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Status of human resources for health in India -Thamma Rao

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Status of human resources for health in India -Thamma Rao

  1. 1. Bangalore 10 Dec. 2010<br />Health System Goals<br /><ul><li>Improve Health Care Accessibility
  2. 2. Reduce Health Inequalities
  3. 3. Be Responsive to User’s Needs</li></ul>Human Resources for HealthDr. D. Thamma RaoAdvisor - Public Health (Human Resources)National Health Systems Resources Centre, NRHMNew Delhi<br />HRH is the Critical Factor <br />For Health Care Accessibility - Equity - Quality <br />
  4. 4. Health Sector Planning & H R H Development <br />1946Bhore - Every Citizen to Secure Adequate Health Care<br />Committee<br />1961Mudaliar “ - Infrastructure Development & Cadres at Primary level<br />1963Chaddha “ - Health Worker /10000 Pop. M&F & PHC - Lab Asst., FP Worker<br />1966Mukerjee “ - Review of Staff Pattern for Fly Planning, NMED etc<br />1967Jungal “ - United Cadre, Org. & HR Integration<br />1974Kartarsingh“ - M P W Concept for Fly Planning<br />1975Srivastava “ - Medical Education & Support Manpower<br /> Cadre of Health Assistants, VHG …. <br /> Training Curriculum - MPHWS, HA & LHV <br />1983Bajaj “ - Essential Educational Infrastructure, Carrer Prospects ..<br />2000GoI - National Population Policy - Decentralised Planning<br /> “ - N R H M<br />2007 “ - Task Force Report -Planning for HRH (Planning Commission) <br />
  5. 5. Human Resources for Health <br />H R H - Norms <br />H R H<br />Providers - Professional, Technicians, Auxillaries , PH specialists … <br />Managerial & Supportive - Policy makers, Administrators, Statisticians, Researchers …<br />HRH are not just individuals but integral part of TEAMS – each one Contributing different Skills and Performing different functions<br />HRH determines - What Service, When, Where, What extent, priority… <br />Of Late, We are witnessing Growing Challenges to maintain required numbers, distribution & quality to meet the changing health care needs <br />
  6. 6. H R H Diversity <br /><ul><li>Rigorously trained Specialists & Super-specialists
  7. 7. General Duty Doctors - Allopathy, AYUSH, Dentists
  8. 8. Physiotherapists, Occupational therapists, Speech therapists..
  9. 9. Nurses - General, O Ts, ICCUs, ICMUs, IRCUs, Post- Operative,
  10. 10. Paramedics - Pharmacists, Radiographers, Optometricians, Counsilors, Medical Social Workers ……
  11. 11. Technicians – Laboratory (Pathology, Microbiology, Biochemistry) OT, ECG, EEG, EMG, USG, CT, MRI, RT, NMT, Audiometry, …
  12. 12. Dressers, Nursing orderlies, OT Attendrs, Stretcher Bearers…</li></ul> Drivers, Cleaners, Cooks, Clerical Staff, Managers<br /><ul><li> Informal HR – TBA, Bone setters, Traditional healers... </li></li></ul><li>Invisible H R H - Preventive Health Care<br /><ul><li>ANM (Auxillary Nurse Midwife) & Health Worker (Male)
  13. 13. Lady Health Visitor & Health Assistant (Male)
  14. 14. Public Health Nurse & Health Inspector
  15. 15. Paramedical Worker & Non-Medical Supervisor
  16. 16. Insect Collectors & Entomologists
  17. 17. Cold chain mechanics & Cold Chain Officers
  18. 18. Food Inspectors & Drug Inspectors
  19. 19. Deputy C M H O & D C M H O
  20. 20. Health Programme Managers – District & State Levels </li></li></ul><li>Health System’s Vital Ingredient - H R H <br />Numerical Adequacy <br />Workforce Management <br />Workforce Performance <br />Capacity Building<br />Skill Mix <br />
  21. 21. HRH in India<br /> HRH in India (%) - Census 2001<br />National Health Profile, MOHFW, Govt. of India 2009<br />Total 21,68,223<br />Doctors(Allopathy) 31 %<br />676756<br />Physicians (AYUSH) 9 %<br />196488<br />Dentists 22962 1 %<br />Nurses 25 % <br /> 545933<br />Midwives 13 % <br />277655<br />Pharmacists 11%<br />239276<br />Other HW, 155177, 7%<br />2009<br />2009<br />2009<br />2009<br />Traditional HWs, 51318, 3%<br />
  22. 22. H R H - Density (Per 10,000 Population)<br />World Health Statistics 2007- WHO<br />
  23. 23. NRHM - HR Vision & Achievements 2009 (for Existing Health Centres)<br />2007 March 2009 Target 2012<br />
  24. 24. Primary Health Care Facilities - Growth<br />
  25. 25. H R H Requirements (as per IPHS norms for year 2011) <br />
  26. 26. H R H Availability & Health Care Outcomes (DLHS-3)<br />
  27. 27. HRH Density & Health Care Outcomes<br />NB: DLHS -3 Children 12-35 months<br />
  28. 28. Inequities within the States<br />Full vaccination in Children - Low & High performing districts in states DLHS -3 <br />D<br />Equitable Distribution & Quality - Essential for health care provision<br />
  29. 29. HR - Quality & Accountability – Consumer’s Perceptions (DLHS-3)<br />
  30. 30. Health inequities across States, Districts & Social Groups<br />Districts<br /> Total Prioritised <br /><ul><li>Institutional Deliveries (< 80%) - 485216
  31. 31. Full Immunisation in Children(<85%) - 358 177
  32. 32. TB Control (NSPCDR of < 60 %) - 243 99
  33. 33. Malaria(API >1.9) or Kala-azar cases - 200 102
  34. 34. Leprosy (PR >1.0) – 53 53</li></li></ul><li>Health Care Challenges Across States <br />
  35. 35. National Rural Health Mission<br />Health Policy Planning & Implementation<br /> Architectural Correction of Health Systems<br />Bottom-up Planning Approach <br />Need Based Planning <br /> Provision of Essential H R H & Infrastructure - Service Guarantees as per IPHS<br />- Contractual Staff (2nd ANM, Nurses, LT ...Drs.)<br /> - ASHAs<br />Convergence of all Vertical Programmes<br />
  36. 36. Vision – National Rural Health Mission (India)<br />SDH / CHC<br />120,000 population<br />SDH – Sub District Hospital <br />CHC - Community Health Centre<br />PHC - Primary Health Centre<br />SHC – Sub Health Centre<br />LHV – Lady Health Visitor<br />AWW - AnganWadi Worker<br />Nurses, <br />MOs,<br />SpecialistsObst./Anaest./Pedia/Med/Sur<br />P H C<br />30-40 Villages 30,000 Population<br />3 Nurses + LHV + Pharmacist + <br />Lab. Tech. + MOs (Allopath)+MO (AYUSH) <br />S H C<br />5 -6 Villages 5000 Population<br />Auxiliary Nurse Midwives (Regular + Contractual) <br />& Health Worker (Male) <br />Community Level (Village) 1,000 Population<br />ASHA (Accredited Social Health Activiist) + AWW (ICDS)<br />
  37. 37. NRHM Achievements 2007-2010<br />Infrastructure up-gradation of - 28,686 SHCs, <br /> 5,407 PHCs, <br /> 4,937 Block PHCs <br /> 444 Dist. Hosp.<br />Additional Human Resource provided in Govt. sector<br />Over 8,20,000 ASHAs, <br /> 48,104 ANMs, <br /> 3,295 Pharmacists,<br /> 26,253 Nurses, <br /> 8,782 Doctors, <br /> 2,474 Specialists ..<br />
  38. 38. Performance of IPHS Institutions<br />
  39. 39. BANKURA<br />
  40. 40. Priyadarshini FBNC,Jaipur<br />
  41. 41. HRH Thrust of NRHM in India<br /><ul><li> Bridge the gaps between HRH Availability and</li></ul> Unmet Needs of the Community<br /><ul><li> Increase HRH in Rural Areas.
  42. 42. Provision of essential HRH, Infrastructure &</li></ul> Service Guarantees - Indian Public Health Standards <br /><ul><li> HRH Skill Up gradation for ensuring services
  43. 43. Eliminate quackery in the Villages
  44. 44. Supportive Supervision of HRH </li></li></ul><li>HRH initiatives in India<br /><ul><li> New Cadre of Rural Practioners for Hilly/ tribal areas</li></ul> - Bachelor of Rural Medical Practioners course 3 ½ years<br /> - Diploma in Medicine & Rural Health Care – <br /> Assam State Rural Health Regulatory Act in 2004<br /><ul><li> Enhancement of MBBS seats in Medical Colleges</li></ul> 150 to 250 per year<br /><ul><li> Doubling of PG Medical Seats (Specialist Doctors)
  45. 45. Central Government Support for new institutes</li></ul>Midwifery & Nursing - increased from 1,646 to 5,222<br /> (2005-06 to 2010-11) <br /><ul><li>Exclusive Council for HRH Educational Institutions </li></li></ul><li>H R H Performance<br />Human Resource Inputs<br />H R objectives<br />Performance<br />Health Care Outcomes <br /><ul><li>Numeric adequacy
  46. 46. Social outreach</li></ul>Coverage<br />Equitable Access<br /><ul><li> Systems Support
  47. 47. Work environment
  48. 48. Remuneration</li></ul>Motivation<br />Healthy <br /> INDIA<br />Efficiency<br /><ul><li>Appropriate skills
  49. 49. Training
  50. 50. Leadership</li></ul>Quality<br />Competence<br />
  51. 51. Provision of Incentives<br />Difficult area incentive :Assam, Andhra Pradesh, Jharkhand, Uttarakhand, Bihar, J&K, Madhya Pradesh, Haryana, Himachal Pradesh, Karnataka, Kerala, Orissa, Arunachal Pradesh, Meghalaya, Mizoram, Nagaland, Sikkim, Tripura, Gujarat, Punjab, Tamil Nadu.<br />Tribal area incentive :Andhra Pradesh, Himachal Pradesh, J&K, Karnataka, Madhya Pradesh, Maharashtra, Nagaland, Rajasthan, Tamil Nadu.<br />Conflict area incentive:Andhra Pradesh, Chhattisgarh,<br /> Jharkhand, Maharashtra, Orissa <br />
  52. 52. Quality of MCH Trainings in Nursing & Midwifery Institutions <br />( Bihar, Chattisgarh, Orissa & Uttarakhand )<br />
  53. 53. Making the Best Use of Available Limited HRH<br />Achievements –<br /><ul><li> Over Burdened Health Workers Stood Up to meet</li></ul> Increased Demands<br /><ul><li> Pooling of Resources at District Level
  54. 54. Decentralisation of Powers to Districts
  55. 55. Incentives for Good Performance</li></ul>Constraints –<br /><ul><li> Inadequate Managerial Support & Supervision
  56. 56. Indicators for HR & Governance
  57. 57. Norms for Accountability
  58. 58. Divergent characteristics of Population & Health Workers
  59. 59. Conflict of Interests - Private Practice</li></li></ul><li>Summary of HR H Issues in the States <br />
  60. 60. HR Division or Cell for HR management - With senior level officers with technical & administrative backgrounds.<br />Should have the powers to change the HR rules.<br />Should review, plan and monitor HR situation<br />All India public health / medical / specialist / GDMOs cadres on par with other central services (IAS, IPS,IRS…..) for postings at the district and state levels<br />Public health qualification (1-2) years must be made mandatory for PH positions, who will supervise and direct PH programs including primary health care. <br />Large hospitals may have professionally qualified hospital managers.<br />31<br />Policy changes needed – HRH Management<br />
  61. 61. HRH Development, Trainings and Deployment<br /> are in State sector as the Heath Services<br /> Delivery and Implementation of Programmes<br /> are by the States / UTs.<br />Substantial Policy changes required to improve HRH and this needs high level of Political Advocacy<br />Are we ready for that ? <br />Dileep IIM Ahmedabad<br />32<br />Health Systems <br />
  62. 62. Population of Indian States & Other CountriesSource : UN Population Prospects 2005 & RGI Population Estimates 2006<br />
  63. 63.
  64. 64.
  65. 65. Thank YOU<br />Deeds, Not words shall speak me<br /> - John Fletcher<br />Dr. D. ThammaRao<br />Advisor (Public Health)<br />New Delhi, India<br />thammarao@gmail.com<br />
  66. 66. 37<br />Key HRH Issues at Health Facilities<br /> FRUs / PHCs<br />Regular anaesthetist and LSAS trained MO avaialable but anaesthesia apparatus unavailable in OTs at the District Hospital.<br />Mismatch between EmOC and LSAS trained personnel - .<br />Pathologist posted at a facility where no lab is available. <br />No partogram used in Laborrooms.<br /> SHCs<br />Poor utilization of services under RI on Wednesday at sub centre. <br />Essential drugs, functional toilets, power supply not available. <br />Lack of coordination between RegularContractual ANM. <br />Contractual ANM unaware of her duties and responsibiities.<br />Records (EC register etc) not maintatined. <br />Inadequate use/lack of availability and awareness of guidelines for utilization of untied funds.<br />
  67. 67. 38<br />Key Issues--Training<br />Non implementation of CTPs at district level. <br />Training institutions needs strengthening of physical infrastructure, development of faculty,<br />Lack of training in essential newborn care & treatment/ stabilization of Sick Newborns for the existing MOs/Staff Nurses/ANMs.<br />Training on IUD/Minlap/SBA/IMEP/ARSH/ Immunisation particularly for contract staff needs urgent focus. <br />

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