By Dr. Gyan Pathak
World Health Organization’s (WHO’s) global warning of a projected shortage of 10 million health workers by 2030, chiefly in developing countries, has come at a time when India, the largest populated country in the world, is undergoing a severe crisis of shortage of doctors and nurses, and hence has a special significance for the country.
WHO Director-General Tedros Adhanom Ghebreyesus, while calling for protection, support, and expansion of healthcare workforce, has furthers said that over 1 in 3 health workers have suffered from anxiety and depression, while 1 in 2 have experienced burnout since outbreak of COVID-19 in 2020. Obviously, we face major health workforce challenges that demand a major response.
His was the opening remark to three days (3-5 April, 2023) the 5th Global Forum on Human Resources for Health in Geneva, Switzerland. The Forum, the largest gathering of the health workforce professionals, health policymakers and multisectoral partners, is focusing on the theme of “Protecting, safeguarding, and investing in the health and care workforce.”
The event is being organized at time when the world is halfway point to Sustainable Development Goals approaches, and three years since the COVID-19 pandemic began, and population health outcomes and life expectancy are in reverse.
WHO is recommending that to prevent any health crisis arising out of the shortfall in health care workers all countries increase graduation of health personnel to reach 8-12 per cent of the active workforce per annum. For instance, a country with a total of 5000 physicians would need to graduate between 400-600 physicians per annum to maintain and improve capacity in relation to population needs and health system demand.
The Director of the Health Workforce Department Jim Campbell has said, “If we want equity and universal health coverage, if we want global health security, we must protect health workers. We must invest in them, and we must take action together.”
Relevancy of their statement and warning must be taken by India seriously to protect, support, and expand healthcare workforce in the country since the people are suffering the most due to lack of nurses and doctors and unaffordable ever rising healthcare costs. The Centre has been trying to divert attention by some inflated claims and health insurance schemes, that has nothing to do with availability of healthcare professionals to patients in time of need.
Even in Central government hospitals there is a dearth of over 3000 doctors. The vacancies are even in AIIMS, the best hospital run by the Central government. Shortage of nursing and support staff is over 20,000. It means that the healthcare delivery has been under server strain and these hospitals are not able to deliver even at the level of their capacity due to lack of healthcare workers.
This simple data shows the Centre’s failure in fulfilling the vacancies, and least in central government run hospitals. However, the Centre has always been trying to divert attention from its faults by blaming state governments for the vacancies in government hospitals stating that the health is the State subject and the primary responsibility to fill the vacancies of health personnel in government hospitals lies with the concerned state governments.
It must be noted that the problem of unavailability of health professionals including doctors and nurses are chiefly due to lack of medical and nursing colleges and seats therein. India has not been producing enough number of nurses and doctors to fill up the vacancies or to fulfil the requirement of the people. It is precisely due to this reason that the ratio of allopathic doctors in India is 1:1445, which is significantly lower than the WHO’s prescribed standard of 1:1000. This is taking a toll on the public health.
However, to show that India was doing well the Centre had claimed a year before in March 2022, that doctor population ratio in India was 1:834. The Centre just added all the doctors outside the allopathic discipline, such as Ayush doctors, and produced this ratio perhaps to divert the attention from severe shortage of allopathic doctors.
The Centre had resorted to such a strategy even when the Rural Health Statistics 2021-22 revealed that there was an 80 per cent shortfall in paediatricians and surgeons and more than 70 per cent paucity in physicians, obstetricians and gynaecologists. India’s high infant mortality rate at 26.619 in 2023up to now per 1000 live birth, which was 27.695 in 2022 has something to do with the lack of nurses and doctors. Inflated doctor population ratio could not save them, because we don’t have allopathic doctors and nurses at least as per WHO standard.
We had only about 13.01 lakh allopathic doctors as on November 2021, about 5.65 lakh Ayush doctors, 2.89 lakh dentists, 32.63 lakhs nursing personnel, and 13 lakh allied healthcare professionals in the country, much less than required. There cannot be substantial improvement in their number since we have only 89857 UG seats a year before in the end of 2021-22. The number of PG seats were only 60202.
In 2019, it was estimated by a US report by the Centre for Disease Dynamics Economics and Policy (DDDEP) scientist that there was shortage of 6 lakh doctors and 20 lakh nurses in India. The 15th Finance Commission, in a first of its kind stock taking exercise in the backdrop of COVID-19 pandemic had said in early 2021 that there was chronic shortages in India’s health system. Only one doctor for 1511 people against the WHO norm of 1:1000. The figure was even higher than the Centre’s allopathic doctors ratio claim of 1:1445. It had said there was 1 nurse for 670 people as against WHO norm of 1:300.
It also should be recalled that the shortage of health workers extending across all levels of frontline health workers were felt acutely during the pandemic, because there were 85.6 per cent shortfall of surgeons and Common Health Centres, a 75 per cent shortfall of physicians ant Primary Health Centres and a 50.8 per cent shortfall of lab technicians at Primary Health Centres.
Moreover, health workers are by and large concentrated in towns and cities. There are also large regional gaps, some states have large concentration of health workers while others have much less than required. During the Modi regime, situation has worsened in respect to availability of specialist doctors, such as surgeons, obstetricians, gynaecologists, physicians and paediatricians in Community Health Centres. A recent data on rural health statistics has revealed that shortfall increased from 69.7 per cent in 2012 to 79.5 per cent in 2022. (IPA Service)