Human Resource Management By – Dr. By- Dr. Dharmendra Gahwai

Guided by- Dr. Y.D.Badgaiyan Prof. and Head Deptt.of Community Medicine CIMS, Bilaspur (CG).

•Human resource management is the critical management area that is the most important asset for any organization as well as health care system.

Definition-

“Human resource management is the integrated use of system, policies and management practices to support the organization to meet its desired goal through recruitment, maintaining and development of employees.”

- According to Management Sciences for Health.

Functions of HRM

– Planning

– Organizing

– Directing

–

Controlling

Operative Functions

P/HRM

Managerial functions:

Procurement

Job Analysis

HR planning

Recruitment

Selection

Placement

Induction

Internal mobility

Development:

Training

Executive development

Career planning

Succession

planning

Human resources development strategies

Motivation and Compensation:

Job design

Work scheduling

Motivation

Job evaluation

Performance and potential appraisal

Compensation administration

Incentivesbenefits andservices

Maintenance:

Health

Safety

Welfare

Social security

Integration:

Grievances

Discipline

Teams and teamwork

Collective bargaining

Participation

Empowerment

Trade unions

Employers’ associations

Industrial relations

Emerging Issues:

Personnel records

Personnel audit

Personnel research

HR accounting

HRIS

Job stress

Mentoring

International HRM

PROCESSES OF HUMAN RESOURCE MANAGEMENT

HRM SYSTEM

SITUATION

ANALYSIS

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

Benefits of a strong HRM system

•FOR THE ORGANIZATION:1.Increases the organization’s capacity to retain staffs and

achieve its goals.2. Increases the level of employee’s performance.3. Uses employee’s skills and knowledge efficiently.

4. Saves costs through the improved efficiency and

productivity of workers.5. Improves the organization’s ability to manage change. 

Benefits of a strong HRM system

•FOR THE EMPLOYEE: 1. Improves equity between compensation of employee

and level of responsibility.2. Helps employees to understand how their work

relates to the mission and values of organization.3. Helps to motivate employees.4. Increases employee’s job satisfaction.5. Encourages employees to work as a team.

Importance Of HRM Components

1.HRM capacity

HRM budget Allows for consistent HR planning and for relating costs.

HRM staff Staff are essential for policy development and

implementation.

2. HRM planning Allows HRM resources to be used efficiently in support of organization goals.

3.Personnel policy & practice Allows organization to standardize the jobs and types of

skills it requires.

4. HRM data Allows for appropriate allocation and training of staff and

tracking of personnel costs.

5. Performance management Defines what should be done by people and how they would

work together.  

6.Training A cost-effective way to develop staff skill and

organizational capacity.

Human Resource Management for Public Health In India

•Since India gained independence, universal and affordable health care has been central to the planning of the country’s health system.

•However, attempts to establish such a network have been unsuccessful because substantial socioeconomic and geographical inequities in access to health care and health outcomes.

•Health manpower requirement of the of the country are based on

•1. Health needs and demands of the population and

•2. desired output.

•Health manpower planning is an important aspect of community health planning.

•It is based on series of accepted ratio like –

• - Doctor- population ratio.• - Nurse- population ratio.• - Bed- population ratio.

CATEGORIES OF HR FOR HEALTH 1.Medical doctors and specialists including public health specialists and health administrators.

2. Nurses, ANMs and allied workers – includes MPWs.

3. Lab techs, pharmacists, and technical support staff .

4. Public health support staff .

SUGGESTED NORMS FOR THE HEALTH PERSONNEL IN INDIA

(MOHFW , New Delhi)

SUGGESTED NORMS FOR HEALTH PERSONNEL

CATEGORIES NORMS SUGGESTED

1.

Doctors 1 Per 3500 population.

2.

Nurses 1 Per 5000 population.

3.

Health worker M/F

1 Per 5000 population in plain area 1 per 3000 population in tribal and hilly area.

4.

Trained dais One for each village.

5.

Health assistant M/F

1 per 30000 population in plain area

1 Per 20000 population in tribal and hilly area.

6.

Pharmacist 1 Per 10000 population

7.

Lab. Technicians 1 Per 10000 population

8.

ASHA 1 Per 1000 population

Health Manpower in some countries2005-2011 (World Health Statistics 2012)

COUNTRY DOCTORSPer 10000population

NURSES and MIDWIFES

BEDSPer 10000population

1 INDIA 6.5 10 9.0

2 BANGLADESH 3.0 2.7 3.0

3 SHRI LANKA 4.9 19.3 29.0

4 THAIAND 21.0 53.0 21.0

5 MYANMAR 4.6 8.0 6.0

HEALTH MANPOWER OF INDIA (As on March 2011)

CATEGORIES IN POSITION

1 Doctors in PHCs 26,329

2 ANM at Sub centre and PHCs 207,868

3 MPW (Male) 52,215

4 Nurse midwife 65,344

5 Radiographer 2221

6 Pharmacist 24,671

7 Lab technicians 16,208

Human Resource Crisis for Health Sector in INDIA

However average number of health care staff are satisfactory on national basis, but they vary widely within the country.

There is also mal-distribution of health manpower between rural and urban areas.

•This mal-distribution is due to - Absence of amenities in rural areas.- Lack of job satisfaction .- Professional isolation.- Lack of rural experience.- Inability to adjust in rural life.

•Studies in India have shown that there is concentration of doctors in urban areas is up to 73.6 % where only 26.4 % population live.

• While the rural population (72%) remains largely underserved.

(Task force on Medical Education, 2006)

KEY ISSUES IN HUMAN RESOURCE FOR HEALTH

1.Availability for recruitment..•1.There are insufficient institutions in

most states.

•2.70% seats concentrated in six states – 30% of seats in rest.

•3.For specialists an estimated 10% migration and increasing private sector preference.

•4.Available pool does not necessarily translate into public sector recruitment- more so if the expansion is in the private sector.

•5.There is a reluctance to join, if the posting is in remote areas.

•6.The ratio of women doctors joining is even less than of men.

2.Product Does Not Match Requirements:•1. Those who join are not from the

underserved areas or social groups. - but relatively privileged persons who

see medical education as best way to break out of their social class or retain existing class status.

•2. Even those who join with noble motives, change through the educational process into “objective” professionals.

- more interested in the disease than in the patient..

3. There no faculty development programmes.

4. Growth in the private sector is particularly haphazard and of very poor quality.

5. Skills they learn are not appropriate nor is the quality as desired.

•7. Focus is on knowledge and certification – little on skills.

•8. There is often no match between skills required and skills imparted.

3.Poor Quality of In- service Capacity Building …•1. Multiple short duration fragmented

training programmes.

•2. Little evaluation of training and no evaluation of whether training led to improved service delivery outcomes.

• 3. No decentralized planning to ensure that all the facilities have the desired skill sets.

•4. No continuing medical education programmes.

•5.Weak training infrastructure.

4. Workforce Issues•1. Transfers, postings, promotions,

disciplinary actions, pensions: - are they timely, transparent, fair and

non discriminatory ? (One of the surest indicators of good

governance)

•2.Issue of incentives…- Do those who work more or in more difficult

circumstances get rewarded more… or - do they actually feel penalized and

discriminated against!!

•3. Inadequacy of compensation package…. Both financial and non financial..

•4. Lack of a career path…

•5. Availability of positive role models and team leadership.

•6. Accountability.. …??? And accountability pyramids…

The center – state divide…•Health is a state subject and only family

planning- (expanded into RCH) and a few disease control programmes on the concurrent list.

•Central manpower support assumes that the core manpower issues are managed by state and center needs only supplement manpower.

•States constrained by lack of funds and most state funds being deployed for salaries and establishment.

Existing systemic deficits in system

1. Lack of data• In India, there is no comprehensive

information available on HRH for health facilities across public and private sectors.

•Data available with professional councils for doctors, dentists, nurses and pharmacists are cumulative and do not exclude attrition (from death, retirement, migration, etc.), as there is no periodic renewal of registration.

2. Skewed production of HRH•The distribution of medical colleges, nursing colleges, nursing and ANM schools, paramedical institutions is uneven across the states with wide disparities inequality of education.

• Six ‘high HRH production’ states (i.e. Andhra Pradesh, Karnataka, Kerala, Maharashtra, Pondicherry and Tamil Nadu) represent 31% of the Indian population, but have a disproportionately high share of MBBS seats (58%) and nursing colleges (63%) as compared to the eight ‘low HRH production’ states (i.e. Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttaranchal and Uttar Pradesh), which comprise 46% of India’s population, but have far fewer MBBS seats (21%) and nursing colleges (20%).

3. Uneven HRH deployment and distribution

•India’s major limitation has been in the production and distribution of human resources across multiple levels of care.

•Non-creation of posts at health facilities is pervasive.

4. Disconnected education and training

•Health curricula in the country have not kept pace with the changing dynamics of public health, health policies and demographics.

•Current medical and nursing graduates in the country, trained in urban environments, are ill-prepared and unmotivated to practice in rural settings.

•There is an increased drive towards super specialization in various medical disciplines, further pushing the focus of care towards tertiary health models rather than essential primary care services.

Indian Strategies –Attracting and Retaining Skilled Service Providers in Rural and Difficult Areas

•a. Regulatory: Insisting of rural service as pre-

qualification to be considered for admission to post graduation courses or bonds which insists on doing rural service after the course.

•b. Workforce management: Transfer policies that provide for

rotational posting in difficult areas and give preference to those who would work in a remote area of their own choice.

•c. Incentives- financial and non-financial. (CRMC scheme in CG)

•d. Educational Strategies: Measures to preferentially admit only

those students who are likely to serve in under-serviced areas and mould education to retain this commitment.

•e. Multi-skilling existing staff:

•Introduction of three year course as rural medical assistants and posting of Ayush doctors.

Recent Initiatives In The Field Of Human Resource Management In India

1.Creating the norms: The IPHS

•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..1. Compulsory rural postings- pre- post graduation

– eg Orissa, Chhattisgarh and Tamilnadu.

2. Contractual appointments .

3. fair transfer policy- rotational postings… tamil nadu..

4. Incentives for difficult areas: eg Chhattisgarh, Himachal and Orissa.

4.Community level service providers

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

2. Anganwadi worker- increasing her effectiveness as health care provider.

3. The RMP: Would training them help?4. The traditional birth attendant:

continuing role for the TBA where institutional delivery levels are low.

5. Community midwifes and maternity huts.

5.Strengthening Capacity building activity…•Strengthening SIHFWs.

•Developing an integrated training approach.

•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.

• 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…!?!

Future challenges include

- Planning for human resource for public health at State/national level,

- Framing of State specific human resource development and training policy,

- Creation of human resource management information system,

- Reorientation of medical and para-medical education and

- Ensuring proper utilization of the trained manpower and standardization of training.

The whys?

1. Why was HR not planned along with infrastructure ?

2. Why are so many institutions dismantled in the last decade?

ANM training schools? MPW training schools?

3. Why are SIHFWs and RHFWTCs poorly functional? Why have district training centers fallen into disuse?

4. Why this very uneven growth of professional education?

5. Why Public Health Specialist are not posted in key managerial posts in Public Health departments.

THANK YOU