A narrative review of healthcare workforce training in Bihar, India

Abstract Introduction The Indian state of Bihar has poor health outcomes compared to the rest of the country, particularly driven by gender inequalities. One way to manage this is through healthcare workforce training. Despite multiple initiatives in India seeking to provide training to healthcare workforces in this context, to date, minimal academic research has compared or summarised such initiatives. Therefore, this literature review maps existing training initiatives and examines their effectiveness through a gender lens within Bihar and across India. This review was prompted by the work of EMMS International, a healthcare organisation operating in Bihar, with the aim of informing further research, policy and practice within Bihar’s healthcare system, alongside guiding expansion of EMMS’ future work. Methods 354 papers were identified utilising various databases, which were refined to 25 through a structured screening process. Deductive thematic analysis was completed using the Social Ecological Model as the analytical framework. Results A multiplicity of initiatives are being conducted across India involving training the healthcare workforce, benefiting individuals, their communities and the health system. Three themes arose as main priorities and benefits of these initiatives: addressing gender inequalities, capacity-building and community collaboration. Conclusion This study has compared and contrasted the work of multiple healthcare workforce training initiatives in India, and identifies their benefits to tackle gender inequalities in Bihar. Given the global focus on working towards the sustainable development goals, all initiatives discovered are valuable. However, programmes focusing on multiple tiers of the SEM are of particular benefit, simultaneously affecting multiple levels of society.