Background Human Resources for Health (HRH) are crucial for improving health services coverage and population health outcomes. The World Health Organisation (WHO) promotes countries to formulate holistic policies that focus on four HRH dimensions—availability, accessibility, acceptability, and quality (AAAQ). The status of these dimensions and their incorporation in the National Health Policies of India (NHPIs) are not well known. Methods We created a multilevel framework of strategies and actions directed to improve AAAQ HRH dimensions. HRH-related recommendations of NHPI—1983, 2002, and 2017 were classified according to targeted dimensions and cadres using the framework. We identified the dimensions and cadres focussed by NHPIs using the number of mentions. Furthermore, we introduce a family of dimensionwise deficit indices formulated to assess situational HRH deficiencies for census years (1981, 2001, and 2011) and over-year trends. Finally, we evaluated whether or not the HRH recommendations in NHPIs addressed the deficient cadres and dimensions of the pre-NHPI census years. Results NHPIs focused more on HRH availability and quality compared to accessibility and acceptability. Doctors were prioritized over auxiliary nurses-midwives and pharmacists in terms of total recommendations. AAAQ indices showed deficits in all dimensions for almost all HRH cadres over the years. All deficit indices show a general decreasing trend from 1981 to 2011 except for the accessibility deficit. The recommendations in NHPIs did not correspond to the situational deficits in many instances indicating a policy priority mismatch. Conclusion India needs to incorporate AAAQ dimensions in its policies and monitor their progress. The framework and indices-based approach can help identify the gaps between targeted and needed dimensions and cadres for effective HRH strengthening. At the global level, the application of framework and indices will allow a comparison of the strengths and weaknesses of HRH-related policies of various nations.

Background Human Resources for Health (HRH) are crucial to improve health services coverage and population health outcomes. The World Health Organisation (WHO) promotes four dimensions - availability, accessibility, acceptability, and quality (AAAQ) for HRH strengthening. Integrating AAAQ dimensions in policymaking is essential to reduce the critical shortage of HRH in India.Methods We created a multilevel framework to evaluate the incorporation of AAAQ dimensions along with strategies and actions that can improve them in HRH-related policies. HRH-related recommendations of all versions of the National Health Policy of India (NHPI) were classified according to targeted dimensions and cadres. We evaluated the extent to which NHPIs incorporated AAAQ dimensions over three decades. Furthermore, dimension-wise normalized indices were formulated to calculate HRH deficits for pre-NHPI years to assess situational deficiencies. Finally, we evaluated whether or not the HRH recommendations of NHPIs addressed the deficient cadres and dimensions for the corresponding year.Results We observed that HRH availability and quality were focused more in NHPI compared to accessibility and acceptability. Doctors were prioritized over auxiliary nurses-midwives and health assistants. AAAQ indices showed deficits in all dimensions in almost all cadres over the years. The cadres focused by NHPI recommendations did not completely correspond to the deficient cadres.Conclusion The framework and indices based method can help identify the gaps between targeted and needed dimensions and cadres for effective HRH strengthening in countries. At the global level, the application of framework and indices will allow a comparison of strengths and weaknesses of HRH-related policies of various nations.

Background: Human Resources for Health (HRH) are crucial to improve health services coverage and population health outcomes. The World Health Organisation (WHO) promotes four dimensions - availability, accessibility, acceptability, and quality (AAAQ) for HRH strengthening. Integrating AAAQ dimensions in policymaking is essential to reduce the critical shortage of HRH in India. Methods: We created a multilevel framework to evaluate the incorporation of AAAQ dimensions along with strategies and actions that can improve them in HRH-related policies. HRH-related recommendations of all versions of the National Health Policy of India (NHPI) were classified according to targeted dimensions and cadres. We evaluated the extent to which NHPIs incorporated AAAQ dimensions over three decades. Furthermore, dimension-wise normalized indices were formulated to calculate HRH deficits for pre-NHPI years to assess situational deficiencies. Finally, we evaluated whether or not the HRH recommendations of NHPIs addressed the deficient cadres and dimensions for the corresponding year. Results: We observed that HRH availability and quality were focused more in NHPI compared to accessibility and acceptability. Doctors were prioritized over auxiliary nurses-midwives and health assistants. AAAQ indices showed deficits in all dimensions in almost all cadres over the years. The cadres focused by NHPI recommendations did not completely correspond to the deficient cadres. Conclusion: The framework and indices based method can help identify the gaps between targeted and needed dimensions and cadres for effective HRH strengthening in countries. At the global level, the application of framework and indices will allow a comparison of strengths and weaknesses of HRH-related policies of various nations.

Background: Human Resources for Health (HRH) are crucial to improve health services coverage and population health outcomes. The World Health Organization (WHO) promotes four dimensions - availability, accessibility, acceptability, and quality (AAAQ) for HRH strengthening. Integrating AAAQ dimensions in policymaking is essential to reduce the critical shortage of HRH in India. Methods: We created a multilevel framework consisting of implementable strategies and actions that can improve AAAQ dimensions. We assessed and monitored the incorporation of dimensions in HRH-related recommendations of all versions of the National Health Policy of India (NHPI) policies using this framework. Recommendations were coded using this framework and classified according to targeted dimensions and cadres. We formulated dimension-wise normalized indices to calculate HRH deficits for pre-NHPI years and assess situational deficiencies. Finally, we evaluated whether or not the HRH recommendations of NHPIs addressed the deficient cadres and dimensions for the corresponding year. Results: We observed that HRH availability and quality were focused more in NHPI compared to accessibility and acceptability. Doctors were prioritized over auxiliary nurses-midwives and health assistants. AAAQ indices showed deficits in all dimensions in almost all cadres over the years. The cadres focused by NHPI recommendations did not completely correspond to the deficient cadres. Conclusion: The framework and indices based method can help identify the gaps between targeted and needed dimensions and cadres for effective HRH strengthening in countries. At the global level, the application of framework and indices will allow a comparison of the strengths and weaknesses of HRH-related policies and indicate implementation strategies and actions.