Chapter -3 RESEARCH METHODOLOGY i
3.1. RESEARCH METHODOLOGY 3.1.1. RESEARCH DESIGN Based on the research objectives, the study is analytical, exploratory and descriptive on the major HR issues on distribution, attraction and retention of physicians and nurses in rural areas in India with special reference to the state of Arunachal Pradesh. The study included both quantitative and qualitative data collection and analyses. This research is primarily based on primary data with inclusion of secondary data as well. Interview and questionnaire are the major technique used in this research along with the technique of observation. Data collection instruments like interview schedule and survey questionnaires were developed with the help of wide literature review. The data as collected from the respondents (physicians, nurses and the management representatives was analyzed and present the findings with description on the topics. Subsequently, the interpretations and commentaries were put on the line keeping in the view of sequences of the respective objectives. 3.1.2. OBJECTIVE OF THE STUDY The research question puts for the study are that- What are the major HR issues on distribution, attraction and retention of physicians and nurses in rural and remote areas in Arunachal Pradesh? What are the major reform initiatives under reform process for major issues on distribution, attraction and retention of physicians and nurses in rural and remote areas in Arunachal Pradesh? Rationally, the following objectives are place for the study:- 1. To explore the major HR issues on distribution, attraction and retention of physicians and nurses in rural and remote areas in Arunachal Pradesh. 2. To explore the major reform initiatives under reform process for major issues on distribution, attraction and retention of physicians and nurses in rural and remote areas in Arunachal Pradesh. 3. To suggest some remedial measures to address the major issues. ii
3.1.3. THE STUDY AREA For this study, the state of Arunachal Pradesh in India was selected. It is situated in north-eastern most part of the country, sharing the international border of 1628 km with Bhutan to the West, China to the North and North-East and Myanmar to the East. The referred state of Arunachal Pradesh is a pre-dominantly a rural and remote area and one of the most splendid and variegated tribal area of the country. As the researcher could able to establish, that there is no academic literature available as on date relating to the research topic in the state of Arunachal Pradesh. This raises the unexplored issues in context of tribal remote and rural areas and even if it is explored, it is not in record in form of any literature. The health system in Arunachal Pradesh is still in a poor state and this is traceable to several factors especially the gross underinfrastructure of the health system and shortage of skilled medical personnel at the primary health care level. Despite the vast improvement in the establishment of primary health infrastructure in the state, several parts of the state continue to suffer from lack of access to primary care services, particularly those in the poorer hilly tribal regions in the absence of physicians and nurses to provide maternal and child health services. Over the last decade, a series of reforms have been undertaken, in the states. The urge about, how this aspect of issues in the state of Arunachal Pradesh are and can be addressed, motivated me to explore the subject in this study area. Demographic and socio economic feature: The state is situated at latitude of 90.36 0 E to 97.3 0 E and longitude of 26.42 0 N to 29.30 0 N covering a total land area of 83,743 sq. km., the largest amongst NE States in India. It has a total population of 1,382,611 with an average population density per square kilometer of 17 persons. Due to its peculiar topography and difficult terrain, there is widely dispersed settlement pattern of the population that applies to both rural and urban areas. The rural population constitutes 77.33% and the urban only 22.67 %.Sex ratio of the state is 920 females per 1000 males. The total literacy rate of the state is 66.95% with a male literacy rate of 73.69 % and female literacy rate of 59.57 %. (Source: Census 2011). The district wise Population as per census 2011 is presented in table 4. Table 4: Demographic indicators Census 2011 and 2001 of Arunachal Pradesh Indicators 2011 (census) 2001 (census) Population 1,382,611 1,097,968 Male 720,232 579,941 Female 662,379 518,027 Population Growth 25.92% 26.21% iii
Percentage of total Population 0.11% 0.11% Sex Ratio 920 901 Child Sex Ratio 960 798 Density/km2 17 13 Density/mi2 43 34 Area km2 83,743 83,743 Area mi2 32,333 32,333 Total Child Population (0-6 Age) 202,759 205,871 Male Population (0-6 Age) 103,430 104,833 Female Population (0-6 Age) 99,329 101,038 Literacy 66.95 % 54.34 % Male Literacy 73.69 % 65.43 % Female Literacy 59.57 % 40.23 % Total Literate 789,943 484,785 Male Literate 454,532 303,281 Female Literate 335,411 181,504 Table 5 : Urban-Rural comparison of demographic indicators of Arunachal Pradesh Indicators Rural Urban Population (%) 77.33 % 22.67 % Total Population 1,069,165 313,446 Male Population 554,304 165,928 Female Population 514,861 147,518 Population Growth 22.88 % 37.55 % Sex Ratio 929 889 Child Sex Ratio (0-6) 964 944 Child Population (0-6) 164,617 38,142 Child Percentage (0-6) 15.40 % 12.17 % Literates 557,105 232,838 Average Literacy 61.59 % 84.57 % Male Literacy 68.79 % 89.45 % Female Literacy 53.78 % 79.04 % The administrative set up of Arunachal Pradesh and its changing district boundaries correspond broadly to natural boundaries of river basin. Even the boundaries of Sub-Divisions, Community Development Blocks and Administrative Circles within the districts have also been directly affected by the terrain features. There are 16 Districts, 37 sub-divisions, 155 circles, 17 towns, 69 blocks and 3862 villages (Source - Census: 2001) constituting an elaborate administrative structure for diffusing developmental activities in the state. iv
3.1.4. MAP OF THE STUDIED AREA Focused Studied Area Figure 5: Map of India (Source : www.stayfinder.com) Figure 6: Map of Arunachal Pradesh (Source : www.arunachalipr.gov.in) v
3.1.5. DATA COLLECTION METHODS AND INSTRUMENTS PRIMARY DATA: The primary data required for the study was collected with the help of interview schedule, survey questionnaire and observation. The primary data was collected through questionnaire among sampled physicians, nurses and mid-wives to understand their attitude towards working and living in rural areas and accepting the rural posting and insight on the HR issues in the area of study. A selected key informants from state and district health official in Arunachal Pradesh was interviewed with the help of interview schedule. Further, the data required on distribution pattern was collected with personal visits to department of health and family welfare, Govt. of Arunachal Pradesh. The survey questionnaire for physicians and nurses including mid-wives was developed with literature review and it was done in two stages. Firstly, it was developed and tested in a pilot survey to ensure that the survey instrument is free from all errors and all inclusions. For the purpose a field visit was undertaken. The pilot survey was done in a rural area Primary Health Centre named as Koronu PHC, Iduli PHC and Parbuk CHC in the Lower Dibang Valley district of Arunachal Pradesh on dated 7.9.2010 to 10.9.10, along with 3 nos. of Physicians, 1 no. of Nurse and 3 midwives. Copies of the instrument in English was prepared for each of them and handed to them personally along with the covering letter attached with the instrument. The filled-in questionnaires were returned to the researcher with some suggestions in about 20 minutes of time. The suggestions of the participants were well taken and necessary suggestions were included and reviewed for a final copy of the survey instrument. The finally developed questionnaire is displayed in Appendix. The participants in pilot survey were again included in the fresh survey after necessary corrections of the instrument. The interview schedule is place in Appendix. SECONDARY DATA: A range of research articles, books and official documents available in soft and hard copies were reviewed which were related to distribution, attraction and retention of workforce in public health sector in rural areas in India and specially referring to the study area. The Rural Health Statistics, 2010, published by Ministry of Health and Family Welfare, Govt. of India was used for exploring the issues in distribution of physicians and nurses in rural India and Arunachal Pradesh. For other secondary data, the printed & online policy manuals of government, printed journals, government publications, articles, research thesis and books was used for collecting relevant secondary information. vi
3.1.6. SAMPLING FRAME Choosing a study sample is an important step in any research study, since it is rarely practical, efficient or ethical to study whole population. In this study, the multistage sampling, convenience sampling and simple random method was used to frame the sample of physicians and nurses in rural areas in the study area. By applying the sampling techniques, the total sixteen (16) districts were divided in four equal zones comprises of four districts in each zone according to their geographical location. Zone 1: (Tawang, West Kameng, East Kameng and Papumpare); Zone 2: (Kurung Kumey, Lower Subansiri, Upper Subansiri and West Siang); Zone-3(Upper Siang, East Siang, Dibang Valley and Lower Dibang Valley); Zone-4: (Lohit, Anjaw, Changlang and Tirap). The simple random sampling was used to pick the sample of physicians and nurses from each of the zone from selected health institutions through convenience sampling. According to the Rural Health Statistics (2010), there are 200 nos. of physicians (doctors) and 688 nos. of nurses and mid-wives (395 nos. of mid-wives and 293 nos. of nurses) in the rural public health system in Arunachal Pradesh. Therefore, the sample size determined were 132 nos. of physicians and 247 nos. of midwives and nurses. The sample was determined with 95% of confidence level, 5% margin of error with a response distribution of 50%. According to the sample size determined, the survey questionnaires were distributed and total of 353 nos. of questionnaires were returned to the researcher out of which 334 nos. (113 nos. of physicians, 98 nos. of Nurses and 123 nos. of midwives) of questionnaires were useable for the study. Henceforth the useable response rate was 88% in total. Whereas the individual response rate for physicians was 85% and mid-wives and nurses was 89%. To get the high response rate the use of reminders (at-least 3 times) and questionnaire survey were used. The distribution of questionnaire and collection of data was done within the period of 7.9.2010 to 25.03.2012. One management representatives each from the 16 districts and one state level management representatives were picked as a sample of management representatives and conducted the interview. vii
3.1.7. DATA ANALYSIS Possessing relevant information generated from the interviews, questionnaires and observations are categorizes the interviewees point to the key themes, into main themes of issues including the observational themes. It includes analyzing by organizing the text from the individual interview respondent and grouping the relevant issues and eliminating the answers which seemed irrelevant to the topic. Once the data are organized, the next step followed was the description i.e., the researcher described the various pertinent aspects of the study including the setting, the individual being studied, the purpose of any activities examined, the viewpoints of the participants, etc. Only after data have organized and described, the final step of analysis process i.e., interpretation and commentary was done, which involves explaining the findings. Subsequently, the interpretation and commentary was placed according to the research questionnaire and the study objectives. Findings and results is presented in the sequence of the research problems. The information collected from both the primary and secondary sources was classified, tabulated and subjected to analysis. SPSS software was used for data entry, validation, cleaning and analysis. The statistical package for the social sciences (SPSS for windows version 19) and Microsoft Excel 2007 was used to analyse the quantitative data. The summaries of the data were undertaken which includes percentage, mean, standard deviations. The statistical analysis used included reliabilities, correlation, T-Test (one sample & paired), ANOVA, Chisquare test, multiple & logistic regression etc. 3.2. LIMITATION OF RESEARCH To lineout the limitation of this study, it may not be free from some of the limitations despite of maximum heed. Although the primary data was collected with the assumption that it truly represented the character, and the views expressed by the respondents and the possibility of personal bias of such respondents cannot be ruled out. Further, analysis includes the researchers own views on the HR Issues and HRM Practice in the health sector of Arunachal Pradesh, which may include personal experience and bias. Moreover, to determine the major issues only pertinent to Physicians and nurses from a wide range of technical professional occupations in health sector was considered. Other service occupations in health sectors are not viii
considered here for the study, as it would have invited a huge area of study which is not possible to sum up in the constraints of funding and timing. 3.3. CONTRIBUTION OF THE RESEARCH It is mentioned in earlier sections that there is limited literature of the topic as on date in Arunachal Pradesh, (so far as this researcher has been able to establish). This research process would not only generate useful contributions to the field of research, but that it would also provide time for reflection and learning for other people involved in this sector. This research work definitely is useful, which has brought out in the light of Human Resource issues and present HR practice in Public Health sector in Arunachal Pradesh. That would I believe generate an atmosphere of enhancing workforce management in the organization creating a WIN-WIN Situation. It also may act as a resource book for future reference to know the HRM in the Public Health Sector in Arunachal Pradesh in health organisation and other study purposes also. In addition, a study such as this one, which focuses on the experiences and views of healthcare workforce, provides useful information to policy-makers and those responsible for the implementation and effectiveness of health sector reform initiative in the state. It also tries to provide ideas for future improvements. ix