The dispute between the country’s minister for health and the director of its premier institution for medical education highlights the immaturity of our institutions which are used for personal battles instead of public policy. We should consider whether these men, and the institutions that they represent, fulfil their ethical responsibilities and make major contributions to the fields of public health and medical education.

India has so many problems in the field of health crying for attention that it is difficult to know where to begin. People are killed by tuberculosis, malaria, diarrhoea, pneumonia – and mass starvation. Thousands of women die in childbirth, and tens of thousands of children die before reaching the age of one. Most of these deaths are preventable with safe water, sanitation, an effective public distribution system and affordable and accessible medical services (1). One expects a health minister to focus on these issues and try to change in the miserable scenario both in health care and public health.

Unfortunately, Dr Anbumani Ramadoss prefers publicity-rich but substance-poor gimmicks like asking Shah Rukh Khan to stop smoking on screen. Even his profile on the government website highlights this as one of his biggest achievements (2). No doubt eradicating tobacco use is a public health priority. The hard move would be to stop the growth of tobacco and close down the tobacco industry. But this would involve tough economic choices, and the health minister has shown a penchant for soft options which produce no tangible results other than keeping his name in the news.

With such an attitude it is not surprising that the minister took the extraordinary step of getting parliament to enact legislation just to remove an individual from government service. Dr P Venugopal, director of the All India Institute of Medical Sciences (AIIMS), would have retired in a short time anyway. (It is worrisome that parliament, which has been lethargic on so many important issues, could be fast-tracked for a matter of no social importance whatsoever.) The situation was this: Dr Venugopal had incurred the displeasure of Dr Ramadoss because he had supported students who agitated against the reservation of seats for Other Backward Classes in AIIMS. Dr Venugopal had been appointed director of AIIMS in 2003, and the normal tenure of the post is for five years. The Act of parliament that Dr Ramadoss got enacted (which has since been struck down by the Supreme Court) mandates that the director will retire at age 65. Since Dr Venugopal was 66 when the Act was passed, he was automatically retired (3). A tremendous amount of public time and public money was used to settle personal scores.

The publicity diverts media attention from Ramadoss’ – and the government’s – inaction on the health front. When he joined the cabinet in 2005, public spending on health had been less than one per cent of gross domestic product for more than a decade. Though the National Health Policy, 2002, had promised to double that proportion, government health spending has not increased at all. However, the government has diligently pursued the NHP’s objective of encouraging the private health sector. This has increased the cost of health care without improving its efficiency. On most measures of health, India remains among the poorest performers in the world. Corruption is rampant, and even the World Bank has been constrained to point this out.

If anything, Ramadoss’ contribution has been to further weaken the government’s role in health care. This is illustrated in his decision a few months ago to shut down three public sector manufacturing units of essential vaccines. His actions crippled this government industry and led to a sudden shortage of vaccines that threatened the universal immunisation programme. Further, with the shortage of government – manufactured vaccine, private companies have benefited (4). The minister’s justification – that the units did not meet WHO standards – has been criticised by health activists who point out that the violations were mostly technical and in any case they could have been remedied easily.

Dr Venugopal is no exemplar either. A director of an institute of the government should not work at cross-purposes with government policy except when asked to do something which is clearly against public interest. Dr Venugopal had no business to provide support to the anti-reservation agitation, and use his position as director for this purpose. If he felt so strongly about it he should have resigned his post.

Venugopal too has courted the media for his personal glory. In 2005, he went so far as to tell the press that stem cell procedures conducted by the AIIMS department of cardiology placed the institute “right at the top of the world’s medicine map”. (5) The stem cell therapy project was shut down, reportedly following controversy about its ethics clearance. There is also the question of the propriety of a scientist publicising his work in the press instead of through a medical journal.

Actually, one would expect that the director of AIIMS, which was set up by a special act of parliament to provide leadership in the fields of medical education and health care in India, would have priorities similar to those that the health minister is expected to have. That is, the director would initiate and encourage research and brain storming to help create public policy to solve the tremendous challenges in the field of public health and medical care in India. Instead, while AIIMS is listed as the “best medical college” in India, perhaps its chief claim to fame has been the number of its alumni who are exported to other countries. Stemming this brain drain requires close collaboration between the teaching institution and the health ministry. Such collaboration is of no interest to either Ramadoss or Venugopal.

The entire episode can be summed up in a line: Two petty men using the institutions of government for their own petty purposes. But they can do this only because the institutions themselves are so corrupted that they do not serve the people for whom they are intended. The poor and disadvantaged public who have waited so long for positive change will simply have to wait a while longer.