Developing a Public Health Cadre in 21st Century India: Addressing Gaps in Technical, Administrative and Social Dimensions of Public Health Services.

This paper presents a possible framework for designing a public health cadre in the present context, with lessons from health services development of the last six decades. Three major gaps that the public health cadre is meant to bridge have been identifi ed. These are capacities within the system to address the technical requirements (epidemiological and health systems analysis); administrative/managerial dimensions; and the social determinants of health. Therefore, it argues that the cadre must not only have a techno-managerial structure, but also create a specifi c sub-cadre for the social determinants of health.

Aren’t Technological Choices Central to Designing Health Systems.

This paper argues that delivery of technology-based preventive, promotive and curative care is one of the central tasks of any health-care system and therefore it forms one of the central pivots for rational structuring/re-structuring of a health-care system. The development of our public health system has, historically, adopted health technologies (HT) uncritically and thereby not explicitly developed institutional mechanisms to assess them for rational choice. Determinants of HT policy choices and structuring of a service delivery system based on that are discussed with examples of modern low cost HT, technologies of codifi ed health knowledge systems other than the modern and local health traditions. Various forms of institutional structures for HT assessment and R and D using a comprehensive primary health-care approach are suggested.

Critical perspectives on the NIMH initiative “Grand Challenges to Global Mental Health”.

In July 2011 Nature carried a Comment titled “Grand Challenges to Global Mental Health”announcing research priorities to benefit people with mental illness around the world. The essay called for urgent action and investment. However, many professionals, academics, and service user advocate organisations were concerned about the assumptions embedded in the approaches advocated and the potential for the project to do more harm than good as a result. Nature refused to print a letter (sent on 20th August 2011) protesting against the issue, citing ‘lack of space’ as the reason. This letter is an effort to critique the initiative through wide participation and consensus

Evidence-based National Vaccine Policy.

India has over a century old tradition of development and production of vaccines. The Government rightly adopted self-sufficiency in vaccine production and self-reliance in vaccine technology as its policy objectives in 1986. However, in the absence of a full-fledged vaccine policy, there have been concerns related to demand and supply, manufacture vs. import, role of public and private sectors, choice of vaccines, new and combination vaccines, universal vs. selective vaccination, routine immunization vs. special drives, cost-benefit aspects, regulatory issues, logistics etc. The need for a comprehensive and evidence based vaccine policy that enables informed decisions on all these aspects from the public health point of view brought together doctors, scientists, policy analysts, lawyers and civil society representatives to formulate this policy paper for the consideration of the Government. This paper evolved out of the first ever ICMR-NISTADS national brainstorming workshop on vaccine policy held during 4-5 June, 2009 in New Delhi, and subsequent discussions over email for several weeks, before being adopted unanimously in the present form.