Challenges of Human Resources in Health
Transcript of Challenges of Human Resources in Health
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
14
23
28
15
1 2
1
13
15
10
20 20
10
3 1
43
13
7 6
8
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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