Regulação das profissões de saúde na Índia
| Autor | Dharmesh K. Lal |
| Cargo | Graduado pelo Conselho Nacional; pós-graduado em Medicina; bacharel em Medicina e Cirurgia. Especialista nacional em Capacitação e Garantia da Qualidade da Fundação Nacional de Saúde da Índia (Public Health Foundation of India). Nova Délhi |
| Páginas | 87-130 |
Tema em Debate / Artigo Original
R. Dir. sanit., São Paulo v.19 n.2, p. 87-130, jul./out. 2018
DOI: https://doi.org/10.11606/issn.2316-9044.v19i2p87-130
Dharmesh K. Lal1
REGULATION OF HEALTH WORKFORCE IN INDIA*
Received: 06/03/2018. Reviewed: 09/13/2018. Approved: 09/20/2018.
1Public Health Foundation of India. New Delhi, India.
*Original paper developed in the scope of the research “Institutional arrangements for mediation of the different
institutions of regulation of health workforce in Brazil: legal-administrative itinerary of creation of new health
professions and improvement of the Chamber of Regulation of Work in Health / MS”, held by the Center of Study
and Research in Health Law (Cepedisa) in 2018.
88
Lal K. D.
R. Dir. sanit., São Paulo v.19 n.2, p. 87-130, jul./out. 2018
ABSTRACT
Health workforce regulations are central to achieving health objectives, ensuring high and
safe standards of healthcare. e health workforce regulation needs to ensure quality of
education, infrastructure and continual maintenance of professionals’ standards across all
health professions. ese measures also assure the public, other stakeholders, and practi-
tioners that all the concerns about standards of the workforce will be addressed in trans-
parent and consistent manner. Broadly the regulations consist of policy making, admission
guidelines to the dierent health professional courses, dening and regulating education
standards through controlling the qualications and expertise of the faculty, teaching
institutes required infrastructure, maintenance of a register, continuous upgradation and
regular assessment of professional skills as well as monitoring the quackery-practice by
unqualied people, investigating and dealing with problems in relation to the conduct,
health or performance of registered practitioners. Healthcare in India is provided by a
variety of groups with varying skill levels, across a range of systems of medicine both in
the public and private sector and there are regulatory bodies for doctors, dentists, nurses
and pharmacists. is paper presents India´s Health Workforce Regulatory Model, iden-
tifying its main institutions and regulatory mechanisms.
Keywords
Health Workforce; Health Workforce Regulations; India Health System; Universal Health
Coverage.
RESUMO
A regulação das prossões de saúde é crucial para atingir os objetivos nessa área, garantindo
atendimento de alto padrão e segurança. As regulamentações sobre as prossões de saúde
precisam assegurar a qualidade da educação, infraestrutura e a manutenção continua dos
padrões prossionais em todas as prossões de saúde. Estas medidas também asseguram ao
público, outras partes envolvidas, e prossionais de que todas as preocupações sobre os padrões
dos prossionais serão tratadas de forma transparente e consistente. Em termos amplos as
regulamentações consistem na criação de políticas, regras de admissão para os diferentes
cursos para prossionais de saúde, denição e regulação dos padrões educativos através do
controle das qualicações e expertise dos docentes, a infraestrutura exigida das instituições
de estudo, a manutenção de registros, melhoramento contínuo e avaliação das habilidades
prossionais, bem como o monitoramento das práticas integrativas e complementares de
saúde por pessoas sem qualicação, investigando e resolvendo problemas relacionados à
conduta, saúde ou desempenho dos prossionais registrados. Na Índia o atendimento médico
é fornecido por uma variedade de quadros com variados níveis de conhecimento, em variados
sistemas médicos, tanto no setor público quanto no privado e existem organismos normativos
para médicos, odontologistas, enfermeiros e farmacêuticos. Este artigo apresenta o Modelo
Normativo das Prossões de Saúde na Índia, identicando suas principais instituições e
mecanismos normativos.
Palavras-Chave
Cobertura Universal de Saúde; Prossões de Saúde; Regulação das Prossões de Saúde;
Sistema de Saúde da Índia.
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Regulation of health workforce in India
R. Dir. sanit., São Paulo v.19 n.2, p. 87-130, jul./out. 2018
Introduction
As per Indian Census 2011, India has a population of 1.2 billion people and
31.16% of its population resides in urban areas. e governance of the country is
carried out by a combination of various states, Union Territories, and Union gov-
ernment at the top, as the federal governance structure.
Constitutionally there is clear segregation of powers between Union and
states’ Governments to avoid the encroachment of each other functions, duties and
responsibilities1,2. Various roles and functions of Union and State Governments are
written in three lists as detailed in the Seventh Schedule of the Indian Constitution:
Union List, State List and Concurrent List. Largely, the Union List consists of subjects
of national importance, such as Defense, Railways, External Aairs etc.; while the
State list consists of subjects of local interest such as Police, Law & Order, Water and
Health, being the last one of the most important subjects of it, and the Concurrent
list consists of subjects important to both Union and State governments, like Electric-
ity, Economic & Social Planning and, important for this paper, Medical Education.
Organizationally, for health governance there is Ministry of Health and
Family Welfare (MOHFW) at national level, and similarly at every state level. As
health is subject to the State, every state needs to provide budget for its own health
delivery system including the infrastructure development, even though the Union
government also provides additional budget from its own funds to states for various
health programs, also known as National Health Programs (NHPs) and other cen-
trally sponsored projects. e Union government through MOHFW also formulates
policies like the National Health Policy, National Population Policy, operational
guidelines, the Monitoring and Evaluation Plan and implementation strategies for
NHPs and other such projects.
India’s health services consist of public and private healthcare providers,
charitable trusts, non-government organizations and informal practitioners, cong-
uring a mixed healthcare system3,4. However, most of the private healthcare providers,
as in most countries, are concentrated in urban India, providing a second and third
higher level of healthcare services. Public healthcare system that is totally run by
governments has been developed in rural India uniformly, across the country with
overarching District hospitals in each district headquarter. However, urban health
1INDIA. Ministry of Home Affairs. . Rural urban distribution of population. Available at:
in: 14 May, 2018.
2INDIA. Governance & Administration. Available at:
3SHEIKH, K.; SALIGRAM, P.S.; HORT, K. What explains regulatory failure? Analysing the architecture of health care
regulation in two Indian states. , v. 30, n. 1, p. 39-55, Feb. 2015. 10.1093/heapol/czt095.
4
in India.
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