India’s Frontline Health Workforce: Theoretical Perspectives and Operational Challenges

Abstract

FHWs are among the most utilized health workforce in majority of LMIC especially in India. Effective use of the FHWs was considered instrumental in the provision of Primary health care (PHC) and the potency of FHW was recognized to be essential to achieve the targets of MDG. FHWs consists of a wide range of health workers such as CHWs, Mid-level care providers, Physician-assistants, Nurses, Doctors etc., who are most of the time the first level contact of the health system to the people, majorly engaged in provision of PHC and the services focusing on disease prevention and health promotion. Unlike the most of FHWs the CHWs are the group of FHWs whose potency is greatly explored and well documented since there conception in 1950’s as barefoot doctors in china. FHWs by itself is a wide area of research and this review does not talk much about already well known areas in frontline health workers. The review is split in to two parts with first part talking about the theoretical perspectives in-terms of FHWs and second part talks about operational challenges. First part focuses much on other theoretical concepts in FHWs such as Task-shifting, Public-health nurses and mid-level care providers etc., which are not very much known, compared to their counter parts and majority of the times ignored. The second part of the review has its emphasis on the prime operational challenges which are faced by the FHWs. By summing-up the majority of literature related to the different theoretical concepts in the area of FHW it reflects on the options available to provide efficient health care to the underserved populations and the challenges being faced while dealing with FHWs. It could be helpful in guiding the planning and implementation of sustainable, holistic and cost effective interventions to provide universal PHC.