I appreciated this article, but fear that its title masks its main points. While the availability of doctors in India is important, it’s the paradigm shift the authors list that is the real meat of the article and I would have liked for the authors to have outlined some of the gaps that underpin their paradigm shift recommendations in the article rather than dedicating so much space to the production of doctors and achievement of the WHO ratio. Having the right ratio of doctors doesn’t help if they are predominantly concentrated in urban areas and this is very much the case in India. The call the authors make for improved deployment and retention of doctors to rural areas is an important one. The call for more team-based approaches the workforce is also critical. The ratio of nurses to doctors in India is low compared with other countries and those that are trained frequently don’t graduate with adequate clinical skills and are not respected or empowered. The same goes for numerous other cadres. The over-emphasis on doctors paradoxically compromises the quality of health care. More resources need to be dedicated to training the health WORKFORCE and not just medical doctors. While the healthcare provider to population ratios are useful for advocacy and for giving countries some basic benchmarks for comparison, I agree with the authors that achieving them does not mean that countries achieve an adequate health workforce. I encourage people interested in this article to read beyond the title and especially look at Table 3 [*see note below] where their recommendations are listed.
HIFA profile: Rebecca Furth is Senior Technical Advisor at Initiatives Inc., USA. Professional interests: Human Resources for Health, Community Health Worker program strengthening, Organizational capacity building, Health systems strengthening, Culture and development. She is a member of the HIFA working group on CHWs. http://www.hifa.org/support/members/rebecca-0
[*Note from HIFA moderator (Neil PW):
Table 3 is available here (it is an image file so I am unable to cut and paste): http://www.jfmpc.com/viewimage.asp?img=JFamMedPrimaryCare_2018_7_5_841_2...
The article is available here: http://www.jfmpc.com (go to Current Issue - all direct links we have received are not working for us)