Measuring inequalities in the distribution of the Fiji Health Workforce

Virginia Wiseman,Sophia Lin,Neha Batura,Wayne Irava,Mylene Lagarde,Graham Roberts

doi:10.1186/s12939-017-0575-1

Abstract

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.

Highlights

Despite 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)
While countries grapple with policies to address national shortages of health workers, many are asking what can be done in the interim to adjust the spread of existing health workers to better address growing health care needs
While the current allocation of health workers based on relative population levels appears to align quite well with an allocation based on the crude death rate, caution is needed

Summary

Introduction

Despite 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). Despite the obvious centrality of health personnel, the planning, production and Wiseman et al International Journal for Equity in Health (2017) 16:115. While countries grapple with policies to address national shortages of health workers, many are asking what can be done in the interim to adjust the spread of existing health workers to better address growing health care needs. In Fiji, there is inconsistency in size and population catchment for similar levels of health facility, with some facilities with small workloads being better equipped and staffed than others with much larger workloads [6]

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Discussion

Conclusion