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

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

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
o Limited career opportunities for doctors with delayed first promotion
o 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

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

Journey : Conception Phase
Year Major Initiatives
2009-10
(Preparatory
Works)
? Discussion initiated
? SHRMU Created
? Evidences collected
? Exposure visits conducted- Tamilnadu & Maharastra
? Series of Expert Consultations held
? Draft Document prepared- “Public Health Cadre in
Odisha”
2010-11
(Shaping future
Structure &
System)
? Series of meetings conducted with Policy makers at
highest level - Development Commissioner, Chief
Secretary, Hon’ble Chief Minister
? Decision taken to create Public Health Cadre

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.”

Implementation Phase Begins
? 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)
Director
Addl.
Director
JD(1) JD(2) JD(3)
DD(1) DD(2) DD(3)
ADMO(PH) DSMO
District
State

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

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

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
Journey in Progress... Expansion Phase

Grade
No of Positions
Before
Restructuring
Restructured
Cadre
Public Health
Special Secretary Grade 1 2
Common Cadre
Senior Administrative Grade (Director) 5 12
Selection Grade (A.D-I)
29
45
374 123
Selection Grade (A.D-II)
Joint Director I 120
895 120
Joint Director -II 431
Group A (SB) 1486 1708 335
Group A(JB) 3317 3683
Common Cadre
Total 5389 6719 578
Cadre Restructuring

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.

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

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

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

Major Challenges & Feasible Solutions
Challenges Solutions which may be effective
Delay in process during Stabilisation
Phase
Hiring Experts/ Establishing PMU to
support in the process
Concurrence from Finance Department Active involvement of Policy Makers at
highest level of Govt.
Initial resistance from doctors especially
clinical specialists, senior doctors and
association of government doctors
Cadre restructured with creation of
huge opportunities for promotion for
both clinical and public health
Specialists. Additional sanction positions
of clinical specialists at CHCs.

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

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

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2-PH-Cadre-Odisha.ppt

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