Amit Mohan PrasadThe focus of public health in India is largely on reproductive and child health and communicable diseases. The vast network of primary health centres and sub-health centres is geared towards maternal and child health, vaccination against communicable diseases, and their treatment.Child mortality has been a major public health concern and so has maternal mortality. With continuous efforts and incremental improvement over the years, we are in a much better position today. The Infant Mortality Rate (IMR) has come down from 129 in 1971 to 25 in 2023; and the Maternal Mortality Ratio has reduced from 398 in 1997-98 to 87 in 2022-24.These are impressive achievements and, seen at a macro level, imply that we are saving lakhs of children and mothers every year who would otherwise have died.Communicable diseases like malaria, filariasis, tuberculosis, plague, cholera, measles, chickenpox, etc., have always been a cause of concern, as they affect large populations and can cause many deaths.Since other determinants of health, such as water, nutrition, sanitation, and hygiene, have not been up to the mark, the spread of communicable diseases and their adverse effects on the population have always been a major concern.Some of the dreaded communicable diseases, like polio and smallpox, have been eradicated, and maternal and neonatal tetanus have been eliminated.However, communicable diseases will always demand our attention, as viruses mutate, new viruses emerge, and they can create havoc, as was the case during the Covid-19 pandemic. The danger with communicable diseases is that they can spread fast and affect a large population in no time if not managed properly and timely.Having said that, with increasing longevity, non-communicable diseases are now a major source of concern for society. Problems such as diabetes and hypertension are now common in India. Samantaray et al., in their article published in June 2026 in Discover Public Health, estimated that 15.37% of the adult population suffers from diabetes and 34.84% of the adult population is hypertensive in India.These two conditions are treated by postgraduate physicians in govt hospitals, and many patients can be appropriately managed by physicians trained in internal medicine, with referral to super-specialists when required. With appropriate additional training, physicians in medicine can manage these two very common ailments in Tier-2 and Tier-3 district hospitals.It is common to hear about people suffering heart attacks, having strokes, or suffering from chronic kidney disease.While many patients with these conditions can be managed at the primary or secondary-care level, acute and complicated cases often require timely access to super-specialists, viz., cardiologists, neurologists, and nephrologists, respectively, who are difficult to find in Tier-2 cities and rare in Tier-3 ones.Even when they are available, they are often found in private-sector hospitals, which are too costly for the common man. In the absence of adequate medical facilities in govt hospitals, where treatment is either free or available at negligible cost, the poor turn to quacks and put themselves in greater danger.Earlier, there used to be a course for a diploma in cardiology. These diploma holders were a great resource for govt hospitals for running their cardiac care centres. Civil Hospital in Lucknow is one such example, where a whole cardiac care centre was efficiently run and managed by these diploma holders. Many other hospitals were providing this facility, staffed by diploma holders.The diploma in cardiology was subsequently discontinued, and cardiology came to be treated as a super-specialty requiring higher postgraduate training. As a result, govt hospitals in many smaller cities and districts may not have access to cardiologists, and patients may have to be referred to govt medical colleges (which are not present everywhere) with cardiologists or to private hospitals having specialists, which are expensive and beyond the means of the common man.There is also the time-critical nature of acute cardiac emergencies, and travelling to bigger cities for specialist care can be time-consuming and life-threatening.A similar scenario prevails in acute stroke as well. It is essential to ensure medical intervention as soon as possible after a stroke. Early assessment and appropriate treatment can substantially improve outcomes, while delays can result in preventable death or long-term disability.People who access medical care promptly after a stroke have a better chance of a favourable outcome, but those who do not receive timely treatment may suffer throughout their lives, either with speech, cognitive, or motor disabilities.The third disease is chronic kidney disease, which requires lifelong intervention. With early detection and appropriate treatment, progression of chronic kidney disease can often be slowed and, in some patients, the need for dialysis can be substantially delayed. Even when dialysis starts, people will not have to travel large distances if qualified doctors are available close by, thereby saving time and money for the patients.The National Health Mission provides dialysis facilities at the district level now but access to comprehensive medical and specialist care for patients with chronic kidney disease remains uneven.The Government of India and the National Medical Commission should consider this to ease the situation. Diploma courses for govt doctors with an MBBS can be restarted for cardiology and started afresh for neurology and nephrology.They will not be licensed or eligible for private practice and will have to furnish a bond in this regard. Starting diploma courses in the three branches is feasible, as a diploma course in cardiology was run in the past and the graduates were providing very valuable service to the people.(Writer is a former IAS officer and served as additional chief secretary, health, UP during Covid pandemic)
