Too few women docs to blame for poor reproductive healthcare in India: WHO

India is among the world’s 83 countries which do not meet the minimum requirement of having 22.8 healthcare workers for every10,000 persons

By Jyotsna Singh
Published: Wednesday 13 November 2013

A World Health Organization (WHO) report, recently released in Brazil, says that nearly 83 per cent of physicians in India are males. The report, titled "A Universal Truth: No Health Without a Workforce", released at the Third Global Forum on Human Resources for Health, blames the shockingly less number of females in healthcare workforce for dismal state of reproductive healthcare in India.

According to the report, India is among the 83 countries in the world which do not meet the minimum requirement of having a healthcare workforce of 22.8 per 10,000 persons. At the present rate of 15.8 skilled health professionals for every 10,000 persons, India is among the worst rated countries.

The report also says that the nurse to physician ratio in India is much below the the globally accepted standard of 2.8 nurses per physician. India has only 0.1 nurse per physician.

"The sex distribution proxy (for physicians) relates to the evidence that the availability and accessibility of women healthcare providers is a critical factor in user demand and satisfaction with services in countries and in populations in which being served by someone of the other sex is not culturally accepted. This particularly concerns reproductive health services in lower-income countries, where the demographic balance is in favour of men," says the report.

The global perspective

According to the report, the world has a shortage of 7.2 million healthcare workers. If not addressed now, the figure is expected to rise to 12.9 million by 2035.

Though, in terms of numbers, maximum shortage is expected to be prevailing in parts of Asia, it is sub-Saharan Africa which is facing the most acute problem. The region, which comprises of 47 countries, has only 168 medical schools. Of these, 11 countries have no medical schools and 24 countries have only one medical school.

“One of the challenges of achieving universal health coverage is ensuring that everyone, especially the people in vulnerable communities and remote areas, have access to well-trained, culturally-sensitive and competent healthcare staff,” says Carissa Etienne, WHO regional director for the Americas. “The best strategy for achieving this is by strengthening multidisciplinary teams at the primary health care level,” she adds.

The publication has also identified maternal and child health as a priority for healthcare workers. It says that around 90 per cent of maternal deaths and 80 per cent of still births occur in 58 countries, largely because they lack trained midwives. Also, of the 6.6 million under-five year olds who died in 2012, most suffered from treatable and preventable diseases, the report adds.

WHO recommendations

The report had made some recommendations to address the workforce crisis and meet goals of universal health coverage, a global health agenda for better healthcare. They include:

  • Better political and technical leadership to support long-term human resource development efforts
  • Collection of reliable data and more human resource for maintenance of health-related databases
  • Maximising the role of mid-level and community health workers to make frontline health services more accessible and acceptable
  • Retention of health workers in countries where the deficits are most acute and greater balancing of the distribution of health workers geographically
  • Providing mechanisms for the voice, rights and responsibilities of healthcare workers in the development and implementation of policies and strategies towards universal health coverage


Shortage of health professionals worldwide
  • 83 countries fall short of the threshold of 22.8 skilled health professionals per 10 000 population
  • 100 countries fall short of the threshold of 34.5 skilled health professionals per 10 000 population
  • 118 countries fall short of the threshold of 59.4 skilled health professionals per 10 000 population
  • 68 countries are above the threshold of 59.4 skilled health professionals per 10 000 population

Some findings of the report:
  • There are shortages in some categories of health workers and the deficit is likely to get more acute
  • The health workforce is ageing and replacement is a challenge
  • Although skills-mix imbalances persist, advanced practitioners, midwives, nurses and auxiliaries are still insufficiently used in many settings
  • Availability and accessibility continue to vary widely within countries because of difficulty in attracting and retaining workers
  • Adapting education strategies and the content of pre-service education is a major challenge

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