Disparity in the expansion of work force & distribution of health personnel in India

The result of this paper  shows that the coverage gap is highest in Uttar Pradesh (37%) and lowest in Madhya Pradesh (21%). Converge gap and socioeconomic development are negatively correlated (r=−0.49, p=0.01). The average coverage gap was highest in the lowest quintile of socioeconomic development. There was an absolute change of 1.5% per year in coverage gap during 2009–2013. In regression analysis, the coefficient of determination was 0.24, β=−30.05, p=0.01 for a negative relationship between socioeconomic development and coverage gap.

. In India, nine high focus states with high fertility and mortality, namely Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Uttar Pradesh, Uttarakhand, Rajasthan, Odisha and Assam, account for 48.48% of India's population.

This study assesses the district-level coverage gap in healthcare interventions in family planning, maternal and newborn health, immunization and treatment of sick children. This study adds a clear picture of the progress made by various districts in minimizing the gap and the gap to be filled up. The maximum coverage gap was observed in the lowest quintile of socioeconomic development status. In districts having a coverage gap of 50% or more, implementation should be intensified; districts with a coverage gap of 30–50% need more concrete plans for reducing inequalities and districts with a coverage gap of below 30% require targeted intervention to reduce inequalities further and improve the overall scenario.

REFERANCE

Awasthi A, Pandey CM, Chauhan RK, Singh U. Disparity in maternal, newborn and child health services in high focus states in India: a district-level cross-sectional analysis. BMJ Open. 2016 Aug 5;6(8):e009885. doi: 10.1136/bmjopen-2015-009885. PMID: 27496225; PMCID: PMC4985800

              There are clear differences of availability of health workers in Urban & Rural. There are more numbers of Qualified Doctors, Nurses, Midwives & other health care workers in urban India compared to rural India.  More than 60% health care workers live in urban India & serves only 26 % of population

               The main reason is fast pacing Urbanization in India, both technical- skilled & educated work force. Main Attraction for urbanization is employment & availability of services.

             Some important steps which can bridge this gap like

1. bridge courses for paramedical workers
2. Increase availability of basic services at rural areas in terms of number & quality.
3. Establishment of medical education institutes or satellite classroom at rural area.
4.  Mandatory bond to serve rural areas for health care students after completion of study.
5. Policy to encourage private hospital to be establish in rural area. Ex low rate loan, Tax benefit Etc.
6. Extra wages for health care workers for working in Rural area.

The density of the total health workforce is estimated to be 29 per 10,000 population but only 16 per 10,000 for trained workers

The skilled health workforce in India does not meet the minimum threshold of 22.8 skilled workers per 10,000 population recommended by the World Health Organisation.

Estimates of non-health workers engaged in the health sector and technically qualified health professionals who are not part of the current workforce is able to be provided in India for the first time by the study as it is based on data from two sources.

Estimated  number of qualified and unqualified healthcare workers actually working in India using the 68th round (July 2011–June 2012) of National Sample Survey Organisation (NSSO) data on ‘Employment and Unemployment Situation in India’ - a household survey conducted every five years.

As well as registered practitioners, the health workforce in India includes many informal medical practitioners, such as traditional birth attendants, faith healers, snakebite curers, and bonesetters without formal education or training.

The total size of health workforce registered with different councils and associations was 5 million, but the NSSO estimated the size of the workforce to be 1.2 million fewer at 3.8 million.

Based on the registration data, the density of the total health workforce was estimated to be 38 per 10,000 population, but the NSSO data found it be lower at 29 per 10,000 population. In eastern and rural states total health workforce density was lower than the WHO minimum threshold of 22.8 per 10,000 population.

According to the registry data the density of doctors and nurses and midwives per 10,000 population across India was 26.7, whereas the NSS0 data put it at 20.6.

The estimates also reveal “an alarmingly large presence of unqualified health professionals,” as adjusting for adequate qualifications of health workers reduced the workforce density from 29 to 16 health workers per 10,000 population.

The presence of unqualified health professionals in the health system is not unique in India. Unqualified health professionals are usually the first point of contact for rural and poor population in many low-income and middle-income countries.

The data also showed that approximately 25% of currently working health professionals do not have the required qualifications as laid down by professional councils, and that 20% of adequately qualified doctors are not in the current workforce. More than 80% of doctors and 70% of nurses and midwives were employed in the private sector.

“Policy should focus on enhancing the quality of health workers and mainstreaming professionally qualified persons into the health workforce.”

Reference:-

//www.bmj.com/company/newsroom/skilled-health-workforce-in-india-does-not-meet-who-recommended-threshold/

Women in the health workforce

In especially for women's health, female doctors and healthcare professionals are an important part of the health workforce. Since women in many areas of the country frequently hesitate to visit male doctors, particularly for their obstetrical and gynecological issues, the gender of the doctor is crucial.

What is the status of women in the Health care workforce ?

Women have shown to be particularly underrepresented in leadership roles, and the heath industry is no exception. Women make up 71% of the global health care workforce, according to a study published in the medical journal Lancet in 2021, and while both men and women make comparable advancements in this field in their early careers, women are five times more likely to experience roadblocks.

Given the importance of women's health and reducing unfair health inequalities, the gender gap in global health leadership is especially concerning

Closing this gap won't automatically fix every issue affecting women's health. However, it is a long overdue first move.

India’s health system has been stretched to the breaking point many times during the pandemic, with the bulk of the caring burden on women.

Up to 30% of physicians and more than 80% of nurses and midwives are thought to be women. Millions of lives have been saved by medical professionals in India and other countries, frequently at the cost of their own.

What Challenges do Women Face?

The situation in India is consistent with worldwide trends; women are less likely to hold senior positions in the health sector of our nation. The typical problems include.

• Pay disparity and irregular labor
• Absence of choice exposes gender bias and harassment realities
• lacking a support system and a network

In the health care industry, women make 28% less money than males on average, with a 10% pay gap that appears to be solely the result of occupational segregation.

What is the Significance of Women in the Healthcare Workforce?

According to studies, increasing the number of women in leadership roles not only boosts organizational productivity but also maximizes the worth of the female workforce.
It will be easier to incorporate the nuances of our societal fabric into policies if women are at the forefront and center of decision-making processes.
According to estimates, women make a 5% yearly contribution to the global GDP (US$3 trillion), of which almost 50% goes unacknowledged and unpaid.

Equal economic participation for men and women would increase global GDP by an estimated $160 trillion, or by 21.7%, or boost human capital wealth.

What might the future hold?

• More deliberate investment is required for effective leadership, as is the creation of chances that level the playing field.
• It is crucial to reevaluate our investments so that the health leadership at all levels is inclusive, diverse, and equitable. The pandemic has exposed the fragility of current systems and the need for quick, effective decision-making.
• A Collective Responsibility: In order to accelerate women's leadership in health and maximize paths thereto, we must make more deliberate, concerted efforts.
  To achieve this, it is necessary to adopt new viewpoints, let go of ingrained sociocultural assumptions, and ensure that everyone has an equitable opportunity to succeed.

Increasing the number of women in leadership positions: It is noteworthy that the Nari Shakti program and Mission Shakti were re-launched during the Budget session to provide unified citizen-centric support for women through integrated care and safety, rehabilitation, and for women as they move through life. This is a positive development.

It is possible that many individuals may have reported themselves as health care workers without having adequate educational qualifications as recognized by different counsils.

Less number of health care workers in labour market

Large proportion of health professional registered with different counsils and association were not part of the current health workforce in india

Doctors are more employed in private sectors while nurses are equally distributed across public and private sectors

This lopsided distribution of health workers not only created a shortage of trained health workforce in many states and rural areas but also led to an unequal skill -mix across different types of health workers in different settings 

There is also issue of high vacancies in sanctioned positions in public sectors for specialists posted at CHCs.

Reference : public health foundation of India 

This study analyzed two sources of data: the National Health Workforce Account (NHWA) 2018 and the Periodic Labor Force Survey 2017–2018 of the National Sample Survey Office (NSSO). It found that India had a total of 5.76 million health workers, including allopathic doctors, nurses/midwives, pharmacist, dentists, and traditional (AYUSH) medical practitioners. However, active health workers' density was estimated to be 6.1 and 10.6, respectively, well below the WHO threshold of 44.5 doctor, nurses, and midwives per 10,000 population. A substantial proportion of active health workers were found not adequately qualified, and more than 20% of qualified health professionals are not active in labor markets. The paper concludes with discussion for several policy implications such as expanding the supply side of the health workforce, increasing the number of nurses in the workforce, increasing participation of trained personnel in the workforce, balancing the skill-mix, fast-tracking recruitment and deployment for public health facilities, harnessing technology, up-skilling programs for less qualified care providers, improving HWF information. 

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

he Census estimates show that there were approximately. I 7 million hea lth workers in India in 2005, which translates into a density of approximatcly 20 hea lth workers per 10,000 popUlation. Among the different categories of health workers shown in Figure I, nurses and midwifes bad the largest share in the health workforce, followed by allopathic physieians,AYUSHJ physic ians and phannacists.Census estimates were based on self-reported occupations, which is susceptible to unqualified providers being counted as qualified health providers. When the Census estimates
were adjusted for health workers who may be unqualifiedbased all education self-reports available in the NSSO, the health worker density reduced to a linle over 8 per 10,000 population. For physicians, estimates from Ihe NSSO survey suggest thaI 37% (63% in rura l and 20% in urbanareas) had inadequate or no medical training; applying this proportion to the Census estimates, the allopathic physician density in India reduced from 6.1 to 3.8 per 10,000 population.

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

Investment in human resources for health not only strengthens the health system, but also generates employment and contributes to economic growth. Human resources for health are a core building block of health systems.The investment case for HRH in India is exemplified by the fact that India has a very low density of health workers per 10,000 population and the distribution of health workforce across the Indian states is highly skewed .A recent WHO report mentions that India needs at least 1.8 million doctors, nurses and midwives to achieve the minimum threshold of 44.5 health workers per 10,000 population in 2030.

Recent research suggesting that investment in more diverse staff and skill-mix can result in improved quality of care, quality of life, and job satisfaction. Women constitute a significant proportion of health workforce globally. However, concentration of women in low-profile jobs within the health sector and the related gender inequality has been a serious concern particularly in including India. The current COVID-19 pandemic has further exposed the acute shortage of health workers in India's health system. Studies have highlighted that there has been acute shortages of doctors and nurses along with low levels of skill-mix. A lack of adequate number of institutions providing training in nursing, and international migration of nurses from India are the two most prominent reasons for the shortage of trained nurses in India. There is a need to make balance between densities of doctor and nurse both for a better availability of health professionals and skill-mix. Skewed distribution of health workforce across states and rural–urban setting is yet another area which needs policy attention. Nearly two-thirds of all health workforce in India is concentrated in urban areas leaving rural population either in extreme unmet need of health workers or to avail their services by travelling in urban areas or both. 

Reference:

//www.ncbi.nlm.nih.gov/pmc/articles/PMC7983088/

Significant inequalities have been created by the existing inadequacies in the production of different categories of health workforce across various states of India. A great shortfall in the number of health workers was reported in the states with poor health outcomes. There is an urgent need to develop workforce development plans with immediate effect which includes retention of health workforce in the rural areas by incentivizing those interested to serve in rural areas, providing them social recognition, scholarship, bank and loan facilities , improving the quality of medical education, continuing education program, regular training, task shifting, multiskilling and training and development of multidisciplinary teams to meets the needs of population at a holistic level, networking of institutes via technology, telehealth and e-health services. There has been rapid increase in the establishment of institutes and hence the number of workforce but more emphasis has to be laid upon the right distribution of the workforce, retention and strengthening the competencies of the workforce. Below is an interesting read. 

//www.ijcmph.com/index.php/ijcmph/article/view/5326/3473&source=gmail&ust=1679270395605000&usg=AOvVaw3H7Kkdv20Qji7HE68pmKk 5"> //www.ijcmph.com/index.php/ijcmph/article/view/5326/3473

Despite progress in addressing health workforce shortages, an estimated shortfall of 18
million health professionals by 2030 has been projected, especially in low- and lower middle-income countries and rural areas, 78 supplemented by an estimated global shortage
of 31.8 million workers in non-health occupations supporting health service delivery. 79, 80
To achieve UHC, these gaps need to be addressed, which would create jobs on a significant
scale. According to ILO estimates, achieving UHC will require significantly more jobs by
2030 in the health sector and beyond; specifically, 27 million new jobs for workers in health
occupations, 45.5 million new jobs for workers in non-health occupations, and creating new
jobs for the estimated 57 million unpaid non-health workers.

References

//www.ilo.org/wcmsp5/groups/public/---ed_dialogue/---sector/documents/publication/wcms_669363.pdf

Disparity in the expansion of work force & distribution of health personnel in India. Large proportion of the health professionals registered with different councils and associations are not part of the current health workforce in India. One widely discussed reason is the migration of qualified health professionals from India to other developed countries.

NHWA provides total stock of health professionals, but not all of them are active in labor markets. Using NSSO, substantial proportion of medically qualified individuals, overwhelmingly women, is currently not a part of workforce, either because they are currently unemployed but available for work or they do not want to join labor markets. This is particularly amplified for nurses/midwives, for whom the difference between the registered and active workers is the highest.

AYUSH practitioners are recognized health professionals by government of India and they use indigenous system of healthcare.

Ref: //www.ncbi.nlm.nih.gov/pmc/articles/PMC7983088/  

Disparity in the expansion of work force & distribution of health personnel in India. Large proportion of the health professionals registered with different councils and associations are not part of the current health workforce in India. One widely discussed reason is the migration of qualified health professionals from India to other developed countries.

NHWA provides total stock of health professionals, but not all of them are active in labor markets. Using NSSO, substantial proportion of medically qualified individuals, overwhelmingly women, is currently not a part of workforce, either because they are currently unemployed but available for work or they do not want to join labor markets. This is particularly amplified for nurses/midwives, for whom the difference between the registered and active workers is the highest.

AYUSH practitioners are recognized health professionals by government of India and they use indigenous system of healthcare.

Ref: //www.ncbi.nlm.nih.gov/pmc/articles/PMC7983088/