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Table 2 Cadrewise HRH-related strategies and actions for AAAQ dimensions recommended in the NHPIs

From: Do health policies address the availability, accessibility, acceptability, and quality of human resources for health? Analysis over three decades of National Health Policy of India

NHPI Year Availability Accessibility Acceptability Quality
Cadre focused Recommendations given Strategy/Action not used Cadre focused Recommendations given Strategy/Action not used Cadre focused Recommendations given Strategy/Action not used Cadre focused Recommendations given Strategy/Action not used
1983 Othera - Create a new HRH cadre - Establish new training institutes
- Increase the number of seats in existing training institutes
- Task shifting and task sharing
- Recruiting HRH from foreign countries
- Retaining HRH within the country
Doctor - Financial incentive - Tele-consultation
- Identify groups/individuals motivated to work in underserved areas
- Remove professional isolation
- Remove administrative barriers in recruitment like walk-in interviews
- Mandatory rural postings
No recommendation focused on the acceptability of HRH Other - Formal training courses for unqualified HRH - Grievance redressal and feedback system for patients
- Maintain quality of HRH
- Professional councils for all HRH cadres
- Improving the training of HRH cadres
- Standard licensing exam for all cadres
- Conduct meetings to review common medical errors
- Regular assessment of in-service staff
Non-cadre-specificb - Measure and monitor availability of HRH using information systems AYUSHc - Streamline and integrate traditional HRH cadres
- Task shifting in underserved areas
Non-cadre- specific - Changes in curriculum
- Develop interpersonal/ soft skills
Non-cadre- specific - Attract and retain HRH from surplus sector/area/level of care/system of medicine to underserved areas
- Increase production of HRH in underserved areas
- Develop information systems and tools to measure and monitor the availability of HRH
2002 Doctor - Develop information systems and tools to measure and monitor the availability of HRH
- Establish new training institutes
- Increase the number of seats in medical institutes
- Task shifting and sharing
- Recruiting HRH from foreign countries
- Retaining HRH within the country
Doctor - Mandatory rural posting
- Removing administrative barriers of recruitment
- Task shifting and sharing in underserved areas
- Tele-consultation
- Establish training institutes in underserved areas
- Provide financial and non-financial incentives
- Identify groups or individuals motivated towards serving underserved areas
- Removing professional isolation
- Develop information systems and tools to measure and monitor the geographical distribution of HRH
- Streamline and integrate traditional medicine HRH in underserved areas
Non-cadre- specific - Create and deploy HRH representative of sex, age, religion, etc. of the population being served - Create HRH closer to the community
- Deploy HRH in the local community
- Induction training of new HRH
- Create appropriate cadre-mix
Doctor - Change the curriculum to suit all levels of care
- Improve the training of HRH cadres
- Continued medical education and training to HRH
- Regular assessment of in-service staff and performance-based incentives
- Grievance redressal and feedback system for patients to identify areas of improvement for HRH
- Standard licensing exam
- Establish policy/rules for promotion, transfer, leave, salary, etc. for all HRH
- Conduct meetings to review the common medical error
- Formal training of unqualified HRH
Nurse - Increase the number of nursing institutes
- Task-shifting and task-sharing
- Develop information systems and tools to measure and monitor the availability of HRH
Nurse - Task-shifting and multi-tasking of HRH cadres in underserved areas Other - Preferentially expand cadres with greater local acceptance Non-cadre- specific - Develop interpersonal/ soft skills in all cadres
- Improving the training of HRH cadres
Other - Establish new training institutes
- Create a new HRH cadre (LMPd)
Paramedic (pharmacist) - Task-shifting and multi-tasking of HRH cadres in underserved areas Paramedic (pharmacist) - Task-shifting and multi-tasking of HRH cadres Paramedic (pharmacist) - Changing the curriculum to suit all levels of care
- Professional councils for all HRH cadres
Dentist - Establish new training institutes Other - Create a new cadre (LMP)
specifically for underserved areas
Doctor - Develop socio-cultural competence in HRH Nurse - Improving the training of nurses
Paramedic (pharmacist) - Task-shifting and multi-tasking Non-cadre specific - Task-shifting and multi-tasking of HRH cadres in underserved areas
Non-cadre specific Create a new HRH cadre
2017 Doctor - Establish new training institutes
- Increase the number of seats in existing institutes
- Task shifting and sharing
- Create a new HRH cadre
- Recruiting HRH from foreign countries
- Reducing emigration
- Reduce attrition
Doctor - Establish training institutes in underserved areas
- Mandatory rural posting
- Remove administrative barriers in recruitments
- Increase production in underserved areas
- Tele-consultation
- Providing financial and non-financial incentives
- Identify individuals/groups motivated to work in underserved areas
- Task shifting and multi-tasking of HRH cadres in underserved areas
- Reduce professional isolation
- Develop information systems and tools to measure and monitor the geographical distribution of HRH
Doctor - Emphasize socio-cultural aspects in the medical curriculum
- Mandatory rural posting
- Create appropriate cadre-mix
- Create and deploy HRH representative with the composition of society in terms of sex, caste religion, etc
- Pre-posting regional training (induction training)
Doctor - Improving the training of HRH cadres
- Standard licensing exam for all cadres
- Continued medical education and training to HRH
- Develop interpersonal/ soft skills in HRH cadres
- Changing the curriculum to suit all levels of care
- Give performance-based incentives
- Regular assessment of in-service staff
- Patient feedback and grievance redressal system
- Conduct meetings to review common medical errors
Nurse - Create a new HRH cadre
- Establish new training institutes
AYUSH Expand cadres with high local acceptance preferentially
Other - Task shifting and multi-tasking of HRH cadres
- Create a new HRH cadre
- Establish new training institutes
- Task shifting and task sharing
- Increase the number of seats in existing institutes
- Develop information system tools to measure and monitor the availability of HRH
Paramedic (pharmacist) - Task shifting and multitasking of HRH cadres in underserved areas
- Increase production of HRH in underserved areas
Paramedic (pharmacist) - Expand cadres with high local acceptance preferentially
- Deploy HRH in the local community
Nurse - Improving training of HRH cadres
- Professional councils for all HRH cadres
- Continued medical education and training to HRH
Paramedic (pharmacist) - Increase the number of seats in existing training institutes,
- Task shifting and task sharing,
- Develop tools to measure HRH (by IPHSe norms)
AYUSH - Streamline and integrate traditional HRH in underserved areas
- Tele-consultation
- Task shifting and multi-tasking of HRH cadres in underserved areas
Nurse - Expand cadres with high local acceptance preferentially Other - Improving training of HRH cadres
- Formal training courses for unqualified HRH
- Standard licensing exam
- Professional councils
- Develop interpersonal/ soft skills in HRH cadres
Non-cadre- specific - Develop information system and tools to measure and monitor availability of HRH
- Establish new training institutes
- Increase number of seats in existing training institutes
Other - Increase production of HRH in underserved areas
- Task shifting and multi-tasking of HRH cadres in underserved areas
- Remove administrative barriers in recruitment
- Identify groups/individuals motivated to work in underserved areas
- Create HRH cadre specifically for underserved areas
ANM - Expand cadres with high local acceptance preferentially Non-cadre- specific - Continued medical education and training to HRH
- Establish policy/ rules for promotion, transfer, leave, salary, etc. for all HRH cadres
- Develop interpersonal/ soft skills in HRH cadres
- Professional councils for all HRH cadres
- Changing curriculum to suit all levels of care
ANM - Task shifting and multi-tasking of HRH cadres in underserved areas Other - Create HRH closer to community -Expand cadres with high local acceptance preferentially
- Task shifting and multi-tasking of HRH cadres
AYUSH - Changing curriculum to suit all levels of care
- Professional councils
Nurse - Task shifting and multi-tasking of HRH cadres in underserved areas
- Create new HRH cadre specifically for underserved areas
Paramedics (pharmacist) - Changing curriculum to suit all levels of care
- Professional councils
Non-cadre-specific - Provide financial and non-financial incentives Dentist - Professional councils for dentist
  1. HRH Human Resources for Health, NHPI National Health Policy of India, AAAQ availability, accessibility, acceptability, quality, aOther includes mid-level practitioners, community health workers, and multi-purpose workers. bNon-cadre-specific recommendations apply to all HRH cadres. cAYUSH: Ayurveda, Yoga, and Naturopathy, Unani, Siddha and Homeopathy, dLMPs: Licentiate Medical Practitioners, eIPHS: Indian Public Health Standards