Do health policies address the availability, accessibility, acceptability, and quality of human resources for health? Analysis over three decades of National Health Policy of India

Abstract

Background Human Resources for Health (HRH) are crucial for improving health services coverage and population health outcomes. The World Health Organisation (WHO) promotes countries to formulate holistic policies that focus on four HRH dimensions—availability, accessibility, acceptability, and quality (AAAQ). The status of these dimensions and their incorporation in the National Health Policies of India (NHPIs) are not well known. Methods We created a multilevel framework of strategies and actions directed to improve AAAQ HRH dimensions. HRH-related recommendations of NHPI—1983, 2002, and 2017 were classified according to targeted dimensions and cadres using the framework. We identified the dimensions and cadres focussed by NHPIs using the number of mentions. Furthermore, we introduce a family of dimensionwise deficit indices formulated to assess situational HRH deficiencies for census years (1981, 2001, and 2011) and over-year trends. Finally, we evaluated whether or not the HRH recommendations in NHPIs addressed the deficient cadres and dimensions of the pre-NHPI census years. Results NHPIs focused more on HRH availability and quality compared to accessibility and acceptability. Doctors were prioritized over auxiliary nurses-midwives and pharmacists in terms of total recommendations. AAAQ indices showed deficits in all dimensions for almost all HRH cadres over the years. All deficit indices show a general decreasing trend from 1981 to 2011 except for the accessibility deficit. The recommendations in NHPIs did not correspond to the situational deficits in many instances indicating a policy priority mismatch. Conclusion India needs to incorporate AAAQ dimensions in its policies and monitor their progress. The framework and indices-based approach can help identify the gaps between targeted and needed dimensions and cadres for effective HRH strengthening. At the global level, the application of framework and indices will allow a comparison of the strengths and weaknesses of HRH-related policies of various nations.

Health personnel and the reform of primary health care in Montenegro

“…Promene u regulativi u ranoj fazi reforme (ukupno je usvojeno jedanaest zakona, od koji su neki bili novi, a u nekim slučajevima su donete izmene i dopune postojećih zakona) podržale su primenu nacionalnih mehanizama po pitanju regulacije zdravstvenih profesija, mehanizama licenciranja zdravstvenih radnika i kvaliteta. Kao posledica tih aktivnosti, "projekat je posebno doprineo kvalitetu i pouzdanosti primarne zdravstvene zaštite" [5].…”

“…Kada je u pitanju univerzalna zdravstvena pokrivenost, AAAQ okvir (engl. availability, accessibility, acceptability and quality framework) Svetske zdravstvene organizacije za upravljanje dostupnošću, pristupačnošću, prihvatljivošću i kvalitetom zdravstvenog kadra, dobija sve više na značaju, i na globalnom i na nacionalnom nivou [4][5][6][7]. Reforma primarne zdravstvene zaštite je u mnogim zemljama prethodila pandemiji KOVID-19 oboljenja, te je dovedena u pitanje korist od racionalizacije zdravstvenog kadra u smislu održivosti primarne zdravstvene zaštite u kontekstu kriznih situacija [8][9][10].…”

“…Legislation changes in the early stage of the reform (eleven new laws were adopted or amended) supported the implementation of national mechanisms regarding the regulation of health professions, licensing mechanisms of health professionals, and quality. Consequently, "the project had particular impact on the quality and reliability of primary care" [5].…”

“…The health workforce development, deployment, and performance are sensitive issues which were not easily solved with the health care reforms. With regard to universal health coverage, the World Health Organization AAAQ framework for governance of health personnel availability, accessibility, acceptability and quality is gaining significance globally and nationally [4][5][6][7]. Primary health care reform preceded the COVID-19 pandemic in many countries, calling into question the benefits of health staff rationalization in relation to the sustainability of primary health care, in the context of crisis [8][9][10].…”

Equity and trend predictions of human resources for health allocation at the Centers for Disease Control and Prevention in China, 2005-2020

“…It is necessary to establish effective HRH planning to ensure the sustainability of CDC HRH. Regarding the lack of HRH, the World Health Organization (WHO) emphasized the need to focus on the availability, accessibility, acceptability and quality of HRH [9]. Thus, HRH planning is based on maintaining the most appropriate rationality in quantity, quality and equity.…”