Tackling talent crunch: Improving capacity and competence

India’s public health sector is plagued by a huge manpower scarcity. In consonance with this dearth, the panel discussion on ‘Tackling Talent Crunch: Improving Care and Competence’ focussed on addressing the challenges such as inadequacy and under-utilisation of human resources, as well as discuss the way forward to improve manpower capacity and competence in public health.

Dr Farhat Mantoo, Regional Coordinator HR, MSF, South Asia, began the discussion by highlighting the severity of the issue. She referred to a WHO report that stated, ‘India is not a unique country when it comes to talent crunch. By the year 2035, there will be shortage of healthcare workers globally.’

From that perspective, she said that it is the right time to deliberate on that subject of talent crunch and raised her first question to Dr Madhumita Dobe, Director-Professor, All India Institute of Hygiene and Public Health, Kolkata, Govt of India, asking her to share her perspective on this issue and what public health really means.

Dr Dobe while referring to the definition provided by CEA Winslow  in 1920 said, “Public health is the science and art of preventing disease, prolonging life, and promoting physical health. That’s where the crux of it lies. Public health just does not mean clinical cure, it is far beyond this. When we talk of issues related to talent crunch, resource allocation and compacity building we need to lay emphasis on this fact.”

The next question was posed to Dr Pravin Shingare, Director of Medical Education and Research, Govt of Maharashtra, on how can medical education play a role in instilling the values and virtues needed in a healthcare provider to practice in the public health domain?

Replying to the same, Dr Shingare informed that our current MBBS course does not produce specialised doctors. He also brought to light the disparities in shortage of health workers within urban and rural areas. He said, “The shortage of doctors is such that we have less than two per cent deficit in metro cities, less than 10 per cent in tier II cities and around 30-40 per cent deficit in the rural areas. In order to tackle this issue, we tried to increase the number of medical seats, incentivise their salaries as well as brought a compulsory rule to practice in rural areas for the starting years of their career, but these stop-gap measures did not work. We then came up with an idea to introduce a specialised course in public health by the state government, where we intend to train undergraduate doctors in public health. This strategy has helped us increase the number of doctors in Maharashtra.”

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Key highlights:

• India has not given due regards to quality medical education and research
• Need for innovation not only in terms of technology but also in our strategies
• Need for specialised course in public health by the state government
• Need for a public health council
• Use digital technology to fill the gap
• Need for mentorship plan for our AIIMS instiutes
• Recruitment creteria should include communication skills and behavioural insights of candidates to work in public health

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Chipping in, Dr Dobe raised two important points while training doctors for public health services. She said, “We need to ask ourselves whether we are giving competence-based skill training needed for public health professionals? And these competencies a wish of the healthcare industry or is it based on job role needed to serve the population of India? It is also important to introspect on who looks into the matter of framing these guidelines. Till date, it was the Medical Council of India (MCI) and the Indian Nursing Council but the time has come when we need to set up a public health council. There is diversity of disciplines incorporated in public health today and so there is a need for a specialised agency to look after this aspect. Thirdly, public health requires certain distinctive competencies such as good communication skills, leadership, knowledge of finance etc. In order to access, attract and retain talent in public health, we will need to restructure our entire promotional strategies, cadre system and so on.”

Prof AK Mahapatra, Chief Neurosciences Centre, AIIMS Delhi, gave a historical background to the increasing number of medical colleges, medical seats and post graduation seats  in India. He also referred to an analysis published in the Careers360 magazine of June 2016 that examines the quality of medical education provided at the colleges as well as the number of students passing out from these institutes. He highlighted that the number of medical colleges have increased over a period of time yet the standard of education provided has not advanced.

Dr Mahapatra quoted that there has been an increasing number of PG seats year-on-  year and informed that despite an increasing number of seats for PG courses, the number of specialised doctors have declined.

Going forward, he went on to speak on the demand and supply gap and said that in the last 70 years, India has produced around six lakh doctors; however, good quality doctors produced are very few.

Another point Dr Mahapatra made was about the lack of good quality teachers in healthcare. She said that lack of good quality medical colleges, teachers and healthcare professionals has been the main reason for the talent crunch in public health. “ India has not given due regards to quality medical education and research,” he remarked.

Sudeep Shrivastava, Director, Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), Ministry of Health & Family Welfare, shared his views on the need to enhance infrastructure to attract talent in public health. He spoke on the vision of PMSSY and also explained the government’s vision to set up two new AIIMS institute — one each in Jharkhand and Gujarat.  He informed that from their past experiences they have come to the realisation that there is a need for mentorship plan for AIIMS institutes that will be enabled to provide high standard education. It will include, good facilities for students, teachers that will also foster research. “This year, the government has doubled the budget allocation for PMSSY. Our agenda is to complete the establishment of the target number of medical colleges and more importantly look after the human resource component to ensure that we recruit good quality teachers. We have instituted a selection committee for the same. Moreover, we are also upgrading the existing medical colleges by commencing a super-speciality block. The government has identified 72 government medical colleges for  upgradation. So, developing infrastructure and HR components are the two areas that the government is focussing to resolve the talent crunch in public health,” he informed.

Dr DK Sharma, Medical Superintendent, AIIMS-Delhi touched upon the subject of effective recruitment process. “While recruiting healthcare professionals for public health, we often go by their qualification and technical knowhow and ignore their communication skills and behavioural insights.”

Adding on Dr Dobe’s views on the need for public health council, Dr Sharma said that there is a need to design our recruitment process and retention policies around public health. “We are looking at healthcare as a sickness industry and not looking at health. To make India healthy, we need to advocate for promotion and prevention of diseases.”

Bringing back the point that India is not unique to problem of scarcity of healthcare professional, Dr Mantoo urged the panelists to provide sustainable solutions to address this issue. Replying to this, Dr Dobe said that medical educationists need to chart a career path for public health professionals. This will ensure that public health has enough opportunities for people to grow.

These thought encouraged the audience to raise more pertinent questions to this discussion. Some also provided measures that they adopted at their state level and institute. An interesting point that was raised by the audience was that digital technology can be a game changer in the management of human resources in public health. Technology will also help increasing efficiency of health workers and track their progress.

Sharing the learnings from this session, Dr Mantoo summed up saying, “Some Indian states have been very innovative in their solutions. There is a need for innovation not only in terms of technology but also in our strategies. Rethink on our policies related to public health and use technology to fill the gap.”