Health workforce and health-related sustainable development goals from 1990 to 2018 in China: a retrospective study based on national statistical data

Abstract

BackgroundThe health workforce has vital roles in protecting and promoting the health of the population, given that it is a prerequisite of health care. Reducing maternal mortality, neonatal mortality, and under-5 mortality are three important health-related sustainable development goals (SDGs). To my knowledge, no study has yet analysed the importance of the health workforce for health-related SDGs in China on the basis of multiple-year national statistical data. I aimed to achieve this with the present study. MethodsUnivariate linear regression analyses were done with maternal mortality ratios, neonatal mortality, and under-five mortality as dependent variables. Aggregate density of health technicians was an independent variable in one set of regressions. Doctor and nurse densities were separately used in two other sets. All variables were transformed into natural logarithms. Statistical data for these variables covered 1990–2018 and were extracted from the China Health Statistics Yearbook 2019, WHO, and the UN Inter-agency Group for Child Mortality Estimation. The study was approved by the ethics committee of the School of Medicine of Xi’an Jiaotong University (number 2014189). FindingsDensity of health technicians was significant in accounting for maternal mortality ratio, neonatal mortality, and under-5 mortality (with elasticities ranging from –1·219 to –2·400, all p-values <0·0001). The elasticities of the three types of mortality with respect to doctor and nurse densities ranged from –1·643 to –3·227 (p=0·00012 for maternal mortality ratio, p<0·0001 for neonatal mortality, and p<0·0001 for under-5 mortality) and from –0·766 to –1·471 (all p-values <0·0001). InterpretationThe density of the health workforce is important in accounting for variation in maternal mortality ratio, neonatal mortality, and under-5 mortality in China. The effect of this density in reducing child mortality is greater than it is in reducing maternal mortality in China, possibly because qualified health technicians can better address the illnesses that put children at risk. Doctor density has a greater effect than nurse density in reducing all the three mortality types, possibly because of a greater of specialisation of doctors. Investment in the health workforce should always be part of a strategy to achieve health-related SDGs in China. FundingMajor Programme of National Social Science Fund of China: Research on Disease Prevention and Healthy China Construction (17ZDA079).