Imbalances in health workforce in a primary health centre (P.H.C.) of Darjeeling district, West Bengal, India

Abstract

Health workforce includes clinically trained health professionals, health management and support workers. Imbalance in health workforce is a major challenge, as its size and quality positively determine country's ability to meet its goals of organizing and delivering health services, like immunization coverage, outreach of primary care etc. Unfortunately, India has uneven, inequitable and mal-distributed health workforce regarding number, skill, gender mix and type. The perceived gap being more in rural hilly areas, this study in a rural primary health centre (PHC) in Ghayabari, approximately 45 kilometres from Darjeeling was envisaged. The objectives of the study was to assess the status of health workforce in Ghayabari PHC in the hilly terrain of Darjeeling district and find out the associated reasons of any existing imbalance.A cross-sectional study was conducted in Ghayabari PHC, from August to October 2011. Focus-Group-Discussion (FGD) with staff, local leaders, In-Depth-Interview (IDI) of medical officers, nurses and record review was done. There are two doctors, three nurses, ten beds for approx.16,800 population with 8.4 turnover rates. Indian Public Health Standard criteria are incompletely met regarding adequacy and health workforce distribution. 27.27% posts are vacant, 13% left jobs in last 3 yrs. Though emergency and referral services are present, outreach and home visits are irregular, increasing load on the PHC. FGD, IDI identify reasons as staff-shortages, absenteeism, attrition, less capacity building efforts, unskilled staff, intense communication problems in adverse terrain, harsh living and working conditions, absent job satisfaction, irregular supervision and no untied funds. Issues pertaining to staff shortage, skill imbalance and job satisfaction need to be addressed with concern and care to ensure primary health care at doorstep of community.