Public Health Cadre In Odisha: Experiences, Learning and Way forward

1. Public Health Cadre In Odisha: Experiences, Learning and Way forward

2. Background • High IMR and MMR • Repeated outbreaks of communicable diseases with high case fatality rate (Malaria, JE, Dengue, TB etc.) • Increasing trend of Disease burden due to NCD • Public health posts largely managed by clinical specialists, who lacks in basic competencies of Public Health functions. • Limited opportunities for undertaking public health education

3. Public Health Cadre : Felt Need / Opportunities • Creation of Public Health Cadre - Conditionality under Incentive/Disincentives under NHM (2013-14) • A study by IIPH (PHFI), Bhubaneswar on career progression of government doctors revealed • Limited career opportunities for doctors with delayed first promotion • Clinical specialists neither interested nor competent for occupying public health posts • Establishment of IIPH (PHFI) Bhubaneswar with an MOU with state government for providing courses on public health. • Establishment of exclusive Cell: State Human Resource Management Unit (SHRMU) at Directorate of Health Services

4. Public Health Cadre : Felt Need/ Opportunities • Established Evidences (Doctors trained at AIIHPH, Kolkata and NIE, Chennai were performing better in dealing with public health issues- Study by IIPHB and NHSRC) • Technical Support from OHSP-TMST for developing Public Health cadre. • Commitment at highest administrative and political level

5. Journey : Conception Phase

6. Major Decisions on Creation of Public Health Cadre “The dedicated PH cadre in Odisha would initially start with separation of Public Health (PH) doctors from clinical positions and over a period of time, include other PH professionals such as Nurses, Paramedics and PH Managers to manage PH positions at different levels.”

7. Director Implementation Phase Begins Addl. Director • Directorate of Public Health established • Functions & Functionaries identified at State & District level • 6 Divisions included (Disease Surveillance, Waste Management, Mental Health, IDD, NCD, Vital Statistics) ADMO(PH) DSMO DD(1) DD(2) JD(1) JD(2) State DD(3) JD(3) District

8. Stabilisation Phase • Directorate of Public Health Strengthened : • Administrative & financial Structure & System established & made functional • On job Short Term & Long Term Training Courses on Public Health management provided with the support of Public Health Institutes • SHRMU spearhead the process • Issues : This phase continued for a quite longer period

9. Journey in Progress... Expansion Phase • Public Health conceptualised in a broader perspective • Structure & System expanded – Top to Bottom hierarchy level (Existing: Directorate &District level Structure) • Cadre restructured for meeting HR need (Public Health) • Public Health qualifications essential for Joining in Public Health Positions

10. Journey in Progress... Expansion Phase Restructuring of OMHS Cadre : Major Features • OMHS cadre restructured with creation of additional 1330 posts • Of which, 578 posts (9 %) identified as public health positions • Base level posts are of common cadre • Posts of CDM & PHO, Directors and Special Secretaries are of common cadre

11. Cadre Restructuring

12. Implementation Modalities • Selection of MBBS doctors for public health positions, in case of non availability of doctors with PH qualification. • Options invited at the time of first promotion • MBBS doctor, opting for PH positions, will be trained in public health management by Government • Doctors with post graduation in clinical and Para-clinical disciplines not eligible for public health positions.

13. Organogram : Revised Structure (State Level) Commissioner -cum- Secretary MD NHM PD OSACS Food Safety Commissioner MD OSMCL Special Secretary (Medical Services) Special Secretary (Public Health) Additional Secretary 1 Additional Secretary 2 Directorate Health Services Capital Hospital RGH Blood Safety Nursing SIHFW Family Welfare Health Intelligence Public Health Food Safety

14. Organogram : Revised Structure ( District Level) Chief District Medical & Public Health Officer (AD - I) DMO (Medical Services) - cum Medical Suptd - DHH (AD - II) DPHO (AD - II) Specialist & MOs of DHH (AD- II, JD, Grp A SB & Grp A JD) ADPHO (TB) (JD) ADPHO (Urban) (AD - II) ADPHO (FW) (AD - II) ADPHO (Leprosy) (JD) ADPHO (Disease Control &IDSP) (JD) ADPHO (VBD) (AD - II) Superintendent SDH (AD - II) BPHO (Grp A Senior Branch) Superintendent of CHCs Superintendent urban CHC (Grp A SB) Specialists & MO of SDH (JD, Grp A SB & JB) UPHO (Grp A Senior Branch) Medical Officer (Grp A JB) (PHC) Medical Officer (Grp A Junior Branch) (UPHC) Specalists & MO of CHC including urban CHC (GrpA JB) & Other hospitals with Specialist)

15. Scope for Career Progression Special Secretary Directors Capsular Course on Public Health & hospital Mgmt. CDMO & PHO AD - I Capsular Course on Public Health & hospital mgmt. AD - II District M.O (MS) DPHO/ Addtional Director JD Specialist/ GDMO DHH ADPHO/ Joint Director BPHO/ UPHO Class A SB Specialist/ GDMO SDH Option for clinical position Option for PH position PG or diploma in clinical PG or diploma in public health Class A JB Specialist CHC PHC (N)/ GDMO (CHC) Post Graduate Doctor MBBS

16. Major Challenges & Feasible Solutions

17. Way Ahead….. • Finalisation of job descriptions • Development of training modules, and identification of institutions for collaboration on training • Finalisation of cadre rules

18. Key Success Factors • Administrative and political commitment • Leadership of present Health Secretary, who initiated the whole process as MD, NRHM during 2011 • One unit – SHRMU taking responsibility and leading the process • Technical and coordination support from academic institute – IIPH (PHFI) Bhubaneswar • Funding support from OHSP and NHM • Promotion of the concept by providing incentives by GOI • Intensive consultative process

19. Thank You