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Human resources for health (HRH) are an important component of health systems, fundamental to achieving universal health coverage (UHC) and several Sustainable Development Goals (SDGs). The 2016 United Nations High-Level Commission on Health, Jobs and Economic Growth underscored that investing in health systems, including investment in the health workforce, to improve outcomes in health, has multiple benefits within and beyond the health sector.
Today, several low- and middle-income countries (LMICs) face a severe shortage of trained and successful health workers, precisely because of sustained underinvestment in health, including health workers, in the workforce. those countries. Our recent study ‘Size, composition and distribution of the health workforce in India: why and where to invest?explains the reasons for these shortages, points out that the use of certain national datasets can lead to a very significant overestimation of the real health workforce, and identifies the need to increase investments in several areas in order to strengthen the situation HRH in India.
Why is there a serious shortage of health workers?
Our study pointed out that the actual size of the active health workforce in India is estimated to be just over half of the number reflected by the registration boards of doctors and nurses / midwives. This means that the density of active health workers in India is less than a third of the WHO benchmark of 44.5 health workers per 10,000 people, estimated to support UHC.
Why this shortage? There are several reasons. First of all, as we point out in the article, the annual total number of new medical graduates (doctors) and nurses / midwives relative to population size is significantly lower in India compared to those of the countries of the Organization for Economic Co-operation and Development (OECD). , as well as several Asian countries such as China, Thailand and Sri Lanka. India currently has just over 500 medical schools and 7,000 nursing institutes producing an average of 9 doctors and 4 nurses / midwives per 100,000 population per year. The same figures reach 44 and 13 respectively in OECD countries. India must therefore invest in opening new institutions to train more health professionals.
Second, the Data from the Periodic Labor Force Survey (PLFS) 2018-2019 indicates that more than 30% of doctors and more than 50% of nurses with the right qualifications are not part of the current health workforce. There are several reasons why qualified healthcare professionals are not part of today’s healthcare workforce. Previous studies ”So much, but little: human resources for health in India‘ and ‘Size, composition and distribution of human resources for health in India: new estimates from national sample survey and registry data‘noted that registration board data is not regularly updated to account for attrition of skilled health professionals due to migration, death or retirement. In addition, there are issues of double counting in the registration data, which leads to an overestimation of the total stock of health professionals in the country.
However, one of the most important reasons for the acute shortage of healthcare workers in India is the attrition in the labor market of skilled healthcare professionals. We have estimated that about 30% of people with medical degrees and over 60% of people with medical degrees are not part of the current health workforce. A small proportion (6-8%) of unemployed staff are unemployed and looking for work. However, a large proportion (25-30%) of skilled health professionals do not identify themselves as part of the labor force. An overwhelming proportion (65-70%) of these health professionals outside the labor market are women aged 35 and over or those over the age of 60.
If efforts are made to reintegrate even 50% of health professionals outside the labor market, by offering them a better wok environment, an increase in the retirement age, secondment to a place of choice, working hours flexible work etc., the current shortage of skilled health personnel in India could be addressed to a large extent.
Another area of concern for HRH in India has been the highly unequal distribution of the health workforce in rural and urban areas, small and large cities, as well as between public and private health facilities. High concentrations of health workers in large cities and in the private sector have left poor, rural and less advantaged populations without access to quality health care.
Our analysis leads us to conclude that India needs major policy interventions as well as significant investments in HRH to make health access more equitable in India. India needs to invest in opening new educational institutions for doctors and nurses, as well as developing other needed health infrastructure on a much higher scale. Increased investments are also needed for the training and qualification / retraining of qualified medical personnel currently working in other areas of the labor market or unemployed, in order to reintegrate them into the health workforce. Such an investment in India has the potential to bring multiple returns within and beyond the health sector, including jobs and economic growth.