Health Labour Market Analysis: CHHATTISGARH Jointly prepared by WHO and State Health Resource Centre, Chhattisgarh for the Department of Health and Family Welfare, Chhattisgarh January 2020 Health Labour Market Analysis: CHHATTISGARH – Policy Brief ISBN: 978-92-9022-782-3 © World Health Organization 2020 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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Printed in India Health Workforce for Universal Health Coverage in Chhattisgarh - A Policy Brief To meet the health workforce requirements for the successful achievement Universal Health Coverage (UHC) in the state of Chhattisgarh a Health Labour Market Analysis (HLMA) was conducted as a collaboration between the Department of Health and Family Welfare and Medical Education, the State Health Resource Center, Chhattisgarh, and the World Health Organization. The HLMA is a policy informing document providing insight into key health workforce bottlenecks and opportunities in the state. The central aim of the HLMA was to develop policy recommendations regarding the health workforce in the state to enable progress towards the achievement of UHC. Through a process of stakeholder engagement two key questions relating the human resources for health in the state were identified: 1. Is the production of health workers (with a focus on specialists, medical officers and nurses) in Chhattisgarh sufficient to meet current demand and how can the recruitment and deployment be improved? 2. What are the key health workforce elements to consider for a successful rolling out of the Health and Wellness Centers in Chhattisgarh? Assessing the Demand for Medical Officers – How many more doctors does Chhattisgarh need? The total number of doctors in Chhattisgarh is estimated to be around 8,500 including both public and private sector. This translates into approximately 3 doctors per 10,000 population far below the national average of approximately 8 doctors per 10,000 population. In Chhattisgarh, approximately 3,800 doctors are working in the public sector, around half of them are Specialists, which is around 45% of total doctors working in the state. This proportion is better than the national average. Number of Government Doctors (including specialists) in Chhattisgarh Number of Government PGs & non-PGs allopathic Doctors 2500 1961 2000 1836 1500 1186 1000 900 431 500 300 180 95 100 200 105 150 150 0 Doctors under Doctors with Doctors under Doctors Doctors in Doctors in Total in Public DHS (regular PG DME working in AIIMS Hospitals Sector + Contractual) qualifications DHS under 2- owned by working under Year Bond for Public Sector DHS MBBS and Units PG Education (Industrial Organisations owned by Central Government) Specialist Doc tors (with PG) MBBS Doctors (without PG) Source of Data: Data collected from DHS, DME and AIIMS 1 However, while the number of approved posts has increased recently, the number of medical officers holding position in the public sector did not keep pace untill 2018. The situation has improved marginally in 2019 with recruitment of 239 new MOs. Gap Between approved posts and working MOs 2500 2000 1500 1000 500 0 2016 2017 2018 Approved Posts Working The number of vacant posts of regular MOs under DHS is significant especially in peripheral areas, reaching more than 70% in 5 districts. VACANCY OF MEDICAL OFFICERS IN CHHATTISGARH 47% 85% 73% Balrampur koriya Surajpur 4% Surguja 49% Jashpur Korba 29% 19% 44% 50% Raigarh 49% Mungeli Bilaspur Kabirdham 61% Janjgir-Champa 58% Bemetara 53% Baloda Bazar 21% 0% Mahasamund Durg Raipur Rajnandgaon 25% 42% 51% 38% Balod Dhamtari 35% Gariyaband 46% Kanker Kondagaon Narayanpur 64% 80% Date Layers Bastar Bijapur 46% Medical Officer. 0% - 25% 79% Dantewada Medical Officer. 26% - 50% 68% Medical Officer. 51% - 75% Medical Officer. >75% Sukma 79% 2 The presence of private doctors is also highly skewed with a large proportion being in bigger urban areas. The state currently needs to recruit around 1200 more MOs to meet its existing needs of the government healthcare facilities. Is the production of medical officers in Chhattisgarh sufficient to meet current demand? Annual Intake of Medical Students 800 700 600 500 400 300 200 100 0 1995 2000 2005 2010 2015 2020 The annual intake of medical students rose from fivefold between 2003 and 2019. Resulting in 2.59 medical graduate per 100,000 population in 2019 which although a vast improvement still sits below the national figure of 5.19 per 100,000 population. Has the increase in supply resulted in an increased availability of medical officers working with government? There is a clear absorption capacity issue: over the past two decades the state has produced around 4,000 MBBS doctors, but only around 900 regular MOs have been recruited. Therefore, attracting and recruiting appears as a major challenge for the absorption of medical officers in the health labour market. The age profile of existing regular MOs shows that the recruitments have been inadequate. Table- Age distribution of regular Medical Officers 1 Under 30 years 12 (1%) 2 31- 40 years 260 (22%) 3 41-50 years 037 (26%) 4 51-60 years 389 (33%) 5 Above 60 years 200 (17%) 6 Age not mentioned 12 (1%) Total 1180 7 Source of Data: Data collected from DHS Age category Percentage The recruitment drives have not been regular with gap of two to three years in successive drives. The success rate in attracting MOs has improved to some extent as seen in the last recruitment drive. 3 Table- Recruitment drives conducted for Medical Officers in last 5 Years Year of No. of Medical % Recruited No. of posts Recruitment Recruitment Agency officers against advertised drive recruited Advertised 2014 Health Department 709 128 18% 2016 Health Department 616 214 35% 2019 Health Department 423 239 57% Source of Data: Data collected from DHS The key concern, that continues to persist in the recent recruitment drives also, is of inability to attract MOs to fill the vacancies in rural and remote areas. Is the production of specialists in Chhattisgarh sufficient to meet current demand and how can recruitment and deployment process be improved? There are estimated 3,461 specialists in the state, similar to the the number of medical officers. A serious shortage of specialists in the public sector is observed throughout the state, especially in District Hospitals and CHCs. The state needs to recruit around 1600 more specialists for filling vacancies in DHS and DME. This shortage is largely attributable to the inability of the system to recruit efficiently and attract specialists especially in remote and rural areas. As a result, over time the number of specialists (regular) working in Chhattisgarh declined whereas the number of approved posts increased, and this despite an increase in the number of PG seats in medical colleges in the state. Gap between approved posts and working specialists (regular) 1800 1593 1600 1395 1395 1400 1200 1000 800 600 400 163 175 132 200 0 2016-17 2017-18 2018-19 Approved Working One key barrier in the recruitment of specialists in Chhattisgarh is that there is no direct recruitment into medical specialist into regular posts, rather the medical specialist cadre is a promotion.