Cameroon public health sector: shortage and inequalities in geographic distribution of health personnel.
Cameroon public health sector: shortage and inequalities in geographic distribution of health personnel.
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DOI：
10.1186/s12939-015-0172-0
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发表时间：
2015-05-12
影响因子：
4.8
通讯作者：
Choi JW
中科院分区：
文献类型：
--
作者：
Tandi TE;Cho Y;Akam AJ;Afoh CO;Ryu SH;Choi MS;Kim K;Choi JW
世界卫生组织（卫生组织）将喀麦隆列为卫生人员严重短缺的国家。由于国家卫生人力的地理分布不平等，情况进一步复杂化。这一短缺阻碍了喀麦隆在改善卫生人力资源以在2015年之前实现千年发展目标方面取得的进展。然而，喀麦隆的卫生人力是否在各个地理区域均匀分布尚不清楚。此外，没有使用人口水平以外的指标来衡量保健需求。这项研究的目的是评估喀麦隆不同地区卫生人力的充足性、分布的均匀性和面临的挑战。通过使用从卫生部数据库获得的2011年年终普查数据，评估了国家卫生人员的可用性和分布情况。利用基尼系数和洛伦兹曲线估计劳动力的不平等和分布，并利用线性回归确定卫生人员密度与选定健康结果之间的关系。用浓度曲线说明了确定保健需求的其他指标。在喀麦隆，卫生人力资源的可获得性存在明显的地域不平等。一些地区的医生（人均）数量高于其他地区，导致整个地区的健康状况不佳。70%的地区的卫生人员对人口的密度低于每1 000人1.5人，这意味着卫生人员严重短缺。恶劣的工作和生活条件，加上职业发展机会有限，导致了记录在案的232名医生和205名护士从公共部门迁移。当使用五岁以下婴儿死亡率和疟疾流行率作为衡量保健需求的指标时，注意到严重的分配不平等。我们的研究结果显示，喀麦隆的公共卫生人员绝对短缺，而全国各地区的地理分配不平等使这一问题进一步复杂化。喀麦隆的目标是到2035年实现全民健康覆盖；为实现这一目标，针对培训、招聘、保留和有效部署积极主动和得到支持的卫生工作人员以及发展和改善卫生基础设施的政策仍然是主要挑战。
Cameroon is classified by the World Health Organization (WHO) as having a critical shortage of health personnel. This is further complicated by the geographic distributional inequalities of the national health workforce. This shortfall impedes Cameroons’ progress of improving the human resources for health (HRH) to meet up with the Millennium Development Goals (MDGs) by 2015. However, it is unknown whether the health workforce of Cameroon is distributed equally across geographic regions. Additionally, indicators other than population levels have not been used to measure health care needs. This study aimed to assess the adequacy, evenness of distribution and challenges faced by the health workforce across the different regions of Cameroon. National health personnel availability and distribution were assessed by use of end-of-year census data for 2011 obtained from the MoPH data base. The inequalities and distribution of the workforce were estimated using Gini coefficient and Lorenz curve and linear regression was used to determine the relation between health personnel density and selected health outcomes. Alternative indicators to determine health care needs were illustrated using concentration curves. Significant geographic inequalities in the availability of health workforce exist in Cameroon. Some regions have a higher number of physicians (per person) than others leading to poor health outcomes across the regions. 70 % of regions have a density of health personnel-to-population per 1,000 that is less than 1.5, implying acute shortage of health personnel. Poor working and living conditions, coupled with limited opportunities for career progress accounted for some documented 232 physicians and 205 nurses that migrated from the public sector. Significant distributional inequality was noticed when under-five infant mortality and malaria prevalence rate were used as indicators to measure health care needs. Our results show an absolute shortage of public health personnel in Cameroon that is further complicated by the geographic distributional inequalities across the regions of the nation. Cameroon aims to achieve universal health coverage by 2035; to realize this objective, policies targeting training, recruitment, retention and effective deployment of motivated and supported health workforce as well as the development and improvement of health infrastructures remain the major challenge.
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