Human Resource for Health (HRH) refers to all people engaged in actions that enhance health, including clinical staff, public health professionals, researchers, community health workers, and health management personnel. HRH is critical for achieving universal health coverage and sustainable development goals. Key HRH indicators tracked by WHO include the number of health workers per 10,000 population and their distribution by occupation, region, workplace, and gender. Nepal faces significant shortages and maldistribution of HRH compared to WHO recommendations, with only 16 health workers per 10,000 people and most located in the hills, despite half the population living in the Terai. Strengthening HRH production and deployment is vital to improving health system access and quality in Nepal.

1. Human Resource for Health:
Human ResourceforHealth (HRH) is defined as ''all peopleengaged in action whose
primary intent is to enhance health''-WHO.
TheHRH is one of the building blockofhealth systemwhich includes clinicalstaffs
such as physicians, nurse, dentist, pharmacist, mid-level health professionals of
different specialty of health science, public health professionals andresearchers.
The community health workers and volunteers are also very important human
resources for health. It also includes health management and support personnel-
those who do not deliver services directly but are essential to the performance of
health system, such as health services managers/administrator , ambulance drivers,
health economist, medical secretaries, and others.
In general HRH includes workers in different domains of health systems including
curative, preventive and rehabilitative care services as well as health education,
promotionand research, peoplewith education and training to deliver health services
but are not engaged in the national health labour market.
Health professionals play a central and critical role in improving access and quality
health care for population. They provide essential services that promote health,
prevent diseases and deliver health care services to individuals, families and
communities based on the primary health care approach.
Health workers are critical for accelerating progress towards Sustainable
Development Goal 3 ('' Ensure healthy lives and well-being for all at all ages'') and
for building equitable primary health care systems.
Roles of clinical staffs:
 Face to face contact with patients for the purposeof diagnosis, treatment, and
ongoing care
 some clinical profession are behind-the- scene such as laboratory
professionals whose work supports diagnosis and treatments
 develop specialized treatment plans after examinations
 educating patients and families on how to best manage their condition
Roles of public health professional and researchers:
 conduct surveys and analyze data and lab results in order to gain better
perspevtive of a population's health

2.  uncovers trends, risk, and other factors such as whether biology, behavior,
society, or the environment plays a role in a population health
 compile the information for other health profession to help better serve a
community through educational programs healthcare policies and regulation.
 provides a better understanding of disparities in healthcare
 influence policy decision at both local and national level
Role of community health workers and volunteers:
 they act to improve access to and coverage of communities with the basic
health services
 creates connection between vulnerable populations and healthcare providers
 help patients navigate healthcare and social service system
 educate healthcare providers and stakeholders about community health needs
Roles of health management and support personnel:
 manage staff within a facility /departments as well as patient care experience
 manage health informatics including record keeping
 ensure organization's compliance with medical and legal regulation and
internal policies
 keep hospital supplies properly stocked and organized
 work closely with other healthcare professional such as nurse, physician in
order to provide patients with exceptional care
Core indicators as identified by WHO:
Recommended core indicator 1: Number of health workers per 10 000
population:
The health worker density – the number of health workers per 10 000 population, by
cadre – is the health workforce indicator that is most commonly reported
internationally and represents a critical starting point for understanding the health
system resources situation in a country.
Recommended core indicator 2: Distribution of health workers – by
occupation/specialization, region, place of work and sex:
This indicators collect, processes and disseminate health workforce data by :
occupation (and within a given occupation, for example by medical specialization),

3. by geographical typology (e.g. urban or rural, within or outside the capital city, by
province/state or district),
by place of work (e.g. hospital or primary health-care facility, public or private),
by main work activities (e.g. preventive/curative/rehabilitative health-care provision
versus other functions such as teaching or research) and
by sex.
Definition: The distribution of health workers according to selected characteristics
notably, by occupation, geographical region, place of work and sex.
 Numerator: The number of health workers with a given characteristic (e.g.
working in a privately operated health facility).
 Denominator: The total number of health workers.
Recommended core indicator 3: Annual number of graduates of health
professions educationalinstitutions per 100 000 population – by level and field
of education
This is another commonly reported indicator for monitoring health workforce
metrics. This is the aggregate of multiple pieces of information, depending on the
number of cadres in the health system.
Definition: Absolute number of graduates of health professions educational
institutions (including schools ofmedicine, dentistry, pharmacy, nursing, midwifery
and other health services) during the last academic year, divided by the total
population.
Insight into Human resource for health status in Nepal:
 Nepal Medical Council's data suggests there are only 16 registered health
workers (doctors, nurses and auxiliary nurse midwives) per 10,000 people.
Even if the Council figures are inconclusive, there is a significant shortfall in
health workers. In addition the same data reveals that only 30% of registered
health workers are enrolled in the public sector.
 Only 43 percent of hospitals and 18 percent of PHC facilities had an
appropriate skill mix i.e. atleast one health worker from each HRH cadre

4. (Medical Doctor, Nurse, Heath Assistant, Assistant Health Worker,
Laboratory Assistant/Technician and Radiographer).
-https://www.nepjol.info/index.php/HPROSPECT/article/download/7431/6026
 The stock of health workers : 54,177 health workers were identified across
the public and private health sectors.
 Doctors made up 12% of the private health sectorworkforce, 5% of the public
health workforce and 8% of the total. A total of 32,809 public health sector
workers were identified, with the health management and supportstaff group
(cleaners, ward helpers, and other non-clinical support workers) the largest
group (33%) followed by paramedical practitioners (26%).
 Ratio of selected staff to population ratios : Nepal was found to have 0.17
doctors per 1,000/population and 0.50 nurses per 1,000/population. This
represents 0.67 doctors and nurses per 1,000/population, which is
significantly less than the WHO recommendation of 2.3 doctors, nurses and
midwives per 1,000/population.
 Gender distribution by health occupation/cadre:46% of the workforce in
the public and private sectors combined and 40% of employees in the public
sector were female. Most of the females were in the two nursing categories.
In all other groups (except dentists) the large majority of the workforce was
male.
 Distribution of public health workers by facility — Health posts and sub-
health posts had the largest number of public health workers at 12,884 (39%),
followed by the central level hospitals, which had 7,386 (23%) of this
workforce. Of all doctors in the public health workforce, 76% (484) were
located in the central hospitals and 9% in district hospitals.
 Distribution by ecological zone: The Terai zone had only 36% of health
workers when it accounted for50% ofthe country’s population in 2011. Sixty-
six percent of all doctors and 58% of all nurses were located in the hills —
partly explained by central level hospitals being in the Kathmandu valley,
which is in the hills.
 Types of employment: The majority of public health workers were
permanent employees (82%) while 13% were employed on contract. Most
staff (96%) in PHCCs, health posts and SHPs were permanent employees.
Only 44% of the workforce in private health facilities comprised permanent
employees while 36% were employed on contracts.

5. Source:http://www.nhssp.org.np/NHSSP_Archives/human_resources/HRH_Nepal
_profile_august2013.pdf
 Sanctioned and fulfilled positions in public sector
In the fiscal year 2010/011, there were a total of 24,477 sanctioned posts of health
workers in the health facilities. Among them, 88% of positions are filled and 12%
are vacant. Slightly more than three fourth sanctioned posts of doctors are filled,
while nearly 90% of nursing staff are filled among the sanctioned posts.
Table 2: Human resources for health under MoHP in Nepal (2010/011)
Position Sanctioned Filled Vacant % filled Share%
Medical
doctor
1,062 816 246 76.84 4.34
Nursing
staffs
including
ANMs
5,935 5,307 628 89.42 24.25
Paramedics 10,642 9,212 1,430 86.56 43.48
Other 6,838 6,394 444 93.51 27.94
Total 24,477 21,729 2,748 88.77 100
Source: Human Resource for Health Strategic Plan, 2011-2015.
 Production capacity, Enrollement, and Graduation per Annum for
Diploma and Bachelors' Level HRH in Nepal

6. source:http://jnhrc.com.np/index.php/jnhrc/article/download/379/376

7. Insight into Human resource for health status in Global context:
 Many countries have reduced their critical deficits of human resources for
health (defined by the WHO in 2006 as fewer than 23 physicians, nurses, and
midwives per 10,000 population), and are moving toward the new levels
established in 2015 (44.5 physicians, nurses, and midwives per 10,000
population) which are considered essential to meet the evolving health needs
of the population and achieve the Sustainable Development Goals (SDGs).
 WHO estimates a projected shortfall of 18 million health workers by 2030,
mostly in low- and lower-middle income countries. However, countries at all
levels of socioeconomic development face, to varying degrees, difficulties in
the education, employment, deployment, retention, and performance of their
workforce.
 The estimates indicates that in 2013, the global health workforce was over 43
Millions. This includes 9.8 million physician, 20.7 million nurses/midwives,
and approximately 13 million other health workers.
 The global nurse/midwife to physician ratio was 2:1.
source: WHO, HRH report 2016