The extent to which health systems provide quality health services in an equitable and efficient manner influences the level of health achieved in a population. Individuals, families, and health workers are all important providers of health care. However, the responsibility of delivering health services falls primarily on the health worker making them central to the health systems capacity to delivery health services. Issues concerning the health workforce such as its capability to cover different socioeconomic groups and geographic regions, the technical competence and skills of individual health workers and motivation with which they perform their jobs – all contribute in important ways to improving health system performance and population health.

Having an adequate health workforce in terms of numbers and skill mix is critical for countries like India which hope to make significant progress towards achieving the Millennium Development Goals for health. Recent studies show that greater availability of health workers is associated with better service utilization and health outcomes such as immunization coverage, outreach of primary care and infant, child and maternal survival (WHO 2006, JLI 2004, Anand and Barnighausen 2007). In addition to numerical strength, the effectiveness of the health workforce is influenced by the skill mix, quality and geographical distribution of health workers, a work environment and infrastructure which enables them to effectively use their skills, adequate remuneration and opportunities for upgrading and refreshing skills. Information on these factors is a basic requirement for policy makers and planners to better manage the health workforce and make it more effective.

Information on India’s diverse health work force is surprisingly fragmented and unreliable, despite recent efforts at quantifying it (WHO 2007, GOI 2005). The World Health Organisation (WHO) defines health workers as “all people primarily engaged in actions with the primary intent of enhancing health” (WHO 2007). In India’s context this encompasses a great diversity of workers in terms of their skills, qualification, the system of medicine practiced and the sector (public or private) in which they are employed.

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