Public Health is defined by a set of functions that utilizes available data on health and assures that multiple sectors are taking part in organized efforts towards universal health coverage. It is the art and science of preventing disease, prolonging life and promoting health through the organized efforts through a multi sectoral approach. Much has been deliberated and published about the gaps in Public Health system and inefficiencies of its initiatives. Over a period of time, a compartmentalized approach has been found to be ineffective in India and various attempts at taking an integrated view has had limited results. A systems approach to what ails the Public Health strategy easily throws up the fault lines in Design, Execution and Excellence areas of the overall system.
Current “Design” of Public Health interventions is fundamentally not for impact. Key achievement indicators for every part of the design is not pre-set and there is a rush to understand the effectiveness, post facto. In the current era where there is increasing demand for improved governance and accountability, policy needs to seek comprehensive performance measures that illustrate evidence of health systems strengthening innovations on service delivery and health outcomes. A focus on programs and operational metrics – while have their merits – measures only efficiency and leaves effectiveness out of purview. Clear frameworks, Strategy roadmap, Action plans, Communication, Mobilization, Technology all need to be subjected to the rigor of effectiveness. Every area has to have a goal and journey against these not only must be tracked but also the effectiveness measured and monitored.
Once the Design is in place the “Execution” engine plays an important role in ensuring effectiveness and achieving outcomes. Given the large scale required for execution in India the approach needs to be re-engineered with higher level skills and community focused delivery solutions. Most of the programs are developed in isolation and are sought to be shoved through existing delivery systems. Integration with sub-systems is often ignored and actually not revisited for decades leaving scope for lag to build. There also is a scope for making changes to the execution system in terms of political, legal and policy intervention that are cumbersome, time consuming and also needs champions to see through the entire transformation cycle. Also, there is a dearth of execution leadership that has often failed in making the operation engine work at its true potential. The operational practices and analytical tools are not current and there is no investment in technology, project skill upgradation and development of quali
ty health workforce in the country. Program management, Monitoring & Evaluation, training etc are the essential areas which need significant focus and improvement.
Public Health in India is at the forefront of understanding and addressing the barriers to available, accessible and effective Healthcare services. A well designed program requires “Excellence” in delivery. While investments are made in benchmarking, best practices studies before the design of an intervention, periodic checks for systemic interventions are clearly missing in the policy planning. Rare audits and operational checks only throw up the gaps that are then debated without any closure instead of a more positive approach of building excellence at every step of the Public Health delivery system.
An optimally evaluated program led by skilled workforce and community involvement are the key components of the “health ecosystem” in India. All these components been put together as a well ‘Designed’ program, best class ‘Execution’ and ‘Excellence’ would lead effectiveness of Public Health system in India. After enough efforts in enhancing efficiencies, it is about time that we bring the focus back on effectiveness to truly deliver world class healthcare services to our citizens.