Article Text

Size, composition and distribution of human resource for health in India: new estimates using National Sample Survey and Registry data
  1. Anup Karan1,
  2. Himanshu Negandhi2,
  3. Rajesh Nair3,
  4. Anjali Sharma4,
  5. Ritika Tiwari4,
  6. Sanjay Zodpey3
  1. 1 Indian Institute of Public Health, Delhi, Public Health Foundation of India, Gurugram, Haryana, India
  2. 2 Indian Institute of Public Health, Delhi, Public Health Foundation of India, Gurugram, Haryana, India
  3. 3 Indian Institute of Public Health, Delhi, Public Health Foundation of India, Gurugram, Haryana, India
  4. 4 Academics, Public Health Foundation of India, Gurugram, Haryana, India
  1. Correspondence to Dr Anup Karan; anup.karan{at}


Objectives We provide new estimates on size, composition and distribution of human resource for health in India and compare with the health workers population ratio as recommended by the WHO. We also estimate size of non-health workers engaged in health sector and the size of technically qualified health professionals who are not a part of the health workforce.

Design Nationally representative cross-section household survey and review of published documents by the Central Bureau of Health Intelligence.

Setting National.

Participants Head of household/key informant in a sample of 101 724 households.

Interventions Not applicable.

Primary and secondary outcome measures The primary outcome was the number and density of health workers,and the secondary outcome was the percentage of health workers who are technically qualified and the percentage of individuals technically qualified and not in workforce.

Results The total size of health workforce estimated from the National Sample Survey (NSS) data is 3.8 million as of January 2016, which is about 1.2 million less than the total number of health professionals registered with different councils and associations. The density of doctors and nurses and midwives per 10 000 population is 20.6 according to the NSS and 26.7 based on the registry data. Health workforce density in rural India and states in eastern India is lower than the WHO minimum threshold of 22.8 per 10 000 population. More than 80% of doctors and 70% of nurses and midwives are employed in the private sector. Approximately 25% of the currently working health professionals do not have the required qualifications as laid down by professional councils, while 20% of adequately qualified doctors are not in the current workforce.

Conclusions Distribution and qualification of health professionals are serious problems in India when compared with the overall size of the health workers. Policy should focus on enhancing the quality of health workers and mainstreaming professionally qualified persons into the health workforce.

  • India
  • health workers
  • human resources for health
  • health associate workers
  • composition of HRH

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Supplementary materials


  • Contributors AK, HN and SZ conceptualised the study. AK, AS, HN, RN and RT conducted data analysis and review of literature. AK, HN and SZ prepared the first draft. All authors contributed to review and revision of the first draft and approved the final version.

  • Funding This article is part of a research project funded by John Snow India (grant number JSI/India/GG/01/01/2016) to the Public Health Foundation of India.

  • Disclaimer The funder has no role in the design of the study, collection of data, interpretation of results, manuscript preparation and decision to publish the article in any journal.

  • Competing interests None declared.

  • Ethics approval Ethical clearance for this study was obtained from the Institutional Ethics Committee (IEC) of the Indian Institute of Public Health Delhi under ‘Expedited Review’.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data set used in the study are publicly available from the National Sample Survey Organisation and the Medical and Nursing Council of India. Anyone can access this data set either by paying the requisite fee or by making request for free access.

  • Patient consent for publication Not required.