Human Resources for Health: A Capacity Development project implemented in India

On a recent trip to India, Renée Zandvliet, working with EuropeAid’s 'Civil Society and Local Authorities' unit, saw that civil society organisations (CSOs) often play a supportive role in improving the functioning and outreach of public health systems, as well as helping strengthen Human Resources for Health (HRH). As part of capacity4dev.eu's CSOs in India Week, she shares her views.

Civil Society and Human Resources for Health

India may be a Middle Income Country with an impressive economic growth rate, however, it also continues to face difficulties in ensuring the effective delivery of health services to its 1.2 billion people. One of the main obstacles is India's low health worker density. According to the World Health Organisation (WHO) there are less than seven physicians per 10,000 inhabitants (compared to 30 in Belgium, for example). The shortages of other health workers, including trained nursing and midwifery personnel, are equally severe. The situation is most acute in rural areas, where health facilities find it particularly difficult to attract and retain health workers.

Although the management of Human Resources for Health (HRH) is primarily a state responsibility, civil society organisations (CSOs) often play a supportive role in improving the functioning and outreach of public health systems, as well as helping strengthen HRH. They can make critical contributions towards shaping HRH policy, conducting analysis, providing evidence of practical applications as well as enhancing people's participation in health governance and oversight.

Recognizing this, in 2009 the European Union (EU) launched a global Call for Proposals entitled 'Good health for all: Engaging civil society organisations to support national health workforce policies, strategies, capacity development and skills transfer' under the thematic programme Investing in People (with an indicative budget of EUR 14.5 million globally). This Call was rather timely in India, as the country had just started preparations for the establishment of a National Council for HRH in order to address the country's HRH challenges.

One of the projects selected under this Call is 'Improving the HRH policy, strategy and practices in India', which is being implemented by SWASTI, an Indian health resource centre established in 2002, which aims to mobilise communities to better address health care priorities and to improve the effectiveness and efficiency of organisations in the health sector. It is implemented in partnership with the Public Health Foundation of India (PHFI), an Indian network of institutions responding to India's public health challenges through education, training, research, communication, advocacy and health systems support.

Recognizing the link between health workers and health outcomes, this project is entirely focused on capacities. Its purpose is to address human resource issues in the health sector at national, state and community level through knowledge mobilisation, capacity development and advocacy. The project looks at a wide range of HRH aspects including planning; recruitment; motivation; compensation and retention; performance management and work culture; capacity development methods and tools; and equity issues in HRH. It includes actions at the national level and pilot activities in two states: Madhya Pradesh in central India and Kerala in the south.

At the start of the project, the partners organised workshops and held discussions with different stakeholders, notably from the government and key civil society initiatives, in order to understand current public health sector needs and overall HRH priorities. The partners also organised a large multi-stakeholder conference to explore civil society initiatives in strengthening HRH. They found that although there is a wealth of experience in HRH at different levels in India, these are often neither well documented nor shared. Through a database of HRH reforms, a nationwide study on good practices, and an extensive literature review, they seek to change this. Almost two years into the implementation of the project, they are finding that although many good and innovative practices have been identified, conditions across the country vary substantially and scaling up is not always easy.

Clearly, in any project on HRH, public authorities – from the local to the national level – are key stakeholders. SWASTI and PHFI had already worked and established a good rapport with many public health authorities, which helps them in the implementation of the project. Public health authorities actively participate in project workshops and other events and benefit from technical expertise. They are also involved in the Project Advisory Committee convened by the project team to provide guidance, ideas, experiences and expert advice from time to time.

The project is currently working with the central Ministry of Health and Family Welfare as well as the Departments of Health and Family Welfare of the Governments of Kerala and Madhya Pradesh to advise and provide technical support on core HRH issues.

A special 'Advocacy and Learning' component is included in the project, which includes support for HRH Expert Groups and Cells at the state and national level, as well as an online forum 'People for Health' which provides civil society and the private sector with an opportunity to advocate for enhanced HRH.

With a new EU policy on EU engagement with CSO in place - which focuses on the role of CSOs in governance in the context of constructive relations between public authorities and CSOs - projects such as this one offer inspiring examples of how CSOs can contribute to more effective public policies.

EC / EEAS staff that are members of capacity4dev.eu can acces project related documents in the EC/EEAS Group on Civil society.

This collaborative piece was drafted with input from Renée Zandvliet and Laurent Le Danois, with support from the capacity4dev.eu Coordination Team. Photos by the Swasti Health Resource Centre.