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Workforce problems at rural public health-centres in India: a WISN retrospective analysis and national-level modelling study

BACKGROUND: Rural India has a severe shortage of human resources for health (HRH). The National Rural Health Mission (NRHM) deploys HRH in the rural public health system to tackle shortages. Sanctioning under NRHM does not account for workload resulting in inadequate and inequitable HRH allocation....

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Autores principales: Nair, Aatmika, Jawale, Yash, Dubey, Sweta R., Dharmadhikari, Surabhi, Zadey, Siddhesh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8796332/
https://www.ncbi.nlm.nih.gov/pubmed/35090494
http://dx.doi.org/10.1186/s12960-021-00687-9
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author Nair, Aatmika
Jawale, Yash
Dubey, Sweta R.
Dharmadhikari, Surabhi
Zadey, Siddhesh
author_facet Nair, Aatmika
Jawale, Yash
Dubey, Sweta R.
Dharmadhikari, Surabhi
Zadey, Siddhesh
author_sort Nair, Aatmika
collection PubMed
description BACKGROUND: Rural India has a severe shortage of human resources for health (HRH). The National Rural Health Mission (NRHM) deploys HRH in the rural public health system to tackle shortages. Sanctioning under NRHM does not account for workload resulting in inadequate and inequitable HRH allocation. The Workforce Indicators of Staffing Needs (WISN) approach can identify shortages and inform appropriate sanctioning norms. India currently lacks nationally relevant WISN estimates. We used existing data and modelling techniques to synthesize such estimates. METHODS: We conducted a retrospective analysis of existing survey data for 93 facilities from 5 states over 8 years to create WISN calculations for HRH cadres at primary and community health centres (PHCs and CHCs) in rural areas. We modelled nationally representative average WISN-based requirements for specialist doctors at CHCs, general doctors and nurses at PHCs and CHCs. For 2019, we calculated national and state-level overall and per-centre WISN differences and ratios to depict shortage and workload pressure. We checked correlations between WISN ratios for cadres at a given centre-type to assess joint workload pressure. We evaluated the gaps between WISN-based requirements and sanctioned posts to investigate suboptimal sanctioning through concordance analysis and difference comparisons. RESULTS: In 2019, at the national-level, WISN differences depicted workforce shortages for all considered HRH cadres. WISN ratios showed that nurses at PHCs and CHCs, and all specialist doctors at CHCs had very high workload pressure. States with more workload on PHC-doctors also had more workload on PHC-nurses depicting an augmenting or compounding effect on workload pressure across cadres. A similar result was seen for CHC-specialist pairs—physicians and surgeons, physicians and paediatricians, and paediatricians and obstetricians–gynaecologists. We found poor concordance between current sanctioning norms and WISN-based requirements with all cadres facing under-sanctioning. We also present across-state variations in workforce problems, workload pressure and sanctioning problems. CONCLUSION: We demonstrate the use of WISN calculations based on available data and modelling techniques for national-level estimation. Our findings suggest prioritising nurses and specialists in the rural public health system and updating the existing sanctioning norms based on workload assessments. Workload-based rural HRH deployment can ensure adequate availability and optimal distribution. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12960-021-00687-9.
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spelling pubmed-87963322022-02-03 Workforce problems at rural public health-centres in India: a WISN retrospective analysis and national-level modelling study Nair, Aatmika Jawale, Yash Dubey, Sweta R. Dharmadhikari, Surabhi Zadey, Siddhesh Hum Resour Health Research BACKGROUND: Rural India has a severe shortage of human resources for health (HRH). The National Rural Health Mission (NRHM) deploys HRH in the rural public health system to tackle shortages. Sanctioning under NRHM does not account for workload resulting in inadequate and inequitable HRH allocation. The Workforce Indicators of Staffing Needs (WISN) approach can identify shortages and inform appropriate sanctioning norms. India currently lacks nationally relevant WISN estimates. We used existing data and modelling techniques to synthesize such estimates. METHODS: We conducted a retrospective analysis of existing survey data for 93 facilities from 5 states over 8 years to create WISN calculations for HRH cadres at primary and community health centres (PHCs and CHCs) in rural areas. We modelled nationally representative average WISN-based requirements for specialist doctors at CHCs, general doctors and nurses at PHCs and CHCs. For 2019, we calculated national and state-level overall and per-centre WISN differences and ratios to depict shortage and workload pressure. We checked correlations between WISN ratios for cadres at a given centre-type to assess joint workload pressure. We evaluated the gaps between WISN-based requirements and sanctioned posts to investigate suboptimal sanctioning through concordance analysis and difference comparisons. RESULTS: In 2019, at the national-level, WISN differences depicted workforce shortages for all considered HRH cadres. WISN ratios showed that nurses at PHCs and CHCs, and all specialist doctors at CHCs had very high workload pressure. States with more workload on PHC-doctors also had more workload on PHC-nurses depicting an augmenting or compounding effect on workload pressure across cadres. A similar result was seen for CHC-specialist pairs—physicians and surgeons, physicians and paediatricians, and paediatricians and obstetricians–gynaecologists. We found poor concordance between current sanctioning norms and WISN-based requirements with all cadres facing under-sanctioning. We also present across-state variations in workforce problems, workload pressure and sanctioning problems. CONCLUSION: We demonstrate the use of WISN calculations based on available data and modelling techniques for national-level estimation. Our findings suggest prioritising nurses and specialists in the rural public health system and updating the existing sanctioning norms based on workload assessments. Workload-based rural HRH deployment can ensure adequate availability and optimal distribution. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12960-021-00687-9. BioMed Central 2022-01-28 /pmc/articles/PMC8796332/ /pubmed/35090494 http://dx.doi.org/10.1186/s12960-021-00687-9 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Nair, Aatmika
Jawale, Yash
Dubey, Sweta R.
Dharmadhikari, Surabhi
Zadey, Siddhesh
Workforce problems at rural public health-centres in India: a WISN retrospective analysis and national-level modelling study
title Workforce problems at rural public health-centres in India: a WISN retrospective analysis and national-level modelling study
title_full Workforce problems at rural public health-centres in India: a WISN retrospective analysis and national-level modelling study
title_fullStr Workforce problems at rural public health-centres in India: a WISN retrospective analysis and national-level modelling study
title_full_unstemmed Workforce problems at rural public health-centres in India: a WISN retrospective analysis and national-level modelling study
title_short Workforce problems at rural public health-centres in India: a WISN retrospective analysis and national-level modelling study
title_sort workforce problems at rural public health-centres in india: a wisn retrospective analysis and national-level modelling study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8796332/
https://www.ncbi.nlm.nih.gov/pubmed/35090494
http://dx.doi.org/10.1186/s12960-021-00687-9
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