HEALTH WORKFORCE IN INDIA

SUBMITED BY-Dr.rajat patel

SUBMITED TO-DR. A. K. JAINMBBS,MBA(HA)L.L.B., PHD

OBJECTIVES:

• To show the big picture of human resource in health of India;

• To understand the different health workforce existing in India ;

• To assess the extent of imbalances in the distribution of the density of health workforce within India and with different countries;

• To assess the contribution of health workforce in influencing the health status of the population;

WHO ARE HEALTH WORKERS?

“The stock of all individuals engaged in the promotion, protection or improvement of population health” are Health workers.

This includes both private and public sectors and different domains of health systems, such as

personal curative and preventive care, non-personal public health interventions, disease prevention, management and support services, health promotion services, research..

“ Human resources actually engaged in the health system can be referred to as the health system workforce or health workforce”

THE BIG PICTURE OF HUMAN RESOURCES IN HEALTH

In the post independent period, India witnessed rapid strides in professionalization of medicine, popularly known as •Allopathy•Dentistry•Ayurveda, Unani, Siddha and Homeopathic medicine (AYUSH)•Nurses and Paramedical Staffs•Non formal workers

1. ALLOPATHIC DOCTORS

There were allopathic medical practitioners practicing in the different states in India and registered with the different State Councils. 662646 Source: Medical Council of India,2006.

Alongside, as on 31st Dec 2006, Dental surgeons were registered with different State Dental Councils. 72496Source: Medical Council of India,2006.

Registered Allopathic

doctors

48649@

16800

35976

654

28525

2550*

40230

1406*

256

9222

71909

34577

30430

100428

15573

36100

24777

75415

49527

54513

682646

•* Incomplete Information Received; @ previous year information repeated

•Source: Medical Council of India

STATE-WISE DISTRIBUTION OF REGISTERED ALLOPATHIC DOCTORS AND DENTISTS-1

STATEWISE DISTRIBUTION OF REGISTERED MEDICAL PRACTIONERS & DENTISTS(2006)

0

20000

40000

60000

80000

100000

120000

ANDRA

PRADESH

ASSAM

BIHA

R

DELHI

HARYAN

A

GUJR

ATJ&

K

KARNA

TAKA

KERELA

M.P

.

MAH

ARASTR

A

ORIS

SA

PUNJA

B

RAJA

STHAN

TAMIL

NADU

U.P.

WEST

BENGA

L

STATESREGISTERED DOCTORS

REGISTERED DENTISTS

NO. OF PERSONS PER DOCTOR.

471

354

714754

861

953

250 250 250 250 250 250 250

1598 1598 1598 1598 1598 1598 1598

0

200

400

600

800

1000

1200

1400

1600

1800

Delhi Goa Punjab Karnataka Tamil nadu Kerala

STATEWISE RATIO

REQUIRED RATIO

AVERAGE

(Source:WHO Survey 2006)

Number of allopathic doctors possessing recognized medical qualifications (under IMC act) and registered with state medical councils for the years 2006 and 2007 were 682646 and 696747, respectively.

Source: Medical Council of India

Number of Dental Surgeon Registered with Dental Council of India in 2006 were 72497.

Source: Medical Council of India

There are increases in availability of Allopathic Medical Practicioners, Dental Surgeon and Nurses per Lakh Population over the years.

Source: Medical Council of India

NO. OF PHYSICIANS & DENTISTS ON SELECTED COUNTRIES(2006).

730801

133641251889

66583

682646

116298

10479

1364000

463663

5872990510

18265

72497

6452

1245

136520

302841000

60512000127953000

32577000

1151751000

160943000

19207000

1328474000

15.30%8.40% 7.90% 10%

4.90%2%

4.20% 4.50%

0.01

0.1

1

10

100

1000

10000

100000

1000000

10000000

100000000

1000000000

10000000000

USA UK JAPAN CANADA INDIA PAKISTAN SRILANKA CHINA

PHYSICIANS

DENTISTS

POPULATION

GDP%

DOCTORS PER 1000 POPULATION

0.62

1.5

2.8

0

0.5

1

1.5

2

2.5

3

INDIA WORLD DEVELOPEDCOUNTRIES

DO

CT

OR

S / 1

00

0 P

OP

UL

AT

ION

(source:indiaonline.in)

Recently 23,858 doctors were found to be in position in the government’s network of rural PHC & CHC across the country.

2. PRESENCE OF ALLOPATHIC MEDICAL PRACTITIONERS IN THE PUBLIC SECTOR

1201, 30%

1215, 31%

884, 22%

678, 17%

SURGEON

OBS & GYN

PHYSICIAN

PAEDIATRICIAN

(Source:WHO Survey 2006)

MEDICAL CONSULTANTS

75%

23%

2%0%

10%

20%

30%

40%

50%

60%

70%

80%

URBAN SEMI URBAN RURAL

PE

RC

EN

TA

GE

DOCTORS

(source:indiaonline.in)

The qualified private providers in urban areas- 80%

75% of specialists and 85% of technology services were in the private sector (GOI, NCMH, 2005).

Service delivery for dental health, mental health, orthopaedics, vascular and cancer diseases 75% 40% of services for communicable diseases and deliveries were being provided by the private sector.

In a study of Ujjain district in M.P.88% qualified doctors were in urban areas and72% were practicing in Ujjain city itself (Deshpande et al,2004).

3. DOCTORS IN THE PRIVATE SECTOR

POPULATION PER DOCTOR IN PRIVATE SECTOR

2300

26860

0

5000

10000

15000

20000

25000

30000

URBAN RURAL

There was a much higher density of qualified providers in urban areas (1:2300) than in rural areas (1:26,860).

(Source:WHO Survey 2006)

5. GROWTH OF MEDICAL COLLEGES

Source: for 1981 statistics: GOI, CBHI, Health Statistics in India 1981. for 2006 Compiled from www.mciindia.org

STATE-WISE DISTRIBUTION OF MEDICAL COLLEGES IN INDIA – 1981 AND 2006

0

5

10

15

20

25

30

35

40

45

A.P

ASSAM

BIHAR

GUJRAT

HARYANA

HIMACHAL

J&K

KARNATAKA

KERELAM

.P.

MAHARASHTRA

ORRISA

PUNJAB

RAJASTHAN

TAMIL

NADU

U.P.

WEST B

ENGAL

DELHI

GOA

PONDICHERY

STATES

NO

. OF

ME

DIC

AL

CO

LL

EG

ES

IN 1980-81

IN 2006

6. CRITICAL SUPPORT STAFF: NURSES AND PARA-MEDICAL PERSONNEL

Nurses and midwives play a critical role in health promotion, prevention, therapeutics and rehabilitation.

There are 0.9 million general nursing midwives, 0.5 million auxiliary nursing midwives in the different states (2007)

It is estimated that only about 40% of the nearly 1.4 million registered nurses are currently active in the country because of low recruitment, migration, attrition anddrop-outs due to poor working conditions

Source: GOI, CBHI, Health Statistics in India .

State/UT Wise Number of Registered Nurses & Pharmacists In India

7. THE ‘DRUG DISPENSERS’ PHARMACISTS

• Pharmacist registered with council- 6.8 lakh• Pharmacists in the rural PHCs- 3%• Community pharmacists- 55%• Hospital pharmacists- 20%

POSITION OF PHARMACISTS - STATE WISE AND IN RURAL AREAS

Source: Column1: Pharmacy Council of India. Accessed from www. Indiastat. com Columns 2: GOI, Bulletin on Rural Health Statistics in India, 2006

8. OTHER HEALTH WORKERS

other health workers includes –

male health workers, health assistants, block extension educations, laboratory technicians, radiographers.

Besides nurses and pharmacists, there are around 12,500 laboratory technicians,

around 3000 block extension educators,

20,000 male health assistants and

61,000 male health workers,

currently in position at different levels of the health system

Source: GOI, Bulletin on Rural Health Statistics in India, 2006

OTHER HEALTH WORKERS

Source: Bulletin on Rural Health Statistics in India 2006- Special Revised Edition, MOHFW

TRAINED BIRTH ATTENDANTS

more than 5 lakh dais were trained between 1974-1985.

more than 13,500 TBAs were trained under USAID’s PRIME II project (PRIME II, 2006).

Thus more recent initiatives are focusing on training community midwives strengthening the ANMs and PHC doctors as skilled birth attendants and multi-skilling rural doctors in provision of emergency obstetric care.

Rural Health Infrastructure - a statistical overview

Primary health center

Community health center

MAN POWER IN PHCs

Overall about 49.9% of the sanctioned posts of specialists at CHCs were vacant. Moreover, there was a shortfall of 6110 specialists at the CHCs as compared to the requirement for existing infrastructure on the basis of existing norms.

The current position of specialists manpower at CHCs

Sanctioned Posts, A Significant Percentage Of Posts Are Vacant At All The Levels

9. AYUSH PRACTITIONERS :01/01/07

Qualified AYUSH practitioners registered with their respective Councils:725338

Ayurvedic physicians; 453661Unani physicians; 46558Siddha practitioners, 3681Homeopathic practitioners 217850Naturopathy practitioners 888

The states of Bihar 165047 practitioners, Maharashtra 105516 practitioners and Uttar Pradesh 92319 practitioners had the highest numbers of AYUSH practitioners in the country.

The AYUSH department has around 23,000 dispensaries and 1355 hospitals

Source: Department of AYUSH, MOH&FW/GOI

NO. OF AYUSH PRACTITIONER ALL OVER THE COUNTRY

725338

443661

217850

368146558

8880

100000

200000

300000

400000

500000

600000

700000

800000

AYUSH

Ayurv

eda

Homeo

path

y

Siddh

a

Unani

Naturo

path

No. of Practitioner

Source: Department of AYUSH, MOH&FW/GOI

Total number of registered AYUSH Doctors in India 2007 was 725338

INFERENCE

AYUSH practitioners are roughly equal in numbers to the allopathic medical practitioners in the country, and in fact even more in some states.

Although, like their allopathic counterparts, alternative practitioners also tend to be concentrated in and around urban areas, they present a significant resource base for the future of health systems and improved health outcomes in India.

10. THE NON FORMAL PROVIDERS

Include practitioners who do not have a professional qualification in any recognized system of medicine, indigenous or allopathic, but who practice a blend of different systems of medicine.

examples of folk and magico-religious healers are bonesetters, ear cleaners, ojhas and bhagats [faith healers and magicians]

These providers are typically male, roughly between 30-40 years of age, with 10-12 years of school education and they perform ojha-tona.

INFERENCE

Several issues emerge from review of the current situation of human resources for health in India.

The largest proportion of medical and paramedical professionals practice in the for-profit private sector, which tends to be concentrated in urban areas. This sector is the primary provider of curative health services in the country for which there is a huge demand.

The smaller public sector is the primary provider for preventive and promotive care and some curative care.

A greater number of well-trained human resources are required, now and in the future, to provide preventive, promotive and curative care especially in rural and urban underprivileged areas in the country.

Furthermore, there exist a large number of AYUSH practitioners in the country, who are a valuable resources that need to be integrated into the health system in bolder and more efficient ways than before.

INFERENCE

Other human resources like public health specialists, health/hospital administrators, social workers, public health engineers, physiotherapists and clinical psychologist amongst others are providing health services. However, there is insufficient and inadequate information available about them.

INFERENCE

REFERENCES:

• GOI, Bulletin on Rural Health Statistics in India, 2006

• Ministry of Health & Family Welfare, Govt. of India accessed from indiastat.com

• Dental Council of India• Department of AYUSH, MOH&FW/GOI• Pharmacy Council of India. Accessed from www.

Indiastat. com

• Census of India 2001• GOI, MOHFW Annual Report 2005-06• WHO Report (NOT ENOUGH HERE, TOO MANY

THERE)2006.