Processes & Importance Of Human Resource Management In Improving

Outcomes Of Health Care: As Implicated In Public Health In India

Presented by : Dr. Rajib Saha

2nd year post graduate traineeMD Community Medicine

Burdwan Medical College & Hospital

Introduction: Management: The purposeful and effective use of resources- manpower, material and finances- for fulfilling a pre-determined objective.

Human Resource: Both professional and technical workers who are needed to provide the service.

Definition Of Human Resource Management : Human resource management is the integrated use of systems, policies and management practices to support the organization in meeting its desired goal through recruitment, maintaining and development of employees. (According to Management Sciences for Health)1.

Importance of Human resource management:

• Human resource management is the critical management area that is the most important asset for any organization as well as health care system also and it accounts about 70 to 80% of its budget.

Relationship between health system inputs, budget elements and expenditure categories 2

EXPENDITURE CATAGORIES BUDGETS ELEMENTS HEALTH SYSTEM INPUTS OUTPUT

RETIREMENT

DEPREDATION

TOTAL FINANCIAL RESOURCES

RECURRENT

TRAINING OF PEOPLE

LABOUR COSTS

MAINTAINANCE

OTHER RECURRENT

HUMAN RESOURCESHUMAN RESOURCES

PHYSICAL CAPITALPHYSICAL CAPITAL

CONSUMABLESCONSUMABLES

PRODUCTION ON HEALTH INTERVENTIONS

PRODUCTION ON HEALTH INTERVENTIONS

Organization invest on work force Satisfied and

motivated workforce

Delivered

quality health services

Fulfilled Its Mission Meet Its Enhance

Health Objectives Its Competitive

Advantage

Benefits of a strong HRM system

• FOR THE ORGANIZATION:

I) Increases the organization’s capacity to retain staffs and achieve its

goals.

II) Increases the level of employee’s performance.

III) Uses employee’s skills and knowledge efficiently. IV) Saves costs through the improved efficiency and productivity of

workers.

V) Improves the organization’s ability to manage change.

 • FOR THE EMPLOYEE:

I) Improves equity between compensation of employee and level of

responsibility.

II) Helps employees to understand how their work relates to

the mission and values of the organization.

III) Helps to motivate employees.

IV) Increases employee’s job satisfaction.

V) Encourages employees to work as a team.

Current Situation Of Human Resources in India

Some data sources regarding human resources of health care system of

India are:

• i) Census of India.

• ii) Revised Indian National Classification of Occupations: Directorate

General of Employment and Training, Ministry of Labour, Government

of India.

• iii) Survey on Employment and Unemployment done by the National

Sample Survey Organisation.

• iv) Recognised medical colleges from the Medical Council of India.

According to 2001 Census, India3

• Health Workers: 2.2 million

• Allopathic Doctors: 6,77000 practitioners

• Ayurveda, Yoga and Naturopathy,

Unani, Siddha, and Homoeopathy: 2,00000 practitioners

• 27 health workers per 10000 populations

• Allopathic Doctors 31%

• Nurses And Midwives 30%

• Pharmacists 11%

• Ayurveda, Yoga and Naturopathy,

Unani, Siddha, and Homoeopathy 9%

• Others 9%

IN CROSS-COUNTRY COMPARISONS

INDIA WHO BenchmarkTotal no. Of

Allopathic doctors, 11.9 per 10,000 people 25.4 workers per 10,000

Nurses, and (about half the WHO benchmark ) population.

Midwifes.

• When adjusted for qualification, the number falls to about a quarter of the WHO benchmark.

• India has roughly one nurse and nurse-midwife per allopathic doctor and the qualification adjusted ratio falls further to 0.6 nurses per doctor.

HUMAN RESOURCE RELATED PROBLEMS OF HEALTH CARE SYSTEM IN INDIA

Uneven distribution of health workers3: Urban Area Rural Area Health Workers 42 per 10 000 population 11.8 per 10 000 population. Allopathic Doctors 13.3 per 10000 people 3.9 per 10000 people Nurses And Midwives 15.9 per 10000 people 4.1 per 10000 people .

• Limited range of services

. Medical education system: Medical colleges are not evenly distributed across India. The south-western states of Andhra Pradesh Maharashtra, karnataka, Kerala and Tamil Nadu which together account for 31% of the country’s population account for 58% of all medical colleges (public and private) in India. The high number of medical schools in these states is because of the growth of private institutions and specific political and caste groups that have invested in the lucrative business of medical education10.

Nursing Education System: The condition of the teaching infrastructure is generally poor with inadequately equipped libraries and demonstration rooms, overworked teaching sta , little ffpractical experience for students, and few opportunities for in-service training for teaching staff11.

PROCESSES OF HUMAN RESOURCE MANAGEMENT

HRM

SYSTEM

Good employment Policy

Adequate Financial resource

Adequate Financial resource

Pre-service education/ training

Pre-service education/ training

Partnership with local community, private sector, donors, other key stake holders

Partnership with local community, private sector, donors, other key stake holders

Leadership and advocacy

Leadership and advocacy

IMPROVED HEALTH WORK FORCE

IMPROVED HEALTH WORK FORCE

Country specific context, including labour market

Country specific context, including labour market

Better health outcome

Better health outcome

Importance Of Human Resource Management Components

IMPORTANCES• HRM capacity HRM budget Allows for consistent HR

planning and for relating costs.

HRM staff Staff are essential in HRM for policy

development and implementation .

• HRM planning Organizational mission and goals Mission provides direction to

HRM activity and to the work of the staff.

HR Planning Allows HRM resources to be used

efficiently in support of organization goals.

• Personnel policy & practice

Job classification system Allows organization to

standardize the jobs and types of skills it requires.

Compensation and benefits system Allows for equity in employee’s salary

and benefits tied to local economy.

 

Recruitment, hiring, transfer, and promotion Assures fair and open process

based on candidate’s job qualifications .

Orientation program Helps new employees to identify

the goals/values of the organization.

Policy manual Provides rules and regulations that govern

how employees work and what to expect.

 

Discipline, termination, and grievance procedures Provides fair and consistent guideline

for addressing performance problems.

 

Other incentive systems- Financial Incentives, Non-financial Incentives.

Union relationships Promotes understanding of common goals and

decreases adversarial behaviours.

 

Labour law compliance Allows organization to function legally and

avoid litigation.  

• HRM data Employee data Allows for appropriate allocation and

training of staff, tracking of personnel costs.

 

Computerization of data Accessible, accurate, and timely data is

essential for good planning.

 

Personnel files Provide essential data on employee’s work history

in organization.

• Performance management

Job descriptions Defines what should be done by people and how

they would work together.

 

Staff supervision Provides a system to develop work plans and

monitor performance.

 

Work planning and performance review Provides information to staff

about job duties and level of performance.

 

 

• Training Staff training A cost-effective way to develop

staff and organizational capacity.

 

Management/leadership development Leadership and good

management are keys to sustainability.

 

Links to external pre-service education Pre-service training based

on skills needed in the

workplace is cost effective.

 

Recent Initiatives In The Field Of Human Resource Management In India12

11. Creating the norms: The IPHS( Indian Public Health Standards)• Two ANMs per sub-center and one male MPW.• Three nurses/ANMs per PHC plus two medical officers.• Adding ayush staff into available pool.• Nine nurses per CHC plus 5 specialists and 3 to 4 medical officers .

2. Expanding available skilled human resource• More medical colleges- government and private and through public private partnerships.• More government seats in private medical colleges.• More nursing schools & nursing colleges.• More technical and paramedical courses.• Reviving ANM and MPW training centers.3. Increasing availability in priority areas Compulsory rural postings- pre- post graduation – eg Orissa, Chhattisgarh and

Tamilnadu. Contractual appointments made to the facility.

1. Eg Additional ANMs nurses in Bihar, West Bengal, Tamil nadu etc.2. Eg specialists in Madhya pradesh.

Fair transfer policy- rotational postings e.g. Tamil nadu. Incentives for difficult areas: eg Himachal and Orissa. ‘Pooling’ of medical officers: West Bengal, Bihar, Jharkhand.

Public Private Partnership options as HR solutions Contract in options.

1. Madhya Pradesh for specialists. Contract out options.

1. Arunachal Pradesh: PHCs to Karuna trust.

2. Bihar: PHCs, diagnostics, district planning.

3. Gujarat: PHCs, CHCs and a district hospital & CHIRANJEEVI.

4. Punjab: Village level dispensaries.

5. Sewa Mandir Rajasthan / Haryana maternity hut .

Increasing availability of skilled in priority areas Multi-skilling existing staff to play more tasks.

1. Medical officers to play specialist roles: emergency.

2. Ayush doctors for medical officer roles.

3. Nurse practitioners to fill in for doctors.

4. Pharmacists providing curative care.

5. Male multi purpose workers work as male multi-skilled workers to provide a set of support services of the PHC.

ANM schools in under-served areas.

4. Community level service providers

ASHA: 4 lakh ASHAs- major and one of most visible components of NRHM.

Anganwadi worker- increasing her effectiveness as health care provider.

The RMP: Training them.

The traditional birth attendant: continuing role for the TBA where institutional delivery

levels are low.

Community midwifes and maternity huts.

5. Strengthening Capacity building activity

• Strengthening SIHFWs.

• Developing an integrated training approach.

• IMNCI plus skilled birth attendance as focus of increasing skills for the ANM and PHC- poorly

integrated with family planning.

• Reviving ANMTCs and MPWTCs.

• Moving towards DTCs.

• Need to redefine the role of SIHFWs/NIHFWs as apex of a pyramid of institutions that ensure

that all the necessary skills required for quality service delivery are in place.

6. Improving workforce performance

• Putting an accountability framework in place:

– Hospital development committees.

– Community monitoring programme.

– Involvement of PRIs.

• Linking funds for new contractual appointment to filling up of regular vacancies.

• Untied funds to enable local health care providers.

• Bringing in a cadre of health managers and data managers and financial managers.

• Introducing health management courses and promoting health management

certification for key posts.

• Insisting on public health qualifications for key public health posts.

References

1. http://www.msh.org/Documents/emanager/upload/eManager2009No1_HRM English.pdf (Last retrieved on 09/11/2011 at 7.00 p.m.)

2. World Health Report 2000 Figure 4.1 g.75

3. Rao K, Bhatnagar A, Berman P. India’s Health workforce: size composition and distribution. La Forgia

J, Rao K eds. India Health Beat, New Delhi. World Bank, New Delhi and Public Health Foundation of

India, 2009.

4. Government of India. Bulletin on rural health statistics 2008 (2009). http://mohfw.nic.in/Bulletin%20on%20RHS%20-%20March,%202008%20-%20PDF%20Version/Title%20Page.htm (Last retrieved on 09/11/2011 at 7.00 p.m.). 

5. Banerjee A, Deaton A, Duflo E. Wealth, Health, and Health Services in Rural Rajasthan. Am Econ Rev 2004; 94: 326-30.

6. Kaushik M, Jaiswal A, Shah N, Mahal A. High-end physician migration from India. Bull World Health Organ 2008; 86: 40-45.

7. Mullan F. Doctors For the world.Indian physician emigration Health A 2006; 25: 380.ff8. Mullan F. The Metrics of the Physician Brain Drain.N Engl J Med 2005; 353:1810-18.

9. Government of India. Task force for planning on human resources in health sector. Planning Commission, Government of India, 2006.

10. Kaul R. Whither equity? Seminar 2000; 494.

11. Academy for Nursing Studies. Situational analysis of public health nursing personnel in India. Hyderabad: Academy of Nursing Studies, 2005.

12. Global Health Workforce Alliance/WHO. 2008. Guidelines: Incentives for Health Professionals.Geneva;WHO.

13. Health Sector Reforms In India Initiatives From States (Volume II). Ministry of Health and Family Welfare March 2007.

THANK YOU

Types of Incentives• Financial Incentives

Terms and conditions of employment • Salary/wage • Pension• Insurance (e.g., health)• Allowances (e.g., housing, clothing, transport parking, child care)• Paid leavePerformance payments• Achievement of performance t• Length of service• Location or type of work (e.g., remote locations Other financial support• Fellowships• Loans

Nonfinancial Incentives

Positive work environment• Work autonomy and clarity of roles and responsibilities.• Recognition of work and achievement.• Supportive management and peer structures.• Manageable workload and effective workload.• Management.• Effective management of occupational health and safety risks, including

a safe and clean workplace.• Effective employee representation and communication.• Enforced equal opportunity policy.• Maternity/paternity leave.• Flexibility in employment arrangements• Flexible work hours. • Planned career breaks.

• n

• n

Access to services, such as

1. Health

2. Child Care Schools

3. Recreational Facility

4. Housing

5. Transportation

Support for development• Effective supervision • Coaching and mentoring structures• Access to and support for training and education• Sabbatical and study leave

Intrinsic Reward

1. Job Satisfaction

2. Personal Achievement

3.Commitment To Shared Values

4.Respect Of Colleagues

5. Membership Of Team