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THE NATIONAL MEDICAL JOURNAL OF VOL. 5, NO.6 291 Medicine and Society

An Indian Medical Service?

G. K. VISHWAKARMA

INTRODUCTION voting) that it was necessary or expedient in the national Before Independence, existed in civil interest to do so, then Parliament might by law provide for administration, police, engineering, forestry and education the creation of one or more All India Services common to the while in medicine, there was a well-organized Indian Medical Union and the States. Service. Although this had both a military and civil wing, it was meant primarily for the needs of the armed forces, and MORE ALL INDIA SERVICES most of the civilian officers were held in reserve to meet the The need for having more All India Services was first stressed requirements in times of war. by the States Re-organization Commission in its report pre- The head of the Indian Medical Service was the Director sented in 1955 which was endorsed subsequently by the Chief General who was responsible for keeping the service and the Ministers Conference on National Integration in August Indian Medical Department up to strength, for placing a 1961. Thereafter the in December 1961 passed number of officers at the disposal of the Commander-in- a resolution under Article 312( 1) of the Chief of the Army for military duty and for recommending to provide for the creation of three new All India Services, officers for promotion. namely, the , the Indian Service of The Public Health Commissioner, who was also a member Engineers and the Indian Medical and Health Service. of the Indian Medical Service, was Adviser to the Government The All India Services Act, 1951, was suitably amended in of India in the Department of Education, Health and Lands. September 1963. However, only the Indian Forest Service He also acted as Director of Research and was Secretary of has been formally organized. the Scientific Advisory Board and of the Governing Body of the Indian Research Fund Association. He controlled the THE INDIAN MEDICAL AND HEALTH SERVICE Medical Statistical Bureau and was responsible for port In 1963, the Chief Secretaries Conference discussed a broad quarantine, the medical aspects of overseas pilgrims and outline of the proposed Indian Medical and Health Service. emigration traffic, and for all aspects relating to international Various issues were settled including the rates of remunera- health. tion, encadrement of posts, grant of non-practising allowance The Bhore Committee, appointed by the Government of and conditions of eligibility for State Medical and Health India, to look into restructuring of the health services sub- Service officers. A draft memorandum and drafts of the rules mitted its report in 1946. With the attainment ofIndependence for regulating recruitment were drawn up and were further in 1947, major changes were made in the health administra- discussed by the Sub-Committee of the Central Council of tion. One of the important recommendations of the Bhore Health in June 1966. These drafts were forwarded to the state Committee was to combine, under a single administrative governments for their comments in November 1966. head, the medical and public health departments both at the The Governments of and considered centre and in the states. Thus the posts of Director General the proposal to be an encroachment on the states' autonomy. of the Indian Medical Service and of the Public Health However, Kerala did not withdraw its consent for participat- Commissioner were abolished on 5 August 1947 and ing in the service. The Government of suggested substituted by the post of Director General of Health certain radical changes in the method of recruitment which Services, who became the principal adviser to the Govern- were not acceptable to the central government. ment of India in both spheres of health administration. A In May 1968, the reconsidered the similar change also took place in most of the states. The matter in the light of the comments made by the state govern- Indian Medical Service was also abolished on 15 August ments and decided to constitute the service excluding the 1947, however, the serving officers continued under the states of Tamil Nadu, Karnataka and (which was Government of India. not covered initially). In January 1969, the recruitment rules All the other All India Services were disbanded, except the were finalized and a notification issued constituting the Indian Indian (which became the Indian Administra- Medical and Health Service with effect from 1 February tive Service) and the Indian Police (). 1969. The recruitment rules, the initial recruitment regula- In Article 312(1) ofthe Constitution ofIndia, it was provided tions and the cadre rules were also notified in February 1969. that if the Rajya Sabha declared by a resolution (supported All the documents were placed before both the Houses of by not less than two-thirds of the members present and Parliament as required under the provisions of the All India Services Act, 1951. Thereafter the Governments of Punjab, G. K. VISHWAKARMA Former Director General Health Services, , and also expressed their Ministry of Health and Family Welfare, Nirman Bhavan, unwillingness to participate in the scheme, thus taking the New 110001 total of such states to seven. © The National Medical Journal of India 1992 292 THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 5, NO.6

FURTHER PROGRESS state cadre. The members of the All India Service would be In April 1970, the Consultative Committee of Parliament recruited and appointed by the central government, but they attached to the Ministry of Health, discussed this issue and in would be allotted to the various state cadres. Even when July 1970 the Executive Committee ofthe Central Council of serving under the central government, the officers would Health also reviewed the progress. The matter was also continue to be borne on the state cadres and their term of discussed by the Consultative Committee of Parliament in service under the central government would be treated as on August 1972 which was informed by the then Minister of tenure deputation. While the normal mode of recruitment to an Health and Family Planning that the government would All India Service would be by direct entry at the lowest level of proceed with the formulation of the service even if some the service on the basis of a common all-India level examina- states stayed out. tion and/or interview to be conducted by the Union Public However, on 26 July 1974, the then Minister of Health and Service Commission, provision would also be made for filling Family Planning (Dr Karan Singh) felt that it would not be up a certain percentage of posts in each state cadre by promo- wise to press for the creation of an All India Service until tion, from officers working in that branch of administration at least a majority of the states clearly indicated their willing- in that state. ness to accept it. With respect to most of the service conditions such as death- In the Eighty-ninth report of the Estimates Committee of cum-retirement benefits, leave, conduct and disciplinary the fifth , presented to Parliament on 5 February matters, the All India Service officers would be governed by 1976, it was observed that the formation of the All India the rules framed by the central government, in consultation Services in Engineering, and Medicine and Health should be with the state governments, which incidentally would apply expedited and finalized within a fixed time limit. to all the different All India Services. However, regarding Therefore, the Conference of Chief Secretaries in May several other matters like local compensatory allowances 1976 decided that steps should be taken to form the Indian and travelling allowance, the All India Service would be Medical and Health Service. In July 1976, the state govern- governed by the rules and regulations framed by the state ments were asked to confirm their agreement to participate government in which they served. in the Indian Medical and Health Service. However, the The other advantages would be: response was not very encouraging. The Department of 1. Common recruitment-would ensure uniform standards of Personnel and Administrative Reforms took the view that medical administration in all states. the constitution of the service should be notified and the 2. Standards of the medical profession would be raised and details could be worked out later. The notification was issued the services provided to the people would improve. on 25 January 1977, but was later withdrawn. 3. Central and state governments would have a wider choice In July 1977, the then Prime Minister (Shri Morarji Desai) in selecting suitable officers to man senior posts. remarked that a new All India Service should not be added. 4. Posting of officers to the centre from the states and their In March 1978, the Cabinet decided not to constitute the return to their parent states after completion of their Indian Medical and Health Service and the state governments tenure would enrich their experience benefiting both were accordingly informed in April 1978. governments. The question of reconstitution of the Indian Medical and 5. A well organized and well managed Indian Medical Health Service was again considered by the Cabinet in 1981 and Health Service could reduce private practice. and it was decided that the state governments might be infor- THE DISADVANTAGES mally consulted and their views ascertained. In 1986, the Department of Personnel and Training re-examined the However, the difficulties likely to crop up in the creation of whole concept. It was noticed that only seven states had the All India Medical and Health Service could be: agreed to the constitution of an Indian Medical and Health 1. All state governments and union territories might not Service, twelve did not express any views and the remaining agree to participate in the service. had disagreed. 2. Some states might consider it to be an encroachment upon While there was no legal impediment in constituting an All their autonomy. India Service in which only some states participated, it was 3. It would be against the policy of decentralization. felt that there were many reasons against doing so. The then 4. In view of the large number of specialties and sub- Prime Minister (the late Shri ) also agreed with specialties into which the proposed service would have this viewpoint. to be divided, there are misgivings on the feasibility of applying the normal concept of interchangeability of THE ADVANTAGES OF AN ALL INDIA SERVICE officers. The philosophy behind the creation of All India Services is 5. State governments may ask for financial help from the that in a vast country like ours, with different religions, centre to meet the additional cost involved in the creation languages and customs, such services would be able to playa of the service. vital role in national integration. They would also provide 6. Only a small fraction of the officers belonging to the Central stability and continuity in administration. Health Service would find a place. in the Indian Medical The basic concept of an All India Service is such that each and Health Service. The rest would have to continue in service would stand divided into a number of state cadres the Central Health Service. including one for the Union Territories. Each state cadre 7. Health being essentially a state subject, unless all the states would have a central deputation quota consisting of an aggre- give wholehearted support, the scheme would be a non- gate number of senior posts under the central government starter. likely to be held by the officers of the All India Service of that I feel it is important to discuss whether another effort should be made to form an Indian Medical and Health Service.