Human resource shortage in India's health sector: a scoping review of the current landscape

BACKGROUND

For healthcare delivery to be optimally effective, health systems must possess adequate levels and we must ensure a fair distribution of human resources aimed at healthcare facilities. We conducted a scoping review to map the current state of human resources for health (HRH) in India and the reasons behind its shortage.

METHODS

A systematic search was conducted in various electronic databases, from the earliest available date till February 2024. We applied a uniform analytical framework to all the primary research reports and adopted the "descriptive-analytical" method from the narrative paradigm. Inductive thematic analysis was conducted to arrange the retrieved data into categories based on related themes after creating a chart of HRH problems.

RESULTS

A total of 9675 articles were retrieved for this review. 88 full texts were included for the final data analysis. The shortage was addressed in 30.6% studies (n = 27) whereas 69.3% of studies (n = 61) addressed reasons for the shortage. The thematic analysis of data regarding reasons for the shortage yielded five kinds of HRH-related problems such as inadequate HRH production, job dissatisfaction, brain drain, regulatory issues, and lack of training, monitoring, and evaluation that were causing a scarcity of HRH in India.

CONCLUSION

There has been a persistent shortage and inequitable distribution of human resources in India with the rural expert cadres experiencing the most severe shortage. The health department needs to establish a productive recruitment system if long-term solutions are to be achieved. It is important to address the slow and sporadic nature of the recruitment system and the issue of job insecurity among medical officers, which in turn affects their other employment benefits, such as salary, pension, and recognition for the years of service.

Providers' perspectives on the performance of primary healthcare centres in India: The missing link

BACKGROUND

Primary healthcare centres (PHCs) form the foundation of the Indian public health system, and thus their effective functioning is paramount in ensuring the population's health. The World Health Organisation (WHO) has set six aspects of performance assessment for general health systems, which are hardly applicable to the PHC setup in a low- and middle-income country. The Primary Health Care Performance Initiative (PHCPI) has prescribed a framework with five domains consisting of 36 indicators for primary healthcare performance assessment from a policy point of view. For the assessment to be realistic, it should include inputs from stakeholders involved in care delivery, so this study examines the perspectives of healthcare providers at PHCs in India.

METHODOLOGY

The authors used qualitative research methodology in the form of responsive evaluations of healthcare provider's interviews to understand the indicators of PHC performance.

RESULTS AND CONCLUSION

The study results showed that healthcare providers considered efficient teamwork, opportunities for enhancing provider skills and knowledge, job satisfaction, effective PHC administration, and good community relationship as PHC performance assessment. These domains of performance could be considered the 'missing link' in PHC assessment, since they are deemed important by providers and did not coincide with the WHO aspects and the PHCPI performance assessment framework.

Relationships of work characteristics to job satisfaction, turnover intention, and burnout among doctors in the district public-private mixed health system of Bangladesh

Background

Work design integrates work characteristics having organizational, social and job components which influence employees’ welfare and also organizational goals. We investigated the effects of work characteristics and other predictors to job satisfaction, turnover intention, and burnout in doctors of the public primary, public secondary and private facilities of the district health system of Bangladesh.

Methods

A quantitative study using a self-administered questionnaire containing mostly structured items was conducted among the public and private doctors with a sample size of 384 from 29 out of a total 64 districts of Bangladesh during October and November 2015. All variables including work characteristics and outcomes of interest were based on literature and measured on 5-point Likert scale. Multivariate analysis of variance, bivariate correlation, and multiple regression were the models operated through SPSS version-21.

Results

A total of 354 doctors responded. No significant differences were found between public primary and secondary level doctors on combined work characteristics and outcomes variables, which however differed significantly between the public and private doctors. Organizational support was the strongest predictor adversely affecting job satisfaction, turnover intention and burnout of both the public and private doctors; private doctors’ experienced more support. The effects of health-professional politics on the public doctors were alarming.

Conclusion

Work design of the Bangladesh’s health system is in need of ample development. Doing so, improvement in organizational supports is crucial; however, other work characteristics components are also important for enhancing doctors’ welfare and health system productivity.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-017-2369-y) contains supplementary material, which is available to authorized users.

Development and validation of an instrument to assess job satisfaction in eye-care personnel

PURPOSE

The aim was to develop and validate an instrument to measure job satisfaction in eye-care personnel and assess the job satisfaction of one-year trained vision technicians in India.

METHODS

A pilot instrument for assessing job satisfaction was developed, based on a literature review and input from a public health expert panel. Rasch analysis was used to assess psychometric properties and to undertake an iterative item reduction. The instrument was then administered to vision technicians in vision centres of Andhra Pradesh in India. Associations between vision technicians' job satisfaction and factors such as age, gender and experience were analysed using t-test and one-way analysis of variance.

RESULTS

Rasch analysis confirmed that the 15-item job satisfaction in eye-care personnel (JSEP) was a unidimensional instrument with good fit statistics, measurement precisions and absence of differential item functioning. Overall, vision technicians reported high rates of job satisfaction (0.46 logits). Age, gender and experience were not associated with high job satisfaction score. Item score analysis showed non-financial incentives, salary and workload were the most important determinants of job satisfaction.

CONCLUSIONS

The 15-item JSEP instrument is a valid instrument for assessing job satisfaction among eye-care personnel. Overall, vision technicians in India demonstrated high rates of job satisfaction.