Need and Challenges of Management Education in Primary Health Care System in India

Primary Health Care System in India is very large and covers almost all the parts of the country. It has more than 20,000 PHCs and 140,000 Sub-centres spread in more than 400 districts. This system consumes large amount of resources and is the system which provides the services for primary care including preventive programmes. The system is mainly managed by doctors, some of whom have brief public health training. This paper argues that given the lack of training of doctors in management it is imperative that the doctors who are put in charge of the PHC system receive reasonable skills and training in management so that the resources spent on the PHC system can be utilised well – in an efficient and effective manner. Unfortunately the experience so far has been that there is hardly any systematic effort on adequate scale to meet the training needs of the PHC system for management training. The efforts done so far, even under the internationally supported projects are too less and of poor quality. It is also observed that most management training is very divorced from the day-to-day realities of the working of the PHC system and the kind of challenges they face. Finally the paper argues that substantial efforts will be needed to be put in preparing doctors for the management posts in the PHC system. This will require large investments in training and linking training to practice in the field. The paper also reviews available documents of the newer projects in health to see if there are indications that such a training will happen in future. The paper argues that there is a need for developing a separate health management cadre in India who will be trained in public health and health management to take up leadership role in PHC system in future.