Human resource shortage and inequalities at the base of India‘s Public Healthcare System

Aditya Singh, Sasee Pallikadavath


Introdução: India today faces a major crisis of human resources for health at all levels of health system. Maintaining adequate number and having a balanced distribution of human resources at Health Sub-Centers (HSC), the first formal contact point between community and the public healthcare delivery system, is important for improving basic health outcomes in rural India.

Objetivos: The paper evaluates the shortage of human resources at HSCs against the Indian Public Health Standard (IPHS) for human resources set by government of India and quantify distributional inequalities and try to explore the reasons why these distributional imbalances in human resources at HSCs occur.

Metodologia ou Descrição da Experiência: We use data from the third wave of District Level Household and Facility Survey, the largest ever nation-wide survey of households and health facilities. We evaluate shortage of human resources against IPHS. Inequalities are then quantified and decomposed using decomposable measure of inequality known as Thiel’s index. At the end, we explore factors associated with unequal distribution of human resources using linear and logistic regression.

Resultados: On an average, an HSC in India is staffed with 2 health workers as against IPHS norm of 4 workers. About 3.8% and 51.6% of HSCs are without an ANM and a male health worker, respectively. State-wise variations are obvious. Overall inter-HSC inequality in India as measured by Thiel’s index is 0.10. When decomposed into ‘within state’ and ‘between state’, a large share (70%) of total inter-HSC inequality is contributed by within state inequality. Ownership of the building, availability of phone, water, functional toilet, regular supply of electricity and distance to district headquarters and nearest bus station are significantly associated with the number of health workers at HSC.

Conclusão ou Hipóteses: To strengthen the health system, improve the health outcomes and reduce burden of exiting health workforce, there is need to recruit more health workers. To reduce inequality, apart from recruiting and deploying more health workers as stated above, the government should also try to maintain basic facilities and amenities at HSCs and focus on HSCs located in far-off places in the districts.



Health Sub-Centre; Auxiliary Nurse Midwife; India

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