On the basis of NSSO data, the nurse to doctor ratio in India is found to be 1.7:1, while the ratio of similar health workers to doctors is estimated to be 1:1, according to a report released by the WHO and the Public Health Foundation of India.
The report found that although there was no normal skill-mix ratio of different health workers, most OECD countries reported approximately 3-4 nurses per physician.
It further said the Indian High-Level Expert Group (HLEG) reference for the nurse-doctor ratio in India stood at 3:1. Moreover, there was also a need to strike a balance (right skill-mix) between doctors and associated health workers.
According to the basis of NSSO data, the nurse to doctor ratio is assessed to be 1.7:1 in India, following Punjab at (6.4:1) and Delhi at (4.5:1) on the higher side even as the states of Bihar, Jammu and Kashmir and Madhya Pradesh have less than one nurse per doctor, said the report.
In the report it has been recommended for India to invest in human resources for health (HRH) in order to increase the number of active health workers and also to recover the skill-mix ratio which requires investment in professional colleges and technical education.
India needs to encourage qualified health professionals to join labour markets and ensure additional trainings and skill building for those who are already working but are inadequately qualified health workers, the report stated.
Along with the increased availability of and accessibility to quality doctors by the population generally , improved investment in HRH will cause strengthening of the health system for dealing with pandemic situations like coronavirus and the other epidemic, it said.
It will cause economic process, participation of women increased within the labour market, validation of the labour market and overall economic wellbeing, the study said.
The study presents an updated estimate on the size and composition of stock of health professionals and active health workforce within the country. Using the knowledge available from the National Health Workforce Account (NHWA) on the stock of health professionals and Periodic Labour Force Survey (PLFS) conducted by the National Sample Survey Office (NSSO 201718) on active health workforce, the study estimated a complete stock of 5.7 million doctors including allopathic doctors (1.1 million), dentists (0.27 million), nurses (2.3 million), pharmacists (1.2 million) and traditional medical practitioners (AYUSH 0.79 million).
However, the active health workforce size is estimated (from NSSO 2017-18) to be much lower (3.04 million), with allopathic doctors and nurses estimated as 0.78 million and 1.36 million respectively.
“The right balance within the skill-mix ratio for doctors provides optimum healthcare conditions. Contrasting the skill-mix ratio with the density of doctors at state levels, an inefficient skill-mix is found to exist between doctor and nurse and doctor and allied health care provider in most states in India,” the report stated.
By a high-rate vacancy of sanctioned positions the public sector is challenged. The study said that the issue is highlighted by the Rural Health Statistics.
While the shortage is most pronounced for specialists posted at Community Health Centres (CHC), India faces shortages across states for various positions.
A review of the serially published reports of the agricultural Health Statistics shows a slow but definite growth within the number of health providers at the general country level. The vacancies are attributed to diverse reasons that range from barriers in recruitment, litigations against recruitment processes and premature exits from the system, especially in contractual positions, the report stated. Increase within the number of the health workforce and therefore the right balance within the skill mix requires a supply of health professionals at an increased rate.
The supply side of health professionals may be a crucial parameter in reaching the goals for minimal optimum density of the health workforce, it added. An analysis of the health workforce projections provides the estimated density of skilled health professionals (doctors, nurses and midwives) per 10 000 population.
“Considering the current rates of growth are sustained, the required density of health workforce will still not be met as the rise in the number of health professionals will be balanced by a rise in the country’s population. At the present level of growth on the supply side, the skill-mix ratio of doctor: the nurse is unlikely to alter by 2030.
“A near 200 per cent growth on the supply side for nurses will improve the doctor: nurse ratio to 1:1.5 by 2030. This will require a further rapid scale-up of nursing programmes,” the report said