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 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.

Need for Increased Investment in Human Resource for Health in India: Estimating the Required Investment for Increased Production of Health Professionals for Achieving Universal Health Coverage and Sustainable Development Goals by 2030.

2021 ◽  
Author(s):  
Anup Karan ◽  
Himanshu Negandhi ◽  
Mehnaz Kabeer ◽  
Tomas Zapata ◽  
Dilip Mairembam ◽  
...  
Keyword(s):  
Human Resources ◽  
Health Worker ◽  
Health Workforce ◽  
Health Workers ◽  
Human Resources For Health ◽  
Labour Force ◽  
Labour Productivity ◽  
Health Sector ◽  
National Income ◽  
Health Coverage

Abstract BACKGROUND: COVID-19 has reinforced the importance of having sufficient, well-distributed and competent health workforce. In addition to improving health outcomes, increased investment has the potential to generate employment, increase labour productivity along with fostering economic growth. With COVID-19 highlighting the gaps in human resources for health in India, there is a need to better and empirically understand the level of required investment for increasing the production of health workforce in India for achieving the UHC/SDGs.METHODS: The study used data from a range of sources including National Health Workforce Account 2018, Periodic Labour Force Survey 2018-19, population projection of Census of India, and review of government documents and reports. The study estimated shortages in the health workforce and required investments to achieve recommended health worker: population ratio thresholds by the terminal year of the SDGs 2030.RESULTS: Our results suggest that to meet the threshold of 34.5 skilled health worker per 10,000 population, there will be a shortfall of 0.16 million doctors and 0.65 nurses/midwives in the total stock of human resources for health by the year 2030. The shortages at the same threshold will be much higher (0.57 million doctors and 1.98 million nurses/midwives) in active health workforce by 2030. The shortages are even higher when compared with a higher threshold of 44.5 health workers per 10,000 population. The estimated investment for the required increase in the production of health workforce ranges from INR 523 billion to 2,580 billion for doctors. For nurses/midwives, the required investment is INR 1,096 billion. Such investment during 2021-25 has the potential of an additional employment generation within the health sector to the tune of 5.4 million and contribute to national income to the extent of INR 3,429 billion annually.Conclusion: India needs to significantly increase the production of doctors and nurses(/midwives) through investing in opening up of new medical colleges. Nursing sector should be prioritized to encourage talents to join nursing profession and provide quality education. India needs to set-up a benchmark of skill-mix ratio and provide attractive employment opportunities in health sector to increase the demand and absorb the new supply of graduates.

scholarly journals Human Resources in Healthcare and Health Outcomes in India

2020 ◽  
Vol 11 (2) ◽  
pp. 133-159
Author(s):  
Venkatanarayana Motkuri ◽  
Udaya S. Mishra
Keyword(s):  
Human Resources ◽  
Health Outcomes ◽  
Census Data ◽  
Health Workers ◽  
Human Resources For Health ◽  
Size Composition ◽  
Healthcare Services ◽  
World Health ◽  
Middle Income ◽  
Minimum Requirement

Human resources for health including health professionals and skilled health workers are crucial in shaping health outcomes. But the shortage of human resources in healthcare services is a reality and hence it has been a cause of concern in lower-middle income countries like India. The present exercise based on census data is a situation analysis of size, composition and distribution of human resources available in the Indian healthcare services. It also explores the relationship between educational development and health workers availability alongside the association between density of health workers and health outcomes across states of India. It is observed that despite the remarkable improvement in health workers density particularly during 2001–2011, the country is falling short of the World Health Organization’s (WHO) need-based minimum requirement (4.45 health workers per 1,000 population) of health workers. The exploratory verification asserts that there is a significant and strong positive relationship/association between the density of health workers and health outcomes.

scholarly journals The role of information technology in strengthening human resources for health

2013 ◽  
Vol 114 (1) ◽  
pp. 67-79 ◽  
Author(s):  
Nicole Sarkis ◽  
Lillian Mwanri
Keyword(s):  
Information Technology ◽  
Health Services ◽  
Human Resources ◽  
Health Professionals ◽  
Service Providers ◽  
Health Workers ◽  
Human Resources For Health ◽  
English Literature ◽  
Content Type ◽  
The Pacific

Purpose – The purpose of this paper is to discuss innovative ways of addressing human resources for health (HRH) shortage in the Pacific, supported by a review of the literature and the Pacific Open Learning Health Network (POLHN), a programme created in response to the Pacific's HRH concern. Design/methodology/approach – A systematic search was conducted of English literature between 1990 and 2012. A number of key words, singly and/or in combination, were used to search for articles on ProQuest and PubMed. Original articles were identified and reference lists scrutinised to obtain additional literature. Due to the paucity of information, only narrative review was conducted and themes emerging from the literature identified and critically reviewed. Findings – There is a worldwide HRH shortage and a need to improve the skills of the health workforce to respond to changing population health needs. Continuing education (CE) through use of information technology (IT) is a means to strengthen HRH. POLHN is one example of an initiative to improve health worker skills and motivation. Technological change is increasingly common place in society. To make sense of these changes, practitioners can look for common themes in successful technological innovations of interactivity; information access, creation or sharing; communication; and simplicity. To ensure effective regulation of CE and IT there is a need to incorporate qualitative as well as quantitative measures, to prioritise the creation of quality, relevant, and appropriate resources and to facilitate access and active participation by health workers. Originality/value – The paper highlights the complexity of HRH shortage as a global problem, which demands multiple initiatives to respond to the shortage in the pursuit of skilled, equitable and just delivery of health services and distribution of health service providers. One initiative that has worked elsewhere is professional development of health professionals through the provision of CE using IT. Online learning offers a pathway to address HRH shortage and overcomes challenges posed by distance, limited infrastructure and in small remote communities. POLHN contributes to improved skills and knowledge among health professionals who can, as a result, deliver better health services in a region as geographically dispersed and isolated as the Pacific.

scholarly journals Intersectionality of gender in recruitment and retention of the health workforce in Africa: a rapid review

2021 ◽  
pp. 698-706
Author(s):  
Chigozie Uneke ◽  
Bilikis Uneke
Keyword(s):  
Human Resources ◽  
Health Workforce ◽  
Health Workers ◽  
Human Resources For Health ◽  
Rapid Review ◽  
Cultural Norms ◽  
Power Relationship ◽  
Recruitment And Retention ◽  
Management Positions ◽  
Pubmed Search

Background: Despite the importance of gender and intersectionality in policy-making for human resources for health, these issues have not been given adequate consideration in health workforce recruitment and retention in Africa. Aims: The objective of this review was to show how gender intersects with other sociocultural determinants of health to create different experiences of marginalization and/or privilege in the recruitment and retention of human resources for health in Africa. Methods: This was rapid review of studies that investigated the intersectionality of gender in relation to recruitment and retention of health workers in Africa. A PubMed search was undertaken in April 2020 to identify eligible studies. Search terms used included: gender, employment, health workers, health workforce, recruitment and retention. Criteria for inclusion of studies were: primary research; related to the role of gender and intersectionality in recruitment and retention of the health workforce; conducted in Africa; quantitative or qualitative study design; and published in English. Results: Of 193 publications found, nine fulfilled the study inclusion criteria and were selected. Feminization of the nursing and midwifery profession results in difficulties in recruiting and deploying female health workers. Male domination of management positions was reported. Gender power relationship in the recruitment and retention of the health workforce is shaped by marriage and cultural norms. Occupational segregation, sexual harassment and discrimination against female health workers were reported. Conclusion: This review highlights the importance of considering gender analysis in the development of policies and programmes for human resources for health in Africa.

scholarly journals The state of strategic plans for the health workforce in Africa

2019 ◽  
Vol 4 (Suppl 9) ◽  
pp. e001115 ◽  
Author(s):  
Doris Osei Afriyie ◽  
Jennifer Nyoni ◽  
Adam Ahmat
Keyword(s):  
Health Workforce ◽  
Health Workers ◽  
Human Resources For Health ◽  
Health Coverage ◽  
African Region ◽  
African Countries ◽  
Regional Office ◽  
Road Map ◽  
Strategic Plans ◽  
Sub Saharan

Many African countries have a shortage of health workers. As a response, in 2012, the Ministers of Health in the WHO African Region endorsed a Regional Road Map for Scaling Up the Health Workforce from 2012 to 2025. One of the key milestones of the roadmap was the development of national strategic plans by 2014. It is important to assess the extent to which the strategic plans that countries developed conformed with the WHO Roadmap. We examine the strategic plans for human resource for health (HRH) of sub-Saharan African countries in 2015 and assess the extent to which they take into consideration the WHO African Region’s Roadmap for HRH. A questionnaire seeking data on human resources for health policies and plans was sent to 47 Member States and the responses from 43 countries that returned the questionnaires were analysed. Only 72% had a national plan of action for attaining the HRH target. This did not meet the 2015 target for the WHO, Regional Office for Africa’s Roadmap. The plans that were available addressed the six areas of the roadmap. Despite all their efforts, countries will need further support to comprehensively implement the six strategic areas to maintain the health workers required for universal health coverage

scholarly journals Community health workers at the dawn of a new era: 2. Planning, coordination, and partnerships

2021 ◽  
Vol 19 (S3) ◽  
Author(s):  
Muhammad Mahmood Afzal ◽  
George W. Pariyo ◽  
Zohra S. Lassi ◽  
Henry B. Perry
Keyword(s):  
Global Health ◽  
Human Resources ◽  
Community Health ◽  
Community Health Workers ◽  
Health Systems ◽  
Health Workforce ◽  
Health Workers ◽  
Human Resources For Health ◽  
Critical Role ◽  
New Era

Abstract Background Community health workers (CHWs) play a critical role in grassroots healthcare and are essential for achieving the health-related Sustainable Development Goals. While there is a critical shortage of essential health workers in low- and middle-income countries, WHO and international partners have reached a consensus on the need to expand and strengthen CHW programmes as a key element in achieving Universal Health Coverage (UHC). The COVID-19 pandemic has further revealed that emerging health challenges require quick local responses such as those utilizing CHWs. This is the second paper of our 11-paper supplement, “Community health workers at the dawn of a new era”. Our objective here is to highlight questions, challenges, and strategies for stakeholders to consider while planning the introduction, expansion, or strengthening of a large-scale CHW programme and the complex array of coordination and partnerships that need to be considered. Methods The authors draw on the outcomes of discussions during key consultations with various government leaders and experts from across policy, implementation, research, and development organizations in which the authors have engaged in the past decade. These include global consultations on CHWs and global forums on human resources for health (HRH) conferences between 2010 and 2014 (Montreux, Bangkok, Recife, Washington DC). They also build on the authors’ direct involvement with the Global Health Workforce Alliance. Results Weak health systems, poor planning, lack of coordination, and failed partnerships have produced lacklustre CHW programmes in countries. This paper highlights the three issues that are generally agreed as being critical to the long-term effectiveness of national CHW programmes—planning, coordination, and partnerships. Mechanisms are available in many countries such as the UHC2030 (formerly International Health Partnership), country coordinating mechanisms (CCMs), and those focusing on the health workforce such as the national Human Resources for Health Observatory and the Country Coordination and Facilitation (CCF) initiatives introduced by the Global Health Workforce Alliance. Conclusion It is imperative to integrate CHW initiatives into formal health systems. Multidimensional interventions and multisectoral partnerships are required to holistically address the challenges at national and local levels, thereby ensuring synergy among the actions of partners and stakeholders. In order to establish robust and institutionalized processes, coordination is required to provide a workable platform and conducive environment, engaging all partners and stakeholders to yield tangible results.

scholarly journals Health workforce financing in Uganda: challenges and opportunities

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Koutsoumpa ◽  
R Odedo ◽  
A Banda ◽  
M Meurs ◽  
C Hinlopen ◽  
...  
Keyword(s):  
Low Income ◽  
Health Workforce ◽  
Management Practices ◽  
Health Workers ◽  
Human Resources For Health ◽  
Health Sector ◽  
Adverse Outcomes ◽  
Low Income Countries ◽  
Current Status ◽  
Poor Management

Abstract Background For health systems to operate well and improve people's health by leaving no one behind, they need a fit-for-purpose health workforce. Shortage of health workers leads to reduced access to healthcare, health inequities, and adverse outcomes in the population's health. A key challenge in many low-income countries is mobilising the needed investment for health workforce development. This study evaluated the policy environment of the health workforce in Uganda, analysed its current status, and identified financing mechanisms and management practices that affect the country's health resource envelope. Methods The study was conducted in 2018/19. It entailed literature review, key informant interviews and stakeholder consultations for validation of the findings. Results The shortage of health workers is persevering, despite efforts of the Ugandan Government and development partners. The health workforce is not keeping up with the population growth, nor the epidemiologic changes and demographic trends. Paradoxically, there is a large pool of qualified and licensed health professionals, who remain unabsorbed. Notably, even if all of them were absorbed, Uganda would be still far from the international requirements for universal health coverage. The issues are recognized at the policy level, but insufficient funding and poor management are impeding the recruitment and retention of health workers. Domestic resources are insufficient to fund a health system which can offer a minimum healthcare package and most donors are reluctant to contribute to health workers' salaries. Besides, Uganda is lacking a national health insurance scheme, which keeps out-of-pocket spending on health at very high rates. Moreover, increases in external financing have been accompanied by decreases in domestic government financing, despite economic growth. Conclusions The health sector financing is influenced by a complex political economy, which impedes investments in the health workforce. Key messages The problems and gaps of the Ugandan human resources for health are persisting due to the insufficient financial allocation and the poor management of the health workforce and existing funds. The shortage of health workers is a global health issue that goes beyond national borders and the health sector. It is an essential requirement for exercising the universal right to health.

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