Workforce performance of the system would be best when we have the most appropriate person, in terms of both skills and motivation, for the right job in the right place, working within the right professional and incentive environment.
New Delhi: Rural Healthcare is indeed a major focus of the National Health Policy 2017. In terms of policy decisions, the NHP indeed focuses on efforts to Attract and Retain Doctors in Remote Areas, also calling for integrated efforts from medical, paramedical and allied forces to take healthcare to the remotest sections of the country. Some of the salient recommendations in regard to this include :-
- Attracting and Retaining Doctors in Remote Areas– The Policy proposes financial and non-financial incentives, creating medical colleges in rural areas; preference to students from under-serviced areas, realigning pedagogy and curriculum to suit rural health needs, mandatory rural postings, etc. Measures of compulsion- through mandatory rotational postings dovetailed with clear and transparent career progression guidelines are valuable strategies. A constant effort, therefore, needs to be made to increase the capacity of the public health systems to absorb and retain the manpower. The total sanctioned posts of doctors in the public sector should increase to ensure availability of doctors corresponding to the accepted norms. Exact package of policy measures would vary from State to State and would change over time.
- Specialist Attraction and Retention– Proposed policy measures include – recognition of educational options linked with National Board of Examination & College of Physicians and Surgeons, creation of specialist cadre with suitable pay scale, up-gradation of short term training to medical officers to provide basic specialist services at the block and district level, performance linked payments and popularise MD (Doctor of Medicine) course in Family Medicine or General Practice. The policy recommends that the National Board of Examinations should expand the post graduate training up to the district level. The policy recommends creation of a large number of distance and continuing education options for general practitioners in both the private and the public sectors, which would upgrade their skills to manage the large majority of cases at local level, thus avoiding unnecessary referrals.
- Mid-Level Service Providers: For expansion of primary care from selective care to comprehensive care, complementary human resource strategy is the development of a cadre of mid-level care providers. This can be done through appropriate courses like a B.Sc. in community health and/or through competency-based bridge courses and short courses. These bridge courses could admit graduates from different clinical and paramedical backgrounds like AYUSH doctors, B.Sc. Nurses, Pharmacists, GNMs, etc and equip them with skills to provide services at the sub-centre and other peripheral levels. Locale based selection, a special curriculum of training close to the place where they live and work, conditional licensing, enabling legal framework and a positive practice environment will ensure that this new cadre is preferentially available where they are needed most, i.e. in the under-served areas.
- Nursing/Paramedical – The policy also talks about addressing the acute shortage of nursing and paramedical professionals in the country. The Policy talks about establishing nursing school in every large district or cluster of districts of about 20 to 30 lakh population and establishing Centers of Excellence for Nursing and Allied Health Sciences in each State. For paramedical, Training courses and curriculum for super specialty paramedical care (perfusionists, physiotherapists, occupational therapists, radiological technicians, audiologists, MRI technicians, etc.) would be developed. This policy also supports certification programme for ASHAs for their preferential selection into ANM, nursing and paramedical courses.
- Public Health Management Cadre: The policy proposes creation of Public Health Management Cadre in all States based on public health or related disciplines, as an entry criteria. The policy also advocates an appropriate career structure and recruitment policy to attract young and talented multi- disciplinary professionals. Medical & health professionals would form a major part of this, but professionals coming in from diverse backgrounds such as sociology, economics, anthropology, nursing, hospital management, communications, etc. who have since undergone public health management training would also be considered. States could decide to locate these public health managers, with medical and non-medical qualifications, into same or different cadre streams belonging to Directorates of health. Further, the policy recognizes the need to continuously nurture certain specialized skills like entomology, housekeeping, bio-medical waste management, bio medical engineering communication skills, management of call centres and even ambulance services
- Human Resource Governance and leadership development: The policy recognizes that human resource management is critical to health system strengthening and healthcare delivery and therefore the policy supports measures aimed at continuing medical and nursing education and on the job support to providers, especially those working in professional isolation in rural areas using digital tools and other appropriate training resources. Policy recommends development of leadership skills, strengthening human resource governance in public health system, through establishment of robust recruitment, selection, promotion and transfer postings policies.