Devendra K. Budakoti
The inadequacy of health services in the country is often viewed primarily as a shortage of human resources within the public health system. However, the real issue may also lie in the efficiency, commitment, and systemic bottlenecks that hinder effective healthcare delivery.
The recent announcement by the Uttarakhand government to increase nursing seats across existing medical institutions is a welcome step toward strengthening human resources in the public health sector. Yet, whether this move will translate into tangible improvements in health services remains to be seen. Since the formation of the state, the number of doctors and paramedical staff has increased considerably. Despite this, the state continues to face serious challenges in delivering quality healthcare, especially in rural and hilly areas. Even with reported improvements in infrastructure and facilities at CHCs, PHCs, and other health centers, questions persist about the actual quality of services on the ground.
A recent protest in the Chaukhutia block of Almora district highlights this concern. Residents, dissatisfied with poor health services, have demanded that the government implement community health center standards. Their plan to march to Dehradun and demonstrate outside the Health Minister’s residence underscores the growing public frustration and reveals the harsh realities of the healthcare situation in many parts of Uttarakhand.
The COVID-19 pandemic further exposed the inadequacies of health systems worldwide, including in developed nations. In developing countries, the situation is even more dire, given the limitations in accessibility, affordability, and availability of health services. The pandemic has also raised serious questions about the capacity of existing medical technology and infrastructure to effectively address large-scale health crises and associated morbidity and mortality.
India’s health policies have traditionally focused on improving the “3As” — Accessibility, Affordability, and Availability — often through expanding manpower, infrastructure, and supply chains. The emphasis has largely been on building new medical institutions to increase capacity. However, an alternative approach could be to leverage the existing educational infrastructure of traditional universities and their affiliated colleges, both in the government and private sectors.
To begin with, human resources in health can be strengthened in key areas such as Nursing, Pharmacy, and Paramedical Sciences by involving traditional universities. Government and private educational institutions that already run B.Sc., M.Sc., and Ph.D. programs with adequate laboratory facilities and infrastructure can be permitted to offer certificate, diploma, and degree courses in these disciplines.
In addition to classroom learning and the use of anatomical and physiological models, practical and clinical training — as mandated by respective professional councils (Nursing, Pharmacy, and Paramedical) — can be facilitated through Memoranda of Understanding (MoUs) between educational institutions and healthcare providers. For example, government district hospitals, sub-district hospitals, and CHCs could collaborate with government degree colleges equipped with suitable infrastructure and faculty. The State Health Directorate could provide final approval for such collaborations, while traditional universities could conduct examinations and award diplomas or degrees.
The state government should consider pursuing this strategy to expand the health workforce through appropriate policy interventions. However, it must also be recognized that simply increasing the number of doctors, nurses, and paramedical staff, or appointing them within the public health system, will not automatically lead to better healthcare outcomes. Without addressing systemic delivery bottlenecks and improving the service conditions of health professionals and support staff, the goal of achieving both quantity and quality in health services will remain elusive.
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The author is a sociologist and has been associated with the development sector for nearly four decades.
