Good quality human resources (HR) are perhaps the most important aspect of the health care system globally and in India. If you don't have enough qualified doctors, nurses, and other staff in health institutions and if you don't take measures to retain them, then the whole concept of reforming the health sector runs the risk of hitting a dead end.
Old and new challenges threaten HR responsible for healthcare planning and delivery in states where the
DFID -supported technical teams work in India - Bihar, Orissa, Andhra Pradesh, Madhya Pradesh, and West Bengal. Among the old challenges, low pay and staff motivation, staff shortages, unequal and inequitable distribution of the health workforce, and poor staff performance and accountability remain key obstacles to health sector development. Among the new challenges, qualified staff move more freely among institutions, and even places that can train and produce health workers are unable to retain them. Limited avenues for promotions and growth only exacerbate the situation. State governments recognize the need to better manage human resources and restructure the way it is set up.
Here is how the technical teams work with state governments to bring change to the HR system and improve health service delivery -
Orissa
- Intensive dialogue with the Department of Health and Family Welfare led to the development of a database of doctors. This enabled the Government of Orissa (GoO) to make major policy decisions related to transfers, promotions, incentives, and overall restructuring of the doctor's workforce.
- A State Human Resource Management Unit was set up to formulate an HR policy, HR planning, management, monitoring and evaluation, and ensure that qualified staff are assigned to relevant and appropriate positions.
- The GoO took measures to strengthen the nursing profession. It set up a Task Force, with representation from the DFID -supported technical teams, to establish a Nursing Management Support Unit.
Results
- Equal distribution of the work force
- Availability of a pool of senior personnel
- Improved staff morale and motivation
- Reduced absenteeism and improved service delivery
Madhya Pradesh
The Government of Madhya Pradesh has constituted 7 core groups under different themes to advise the Chief Minister on policy, structural, and operational reforms. Health and Education have been clubbed into one of the 7 core groups. The technical support team in Madhya Pradesh is the lead on the core group for health.
The following are some policy decisions taken by the core group -
- Review of medical, administrative, and managerial position in the Department for Health and Family Welfare
- Formulation policies on recruitements, transfers, postings, and training for medical and paramedical staff
- Strengthening nursing staff and opening nursing colleges
- Development of a retention strategy for medical and paramedical staff
West Bengal
- Improvements in organization structure: setting up a hospital management cell, introducing appropriate HR processes, addressing training needs of staff, clearly defining roles and responsibilities, introducing technology-based reporting.
- Improving HR management, recruiting Auxiliary Nurse Midwives and filling up vacancies.
- HR database: DFID support has brought about reforms in HR systems and organizational development through an HR databse. The technical assistance team in West Bengal has developed an innovate dashboard monitoring tool to monitor performance across a range of indicators and districts.
Results
- A large number of doctors and nurses recruited
- Vacancies for nurses reduced
- Nurse midwives trained for better performance
Andhra Pradesh
Addressing institutional and issues related to systems within the health department was seen as essential to improving access to and utilization of quality health services. Some challenges identified were related to lack of an effective HR policy, leading to non-functional health facilities, inadequate doctors and nurses, and low morale and motivation among staff. Lack of incentives and no performance monitoring and accountability contributed to high staff absenteeism.
The
DFID-supported technical assistance team, led by Family Health International, worked with the state government of Andhra Pradesh to strengthen HR systems and address other issues grappling service delivery. Some activities undertaken as part of the technical team's work on improving organizational and HR systems were -
- Making monitoring and evaluation more effective through IT-enabled Management Information Systems
- Managing the performance of health institutions
- Developing an HR policy including a training policy
- Developing alternate models of service delivery to ensure availability of staff in remote areas (several public private partnership models are being implemented to ensure that services are accessible, need-based, and accountable to users)