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3.3.4 Human resource management Linked to the lack of strategic planning and monitoring are failures in staff training and recruitment. According to recent surveys, almost half of all doctors in district hospitals, 90% of staff in community health centres, and 80% of staff in primary health centres need additional training (Chow et al. 2007). Shortages of nursing and midwifery staff are supposed to have been addressed by increasing the number of training places, but this programme is behind schedule (NRHM 2007c). Opportunities for in-service training are few (Rao Seshadri and Subramaniyam 2007), and the quality of much clinical training, especially for nurses, is doubtful (NCMH 2005; NRHM 2007c). Once in post, staff in many states have been poorly managed; most doctors, for example, have no contracts, terms of reference, or clear lines of accountability. Few states have had an effective system for monitoring the performance of clinical staff. Rates of absenteeism are notoriously high. In one survey, absenteeism among doctors ranged between 66% (Bihar) and 28% (Madhya Pradesh), with no reason being given for the majority of absences (Das and Hammer 2005) (Figure 3.2). FIGURE 3.2 ABSENTEEISM AMONGST DOCTORS BY STATE & REASONS FOR ABSENCE, 2003
Source: Das and Hammer 2005