The attrition rate in the health sector in India is assumed to be around 25%; however, the rates are higher for Auxiliary Nurse Midwife (ANMs) and nurses (about 40%) (KPMG, 2017). Even as the public health system in India faces considerable challenges due to staffing shortage, the patterns of health staff vacancies in India has changed significantly over the past few years. Especially, the ratio for doctors and nursing personnel has also shown upward trends. The doctor-to-nurse ratio is also likely to improve with more nurses joining the workforce. The network of Accredited Social Health Activists (ASHAs) (ASHAs are community health workers appointed under the National Rural Health Mission, who act as a point of contact between the public health services and the community) has expanded to cover all rural parts of the country. Simultaneously, the size of Anganwadi Workers and ANMs has also increased (Anganwadi is a government-sponsored child-care and mother-care development programmes in India at the village level). The number of available pharmacists, support staff, and specialised cadres (e.g., psychologists for child development screening, audiologists and optometrists), however, remains low. There is an effort to increase the number of public health/epidemiology personnel, anaesthetists and sonologists in the system.

There are areas within the country where the public health system is almost the sole provider of health services (e.g., Himachal Pradesh) while in certain areas, care is mostly delivered through informal private providers (e.g., rural Haryana and Bihar). It is expected that the healthcare sector would require about a 100% growth in terms of workforce by 2022 in comparison to 2013, so that it can meet the market demand (KPMG, 2017) .The demand will be especially high for nurses and midwifery cadre. In particular, as the demand for quality tertiary and quaternary care services continues to increase, there is a substantial need for specialised human resources such as nurses, doctors, and allied health professionals (KPMG, 2017). However, outreach services in urban areas are affected with issues of unavailability, as well as poor optimisation of staff. Challenges in terms of selection, deployment, employability, and remuneration have been highlighted. The majority of the health care staff across the country is contractual, especially, the allied personnel (allied health professionals are associates/technicians/technologists who support a number of services such as diagnosis, treatment, prevention, rehabilitation etc. (Government of India, 2018b). Contractual agreements and performance linked payments with lack of clarity on career track progression are understood to contribute to worker attrition and migration. Challenges in selection, deployment, employability, and remuneration have also been highlighted (Rajbangshi et al., 2017).

References:

Government of India. (2018b). THE ALLIED AND HEALTHCARE PROFESSIONS BILL, 2018. Available from http://164.100.47.5/committee_web/BillFile/Bill/14/113/LX%20of%202018_2019_2_14.pdf

KPMG (2017). Human resources and skill requirements in the health sector. Ministry of Skill Development and Entrepreneurship and National Skill Development Corporation. Available from: https://skillsip.nsdcindia.org/sites/default/files/kps-document/Healthcare.pdf

Rajbangshi, P. R., Nambiar, D., Choudhury, N., & Rao, K. D. (2017). Rural recruitment and retention of health workers across cadres and types of contract in north-east India: A qualitative study. WHO South-East Asia Journal of Public Health, 6(2), 51–59. Available from: https://doi.org/10.4103/2224-3151.213792