Relevance of developing public health service cadres alongside a more prevention oriented Indian health system: an overview

Rounik Talukdar


The relevance of public health has been emphasized in the wake of the global epidemic COVID-19. There are several success stories that we often tend to forget, such as the fight against various infectious illnesses like smallpox, poliomyelitis, and current human-immunodeficiency virus (HIV) prevention, to name a few, public health has played a significant impact. Diarrheal diseases, for example, which contributes significantly to India's under-five mortality rate and is one of the leading causes of malnutrition, can be effectively handled by improving access to safe water and sanitation. Because public health encompasses more than just health, we require a workforce with managerial and leadership skills as well as training in public health as a specialty. This paper explores some of the successes and lessons learned from systematic investments in public health in the Indian state of Tamil Nadu, namely The Tamil Nadu model and other countries, as well as the system's flaws. In India, a feasible framework for establishing dedicated public health cadres has also been explored. Evidence was acquired from PubMed, Google Scholar, newspaper stories, and publicly released government orders and papers. The recruitment of cadres may resemble that of the Indian economic/statistical services (IES/ ISS) by the UPSC. Another area to emphasize for health professionals interested in public health is training. Starting from frontline workers, block level workers to district and state we need dedicated public health workforce. Moreover, the need of the hour is to establish such a system which will work alongside pre-existing clinical fields.


Indian Public health Service Cadres, Community health needs assessment, Public health, Tamil Nadu model

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India PT of. India gained more than a decade of life expectancy since 1990: Lancet. Business Standard India. 2020. Available at: Accessed on 15 August 2021.

Indian Council of Medical Research, Public Health Foundation of India, University of Washington, Institute for Health Metrics and Evaluation. India: health of the nation’s states: the India state-level disease burden initiative: disease burden trends in the states of India, 1990 to 2016. 2017.

Sankar MJ, Neogi SB, Sharma J, Chauhan M, Srivastava R, Prabhakar PK, et al. State of newborn health in India. J Perinatol. 2016;36:3-8.

Dandona R, Kumar GA, Henry NJ, Joshua V, Ramji S, Gupta SS, et al. Subnational mapping of under-5 and neonatal mortality trends in India: The Global Burden of Disease Study 2000–17. The Lancet. 2020;395:1640-58.

Kapur K. How fares India in healthcare? A sub-national analysis. ORF. Available at: Accessed on 15 August 2021.

Arcaya MC, Arcaya AL, Subramanian SV. Inequalities in health: definitions, concepts, and theories. Glob Health Action. 2015;8:10.

Maity S, Ghosh N, Barlaskar UR. Interstate disparities in the performances in combatting COVID-19 in India: efficiency estimates across states. BMC Public Health. 2020;20:1925.

Díaz-Vélez C, Soto-Cáceres V, Peña-Sánchez RE, Segura MAA, Galán-Rodas E. Clinical Epidemiology and Its Relevance for Public Health in Developing Countries. Current Topics in Public Health. Intech Open. 2013.

Sundararaman T, Parmar D, Professionalizing public health management. Available at: Accessed on 15 August 2021.

Functions of the Public Health System | HSM111. Available at: Accessed on 15 August 2021.

Kumar S, Bothra V, Mairembam DS. A Dedicated Public Health Cadre: Urgent and Critical to Improve Health in India. Indian J Community Med. 2016;41:253-5.

Middleton J. Public health in England in 2016—the health of the public and the public health system: a review. Br Med Bull. 2017;121:31-46.

Middleton J, Williams J. England. Organization and financing of public health services in Europe: Country reports. European Observatory on Health Systems and Policies. 2018. Available at: Accessed on 15 August 2021.

Health and wellbeing boards (HWBs) explained. The King’s Fund. 2016. Available at: https://www. Accessed on 15 August 2021.

Lee ACK, English P, Pankhania B, Morling JR. Where England’s pandemic response to COVID-19 went wrong. Public Health. 2021;192:45-8.

Covid: UK’s early response worst public health failure ever, MPs say. BBC News. 2021. Available at: Accessed on 15 August 2021.

Lawrence F, Garside J, Pegg D, Conn D, Carrell S, Davies H. How a decade of privatisation and cuts exposed England to coronavirus. The Guardian. 2020. Available at: https://www.theguardian. com/world/2020/may/31/how-a-decade-of-privatisation-and-cuts-exposed-england-to-coronavirus. Accessed on 15 August 2021.

Country comparison | Available at: /compare/cuba/india. Accessed on 15 August 2021.

Suravajjula DR. Lessons from Cuba’s healthcare. 2021. Available at: hans/opinion/news-analysis/lessons-from-cubas-healthcare-690952. Accessed on 15 August 2021.

José A, de LO. A first-hand look at public health in Cuba. Estudos Avançados. 2011;25(72).

Losman DL. The Embargo of Cuba: An Economic Appraisal. Caribbean Stud. 1974;14:95-119.

Pineo R. Cuban Public Healthcare: A Model of Success for Developing Nations. J Develop Soc. 2019;35:16-61.

Cuba says the U.S. embargo is “genocidal.” What does it really do? NBC News. Available at: Accessed on 15 August 2021.

Barry M. Effect of the U.S. Embargo and Economic Decline on Health in Cuba. Ann Intern Med. 2000;132:151-4.

Cuba: Emphasis on community-based primary care in a tiered system improves outcomes | PHCPI. Available at: Accessed on 15 August 2021.

Keck CW, Reed GA. The Curious Case of Cuba. Am J Public Health. 2012;102:13-22.

Ashton J. Shoe leather epidemiology in the age of COVID: lessons from Cuba. J R Soc Med. 2020;113:282-3.

Serena JM. Infant mortality rate drops by one point in Tamil Nadu. The Hindu. 2020. Available at: Accessed on 15 August 2021.

India’s maternal mortality ratio dips to 113 in 2016-18, Assam has highest and Kerala lowest. Available at: Accessed on 15 August 2021.

Tamil Nadu Budget Analysis 2021-22. PRS Legislative Research. Available at: Accessed on 15 August 2021.

Parimalam EJ, Sathishkumar V, Rajanbabu R. Public Expenditure on Healthcare in India and Tamil Nadu: Five-Year Plans. Indian J Public Health Res Develop. 2021;12(4):80-6.

Parthasarathi R, Sinha SP. Towards a better health care delivery system: The Tamil Nadu model. Indian J Comm Med. 2016;41:302.

The Development Monitoring and Evaluation Office (DMEO). Public Health Cadre in Tamil Nadu. NITI AYOG DMEO. Available at: in/evaluation/dmeo-evaluation-studies. Accessed on 15 August 2021.

Narula PS. Tamil Nadu Health: Review of Primary Health Centres and Schemes. Int J Adv Sci Tech. 2020;29:3415-23.

Agrawal S. Tamil Nadu’s showpiece primary healthcare is on display here in Thoothukudi in 2nd Covid wave. The Print. 2021. Available at: Accessed on 15 August 2021.

Public Health Cadre Restructuring and Capacity Building Further Developed Including in the Light of Findings and Recommendations of The Faculty of Public Health, UK. Department of Health & Family Welfare Government of Odisha. 2014. Available at: Accessed on 15 August 2021.

Sathyanarayan TN, Babu GR. Creating a public health cadre in India: The development of a framework for interprofessional and inter-sector collaboration. J Interprofessional Care. 2011 25:308-10.