t hat se serr vi ces ces sh sho oul d be '

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(v) i nt egr at ed r i ght f r omthe hi ghest t o t he l owest l evel i n ser ser vi ce ce,, or gani sa satt i n and per son sonnel . Respo sponsi bi l i t i es f or heal t h of di f f eren erentt secti on ons s of t he com communi t y sh shou oull d be u un ni f i ed i n one one aut hori t y a att cen cent r al an and d St ate l ev evel el s. an and d med edii cal cal ed edu uca catt i on be i nt egr at ed wi t h ser ser vi ce. ce. The Co Commi t t ee a all so f el t t hat i n deve vell opi ng cou count r i es 1i 1i ke I ndi a en ent i r e he heal t h ser ser vi ces ces h ha ave t o be re- or gani ani sed. sed. The Th e a ad dmi ni st r at i on sho shou ul d be mor e sc cii ent i f i c a all l y gui ded.  The Commi t t ee not ed t hat t her e i s gr eat er r eal i zat i on of i nt er - i ndep epen end dence ence bet bet ween een Cen Centt r al St at es an and d l oca ocall gover over nment ent i n heal eal t h mat t er s i ncl udi ng t he p prr og ogrr ammes.  The Commi t t ee r ecommended ended t hat t he di st r i ct l evel shoul d be st r en eng gt hen ened ed suf suf f i ci en entt l y t o ' undert ak ake e co com mpr eh ehen ensi si ve heal eal t h wor k o on n r egi onal i ze zed d basi s. The he heads o off di st r i ct heal t h or gani za zatt i on may be f r om cu curr at i ve, ve, pr even vent i v or t eachi chi ng sp spe eci al i t y, but t hey must have suf suf f i ci ent r e- or i ent at i on or or t r ai ni ng i n co compl i cat cat ed tec tech hni cal cal and adm admi ni st r at i ve sci en ence ce of of pl an anni ni ng and and manag anagem ement ent of i nt eg eg-- Ar ated med edii cal cal an and d hea eall t h car car e se serr vi ces ces so as t o pr pr ovi ovi de i nt el l i ent educa catt i ve sup super vi si on and gui dance i n bot h f i el ds.  They shoul d al so have exper i ence i n communi uni t y or gan ganii sat i on. A pr i mary h hea eall t h cen cent r e i s a param paramou oun nt i nst i t ut i on on,, and and medi cal cal of f i cer cer must be i n com compl ete ad admi ni st r ati ve con cont r ol of th he e sta aff f . Ser vi ces ces are as go good as as t he pe per son sonn nel gi vi ng ser ser vi ce. ce. I t i s t her ef or e ne necessa cessarr y t hat medi cal cal of f i cer cer who ar ar e t he l eader s of t he hea heall t h t eam eams, sho shou ul d hav ave e h hii gh mor al e. Mor al e i s ho how wev ever er , i nf l uenced ced b by y va var i ous f act or s, i mpor t ant bei ng se secu curr i t y, chan chance ces s of pr ogr ess, t ech chn ni ca call l y a an nd f i nan- ci al l y, pr ovi si on of adequat e saf saf eguar ds t o en ensu surr e recog recogni t i on of good and l oya yall ser ser vi ce, ce, f ai r an and d j ust dea eall , an and d pr ov ovii si on of pen ensi si on an and d gr atui t y t o pr ovi ovi de mi ni mum l i vi ng i nco ncom me i n o oll d ag age. Th The e C Com ommi t t ee di di scussed t he va varr i ou ous s asp aspec ectt s i ncl udi ng t he pay ay,, servi ce con condi t i on ons s a an nd t he pr ocess ocess b by y whi ch uni f i cat cat i on of cad cadr e ca can n be e eff f ec ectt ed ed.. The The Commi t t ee d drr ew t he at t ent ent i on t o t he exampl e p prr ovi ded ded b by y t he Ar my and and by by t he St at e Gover Gover nment ent of West Benga engall , Punj Punj ab and and Mysor e. The The de dett ai l s may var y but but t he gr gr eat est common measur e of agr agr eement ent shou shoull d be i n t erms of ( a)s i ngl e p port ort al of ent ent r y, ( b) com common se en ni or i t y , ( c ) ; r e ec c ogni t i on of ext r a qual i f i c at i on by p r o v i s i o n of an antt e- date or f i nan anci ci al ad adva van ncem cemen entt , ( d ) equ equal pay f or equal equal work, an and d( e) spec specii al pay f or spec specii al i zed work, spec specii al pr og ogrr amme r esea sear ch, ch, t eachi chi ng, publ i c heal t h and extr a hazar zar d. On pr i va vatt e pr pr ac actt i ce the C Com ommi t t ee f el t t hat no Gov over er nment ent medi edi cal of f i cer s hou oull d nor mal l y b be e al al l owed pr i vat vat e pr acti ce ce.. El i mi nat i on of of pr i vat e ser ser vi ce i s, however bese sett wi t h many pr pr obl ems f i nanci al and a ad dmi ni s- t r at i ve ve.. J udi ci ous ant ant " mor e r eason easonab abll e pr pr ocedur ocedur es woul oul d

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(v vii ) be t o e ell i mi nate pract i ce on on a phased ased basi s wi t h t each eachii ng or r esea searr ch post heal t h of f i ce cerr heal t h can cand su sup per vi sory p po ost s at t he stat e he headquart er s and and di st r i ct l evel vel s. Compensa satt i on f or t he l oss of pr act act i ce sh shou oull d however ever be r eason easonab abll e.

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REPORT OF THE COMMITTEE ON INTEGRATION OF HEALTH SERVICES Preamble:

 The  Th e even eventt ual ef f ect i ven veness of publ ubl i c heal eal t h pr ogr ogr ess i s det erm er mi ned by t he so sou undne ness ss of t he p prr i nci pl es u up pon whi ch i t s admi ni st r at i on i s b ba ase sed d. Two o off t he pr i nci pl es de der i ved f r omB mBrr i t i sh exper i ence ar e si gni f i can cant . 1. The The Magn agna Chart a of ad adm mi ni st r ati ve pr i nci pl es was enunci at ed by, by, t he B Brr i t i sh Mi ni st r y o off Recon const r uct i on i n 19 1919 a an nd l ed t o t he est abl i sh shm ment of Mi ni st r y of H He eal t h.  The  Th e f i r st pr i nci pl e of goo ood d adm admi ni st r at i on rreq equ ui r es t hat when hen a spe speci ci al f unct i on i s t o be u un ndert aken aken,, i t shou shoul d be undert aken aken by on one e gover governi ni ng body body f or t he whol hol e communi uni t y need needii ng t he ser vi ce an and d not f or di f f erent erent sect i ons ons of t he communi t y b by y se seve verr al governi overni ng bodi es. 2. I nt er i m Repor t on t he Fut Fut ur e Pr ovi si on of Medi cal cal and Al l i ed Ser vi ces(1)sa ces(1)saii d: " Pr Prev even entt i ve an and cur cur at i ve medi edi ci ne can cann not be sep separ arat at ed on any any sound pr i nci pl e, and sound and i n a an ny schem scheme of med edii cal ser vi ces must be b brr oug ought t oget her i n cl ose coo coor di nat i on. " i nt egr at i on of heal t h se serr vi ces ces was f i r st moot ed i n 1937 i n I ndi a b by y t he Cen Centt r al Advi sory B Boa oarr d of of heal t h. The p prr i nci pl es were r ecommend ended ed by by t he Heal t h S Sur ur vey and t he Devel opment Commi t t ee( l 946) 946) as a pr el i mi nary st ep f or t he del i ver ver y o off compr ehen ehensi si ve heal eal t h ser vi ces. . Th Thii s was a accep cceptt ed by t he Cent ent r al and and St at e Gover overn nment ent s, I mpl ement ent at i on was, however, ever, sl ow and and i ncon consi st ent ent . Whi l e t he Cent ent r al Gov over ern nmen entt i mpl ement ent ed t he pr pr i nci pl e, many any of t he S Stt at es l agged agged behi behi nd. nd. Thi s was commen entt ed on by tthe he Heal t h S Sur urvey vey a and nd Pl anni anni ng Commi t t ee(195 e(1951) . I n one of i t s r eso soll ut i ons, t he Cent ent r al Counci l of Heal eal t h recom r ecommende ended d in 1 196 964 4 t hat hat a Com Commi t t ee of of t he Di r ect or ors s of Heal t h Ser vi ces ces of Guj r at , Punj ab. , Ut t ar Pr ade adesh, sh, and West bengal , t he Diedi r ec ect t orAo f Pubati l i conHeuanldter h, tM as arnm dan ashi r eprof ese esen hal e Ia, ndti h ae n M ed i cal ssoci haedrch chai aian anshi Dnrt.ati N. Jve ungof al lt w Di r ect or , Nat i onal I nst i t ut e o off Heal t h Admi ni st r at i on and E Ed ducat cat i on, exam exami ne t he var var i ous ous p prr obl obl ems i ncl udi ng t hose of ser servi vi ce con condi t i ons, ons, t he e ell i mi nat i on of pr i vat e pr pr act i ce ce,, et c. and sub submi t a rep repo or t t o the' the' Gover over nment ent of I ndi ndi a. Th The e Commi t t ee were er e f or t unat unat e tto o ttake ake t he se serr vi ces ces of Dr . P. R. Dut t , who co compi l ed t he rep repo or t , and are g grr at ef ul to h hii m f or t he e ext xt ensi ensi ve work do don ne b by y hi hi m.

( 1) Mi ni st r y o off Heal t h (Co (Consu sull t at i ve C Co ounci l of Medi cal cal and Al l i ed Ser vi ces) ces) I nt er i mRepor t on t he Fut Fut ur e Pr ovi si on of Medi ca call and Al l i ed Servi ces, ces, Lon Lond don, on, 1920.

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A quest i onnai r e was ci r cul cul at ed t o t he S Stt at e A Ad dmi ni st r at i ve Medi cal cal Of f i cer cer s. Repl i es wer e recei recei ved ved f r omf omf our t een st at es and and ni ne ce cen nt r al l y ad admi ni st ered t err i t ori es. The The C Com ommi t t ee met on 12. 2. 1966 and su sub bsequ sequent l y, vi si t ed some of of t he St St at es t o col col l ect f ur t her i nf or mat i on a an nd to st udy t he e exi xi st i ng o orr gani za zatt i onal pat t erns a an nd t hei r mer i t s and and demer i t s. 2. Def i ni t i on: 2. 1. I nt egr at i on: It means pu put t i ng t he p pa ar t s t oget her to f or m t he whol e. To i nt egr at e i s t o u un ni f y, t o com compl et e( i mper f ect) by addi t i on of par t s, t o com combi ne( par t ) i nt o a whol e. I n i t s a ap ppl i cat cat i on to h hea eall t h servi ce ces, s, i t mean eans a se serr i es of op operati erati ons co con nce cerr ned i n essenc esse nce e wi t h the b brr i ngi ng t ogether ogether of otherw otherwii se i nd ndep epen end den entt admi ni st r ati ve st r uct ur es, f unct i on ons s a an nd men entt al att i t udes i n suc such h a way as t o co com mbi ne these i nt o a who holl e (2) . I t i mpl i es t he a act ct of combi ni ng t he di f f er ent ent i t i es i nt o a si ngl e whol e. I nt egr at i on may b be e s sa ai d to e exi xi st when t wo o orr more o orr gani ani zat i on onal al un unii t s are su subj bj ected t o a uni f i ed di rec rectt i on and a si ngl e admi ni st r at i ve c on ont ro l . I t i s a st r onger t er m t han coo coor di nat i on. 2, 2. Coo oorr di nat i on: t he pr oc ocess ess of of ach achi ev evii ng su such ch op ope er at i onal r el at i on ons s amon ong g di f f er ent i ated and a au ut on onom omous orga organ ni zati on onal al ent i t i es as w wii l l i nsu surr e t hei r opt i mumf unc t i onal ro l e i n at t ai ni ng t he goal s whi ch t hey hey h have ave i n co com mmon on.. Coo oorr di nat nat i on i s an a adm dmi ni st r at i ve met hod hod f or harmoni oni zi ng and and a ad dj ust i ng t he who holl e r el ati on bet bet ween een su such ch componen onentt s i n t erms of t hei r sha sharr ed obj obj ecti ves ves ( 3) 2. 3. Regi onal i za zatt i on i s t he or gani zat zat i on of al l agenc i es- f or cur cur at i ve medi ci ne, publ i c h he eal t h a an nd so soci ci al ser ser vi ces ces w wii t hi n a gi ven ven geo eog gr aphi c area area,, co coo or di nat ed i nt o a si ngl e sy syst st em. 3. I nt egr at i on, i n publ i c Heal t h: 3. 1. The t erm publ i c h he eal t h was r est r i c t ed i n e ea ar l i er days t o sani t ar y measu sani asurr es i nst i t ut ed a ag gai nst heal t h h ha azards w wii t h whi ch the i nd ndii vi du dual al was p pow owerl ess t o co cone ne and and whi ch when presen presentt one one i nd ndii vi dual dual cou coul d adver ver sel sel y a aff f ect ot her s.

( 2)WH0( 19 1965 65} }I nt egr egr ati on of Mass C Com ompai gn a ag gai nst spe speci ci f i c di sea seases ses i nto ge gen neral he heal al t h se serr vi ces, Rep eport ort of WHO st udy Gr oup oup. Tech Tech.. Rep Seri es No. 294, 5. ( 3) Pa Pan n A Am meri can Sa Sani ni t ary Bu Burr ea eau, u, Reg eg.. of f i ce, WHO. Report eport of t he Advi sor y Gr ou oup p o on n Hea eall t h P Pll an anni ni ng Washi ngt ngt on on,,

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Fol Fol l owi ng the gr eat bact er i ol ogi cal cal and i mmunol ogi cal cal di sco scove verr i es of t he l at e 19t h an and d ear ear l y 2 20 0t h cen centt ur i es the con concep cept of pr even eventt i on of di sea sease se was add added, ed, publ i c he heal al t h t hus came t o mean ean i nteg nt egrr at i on of san sanii t ary sc scii ences ces a an nd medi cal cal servi ces. ces. The def i ni t i on of publ i c heal t h t o i ncl ude so soci al ser ser vi ce( ce( 4) i n i t s scop scope was f i r st enu enunci at ed by C C.. E. A. Wi nsl ow( 1920) and and has has si nce be been en modi odi f i ed at at t he sci ence and ar t of so soci ci al Ut i l i sat sat i on of sci ent i f i c kn knowl edge f or medi edi ca call pr otect i on by mai nt ai ni ng heal eal t h, pr even eventt i ng di sea seases ses and and* cur i ng di sea sease se t hr oug ough orga or gan ni sed communi t y e eff f ect . pu pub bl i c heal heal t h wor ork k t hus e exp xpan and ded f r omi t s hu hum mbl e co con ncer cern n wi t h gr oss e en nvi r onm onment ent al sani sani t ati on t o add add i n seq sequ uence ence,, san sanii t ary engi neer i ng, pr even vent i ve physi cal cal medi cal cal sci ence, ce, so soci ci al sci ence ence or promot i ve and and soci al asp aspec ectt s of of person ersonal al medi edi ci ne. Pub Publ i c hea heall t h t hus becom becomes communi t y hea heall t h care. car e. Dr . J . B. Gr ant ant denot enot es b by y t hi s t ierm " organ orga ne i sed com mm y lact ae ct ie on m ai tnal t ai- norheal ea tcau o ses; p prr even event t d sease seases s du due t o co com mu un nii tcab cabl env nvii tr o on onm m ent en otl thh er, causes; to i nst i t ut e measures easures f or t he ear ear l y di agn agnosi s an and pr even eventt i ve t r eat eat ment ent of i l l ness; and t o reha rehabi l i t at e i ndi vi dual s d dii sab sabl ed by a acc ccii dent or di sea sease se to soci al usef ul ness i n t he com communi t y"( 5) . Or gani ani sed co com mmuni t y act act i on t akes akes i nt o acco accou unt i ndi vi dual and and v vol ol unt ary or gani sa satt i on' s ef ef f or t s. I t i s ne needl ess t o ment i on t hat t he organ orga ni sed co com mmuni t y act act i on i mpl i es a all so. t hat var varii ous ous f orms of medi edi cal and and heal eal t h act act i vi t i es be pr operl operl y perf ormed, ed, coordi coordi nat ed and bal ance ced d. I n othe otherr - words, t he sy syst st em of del i ver ver y o off good med edii cal ( hea eall t h) care car e must have ave a u un ni f i ed app appr oach oach co cove verr i ng u un nder a si ngl e admi ni str at i ve aut hor i t y. Thi s i s i nt egr at i on. 3. 2. An i nt egr at ed heal t h se ser vi ce wi l l have: ve: i)

a uni f i ed appr oach f or a all l prob probll ems i nst ead of segmen entt ed ap approach proach f or di f f er en entt pr obl obl ems; and and

a

i i ) medi cal cal ca carr e of t he slat and co con nve ven nt i onal publ i c heal heal t h pr ogr ogr ammes f unc nctt i oni oni ng und nder er a si ng ngll e ad adm mi ni st r at or and and oper at ed ' a a uni f i ed manner at al l l eve vell s of hi er ar chy chy wi t h du due e p prr i ori t y f or ea each ch pr ogr ogr amme o ob bt ai ni ng at a p poi oi nt of t i me.

( 4) Soci al ser ser vi ce ces s ar ar e t hose se serr vi ce ces s p prr ovi ded or f i nanci al l y assi st ed by a publ i c a au ut hor i t y whi ch have as thei thei r abj ect t he enhance ancem ment ent of t he person persona al wel f are o off t he i ndi vi dual ci t i zen zen.. The The pol i t i ca call Eco con nomi c P Pll anni ng Repo epor t on Br i t i s h Soc i al Servi ce ces( s( 1937) ( 5) Se Seii pp pp.. Con onrr ad, ad, Th The e H Hea eall t h , Care f or t he co com mmuni t y sel ected p pap apers ers of Dr . J ohn B B.. Gr ant . J ohns H Ho opki ns Pr es s . Bal t i mor e 1 19 963, PP. 6- 7 7..

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3. 3. Such a an n i nt egr egr at ed heal eal t h se serr vi ce h has as many any ad adva van nt ages: ages: ( a)   ' The The heal eal t h of t he. t otal co com mmuni t y i s l ooke ooked d af t er more ef f ect ect i vel vel y and and more e eco con nomi ca call l y. ( b)   A basi s f or compr ehen ehensi si ve heal eal t h servi ce t o e eve verr y f ami l y ise estab stabll i she shed, whi ch cut cut s t he v vii ci ous ci r cl e of of endl essl y referr i ng pat i ent s f r om pl ace t o p pll ace. ce. ( c)   A bal ance i s mai nt ai ned i n or gani sati on f or t he di st r i but i on of med edii cal cal ca carr e, assum ssumi ng t he pr omot i on of posi t i ve, ve, ment ent al and and physi ca call heal eal t h. ( d)   A si ngl e admi ni st r at or or a person r esp spon onsi si bl e f or a t ot al hea eall t h p prr ogr ogr amme i n t he communi t y ha has s a bet bettt er over overal al l perspe er spect ct i ve and an si gh n o trhvi e npr pgr obl ob s, on an and eacy p prr ogr og es.entThi Th s wi d llin assu assur r te ip pr rtese eser and anldem m ai nsol t aiuntiinons g st h e dprtihm ofr am prmeven ev t i ive med edii ci ne. Pr Prev even entt i on i s bet bet t er and and chea cheap per t han cu curr e. At t he same t i me pr pr even eventt i on i s compl ement ent ary ar y t o cur cur e. 3. 4. I nt egr ati on of heal t h servi ces( ces( 6) has t o be con consi der ed i n t hr ee maj or compone ponent nt s: i.

Heal eal t h se serr vi ce ces s or f unct i ons ons and and method ethods del i ver y or di str i but i on of t hese se serr vi ces. ces.

of

i i . Th The ei r or gani sat sat i on , an d i i i . t he per so son nnel pr ovi di ng t he ser ser vi ces ces a an nd t hei r admi ni str at i on". 3. 4. 1. HEA EALTH LTH SE SER RVI CES ES.. A com pr ehen ehensi si ve h hea eall t h ca carr e i n t he co com mmuni t y i s po possi ssi bl e o on nl y by conti conti nuo uou us and ba ball anced anced pr ovi ovi si on of pers on onal al and and i mper per son sonal al s er er v i c e es s.

As t he f amou ous s Bohe Bohem mi an mor ph phol ol og ogii st and and p phy hysi si ol ogi ogi st J oh ohan anne nes s Ev ang g i st pu ur kii tnj e 150 0 y yea ear s ba back ck p "Med "M inci ca can nses o on nl ya a achi chiweve ev e iEvan ts i el deal ea l awhp en i swriote n a15 p posi osi t iron to pr r eedi ve ven t ndei sea seases an n d hen preventi preve nti on i s gi ven ven grea greatt er empha hasi si s t han cur cur at i ve care. He thou thoug ght t ha hatt med edii ci ne wou oull d t r i umph whe hen n i t be becam came p pub ubll i c( soci al ) an and d when. hen. i t set set i t sel sel f t he t ar get of ensu surr i ng heal t h and physi cal cal wel l bei ng f or a peop eopl e under a publ i c au autt hori t y. ( 6) Th The e term ' heal t h se serr vi ces' ces' cove coverr s t he o orr gani sa satt i on of medi cal cal and h he eal t h c ca ar e a as s w we el l ' as t he p prr even vent i ve, ve, envi r onment al , cur cur at i ve and r ehabi l i t at i ve se serr vi ce ces. s. The wor d ' Ser vi ces' ces' is u use sed d compreh prehen ensi si vel vel y i n t he sen sense se b both oth o off t he ser vi ces af af f orded and and t he heii r or gani sa satt i on a an nd ad admi ni st r at i on,

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Pa Parr al l el ser ser vi ces, ces, what ever ver may b be e the h hii st or i cal cal r eason sons, ar e wast ef ul and a arr e p prr i mar i l y the r esu sull t of l ack o off pl anni ng o orr bad pl an ann ni ng. Fun Funds av avai ai l ab abll e f or. heal t h car car e pur pose oses s in dev evel el op opii ng co cou unt r i es a all l ow on onll y a l ow qual i t y o off servi ce ce.. The The heal t h c ca ar e ser ser vi ces ces sho shou ul d b be e d dii st r i but ed o on n a r egi onal basi s.  The c oncept of r egi ona onall i sat i on, t hou hough gh or i gi nat ed i n Eng Engll and i n. 1920 1920 by Lo Lorr d Dawson o off Pe Penn nn Rep epor or t " The The S Stt at e Provi si on of Med edii cal and and A All l i ed Se Serr vi ces" i s f oun ound a att l ea east st i n so som me co com mpone ponents nts i n so som me co cou unt r i es o ou ut si de E En ngl and, 1t i s compr eh ehen ensi si ve i n C Czec zech hosl ov ovak akii a.  Thi s concept has ext end ended ed beyon beyond d t he i dea of a coor di nat ed systemf or del i ver ver i ng h he eal t h c ca ar e se serr vi ces ces t o co con nnot e co con nt i nui ng ed edu uca catt i on of t he h he eal t h ca carr e p prr of essi on wi t hi n the area of a reg regii on an and d t he de devel vel op opm men entt of t he t ech echni ni cal con consci sci ou ousness sness of t he consum consumer publ i c .  Theoret  Theor et i cal l y, he ar ea t o be r egi onal i sed, shoul d cont ai n a pop popo ol at i on l arge enough to be sel f - co con nt ai ned i n su sup pport i ng the pro v vii si on of al l br anc h he es of of heal t h c ar ar e- f ac i l i t i es. Coordi nat i on sh shou oull d b be e e eff f ect ect ed by est est ab abll i sh shii ng a t wo- way f l ow of pr of essi onal an and d adm admi ni st r ati ve ser vi ces betw etwee een n t he peri phe herr al un unii t s an and t he base, se, whi ch sho shoul d pr ovi de t eachi chi ng and t r ai ni ng f aci l i t i es.  The need f or r egi onal i sat i on- of hea heall t h car e ser vi ces i s pr op oport ort i on ona a1 to t he e eco con nomi c l eve vell of t he co cou unt r y a an nd i s ab absol sol ut el y essen ssentt i al f or I ndi a, wher e part of t he heal t h car car e servi ce must be r ender ed on a vo voll unt ar y sel sel f - hel p bas i s . Thi Thi s i s o on nl y possi bl e under co on nst a nt nt ' pr of essi onal su sup per vi si on . An admi ni st ra t i ve di s t r i c t f orms a c o on nveni ent basi s f or or gani si ng l oc a all heal t h admi ni st ra t i on. Popul at i on of a di st r i c t va varr i es f r om20 m20,, 453 to 6 62 2, 80, 916 b bu ut t he med edii umpo mpop pul at i on i s 1. 2 mi l l i on: At t h i s l evel - i t i s e ea as y t o br i ng heal t h s se er v i c e es s i n c l os er er associ ati on wi t h deve evel opment ent of ot her acti vi t i es su such ch as e ed ducat cat i on, agr i cul cul t ur e, ani mal husba sbandr y, i ndust r y, i r r i gat i on, com communi cat cat i on et c. A di st r i ct ho hosp spii t al al so pr ovi des a base f or ; devel vel opi ng sp spe eci al i st servi ce ces s in a an n i nt egr at ed manner t hus ef f ec ectt i ng e eco con nomi cal cal use o spe sp ci a l i st ce andt o tec tech nilcal ca qui pma esntt .he Thu Th us c ai nst di di st ctt hfosp ospi i teal sho shoul ul d a bd evisu such ch as b bee-habl ab e lto e serve as b basi asi r urmient en not on onll y f or pr ovi di ng medi ca call ca carr e but al so f or pr ov ovii di ng i nst r ucti ons an and d s su uper vi si on, gui dance and c co onsu sull t at i on to a all l pr event i ve, ve, c u urr at i ve and r ehabi l i t at i ve c ar ar e uni t s i n t he di st r i c t , Not onl onl y the servi ces b but ut t he method ethods s of t hei r del i ver ver y sh sho oul d b be e i nt egr at ed, namel y t he stati c a att cl i ni cs a an nd hosp ospii t al s an and d the domi ci l i ar y a att t he h ho ome.

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3. 4. 2.

ORGANI SA SATI TI ON:

3. 4. 2. 1- Gener al heal t h se serr vi c e es s i s a sy syst st em of i nst i t ut i ons r esp espon onsi si bl e f or ca carr r yi ng ou out ' heal eal t h p prr ogr ammes o off a mul t i - pur pose nat ur e u usi si ng to a l arge e ext xt en entt mul t i pur pur pose pose h hea eall t h worker s an and d seeki see ki ng, as i t s u ull t i mat e obj ect ect i ve ve,, t o meet t he ov ove er al l hea eall t h need eds s of t he co com mmuni t y. A pyrami dal st r uct ur e wi t h 3 cl ea earr di st i nct l ev evel el s f r omt he ce cen nt r e to t he p peri eri pher y h ha as be bee en a acce ccep pt ed uni ve verr sal l y as as a sou sound or gani sa satt i on f or pr ovi di ng heal t h s se er vi ces. ces. The l ocal cal l evel vel com compr i se ses s t he p pe er i pher al f uncti oni ng un uni t s, t he i nt er medi at e l evel vel ( com compr i si ng se seve verr al sch sche el ones, r egi onal , di st r i ct) pr ovi des g gu ui dance and on- t he- sp spo ot su sup per vi si on of t he l oca call l eve vell : and t he cen cent r al l evel vel est abl i she shes st andar ds an and d p po ol i ci es, et c. and a assu ssurr es uni uni t y i n the gen ene er al di r ect ect i on o off t he whol e sy syst st em. i sthe n ne eep d ess o m ent i oce n o t rhaatnyi n r apr ti o og nr am ofmecur cu servi ce Iwti t h pr r leve ev ent it ve servi or o ottt e hg er f ralalt ii ve ng und nder er t he purvi ew of he heal al t h must ha have ve-- prop proper er i nt egr egr at i on at al l t he t hr e e l evel s . An or gani sa satt i on sh sho oul d be su suff f i c i ent l y f l ui d, f l exi bl e, and adapt abl e t o meet chang adapt changii ng p prr ogr amme ne needs eds wi t hou houtt und undue ue d del el ay and and f r i cti on and yet yet have su suff f i ci ent st r uct ur e and f or mal i t y t o pr ovi de con cont i nui t y and uni f or mi t y i n r ender i ng se serr vi ces. ces. I n a de deve vell opi opi ng cou countr ntr y the orga organi ni sat i on sho shoul ul d be, by purpose urpose an and b by y p prr oce ocess, ss, wi t h a bi as t owards t ha hatt sect i on of t he communi uni t y whi ch i s of great er devel devel op opm men entt al i mpor por t ance. ance. No admi ni st r at i on, par t i cul cul ar l y heal t h, can can af f or d t o negl ect t he t wo n new ewer aspe aspect ct s of t he soci al pr obl obl ems of orga organi ni sat i on na nam mel y Par t i ci pa patt i ve man anage agem ment ent ' and ' dyn dynam ami c manag anagem ement ent ' . The These se con concept cept s hav ave e to be r eco ecog gni zed an and d ada adapted pted i nto f ormal organ organii sat i on, on, so t ha hatt i t make kes s al l owance ce'' , f or empl oye yee es att i t udes' and b be el i ef s, t he go gover ver nment ent al pr ocess and commun unii t y val ue ues. s. 3. 4. 2. 2. The most di f f i cul cul t pr obl ems of desi gni ng o off an or gani sa satt i onal st r uct ur e i s to p pll ace a l egi on of oper at i ng, su sup ngl ta an n ad ddm i nai m st r atfil ve rati al gnri osat uptii nogns,cap hiblch wop up lo drrt ei sul su i dn a yna yn i c, exi tbal leks , efi fni ci entonorga organ sa caw pa e of di sch schargi argi ng pr esen esent and f ut ur e r espon esponsi si bi l i t i es i n an exe xem mpl ary mann anner er .  The pr obl em i s , t her ef or e, t o ar r ang ange e l ar ge f unct i ona onall gr oupi oupi ng ngs. s. Fu Func nctt i ons ons i n e each ach maj or un unii t can t he hen n b be e g grr ou oupe ped d i nto opera t i ng d dii vi si ons a n nd d st st af f f unc t i ons.

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3. 4. 2. 3. The d dii st i nc t i on b be et ween s stt af f and l i ne a ac c t i vi t i es a n nd d personn ersonnel sho shoul d b bo o reco recog gni sed as an op operat erat i ng p prr i nci pl e. St af f f uncti ons

ar e mai nl y t hr ee:

( a) Admi ni st ra t i on: I. budgeti ng an and d f i nan ance ces s ii. perso n nn nel admi ni st r at i on. i i i . l ogi s t i c s , and i v. man anag agem emen entt a ana nall ysi s an and d proced procedural ural s t anda andarr ds. (b) 

Programmes,

(c) 

Hea eall t h

pl an ann ni ng . and and an anal al ysi s

i nf ormati on and and

:

and and 

edu educati on 

 The st af f f unct i ons ar e i mpor t ant i n t hat t hey he hell p i n mor e ef f ecti ve and mor e e eff f i ci ent coo coor di nat i on b by y a ach chii evi ng c cll ear l ater al ch cha annel s f or communi ca catt i on on,, pl anni ng, pr ob obll em emsol sol vi ng an and ac t i on. Coor di nat i on i s a an n e esse ssen nt i al i nt egr al part of admi ni st r at i on. I n e esse ssen nce, ce, i t i s t he c crr eat i on o off har moni ous r el ati onshi onshi ps among ong t he componen onentt s of an orga organi ni sat i on so t ha hatt t hei r co com mbi ned e eff f ort s prod produ uce a desi r ed and su sust st ai ned r esu sull t . Hi gher an i nst i t ut i on t he g grr eat er i t i s i n need of ef f ec t i ve c co oor di nat i on, f or t he v va ar i ous h hii ghl y sp spe ec i al i se sed d pr ogr ogr ammes de dep pend end f or succe successf ssf ul operat operat i on on an i ntr i cate net- wor k of r el ati on onsh shii ps w wii t h o ott her gov overnm ernmen entt al agen agenci ci es at var var i ous l evel vel s an and d wi t h v va ar i ous vo voll unt ar y o orr gani sat sat i ons. 3. 5. 3. per son sonnel and admi ni st r at i on; The The f i r st esse ssen nt i al st ep t owar ds : ' i nt egra t i on wi l l be uni f i c a att i on of t he Cadr e of st a f f f r omt he so ca call l ed medi edi ca call and ' publ i c h hea eall t h' Si de and and al so t he sp spe eci al i st s ' and t eachi chi ng f acul cul t y. A r eor gani sat sat i on of t he cad cadr e i s esse essen nt i al t o br i ng al l t he exi st i ng cad cadr es on on a par f or pur poses ses of pay, al l owances, ces, co con ndi t i ons, . of se serr vi ce, ce, pr omot i ons- Aand sQ on on.. rgan Som Som o offt i tohe aspect ctest he w whi hiich de consi de dur such reo reorga ne i sa sat n waspe ill b nt edeser rcser h ha anve ge con a an ndsitder r arnat sf ieon r odu f cr li ing ni c al al , pr ev even entt i ve an and d t each eachii ng post s an and d r otat i on of med edii cal cal of f i ce cerr s f r omrural t o u urr ban a an nd vi vi ce ve ver sa a an nd p pll en entt y o off sco scop pe t o p prr ov ovii de consul con sul t ati on, on, gui dance ance a an nd co con nf i dence ence t o t he you young nger er grou groups ps or or gr oups l ef t t o work i n i so soll at i on. 4. 4.1.

Hi stori ca call rev revii ewo woff devel opment of I n t he

' medi cal cal an and he heal al t h Se Serr vi ces'

co cou unt r y

 The count r y pr esent s t o- day a mosai c of di ver se cul t ur al pr acti ces ces w wii t h an under l yi ng un uni t of bel i ef and

7

 

unders t and andi ng. The The cu cull t ur al heri t age age i s t he l egacy egacy of not one one h hu ut many any ci vi l i za zatt i on and r el i gi ous cul cul t s t hat have i nf l uenced ced t he cou count r y f r om omtt i me' t o t i me. I ndi a l i ke Eg Egypt ypt , Gr eece eece a an nd Rome h has as h had ad a p prr i de of pl ac ace e i n t he de devel vel op opm ment of t he Heal i ng Ar t s. Cur anci ent l or e i s r i ch wi t h t he ach achii evem evemen entt of Shu husr sr ut a, ch char arak aka a and and ot her i n t he appl i cat cat i on o off medi ci nes( of che chemi ca call , bot ani cal cal and b bii ol ogi cal cal ori gi n) and and nat ur opat opat hi c metho ethod ds f or t he t r eat eat ment ent and and al l evi evi ati on of physi ca call ai l ment ent s, There There ar ar e r eason easons s t o bel i eve eve t hat t here were a f ai r l y devel evel oped oped medi edi ca call and and san sanii t ary o orr gani ani sat i ons ons an and d t hat t here was a ce cerr t ai n a am moun ount of coor coor di nat i on bet ween een t hen i n th t he t i me of of Chand handrr a Gupt upt a and and dur dur i ng Budhi udhi st er era. a. Mod oder ern n med edii cal ser vi ces were er e est abl abl i she shed d i n t he ei ght ght een eent h ce cen nt ur y by by t he East East I ndi a C Com ompany any b by y u utt i l i si ng t he se serr vi ces ces of army doct oct ors . Thu Thus medi edi cal r el i ef had been een acce accep pt ed by t he st at e a as s i ts rdespon esp simb i lt i tof y fprromt htei ve ver verm yedi biegi eg g. t Thou Th grhi tti hsh ereAr as af tger r adu adu ale evel evelonsi opm op ent en even event ed cii nneni inn heoug B Br Arw m y a af th Cr i mean and Nap apol ol eni eni c war s no at t empt was made ade f or di sease pr preven eventt i on exce xcept i ng vacci vacci nati on ag aga ai nst smal l - pox. I t was onl onl y af af t er t he Royal yal Commi ss i on of 18 1859 59 had made tthei hei r r ecommendat endatii ons ons i n 18 63 ttha hatt Sani ani t ar ary y C Com ommi ssi on were er e ap app poi nt ed t o st udy an and d a assess ssess t he publ i c heal heal t h prob pr obll ems an and d advi advi se t he Gove overr nment ent on t he act i ons ons f or t he pr ev even entt i on of di seases seases f or Beng engal , Madr adr as and and B Bom ombay p prr esi denci enci es on t he basi s o off t hei r r epor t s. By 1 186 869 9 Sani Sani t ary ar y Com Commi ssi ss i on oner ers s were er e a app ppoi oi nted nt ed al so f or Nort or t h- West ern er n p prr ov ovii nces and and o ou udh, Punj Punj ab, ab, Cent ent r al pr ov ovii nces whose dut i es wer e pu pur el y a ad dvi so sorr y. I n 1880, a si ngl e o off f i cer cer was ap app poi nt ed f or t he doubl e of f i ces ces of of t he Di r ect or Gene ener al , I ndi an Medi cal cal Ser Ser vi ce, and and Sani Sani t ary ar y C Com ommi ss ssii oner oner . on t he ecommenda endatt i on of t he Pl ag ague ue Commi ssi on i n 1 19 904 t he o off f i ce of of t he San Sanii t ary ar y C Com ommi ssi oner oner wi t h t he Governm overnment ent of I ndi a was separat separat ed f r om omtt hat of t he Di r ect ect or Gener al , I ndi an Medi ca call . Servi ce o on nl y t o b be e reu reun ni t ed a ag gai n i n 19 1912, I n 19 1921 a San Sanii t ar ary y C Com ommi ssi oner oner was r edesi edesi gnat ed as Pub Publ i c Hea Heall t h Commi ssi on oner er and and t he S San anii t ary ar y C Com ommi ssi oner oner i n th t he St St at es as Di r ect or of Pub Publ i c Hea eall t h. Th The e S San anii t ary ar y Depar epartt ment ent beca ecam me p pu ubl i c h hea eall t h depa deparr t ment ent .  Thou ghccessf t hssf e pu pub c he heal de part ar m en ha byr am i tm sel be ach achi evi ev Th i ngough su succe ulblriesul esu l tal s ti hn dep many an y to of fent tthehad pr pd r ogr og es, ft hbeen e en l ack ack of coorr di nat i on bet ween coo een t he cu curr at i ve an and" pr prev even entt i ve d dep epar artt ment ent s had r esul esul t ed i n l arge gap i n pr ogr ogr ammes l i ke ke,, MCH, t ubercul osi s, ven venerea ereall di sease seases" s" cont cont r ol , et c. Real i sat sat i on sl owl y gr ew among t he admi ni st r at i ve med edii cal cal of f i cer cer s t hat pr even vent i on of di sea sease se was a bet t er ai mof medi ca call wor k rath rathe er t han r el i ef i t sel sel f and al so t hat i t was i n t he i nt erest of ef f i ci ency ency a an nd econ econom omy t hat a medi edi cal man oug ought t o e en ngage age b bot ot h i n medi edi ca call r el i ef and and p pu ubl i c h hea eall t h work. The The Cent ent r al Advi dvi sor y Boa Boarr d of Hea eall t h f orm or med i n 1 193 937, 7, r ecommende ended d

8

 

t hat at t he di st r i c t l evel vel , se sep par at e di r ec t i ng st af f sh sho oul d ho co coordi ordi nat ed by an admi ni st r at i ve head ead. Fur Fur t her , t he d dii spen spensary sary do doct ct or s must be br ought mor e i nt i mat el y i nt o t he l ocal cal heal t h pi ct ur e. I n 1945 1945,, t houg hough h a sep separ ar at e depa deparr t men entt of heal heal t h was con const st i t ut ed cent r e, a f ew ot her cent her de depa parr t men entt s w wer er e a all so con concer cer ned ned wi t h heal heal t h i n r espe espect ct of cer t ai n g grr ou oups ps who wer e co conn nnect ect ed wi t h o orr empl oye oyed d by by t ho hose se d dep epart art ment ent s. Th The e Di r ector General eneral , I nd ndii an Medi edi cal Ser Ser vi ces a and nd t he Pub Publl i c H Heal eal t h C Com ommi ss i oner oner be becam came t he he heads ads o off t he med edii cal and and heal eal t h de depa parr t ment ent s at t he cen centt r e. at the

I n t he pr ov ovii nce ces s ov overal eral l ad adm mi ni st r ati on was i n ch charge arge of a Mi ni st er r espon sponsi si bl e t o t he Le Leg gi sl at ur e. There There wer e sepa separ ate tech techn ni cal cal head heads s f or med edii cal an and d heal heal t h depa deparr t men entt s, Sur Sur geon geon Gen ener er al or I nsp nspect ect or General eneral of Pri son sons s f or t he Medi edi cal de dep part ment ent and and t he Di r ector s of Pu Publ blr iecmed H Hea eal l t h an f or tubl he eal l talht dhepart ep artarmtent en t . t The Th eerex excep i on as and i nd O ssa whe her edi i cal and dp pub l i hcea he heal d dep epar men ent sw wer e cept i nttegr eg r atwed an p plrl iace aced d under a si ngl e of f i c e err . Revi ewi ng t he s sii t uat i on exi st i ng t i l l 1945, t he Heal t h Sur vey vey and Devel opment Commi t t ee po popul pul ar l y known as t he B Bhor hor e C Com ommi t t ee r ecom ec ommended:

1.   se sett t i ng up of Mi ni st r i es of Heal t h at t he Cent r e a an nd i n t he pr ovi nces; ces; 2.   f or mati on of a stat ut or y B Bo oar d of Heal eal t h con consi st i ng of Cent r al and Pr ovi nci al Mi ni st er s o off Heal t h i n or der t o pr omote mut ual co con nsu sull t ati on and and co coordi ordi nati on. on. 3.   uni f i cat cat i on of r espo sponsi bi l i t y un under Mi ni str y of of Heal t h f or al l heal t h se serr vi ces ces f or al l gr oups o off popul at i on: 4. i nt egr at i on of cur cur at i ve and pr even vent i ve se serr vi ces ces a att t he Cent entrr e an and d i n t he p prr ovi nces: ces: 5.ent exch chan or depu eput at i on of members er s of t he ser vi ces f r om C entex re tang oge or St at e and f r om St ate t o Cent r e and St at es, et c; and 6. uni f i ed heal t h aut hori t y at t he di str i ct l evel .

 The  Th e Commi t t ee hoped oped t hat an i nt egr egr at i on of ser vi ces woul d aut aut omat i cal cal l y occu ccurr at l east i n t he per i pher y, t o st ar t wi t h, when t he p prr i mary heal heal t h cen cent r e was* est abl abl i shed shed*. *. Short or t l y t herea er eaff t er, er , t he cou count r y b beca ecam me i ndepen epend dent ent and and ad adop optt ed i t s own C Con onst st i t ut utii on. on. Th The e count countrr y b beca ecam me a

9

 

sover ei gn Democr at i c Rep sover Repub ubll i c and and a Uni on of St at es bou bound nd t og oget et he herr by a pr ev evii si on of t he Con Const st i t ut i on whi ch ga gave spe speci f i c p pow ower s t o St ate' s and and to t he Fe Federal aut hori t y, . t he C Ce ent r al Gov ove er nment , Howeve everr , mechani echani sms ha have ve been been pr pr ovi de ded d t o f or ge a l ar ge mea easur sur e of uni t y i n pol i cycy- maki ng and i n i t s exe execu cutt i on i n t he f ace of a cl cl ear de dem marcat arc at i on of f un unct ct i ons ons betw bet wee een n t he Cen entt r e and and t he St at es. One such mechan echanii smwas smwas t he est ab abll i shmen entt of t he Gen eneral eral Cou oun nci l of Hea eall t h.  The Heal t h Su Surr vey and pl anni anni ng Commi t t ee( Mudal udal i ar Commi t t ee ee)) 1961, r ev evii ewed t he si t uati on on.. The The i nt egr egr ati on of t he cur cur ati ve an and d pr ev even entt i ve hea eall t h servi ces ces h hea ead dquart ers l ev evel el has come ab abou outt at t he Cen entt r e and and st at es exce except pt i n Madr adr as. Andhr ndhr a Pr adesh, adesh, and and Mahar ahar asht r a. Madr adr as and Mahar ahar asht r a h have ave accept ed i n pr i nci pl e. Med edii cal cal an and d publ i c h hea eall t h dep epart art men entt s co con nt i nue t o f unct i on se sep par at el y at di st r i ct l eve vell s e exc xce ept i n West Bengal an and an.. Th The e peri pheral l ev evel el i s how however ever i nt eg egrr ated i n al d l R saj ta atast t es e sh . an

 The commi t t ed have emphasi phasi sed t he i mmedi at e ur gency gency f or i nt egr at i on of cur cur at i ve and pr eve ven nt i ve ser ser vi ces ces a att al l . l eve vell s an and al so t he i ncl usi on of publ i c he heal t h engi neers, stati st i ci ans, ep epii de dem mi ol ogi ogi st s and and so som me ot ot he herr exper exper t s i n ho Cen entt r e and and St Stat at e Di r ectorates. ctorates.  The Commi t t ee have r ecommended ended or i ent at i on of number of medi cal cal and publ i c he heal t h servi ce and per i od odii c shi shi f t i ng of per sonn sonnel ' f r ommedi cal cal t o publ i c hea heall t h posts and and vi ce ve verr sa i n or de derr t o make t he i nter nt er ai on process smoot oot h.  The Com Commi t t ee al so r ecommended ended t he f or mat i on of an Al Al l I nd ndii a Heal t h Se Ser vi ce whi ch wou oull d- have on i t s pan panel spe speci al i ses, consul t ant ant s and tea t eacher cherss who who can can be be exch exchan ange ged d and and de depl pl oyed oyed accor accor di ng t o t he nee needs ds of of t he Cen entt r e an and t he S Stt at es. 4. 2.

I n t he Wor l d

 The sys t em of publ publ i c heal heal t h of count r i es var i es wi del y, dependi ng on t he hi st or i cal cal , soci soci al end rel i gi ous t r adi t i ons, p o1 i tli s, cal cal aw co con nce cep pesst I on,of atdm atl ievean sdt ruct ruc econo econom m soci ald l o1i eve vel arenessaren hieni pe pstr eop opl anst ont ut re, he respon resp onsi sii cbi land i t y pl p l aced ce by t he go gove verr nment ; at 3 tr adi t i onal l eve vell s, cen cent r al , i nt er medi at e and l ocal . The gener gener al t r end i n al 1 co cou unt r i es i s tto o war ds com compr ehensi ve and i nt egrated ser vi ces.  The USSR USSR pr pr ovi des a good exampl e. The St at e accept s t he f ul l responsi bi l i t y for t he provi respo rovi si on of al l heal t h servi servi ces ces wi t hi n an i nt egr at ed soci soci al i st pol i t i cal cal econ conomy. The br oad pat t er n i s of of nat i on onal al he heal al t h syst emas. a part part of a p pll an ann ned econo econom my i n whi ch: a) al l hea eall t h est ab abll i shm shment ent s are st ate- owned an and d sup support ed an and d al l heal eal t h st af f are st ate- empl oy oyed ed;;

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b) t he ex exe ecut cut i ve ef f ort i s pe per f or med by l ocal cal heal t h uni t s, i ndi vi dual and and other other wi se com combi ni ng pr even eventt i ve and and cu curr at i ve met hods hods wi t h em emphasi phasi s ont he f orm or mer er.. Si nce 19 1956, pr ev even entt i ve and and curat i ve ser vi ces h hav ave e b bee een n i nt eg egrr at ed throug through t he ray rayo on hosp spii t al . At hi gher l evel evel s a netw etwork ork of advi advi sory cou coun nci l s an and d sci sci ent i f i c an and r esea sear ch i nsti t ut i ons a assi ssi st s t he h he eal t h mi ni st r y and and depar depar t ment ent s, Czech zechosl osl ovak ovakii a i s ano anott her good ood e exa xam mpl e. 5. Cer t ai n ch changi ng co concep cept s i n h he eal t h a ad dmi ni st r ati on. 5. 1. The The br oad oadeni eni ng out out l ook ook on soci al wel f are:  The  Th e t r end end r el at es t o t he cl oser under der st andi andi ng bet ween een heal t h a an nd soci soci al wel f ar e wi t h so soci ci al i nsur sur ance a as s t he co con nnect i ng l i nk an and a val uabl e pi l l er of so soci ci al wel f ar e, Thi s woul d per mi t heal t h c ca ar e ser ser vi ce to evo evol ve wi t hi n the f r amework of soc socii al secu securr i t y and heal t h i nsu surr ance. ce. . 5. 2. Cent r al i sa satt i on and dece cen nt r al i sat sat i ons  Tr  Tren end d t oward ar ds de decen centt r al i sat i on i s gr eat eat er i n st r eng engt h, i mpet us and and va varr i et y t han any any movem ovemen entt i n t he con cont r ary ar y d dii r ect i on. on. Dec ecen entt r al i sat i on i s how however ever r arel y co com mpl et e b bec ecau ause se t he C Cen entt r e must al ways ays r et ai n some el el emen entt of ul t i mat e con cont r ol , not merel er el y t hr oug ough gu gui dance ance a an nd a ad dvi ce bu but t hr oug ough a ap ppr opr opr i ate i nhi bi t ory devi evi ce ces s a an nd f i nanci anci al nexu exus i s al most al ways ays p prr ese esen nt . Cont ont r ol apart apart , degr egr ee of del egati egati on va varr i es e en normousl ousl y.  The  Th e gener eneral al t r end end f or t he Cent ent r al Gover overn nment ent app appear ear s t o retai n power s r el at i ng t o n na at i onal heal t h pr ot ect i on measures, easures, r el at i ons ons wi t h other other cou coun nt r i es on heal eal t h matt ers , hi gh l evel pl anni ng, con cont r ol of f i nanci al sub subsi di es, and hi ghl y spe speci al i sed mat t er s su such ch a r adi adi at i on pr ot ect i on etc. Extr emes of cen cent r al i sat sat i on and and decen cent r al i sa satt i on are bei ng modi odi f i ed. ed. The The WHO r eg egii on onal al Conf onf eren er ence ce on Pub Publ i c H Hea eall t h Admi ni st r at i on i n Eur op ope( e( 1964) con concl cl uded uded t hat t here er e were er e n no o mer i t s i n cen cent r al i sa satt i on or decen cent r al i sat sat i on i n t hemsel sel ves as acad academ emi c co con ncep ceptt s an and d t hat t he touch touchst st one one o off cr i t eri a f or t he degr ee o off cen cent r al i sati on or dece decen nt r al i sat sat i on must be the ef f i ci ency o off t he ser ser vi ce whi ch i t br i ngs t o the pat i ent and t he communi uni t y. 5. 3. S peci al i sa sati ti on; Spe peci ci al i sed ser vi ces sho shou ul d be devel evel oped oped at prope properr l evel evel s b but ut precau precautt i ons ons sh shou oull d be t aken aken agai agai nst exce excessi ssi ve s pe pec i al i s at at i on or c r e ea at i on of s pe pec i al i s a att i on wi t hi n a s sp pec i al i t y .  Tr ai ni ng of gen gener er al pr act i t i oner oners s i n pr event i ve

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med edii ci ne must be i mpr oved oved.. and and a all so h hii s st at us bo bott h wi t h the p pu ubl i c and and wi t h" t he med edii cal pr of essi on en enha hance nced. d. 5. 4. The ch cha angi ng co con nce cep pt of pr eve event nt ab abll e di seases:  The t er m " pr event abl e di seas sease" e" has now a wi der connot ati on t han be conn beff ore. Th Thii s br oa oade derr concep conceptt has f ormed t he backgr backgr ou ound nd of man any y of t he new newer preven preventt i veh vehea eall t h servi ces. An under st andi ng o off t he ca cau usa satt i on o off nut r i t i onal di sor sor der s has has poi poi nt ed t he way t o p prr eve event nt i ve mea easur sur es. 5. 5.

I nt egrati on of t he. prev reve ent i ve & cu curati rati ve, care care se servi rvi ces: ces:

 Ther e i s a def i ni t e t r end t owar ds i nt egr at i on of preventi preve nti ve and and cu curr ati ve medi edi cal Care Servi Servi ces wi t hi n a compr ehen ehensi si ve he heal al t h ser vi ces. I nt egr at i on i s f undament al pr i nci pl e of publ i c h he eal t h i n t he U USS SSR R, whe herr e p prr ev even entt i ve a an nd cu curr ati ve se serr vi ces arc one one a and nd i ndi vi si bl e, wi t h t he com common obj ecti ve of pr eve ven nt i on. Al l l ocal cal heal t h. Ser vi ces ces a arr e uni f i ed and cen cent - ar ed i n t he di st r i ct hosp spii t al under o on ne ad adm mi ni st r ati on on.. 5. 6.

To Tow wards b bet et t er ment ent al hea eall t h;

Wi t h exp expan andi di ng kn know owl edge edge o off medi edi cal psychol ogy ogy and n new ew method ethods s of t r eat eat men entt a n new ew ori ent ent ati on on medi edi cal he heal al t h i s r evea veal i ng a an nd a wi de f i el d o off oppor t uni t y f or t he he heal t h se serr vi ces ces i s op ope eni ng u up p par t i cul cul ar l y i n p prr even vent i ve ment al ser ser vi ces. ces. 5. 7.

Gr owi ng em pha hasi si s on heal heal t h educa ucatt i on on::

 The adag adage e t hat " Pr event i on begi begi ns and ends wi t h heal t h ed educa ucatt i on on"" i s no now w bei bei ng r ecogn ecognii zed an and d ref l ect ed i n the move ovem men entt to e exp xpan and d a and nd de deve vell op op// heal eal t h e ed ducat ucat i on work. The The t r end end i s f or heal t h edu educa catt i on t o e exp xpan and d i t s i nf l uence as a an n essen ssentt i al preventi preve nti ve a and nd he heal al t h se serr vi ce, ai ded by modern odern t ech echn ni que ues s of pr ese sen nt at i on a an nd spe speci al l y t r ai ned p pe er son sonnei . 5. 8.

Th The e bi ost at i st i cal cal appr oach; ch;

A s t a t i s t i c al al s er er v i c e i s e es sse en nt i al f or p l anni ng, adm admi ni st eri ng and and eval eval ua uatt i ng heal eal t h ser vi ces. The The epi epi demi ol og ogii cal met hod hod i s now be beii ng used mor e wi del del y t o d det et er mi ne t he i nci de den nce, ba backg ckgrr ou oun nd and and con contt r i bu butt ory f actor s of many any d dii sea seases, ses, i nf ect i ou ous s an and d no nonn- i nf ect i ou ous. s. , an and d man any y h hea eall t h prob robll ems. The bi ostati stati sti cal approa roach to th the e s so ol ut i on of vari ou ous s he heal al t h probl ems i s wi deni ng r api dl y. ' 5. 9.

International collaboration

 The movement t owar ds cl oser col l abor aborat at i on i n hea heall t h af f ai r s bet ween c co ount r i es o off f i c i al l y a an nd u un nof f i c i al l y i s a an n i mpor t ant t r end end.

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5. 10. Or gani sati on:   5. 10. 1. Large sca scall e or or gani ani sat i ons ons must be r egarde egarded d a as s cross- se sect ct i ons of of t he t ot al so soci ci et y. O Orr gani sat sat i on i n f ut ur e wi l l put gr eat er st r ess on on t he d dii gni t y o off t he i ndi vi dual . Equal i t y of t r eatment t hr oughout t he or gani sat sat i on wi l l gr ow i n i mpor ortt ance. ance. I mpr oved chan channe nell s commun unii cat i on and and co coope operr at i on - ho i z en ent al and ver t i c al al . 5.10.2.

Commun unii cat i on i s t he cent r al mean eans s of combat bat i ng di sor ga gani ni sat i on and and l ack of coo coorr di na natt i on on.. Tremend endous ous ad adva van nces i n da dat tua prrboce ocessi hav ave e pr r ovi ovi ded means ea by y w wh hi ch i nf o r el at i on co cou l dp egi egi ssi n tn og pl h ay such sup ch a t he r ol e.ns b

5. 10. 3.    Th  The e i dea of t he t op execu executt i ve as t he r eal eal coordi coordi nator of t he o orr gani sa satt i on i s be beco com mi ng l ess a an nd l ess r eal i sti c. I ndi vi dual s wi l l con cont i nue t o sym symbol i se t he t ot al or gan anii sat sat i on but f or coordi coordi nat i ve r equi r ement s, t he e exe xecu cutt i ve t r end ends t o b be eag grr oup oup wi t hout out however ever dest r oyi oyi ng t he i mage age of t he chi chi ef exe xecu cutt i ve as as t he i ndi vi dual l eader of t he o orr gani sat sat i on.  Thii s mea  Th ean ns t hat much of org or gani ani sat i on t heor heory y wh whi ch concen concentt r at es on t he r ol e of t he pers on at t he t op of t he pyrami d, i s du due f or subst ant ant i al amend endm ment ent 5. 10. 4.    Th  Ther ere e i s a t r en end d t oward ar ds f ewer l evel evel s of hi erar er arch chy y a an nd t oward ar d an exp expansi ansi on i n t he spa span n of con contt r ol of execut cut i ves. ves. Thi s f l at t eni ng i s d du ue t o t he con consci ous e eff f or t t o del egate egate au autt hori t y wi t hi n t he o orr gani ani sat i on, on, Modern odern d dev evii ces a an nd i ncr eased eased use of st af f l eave eave t he ex exec ecu ut i ve bett er equ equi pped t o deal eal wi t h more su sub bordi nates t han pr evi evi ousl ousl y. The The f l att eni eni ng put s t he e exe xecu cutt i ves ves i n cl oser ser ' t ouch wi t h hi s organ organi sa satt i on and hence i n a posi t i on of mor e ef f ecti ve con cont r ol . I t i s pr pr obabl e t hat f l at t eni ng wi l l con cont i nue i n f ut ur e o orr gani sat sat i on pat t er ns, part i cu cull arl y as thethe- dogm ogma of t he smal l span span of con cont r ol r eced ecedes es asgan an im or p t yr anam t i st cr cr iat e"squee r i oneeze" . ze" I nw o herwi l w s, orga or ni sat ip on yram d ir sucturi un unde derrnggoi ng "squ wh hot i tch l ormd ake i t i n f ut ur e mor e l i ke a r ectan ctang gl e. 5. 10. 5.    Th  The e con contt emporar or ary y t r end end i n l arg ar ge scal e org or gan sa satt i on i s t owards d dec ece ent r al i sat sat i on. Thi s i s beca becau use so som me or gan anii sat sat i ons are i ncap capabl e of con cont r ol l i ng f r omthe bop, On t he ot her- hand, stu stull t i f yi ng i nf l exi bi l i t y, red t ape, p po oor and costl costl y s se er vi ce, ce, a di stort ed "ci vi l ser ser vi ce" ce" ment al i t y, et c. , have al l f or ced ced ur gent at t ent i on t o' decen cent r al i sat sat i on ef f or t s. Decen cent r al i sa satt i on su sug ggest s a sy syst em i n whi ch t he coo coor di nat i ng pr ocess cess wi l l be l ess r est r i ct i ve a an nd i n whi ch peop opll e wi l l have an oppor t uni t y to pu pur sue sue the theii r i ndi vi dual goal s t o t he maxi mum umand and yet wor k i n h har ar mony t owar d g grr oup

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goal s wi t h ot her s who l ook upon t hi ngs d dii f f er ent l y. Loca Locall aut aut onom onomy, begi egi nni ng wi t h t he i ndi vi dual , i s an i mport ant ant cr edo edo of de dece cen nt r al i sa satt i on. I t i s wel f ar e- ce cen nt r ed wi t h a cer cer t ai n f l avour of devot i on to h hu uman Upl i f t . I t r etai ns at t he sa sam me t i me t he pr pr oduct i on d drr i ve and and compet i t i ve at mosph osphere er e of of t he i ndust r y. The The f orm or mal st r uct ur e of of a d dec ece ent r al i sed sed o orr gani sa satt i on ten tend ds t owar d hi er ar chi chi al f l at ness; sp spe eci al i se sed d sup suppor t t o t he oper at i ng l evel s i s p prr ovi ded on t he basi s o off t he l i ne and st af f pat t er n. I t ca call l s f or a c ch hange i n t he p pa at t er n of execu xecutt i ve behav ehavii our our f r oma st ereot ereot ype ype t o model odel exec execu ut i ve behav ehavii our our . Hi s  j ob obs s becom become pl pl ann anni ng, eval eval uat i on and. and. del egat egat i on. on. Del egat egat i on i s a r eal par t of decen cent r al i sa satt i on phi l osop soph hy. Deci eci si on maki ng i s to b be ep pu ushed shed down t o t he l owest pract i cabl cabl e l evel evel , depen epend di ng on: on: a)   t he ski l l and and competen etence ce avai avai l abl abl e a att a cer cer t ai n deci si on ce cen nt r e; and b)   t he amoun ount of i nf orm or mat i on t hat hat can be made ade av avai ai l abl abl e at t hat deci si on ce cen nt r e. I t i s i n t he begi nni ng a mor e di f f i cul cul t way of l i f e becau ecause i t i nvo voll ve ves s a cha chan nge i n beh ehav avii our our r unni ng cou coun nt er t o hi st or i ca call l y r oot ed cul cul t ur al pat t er ns o off manki nd. I t not onl y exacts exacts matur i t y and and ch charact aract er f r om i ndi vi dual members of or gani sati on, but al so requ requi r es t hat t hey b be e p prr ese sen nt i n t he cul cul t ur e of t he l ar ger soci soci et y, 5. 10. 6. The The con concep ceptt s of orga or gan ni sat i on have ave been een modi odi f i ed i n t he p past ast decad ecade e b by y e ext xt ensi ensi ve r esearch esearch i nt o the soci al pr obl obl ems i n org or gani ani sat i on, on, Resea esearr ch has has be been en mai nl y i n 2 f i el ds: a) par artt i ci pat i ve manag anagem ement ent ; and and b) dyna dynam mi c man anag agem emen entt . I t emphasi phasi zedt he obj obj ect i ves of t he or gani sat sat i on i n r el at i on t o cha changi ng val val ues o off so soci ci et y, t he co con nst ant ant l y ev evol ol vi ng governm overnment ent al pr ocess ocess of st udy, pr eparat eparat i on, on, adopt i on. ' and modi f i cat cat i on of publ i c p po ol i cy, cy, ' t he i nf l uence of pr essure gr grou oup ps, t he i nt er erd depen epende den nce o off busi ness an and d governm overnmen entt i n pol i cy f ormul ati on and and othe otherr organ organi sat i onal onal ch chan ances ces t ha hatt occu occurr con const st ant ant l y i n r esp espon onse se t o a ch chan ang gi ng envi envi r onm onment ent . I t i s her her e t hat or gani ani sat i on and and' manag anagem ement ent are ar e most di r ect l y a aff f ect ed by soci soci ol ogy, econ conomi cs, publ i c pl an ann ni ng, geo eog gr aphy, pol i t i cal cal sci ence and psyc sych hol ogy, 5. 10. 7. Ot her t r ends i ncl ude: a)

cl ose al i gnment of r el at ed f unct i ons i n pat t erns desi gned t o p prr omote t he at at t ai nment ent of speci speci f i c prog pr ogrr amme obj obj ect i ve.

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b) Resea esearr ch i s beco becom mi ng an i nt eg egrr al par par t of each each p prr ogr ogr amme . Th Thii s wou oull d nee eed d pr og ogrr ammes i n r esear esear ch par t i cul cul ar l y oper at i onal r esea sear ch and t r ai ni ng of va varr i ous l eve vell s o off wor ker ker s f or communi t y h hea eall t h ser vi ce, pl ann anni ng and and manage anagem ment . c) Pr og ogrr amme b bu udget i ng r at her t han or gani ani zat i onal onal budget i ng i s comi ng i nt o vog vogu ue. 5. 8.

UNDESI RA RABLE BLE TRENDS 5. 8. 1. Frag Fragm ment at i on spl spl i nt er i ng o off heal t h se serr vi ce ces; s;

As t he d de ef i ni t i on of publ i c h he eal t h gr ows an and d publ i c con conce cerr n sharpe sharpen ns, a di di st ur bi ng man anii f est ati on i s t he g grr owi ng f r agment at i on not onl y o off heal t h ser ser vi ces ces bu but al so the di spe sper sal sal of pu publ bl i c he heal al t h ser vi ces amon ong g man any y agen agenci ci es of gover gover nment ent . An asso associ ci ated l ea ead di ng pr ob obll em i s t he i ncr easi easi ng t en end den ency cy t o cr ea eatt e a spec specii al aut aut hori t y o orr com commi ssi on t o h han and dl e a si ngl e heal heal t h p prr obl obl em. Al t houg hough h t he herr e may be some t empor ar y ad advan vantt ages ages i n t hi s a ap ppr oach ch,, t he r esul sul t i s a spl spl i nt er i ng of a heal t h f unct i on f r om an over ver al l heal t h pr obl em.  Thi s t r end i s al so ass umi ng i mpor t ance i n t hi s count r y. 5. 8. 2. Cont i nuat i on of of r es po pons i bi l i t y f or heal t h o off di f f eren erentt seg segm men entt s of t he cou coun nt r y i n organ organi sat i on ons s an and d mi ni st r i es oth othe er t han heal t h. 6.

THE THE PRES PRESEN ENT T POSI TI ON; 6. 1. C Ce ent r al Le Lev vel ;

 The Di Di r ect or Gener al of Heal t h Ser vi ces i s si nce 1947 1947 t he si ngl e ad adm mi ni st r at i ve hea ead d of bot h t he depar epar t ment ent s of medi edi cal an and d hea eall t h r ep epll ac acii ng t he Di r ec ectt or G Gen eneral eral I ndi an Med edii cal cal Ser vi ce an and Pu Pub bl i c H Hea eall t h Commi ssi oner oner . 6. 2. At St at e hea headquar t er s; I nt egr at i on of cur cur at i ve and pr eve ven nt i ve heal t h ser ser vi ces ces has bee been n car car r i ed ou outt at St ate head headq quart ers l ev evel el ex exce cep pt i n 3 st at es namel y And Andhr hr a Pr ad adesh, esh, Mad adrr as, and and Mahar ahar asht r a whi ch st i l l r et ai n th the e se sep par at e Di r ectorat es of t he medi ca call and publ i c he heal al t h ser vi ces. However ever , Mad adrr as and and Mahar ahar asht r a h have ave accep acceptt ed t he pr i nc i pl es an and t he ot her s t at e i s l i kel y sh shor t l y t o f ol l ow s ui t . 6. 3. Regi onal Le Lev vel : A r egi onal l evel exi st s i n a f ew St at es. 6. 4. At Di stri ct Level : Some of of t he St St ates wi wi t h i nt eg egrr ated Hea eall t h Di r ec ectt orat es

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ar e yet t o I nt egr at e t he di st r i ct hea heal t h or gani sat sat i ons. . Assa ssam m, Bi har, Keral a, Madh adhya P Prr adesh adesh,, Pun Punj ab, ab, West Beng engal and and ce cen nt r al l y admi ni st er ed t err i t or i es ha have t hei r di st r i ct progr progr ammes c con ontt r ol l ed by a si ngl e admi ni st r at or . I n t hese St at es wi t h i nt egr at ed di st r i ct heal t h or gani sa satt i on. t he Ci vi l Sur geon, var i ousl y c ca al l ed as C Ch hi ef Medi edi ca call Of f i ce cerr of Heal t h or Sen enii or Execu xecutt i ve Medi cal cal Of f i cer cer who i s usu sua al l y a cl i ni ci an, bel ongi ng t o the the "Medi cal cal Ser vi ces"' ces"' has assu ssum med no nomi nal con cont r ol of Hea eall t h' act act i vi t i es. The f or mer D. H. O. , who i s no now w a Deput y t o t he D. M. O. , or D. C. M. O. st i l l mai nt ai ns actua actuall supervi sup ervi si on t houg ough h he e h has as l ost i ndepen epend dent ent charge charge o off publ i c he heal al t h wor k. I n any case case,, hi s sup super vi si on i s str i ctl y l i mi t ed t o "p "pu ubl i c hea eall t h work". 6. 5. At Sub- Di vi si onal Le Lev vel :  The  Th e sub sub-- di vi si onal onal l evel evel i s, l i ke rreg egii onal onal l evel evel , not a u uni ni f orm or m l evel of admi ni st r at i ve h hii er ar chy chy. I t exi sts onl y i n t he ea eastern St at es wher ere e i t was i nt r od odu uced i n ol den den days ays t o meet eet cer certt ai n admi ni st r at i ve ne needs. I n Assa ssam m, t hi s l evel i s i nt egr at ed 6. 6. At At - pr i mar y He Heal t h C Ce ent r e Le Leve vell : I nt egr at i on i s st at ed t o have been car car r i ed out at t he l oca call l evel i n al l St at es. However , f uncti onal l y, t he medi cal cal of f i cer cer i s i nt er est ed i n and and ke kee eps h hii msel f busy wi t h hi s cl i ni cal cal wor k(no k(nott nec ece essa ssarr i l y ow owi ng t o the l oad of cl i ni cal cal wor k) and. exe exer ci s3S s3S no supervi sup ervi si on ei t her ov over er MCH and and f ami l y pl ann anni ng st af f or San Sani t ary I nsp spec ectt ors and and as su such ch i nt egr egr ati on has b bee een n ver ver y sl ow and and t ardy ardy.. 6. 7. Cadr e of of Med edii cal cal Pe Perr so son nnel : Uni f i ca catt i on of cad cadrr e of doct oct ors has has n not ot be been en carr i ed out out i n most of t he st at es exce except pt i n Assam ss am, Ke Kerr al a, Madhy adhya a P Prr adesh adesh a and nd West Beng engal . The The matt er, i s ho how wever, ever, under con consi derat i on i n most of t he ot her St at es. A whol l y i nt egr egr ated servi ce wi t h uni t ary av aven enu ue o off ent ent r y an and uni t ary ca cad dr e wi t h scope scope f or prop proper er pl ace acem ment ent , pr omoti on, on, etc. exi exi st i ssamand nc ce ent r a l eral ya ad i stcept er tedf torer Pon ri n td ori eary s, yWe std B ngal, : t M ad hya ad sh A ssaman dl K er aldm a.i nEx Excep Po i ch char a an n Ae ssam eachi ea chi ngPrj ade obs obe ssh, i ,n med edii cal cal col col l eges d do o not f i nd a pl ac ace e i n t he j oi nt - ca cad dr e A t r end end i s ga gaii ni ng gr oun ound i n separat separat i ng medi edi cal cal edu educat cat i on f r om t he i nt egr at ed se serr vi ce. ce. Thi s i s t he si t uat i on i n Ker al a, was so i n Pun Punj ab t i l l r ece ecen nt l y, and and h has as bee been n i mpl ement ent ed i n Madr adr as.

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6. 8. I hus, t r uel y t hr ee patt patt er ns beco becom me e evi vi dent : 1.   a whol l y I nt egr at ed stat e ser ser vi ce wi t h un uni t ar y ca cad dr e a an nd aven avenu ue of of ent ent r y; 2.   a whol l y di di chot chot omou ous s ser vi ce wi t h 2 br anche anches, s, sep separ arat at e r i ght f r omt he begi nni ng or ver ver y nearl y so; and 3.   a mi xe xed d i nt nten end ded or pr oposed oposed t o b be e i nt egr egr at ed but but act ual l y f unct i on onii ng a as s a di di cho chot omous servi ce, ce, I n sum sum, par t i al i nt egr at i on ha has be bee en car car r i ed out out i n most S St at e Headquar t er s, i nt er medi at e or or at t he ptea r ti e ps heei r yt. her at t he St I n t he mat t er of pr i vat vat e p prr act i ce vi ews are wi del y d dii ver ver gent .  The consen  The consensus sus of opi opi ni on as cou coull d be shi f t ed f r omt he r epl epl i es does oes not seem seem t o b be e i n f avou vour of abol i t i on of pr i vat vat e p prr act i ce among gover overn nment ent medi edi cal of f i ce 7. Di scussi scussi ons ons and and C Com om ment ent s: 7. 1. The The h hea eall t h ser vi ces end end h hea eall t h pr ogr ogr ammes i n t he cou coun nt r y have ave d du ur i ng t he past past 15 year years s i ncr ea eased sed at an unpr ece eced dent ent ed scal e. A f i xed o orr gani sa satt i on has i t s i nher ent weakne kness i n tha that i t def eat s i t s own p pu ur pose i n t he pr esence esence o off a h hii ghl y d dyn ynam ami c si t uat i on, on, Exam xampl es ar e i n pl ent y wher e, as a r esu sull t of t r yi ng t o f i t exi st i ng and i ncr easi ng f unct i ons, some i mpor t ant act i vi t i es have have been b bu ur r i ed t oo f ar bel ow t he l evel of pol i cy f or mul at i on and deci si on or , t he di l emma o off sel ect ect i ng a maj or f unct i onal onal gr oup oupi ng f or t he f ocu ocus of a new ac actt i vi t y ha has r esu sull t ed i n a wr ong cho choi ce. ce. These may r esul sul t i n f unct i onal r el ati onshi shi ps t o becom come bl ur r ed wi t h r esu sull t ant l oss of coo coor di nat i on an and d con cont r ol . Hea eall t h servi ce ces s a ad dmi ni st r at i on has a all so undergon ergone ce cerr t ai n evol evol ut i onary onary a all t erat i ons ons b bu ut t hi s has has not be been en uni f or m al l ov ove er t he cou coun nt r y. Some stat es h hav ave e c com ompl et el y r ost eor got anh i ers, se sed d t thh eere i r ad adm mi non teen i vne aorcer ga sa i ooun na al l r esh l evu efl fsl ib bu u in m h has as oinst l yr ab bee ce rn t iaisat nt am ou nt of eshu ntg of r esp spo onsi bi l i t y wi t hi n t he or or gani sa satt i on. Addi t i onal st eps must be t aken ken t o b bu ui l d up a d dy ynami c, f l ui d, and f l exi bl e o orr gani sat sat i on, cap capabl e of abso absorr bi ng pr ese sen nt and f ut ur e r esp spo onsi bi l i t i es i n an ef f i ci ent manner . 7. 2. AT THE CEN CENTR TRE: E: 7. 2. 1. Bet ween t he Mi ni st r i es:  The  Th e rresp espon onsi si bi l i t y o off t he hea heall t h at at t he C Cen entt r e has has n not ot yet yet been een uni f i ed under on one e Mi ni st r y, Thi s i s no not i n con conf i r mi t y wi t h one of t he basi c pr pr i nci pl es o off admi ni st r at i on enunci at ed i n 1918 by the Br i t i sh Mi ni str y of

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Rec eco onst r uct i on, whi ch was r espo sponsi bl e f or t he cr eat i on of " Br i t i sh Mi ni st r y of Heal t h. "Th "The e f i r st pri nci pl e of good admi ni st r at i on r eq equ ui r es that that when a spe speci al f unct i on i s t o be be un undert aken ken, i t be under undertt aken by one one g gover overni ni ng body body f or t he whol hol e communi uni t y ne need edii ng t he se serr vi ces, ces, and n no ot f or di f f er ent sect sect i ons of t he co com mmuni t y b by y se seve verr al governi overni ng bodi odi es. " Heal t h i n r esp spe ect of l abour i s t he r espo sponsi bi l i t y of t he Mi ni st r y of of Lab Labou ourr and and Em Empl oyment ent . Th The e Em Empl oye oyees es St Stat at e I nsu nsurr ance ance A Act ct pr ovi ovi des a mean eans of coo coorr di nati on of ef f ort s betw betwee een n t he Mi ni st r y o off Heal t h a and nd Fami l y Pl anni anni ng and and Mi ni st r y of Labou Labourr and and E Em mpl oyment ent and and t he medi edi ca call of f i cers w worki orki ng i n t he Em Empl oyee oyees' s' St ate I nsuran surance ce Coo oop per at i on have been i ncl uded i n t he Cent r al Heal t h Ser vi ce ce.. St i l l , t her e i s roo roomf mf or f ur t her cl ose serr associ ssoci at i on so t hat bet t er servi ces ces can be pr pr ov ovii ded more or e econ econom omi cal l y b by y poo pooll i ng o off t he r esou esourr ces t o t he e xtent t spo ssidb l e.r abl I nl et htto eo i b nrt ien rg est of o i cise ncy ansd of econ cotnhoemy, im t uw pxten erh er haps ap be esi ab t he ote t fhfer ect i ons on com nii lt ly wi t hi n t he f ol d of t he Heal t h Mi ni st r y, Unt i l such such t i me the co coo or di nat i on of of ef f or t s mi ght be e en nvi sa sag ged throu throug gh I nt er - Mi ni st er i al Coor oor di nat i on Commi t t ee. ee. 7. 2. 2. Wi t hi n t he Mi ni st r y of Heal t h: Admi ni st r ati ve pr oced ocedu ur es ar ar e b bei ei ng adj adj ust ed t o avo avoii d dupl i cat cat i on of ef f or t s b be et wee een n t he Di r ect ect or Gener l ' s of of f i ce and t he Mi ni st r y. One of t he t ool ool s dev devii sed i s t o have ave common of f i ces an and f i l es. The The P Pll ann anni ng B Bu ur eau eau pr pr ovi ovi des an an e exa xam mpl e. Pri mary H Hea eall t h Cent r e Cel l i s a an not her exa xam mpl e. Anot her si gni f i can cant t ool i s t he j oi nt st af f meet eet i ng whi ch pr ovi ovi des a an n op opp por ortt uni t y tto o p prr esen esent more or e var var i ed su sub bor di nat e vi vi ew- poi nt s t o t he Mi ni st er and and the Secr etar y. Under t he co const i t ut i on of I ndi a, t he va var i ous f uncti ons i n r espect espect of heal eal t h a arr e shar shared ed by t he Cen Centt r al and and S Stt at e Gover overn nment ent s.  The  Th e pr ovi ovi si on of medi edi cal r el i ef and and pr prev even entt i ve he heal al t h t o t he peo peop pl e i s t he respo responsi bi l i t y o off t he S Stt at e Gove over nment s. The Cent ent r al Gov ove er nment ' s r espon sponsi si bi l i t y i ncl udes su sub bj ect s su such ch as i nt er nat i onal hea eall t h and f ood quar ant i nes i nt er - st at e q qu uar ant ant i ne, r ese esea ar ch ch,, pr omot i on of spe speci al st udi es an and da ad dmi ni st r at i on o off Cent ent r al agenci es and i nsti t ut i ons.  The  Th eC Cen entt r e i s now owd di r ect l y r esp espon onsi si bl e f or St at e subj subj ect s onl onl y f or t he Terr Terr i t ori es of of Del hi , Andaman and and Ni cob cobar I sl and ands an and d Lacca Lac cad di ve, ve, Mi ni co coy y and and Ami ndi vi e I sl and ands.  The  Th e Cen entt r e and and St at es hav ave e powers er s of l egi egi sl at i on on cert cer t ai n su sub bj ect s i ncl uded i n t he con concur cur r ent l i st .  The  Th e Cent ent r al Coun ounci l of Heal eal t h Zonal onal Coun ounci l s provi des des t he mecha chani smf or j oi nt co con nsi der at i on of t he b brr oad*l i nes o off pol i cy f or al l mat t er s of heal t h i ncl udi ng l egi sl at i on, pat t er n o off devel opment i n t he cou count r y, et c.

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I n a devel opi ng co cou unt r y l i ke I ndi a wi t h so l i t t l e r eso sou ur ce ces s bur den of hea eall t h pr ob obll ems and and a ad dmi ni st r ati on of hea eall t h car car e ser ser vi ces ces i s growi ng t oo bi g an and d t oo com compl ex f or ei t her t he C Cen entt r al or St ate Gover over nmen entt s t o han hand dl e ef ef f i ci en entt l y al al on one. e. Ther Ther e a arr e many any a arr eas eas t he St at es do not not have have t he r esour ces t o h han andl dl e t hem hemsel ves and many any mor e i n whi ch t he Cen Centt r al Gov overnm ernmen entt must t ak ake e t he i ni t i ati ve i f an anyt yt hi ng i s ev ever er t o be be d don one. e. There i s a gr gr ad adu ual r ec ecog ogn ni t i on t hat most of t he pr ogr ogr ammes n nee eed d l oc ocal al f oc ocu us and and ef ef f ort t o mak ake e t hemwork ef f i ci en entt l y. Any go gove verr nment al act i vi t y i s al most cer cer t ai n t o i nvo voll ve t he i nf l uence, ce, i f not f or mal admi ni st r at i on, of al l t hr ee pl ans o off gove verr nment , Cent r al , St at e and Loca Locall .  The Cent r al Gover nment i s t r yi ng t o f i nd t he most ef f ect i ve way possi bl e t o sol sol ve t he p prr ob obll ems and and sha sharr e t he b bu ur den. en. I n t hi s t he Cent ent r al Gov over er nmen entt hav ave e wi sel y resi st ed t he t empt at i on of pl ayi ayi ng t oo p vasi an d el dem neer ee ngt raalr olGe ier n ndm eci on t ee hat eekibet bi et made ad e at t er heva St Ssi t atve e and l evel ev . i Th The e rCen Ci ent over ov ent entsi hons ads b een n ar se seek ngt er t he h hel el p, co coop operat erat i on an and d cou counsel of t he St ate an and vol vol unt ary a ag gen enci ci es. I t i s f or gi ng par t ner shi shi p t hat has wi de- r angi ng i mpl i cat cat i ons. The f ut ur e of t he Cen Centt r al com compac actt dep epen end ds on t he wi l l i ngness a an nd a ab bi l i t y of of t he St ates and and l oc ocal al bodi odi es to h hel el p i t f i nd t he way ay.. Th There ere i s now now a bett er r ea eall i sat i on t hat t he pr og ogrr ammes are j oi nt ven vent ur es of Cen Centt r al Gov overnm ernmen entt , St ates an and d l oc ocal al bod odii es an and r ea eall i sat i on of t he nati on onal al r espon esponsi si bi l i t y i n ev every ery sph sphere t hat no maj or act i vi t y can can be undert ak aken en i n an any y sph sphere e exce xcep pt as i t works t hr ou oug gh St ates, ci t i es an and d l oc ocal al bodi odi es and pr i vat e ci t i zen zens. 7. 2. 4. Di r ect or at e Gener al of Heal t h Ser vi ces: ces:  The Or gani gani sat i on of t he Di r ect or Gener al of Heal t h Ser vi ces has be been u un nder per i odi cal cal r evi ew par t i cul cul ar l y du dur i ng t he l ast 3 or 4 yearr s. Var i ou yea ous s common f unct unct i on ons s ar e bei bei ng gr oupe ouped d i nt o b bur ur eau eau su such ch a as s Cent ent r al Hea eall t h Educat i on Bur ea eau u, Cent ent r al Bur ea eau u of Hea eall t h I nt el l i gence, ce, Pl anni ng Bur eau, Cent r al Publ i c He Heal t h Engi neer i ng Or gani sa satt i on. Owi ng to t he n na at ur e of of t he f unct i ons, t he Di r ect or at e Gen eneral eral of Hea Heall t h Servi ces, ces, wi l l hav ave e l arge number of sp spec ecii al i st s an and pr og ogrr amme ch chii ef s C Coo oorr di nat i on bet ween een t he var var i ous ous f unct i oni oni ng uni t s i s a maj or acti vi t y, Though coo coor di nat i on i s t he res resp ponsi bi l i t y o off ever y pr ogr ogr amme chi chi ef , t hei r ac actt i vi t i es are a att pr esen esent bei ng coordi coordi nated by Addl . Di r ector Gener al . Now t ha hatt a new new Depar epar t ment ent of Fami l y Pl anni anni ng ha has s been cr eat ed, ed, t he or or gan anii sat i on i s ag agai ai n bei ng r ev evii ewed t o br br i ng ab abou outt more ef ef f ec ectt i ve coorr di nat i on bet ween coo een f ami l y pl an ann ni ng and and heal eal t h ser vi ces a an nd al so wi t hi n heal t h ser ser vi ces ces o orr gani sat sat i ons. I ndi cat cat i ons ons are t hat t he com communi t y h hea eall t h servi ces ces wi l l gr ow i n mor e an and d mor e i mpo porr t an ance ce as t he hey y i nt egr egr at e 

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mor e a an nd mor e the vi gi l ance a an nd resi dual acti vi t i es of er adi cat cat i on/ con cont r ol pr og ogrr ammes at t ai ni ng the theii r ob objj ect i ve ves s an and d u un nder t ake ake a ad ddi t i onal l oa oad d o off r eorga organ ni sed MCH and f ami l y pl pl an ann ni ng act i vi t i es. I t wi l l perha erhap ps b be e n nec ecessa essarr y wi t hi n a f oresee oreseeab abll e pe perr i od t o ha have ve sep separat arat e un unii t un und der a Deputy eputy D Dii r ector Gener al t o red redu uce to t he u utt most( al most t o a si ngl e ch chan ann nel ) t he p prr of essi on onal al chan channe nell of commun unii cati on by f un unne nell i ng o off i nf ormati on other t han r out out i ne matt ers t o S Stt ate l evel evel . Th These ese woul oul d i mprove t he q qu ual i t y a and nd t he spe speed ed of act i on onst st o b be e t ake aken n b by y t he St at e Gove overr nmen entt s. 7. 2. 5.

Cent r al R Re egi onal O Orr gani sa satt i on:

Exp xpe er i ence ence i n t hi s co cou unt r y a an nd ou outt si de wi t h a f eder al st r uct ur e has i ndi ca catt ed t he need eed f or a ce cen nt r al heal eal t h orga organ ni sati on on a r eg egii on onal al basi s near er t he St at es, wi t h t he f ol l owi ng f uncti ons: a)   sp spe eci al i se sed d t ech chn ni cal cal assi st ance i n publ i c h he eal t h Admi ni st r at i on and and g gen eneral eral i sed t ech echn ni cal assi st a- Ace i n p prr ogr ogr amme matt ers ; b)   mai nten ntenan ance ce an and d i mpr ovem ovement ent of i nt er- governm overnment ent al r el ati ons; ons; c) c)   pr ogr amme pr omot i on; d)   Col l ec t i on of i nt el l i genc e pr obl ems and pr ogr ammes; and e)

on on

r egi onal

heal t h

ad adm mi ni st r ati on of grant p prr og ogrr amme.

7. 3, St at e Le Leve vell ; 7. 3. l . St at e headquar t er l evel vel ; Mai n f unct i on ons s i ncl ude e est st ab abll i shi ng of gen ene er al st and andar ds an and d assu assurr i ng of uni t y i nt o the gener al di r ecti on o off t he whol e sy syst st em. As suc such h, t her e wi l l be a number of spec specii al i st uni t s. I t i s nec necessa essarr y to gr gr ou oup p t he r el at ed f unct i ons : i nt o a smal l er number of uni t s an and d to e eff f ect co coordi ordi nati on b betw etwe een t hem. Th There ere must al so b be e a cl ea earr l i ne of demarcat i on of l i ne aut aut ho horr i t y a and nd s t a f f f unc t i ons .  The advi ser s or pr ogr amme di r ect or s at t he Di r ect or at e wi l l have t o l ay d dow own n nor or ms and st anda andarr ds of wor k l oad and and f un unct ct i ons ons a an nd al so t he met ho hodo doll ogy ogy f or some of t he p prr ogr ogr ammes ot her t ha han n t he n nat at i ona onall pr og ogrr ammes.  They have t o wor k t hese out i n consul t at i on among t hemsel ves and al so wi t h st af f i n t he per i pher y. I t i s a all so equal l y n ne ecessa cessarr y that that t he t eache cher s o off c l i ni c a all su sub bj ec t s pa parr t i c u ull ar l y o off pr event i ve and so soc c i al medi c i ne p pa ar t i c i pat e acti vel vel y i n d drr awi ng u up p j ob spe speci ci f i cati ons ons an and d pr pr ogr ogr amme p pll ans. ans. Th The e n nee eed d f or a combi ne ned d t hi nki ng cann cannot ot be over emph phasi asi sed si nce t he pl ans ans and wor k schedul sched ul es sho shoul ul d not not be becom come u unreal nreal i st i c i n t he hand hands s of an any y o one ne group of per so son ns owi ng to a ten tend dency to o ove verr - l ook p prr acti cal cal di f f i cul cul t i es w wh hi ch t he f i el d st af f woul d be abl e t o pr ese sen nt grap graph hi cal cal l y.

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One of t he mai n weakne eakness sses es i n t he st at e o orr gani gani sat i on has has be been en t he l ack o off coordi coor di nat nat i on bet bet ween t he var varii ou ous s prog pr ogrr ammes an and d t he t ende endency ncy of t he prog pr ogrr amme chi chi ef s t o rrun un t hei hei r prog pr ogrr ammes wi t hout hout due car e f or ot her her pr ogr ogr ammes or or t he gen general eral heal eal t h se serr vi ces. The The o orr gani ani sat i on of t he v vari ari ous ous St at e Heal t h Di r ectora ctoratt es v va ar i es g grr eat l y, hor i zon zont al l y and ver t i cal cal l y. I t wi l l be r ewar di ng t o c ca ar r y ou out r evi ew of or gani sat sat i on i ncl udi ng anal ysi ysi s o off per so son nnel and f aci l i t i es u utt i l i sa satt i on, wi t h t he obj ect of meet i ng pr esen sent need eeds an and d a an nt i c . pat ed f ut ur e nee need ds. Est abl abl i shment ent of a se sep parat e p pll ann anni ng ce cell l wi t h f ost eri ng of of a posi posi t i ve att i t ude t owards manag anagem ement ent and and pl ann anni ng by en enco cou ur agi ng p pa ar t i ci pat i on a an nd i nvol vol vem vement at al l l evel vel s i s a cr yi ng n ne eed Repor eportt i ng, i nden entt i ng, accou account i ng and and man any y of of our our r out out i ne p prr oce oced dur es n nee eed d i mmedi at e sp spe eci f i caca- t i on and st andar di zat zat i on. on. I n a St at e Hea eall t h o orr gani sat sat i on wi t h a ab bout out 20- 30 u un ni t s di r ect l y un under t he Di r ect ect or of Hea eall t h Servi ce ces, s, co coordi ordi nat i on t hr oug ough i ndi vi dual pr ogr ogr amme chi chordi i ef snati i s on di di effffi ocul cu t A t ocoo co ce d l la/chi ch i ietveb . ecom I tmescal can lelce s ssar f orr y. spe sp coordi co r tl s. cocon orn dcei i niavtei onancel ce un co ne cessa Oe nci e a of olf t he mai n f unct i ons ons of t hi s coo coorr di nati on uni t woul oul d bo bo t o sum summari se t he con cont ent s, i nt er pr et , co com mment , i ndi cat cat e a pr i or i t y i n t he v va ar i ous ac actt i ons desi r ed by t he var var i ous ous d dep epart art ment s t o be t aken aken at t he peri pheral l evel evel . I n t hi s way, t he Depar t ment wi l l be ab abl e to mai nt ai n at a de desi r abl e l evel vel . t he or orga gan ni sat i on and and t he pr og ogrr ammes at at t he peri er i phery, er y, con contt r ol t he behav ehavii our our of t he p peri eri pheral uni t s by t he co con nt r ol of com communi cati on and and c coo oorr di nate t he babb abbl e o off voi voi ces i nt o o on ne v voi oi ce t o d dev evel el op an i nt egr egr at ed heal heal t h p prr ogr ogr amme by st r i ki ng a compr omi se am among ong t he sp spec ecii al i st s an and db bet et ween een t he sp spec ecii al i st s' vi ew and t he l ocal cal vi ews. 7. 3. 2. I nt er medi at e l evel ( Di str i ct, r egi onal / zon zonal Sud- di vi si onal : 7. 3. 2. 1.  The  Th e mai n f unct nctii on i s t o pr ovi ovi de i mmedi edi at e gui dance ance and and onon- t he- spo spott su sup per vi si on t o*t he l oca call l evel . Thr ough i t s r espo sponsi bi l i t y f or i mmedi at e sup super vi si on; i t hol ds t he key key t o t he succe success ss o orr f ai l ur e of any any ki nd of heal t h work. Si nce t he pr i mary h hea eall t h ce cen nt r es have ave t o f unct i on i n a r egi egi onal onal i sed f r amewor k, i t i s e esse ssen nt i al t hat i nt egr at i on of var i ous f unct i ons t akes kes pl ace at t hi s l evel vel . A uni f or mand pr opor t i ona onal devel vel opment of t he servi ces ces eqchi ui ir n egthe th un un i fes. i ed con consul sul t at i ve e eff f or t s of of t he c cll i ni cal cal , pr event i ve an and tr each ea b bre r anch an ches. Si nce t he st af f at t he l ocal cal l evel r equi r e sup suppor t i ve sup super vi si on i n rou routt i ne a act ct i vi t i es an and t he many spe speci al f unct i ons t hat can can be be p prr ovi ovi ded onl y by by the sp spe eci al i st s, di st r i ct or gani sat sat i on sho shoul d be under a u un ni t ar y admi ni st r at i ve co com mmand wi t h sp spe eci al i st ce cell l s f or advi advi sory f unct i ons.

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I n t he i nt erest rest of f ul l er ut ut i l i sat sat i on of perso rson nnel and f aci l i t i es, t he f ol l owi ng ar e esse ssen nt i al r equi si t es f or a di st r i ct adm admi ni str at i ons 1. Adequat e aut aut hor i t y and r esp spo onsi bi l i t y f or t he Medi ca call Of f i ce cerr of Heal t h i n ch cha ar ge of t he di st r i ct t o act wi wi t h a mi ni mumof i nt erf erence erence f r om St ate Gov overnm ernment ent or pa pan nchay chayat at i r aj admi ni st r at i on on.. Thi s i ncl udes d del el egat i on of admi ni st r at i ve and f i nanci anci al aut aut hori or i t y b by y panch anchaa- yat yat and and gover overn nment ent t o Medi edi cal Of f i cer cer of Heal t h f or al l per son sonnel . 2. Removal t o t he f ul l est ext et possi bl e o off r out i ne cl i ni cal cal dut i es f r om Medi cal cal Of f i cer cer of Heal t h i n cha char ge t o l ay admi ni st r at i on. 3. Prov Provii si on of a hi gh power ed mobi l e t eam of mul t i di sci pl i nar y heal t h pr  of essi onal s f or st i mul at i on, con consul sul t at i on, and sup super vi si on, 4.   I nt egr at i on of not onl y pr event i ve, and cur cur at i ve( r ehabi l i t at i ve i f pr ese sen nt ) se serr vi ces ces bu but al so o off se serr vi ce ce,, educat cat i on an and a ad dmi ni st r at i ve r esea searr ch. ch. 5.   Rat i onal i sa satt i on of admi ni st r at i ve or or gani sat sat i on wi t h sep separ at i on of staf f f uncti ons an and l i ne aut hor i t y. Si nce t he adm admi ni st r ati ve co com mpetence etence i s t he, pr i mary o ob bj ect ect i ve, ve, chi chi ef s o off t he di di st r i ct he 1 1tt h or gani sa satt i on may b be e s se el ectee f r om ei t her cur cur at i ve, ve, pr even vent i ve or t each chii ng sp spe eci al i t i es. They must be made a ava vaii l abl e f or t ech echni ca call co con nsul t ati ons ons on pati ent ent s as nee need ded. ed. One o off t he most i mpor t ant . f unct i on i s how how t o make an i nven vent or y o off exi st i ng reso resou ur ces ces so t hat t hey hey can b be e coor coordi di nat nat ed a and nd expand expanded ed to t o meet a measured easur ed d dem emand. and. I f heal eal t h ser vi ce pl pl ann anni ng and and man anag agem emen entt and and preven prevent i ve act i vi t i es ar ar e t o b be e gi ven hi gh pri ori t y, i t i s esse essen nt i al t hat i ndi vi dual s wi t h overal l admi ni st r at i ve r esp spo onsi bi l i t y f or t he heal t h wor k( ch chii ef Medi cal cal Of f i cer cer s)be gi ver s tr ai ni ng or or i ent at i on i n publ i c he heal t h par t i cul cul ar l y i n t he t echn echni cal and and ad adm mi ni st r at i ve sci en ence ce of of pl ann anni ng and and manag anagem ement ent of i nt egr egr ated medi edi cal and and heal eal t h ca carr e servi ser vi ces ces a an nd al so i n hosp ospii t al adm admi ni st r ati on. on. Another other Cr i t eri on on whi ch t he S Sh hore C Com ommi t t ee l ai d emphasi s i s S Sii ne e exp xperi eri ence ence of t he o off f i cer cer i n communi t y o orr gani ani sat i on. on.  The  Th e Chi ef Med edii cal Of f i ce? sho shou ul d ei t her nave ave f ul l t r ai ni ng as of D. P. H. , or a st af f Col l ege t r ai ni ng Cour se ses s at at Nat i onal I nst i t ut e of Heal t h Admi ni st r at i on and and Educa catt i on i n whi ch t he a arr t and and sci ence ence o off publ i c hea heall t h ad adm mi ni st r at i on shou shoul d b be e gi gi ve ven n gr eat eat er emphasi s t han now. 7. 3. 2. 3.

Rat i onal & Zonal L ev evel :

an of f i ce cerr of t he g grr ade of of a Deput y Di r ector wi l l r el i eve t he Di r ector of Heal t h Ser vi ces ces g grr eat l y i n

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r out i ne mat t er s, epi demi ol ogi cal cal i nt el l i gence and i n car car r yi ng out i nve vest st i gati ons. ons. Th There ere sh shou oull d be on one e of of f i cer cer f or not not more t han 4 or 5 di st r i ct s o on n t he basi s o off work l oa oad d, ad adeq equ uate st af f sho shoul d be att ach ached t o t he he of f i c er . 7.3.2.3.

Sub- Di vi si onal Le Lev vel :

Af t er t he Di st r i ct Heal t h Or gani sat sat i on h ha as de deve vell oped r eason sonabl y, so som me o off t he respo responsi bi l i t y o off r egi onal i sat sat i on may b be e devol ved to t he sub sub- di vi si onal l evel when mor e f aci l i t i es wi wi l l be pr ovi ded at t hat l evel . 7. 3. 2. 4. Per i pher al l evel vel ( Pr i mar y heal t h centr ej Mor e of of t en t han not t he p pe er i pher al uni t r ef er r ed t o i s t he pr i mar y heal t h cen cent r e. Excep cept f or sp spe eci al cl i ni cs, smal l hospi spi t al s, etc. , t he f l ow of servi ces ces i nt o t he com communi t y wi l l be t hr oug ough pr i mary heal t h cen cent r es. I t i s t ake ken n f or gr ant ed f r om t he ve verr y nat ur e of t he co con ncep cept of pr i mary he heal al t h c cen entt r e t hat t he se serr vi ces ces ha have ve t o be be ad adm mi ni st er ed i n an i nt eg egrr at ed man ann ner . Unf or t unat el y t her e ha have b be een c ce er t ai n di f f i cu cull t i es i n t he i mpl emen entt ati on of t hi s conce concep pt . Th The e p prr i mary he heal al t h c cen entt r e, t o b be e ef f ec ectt i ve ve,, must be a paramou oun nt i nst i t ut i on an and d t he med edii cal cal of f i cer cer must pr ov ovii de ad adequ equat e super super vi si on an and d gui dance, ance, adm admi ni st r at i ve and and t ec ech hni cal cal , t o t he st af f . Th The e l og ogii cal cal chai chai n of of com comman and d wou oull d b be e to h hav ave e di r ec ectt ad adm mi ni st r ati ve an and d t ech echni cal cal chan chann nel t hr ou oug gh t he Med edii cal cal Of f i cer cer of t he pr i mar y heal t h cen cent r e. The ent i r e st af f of t he pr i mar y hea eall t h cen cent r e sh shou oull d be un under t he ad admi ni st r ati ve con cont r ol of t he med edii cal of f i cer cer i n ch cha ar ge and i t i s n no ot desi r abl e t o have a par t of t he st af f under t he di r ect ect ad adm mi ni st r ati ve con cont r ol of pan anch chay ayat at or t he Bl ock ock Devel evel op opm ment ent Of Of f i cer . 7. 4. Uni f i ca catt i on of Cadr e: 7. 4. 1. Th Thii s has has b bee een n a bu bur ni ng quest i on i n al l t he St St ates an and d al so at at t he Cen Centt r al Gov overnm ernmen entt l ev evel el . Barr i ng a f ew St ates ot her have ave not bee een n ab abll e t o ach achii ev eve e t hi s yet yet . Th The e I ndi an Med edii cal cal Associ ati on had rstecom eco end ended at tbe e lshou sh oul dotbe beonl u un n ye i innta aleg l l r tati heon St St at an and d a and anm dm ard p patt attt h ern bh eere evo vol ve ved dl n on l iyf or f ormi tt h egr of es t he two two Dep epart art men entt s but but al so f or a un unii f i ed cad cadr e wi t h uni f ormr emunerat i on of t he f ol l owi ng pat t er n:  J uni uni or Scal e:

Rs. 625625- 30 30-- 775775- 3535- 950950- EBEB- 4040- 1350 1350

Sen enii or Scal e:

Rs. 1000- 40- 1200- 50- 1450- EB- 55- . 20 2000 00..

Sel ect i on Gr ad ade: e:

Rs. 2000- 100- 2500 Speci al

post s( D. G. / Addl . D. G. / C. M. O. ( Rai l way) : Rs. 27 2750 50-- 12 1255- 3000 3000..

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 The  Th ea adv dvan antt ages ages of uni f i cat i on of cad cadrr e a arr e rrea eall i n th t hat i t " does does away wi t h t he mul t i pl i ci t y of Cadr es and wi t h i t , t he so cal cal l ed cast e syst em, i t cr eat eat es a se sen nse o off bel ong ongi ng t o t he sam same f ami l y and f oster s a r esp spii r i t de ccop ccops whi ch i s an an essen ssentt i al i ngr edi ent i n Hea eall t h Depar epartt ment ent wher ere e t he per person sonn nel con const st i t ute ut e t he mai n r esou esour ces. ces.  The  Th e f orm or mat i on of I ndi an Medi edi cal and and H Hea eall t h ser vi ces i s under nder di scu scussi ssi on. Thi s woul d i ncl ude Cl ass I of f i cer cer s u up pt o Ci vi l Sur geon and D. M. O. Hs Si Si nce t hi s i s st i l l under d dii scu scussi ssi on, we wi l l al so have t o t hi nk of of a c cad adrr e f or each each St ate. Thu Thus we requ requi r e tw two o cad cadrr es, . Cen entt r al and S Stt at e. 7. 4. 2.

St at e Cadr e:

7. 4. 2. 1. Pay Pay a an nd Al l owan ances; ces; At pr ese esen nt pay and and al l owances ances o off t he S Stt ates vary grea gr eatt l y. West Beng engal and and P Pu unj ab scal es ar ar e hi hi gher t han t hose of ot her St at es. The q qu uesti on o off uni f or mscal es of pay t hrou hr ough ghou outt t he cou count ntrr y i s compl ex as t hey hey d dep epen end d on var varii ous ous f actors. I t i s p prr obabl y di f f i cul cul t t o f i nd t wo cou count r i es h ha avi ng t he same scal scal e o off pay unl ess t he cou count r i es ar ar e rel ated t o e eac ach h o ott her t hroug hrough h some ad adm mi ni st r at i ve conn connect i ons. ons. What hat i s i mport or t ant ant t o ensur ensure e i s t hat t he p ph hysi ci ans ans pay a an nd a all l owances ances sho shou ul d co com mpare ar e f avour abl y wi t h t hat of t he St St at e Ci vi l Ser vi ce Of f i cer cer s, However ver , t her e sh sho oul d be gr gr oupi ng o orr cat cat egor i sa satt i on of t he ca cad dr e* j uni or scall e, se sca sen ni or sca scall e and and se sell ec ectt i on gr ade. Physi Physi ci ans ans be bell ong ong t o a pr pr of essi on t hat demand and rrou oun nd- t he- cl ock servi ce ce,, no r egu egul ar i t y of hour s, hard l i vi ng, et c. These woul d need eed compensat ensat i on i n t er erm ms of spe speci ci al al l owances. ances. Among ong t he al l owances ances t hat may be at at t ach ached t o t he pay pay of t he medi edi cal cal of f i cer, non on-- pr act i si ng al l owance ance of r eason easonab abll e amount ount meri er i t s consi con si derat i on. on. To avai avai l of t he ser servi vi ce ces s of a a doct oct or i n a communi t y dep eprr i ve ves s hi s s cop cope e f or maki ng money oney on on a l arg ar ger scal e whi ch ot her wi se a doc octt or woul d pr ef er t o i ndul ge i n. To g gii ve hi s t echn chni cal cal ski l l t o t he co com mmuni t y the doct or wi l l co con nsi der i t a mat t er of bi r t h- r i ght and i t may not t her ef or e be possi bl e t o st op hi s pr acti ce par t i cul cul ar l y owi ng t o t he f i nanci al di f f i cul cul t t i es wher e adeq adequ uat e com compensat ensat i on f or t he. l oss o off hi s pr pr acti ce/ ce/ sho shou ul d not be permi t t ed as f or exam xampl e the heal t h of f i cer cer at an any y l evel vel , t he medi edi cal of f i ce cerr of pr i mary \ heal eal t h cen cent r e and and t each eachii ng and and r esea esear ch post s. 7. 4. 2. 2. Racr ui t ment and se serr vi ce c co ondi t i ons  Ther  Th ere e sho shou ul d be a uni t ary ar y port or t al of ent ent r y t hr oug ough t he St at e Pub Publ i c Se Serr vi ce Com Commi ssi on. on. Se Sen ni or orii t y must be common f or . 11 t he posts i r r esp spe ect i ve of t he Di vi si on/ Depa epar t ment i n whi ch one i s worki ng. Ant e- dates may be gi ven ven f or qu qual al i f i cat cat i ons ons b bu ut t hat sho shou ul d be gi gi ven ven onl onl y du dur i ng t he t i me of ent ent eri ng t he se serr vi ce. ce. The The peri od of ant ant e- dat dat e an and t he

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r easons sons f or g gii vi ng ant ant e- dat e sho shoul d be sp spec ecii f i cal cal l y l ai d down. But t hi s a an nt e- dat i ng may not cou count t owar ds se sen ni or i t y. I t wi l l count cou nt onl onl y t owar ard ds pay pay and and al al l owances. ances. The The o ott her al t erna er natt i ve may be t he, gr an antt of advan vance of i ncr ement s f or ext ext r a qual i f i cat cat i ons. ons.  The  Th e ext ext ent ent sho shoul ul d however ever be l ai d down depen depend di ng on t he nat ur e and degr ee of of qual i f i cat cat i ons, 7. 4. 2. 3. pr omot i ons: Pr omoti on sho shoul d be be b ba ase sed d on on c ce er t ai n o ob bj ect i ve cr i t er i a ser vi ce f or a mi ni mumnum number of ye year ars s pl us po post st gradu graduat at e t r ai ni ng i n publ i c h he eal t h admi ni st r at i on or spe speci al i t y o orr bot h t o e eq qui p an of f i ce cerr of adm admi ni st r at i ve and t echn chni cal cal r espo sponsi bi l i t y r equ equi r ed f or t he hi gher post post s as i n t he army. 7. 4. 2. 4. Te Teac ach hi ng Cadr e: I t appea earr s t hat t her e i s a t r end f or kee keeni ng t he teach teachii ng and and resea researr ch cad cadr e o ou ut si de t he mai n u un ni f i ed cad cadr e, There There ar are e ce cerr t in a adv dvan antt ag ages es i n thi t hi s; On tthe he ot her her hand hand t hat hat woul oul d mean ean sp spll i t t i ng of of t he ca cad dr e i nst ead of one. The p pe eopl e worki ng i n t he medi edi cal co coll l eges eges are l i abl abl e t o be detach etached ed com compl et el y f r omt he hap appe pen ni ngs i n t he f i el d. The The peo peop pl e who h hav ave e b bee een n succe successf ssf ul i n t hei r l i ne o ou ut si de the Medi cal cal Col l eges can cannot br i ng t hei r exp experi ence ence i n e ed duca catt i on. on. A person who has has worked ef f i ci ent ent l y as as a sp spe eci al i st or a ci vi l su surr geon or a heal t h of f i cer cer , i f he kno knows t hat he i s l i abl e t o b be e post ed i n a medi cal cal col col l ege, wi l l t end t o ke keep ep hi s know knowl edg edge up upt o d dat at e an and when hen a ap ppoi nt ed, ed, wi l l bri ng t he ri ch exp exper i ence of f i el d t o e ed ducat cat i on. Thi s was a system pr eval eval ent ent i n t he ol d I ndi an Medi edi ca call Servi ce and and by a an nd l arge t hi s has n no ot wor ked ked i nef f i ci ent l y ei ei t her i n t he ser ser vi ce or i n t he t each eachii ng si de. I n f act act some of of t he r esearch esearch workers and and teac teach hers had been i n t he se serr vi ce bef or e Th Thi s pr pr act i ce i s pr pr eva eval ent i n at l east one one so sou ut her n St at e, as f ar as the Prof essor of Pr even vent i ve and and Soci al Medi edi ci ne i s con concer cern ned. ed. Anot her St at e has has u un nder co con nsi derat i on a sch schem eme f or i nt ercha erchan nge o off st af f betw etwee een n servi ces ces and and edu educat i on. on. 7. 4. 3. pr ocess cess of uni f i cat cat i on; 7. 4. 3. l . The The heal t h se serr vi ce of a cou count r y i s as as go good or as bad as t he pe peopl e g gii vi ng t he se serr vi ce. ce. The whol e . . ser ser vi ce i s l i t er al l y t he per son sonnel , t her e bei ng r el at i vel y l i t t l e over head exp expense ense f or mach achii nery, t ool ool s, etc. Heal eal t h work has has c cert ert ai n cha char act er i st i cs whi ch gi ve r i se t o pecul cul i ar person ersonn nel pr obl ems i n con cont r ast t o most busi nesse sses s and and i ndust r i es. I t i s cu curr i ous mi xt ur e - of publ i c an and soci soci al r esp spo onsi bi l i t y and ser ser vi ce. ce. Thi s assumes more or e si gni f i can cance ce i n d dev evel el opi opi ng cou coun nt r i es en eng gaged aged i n t el esco escop pi ng deca ecad de' s work i n years. years.

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Demand ands on t he doct or i n t he ser servi vi ce are so gr eat eat and and. compensat pensatii on so unr unr emuner uner at i ve as as compar par ed t o othe ot herr prof pr of essi ons ons t hat i nsp spii t e of t he phenom enomenal enal i ncr ease ease i n pr odu oduct i on, on, f ewer doct or s are j oi ni ng t he se serr vi ce ce.. Mor eover , t her e i s al so a dr ai n on the pr of essi on ar i si ng o ou ut of mi gr at i on o off you young doct or s i n l ur e of of more or e money oney,, and and o ott he herr more or e f aci l i t i es whi ch mort or t al men aspii r e t han at home. I mpr ovem asp ovement ent of servi ce co con ndi t i ons ons i s t he cr yi ng need eed of t he day not on onll y to at t r act act and and r etai n person ersonn nel of t he r i ght t ype, ype, whi ch i s of i mmedi edi ate co con ncer cer n but al so to mai nt ai n a an nd i mpr ove ove q qu ual i t y o off ent ent r ant ant s t o t he pr pr of essi on whi ch is o off no l ess con conce cerr n t o t he so soci et y at l ar ge. For For t unat el y, t he pol i t i ca call and pr of essi onal l eader s o off t he count r y ar coun ar e a aw ware ar e o off t he great I mport or t ance ance o off a uni f i ed cadr cadr e a as s a cor cor r ecti ve measur sur e. I n f act, t hi s i s vi vi r t ual l y t he si ngl e m ea gr eat ea eapaf orw ard t odied nt egr egprrati on . . The TheI tp prr oce ocess ueasure ni sure f i ca catt fi or on a g rrem ait nlseap manyan y- si obl oblon. em i sss of an an admi ni st r ati ve pr obl em r el at i ng to t he usef usef ul empl oyment of di f f er ent cat cat egor i es o off doctors wi t h var i ous spe speci al i t i es, equat i on of post s, det er mi nat i on of sen seni or i t y i n t he cad cadr e, r ecr ecr ui t ment ent , co com mpensat ensat i on, on, t enu enur e an and p prr omot i on. on. I t al so pose poses s psychol sychol ogi ogi ca call pr obl obl ems. Cur ati ve work h has as a a** grea greatt er pr prest est i ge not onl y a am mon ong g t he peop eopl e at l arg ar ge but al so i nsi de t he pr of essi ons, apar t f r omi t s f i nanci al advant age, Admi ni st r at i on is a asso ssoci ci at ed wi t h a hi gh st atus b bu ut unf ort unat el y publ i c heal eal t h, r ese esearch arch and and e eve ven n teach teachii ng hav have en nei ei t her t he p prr est i ge n nor or t he a ap ppeal eal . Rese esearch arch an and t each eachii ng car car r y p prr est i ge t o t he e ext xt ent ent t he per so son ns d do o pr i vat vat e pr act i ce ce.. Nat ur al l y, at t empt s a att uni f i ca catt i on wi l l be res resii st ed. Many v vii r t ues of sep separ at e c ca adr es wi l l be r eci t ed. The publ i c h he eal t h wor ker ker s f ear t hat t hey wi l l be ' swamped' ed' by t he bi bi gger ' medi edi cal cal ' worker orkers s g grr oup oup. I t i s t heref er ef ore or e o off t he ut most i mpo porr t an ance ce to t o r emove ove psych sychol ol ogi ogi cal barr i ers. 7. 4. 3. 2. I nt egr at i on has be been at t empt ed i n a f ew st ates but not uni f orm or ml y. Whi l e i t may not be n nece ecessar ssar y t o evo evoll ve a uni f or mmet hod f or al l t he st at es; i t i s pr pr obabl y desi r abl e t o l ay down c cert ert ai n norm norms t o e en nsur sur e a f ai r measu easurr e o off uni f ormi t y. 7. 4. 3. 2. 1. We may l ook ook t o t he a arr med ser vi ces whi ch i s or i en entt ed t o pr even vent i ve medi ci ne. Mi l i t ar y Medi cal cal Or gani sat sat i ons ons have t o sol ve pr obl ems of of or gani ani sa satt i on, t r ai ni ng, sup support , t r anspo ansporr t at i on, on, equ equi pment ent , et c. much more or e q qu ui ckl y t han most l i esur sur el y movi ng ci vi l or gani sa satt i ons I t woul oul d be wor t hwhi l e t o expl or e system systemat i cal cal l y t he possi bi l i t i es f or appl i cat cat i on t o ci vi l use, We may al so d drr aw upon a f ew st ates t hat have ave u un nder t he i nt egr at i on.

26

 

West Beng engal al :

Medi edi cal and and publ i c h hea eall t h ser ser vi ces ces were br br oug ought wi t hi n t he f ol d o off a un uni f i ed cad cadr e throu throug gh pr omul gat i on of : i ) West Beng engal Heal eal t h Servi er vi ces( cad cadrr e, pay and and al l owances ances Rul es, 1958) i i ) West Bengal Heal t h Se Ser vi ces( ces( pay, al l owances, ces, pr omot i on of nonon- gaze azett t ed medi edi cal of f i cer cer s R Ru ul es, 1959)  The  Th e f orm or mer r ul es di d away wi t h t he exp expr essi on " Ci vi l Sur geon eon, assi st ant ant sur sur geon eon, and and sub sub-- assi st ant ant sur sur geon eon". Ever y doct or was c ca al l ed ' medi cal cal of f i cer cer ' . Par t i cul cul ar post s wou oull d no not car car r y sp spe eci f i c p pay ay sca scall es. A medi cal cal of f i ce cerr woul d dr aw pay accor accor di ng t o t he g grr ade ade t o whi ch he he may bel ong ong i r r esp espect ect i ve of t he a ap ppoi nt ment s hel hel d b by y hi hi m unt i l he i s promoted to t he n nex extt hi gher gr ade acco ccor di ng t o hi s se sen ni or i t y and sui sui t abi l i t y.  The  Th e l at t er r ul e br oug ought post s of nonon- gaze azett t ed medi edi cal of f i ce cerr s wi t hi n t he u un ni f i ed ca cad dr e f r om1/ 1/ 1959. The e en nt i r e c ca adr e becam ecame a n non on-- pr act i si ng cad cadrr e wi t h t he onl onl y e exce xcep pt i on t hat con cont r ol l ed pr i vat vat e pr act i ce was al l owed at t he di scr et i on of t he Gover ver nment t o t he spe speci al i st s p po ost ed i n di st r i ct an and d su sub b- di vi si onal head headqu quar artt er s ho hospi spi t al s on such t erm er ms an and d con condi di t i ons ons as may be pr escri bed f r omt omt i me t o t i me. Another other st ep was t he r eor eor gani ani sat i on of t he e ex xi st i ng s se et - up o off t he Di r ector at e of of Heal t h Se Ser vi ces ces i ncl udi ng di st r i ct and l ower l evel vel s u un nder whi ch t he c cii vi l su surr geons were r edesi gnat ed as ' Chi ef Medi cal cal Of f i ce cerr of Heal t h' and pl ace aced i n admi ni st r at i ve ch charge arge of both t he "cur "cur at i ve" ve" and "pr "pr even vent i ve" ve" acti vi t i es i n t he di str i ct, bei ng rel i eved of al l prof essi ssi onal dut i es i n di st r i ct hosp ospii t al s, whi ch deve evel oped on t he se sen ni or most medi ca call of f i cer cer s o off t he di st r i ct hospi spi t al s de desi gnat ed as t he "Di "Di st r i ct Medi edi cal cal Of f i ce cerr s" ( G. Os No. No. Medh edh/ 1069878- 2/ 67 dat ed 10. 12. 57) . Lat Lat er i n 1 19 965, cer cer t ai n post s wer e d dec ecll ar ed n no on- pr act i si ng and and of f i cer cer s were al al l owed opt opt i on of pr i vat vat e p prr act act i ce i n t he e exe xem mpt ed post s( W. B. G. 0. Est t . / 2007/ 25- l 20 dated 1. 4. 65) Par t i cu cull ar s rel at i ng t o pay sca scall es. , al l owances, ces, et c. .  The  Th e gen ener eral al pat t ern er n i s t hat t he of f i cers cer s i n t hei r ear ear l y car car eer wor k as ge general dut y medi cal cal of f i cer cer s i n hospi spi t al s, heal t h ce cen nt r es, publ i c heal eal t h dut i es, nati onal onal schem schemes an and d t each eachii ng dut i es( Fo Forr mati ve st age) age) . Subsequ sequent ent l y,

27

 

dependi ng on t r ai ni ng. , ap aptt i t ude, ac actt ual perf ormance etc. , t hey have ave t he c ch hance t o c ch hal k o ou ut t hei r f ut ur e i . e. , whet her t o remai n i n p pu ubl i c heal t h wor k, c l i ni c a all work, t eac h hii ng o orr admi ni st ra t i ve ve(( Def i ni t i ve per i od) . Fi nal l y, a s se el ect i on i s can candi dat es f or t he top posi t i on

made

to

e ea ar mar k

6 6-- 10

l i ke kell y

 Thus i t may be sai d t hat i n an of f i cer ' s ser vi ce 1i f e t here i s a f or mat i ve peri od od,, de deff i ni t i ve peri od or mi d- phase and a f i nal peri od pr epar i ng f or t he t op app appoi nt men entt . There There i s no di scr i mi nati on i n t he p pay ay and al l owance ces s of of f i cer cer s, wher ev ever er t hey happen t o be empl oyed yed e. g. , t eachi chi ng, cl i ni cal cal , admi ni st r at i ve or publ i c h he eal t h dut i es. Ther e ar e al so t hr ee gr ades o off ser ser vi ce e. g. , i ) Basi c gr ad ade e

-

Rs. 300 t o 800

-

Rs. 850 t o 1350

i i ) Sel ecti on gr ade 8% i i i ) Sp S pec i al s el el ec t i on gr ade 2%

-

Rs . 1 15 500 t o 1800

wi t h a all l owance e. g. , non- pr act i ci ng p pa ay, publ i c h he eal t h a all l owance, ce, admi ni st r at i ve al l owance, ce, r ur al al l owance, ce, wor k a all l owance, ce, et c. Det ai l s a arr e i n a ap ppendi x ' 3' . 7. 4. 3. 2. 3.

Punj ab:

Under t he r eor gani sat sat i on pat t er n( Di st r i ct l evel vel ) t he var var i ous cadr es ha have ve be been en amal ga gam mat ed and and t he pu punj nj ab Ci vi l Medi edi cal Se Serr vi ce ha has s be been en r enam enamed; 1.

Pun Punj ab Medi ca call Se Serr vi ce ces s I ( PC PCH HS I ) Se Sell acti on Gr ad ade e

2.

Pu Punj nj ab Medi edi cal Servi ces I

3. 

Pu Pun nj ab Medi edi ca call Servi ce ces s II

4. 

Pu Pun nj ab J uni or Medi edi ca call Servi ce ces s

5. Pun Punj ab J uni or Medi edi ca call Ser vi ce ces s

-

Rs. 13 130 00 - 16 160 00 -

-

Rs. Rs.

75 750 0 - 125 250 0 25 250 0

- 750 

Sel ect i on gr ade ade  Rs. 400 400 - 600 600 Ti me sca scall e Rs. 15 150 0 - 38 380 0

7. 4. 3. 2. 4. Myso ysorr e I nt egr at i on i s b be ei ng c ca arr i ed o ou ut i n s stt ages: As a f i r st st ep, medi c a all i nst i t ut i ons a att and bel ow t al uk l evel evel s ha had d be been en t r ansf ansf err ed i n 19 196 60 f r om t he medi edi cal depart epart ment ent t o pu publ bl i c h hea eall t h de dep part men entt . Th The e ca cadre dre o off medi edi cal and and publ publ i c h hea eall t h per son sonel el had a all so b bee een n Uni f i ed, whi l e recrui t ment t o the servi ce an and d n new ew r ecrui t s

28

 

ar e desi gnat ed as assi st an antt medi ca call of f i ce cerr s of of Heal t h- cu cum m- assi st ant ant sur geon geons s si nce 1960 1960,, As a se secon cond d st ep amal gmati on of ser vi ces a att t he Di r ector ate l ev evel el had had b bee een n e eff f ect ed si nce Dece ecem mber ber , 1964 1964,, when hen t he po post st s of Di r ect or of Medi edi cal Se Serr vi ces a and nd Di r ector of Hea eall t h S Servi ervi ces were ab abol ol i she shed d a an nd a uni f i ed Di r ector of Heal t h Ser vi ces ces f or med. Compl ete i nt egr at i on of medi ca call an and d p pu ubl i c h hea eall t h d dep epots ots at al l l ev evel el s has not ve vett b be een ach chii eved eved by i nt egr egr ati ng servi ce per son sonn nel of bot bot h d dep epar ar t men entt s. 7. 4. 4.

Som Some sug sugge gest st i on ons s emer ge ge::

1.   Recr ui t ment : There wi l l be a si ngl e port al of entry f or al l medi c a all of f i c e err s, i n c u ura ra t i ve, ve, publ i c h he eal t h, r ese sea ar c h, h, t r ai ni ng et c , 2.   Cadr adr e: Cad adrr e wi l l be one. one. I t may be sub sub-- di vi ded ded i nt o 3 grad grades: es: a)   Basi c Gr ade; b)   Sel ecti on - 20% gr ade c) Speci al grade grad e 5%

se sell ecti on

3. Seni or i t y :  Ther e shoul d be a common seni or i t y whi ch f ol l ows r ecrui t ment .

aut omat i cal l y

4. Ant e- dat e f or p po ost - gr aduat e qual i f i cat cat i ons at t he ent r ance; ce; t he va varr yi ng per i ods sho shoul d be f i xe xed d f or vari ous q qu ual i f i cat cat i ons. Thi Thi s wi l l cou count nt t owar ds a adv dvan ance ce i n pa pay y a and nd al l owan ances ces b but ut not t owar ds se en ni or i t y . 5.

Pa Pay y wi l l be on t he b ba asi s o off ye yea ar s of of se serr vi ces ces i n r esp spe ecti ve

gr ades, ades, 6. S peci al al l owan ance ces s to b be e a ad dded f or spe speci ci al f unct i on ons s suc such h as i ) Sp pe ec i al i s t s - M. D. , M. S. , M. D. , ( PH) , D. P. H. . M. P. H. , et c . t ype ypes o off sp spe ec i al i st s – J uni or spe spec c i al i st s a an nd se sen ni or sp pe ec i al i s t s ii) R Re ese sea ar ch i i i ) Te ea ac h hii ng i v)

Pu Pub bl i c Heal eal t h or spe speci ci al pr og ogrr ammes e en nt ai l i ng i nt en ensi si ve and and exten xtensi si ve f i el d wor k.

29

 

v) Admi ni st r at i on. vi ) Speci al haza zarr d. 7. Non on-- pr ac actt i ce al l owance ce:: Al l post s sh sho oul d be non on-- pr act i si ng and al l owance gi ve ven n f o r l oss o off pr act i ce shou shoull d be r ea eason sonab abll e - 50% of t he p pay ay sub subj ect ect t o t he mi ni mum of Rs. 60 0 0// I f , however, ever, st at e g go ove verr nment ent wi sh she es t o e ell i mi nat e p prr i va vatt e pr acti ce on a phased sed basi s, t he t eachi chi ng ( cl i ni cal cal and non- cl i ni cal cal su sub bj ects) and r ese sea ar ch post s, heal t h o off f i cer cer s a att al l l evel vel s( M0S, PHC i ncl uded) ed) post s, posts i n sp spec ecii al pr og ogrr ammes ( nati on onal al or st ate) and t he post s i n di st r i ct he hea ad uar t er s( admi ni st r at i ve ve)) and St at e Di r ect or at e sh shou oull d be br ought f i r st i nt o non on-- pr ac actt i si ng gr ou oup p. Teac Teach hers na nay, y, however, ever, be al l owed con contt r ol l ed pract i ce f or no nott more t han 2 h hou ourr s i n sorr t of payi ng cl i ni cs a so att t he medi cal cal i nst i t ut i on OPD N No o opt i on sh shou oull d be g gii ve ven n t o medi edi ca call of f i ce cerr s w wh het her t o p prr act act i se o orr not. 8

Tr ai ni ng and or i ent at i on:

8. 1. For t he f i rst 8 yea years medi c al al of f i c ers ers w wii l l be i n f ormati ve st ag age e a an nd b be e r egarde egarded d a as s ge gene nerr al dut dut y medi edi cal of f i cer. They They may q qu ual i f y f or j uni or sp spe eci al i st s on post - gr aduat e tr ai ni ng and g ge et sp spe eci al i st s p pa ay, i f wor ki ng agai nst a sp spe eci al i st post . Si nce t hey h ha ave t o wor k i n i nt egr at ed h he eal t h c ca ar e a all l medi cal cal of f i cer cer s, i mmedi at el y af t er be beii ng r ecr ecr ui t ed sh shou oull d under go r egu egul ar t r ai ni ng at a reco recog gni sed or i en entt ati on t r ai ni ng ce cen nt r e or i nst i t ut i on i n gov overnm ernmen entt pr oc oced edu ur es and and basi c pri nc ncii pl es of hy hygi gi ene, ene, he 1 1tt h e ed duc ucati ati on an and d co com mmun unii t y or gani ani sati on. Thi Thi s t r ai ni ng sh shou oull d be f or 4 t o 6 wee eeks. ks. 8. 2.   At t he end of 8 yea year s al al l of f i cer cer s a asp spii r i ng t o t he sel ec ectt i on g grr ade must under go staf f t r ai ni ng c cou ourr se f or a pe per i od of 6- 12 mon ontt hs. Al l medi ca call of f i ce cerr s of heal t h an and d Assi st ant Dep epu ut y, and  J oi n. . Di r ect or s must at t end a st af f cour se wher e t he ar t and sc i ence of pu pub bl i c hea heall t h adm admi ni st r at i on sho shou ul d be a core sub subjj ect- They They may be exem exempted i f t he hey y h had ad at t ende ended d a cou courr se of of DPH. other medi edi cal of f i cers sh sho oul d under go post - gr aduat e s stt udi es i n t hei r cl i ni cal cal su sub bj ects. A per per i od beyon beyond d 12 mon ontt hs sho shoul ul d be t r ea eatt ed as st udy udy l eave eave unt unt o t he maxi mum per per i od of t wo y yea earr s, 8. 3.   Medi edi ca call of f i ce cerr s wi wi shi ng t o d do o p postost- gr aduate st udy be beff or e 8 years may d do o u und nder er no norr mal st ud udy y l eave eave.. 8. 4. St udy 1 1ea eave ve sho shou ul d b be e 1 1ii ber al i sed sed..

At pr ese sen nt f aci l i t i es pr ovi ded t o ser ser vi ng medi cal cal o off f i cer cer s f or f urt her stu stud di es are are n no ot su suff f i ci ent , Thi s i s

30

 

r athe atherr unf ort unate si nce a doc octt or, by n nature ature of of hi s p prr of essi on and wor k i s a st ude udent t hr oughout hi s l i f e. Al so fa c cii l i t i es sh sho oul d be pr ovi ovi de ded d i ncl udi ng host el acco accom mmodati odati on f or f ami l i es dur dur i ng t he p pe eri od of st ud udy. y. St af f c o oll l ege' s, el t her on st a t e ba basi s o orr pr ef er abl y on a r egi onal basi s, sh sho oul d be cen cent r al l y assi st ed. 9 • Pay Pay a and nd Al l owances: ances: Fi xat xat i on of pay sca scall e sho shoul ul d d dep epen end do on nan num umber ber of f actor s i ncl udi ng p pa ayment ent f or co com mpar ab abll e wor k el sewher e, co cost st of l i vi ng, wage age t r end ends, et c. Mi ni mumr ate of a h hii gher po posi si t i on sh shou oull d not not be l ess t ha han n sh she e maxi axi mum r ate of l ower cl ass. The The i nt ermedi edi ate st eps( eps( be bett ween t he mi ni mum uman and d maxi mum umshou shoull d be r eason easonab abll e, say ab abou outt 10 or or 12 12)) . 10. Shor t age of medi cal cal of f i cer cer s i n r ur al ar eas i s ch hrr o n nii c , but not abs ol ol ut e ; i t i s r e l at i ve. l t i s an an admi ni s t r at i ve pr obl em. I t i s a p prr obl emn mno ot pecul cul i ar t o I ndi a. Doctors assi gned t o r ur al areas must ha have ve t otal emol ument ent s more t ha han n t hei r ci t y col col l eagues be becau cause o off t he h he eavi er r espo sponsi bi l i t i es - and the l ess ag agrr eeab eeabll e worki ng con condi di t i ons. ons. Th Thii s ha has s be beer er r eal eal i sed i n many any co ou unt r i es , s oc oc i al i s t or ot her wi wi s e. e. I n addi t i on t o f i nanc i al i nc e en nt i ves, ves, pr of essi onal and so soc c i al i so soll at i on of rura l do doct ct ors( an and d t hei r wi ves ves an and d chi l dr en en)) sho shoul ul d be amel i orat ed as muc uch h a as s possi bl e b by y such mean eans as r ef r esh esher er cou courr ses, pr ov ovii si on of books a an nd magazi nes, cl i ni ca call meet i ngs at at di st r i ct hosp spii t al s, et c . 7. 5. I t i s o ob bvi ous t h ha at d i f f i c ul ul t i es i n i nt e g grr a t i ng heal t h ser vi ces may be group grouped ed i n 3 Cat eg egor or i es: a)  admi ni st r at i ve ve;; b) psyc sych hol

ogi cal cal , and 

c)l ack of or i ent at i on i n pr even vent i ve medi ci ne. 7. 5, 1. Admi ni str at i ve: Deart h o off medi cal cal of f i cers cers on pu publ bl i c hea eall t h si de i s d du ue to l ack o off ap aptt i t ude a an nd pr oper i nce cen nt i ve ve.. The The cadrr e o cad on n t he p pu ubl i c he heal al t h si de has n not ot bee een n made ade a as s at t r acti ve as on on t he c cll i ni c a all si de fi nanc i al l y a as sw we el l as f r omt he wor k po poi nt of vi ew. Havi ng start ed the heal t h o off f i cer cer s on l ower sca scall es of pa pay y t he u upg pgrr ad adii ng of t hese hese po post st s an and d amal gam gamat i ng t he hen n wi t h c l i ni c al al pos t s i s i n I t s e ell f a bi g f i nanc i al pr o b bll em whi c h t h e government f i nds i t di f f i c u ull t t o ha handl e. 7. 5. 2. Psy Psych cho ol ogi cal cal : Speci al i za zatt i on h ha as i mpr oved ved the ski l l s an and d d dii sci pl i ne nes s w wh hi l e a att t he sa sam me ti me h hav ave e h ham ampered uni f i ed t hi nk i ng, Thi s i s n no ot s ur ur p r i s i ng.

31

 

Speci al i sa satt i on br br eeds pa parr ochi chi al i sm. Speci al i st s do not gener al l y l i ke t o l ook beyon beyond d t hei hei r own br br anch anch or or depa deparr t ment ent and and h hen ence ce coordi coordi nati on becom ecomes an ef f ort . The The need eed and and abi abi l i t y f or synt synt hesi s an and d b brr i ngi ng abou aboutt harm ar mon ony y bet bet ween een var var i ous ous ki nds of speci speci al i sed l ear ear ni ng and and f unct i ons ons i s t heref ore of paramoun ount i mport ance. ance. Moreve oreverr , a heal eal t h of f i ce cerr i s n not ot l ooke ooked d upon by t he cl i ni ci ans ans an and d t each eachers ers as a p person erson doi ng anyt anyt hi ng usef ul or as know knowi ng en enou oug gh of of medi edi ci ne. Even ven a Ci vi l Sur geon eon o orr D. M. O. t hi nks ver y l i t t l e o off hi s co cou unt er par t , t he D. H. O, on t he pr pr event i ve s sii de  The  Th e Ci vi l : Sur geon eon i s pa paii d much be bett t er and and has a seni seni or St at us.  The  Th e at t i t ude of t he t eache eacherr s i n med edii cal col l eges eges i s no l ess presum pr esumpt ptuo uous. us. Under nder such co cond ndii t i ons ons an a am mal gam gamat i on of t he cad cadrr es and and t he servi ser vi ces ces ap app pear ear s t o b be e a t i ckl i sh pr obl obl em. Thi Thi s psy sych cho ol ogi cl bar r i er has t o be t ackl ckl ed t actf ul l y so t hat per so son nal i t i es are n no ot af f ected. cted. 7. 5. 3. La Lack ck o off or i ent at i on i n pr event i ve medi ci ne.  Thii s i s, i n f act , t he mai n r ea  Th eason son.. The The i dea of a communi t y and and h how owa a compreh pr ehen ensi si ve h heal eal t h care car e can be gi ven and t he econo econom mi cs of suc such h an an i nt egr egr ated ser ser vi ce h hav ave e not not been een co con nsi dered i n t r ue l i ght by t hose eng engaged aged i n t he cur cur at i ve servi ser vi ce or t each eachii ng or r esea sear ch ch.. Agr eement on the pr i nci pl e o off i nt egr at i on of t he servi ce ces s ha has s f r equ equent ent l y b bee een ne exp xprr esse essed d i n many any ci r cl es pu put howf ar t hat i s u un neq equ ui voca vocall an and d wi t hout an any y k kii nd of r eserva servatt i on i s yet yet t o be ascer ascer t ai ned. ed. Unl ess a pr oper oper ori or i ent ent ati on i s att empt ed t o hel p t he medi edi ca call of f i ce cerr s i n any any br br anch anch or spe speci ci al t y to u un nders t and and t he on onen eness ess of pur pose i n a h hea eall t h ad adm mi ni st r at i on and and t he n nee eed d f or a uni f i ed appr oach t o the pr obl em wi l l con cont i nue f or ever ver . Bef or e, t her ef or e, est abl i sh shii ng an i nt egr at ed ser ser vi ce t he t r ai ni ng of t he doctors at di f f er ent l evel s an and d in d dii f f er ent admi ni str at i ve ca cap paci t i es i s e esse ssen nt i al t o enabl e t hemt o f al l i n l i ne wi t h t he - vow vowed t hought and obj ec ectt i ve. ve. The i nt egr egr at i on of t r ai ni ng, ser vi ce an and d resea r esearr ch sho shoul ul d becom become a si mpl e rul e o off t hr ee and and not a f or ce ced d : i ssue ssue. I t sh sho oul d be a pr ocess cess o off l ogi cal cal evol ut i on and not a r evol ut i on. 7.6.

PR PRII VATE PR PRA ACTI CE:

 The quest i on of pr i vat  The vat e pract i ce i s l i nked nked up wi t h t he t ot al i ncome a doct doct or sho shou ul d h hav ave. e. He shou shoul d e ear arn n e en noug ough t o g gii ve chi chi l dr en t he h host ost ed edu ucat i on he can can,, and and t o make ake a r eason easonab abll e l i vi ng. I t i s b ba ad. f or a doctor ctor t o su suff f er f romf romf i nanci al anxi et y as i t makes i t di f f i cul cul t f or hi mt o be a good doctor, i t i s al al so bad bad f or a d doct oct or t o becom become rrii ch, f or t he same r easoneason- To make a f or t une out of a voca catt i on dedi ca catt ed t o the the rel i ef of suf suf f er i ng seem see ms t o be co con nt r adi adi ct i on. on. Medi edi ci ne i s not not a bu busi ness.

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<

service 

However ever,, pr of essi on ons s i ncl udi ng med edii ci ne h hav ave e t he su sup pr eme meri er i t of openi ng t hei r do door s to t al ent s f r omal mal l str at a of soci soci et y. I t i s a way of br i ngi ng up the gi gi f t ed t o t he t op of a so soci ci ety whi ch woul oul d otherr wi se st agn othe agnat e i n a f i xe xed d hi erar chy. chy. Thi Thi s woul oul d need eed r econ consi der at i on of cri t er i a f or f i xat i on of pay and al l owances. ces. A physi ci an, an, i r r esp especti ecti ve of whet her he i s en engaged i n cl i ni cal cal workor orkorad adm mi ni st r ati on, on, supervi supervi si on or r esearch, esearch, i n governm overnment ent ser ser vi ce, ce, i s a r eal r ound- t he- cl ock of f i ci al . Hi s e em mol ument s shou sho ul d compare ar e not s er ervi vi ce unf av avou ourr abl abl y wi t h ot her t ech echn ni cal and and admi ni st r at i ve <of f i cer s . I t ap app pea earr s t hat man any y of of t he St at es a arr e i n f avou avourr of St opp oppage age of pr i vat e pr acti ce but f i nanci al i nsuf suf f i ci ency appear s t o st and i n t he way. ay. Howev ever er,, a st ar artt may be mad ade e wi t h t he heal heal t h of f i cer cer,, publ i c h hea eall t h ca carr e d doctor octor , t he d doctor octor i n charge charge t each eachii ng and and r esearch esearch i nst i t ut i ons ons where an any i ncl i nati on t o make ake money oney wi l l adver ver sel y af af f ect t he ef f i ci ency of t he wor k a an nd ul t i mat el y the obj ecti ves o off t he i nsti t ut e. Cert i f i cat cat i on of si ckn ckness or f i l l i ng f i t ness, ss, i nsuran surance ce medi cal cal cer cer t i f i cat cat es e ett c. wi l l con consti t ut e n no or mal dut i es o off a medi edi cal of f i cer cer espec especii al l y when he i s post post ed i n a r ur al area and and hence ence sh shou oull d nei t her be p prr ohi ohi bi t ed nor con consi si dered as p prr i vat vat e pr acti ce 8 • Recommend endat at i ons: 8. 1. I nt egrati on:  The  Th e I nt egr egr at i on Commi t t ee: ee: 1.   Nothi ng t he a ad dvan vant ages ages of of i nt egr egr ati on of cur cur at i ve and and pr even vent i ve heal t h servi ces; ces; 2.   Consi der i ng t hat t he rea reason son of non- i nt egr ati on of t he servi ces whi ch are mai nl y ad admi ni st r ati ve and and psych sychol ol ogi ogi cal are nei t her f ormi dabl abl e nor. i nsu surr moun ount abl abl e; Reco ecom mmend ends t hat hat t he St St at es sho shou ul d reor gani ani ze t hei r heal eal t h servi ces ces i n su such ch a mann anner t hat i nt egr egr at i on of cur cur at i ve and and pr even eventt i ve servi ser vi ces ces i ncl udi ng t he r ese esearch arch a an nd t each eachii ng depart epart ment ent s cad cadrr es i s ef f ected 8. 2. The The Commi t t ee. ee. Real i si ng t hat i nt egr at i on of ser ser vi ces ces a all one wi l l not be ef f ect i ve u un nl ess a all l medi ca call of f i cer cer s are b brr ought i n one c ca adr e. Reco ecom mmen ends ds t hat ( i ) uni f i cat i on of cad cadrr e sh shou oull d be i mmedi edi at el y ef f ect ed and( i i ) t er ns a an nd con condi t i ons o off ser ser vi ce sh sho oul d pr ovi de a) uni f or m sc a all es o off pay:

33

 

b)   drawal drawal of pa pay y accor accor di ng t o t hehe- grade t o whi ch h he' e' may bel bel on ong g i r r esp espec ectt i ve of t he ap app poi nt ment ; c) c)   i nt er - ch cha ange and r ot at i on of of f i cer cer s b be et ween cl i ni cal cal , publ i c he heal al t h, t each eachii ng a an nd research research b brr anch anche es, d)   a common seni or i t y; e)   chan chances ces of of pr omoti on on an overal overal l con consi si der der ati on of years years of se servi rvi c e e,, meri t , admi ni st r at i ve c ap apabi l i t y et c . Speci al al l owances ces f or speci speci al i st s a an nd f or spe speci ci al f) progr ammes and ad adm mi ni st r at i on on;; g)

or i ent at i on t r ai ni ng, post - gr aduat e st udi es a an nd st a f f c o ou ur se ses s f or medi c a all of f i c er er s;

h)

a ad dequ equat e f i nanci al and o ott her i nce cen nt i ve ves s t o med edii cal cal of f i ce cerr s posted posted i n r ur al area areas s or or ar ea eas s d de ecl ared by the st ate a as s att ended wi t h an any y sp spe eci al hazard o orr r i sk.

8. 3.

The Commi t t ee

1.   Reco cog gni si ng t hat pr i va vatt e p prr act i ce depr i ve ves s a med edii cal cal of f i c e err of gi vi ng f ul l at t ent i on t o t he work he he i s a assi ssi gned t o; 2.   Not i ng t he di f f i c u ull t i es , admi ni s t r at i ve a an nd f i nanc i al , i n el i mi nati ng i mmedi edi atel y p prr i vat vat e- pr acti ce amon ong g t he medi edi cal of f i c e err s i n s er er v i c e e;; Reco ecom mmends ends t ha hatt ( i ) pr i vat vat e p prr acti ce be be e ell i mi nat ed on a gr adual l y i ncr easi ng p ph hase, ase, begi nni ng wi t h teac teach hi ng, r ese esearch arch an and sup super vi so sorr y p po ost s i n the Heal t h Di r ectorat e, Regi onal and Di st r i ct hea eall t h orga organ ni sati on on,, sp spec ecii al pr ogr ammes, ho h hea eall t h o off f i ce cerr s and and hea eall t h ce cen nt r e doc octt ors, (i i )

non- pr acti ce al l owance sho shoul d be a r eal i st i c and

r ea eason sonab abll e co com mpensati ensati on f or l oss o off pr i va vatt e pr act act i ce. ce.

34

 

35

 

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(i)

PAY AND AND ALL AL L OWANCES

OF WEST BENGAL

APPEND APPEN DI X @

1. Desi gnat i on of t he p po ost : Al l Medi cal cal Of f i cer cer s b be el ongi ng t o t he uni f i ed cad cadr e o off t he west Ben eng gal Hea eall t h Servi ce are cal cal l ed "' Med edii cal cal Of f i cer cer s" an and d desi gnated ac acco corr di ng t o t he p post ost s he hell d by t he . ( 2) Cl ass ssii f i cat cat i on of t he posts:  The un unii f i ed cadr e of t he com compr i se ses s t wo se sect ct or s vi z. ,

west Bengal engal Heal t h Ser vi ce

( l ) Gaze zett t ed and

( 2) Non on-- Gazet azet t ed ed.. ( 3)

Exi st i ng

sca scall es

of pay:

( l ) Gazet zet t ed: ( a) Basi c G Grr ade:

Rs. 300- 25- 800( E. B. af t er 8t h  and th 16   st ag age es) Th Those ose who a arr e d dii r ec ectt l y r ecrui t ed as S Sp peci al i st s a arr e g gii ven hi gher i ni t i al pay i n t hi s g grr ade on t he basi s of t hei r ant e- dat e c ca al cu cull at ed accorr di ng acco to t he Post Post - Gr adu aduat e qual i f i cat cat i on ons s an and d ex exp peri ence ence posse ossessed ssed by t hen. en.

( b) Sel ect i on Gr ad ade: e: Rs. 850- 60- 1350 ( Cal cul cul at ed @ 8% 8%o of t he t ot al per man anen entt st r engt h of of t he cad cadr e) ( c) Spec ecii al Sel ec ectt i on Rs. 1500- 60- 1800 Gr ade: ade: ( cal cal cu cull at ed 2% of t he t ot al er manen anentt st r en eng gt h of of t he ca cad dr e) . I I . Non- gazet zet t ed : a)For t hose Posse Possessi ssi ng M. B. B. S. or M. M. F. Qual i f i c at at i on

Rs. 225225- 1010- 325325- 1515- 475 475 ( E. B. af t er ; 10t h st age)

( b) Fo Forr Li cen cent i at es:

Rs. 200- 10- 400 E. B. af t er 10t h s t a ag ge)

 The pay sc al es ment i oned above ar e t he l at est sc al es as l ast r ev evii sed under t he west Ben eng gal Ser vi ces ( Rev evii si on of pay and and Al l owan ance ce)) Rul es, i 96l af t er mergi ng Dea earr ness A All l owan anc c e in the scales.

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(ii) I n the uni f i ed cad cadr e o off t he West Ben eng gal Hea eall t h Servi Servi ce t her e i s no no spe speci f i c p pa ay sca scall e at t ache ched t o a par t i cul cul ar post and and t he Med edii cal Of f i cer s of t he cad cadr e d drr aw t hei r pay and and al l owances ances accor di ng t o t he gr ad ade e t o whi ch t hey hey n nay ay bel bel ong ong unt i l such t i ne as t hey ar e pr omot ed t o t he n nex extt hi gher gr ade ade ac c co or di ng t o t hei r s en eni or i t y and s ui ui t abi l i t y.  The t ot al emol ument s compr i si ng pay, speci al pay and non- pr act i si ng al l owance admi ssi bl e to a Medi cal cal Of f i cer cer of t he uni f i ed cad cadr e of t he west Ben Bengal Hea eall t h Servi ce i s Rs. 21 2100 00// - ( r upees upees t wo t housan housand d and and one one h hun undr dr ed) ed) pe perr mont ont h. 4.

Non- pr act i si ng al l owance, ce, o ott her con concessi cessi ons,

et c.

 The ser vi ce i s non non-- pr act i si ng but but cont r ol l ed pr i vat e pr acti ce i s a all l owed t o th the e sp speci al i st Medi ca call Of f i ce cerr s po post ed in t he ho hos pi pi t al s a att Di s t r i c t and Sub- di vi s i onal headquar t er s. Pr i vat vat e p prr act i ce of any k kii nd i s no not al l owed t o t he Med edii cal cal Of f i cer cer s of t he cad cadr e post ed i n t ea each chii ng i ns t i t u utt i ons . ( a)

Non- pr act i si ng al l owance: ce:

( i ) Basi c Gr ade: Up t o 5 years' years' ser servi vi ce above above 5 y year ears' s' an and d up up t o 15 yea year s' se serr vi ce ( i i ) Sel ecti on Gr ade ( i i i ) Speci al Sel ecti on Gr ade ( i v) Non- Gaze zett t ed Medl . Of f i cer cer s ( b)

Spec i al i s t

Rs. 75/ - p. m. Rs. 100/ - p. m. Rs. l 60/ - p. m. Rs. 200/ - p. m. Rs 30 0/ - p. m. Rs 4040- 6060- 75 p. m. acco ccorr di ng to l engt h of servi servi ce. ce.

pay:

Med edii cal cal Of f i cer cer s n not ot exce exceed edii ng 25( t wen entt y f i ve) ve) per ce cen nt of t he t ot al ca cad dr e con const i t ut e a "Sp "Speci al i st pool " and ar ar e g gii ve ven n a Speci al i st pay(t r eat ed a as s spe speci ci al pay) ay) of Rs. 50/ - per mon ontt h pr pr ov ovii ded t hey p possess ossess r ecog cogni ze zed d post - gr aduat e qual i f i cat cat i ons a an nd/ or exper i ence ced d i n par t i cu cull ar sub subj ects. ( c) Teachi chi ng a all l owance: ce: ( t r eat ed as as Speci al pay) ( i ) Di r ec t or- Pr of es s or or s ,

P Prr of es s o orr

Asso ssoci ci at e Pr of esso ssorr s ( i i ) Reader s, Assi st ant Pr of esso ssorr s: ( i i i ) Lec Lec t ur ur er s , Demons t r at or s , Cl i ni c al al Tut or s ,

Rs. l 00/ - p. m. Rs. 75/ - p. m. Rs . 50/ - P. m.

( d) Publ i c He Heal t h pa pay( t r eat ed a as s Sp Spe eci al pay) Medi cal cal Of f i cer cer s po post ed f or publ i c h he eal t h dut i es a arr e gi ve ven n a S Sp peci al pay @ Rs. 50/ - per mont ont h each each..

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(iii) ( e) A Ad dmi ni st r ati ve pay ay(( t r eated as Speci al pay) ay) Medi cal cal Of f i cer cer s h ho ol di ng admi ni st r at i ve post s i n t he Sel ecti on Gr ade ade or i n t he Sp Speci eci al Sel ecti on Gr ade ade are a all so g gii ven ven Admi ni st r ati ve pay r angi ng f r om 100/ - t o R Rs. s. 250/ - per mont h a as s i ndi ca catt ed bel ow: |i ) ii)

(i i i )

Di rec t o orr of Heal t h Servi c e Pr i nc i pal s of Medi c a all Col l eges , Dy. Di r ector s of Heal t h Se Serr vi cesa cesand nd Sup uperi eri ntend ntenden entt s or Head ads s of l arge hosp spii t al s or i ns t i t ut i ons a as s wel l as s i mi l ar ot her post s i nvo voll vi ng admi ni st r at i ve f uncti ons o off equi equi val val ent ent magni agni t ud ude. e. A As s s t t . Di r e c ctt or s o off H He eal t h Ser vi ce ces, s, Chi ef Medi cal cal Of f i cer cer s of Heal t h Di r ec t o rs o f di f f er ent depart epart ment ent s o off t eac ach hi ng i nst i t ut i ons an and d su sup peri nt end endent ent s of hosp ospii t al s or i ns t i t ut i ons a as s wel l as s i mi l ar ot her post s i nvol vol vi ng admi ni st r at i ve f unct i ons of equi va vall ent magni t ude.

Rs. 250/ - p. m.

Rs. 150/p. 0/ p. m.

Rs. 100/ - p. m.

( f ) House ouse Rent ent Al l owance ance:: Medi cal cal Of f i cer cer s po post st ed i n Heal t h C Ce ent r es, Cl i ni cs o orr othe otherr i nst i t ut i ons i n ar eas o ou ut si de t he headquar t er s o off Di st r i cts an and d su sub b- di vi si on ons s are g gii ve ven n f r ee unf ur ni she shed d quart ers or act ual hou ouse se r ent ent i n l i eu t hereof sub subjj ect t o a m axi mumo moff 20 per per cen centt of t hei r J ay i nc l udi ng sp spe ec i al pay, i f any.  Those who ar e debar r ed f r ompr i vat e pr act i ce and ar e post ed i n Cal cu cutt t a area ar e al so el i gi bl e f or h hou ouse se r en entt al l ownce as adm admi ssi bl e t o t he S Stt at e e em mpl oy oye ees o off ot her cat cat egori es. Normal l y on onll y on one e of of t he spe speci ci al pays pays ment ent i oned oned i n i t ems( b) ( c) and( e)ab e)abov ove e i s ad adm mssi bl e to a Med edii cal cal Of f i ce cerr at a ti me i . e. , not mor e t ha han n o one ne speci al pay pay can be drawn si mul t an aneo eousl usl y.

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