Prime Minister of India - Dr. Manmohan Singh

PM launches Public Health Foundation of India

It gives me great pleasure to be with you at the birth of the Public Health Foundation of India. I commend all those who have worked with passion and commitment to create this Foundation. I wish you every success in this endeavour to galvanize public health in India and to guide policy in this critical area of social development.

The importance of public health in India's development cannot be over emphasized. Ours is a demographically young country. The largest growing demographic segment in India over the next two decades lies between 15 and 59 years. This provides a wide window of opportunity to enhance national growth, if we can productively deploy this human resource. However, this requires adequate investment in education and health; the two vital areas of human resource development. If we do not effectively upscale knowledge and skills of our people and act purposefully to protect and promote their health, we run the risk of wasting this precious human resource.

Good health is not merely a developmental resource - it is an inalienable human right of every citizen of this country. Every Indian has the right to demand and obtain essential preventive, promotive, diagnostic and curative health services. It is the bounden duty of the state as well as society at large to ensure that this right is fully respected and adequately realized.

However, the management of health has overly focused on clinical management of diseases and ignored the larger social and economic context in which health is best managed. It has been aptly said that the conventional understanding of malaria is that it is caused by an Anopheles mosquito but if you widen the lens and ask what facilitiates the mosquito, the answer may be that we are living in an environmentally degraded space. And further analysis would reveal that this in turn may be the result of economic causes. Therefore health issues need to be conceptualized in a framework that understands these relationships, even though a specific disease itself can be treated through a mixture of social and clinical management. Issues of health particularly in developing countries have strong links with social, economic, environmental and cultural factors. They therefore need responses that appreciate intersecting spaces.

It is this understanding of the intersecting spaces within which health policy needs to be located that the initiative of the PHFI has posed before us. It seeks to bridge a very major gap in our health education by training professionals in disciplines that relate to health, such as economics, sociology, demography and environment�in addition to management of diseases. We need to develop a new cadre of professionals who are managers of health and not just of diseases. We have good quality human resources in the area of clinical management. But we woefully lack public health managers. I commend the PHFI in taking this initiative to bridge a critical gap in health education and in blazing a trail by setting up a series of public health schools.

From what I see, we face a major gap in human resources in health. We have recently asked the Planning Commission to make an assessment of the scenario of human resources for health. This is important to address the wide inequalities in the provision of services within India. While states like Kerala, Tamil Nadu and Gujarat may have acceptable standards, there are several states in the country which do not have even the minimum number of institutions to turn out support staff for health care. There are also serious lacunae in the capacity of the health sector to absorb and optimally utilize extra financial resources. This gap must be bridged to ensure effective delivery of programmes. Programmes for the poor will degenerate into poor programmes, if these deficiencies are not corrected.

We must also address the capacity gap among health personnel. The skewed distribution of specializations among our doctors is also a concern. There is a severe shortage of trained public health professionals with broad based multi-disciplinary knowledge of the determinants of health. Such deficiencies are more acute within our public health services sector, and this generates a more severe impact than deficiencies in clinical medicine. They complicate the task of managing public health programmes. Such lacunae also impose an additional burden on medical doctors, who are trained primarily as clinical care providers. All of these problems have resulted in the suboptimal performance of major health programmes. We need public health professionals equipped with expertise and managerial skills to design and deliver health programmes at the national level and down to the village level. We must also provide relevant training to enhance the capabilities of health care providers involved in public health activities.

Apart from the lacunae, there is also the realm of future opportunities. India faces the possibility of becoming a global destination for cheap and high quality health care. The demographic contrast between a young India and an aging world gives us an opportunity to train professionals at different levels to meet the needs of the emerging global care industry. These issues have not come on the policy radar because of the absence of institutions like public health schools which would have tracked such issues.

Our Government is sensitive to these issues. Quite apart from an unprecedented increase in budgetary allocations, we have tried to make architectural corrections in our programmes to see health in a holistic framework through the National Rural Health Mission. The Mission will not only seek to reduce inequities in health in rural areas, it is also designed to greatly improve access to essential health services and to enhance citizens' control over healthcare planning. We are trying to move away from centralized management of health care to decentralized management through the development of district plans. These will not only address management of diseases but also the determinants of health care such as safe water, sanitation and nutrition. This major agenda can be effectively implemented only with adequate planning capacity at the district level. I look forward to your public health schools helping us bridge this gap by training people who can in turn build capacities at middle and senior management levels in the Indian health system.

I would also like you to develop an Indian agenda both in academics and research. Many tropical diseases are under- researched and this institution could, by harnessing the best technical expertise from all over the world break new ground in the management of tropical diseases. A research agenda responds to the Indian situation would also emerge.

I am happy that the Public Health Foundation of India has many of these issues on its agenda. I hope the public health professionals you train will help transform the state of our public health services. From my own personal observations, In many areas of social development, our problem is not a lack of ideas. On the contrary, institutions have failed to deliver. I therefore hope the PHFI will also invest in capacity-building in existing public health institutions across the country. We also need to revitalize and strengthen departments of social and preventive medicine in our medical colleges. We have a rich legacy in this area, but of late, we have neglected this aspect. Your efforts will help invigorate our health services and contribute to the success of health programmes.

Apart from insititutional work, it is necessary to make capacity building programmes transcend training public health professionals. We need to enhance health literacy among all sections of our people. Every citizen of India can contribute to public health through measures to protect individual health as well as by acting to promote societal health. We must empower people to become effective agents for the promotion of personal and public health. I hope your Foundation will also undertake programmes in health education and assist in community empowerment in this area.

The setting up of the Public Health Foundation of India presents an opportunity to develop innovative models of public-private partnership in social sector programmes. Such partnership can help blend the commitment of government with the operational efficiency of not-for-profit private groups. There are many noteworthy examples of the latter, such as Dr. Devi Shetty's hospitals, Dr V. Shantha's Cancer Institute in Chennai and so on. Regrettably, on the whole, the record of the private sector in health care provisioning in India has not been very good even though it is the dominant source of health care provisioning. We are all familiar with reports of unethical practices, including commissions given in return for referral and diagnostic work. We must have appropriate measures to tackle this.

In this context, I congratulate the corporates who have contributed to this laudable effort. I hope others will also follow suit with their generous support. It is heartening to see that support is also being offered to this initiative by several international academic institutions of high repute and by corporate houses and corporate philanthropists from other countries. Such inspired support as part of a public private partnership is heartwarming. We also hope that State Governments will find it beneficial to partner your initiative to introduce greater levels of expertise into their public health system. You can also assist our States by mobilizing resources to build capacity to strengthen public health in a sustainable manner.

I am extremely happy that this initative has come up in public-private partnership. I applaud the splendid spirit of international cooperation that underlies this cooperative effort. I am confident that the institutions established by PHFI would build bridges with other institutions in many countries, to collaboratively share knowledge and collectively shape the future of global public health. I would like to congratulate and thank all donors who have graciously contributed to this noble effort. Dreaming together and working together is an idea that has now begun to work in many parts of the world. I wish your initiative all success. I look forward to receiving reports of your steady progress in helping us improve the quality of life of our citizens.

Thank You.