Health in Southeast Asia 5 Human resources for health in southeast Asia: shortages, distributional challenges, and international trade in health services
Health in Southeast Asia 5 Human resources for health in southeast Asia: shortages, distributional challenges, and international trade in health services
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DOI：
10.1016/s0140-6736(10)62035-1
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发表时间：
2011-02-01
期刊：
影响因子：
168.9
通讯作者：
dela Rosa, Jennifer Frances
中科院分区：
文献类型：
--
作者：
Kanchanachitra, Churnrurtai;Lindelow, Magnus;dela Rosa, Jennifer Frances
在本文中，我们解决的问题，短缺和分布不均的卫生人员在东南亚的背景下，在国际贸易的卫生服务。虽然本区域总体上不缺乏保健工作者，但如果单独分析，五个低收入国家存在一定程度的短缺。东南亚所有国家都面临着卫生工作者分布不均的问题，农村地区往往人手不足。尽管公共和私人设施的医疗和护理培训能力很强，但保健工作者的生产与就业能力之间的协调很弱。应对这些挑战的区域经验和对策可用于指导本区域和其他地方今后的政策。东南亚的一个显著特点是参与国际卫生服务贸易。新加坡和马来西亚进口卫生工作者，以满足国内需求，并为国际病人提供服务。泰国吸引了许多外国患者来享受医疗服务。这种情况导致了所谓的人才外流，高度专业化的工作人员从公立医学院流向私立医院。菲律宾和印度尼西亚是该地区医生和护士的主要出口国。根据《东南亚国家联盟服务框架协定》达成的关于相互承认三类保健工作者专业资格的协定，可能会导致今后该区域内的流动增加。为了确保提供重要的卫生人力资源，以满足其服务的人口的需要，需要将移徙管理和保留战略纳入正在进行的加强东南亚卫生系统的努力。卫生部门和贸易部门还需要加强对话，讨论如何平衡与卫生服务贸易有关的经济机会与国内卫生需求和公平问题。
In this paper, we address the issues of shortage and maldistribution of health personnel in southeast Asia in the context of the international trade in health services. Although there is no shortage of health workers in the region overall, when analysed separately, five low-income countries have some deficit. All countries in southeast Asia face problems of maldistribution of health workers, and rural areas are often understaffed. Despite a high capacity for medical and nursing training in both public and private facilities, there is weak coordination between production of health workers and capacity for employment. Regional experiences and policy responses to address these challenges can be used to inform future policy in the region and elsewhere. A distinctive feature of southeast Asia is its engagement in international trade in health services. Singapore and Malaysia import health workers to meet domestic demand and to provide services to international patients. Thailand attracts many foreign patients for health services. This situation has resulted in the so-called brain drain of highly specialised staff from public medical schools to the private hospitals. The Philippines and Indonesia are the main exporters of doctors and nurses in the region. Agreements about mutual recognition of professional qualifications for three groups of health workers under the Association of Southeast Asian Nations Framework Agreement on Services could result in increased movement within the region in the future. To ensure that vital human resources for health are available to meet the needs of the populations that they serve, migration management and retention strategies need to be integrated into ongoing efforts to strengthen health systems in southeast Asia. There is also a need for improved dialogue between the health and trade sectors on how to balance economic opportunities associated with trade in health services with domestic health needs and equity issues.