The density of the health workforce (per 10,000 people) varies significantly among the Indian states, from 23.2% in Chandigarh to 10.5% in Meghalaya. States like Goa and Kerala, for instance, have doctor densities that are up to three times higher than those of Orissa and Chhattisgarh. Corresponding to this, these states have nurse and midwifery densities that are up to six times higher than those of low density states like Bihar and Uttar Pradesh. In general, the north-central states—some of which are among the poorest in India—have low densities.

If correct policy is developed regarding their recruitment and sustainability, AYUSH workforce could be a superior alternative to having fair health staff distribution in rural India. In order to achieve both horizontal and vertical health equity in rural India, an equitable distribution of the health workforce is essential. This can be done with the help of an effective AYUSH workforce. These doctors occasionally need to be reoriented on particular areas of healthcare because the AYUSH curriculum differs from those of their allopathic counterparts. Without a doubt, this will address the disparity in the health personnel and help ensure that health facilities are distributed fairly in rural areas.

Reference:

//documents1.worldbank.org/curated/en/928481468284348996/pdf/702410BRI0P1020k0Final000Vol010no03.pdf

//www.researchgate.net/publication/282640272_Role_of_AYUSH_Doctors_in_Filling_the_Gap_of_Health_Workforce_Inequality_in_Rural_India_with_Special_Reference_to_National_Rural_Health_Mission_A_Situational_Analysis

In India, such investments in HRH have the potential to enhance employment growth. They also increase the share of formal employment instead of informal employment and increase women's labor force participation in addition to increase in accessibility to health workers by population, particularly those living in rural and remote areas. Existing studies highlight an acute shortage of health workers at all levels, which has also been etched during the current pandemic crisis of COVID-19. World Health Organization. A recent 2020 WHO mid-term review of progress on the Decade for health workforce strengthening in SEAR 2015-2024, mentions that India needs at least 1.8 million doctors, nurses, and midwives to achieve the minimum threshold of 44.5 professional health workers per 10 000 population. India needs to invest in HRH for increasing the number of the active health workforce and to improve the skill-mix ratio (nurses-doctors, allied doctors, etc.Using the information available from the National Health Workforce Account (NHWA) on the stock of health professionalsand Periodic Labour Force Survey (PLFS) conducted by the National Sample Survey Of (NSSO 2017–18) on active health workforce, the study estimated total stock of 5.7 million health workers which included allopathic doctors (1.1 million), dentists (0.27 million), nurses (2.3 million), pharmacists (1.2 million) and traditional medical practitioners (AYUSH 0.79 million). However, the active health workforce size is estimated (by the NSSO 2017-18) to be much lower (3.04 million) with allopathic doctors and nurses estimated at 0.78 million and 1.36 million respectively. The prime reasons for differences between the two include the outmigration of health professionals, economically inactive health professionals, and lack of regular updates of the NHWA database. 

Reference:

//images.hindustantimes.com/images/app-images/2021/9/health-workforce.pdf

In India, community health centers (CHCs), available with 30-beds, round-the-clock rural hospitals that serve roughly 120,000 people, are at the top of a three-tier hierarchy of publicly supported health facilities. Primary health centers (PHCs) are in the middle, while health sub-centers (HSCs) are at the bottom. The CHC offers specialized treatments through a team of medical professionals that includes four specialist doctors (doctors with a postgraduate medical degree in specific areas), namely a surgeon, pediatrician, obstetrician, and anesthetist, and serves as a referral hub for the PHCs and HSCs in its located region, while HSCs and PHCs deliver essential healthcare services.

Further, while most urban regions have private health facilities that provide specialized services, however CHCs are largely responsible for ensuring access to these services in rural areas. The lack of skilled health workers and their unequal distribution at the CHC level found to have substantial effects on maternal and infant mortality as well as the quality of health care provided at higher levels, such as at district or regional hospitals. Nonetheless, due to the shortage of experts at the CHCs rural population frequently skip treatment or use the private sector, which is notorious for its expensive rates. As a result of the increased illness load and mortality experienced by the rural population due to a lack of CHC specialists, as well as the high out-of-pocket costs associated with receiving medical care, rural households get trapped in a cycle of poverty. 

Reference: Singh A. Shortage and inequalities in the distribution of specialists across community health centres in Uttar Pradesh, 2002-2012. BMC Health Serv Res. 2019 May 24;19(1):331. doi: 10.1186/s12913-019-4134-x. PMID: 31126283; PMCID: PMC6534828.n the expansion of work force & distribution of health personnel in India

India’s health workforce has expanded considerably in the past decade. The supply of qualified health workers has increased, owing to the substantial growth in training institutes for doctors, nurses and other health workers. Moreover, the National Rural Health Mission (now National Health Mission) has substantially augmented the workforce by adding 870 089 accredited social health activists (ASHAs) to serve as community health workers. These developments are significant, given the findings from earlier studies that India faces an overall deficit of health workers and that health workers are largely concentrated in urban areas of the country. It is far from clear, however, to what extent the growth in the health workforce has reduced the overall deficit or inequity in geographical distribution of health workers.

Information on the health workforce remains weak in India, as the routine sources of information on the health workforce provide fragmented and unreliable data. Government sources provide information on the public-sector health workforce in rural areas, but are silent on that for urban areas (at secondary and tertiary levels), as well as the private sector. Professional councils of doctors, nurses, pharmacists and Ayurveda, yoga and naturopathy, Unani, Siddha and homoeopathy (AYUSH) providers routinely publish statistics of the number of registered members; however, the absence of live registers in these institutions casts doubt on the reliability of these estimates, since they do not account for health workers exiting the workforce due to migration, death or retirement.

References 

//www.who-seajph.org/article.asp?issn=2224-3151;year=2016;volume=5;issue=2;spage=133;epage=140;aulast=Rao

In India there has been a huge expansion to enumerate the size, composition and distribution of India’s health workforce. Workforce estimates based on this survey suggest that the density of all health workers is 20.9 , allopathic doctors 5.8 , nurses and midwives 7.6 per 10 000 population. The overall estimates of health-worker density are similar to those based on the 2001 census. The combined density of qualified allopathic doctors and nurses and midwives of 6.4 per 10 000 population is considerably below the WHO benchmark of 22.8 workers per 10 000 population for achieving 80% of deliveries attended by skilled personnel, in cross-country comparisons. This suggests that there is a shortage of qualified providers of clinical care in India. There is considerable variation across states in the availability of qualified health workers, with those in north-central and north-eastern India having lower densities as compared to the national average. Kerala is the only state in India to achieve the WHO benchmark. This highlights that shortage of providers of clinical care is a feature of almost every Indian state. The results also confirm the skewed distribution of the workforce favouring urban areas, a phenomenon that is present in most countries.

The availability of reliable and comprehensive health workforce information is critical for workforce planning. In India, routine data sources on the health workforce are insufficient and untrustworthy. This paper addresses this issue and provides an in-depth look at India's health workforce. The study identifies several areas of concern, including overall low numbers of qualified health workers, a large presence of unqualified health workers, particularly in rural areas, and large differences in the distribution of qualified health workers between urban and rural areas.

Reference: 

//www.who-seajph.org/article.asp?issn=2224-3151;year=2016;volume=5;issue=2;spage=133;epage=140;aulast=Rao

India’s health system faces the ongoing challenge of responding to the needs of the most disadvantaged members of Indian society. Despite progress in improving access to health care, inequalities by socioeconomic status, geography and gender continue to persist. This is compounded by high out-of-pocket expenditures, with the rising financial burden of health care falling overwhelming on private households, which account for more than three-quarter of health spending in India. Health expenditures are responsible for more than half of Indian households falling into poverty; the impact of this has been increasing pushing around 39 million Indians into poverty each year...

//www.ncbi.nlm.nih.gov/pmc/articles/PMC3093249/

A crucial component of health systems is human resources for health (HRH). A focused investment in the health workforce fosters economic growth through a variety of pathways, including improved productivity and output, social protection and cohesion, social justice, innovation, and health security, according to the High-Level Commission on Health Employment and Economic Growth (ComHEEG). Progress toward a number of Sustainable Development Goals (SDGs) is fueled by investments in the health workforce.   According to the Global Strategy on Human Resources for Health: Workforce 2030 Report, appropriate investment in the health workforce, coupled with availability, accessibility, acceptability, and coverage, promotes general social and economic development and improves population health.  

Reference: //human-resources-health.biomedcentral.com/articles/10.1186/s12960-021-00575-2

I agree that a population's health depends on the equitable and efficient management of healthcare services.

Yet, a large fraction of Indians obtain care from unqualified or underqualified doctors as a result of state-level, urban-rural disparities. In the research quoted in the discussion (Rao,2016) nation's health workers are located in metropolitan regions, yet only 26% of the population has access to them. The government must concentrate on increasing the number of healthcare workers in rural areas in order to address this issue. It's time to close the healthcare workforce gap between urban and rural communities so that everyone has fair access to high-quality medical treatment.

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. 

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.

Reference 

//human-resources-health.biomedcentral.com/articles/10.1186/s12960-021-00575-2

//www.researchgate.net/publication/350300435_Size_composition_and_distribution_of_health_workforce_in_India_why_and_where_to_invest

Government occupies crucial part in influencing the health force status across  country.State's budgetary allocation leads to inter-state disparity in health services and health of professional  in India. The study analysed the inter-state disparities in health sector using data from 15 major states of India.The 3 rd most populated state Bihar has spent substantially lesser than other states with lesser population and stands in 11 th position in terms of Total Health Expenditure and the same goes to Odisha and Jharkhand as well. It is important to note that, states like Kerala, Gujarat, Maharashtra, Punjab and Tamil Nadu have made larger expenditure per person for health (Table 2) and holds top five ranks in health status indicators have spent relatively less in terms of percentage to GSDP. Government is the major stakeholder for expansion of workforce and distribution health personal in India. If allocation of health expenditure status  remains as such the barrier to attaining relative equal distribution through out india looks troublesome until and unless health expenditure is increased state wise and by central government.  Recruitment, sustainability of Health professional in rural areas need initial financial support until the facilities in those area are in line with facilities and opportunities availability. 

Reference : Lakshmanana Ganeshan.2019.A study of inter-state disparities in public health expenditure and its effectiveness on health status in India. //www.researchgate.net/publication/332292586_A_STUDY_ON_INTER-STATE_DISPARITIES_IN_PUBLIC_HEALTH_EXPENDITURE_AND_ITS_EFFECTIVENESS_ON_HEALTH_STATUS_IN_INDIA

Investment in human resources for health not only makes the health system stronger but also provides the employment and I contribute to economic growth. I think India is overpopulated and there is obviously a disparity in the expansion of work force and distribution of health personnel. Disparity means a difference in level or treatment, especially on that is seen as unfair. The study estimated ( from NHWA 2018) a total stock of 5.76 million health workers which included allopathic doctors (1.16 million), nurses or midwives (2.34 million), pharmacists (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. I think it is because of the lack of facilities, quality deficiencies, access limitations, and bad working environment, etc. A knowledgeable, skilled and motivated workforce is critical for UHC. And health workforce includes those that provide health services such as doctors, nurses, and the kind of things that support the health workforce like hospital managers and transport services etc. On the other hand, the skilled health workers are unable to deliver the health services effectively without appropriate physical capital and consumables. In India, the availability of health workforce is a challenge in rural areas and other remote parts of the country. I think that recruitment and deployment in rural areas with good facilities and salary for public service delivery should be increased to correct the disparity. The retention of the skilled professionals in rural areas with development programs seems to be useful as well.

India faces significant disparities in the distribution of its health workforce, with urban areas and certain regions enjoying better access to health personnel than rural and remote areas. Some of the key factors contributing to this disparity include:

1. Inadequate infrastructure and facilities in rural areas: Many rural areas lack basic amenities such as roads, transportation, electricity, and sanitation, making it challenging for health workers to access and provide services in these areas.
2. Limited training and career advancement opportunities: Health workers in rural areas often have limited access to training and career advancement opportunities compared to their urban counterparts, which can lead to lower job satisfaction and higher turnover rates.
3. Unequal distribution of resources: Resources such as funding, medical supplies, and equipment are often concentrated in urban areas, leading to disparities in the quality and availability of healthcare services.
4. Socioeconomic factors: Health personnel may be reluctant to work in rural areas due to lower pay, limited job security, and lower quality of life compared to urban areas. 

To address these disparities, India has implemented various initiatives, including increasing the number of medical schools and training programs in rural areas, providing financial incentives for health workers to work in underserved areas, and expanding telemedicine services to improve access to healthcare in remote areas. However, there is still a long way to go to achieve equitable distribution of the health workforce in India.

1. National Health Policy 2017. Ministry of Health and Family Welfare, Government of India. (2017). Retrieved from //www.nhp.gov.in/NHPfiles/national_health_policy_2017_draft.pdf
2. Dolea, C., Stormont, L., & Braichet, J. M. (2010). Evaluated strategies to increase attraction and retention of health workers in remote and rural areas. Bulletin of the World Health Organization, 88(5), 379-385. doi: 10.2471/BLT.09.070607
3. Gupta, M., & Kumar, R. (2012). Human resources for health in India: Strategy for universal health coverage. New Delhi: World Health Organization Regional Office for South-East Asia.
4. World Health Organization. (2016). India health workforce report 2016: Towards a more efficient and responsive health workforce. Retrieved from //www.who.int/hrh/resources/16058-india-health-workforce-report-2016.pdf
5. Government of India, Ministry of Health and Family Welfare. (2011). Rural health statistics in India. Retrieved from //www.nrhm-mis.nic.in/Pages/Ruralhealthstatistic.aspx

The health sector is the baseline for both society and the economy. It is an important aspect of the social development and health of working people. Now a day, the government of India does more concentration on the professional development of health care workers and the higher education system. (KPMG, 2016) Despite the government of India's focus on producing medical education and allowing private organizations to upbringing medical education and produce health practitioners in the medical field, there is still a lack of an unequal distribution of health care professionals in some the state of India. (KPMG, 2016 & Singh A, 2017) The lack of medical professionals in India might be due to not only surpassing the non-communicable diseases in India but also the increased expansion of health services such as telemedicine and low medical service price in comparison to the US/ western Europe. (KPMG, 2016)

A study was conducted in rural India to evaluate the shortage of human resources at Health sub-centers (HSCs) against the Indian Public Health Standard (IPHS) for human resources set by the government of India and tries to explore the reasons why these distributional imbalances in human resources at HSCs occur. The study showed that only 2 health workers of HSC in India are staffed against IPHS norms of 4 workers. About 3.8 % of HSCs are without an ANM and 51.6% of HSCs are without male health workers. There are 70% of total inter-HSC inequality is within the state. Ownership of the building, availability of phone, water, functional toilet, regular supply of electricity, and distance to district headquarters and nearest bus station are significantly associated with the number of health workers at HSC. In conclusion, either unequal distribution of human resources with the state or the limited number of health care workers recruited in the Indian Public Health System is the main contributor. (Singh A & Pallikadavath S, 2014)

According to the International labor organization (ILO), there will be a shortage of approximately 18 million health workers by 2030 especially in low- and lower middle-income countries and rural areas.

References

1. KPMG & National Skill Development Corporation, Environmental Scan 2016 report, 2016. Available from: //www.tsscindia.com/media/2565/kpmg-environmental-scan-report-2016.pdf
2. Singh A. Availability and distribution of staff nurses in Uttar Pradesh. TNNMC Journal of Community Health Nursing. 2017;5(2):23-33. Available from: com/ijor.aspx?target=ijor:tnnmcjchn&volume=5&issue=2&article=006
3. Singh A, Pallikadavath S. Human resource shortage and inequalities at the base of India‘s Public Healthcare System. In ANAIS DO CONGRESSO SUL-BRASILEIRO DE MEDICINA DE FAMÍLIA E COMUNIDADE 2014 (Vol. 4, p. 8). Available from DOI: 10.13140/RG.2.1.2960.1522
4. //www.ilo.org/wcmsp5/groups/public/---ed_dialogue/---sector/documents/publication/wcms_669363.pdf