From MBA to Public Health: A Conversation with Trushar Parmar

Q. What drew you to public health?

Trushar Parmar: I didn't plan this trajectory. The BHMS was clinical training, and for a while that felt sufficient as you see a patient, you treat, you document. But community medicine was part of the curriculum, and something about it stuck. It asks a different question from clinical medicine: not what is wrong with this person, but why this condition keeps recurring in this population, in this district, year after year. That shift in unit of analysis, from individual to group, changed how I thought about health altogether.

The MBA followed, partly out of curiosity about the system side: how facilities function, how care gets financed, where access breaks down. Working across Reproductive and Child Health, TB, and immunization programs after that made the abstraction concrete. In the field, the gap between what a policy prescribes and what actually reaches a beneficiary is stark, and that gap is where most of the real work sits. As I mentioned above, the pull toward public health started earlier, in a community medicine lecture, in a question that no individual consultation could answer.

Q. What key areas are you currently focusing on to advance global health financing?

Trushar Parmar: My current focus sits at designing of Health Benefit Packages (case-based payment system) under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, which is world's largest health insurance/assurance scheme. The role's emphasis is on key questions such as what's in the benefit package, how providers are paid, and what data gets collected.

This reform, I believe, is realistic and incremental: tightening benefit package design, improving claims classification using ICD-11 and ICHI to understand what's being treated, and using that evidence to refine payment logic over time. India's provider base is heterogeneous, information systems are still maturing, and rate revision carries real political weight.

So, the work that matters right now is the groundwork: what morbidities are to be prioritized and covered, getting classification right, identifying where the current package has gaps or perverse incentives, and building in structured patient feedback that feeds into quality assessments rather than sitting as standalone satisfaction data. The longer objective is UHC. But the lever is in the design details.

Q. Having worked both inside government and with development organizations, what overarching insights have shaped your perspective on these two systems?

Trushar Parmar: Government work taught me that legitimacy and governance matter more. A well-designed reform with no internal ownership goes nowhere and I've seen that firsthand. Development organizations have the opposite perspective: strong execution, but on timelines that don't always survive the next funding cycle.

Inside National Health Authority, what strikes me is that neither system is self-sufficient. Government provides policy anchor and governance oversight. Partners bring capacity and technical depth. The gap between them is at design level and bridged by coordination.

Q. You've studied at renowned institution like London School of Hygiene and Tropical Medicine. What is the single biggest lesson that has stayed with you?

Trushar Parmar: I arrived at LSHTM with more than a decade's experience, so the technical content wasn't entirely new. What shifted was how I thought about evidence. The one hard thing to ignore was rigorous analysis and political feasibility are different problems, and conflating them is where most reforms quietly fail.

Good evidence that can't survive the institutional environment it lands in doesn't change much. That's the lesson I carried back, and it shows up constantly in the PM-JAY work.

Q. How can aspire public health professionals from LMICs navigate and succeed at the international level amid the current global funding constraints?

Trushar Parmar: Funding constraints, although they are really challenging, don't eliminate opportunity. Rather, they concentrate on it. Generalist space is shrinking. What remains is demand for people who can do specific things well in specific contexts.

For experienced professionals, the starting point isn't reinvention but translation. Technical depth built inside a national program travels. How policy moves through a system, how providers respond to payment incentives, where implementation breaks down; these patterns repeat across LMICs. That experience is transferable if you can articulate it clearly. Specialize, document your work, make it visible. That's the durable path.

Q. Whom do you most admire in professional life, and why?

Trushar Parmar: Honestly, it's hard to pin one name. Across TB programs, health financing work, and field postings I've been opportune to observe and learn on what works and what does not. Learning in public health is oddly distributed that way.

But Paul Farmer stays with me. He refused a premise most institutions quietly accept that where you're born determines the care you deserve. He put it simply: "The idea that some lives matter less is the root of all that is wrong with the world." Hard to argue with that. Harder still to actually build your work around it.

Q. What book(s) are you currently writing?

Trushar Parmar: Not a book yet honestly, that ambition is parked for now. What's actually taking up my thinking is a piece on financing for surgical care in LMICs, which remains oddly underexplored given how much of the disease burden it touches. And a deeper dive into PM-JAY, not another programme review, but something that sits with the data long enough to ask uncomfortable questions about who the scheme is really reaching and what it's actually paying for, for example cancer care.

Q. Do you have a personal motto or mantra you live by?

Trushar Parmar: Not a formal motto, but two voices I keep returning to. Paul Farmer's insistence that the suffering of the poor is never inevitable - that it has causes, and causes can be changed. And Margaret Mead's reminder that small groups of committed people are behind every meaningful change the world has seen.

Between the two, something like a working principle: care enough to understand the root, then act like it's possible to shift it. That's the standard I try to hold myself to, imperfectly.