National Health Systems Resource Centre, National Institute of Health and Family Welfare, Baba Gang Nath Marg, Munirka, New Delhi, India.
Bull World Health Organ. 2011 Jan 1;89(1):73-7. doi: 10.2471/BLT.09.070862. Epub 2010 Nov 1.
The lack of skilled service providers in rural areas of India has emerged as the most important constraint in achieving universal health care. India has about 1.4 million medical practitioners, 74% of whom live in urban areas where they serve only 28% of the population, while the rural population remains largely underserved.
The National Rural Health Mission, launched by the Government of India in 2005, promoted various state and national initiatives to address this issue. Under India's federal constitution, the states are responsible for implementing the health system with financial support from the national government.
The availability of doctors and nurses is limited by a lack of training colleges in states with the greatest need as well as the reluctance of professionals from urban areas to work in rural areas. Before 2005, the most common strategy was compulsory rural service bonds and mandatory rural service for preferential admission into post-graduate programmes.
Initiatives under the National Rural Health Mission include an increase in sanctioned posts for public health facilities, incentives, workforce management policies, locality-specific recruitment and the creation of a new service cadre specifically for public sector employment. As a result, the National Rural Health Mission has added more than 82,343 skilled health workers to the public health workforce.
The problem of uneven distribution of skilled health workers can be solved. Educational strategies and community health worker programmes have shown promising results. Most of these strategies are too recent for outcome evaluation, although this would help optimize and develop an ideal mix of strategies for different contexts.
在印度农村地区，缺乏熟练的服务提供者已成为实现全民医疗保健的最大制约因素。印度约有 140 万名执业医师，其中 74%居住在城市，仅为 28%的人口提供服务，而农村人口的服务需求仍未得到充分满足。
印度政府于 2005 年发起的国家农村卫生使命，推动了各种州和国家倡议来解决这一问题。根据印度联邦宪法，各州负责实施卫生系统，国家政府提供财政支持。
在最需要医生和护士的州，由于缺乏培训学院，以及城市专业人员不愿到农村地区工作，医生和护士的数量有限。在 2005 年之前，最常见的策略是强制农村服务债券和农村服务作为优先进入研究生课程的条件。
国家农村卫生使命下的倡议包括增加公共卫生设施的核定职位、激励措施、劳动力管理政策、特定地点的招聘以及专门为公共部门就业创建一个新的服务干部。因此，国家农村卫生使命为公共卫生人员增加了 82343 多名熟练的卫生工作者。
可以解决技能型卫生工作者分布不均的问题。教育策略和社区卫生工作者计划已经显示出有希望的结果。虽然对结果进行评估有助于优化和制定不同情况下的理想策略组合，但这些策略大多还为时过早。
