Human resources for health development policy: a comparison between China and India

Abstract

ABSTRACT In the 1950s, China and India had very similar levels of health and socio-economic development, yet over the last seven decades their health outcomes diverged significantly. Given the important role of human resources for health (HRH) in the health development of a country, their distinct strategies of HRH development can help us understand the differences in their health development. We conducted a comparative analysis of the HRH development strategies of China and India between 1950 and 2017. We found that China followed a distinct adaptive approach of HRH development whereby it progressively rationalized its HRH. In contrast, India went straight to provide highly qualified HRH and failed to adequately deliver even basic preventive care. It was only after 1975 that India attempted to change its HRH development strategy but with only limited success. In 2017, China had 2.44 doctors and 8.45 health workers per 1000 people, whereas India had 0.78 doctors and 2.90 health workers (2016 estimates). Our findings indicate that an adaptive approach which uses multiple pathways for HRH development and is flexible in its use of resources at hand might serve developing countries better, than a narrow approach which does not allow for context-based HRH utilization and development. Abbreviations: ANM: Auxiliary Nurse Midwife; ASHA: Accredited Social Health Activist; AYUSH: Ayurveda, Yoga, Unani, Siddha and Homeopathy; BCH: Bachelor of Science in Community Health; CHV: Community Health Volunteer; GHWS: Global Health Workforce Statistics; HRH: Human Resources for Health; IHME: Institute of Health Metrics and Evaluation; IMR: Infant Mortality Rate; ISM&H: Indian System of Medicine & Homeopathy; LMP: Licentiates in Medical Practice; MCI: Medical Council of India; MMR: Maternal Mortality Rate; MOH: Ministry of Health; MOHFW: Ministry of Health and Family Welfare; NHP: National Health Policy; NRHM: National Rural Health Mission; SRT: Standard Residency Training; TCM: Traditional Chinese Medicine; U5MR: Under-five Mortality Rate; WHO: World Health Organization.