Context: According to a World Health Organisation database, Despite the health sector employing five million workers, India continues to have low density of health professionals.

Critical Shortage in India.

Concerns for India:

• Acute shortages and inequitable distributions of skilled health workers
• India is in the “critical shortage of healthcare providers” category.
• Bihar, Jharkhand, Uttar Pradesh and Rajasthan are the worst hit while Delhi, Kerala, Punjab and Gujarat compare favorably.
• The health workforce in India comprises broadly eight categories, namely: doctors (allopathic, alternative medicine); nursing and midwifery professionals; public health professionals (medical, non-medical); pharmacists; dentists; paramedical workers (allied health professionals); grass-root workers (frontline workers); and support staff.
• Government statistics for 2008, based on vacancies in sanctioned posts showed 18% of primary health centres were without a doctor, about 38% were without a laboratory technician and 16% were without a pharmacist.

The major challenges faced by healthcare system in India are (general observations):

Doctor-Density Ratio: The doctor-density ratio in India at 8 per 10,000 people as against one doctor for a population of 1,000.

Shortage of Medical Personnel: There is a staggering shortage of medical and paramedical staff at all levels of care: 10,907 auxiliary nurse midwives and 3,673 doctors are needed at sub-health and primary health centres, while for community health centres the figure is 18,422 specialists.

Finance: At about 1.3% of the national income, India’s public healthcare spending between 2008 and 2015, has virtually remained stagnant. This is way less than the global average of 6 per cent.

Crumbling public health infrastructure: Given the country’s crumbling public healthcare infrastructure, most patients are forced to go to private clinics and hospitals.

High Out of Pocket Expenditure: 70% of the medical spending is from the patient’s pockets leading to huge burden and pushing many into poverty. Most consumers complain of rising costs.

Insurance: India has one of the lowest per capita healthcare expenditures in the world. Government contribution to insurance stands at roughly 32 percent, as opposed to 83.5 percent in the UK. The high out-of-pocket expenses in India stem from the fact that 76 percent of Indians do not have health insurance.

Rural-urban disparity: The growth of health facilities has been highly imbalanced in India. Rural, hilly and remote areas of the country are under served while in urban areas and cities, health facility is well developed. The SC/ST and the poor people are far away from modern health service.

Poor healthcare ranking: India ranks as low as 145th among 195 countries in healthcare quality and accessibility, behind even Bangladesh and Sri Lanka.

Commercial motive: lack of transparency and unethical practices in the private sector.

Lack of level playing field between the public and private hospitals: This has been a major concern as public hospitals would continue receiving budgetary support. This would dissuade the private players from actively participating in the scheme.

Global scenario:

• Shortages of skilled health workers across low- and middle-income countries.
• Southeast Asia needs a 50% increase in healthcare manpower to achieve universal health coverage by 2030.

Need of the hour:

The need of the hour is to design courses for different categories of non-physician care providers. Competencies (and not qualification alone) should be valued and reform must be brought in regulatory structures to provide flexibility for innovations.