Examining Inequality in the Public Health Workforce Distribution in the Centers for Disease Control and Prevention(CDCs) System in China, 2008–2017

Objective Allocation of human resources to address inequalities in the public health system has increasingly attracted societal and political attention.Using the Centers for Disease Control and Prevention(CDCs)system of China as an example,we evaluated inequality in the public health workforce distribution across different regions in China between 2008 and 2017,with the aim of providing information for policymakers to support resource allocation and address growing health inequities.Methods We used three standard public health workforce inequality indices-Gini coefficient,Theil L,and Theil T-and spatial autocorrelation analysis to explore spatial clusters of the workforce in different provinces,visualized with geographical tools.Results The aggregate workforce-to-population ratio decreased from 1.47 to 1.42 per 10,000 population from 2008 to 2017,and was consistently lower than the National Health Commission’s(NHC)recommended critical shortage threshold of 1.75.The workforce distribution inequality indices varied by regional socioeconomic and health system development.Geographic clustering of CDCs workforce distribution was evident,with H–H and L–L clusters in western China and the Guangdong-Fujian region,respectively.Conclusions Our study addressed key issues for government and policymakers in allocation of public health human resources.There is an urgent need for careful identification of analytic questions that will help carry out public health functions in the new era,alongside policy implications for an equitable distribution of the public health workforce focusing on the western region and low–low cluster areas.

Equity Study in Health Workforce on Tuberculosis Control in China: a Nationwide Evaluation

We aimed to describe the distribution of tuberculosis （TB） health workers in China and provide evidences of potential inequity for policy development. We used Lorenz curves and Gini index to characterize the distribution of TB health workers by population size, geographical area and number of annual registered TB cases. An additional stratified analysis was done by three economic regions. The Gini index were 0.33 for population size, 0.62 for geographical area and 0.30 for number of registered tuberculosis cases that indicated an acceptable average, significant inequity and a relative average distribution nationwide respectively.

Applying the workload indicators of staffing needs method in determining frontline health workforce staffing for primary level facilities in Rivers state Nigeria

Background:Nigeria faces health workforce challenges and poor population health indices resulting from disparities in health worker densities by geographical locations and levels of health care delivery.Nigeria is constantly reforming its health system with the primary aim of having the right number of health workers in the right place at the right time to meet the population’s health needs.The majority of primary health facilities in the country are staffed using perceived needs.The Workload Indicators of Staffing Need(WISN)tool developed by the World Health Organization is used to determine staffing requirements for facilities.Methods:The WISN tool was used in assessing the staffing requirements for nurses/midwives and community health practitioners in 26 primary health facilities in Port Harcourt City Local Government Area(PHALGA)and Obio Akpor Local Government Area(OBALGA).Documents were reviewed to obtain information on working conditions and staffing,and interviews conducted with key informants in 12 randomly selected facilities.We supported an expert working group that comprised of nurses/midwives and community health practitioners to identify workload components and activity standards and validate both.We also retrieved workload data from January 1-December 31,2015 from the national district health information system.Results:Findings showed varying degrees of shortages and inequitable distribution of health workers.Health facilities in PHALGA had a WISN ratio of 0.63 and a shortage of 31 nurses/midwives.There was also a shortage of 12 community health practitioners with a WISN ratio of 0.85.OBALGA had a shortage of 50 nurses/midwives and 24 community health practitioners;and WISN ratios of 0.60 and 0.79 for nurses/midwives and community health practitioners respectively.Conclusion:Our findings provide evidence for policies that will help Nigeria improve the population’s access to quality health services and reduce inequities in distribution of the health workforce.Evidence-based health workforce planning and redistribution using WISN should be institutionalized.Review of scopes of practice of health workforce should be conducted periodically to ensure that the scope of practice matches the training received by the specific cadres and those skills are used to deliver quality services.

Transnational public and global health education in China

Transnational public and global health programs in China have rapidly expanded over the past 20 years,and have potential to make important contributions to China’s global health workforce.However,there has been sparse if any literature specific to transnational public and global health higher education in China.In response,this perspective article aims to:(1)outline current transnational public and global health programs in China,and(2)delineate opportunities and challenges for transnational public and global health programs to enhance China’s global health workforce.Based on internet searches,eight active transnational public and global health programs in China were identified in September 2022(one Bachelors;four Masters;three doctorate).Degree awarding institutions are located in Australia,Portugal,the United Kingdom,and the United States.Courses for stand-alone transnational programs were co-delivered by faculty from the Chinese and foreign sponsoring institutions.The earliest and latest programs were respectively established in 2001 and 2022,and the average year of establishment was 2013.The endurance of some programs(three programs operating≥10 years)indicates the potential sustainability of transnational public and global health programs in China.However,opportunities for cross-cultural engagement appear to be constrained by lack of English(or other language)requirements in some programs,limited recruitment of international students,pandemic travel restrictions,and a dearth of funding for global health research outside China.In addition,students enrolled at transnational universities in China are currently ineligible for China Scholarship Council funding.As China’s need for global health capacity grows amid a rapidly shrinking population of younger citizens,strategic investments in transnational public and global health programs may be of increasing value.

Down the brain drain:a rapid review exploring physician emigration from West Africa

Background The emigration of physicians from low-and middle-income countries(LMICs)to high-income countries(HICs),colloquially referred to as the“brain drain”,has been a topic of discussion in global health spheres for years.With the call to decolonize global health in mind,and considering that West Africa,as a region,is a main source of physicians emigrating to HICs,this rapid review aims to synthesize the reasons for,and implications of,the brain drain,as well as recommendations to mitigate physician emigration from West African countries to HICs.Methods A literature search was conducted on PubMed,EMBASE and The Cochrane Library.Main inclusion criteria were the inclusion of West African trained physicians’perspectives,the reasons and implications of physician emigration,and recommendations for management.Data on the study design,reasons for the brain drain,implications of brain drain,and proposed solutions to manage physician emigration were extracted using a structured template.The Hawker Tool was used as a risk of bias assessment tool to evaluate the included articles.Results A total of 17 articles were included in the final review.Reasons for physician emigration include poor working conditions and remuneration,limited career opportunities,low standards of living,and sociopolitical unrest.Implications of physician emigration include exacerbation of low physician to population ratios,and weakened healthcare systems.Recommendations include development of international policies that limit HICs’recruitment from LMICs,avenues for HICs to compensate LMICs,collaborations investing in mutual medical education,and incorporation of virtual or short-term consultation services for physicians working in HICs to provide care for patients in LMICs.Conclusions The medical brain drain is a global health equity issue requiring the collaboration of LMICs and HICs in implementing possible solutions.Future studies should examine policies and innovative methods to involve both HICs and LMICs to manage the brain drain.