Health Work Force in India
Only 38% of those who called themselves doctors in India have a professional degree.
Only 38% of those who called themselves doctors in India have a professional degree in medicine. This the most startling revelation from a report titled “Situation Analysis of Health Workforce in India” released last month by Public Health Foundation of India.
A further 25% had a PG diploma or certificate in Medicine.
12% had only an undergraduate certificate or diploma in medicine.
25% had no technical degree or diploma.
(The ones who practice the medicine are called quacks. Situation of quackery differs from state to state. In Udaipur district of Rajasthan, it was found that 41% of those who called themselves doctors did not have a medical degree and 17% had not even graduated from high school city.)
India has 20 health workers per 10,000 people.
The 2.2 million health workers include 677,000 allopathic doctors i.e., 31% of the total.
Two lakh AYUSH (Ayurveda, Unani, Sidda and Homeopathy) practitioners account for 9% of the health workforce.
Nurses and midwives account for 30%, pharmacists 11%.
Remaining 9% consist of ophthalmic assistants, dentists, radiographers and technicians.
The World Health Organisation (WHO) recommends 25.4 health workers for each 10,000 population for achieving 80% of birth attended by skilled personnel cross the country.
When adjusted for qualification, the density falls to around one-fourth of what the WHO recommends.
There is approximately one nurse and midwife per allopathic doctor and the qualification adjusted ratio falls further to 0.6 per doctor. While there is no standard doctor-nurse ratio, a higher ratio is desirable because nurses deliver the basic medical care.
It is also observed that India has a higher density of physicians than Indonesia and Thailand, but a substantially lower density when compared to China and Mexico.
India has 6.07 allopathic doctors and 7.39 nurses per 10,000 people.
China has 14.2 doctors and 9.6 nurses per 10,000 people.
Indonesia has 1.3 doctors and 8.2 nurses/midwives per 10,000 people.
Thailand 3.1 doctors and 13.6 nurses/midwives per 10,000 people.
Mexico has 28.9 and 39.8 nurses/midwives per 10,000 people.
India has approximately one nurse or nurse-midwife per allopathic doctor, while in most countries nurses and midwives outnumber doctors.
As for the health workforce, the situation varies from state to state.
The total number of health workers per 10,000 population varies from 10 in Bihar to over 40 in Goa.
Looking at the health workforce strength in each of the states we observe that the states with low health workforce density (10-16 workers per 10,000 population) include Rajasthan, UP, MP, Bihar, Jharkhand, Chhattisgarh, Assam and Meghalaya.
The states of Jammu & Kashmir (J&K), Haryana, Uttaranchal, Orissa, Andhra Pradesh, Karnataka, Manipur and Tripura have an average of 16-22 workers per 10,000 population.
Higher workforce densities (more than 22 workers per 10,000 population) are found in Punjab, Himachal Pradesh (HP), Maharashtra, Goa, Kerala, Tamil Nadu (TN), West Bengal, Mizoram, Nagaland, Sikkim and Arunachal Pradesh, with Goa, Kerala, Mizoram and Sikkim having more than 37 workers per 10,000 population.
States with low doctor density (3-6 per 10,000 population) include Gujarat, Rajasthan, UP, MP, Bihar, Jharkhand, Chhattisgarh, Orissa and Assam. Low doctor density states also include HP, Kerala and TN. The states of J&K, Punjab, Haryana, Uttaranchal, Maharashtra, Goa, Karnataka and Andhra Pradesh have more than 6 doctors per 10,000 population with Goa reporting a maximum of 13 allopathic physicians per 10,000 population.
Urban vs. Rural Situation
Almost 60% of health workers live in urban areas, which account for 26% (latest figures suggest 31%) of the country’s population.
Health worker density in urban areas at 42 per 10,000 is nearly four times higher than rural areas which have only 11.8 workers for a similar size of population, which is geographically more spread out given much lower population densities in rural India.
Private Vs Public
70% of all health workers in India are employed in the private sector.
80% of allopathic and AYUSH doctors and 90% of dentists work in the private sector.
Only 50% of the nurses and midwives are employed in the private sector.
It is estimated that there are seven female health workers per 10,000 populations which translates into women comprising one-third of the total health workers in the country.
Female doctors constitute only 17% of the doctors in the country.
But 70% of the nurses/midwives are female.
(Note: Female workforce is a crucial factor as women patients hesitate to consult the male doctors, more particularly for their obstetrical and gynecological problems.)
Unfilled position in health facilities are a bane.
At the national level, it is estimated that 10% of primary health centres (PHC is the basic units of healthcare) are without a doctor.
34% don’t have a laboratory technician.
Up to 16% are running without a pharmacist on the rolls.
This is a national level estimate. There are large regional variations. For example, at the PHC level, Andhra Pradesh has less than 10% of positions vacant whereas in Uttarakhand over half the posts are vacant.
There are 278 medical colleges in India now which turn out 28,000 graduates (MBBS) every year. At the time of Independence, we had 19 medical colleges which were producing only 1,200 MBBS every year.
The Report notes that the private medical education is very poorly regulated.
In 1990, one third of all medical colleges were privately run, that figure has now increased to 57% of medical colleges.
The expansion of the private sector is particularly notable in the states of Maharashtra, Andhra Pradesh and Karnataka. In Andhra Pradesh, only 13 of the 36 medical colleges are in the public sector, in Karnataka the proportion is even lower with 10 of the 38 medical colleges being run by the Government (Medical Council of India, 2011).
(Source: This report has been compiled with information extracted from report compiled by Mr. Krishna D. Rao. The full report can be accessed at http: //uhc-india.org/ uploads/ sisoftheHealthWorkforceinIndia.pdf)