Turf war brews in health sector over ‘parallel workforce’

Discontent is brewing in the Health department with public health field workers in the supervisory cadre up in arms against the “intrusion” by the National Health Mission which, they claim, has been appointing people in similar supervisory cadres, resulting in duplication of work and conflict in workplaces in many districts.

The Kerala Health Inspectors’ Union has written to the Additional Chief Secretary (Health) that it would resist any attempt by the NHM to threaten the work and authority of over 12,000 public health field workers in supervisory cadres across the State. The protest is over the appointment of epidemiologists and data managers by the NHM on contract basis in block-level public health units (BPHUs), whose work is essentially the broad evaluation and monitoring of data relating to communicable and non-communicable diseases, reproductive and maternal, newborn, child and adolescent health and health system strengthening, identifying gaps and conducting operational research studies.

NHM authorities point out that creation of BPHUs was as per the recommendations of the 15th Finance Commission so that these will “serve as a hub for public health action, disease surveillance, and diagnosis; improve decentralised planning and reporting; and strengthen primary health-care facilities at the block level.” The appointment of epidemiologists and data managers in BPHUs across all States were also as per the strictures of the Finance Commission and their task was to work in coordination with the existing health team, not to take over or supervise the staff of the Health department.

“We have not issued any orders that our BPHU personnel will be given supervisory powers over the existing field-level supervisors. We do not know why the Health department field staff should feel threatened,” a senior NHM official said.

BPHU personnel said that their task was to provide technical support and enable a coordinated, data-driven approach to disease control and health promotion at the block. The epidemiologists are medical graduates with additional postgraduate qualification in public health or epidemiology.

“We are part of the technical support team and our task is to provide technical support to the block medical officer for robust disease surveillance and public health interventions and to ensure data accuracy, data integration, and analysis. We are expected to evaluate the data that the field supervisors bring, identify gaps and give recommendations. Our work is technical but they feel that we are stepping on their toes,” an epidemiologist in one of the BPHUs in the district said.

While the NHM has not issued any orders that would allow overarching power to its BPHU personnel, a recently prepared draft of the guidelines regarding the job responsibilities of BPHUs, shared widely over WhatsApp groups of the Health department staff, triggered the reaction from the Kerala Health Inspectors’ Union.

“The supervisory cadre of field workers in the Health department — including Junior Health Inspectors, Junior Public Health Nurses, Health Supervisors, Technical Assistants etc. — are appointed by the PSC and have been in existence over the past 40 years. We have helped create the State’s strong public health system. We do not need a parallel workforce to oversee the work that we produce. The government has not even given us proper digital devices to help us in data collection,” said M.M. Sakkeer, the State president of Kerala Health Inspectors’ Union.

The union has decided to observe December 31 as “Black Day” to protest against what they see is unfair action by the NHM. “In the next phase, we will gather our entire workforce to agitate against NHM’s intrusion into our work and to make us irrelevant,” he added.