| Objectives: The aim of this study was to comprehensively master the situation and demand of human resources for health, the change of medical education and training in Gansu Province of 2014. In addition, forecasting methods were used to predict the demand and supply of human resource for health and medical education of Gansu province in 2017. The purpose was to understand the distribution characteristics of health human resources in the medical institutions of Gansu Province and identify the main problems, then put forward corresponding suggestions and countermeasures to help the administrative department of public health to establish reasonable plans about health personnel. Besides, the study also intent to develop a perfect medical education pattern in Gansu Province, which mainly refers to professional settings and teaching content, and make appropriate policies of training and motivation for health personnel of the primary medical care institutions.Methods: According to the economic and social development of Gansu province, all the investigation units were divided into three areas(city, state). Firstly, using the principle of multi-stage stratified cluster sampling, a county and a district were extracted from each area. Secondly, a county and a district were extracted from each kind region in the middle of social and economic development, and at last, three townships and three streets medical institutions were re-extracted from corresponding county and district. The samples of each area were included the city, county or district, township or village level medical institutions, and also contains township hospitals and village clinics.The contents of the survey include the number of health workforce, the structure and changes of each medical institutions, and the enrollment scale and employment at various levels of medical colleges in Gansu province. The information of each medical institution was collected through the corresponding questionnaire. According to the questionaires, the basic situation of the health manpower workforce has been statistical described, and calculated the whole.The gray model was used to predict the demands of total health workforce in Gansu Province. Furthermore, combined to the enrollment and employment situation in recent years, the balance between the health workforce supply and demand of Gansu province was mastered.Results: 1.The structure of human resources for health:The proportion of male and female health personnel in medical institutions above the county or district level of Gansu province was about 1: 2.50, the proportion of men and women in medical institutions at rural(village) level was 1: 1.57. Health personnel age was given priority to with young and middle-aged, which was quite reasonable in distribution.The health personel in provincial medical institutions was with bachelor degree of 53.80%, the health personel of the first and the second area at city and county(district) level with udergraduate academic was came to a higher proportion, the education background of health personel in the third class area at city and county(district) level was mostly get college degree, the health personel in the first area at township(village) level was mainly get college degree. The medical institutions of the second and the third class region at rural(village) level were mainly technical secondary school degree or less. So the health personnel education levels in Gansu Province have been improved compared with 2010, but the overall level was still low.The ratio structure of high, middle and junior professional titles in provincial medical institutions of Gansu province was 2: 3: 8, which meant that there was relatively lack of intermediate grade, the medical institutions of city level was 1: 2.27: 4.64. Besides, there were more senior professional staffs at the city level of the first and the second class areas, middle and low grade officers were relatively shortage, primary title accounted mostly in medical institutions of country(district) level. The proportion of all professional titles was lower at township(village) level. In a word, the health personnel title structure of medical institutions at all levels in Gansu Province was irrational.The practicing or assistant doctors and nurses were the main of professional categories of medical institutions at all levels of health technicians. The ratio of doctors and nurses in provincial medical institution was 1: 1.52, the ratio in the first, second, third class area were 1: 1.45, 1: 1.37 and 1: 1.91, the ratioin the medical institutions of county(district) level of the three areas were 1: 1.58, 1: 1.19 and 1: 1.59, which all have reached the national standards and met the requirements of the province reference value, especially nurses have increased. But the ratios in the first, second and third rural areas were 1: 0.85, 1: 0.75 and 1: 0.75. Comparing with national standard, the ratio was still low, and the number of the nurses was inadequate in primary medical institutions.The proportion of provincial medical staffing was gradually decreasing year by year from 2011 to 2014, except for the rural(village) level medical institutions.The staff in medical institutions have more opportunities of provincial level except for rural and community medical institutions, the time of training was mainly less than 3 months. However, the staffs of the township institutions mainly have taken part in the training of country level. The training of health technical personnel in medical institutions of each class was increased year by year from 2011 to 2014 in Gansu Province, which meant that the medical institutions were giving attention to the training of health technicians.The ratio of new staffs in different levels of medical institutions showed a declining trend from 2008 to 2014. The main reason of new staff leaving was quitting office, the second reason was transferring.2. From the health workforce predicted results of Gansu Province:Speculate Gansu Provincial Health manpower needs was speculated by a sample survey from the subjective health manpower need of each medical institution. Total health manpower demand of Gansu Provincial was about 98,550 people, which was the highest number of practicing physicians demand, followed by nurses and medical technicians, and the rank of management staff needs was the last. The highest demand of practicing physicians was clinical practitioner and the Chinese medicine practitioners followed.Health Technical Personnel per thousand populations in Gansu Province will increase from 4.86 people in 2014 to 5.09 people in 2015, and 5.71 people in 2017. The number of doctors per thousand populations will increase from 1.78 people in 2014 to 1.84 people in 2015, and 1.99 people in 2017. The number of nurses per thousand populations will increase from 1.73 people in 2014 to 1.92 people in 2015, and 2.34 people in 2017. By 2015, the volume of per thousand population health technicians will exceed the national standard in the study, but per thousand population practicing(assistant) doctors and registered nurses can not reach the target number of Gansu Province, until 2017 it will achieve this goal.3. In terms of the current medical education in Gansu Province:The scale of enrollment in the high medical universities and junior colleges were enlarged, while the enrollment of secondary health school continued to decline. In fact, the proportion of secondary health school enrollment was still large, the undergraduate enrollment only accounted for a little of proportion. Moreover, the enrollment ratio of high medical universities outside the province has been decreased. On the contrary, more and more graduates wanted to work outside. The medical colleges enroll more students to the major of nurse than any other professions, which were unreasonable. According to the current enrollment and professional settings development, it still could not meet the health manpower needs in the future of Gansu Province.Conclusions: The number of health workforce in medical institutions of Gansu province could not meet the current demand, which was reflected in lower health personnel qualifications, the shortages titles and the unreasonable professional structure of health workforce. The relationship between the training of medical students and need of health professionals was not harmonious. So the more investments should be appropriately put into human resources for health in Gansu province, especially in rural areas and economic level which is relatively backward regions. And it is important to make the adoption of regional health manpower planning, so that the human resources for health can be allocated more reasonable. |
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