1. 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 trainee
MD Community Medicine
Burdwan Medical College & Hospital

2. 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.

3. 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.

4. Relationship between health system inputs, budget elements
and expenditure categories 2
EXPENDITURE CATAGORIES BUDGETS ELEMENTS HEALTH SYSTEM INPUTS OUTPUT
HUMAN
RESOURCES
RETIREMENT
PHYSICAL
TOTAL CAPITAL
FINANCIAL
RESOURCES PRODUCTION ON
HEALTH
INTERVENTIONS
LABOUR
COSTS
DEPREDATION
MAINTAINANCE
OTHER CONSUMABLES
RECURRENT

5. Organization invest on work force Satisfied and
motivated workforce
Delivered
quality health services
Fulfilled Its Mission Meet Its Enhance
Health Objectives Its Competitive
Advantage

6. 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.

7. 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.

8. 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%

9. IN CROSS-COUNTRY COMPARISONS
INDIA WHO Benchmark
Total 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.

10. HUMAN RESOURCE RELATED PROBLEMS OF HEALTH CARE SYSTEM IN INDIA

11. . 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 staff, little
practical experience for students, and few opportunities for in-service training for teaching staff11.

12. PROCESSES OF HUMAN RESOURCE MANAGEMENT
Good
employment
Policy
Leadership
and
advocacy Adequate
Financial
HRM resource
Partnership SYSTEM
with local
community, p
rivate
sector, donors Pre-service
, other key education/
stake holders training
Better
health
outcome

13. 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.

14. • 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.

15. 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.

16. • 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.

17. 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.

18. 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.

19. 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.

20. 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.

21. 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 Aff 2006; 25: 380.
8. 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.

23. 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 leave
Performance payments
• Achievement of performance t
• Length of service
• Location or type of work (e.g., remote locations
Other financial support
• Fellowships
• Loans

24. 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

25. 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