Human Resource Management
By – Dr.
By- Dr. Dharmendra Gahwai
Prof. and Head
Deptt.of Community Medicine
CIMS, Bilaspur (CG).
•Human resource management is the
critical management area that is the
most important asset for any
organization as well as health care
“Human resource management is the integrated use of
system, policies and management practices to support
the organization to meet its desired goal through
recruitment, maintaining and development of
- According to Management Sciences for Health.
Functions of HRM
PROCESSES OF HUMAN RESOURCE MANAGEMENT
Benefits of a strong HRM system
• FOR THE ORGANIZATION:
1.Increases the organization’s capacity to retain staffs
and achieve its goals.
2. Increases the level of employee’s performance.
3. Uses employee’s skills and knowledge efficiently.
4. Saves costs through the improved efficiency and
productivity of workers.
5. Improves the organization’s ability to manage
Benefits of a strong HRM system
• FOR THE EMPLOYEE:
1. Improves equity between compensation of employee
and level of responsibility.
2. Helps employees to understand how their work
relates to the mission and values of organization.
3. Helps to motivate employees.
4. Increases employee’s job satisfaction.
5. Encourages employees to work as a team.
Importance Of HRM Components
Allows for consistent HR planning and for relating
Staff are essential for policy development and
2. HRM planning
Allows HRM resources to be used efficiently in
support of organization goals.
3.Personnel policy & practice
Allows organization to standardize the jobs and
types of skills it requires.
4. HRM data
Allows for appropriate allocation and training of staff
and tracking of personnel costs.
5. Performance management
Deﬁnes what should be done by people and how they
would work together.
A cost-effective way to develop staff skill and
•Since India gained independence,
universal and affordable health
care has been central to the
planning of the country‟s health
• However, attempts to establish such a
network have been unsuccessful
because substantial socioeconomic
and geographical inequities in access
to health care and health outcomes.
• Health manpower requirement of the of the
country are based on
• 1. Health needs and demands of the population
• 2. desired output.
• Health manpower planning is an important
aspect of community health planning.
• It is based on series of accepted ratio like –
• - Doctor- population ratio.
• - Nurse- population ratio.
• - Bed- population ratio.
CATEGORIES OF HR FOR HEALTH
1.Medical doctors and specialists including
public health specialists and health
2. Nurses, ANMs and allied workers –
3. Lab techs, pharmacists, and technical
support staff .
4. Public health support staff .
SUGGESTED NORMS FOR HEALTH PERSONNEL
CATEGORIES NORMS SUGGESTED
Doctors 1 Per 3500 population.
Nurses 1 Per 5000 population.
Health worker M/F 1 Per 5000 population in plain area
1 per 3000 population in tribal and hilly
Trained dais One for each village.
1 per 30000 population in plain area
1 Per 20000 population in tribal and hilly
Pharmacist 1 Per 10000 population
Lab. Technicians 1 Per 10000 population
ASHA 1 Per 1000 population
Health Manpower in some countries
2005-2011 (World Health Statistics 2012)
1 INDIA 6.5 10 9.0
2 BANGLADESH 3.0 2.7 3.0
3 SHRI LANKA 4.9 19.3 29.0
4 THAIAND 21.0 53.0 21.0
5 MYANMAR 4.6 8.0 6.0
HEALTH MANPOWER OF INDIA
(As on March 2011)
CATEGORIES IN POSITION
1 Doctors in PHCs 26,329
2 ANM at Sub centre and PHCs 207,868
3 MPW (Male) 52,215
4 Nurse midwife 65,344
5 Radiographer 2221
6 Pharmacist 24,671
7 Lab technicians 16,208
However average number of health
care staff are satisfactory on national
basis, but they vary widely within the
There is also mal-distribution of
health manpower between rural and
• This mal-distribution is due to
- Absence of amenities in rural areas.
- Lack of job satisfaction .
- Professional isolation.
- Lack of rural experience.
- Inability to adjust in rural life.
• Studies in India have shown that
there is concentration of doctors in
urban areas is up to 73.6 % where
only 26.4 % population live.
• While the rural population (72%)
remains largely underserved.
(Task force on Medical Education, 2006)
1.Availability for recruitment..
• 1.There are insufficient institutions in most
• 2.70% seats concentrated in six states – 30% of
seats in rest.
• 3.For specialists an estimated 10% migration
and increasing private sector preference.
• 4.Available pool does not necessarily translate
into public sector recruitment- more so if
the expansion is in the private sector.
• 5.There is a reluctance to join, if the posting
is in remote areas.
• 6.The ratio of women doctors joining is even less
than of men.
2.Product Does Not Match Requirements:
• 1. Those who join are not from the underserved
areas or social groups.
- but relatively privileged persons who see
medical education as best way to break out of
their social class or retain existing class status.
• 2. Even those who join with noble motives,
change through the educational process into
- more interested in the disease than in the
3. There no faculty development programmes.
4. Growth in the private sector is particularly
haphazard and of very poor quality.
5. Skills they learn are not appropriate nor is the
quality as desired.
• 7. Focus is on knowledge and certification – little
• 8. There is often no match between skills
required and skills imparted.
3.Poor Quality of In- service Capacity Building …
• 1. Multiple short duration fragmented training
• 2. Little evaluation of training and no evaluation
of whether training led to improved service
• 3. No decentralized planning to ensure that all
the facilities have the desired skill sets.
• 4. No continuing medical education
• 5.Weak training infrastructure.
4. Workforce Issues
• 1. Transfers, postings, promotions, disciplinary
- are they timely, transparent, fair and
non discriminatory ?
(One of the surest indicators of good
• 2.Issue of incentives…
- Do those who work more or in more difficult
circumstances get rewarded more… or
- do they actually feel penalized and
• 3. Inadequacy of compensation package…. Both
financial and non financial..
• 4. Lack of a career path…
• 5. Availability of positive role models and team
• 6. Accountability.. …??? And accountability
The center – state divide…
• Health is a state subject and only family
planning- (expanded into RCH) and a few
disease control programmes on the concurrent
• Central manpower support assumes that the
core manpower issues are managed by state and
center needs only supplement manpower.
• States constrained by lack of funds and most
state funds being deployed for salaries and
1. Lack of data
• In India, there is no comprehensive information
available on HRH for health facilities across
public and private sectors.
• Data available with professional councils for
doctors, dentists, nurses and pharmacists are
cumulative and do not exclude attrition (from
death, retirement, migration, etc.), as there is no
periodic renewal of registration.
2. Skewed production of HRH
• The distribution of medical colleges,
nursing colleges, nursing and ANM
schools, paramedical institutions is
uneven across the states with wide
disparities inequality of education.
• Six ‘high HRH production’ states (i.e. Andhra
Pradesh, Karnataka, Kerala, Maharashtra,
Pondicherry and Tamil Nadu) represent 31% of the
Indian population, but have a disproportionately
high share of MBBS seats (58%) and nursing
colleges (63%) as compared to the eight „low HRH
production’ states (i.e. Bihar, Chhattisgarh,
Jharkhand, Madhya Pradesh, Odisha, Rajasthan,
Uttaranchal and Uttar Pradesh), which comprise
46% of India‟s population, but have far fewer MBBS
seats (21%) and nursing colleges (20%).
3. Uneven HRH deployment and distribution
• India‟s major limitation has been in the
production and distribution of human resources
across multiple levels of care.
• Non-creation of posts at health facilities is
4. Disconnected education and training
• Health curricula in the country have not kept
pace with the changing dynamics of public
health, health policies and demographics.
• Current medical and nursing graduates in the
country, trained in urban environments, are ill-
prepared and unmotivated to practice in rural
• There is an increased drive towards
super specialization in various
medical disciplines, further pushing
the focus of care towards tertiary
health models rather than essential
primary care services.
• a. Regulatory:
Insisting of rural service as pre-qualification to
be considered for admission to post graduation
courses or bonds which insists on doing rural
service after the course.
• b. Workforce management:
Transfer policies that provide for rotational
posting in difficult areas and give preference to
those who would work in a remote area of their
• c. Incentives-
financial and non-financial.
(CRMC scheme in CG)
• d. Educational Strategies:
Measures to preferentially admit only those
students who are likely to serve in under-
serviced areas and mould education to retain
• e. Multi-skilling existing staff:
• Introduction of three year course
as rural medical assistants and
posting of Ayush doctors.
1.Creating the norms: The IPHS
• two ANMs per sub-center and one male MPW.
• Three nurses/ANMs per PHC plus two medical
• Adding AYUSH staff into available pool.
• Nine nurses per CHC plus 5 specialists and 3 to
4 medical officers .
2.Expanding available skilled human resource
• More medical colleges- government and private
and through public private partnerships.
• More government seats in private medical
• More nursing schools & nursing colleges.
• More technical and paramedical courses.
• Reviving ANM and MPW training centers.
3.Increasing availability in priority areas..
1. Compulsory rural postings- pre- post graduation – eg
Orissa, Chhattisgarh and Tamilnadu.
2. Contractual appointments .
3. fair transfer policy- rotational postings… tamil nadu..
4. Incentives for difficult areas: eg Chhattisgarh, Himachal and
4.Community level service providers
1. ASHA: 4 lakh ASHAs - one of most visible
components of NRHM.
2. Anganwadi worker- increasing her
effectiveness as health care provider.
3. The RMP: Would training them help?
4. The traditional birth attendant: continuing role
for the TBA where institutional delivery levels
5. Community midwifes and maternity huts.
5.Strengthening Capacity building activity…
• Strengthening SIHFWs.
• Developing an integrated training approach.
• Need to redefine the role of SIHFWs/NIHFWs
as apex of a pyramid of institutions that ensure
that all the necessary skills required for quality
service delivery are in place.
6.Improving workforce performance..
• Putting an accountability framework in place:
▫ Hospital development committees.
• Bringing in a cadre of health managers and data
managers and financial managers.
• Introducing health management courses and promoting
health management certification for key posts.
• Insisting on public health qualifications for key
public health posts…!?!
Future challenges include
- Planning for human resource for public health
at State/national level,
- Framing of State specific human resource
development and training policy,
- Creation of human resource management
- Reorientation of medical and para-medical
- Ensuring proper utilization of the trained
manpower and standardization of training.
1. Why was HR not planned along with infrastructure ?
2. Why are so many institutions dismantled in the last decade?
ANM training schools? MPW training schools?
3. Why are SIHFWs and RHFWTCs poorly functional?
Why have district training centers fallen into disuse?
4. Why this very uneven growth of professional education?
5. Why Public Health Specialist are not posted in key
managerial posts in Public Health departments.