HEALTH WORKFORCE IN INDIA

SUBMITED TODR. A. K. JAIN

MBBS,MBA(HA) L.L.B., PHD

SUBMITED BYDr.rajat patel

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. 72496
Source: Medical Council of India,2006.

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

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

STATEWISE DISTRIBUTION OF REGISTERED MEDICAL PRACTIONERS & DENTISTS(2006)

120000

100000

80000

60000

40000

20000

ES H

A RI SS A PU N RA JA B JA ST HA TA N M IL N AD U

M BI HA R DE LH I

AT

KA

EL A

M .P .

RY AN

AS SA

ST R

U. P. W ES T

J&

PR AD

UJ R

TA

KE R

RN A

AR A

DR A

HA

AN

STATES
REGISTERED DOCTORS REGISTERED DENTISTS

M AH

KA

BE N

GA

NO. OF PERSONS PER DOCTOR.

1800

1600

1598

1598

1598

1598

1598

1598

1598

1400

1200

1000 953 861 800 714 600 471 400 250 200 354 250 250 250 250 250 250 754

STATEWISE RATIO REQUIRED RATIO AVERAGE

0 Delhi Goa Punjab Karnataka Tamil nadu Kerala

(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).

10000000000 1151751000 302841000 100000000 127953000 60512000 32577000 160943000 19207000 1328474000 1000000000

10000000 1364000 682646 251889 133641 58729 90510 66583 18265 6452 72497 116298 136520

1000000

730801 463663

100000

10000

10479 1245

1000

100

10

1 USA 15.30% UK 8.40% JAPAN 7.90% CANADA 10% 4.90% 2% 0.01 4.20% 4.50% INDIA PAKISTAN SRILANKA CHINA

0.1

PHYSICIANS DENTISTS POPULATION GDP%

DOCTORS PER 1000 POPULATION

3
DOCTORS / 1000 POPULATION

2.8

2.5 2 1.5 1.5 1 0.62 0.5 0

INDIA WORLD DEVELOPED COUNTRIES

(source:indiaonline.in)

2. PRESENCE OF ALLOPATHIC MEDICAL PRACTITIONERS IN THE PUBLIC SECTOR

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

678, 17% 1201, 30% SURGEON OBS & GYN PHYSICIAN PAEDIATRICIAN

884, 22%

1215, 31%

(Source:WHO Survey 2006)

MEDICAL CONSULTANTS
80% 70% 60% 75%

PERCENTAGE

50% 40% 30% 20% 10% 0% URBAN SEMI URBAN RURAL 2% 23%

DOCTORS

(source:indiaonline.in)

3. DOCTORS IN THE PRIVATE SECTOR

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 and 72% were practicing in Ujjain city itself (Deshpande et al,2004).

POPULATION PER DOCTOR IN PRIVATE SECTOR

30000 26860 25000 20000 15000 10000 5000 0 URBAN RURAL

2300

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

NO. OF MEDICAL COLLEGES

10

15

20

25

30

35

40

45

0
A. P AS SA M BI HA GU R JR AT HA RY AN HI A M A CH AL KA RN AT A KA EL A KE R M AH A .P . SH TR A OR RI SA PU RA NJ JA AB S TA TH AN M IL N AD U W ES U. T P. BE N GA L RA M J& K

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

STATES
DE L PO H GO I

IN 1980-81 IN 2006

ND A IC H ER Y

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 and drop-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 USAIDs 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

The current position of specialists manpower at CHCs

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.

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

800000 700000 600000 500000 400000 300000 200000 100000 0 3681 46558 888 217850 443661 725338

U SH

pa th y

dh a

ni

ve d

Si d

U na

A Y

A yu r

eo

H om

No. of Practitioner

Source: Department of AYUSH, MOH&FW/GOI

N at

ur o

pa th

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.

INFERENCE
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.

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.