Executive summary

Health workforce planning is extremely important for every developing country to sustain and utilise best of the human resources available to it. India being a country with immense population is continuously facing problems relating to health workforce in terms of the size of the workforce and the quality of it. The country is classified in the lower middle income group by World Health Organisation (WHO) and is many times a matter of concern because of the acute shortage of the health workforce it deals with. The current report has reflected the data profile the country needs to develop for the five year health workforce plan ranging from year 2019 to 2023. The critical issues dealing with the quality, migration etc. are being discussed along with formulation of key strategies required for the resolution of these issues based upon the recommendations set by WHO in WHO 2016 report: Working for health and growth.

Introduction

To be able to understand a health workforce plan, it is initially important to know what health workforce is. The people of a particular geographical area who are involved with the activities concerning the enhancement of the health of people, including every form of non-clinical and clinical staff, are termed under the category health workforce. Formulation of a health workforce plans enables a proper management of the health workforce by enhancement of their staff performance, reduction of imbalance in workforce, improvement in the staff retention and etc. It is through a properly embedded health workforce plan that the operations of both private and public sector health care facilities can be done efficiently and in a cost effective manner (McMenamin, & Mannion, 2017).  However, in order to prepare the health workforce plan, we have selected India as it is one of the national health workforce plan for one country in the category of low and lower-middle income countries defined by WHO.

For the current report, India is chosen from the lower-middle income category of countries published in the ‘World Health Statistics Report, 2015’ to provide a National Health Workforce Plan for. India is selected to develop a health workforce plan because of the diversity observed in the country. The country exhibits diverse patterns of health situations, governance health systems and socioeconomic statuses owing to the variety of states and cultures blended therein. There is an acute shortage of health professionals in the country, yet the country is exhibiting expansion in both private and public health care facilities. If a proper plan is formulated to guide the direction of health workforce, the investments made in both the sectors shall reap good results. An old study conducted by WHO suggested the requirement of an investment of approximately US$ 2 billion every year in India till 2015 to fulfil the shortage in the health workforce. Yet till date the shortage have not been met (Vishwanatha, Basha, Nair, & Jones, 2019).

To develop a health workforce plan a proper methodology is often followed. This involves a series of steps. The first step involves defining the plan descripting the purpose, scope and ownership. The second step is all about the selection of model to move ahead, estimation of costs, etc. In the third step, the requirement of workforce is established, while the fourth step involves understanding about the current workforce availability. In the fifth step an action plan is developed followed by its execution, implementation and monitoring in the step sixth.

cIndia is currently facing severe shortages when it comes to the number of nurses, midwives and doctors. Currently the number of these health professionals is almost half of the requisite ratio of approximately 24.5 professionals on every population of 10,000. The average number of patients served by a doctor should be 1000 as per WHO.  In some Indian states the number of patients served even exceeds 10 times of the standard set by WHO’s recommendations. A government doctor in India has been observed to be attending around 11,082 people. State-wise scan reveals treatment of 28,391 people by a government doctor in Bihar to treatment of 2203 patients by a government doctor in Delhi. However, the extreme as well as the lowest, both exceed the WHO standard (Brunton, & Smedley, 2019). This environmental scan plan helps in reducing the problem and issues faced by the individual in the economy of the India. 

The recent data studied in March 2017 reveals a shortage in the number of female health workforce in India. The female health workers are short by 10,112, the female health assistants are short by 11,712, and the auxiliary nurse midwifes are short by over 61000. There is a need of around 3,000 doctors in the primary health centres across the country. The surgeons in the community health centres lack by 5000 approximately. India has even witnessed such health centres where there are no doctors. This is the situation of mostly the rural counterparts of India. Even a single doctor is observed in approximately 15,700 primary health centres (WHO, 2019),

The rise in the Population of India is around 26 million annually against which 56748 doctors and 125,764 nurses are made ready by 462 medical colleges and 3,123 health institutions respectively. The rise in population if compared with the rise in the population of the health workforce seems ineffective. The approximate number of doctors lacking in the field is 600,000 as per the analysis observed by India’s Union Minister recently. It is expected that the crisis in the number of doctors shall be bridged by year 2022 (Younger, 2016).

At the global level the countries spend atleast 6% of their GDP to improve the public healthcare. While in India only 1.3% of GDP is hardly spent upon the health care improvement. To improve the situation, it is expected that the country atleast need 2.07 million doctors in addition to the existing doctors by year 2030 to achieve the WHO standard of 1 doctor serving 1000 patients. With the ramified changes in the economy, this has also impacted the economy of the country at large (WHO, 2019),

Data profile of the health workforce by category using WHO data

Based upon the environmental scan into the health workforce of India, the existing condition of the health workforce is identified. The environmental scan has also provided with the additional requirement into the health workforce which is minimum to bridge the gap between the required health workforce and the already existent health workforce in India. Using the environmental scan, the already existent number of health workforce and the estimated needs, the following data profile is generated. The data profile relates to the main categories of health workforce as established by the data of WHO. The data profile is generated for five years, basically highlighting the rise needed in the number of practitioners in the health workforce in India (Donham, & Thelin, 2016).

The expected need is 2.07 million additions in the health workforce atleast by 2030. The current data plan has been prepared for five years based upon the data of year 2018. An average rise of 1% is expected in the number of health workforce of the country every year till 2024 to reach an overall rise of 3.52 million.

The requirement of the health workforce per 10,000 of population is depicted by the above chart. Even when the medical doctors reach approximately 8 doctors per 10,000 populations, the result cannot match the standard of 1 doctor for 1,000 of population. 

As per the expected data prepared for the number of the health workforce estimated to rise by an average of 1% every year, it is certain that the gap of 2.07 million shall be fulfilled by the core workforce itself. The total rise of the health workforce in all these departments shall cover up 2.07 million and shall even exceed making the rise to be 2.54 million.

The number of workforce in the other categories related to the core medical doctors, midwifery, dental assistants, and dental prosthetic technicians is also expected to rise by 0.97 million. The above given tables and graphs shown the changes in the workforce based on the core medical professional which has increases since last five years and will be changing throughout the time

Critical issues to be addressed in the workforce plan

The three stages of workforce planning have been discussed yet including the need of workforce plan, the existing scenario and expected data profile for the plan to be set as a target. However, potential issues exist which can hinder the achievement of the data profile set by the workforce plan.  Some of these issues are:

• The rise expected in the population of the country is uncertain. This is uncontrollable to some extent. A heavy rise in the population could lead to the continued scarcity in the health workforce. The unexpected rise shall create newer demands for health force, which in case of inappropriate supply shall either left unmet or met inefficiently (Dahal, Sharma, & Zodpey, 2018).
• There has been high number of the discrimination issues in allocation of the work plan to the people in India. 
• Even when the number of the health workforce can be enhanced, but the quality of the health workforce is any day of more importance than the quantity. Some of the institutions preparing the health workforce are not par with the quality.
• The youth at many places in India is reluctant to be in the health workforce line. The reasons observed relate to uncertainty of employment, high end study expenses, lack of support from family and etc.
• There is high expectation that the gender gap in the health workforce shall still be prevalent. The dominance of male in the health workforce is still expected to stay.
• The education for some of the popular and best institutions is still very costly. Many aspirants lack to attain health education because of high end expenses. Also the opportunities prevalent to youth in this profession are comparatively less as compared to the experienced workforce (Sinha, & Sigamani, 2016).
• The quality health workforce often migrates outside India in lieu of better work opportunities and pay-scale.

Strategies to address these issues using the set of ten recommendations made by WHO

1. The youth must be promoted to join the health workforce by creating much better job opportunities in the health line. The job must be matched with the skills and not with the gender or caste (Rajiah, & Maharajan, 2016).
2. Any sort of discrimination against women should be eliminated. Strategies should be developed which can curb the harassment faced by women in the health sector. The concentration of women must be strengthened by aiding them with fundamental right of equality.
3. The investment of country’s GDP in the education for creation of a qualitative health workforce must be raised. Any kind of barriers in the health education, be them related to any factor should be eradicated (Narain, 2016). 
4. The government of India must try to supervise both private and public sector health workforce in an equal manner to ensure quality of services provided by them. The health workforce should be continuously monitored to ensure the extent to which the need of public for quality health services is furnished (Barr, 2016).
5. Not only cure, but the health workforce should be made skilled enough to detect and mitigate the chances of any potential health issues which can hit the country or even the areas beyond the political and geographical boundaries of India. Along with, the health of the workforce working in this area should also be considered of immense priority.
6. Continuous innovation in the technology used by the health workforce should be undertaken. The innovation should be a two end process, which aids the health workforce as well as the consumers of the health facilities. The technological advancement should be concerned with the communication between the workforce and the patient as well (Khurmi, Karpe, & Kaur, 2015).
7. Financing for improvement in the quality and quantity of health workforce is a major area of concern. Funds must be tried to be raised from market as well to avoid any kind of shortage of revenues to deal with health workforce’s investment. This must be undertaken with the help of proper financial budgets.
8. The government of India must strive to achieve collaboration with organisation working at national and international level dealing with the issues related to development of the health workforce. Also the support of different sectors of economy must be gathered. A balanced approach has to be adopted wherein the country can develop health workforce without hampering or disheartening other economic sectors.
9. Migration of qualified health workforce is inevitable though, yet it can be let happen in a planned and controlled manner. Agreement must be entered by India from destination countries of migrating health workforce as per usual observation which could help the country to reap mutual benefits from the migrated workforce as reaped by the destination country from the same.
10. The workforce plan can succeed for any duration only when the plan is continuously monitored as per the current market statistics and continued research in relation to the workforce demand. Stagnancy in the policies made in the workforce plan must be avoided.

Conclusion

India has been since years facing shortage in the number of health workforce because of the population size and severe migrations. The condition of this shortage faced by the country could be effectively managed if the recommendations set to raise the quality and quantity of the workforce is followed at least. The problem however is big, yet is able to be solved if the data related to the health workforce is efficiently worked upon.