The number of skilled health workers in India is well below the minimum threshold recommended by the World Health Organisation (WHO), new research shows.
The Global Health Workforce Alliance (GHWA) and WHO categorised India among the 57 countries at risk of severe crisis in terms of availability of human resources for health.
Most previous reports reveal that India falls short of the WHO’s threshold of 22.8 health professionals per 10,000 population, which has since been revised up to 44.5. Those studies, however, heavily relied on outdated data, casting a doubt on their credibility.
To uncover the true picture of India’s health workforce, a research team led by Anup Karan from the Indian Institute of Public Health in Delhi, calculated the number of health workers per 10,000 by analysing two sources of data.
One was National Sample Survey Organisation (NSSO) data on employment; the other was websites and reports providing information on health worker qualifications and registrations.
In a paper published in the journal BMJ Open, Karan and colleagues report that the two sources yielded significantly different results. The size of the total health workforce registered with different councils and associations was five million, compared to the NSSO estimate of 3.8 million.
There were 29 health workers per 10,000 people based on NSSO data, and 38 according to the registration data.
Most of the central and eastern Indian states have low density of health professionals, ranging from approximately 23 per 10,000 in Bihar to as low as seven in Jharkhand. The highest concentration is in Delhi, followed by Kerala, Punjab and Haryana.
“Our estimates also reveal that India has a large number of unqualified health professionals in the workforce,” says Karan. Adjusting for adequate qualifications reduced the density from 29 to 16 per 10,000, he notes.
On the revised figures, the density of formally qualified doctors declined from 5.9 to 4.5 per 10,000. Approximately 30% of all health workers and 15% of people claiming to be doctors reported their educational level below the higher secondary level.
The unqualified health workers also include quacks, traditional healers and bonesetters, who mostly work in rural areas. India has no clear policy on this type of health worker.
From a policy point of view, these estimates provide extremely useful information, says Karan, who adds that the research reveals the magnitude and types of issues that plague the health sectors in India.
The country faces a challenging task to meet WHO’s revised health worker threshold.
Karan believes that enhancing funding for the health sector, particularly improving the infrastructure and training levels, has huge potential in restoring the situation in India.
Policies designed to bring non-working qualified health professionals into mainstream employment, particularly women, can improve the situation, he adds.
