Measuring inequalities in the distribution of the Fiji Health Workforce.
Measuring inequalities in the distribution of the Fiji Health Workforce.
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DOI：
10.1186/s12939-017-0575-1
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发表时间：
2017-06-30
影响因子：
4.8
通讯作者：
Roberts G
中科院分区：
文献类型：
--
作者：
Wiseman V;Lagarde M;Batura N;Lin S;Irava W;Roberts G
尽管卫生人员对人口健康至关重要，但在许多低收入和中等收入国家，卫生人力资源的规划、生产和管理仍然不发达。除了卫生工作者普遍短缺之外，低收入国家中心内卫生工作者的分布也存在严重的不平等。对于像斐济这样的国家来说尤其如此，这些国家在将卫生人力分布在许多有人居住的岛屿上面临着重大挑战。在这项研究中，我们使用来自2007年人口普查的数据和卫生部关于粗死亡率和卫生人力人员的记录，描述和衡量斐济卫生工作者的分布不平等。我们采用经济学文献中的方法，包括洛伦茨曲线/基尼系数和泰尔指数，来衡量斐济国家以下一级卫生工作者在三类卫生工作者(医生、护士和所有卫生工作者(医生、护士、牙医和卫生支助人员))分配上的不平等程度和驱动因素。人口规模和粗死亡率被用作卫生保健需求的替代指标。与斐济的区级相比，省级卫生工作者的密度差距更大--15个省中有6个省达不到建议的每1000人2.3名卫生工作者的门槛。估计的十分之一比率、基尼系数和泰尔指数表明，斐济在省级一级存在不平等现象，主要是在医生分布方面；然而，这些不平等现象相对较小。虽然死亡率较低的人口往往拥有较大比例的卫生工作者，但在斐济，卫生工作者根据需要进行的总体分配比许多其他低收入中等收入国家更为公平。卫生工作者的总体短缺可以通过建立新的卫生工作者干部队伍、雇用包括专家在内的越来越多的外国医生以及增加对卫生工作者培训的资金来解决，斐济政府已经证明了这一点。密切监测今后增加的卫生工作者的公平分配情况至关重要。
Despite the centrality of health personnel to the health of the population, the planning, production and management of human resources for health remains underdeveloped in many low- and middle-income countries (LMICs). In addition to the general shortage of health workers, there are significant inequalities in the distribution of health workers within LMICs. This is especially true for countries like Fiji, which face major challenges in distributing its health workforce across many inhabited islands. In this study, we describe and measure health worker distributional inequalities in Fiji, using data from the 2007 Population Census, and Ministry of Health records of crude death rates and health workforce personnel. We adopt methods from the economics literature including the Lorenz Curve/Gini Coefficient and Theil Index to measure the extent and drivers of inequality in the distribution of health workers at the sub-national level in Fiji for three categories of health workers: doctors, nurses, and all health workers (doctors, nurses, dentists and health support staff). Population size and crude death rates are used as proxies for health care needs. There are greater inequalities in the densities of health workers at the provincial level, compared to the divisional level in Fiji – six of the 15 provinces fall short of the recommended threshold of 2.3 health workers per 1,000 people. The estimated decile ratios, Gini co-efficient and Thiel index point to inequalities at the provincial level in Fiji, mainly with respect to the distribution of doctors; however these inequalities are relatively small. While populations with lower mortality tend to have a slightly greater share of health workers, the overall distribution of health workers on the basis of need is more equitable in Fiji than for many other LMICs. The overall shortage of health workers could be addressed by creating new cadres of health workers; employing increasing numbers of foreign doctors, including specialists; and increasing funding for health worker training, as already demonstrated by the Fiji government. Close monitoring of the equitable distribution of additional health workers in the future is critical.