Projection Of Human Resource For Health And Incentive Factors Research For Primary Health In Western China

BackgroundAll countries around the world have been challenging with varying levels of shortage issues of health workforce since 1960s.World health report 2006 implied that human resource for health(HRH)allocation are not match with economic burden of disease in varies regions of the world,HRH shortage are more severe especially in developing countries of Africa and Asia.The global economy is projected to create around 40 million new health sector jobs by 2030,mostly in middle-and high-income countries.Despite the anticipated growth in jobs,there will be a projected shortage of 18 million health workers to achieve the Sustainable Development Goals primarily in low and lower-middle income countries.The imbalance of supply and demand of HRH has been as one of the root reasons that impedes the development and goal achievement of global health.The quantity increasing and quality promotion of HRH not only improve health and health security,but also impetus inclusive economic growth.With the deepening and developing of economic and health reform in China,different tone of economic growth among regions extends the HRH imbalance issue and might made it more severe,which made attraction and retention of HRH in underdeveloped western area of China especially essential.To solve this issue,the allocation and equity situation of HRH in western area need to be analyzed,while the developing trend in the future should be projected to find out the shortage,and thus strategies to change the shortage need to be explored.Currently in China,however,projection and planning research of HRH remains in the primary stage,there have not been a systematic research on attraction and retention issue of HRH in rural and remote area of western.Thus,based on the background,this paper puts forward and focuses issues mainly on two aspects.One is situational and equity analysis and HRH projection research to figure out the shortage on quantity,quality and skill mix in western.Another research on answer "how to close the gap",which need to research on the bottleneck of imbalance issue,especially analysis on incentive factors that influence attracting and retention of HRH in under-served rural and remote areas.ObjectivesFacing the increasingly severe HRH challenges,this paper takes HRH allocation optimization of western China as research object.Based on constantly emerged studies and trend both from domestic and abroad,the paper aims to figure out incentive factors that influencing atrrating and retention health workers in rural and remote areas after HRH projection and gap analysis.Specific objectives are as follows:1)To figure out the current situation and allocation equtiy of HRH in western.2)To research on demand and supply projection of HRH to 2020 in western.3)Gap analysis on quantity,quality,and skill mix of HRH in western.4)Incentive factor analysis of attracting medical students from job willingness and preference aspect.5)Incentive factor analysis of retention health workers from job satisfaction aspect.6)To put forward corresponding incentive strategies and policy recommendations.MethodsData on situational,equtiy analysis and HRH projection are extracted from Chinese Health and family planning yearbook 2015 and Chinese statistic yearbook 2016.And sample data of HRH are from field survey of a joint research project funded by China Medical Board(grant number 10-029).The survey mainly focued on health workers and medical students near graduation in health facilities and medical colleages in 11 provinces and autonomous regions of western China except Chungking.In situational analysis,panel data were used to observe the quantity,structure,and distribution of HRH.Gini and Theil coefficient method were employed to evaluate the equity of HRH allocation under two assumptions as resource homogeneity and heterogeneity.In HRH projection and planning part,the research applied workforce-to-population ratio method and Grey model GM(1,1)and ARIMA(3,1,0)time series model in demand projection.While "flow in and flow out" analysis,curve regression model,and Grey model were utilized in supply projection.Based on the categorize of incentive factors,research explored job willingness of medical students,as future supply,to rural areas and its factors through Chi-squared test,One-Way ANOVA,and Binary Logistic Regression.Incentive factor analysis of health workers,as stock,were discussed based on job satisfaction theory and through Factor Analysis and four quadrant model to explore most unsatisfied factors and corresponding policy directions.Besides,qualitative analysis of health worker interviews and typical HRH policy evaluation were also finished to discuss incentive strategies that could bridge the HRH gap.Satistical software as SPSS(version 19.0)and Matlab(version R2016a)were applied in data analysis and HRH projection.ConclusionsThe research finally goes to conclusions as follows:1)HRH of western China increasing fast and policy innovate works in last decades,while quantity,structure,quality and distribution issues are still prevailing.While distribution of HRH in western is more inequity according to economic development and geography features,and inequity mainly from disparities between urban and rural.2)Supply of HRH in western area increases rapidly since the new round medical reform in 2009,but still could not match with the rising of HRH demand,the shortage of quantity,skill mix,and quality will persist in the short term.3)The willingness to rural facilities of medical students affected by multiple factors,both financial and non-financial incentive factors works.Only financial factors might not work well,multifaceted incentive policies should integrate together.4)Job satisfaction varies among primary health facilities and provinces of western China.Currently,factors as rewards and returns compared with health worker's contribution,living conditions,and professional environment are more unsatisfied by primary health workers.5)Implementation of health workforce policies at the local level always sufferred with coordination problem among departments,and supporting strategies are also insufficient.Policy recommendations1)Emphasizing and supporting of policy makers and health administration is the footstone for success of HRH projection,planning and policy implementation.2)Western provinces should face up to their HRH shortage issues,continously increasing the supply and promote the quality of health workforce,attracting and retention sufficient and qualified health workers to rural and remote areas to fill the HRH gap.3)Effective measures should be adopted as appropriately expanding the medical education scale of western region,vigorously promoting medical education quality,and enhancing advocation and guidance of primary level HRH policies.Proper enrollment scale of medical students of each professions should be arranged according to HRH targets,especially enroll some students come from rual and remote.4)Each province should formulate specific HRH polices accordingly,and implementation,in time survillance and evaluation of these policies should be emphasized.Meanwhile,more importance on balance and coordination of varies stakeholders of HRH policy should also be attached as well as synergistic or antagonistic effects among varies policies.6)Multifaceted incentive policies should integrate together to promote health workforce's job willingness and satisfaction,thus further enhance job performance.Innovations and LimitationsThe research mainly has three innovations as follows:1)the equity analysis of western HRH allocation not only find out the resource of inequity,but also put forward a PEDI coefficient.2)It is the first time that demand and supply of western HRH being projected and shortage gap being analyzed.3)Incentive study that based on a big scale investigation among 11 sampled provinces and autonomous regions in western area is another innovation.The limitations and prospects of the research:1)limited to the database,HRH demand projection could not cover the utilization of health services and supply projection assume the HRH inflow and outflow is being stable,which to some extend influence the accuracy of the outcome.If data available,specific projection as physicians.nurses,pharmacists,general practitioners etc.could also be achieved.2)There might be sampling bias in field survey in 33 counties of 11 western provinces.3)Applying the new technology as remote medical mode to promote the capacity building of primary health facilities is a promising research direction.4)Specific incentive and performance promotion in health administration among facilities will be an extending direction.