Health Administrator Vol: XVII, Number 1: 102-111, pg.

26. MEDICAL GENETICS IN PUBLIC HEALTH

ADMINISTRATION IN INDIA: A HANDICAP
OF BUREAUCRACY, BIAS, AND CORRUPTION*

R.S.BALGIR***

ABSTRACT: In a public welfare state like India, the public
health and health administration have attracted
considerable attention in the recent past. These fields are
meant for communication of relevant health information;
account for health care priorities, policy and delivery;
manage crises; and address major health concerns. The
human genetics is the biological science, which deals with
inherited characteristics, human origin and variations,
application of genetic knowledge for genetic/marriage
counseling, community health, prevention and control of
genetic diseases, and promotion of health strategies for
the amelioration of sufferings of the people. The genetic
paradigm recognizes the role of intrinsic factors for individual
disease susceptibility or resistance; the medical paradigm
emphasizes the importance of extrinsic factors in the
etiology of a disease. The genetic paradigm recognizes
disease as a spectrum and the position of a particular
illness on the spectrum is relevant in planning of its
prevention and treatment. There is lack of training in
undergraduate as well as in postgraduate level in medical
education for medical genetics and public health
administration in India. Bureaucracy handles public health
administration for which neither they are expertise in
medical health nor in public health administration, resulting
in health bias and corruption. Some suggestions have been
incorporated here in the light of health informatics for the
improvement in public health administration in India.
INTRODUCTION
The dictionary meaning of public health is the science
and practice of protecting and improving the health of a
community, as by preventive medicine, health education,
control of communicable diseases, application of sanitary
measures, and monitoring of environmental hazards. In
medical term, public health is community health. It has
been said, "Health care is vital to all of us some of the
time, but public health is vital to all of us all the time". The
mission of public health is to fulfill the interest of society in
assuring conditions in which people can be healthy. The
three core public health functions are:
1. The assessment and monitoring of the health of
communities and populations at risk to identify
health problems and priorities;
2. The formulation of public policies designed to solve
identified local and national health problems and
priorities;
3. To assure that all populations have access to
appropriate and cost-effective care, including health
promotion and disease prevention services, and
evaluation of the effectiveness of that care.
Public health professionals monitor and diagnose the
health concerns of entire communities and promote healthy
practices and behaviors to assure that populations stay
healthy.
The public health and health administration are
increasingly important areas in the current environment.
The fields of public health and health administration are

*******************************************************************************************************************
* Division of Human Genetics, Regional Medical Research Centre (ICMR), Chandrasekharpur,
Bhubaneswar - 751 023, Orissa
** Author takes the responsibility of the views expressed in this article, which do not necessarily reflect in any
way the views of the organization of author’s official affiliation.
*** Address for communication: Dr.R.S.Balgir, Deputy Director (Senior Grade) & Head, Division of
Human Genetics, Regional Medical Research Centre (ICMR), Opposite Kalinga Hospital,
Chandrasekharpur, Bhubaneswar-751 023, Orissa, E-mail: balgirrs@yahoo.co.in.

101
meant for communication of relevant health information;
account for health care priorities, policy and delivery;
manage crises; and address major health concerns. All
these activities are information intensive -- that is, they
rely heavily on systems of information access to support
professional decision-making, practice and action.
Information, resources, technology, research and new
challenges are expanding tremendously in health care and
medicine.
PURPOSE OF PUBLIC HEALTH
ADMINISTRATION
1. To provide a forum for the exchange of information
on public health, health administration and policy,
health services research, and related issues;
2. To foster public health and health administration
database;
3. To promote the educational, scientific, and
professional growth of public health and health
administration database libraries and information
specialists; and
4. To represent members’ interests within the Medical
database forum.
Planning and development of public health in India;
public health administration at centre and in the states;
environmental sanitation; prerequisites of healthy life --
water, air and ventilation, food and housing; family planning
and population control; school health, rural sanitation;
sanitation of camps, fairs and festivals; social security and
health services; comprehensive health care; social
medicine, health education, health statistics and statistical
methods, etc. are the broader domains of public health
administration in India.
Human genetics is the biological science, which
deals with inherited characteristics, human origin and
variations, application of genetic knowledge for genetic/
marriage counseling, community health, prevention and
control of genetic diseases, and promotion of health
strategies for the amelioration of human sufferings
(Balgir 2006).
Over the past decade, Medical Genetics has emerged
as an important and powerful medical specialty with
increasing appreciation of its role and function among the
102
medical specialties. This emergence is related to a great
extent to the progress in the Human Genome Project,
which promises wide-ranging applications in the diagnosis,
treatment and prevention of human diseases. Nevertheless,
discussions about the role of genetics in preventive
medicine and public health rightfully lead to ethical, legal
and social concerns about general applicability of genetic
testing in the population. The interpretation of the word
prevention in the context of genetic diseases leads to the
unavoidable discussions of genetic engineering, prenatal
diagnosis and selective termination, as well as broader
concerns about discrimination in health care coverage,
employment and in society.
Fig 1 shows the classical public health view of disease
prevention when applied to infectious and environmental
agents. Primary prevention is classically thought of as the
interruption of transmission of infectious agents or
exposure to environmental agents in the population through
education, behavior modification, immunizations, and
environmental measures (e.g., human immunodeficiency
virus (HIV) infection and cigarette smoking). Secondary
prevention is thought of as the interruption of clinical
disease after the acquisition of the infectious agent or
exposure to the environmental agent. In the case of HIV,
this entails steps to prevent or delay the onset of the
acquired immunodeficiency syndrome (AIDS) by using
drugs and other medical, nutritional and psychosocial
measures. Tertiary prevention is thought of as the prevention
of complications of the disease after it occurs. For example,
this applies to the prevention of opportunistic infections
(OI) in AIDS through appropriate prophylactic medical
guidelines. The prevention of human disease by preventing
exposures and infectious agents has been the force driving
programs in public health and preventive medicine.
When it comes to genetic diseases, as shown in the
figure, a typical reaction of medical and public health
professionals is that the classical public health model does
not work since peoples’ genotypes are not changeable
(except, of course, with genetic engineering), and that such
a prevention model could lead to eugenic consequences
(i.e. preventing the birth of people with specific genotypes).
This may lead to reasonable concerns about public health
applications of genetic technologies and genetic tests.
Here, I argue for medical genetics and public health to
interact successfully, the public health community needs
to change the classical disease prevention paradigm and
the medical genetics community needs to change the
definition of and the approach to the label "genetic disease."
Let us use the word genotype for both disease genes
and disease-susceptibility genes. The first group includes
genotypes that have high penetrance for the development
of clinical disease (e.g. homozygosity for the sickle cell
mutation, the cystic fibrosis gene mutations, and
heterozygosity for BRCA1 mutations). The second group
includes genotypes that have low penetrance for clinical
disease development and some could even be considered
normal variants (i.e. genetic risk factors such as HLA- B27
and ankylosing spondylitis, and apolipoprotein E-E4 allele
and Alzheimer’s disease). For example, inheritance of the
sickle cell mutation in the homozygous phase leads to
sickle cell anemia. In turn, various medical problems and
complications arise as a result of sickle cell disease
including strokes and pneumococcal sepsis. Certain
BRCA1 mutations lead to the development of breast and
ovarian cancers, which lead to various medical
complications including metastasis and psychosocial
complications.
Here one can ask two simple questions: what is
prevention in the context of genetic conditions? Clearly,
primary prevention refers to the prevention of the disease
entity for which the genotype is an important component.
Primary prevention can occur by interrupting the
environmental cofactors that interact with peoples’
genotypes and/or by using gene therapy (Fig 1). Primary
prevention does not and should not refer to the prevention
of the genotypes per se (i.e. prevention of births of individuals
with specific genotypes). While we all recognize that
couples make informed reproductive decisions on the basis
of carrier testing and prenatal diagnosis, such individual
decisions should not be confused with disease prevention
as discussed in the realm of public health.
The second question is: what is a genetic condition
after all? Geneticists often make a distinction between
single gene disorders and susceptibility genes that are
risk factors along with other genes and environmental
exposures in disease development. This distinction is
quantitative rather than qualitative as embodied in the
concept of penetrance of the genotype. As a matter of

Primary Secondary Tertiary

Prevention Prevention Prevention

Infectious

Clinical

Complications

Agent Disease
Example HIV

AIDS Opportunistic
Infections

Primary Secondary Tertiary

Prevention Prevention Prevention

+Cofactors

Genotype

Clinical

Complications

Disease
Examples High Penetrance
Disease genes
Hbss Sickle Cell
Anemia
Pneumococcal
Sepsis

BRCA1

Breast

Metastasis

Cancer
Low Penetrance
Susceptibility alleles
Normal variants
Apo E E4

Alzheimer
Disease
Disability

Fig 1. Paradigms of disease prevention for infectious diseases and in medical genetics: HIV, human
immunodeficiency virus; AIDS, acquired immune deficiency syndrome; HbSS, homozygous sickle hemoglobin.
103
fact, the distinction tends to fade when one realizes that
all human disease is the result of the interactions between
our genotypes and the environment-broadly defined. Even
the classical single gene metabolic disorders do involve
nutritional interaction between the enzyme deficiency and
the dietary exposure to one or more chemicals (e.g.
phenylalanine and phenylalanine hydroxylase deficiency,
iron and the hereditary hemochromatosis homozygous
genotype). It is easy to show that 100% of any disease is
environmentally determined and 100% is genetically
determined as well! Any other view is based on a naive
view of causation. Perhaps, the wide range of penetrance
with respect to clinical disease could be due, in part, to
the variations in the prevalence of the interacting cofactors
(other genes and modifiable risk factors). The fact that
there is universal phenylalanine exposure in the diet of
newborn infants, leads to a high penetrance for those who
inherit the phenylalanine hydroxylase deficiency (i.e.
mental retardation).
This analysis leads to two simple clarifications:
1). Primary prevention of human disease in the context
of medical genetics refers to the prevention of the
disease entity for which the gene or genes in
question play a role. How can that occur? While
gene therapy may become appropriate to correct
certain deficient gene products leading to human
disease, primary prevention of many multifactorial
human disease will entail understanding and
interruption of the environmental cofactors among
individuals who inherit genetic susceptibility
(polymorphisms or disease mutations).
Phenylalanine and iron in the diet have been
mentioned for phenyl ketonuria (PKU) and hereditary
hemochromatosis. However, for most human genes
including BRCA1 (in relation to breast cancer), and
Apo E-E4 (in relation to Alzheimer disease), such
cofactors are still poorly understood and a lot of
epidemiologic work needs to be done in various
populations in order to target prevention.
2). We need to refine our approach to defining and
labeling genetic diseases. If we accept the basic
premise that genes cause human diseases, it may
make a lot of sense to stop labeling a disease as
genetic or not. For example, this approach will lead
to labeling hereditary hemochromatosis as an iron
overload disorder resulting from the interaction
between an inherited abnormality in iron transport
and iron intake. Using the same approach, breast
cancer in some individuals could result from the
interaction between an inherited mutation in the
BRCA1 gene and yet to be described cofactor (s).
The parallel between genetic diseases and infectious
disease is such that the concept of prevention and
104
control that may be acceptable in the context of
infectious agents is totally unacceptable in the
context of genetic conditions. We are all at risk for
something! This ultimate and powerful realization
could be the driving force in medicine, public health
and society at large to accept once and for all our
genetic make-up and direct our focus and attention
to the prevention of human disease and suffering by
targeting our disease prevention strategies to
modifiable risk factors (e.g. dietary factors)
according to each and everyone’s unique biologic
susceptibilities. Such a realization could also be
the engine that drives the much-needed reform in
our health care system.
HUMAN GENETICS IN HEALTH AND DISEASE
Human genetic variability proposes a genetic
paradigm of health and disease such that the health is
viewed as a state of equilibrium and disease as
disequilibrium in relationship between man and the
environment (Balgir 1999a). Any biological function involved
is ultimately dependent on environment; a gene product
controls the interaction between environment and the
function. The interaction results either, when the
environment component is changed significantly or when
the gene product is modified by mutation. The genetic
paradigm recognizes the role of intrinsic (genetic) factors
for individual disease susceptibility or resistance; the
medical paradigm emphasizes the importance of extrinsic
(environmental) factors in the etiology of a disease (Balgir
1999a).
Since individuals have their own genetic signatures, it
follows from the genetic paradigm that each person is at
his/her own specific risk for a particular disease. Each
person is adjusted in a different manner to the environment
and every one has a different and relative state of health.
Thus, the traditional medical paradigm is effective in
preventing and curing diseases when the environment plays
the primary role in pathogenesis. However, for diseases
involving prominent genetic component such as cardiac
vascular disease, hyper-tension, duchenne muscular
disease, Huntington’s chorea, hemoglobinopathies,
glucose-6-phosphate dehydrogenase (G-6-PD) deficiency,
schizophenia, manic depressive psychosis, etc., their
control requires a different approach, i.e. genetic strategies
(Balgir 1999a). It has become imperative for the practicing
clinicians to detect the different disorders affecting the
human being due to genetic origin. The treatment and
prognosis of a malady depends on a correct diagnosis
and also for its possible prevention.
The genetic paradigm recognizes disease as a
spectrum. The position of a particular illness on the
spectrum is relevant in planning of its prevention and
treatment. There are some diseases in which the
expression of a particular gene or genes in a specific
environment is responsible for precipitating the illness, e.g.
schizophrenia, manic-depressive psychosis, etc. The
pharmacogenetic disorders and multifactorial diseases have
this character, e.g. coronary artery disease, diabetes
mellitus, etc. There are diseases whose origins lie in the
interaction of specific environment with the genotype.
Modern epidemics of non-communicable diseases fall in
this category.
HUMAN GENETICS IN PUBLIC HEALTH
ADMINISTRATION
It has two missions:
* To reduce death, illness and disability from genetic
disorders, birth defects and chronic diseases and
injuries and to improve the quality of life for
individuals, and
* To protect and promote the health of children with
special health care needs by assuring a family-
centered, community-based, comprehensive,
coordinated and culturally appropriate system of
special health care.
Education of patients, parents, professionals,
voluntary organizations and the general public about
genetics, genetic disorders, birth defects and genetic
services is an important activity. Educational services and
materials should be available to all.
Services include specialty services and care
coordination for children with complex medical conditions.
Efforts should be targeted toward identifying eligible children
with disabilities and their needs, then offering them the full
range of services available to ameliorate the disability.
Services should be provided to children with diverse medical
conditions throughout the state/country. Genetics services
include primary, secondary and tertiary prevention services
intended to prevent disability and to ameliorate existing
disability from genetic diseases and birth defects (Balgir
2004a). Most people served by this type of program should
not be significantly disabled. However, a small number of
people with genetic disabilities should be served primarily
through our Primary Health Centre/clinics and case
management and birth defects programs.
The advent of molecular testing has been a great
boon for the people, as this has enabled antenatal diagnosis
of many burdensome disorders, which were earlier not
identifiable in the fetus. Molecular diagnosis is now possible
for a large number of genetic disorders. For the strategy of
management of genetic diseases, the intake of patients
into the program will occur by two routes: through planned
105
genetic screening and through individual referrals for
medical diagnosis and genetic counseling (Balgir 1999a).
Genetic screening has three major objectives:
a). To provide opportunity for medical intervention
(treatment)
b). To provide opportunity for counseling about
reproductive options; and
c). To collect research data pertinent to public health
policy and basic knowledge.
At present, there are several institutes/centers
throughout India especially in Metro-cities where sufficient
technological facilities are available for the detection/
diagnosis of various genetic diseases along with the
detailed investigations as well as genetic/marriage
counseling (Balgir 1999a, 1999b, 2004a).
Genetic Counseling is
1. Determining the facts: diagnosis, etiology, and
inheritance pattern, prognosis, natural history,
treatment, and recurrence risks
2. Transmitting the information to those requesting
it in a sensitive, culturally appropriate,
understandable way.
3. Supporting the decision making process of the
couple.
4. Genetic Counseling is non-directive
Prerequisites for Genetic Counseling:
A. Detailed family history
B. Accurate Diagnosis
C. Understanding of the medical aspects of the
disorder (etiology, natural history,
treatment, prognosis, burden)
D. Understanding the inheritance pattern (recurrence
risk)
E. Understanding the psycho-social impact of the
information
F. Training/Experience in counseling techniques
G. Understanding the concepts of health/disease/
health care in the appropriate cultures.

Indications for Genetic Counseling and/or Education
In Pediatric Practice:
i). Children with 2 or more major malformations or a
major and several minor malformations.
ii). Children with common birth defects (neural tube
defects, congenital heart disease, cleft lip/palate,
clubfoot, dislocated hips, multiple vertebral
anomalies, atresias or stenosis of Gestro-
Intestinal tract).
iii). Families who have had a fatally malformed infant
(stillborn or neonatal death).
iv). Mental retardation especially when:
* the child has evidence of a metabolic disturbance
- acidosis,
* chronic/recurrent vomiting, pigmentary
abnormalities, etc.
* the child has malformations
* multiple sibs are affected or a parent and child
are similarly affected
* multiple males in a family are affected
v). Newborns with lethargy/coma, anorexia/vomiting
or acidosis/ketosis without a clear explanation.
vi). Children with loss of milestones or/and
organomegaly beginning at several months to
several years of age who were previously
apparently thriving.
vii). Cases of abnormal sexual development, primary
amenorrhea or aspermia.
viii). Cases of early complete or partial hearing loss or
blindness, neurodegenerative disorders, short
stature, premature heart disease, immune
deficiency, abnormalities of the skin, hair or bones
and sickle cell anemia/thalassemia, other blood
disorder or coagulopathy.
ix).Cases of any known hereditary disorder.
x).Families where any disorder "runs in the family."
xi). Mothers desiring more children who:
* are on chronic medications
(anticonvulsants, antimetabolites, thyroid
antagonists, steroids, etc.)
* are "on drugs" (including alcohol)
* have had recurrent pregnancy losses
* are over 35 or have husbands over 55
* have a previous retarded or malformed child
* have questions about prenatal diagnosis for any
disorder
xii). Recurrent pregnancy loss/stillbirth
xiii). Couples of "advanced age" (females over 35 and/
or males over 55) who are considering pregnancy
or expecting.
xiv). Primary amenorrhea, aspermia, infertility or
abnormal sexual development.
xv). Previous history or family history of children with
multiple malformations and/or mental retardation.
xvi). Known familial chromosomal abnormality.
xvii).Common birth defects (cleft lip/palate, neural tube
defects, multiple vertebral anomalies, congenital
heart disease, clubfoot, dislocated hips, etc.).
xviii).Couples in which the spouses are related.
xix). Elevated maternal serum alpha-fetoprotein.
xx). Couples with an ethnic background suggesting a
high risk for any disorder (Jewish couples for Tay-
Sachs screening, Black/Mediterranean couples
with positive screens for a sickle
hemoglobinopathy or thalassemia, etc.).
xxi). Woman exposed to potential teratogens -
radiation; chemicals; certain medications
(anticonvulsants,anticoagulants, antimetabolites,
thyroid antagonists, steroids, etc.); recreational
drugs (including alcohol); certain viral agents; very
high fevers, etc.
xxii).Women considering pregnancy who themselves
have a hereditary disorder even though treated and
clinically normal (Phenyl Ketonuria,
homocystinuria, etc.).
xxiii).Families with known hereditary conditions and/
or questions about recurrence risks.
xxiv).History of any disease "running in the family,"
especially hearing loss; blindness;
neurodegenerative disorders; short stature;
premature heart disease; immune deficiency;
abnormalities of the hair, skin or bones; or mental
retardation.
106
 xxv).Couples with questions about prenatal diagnosis
for any disorder.
The accumulated genetic data have enhanced the
rapid advancement of clinical genetics in India (Balgir
1999a, 2004a, 2006). Basically, the practice of genetic
medicine seeks the answer to three questions:
1. What is wrong? The answer is accurate diagnosis,
which is aided by pedigree analysis, biochemical tests,
cytogenetics and chromosomal studies of cultured
fibroblast and leucocytes for pinpointing the gene or
chromosome responsible for a change. Additional factors
involved are the environmental ones -- internal, external or
social.
2. What will happen? The answer is prognosis, which
is the basis of genetic counseling, to be helped by prenatal
diagnosis, family history and pedigree studies.
3. What can be done about it? The answer is
treatment - palliative and/or curative. Prevention is better
than cure in some instances, when the parents are carriers.
Stem cell implantation or gene therapy is the other option,
although limited in India. For both these alternatives,
exhaustive knowledge about the basic defect is a must.
For the prevention of recessive diseases, identification of
carriers will help to impart prospective counseling and gene
therapy in future.
Currently in India, the emphasis is on the small family
norms and the socio-economic constraints have created
a desire in all the eligible couples that every child born
should be normal. Thus, it has been emphasized that
medical genetics play a pivotal role in the clinical practice,
therapy, innovative developments, prevention, and the
management of genetic diseases (Balgir 1999b, 2000,
2002, 2004b).
HEALTH INFRASTRUCTURE IN INDIA
India’s population of 1 billion resides in 35 states
and union territories. The administrative unit within the state
is the district, which is key for development activities, as
well as for management of health care. India has 593
districts, each with a Chief Medical and Health Officer
(CMHO) charged with the responsibility of managing the
public health care system.
Within a district, services are delivered through a
network of Subcenters (staffed by 2 paramedics, covering
populations of 3-5000), Primary Health Centers (staffed
by 2-3 doctors and covering a population of approximately
30,000); Community Health Centers (staffed by 6-10 doctors
and covering a population of approximately 150,000). The
CHC operates at block headquarters, the administrative
107
unit within a district. Above the CHC is a District Hospital
with approximately 30 doctors and covering the population
of the entire district, which is, on average, 1.5 m.
India has approximately 140,000 subcenters, 23000
Primary Health Centers, 3000 Community health centers,
30,000 doctors in the public sector and 300,000
paramedical staff in the public sector. The CMHO therefore
has the daunting task of managing infrastructure, motivating
staff, strategic planning, budgeting and budget
management, and regulatory functions. CMHOs are also
expected to guide their deputies, their Block level medical
officers (doctors) and medical officers in charge of PHCs
in fulfilling their managerial functions. His/her basic medical
education equips him/her poorly for this function, and on-
the-job training is limited.
Recognizing the need to enhance the management
skills of public system managers, the Reproductive and
Child Health program of the Government of India has made
a beginning by running short-term courses through selected
management training institutions. These courses have
been recently initiated. Training capacity is limited, and
there is need for additional initiatives, particularly those
that can address personal development needs of the
managers as opposed to only capacity development for
planning (Balgir 2004b, 2004c, 2005).
LACUNAE IN PUBLIC HEALTH ADMINISTRATION
1. There is total lack of curricula and training in
undergraduate as well as in postgraduate level in medical
education for medical genetics and public health
administration in India. Bureaucracy governs and handles
public health administration, but neither they have expertise
in medical health nor in public health administration. This
leads to total hierarchical misuse of power and public
health management and administration bias and futile
exercise for program implementation.
2. There is a segregation and division of health
infrastructure like allopathic, aryuvedic system,
homeopathy, siddha system of medicine, unani system of
medicine, etc. which not only duplicate their services under
the same umbrella but drain a major resource of public
funding. There is no priority for particular system, which
the people like and seek health care and treatment facilities
in particular area/region/state. As India is a diverse country,
people’s expectations, aspirations and health seeking
behavior are different at different localities. Enforcement
of uniform system for health care and treatment is
unwarranted in a diverse country.
3.There are several autonomous bodies looking after
the health sector in India. Although the funding
source is the same, but in the presence of multi-
 sector health care delivery system, practically no
one takes the responsibility for delivering goods to
the people. Responsibility/accountability jumps from
shoulder to shoulder from one department to another.
Under these circumstances, what could be the fate
of the people?
4. Again, there are several research organizations
dealing with the health of the people falling under
one umbrella. Appointments of the leaders of such
organizations are done at political level rather than
taking into consideration the caliber of the person.
Political pressure remains on every such head. This
leads to deterioration of the goodwill of the people.
A high level corruption starts from this end, which is
perpetuated in all the spheres of public health
administration by putting all the persons at different
places belonging to the lobby. There is no monitoring
by the government level and there is no way of
removing such corrupt practitioners.
5. Misuse of the power is the game of the public health
administration strategy. In the name of research,
instruments/equipments, vehicles and medicines/
drugs, etc. tax-payers hard earned public funds are
exploited for personal gains and comforts.
Fabrication of false data for disease prevalence,
distortion of actual figures and manipulation and
compromise for poor quality of medicines/drugs, etc.
are issues which breed all sorts of corrupt practices.
How much output of public health administration
reaches the downtrodden, illiterate masses and
actual producers of the country, is still to be
ascertained?
6. Biotechnological advancements are the guiding star
for the future. With age and passage of time, the
old values, concepts and technology are rapidly
changing. The out-dated experts cannot envision
them and realize the importance of new technology.
Putting the deadwood in different developmental and
review committees seems to be unrealistic and is
mere wastage of financial resources.
There are still so many limitations and deficiencies,
which need to be checked, it is difficult to enlist all of them
in this write up to streamline the human genetics and public
health administration in India.
SUGGESTIONS FOR PUBLIC HEALTH
ADMINISTRATION
1. There is an urgent need to introduce the curricula of
medical genetics and public health administration
in the medical education in India. Assignments in
all public health sector departments should be made
108
of public health expertise with full powers and not of
bureaucrats. They should be made responsible/
accountable for public health care of the people.
2. There should be a merger of all kinds of treatment
facilities without any duplication. Distribution of
specialty/system should be as per people’s need
and not the enforcement of allopathy because some
communities do not have faith in allopathy. Referral
services dilute the unnecessary over burden of patient
care and will be important and valuable input for
respective specialty. Traditional system of medicine
should be encouraged because it has a socio-
cultural component which has relevance from
people’s perception of illness, health seeking
behavior, attitude, beliefs, faith and day-to-day
activities of life.
3. There should be clear-cut demarcation of the
boundaries of research, investigative laboratories,
medicine/drugs production, reatment, management
and counseling, etc. functioning under health sector
and overlapping areas can work in collaboration. This
will further reduce the expenditure on instruments/
equipments, use of vehicles, etc.
Specific responsibility/ accountability will also help
in curtailing the confusion of throwing the buck on
others.
4. Appointment as leader of an organization should be
based on specialty, caliber, contribution made,
management skills and background or past record
of the person. Political pressure in any way should
not interfere with the functioning of an organization.
Government should ensure security, stability and
independent functioning, as the leader is
responsible/accountable of the output of an
organization.Basic research should be limited, more
emphasis should be on public health, rehabilitation,
family welfare and people oriented.
5. Performance is to be judged by the employees
working under a leader. Satisfaction of the public/
community is the criteria of retention. Public should
be empowered to retain or remove a person at high
position by voting for or against him/her every two
years. In case of removal, transfer is not acceptable
solution. This will help maintaining good governance.
6. Since public health administration is ever challenging
responsibility, updating knowledge and acquiring
efficient skills every year through refreshers course
is a must. The quality of the life of people is
dependent upon the quality of public health
administration in a country.

Recently, the administration/management
philosophy has shifted from the scientific to human
relations in the firm belief that the health of the individual is
crucial to the health of the management. The better the
health of employees, the better the work out-put of the
organization in the Indian setting.
REFERENCES:
Balgir RS (2006) Human Genetics in Community Health
Practice in India: An Urgent Need of Action. In: Sharma
Krishan Ed. “Health, Genetics and Ethics: An
Anthropological Perspective. National Seminar held
during the 15-16th February 2005 at Chandigarh.
Balgir RS (2005) Biomedical Anthropology in Contemporary
Tribal Society of India. In: Contemporary Society: Tribal
Studies (Tribal Situation in India). Vol.6. Behera,
Deepak Kumar & Pfeffer, Georg (Eds). Concept
Publishing Company, New Delhi. pp. 292-301.
Nutritional Status of Kondh Tribe and Tribal Welfare in
Orissa: A Biotechnological Approach. Proceedings of
the UGC Sponsored National Conference on Human
Health and Nutrition: A Biotechnological Approach (Lead
Lecture), 12-13th December 2004, Thane. pp. 47-57.
Balgir RS (2002) Biomedical Anthropology in the Service
of Mankind in the New Millennium: Are We Ready? In:
Anthropology :Trends and Applications. MK Bhasin and
SL Malik (Eds.) Kamala Raj Enterprises, New Delhi. p.
141-147.
Balgir RS (2000) The Burden of Hemoglobinopathies in
India and the Challenges Ahead. Current Science,
79(11): 1536-1547.
Balgir RS (1999a) Medical Genetics in Clinical Practice in
India.Current Medical Trends, 3(3): 567-572.
Balgir RS (1999b) Control and Prevention of Genetic Load
of Hemoglobinopathies in India. The National Medical
Journal of India, 12(5): 234-238.

Balgir RS (2004a) Medical Genetics in Orissa: An Urgency

in Health and Disease. Proceedings of the 8th Orissa
Bigyan Congress on Science for Sustenance held during
11-12th December 2004, Bhubaneswar. pp.20-23.

Balgir RS (2004b) Health Care Strategies, Genetic Load,

and Prevention of Hemoglobino-pathies in Tribal
Communities in India. South Asian Anthropologist, 4
(2): 189-198.

Balgir RS (2004c) Dimensions of Rural Tribal Health,

109
110
111