Background Burn injuries represent a significant public health problem in India, causing around 25000 deaths annually. Delivering specialized care for major burns requires a multidisciplinary health workforce team. Health workforce shortages and training gaps in burn care are well-recognized challenges in India. The performance of health systems is affected by both the ‘hardware’, such as infrastructure, health workforce and financing and ‘software’, such as interest, power, and relationship. However, little is known about the ‘software’ issues within the health systems which affect the health workforce performance in burn care.

Objective To explore the health workforce challenges for burn care in Uttar Pradesh, India, and identify health systems software and hardware issues affecting health workers’ performance.

Methods Qualitative in-depth interviews were conducted with purposively selected (n= 31, 18 women and 13 men) health workers from multiple cadres in two large burn units and their attached primary health centre in Uttar Pradesh, India. Inductive coding and thematic analysis were performed to analyse the data.

Results The health workers included in the sample were medical faculty members, resident doctors, nurses, rehabilitation practitioners, intensivists, technicians, wound dressers, frontline health workers, primary care medical officers, and multi-purpose workers. Thematic analysis identified three major themes:

First, the dynamics within the multidisciplinary team, where complex relations, power and normative hierarchy hampered performance. Plastic surgery residents were in a dilemma for their role in burn care due to discordance between training and career aspirations.

Second, the dynamics between health workers and patients due to the clinical and emotional challenges of dealing with burn wounds and multitasking without specific burn care training.

Third, dynamics between specialized burn units and overall health systems as narrated in challenges due to inadequate first response and delayed referral from primary care facilities. However, primary health care workers indicated orientation and training gaps.

We also noted a pattern in health workers’ gender, males were more forthcoming about their rights, and responsibilities, while females expressed more satisfaction with their jobs.

Conclusions In conclusion, health workers in India face multiple challenges in burn care that need systemic action with a multipronged human resource for health framework.