Allied and Healthcare Professionals (AHP) make a significant contribution to the healthcare delivery system. They provide range of preventive, technical, diagnostic, therapeutic, rehabilitative and curative services and help in effective functioning of the system. During the time of any health crisis, they are the frontline warriors and help in scaling up healthcare services under the supervision of doctors and nurses. Despite a huge demand for their services, this sector is highly fragmented in India, mainly due to the absence of a central regulatory authority.
In the past, efforts were made to define and regulate AHPs’ role in the healthcare delivery system, but there always has been a tacit resistance by medical fraternity due to the lack of role clarity and its unregulated nature.
In 2011, National Commission for Human Resources for Health Bill which included proposal for constitution of Allied Health (Paramedical) Council and having a one structure for all health professionals (both regulated and unregulated) was strongly opposed by the then Medical, Dental and Indian Nursing Councils (of India) and finally got revised.
The first formal attempt to understand the role of AHP in the Indian healthcare delivery system was made by the Ministry of Health and Family Welfare when they commissioned a study led by the Public Health Foundation of India (PHFI). Report of this seminal study -- From Paramedics to Allied Health Services -- which was published in 2012, defined AHPs’ role as:
“Individuals who are involved with the delivery of health or healthcare related services, with qualification and competence in therapeutic, diagnostic, curative, preventive and/or rehabilitative interventions. They could work in interdisciplinary health teams in varied healthcare setting that include doctors, nurses and public health professionals to promote, protect, treat and/or manage a person’s physical, mental, social, emotional, environmental health and holistic well-being.”
In other words, AHPs services are mainly focused on keeping people ‘healthy’rather than ‘fixing ill-health’. Latter remains in the hands of doctors and nurses.
The recent effort in acknowledging the importance of AHP in the healthcare delivery system is “Allied and Healthcare Professions Bill, 2018”, which was presented to the Rajya Sabha on Jan 31, 2020 and laid to the table of Lok Sabha on the same date. This bill recognises 53 professions of AHPs, bringing working balance between medical professionals and AHPs and setting guidelines for AHPs’ education, services, and regulation. In many ways, this bill is a landmark in recognising the role of AHPs in the healthcare system. Once enacted as an Act and executed in its letter and spirit, it has the potential to create multiple benefits.
Impact on Healthcare Delivery System
India’s struggle to meet the healthcare needs of its growing population is mainly due to two major challenges. First is the scarcity of financial resources. As per the World Health Organization (WHO), India ranks 184 out of 191 countries in terms of percentage of the gross domestic product (GDP) spend on healthcare. Second is the shortage of human resources at all levels of the healthcare system - India already has shortage of an estimated six lakh doctors and two million nurses.
Therefore, other than increasing health expenditure as a percentage of the GDP from the existing 1.15 per cent to 2.5 percent by 2025, as envisioned in the National Health Policy 2017, India also needs a coordinated effort among doctors, nurses, AHPs and frontline healthcare workers to improve the reach of quality health services to its vast population.
With the advancement in technology, it is now imperative to create a fresh vision of healthcare delivery based on multi-disciplinary team-based care than a system only driven by doctors and nurses. Any investment on creating a strong cadre of AHPs can play a significant role in realising this new vision and will also prepare us for a better response in case on any unforeseen health crisis.
Impact on Job Creation
As per the WHO, by the year 2030, there will be 40 million new health sector jobsmostly in the middle and high income countries. Similarly, Mckinsey Global Institute in its Job Lost, Job Gained Report, 2017 has predicted 130 million new jobs globally in healthcare due to aging and rising incomes by 2030.
Considering India’s vast population, increased life span of its population, growth of private health service providers, launch of schemes like Ayushman Bharat, with the advancement of technology and the international demand of AHPs, one can easily estimate the number of new jobs opportunities India will create.
On the other side, if we look at the current availability of healthcare workers in India, apart from the shortage of doctors and nurses, the strength of AHPs in India is not even five percent of the current demand. As per the PHFI Report, 2012, there was a shortfall of 64 lakh AHPs in India.
Combining both existing gap and arising opportunities will create millions of jobs for AHPs in the coming decade. India can reap this benefit of national and global demand by investing in capacity building and training of AHPs at par with global standard.
Impact on Women LFPR
Among G20 States, India is second from the bottom in women participation in workforce. Women LFPR is at historc low at 23.3 per cent. Nearly 120 million Indian women having at least a secondary education do not participate in the workforce for various personal, social and economic reasons. The nature of job also acts as an important barrier for women.
The AHP job roles are women friendly. As per the WHO, Health Workforce in India Report, out of total health workers, 38 percent are female. And in the nurses & midwives category, females account for 83.4 per cent.
Most of the corporate hospitals and private clinics prefer hiring trained women AHPs, mainly due to their caring nature and preference of patients (e.g. female patients prefer to be helped by female AHPs than male). The aspirational nature of job and the accommodation support extended by corporate hospitals and private clinics enable females to take up AHPs jobs, even if there is an migration involved.
Our experience at Dr. Reddy’s Foundation (DRF) has been similar while running placement linked healthcare programs to create quality AHPs. While in our “Core Employability Skills” Program, we have witnessed a ratio of male and female is 56:44; in our “AHP Skilling Program” male and female ratio is 25:75. More participation of women in training also led to more of them taking up the job after completion of training. 82 percent of women who are 10th-12th standard pass start working after completion of 600 hours of residential training with a monthly salary range of INR 12000 to 16000.
Impact on Training Quality
Standardisation of AHP training programmes is a key improvement area. Current skilling programs for AHPs are largely guided by National Occupation Standards (NOS) and Health Sector Skill Council. Though NOS specifies the standard of performance an individual must achieve when carrying out a function in the workplace, laid down by employers, the Sharda Prasad Committee Report, 2016 which was constituted by the Ministry of Skill Development and Entrepreneurship observed that qualification packs (QPs) developed are narrowly defined and recommended for these QPs to be standardised across the International Standard Classification of Occupations to prepare Indian youth to not only be ready for national jobs but also for international requirements mainly due to the ageing population in other parts of the world.
It is very encouraging to see that the new Allied and Healthcare Professions Bill, 2018 recognises 53 professional profiles clubbed under 15 major professional categories coded according to the ILO documentation of the International Standards for Classification of Occupations (ISCO)-08 so as to allow for global recognition and mobility. Bill also defines that Allied Healthcare Professionals and Healthcare Professionals should have a minimum of 2000 and 3600 hours of training respectively. There is also a provision for certification of skilled workers who have undergone formal training of less than 2000 hours, to help recognise youth trained under various skilling programs sponsored under Skill India initiative.
Quality execution of training programmes is another area of improvement. At DRF in our new healthcare training program to create quality AHPs, specially designed for 10th & 12th standard youth from low income families, we have witnessed that after completion of 600 hours of residential training, 80 percent of them get placed in the salary range of INR 12,000 to 16,000 with accommodation facilities. The quality delivery of programme is ensured by focussing on demand led training - in this case AHP, certified trainers such as B.Sc. and M.Sc. nurses having competency to deliver quality training, arranging on the job trainings, setting up world class skill lab for job simulation, and providing extra input on “core employability skills” such as communication, English, soft skills, interview facing skills other than the technical trainings to make trainees job ready.
In a country of 1.36 billion population, where on the one hand healthcare access and quality are lagging behind Sri Lanka and Bangladesh, and on the other hand less than five per cent of workforce are formally skilled, building a strong cadre of AHPs can be a strategic intervention. This will not only ensure a quality healthcare delivery system but also create millions of meaningful jobs, particularly for women. Time is ripe for bringing a systemic change by introduction of Allied & Healthcare Professions Act and investing in creating quality AHPs, at scale, to meet national & global demand.
(Pranav Kumar Choudhary is currently serving as Director-Operations- Dr. Reddy’s Foundation and leads Foundation’s flagship Youth Skilling Programs. Views expressed are personal.)