Health Workforce Development: Hierarchies within the Health Service System
The dilution of public health services during the post reform period and its implications for the health status of the population generated wide attention among the public health activists in India. The policy shifts towards privatization of health care accompanied by reduction in public investment and introduction of user fees in public health institutions, unregulated growth of private players and increase in cost of treatment, eliminated the majority of the population from the ambit of the health services delivery. Further, the changes in the public policies adopted in the aftermath of selective primary health care focused on target based and ‘tangible’ activities with a narrow perception of ‘health’. In the context of debates around ‘universal health coverage’, the Indian Public Health Movement is actively involved with issues such as access to medicine, regulation of pharmaceutical industry, community participation and responsiveness of care etc. For the purpose of the present exercise, I selected the issues with human resource development which is one of the major component hindering the availability and quality of care.
1. Health Workforce ‘Shortage’
The human resource shortage is projected as one of the major impediments for delivering quality care in the public health service system. The data shows that there is only 0.69 doctors for 1000 population in India. Further, there is an estimated shortage of six lakh doctors, ten lakh nurses and two lakh dental surgeons (World Bank 2012). In this context, it is significant to understand what constitute this ‘shortage’ and how can we address it with the existing resources. Broadly speaking, the term human resource shortage (in health service system) denotes inadequacy at numerical level and at the specific skill-mix of the workforce. It is interesting to look into this ‘shortage’ in relation with the hierarchies existing within the health service system. These hierarchies can be located at three levels viz.,
1. Health Workforce ‘Shortage’
The human resource shortage is projected as one of the major impediments for delivering quality care in the public health service system. The data shows that there is only 0.69 doctors for 1000 population in India. Further, there is an estimated shortage of six lakh doctors, ten lakh nurses and two lakh dental surgeons (World Bank 2012). In this context, it is significant to understand what constitute this ‘shortage’ and how can we address it with the existing resources. Broadly speaking, the term human resource shortage (in health service system) denotes inadequacy at numerical level and at the specific skill-mix of the workforce. It is interesting to look into this ‘shortage’ in relation with the hierarchies existing within the health service system. These hierarchies can be located at three levels viz.,