About The Project

The role of health workers in the performance of health systems has attracted much recent attention. While their importance in the delivery of health services is well recognized, little attention has been paid to the systematic study of health workforce issues and how it influences health system performance and health outcomes. The quality, availability and efficiency with which health services are delivered are closely linked with the skills, presence, composition and distribution of health workers. Further, recent studies have shown that the availability of health workers is associated with the utilization of health services and key health outcomes. Paying attention to issues concerning human resources for health (HRH) is important for countries like India which hope to make significant progress towards achieving the MDGs and greater equity in health.

The Public Health Foundation of India (PHFI), in partnership with the World Bank conducted a systematic analysis of issues concerning human resources for health in India. The overall objective of these studies was to provide a deeper understanding of issues concerning HRH in India and provide evidence based policy guidance in this important area. The following three studies were conducted in 2007-08:

Study 1

An assessment of available data sources on human resources for health including the official registration data, the 2001 census, and the 2004-05 NSSO labor force survey. Estimates of the health workforce from these different sources have been compared and the results triangulated. The study presents estimates on the size, composition and geographical distribution of health workers in India. These are presented state-wise, for urban and rural areas and for the private and public sectors.

Study 2

A historical review of key policies related to health system development and HRH. An analysis of key functions in HRH policy and management and which institutions are responsible for them at national level (Central Health Service) and in two states – Uttar Pradesh (UP) and Tamil Nadu (TN). A set of case studies of institutional processes are presented with a "political economy" perspective. These include health worker recruitment at Centre, UP and TN; the development and maintenance of nursing schools in UP and TN; and of contract doctors in UP.

Study 3

An examination of The career aspirations and employment expectations of graduating medical and nursing students in UP using qualitative data such as focus groups and in-depth interviews.  The findings indicate job characteristics important to these students, the factors which influence their choice of sector (public or private) and location (rural and urban) to work in, and what factors will influence them to choose rural employment with the public sector.

Research team

The above studies were conducted by a team comprising staff of PHFI and the World Bank. The following researchers (listed alphabetically) were involved in this project:

Prof. Peter Berman, World Bank
Aarushi Bhatnagar, PHFI
Shomikho Raha, World Bank
Krishna Dipankar Rao, PHFI
Indrani Saran, PHFI

The study on career preferences of graduating medical and nursing students in UP involved the following researchers from King Georges Medical College, Lucknow:

Prof. Shally Awasthi
Tuhina Verm