A remedy to nursing shortage: IIT alumni, a clutch of NGOs filling this gap

The pandemic has drawn attention to the need for more health workers

It seems fitting that 2020, when the novel coronavirus cut swathes across the world’s population, was also designated by the World Health Organisation (WHO) as the International Year of the Nurse and Midwife. Originally done to honour the 200th birth anniversary of Florence Nightingale, it has focussed attention on the crucial role that nurses, midwives and community health workers (CHWs) like ASHAs (accredited social health activists) and ANMs (auxiliary nurse midwives) have played in handling the pandemic.

This has been particularly significant in India, where doctors are in short supply (with one servicing 1,404 people against the WHO prescribed ratio of 1:1,000) and CHWs have led the frontline effort against the pandemic. Yet, Indian hospitals and health centres remain woefully understaffed with nurses and CHWs. Overall, India has 3.07 million registered nursing personnel (nurses, midwives, women health visitors and auxiliary nurse midwives), as revealed by a government reply to a question in Rajya Sabha in March, 2020. With 1.7 nurses per 1,000 population, this number is 43 per cent lower than the WHO prescription of three per 1,000.

Enter NGOs that have twin goals of improving livelihood opportunities and public health infrastructure in far flung, underdeveloped districts. Over the years, several models of training nurses and community health workers have emerged across the country. Today, these could play a crucial role in bulwarking the country’s health infrastructure.

Here are some examples. Maharashtra-based SEARCH has trained a cadre of about 140 CHWs in 134 villages in Maharashtra’s Gadchiroli district. Most have studied up to class eight, but with capacity building and practical experience, these barefoot health personnel have over the years succeeded in bringing down the region’s infant mortality rate from 121 to 22 per every 1,000 live births (the national average is 32). “During the pandemic, our CHWs have managed deliveries, neonatal care as well as hundreds of mild Covid cases at home,” says Abhay Bang, the doctor who is the co-founder of SEARCH. As soon as the pandemic reached India, Bang and team ensured training in diagnosis (without RT-PCR tests, which are not easily available in the district), as well as in the treatment of Covid patients.

Others like Society for Nutrition, Education and Health Action (SNEHA) and PanIIT Alumni Foundation (an umbrella organisation representing alumni of all Indian Institutes of Technology) operate more formal nurse training programmes.

SNEHA’s eight-month nurse aide training programme covers over 651 slum or low income communities across Mumbai. Many of their 1,303 alumnae are now working in Covid hospitals across the city. Others provide their low income neighbourhoods access to public health services and treatment for preventable infectious diseases.

“The pandemic has increased the demand for nurses, auxiliary nurses and midwives in India,” says Kalyan Chakravarthy, executive director of PanIIT Alumni Foundation. The foundation has been successfully running a two-year residential Auxiliary Nursing Midwifery (ANM) training programme in eight centres called Kaushal Colleges with the Jharkhand government since 2018. These have trained over 2,500 young women so far. PanIIT has invested in state-of-the-art medical training infrastructure — simulators, real-life situation rooms, practicing wards and an experienced faculty.

HDFC Bank provides students with loans, which they repay after placements. “Now, we’re training them not only in managing Covid-19 and other infectious diseases but also in areas like elder care, which is in high demand,” Chakravarthy says. The foundation is hoping to tap into more corporate social responsibility (CSR) and state funding to train a further 5,000-plus public healthcare ANM nurses and the same number of existing CHWs. “This year, during placements, we had more jobs available than applicants,” he adds.

Given this demand for nurses and CHWs, health sector observers believe this is also a good time to secure better salaries and working conditions for them. The PanIIT Alumni Foundation ensures that its alumnae are paid between Rs 15,000 and 19,000, higher than the industry average of about Rs 12,500.

Their recruiters include the Apollo group, Fortis and several other government and private hospitals. “With more corporate sponsors and state partners, our model can be replicated to scale up the country’s nurse/ANM workforce,” says Chakravarthy. This will not only bolster the effort against the pandemic, but also improve patient outcomes.

A May 2021 study in The Lancet of public hospitals in Queensland, Australia, which introduced mandatory minimum nurse-to-patient staffing ratios, has found substantial evidence that patient outcomes are more favourable in hospitals with more nurses.

“The way forward is to view the coronavirus pandemic as an opportunity to upgrade and broaden the base of India’s healthcare pyramid – our nurses and CHWs,” says Chakravarthy. “The generation of more job opportunities for young women in rural India is an added bonus.”