Thiruvananthapuram: The Union Health Ministry has directed the Kerala government to accelerate the implementation of its Public Health Management Cadre (PHMC), urging the state to complete key reforms on a “mission mode” ahead of an upcoming national progress review.
The directive, issued last week to all states and union territories, asked Kerala to assess the current status of PHMC implementation and urgently fill vacancies to meet national health reform timelines.
PHMC a National Mandate Under Health Policy 2017
According to a letter accessed by The Times of India, the Centre reminded Kerala that the creation of a Public Health Management Cadre is a national mandate under the National Health Policy, 2017.
The letter noted that state health ministers, including Kerala’s, had committed to implementing the reform within defined timelines during the 13th, 14th, and 15th Central Council of Health and Family Welfare meetings.
Aim: Strengthen Public Health Leadership
The Union Health Ministry emphasised that the PHMC is designed to:
- Build a structured public health leadership workforce
- Strengthen district- and block-level public health governance
- Institutionalise preventive and promotive healthcare
- Ensure clear separation between clinical and public health roles
Kerala has been asked to transition from a clinician-driven system to a structured public health leadership model.
Other States Cited as Models
A detailed guidance note accompanying the letter highlighted how states such as Tamil Nadu and Odisha have made significant progress in cadre restructuring, effectively integrating trained public health professionals into leadership roles.
The document drew lessons from the COVID-19 pandemic, stating that states with dedicated public health cadres “showed greater resilience” and were better able to maintain essential health services during public health emergencies.
Four-Cadre Framework Proposed
The Centre has asked Kerala to constitute or strengthen its PHMC task force and reorganise its health workforce into four distinct cadres:
- Public Health
- Health Management
- Specialist
- Teaching
States have also been instructed to map existing staff, create a time-bound training and career progression roadmap, and institutionalise preventive healthcare leadership at the district and block levels.
12-Week Action Plan Suggested
The ministry recommended a rapid 12-week action cycle for implementation, beginning with task force activation and workforce mapping.
The cycle would culminate in submission of an implementation plan to the state cabinet, followed by quarterly progress reviews to ensure accountability and momentum.
Public Health Training Made Mandatory
As part of the reform, the Centre advised that:
- Newly recruited MBBS doctors in Kerala’s health services should acquire a public health qualification within 3–5 years
- Leadership positions at district and block levels should prioritise professionals trained in public health
- Robust data monitoring and reporting systems should support decision-making
Centre Signals Close Monitoring
The Union Health Ministry has indicated that a follow-up review meeting will be held soon to assess progress and address state-specific challenges, signalling that the Centre will closely monitor not just compliance, but the speed and effectiveness of implementation.
Reform Could Redefine Kerala’s Health Governance
If implemented effectively, the PHMC reform could significantly reshape Kerala’s traditionally clinician-led primary care system by redefining leadership in district-level planning, disease surveillance, and public health management.
With national alignment deadlines approaching in the next financial cycle, Kerala now faces mounting pressure to demonstrate tangible progress toward cadre-based public health governance.
