A Sense of Service

Keshav Desiraju (1970) joined the IAS in 1978. He is currently Special Secretary in the Ministry of Health and Family Welfare, Government of India. In the 34 years since Keshav joined the IAS, he has only known three other Cathedralites in the civil service

Tell us about the sector in which you currently work.

My work in the Ministry of Health and Family Welfare covers a wide range of health policy issues including the prevention, treatment and management of non-communicable disease, issues in medical education, strengthening health human resource development and matters related to the WHO. In our federal system, the responsibility for the delivery of health care rests with the state governments who are also free to frame their own policies. In practice, however, major policy initiatives in recent years, such as the National Rural Health Mission (NRHM), have come from the Government of India. Among the many things I learnt from Cathedral, was a sense of service and while we have known alumni play prominent roles in public service, working for the Government has not been an option that Cathedralites have readily looked at.

What are the key problems?

As we look to the 12th Five Year Plan, 2012-2017, the big issue is universal access to health. Some readers would be familiar with the remarkable achievements made by Cuba and Thailand in providing universal access. The task is more difficult in

a country of our size. Finding the resources is one problem, but a much more difficult problem is finding the right people. India faces an alarming shortage of qualified professionals at the locations where they are needed. This covers the entire range from health workers and midwives in the villages to specialists and super specialists at tertiary care centres.

You have said, “Public health has to be a public responsibility”. Please comment

The question of qualified human resources is linked closely to the question of private provisioning of health services. There is no denying the contribution to healthcare delivery of the private sector and the services provided by private hospitals. However, for the vast bulk of India’s people, healthcare needs to be provided easily, locally and inexpensively.

Where do the challenges and opportunities lie?

We need to invest much more substantially in health research, with a view towards new and improved treatment for both communicable and non-communicable diseases.

We have seen remarkable success in addressing the challenge of polio, but malaria and other communicable diseases remain a challenge. India is a large producer of inexpensive generic drugs. Our challenge is to maintain our competitive edge while also seeking a greater share of the world market. Infant mortality remains unacceptably high; at the same time Indians are living longer and we need to be able to address the problems of old age, not all of which have medical solutions.

What are the perceptions of the government and the civil services in a changing polity?

The print and television media does not hold the government in any great regard, and the IAS in particular is an object of scorn. Certainly it could be said that the civil servants have failed to maintain the standards for which their community was known and which were so much in evidence in the early years of India’s independence. But to my mind, and it surprises me that I should have taken so long to realise this, there is so much that can be done in this government. While I may have entered the government service somewhat shakily, there is now nowhere else I would rather be.

By Mukeeta Jhaveri nee Kataria

(ISC 1983)