Eleventh Five Year Plan

Health and Family Welfare and AYUSH 97Box 3.1.19Human Resources for HealthIssues• Growing shortage of all key cadre in rural areas—Doctor, Paramedicals, ANMs, Nurses, Lab Technicians, and OTAssistants.• Problems of absenteeism and irregular staff attendance.• Non-availability of drugs and diagnostic tests at health facility leading to demotivation of doctors.• No motivation or will to serve in rural areas.• Weak or non-existent accountability framework leading to powerlessness of local communities and Panchayat vis-à-visthe health system functionaries.• Non-transparent transfer and posting policy leading to demoralization.• Inadequate systems of incentive for all cadres especially in difficult area postings.• Lack of career progress leading to demotivation and corruption.• Lack of standard protocols to promote quality affordable care and full utilization of human resources.Possible Solutions• State-specific human resource management policy and transparency in management of health cadres.• Training and utilization of locally available paramedics, RMPs, and VHWs to meet the gaps in rural areas. Allow them toprescribe basic medication.• Reintroducing Licentiate course in Medicine• Incentives for difficult areas and system for career progression.• Accountability to local communities and Panchayats.• Devolution of power and functions to local health care institutions—provide resources and flexibility to ensure serviceguarantee.• Resources, flexibility, and powers to ensure that IPHS are achieved.• Adequate staff nurses and a minimum OPD attendance and service provision• Improved and assured tele-linkages.• Efforts of the National Board of Examinations(NBE) will be enhanced for overcoming the shortageof specialists and also to improve the quality oftraining.• Councils to create a scientific data bank of healthprofessionals.• Re-registration of all medical and dental practitionersincluding specialists after every five years tillthey are practising or serving.• New medical, nursing, and dental colleges will beestablished in the underserved areas.• As recommended by the NCMH (2005), prioritywill be given to reducing the existing inequalityby establishing 60 medical colleges in deficit States(UP, Rajasthan, MP, Orissa, Chhattisgarh, etc.) and225 new nursing colleges in underserved areas.PPP will be used to bridge this gap.• Experiences of University of Health Sciences set upin various States during the Tenth Plan, against medicalcolleges that are part of the general universities tobe evaluated before more such universities are set upduring the Eleventh Five Year Plan.• Implementation of recommendations of OSC fordevelopment of Human Resources for health.• Equip medical graduates with the skills essential forproviding broad-based community health care.• Stem the high rate of attrition of academics; teachingin professional colleges to be made attractive.Need to enhance the salary structure and providean innovative programme of incentives. PrivateOPDs in the medical colleges to be considered asone such incentive.• RMPs, after training, can contribute towards activitiesunder NRHM. Few suggested roles have beenlisted in Box 3.1.20.Public Health Education3.1.159 Currently several institutions are engagedin imparting public health and related educationin the country. Various medical organizations are in