Why India’s G20 Presidency Should Bring Healthcare Workforce Upskilling Centre Stage?

India assuming the G20 Presidency is a momentous opportunity

This is particularly in the backdrop of the unprecedented challenges confronted by healthcare administrators during the recent pandemic. While the country has managed to get through the pandemic fairly successfully by now, there were nonetheless segments and issues that exposed the gaps and vulnerabilities in the Indian healthcare delivery system. And among them, apart from shortage of infrastructure and material, overburdened and under-trained healthcare staff struggling to navigate through and manage the crisis has been notable highlights. Simultaneously, the country’s medical emergency response systems had fallen short, mainly due to shortage of adequately trained personnel.

So, with India taking over the reins of leadership at G20, this is an opportune time for bringing the need for skilling and upskilling of healthcare workforce to the attention of world leaders.

India’s healthcare severely understaffed

No one can dispute the fact that there is acute shortage of sufficiently-trained healthcare personnel including doctors, nurses, healthcare attendants and workers in the country. While the doctor-population ratio hovers around 1: 834 compared to WHO standards of 1: 1000, the nurse to population ratio fares poorly at 1: 670 against WHO’s prescription of 1: 300. Similarly, according to data of doctors, India has less than 20,000 – a measly figure without doubt – trained in Pulmonology, Anaesthesiology, Critical Care and Emergency Medicine, again underlining the dire situation our emergency response systems are in. This is in a country that witnessed more than 4 lakh accident-led deaths in a year. Furthermore, the lesser said about the persistent urban-rural and big city-small city gap in terms of availability of trained personnel, the better. According to WHO, India needs at least 1·8 million doctors, nurses, and midwives to achieve the minimum density of 44·5 health professionals per 10 000 population (currently 21 per 10 000).

High disease burden, a chronic problem

Again, most surveys and reports point to India carrying an extraordinarily high disease burden for both communicable and non-communicable diseases. In terms of communicable diseases, while India accounts for 26% of global tuberculosis burden, it is the second-most AIDS or HIV-affected country. In a similar vein, for NCDs, while India carries 60% of the burden of cardio-vascular diseases globally, it has the second highest number of diabetes patients in the world. Against such staggering figures, India has chronic shortage of specialists for cancer, diabetes, cardio-vascular diseases and other non-communicable conditions.

Low participation of trained personnel as a part of active health workforce

Against this understaffed backdrop, it has been even more revealing to know that a good number of those having acquired healthcare training did not actively participate in the healthcare administration and delivery processes. Some years back, research had pointed out that the estimated stock of health workers in the country was way above what was reckoned to be working actively in the health labour market according to a Periodic Labour Force Survey. This further emphasizes the urgency for skilling and upskilling of a greater number of healthcare personnel in the country.

G20 sets the tone for addressing healthcare training deficiency

It is encouraging to know that that the Indian leadership at the G20 has sent all the right signals on its intent and focus on addressing all issues surrounding healthcare. Indeed, at the first G20 Health Working Group meeting, of the three priorities that the government has set out, Health Emergencies Prevention, Preparedness and Response (with focus on One Health & AMR) has stood out with the other two focusing on Strengthening Cooperation in Pharmaceutical Sector; and Digital Health Innovations and Solutions to Aid Universal Health Coverage and Improve Healthcare Service Delivery. And it goes without saying that achieving each of these presupposes not only training and upskilling of domestic healthcare workforce keeping in step with new technologies, tools, methodologies, best practices, and most of all, new research insights and findings adopted by healthcare personnel in advanced countries, but also concerted global effort and partnership that would be mobilized by India at the G20. The finance minister announcing the setting up of 157 new nursing colleges and dedicated multidisciplinary courses for medical devices in existing institutions in the budget further attests to the resolve of the government in this direction and even complements its own initiatives at the G20.

What more the government could do

Not withstanding the above initiatives all of which are commendable, the government could do more to train more people and increase the competency levels of healthcare workers at all levels, whether doctors, nurses and midwives, paramedics and emergency medical workers and technicians, or even non-expert attendants and caregivers.

First, it should actively draw attention of the fellow members to the need for availability of skilled healthcare personnel for all possible diseases and conditions prevailing in the country. India could share this concern and make a common cause with some of the other G20 countries. Second, having registered its need, it could push for assistance from advanced member-countries for capacity-building and expert training through health education and exchange programmes. The government could use the increasing traction in edtech and digital media platforms for facilitating this knowledge exchange and transfer. Third, the government could also encourage and incentivize Indian medical schools and institutions to collaborate with universities and research centres of other G20 members based on its needs. Fourth, apart from suitably incentivizing private health education and training providers in India, the government should impress upon fellow members to pursue similar policies in their own countries in order to make the exchange process smoother. And fifth, given the increasing role of foundational digital and internet infrastructure for knowledge and capacity transfer between countries, India could also explore pathways for cooperation for relevant technologies and equipment with member countries.

Therefore, it is but natural that if healthcare upskilling is good for India, it will also be good for the rest of the world, particularly the developing and the low-income countries. And since G20 represents global leadership, the grouping can't remain indifferent to the needs of the rest of the world. Notwithstanding G20’s original but enduring focus on matters of finance, economy and sustainable development, upskilling healthcare professionals and developing healthcare expertise in general would only serve to contribute to those objectives. Although G20 collectively constitutes two-thirds of humanity, it is Vasudhaiva Kutumbakam or One Earth, One Family, One Future, that is the overarching theme for this year under India’s presidency.