IIDM India 2 Determinants of Workforce Availability and Performance- Bihar IIDM India 3 Determinants of Workforce Availability and Performance- Bihar Acknowledgement We are thankful to National Health System Resource Center, New Delhi (NHSRC) for assigning this study to our Institute and subsequently providing administrative support in the completion of the study. Our special thanks are due to Dr. D. Thamma Rao Advisor (Human Resources for Health) NHSRC New Delhi for providing administrative as well as academic & Technical support through out the study. Our Special Thanks are due to Dr. A. K. Tiwari, State Programme Officer Cum State Surveillance Officer, State Health Society Bihar, Mr. Ajit Kumar Singh, State Facilitators- NHSRC, Bihar for providing academic & field level support through out the study. Our special thanks are due to all CMHOs & Dy. Superintendents of interviewed sample Health Institutions of Bihar. Our Special Thanks are due to all DPMs of Kaimur Bhabhua, Ara, Samastipur, Nawada, Kishanganj, Vaishali, & Sitamadi. We place on record our appreciation to Dr. P.K. Bajaj for Institutional & field level data collection & participation in workshop. We are thankful to Dr. Rajeev Mohan and Dr. M. K. Mishra for their academic support & guidance in data collection. We gratefully acknowledge the immense help received from Dr. I.C. Tiwari Our Advisor, Health System Research, in data analysis & report writing. We also place on record our thanks to our team of research officers involving Mr. Dinesh Chandke & Ms. Payal Tiwari for their efforts in data collection processing and data tabulation. Dr. S. K. Trivedi Ph.D Director IIDM India 4 Determinants of Workforce Availability and Performance- Bihar List of contents EXECUTIVE SUMMARY ................................................... ................................................... ....... 7 CHAPTER-1 ................................................... ................................................... ........................ 12 INTRODUCTION ................................................... ................................................... ................. 12 1.Objectives of the study ................................................... ................................................... ...... 13 2. Scope of work ................................................... ................................................... .................. 13 CHAPTER- 2 ................................................... ................................................... ....................... 15 BIHAR STATE – A BRIEF PROFILE ................................................... ...................................... 15 1.Physical features ................................................... ................................................... ............... 15 2.Administrative units ................................................... ................................................... ........... 15 3.Demography ................................................... ................................................... ..................... 15 4.Vital statistics rates ................................................... ................................................... ........... 16 5.Socio-economic indicators ................................................... ................................................... 17 6.Organisation of Health Services in Bihar ................................................... .............................. 17 7.Health Institutions in Bihar ................................................... ................................................... 18 8.Staff Position in Public Sector Health Facilities in Bihar ................................................... ....... 18 9.Pay Scales ................................................... ................................................... ........................ 19 CHAPTER -3 ................................................... ................................................... ....................... 20 Methodology of the Study ................................................... ................................................... .... 20 1.Sampling Design for Study ................................................... ................................................... 20 2.Sampled institutions visited and respondents interviewed ................................................... .. 22 3.Process of data collection ................................................... ................................................... 22 CHAPTER - 4 ................................................... ................................................... ...................... 24 RESULTS ................................................... ................................................... ............................ 24 1. Results of facility survey ................................................... ................................................... ... 24 2. Profile of the doctors interviewed ................................................... ....................................... 43 3. Facilities available to the doctors at place of work ................................................... .............. 44 4. Service Conditions of Doctors in Bihar ................................................... ................................ 46 5. Human Resource Policy for doctors in Bihar ................................................... ....................... 57 CHAPTER - 5 ................................................... ................................................... ...................... 66 CONCLUSIONS AND RECOMMENDATIONS ................................................... ....................... 66 Recommendations ................................................... ................................................... ............... 68 IIDM India 5 Determinants of Workforce Availability and Performance- Bihar Annexure I ................................................... ................................................... ........................... 70 Annexure II ................................................... ................................................... .......................... 72 IIDM India 6 Determinants of Workforce Availability and Performance- Bihar LIST OF ABBREVIATIONS USED ACR Annual Confidential Report AYUSH Indian System of Medicine (Ayurveda, Yoga, Unani, Sidha, Homeopathy) BDS Bachelor of Dental Surgery BPSC Bihar Public Service Commission CHC Community Health Centre CME Continuing Medical Education DH District Hospital DNB Diplomate of National Board GDMO General Duty Medical Officers GOI Government of India HR Human Resource HRA House Rent Allowance IIDM Indian Institute of Development management IMR Infant Mortality Rate IPHS Indian Public Health Standards I.V. fluid Intravenous fluid M.D. Doctor of Medicine M.S. Master of Surgery NHSRC National Health System Resource Centre NRHM National Rural Health Mission NSDP Net State Domestic Product OPD Out Patients Department ORS Oral Rehydration Salt OT Operation Theatre PHC Primary Health Centre RCH Reproductive Child Health SDH Sub Divisional Hospital SRS Sample Registration System IIDM India 7 Determinants of Workforce Availability and Performance- Bihar EXECUTIVE SUMMARY Background of the study: Recognizing the importance of human resource for health as the core issue for achieving effective delivery of public health services in rural areas, the National Rural Health Mission (NRHM) has taken a number of initiatives to address the problem of manpower shortage, particularly in the underserved areas, faced by the States, The National Health System Resource Centre (NHSRC) Delhi, created under NRHM to provide technical support to the Mission, commissioned the present study to study human resource policies and practices in the state of Bihar with an overall objective of assessing the productivity, coverage and outreach of health system. The study focused on the issues related to medical manpower (doctors) only. Methodology of data collection It was decided, in consultation with NHSRC and the officials of the State, to focus the study in districts with low composite (socio-economic) index. Five districts out of 23 districts with low composite index and one control district with high composite index were included in the study. The districts and the institutions (district hospital, Sub Divisional Hospital, Community Health Centres and Primary Health Centres) within it were selected using multi stage sampling technique. The investigators from the study team visited the districts and collected data from the institutions and interviewed the doctors using pre-designed and pre- tested proforma. Findings 1 Survey of the health facilities showed that physical facilities in most of the institutions e. g. 24- hour water supply, operation theatre, 24-hour power supply with generator/ inverter back up, ambulance and telephone facilities and computer were available in all the district hospitals and SDH with a few exceptions. 2. Bed strength in most institutions including district hospitals, SDH and CHCs was inadequate. However, all the PHCs had six beds as per the recommendations of GOI. 3. Equipment availability at the health facilities was assessed by noting the presence/ absence of operating tables, OT lights, delivery tables, Boyle’s apparatus, Sterilizers/ Autoclaves, and surgical equipments. All the District hospitals and most SDH were found to be well equipped