Shortage and inequalities in human resources at Primary Health Centers of India

Resumo

Introdução: Maintaining adequate number and having a balanced distribution of human resources at Primary Health Centers (PHC), the first point where a doctor is made available to the general population, is one of the most important challenges being faced by rural health system in India today.

Objetivos: The paper evaluates the shortage of human resources at PHCs against the Indian Public Health Standard (IPHS) for human resources set by government of India. We then quantify distributional inequalities and try to find out the reasons why these distributional imbalances occur.

Metodologia ou descrição da experiência: We use data from the third wave of District Level Household and Facility Survey, the largest ever nation-wide survey of households and health facilities. We evaluate shortage of human resources against IPHS. Inequalities are quantified and decomposed using decomposable measure of inequality known as Thiel’s index. At the end, we explore factors associated with unequal distribution of human resources using linear and logistic regression.

Resultados: The proportion of PHCs without any doctor, lab technician and pharmacist in India was 4%, 36.5% and 23.1%, respectively. The proportion of sanctioned but vacant posts of male and female health assistants and doctors was 37.1%, 34.4% and 20.4%, respectively. There are state level variations too. Thiel’s index for India as whole was 0.063. On decomposition of Thiel’s index by state, it is found that within state inequality contributes to about three-fourth of total inequality. Source of water, availability of stand by generator or inverter, telephone, residence, furniture and drugs were found significantly associated with number of health workers.

Conclusões ou hipóteses: Not only there is a serious lack of human resources in PHCs in India but also there are serious inequalities in the present distribution of these human resources. The analysis reveals that state of infrastructure in the health facilities affects the number of health worker in-position.