HEALTH WORKFORCE OF INDIA IN NUTSHELL :HEALTH WORKFORCE OF INDIA IN NUTSHELL Dr Nihar Ranjan Ray Indian Institute Of Public Health, Gandhinagar


Objective of the Session: :Objective of the Session: To define Health workforce of India To focus on Health scenario of India A brief on Health system of India To quantify the shortage of health workforce To find out a solution………. Gruop 1 2 Allopathic doctors AYUSH Support staffs


Back ground: HRH India :Back ground: HRH India Three main challenges that India faces Gruop 1 3 Communicable Dis., MCH, strengthening of health system Premature burden of NCDs. Management of Challenges like Shortage of health workforce Retention, Attrition & Migration Quality, Accountability & PP partnership


HRH Shortage: An issue of Concern ? :HRH Shortage: An issue of Concern ? Evidence from World Health Report 06 Health system is highly dependant upon Health workers All most all nations faces the challenge of shortage. Low motivated, low productivity….. Migration Gruop 1 4 Out of Country Rural-Urban Public-Private Health sector- Other sector ( Dangerous Transformation )


Health Workforce in India :Health Workforce in India Range: Super Specialty --- Bare foot Doctors Gruop 1 5 Spl. Doctors Paramedics Policy makers Planners, Educators, Promoters Ayurvedic Unani Siddha Naturopathic Non-Formal Providers


The Evolution & Revolutions :The Evolution & Revolutions Richer India ( GDP GR > 9% ) Nuclear empowered India as a Global power As an IT & Biotech power Gruop 1 6 IT & Telecom revolution Public Health Revolution Ex: PHFI & IIPH Eradication of Small pox Control of leprosy & Polio Increase life expectancy


Other Side of The Coin :Other Side of The Coin Still far from achieving its population health goals High level of IMR, MMR, CMR & Malnutrition Heavy burdens of communicable diseases like HIV, TB, Malaria, RTI & Diarrhoea. (50%) Non Communicable diseases in an increasing trends Gruop 1 7


Problem statement :Problem statement Emerging Infectious & anti-microbial resistance Behavioral issues influencing health Increase disease burden of Non communicable Diseases (NCD) Migration, Attrition, and Retention problems Skewed distribution of the Health workforce Gruop 1 8 Urban Rural


HEALTH SYSTEM OF INDIA :HEALTH SYSTEM OF INDIA Health is part of Indian constitute and each state is responsible for delivery of health services. Two major groups of services ---public health service. ---private health service. Recent national survey shows that in both rural and urban areas dependence on private sector for indoor and outdoor services increased over last decade. Private health care service play major role in health services than public. Gruop 1 9


Provision of expenditure :Provision of expenditure For private sector---- from individual pocket of population. For public sector--- funds from government to states and from WHO,UNISEF. Gruop 1 10


PUBLIC SECTOR :PUBLIC SECTOR Public health system consist of central state and municipality local level bodies. Two wings of administrative structure. Secretariat wing.—civil servants.---secretary of health Technical wing.---- medical doctors.----under director general. Final authority is health minister of state and central. At district level –district medical superintendent for civil hospital and municipal hospitals. CDHO for primary health centers. Gruop 1 11


HEALTH INSTITUTIONS. :HEALTH INSTITUTIONS. Teaching,nonteaching.district,civil,cottage,rural,peripheral hospitals,hospitals for special care like for tuberculosis, leprosy mental, maternity and dispensaries. At district level 150 bedded civil general hospital in main district town. Municipality area municipal corporation hospitals under civil surgeons directly.. In rural areas ----- Primary health center each 25000 population. Community health center for each 100000 population. At sub center level one male and one female health worker for each 5000 population. Gruop 1 12


Cont…… :Cont…… Civil hospitals basically for the curative purposes. Overall 1562 postmortem rooms,550 at ,districts level and 1012 at subdistrict level. In addition to above ESIS hospitals run in each state and provide curative services for industries populations. Gruop 1 13


PRIVATE SECTOR :PRIVATE SECTOR “Not for profit” and for “ profit”. Not profit sectors are NGO,charitable trusts, missions. For profit sectors private hospitals, to large corporate hospitals. Available sources suggest that 60% of private hospitals run by individual and other by multi ownership. With regards to practitioners the GP are the signal largest category of the health care service utilized by people. There are also large number of non qualified doctors that present mostly at village level but their data is not available. In 1991 there were 9.20 lakhs registered doctors out of that 3.65 lakhs allopaty doctors and 5.55 lakhs are non allopathic doctors. One interested data shows 75% of doctors are in private sector and only 25% in public health. Gruop 1 14


BIG PICTURE OF HUMAN RESOURCES IN INDIA :BIG PICTURE OF HUMAN RESOURCES IN INDIA Distributed across a formally organized & non-formal health sector. Human resources also be categorized into a public & private sector. India has a pluralistic health sector & health providers. In the post independent period, India witnessed rapid strides in professionalization of biomedical medicine, i.e. Allopathy as well as Ayush. Gruop 1 15


Allopathic Doctors :Allopathic Doctors Recent figures – 643,520 allopathic medical practitioners. Up to Dec 2005 – 55000 dental surgeons. Per year 29222 doctors graduated from India As per MCI figures, the doctor to population ratio in India is 1 per 1598 persons or 62.5 doctors per 100,000 population. Public Health sector employes only 10% clinicians Target 1 Doctor per 1000 population by 2012 (McKinsey) 23,858 Doctors working in rural India (GOI 2006) Gruop 1 16 Lady Doctor: Only 15% of total


Population vs Govt. Doctors :Population vs Govt. Doctors Gruop 1 17 Delhi 1:471, Goa 1:554, Hariyana 1:15547 Target 1 Doctor per 1000 population by 2012 (McKinsey)


Medical Education & Training :Medical Education & Training Gruop 1 18 Pvt. Medical education can’t afforded by common people Increase in Pvt. Medical colleges (1950) 1%- (2006) 45%


Slide 19:Gruop 1 19 Distribution of AYUSH Practitioners in India 50 % of total registered Doctors in India Maximum in Bihar & UP


Slide 20:Gruop 1 20


Doctors in private sector :Doctors in private sector The national commission on Macroeconomics & health reported 75% specialist & 85%of technology services were in private sector. 75% of service delivery for dental, mental health, ortho, vascular & cancer diseases from Pvt. Providers Urban areas are rich with Pvt. Practitioners (88%) Better job opportunity, Flexible duty hours and better salary is the driving factor. Gruop 1 21


Critical support staff :Critical support staff Include…. Nurses Auxiliary nursing midwives & health visitor Pharmacist & laboratory technician Male health worker & supervisory staff Other clerical staff Gruop 1 22


Role of critical staff :Role of critical staff Health promotion Prevention Therapeutics Rehabilitation Gruop 1 23


Supporting staffs (HRH)…….. :Supporting staffs (HRH)…….. Gruop 1 24


Other Health Workers :Other Health Workers Gruop 1 25


Non Formal Health Providers :Non Formal Health Providers 1.Folk & magico-religious healer Bonesetter, Ear cleaner,Ojhas,Bhagat etc. 2. Trained birth attendants or Dais 3. Quacks : the person provides the health services without formal education Gruop 1 26


Session Wrap up: :Session Wrap up: Training of critical support staff not adequate Proper orientation of Non formal health providers is required Work force available but skewed in distribution Health workers need to be motivated, trained, well paid Shortage of Health Managers & Support staff Accessibility, Affordability & Availability of services need to be addressed (3 delay model) Increase public spending in Health. Gruop 1 27


Is There Any Way…??? :Is There Any Way…??? Gruop 1 28 Good Job Better Life Service


Slide 29:Thanking all……….for Your Precious Time & Active Participation Gruop 1 29 Any