Size, composition and distribution of health workforce in India: why, and where to invest?

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Abstract

Background

Investment in human resources for health not only strengthens the health system, but also generates employment and contributes to economic growth. India can gain from enhanced investment in health workforce in multiple ways. This study in addition to presenting updated estimates on size and composition of health workforce, identifies areas of investment in health workforce in India.

Methods

We analyzed two sources of data: (i) National Health Workforce Account (NHWA) 2018 and (ii) Periodic Labour Force Survey 2017–2018 of the National Sample Survey Office (NSSO). Using the two sources, we collated comparable estimates of different categories of health workers in India, density of health workforce and skill-mix at the all India and state levels.

Results

The study estimated (from NHWA 2018) a total stock of 5.76 million health workers which included allopathic doctors (1.16 million), nurses/midwives (2.34 million), pharmacist (1.20 million), dentists (0.27 million), and traditional medical practitioner (AYUSH 0.79 million). However, the active health workforce size estimated (NSSO 2017–2018) is much lower (3.12 million) with allopathic doctors and nurses/midwives estimated as 0.80 million and 1.40 million, respectively. Stock density of doctor and nurses/midwives are 8.8 and 17.7, respectively, per 10,000 persons as per NHWA. However, active health workers’ density (estimated from NSSO) of doctor and nurses/midwives are estimated to be 6.1 and 10.6, respectively. The numbers further drop to 5.0 and 6.0, respectively, after accounting for the adequate qualifications. All these estimates are well below the WHO threshold of 44.5 doctor, nurses and midwives per 10,000 population. The results reflected highly skewed distribution of health workforce across states, rural–urban and public–private sectors. A substantial proportion of active health worker were found not adequately qualified on the one hand and on the other more than 20% of qualified health professionals are not active in labor markets.

Conclusion

India needs to invest in HRH for increasing the number of active health workers and also improve the skill-mix which requires investment in professional colleges and technical education. India also needs encouraging qualified health professionals to join the labor markets and additional trainings and skill building for already working but inadequately qualified health workers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12960-021-00575-2.

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Most cited references 24

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Traditional Chinese Medicine in the Treatment of Patients Infected with 2019-New Coronavirus (SARS-CoV-2): A Review and Perspective

Yang Yang, Md. Islam, Jin. Wang … (2020)

Currently, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2, formerly known as 2019-nCoV, the causative pathogen of Coronavirus Disease 2019 (COVID-19)) has rapidly spread across China and around the world, causing an outbreak of acute infectious pneumonia. No specific anti-virus drugs or vaccines are available for the treatment of this sudden and lethal disease. The supportive care and non-specific treatment to ameliorate the symptoms of the patient are the only options currently. At the top of these conventional therapies, greater than 85% of SARS-CoV-2 infected patients in China are receiving Traditional Chinese Medicine (TCM) treatment. In this article, relevant published literatures are thoroughly reviewed and current applications of TCM in the treatment of COVID-19 patients are analyzed. Due to the homology in epidemiology, genomics, and pathogenesis of the SARS-CoV-2 and SARS-CoV, and the widely use of TCM in the treatment of SARS-CoV, the clinical evidence showing the beneficial effect of TCM in the treatment of patients with SARS coronaviral infections are discussed. Current experiment studies that provide an insight into the mechanism underlying the therapeutic effect of TCM, and those studies identified novel naturally occurring compounds with anti-coronaviral activity are also introduced.

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Human resources for health in India.

R. M. Chatterjee, Ashok Kumar, Ch Rao … (2011)

India has a severe shortage of human resources for health. It has a shortage of qualified health workers and the workforce is concentrated in urban areas. Bringing qualified health workers to rural, remote, and underserved areas is very challenging. Many Indians, especially those living in rural areas, receive care from unqualified providers. The migration of qualified allopathic doctors and nurses is substantial and further strains the system. Nurses do not have much authority or say within the health system, and the resources to train them are still inadequate. Little attention is paid during medical education to the medical and public health needs of the population, and the rapid privatisation of medical and nursing education has implications for its quality and governance. Such issues are a result of underinvestment in and poor governance of the health sector--two issues that the government urgently needs to address. A comprehensive national policy for human resources is needed to achieve universal health care in India. The public sector will need to redesign appropriate packages of monetary and non-monetary incentives to encourage qualified health workers to work in rural and remote areas. Such a policy might also encourage task-shifting and mainstreaming doctors and practitioners who practice traditional Indian medicine (ayurveda, yoga and naturopathy, unani, and siddha) and homoeopathy to work in these areas while adopting other innovative ways of augmenting human resources for health. At the same time, additional investments will be needed to improve the relevance, quantity, and quality of nursing, medical, and public health education in the country. Copyright © 2011 Elsevier Ltd. All rights reserved.

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What is the private sector? Understanding private provision in the health systems of low-income and middle-income countries.

Maureen Mackintosh, Amos Channon, Anup Karan … (2016)

Private health care in low-income and middle-income countries is very extensive and very heterogeneous, ranging from itinerant medicine sellers, through millions of independent practitioners-both unlicensed and licensed-to corporate hospital chains and large private insurers. Policies for universal health coverage (UHC) must address this complex private sector. However, no agreed measures exist to assess the scale and scope of the private health sector in these countries, and policy makers tasked with managing and regulating mixed health systems struggle to identify the key features of their private sectors. In this report, we propose a set of metrics, drawn from existing data that can form a starting point for policy makers to identify the structure and dynamics of private provision in their particular mixed health systems; that is, to identify the consequences of specific structures, the drivers of change, and levers available to improve efficiency and outcomes. The central message is that private sectors cannot be understood except within their context of mixed health systems since private and public sectors interact. We develop an illustrative and partial country typology, using the metrics and other country information, to illustrate how the scale and operation of the public sector can shape the private sector's structure and behaviour, and vice versa.

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Author and article information

Contributors

Anup Karan:

ORCID: http://orcid.org/0000-0002-3452-4326

anup.karan@iiphd.org

Journal

Journal ID (nlm-ta): Hum Resour Health

Journal ID (iso-abbrev): Hum Resour Health

Title: Human Resources for Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1478-4491

Publication date (Electronic): 22 March 2021

Publication date PMC-release: 22 March 2021

Publication date Collection: 2021

Volume: 19

Electronic Location Identifier: 39

Affiliations

[1 ]GRID grid.415361.4, ISNI 0000 0004 1761 0198, Indian Institute of Public Health-Delhi, Public Health Foundation of India, ; Plot No. 47, Sector 44, Institutional Area, Sector 32, Gurugram, Haryana 122002 India

[2 ]GRID grid.417256.3, South-East Asia Regional Office, Indraprastha Estate, World Health Organization, ; Mahatma Gandhi Marg, Outer Ring Rd, New Delhi, Delhi 110002 India

[3 ]GRID grid.417256.3, Health Systems, World Health Organization, Office of the WHO Representative To India, ; 537, A Wing, Nirman Bhawan, Maulana Azad Road, New Delhi, 110 011 India

[4 ]GRID grid.117476.2, ISNI 0000 0004 1936 7611, Faculty of Health, , WHO Collaborating Centre, University of Technology, ; Sydney, Australia

Author information

Anup Karan http://orcid.org/0000-0002-3452-4326

Article

Publisher ID: 575

DOI: 10.1186/s12960-021-00575-2

PMC ID: 7983088

PubMed ID: 33752675

SO-VID: 95448ec4-fd2c-4ba4-8399-91083f1f7617

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 2 November 2020

Date accepted : 24 February 2021

Funding

Funded by: World Health Organization, Country Office, India

Award ID: WHO Registration 2020/996952-0; Purchase Order 202512192

Award Recipient : Sanjay Zodpey

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: health workforce,human resource for health,investment in health,india

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: health workforce, human resource for health, investment in health, india

Size, composition and distribution of health workforce in India: why, and where to invest?

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Most cited references 24

Traditional Chinese Medicine in the Treatment of Patients Infected with 2019-New Coronavirus (SARS-CoV-2): A Review and Perspective

Human resources for health in India.

What is the private sector? Understanding private provision in the health systems of low-income and middle-income countries.

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