Tiwari Ritika, Negandhi Himanshu, Zodpey Sanjay
Symbiosis International (Deemed University), Pune, India.
Indian Institute of Public Health - Delhi, Public Health Foundation of India, New Delhi, India.
WHO South East Asia J Public Health. 2019 Apr;8(1):56-65. doi: 10.4103/2224-3151.255351.
Current ambitious reforms in India mean that public health professionals (PHPs) will become an increasingly vital component of the health workforce. Despite a rapid growth in schools of public health in India, uptake of places by students without a medical background is low. This paper reports the results of an exercise to estimate the baseline supply of, and need for, PHPs in India in 2017 and to forecast possible supply-need scenarios up to 2026. Supply was estimated using the stock and flow approach and the service-target approach was used to estimate need. The additional need resulting from development of a new public health cadre, as stated in the National Health Policy 2017, was also included. Supply-need gaps were forecast according to three scenarios, which varied according to the future intensity of policy intervention to increase occupancy of training places for PHPs from a non-medical background: "best guess" (no intervention), "optimistic" (feasible intervention), and "aspirational" (significant intervention) scenarios. In the best guess scenario in 2017, i.e. with a low non-medical place occupancy of 60%, there is a supply-need gap of around 28 000 PHPs. In the absence of any intervention to increase place occupancy, this shortfall is forecast to increase to 45 000 PHPs by the year 2026. By contrast, in the aspirational scenario, i.e. with a high place occupancy of 75% for non-medical places, the baseline gap for 2017 of almost 26 000 PHPs reduces by 2026 to around 21 000 PHPs. By 2026, most new PHPs will be produced by public health training programmes offered by institutions other than medical colleges. Without significant interventions, India is likely to have a significant shortfall in PHPs in 2026. Policy-makers will have to carefully examine issues surrounding the current low uptake of non-medical public health seats and review the current framework regulating training of PHPs, in order to respond adequately to future requirements.
印度当前雄心勃勃的改革意味着公共卫生专业人员将日益成为卫生人力队伍中至关重要的组成部分。尽管印度的公共卫生学院迅速增加，但没有医学背景的学生对这些学院名额的申请率较低。本文报告了一项评估活动的结果，该评估旨在估算2017年印度公共卫生专业人员的基线供给量和需求量，并预测到2026年可能出现的供给-需求情况。供给量采用存量与流量法进行估算，需求量采用服务目标法进行估算。2017年《国家卫生政策》中提出的新公共卫生干部队伍发展所产生的额外需求也被纳入其中。根据三种情况预测了供给-需求差距，这三种情况因未来为增加非医学背景公共卫生专业人员培训名额的占用率而进行政策干预的强度不同而有所差异：“最佳猜测”（无干预）、“乐观”（可行干预）和“理想”（重大干预）情况。在2017年的最佳猜测情况下，即非医学背景名额占用率较低为60%时，公共卫生专业人员的供给-需求差距约为28000人。在没有任何增加名额占用率干预措施的情况下，预计到2026年这一缺口将增至45000人。相比之下，在理想情况下，即非医学背景名额占用率较高为75%时，2017年近26000人的基线差距到2026年将减少至约21000人。到2026年，大多数新增公共卫生专业人员将由医学院以外的机构提供的公共卫生培训项目培养。如果没有重大干预措施，印度在2026年可能会出现公共卫生专业人员的严重短缺。政策制定者必须仔细研究当前非医学公共卫生专业名额申请率低所涉及的问题，并审查当前规范公共卫生专业人员培训的框架，以便充分应对未来的需求。
