Do health policies address the availability, accessibility, acceptability, and quality of human resources for health? Analysis over three decades of National Health Policy of India

Human Resources for Health

Siddhesh Zadey¹  Sweta Dubey²  Jeel Vasa³ 

[1] Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India;Duke Global Health Institute, Duke University, Durham, NC, USA;Department of Surgery, Duke University School of Medicine, Durham, NC, USA;Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India;Government Medical College and Hospital, Nagpur, Maharashtra, India;Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India;Rajarshi Chhatrapati Shahu Maharaj Government Medical College, Kolhapur, Maharashtra, India;

关键词: Human Resources for Health;    India;    Policy analysis;    Health system strengthening;    Deficit indices;    National Health Policy;   

DOI  :  10.1186/s12960-021-00681-1

来源: Springer

【 摘 要 】

BackgroundHuman Resources for Health (HRH) are crucial for improving health services coverage and population health outcomes. The World Health Organisation (WHO) promotes countries to formulate holistic policies that focus on four HRH dimensions—availability, accessibility, acceptability, and quality (AAAQ). The status of these dimensions and their incorporation in the National Health Policies of India (NHPIs) are not well known.MethodsWe created a multilevel framework of strategies and actions directed to improve AAAQ HRH dimensions. HRH-related recommendations of NHPI—1983, 2002, and 2017 were classified according to targeted dimensions and cadres using the framework. We identified the dimensions and cadres focussed by NHPIs using the number of mentions. Furthermore, we introduce a family of dimensionwise deficit indices formulated to assess situational HRH deficiencies for census years (1981, 2001, and 2011) and over-year trends. Finally, we evaluated whether or not the HRH recommendations in NHPIs addressed the deficient cadres and dimensions of the pre-NHPI census years.ResultsNHPIs focused more on HRH availability and quality compared to accessibility and acceptability. Doctors were prioritized over auxiliary nurses-midwives and pharmacists in terms of total recommendations. AAAQ indices showed deficits in all dimensions for almost all HRH cadres over the years. All deficit indices show a general decreasing trend from 1981 to 2011 except for the accessibility deficit. The recommendations in NHPIs did not correspond to the situational deficits in many instances indicating a policy priority mismatch.ConclusionIndia needs to incorporate AAAQ dimensions in its policies and monitor their progress. The framework and indices-based approach can help identify the gaps between targeted and needed dimensions and cadres for effective HRH strengthening. At the global level, the application of framework and indices will allow a comparison of the strengths and weaknesses of HRH-related policies of various nations.

【 授权许可】

CC BY