Skilled women workforce will give a big boost to the Indian health sector!

The skilled workforce is indispensable to maintain vibrancy in the country's health sector. The workforce, which is tailored to real world applicability and employability, matters a lot in rendering treatment at primary, secondary and tertiary level. They are also in high demand in several foreign countries. As per the International Nursing Council (ICN), the global shortage of trained nurses by 2030 has been pegged at 13 million including India's additional demand of 4.3 million by 2024. As per a recent report of the World Health Organization (WHO), India requires at least 1.8 million doctors, nurses and midwives to achieve the minimum threshold of 44.5 health workers per 10,000-population by 2030. The current Covid-19 pandemic has further stressed the need for more health workers at different levels in the country.

As per an estimate, the global nursing workforce was estimated to be 27.9 millions in 2019-20. Prior to the pandemic, the global shortage of nurses had been pegged at 5.9 million nurses. Nearly all of these shortages were concentrated in low and lower middle income countries. As human resources for health (HRH) are at the core of health systems, a targeted investment in the health workforce promotes economic growth through a range of pathways such as enhanced productivity and output, social protection and cohesion, social justice, innovation and health security. Investment in the health workforce is a driver of progress towards several SDGs.

The health system does not mean only doctors. They are certainly an important part of the human resources for health but not the ultimate end in themselves. The Sustainable Development Goals (SDGs) reaffirm a global commitment to achieve universal health coverage (UHC) by 2030. This means that all people and communities everywhere in the world, should have access to the high-quality health services they need – promotive, preventive, curative, rehabilitative, or palliative – overcoming barriers due to access, availability and affordability. High-quality health services involve the right care, at the right time, responding to the service users' needs and preferences, while minimizing harm and resource waste.

Women constitute a significant proportion of the health workforce globally. However, concentration of women in certain jobs within the health sector and the related gender inequality has been a serious concern particularly in (LMICs) including India. They are playing a critical role in managing Anganwadis, an important component in rural healthcare and development. It is estimated that India has over 2.5 million Anganwadi workers and helpers. They are from the local community who come forward to render their services, on a part time basis, in the area of child care and development. Being honorary workers, they are paid monthly honoraria as decided by the government from time to time. Their role should be further institutionalised and expanded to prevent people's primary health issues from snowballing into tertiary issues. For this, they need to be trained accordingly so that they are able to identify and help people deal with problems of high sugar, blood pressure, eyesight issues, malnutrition, neonatal care and anaemia.

We need to admit that people living in rural areas have to cope with multiple constraints including financial and livelihoods. Health and education take the backseat. Luckily, there are a number of government welfare schemes meant for them. Notwithstanding all efforts, a large number of them are not able to reap the benefits of welfare schemes for want of awareness, lack of knowledge and minimum resources. An overwhelming number of rural people struggling with multiple health issues due to lack of awareness and proper counselling are poor parents and their children. Out of ignorance they do not know that their health is slowly and steadily slipping into a critical zone where they need prompt secondary and tertiary level care, which they cannot afford for want of necessary socio-economic wherewithal.

India is luckily blessed with a vibrant and ambitious Integrated Child Development Scheme (ICDS) under which over 6291 projects are being run across the country along with 10.53 lakh Anganwadi Centres (AWCs) and 36847 Mini Anganwadi Centres (MAWCs). Taken together, the total number of sanctioned AWCs and MAWCs is around 10.90 lakh. It is a great situation in terms of infrastructure and over 2.5 Anganwadi workers and helpers. They will do wonders if they are well compensated along with auditing their performance and online monitoring. Their outcome should be analyzed and discussed right from block to district level, and deliberations should be documented for further discussion and needful.

At present, training is provided to Anganwadi Workers (AWWs) at the Anganwadi Workers Training Centres (AWTCs) under the ICDS Training Programme. AWWs are provided with a job training course for 26 working days. In case of backlog, induction training with a shorter duration of five working days is conducted for placing functionaries into jobs prior to their job training. Vertical training for the block functionaries is conducted in selected districts at the district level. Under the POSHAN Abhiyan, capacity building of AWWs is done through Incremental Learning Approach (ILA) having 21 training modules. AWWs are oriented on one module every 15 days. The e-ILA software is developed as a comprehensive training and evaluation web-based learning portal for the field workers.

The utility of AWWs will amplify if their training is slightly reoriented and is aligned to meet the needs of primary health care. They should be attached with health facilities in their localities for the needful training. As on January 1, 2021, India had 760100 health facilities including government hospitals, primary health centres (PHCs) and Community Health Centre (CHCs). Given the magnitude of public health, AWWs must be used in strengthening the capacity of the primary health system to cater to detection and cure of new and emerging lifestyle diseases. It is estimated that around 9.27 lakh doctors are available for active service in the country. Though our doctor-population ratio is 1:1456 as per the current population estimate of 1.35 billion against the WHO norm of 1:1000, they can spare a few hours every month to train AWWs in giving first aid to the needy in villages.

One must note that the burden of rare diseases is getting huge in India. The 'National Policy for Rare Diseases-2021' is aimed at the prevention and management of rare diseases. Early diagnosis of rare diseases is a major challenge owing to a variety of factors that include lack of awareness among primary care physicians, lack of adequate screening and diagnostic facilities. Though there are also fundamental challenges in research and development for the majority of rare diseases as relatively little is known about pathophysiology or natural history of these diseases, mass awareness campaigns will be quite useful. AWWs should be tasked to encourage people to go for screening at primary and secondary health care infrastructure. Just a serious beginning has to be made!

(The writer is a senior journalist, author and columnist. The views expressed are strictly his personal)