Man power planning

INTRODUCTION:-
• Indian healthcare industry slated to become a $ 75
billion industry by 2012 and medical tourism
reaching $ 2 billion in the same span
• Huge investments are being pumped
• But where are the experts to take the healthcare
industry ahead?

THE PLANNING COMMISSION REPORT 2008
• High demand for Indian healthcare professionals
around the world
• India faces a shortage of about
• Six lakh doctors, 15 lakh nurses, two lakh dental
surgeons and large numbers of paramedical staff.

• Indian nurses are in great demand
• Europe is experiencing a severe shortfall
• Healthcare experts estimate the requirement to be
anywhere between 30,000 to 50,000. In Britain alone,
there is an immediate demand for 18,0000 nurses.

EXPERTS SAY
• The geriatric population across Europe is on the
rise
• High hospitalizations cost
• lack of family support systems is forcing the
geriatric population to seek the services of
private nurses.

EXPERTS ALSO FEEL
• The overseas boom might hit the domestic
healthcare sector infrastructure
• Mass exodus leaving hospitals in India wanting for
qualified, trained nurses
• Career development facility for nursing personnel is
very minimal in India

Central Bureau of Health Intelligence 1993
• Very few nurses in India get three promotions in
their whole service career.
• The nurse population ratio in India in 1993 was one
nurse to 2,198 people, while the ratio in developed
countries ranged from 1:150 to 1:200.
• Further, while in western countries there were
average two to three nurses to a doctor, the doctor
nurse ration in India was almost 1:1.5.
• The study group noted that the requirement of
general nurses by the end of ninth five year plan
would be around 15 lakh.

HEALTH MANPOWER PLANNING:-
ACCORDING TO DEV RAY
"A health manpower plan is meant to ensure that the
right number and quality of manpower are available
to staff the health facilities as the needs expand, so as
to keep up with current and future demands of
services from the people".

The WHO Chronicle States:-
"Manpower Planning is concerned with
organizing, in systematic fashion, the goals,
objectives, priorities and activities of manpower
development in order to ensure that the right
number of staff with the appropriate skills are
provided at the right time to meet the
requirements of the work to be done".

NEED OF MANPOWER PLANNING:-
• A developing economy needs high-level technical
manpower as urgently as it needs capital.
• A crucial factor in improving the coverage and
quality of health services is the availability of
adequate number of health personnel with task-
oriented training.

Health service planning, health manpower planning in
India has not received adequate attention.
• Little attempt to assess the requirement in
manpower and to match health manpower
production with requirement.
• Production of physicians and specialists has been
more than the estimated requirement, dental and
Para-professional manpower production has lagged
far behind the present and projected needs.

Its technique of correcting imbalances between the
manpower demand and manpower supply in the
economy.
Such imbalances can create either the problem of
unemployment or shortages. Both situations are
dangerous and suicidal for the socio-economic
development of a country.
Effective health manpower planning is a vital
national responsibility because on it largely
depends the success of all other health activities

ADVANTAGES OF MANPOWER PLANNING: -
1. It is useful both for organization and nation.
2. It generates facilities to educate people in the
organization.
3. It brings about fast economic developments.
4. It boosts the geographical mobility of labor.
5. It provides smooth working even after expansion of
the organization.
6. It opens possibility for workers for future
promotions, thus providing incentive.
7. It creates healthy atmosphere of encouragement
and motivation in the organization.
8. Training becomes effective.
9. It provides help for career development of the
employees.

STEPS IN MANPOWER PLANNING
1. Predict manpower plans
2. Design job description and the job requirements
3. Find adequate sources of recruitment.
4. Give boost to youngsters by appointment to higher
posts.
5. Best motivation for internal promotion.
6. Look after the expected losses due to retirement,
transfer and other issues.
7. See for replacement due to accident, death,
dismissals and promotion

FACTORS WHICH AFFECT THE EFFICIENCY
OF LABOR: -
1) Quality and rate of physical as well as mental
development, which is dissimilar in case of different
individuals is the result of genetic differences.
2) Climate: Climatic location has a definite effect on
the efficiency of the workers.
3) Health of worker: worker’s physical condition plays
a very important part in performing the work. Good
health means the sound mind, in the sound body.
4) General and technical education: education
provides a definite impact on the working ability and
efficiency of the worker.
5) Personal qualities: persons with dissimilar personal
qualities bound to have

5) Definite differences in their behavior and methods
of working. The personal qualities influence the
quality of work.
6) Wages: proper wages guarantees certain reasons in
standard of living, such as cheerfulness, discipline
etc. and keep workers satisfy. This provides
incentive to work.
7) Hours of work: long and tiring hours of work
exercise have bad effect on the competence of the
workers.

PERQUISITES OF MANPOWER PLANNING:-
Step1
Job Analysis / job design - Management must define what
work to be performed, how tasks to be carried out and
allocated into manageable work units (jobs)
Step 2
Job description & job specification: It refers to incumbent
where a job specification with regard to qualification and
experience needed to perform a job
Step 3
Forecasting procedures: Corporate planner has to forecast
the number of people needed for a particular job. It can be
done by forecasting the internal supply and external supply
of the people who can perform the job
Step 4
Internal Supply of Manpower: Identifying the manpower
internally.

INGREDIENTS OF HEALTH MANPOWER PLANNING
1) Long 'Lead Time' between the Need and Supply of the
Health Manpower
"For a profession such as Nursing, even a ten-year planning
period is insufficient. Decision made in year one can begin to
affect supply only by year eight or nine“
2) High Cost of Training Health Personnel
Budget of health services is cost of training and retention
of staff.
Data from various sources indicate that the expenditure on
the establishment of health personnel in many
countries ranges between 60-70 per cent of the cost of
delivering health services.
The cost of educating a Nurse ranges between US $ 50,000
and US $ 80,000 depending upon the socio-economic
conditions in the country and In India, it is estimated
that the cost of training an under-graduate Nurse is
Rs. 500,000

3) MIGRATION OF PHYSICIANS AND NURSES
In 1991 that there were at least
140,000 physicians and 135,000 nurses working
outside their country of birth, citizenship or training.
The most affected countries in this regard are India
and the Phillipines, each with over 10,000 physicians
abroad. Other countries suffering heavy losses are
Ireland, Iran, Pakistan, Bangladesh and the
Republic of Korea, all with over 3,000 physicians
abroad.
Brain drain from one country is another country's
brain gain.
What is the impact of this migration on the health
manpower planning machinery in a developing
country?

THE POLICY IMPLICATIONS
• Reform the professional system so that the right skills in
the right proportions are produced
• Send abroad only those students for whom specialized
training at home cannot be provided and whose
specialties will be directly applicable on their return.
Besides, the health manpower planning units should
discourage the migration through:
(a) Fostering of national loyalties and ideals of service;
(b) Opening of new avenues to retain qualified and
competent personnel
(c) Strict legislation to stop migration
(d) Strict legislation to serve in the country while granting
fellowship to study abroad.

(5) Individuals with Differing Skills may not be
easily Substituted
Health is highly specialized. It is not possible to
substitute any health expert in an other's place.
They are to be substituted only by the personnel of the
same specialization. Sometimes,
It happens that in a hospital two physicians are
provided but no surgeon. One cannot substitute the
other. This becomes very serious in the case of
teaching-cum-research institutions.
The manpower planning units must attend to this
difficulty and avoid overgrowth or undergrowth in
any branch of specialization.

(6) TEAM WORK
Most of the health workers are working in
isolation, i.e., their activities are not coordinated
properly resulting in lower output of services.
The health workers should form part of health
manpower planning system.

(7) Coordination among the Public, Private and
Voluntary Health Sectors
Health services are being provided through public,
private and voluntary agencies. It is very difficult to
control the personnel policies of the private and
voluntary sectors.
Private sector is helping a great deal in the promotion
of health. The health manpower planning unit must
take into consideration the personnel of all the
sectors und not concentrate only on the public
sector.

(8) Feed-back System
Feed-back is important to remove the defects of
health manpower planning. In developing
countries, there is no machinery to develop the
health manpower plans on scientific lines.

(9) New Patterns and a Variety of Approaches
• The concept of health manpower planning is still in
its infancy.
• The health departments in the developing countries
pay little attention to this aspect.
• We will have to find new structures, new patterns
and a variety of approaches to develop health
manpower planning suiting the requirements of the
developing countries.
• We must encourage applied researches to find the
solutions to the problems of health manpower
development. The association of social scientists
interested in health care administration would be a
step in the right direction.

DEVELOPMENT OF HEALTH MANPOWER
PLANS:-
• Three main elements of the health manpower
development process—
• Planning, Production and Management of health
manpower.

(1) Linking Health Manpower Plan with the Health
Policy and Plan
To develop health manpower plan is to link it to the health
policy and plan of the country.
It may also be kept in mind that health manpower
planning cannot be divorced from the national socio-
economic and health plans

(2) Assessment of the Health Manpower Situation
(a) The system—public, private and voluntary.
all types of health care system— Allopathic. Ayurvedic,
Homeopathic, and Nursing.
(b) The organization of health services, the number, size and
geographical distribution of each category of service,
agency or institution; the programmes of each category
(c) The health manpower available to each category, sex,
level of training, type of functions ( administration,
teaching, direct care, etc.).
(d) The deployment of health manpower, i.e. staffing patterns.
(e) The adequacy of education and training,
(f) The utilization of health personnel, i.e. how far health
personnel are utilizing their time for providing
health/medical services.

(g) The number of vacant positions existing in the services.
(h) The health manpower policies of employing
institutions, since such policies affect not only current
recruitment but also future health manpower.
Information may be obtained on policies relating to such
matters as hours of work, age of retirement, salaries and
benefits, recruitment and appointment, the creation of new
positions, career possibilities.
(i) For education and training programme in training
institutions, information is needed on the following :
admission requirements; number of students passed for the
last five years; total number of students in training, by class;
student attribution rate; number of students that could be
admitted to each class for each year with current facilities of
teachers; number and kinds of full-time and part-time
teaching staff; facilities used for part-time clinical practice;
students' maintenance and other operational costs and
adequacy of the buildings and equipment.

(3) Classification & Interpretation of Information (Health
Situation)
The information collected must be classified or
arranged so as to facilitate analysis in terms of
percentages, proportions, ratios, etc., as such
analysis can provide information regarding the
number of health personnel per given unit of
population or the ratio of one type of health
personnel to another, i.e. ratio of nurses to
physicians, etc. and mortality and morbidity in the
various areas of the country in relation to the health
manpower.

(4) Up-Dating of Information
Means for keeping manpower information
up-to-date is an important part of health
manpower planning

(5) Developing Professional Standards or Norms
Uniform units of measurement, prevailing practices
or average levels of attainment; or goals or
descriptions of the desired state of affairs.

Supply of Health Personnel :-
Making arrangements for the preparation of
health personnel

(6) Research Studies
Carry out research to measure the utility of health manpower
planning.
The studies can be in the form of case studies. On the basis of
these studies, future changes can be advised.
The Government of India set up an Institute of Applied
Manpower Research in 1962.
It is an autonomous institute devoted to research in the field of
manpower planning.
During the period of its existence, the institute has conducted a
number of useful and stimulating studies pertaining to
manpower utilization, forecasting demand and supply of
various categories of manpower and coordinating the
training and educational facilities with the manpower
requirements of our plans

CAUSES OF THE LACK OF PROPER HEALTH
MANPOWER PLANNING:-
(a) Failure to consider the political framework;
(b) Lack of coordination between the services and training
institutions;
(c) Fragmentation of health services among multiple
administration and agencies;
(d) Uncoordinated use of resources—manpower, materials
and money;
(e) Organizational rigidity
(f) Lack of appreciation of planning and what it entails;
(g) Lack of involvement of the planners in the
implementation of their plans.

RECOMMENDATIONS AND CONCLUSIONS
(i) Eliminate haphazard growth of health personnel; there
should be adequate manpower planning, so that there is
logical forecasting of the manpower needs at least ten
years in advance. It should be related to the health
plans and health policy.
(ii) It is essential that the health organizations should have
a declared and well accepted personnel policy.
Manpower planning like health planning, is a
continuous cyclical process with constant reviews and
adjustments being made to ensure that the health service
goals and manpower demands are matched by an
appropriate supply of staff.

(iii) This declared personnel policy must be developed by
a staffing section at headquarters or comparable . It
would be quite desirable if the academic guidance may
be sought from NIHFW and the universities.
(iv) The staffing section must be under the charge of a
duly qualified and trained personnel officer. It is often
forgotten that manpower planners, as well as health
planners must acquire special skills, not only through
experience but also by learning the principles and
theories.
(v) Manpower planning should be based on a proper-mix
of different categories of health workers. This proper-
mix should be determined by the health policy and the
socio-economic status of the country. They must have
special aptitude and motivations if they are to be
effective.

(vi) While formulating the personnel policy, internal as
well as external sources may be explored. To
supplement the internal data, the administration must
collect information from external sources, e.g.
associations/unions of employees.
(vii) There is a need of proper classification of health
personnel so that their duties and responsibilities may
be clearly demarcated. The ambiguity in this sphere
results in confusion,
(viii) Manpower planning should ensure optimum
utilization of the
capacity of the existing personnel.

(ix) Need to provide proper motivation which can help the
employees for the maximum optimization of goods and
services. This would require judicious decentralization,
delegation, job enlargement and proper system of
performance appraisal.
(x) Health manpower planning should be relevant to the
existing disease pattern.
(xi) Manpower planners must be involved in
implementing their plans. The separation between
planning and implementation must be broken down if
plans are to be successfully converted into reality.
(xii) Health manpower planning should not concentrate on
the personnel and training resources of the public sector
only but also lake into account the private sector and
voluntary sector.

(xiii) The entire efforts in the field of health manpower
development should be directed towards making the
manpower relevant to the needs of the health services
which should also be reoriented to provide wider
coverage to the rural people and the under-served urban
poor.
(xiv) Training programmes for health manpower should
be formulated to make them need-based, task-oriented
and relevant to specific situations where the trainees
will work and apply their skills.
(xv) More emphasis should be laid on the training and
utilization of auxiliary and primary health workers
rather than on the classical 'categories' of health workers
(doctors, nurses, etc.).

REQUIREMENT IN NURSING
Some step to be taken in projecting staffing need
include
1) Identify the components of nursing care &
nursing services
2) Define the standards of patient care to be
maintained
3) Estimate the average number of nursing hours
to be provide by registered nurses & other
nursing services personal (RN)

REQUIRMENT AT DIFFERENT LEVEL
Hospital in that Requirement of the Nurses
Mildly ill – Minimum dependency needs ,1:6 or 1:10
Moderately ill – in 24 hours ,nurses patient ratio of
1:3 in teaching hospital
Acute ill – life saving priority or bed ridden,
1:1,2:1 nurses patient ratio

STAFFING IN EDUCATIONAL SETUP
• For nursing school & college requirement
• 50 student – 5 teacher (2 M.Sc + 3 B.Sc)
STAFFING IN ADMINISTRATION SET UP –
chief nurses but not in an executive position
Community Level – district level no chief
nursing officer but either district public health
nurses
State level – one nurses either superintendent of
nursing services or assistant director
nursing ,majority of state have no second
nurses at the state level .

CENTRAL LEVEL
• Chief nurses is called nursing advisor under the
deputy director general (DGHS)
• She /he assist her under assistant commissioners
training in rural division of the ministry of health &
family
• In ENGLAND & WALES has 60 nursing officer at
the center and SCOTLAND had 10 nursing officer
for planning & programming for their respective
part of the community.

ACCORDING TO INC
• There were over 1.28 million registered nurses
in 2002.
PLANNING COMMISSION SAYES
• ideal population of nurses should have been
2,188,890 in 2007,at present there are only
1,156,137 nurses.
• Private companies should to allowed open
nursing colleges, other barrier such as land &
built up area space should be brought down to
realistic level

ACCORDING TO NINTH PLAN
• Nursing education & nursing service have been give
a high priority in order to bridge the large gap
between requirement & availability of nurses
• Efforts will be made to meet the increasing demand
for nurses with specialized training in specialty and
sub social area

FUTURE PLAN
Appreciating the role of nurses in the health care system
President MRS.PRATIBHA DEVI SINGH PATIL has
called for bridging the gap between the existing and
requirement of nursing personal

FUTURE PLAN………..
11th
year planning commission give importance through
NRHM FOR NURSES IS That
- A dedicated nursing & man power planning division
should be established the center & state level
- All medical college should be established a college of
nursing courses (BSC,MSC,DIPLOMA)
- All district hospital should be mandated to establish a
school of nursing offering ANM & GNM

FUTURE PLAN……………………
• Smaller hospital in public sector having at
least 30 OBG beds should encouraged to
start ANM training

Health manpower planning should therefore
be considered as an endless process
producing successive approximation and
not simply as an event ending up with a
report.

BIBLIOGRAPHY
BOOKS
S.L Goel .Health Care Management & administration .New Delhi;
Deep& deep publications; 2004 pgno 117-137
Eleanarj sullivan .Phillip j d .Effective Management in
Nursing:california; Addison –wesly;1992 pg no123-145
Baker TD: Dynamics of Health Manpower Planning, Medical
Care 4, No. 4 (1966) pp. 205-211.
Brekke, D and Liebman, M: Health Manpower Planning Process,
Mimeographed August, 1974.
McClendon B J: Health Manpower Linkage Systems, Paper
presented at the National Association for Regional Medical Programs
Annual Meetings, September, 1975.
Snoke W, and Glasgow JM: Regional Planning: Pious Platitude
or Practical Implementation, Inquiry 7, No. 3 (September, 1970) pp. 17-
25.

• Abt Associates. A Methodology for Studying
Linkages for Health Manpower Education Planning
and Decision Making,
• DHEW, Health Resources Administration,
Rockville, MD,March, 1975.

Man power planning

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Man power planning