Measuring inequalities in the distribution of the Fiji Health Workforce

International Journal for Equity in Health

Research

Wayne Irava¹  Virginia Wiseman²  Graham Roberts³  Neha Batura⁴  Mylene Lagarde⁵  Sophia Lin⁶ 

[1] Centre for Health Information Policy & Systems Research, College of Medicine Nursing and Health Sciences, Fiji National University, Suva, Fiji;Department of Global Health and Development, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK;School of Public Health and Community Medicine, University of New South Wales, 2033, Kensington, NSW, Australia;Human Resources for Development Alliance, PO Box 10570, Suva, Laucala Beach, Fiji;Institute for Global Health, University College London, Gower St, Kings Cross, WC1E 6BT, London, UK;London School of Economics and Political Science, Houghton Street, WC2A 2AE, London, UK;School of Public Health and Community Medicine, University of New South Wales, 2033, Kensington, NSW, Australia;

关键词: Health workers;    Equity;    Human resources for health;    Distributional inequalities;   

DOI  :  10.1186/s12939-017-0575-1

 received in 2017-02-07, accepted in 2017-05-05,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundDespite 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.MethodsIn 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.ResultsThere 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.ConclusionWhile 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.

【 授权许可】

CC BY   
© The Author(s). 2017