This document is developed by Swasti, Health Resource Centre as a product of the People for Health Project.

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Tyrone Eugene Crawford
8 years ago
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4 Acknowlegement This document is developed by Swasti, Health Resource Centre as a product of the People for Health Project. This study has given us a better understanding of the human resource management practices adopted across the country and helped us get a deeper perspective of the challenges faced in this space. Through this process we have gained an appreciation for all efforts being made both by public and private healthcare players. We thank all the organisations that have shared information on their HR practices to help us complete this study. Given the sensitive nature of human resources, we appreciate the honesty and willingness displayed by them. We also thank representatives from the Department of Health & Family Welfare, Madhya Pradesh, Kerala, and Jammu & Kashmir as well as the Indian Railways for being forthcoming in sharing their HR practices and for spending their valuable time with us despite their busy schedules. We also thank participants from Chirayu Medical College & Hospital, Jawaharlal Nehru Cancer Research Centre, Lourdes Hospital, and Kerala Institute of Medical Sciences for sharing HR practices from the private sector. We understand their difficulty in sharing this information and we truly appreciate it, as without their inputs, this report would be incomplete. We consider ourselves lucky to have had the opportunity to capture civil society contributions in this report by documenting practices at Aravind Eye Care System, Karuna Trust, and IntraHealth. We would like to thank their representatives for supporting us. We also acknowledge Public Health Foundation of India, whose contribution through the literature review was well appreciated. We must make a mention of Mr. Shiv Kumar, President and Chief Executive Officer of Swasti, for his advisory support in designing the study in the limited time available. We hope readers of this report will find the analysis presented here useful and also sincerely hope that healthcare organisations will adopt some of the recommendations detailed in this report. We were delighted to conduct this survey and hope it will guide organisations move towards better HR practices and eventually towards delivering better health outcomes. Dr. Angela Chaudhuri (angela@swasti.org) Director, Partners for Results Swasti Health Resource Centre

Through this process we have gained an appreciation for all efforts being made both by public and private healthcare players.

5 Introduction Swasti, is a Health Resource Centre working in South and South East Asia. The Public Health Foundation of India (PHFI), is an Indian network of institutions responding to India s public health challenges through education, training, research, communication, and advocacy. Together, Swasti and PHFI are partnering to implement this initiative within a time frame of , to advance Human Resources for Health in India, funded by the European Union. This initiative seeks to engage civil society organisations and other non-state actors (including the private sector), and networks to strengthen health workforce policies, strategies, and practices through effective knowledge management and capacity building at the national level and in two Indian states, Madhya Pradesh and Kerala. This document details the study and the findings of HR planning in public, private, and NGO-managed health sector and presents recommendations for improving HR planning in the public sector.

Together, Swasti and PHFI are partnering to implement this initiative within a time frame of 2011 14, to advance Human Resources for Health in India, funded by the European Union.

6 SECTION CONTENT PAGE 1 Health Human Resource Planning 8 2 Health HR Planning in India 8 3 The People for Health Project 9 4 Scope of the Current Study 10 5 Findings from the Government Sector Madhya Pradesh Health Department Kerala Health Department Indian Railways 17 6 Findings from the Private Sector Chirayu Medical College and Hospital, MP Jawaharlal Nehru Cancer Hospital, MP 19 7 Findings from the NGO Sector Aravind Eye Care System, Tamil Nadu Karuna Trust, Karnataka and other states in India Lourdes Hospital, Kerala 23 8 Summary of Lessons Learned 23 9 Recommendations for Strengthening the Health HR Planning Processes 9.1 Meeting Current Requirements Meeting Future Requirements 28 Annexure 1 Methodology 30 Reference 32 25

2 Jawaharlal Nehru Cancer Hospital, MP 19 7 Findings from the NGO Sector 20 7.1 Aravind Eye Care System, Tamil Nadu 20 7.2 Karuna Trust, Karnataka and other states in India 22 7.

7 ANM ANSWERS AYUSH CHC CME CMD DHS DMO GOI GoMP HR HRH HRMIS HRM IMG IPHS MBBS MCI MIS MLOP MO MP MPHSRP MPPSC NABH NGO NRHM P4H PG PIP PHC PSC PEB SC Auxiliary Nurse and Midwife Academy for Nursing Studies and Women s Empowerment Research Studies Ayurveda, Unani, Siddha, and Homeopathy (Alternate systems of Medicine) Community Health Centre Continuing Medical Education Chief Medical Director Director of Health Services District Medical Officer Government of India Government of Madhya Pradesh Human Resources Human Resources for Health Human Resource Management Information System Human Resources Management Institute of Management in Government Indian Public Health Standard Bachelor of Medicine and Bachelor of Surgery Medical Council of India Management Information System Mid Level Ophthalmic Personnel Medical Officer Madhya Pradesh Madhya Pradesh Health Sector Reform Programme Madhya Pradesh Public Service Commission National Accreditation Board for Hospitals Non-Governmental Organisation National Rural Health Mission People for Health Post Graduate Program Implementation Plan Primary Health Centre Public Service Commission Professional Examination Board Scheduled Castes

Director of Health Services District Medical Officer Government of India Government of Madhya Pradesh Human Resources Human Resources for Health Human Resource Management Information System Human

11 Population above poverty line Population below poverty line 63% 37% Total Population: 60 million

13 Body The Professional Examination Board (PEB), a government agency Madhya Pradesh Public Service Commission (MPPSC) The Establishment Section, Health Department Nursing Section Function Overall recruitment in Madhya Pradesh Supports overall recruitment process, but is limited to recruitment Responsible for the postings and transfers of staff especially those pertaining to doctors The posting of nursing staff

recruitment in Madhya Pradesh Supports overall recruitment process, but is limited to recruitment

14 Facility No. Beds Teaching Hospitals 13 10,674 General Hospitals 12 4,866 District Hospitals 15 4,854 Speciality Hospitals 19 5,740 Taluk Hospitals 80 9,502 Community Health Centres 230 6,527 PHCs (24x7 and regular) 835 5,525 Other Institutions

15 Person Director of Health Services (DHS) Responsibilities Appointing medical officers Additional Director Managing HR functions Establishment Division Supporting the Additional Director, looking after appointments and transfers. The division is staffed with a clerk, a junior superintendent, and/or senior superintendent Nursing Section Posting of nursing staff

Director, looking after appointments and transfers.

21 Doctors and fellows Chief Medical Officer Head of Department Fellows/Trainees Paramedical Staff MLOPs Nurses Nursing Superintendent Admin and support Management Coordinators Directors

22 Personnel Strength Medical Officer 2 Pharmacist/compounder 1 Driver 1 Staff Nurse 3 Lab. Technician 1 Accountant 1 ANM 5 Class IV 1 Total 14

26 Challenges Inadequate availability and capacity of human resources, which worsens in remote rural and tribal areas. District leadership lacks capacity in programme management and technical areas across sectors Absence of comprehensive health HR policies in most Indian states Strategic Approaches Comprehensive approach to HR systems: Diversifying human resource needs Multi-skilling Rationalisation Task shifting Proactive filling of vacancies Incentive approaches Recruitment policy Linking HRMIS to programme management Retention: lack of responsive mechanisms for - performance management - recognition and grievance redressal Multi-stakeholder consultation Absence of gender considerations A comprehensive framework for capacity building, strengthened training infrastructure, and capacities to ensure capable and motivated staff Sub-optimal monitoring and utilisation of HR MIS Gender disaggregated HR MIS

29 Current numbers of staff of different cadres and skills required

This document is developed by Swasti, Health Resource Centre as a product of the People for Health Project.

Developed by Acknowlegement This document is developed by Swasti, Health Resource Centre as a product of the People for Health Project. This study has given us a better understanding of the human resource