scholarly journals Size, composition and distribution of human resource for health in India: new estimates using National Sample Survey and Registry data

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e025979 ◽  
Author(s):  
Anup Karan ◽  
Himanshu Negandhi ◽  
Rajesh Nair ◽  
Anjali Sharma ◽  
Ritika Tiwari ◽  
...  
Keyword(s):  
Human Resource ◽  
Health Workforce ◽  
Health Professionals ◽  
Health Workers ◽  
Size Composition ◽  
National Sample ◽  
Registry Data ◽  
Sample Survey ◽  
Secondary Outcome ◽  
Nurses And Midwives

ObjectivesWe provide new estimates on size, composition and distribution of human resource for health in India and compare with the health workers population ratio as recommended by the WHO. We also estimate size of non-health workers engaged in health sector and the size of technically qualified health professionals who are not a part of the health workforce.DesignNationally representative cross-section household survey and review of published documents by the Central Bureau of Health Intelligence.SettingNational.ParticipantsHead of household/key informant in a sample of 101 724 households.InterventionsNot applicable.Primary and secondary outcome measuresThe primary outcome was the number and density of health workers,and the secondary outcome was the percentage of health workers who are technically qualified and the percentage of individuals technically qualified and not in workforce.ResultsThe total size of health workforce estimated from the National Sample Survey (NSS) data is 3.8 million as of January 2016, which is about 1.2 million less than the total number of health professionals registered with different councils and associations. The density of doctors and nurses and midwives per 10 000 population is 20.6 according to the NSS and 26.7 based on the registry data. Health workforce density in rural India and states in eastern India is lower than the WHO minimum threshold of 22.8 per 10 000 population. More than 80% of doctors and 70% of nurses and midwives are employed in the private sector. Approximately 25% of the currently working health professionals do not have the required qualifications as laid down by professional councils, while 20% of adequately qualified doctors are not in the current workforce.ConclusionsDistribution and qualification of health professionals are serious problems in India when compared with the overall size of the health workers. Policy should focus on enhancing the quality of health workers and mainstreaming professionally qualified persons into the health workforce.

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

2021 ◽  
Author(s):  
Anup Karan ◽  
Himanshu Negandhi ◽  
Suhaib Hussain ◽  
Tomas Zapata ◽  
Dilip Mairembam ◽  
...  
Keyword(s):  
Health Workforce ◽  
Health Professionals ◽  
Health Workers ◽  
Human Resources For Health ◽  
Labour Force ◽  
Medical Practitioner ◽  
Size Composition ◽  
Skewed Distribution ◽  
Sample Survey ◽  
Skill Mix

Abstract BACKGROUND: Investment in human resources for health not only strengthen 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 2017-18 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 (NSSO2017-18) 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/mid-wives 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/mid-wives 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 labour 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 labour markets and additional trainings and skill building for already working but inadequately qualified health workers.

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

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Anup Karan ◽  
Himanshu Negandhi ◽  
Suhaib Hussain ◽  
Tomas Zapata ◽  
Dilip Mairembam ◽  
...  
Keyword(s):  
Labor Markets ◽  
Health Workforce ◽  
Health Professionals ◽  
Health Workers ◽  
Human Resources For Health ◽  
Labour Force ◽  
Medical Practitioner ◽  
Skewed Distribution ◽  
Sample Survey ◽  
Skill Mix

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.

scholarly journals Size, Composition and Distribution of Health Workforce in India: Why, and Where to Invest?

2020 ◽  
Author(s):  
Anup Karan ◽  
Himanshu Negandhi ◽  
Suhaib Hussain ◽  
Tomas Zapata ◽  
Dilip Mairembam ◽  
...  
Keyword(s):  
Health Workforce ◽  
Health Professionals ◽  
Health Workers ◽  
Human Resources For Health ◽  
Labour Force ◽  
Medical Practitioner ◽  
Labour Markets ◽  
Skewed Distribution ◽  
Sample Survey ◽  
Skill Mix

Abstract BACKGROUND: Investment in human resources for health not only strengthen 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 2017-18 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 (from NSSO2017-18) 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/mid-wives 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/mid-wives 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 labour 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 labour markets and additional trainings and skill building for already working but inadequately qualified health workers.

scholarly journals Time trends in the regional distribution of physicians, nurses and midwives in Europe

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Juliane Winkelmann ◽  
Ulrike Muench ◽  
Claudia B. Maier
Keyword(s):  
Health Workforce ◽  
Health Professionals ◽  
Time Trends ◽  
Regional Distribution ◽  
Annual Growth Rate ◽  
Physician Density ◽  
Cross Country ◽  
Nurses And Midwives ◽  
Over Time ◽  
Distribution Of Physicians

Abstract Background Country-level data suggest large differences in the supply of health professionals among European countries. However, little is know about the regional supply of health professionals taking a cross-country comparative perspective. The aim of the study was to analyse the regional distribution of physicians, nurses and midwives in the highest and lowest density regions in Europe and examine time trends. Methods We used Eurostat data and descriptive statistics to assess the density of physicians, nurses and midwives at national and regional levels (Nomenclature of Territorial Units for Statistics (NUTS) 2 regions) for 2017 and time trends (2005–2017). To ensure cross-country comparability we applied a set of criteria (working status, availability over time, geographic availability, source). This resulted in 14 European Union (EU) countries and Switzerland being available for the physician analysis and eight countries for the nurses and midwives analysis. Density rates per population were analysed at national and NUTS 2 level, of which regions with the highest and lowest density of physicians, nurses and midwives were identified. We examined changes over time in regional distributions, using percentage change and Compound Annual Growth Rate (CAGR). Results There was a 2.4-fold difference in the physician density between the highest and lowest density countries (Austria national average: 513, Poland 241.6 per 100,000) and a 3.5-fold difference among nurses (Denmark: 1702.5, Bulgaria: 483.0). Differences by regions across Europe were higher than cross-country variations and varied up to 5.5-fold for physicians and 4.4-fold for nurses/midwives and did not improve over time. Capitals and/or major cities in all countries showed a markedly higher supply of physicians than more sparsely populated regions while the density of nurses and midwives tended to be higher in more sparsely populated areas. Over time, physician rates increased faster than density levels of nurses and midwives. Conclusions The study shows for the first time the large variation in health workforce supply at regional levels and time trends by professions across the European region. This highlights the importance for countries to routinely collect data in sub-national geographic areas to develop integrated health workforce policies for health professionals at regional levels.

HUMAN RESOURCE CAPACITY TO EFFECTIVELY IMPLEMENT MALARIA ELIMINATION: A POLICY BRIEF FOR ETHIOPIA

2013 ◽  
Vol 29 (2) ◽  
pp. 212-217 ◽  
Author(s):  
Adugna Woyessa ◽  
Mamuye Hadis ◽  
Amha Kebede
Keyword(s):  
Human Resource ◽  
Malaria Control ◽  
Health Workforce ◽  
Malaria Elimination ◽  
Health Personnel ◽  
Career Guidance ◽  
Health Workers ◽  
Malaria Incidence ◽  
Audit And Feedback ◽  
Educational Outreach

Objective: The aim of this study was to investigate malaria elimination in Ethiopia. Ethiopia has planned to eliminate malaria by 2015 in areas of unstable malaria transmission and in the entire country by 2020. However, there is a shortage and maldistribution of the health workforce in general and malaria experts in particular. Training, motivating, and retaining the health workforce involved in malaria control is one strategy to address the shortage and maldistribution of the health workforce to achieve the goal of elimination.Methods: Policy options include the following: (i) in-service training (educational outreach visits, continuing education meetings and workshops, audit and feedback, tailored interventions, and guideline dissemination) may improve professional practice; (ii) recruiting and training malaria specialists together with academic support, career guidance, and social support may increase the number of malaria experts; and (iii) motivation and retention packages (such as financial, educational, personal, and professional support incentives) may help motivate and retain malaria professionals.Results: Implementation strategies include the following: (i) massive training of health personnel involved in malaria elimination and malaria experts (requiring special training) at different levels (national, sub-national, District & community levels), and (ii) recruiting highly qualified health personnel and retention and motivation mechanisms are needed.Conclusions: The lack of adequately trained human resources and personnel attrition are major challenges to effectively implement the planned multi-faceted malaria elimination by 2020 strategy in Ethiopia. Although a reduction in malaria incidence has been observed in the last 3-4 years, maintaining this success and achieving the malaria elimination goal with the present human resource profile will be impossible. A clear strategy for developing the capacity of the health workers in general, and malaria experts in particular, and retaining and motivating staff are crucial for malaria control and elimination.

scholarly journals The Australian health workforce:facts and futures

2000 ◽  
Vol 23 (4) ◽  
pp. 60 ◽  
Author(s):  
Stephen Duckett
Keyword(s):  
Quality Of Care ◽  
Health Workforce ◽  
Health Professionals ◽  
Health Workers ◽  
Technical Skills ◽  
Health Costs ◽  
Policy Issues ◽  
Australian Health ◽  
Care Services

The quality of care received by a patient or consumer critically depends on the knowledge, skills and attitudes of thehealth workforce; the structure and functioning of the health workforce is critical to the structure and functioning ofthe health system overall. To a very large extent, diagnosis and treatment decisions call on the training and experienceof the health professional. The quality of the interaction between a patient or consumer depends on the interpersonaland technical skills of health professionals. In a sense, health workers are important to defining the very nature ofhealth care services. The importance of the health workforce is further highlighted by the fact that, as is typical of mostservice industries, labour accounts for a large proportion of health costs (around 80%).This paper provides an overview of the size and composition of the health workforce in Australia. It then reviewsthree segments of the workforce in more detail (medical, nursing and other health professionals) and reviewscontemporary policy issues affecting those groups.

scholarly journals Transforming tuberculosis (TB) service delivery model in China: issues and challenges for health workforce

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Ziyue Wang ◽  
Weixi Jiang ◽  
Yuhong Liu ◽  
Lijie Zhang ◽  
Anna Zhu ◽  
...  
Keyword(s):  
Service Delivery ◽  
Workforce Development ◽  
Health Workforce ◽  
Health Professionals ◽  
Health Workers ◽  
Health Centers ◽  
Service Delivery Model ◽  
Service Model ◽  
Delivery Model ◽  
Health Workforce Development

Abstract Background China’s TB control system has been transforming its service delivery model from CDC (Centers for Disease Control and Prevention)-led model to the designated hospital-led model to combat the high disease burden of TB. The implications of the new service model on TB health workforce development remained unclear. This study aims to identify implications of the new service model on TB health workforce development and to analyze whether the new service model has been well equipped with appropriate health workforce. Methods The study applied mixed methods in Zhejiang, Jilin, and Ningxia provinces of China. Institutional survey on designated hospitals and CDC was conducted to measure the number of TB health workers. Individual questionnaire survey was conducted to measure the composition, income, and knowledge of health workers. Key informant interviews and focus group discussions were organized to explore policies in terms of recruitment, training, and motivation. Results Zhejiang, Jilin, and Ningxia provinces had 0.33, 0.95, and 0.47 TB health professionals per 10 000 population respectively. They met the national staffing standard at the provincial level but with great variety at the county level. County-designated hospitals recruited TB health professionals from other departments of the same hospital, existing TB health professionals who used to work in CDC, and from township health centers. County-designated hospitals recruited new TB health professionals from three different sources: other departments of the same hospital, CDC, and township health centers. Most newly recruited professionals had limited competence and put on fixed posts to only provide outpatient services. TB doctors got 67/100 scores from a TB knowledge test, while public health doctors got 77/100. TB professionals had an average monthly income of 4587 RMB (667 USD). Although the designated hospital had special financial incentives to support, they still had lower income than other health professionals due to their limited capacity to generate revenue through service provision. Conclusions The financing mechanism in designated hospitals and the job design need to be improved to provide sufficient incentive to attract qualified health professionals and motivate them to provide high-quality TB services.

scholarly journals Time trends in the regional distribution of physicians, nurses and midwives in Europe

2020 ◽  
Author(s):  
Juliane Winkelmann ◽  
Ulrike Muench ◽  
Claudia B. Maier
Keyword(s):  
Health Workforce ◽  
Health Professionals ◽  
Time Trends ◽  
Regional Distribution ◽  
Annual Growth Rate ◽  
Physician Density ◽  
Cross Country ◽  
Nurses And Midwives ◽  
Over Time ◽  
Distribution Of Physicians

Abstract Background. Country-level data suggest large differences in the supply of health professionals among European countries. However, little is know about the regional supply of health professionals taking a cross-country comparative perspective. The aim of the study was to analyse the regional distribution of physicians, nurses and midwives in the highest and lowest density regions in Europe and examine time trends.Methods. We used Eurostat data and descriptive statistics to assess the density of physicians, nurses and midwives at national and regional levels (Nomenclature of Territorial Units for Statistics (NUTS) 2 regions) for 2017 and time trends (2005-2017). To ensure cross-country comparability we applied a set of criteria (working status, availability over time, geographic availability, source). This resulted in 145 European Union (EU) countries and Switzerland being available for the physician analysis and eight countries for the nurses and midwives analysis. Density rates per population were analysed at national and NUTS 2 level, of which regions with the highest and lowest density of physicians, nurses and midwives were identified. We examined changes over time in regional distributions, using percentage change and Compound Annual Growth Rate (CAGR).Results. There was a 2.4-fold difference in the physician density between the highest and lowest density countries (Austria national average: 513, Poland 241.6 per 100,000) and a 3.5-fold difference among nurses (Denmark: 1702.5, Bulgaria: 483.0). Differences by regions across Europe were higher than cross-country variations and varied up to 5.5-fold for physicians and 4.5-fold for nurses/midwives and did not improve over time. Capitals and/or major cities in all countries showed a markedly higher supply of physicians than more sparsely populated regions while the density of nurses and midwives tendeds to be higher in more sparsely populated areas. Over time, physician rates increased faster than density levels of nurses and midwives.Conclusions. The study shows for the first time theThe large variation in health workforce supply at regional levels and time trends by professions across the European region. This highlights the importance for countries to routinely collect data at in sub-national geographic areas in order for workforce planners, employers, educators and others to develop integrated health workforce policies and initiatives that may impact supply offor health professionals at regional levels.

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