India currently has more or less adequate number of healthcare professionals, but their distribution across the country is rather lopsided, according to a new study.

Although the overall size of health workers population in India is smaller than that of many developed countries, these numbers are close to the World Health Organization’s (WHO) minimum threshold of 22.8 doctors and nurses per 10,000 population. However, there are serious problems related to their distribution across States and rural-urban settings, revealed a study carried out by researchers from the Indian Institute of Public Health (IIPH), Gurugram.

“The bulk of doctors and nurses are located in major cities, leaving a significant gap in rural areas and in poor States,” said the IIPH researchers led by Anup Karan in a paper published in British Medical Journal BMJ Open.

Despite 71 per cent of the country being predominantly rural, the proportion of doctors and nurses in rural areas are 34 per cent and 33 per cent, respectively, it showed. More than 80 per cent of the doctors and 70 per cent of the paramedics work in the private sector.

The researchers used the 2016 National Sample Survey (NSS) data as well as national registries of professional practitioners till 2015 to tabulate the data. The density of doctors and nurses and midwives per 10,000 population is 20.6 as per the NSS data, while it was 26.7 per 10,000 if the total number of health professionals registered with different councils and associations is taken into account.

The density of health professional is highest for Kerala and Delhi at 52.7 and 49.9 (per 10,000), respectively. The number of doctors is highest in Delhi with 34.4 per 10,000 people, followed by Maharasthra (19.7) and Chhattisgarh (18.3). The lowest density of physicians and surgeons is in Assam and Himachal Pradesh — a lowly 1.8 and 1.9 per 10,000 people.

“With nearly 60,000 medical college seats available in the country, we would be able to have adequate number of practising doctors in India in a few years’ time,” said Himanshu Negandhi, IIPH researcher and a co-author of the study.

Quality of workers

Another serious concern, according to Himanshu Negandhi, IIPH researcher and a co-author of the study, is the quality of health workers. It found that 24 per cent of allopathic doctors, 21 per cent practitioners of Indian systems of medicine and 58 per cent of nurses and midwives do not have the requisite qualifications.

The study also pointed out that almost 1.2 million technically qualified personnel are not part of the existing health workforce. There could be several possible explanations for this, it said. One, many professionally qualified people may have migrated to other countries and secondly, some may be unemployed and looking for suitable opportunities. There could also be some who might have stayed out of the labour force by choice or because of old age. This called for regular updating and maintaining of live registers, the study said.