Universal Health Coverage and Role of National Board of Examinations (NBE)-in Postgraduate Medical Education at District Hospitals in India: A Policy Analysis

Introduction: There is adequate evidence on the dearth of medical specialists in public sector hospitals along with other support staff in India and there are best cost-effective alternative approaches to address the issues. However, the understanding and interest of policy actors and policy decision-making processes may affect the adoption of sustainable alternative options. Further, it is not clear that why policy actors do not promote potential policy options for human resources for health (HRH) to have sustainable universal health coverage (UHC). This policy analysis may illumine the potential options for improvement of medical specialists' attraction and retention in divergent actor's environment. Materials & Methods: We used the qualitative research method for policy analysis based on primary data collection supplemented with documents review. Semi-structured interviews were conducted with 15 key informants. Results: The study findings show several interesting features in terms of policy actors experiences, interpretations, which may potentially influence DNB course promotion in public sector hospitals at the district level. The key facilitators include: available good infrastructure, a high number of patients inflow into government hospitals for exposure to post-graduate training, established DNB postgraduate curriculum and monitoring mechanisms, the eagerness of health administrators. The key barriers include limited teaching support system, the high workload for senior practitioners and limited time to teach trainees, lack of library and academic environment and a dearth of government pro-activeness to improve the working environment and higher medical education. Conclusion: This paper unlocks a debate about how to move forward with twin initiatives of universal health coverage and human resources for health. The paper argues not only to adopt low cost best available medical specialists' attraction and retention strategies through DNB courses in district hospitals but also facilitate the current attempts to promote UHC in a sustainable fashion.