BArbara Yogya 160730
Health workforce, equity and
UHC
Barbara McPake
Nossal Institute for Global Health
How many health workers do we
need?
• In 2006, the answer was given as 2.28/1,000
population (22.8/10,000 population)
• How was that worked out?
Source: WHR 2006
Updated in context of UHC
• ILO uses Thailand’s ratio (313 persons per
health professional) as a benchmark
• = 32/10,000
Disparities in physician density
within OECD countries
6.3.1. Physician density, by Territorial Level 2 regions, 2011 (or nearest year)
Australia
Austria
Belgium
Canada
Chile
Czech Rep.
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Israel
Italy
Japan
Korea
Luxembourg
Mexico
Netherlands
New Zealand
Norway
Poland
Portugal
Slovak Rep.
Slovenia
Spain
Sweden
Switzerland
Turkey
United Kingdom
United States
Vienna
Brussels
Prague
Attica (Athens Region)
Lisbon
Bratislava
Washington, D.C.
0
1
2
3
4
5
6
7
8
9
10
Density per 1 000 population
Source: OECD Regions at a Glance 2013.
Source: OECD Regions at a Glance
(forthcoming)
6
Some other key HRH issues in region that
affect health workforce equity and UHC
Dual practice for health professionals
Growth of private sector education and health
sector employment
Management and regulation of health
professional education more generally
Estimates of dual practice prevalence
• 87% of civil servants supplement salaries through
second jobs – various LMICs (Macq et al. 2001)
• Practice common in wide range of settings including
PNG, Indonesia, Cambodia, Thailand and Vietnam
(Ferrinho et al., 2004)
• 30-55% of all doctors in 3 African cities (Maputo,
Praia and Bissau) undertake dual practice (Russo et
al. 2014)
www.qmu.ac.uk/iihd
25%
20%
15%
10%
5%
0%
1
Private Sector Doctors
Private Sector Midwives
Private Sector Nurses
Private Sector Total
Ghana: public-private HRH distribution by cadre
Source: Witter et al., 2011
Concentration indices: public and private
sectors
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
Public sector
Private sector
NGO/FBO sector
0
Source: McPake et al., 2011
www.qmu.ac.uk/iihd
South Africa: enrolled nurse and enrolled nurse
auxiliaries training 1999-2007
Nursing in a New Era: The profession and education of nurses in South Africa, by Breier
M, Wildschut A and Mgqolozana T (2009), Cape Town: HSRC Press, at:
http://www.hsrcpress.ac.za/product.php?productid=2258.
www.qmu.ac.uk/iihd
Medical Colleges in India Source: Raha et al., 2011
Are they reflected here?
Major transitions here
Conclusions
• Counts of health workers continue to reveal stark
inequities globally and within countries
• There are equally important questions that relate to
achieving the best value from the health
professional workforce for UHC
• These include questions related to public private mix
• ..and questions related to health professional
education systems
• There are many potential points of intervention
through policy reforms that could support greater
health workforce equity and progress towards UHC
UHC
Barbara McPake
Nossal Institute for Global Health
How many health workers do we
need?
• In 2006, the answer was given as 2.28/1,000
population (22.8/10,000 population)
• How was that worked out?
Source: WHR 2006
Updated in context of UHC
• ILO uses Thailand’s ratio (313 persons per
health professional) as a benchmark
• = 32/10,000
Disparities in physician density
within OECD countries
6.3.1. Physician density, by Territorial Level 2 regions, 2011 (or nearest year)
Australia
Austria
Belgium
Canada
Chile
Czech Rep.
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Israel
Italy
Japan
Korea
Luxembourg
Mexico
Netherlands
New Zealand
Norway
Poland
Portugal
Slovak Rep.
Slovenia
Spain
Sweden
Switzerland
Turkey
United Kingdom
United States
Vienna
Brussels
Prague
Attica (Athens Region)
Lisbon
Bratislava
Washington, D.C.
0
1
2
3
4
5
6
7
8
9
10
Density per 1 000 population
Source: OECD Regions at a Glance 2013.
Source: OECD Regions at a Glance
(forthcoming)
6
Some other key HRH issues in region that
affect health workforce equity and UHC
Dual practice for health professionals
Growth of private sector education and health
sector employment
Management and regulation of health
professional education more generally
Estimates of dual practice prevalence
• 87% of civil servants supplement salaries through
second jobs – various LMICs (Macq et al. 2001)
• Practice common in wide range of settings including
PNG, Indonesia, Cambodia, Thailand and Vietnam
(Ferrinho et al., 2004)
• 30-55% of all doctors in 3 African cities (Maputo,
Praia and Bissau) undertake dual practice (Russo et
al. 2014)
www.qmu.ac.uk/iihd
25%
20%
15%
10%
5%
0%
1
Private Sector Doctors
Private Sector Midwives
Private Sector Nurses
Private Sector Total
Ghana: public-private HRH distribution by cadre
Source: Witter et al., 2011
Concentration indices: public and private
sectors
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
Public sector
Private sector
NGO/FBO sector
0
Source: McPake et al., 2011
www.qmu.ac.uk/iihd
South Africa: enrolled nurse and enrolled nurse
auxiliaries training 1999-2007
Nursing in a New Era: The profession and education of nurses in South Africa, by Breier
M, Wildschut A and Mgqolozana T (2009), Cape Town: HSRC Press, at:
http://www.hsrcpress.ac.za/product.php?productid=2258.
www.qmu.ac.uk/iihd
Medical Colleges in India Source: Raha et al., 2011
Are they reflected here?
Major transitions here
Conclusions
• Counts of health workers continue to reveal stark
inequities globally and within countries
• There are equally important questions that relate to
achieving the best value from the health
professional workforce for UHC
• These include questions related to public private mix
• ..and questions related to health professional
education systems
• There are many potential points of intervention
through policy reforms that could support greater
health workforce equity and progress towards UHC