Challenges of

Human Resources in

Health

Dr. Vishwas Mehta

Joint Secretary

Medical Education & HR

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Current Scenario of HR

1. DOCTORS

• Number of Doctors – 8.58 lakh (as per IMR)

• Those available (75%) – 6 to 6.5 lakh (approx)

• Doctor Population Ratio – 1:1953 (Current)

Target ratio– 1:1200 by 2025

Doctor per 1000 population

Compared to China - 1.6, USA – 2.6, UK –

2.3, Sweden – 3.3

• Additional Doctors required – 4.2 lakh by 2022

1.5 lakh in 50000 PHCs

0.8 lakh in 12500 CHCs

1.1 lakh in 5642

SDH/DH

0.5 lakh in 800 MCHs

4.2 Lakh by 2020

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Current Scenario of HR –contd…

2. NURSES

• Nurses registered – 11.2 lakh

• Available – 9 lakh (Approx)

• Nurse-Population Ratio – 0.4 : 1000

• Nurses +ANM Vs Doctor Ratio – 1.5 : 1 (Desired 3:1)

• Brazil – 3:1, South Africa – 5:1, USA 3:1, UK 5:1

• Additional Nurses required – 16.2 lakhs by 2022

Target – 1:2.19 by 2025

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Current Scenario of HR – Contd…. 3. Allied Health Professionals [AHP] (such as Lab tech. Radio tech, Med Record tech, Rehab , Ophthalmic tech….to name a few)

• Allied Health Workforce available – 62.65 lakhs (Approx)

• Additional Workforce required – 64.1 lakhs

5.28 5.64

10

4.62 4.22 3.68

Bihar Maharashtra Uttar Pradesh

West Bengal Andhra Pradesh

Tamil Nadu

State-wise short-fall Approximately 34 lakh AHPs required in the major states as indicated below

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Current scenario of Infrastructure - Medical colleges

1 Medical colleges in the Govt. Sector. 161

2 Medical colleges in the Pvt. Sector 194

3. TOTAL Medical Colleges 355

4. Total intake capacity of UG seats 45252

5. Intake capacity of UG excluding non-renewal seats(1300) 43952

6. Total intake capacity of PG seats 22503

145

150

155

160

165

170

175

180

185

190

195

Medical colleges in the Govt. Sector.

Medical colleges in the Pvt. Sector

161

194

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

Total intake capacity of UG seats

Total intake capacity of PG seats

45252

22503

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Current Scenario of Infrastructure – Dental Colleges

1 Dental colleges in the Govt. Sector. 41

2 Dental colleges in the Pvt. Sector 256

3. TOTAL 297

4. Total intake capacity of UG seats 24570

5. Total intake capacity of PG seats 4585

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Current Scenario of Infrastructure – ANM and GNM Schools

S. No Items 2010-11 2011-12 Total

1 No. of ANM Schools sanctioned 51 11 62 (out of 132)

2 No. of GNM Schools sanctioned 39 31 70 (out of 137)

3 No. of States covered 16 10 20 (29)

4 States where no fund released 8

(A&N, A.P., Assam, Tripura, H.P., U.P., Kerala, Karnataka)

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Growth of number of medical colleges

0

50

100

150

200

250

300

350

400

TOTAL MEDICALCOLLEGES

NEW MEDICALCOLLEGES SET UP

300

11

314

14

335

21

355

20

2009-10

2010-11

2011-12

2012-13

TRENDS IN MEDICAL EDUCATION

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TRENDS IN MEDICAL EDUCATION

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35227 37027 41569

43952 14470

18470 20868

22503 23570 23630

24210 24570

2653 2883

3418 4585

0

20000

40000

60000

80000

100000

120000

2009-10 2010-11 2011-12 2012-13

Increase in the MBBS Seats

UNEQUAL DISTRIBUTION OF MEDICAL COLLEGES

North 17%

South 44%

West 22%

Central 4% East

10%

North-East 3%

% age of medical colleges against the total number of colleges

TRENDS IN MEDICAL EDUCATION

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GEOGRAPHICAL DISTRIBUTION OF MEDICAL COLLEGE IN THE COUNTRY

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Health Services – Urban Rural Disparity

o Medical Education is Urban centric & Hospital based

o 80% of Doctors

o 75% of Dispensaries

o 60% of Hospitals

Qualified Physicians

11.3 per 10,000 – Urban Areas

1.9 per 10,000 – Rural Areas

}

Are located in Urban areas

TRENDS IN MEDICAL EDUCATION

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Existing Ratios

Beds per 1000 population Doctors per

1000 population

Health Worker per 1000

population

Nurse per doctor

0.9

0.55

1.29 1.5

TRENDS IN MEDICAL EDUCATION

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Steps Taken by Government

To Meet The Human

Resource Demand:

Reforms and Next steps

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Huge NRHM effort for HR (increase in the HR since 2005 )

Doctors-10,000

ANM- 47000

Paramedics- 1,50,000

Nurses- 2,70,000

ASHA- 8,50,000

Reforms and Next steps

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Increase HR in medical education in Govt. institutions Strengthen infrastructure in under served areas

Enhance the quality of HRH education and training Support MCI/DCI/INC reform process

Standardization & Accreditation

Bridge the gap between Doctors & ASHAs Bachelor of Rural Health Sciences

Allied Health Professionals for Public Health Needs

Community Health Officers for rural areas

Create public health career ladder from grassroots Create sufficient avenues for promotion & growth

Harness Technology Infuse technology in HRH education and training

Develop a national health information technology network

Current focus areas

Reforms and Next steps

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REFORMS IN STRENGTHENING MEDICAL EDUCATION

MCI Regulation amended to rationalize existing Norms:-

(i) Land Requirement:

Relaxed from 25 acres to 20 acres.

States allowed to set up medical college in two pieces of land within 10 K.M.

(ii) Bed Strength:

Requirement of beds & bed occupancy relaxed.

Further relaxations for NE States and Hill States.

(iii) Increase in Maximum intake:

Maximum intake at MBBS level raised from 150 to 250..

REFORMS IN STRENGTHENING MEDICAL EDUCATION

(iv) Other relaxations:

Staff & infrastructure for 50/100/150 seats rationalized.

Age limit of faculty increased from 65 to 70.

DNB Qualification recognized for appointment as faculty

Ratio of teacher to students revised.

Recognition of Postgraduate and Graduate medical degrees of five countries (US, UK, Canada, Australia and New Zealand) for teaching , research and practice.

Steps to encourage posting of doctors in rural areas

Companies registered under Companies Act allowed to establish medical colleges

Strengthening & Up-gradation of State

Government medical colleges

Central Outlay : Rs. 1350 Cr. to increase 4147 PG seats.

Funding Pattern : 75% by Centre: 25% by States

Amount released till date : Rs. 501 Cr to 72 colleges in 20 States.

Second installment being released to States: 6 States: Gujarat, Orissa, Kerala,

Rajasthan, U.P., West Bengal,

First installment utilized by Uttarakhand, H.P.(some document pending)

Utilization Certificate pending : 11 States:

A.P., Assam, Bihar, Chandigarh, Chhatisgarh

Goa, J&K, Jharkhand, M.P. Maharashtra, Tripura.

Scheme for ANM & GNM Schools

132 ANM & 137 GNM schools – total 269 ANM/GNM Schools

278 districts identified in 29 States/Uts

Rs. 424.74 Cr released for 62 ANM & 70 GNM schools(132)

Funding pattern : 85% Centre & 15% State

For ANM Schools Rs. 5 Crores (Rs. 3.94 cr for non-recurring + Rs. 1.06 cr for recurring)

For GNM Schools Rs. 10 Crores ( Rs. 7.95 cr for non-recurring + Rs. 2.05 cr for recurring)

Rs. 1 Crore for State Nursing Cell in 15 States

Rs. 20 Crores each for Nursing Colleges in 6 AIIMS

Establish National Institute of Paramedical Sciences(NIPS), Delhi

9 Regional Institutes of Paramedical sciences:

Chandigarh, Lucknow, Bhopal, Hyderabad, Coimbatore, Bhubaneswar, Patna and Aurangabad.

Outlay of Rs. 1156.43 Crores : Rs. 87 Crores released to HLL

Setting up of State Paramedical Institutions and supporting 149 State Govt. Medical Colleges for conducting allied health courses through one time grant.

Manpower development support : 4 crores for UG & 2 crores for PG

21.22 Crores released to 5 medical colleges(2-Maha + 3-Raj)

A total of 2,04,000 paramedical professionals would be trained per year under both the schemes when fully functional.

4. REFORMS IN THE ALLIED HEALTH EDUCATION

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RANKING OF THE STATES WITH RESPECT TO SEAT : POPULATION RATIO

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CRITICAL GAPS

NO OF DISTRICTS W/O ANY MEDICAL COLLEGE IN THE STATES

3 2

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CRITICAL GAPS

DETAILS OF BED STRENGTH IN THE DISTRICTS W/O ANY MEDICAL COLLEGE

S.N Bed Strength Range

No of District Hospitals*

Deficit with respect to 500 beds ( 100 intake capacity)

1 100-299 239 About 250

2 300-399 49 About 150

3 400-499 7 About 50

4 500 and above 12 nil

* Districts without any medical college is taken

100-299 300-399 400-499 500 and above

239

49

7 12

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CRITICAL GAPS

NEW INITIATIVES BEING TAKEN

Establish new medical colleges after Up-gradation of district hospitals- Up-

grade about 67 district hospitals with intake of 100 MBBS students will

lead to increase of 6700 MBBS seats annually

Strengthening of government medical colleges to increase the MBBS

Seats- this will lead to increase of 10700 MBBS seats annually

Start a Nursing College with every Government Medical College.

Establish a body for Allied Health Professionals for standardization,

accreditation & regulation.

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S. No.

Intake capacity

No. of Colleges

Permitted Withdrawal of Recognition

Recognized, but

Renewal for increased seats

NET

1 50 20 00 01 01 18

2 100 74 24 01 03 46

3 150 51 02 01 02 46**

4 200 09 00 00 02 07

5 250 07 00 00 04 03*

TOTAL 161 26 03 12 120*

* Total colleges to be considered for seat increase = 120-3= 117

** Out of 46 MC of 150 intake capacity only 45 are of more than 10 yrs of

standing. So colleges expected to be covered = 117-1= 116

DETAILS OF MEDICAL COLLEGES TO BE COVERED

DETAILS OF EXPECTED UG SEAT INCREASE

S . No . Seat increase

(From -TO) No. of Medical colleges Expected Seat increase

1 50-150 18 18x100=1800

2 100-150 11( less than 10 yrs old) 11x50=550

3 100-200 35 ( more than 10 yrs ) 35x100=3500

4 150-250 45( more than 10 yrs ) 45x100=4500

5 200-250 7 7x50=350

Total 116 10700

EXPECTED OUTCOME

Increase of around 17,400 MBBS seats annually [total as per

two schemes]

Training of 300 candidates as Nursing faculty

Adding 20,000 nurses annually

Training 2, 04,000 paramedical (allied health ) professionals

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ACTION POINTS FOR STATE GOVERNMENTS

MoU to be sent on prescribed format

Furnish documents for existing scheme:

Year-wise audited Utilization certificate

Audit Statement

Bank Reconciliation Statement

Physical progress report

Installation Certificate

Release State Government Share.

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ACTION POINTS FOR STATE GOVERNMENTS – CONTD...

Furnish updated information of bed strength of state government medical

colleges and district hospitals.

Submission of project report for up-gradating district hospitals into medical

colleges with 100 admissions(Maximum ceiling - Rs. 200 Cr.)

Furnish report on gap analysis of existing state government medical colleges

for increase in intake capacity of MBBS seats.

Preference to those districts, where there is no medical college in Govt./Pvt

Sector.

Ear-mark sites for ANM/GNM schools in already identified districts

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Details of funds released – State-wise

S.

No.

Name of the

State

No. of M

C

funded

funds

approved

Central Govt. Share

(75%)

Amount released No. of PG seats to

be increased

1 Uttar Pradesh 07 55.09 41.3 19.25 265

2 Bihar 06 74.425 55.82 27.72 199

3 Orissa 03 19.7 14.77 5.54 107

4 Assam 03 47.2 35.41 17.71 143

5 Chandigarh 01 45.56 34.17 17.09 48

6 Himachal

Pradesh

01 14.5 10.88 5.44 17

7 Madhya

Pradesh

04 87.758 65.82 26.91 203

8 Punjab 02 60.285 45.22 8.09 176

9 Rajasthan 06 138.0815 103.79 51.91 297

10 Uttarakhand 01 12.55 9.41 2.65 62

11 Kerala 02 54.453 40.838 21.455 150

12 West Bengal 08 168.91 126.6825 37.81 466

13 Goa 01 22.14 16.60 3.83 124

14 Gujarat 01 29.62 22.22 6.25 86

15 Tripura 01 24.55 18.41 7.29 115

16 Chhatisgarh 01 32.73 24.55 12.275 79

17 Maharashtra 11 345.7935 259.34 129.57 692

18 Andhra

Pradesh 10 185.126 138.881 69.64 689

19 J & K 01 37.57 28.18 14.08 127

20 Jharkhand 02 44.01 33.005 16.49 102

Total 72 1500.052 1125.2965 501.00 4147