By Dr. Amey Patil
Burnout among healthcare workers has always been a prevalent issue in India. A plethora of factors ranging from administration to socio-economic conditions have amplified this issue over the years. To add insult to injury, the COVID-19 pandemic has further exacerbated this issue leading to both physical and mental burnout among healthcare workers.
CONTEXT
Before analyzing the factors that influence burnout, it is important to understand what ‘burnout’ actually means. The term ‘burnout’ may sound superficial, however, it is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon. It is mentioned as one of the ‘factors influencing health status or contact with health services.’
Burn-out is defined in ICD-11 as a “syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” The fact that burnout is not a medical condition and is still included in ICD-11 as an occupational phenomenon, goes to show the severity of this issue.
Now that we have established that burnout can happen from an occupation, let’s see how and why it affects healthcare workers in particular.
A flawed healthcare system!
An efficient healthcare system has all the building blocks working in harmony and coherence. The Indian Public healthcare system comprises of a three-tier system with Sub-centres, PHCs, and CHCs for primary healthcare along with District Hospitals for secondary and tertiary care. Despite such a comprehensive network, the private sector remains to be the primary source of healthcare. According to the National Family Health Survey (NFHS)-3 data, private sector is the primary source for 70% of households in urban and 63% of households in rural areas. This uneven distribution of patients leads to unnecessarily increased workload among the healthcare workers employed in the private sector.
Lack of human resource
The inefficient healthcare system burdens an already crippled human resource of the Indian healthcare system. According to the Economic Survey of 2019-2020, the doctor-population ratio in India is 1:1456. The ratio is very much against the WHO prescribed norm of 1:1000. Despite the pandemic, according to the figures reported by the 15th Finance Commission in February 2021, the ratio has further worsened to 1:1511. The nurse-population ratio, on the other hand, is quite poor as well at 1:1670 against the WHO norm of 1:1300. Also, due to poor working conditions, low pay, and poor living conditions in rural areas lead to health workers opt to work in urban areas further leading to burnout.
The COVID-19 Pandemic
Other issues seem to be just the tip of the iceberg when compared to the COVID-19 pandemic. COVID-19 affected the entire world disrupting the lives of millions of people. Obviously at the top of the list of the people affected, are the healthcare workers. The pandemic had a huge psychological impact on the healthcare workers on top of the catastrophic impact they were already going through physically.
India witnessed a sharp surge in COVID-19 cases throughout both the waves and due to the Omicron variant. This led to many healthcare workers being tested positive ultimately resulting in their deaths. The health workers feared the worst as the pandemic was taking the lives of hundreds of their own. According to the Indian Medical Association, COVID-19 had taken the lives of 734 doctors by February 2021 and nearly 800 doctors during the second wave. This amplified the burnout among the health workers triggering conditions like stress, anxiety, depression, post-traumatic stress disorder, etc.
The positive cases along with many factors like understaffing, violence on health workers, lack of PPE kits, Stigma, isolation, long hours of work, a pay cut in salaries, etc. This led to a vicious cycle of psychological distress culminating in burnout.
Measures moving ahead
The primary step should be an increase in allocation to health as compared to the GDP. India spent only 1.8% of its GDP on health in 2020-2021. There has been some improvement compared to previous years which still needs more work. The National Health Policy 2017 has a goal of India spending at least 2.5% of its GDP on health by 2025. The increase in allocation would further iron out the issues in the public healthcare structure and staffing.
It's high-time that mental health gets due priority. The recent health budget allocated an amount of Rs. 40 crores to the National Mental Health Program, a rise of 27.5% from Rs. 29 crores in 2021-22. This is certainly a welcome step moving forward.
Dr. Amey Patil is an Ayurveda doctor by profession and currently pursuing Masters of Public Health from National Institute of Public Health, Mumbai.