A recent study has found that over two million people who are counted as healthcare workers in an official dataset could be missing in action within the country’s healthcare system. The study, “Health Workforce in India: Why, where and how to invest?”, has been carried out by the World Health Organization (WHO) and the Public Health Foundation of India.
While the National Health Workforce Account (NHWA) on stock of health professionals estimates that India has 5.7 million health workers -- allopathic doctors (1.1 million), dentists (0.27 million), nurses (2.3 million), pharmacists (1.2 million) and traditional medical practitioners (AYUSH 0.79 million) --the Periodic Labour Force Survey conducted by the National Sample Survey Office (NSSO 2017–18) on active health workforce puts this number at 3.04 million with allopathic doctors and nurses estimated at 0.78 million and 1.36 million respectively, the study, which compared the two datasets, says.
“The prime reasons for differences between the two include outmigration of health professionals, economically inactive health professionals and lack of regular updates of NHWA database. For real and accurate estimation, the two datasets must be triangulated,” the study points out. The study highlights that while many inadequately qualified health workers report themselves as health workers, a large proportion of adequately qualified people, holding a degree or diploma in medicine, are not currently working in labour markets.
The study points to the need for investments in human resource for health (HRH). It is estimated that India needs at least 1.8 million doctors, nurses and midwives to achieve the minimum threshold of 44.5 professional health workers per 10,000 people. India needs to invest in HRH for increasing the number of active health workforce and improve the skill-mix ratio (nurses-doctors, allied-doctors etc.), the study says. “At the present level of growth on the supply side, the skill-mix ratio of doctors-nurses is unlikely to alter by 2030. A near 200 per cent growth on the supply side for nurses will improve the ratio to 1:1.5 by 2030. This will require a further rapid scale-up of nursing programmes,” the study says.
Among the states, Kerala has the highest density of doctor workforce (20.96 per 10,000 people) whereas Delhi has the highest density of nurses and midwives. Considering the doctor and nurse workforce together, Kerala, Delhi and Tamil Nadu are on the top while Bihar, Jharkhand and Odisha appear at the bottom.
Investments in HRH can enhance employment growth. They can also increase the share of formal employment instead of informal employment and increase women labour force participation in addition to accessibility to health workers, particularly for those living in rural and remote areas, the study says.