Mind the gap: Health workforce shortage
India is witnessing rapid expansion of healthcare infrastructure but challenges remain. Shortage of qualified medical professionals; non-availability of resources and medical professionals have complicated problems. Governments must address the challenges as sum part of the whole
India is witnessing rapid expansion of healthcare infrastructure with both public and private sector investing in creating new facilities offering health services. Most notable has been the creation of additional All India Institute Of Medical Science (AIIMS) institutions across the country to enable access to quality tertiary healthcare services to previously underserved areas. Coupled with this has been the expansion and re-development of public health infrastructure with the National Health Mission earmarking funds for capacity augmentation.
India continues to face challenges on the availability of health infrastructure. Our current bed-to-patient ratio remains a cause for concern. The US has one bed for every 350 patients while the ratio for Japan is 1 for 85. In contrast, India has one bed for every 1,050 patients. This critical lack of availability means that capacity creation needs to pick up pace to meet even the existent needs of the Indian population.
While India faces down to this challenge through the creation of additional infrastructure, it is also coming to terms with a resultant obstacle. Mere buildings and capital expenditure are not key determinants in the health delivery ecosystem. Human health resource, its appropriate utilisation and availability are an equal, if not greater, element. Shortage of qualified medical professionals is one of the key challenges facing the Indian health care industry.
India’s ratio of 0.7 doctors and 1.5 nurses per 1,000 people is dramatically lower than the World Health Organisation’s (WHO) global average of 2.5 doctors and nurses per 1,000 people. Estimates suggest that our country needs an additional 1.54 million doctors and over 2.4 million nurses today to match the global average.
Health human resource shortages are, regrettably, by no means an Indian problem. As per the 2013 report by the WHO and the Global Health Workforce Alliance, titled ‘A Universal Truth: No Health Without Workforce’, 83 countries fall below its acceptable threshold criteria of 22.8 skilled health professionals per 10,000 population. The estimated 2013 global shortage of health workers stands at a staggering 7.2 million, with the number expected to soar to 18 million by 2035.
Simply put, in under 20 years the world would need an additional 2.6 million doctors and over nine million nurses and midwives to ensure equitable and accessible healthcare for everyone. The largest shortage of healthcare workforce remains in Southeast Asia and in large parts of Africa, driving the need to undertake urgent measures immediately.
The resource shortage challenge is further exacerbated by prevailing trends that have made the situation grim. Funding to train doctors and nurses is inadequate. By some estimates a premier public institution like AIIMS spends over one crore rupees to train a single doctor.
Similarly, training in super specialties in both the public and private sectors remains high. Add to that the limited number of seats available ensures that the supply side of the problem continues unabated. One measure to address this was the expansion of medical education through private institutions, which while enhancing capacity, has been mired in controversy.
Geographic distribution and availability of human resources has also been a challenge. With over 80 per cent of the health work force working in urban and semi-urban areas, large swathes of the country face immense shortages. Periodic attempts to alternately mandate and incentivise rural health jobs have been attempted, with limited success. Without adequate and holistic socio-economic development of rural areas, expecting health workers to voluntarily migrate to these areas remains futile.
The allure of foreign lands by trained and experienced health workers has also been a cause for concern. While India is putting checks and balances to limit this outflow, understanding the fundamental reasons as to why professionals leave our health system needs more reflection.
While these and other challenges remain, expanding the health workforce offers immense benefits for the country as a whole. It is estimated that by 2035, 40 million health sector jobs will be added globally. Therefore, healthcare, can and must, act as a force multiplier for employment of our citizens. Governments at all levels need to change their optics and address the twin challenges of unemployment and manpower shortages as sum part of the whole. First, improving salary structures for public health workers will further improve staff retention and make the public system more attractive to professionals.
Second, the Government must work towards expanding the number of seats available for health professionals across the board.
Third, a mismatch between skill availability needs has to be adequately addressed. The nature of health challenges faced by India is diverse and ever changing. Training and up-skilling are needed urgently. Similarly, career planning for existing workforce at all levels needs to be relooked. Without adequate professional growth and economic imperatives, the health system will continue to see migrations.
Fourth, the WHO’s Global Strategy on Human Resources for Health: Workforce 2030 clearly outlines the need to have ‘inter-sectoral coordination’ between various ministries to ensure adequate efficacy. Developing health human resources for India would need an active and seamless coordination for resource planning, course development, skilling, training, employment, emoluments and compensations. A taskforce approach towards addressing this challenge would help address this availability gap as the Government expands the reach and efficiency of the health system.
(The writer is general manager, Operation and Public Affairs, Indraprastha Apollo Hospitals. He can be reached at firstname.lastname@example.org)
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