The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution
The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution
复制标题
孟加拉国的卫生人力危机：短缺、技能组合不当和分配不公平
作者：
S. Ahmed;Md. Awlad Hossain;Ahmed Mushtaque RajaChowdhury;A. Bhuiya
孟加拉国被确定为卫生工作者严重短缺的国家之一。然而，缺乏关于孟加拉国正规和非正规部门卫生人力资源的全面数据。这些数据对于制定卫生保健政策和计划以满足人口不断变化的卫生需求至关重要。本文试图通过使用2007年进行的具有全国代表性的抽样调查数据来填补这一知识空白。方法本调查的研究人群包括正规和非正规部门所有类型的目前活跃的卫生保健提供者（HCPs）。该调查使用了来自农村和城市地区的60个工会/区（平均人口约为25,000人），这些工会/区根据“概率比例与规模”抽样技术按比例分配给六个分区和分布地区。对每个抽样地区的执业医务人员进行了简单的免费清单，并与社区进行了交叉核对，以进行确认并避免重复。这项工作产生了按联盟/病房划分的不同医护人员的所需清单。结果测定了每1万人口shcp密度。每1万人中大约有5名医生和2名护士，护士与医生的比例仅为0.4。不同地区之间存在很大差异，分布极不平衡，有利于城市地区。每万人中有12名不合格的乡村医生和11名不合格的药品零售销售人员，后者在全国统一分布。此外，来自非政府部门的社区卫生工作者是政府部门的两倍，而且传统接生员数量惊人。乡村医生（以男性为主）和保健员（以女性为主）主要集中在农村地区，而辅助专业人员主要集中在城市地区。其他数据显示了信仰/传统治疗师、顺势疗法医生（合格和不合格）和基本护理提供者的数量。孟加拉国正面临严重的人力资源危机——合格提供者短缺、技能组合不恰当以及分配不公平——这需要政策制定者立即予以关注。
BackgroundBangladesh is identified as one of the countries with severe health worker shortages. However, there is a lack of comprehensive data on human resources for health (HRH) in the formal and informal sectors in Bangladesh. This data is essential for developing an HRH policy and plan to meet the changing health needs of the population. This paper attempts to fill in this knowledge gap by using data from a nationally representative sample survey conducted in 2007.MethodsThe study population in this survey comprised all types of currently active health care providers (HCPs) in the formal and informal sectors. The survey used 60 unions/wards from both rural and urban areas (with a comparable average population of approximately 25 000) which were proportionally allocated based on a 'Probability Proportion to Size' sampling technique for the six divisions and distribution areas. A simple free listing was done to make an inventory of the practicing HCPs in each of the sampled areas and cross-checking with community was done for confirmation and to avoid duplication. This exercise yielded the required list of different HCPs by union/ward.ResultsHCP density was measured per 10 000 population. There were approximately five physicians and two nurses per 10 000, the ratio of nurse to physician being only 0.4. Substantial variation among different divisions was found, with gross imbalance in distribution favouring the urban areas. There were around 12 unqualified village doctors and 11 salespeople at drug retail outlets per 10 000, the latter being uniformly spread across the country. Also, there were twice as many community health workers (CHWs) from the non-governmental sector than the government sector and an overwhelming number of traditional birth attendants. The village doctors (predominantly males) and the CHWs (predominantly females) were mainly concentrated in the rural areas, while the paraprofessionals were concentrated in the urban areas. Other data revealed the number of faith/traditional healers, homeopaths (qualified and non-qualified) and basic care providers.ConclusionsBangladesh is suffering from a severe HRH crisis--in terms of a shortage of qualified providers, an inappropriate skills-mix and inequity in distribution--which requires immediate attention from policy makers.