Political Accountability for Outbreaks of Communicable Diseases

The outbreak of the cholera epidemic in New Delhi in 1984 dramatically exposed the extent of the breakdown of the public health system in the country (Banerji 1984). This deterioration has been going on ever since the political leadership with the support of foreign powers launched the ill-fated family planning programme in 1967. Assuming that the Indian Administrative Service (IAS) officers who inherited the anti-people attitude of the British trained Indian Civil Service (ICS) would be better suited to perform the hatchet job of forcing the poor to submit to sterilisation, the politicians handed over this task to them. The union ministry of health was broken up to form a separate and well-funded department of family planning.

By 1984, when the cholera epidemic broke out in Delhi, the bureaucrats had considerably increased their power and extended their tentacles into wide areas of public health. However, they had neither the required qualifications nor experience and nor could they be held accountable due to frequent transfers. For example, how could a health secretary, who has spent most of his service life outside the ministry and who has a college education, say, in English literature, negotiate with international agencies about acceptance of the latter’s patently faulted International Initiatives for India? How can he take key decisions on areas of cadre structure, health manpower development or hospital administration? When the opportunistic politicians decided to set up a separate department for ayurveda, yoga, unani, siddha and homeopathy (AYUSH) in the ministry of health, they chose a bureaucrat to provide the leadership. The administrative situation is much worse in the states, despite health being a state subject.