Human Resources for Health: Lessons from the Private Sector

Human Resources for Health (HRH), held on January 30 in New Delhi, India, included health professionals, community health workers, administrators, and educators that provide and support health care services and programs. With a health workforce density of less than 2.0/1000 people, India is below the WHO’s benchmark of 2.5/1000.  Recruiting and retaining employees, ensuring distribution of personnel to rural areas, and low employee productivity are all examples of the struggles currently facing India’s HRH system. 

How can India improve not only the strength of its health workforce, but also the quality?This was one of the questions Swasti, along with the Public Health Foundation of India, examined over a three year partnership. Funded by the European Union, the People for Health project concluded with a dissemination meeting of over 75 attendees in New Delhi on January 30.  The Center for Health Market Innovations supported this event bringing together private sector representatives, who shared their experiences in human resources in health.

Promising examples that addressed India’s human resources challenges from across the country were discussed during an open “world café-style” conversation between panelists and representatives from the public and private sectors. We highlight here some of the key messages from the private sector: 

On the topic of recruitment, Dr. Santanu Chattopadhyay, Founder and CEO of Nationwide Primary Healthcare Services, highlighted the disproportionate number of Indian medical students preferring to become specialists to general practitioners (GPs). The lack of GPs along with difficulties in retaining women in the work force, put increased strain and cost on the healthcare system. Effective recruitment of new health personnel and ongoing training will continue to be an issue as the healthcare system struggles to meet public demand. Nationwide, which manages a chain of family medicine clinics, conducts a 200-hour continuing medical education (CME) program. Employees and consultants of Nationwide are required to complete this annual requirement and in order to do so their clinics remain shut on Tuesday mornings.  Not only does this keep staff up-to-date on new developments, but the clinicians see the value because the program allows them to take up the MRCGP (Int) examination offered by the Royal College of General Practitioners in the UK and clear it in the first attempt, versus the 10% pass rate of general applicants.  Meeting the individual aspirations of the clinicians as well as maintaining the quality of care is achieved through this type of CME program. 

Saurabh Leekha, Health Information Systems Programme (HISP) shared how information technology and its adoption has helped to manage human resources more efficiently. Leekha recognized that though IT systems have been in use for a long time, and collect a large account of specific data, the challenge has been to how to use this data to make informed decisions, especially in the context of human resources for health. HISP is working towards integrating two systems of data – service delivery data captured through reporting systems (MIS) and human resource related data- to facilitate sharing and decision-making. Core indicators have been developed for health service delivery, skill-sets and worker distribution making available a variety of different analysis. The analysis also provides guidance on gaps in training and facilities. 

On the topic of training and managing human resources effectively, Dr. R. K. Jain of Indian Railways spoke of the railway’s health care system that provides services to over 6.3 million beneficiaries. The Indian Railway maintains their own hospitals and ensures quality through a training infrastructure by which all their medical officers receive instruction in HR practices. Additionally, a performance management system consistently measures outcomes on 17 key performance indicators and provides ongoing opportunities for improvement and adjustments. Ensuring quality and accountability within the system, as well as providing care for employees and their families for life are other critical factors that have allowed the health care system of the Railways to be the largest single health care provider in the country, outside of the Ministry of Health and Family Welfare.  

Dr. Paresh Navalkar, Medical Director, Ziqitza Health Care Ltd, spoke about how Ziqitza has addressed the lack of emergency health care providers. Ziqitza was founded in 2002 at a time when ambulances were not standardized and there were no designated emergency medical technicians. Ziqitza’s non-profit arm, Lifesupporters Institute of Health Sciences (LIHS) has developed standard operating procedures and curricula for the training of EMTs, offering two courses for those wishing to become EMTs. In Maharashtra, students who complete the EMT course receive INR 10,000 as an incentive, but Dr. Navalkar finds that there are still not enough people interested in taking the course. LIHS is working to form a paramedical council to work on increasing interest for the course throughout India. 

It was clear from the panel session that the private sector had come up with creative ways in which to address the challenges in delivery health care in India. Opportunities for further joint collaboration with the public health system were evident and I believe that this forum provided a starting point to many.  

Learn more about the People for Health project.

Photo: The 1298 Ziqitza Healthcare Limited ambulance in action in Dadar, Mumbai by Karen Dias for CHMI.