Abstract
BackgroundInvestment in human resources for health not only strengthens the health system, but also generates employment and contributes to economic growth. India can gain from enhanced investment in health workforce in multiple ways. This study in addition to presenting updated estimates on size and composition of health workforce, identifies areas of investment in health workforce in India.MethodsWe analyzed two sources of data: (i) National Health Workforce Account (NHWA) 2018 and (ii) Periodic Labour Force Survey 2017–2018 of the National Sample Survey Office (NSSO). Using the two sources, we collated comparable estimates of different categories of health workers in India, density of health workforce and skill-mix at the all India and state levels.ResultsThe study estimated (from NHWA 2018) a total stock of 5.76 million health workers which included allopathic doctors (1.16 million), nurses/midwives (2.34 million), pharmacist (1.20 million), dentists (0.27 million), and traditional medical practitioner (AYUSH 0.79 million). However, the active health workforce size estimated (NSSO 2017–2018) is much lower (3.12 million) with allopathic doctors and nurses/midwives estimated as 0.80 million and 1.40 million, respectively. Stock density of doctor and nurses/midwives are 8.8 and 17.7, respectively, per 10,000 persons as per NHWA. However, active health workers’ density (estimated from NSSO) of doctor and nurses/midwives are estimated to be 6.1 and 10.6, respectively. The numbers further drop to 5.0 and 6.0, respectively, after accounting for the adequate qualifications. All these estimates are well below the WHO threshold of 44.5 doctor, nurses and midwives per 10,000 population. The results reflected highly skewed distribution of health workforce across states, rural–urban and public–private sectors. A substantial proportion of active health worker were found not adequately qualified on the one hand and on the other more than 20% of qualified health professionals are not active in labor markets.ConclusionIndia needs to invest in HRH for increasing the number of active health workers and also improve the skill-mix which requires investment in professional colleges and technical education. India also needs encouraging qualified health professionals to join the labor markets and additional trainings and skill building for already working but inadequately qualified health workers.
Highlights
Human resources for health (HRH) are a core building block of health systems [1]
Investment in health workforce is a driver of progress towards several Sustainable Development Goals (SDGs) [2,3,4]
This aligns with the Global Strategy on Human resources for Health: Workforce 2030 Report, which notes that adequate investment in health workforce along with availability, accessibility, acceptability and coverage leads to overall social and economic development along with improvements in population health [4]
Summary
The present study used data from two main sources: (1) National Health Workforce Accounts (NHWA) on India2018 [31] and (2) Periodic Labour Force Survey (PLFS) conducted during July 2017–June 2018 by the National Sample Survey Office (NSSO 2017–2018) [32]. NHWA data The NHWA for India provides information on different categories of stock of health workers at national and state levels. We extracted number of health professionals from NHWA for four different categories Sources: using information from CBHI 2019 and Councils of health professionals (ANM), and pharmacist) at the all India and state levels for the year 2018. We estimated size of comparable categories of health workforce from the NSSO 2017–2018, using the worker population ratio (WPR) and projected population as of January 2018. The NSSO survey reports up to two self-reported activities of all persons based on major and short time dispensation criteria separately We considered both activities of each individual and identified health workers on the basis of either primary or secondary status. We modeled scenarios according to different levels of policy intervention which was similar to that adopted by Ridoutt et al [34]
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