It is estimated that India has a shortage of 600,000 doctors and 2 million nurses as per the Center for Disease Dynamics, Economics & Policy (CDDEP) in the US.
BY DIPANKAR BHATTACHARYA AND ARUSHI PANDEY
Healthcare in India faces a human resource crisis. Inadequate staffing levels is a major driver of the subpar healthcare crisis, which results in the death of 1.6 million Indians annually, out of which, 838,000 people died entirely due to lack of access to adequate health services as per a report by The Lancet in 2018. It is estimated that India has a shortage of 600,000 doctors and 2 million nurses as per the Center for Disease Dynamics, Economics & Policy (CDDEP) in the US. To ensure every Indian has access to the healthcare they need, strengthening the cadre of human resource in health (HRH) is critical.
The second edition of ‘Healthy States, Progressive India’ Report 2019, recently released by NITI Aayog, provides compelling evidence of how improving the public health delivery system can substantially improve the health outcomes. The report captures the performance of states through an index comprising 23 health parameters under three key domains—health outcomes, governance and information, and health systems or service delivery. Of these, the domain of health systems/service delivery indicators has 10 indicators and nearly 20% of the weightage and presents data on key measures of system capacity and performance, including vacant healthcare provider positions at different levels, the functionality of the facilities and quality of service delivery.
Based on data shared by the states and centre in NITI Aayog’s report, the states with the top one-third of overall index scores, called “front-runners”, have also scored relatively high in the health systems/service delivery domain. On the other hand, states that are among the poorest performers with index scores in the bottom one-third, called “aspirants”, have poor scores in the health systems/service delivery domain.
The strong health system/service delivery scores of “front-runners” viz. Kerala, Gujarat, and Karnataka indicate that their health systems are geared up to meet the diverse health challenges of their states and achieve the Sustainable Development Goal 3. “Achiever” states like West Bengal, and Assam, have scored relatively higher in the health systems/service delivery domain, suggesting that they have laid the groundwork to improve their health outcomes and close the gap with the “front-runners”.
The proportion of vacant health care provider positions (regular & contractual) in public health facilities is one such indicator. States like Bihar and Rajasthan have reported over 50% vacancies in the positions of staff nurses at Primary Health Centers (PHCs) and Community Health Centres (CHCs), while Uttarakhand reported 70% vacancy of Medical Officers (MO) at PHCs. Both Bihar and Uttarakhand reported over 60% dearth of specialists at the district hospitals. Whereas, the “front-runners” such as Kerala reported a vacancy of 3.6% staff nurses, 2.4% of Medical Officers and 13.5% of specialists at the District Hospitals.
Over and above the shortages of health staff, nearly 70% of all doctors and nurses are employed in the private sector and 25% of the healthcare professionals do not have requisite qualifications as laid down by the medical council (NSSO, 68th Round, 2011-12). Further, 80% of the health workforce is concentrated in the urban or semi-urban areas, therefore, a large part of the country remains under-served. Preference of the private sector over the public sector and urban areas over rural areas is owing to several factors viz. better income, better infrastructure, better living conditions and better education opportunities for their children.
NITI Aayog’s report clearly indicates the need for more investments to augment the number of doctors and other healthcare providers. Instead of short-term arrangements like contractual staff or outsourcing of the recruitment processes, a comprehensive policy on human resources for health is the need of the hour, which not only incorporate in-service training and skill enhancement but also career planning and progression. A better incentive structure would further improve staff retention and also attract qualified professionals to the public health workforce.
(Dipankar Bhattacharya leads the knowledge generation vertical in the Learning4impact knowledge collaborative for Reproductive, Maternal, Newborn, Child and Adolescent Health and TB, which is supported by USAID India Health Office. Arushi Pandey works as a Technical Specialist in the Learning4impact knowledge collaborative, which is supported by USAID India Health Office. Views expressed are personal.)