Strengthening nursing and midwifery for enhancing health care services in India

The density of health workers, in terms of numbers of doctors, nurses and midwives per 10,000 population, have always told us that India has far less nurses and midwives than needed. Measures such as the integration of ASHAs into the health workforce, and families providing subsitute bedside nursing care in hospitals, hide some of this acute shortage in the public health system. The recommendations should start at the highest level within the ministry of health and family welfare, the DGHS, and in most state health & family welfare and medical directorates, starting with the inclusion of more nurses or midwives in decision making and filling of all required high-level nursing and midwifery positions by nurses and not held ad hoc or officiating by doctors. Nearly 10 years on, now I take this opportunity to reassess progress on HRH in nursing and midwifery and to see what processes are in place and explain why progress has been held back despite recommendations made for better career advancement, monetary rewards and additional training and responsibility suggested for these vital professionals within our mixed health system. Although public sector doctors in many states doctors can practice or are provided an additional non-practicing allowance many still chose to work in the private sector where they have more control over their incomes through complex incentive system in the health care industry which highlight the doctor as the leader of the health team and creator of revenue.