Measuring inequalities in the distribution of health workers: the case of Tanzania.
Measuring inequalities in the distribution of health workers: the case of Tanzania.
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DOI：
10.1186/1478-4491-7-4
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发表时间：
2009-01-21
影响因子：
4.5
通讯作者：
Maestad, Ottar
中科院分区：
文献类型：
--
作者：
Munga, Michael A;Maestad, Ottar
背景：许多发展中国家的总体人力资源短缺和卫生人力分配不平等是众所周知的。然而，在系统地衡量不平等程度方面，几乎没有做过什么。此外，很少有人试图分析在衡量卫生人力分布不平等时使用卫生保健需求的替代措施所产生的影响。大多数研究都隐含地依赖于人口水平作为衡量卫生保健需求的唯一标准。本文试图实现两个目标。首先，它描述和衡量了坦桑尼亚卫生工作者的人均分配不平等；其次，它建议并应用额外的卫生保健需求指标来衡量分配不平等。方法：我们绘制了洛伦茨和集中度曲线，以图形化地说明卫生人力总数的分布和特定干部(技能组合)的分布。浓度曲线说明了卫生保健需求的替代指标。通过计算基尼系数和集中度指数来衡量不平等程度。结果：卫生工作者的人均分布存在明显的不平等。总体而言，人均卫生工作者最少的人口五分之一仅占所有卫生工作者的8%，而卫生工作者最多的五分之一人口占46%。无论是在城市还是农村地区，不平等都是显而易见的。技能组合的不平等也很大。卫生工作人员所占比例较小的地区(相对于其人口水平而言)，训练有素的医务人员所占比例更小。一小部分训练有素的人员得到较大比例的临床干事(中级干部)的补偿，但没有得到较大比例的未受过培训的保健人员的补偿。临床医生的分布相对平均。当五岁以下儿童的死亡被用作卫生保健需求的指标时，分配不平等往往更加明显。相反，如果以艾滋病毒流行率来衡量卫生保健需求，分配不平等似乎会下降。结论：卫生人力分布不平等的衡量标准可能强烈依赖于卫生保健需求的基本衡量标准。在卫生保健需求在各地理区域分布不均的情况下，可能需要制定人口水平以外的卫生保健需求的其他衡量标准，以确保更有意义地衡量卫生人力资源的分配不平等。
BACKGROUND: The overall human resource shortages and the distributional inequalities in the health workforce in many developing countries are well acknowledged. However, little has been done to measure the degree of inequality systematically. Moreover, few attempts have been made to analyse the implications of using alternative measures of health care needs in the measurement of health workforce distributional inequalities. Most studies have implicitly relied on population levels as the only criterion for measuring health care needs. This paper attempts to achieve two objectives. First, it describes and measures health worker distributional inequalities in Tanzania on a per capita basis; second, it suggests and applies additional health care needs indicators in the measurement of distributional inequalities.METHODS: We plotted Lorenz and concentration curves to illustrate graphically the distribution of the total health workforce and the cadre-specific (skill mix) distributions. Alternative indicators of health care needs were illustrated by concentration curves. Inequalities were measured by calculating Gini and concentration indices.RESULTS: There are significant inequalities in the distribution of health workers per capita. Overall, the population quintile with the fewest health workers per capita accounts for only 8% of all health workers, while the quintile with the most health workers accounts for 46%. Inequality is perceptible across both urban and rural districts. Skill mix inequalities are also large. Districts with a small share of the health workforce (relative to their population levels have an even smaller share of highly trained medical personnel. A small share of highly trained personnel is compensated by a larger share of clinical officers (a middle-level cadre) but not by a larger share of untrained health workers. Clinical officers are relatively equally distributed. Distributional inequalities tend to be more pronounced when under-five deaths are used as an indicator of health care needs. Conversely, if health care needs are measured by HIV prevalence, the distributional inequalities appear to decline.CONCLUSION: The measure of inequality in the distribution of the health workforce may depend strongly on the underlying measure of health care needs. In cases of a non-uniform distribution of health care needs across geographical areas, other measures of health care needs than population levels may have to be developed in order to ensure a more meaningful measurement of distributional inequalities of the health workforce.