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Status of human resources for health in India -Thamma Rao
- 1. Bangalore 10 Dec. 2010Health System GoalsImprove Health Care Accessibility
- 2.
- 3. Be Responsive to User’s NeedsHuman Resources for HealthDr. D. Thamma RaoAdvisor - Public Health (Human Resources)National Health Systems Resources Centre, NRHMNew DelhiHRH is the Critical Factor For Health Care Accessibility - Equity - Quality
- 4. Health Sector Planning & H R H Development 1946Bhore - Every Citizen to Secure Adequate Health CareCommittee1961Mudaliar “ - Infrastructure Development & Cadres at Primary level1963Chaddha “ - Health Worker /10000 Pop. M&F & PHC - Lab Asst., FP Worker1966Mukerjee “ - Review of Staff Pattern for Fly Planning, NMED etc1967Jungal “ - United Cadre, Org. & HR Integration1974Kartarsingh“ - M P W Concept for Fly Planning1975Srivastava “ - Medical Education & Support Manpower Cadre of Health Assistants, VHG …. Training Curriculum - MPHWS, HA & LHV 1983Bajaj “ - Essential Educational Infrastructure, Carrer Prospects ..2000GoI - National Population Policy - Decentralised Planning “ - N R H M2007 “ - Task Force Report -Planning for HRH (Planning Commission)
- 5. Human Resources for Health H R H - Norms H R HProviders - Professional, Technicians, Auxillaries , PH specialists … Managerial & Supportive - Policy makers, Administrators, Statisticians, Researchers …HRH are not just individuals but integral part of TEAMS – each one Contributing different Skills and Performing different functionsHRH determines - What Service, When, Where, What extent, priority… Of Late, We are witnessing Growing Challenges to maintain required numbers, distribution & quality to meet the changing health care needs
- 6.
- 7. General Duty Doctors - Allopathy, AYUSH, Dentists
- 8. Physiotherapists, Occupationaltherapists, Speech therapists..
- 9. Nurses - General, O Ts, ICCUs, ICMUs, IRCUs, Post- Operative,
- 10. Paramedics - Pharmacists, Radiographers, Optometricians, Counsilors, Medical Social Workers ……
- 11. Technicians – Laboratory(Pathology, Microbiology, Biochemistry) OT, ECG, EEG, EMG, USG, CT, MRI, RT, NMT, Audiometry, …
- 12. Dressers, Nursing orderlies, OT Attendrs, Stretcher Bearers… Drivers, Cleaners, Cooks, Clerical Staff, Managers Informal HR – TBA, Bone setters, Traditional healers... Invisible H R H - Preventive Health CareANM (Auxillary Nurse Midwife) & Health Worker (Male)
- 13. Lady Health Visitor & Health Assistant (Male)
- 14. Public Health Nurse & Health Inspector
- 15. Paramedical Worker & Non-Medical Supervisor
- 16. Insect Collectors & Entomologists
- 17. Cold chain mechanics & Cold Chain Officers
- 18. Food Inspectors & Drug Inspectors
- 19. Deputy CM H O & D C M H O
- 20. Health Programme Managers – District & State Levels Health System’s Vital Ingredient - H R H Numerical Adequacy Workforce Management Workforce Performance Capacity BuildingSkill Mix
- 21. HRH in India HRH in India (%) - Census 2001National Health Profile, MOHFW, Govt. of India 2009Total 21,68,223Doctors(Allopathy) 31 %676756Physicians (AYUSH) 9 %196488Dentists 22962 1 %Nurses 25 % 545933Midwives 13 % 277655Pharmacists 11%239276Other HW, 155177, 7%2009200920092009Traditional HWs, 51318, 3%
- 22. H R H - Density (Per 10,000 Population)World Health Statistics 2007- WHO
- 23. NRHM - HR Vision & Achievements 2009 (for Existing Health Centres)2007 March 2009 Target 2012
- 24. Primary Health Care Facilities - Growth
- 25. H R H Requirements (as per IPHS norms for year 2011)
- 26. H R HAvailability & Health Care Outcomes (DLHS-3)
- 27. HRH Density & Health Care OutcomesNB: DLHS -3 Children 12-35 months
- 28. Inequities within the StatesFull vaccination in Children - Low & High performing districts in states DLHS -3 DEquitable Distribution & Quality - Essential for health care provision
- 29. HR - Quality & Accountability – Consumer’s Perceptions (DLHS-3)
- 30. Health inequities across States, Districts & Social GroupsDistricts Total Prioritised Institutional Deliveries (< 80%) - 485216
- 31. Full Immunisation inChildren(<85%) - 358 177
- 32. TB Control (NSPCDR of < 60 %) - 243 99
- 33. Malaria(API >1.9) orKala-azar cases - 200 102
- 34. Leprosy (PR >1.0) – 53 53Health Care Challenges Across States
- 35. National Rural Health MissionHealth Policy Planning & Implementation Architectural Correction of Health SystemsBottom-up Planning Approach Need Based Planning Provision of Essential H R H & Infrastructure - Service Guarantees as per IPHS- Contractual Staff (2nd ANM, Nurses, LT ...Drs.) - ASHAsConvergence of all Vertical Programmes
- 36. Vision – NationalRural Health Mission (India)SDH / CHC120,000 populationSDH – Sub District Hospital CHC - Community Health CentrePHC - Primary Health CentreSHC – Sub Health CentreLHV – Lady Health VisitorAWW - AnganWadi WorkerNurses, MOs,SpecialistsObst./Anaest./Pedia/Med/SurP H C30-40 Villages 30,000 Population3 Nurses + LHV + Pharmacist + Lab. Tech. + MOs (Allopath)+MO (AYUSH) S H C5 -6 Villages 5000 PopulationAuxiliary Nurse Midwives (Regular + Contractual) & Health Worker (Male) Community Level (Village) 1,000 PopulationASHA (Accredited Social Health Activiist) + AWW (ICDS)
- 37. NRHM Achievements 2007-2010Infrastructure up-gradation of - 28,686 SHCs, 5,407 PHCs, 4,937 Block PHCs 444 Dist. Hosp.Additional Human Resource provided in Govt. sectorOver 8,20,000 ASHAs, 48,104 ANMs, 3,295 Pharmacists, 26,253 Nurses, 8,782 Doctors, 2,474 Specialists ..
- 38. Performance of IPHS Institutions
Editor's Notes
- #2 As Advisor HRH at New Delhi, I am delighted that the IPH has taken the initiative towards HRH reforms -
- #3 Most of the committees headed by the then DGHS or other technical heads - What were Achieved till NOW - Managers were too preoccupied with the heavy priorities and too little time for long term prospectives - When we are busy, we don’t even remember our food - HRH met the same fate all these years
- #5 Health care often seen as doctor in the hospital and then the nurse for nursing care, pharmacist to give drugs, Technician for diagnostics, Attender for dresssing / cleaning the wounds ………. - How about the prevention - crucial Public Health
- #6 The preventive health or the Public Health HRH are less visible except for the high intensity campaigns such as Polio. Prioritisation of tertiary / secondary care is more often at the cost of preventive / primary health care.
- #7 The 13 teams of CRM explicitly expressed the HRH as major constraint in 12 out of 13 States visited. First fore most being critical shortfalls in HRH -- HRH Availability, Competence & Productivity
- #9 Ironically, India producing largest number of skilled workers, has very low HRH. China has more doctors and Lab. workers; Cuba almost 10 times more doctors The scenario is no different for nurses, Lab. Workers etc. This is in spite of our awareness from Pre-independence era – Govt. of India committees on HRH - Bhore (1946), Chadha (1963), Kartar (1973), Srivastava (1975) as well as NHPs, NPP emphasised HRH issues. Lack of HRH DATA IS THE issue even at the State level. HRH equity, quality & Accountability can only be ensured based on the demographic & epidemiological data, health status of the population and most importantly the health facilities provided ……..
- #10 NRHM - Enhanced availability of HRH was started with 2nd ANM - extended to MOs, Specialists, Lab Technicians …… Contractual MOs 6906, AYUSH Drs 5321, Specialists 2266, Nurses 22789, ANMs 39633, Paramedics 5428 & ASHAs 6.96 lakhs: States filling vacant posts: Incentives - Difficult area / Rural service a preference for PG Availability of Untied Funds improved HR morale & performance
- #11 States with Good Infrastructure & Higher HRHDeliver Better Health Care. Five year plans ensured progress. Vision of ID Dev. - I & II plan achieved during 80s and stagnating since then - Is it lack of wisdom to implement or finances or realisation of non-availability of HRH.
- #13 This is just to reconfirm that with NRHM initiatives of untied funds etc, eased away the physical infrastructure bottlenecks - and the time has come for greater thrust on the other critical component - HRH - for health care outcomes - the higher the output of HRH the better Immunisation levels and lesser IMR.
- #14 Non- availability of adequate HRH is the constraint in High Focus States - WHO recommends HRH of 25 - In India variance in States is too wide - 10 in Bihar to 38 in Kerala
- #15 With in the States, even good performance States, there are pockets of districts / Blocks even for Immunisation of Children.The good news is that some of the districts in Bihar, UP, Rajasthan etc are performing better than some of the districts in Kerala or Tamilnadu
- #16 As per details of DLHS -3 data available for the 14 States - over 85 % of Women who availed the Govt. facilities stated that the Staff were physically available at the facilities (Bihar very marginally less at 79%) thus clearly indicating positivity of HR Accountability. However, the perception for Quality ranged widely with low of 35 % to higher levels of over 60% in Pondy, Goa, Kerala Orissa
- #28 Rural area incentive ranges from Rs. 3000 to 5000 for MOsThe incentive ranges by Rs.5000 to 10,000 for MO & Specialists pm Incentive for ANM is Rs.1000 pm and GNM is Rs. 2000 pmJharkhand : support for insurance coverage of the ANM, Staff Nurses, other support staffs and Doctors posted in the identified Naxalite areas.Jharkhand : Free daily transportation to remote area in Naxalite affected areas Maharashtra:MOs & Specialist incentive - Rs. 1000/- in tribal area and Rs. 1500/- in extremism affected areasANM Package – Rs. 6000/ month for rural area, Rs. 7000/month for tribal area & Rs. 7600 /month for extremism areasStaff nurses & LHV – Rs. 8000/ month for rural area, Rs. 9000/month for tribal area & Rs. 9500 /month for extremism area Madhya Pradesh10,000/pm to regular and contractual specialists ( O&G, Paed), 5,000/pm to MO( regular and contractual) staying at the Facility Incentive of 1 month salary for field staff posted at underserved districts in Nagaland
- #29 Quality of care very critical and it can be only through adequate training – Students in their final months of training were interviewed and ……
- #30 DLHS -2 (2002-04) DLHS -3 (2007-08)
- #35 Our recent visit to Drass & Kargil areas of Kashmir as part of the Common Review Missions was an eye-opener as the only request from the president of a remote village (population of 400 at Zozila Pass (near Amarnath) was to station an ANM during the snow fall isolation period of five months, the clear perception even from the citizens in the remotest Indian villages.
- #36 Full complement in remote area of Kashmir - ANM + 2nd ANM