The Union Ministry of Health and Family Welfare has issued a fresh, urgent directive to the Kerala government, pressing for the immediate acceleration of the state's Public Health Management Cadre (PHMC) rollout. This communication comes ahead of a scheduled national progress review, signaling the Centre's focus on expediting this critical health system reform.
A National Mandate with a Mission Mode Directive
In a letter sent to all states and union territories last week, the Centre has specifically asked Kerala to assess its current implementation status and fill all existing vacancies "on a mission mode." The communication underscores that the creation of the PHMC is not optional but a national mandate under the National Health Policy of 2017. It reminds the state that its health ministers had committed to completing this reform within defined timelines during the 13th, 14th, and 15th meetings of the Central Council of Health and Family Welfare.
The core objective of the PHMC is to fundamentally strengthen health systems by ensuring a clear separation between clinical duties and public health roles. The initiative aims to build dedicated leadership at district and block levels while institutionalising preventive and promotive healthcare services.
Learning from Pioneers and the Pandemic
Along with the directive, the Union Ministry enclosed a detailed guidance note highlighting the progress made by states like Tamil Nadu and Odisha. These states have moved ahead with restructuring their cadres and integrating trained public health professionals into the system.
The document draws crucial lessons from the Covid-19 pandemic, stating unequivocally that states with dedicated public health cadres "showed greater resilience" during the crisis. Such structures helped them avoid major disruptions in essential health services, a point the Centre is using to bolster its case for rapid implementation in Kerala.
A Structured 12-Week Action Plan for Kerala
The Centre has laid out a concrete and rapid action cycle for Kerala to follow, benchmarked at just 12 weeks. The key steps in this cycle include:
- Activating or strengthening a dedicated state task force.
- Mapping all existing health staff comprehensively.
- Reorganising personnel into four defined cadres: Public Health, Health Management, Specialist, and Teaching.
- Developing and rolling out a time-bound roadmap for training and career progression.
- Submitting a finalised implementation plan to the state cabinet.
Following this, the state must commit to a quarterly review of the rollout status. The guidance also introduces significant career-linked mandates: new MBBS doctors joining Kerala's health service will be required to obtain a public health qualification within 3-5 years. Furthermore, leadership positions at district and block levels must prioritise professionals trained in public health, supported by robust data monitoring systems.
The Union Health Ministry has announced that a follow-up review meeting will be convened soon to track progress and address state-specific challenges, indicating that the Centre will measure not just compliance but the speed of execution.
Reshaping Kerala's Health Governance
For Kerala, which boasts a historically strong but clinician-driven primary care system, this reform has the potential to reshape its health governance. It would redefine leadership for district-level planning, disease surveillance, and overall public health management. With the deadline for national alignment approaching in the next financial cycle, this latest communication places the onus on Kerala to demonstrate tangible evidence of moving towards a cadre-based, structured public health workforce.
