• Of a total population of 1 028 610 328 in 2001, there were 2 069 540 health workers of which 819 475 (or 39.6%) were doctors,
630 406 (or 30.5%) were nurses and midwives, and 24 403 (or 1.2%) were dentists. Of all doctors, 77.2% were allopathic and 22.8% were ayurvedic, homeopathic or unani. Other categories of health workers were pharmacists, ancillary health professionals, and traditional and faith healers, who comprised 28.8% of the total health workforce. There are nine separate health worker categories in this
study.
• The national density of doctors was 79.7 per lakh population, of nurses and midwives 61.3 per lakh, and of dentists just 2.4 per lakh.1
• There were 1 225 381 health workers in urban areas and 844 159 in rural areas, an urban–rural ratio of 1.45. Of all health workers, 59.2% were in urban areas, where 27.8% of the population resides, and 40.8% were in rural areas, where 72.2% of the population resides. The ratio of urban density to rural density for doctors was 3.8, for nurses and midwives 4.0, and for dentists 9.9.
Male–female ratios
• Of all health workers 38.0% were female. The male–female ratio of all heath workers was 1.6, of doctors 5.1, and of nurses and
midwives 0.2.
• Among allopathic doctors, as many as 31.4% were educated only up to secondary school level – and as many as 57.3% did not have a
medical qualification. Among nurses and midwives, 67.1% had education only up to secondary school level.
• The education level and medical qualification of urban doctors were much higher than those of rural doctors. Among allopathic doctors, 83.4% of urban doctors had higher than secondary schooling compared to 45.9% of rural doctors. Of urban allopathic doctors 58.4% had a medical qualification, whereas only 18.8% of rural allopathic doctors had one.
• In every health worker category except “ancillary health professionals”, a higher proportion of female than male health workers were educated to more than secondary school level. In every health worker category, a higher proportion of females had a medical qualification than males. Among allopathic doctors, 67.2% of females had a medical qualification compared to 37.7% of males. Among nurses and midwives (hereafter referred to as “nurses”), 11.3% of females had a medical qualification compared to 2.9% of males.
For certain categories of health workers, there were very high concentrations in particular states. West Bengal had 30.6% of all homeopathic doctors in the country but only 7.8% of the population. Uttar Pradesh had 37.5% of all unani doctors in the country with 16.2% of the population. Maharashtra had 23.0% of the country's ayurvedic doctors with 9.4% of the population. Kerala had 38.4% of the country's medically qualified nurses but only 3.1% of the population.
• Although nationally 22.8% of all doctors were ayurvedic, homeopathic or unani (hereafter referred to as “AYUSH”), in some states the fraction of AYUSH doctors was much higher: 41.7% in Tripura, 40.5% in Orissa and 38.1% in Kerala.
• There is some suggestion of substitution between nurses and doctors within states. There is a negative Pearson correlation coefficient across states of –0.60 between the percentage of nurses in the health workforce of a state and the percentage of doctors.
• The density of all health workers in a state was positively but imperfectly correlated with the per capita income of the state (correlation coefficient of 0.76). Better-off states seem to afford more doctors plus nurses per capita (correlation coefficient 0.92), and more dentists per capita (correlation coefficient 0.93).
• There was a 6-fold interstate differential between the highest and lowest density of all health workers; for health workers with more than secondary schooling this differential was 10-fold, and for health workers with a medical qualification it was 20-fold. Similar interstate
differentials were observed for individual health worker categories.
• The percentage of all health workers in the country who were female was 38.0%, but there was great variation across states. The states with the highest share of female health workers were Kerala (64.5%) and Meghalaya (64.2%), and the states with the lowest were Uttar Pradesh (19.9%) and Bihar (22.3%).
Interdistrict differentials in India
Interdistrict inequality in health worker densities
• Interdistrict inequality in health worker densities across the country's 593 districts is indicated in this study by the Gini coefficient. For all health workers, the national interdistrict Gini was 0.29, but it was higher for each of the nine individual categories of health worker.
• The interdistrict Gini for a health worker category increases as we restrict the category to those with more than secondary schooling and further restrict it to those with a medical qualification. For example, for allopathic doctors the interdistrict Gini is 0.31; it is 0.37 for those with more than secondary schooling, and 0.49 for those with a medical qualification. For nurses the interdistrict Gini increases from 0.40 to 0.43 to 0.75. For dentists the Gini increases from 0.56 to 0.61 to 0.70.
• This study contains tables of the lowest 30 and highest 30 districts ranked by health worker density. Similar tables are provided for
districts ranked by density of health workers with more than secondary schooling and those with a medical qualification.
• Among the lowest 30 districts ranked by density of allopathic doctors, half are in north-eastern states and the remainder are in central states. The lowest 30 districts ranked by density of allopathic doctors with a medical qualification are found mainly in the states of Uttar Pradesh, Bihar and Madhya Pradesh
