This discussion theme is in continuance to our first discussion titled ‘Health System in India: Bridging the Gap between Potential and Performance’. To review what others have commented on this subject earlier in the first discussion, visit our Blog.
How can we maximize health returns through strengthening Human Resources?
1. Issues
1.1. There is a shortage of human resources for health (HRH), particularly allied health professionals, that affects the implementation of programmes. The unwillingness among health workers to serve in rural areas also leads to numerous vacancies. A high proportion of absenteeism among doctors at public sector health facilities further limits the delivery of health services.
1.2. Public health facilities are staffed by less than optimally motivated workers.
1.3. Professional isolation of those working in rural areas prevents upgradation of skills.
1.4. Social isolation of public health workers limit their performance.
1.5. Line item budget payment methods for public health facilities limit the responsiveness of the system.
1.6. There is a lack of detailed standards for medical education and allied health sciences.
2. Suggestions
2.1. The available human resources for health (HRH) may be trained, empowered and channelled to deliver appropriate health services.
2.2. The services of available practitioners of alternate systems of medicine (4.4 AYUSH doctors per 10,000 population (Ayurveda Yoga and Naturopathy, Unani, Siddha and Homeopathy)2 may be utilized. Measures such as bridge courses for AYUSH professionals and legal empowerment may be considered to facilitate deployment of additional human resources for service delivery.1,3 Training to AYUSH doctors wherever feasible for services in skilled birth attendance, reproductive and child health services and Integrated Management of Neonatal and Childhood Illnesses may be provided to ensure better outreach of service delivery.
2.3. The necessary training and opportunity may be provided for the large number of less than fully-qualified/non-qualified practitioners in the field (such as Registered Medical Practitioners, traditional birth attendants and compounders), as per their qualifications and experience to be integrated into the health work-force in suitable capacities.
2.4. Accredited Social Health Activists (ASHAs-community based health workers) may be legally empowered for management of infections in infants with antibiotics to improve service delivery through non-specialized health workforce.
2.5. Similarly, non-specialist health workers may be engaged and trained towards improving outcomes for persons with common mental illnesses.
2.6. Pharmacists may be trained for improving outcomes of patients with chronic conditions such as blood glucose management, management of blood cholesterol and blood pressure.
2.7. The designations and job profiles of available human resources under specific central/externally funded programmes may be modified into generic, multi-functional categories who can perform services as per local needs.
2.8. Gaps in HRH may be met through composite training centres nested in District Hospitals and community health centres, transforming them into knowledge centres, along with patient care. These would also create teaching capacities for new categories of health workers.
2.9. AIIMS (All India Institute of Medical Sciences)- like institutes can serve as composite training centres for continued professional education and multi-skilling of trainers.
2.10. District hospitals that cannot be converted to teaching institutions may be accredited to train students in the Diplomate of National Board (DNB) programme in courses such as Family Medicine to improve standards of patient care in district hospitals.
2.11. A comprehensive set of human resource management principles may be adopted. Some of the suggested guidelines may include:
a. Quality standards for facilities to determine the number of staff posts to be sanctioned. In cases of excess staff with respect to caseloads, the numbers may be rationalized.
b. Decentralized recruitment may be adopted with quick turnaround times and preference to residents of the region of proposed deployment.
c. Fair and transparent postings and timely promotions must be provided.
d. Non-monetary (and monetary) incentives may be provided to encourage and facilitate doctors and allied health cadres to serve in rural and remote areas.
e. Professional isolation may be reduced through continuing medical education (CME) and skill up-gradation programmes, supported by tele-medicine and networking of HRH working in similar circumstances.
f. Social isolation may be addressed by investing in processes that bring providers and community together.
g. Training programmes must be provided for the HRH which makes them suitable to local health needs as well as for their own career progression.
2.12. Career progression of Accredited Social Health Activists and Anganwadi workers into Auxiliary Nurse Midwives (ANMs) may be encouraged as well as assurance of career tracks for competency based professional advancement of nurses.
2.13. Bonus payments may be provided for public sector managers and health personnel as a method of responsive payment mechanisms. These payments may be linked to performance outcomes such as better coverage of services/ reduced private sector use by beneficiaries in the area/achieving measurable health outcomes.
2.14. Data availability for better planning on health professionals in the country must be improved. It may be ensured that Professional councils maintain updated data on numbers, specializations, distribution and status of practice, adjusted for attrition and migration.
2.15. Creation of a National Commission for Human Resources and Health (NCHRH) as an overarching regulatory body for medical education and allied health sciences may be prioritized, with a view to reform the existing regulatory framework and enhance supply of skilled human resources for health.
