Distribution Of Health Workers Research Articles

The relationship between perceptions of health- illness with the utilization of health services in rural coastal communities in the working area of Kapoiala Health Center and Soropia Health Center, Konawe Regency, Southeast Sulawesi Province, Indonesia, 2

Background: Correct perception of pain will give rise to concern for the condition of the body and immediate action to seek help. The morbidity rate according to gender in Konawe Regency in 2021 reached 11.21%, while the percentage of the population who had health complaints and sought outpatient treatment in Konawe Regency in 2021 reached 28.86% Method: The type of research used is descriptive quantitative with a cross-sectional study approach, namely determining the relationship between perceptions of health and illness and the utilization of rural coastal community health services. The number of samples in this research was 535 respondents. The sampling techniques are purposive sampling and accidental sampling. The analysis used is chi-square. Results: Statistical test results show that the ρ value (0.942)>0.05, which means there is no significant relationship between perceptions of health and illness and utilization of rural coastal community health services in Konawe Regency. Of the 442 who utilized health service facilities (Puskesmas), there were 320 (72.40) respondents who had a good perception of health and illness and 112 respondents (27.60% who had a perception of health and illness in the bad category. Meanwhile, of the 93 respondents who did not utilize the facilities health services, there were 73 respondents (78.49%) who had a good perception of health and illness and 20 respondents (21.51%) who had a bad perception. Conclusion: There is no significant relationship between perceptions of health and illness and utilization of health services in rural coastal communities. Therefore, the Health Service needs to consider policies regarding placement, workload analysis and even distribution of health workers so that the workload of officers is not too high and can provide maximum health services and increase public knowledge by carrying out health promotions or providing health education to the public regarding services available at the Community Health Center.

Study on risk factors of mycobacterium tuberculosis infection among health workers in medical institutions

Objective: To understand the infection status of mycobacterium tuberculosis among health workers in tuberculosis designated medical institutions and explore the risk factors of infection. Methods: From September 2021 to June 2022, a questionnaire survey was conducted among health workers in relevant departments of 4 tuberculosis designated medical institutions by cluster stratified sampling, including the implementation of hospital infection control measures in medical institutions and occupational exposure of medical staff to mycobacterium tuberculosis. Peripheral blood interferon gamma release assays (IGRAs) and lung imaging examination were performed to determine the mycobacterium tuberculosis infection. Factors with statistical significance in univariate analysis were included in multivariate logistic regression to analyze the risk factors of mycobacterium tuberculosis infection. Results: A total of 657 people completed the lung imaging examination and questionnaire, of which 654 people had peripheral blood IGRAs detection, and the latent infection rate of tuberculosis was 39.45% (258/654) . Univariate analysis showed that age, sex, marital status, economic income, occupational category, professional title, length of service, and other variables had statistical significances in tuberculosis latent infection (P<0.05) . In terms of personal health status, there were statistically significant differences in the distribution of health workers in terms of their tuberculosis history, tuberculosis history of their immediate family members, previous tuberculin skin test (TST) (P<0.05) . Multivariate analysis showed that there were four risk factors related to tuberculosis, including professional title (X(1)) , years of tuberculosis related works (X(2)) , tuberculosis history (X(3)) and previous TST (X(4)) . The regression equation of the probability of tuberculosis among health workers was y=-1.920+0.246X(1)+0.046X(2)+1.231X(3)+0.478X(4). Conclusion: The latent infection rate of tuberculosis among health workers in tuberculosis designated medical institutions is high. It is necessary to strengthen the management of infection control, carry out regular screening, enhance the self-protection awareness of health workers, and reduce their exposure to mycobacterium tuberculosis and infection risk.

The Place of Human Resource Management in Lagos State Healthcare Delivery: A Statistical Overview

Background: Behind every great system is an organized team; this is especially true in the healthcare industry, where a dedicated human resources team can effectively recruit employees, train staff, and implement safety measures in the workplace. The importance of human resources in the healthcare industry cannot be overstated, with benefits ranging from providing an orderly and effectively run facility to equipping staff with the most accurate and up-to-date training. Proper human resources management is critical in providing high-quality health care. A refocus on human resources management in healthcare requires more research to develop new policies. Effective human resources management strategies are greatly needed to achieve better outcomes and access to health care worldwide. Methods: This study leveraged NOI Polls census data on Health Facility Assessment for Lagos State. One thousand two hundred fifty-six health care facilities were assessed in Lagos State; numbers of Health workers were documented alongside their area of specialization. Also, demographic characterizations of the facilities, such as LGA, Ownership type, Facility Level Care, and Category of the facility, were also documented. Descriptive statistics alongside cross tabulation was done to present the various area of specialization of the health workers. Multiple response analysis was done to understand the distribution of human resources across the health facilities. At the same time, Chi-square and correlation tests were conducted to test the independence of various categories recorded while understanding the relationships among selected specialties. Results: The study revealed that Nurses were the most common health specialist in the Lagos State health facilities. At the same time, Gynecologists and General surgeons are the two medical specialists mostly common in health facilities. Midwives are the second most common health specialist working full time, while Generalist medical doctors make up the top three health specialists working full time. Nurses and Midwives had the highest number in Lagos State, while Pulmonologists were currently the lowest human resource available in Lagos State health care system. It was also noted that health facility distribution across Lagos’s urban and rural areas was even. In contrast, distribution based on other factors such as ownership type, Facility level of care, and facility category was slightly skewed. Conclusion: The distribution of health workers in health facility across LGA in Lagos State depend on Ownership type, Facility level of care, and category of the facility.

Challenges and Implementation of Universal Health Coverage Program in Indonesia

The existence of Universal Health Coverage (UHC) implementation means that everyone in Indonesia will have access to the health services they need, when and where they need it, without financial hardship. It covers a wide range of essential health services, from health promotion to prevention, treatment, rehabilitation and miscellaneous care. Many countries are already making progress towards UHC, although the ubiquity of the global covid-19 pandemic is impacting the availability of health systems' ability to provide undamaged healthcare. All countries can take action to move more quickly towards UHC despite the setbacks caused by the pandemic, or to maintain the gains they have made. Indonesia continues to strive to realize Universal Health Coverage (UHC) through the implementation of the National Health Insurance-Healthy Indonesia Card (JKN-KIS) program whose program has been implemented by the government since 2014. Since the enactment of the policy on providing health services for the community through the National Health Insurance and the Healthy Indonesia card (JKN-KIS) by the Government, there have been more than 40 million people who have not been registered as participants in the National Health Insurance-Healthy Indonesia Card (JKN-KIS) program. This study uses a qualitative method by making a literature review with the aim of making it affordable for those whose health has not been protected through JKN-KIS services. As a recommendation in efforts to accelerate the achievement of UHC, the government must be committed to reducing the level of inequality between provinces and regions as well as regions in Indonesia, by building better health infrastructure and facilities, including a more even distribution of health workers in provinces with a UHC service coverage index that is still low.

Health Workers in Samarinda City: An Examination of Their Distribution Based on Strategic Issues

Providers and organizers of health care in the city are health professionals. The number of health workers needed in Samarinda has not yet been determined according to WHO guidelines, which is a ratio that compares the number of health workers to the population. The method used in this study is a descriptive-analytical non-experimental design (cross-sectional). Following the study's goals, research participants used secondary data from the Central Statistics Agency's report for Samarinda City in 2018/2019 in the form of social and population data. Results: The number of doctors in Samarinda did not meet the WHO minimum requirements for the ratio of doctors to population of 1:2,500, with a ratio of 1:10,249 in the Samarinda Seberang district. The number of nurses is identical, but the standard ratio of 1:855 cannot be met; six sub-districts fail to meet the ratio, Sungai Pinang is the most effective sub-district in terms of achieving the nurse-to-population ratio. Apart from Samarinda Ulu and Samarinda Kota, the distribution of pharmacists has caught the attention of almost all districts in the city of Samarinda, a total of eight districts. Even one pharmacy in the Sungai Pinang district must serve 54,386 people.. Conclusion: The distribution of health workers in Samarinda is not equally distributed, owing primarily to external issues.

Peculiarities of forming human resources in the healthcare system of the Republic of Tajikistan during the period of reforms

Aim. To analyze trends in the number and structure of physicians in the healthcare system of the Republic of Tajikistan during the period of healthcare reform.Materials and methods. The sources of information were the official data of the Republican Center for Statistics and Medical Information, the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan (MoHSP), departments of science, medical and pharmaceutical education, and the personnel department of the MoHSP, and other regulatory legal documents.Results and discussion. In 2019 there were 19,268 doctors active in the health sector, which is 20.7 doctors per 10,000 population. In 2019, there were only 76 private health facilities (WHO, 2020).Conclusions. The even geographic distribution of health workers appears to be one of the challenges in improving access to healthcare in Tajikistan.

Telemedicine dalam Konstruksi Hukum di Indonesia

The Covid-19 pandemic that occurs in the world is one of the challenges that must be addressed by following technological developments. Telemedicine is currently an alternative in doctor-patient communication by taking advantage of technological developments in the Industrial Revolution 4.0. This study uses a normative legal method with an approach to telemedicine theories, regulations, and cases. The formulation of the problem raised in this study is about the benefits of telemedicine in general and the confidentiality of patient medical data and information. Telemedicine can reach all levels of society, especially with the geographical conditions in Indonesia and the uneven distribution of health workers. Telemedicine makes it easy for the public to conduct consultation and communication with health service facilities. The aspect of protecting patient medical data and information is one of the things that need to be considered in this telemedicine service because it is something that is regulated in layers through Law No. 29 of 2004 concerning Medical Practice, Law no. 36 of 2009 concerning Health, Regulation of the Indonesian Medical Council (Perkonsil) No. 74 of 2020.Keywords: Telemedicine, Benefits, Confidentiality

Interventions for improving attraction and retention of health workers in rural and underserved areas: a systematic review of systematic reviews.

Global health workforce shortages exist with disparities in the skill mix and distribution of health workers. Rural and underserved populations are often disadvantaged in terms of access to health care. This systematic review summarized all systematic reviews that assessed interventions for improving attraction and retention of health workers in rural and underserved areas. We systematically searched selected electronic databases up to 31 March 2020. The authors independently screened the reviews, extracted data and assessed the certainty of evidence using GRADE. Review quality was assessed using the ROBIS tool. There was a paucity of evidence for the effectiveness of the various interventions. Regulatory measures were able to attract health workers to rural and underserved areas, particularly when obligations were attached to incentives. However, health workers were likely to relocate from these areas once their obligations were completed. Recruiting rural students and rural placements improved attraction and retention although most studies were without control groups, which made conclusions on effectiveness difficult. Cost-effective utilization of limited resources and the adoption and implementation of evidence-based health workforce policies and interventions that are tailored to meet national health system contexts and needs are essential.

Developing strategies to attract, retain and support midwives in rural fragile settings: participatory workshops with health system stakeholders in Ituri Province, Democratic Republic of Congo

BackgroundMidwifery plays a vital role in the quality of care as well as rapid and sustained reductions in maternal and newborn mortality. Like most other sub-Saharan African countries, the Democratic Republic of Congo experiences shortages and inequitable distribution of health workers, particularly in rural areas and fragile settings. The aim of this study was to identify strategies that can help to attract, support and retain midwives in the fragile and rural Ituri province.MethodsA qualitative participatory research design, through a workshop methodology, was used in this study. Participatory workshops were held in Bunia, Aru and Adja health districts in Ituri Province with provincial, district and facility managers, midwives and nurses, and non-governmental organisation, church medical coordination and nursing school representatives. In these workshops, data on the availability and distribution of midwives as well as their experiences in providing midwifery services were presented and discussed, followed by the development of strategies to attract, retain and support midwives. The workshops were digitally recorded, transcribed and thematically analysed using NVivo 12.ResultsThe study revealed that participants acknowledged that most of the policies in relation to rural attraction and retention of health workers were not implemented, whilst a few have been partially put in place. Key strategies embedded in the realities of the rural fragile Ituri province were proposed, including organising midwifery training in nursing schools located in rural areas; recruiting students from rural areas; encouraging communities to use health services and thus generate more income; lobbying non-governmental organisations and churches to support the improvement of midwives’ living and working conditions; and integrating traditional birth attendants in health facilities. Contextual solutions were proposed to overcome challenges.ConclusionMidwives are key skilled birth attendants managing maternal and newborn healthcare in rural areas. Ensuring their availability through effective attraction and retention strategies is essential in fragile and rural settings. This participatory approach through a workshop methodology that engages different stakeholders and builds on available data, can promote learning health systems and develop pragmatic strategies for the attraction and retention of health workers in fragile remote and rural settings.

Health workforce malldistribution: Lesson from central Lampung Regency in Indonesia

The purpose of this study is to explain: (1) Distribution of health workers in basic health services in Central Lampung, and (2). Factors that influence the process of procurement and distribution of health workers in primary health care in Central Lampung. Research conducted with this descriptive qualitative method involved health stakeholders in 34 health centers and 17 hospitals in the region. The results of this study include: (a). Analysis of the Distribution of Health Workers by Region, it is known that the pattern of distribution is not balanced and there are some districts that do not have several types of health workers. (b). Analysis of power distribution based on health workplaces is known that the majority of health workers are in health centers, even midwives and nurses are mostly in health centers and some types of health workers are not yet available in health centers. Also known factors that influence the process of procurement and distribution of health workers in primary health care include structural and environmental factors.

DISTRIBUTION ANALYSIS OF DOCTORS IN INDONESIA

Introduction: The distribution of health workers in Indonesia raises an interesting discussion since Indonesia as an archipelagic country has a wide geography and challenges for fulfilling equitable health services.Aim: This study identified factors related to the distribution of doctors in provinces of Indonesia.Method: Advanced analysis of secondary data was done and obtained from the "Data and Information: Indonesian Health Profile in 2017". The units analyzed in this study were all 34 provinces in Indonesia. The variables analysed were the number of doctors, population, density, percentage of poor population, the number of hospitals, and the number of primary healthcare centers.Results: Variability in the number of doctors was very wide. The more the population is, the more attractive it is for doctors to conduct practices in the provinces. The denser the population is, the more doctors are interested to work in the provinces. It also figured out that doctors tend to opt to work in the provinces which have more hospitals and primary healthcare centers.Conclusions: Out of five independent variables studied, there were four variables related to the number of doctors distributed in the provinces. Population, density, the number of hospitals, and the number of primary healthcare centers were positively related to the number of doctors. The results of this study were important for doctor redistribution policy in Indonesia. Keywords: distribution analysis, doctor distribution, health resources management, health workers.

A mandatory bonding service program and its effects on the perspectives of young doctors in Nepal.

To address regional differences in the distribution of health workers between rural and urban areas, the Nepal government has adopted the policy of deploying fresh medical graduates to remote areas for 2 years under a compulsory bonding service program. However, the impact of such an approach of redistribution of human resources for health is not well understood, nor is the experience of the health workers who are deployed. This study aimed to understand the experience of the medical graduates who have served under the bonding service program and suggest ways to improve the program as well as to make health service provision easier through the young doctors. A semi-structured questionnaire-based survey was administered online to 69 young medical doctors who had worked under the bonding service program. The responses were analysed qualitatively and the findings were presented in separate pre-established domains. Most young doctors felt they were not adequately prepared for the bonding service program. Adapting to the deployed place and to the local culture was a challenge to some young doctors, which hindered their potential to serve the local community. Most found the response from the rural communities to be positive even though they faced some challenges in the beginning. While the young doctors found serving the rural communities motivating, they felt that they were limited in their capacity to provide an optimal level of health service due to limitations of infrastructure and medical equipment. They also felt that the compulsory bonding program had stunted their growth potential as medical doctors without adequately compensating them for their time and service. Despite the program's noble intentions, the medical doctors who were involved with the bonding service program felt that the program had yet to address several basic needs of the doctors who were deployed for service provision. In order to motivate the doctors to work in rural areas in future after the compulsory binding has ended, the stakeholders need to address the existing gaps in policies and infrastructure.

Bringing greater transparency to health workforce planning in Tajikistan: using the WISN approach

Abstract Background For many countries, overcoming problems related to human resources is critical for progress towards Universal Health Coverage. Planning the workforce means to make decisions on required number, qualification and distribution of health workers. In Tajikistan, despite significant reforms, the health workforce is unequally distributed with physicians being mainly specialized and concentrated in urban areas. Description Using the Tajik case, we present a first comprehensive assessment of the Primary Health Care (PHC) staffing situation in a Central Asian setting applying and critically discussing the Workload Indicators of Staffing Need (WISN) method developed by the World Health Organization. Staffing requirements were derived using annual service statistics, obtained from a re-count of monthly routine data from registration books at facility level in the year 2016. Available health cadres in PHC at district and facility level were compared to the according staffing needs. Sensitivity analysis was performed to test the robustness of the predictions, and to identify the main contributors to uncertainty in the predicted staff requirements. Results For doctors performing general tasks in the PHC, there is currently an excess of full time equivalents. Moreover, health centres are overstaffed in terms of nurse positions. If the various speciality doctors currently working at rural health centres are not included, there is a shortage of family doctors in place. Sensitivity analysis revealed that staffing requirements in the PHC sector in Tajikistan are most importantly influenced by antenatal care visits. Lessons The present study concludes that there is an oversupply of doctors and nurses at PHC and a shortage of family doctors working at the level of health centres. Consequently, a more rational health workforce planning based on well-grounded methodology such as WISN has potential to contribute to more efficient and effective health service delivery in Tajikistan. Key messages Countries shifting towards a family medicine model face challenges like an oversupply of specialists performing general medical tasks and a lack of general/family doctors in the transition phase. To identify staffing requirements a transparent and reproducible approach, such as the WISN methodology, is required to steer future staffing needs and possible re-training of current staff.

Investigation of Inequality Trend in Distribution of Health Sector Resources in Iran during 2006, 2011 and 2016 Timelines Using Gini Coefficient

Background: Equality in resource distribution is one of the important aspects of effectiveness in achieving the goals of health system. Spending more resources in the health sector will not decline the inequality in the distribution of resources. Generating evidence and adopting evidence-based policies are very essential to reduce inequality in the distribution of health resources in the country. The present study investigates the equality trend in the distribution of health sector resources in Iran using Gini coefficient.&#x0D; Methods: This is a descriptive-analytical study performed to investigate the equality trend in the distribution of health workers (Behvarz in Persian), general practitioner, pharmacist, pharmacy and fixed beds over 2006, 2011 and 2016 timelines. Data were extracted from the reports of the Iranian Statistics Center database and according to the population and housing censuses. Moreover, the data from the Plan and Budget Organization of the Islamic Republic of Iran (PBO) reports are used. Finally, data analysis was carried out through using Stata 14 software.&#x0D; Results: The Gini coefficient for general practitioner distribution has had a constant trend. The Gini coefficient for pharmacists and pharmacies has decreased, i.e. the distribution of these resources is improving. In addition, the Gini coefficient for fixed beds and Behvarz has increased, referring to a relative decrease in equality in the distribution of these resources. There is equality in the geographical distribution of Behvarz in 2006 and 2011; but in 2016, there is a relatively unequal distribution. Concerning beds, pharmacies and general practitioners, it can be claimed that geographical distribution is generally equal. Despite the found trends, with respect to the Gini coefficient, the geographical distribution of pharmacists is estimated quite unequal.&#x0D; Conclusion: Although the ratio of each variable to population is different in different provinces, it can be claimed that there is a relative equality in the distribution of general practitioners, Behvarz, pharmacies and fixed beds. In addition, health policy makers and decision makers have to consider the extent to which the target community needs each of these resources, in addition to crude distributional equality.

Penerapan Analisis Multidimensional Scaling (MDS) Pada Pemetaan Kabupaten/Kota di Provinsi Sulawesi Tengah Berdasarkan Indikator Tenaga Kesehatan

Health workers is any person who dedicates theirself in the health sector and have knowledge, skills and authority to make health efforts. The lack number of health workers or the univen distribution of health workers is a problem that often occurs in each region. This research will use the method of multidimensional scaling in mapping districts / cities in Central Sulawesi Province based on indicators of health workers. The results obtained are formed in to 4 groups of districts/cities that have similarities among its members but different from other groups. In the group 1 is Palu, Group 2 contained Parigi Moutong districts. In the group 3 consists of Banggai, Poso, Sigi and Toli-Toli Districts. In the group 4 consist of Tojo Una-una, Morowali, Donggala, Morowali Utara, Banggai Laut, Buol, and Banggai Islands. Stress value obtained is 4.354% and the value of R^2 is 99.568%, which indicates that the data used can be mapped properly.

The role of financial factors in the mobility and location choices of General Practitioners in Australia

BackgroundThe geographic distribution of health workers is a pervasive policy concern. Many governments are responding by introducing financial incentives to attract health care workers to locate in areas that are underserved. However, clear evidence of the effectiveness of such financial incentives is lacking.MethodsThis paper examines General Practitioners’ (GPs) relocation choices in Australia and proposes a dynamic location choice model accounting for both source and destination factors associated with a choice to relocate, thereby accounting for push and pull factors associated with job separation. The model is used to simulate financial incentive policies and assess potential for such policies to redistribute GPs. This paper examines the role of financial factors in relocating established GPs into neighbourhoods with relatively low socioeconomic status. The paper uses a discrete choice model and panel data on GPs’ actual changes in location from one year to the next.ResultsThis paper finds that established GPs are not very mobile, even when a financial incentive is offered. Policy simulation predicts that 93.2% of GPs would remain at their current practice and that an additional 0.8% would be retained or would relocate in a low-socioeconomic status (SES) neighbourhood in response to a hypothetical financial incentive of a 10% increase in the earnings of all metropolitan GPs practising in low-SES neighbourhoods.ConclusionWith current evidence on the effectiveness of redistribution programmes limited to newly entering GPs, the policy simulations in this paper provide an insight into the potential effectiveness of financial incentives as a redistribution policy targeting the entire GP population. Overall, the results suggest that financial considerations are part of many factors influencing the location choice of GPs. For instance, GP practice ownership played almost as important a role in mobility as earnings.

Health system constraints in integrating mental health services into primary healthcare in rural Uganda: perspectives of primary care providers

BackgroundThe World Health Organization issued recommendations to guide the process of integrating mental health services into primary healthcare. However, there has been general as well as context specific shortcomings in the implementation of these recommendations. In Uganda, mental health services are intended to be decentralized and integrated into general healthcare, but, the services are still underutilized especially in rural areas.PurposeThe purpose of this study was to explore the health systems constraints to the integration of mental health services into PHC in Uganda from the perspective of primary health care providers (PHCPs).MethodsThis was a cross sectional qualitative study guided by the Supporting the Use of Research Evidence (SURE) framework. We used a semi-structured interview guide to gain insight into the health systems constraints faced by PHCPs in integrating mental health services into PHC.ResultsKey health systems constraints to integrating mental health services into PHC identified included inadequate practical experience during training, patient flow processes, facilities, human resources, gender related factors and challenges with accessibility of care.ConclusionThere is need to strengthen the training of healthcare providers as well as improving the health care system that supports health workers. This would include periodic mental healthcare in-service training for PHCPs; the provision of adequate processes for outreach, and receiving, referring and transferring patients with mental health problems; empowering PHCPs at all levels to manage and treat mental health problems and adequately provide the necessary medical supplies; and increase the distribution of health workers across the health facilities to address the issue of high workload and compromised quality of care provided.

Model Task Sharing dalam Community Based Healthcare: Studi Kasus pada Program SMART Health di Desa Sidorahayu Kecamatan Wagir Kabupaten Malang Jawa Timur

This paper examines model of task sharing in community based healthcare within SMARThealth program in Sidorahayu village Malang East Java Indonesia. A single case study was applied to explore task sharing model from health workers to non health workers in health screening for risks of cardiovascular disease. Indepth interviews were conducted to 10 key informants between January to May 2018. The findings show that task sharing model occurs within a health facility in which non health workers can provide services with adequate competency and quality. Responsibilities in health screening is delegated to lower level health service providers so that it can effectively reach consumers. The results sugests that task sharing model provides an alternative model for solving low number and distribution of health workers in rural areas in providing health screening for cardiovascular risks.

Measuring inequalities in the distribution of the Fiji Health Workforce

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.

Human Resource Challenges in the Public Health Sector in Rural India

Shortage of health workers in rural areas is one of the biggest problems faced in India’s health sector. This paper examines the current status of health workforce and human resource challenges in the public health sector in rural India. The findings show that the public health sector in rural areas across the country has suffered from poor availability of health workers even after more than a decade of implementation of the National Rural Health Mission. The density of health workers is abysmally low compared to the global norms. The paper highlights various human resource challenges in the rural health sector, such as, health workers shortage, lack of female practitioners, large scale vacancy, unbalanced skill mix, uneven distribution of health workers among states, absenteeism, and the quality of medical education. The paper emphasises on a compact package of interventions comprising regulatory measures, monetary and non-monetary incentives, workforce management, public-private partnerships, and task shifting, etc. to ameliorate the shortage of health workers in rural areas.