Human resources and infrastructure ▪ Shortage of infrastructure and human resources
▪ Inequitable distribution
▪ Health Sub-centres (HSCs) led by one or two Auxiliary nurse midwife (ANM) who has focus on Mother and child services
▪ Narrow range of skills and services at lower level PHC facilities ▪ Provision of Mid-level healthcare provider (MLHP), trained in 6-month course at AB-HWCs to address common health problem
▪ Institutional strengthening for increased annual production of MLHP
▪ Task shifting to different cadre of healthcare providers and team-based service delivery
▪ Proposal to change the roles of ANMs as multi-purpose workers (female) or MPW- F
▪ Services at the HWC-HSC, to be delivered through a team, led by a new cadre of non-physician health worker, a MLHP or CHO, supported by one or two multipurpose workers, and ASHAs
▪ Shift from doctor centric facilities to a team-based service delivery where provision of providers is dependent upon service need
▪ AYUSH providers to be mainstreamed in PHC systems ▪ Recruitment of contractual providers in the system
▪ Flexibility to states in salary for HR, under NHM to ensure recruitment
▪ Institutionalize the mechanisms for training of MLHP
▪ Consider an All India cadre of specialist doctors to tackle shortage of specialist doctors & that of public health specialists
▪ Innovation in human resources including incentives to recruit and retain