BArbara Yogya 160730

(1)

Health workforce, equity and

UHC

Barbara McPake

(2)

(3)

How many health workers do we

need?

• _{In 2006, the answer was given as 2.28/1,000}

population (22.8/10,000 population)

(4)

(5)

Updated in context of UHC

• _{ILO uses Thailand’s ratio (313 persons per}

health professional) as a benchmark

(6)

Disparities in physician density

within OECD countries

6

Source: OECD Regions at a Glance (forthcoming) Czech Rep. Denmark New Zealand Norway Poland Portugal Slovak Rep. Slovenia Spain Sweden Switzerland Turkey United Kingdom

United States

Source: OECD Regions at a Glance 2013.

6.3.1. Physician density, by Territorial Level 2 regions, 2011 (or nearest year)

0 1 2 3 4 5 6 7 8 9 10 Density per 1 000 population Vienna

Brussels

Prague

Attica (Athens Region)

Lisbon

Bratislava

(7)

(8)

(9)

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

(10)

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)

(11)

1 0%

5% 10% 15% 20% 25%

Private Sector Doctors Private Sector Nurses Private Sector Midwives Private Sector Total

Ghana: public-private HRH distribution by cadre

(12)

Concentration indices: public and private

Public sector Private sector NGO/FBO sector

(13)

South Africa: enrolled nurse and enrolled nurse

auxiliaries training 1999-2007

www.qmu.ac.uk/iihd

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:

(14)

(15)

(16)

(17)

(18)

(19)

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}