In this series we look at the challenges facing Indian healthcare system, especially since the pandemic has brought to light how inadequate healthcare facilities can be fatal.
In 2015, India’s Ministry of Health & Family Welfare developed the National Initiative on Allied Health Professionals to strategically plan and help develop a health workforce to increase access to care. This was an effort to meet their goal of Universal Health Care by 2020.
Globally, the growing health workforce shortages, the evidence that 80% of a person’s health status is determined by the social determinants of health (SDOH), the shift in community based primary care from tertiary health care and the recognition that ‘health is an investment’ leading to economic growth have all fueled health professional educational shifts (Cobb, 2019).
It is evident in many ways that India’s health care sector is facing a major crisis: inadequate infrastructure and human resources.
In a study by Indian Journal of Public Health (2017), they estimated that there is a need for about 1,476,000 practicing doctors in 2030 to meet a doctor-population ratio of 1:1000 people. This requires a growth rate of 151% of doctors in the 20year period from 2010.
The table below shows the percentage of child-births attended by the skilled health personnel with India seen at only 67%
Table 1 (Source: Indian Journal of Public Health)
GENDER REPRESENTATION OF HEALTHCARE WORKERS BY STATE
Female doctors and health workers are an important part of the health workforce, particularly for women’s health. The importance of gender of the doctor is important since women in large parts of the country are often reluctant to go to male doctors especially for their obstetrical and gynecological problems (Bang et. al 2003).
According to WHO, 2016 report, out of all health workers, 38% were female in India. The male-female ratio of all health workers was 1.6, of doctors 5.1, and of nurses and midwives 0.2. Female doctors comprise only 17% of the doctors in the country (Rao et al 2009)
The distribution of female health workers, particularly female doctors is extremely uneven across states. The states of Gujarat, Rajasthan, Haryana, Himachal Pradesh, Uttaranchal, Uttar Pradesh, Madhya Pradesh, Bihar, Jharkhand, Chhattisgarh, West Bengal, Orissa and Assam have a low density of female doctors. States with higher female doctor densities include the states of Jammu & Kashmir, Punjab, Maharashtra, Goa, Karnataka, Kerala, Tamil Nadu, Manipur and Mizoram.
The states with the highest share of female health workers were Kerala (64.5%) and Meghalaya (64.2%), and the states with the lowest were Uttar Pradesh (19.9%) and Bihar (22.3%). Qualified female health workers constitute almost half of the qualified health workforce (see Table 3).
LACK OF ACCESS TO HEALTHCARE FACILITIES – A GENDER COMPARISON
In a study conducted by All India Institute of Medical Sciences (AIIMS), the Indian Statistical Institute, Prime Minister’s Economic Advisory Council, and Harvard University (2016), the experts found that only 37% of women got access to health care, as compared to 67% of men. This study also showed that getting proper health care was dependent on the location of the women and their family.
Gender bias increased with a region’s distance from metropolitan cities like New Delhi. For instance, in 2016, a study showed that 11,507484 more men from Bihar visited AIIMS compared to women from the same state. The cost of travel incurred has a direct impact on the access of healthcare for women. The greater the distance from the hospital, less chances of the women turning to healthcare (Anuj, 2016).
In the coming articles we look at the research which shows why doctors prefer urban areas, unqualified healthcare workers and a shortage of quality healthcare in rural areas.