Urgent need to re-introduce Indian Medical Services to address India’s healthcare needs, say medical experts

Hhink Change Forum (TCF), an independent think tank dedicated to generating new ideas and finding solutions for navigating through a new changing world, recently held a panel discussion titled — Is it time for India to resurrect Indian Medical Services? The discussion highlighted the imperative of strengthening the public healthcare system and emphasised the pivotal role that Indian Medical Services (IMS) can play in achieving this objective.

The panel consisted of representatives from medical associations, public-sector health institutions, and the private medical sector. The participants included Dr Sharad Agarwal – National President, the Indian Medical Association (IMA); Dr Varuna Pathak – Former Professor of Gynecology & Obstetrics, Gandhi Medical College, Bhopal; Dr Sita Naik – Professor and Head of the Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences; Dr Vidur Jyoti – Senior Director & Head, Minimal Access & General Surgery, Max Hospital, Gurgaon; Dr Rajesh Gupta – Additional Director, Pulmonology & Critical Care, Fortis Healthcare, Noida; Dr SL Vig – Assistant Professor Community Medicine – ESIC Medical College Faridabad.

Experts urged for the introduction of an elite cadre for medical experts under Indian Medical Services (IMS) akin to Indian Administrative Services (IAS).

IMS will help bring the sheen and trust back to the public health sector which has been lost to the private sector; help stop the brain drain from public medical services by attracting and retaining the best medical talent; allow for superior healthcare outcomes with better-managed facilities and processes, as no longer generalists will be managing the specialists; reduce health crises and reduction in tertiary cases by improved preventive healthcare at primary levels; and last but not the least will enable seamless coordination between states and Centre for healthcare policymaking.

IMS was present during the British era but was discontinued after India’s Independence. The current government has made commendable efforts in healthcare and has implemented impactful schemes like Ayushman Bharat. However, still, the gap is huge, requiring systemic changes.

Expert panellists have proposed a ‘5-Point Agenda’ for bringing IMS back in India:

The first point emphasizes an excessive reliance on the private sector to meet the healthcare demands of Indian citizens. Overall, the healthcare infrastructure is fractured and falls short of providing quality and effective healthcare at scale. These shortcomings primarily stem from inefficient bureaucratic management rather than a lack of skills among healthcare professionals. An IMS will help bring the sheen and trust back to the public health sector which has been lost to the private sector.

Explaining this, Dr Rajesh Gupta said, “The majority of the Indian public relies on the private sector for healthcare services, with 60 per cent of inpatient admissions (IPDs) and 80 per cent of outpatient visits (OPDs) occurring in private facilities.”

Dr Varuna Pathak, elaborated further, “Most of the time, we observe systemic failures in healthcare, which are not necessarily the fault of healthcare professionals but rather of the administrator who would typically be a generalist bureaucrat.”

Dr Vidur Jyoti said, “During the COVID-19 pandemic, the challenges and bottlenecks encountered in managing contingencies were primarily attributed to bureaucratic hurdles rather than any lack of commitment from healthcare professionals.”

The second point highlighted challenges in staffing the public healthcare system with skilled doctors. The lack of incentives for these highly educated professionals to work under generalist administrators has resulted in a brain drain. To retain quality doctors and ensure health security for the population, there is an urgent need to establish IMS which will help stop brain drain from public medical services by attracting and retaining the best medical talent.

Dr. Sharad Agarwal said, “The implementation of IMS holds the promise of enhancing service quality through induction of skilled doctors and addressing the persistent doctor shortage, especially in rural areas. Crucial to its success is equipping the cadre with ample facilities and resources comparable to those provided to IAS or IPS officers. This will ensure that doctors are incentivised to join IMS, drawn by a clear career trajectory and motivated to serve communities, even in remote areas.”

Dr. SL Vig said, “For fresh medical graduates, the IMS can serve as a promising career path, commencing with postings at district or block levels. Advancement of opportunities within the cadre should be structured, allowing progression based on experience, from community health centre (CSC) to district, state and eventually ministry levels.”

The third point underscored the necessity of superior health outcomes for the citizens with better-managed facilities and processes, which will happen when no longer generalists will be managing the specialists. Integrated Health Leadership, with leaders having both clinical capabilities and management capabilities, is what a country like India uniquely needs, to efficiently manage healthcare systems ranging from grassroots to the tertiary levels.

Dr Sharad Agarwal explained, “We are advocating for the reinstatement of IMS because healthcare requires a unique approach distinct from other fields. The case for an IMS becomes even more apparent when observing successful private healthcare setups, wherein medical professionals adeptly balance both clinical expertise and administrative skills.”

Dr Sita Naik also suggested that “There is a need to transform the Central Government Health Scheme (CGHS) into an all-India service in the form of IMS.”

The fourth point focuses on an urgent need to avert growing incidences of health crises and reduction in tertiary cases which can happen by improving preventive healthcare and delivery at primary healthcare levels. An effective IMS will enable this, which in turn reduces the cost of health for all stakeholders.

Explaining this, Dr Vidur Jyoti said, “The need for change in medical services in India lies in the fact that the essentials of healthcare are being overlooked. We are essentially moving into disease management and are neglecting health management which has put immense pressure on the tertiary system. In healthcare, the essentials are knowledge acquisition, deployment and application which require constant updating, unlearning and relearning. To effectively manage these complexities, it is necessary to have dedicated medical service officers in the country.”

Dr SL Vig said, “Along with primary care, we need to offer primordial prevention and primary prevention also.”

The fifth point highlights that an IMS will be able to enable seamless coordination and cooperation between the central and state health departments, for improved national healthcare policies for the country.

Dr SL Vig elaborated on this, “Respecting the constitutional framework, let’s preserve health as a state subject while introducing the IMS. Similar to other central services, the IMS cadre can serve as a force multiplier to implement central healthcare policies and schemes, customising them to meet the unique healthcare requirements at the state and community levels.”