Reimagining human resources for health in India
The state, market and people of India have played proactive roles in transforming the health human resource scenario in India over 75 years. In the 1940s, there was a scarcity of trained health personnel and very few educational institutions for health sciences. Since then, an army of health professionals and workers across many disciplines have been developed. Many are highly competent, receiving global recognition. Educational institutions have grown. Are the systems fit for purpose?
Does the mode of planning, management and predicted growth of the health workforce meet the needs of the times? Does it protect and promote health? Does it ensure access to quality health care for all citizens, with equity and integrity at its heart?
The Covid 19 pandemic tested health systems worldwide. The scientific response was sturdy and strong. New collaborations emerged. The ‘communitisation’ of the public health system in India was a structural reform introduced in 2005-6 as part of an architectural correction. This continued beyond 2013 through the National Health Mission (NHM), becoming a social vaccine during the pandemic, with frontline health workers as key personnel. The health workforce is a pillar of strength for the entire population in good times and bad. Gaps and inadequacies in health workforce planning and management need to be filled.
The pandemic brings to our collective mind the need for a futuristic, planned, scientific, evidence-based approach to addressing health workforce requirements and management systems. Article 47 of the Indian Constitution requires the State ‘to improve the standard of public health as one of its primary duties’. India enthusiastically contributed to, and signed onto the 1978 WHO-UNICEF Alma Ata declaration. We committed to ‘Health for All’ as a social goal, with ‘comprehensive primary health care’ as the strategy to realise this. Primary health care is most commonly misunderstood as being a primary level or contact of care. Comprehensive primary health care (CPHC) is in fact a broad approach that encompasses all levels of health care; all components from health promotion, disease prevention, treatment, care and rehabilitation; a functioning referral system, intersectoral coordination to address the key determinants of health (food, water, sanitation, education, housing) appropriate technology, and community participation in decision making. Actualising CPHC is one of the objectives of the NRHM/NHM. Detailing of its human resource requirements is overdue.
Core among the crucial building blocks of the health system are human resources for health. Did our health human resource strategy and financial planning keep pace with the legitimate aspirations of every citizen for good health and access to health care? A closer look at the pandemic response and the impact on access to routine health care needs, points to a need to revisit and redesign our health system, including the human resources for health.
The Lancet Citizens Commission on Reimagining India’s Health System has Human Resources for Health as one of its five work streams. Planning ahead to realise Universal Health Care within the next decade, requires a redesign of the system. Starting from the ground up and based on evidence synthesis, but not limited by it, we hope to break new ground. Costing of human resources for health at a district level; relooking at health personnel education strategies, including continuing education and accreditation; integrating the rich diversity of health and healing knowledge systems, traditions, and practices available in India; ensuring robust governance mechanisms with citizen charters and feedback; and utilising technology more effectively and seamlessly based on technology commons, are some of the broad strokes. Learning from and building on the past, and also disrupting and transforming dysfunctional systems is needed if the right to health and access to health care of every citizen has to be achieved.
(The piece has been authored by Thelma Narayan is a public health professional and health activist who currently works as an honorary Community Health Adviser at Centre for Public Health and Equity)