Measuring inequalities in the distribution of the Fiji Health Workforce

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.

End‐stage kidney disease in Fiji

“…The application of strict inclusion and exclusion criteria in this study combined with known inequity in access to healthcare services and distribution of the health workforce in Fiji, particularly for patients in rural and remote areas and those requiring specialist medical services, means this study may underestimate the true burden of ESKD …”

“…The application of strict inclusion and exclusion criteria in this study combined with known inequity in access to healthcare services and distribution of the health workforce in Fiji, particularly for patients in rural and remote areas and those requiring specialist medical services, means this study may underestimate the true burden of ESKD. [33][34][35] Conclusion ESKD is a rapidly growing global problem and there has been a paucity of data about this condition from the developing countries of the Western Pacific. 36 This study from Fiji, the largest of the developing nations in this region, concludes that the incidence of ESKD and associated mortality in Fiji is very high.…”

Measuring inequalities in the demographical and geographical distribution of physicians in China: Generalist versus specialist

“…This result is mainly due to the population‐oriented allocation policy of health workforces. Most health resource planning programs, including programs raised by WHO, regard population size as the most important factor . Few consider geographical area and other influencing factors.…”

Inequality in the Distribution of Healthcare Human Resources in Poland

“…Then, Munga and Maestad [63] found significant inequalities in the distribution of health workers in Tanzania. Wiseman et al [64] conducted research in Fiji and found greater inequalities in the density of health workers at the provincial level compared to divisional level. Also, inequities in the distribution of healthcare workers were found in Cameroon by Tandi et al [65].…”