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Abstract
ObjectivesTo reveal the equity of health workforce distribution in urban community health service (CHS), and to provide evidence for further development of community health service in China.MethodsA community-based, cross-sectional study was conducted in China from September to December 2011. In the study, 190 CHS centers were selected from 10 provinces of China via stratified multistage cluster sampling. Human resources profiles and basic characteristics of each CHS centers were collected. Lorenz curves and Gini Coefficient were used to measure the inequality in the distribution of health workforce in community health service centers by population size and geographical area. Wilcoxon rank test for paired samples was used to analyze the differences in equity between different health indicators.ResultsOn average, there were 7.37 health workers, including 3.25 doctors and 2.32 nurses per 10,000 population ratio. Significant differences were found in all indicators across the samples, while Beijing, Shandong and Zhejiang ranked the highest among these provinces. The Gini coefficients for health workers, doctors and nurses per 10,000 population ratio were 0.39, 0.44, and 0.48, respectively. The equity of doctors per 10,000 population ratio (G = 0.39) was better than that of doctors per square kilometer (G = 0.44) (P = 0.005). Among the total 6,573 health workers, 1,755(26.7%) had undergraduate degree or above, 2,722(41.4%)had junior college degree and 215(3.3%) had high school education. Significant inequity was found in the distribution of workers with undergraduate degree or above (G = 0.52), which was worse than that of health works per 10000 population (P<0.001).ConclusionsHealth workforce inequity was found in this study, especially in quality and geographic distribution. These findings suggest a need for more innovative policies to improve health equity in Chinese urban CHS centers.
Highlights
Health equity is an explicit goal for health care reform around the world, numerous countries have pursued this goal to ensure universal and equitable access of healthcare [1, 2, 3, 4]
There was an average of 4.7 doctors per square kilometer in the 190 community health service (CHS) centers, with the maximum number of 47.06 and the minimum number of zero
The study focused on quantity and quality equity on health workers distribution in urban CHS
Summary
Health equity is an explicit goal for health care reform around the world, numerous countries have pursued this goal to ensure universal and equitable access of healthcare [1, 2, 3, 4]. In the 58th World Health Assembly (2005), all member states were encouraged to achieve universal healthcare coverage, thereby achieving equity in access [5]. Financial, material, and human resources are three major inputs that national health reform have to deal with in China. Money, drugs, and equipment are needed, but these inputs are meaningless without effective workforce. There are substantial evidences which revealed wide inequity of health workforce in primary health care [7, 8]
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