The first time that I met Keshav Desiraju was when he was Union health secretary and I was the director of the Tuberculosis Research Centre. We were having a discussion on challenges in the TB control programme. What struck me was that he could get to the heart of the problem immediately, that he could identify what the bottlenecks in implementation were and then look for solutions in a constructive manner. The second thing that I noticed was that he was a very inclusive person, in the sense that he didn’t listen only to people in positions of power or behave in a hierarchical way, but also paid heed to civil society groups, activists, NGOs and patients groups. He recognised the importance of all voices in finding a solution, particularly for a disease like tuberculosis where social and behavioural issues are very important. His commitment to equity and social justice shone through.
He took many initiatives when he was Union health secretary. One that stands out is the development of the national mental health policy. And again the way he did that was very different. He used people with hands-on experience and NGOs to develop that national mental health policy. So, it was not done top down but rather it was done bottom up. That will be a lasting contribution as mental health is still a neglected problem in India and globally. While the policy still needs full implementation, the development of such a detailed district-level plan was a major national and global landmark.
Keshav was also instrumental in the creation of the National Technical Advisory Group on Immunisation (NTAGI). This is the group that does policy making on immunisation, the national expert group that decides on which vaccines should go into the national programme. From being a rather ad hoc affair, the NTAGI was set up in a way that decisions would be transparent and based on data and evidence, with technical sub-committees, which would examine the problem. The committee was co-chaired by the health secretary, secretary, health research and secretary and department of biotechnology, and it had a number of different experts, including some of the critics of the national immunisation programme. This process gave all a chance to be part of the discussions and express their views, and then decisions would be based on consensus. That was a unique and innovative way of handling a sensitive topic where all voices were heard, but decisions were based on science.
I believe that Keshav also strengthened the governance of the National Health Mission, which was still in its formative years. Keshav believed in listening to voices from the community and being responsive.
I would say he was an ideal policy maker, who not only created visionary policies, but also saw that they were implemented. He was a man of impeccable integrity and took a tough stance on tobacco and other commercial determinants of health. He was also trying to streamline medical education at the time when he was secretary.
After he retired, I had been in touch with him and worked closely with him on a number of different initiatives, where he was serving in an advisory role, several of them around mental health. Living in Tamil Nadu, which has several NGOs working on mental health, he was closely involved and helpful, as it was something he was very passionate about. He was also serving in advisory role to some WHO departments, including the Alliance for Health Policy and Systems Research, where he brought a very unique perspective as somebody who had been a policy maker and a decision maker, and who understood the importance of health system research for a policy maker. He was due to finish his term on the board of the Alliance in December. So, that is another area where he is going to be very sorely missed.
There is a flagship report called Learning Health Systems, which is going to be launched on Monday. And he had a major role to play in developing this report. He also had an important role to play in developing the next five years’ strategy of the Alliance and that strategy is also being finalised now.
(Dr Swaminathan is the chief scientist of World Health Organisation)