CTDT

10.5005/jp-journals-10055-0013
Health Manpower Planning
Health Manpower and Management

Health Manpower Planning

1
Rajoo S Chhina, 2Rajdeep S Chhina, 3Ananat Sidhu, 4Amit Bansal

ABSTRACT INTRODUCTION
Manpower is the most crucial resource toward delivery of health A developing economy needs high-level technical man-
planning. Health manpower refers to people who are trained to power as urgently as it needs capital. A crucial factor in
promote health, to prevent and to cure diseases, and to rehabili- improving the coverage and quality of health services is
tate the sick. The aim of manpower planning is to make available
the availability of adequate number of health personnel
the right kind of personnel in the right number with appropriate
skills at the right place at the right time doing the right job. Various with task-oriented training.
types of health resources are doctors, nurses, pharmacists, lab According to Dev Ray, “A health manpower plan
technicians, radiographer health assistants, health workers, is meant to ensure that the right number and quality of
auxiliary nurse midwife (ANM), accredited social health activists manpower are available to staff the health facilities as the
(ASHAs), anganwadi workers, trained dais, and so on. Currently, needs expand, so as to keep up with current and future
developing countries including India lag behind suggested norms
demands of services from the people.”1
of required health manpower. Presently, India produces 30,000
doctors, 18,000 specialists, 30,000 Ayurveda, Yoga and natu-
ropathy, Unani, Siddha, and Homeopathy (AYUSH) graduates, HEALTH MANPOWER PLANNING
54,000 nurses, 15,000 ANMs, and 36,000 pharmacists annually.
Manpower is the most crucial resource toward delivery
This production is not equal across the states, leading to unequal
distribution of doctors. Such a skewed distribution results in of health planning. Manpower planning is a technique of
large gaps in demand and availability. Various reasons for this correcting imbalances between manpower demand and
are skewed production of health manpower, uneven human manpower supply in the economy. Manpower planning
resource deployment and distribution, disconnected education is concerned not only with balancing of demand and
and training, lack of job satisfaction, professional isolation, and supply of different categories of manpower, but also with
lack of rural experience. The 12th Plan should aim to expand
the overall development and utilization of manpower
facilities for medical, nursing, and paramedical education;
create new skilled health worker categories; enable AYUSH resources in the country. The utilization of manpower
graduates to provide essential health care by upgrading their is the process of matching men and work in accordance
skills in modern medicine through bridge courses; establish a with their level of development. So it is an integrated
management system for human resource in health to actualize approach that should not be considered isolated.
improved methods for recruitment, retention, and performance;
put in place incentive-based structures; create career tracks for
Health Manpower
professional advancement based on competence; and, finally,
build an independent and professional regulatory environment. Health manpower refers to people who are trained to
Keywords: Health, Manpower, Planning. promote health, to prevent and to cure disease, and to
rehabilitate the sick.
How to cite this article: Chhina RS, Chhina RS, Sidhu A,
Bansal A. Health Manpower Planning. Curr Trends Diagn Treat The aim of manpower planning is to make available
2017;1(1):53-57. the right kind of personnel in the right number with
Source of support: Nil appropriate skills at the right place at the right time doing
Conflict of interest: None the right job.

IMPORTANCE OF HEALTH
1 2 3 4
Professor and Dean, Fellow, Student, Senior Resident MANPOWER PLANNING
1
Department of Gastroenterology, Dayanand Medical College
and Hospital, Ludhiana, Punjab, India
Health manpower planning comprises of
2
Department of Radiology, Kings College London, London
• Health manpower planning
United Kingdom • Health manpower management.
3
Dayanand Medical College and Hospital, Ludhiana, Punjab, India
4
Department of Gastroenterology, Dayanand Medical College HUMAN RESOURCES FOR HEALTH
and Hospital, Ludhiana, Punjab, India
Corresponding Author: Rajoo S Chhina, Professor and Dean
Trained and competent human resource is the foun-
Department of Gastroenterology, Dayanand Medical College dation of an effective health system. Various types of
and Hospital, Ludhiana, Punjab, India, e-mail: drrajoosingh@ health resources are doctors [allopathic and Ayurveda,
gmail.com
Yoga and naturopathy, Unani, Siddha, and Homeopathy
Current Trends in Diagnosis and Treatment, January-June 2017;1(1):53-57 53
Rajoo S Chhina et al

Table 1: Suggested norms for health manpower Table 2: Current status of health manpower in various countries
Category of health personnel Norms suggested Nurses/ Health workers
Doctor 1 per 1,000 population Doctors midwives (doctors, nurses/
Nurse 1 per 500 population per 10,000 per 10,000 midwives) per
Country population population 10,000 population
Health worker(male and 1 per 5,000 population in plain
female) area and 3,000 population in India 7 17.1 24.1
tribal/hilly/hard to reach area Germany 38.9 114.9 153.8
Health assistant (male 1 per 30,000 population in plain UK 28.1 88 116.1
and female) area and 20,000 population in Qatar 77.4 118.7 196.1
tribal/hilly/hard to reach area Pakistan 8.3 5.7 14
Pharmacist 1 per 10,000 population Niger 0.2 1.4 1.6
Lab technician 1 per 10,000 population Bangladesh 3.2 2.2 5.4
Anganwadi worker 1 per 400–800 population China 14.9 16.6 31.5
ASHA 1 per 1,000 population Sri Lanka 6.8 16.4 23.2
Trained dai 1 per village Source: World Health Organization (WHO). World Health Statistics
Source: Govt. of India (2008), Annual report 2007–2008, Ministry 2015. Geneva: WHO; 20113
of Health and Family Welfare, New Delhi2

Table 3: Number of institutions and admission capacity of

paramedical staff
No. of Admission
Courses institutions capacity
General nurse midwives 2,865 115,844
ANMs 1,853 52,479
Pharmacists 723 43,300
Source: CBHI: Ministry of Health and Family Welfare (MOHFW).
Rural Health Statistics Report 2014–2015. New Delhi: MOHFW,
Government of India; 20115

unevenly spread across the states and also present wide

disparities in the quality of education. Only 193 of the
640 districts have a medical college, while the remaining
447 districts do not have any medical teaching facilities.
Graph 1: Total number of registered allopathic doctors4
As on March 31, 2015, there were 153,655 subcenters,
25,308 primary health centers (PHCs), and 5,396 com-
(AYUSH)], nurses, pharmacists, lab technicians, radiogra- munity health centers (CHCs) functioning in the country.
pher health assistants (male and female), health workers While the subcenters, PHCs, and CHCs have increased
(male), auxiliary nurse midwife (ANM), accredited social
in number in 2014–2015, the current numbers are not
health activists (ASHAs), anganwadi workers, trained
sufficient to meet their population norm. Of 25,308
dais, and others (health inspectors, health educators,
PHCs, 799 have 4+ doctors, 770 have 3 doctors, 2,041 are
occupational therapy assistant, dieticians, etc.).
without any doctors, 9,649 are without lab technicians,
While Table 1 shows the suggested norms of health
and 5,553 are without pharmacists; 6,436 PHCs have lady
manpower required for provision of adequate health
doctors. A total of 10,237 PHCs have AYUSH facility.
facilities, currently, various developing countries lag
Bihar has the maximum number of AYUSH facilities of
behind these suggested norms, including India. The
current status of health manpower in various countries 1,384. The number of ANMs at subcenters and PHCs has
is shown in Table 2. increased from 133,194 in 2005 to 212,185 in 2015, which
Presently, India produces 30,000 doctors, 18,000 spe- amounts to an increase of about 59.3%. As on March 31,
cialists, 30,000 AYUSH graduates, 54,000 nurses, 15,000 2015, the overall shortfall in the posts of health worker
ANMs, and 36,000 pharmacists annually. There has been (female)/ANM at subcenters and PHCs was 5.21% of
a steady rise of allopathic doctors since 2008 (Graph 1). the total requirement. Because of the above-mentioned
Along with doctors, presently, admission capacity for facts, there are only 19 health workers (6 doctors and
nursing staff and pharmacists is also less than required 13 nurses and midwives) per 10,000 people in India,
(Table 3). against a World Health Organization recommended
This production is not equal across the states, leading norm of 25 health workers (doctors, nurses, and mid-
to unequal distribution of doctors. Medical colleges are wives). Such a skewed distribution results in large gaps

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Health Manpower Planning

Table 4: Shortfall against requirement for existing centers education and training, lack of job satisfaction, profes-
Currently sional isolation, and lack of rural experience. The 12th
serving in Current Estimates of Plan should aim to expand facilities for medical, nursing,
rural public shortage* total required
and paramedical education; create new skilled health
Cadre sector* (rounded off) for 2020
ANM 1,90,000 15,000 7,42,000 worker categories; enable AYUSH graduates to provide
Health worker male 52,000 94,000 4,04,000 essential health care by upgrading their skills in modern
Nurses 58,450 13,700 14,09,000 medicine through bridge courses; establish a management
Doctors 25,800 6,148 3,67,000 system for human resource in health to actualize improved
Specialists 6,781 11,361 2,00,000 methods for recruitment, retention, and performance; put
Managerial, 15,000 NA 1,06,000 in place incentive-based structures; create career tracks
nonclinical
for professional advancement based on competence; and,
Source: *RHS (2010), High Level Expert Group estimates6,
Working Group on National Rural Health Mission7; NA: Not finally, build an independent and professional regulatory
applicable environment.8

in demand and availability, particularly for government

SKILLED HEALTH WORKERS
health care facilities, which are represented in Tables 4 Our health system needs three basic categories of human
and 5 and Graphs 2 and 3. resource in sufficient numbers and quality. Under each
Various reasons for shortfall in health manpower are of these four categories, there is scope for expanding the
skewed production of health manpower, uneven human existing nature and functions of designated profession-
resource deployment and distribution, disconnected als for that category and also for increasing the depth of

Table 5: Status of medical and paramedical staff in 2005 and 2015

2005 2015
Required In position Shortfall Required In position Shortfall
ANM/HW (F) 169262 133194 19311 178963 212185(59.3) 9326
HW(M) 146026 60756 85270 153655 55657 98027
Health Assistant (F)/ LHV at PHCs 23236 19773 3463 25308 13372 12448
Health Assistant (M) at PHCs 23236 20086 3150 25308 12646 15513
Doctors(Allopathic ) at PHCs 23236 20308 1004 25308 27421(35) 3002
Specialists* at CHC 13384 3550 6110 21584 4078 17525
Radiographers at CHC 3346 1337 1176 5396 2150 3406
Pharmacists at PHCs & CHCs 26582 17708 2858 30704 23131 8321
Lab technicians at PHCs & CHCs 26582 12284 7226 30704 17154 13691
Nursing staff at PHCs & CHCs 46658 28930 13352 63080 65039 12953
Source: Ministry of Health and Family Welfare (MOHFW). Rural Health Statistics Report 2014–2015. New Delhi: MOHFW, Government
of India; 20115

Graph 2: Shortfall against requirement for existing centers. Graph 3: The shortage figure for doctors relates to doctors at PHCs.
Source: Ministry of Health and Family Welfare (MOHFW). Rural Health Source: Ministry of Health and Family Welfare (MOHFW). Rural Health
Statistics Report 2014–2015. New Delhi: MOHFW, Government of Statistics Report 2014–2015. New Delhi: MOHFW, Government of
India; 2011.5 HW, health worker; LHV, lady health worker India; 2011.5 HW, health worker; LHV, lady health worker

Current Trends in Diagnosis and Treatment, January-June 2017;1(1):53-57 55

Rajoo S Chhina et al

training/retraining to make it relevant to national health knowledge centers, where medical and paramedical
goals. The three categories and the required nature of teaching and refresher courses can occur side-by-side
expansion in their scope are listed below. with patient care.
• Setting up 30 new medical colleges with public financ-
Medical Graduates ing, preferentially in states with larger gaps. This step
Undergraduate teaching should aim to produce clinicians alone would increase undergraduate medical seats
who can independently manage the case load in a primary from 41,569 to 63,000 and postgraduate seats from
care facility. Ayurveda, Yoga and naturopathy, Unani, 20,868 to 31,000.
Siddha, and Homeopathy doctors can be trained through • Strengthen state government medical colleges and
short bridge courses to manage essential health care in central government health institutions with the triple
primary care settings. Doctors deployed in primary and objective of increasing the intake of undergraduate
secondary health facilities need to be multiskilled, so and postgraduate candidates by 20,000 and 10,000
that they can manage day-to-day conditions relating to respectively; providing superspecialty and other spe-
obstetrics, anesthesia, psychiatry, pediatrics including cialized services for patient care at these tertiary care
neonatology, and trauma care. centers; and setting up degree programs for nursing
and paramedical courses within these institutions, in
Medical and Surgical Specialists case none exists.
• Setting up paramedical education courses in 149 gov-
The discipline of family medicine should be introduced
ernment medical colleges, in addition to initiating
in all medical colleges so that qualified specialists in this
paramedical institutions in 26 states. Strengthening and
discipline can effectively manage most of the medical
upgradation of government pharmacy institutions.
problems encountered at the primary level, and referral
to specialists occurs only when necessary. Such recom-
MANAGEMENT SYSTEM FOR HUMAN
mendations have been made earlier too by the Mehta
RESOURCE IN INDIA
Committee in 1983.9
The shortage of health personnel against the requirement
Paramedical Workers for Health Facilities across the country as per the Bulletin of Rural Health
Studies suggest that in primary care, appropriately Statistics, 2010 is 63% for specialists, 19% for doctors, and
trained nurses can produce as high a quality of care and 7% for ANMs. Reasons for the same are attributed to delays
achieve as good a health outcome for patients as doctors in recruitment and to postings not based on workload or
sanctions. Though most of the public health workers and
Paramedical and allied health care professionals consti-
medical officers are recruited, deployed, and managed
tute the base of the pyramid and are required in adequate
by the states, the central government can suggest model
numbers for optimal performance of teams. The issues in
human resource policies and minimum standards of work-
question are shortages, absence of many required cadres,
force management for better retention and performance.
and underutilization of their potential. For example, in
These guidelines should include the following strategies:
the context of hospitals, a survey by the Federation of
• The Indian Public Health Standards should be taken
Indian Chambers of Commerce and Industry in June
as the guiding principle for sanctioning posts, though
2011 identified five skillsets that need immediate atten-
the actual posting may depend on caseloads.
tion, namely, dialysis technicians, operation theater/
• Recruitment should be decentralized with a quicker
anesthesia technicians, paramedics, lab technicians, and
turnaround time and preference must be given to
patient care coordinator cum medical transcriptionists.
residents of the region of proposed deployment.
The existing paramedical human resource need to be
• Fair and transparent system of postings and timely
suitably trained, clinically empowered, and deployed to
promotions.
enable optimal utilization of their services.10 • Financial and nonfinancial incentives (like preferen-
EXPANSION OF MEDICAL, PUBLIC HEALTH, tial eligibility for postgraduate courses, promotions,
subsequent choice of postings) for performance and
NURSING, AND PARAMEDICAL EDUCATION
service in remote areas.
• The strengthening of existing institutions, and also • Measures to reduce professional isolation by preferen-
the creation of new ones, in terms of infrastructure tial access to continuing medical education and skill
and faculty is required for training of new health upgradation programs, as well as back-up support
workers and reskilling of existing human resources. on telemedicine (Internet or mobile based) and by
For this, a feasible and cost-effective option is to networking of professionals working in similar cir-
upgrade existing district hospitals and CHCs into cumstances (Flow Chart 1).11

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Flow Chart 1: Interrelationships in health services and manpower development

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