What ails the DGHS?

This dual structure has many deleterious implications. First, it inserts an institutional barrier between new medical knowledge discovered or accessed from the world scientific pool by the ICMR labs and the applications of that knowledge by the DGHS labs and institutes. The cliched euphemism would be that it is an ‘‘interface’’, but given the sociology and psychology of our scientific community and the problems of bureaucratisation in our governmental system, it is more of a barrier.

Second, ICMR is a so-called ‘‘autonomous institution’’ in the form of a registered society, whereas the DGHS is a government body. Each is subject to different policies related to personnel, procurement of equipment and materials, construction of buildings and even the specialised civil and electrical infrastructure required to house and operate sophisticated scientific and technical facilities. ICMR has its own practices in all these crucial areas of management and to that extent, has a fair degree of policy-making and managerial autonomy and ability to set up and run specialised equipment and have high-level S&T personnel on its staff. In contrast, the DGHS is subject to the dead hand of the Union Public Service Commission (UPSC) for personnel, the Directorate General of Supplies and Disposals in the Department of Supply (a World War II vintage creation of the British) for procurement and the CPWD for civil, electrical and other construction-related works. What’s more, the DGHS is an ‘‘attached office’’ of the Ministry of Health and Family Welfare. So it has very little administrative and financial autonomy vis-a-vis the Ministry. The civil service has ensured that the Director General has the salary of an Additional Secretary but not the designation, and hence not the powers. Even trivial matters have, therefore, to be ‘‘referred’’ to the Ministry where it often takes months for them to be ‘‘cleared’’.

Third, the DGHS is staffed by an integrated cadre of medical doctors who come from the medical service community rather than the medical research community. So, the Director of a DGHS lab like NICD may not only have been the Medical Superintendent of a Central Government hospital like Safdarjung or Ram Manohar Lohia, but even the Director of Health Services in a State! Therefore, his knowledge of the latest state-of-the-art system for testing and evaluation of pathological samples such as blood and sputum, the prevailing WHO standards for such tests and the internationally current techniques and instrumentation for conducting them, interpreting the data and reaching valid conclusions, may be inadequate. Furthermore, his tenure as Director NICD, VRC, Pune or any of the other DGHS labs may often be no more than two years. Thereafter, he is likely to be transferred to a DGHS lab in a totally different field of medical science, or even back to the stream of public health services provision. The time available for him to address the myriad problems of NICD is often too short to make an impact. This also makes any degree of scientific, technical and managerial specialisation next to impossible.

To add to all these problems is the severe financial constraints to which DGHS labs — even more than ICMR labs — have traditionally been subjected to. For example, during the 9th Plan (1997-98 to 2001-02) the plan outlay on all the DGHS labs was much less than that of ICMR despite both organisations having about the same number of labs in a similar range of medical sectors and disciplines. More seriously, the non-plan outlay of the DGHS labs over the same period was only marginally higher compared to the corresponding outlay in the 8th Plan period. It is from such ‘‘non-plan’’ funds that not only are staff salaries paid, but all the maintenance expenditure of the DGHS labs — maintenance and refurbishment of buildings, upkeep of lab campuses and equipment, purchases of spares and consumables, travel of scientists for conferences, purchase of books and journals for the library — are met. This non-plan expenditure is treated as ‘‘non-developmental expenditure’’ by the Finance Ministry. So, annual increases are often as low as 3 per cent, often below the inflation rate. This may be compared with the relative munificence of funding of even premier teaching hospitals such as AIIMS, Delhi and PGI, Chandigarh not to mention the luxurious National Institute of Immunology of the Department of Biotechnology, the Centre for Biotechnology of the Indian Agricultural Research Institute in Delhi or the Centre for Cellular and Molecular Biology of CSIR in Hyderabad.

It is time we realised that the skills, instrumentation and technical infrastructure in ‘‘service providing’’ labs of organisations like DGHS need to be as demanding as those in the R&D labs of ICMR. What is more, those skills, equipment and infrastructure are becoming more and more sophisticated with every passing day. So, the DGHS labs have to not only keep abreast of such advances worldwide, they have to undertake R&D on the testing and evaluation methods as also on the interpretation of the scientific data generated by the use of those techniques. Otherwise the labs will get outdated in no time, as many of them have.

There is, therefore, and has been for the last three decades, an urgent need to pump substantial plan funds into the labs of DGHS to modernise them on an all around basis. This must include: a review of their personnel policy and practices — chiefly the integrated cadre — taking at least the posts in DGHS labs out of the purview of the UPSC, giving the DGHS the freedom to design and implement modern sets of policies and practices for purchase of equipment and materials directly instead of going through DGS&D and similar freedom from OPWD in regard to construction. The Director General must be given the rank and powers, both administrative and financial, of an Additional Secretary in the Ministry of Health (as has been the practice even in regard to the Director General, Roads in the Ministry of Surface Transport since as far back as 1975). Only a multi-pronged revamping of this kind will give the DGHS the policy and operational autonomy it so badly and urgently needs to fulfil its important national functions.

— The writer is a professor in the Centre for Studies in Science Policy, JNU, New Delhi