By contrast, the sections on family planning begin with a careful review of program performance, reasons for shortfalls, and how to overcome them. The need for operational research is highlighted, as well as creative suggestions for generating greater demand for family planning. Indeed, the program developed a highly successful IEC campaign to change people’s desired family size and bolster program success. Similar efforts have been made in the health sector only sporadically, and typically to bolster campaign efforts such as immunization, rather than seeking to radically alter people’s health behaviors to reduce their exposure to communicable diseases.

# **5. Encouraging trends for the future**

There are many reasons to be hopeful that public health may receive more attention in the near future. Financing is available through large programs, for example the Rural Health Mission, National Sanitation Mission, and the renewed support for the Employment Guarantee Scheme. If implemented creatively, these programs can be used to improve public health outcomes. For example in the US, the Depression-Era food-for-work programs were used to eradicate malaria from large parts of the South. The success of this effort resulted from careful planning and oversight of the work by teams of sanitary engineers, entomologists, and administrators.<sup>16</sup> Institutions are also being built at the local and national levels, which can play powerful roles in public health. The Panchayati Raj Act has placed emphasis on building local government, and devolving health activities to them. This makes it possible to build institutions for managing public health activities on the ground, with the requisite intersectoral coordination. States such as West Bengal and Kerala are experimenting with these possibilities in ways that can serve as models for other states.

At the national level, a new thrust is to build an institution modeled on the US Centers for Disease Control.<sup>17</sup> This model has been adapted across the world, most recently by China and the European Union, which recognizes that the public health systems of its component countries need to be coordinated and supported by a “federal” authority. If designed creatively, this could transform the way that the central government shapes and supports public health services in India. In a large federal country, the key roles of such a central agency include monitoring trends, research, advocacy, and helping states address specific gaps with targeted financial and technical help.

India has exceptional capacity to deliver services, as evidenced by its smooth conduct of elections and censuses across a vast population including pavement-dwellers and remote villages. Its inattention to public health is taking a large toll on its economy, as well as on the lives of its citizens, and it is time to recognize that public health is a key part of its development infrastructure.

> 16 Fee (2004).

> 17 In doing this, it is important to learn from and avoid repeating the mistakes made when designing the National Institute of Communicable Diseases as a Centre for Disease Control. This was set up without the necessary authorities to fulfill the complex roles of such a Centre.

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