India needs big investment in health workforce
The current COVID-19 pandemic significantly exposed the limitations of India’s health system. Acute shortages of health workforce, along with medical goods, devices and supplies, placed India at the top of the list of countries with the highest number of COVID-19 infection and the case fatality. While maintaining COVID-19 safety protocol at all levels and fastening the vaccination process are of crucial importance, the need of an increased investment in the India’s health system is the most important learning from the current pandemic crisis. Strengthening health workforce situation in India is one such area that needs urgent policy attention.
A recent study ‘Size, composition and distribution of health workforce in India: why, and where to invest?’ published in a leading international journal Humans Resources for Health highlighted that density of active health workforce in India is a little over one-fourth of the WHO recommended threshold of 44.5 skilled health workers per 10,000 persons required for achieving the Universal Health Coverage and Sustainable Development Goals. The reported shortages are more severe for nurses and midwives compared to doctors, resulting into to a highly inadequate skill-mix of doctors and nurses/midwives.
Although data from Medical Council of India and Indian Nursing Council show a stock of 11.6 lakhs doctors and 23 lakhs nurses and midwives in India as of 2018, the Periodic Labour Force Survey (PLFS) 2018-19 data reflect that only 9 lakhs doctors (including AYUSH practitioners) and 8 lakhs nurses and midwives were active health workforce in 2019. Accordingly, the density of qualified active health workforce in India is as low as 11 to 12 doctors and nurses/midwives per 10,000 persons. This is almost half of the WHO recommended the lowest required threshold of 22.8 health workers per 10,000 persons to achieve a limited target of 80% coverage of assisted deliveries by a skilled birth attendant.
There are several reasons why India faces an acute shortage of health workforce. First, India produces only 13 new medical graduates (doctors and nurses) per annum per 100,000 persons as compared with more than 55 medical graduates in developed countries. Less developed countries like China, Brazil, Thailand and Sri Lanka produces more medical graduates than in India. Second, a large percentage of qualified health professionals are not part of the current active health workforce. More than 30% of the doctors and 50% of the nurses with adequate qualifications are not part of the current health workforce either because they are unemployed or they do not wish to join to labour force. Third, while many developed countries have benefited by the presence of Indian origin and Indian trained doctors and nurses, during the COVID-19 pandemic India is struggling with low numbers of trained health personnel.
Realising the acute shortage of the health workforce, the Central government announced setting up of new educational institutions for producing doctors and nurses. Government announced setting up of new 157 medical colleges and approximately 50 nursing institutions in different phases. These institutions are likely to produce about 22,500 doctors and 2,000 nurses every year. This essentially implies that even if 100% of the new graduates join the health workforce, it will take more than 10 years to add 2.5 lakhs health professionals to the existing health workforce size of about 1.7 lakhs. Since population during the same period is likely to increase by a little less than 2% per annum, the density of health workforce per 10,000 persons will only marginally increase by 2030.
India needs big investment to meet even the minimum threshold of 22.8 health workforce per 10,000 persons. Increased investment is needed to open new institutions for producing new doctors and nurses and create conducive environment and attractive pay packages to encourage qualified health professionals to join active health workforce.
(The article has been authored by Anup Karan, Additional Professor, Indian Institute of Public Health, Delhi, Public Health Foundation of India)