70241 Slipportillg Evidellce-based Policies alld Implemelltatioll INDIA'S HEALTH WORKFORCE: SIZE, COMPOSITION, AND DISTRIBUTION' Krishna D. Rao t, Aamshi Bhalnagar t and Peler Bcmlan l This /lale describes the size, compositioll and distribution o/llIdia:~ health workforce calculated IISiflg data from the Censlis. Results indicate thai heallll workforce density in Illdia is below rhe 2.5/ 1000 popu/atioll benchmark, Ihough Ihere is considerable illler-state variation. The majority of rile heallh workforce is concentrated in IIrban areas and works ill Ihe private sector ill both urban and rura! areas. Th e lIote specifically looks al female heallll workers and community workers and suggests policy aCliol/sjal" increasing the dellsily of heaflh workers and correcting imbalances i ll tileir distribution. Infomlation on India's di verse health work foree is based all education self-reports available in the NSSO, the surpri singly fragmented and unreliable, despite recent health worker density reduced to a linle over 8 per 10,000 efforts at quantifi cat ion (See, WHO 2007, GO I 2005). None population. For physicians, estimates from Ihe NSS O of the routine offi cia l sources on the health workforee have survey suggest thaI 37% (63% in rura l and 20% in urban infomlation on all types of health workers in the country. areas) had inadequate or no medical training; applying Professional council s carry infonnati on on only certain this proportion to the Census estimates, the allopat hi c types of hea lth workers such as doctors, nurses and phys ic ian density in India reduced from 6.1 to 3.8 per phamlaeists. Further, this infomlation is not sourced from 10,000 popu lation. live registers making their accuracy doubtful. There arc approxi mate ly 1.6 nurses and midwi fes per This policy note describes the size, compositi on and allopathic physician; if only nurses are considered, then distribution of Ind ia's health workforce. These estimates are there arc approximately 1.1 nurses per allopathic physician. based on nationally representative data from the 200 I Adj usting for possibly unqua lified health workers using the Census and the National Sampl e S urvey's (NSSO) 61 " NSS O proportions of self-report ing q ua lifi eations, the round Oil ' Employment and Unemployment,.1 nurse-doctor ratio is 0.5. !-laving similar number of nurses and physicians is widely seen internationally as a signifi cant INDIA'S HEALTH WORKFORCE: NUMBERS, imbalance in buman resource ski ll mix. In co mpari son, COMPOSITION, DISTRIBUTION' advanced countries such as USA and UK have nurse- Th e Census estimates show that there were approximately physician ratios of3 and 5 respectively (Sec, WHO 2006). 2 . I 7 million hea lth workers in Ind ia in 2005, which There is considerabl e variation in the density of the health translates into a density ofapproximatcly 20 hea lth workers workforce (per 10,000 population) across the states in India, per 10,000 popUlation. Among the different categori es of ranging from 23 .2 in Chandigarh 10 2.5 in Meghalaya. For health workers shown in Figure I, nurses and midwifes bad example, states like Goa and Kerala have doctor densities the largest share in the health workforce, followed by up to three times as high as states like Orissa and J allopathic physieians,AYUSH physic ians and phannac ists . Chhattisgarh. Similarl y, for nurse and midwives, these Census estimates were based on self-reported occupations, sta tes have dens iti es up to six times as much as the low whi ch is susceptibl e to unqualifi ed providers being counted density states like Bihar and Uttar Pradesh . In genera l, the as qualifi ed health providers. When the Census estimates north-central states have low densities, which also include were adjusted for health workers w ho may be unqualified some of the poorest states in India . . Health workers in sufficient numbers, in the right places, and adequately trained. motivated and supponed arc the backbone of an effective, equitable, and efficient health care system. Success in creating and sustaining an effective health workforce in India to ach ieve national health goals will require sound policy and creative and committed implementation. More and bel\er infomlation on human resources ror health in India is one clement needed to achieve this. This note summarizes recent and ongoing work in support oflndia's health work force goals. For the fu ll report, sec Roo, K. et 01 ··India·s Health Workforce: Size, Composition lind Distribution" HRH Technical Report #1 at wll'W. hrhindia. org t The Public Health Foundation of Ind ia, New Delhi; : The World Bank , Washington DC The di stribution of health workers was heavil y skewed Only the National Sample Survey provided representative towards urban areas with typica lly 60% of the health data on whether health workers work in the public or private scetor. These data show that a large majority (70%) of health workers were employed in the Figure 1: Health Worker Density - All India. 2005 private sector in both urban and rura l areas. (Per 10.000 Population) Significant ly, the vast majority of doctors, Allopathic Physician ~:!!!!!!!:=­ AYUSI-I practitioners and dentist s were Nurse i employed by the private sector in both urban and Midwife & Related rura l areas. In contrast, only about half the AYUSH Dentist nurses were emp loyed by the private sector. Pharm aci st Self-reporting of lack of fornml qua lificat ions Others was mainly found in the non-govenunent sector. Other Traditional Adjusting the figures for physicians to account All ~~=~~:~:~::::::::::':- o 2 4 6 8 10 12 14 16 18 20 forthis wou ld modestly reduce the proport ion of physicians in the non-government sector. _ Comsus _ Oual ifi&d Pracmklr.ers· The proportion of women in the hea lth workforce was low. There are approximately 7 • ESlimales based on selt-repor1&d occupation in NSSO female health workers per 10,000 population, Soorce: Census 01 India 2001 indicating that women comprised only around a Others .. Dietician & NUlriIionlsl, Opticians , Dental Assfslanl, Physiotherapist, Medicat Assistanl & Technician and Other Hospital Stall third of all health workers in the country. The Other Traditional . Traditional M&dicine PracUtion