GAPS IN HEALTH HUMAN

RESOURCE

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INTRODUCTION
 MODERN TECHNOLOGY HAS THE POWER TO
PREVENT SICKNESS AND ASSURE EARLY
CURE.

 vibrant health system.
 well–trained, motivated and professional
human infrastructure
 a wide array of community-based workers,
nurses and other paramedics and doctors-
dynamic outcomes.

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INDIAN HEALTH CARE
SECTOR
US $,billion

Years
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  Market growth – 18% annually.
 Private player – 86%.
 Health tourism – expected to rise up to US $
2,200 billion by 2011.



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Health Human Resource
 Heart of the health care systems, yet, a
neglected component.
 It is a process of planning , directing, development and
Utilization of human resources in an organization.
 Implementing objectives, policies, and procedures that
enhance employee contributions to the organization
through increase in productivity, quality of work life
and legal compliance.
 Satisfactorily meets societal and employee needs,
demands and expectations.


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Present Scenario
 Despite of new, up-to-date and complete
country and international database of
health workers, disparities across countries
are large.
 Physician /nurse ratio are three to four times
more in high income countries as
compared to lower ones.
 “Human crisis in health” – a global issue.

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Human Resources ‐ Who are
the health workers?
The National Classification of Occupations used by


the Census of India has the following categories

of health workers:
 Allopathic physicians/surgeons
 Dental specialists and assistants
 Ayurvedic, Unnani, Homeopathy physicians
 Nursing professionals and associates
 Sanitarians
 Midwifes
 Pharmaceutical assistants
 Medical assistants


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
 Medical equipment operators
 Dieticians and nutritionists
 Optometrists
 Physiotherapists
 Traditional medicine practitioners
 Faith healers


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FACTORS REFLECTING GAPS IN
HEALTH HUMAN RESOURCE
 Imbalance (Urban & Rural; Government &
Non Government).
 Health care providers.
 Low productivity of personals.
 Mal distribution.
 Poor work environment.
 Vacant posts.
 Shift to private sectors.



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 Migration.
 Motivational lags.
 Gaps in managing HR in health care
institutions.
 Audits.

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Imbalance (urban & rural;
government & non
government)
 Rural sector is lagging behind to provide
healthcare services effectively to achieve
quality in healthcare services.
Reasons

 Private entry in healthcare saturated in

urban sector mainly.
 Poverty and low income.
 Ignorance of illness, illiteracy, superstition,
disparity in information and knowledge,
lack of ethical practices.


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 Rural population which is 70 % of Indian
population finds it difficult to get
healthcare access-Dr. Naslin Choparia
(Neurologist, Jahangir Hospital Pune)
 People in rural areas do not come with a
disease but they come with family of
disease and reason for this is they are not
getting treated at primary level of
infection.-Dr. Shirin Vyankatraman
( Gynecologist )

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Scenario in Public sector
 Sub centre- 7% lack ANM (11,190).
 MHW – 50% lack.
 Current need – 200,000 ANM.
 PHC - Availability- One staff nurse/PHC.
 Requirement – At least 3/PHC.
 700 PHC without Doctors.
 Current need- 24,000 MBBS Doctors
and 46,000 AYUSH Doctors.
 CHCs – shortfall of specialists, average 50%.

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Health Care Providers
 The number of trained health workers has
been inadequate, but in recent years there
has been a scarcity of almost all cadres of
workers.
 Production of health workers has not kept
pace with needs, especially with increasing
burden of disease.


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 Exhibit: The ratio between allopathic doctor
and population was 1 for 1665 persons in
the country (60 doctors for 100, 000
population) while in Australia, Canada, the
United Kingdom and the United States of
America, it was 249.1, 209.5, 166.5 and
548.9 respectively.
 The ratio between nurse and population in
India was 1:1205 as against 1:100-150 in
Europe8.

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Reference : WHO survey 2006

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Low Productivity of
Personals
 Shortage of skilled personals e.g. skilled
managers to handle HR.
 Lack of continuous training programs.
 Fake practitioners.




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Quality of Personals

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 Percentage shortfall of specialists as compared to
requirements based on existing infrastructure

73.6
69.0
p 68.7
e 60.1
r
c
e
n
t
a 64.8
g
e

Source-Rural health statistics,MOHFW,GOI 2007

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MALDISTRIBUTION
 Nearly all countries have mal distribution, which
is worsened by unplanned migration. The
urban concentration of workers is a problem
everywhere.
 Improving within country equity requires
attracting health workers to rural and marginal
communities – and retaining them.
 There is also a mal distribution between public
and private sectors in many countries.
 International equity is worsened by unplanned
international migration, with the loss of nurses
and doctors crippling health systems in many
poor sending countries.


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What Can Be Done????


 Education incentives: • Reservation for post‐

graduate studies in medicine in Tamil Nadu (e.g.
Tamil Nadu)
◦ •Paying the cost of MBBS degree (e.g.
Meghalaya)
◦
 Monetary compensation:• Higher salary to serve
in remote areas (e.g. Himachal Pradesh,
Uttrakhand


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 Public- Private Partnership

Contracting of PHCs to NGOs

Contracting of Doctors and Health Workers

Alternative Sources
>AYUSH Doctors

>Rural Health Assistants

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POOR WORK ENVIRONMENT
Scarcity of resources.

 Inadequate supplies and facilities.
 Limited monetary and non-financial
incentives to retain and motivate health
workers.
 Unheard voices of the health workers.
Consequences

 Low morale of the workers inviting

counterproductive behavior.
 Affects the quality of service output.
 Staff grievances.


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Vacant Posts
 There is a huge vacancy of posts at the PHC level.
The shortage of medical and paramedical staff
is as follows-
ØDoctors - 5224
ØHealthcare workers – 7243
ØHealth assistants -1701
ØSanctioned posts for specialists – 4026
ØPharmacists – 5000
ØLab Technicians – 5591
ØNurses and midwife – 10,089
ØHealth workers in sub centres – 26, 208


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 Vacancy position-Percentage of sanctioned post vacant

p
e 32.0
r
c
e 22.1
n 18..0
t 13.8
a
g 8.8
e

Source-Rural health statistics,MOHFW,GOI 2007

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Percentage of PHCs working without doctors, lab tech,
Pharmacists

41
p
e
r
c
e
n 17
t
a
g 5..3
e

Source-Rural health statistics,MOHFW,GOI 2007

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Migration to Greener
Pastures

Indian Nurses

Indian Doctors working
Registered in the United
in Australia
Kingdom
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Migration
Major donors Major Both donor &
recipients recipient
India, Pakistan Sri US UK Canada Australia UK Germany Canada
Lanka, Philippines South Germany
Africa, Nigeria Ghana,
UK, Canada Germany,
New Zealand

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Gaps in managing HR in health
care Institutions
 Human resource plays a very significant role in
effective performance of a hospital which
depends to a great extent on the quality of its
staff.
 Management also faces problems in dealing
with skilled as well as unskilled staff.
 e.g Doctors perhaps have education/knowledge
superiority when compared with management
professionals. They do not consider the
management professionals at par with them
and therefore, there is a problem of
adjustment

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 There is need to develop positive attitude
towards all the jobs of the hospital.
 Sacking/suspension/discharge is a easy way
out to get rid of the staff we do not like but
retaining them in job is a real difficult job
and only an able hospital administrator can
do it.


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Bridging the gaps
 There is a critical need of capacity building
in human resource management in health
sector.
 Gaps or challenges in HR are severely
limiting the capacity of health service
organization and health care professionals
to meet needs of the population.

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 Basic model to overcome the
crisis.
Numeric adequacy coverage
Skill mix Access
Social outreach and
Equitability

Efficiency
Satisfactory Remunerationmotivation and Health of
Work environment Effectiveness Population
System support

Appropriate skills Quality and

competency Responsivenes
Training and learning
Leadership and entrepreneurship s

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References
 Regional Health Forum – Volume 10, Number
1, 2006.
 Joint Learning Initiative (JLI). “Human
Resources for Health: Overcoming the
Crisis.” JSI (John Snow,Inc.) Research and
Training Institute Strategic Report.
Cambridge, Mass.: JSI, 2005.
 WHO. The World Health Report 2004 -
Changing history. Geneva:World Health
Organisation, 2004.

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Presented by…
 Bipin Thomas
 Arpita Chaudhuri
 Rebecca Lal
 Chaitali Chaudhari
 Pooja Bharti
 Jyoti Sinha
 Nishidha Rasal
 Deepti Joshi


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