HR in Health System

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HR in Health system Health Workers in India India¶s health workforce is made up of a range of health workers who offer health-care services in different specialties of medicine.The workforce includes many informal medical practitioners, generally called registered medical practitioners, such as traditional birth attendants (known locally as dais), herbalists, snake-bite curers, and bone setters. Doctors (allopathic): medical graduates with a bachelorµs or postgraduate specialistdiploma or degree registered with the Indian Medical Council. Practitioners of ayurveda, yoga and naturopathy, unani, siddha, and homoeopathy: medical graduates with a bachelor¶s or postgraduate degree in ayurveda, unani, siddha, or homoeopathy registered with the Central Council for Indian Medicine or the Central Council for Homoeopathy. Nurses: have a diploma in General Nursing and Midwifery (3·5 year course) or a 4-year bachelors degree or a 2±3-year  postgraduate degree registered with the Indian Nursing Council. Dentists: graduates with a bachelor¶s or postgraduate degree in dentistry registered with the Dental Council of India. Auxillary nurse midwifes: have a diploma in auxillary nurse midwifery (2-year course). Pharmacists: have a diploma or bachelor¶s degree course in pharmacy. Technicians and allied health professionals professionals:: professionals who have undertaken specialised studies, including laboratory technicians, technicians, radiology technicians, dental assistants, and other technical staff . Allied health professionals include dieticians, nutritionists, opticians, physiotherapists, and administrators. Community health workers: professionals who have completed 10 years of formal education and have undergone a 23day training course. Other community health workers include health educators and health assistants. Accredited social health activists: trained trained community health volunteers who reside in a village, have completed 8 years of formal education, and are preferably aged 25±45 years. Registered medical practitioner: unlicensed health practitioners who give allopathic treatment and work in rural areas with little or no formal medical training. Traditional medicine practitioners and faith healers: treat physical and mental illnesses with the help of selling talismans and charms, and by performing special rites.

25% of individuals classified as allopathic doctors (42% in rural areas and 15% in urban areas) have no medical training.   Size of Workforce: 2·2 million health workers, including about 677 000 allopathic doctors and 200 000 practitioners of ayurveda, yoga and naturopathy, unani, siddha, and homoeopathy.21 India has roughly 20 health workers per 10000 population . The total health-care workforce consists of allopathic doctors (31%), nurses and midwives (30%), pharmacists (11%), practitioners of ayurveda, yoga and naturopathy, unani, siddha, and homoeopathy (9%), and others (9%).     Shortage:   The public health system has a shortage of medical and paramedical personnel. Government estimates (based on vacancies in sanctioned posts) indicate that 18% of primary health centres are without a doctor, about 38% are without a laboratory technician, and 16% are without a pharmacist. Specialist allopathic doctors are in very short supply in thepublic sector; 52% of sanctioned posts for specialists at community health centres are vacant. Of these vacant posts, 55% are for surgeons, 48% are for obstetricians and gynaecologists, 55% are for  physicians, and about 47% are for paediatricians. Many nursing posts are vacant²18% of posts for staff nurses and auxiliary nurse midwives at primary and community health centres are vacant.In cross-country comparisons, the total number of allopathic doctors, nurses, and midwifes (11·9 per 10000 people) is about half the WHO benchmark of 25·4 workers per 10 000 population.   Way Out: The National Rural Health Mission, for instance, recommends a vastly strengthened infrastructure, with substantial increases in personnel at every tier of the public health system.80   According to the National Rural Health Mission, a district of 1·8 million people should have about 400 subcentres, 50 primary health centres, nine community health centres, and a district hospital. To achieve these targets, every district would have to employ about 1450 midwives and nurses and 370 medical officers²currently, a district with roughly 1·8 million people employs roughly 500 nurses and 100 medical officers in the public sector. The Indian Government¶s estimatescall for 41 additional medical colleges and 137 nursing schools. The government has recently relaxed norms for private medical colleges to be set up in the districts with government hospital facilities. Local women (aged 25±45 years), married or widowed, with at least 8 years of formal education are recruited and trained to each serve a population of about 1000 people. In many states, a important first step has been taken in identifying accredited social health activists, and training and supporting them to provide basic health care and ease cooperation with the public health system by acting as a point of reference for people¶s health queries. These female health workersreceive no pay but do receive incentivised compensation.

 

Some states have recruited traditional birth attendants tobe trained as accredited social health activists.Other  states have engaged in public±private partnerships to improve the availability of general and specialist health services in the public sector.         Question to be asked to me by person doing rural :   The number of health workers per 10 000 population in urban areas (42) is more than four times that in rural areas of allopathic doctorsand per midwifes 10 000 people is more three times larger in urban (13·3) (11·8). than in The ruralnumber areas (3·9), and for nurses (15·9 in urbanthan areas vs4·1 in rural areas). 21  areas More practitioners of ayurveda, yoga and naturopathy, unani, siddha, and homoeopathy work in urban areas (3·6 per 10 000 population) than in rural areas (1·0 per 10 000 population).   Ans:   Monetary incentives Most states in India off er a higher salary for public sector medical officers serving in rural or remote areas than for those serving in urban areas, though the amount of the incentive varies between states. Educational incentives Compulsory rural service bonds have been introduced by some states (eg, Tamil Nadu and Kerala for specialist doctors and Meghalaya for general doctors) in exchange for  subsidised, government-provided government-provided medical education. Other states have introduced mandatory rural service for a doctor to be considered for admission to postgrad postgraduate uate specialisation programmes. Other states, such as Tamil Nadu, Gujarat, and Andhra Pradesh, reserve postgraduate seats for or give preference to those who have completed a specifi c number of years of rural service. Workforce policies Haryana has adopted a simplified, decentralised recruitment process with incentive packages as a way of fi lling medical officer and specialist vacancies. West Bengal has introduced location-specifi location-specifi c recruitment of candidates from unde rserviced areas. These candidates have to undergo an 18-month training course for nurse midwives after which they are posted in their respective local facilities. New cadres In Chhattisgarh, Assam, and West Bengal, a 3-year course for the provision of a rural medical practitioner with adequate skills for primary health care has been introduced and it has helped fi ll most vacancies in the public sector. In most Indian states, physicians trained in ayurveda, yoga and naturopathy, unani, siddha, and homoeopathy are being recruited to primary health centres, where they often serve as medical officers. In Rajasthan, nurse practitioners are being used for primary health care in select areas. Public±private partnerships These take several forms, the most common is the tempor ary employment (from private private hospitals) of physicians (and other staff ) to fi ll vacancies. In Karnataka and Arunachal Pradesh, select primary health centres have been contracted out to non-governmental organisations. In Gujarat, Gujarat, the government has purchased services from private gynaecologists to increase deliveries in institutions among individuals who are poor.       Question for finance guy:  

Insufficient investments in medical and nursing education have largely caused India¶s crisis in human health resources.       Question for private sector guy: quality of health care provided at some private sector facilities is excellent, such high-quality care is not necessarily provided at all privately run facilities.results of a study in Maharashtra showed that 55% of private sector institutions were registered, only 38% maintained standard records, and that a very high proportion lacked basic equipment; only 10% of hospitals had an electrocardiogram monitor, 65% had a steriliser, and 56% had an oxygen cylinder. Moreover, nearly 30% of private institutions were operated by doctors who were not trained in allopathic medicine and only 2% of institutions employed trained nurses.

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