Human resources are the key factors in managing and delivering health care services. A highly skilled and dedicated workforce is required for providing promotive, preventive, curative and rehabilitative health services.
A nation’s overall progress is largely dependent on the health of its population. Therefore an efficient and effective health management system becomes priority for progress of any nation; India is no exception to this fact.
India has a vast variation in the distribution of health care facilities, the sophisticated facilities mostly being available in the urban areas. Also the poor people in the urban slums often do not get adequate basic medical facilities, leave aside the sophisticated ones.
Today the developed countries are spending a huge amount of money on health care management but in India only 6 per cent of GDP is spent on it. Our aim should be to workout an ideal health system for our country, which provides basic health care facility to each of us, irrespective of status, location and resources. Our challenge in this respect is to ensure right number of health workers, with the right skills in the right place at the right time.
An ideal health system should have strong emergency medical services line up which would provide medical care in every part of country within an acceptable status, this should also be applicable for the advance treatment as well.
The human resource indicators in health care system indicate that there is a gross shortfall of trained nurses and doctors in our country. A study indicates that over 20 lakh nurses will be in demand in coming years. This is a huge challenge in front of the nation to ensure the right number of health workers with the right skill at the right time.
The requirement of health care staff specially doctors can be fulfilled only by opening good medical institutions. Currently 271 medical colleges are actively involved in fulfilling this demand out of which 130 are private and 141 are government medical colleges; but the problem here is that most of the medical institutions are in southern part of the country, the ratio being 60:40. This imbalance is reflected in the number of students who get admission in the same proportion.
Similarly, there is a gross imbalance between the rural and urban heath facilities—70 per cent of population lives in rural India, whereas 30 per cent lives in urban areas but division of hospital bed is reverse. The rural India has only 1,52,736 beds in the hospitals whereas 3,27,570 beds cater to the needs of the urban population. This irregularity is again reflected in the expenditure on health care delivery services in rural and urban areas.
The numerical and distributional imbalance is not only wasteful but also contributes to the poor coverage of health services. On top of these, poor training and technical skills of health personnel impedes the effective delivery of health care.
To tackle the healthcare problems of the population a very positive, honest and professional approach is needed. The health care policy makers should identify the services needed on the basis of prevalence of diseases, demographic features and interventions required at each level. An areawise balanced distribution of skilled health workers, doctors and paramedics should be planned within a fixed time frame and to achieve fixed goals. There should be more direct investment in training and support of health workers.
More efficient planning of health care education will raise doctors and paramedics in the branch of medicine which has the most shortages. Less skilled workers should be assigned simple health care tasks.
Encouragement of women health workers would make the whole family aware of the available health care facilities as well as their rights.
Recent attacks on health care workers have necessitated the need to provide protection and fairer treatment to health care workers and doctors.
I have observed a general reluctance amongst the doctors and paramedics towards serving in the rural areas and areas with less development. A major change in this attitude is required. This can be done with the provision of orientation and incentives to the fresher coming in the field of medical practice, this in turn would require the development of educational and infrastructural facilities like housing, roads, entertainment which are the major hurdles in the appointment and retention of doctors and paramedics there.
For the provision of good health services, the health care workers in general should have capability, commitment and communication skills apt to their work. And in addition they should have a sympathetic and flexible approach towards their patients. Health managers can prove very useful with regards to personnel management, financial management and provide useful inputs regarding the development of interpersonal skills amongst the health care staff.
Keeping the above facts in mind, we can see the following challenges in the provision of health care services which will cover the population as a whole. These are scarcity of manpower in health care sector, retention of existing manpower, irregularities of the public sector staff like not staying at the place of duty etc. Optimal utilisation of the existing health care manpower needs a special attention.
Development of new manpower is reflected by the number of medical, dental and nursing institutions recognised by the various health care councils and the number of students that come out every year from these institutions. Currently there are 271 recognised medical colleges, 104 dental colleges, over 1600 nursing institutions and over 460 pharmacy colleges. There is a need of increasing the number of these institutions with increased number of seats according to MCI norms in the rural areas.
Thus the key to provide good basic and advanced health care facilities lies in the strengthening of existing health care manpower, continual training to them and improving medical and nursing institutions along with an efficient and effective health management of human resource.