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Human Resources for Health: Who Will Deliver?

Human Resources for Health: Who Will Deliver? . Dr. Krishna D. Rao Public Health Foundation of India kd.rao@phfi.org. Study 1: Situation Analysis- Where are the health workers?. Production – Increased Supply Is From Private Training Institutions. How to get health workers to rural areas?.

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Human Resources for Health: Who Will Deliver?

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  1. Human Resources for Health: Who Will Deliver? Dr. Krishna D. Rao Public Health Foundation of India kd.rao@phfi.org

  2. Study 1: Situation Analysis- Where are the health workers?

  3. Production – Increased Supply Is From Private Training Institutions

  4. How to get health workers to rural areas?

  5. Strategies to Improve Rural Recruitment and Retention • Many experiments taking place at the state level on strategies to recruit and retain health workers in underserved areas: • Monetary strategies • Higher salary for rural areas • Non-monetary strategies • Compulsory rural service • Education incentives (e.g. Post-graduate seats for rural service) • Workforce management (e.g. direct recruitment by ministry) • Others (good housing, transport, quality of life)

  6. Compulsory Rural Service MBBS students protest rural posting, say shift it to PG course Express news service : New Delhi, Fri Aug 09 2013, 02:21 hrs

  7. Study 2: Education Incentive - Post Graduation (PG) Reservation in Andhra Pradesh • The PG reservation scheme: • Scheme started at least a decade ago • PG seats (10-30%) at Govt. Medical Schools reserved for Medical Officers serving for at least 2 years in a tribal or 3 years in a rural area or 5 years of continuous regular service • Candidates take entrance exams, but complete for only the reserved seats. • Students sign a bond of Rs. 20 lakh ($40K) to serve the Government as specialists for five years after completing their PG education

  8. Study 2: PG Reservation in Andhra Pradesh - Medical Officers at PHCs

  9. Study 2: PG Reservation in Andhra Pradesh - Specialists at CHCs Source: Bulletin on Rural Health Statistics in India, Ministry of Health and Family Welfare

  10. Study 3: What Incentives Can Improve Doctors And Nurses Recruitment to Rural Areas? (DCE Study) • Study conducted in 2010 in the states of Uttrakhand and Andhra Pradesh • Discrete Choice Experiment(DCE) idea: • Stated preference elicitation method • Jobs described by their attributes (e.g. salary, location) • Sample: Medical students, in-service doctors, nursing students, nurses. • Respondents asked to choose between jobs described by attribute- levels.

  11. Study 3: Willingness to Accept Rural Postings at Different Salary Levels - Doctors Vs Nurses Source: Rao and others (2013).

  12. Non-physician Clinicians And Quality Of Care

  13. Study 4: Which Doctor For Primary Health Care • Scarcity of physicians has resulted in several types of clinical care providers heading PHCs in Chhattisgarh state: • Regular and Contractual Medical Officers (47% PHCs) • MBBS or higher degree • Rural Medical Assistants (RMA) (10% PHCs ) • Allopathic clinicians with diploma of 3 1/2 yrs training plus one year internship at PHC, CHC, and District Hospital. • Serve in PHCs, lady RMAs in CHCs w/o lady physician • AYUSH physicians (24% PHCs) • Have Bachelors in Ayurveda and Surgery (BAMS) • Paramedical staff (staff nurses, pharmacists) (7% PHCs) • No formal clinical training but treat patients

  14. Study 4: Results- Clinician Competence Score by Case

  15. Discussion • Incentivizing medical students for rural service appears difficult • (2) Incentives can increase rural uptake of nursing students, and in-service doctors and nurses • Post-graduate reservation has large effect on medical students/in-service doctors, but do they want to be rural doctors • Higher salary (nurses) • (3) More affordable solution to reduce rural clinician deficit is to use non-physician clinicians • BRHC model is a positive development, but • Will graduates be accepted by medical fraternity/colleagues? Are nurse-practitioners more acceptable? • Can graduates become ‘MBBS’ with a bridge course? • How do you ensure that graduates remain rural? • How does AYUSH in primary health care change things?

  16. Thank You

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