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Many of the issues facing India's health sector today can be traced to distortions in the area of human
resources in health. India faces a shortage of qualified health workers. Analysis based on the 2001
Census indicates that the estimated density of all health workers (qualified and unqualified) in India is
about 20% less than the WHO norm of 2.5 workers (doctors, nurses and midwifes) per 1000
population, meaning that there are substantial shortage of qualified health workers in the country. The
large geographic variations in the health workforce, across states and rural and urban areas are
important challenges in reforming India's health workforce policies. The disparity between urban and
rural areas is particularly significant, as the urban areas account for less than a third of India's total
population but are home to a majority of health workers. Similarly, the concentration of health workers
in the private sector is also a cause of concern, mainly due to the large number of vacancies facing the
public sector and the higher cost of treatment involved in the private sector.
There are important distortions in the production of health workers in India. While there has been an
increase in medical colleges in the last decade, it has mostly been due to an increase in private medical
colleges in the southern states. Overall, the production capacity of doctors (and nurses) is much higher
in states with better health indicators and this reflects the distorted distribution of the country's
production capacity of health workers. Private medical colleges also place a heavy burden of fees on
students and their admission procedures are not transparent. The curricula of medical schools, both
public and private, are not designed for producing 'social physicians' as envisioned in the Bhore (1946)
and other Committees. Rather, the training they provide is better suited to the problems of urban India
and for employment in corporate hospitals.
Nurses are another important cadre which has been ignored in our doctor-centric systemas has been the
tremendous potential they offer in providing health services in underserved areas. Nurses continue to
have a low position in the health workforce hierarchy, while in other countries nurse-practitioners have
elevated the practice and stature of nursing. Nursing education is also in a state of crisis with many
nursing institutes being under-staffed and private institutes providing poorly trained nurses. The
adverse nurse-doctor ratio of 0.8 remains a matter for serious concern. Nurses can deliver many of the
basic clinical care and public health services, particularly at the community level, at a lower cost than
trained physicians.
Professional councils such as the Medial Council of India, the Indian Nursing Council, and the
Pharmacy Council have been set up by statutes of Parliament to regulate the practice of their respective
professions, including education. However, many of these councils, besides being far too unwieldy
have attracted criticism of their functioning, from health professionals', health administrators and
media. They have also drawn judicial censure on several occasions. Further, the existence of these
different regulatory bodies, each responsible for important cadres of health workers have failed to
provide a synergistic approach to addressing the human resources needs of the country. There is an
urgent need for innovation in health related education which encourages cross connectivity across
disciplines and categories of health workers. Any effort to make piecemeal changes in the existing
Statutes is not likely to bring any substantial reform in the field of health education and services. The
Indian health system stands to benefit tremendously from the generation of new cadres and
competencies that can actively meet the health needs of the country. The broad vision of human
resources in terms of the quantity, composition and quality required for enabling the country's health
system provide health care for all, is hidden from the perspective of these individual regulatory bodies.
NEWS LETTER - INDIAN ASSOCIATION OF PHYSIOTHERAPISTS - NOV.. 2010
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