By Anup Karan
Health workers were globally applauded for their tireless and assiduous services during the Covid-19 crisis—not merely for their role in dispensing healthcare and saving lives, but also for enormously stretched working hours, dealing with constrained resources, contracting infections, and sustaining unnecessary and unwarranted violence. The shortage of health workforce during this period was widely exposed and many sufferings of health workers are related to such shortages at different levels of care and treatment of patients. On one hand, the OECD countries benefit immensely by a large presence of Indian origin and Indian-trained doctors and nurses in crisis situations such as this, and on the other the country’s health system is struggling with low numbers of trained health personnel.
Acute shortage of health workforce: Human resources are necessary for delivery of health services and population health. States like Kerala and Tamil Nadu having high health workforce population ratio also have high population health outcomes. Only by securing a sufficient, equitably-distributed, adequately-supported and well-performing health workforce can a country meet its health goals. Shortage of qualified and trained health workforce in India has been repeatedly highlighted in several research studies. A recent one by this author and his colleagues, ‘Size, composition and distribution of health workforce in India, why and where to invest’, published in the Human Resources for Health, in March 2021, noted that the density of health workforce in India is not even half of the 44.5 health workers per 10,000 persons as recommended by the WHO for achieving universal health coverage.
Although the registration council data of doctors and nurses shows availability of 11.6 lakh doctors and 23.4 lakh nurses as of 2018, the PLFS of the NSSO for 2018-19 reflects that more than 30% of doctors and more than 50% of nurses with adequate qualifications are not part of the current health workforce. The density of qualified active health workforce in India is as low as 12-13 doctors (including AYUSH practitioners) and nurses/midwives per 10,000 persons, which is almost half of the WHO-recommended minimum threshold of 22.8 health workers per 10,000 persons required for achieving 80% coverage of assisted deliveries by a skilled birth attendant. Moreover, the number of nurses per doctor in India is very low, approximately 1.3 nurses per doctor on an average, as against three nurses per doctor in developed countries.
Skewed distribution: Apart from low availability, the distribution of these health workers is acutely skewed with the less developed states like Assam, Bihar, Jharkhand, Madhya Pradesh, Odisha and Uttar Pradesh having health worker population ratio of as low as 6-8 health workers per 10,000 persons. Also, more than 60% of doctors and a little over 50% of nurses/midwives are employed in the private sector, while public facilities in different states report high level of vacancies against the sanctioned posts of health workers. Skewed distribution of health workers is pronounced across rural-urban settings. While rural population is about 66% of India’s total, only 33% of total health workforce and only 27% of doctors are available in rural areas.
Need for investment health workforce: Realising the acute shortage and skewed distribution of health workforce, the central government aims to increase the number of doctors and nurses and announced setting up of new educational institutions—157 medical colleges and about 50 nursing institutions in different phases. These institutions are likely to produce about 22,500 doctors and 2,000 nurses every year. This implies that even if 100% of the new graduates join health workforce, it will take more than 10 years to add 2.5 lakh health professionals to the existing qualified active health workforce of about 15 lakh. Since population during the same period likely to increase by a little less than 2% per annum, the density of health workforce per 10,000 persons will only marginally increase by 2030.
India needs big investment to meet even the minimum threshold of 22.8 health workforce per 10,000 persons. It’s needed to open new institutions for producing doctors and nurses, and create conducive environment and attractive pay packages to encourage qualified health professionals to join the active health workforce.
The author is additional professor, Indian Institute of Public Health Delhi, Public Health Foundation of India. Views are personal