Time trends in the regional distribution of physicians, nurses and midwives in Europe

Abstract Background Country-level data suggest large differences in the supply of health professionals among European countries. However, little is know about the regional supply of health professionals taking a cross-country comparative perspective. The aim of the study was to analyse the regional distribution of physicians, nurses and midwives in the highest and lowest density regions in Europe and examine time trends. Methods We used Eurostat data and descriptive statistics to assess the density of physicians, nurses and midwives at national and regional levels (Nomenclature of Territorial Units for Statistics (NUTS) 2 regions) for 2017 and time trends (2005–2017). To ensure cross-country comparability we applied a set of criteria (working status, availability over time, geographic availability, source). This resulted in 14 European Union (EU) countries and Switzerland being available for the physician analysis and eight countries for the nurses and midwives analysis. Density rates per population were analysed at national and NUTS 2 level, of which regions with the highest and lowest density of physicians, nurses and midwives were identified. We examined changes over time in regional distributions, using percentage change and Compound Annual Growth Rate (CAGR). Results There was a 2.4-fold difference in the physician density between the highest and lowest density countries (Austria national average: 513, Poland 241.6 per 100,000) and a 3.5-fold difference among nurses (Denmark: 1702.5, Bulgaria: 483.0). Differences by regions across Europe were higher than cross-country variations and varied up to 5.5-fold for physicians and 4.4-fold for nurses/midwives and did not improve over time. Capitals and/or major cities in all countries showed a markedly higher supply of physicians than more sparsely populated regions while the density of nurses and midwives tended to be higher in more sparsely populated areas. Over time, physician rates increased faster than density levels of nurses and midwives. Conclusions The study shows for the first time the large variation in health workforce supply at regional levels and time trends by professions across the European region. This highlights the importance for countries to routinely collect data in sub-national geographic areas to develop integrated health workforce policies for health professionals at regional levels.

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Time trends in the regional distribution of physicians, nurses and midwives in Europe

10.21203/rs.3.rs-42104/v2 ◽

2020 ◽

Author(s):

Juliane Winkelmann ◽

Ulrike Muench ◽

Claudia B. Maier

Keyword(s):

Health Workforce ◽

Health Professionals ◽

Time Trends ◽

Regional Distribution ◽

Annual Growth Rate ◽

Physician Density ◽

Cross Country ◽

Nurses And Midwives ◽

Over Time ◽

Distribution Of Physicians

Abstract Background. Country-level data suggest large differences in the supply of health professionals among European countries. However, little is know about the regional supply of health professionals taking a cross-country comparative perspective. The aim of the study was to analyse the regional distribution of physicians, nurses and midwives in the highest and lowest density regions in Europe and examine time trends.Methods. We used Eurostat data and descriptive statistics to assess the density of physicians, nurses and midwives at national and regional levels (Nomenclature of Territorial Units for Statistics (NUTS) 2 regions) for 2017 and time trends (2005-2017). To ensure cross-country comparability we applied a set of criteria (working status, availability over time, geographic availability, source). This resulted in 145 European Union (EU) countries and Switzerland being available for the physician analysis and eight countries for the nurses and midwives analysis. Density rates per population were analysed at national and NUTS 2 level, of which regions with the highest and lowest density of physicians, nurses and midwives were identified. We examined changes over time in regional distributions, using percentage change and Compound Annual Growth Rate (CAGR).Results. There was a 2.4-fold difference in the physician density between the highest and lowest density countries (Austria national average: 513, Poland 241.6 per 100,000) and a 3.5-fold difference among nurses (Denmark: 1702.5, Bulgaria: 483.0). Differences by regions across Europe were higher than cross-country variations and varied up to 5.5-fold for physicians and 4.5-fold for nurses/midwives and did not improve over time. Capitals and/or major cities in all countries showed a markedly higher supply of physicians than more sparsely populated regions while the density of nurses and midwives tendeds to be higher in more sparsely populated areas. Over time, physician rates increased faster than density levels of nurses and midwives.Conclusions. The study shows for the first time theThe large variation in health workforce supply at regional levels and time trends by professions across the European region. This highlights the importance for countries to routinely collect data at in sub-national geographic areas in order for workforce planners, employers, educators and others to develop integrated health workforce policies and initiatives that may impact supply offor health professionals at regional levels.

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Time trends in the regional distribution of physicians, nurses and midwives in Europe

10.21203/rs.3.rs-42104/v3 ◽

2020 ◽

Author(s):

Juliane Winkelmann ◽

Ulrike Muench ◽

Claudia B. Maier

Keyword(s):

Health Workforce ◽

Health Professionals ◽

Time Trends ◽

Regional Distribution ◽

Annual Growth Rate ◽

Physician Density ◽

Cross Country ◽

Nurses And Midwives ◽

Over Time ◽

Distribution Of Physicians

Abstract Background. Country-level data suggest large differences in the supply of health professionals among European countries. However, little is know about the regional supply of health professionals taking a cross-country comparative perspective. The aim of the study was to analyse the regional distribution of physicians, nurses and midwives in the highest and lowest density regions in Europe and examine time trends.Methods. We used Eurostat data and descriptive statistics to assess the density of physicians, nurses and midwives at national and regional levels (Nomenclature of Territorial Units for Statistics (NUTS) 2 regions) for 2017 and time trends (2005-2017). To ensure cross-country comparability we applied a set of criteria (working status, availability over time, geographic availability, source). This resulted in 14 European Union (EU) countries and Switzerland being available for the physician analysis and eight countries for the nurses and midwives analysis. Density rates per population were analysed at national and NUTS 2 level, of which regions with the highest and lowest density of physicians, nurses and midwives were identified. We examined changes over time in regional distributions, using percentage change and Compound Annual Growth Rate (CAGR).Results. There was a 2.4-fold difference in the physician density between the highest and lowest density countries (Austria national average: 513, Poland 241.6 per 100,000) and a 3.5-fold difference among nurses (Denmark: 1702.5, Bulgaria: 483.0). Differences by regions across Europe were higher than cross-country variations and varied up to 5.5-fold for physicians and 4.4-fold for nurses/midwives and did not improve over time. Capitals and/or major cities in all countries showed a markedly higher supply of physicians than more sparsely populated regions while the density of nurses and midwives tended to be higher in more sparsely populated areas. Over time, physician rates increased faster than density levels of nurses and midwives.Conclusions. The study shows for the first time the large variation in health workforce supply at regional levels and time trends by professions across the European region. This highlights the importance for countries to routinely collect data in sub-national geographic areas to develop integrated health workforce policies for health professionals at regional levels.

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Time Trends in the Regional Distribution of Physicians, Nurses and Midwives in Europe

10.21203/rs.3.rs-42104/v1 ◽

2020 ◽

Author(s):

Juliane Winkelmann ◽

Ulrike Muench ◽

Claudia B. Maier

Keyword(s):

Health Professionals ◽

Time Trends ◽

Regional Distribution ◽

European Countries ◽

Annual Growth Rate ◽

Physician Density ◽

Cross Country ◽

Nurses And Midwives ◽

Over Time ◽

Distribution Of Physicians

Abstract Background. Country-level data suggest large differences in the supply of health professionals among European countries. However, little is know about the regional supply of health professionals taking a cross-country comparative perspective. The aim of the study was to analyse the regional distribution of physicians, nurses and midwives in the highest and lowest density regions and examine time trends.Methods. We used Eurostat data and descriptive statistics to assess the density of physicians, nurses and midwives at national and regional levels (Nomenclature of Territorial Units for Statistics (NUTS) 2 regions) for 2017 and time trends (2005-2017). To ensure cross-country comparability we applied a set of criteria (working status, availability over time, geographic availability, source). This resulted in 15 European countries being available for the physician analysis and eight countries for the nurses and midwives analysis. Density rates per population were analysed at national and NUTS 2 level, of which regions with the highest and lowest density of physicians, nurses and midwives were identified. We examined changes over time in regional distributions, using percentage change and Compound Annual Growth Rate (CAGR).Results. There was a 2.4-fold difference in the physician density between the highest and lowest density countries (Austria: 513, Poland 241.6 per 100,000) and a 3.5-fold difference among nurses (Denmark: 1702.5, Bulgaria: 483.0). Differences by regions across Europe were higher than cross-country variation and varied up to 4.5-fold both for physicians and nurses/midwives and did not improve over time. Capitals and/or major cities in all countries showed a markedly higher supply of physicians than more sparsely populated regions while the density of nurses and midwives tends to be higher in more sparsely populated areas. Conclusions. The large variation in workforce supply at regional levels highlights the importance for countries to routinely collect data at sub-national geographic areas in order for workforce planners, employers, educators and others to develop policies and initiatives that may impact supply of health professionals at regional levels.

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Time trends in the geographical distribution of physicians, nurses and midwives in Europe

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.526 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

J Winkelmann ◽

C B Maier

Keyword(s):

Geographical Distribution ◽

Health Professionals ◽

Time Trends ◽

National Level ◽

Regional Level ◽

European Countries ◽

Physician Density ◽

Cross Country ◽

Nurses And Midwives ◽

Over Time

Abstract Background Data on the supply of health professionals show large variations in the health workforce density among European countries based on national-level data. However, little attention has been paid to the comparison of health professional density at the regional level. This study aimed to analyse the density of physicians, nurses and midwives at regional level, using a cross-country comparative design and examine time trends. Methods Descriptive analysis of Eurostat data on the rate of health professionals per population at national and regional levels (NUTS 2 regions) for 2017 and time trends (2005-2017) and comparison to population density. To improve the cross-country comparability of data a set of criteria was applied, resulting in 15 European countries covered on physicians and eight for nurses and midwives. Changes over time in the regional distribution were analysed, using percentage change and compound annual growth rate (CAGR). Results We found a 2.4-fold difference in the physician density between the highest and lowest density countries (Austria: 513, Poland 241.6 per 100.000) and a 3.5-fold difference among nurses (Denmark: 1702.5, Bulgaria: 483). Differences by regions across Europe were higher and varied up to 4.5-fold both for physicians and nurses/midwives and did not improve over time. Results show that in all countries physician density levels are highest in densely populated regions, with capitals and/or major cities, while density of nurses and midwives tends to be higher in less populated areas. Overall, physician rates grew at a faster rate than the density levels of nurses and midwives. Conclusions International data should not only cover supply indicators at national level, but routinely collect regional data on the number of health professionals to demonstrate regional differences in workforce supply and to improve monitoring and workforce planning at regional levels. Key messages Despite increases in the density levels of physicians, nurses and midwives, time trends over a ten-year period showed no improvement in the geographical distribution within countries. The study is the first of its kind to descriptively analyse geographical density levels and time trends among health professionals across a selection of European countries using Eurostat data.

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Size, composition and distribution of human resource for health in India: new estimates using National Sample Survey and Registry data

BMJ Open ◽

10.1136/bmjopen-2018-025979 ◽

2019 ◽

Vol 9 (4) ◽

pp. e025979 ◽

Cited By ~ 8

Author(s):

Anup Karan ◽

Himanshu Negandhi ◽

Rajesh Nair ◽

Anjali Sharma ◽

Ritika Tiwari ◽

...

Keyword(s):

Human Resource ◽

Health Workforce ◽

Health Professionals ◽

Health Workers ◽

Size Composition ◽

National Sample ◽

Registry Data ◽

Sample Survey ◽

Secondary Outcome ◽

Nurses And Midwives

ObjectivesWe provide new estimates on size, composition and distribution of human resource for health in India and compare with the health workers population ratio as recommended by the WHO. We also estimate size of non-health workers engaged in health sector and the size of technically qualified health professionals who are not a part of the health workforce.DesignNationally representative cross-section household survey and review of published documents by the Central Bureau of Health Intelligence.SettingNational.ParticipantsHead of household/key informant in a sample of 101 724 households.InterventionsNot applicable.Primary and secondary outcome measuresThe primary outcome was the number and density of health workers,and the secondary outcome was the percentage of health workers who are technically qualified and the percentage of individuals technically qualified and not in workforce.ResultsThe total size of health workforce estimated from the National Sample Survey (NSS) data is 3.8 million as of January 2016, which is about 1.2 million less than the total number of health professionals registered with different councils and associations. The density of doctors and nurses and midwives per 10 000 population is 20.6 according to the NSS and 26.7 based on the registry data. Health workforce density in rural India and states in eastern India is lower than the WHO minimum threshold of 22.8 per 10 000 population. More than 80% of doctors and 70% of nurses and midwives are employed in the private sector. Approximately 25% of the currently working health professionals do not have the required qualifications as laid down by professional councils, while 20% of adequately qualified doctors are not in the current workforce.ConclusionsDistribution and qualification of health professionals are serious problems in India when compared with the overall size of the health workers. Policy should focus on enhancing the quality of health workers and mainstreaming professionally qualified persons into the health workforce.

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Introduction

10.1093/oso/9780198782797.003.0001 ◽

2018 ◽

Author(s):

Telesca Giuseppe

Keyword(s):

Structural Analysis ◽

Institutional Change ◽

Cultural Context ◽

The Past ◽

Final Goal ◽

Social Structural ◽

Country Analysis ◽

Cross Country ◽

Over Time

The ambition of this book is to combine different bodies of scholarship that in the past have been interested in (1) providing social/structural analysis of financial elites, (2) measuring their influence, or (3) exploring their degree of persistence/circulation. The final goal of the volume is to investigate the adjustment of financial elites to institutional change, and to assess financial elites’ contribution to institutional change. To reach this goal, the nine chapters of the book introduced here look at financial elites’ role in different European societies and markets over time, and provide historical comparisons and country and cross-country analysis of their adaptation and contribution to the transformation of the national and international regulatory/cultural context in the wake of a crisis or in a longer term perspective.

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Time trends of socioeconomic inequalities in adolescent smoking in Okinawa, Japan, 2008–2016: a repeated cross-sectional study

Environmental Health and Preventive Medicine ◽

10.1186/s12199-021-00948-y ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Minoru Takakura ◽

Masaya Miyagi ◽

Akira Kyan

Keyword(s):

Time Trends ◽

Parental Education ◽

Cross Sectional Study ◽

Socioeconomic Inequalities ◽

School Type ◽

Sectional Study ◽

Cross Sectional ◽

Japanese Adolescents ◽

Index Of Inequality ◽

Over Time

Abstract Background Smoking among Japanese adolescents has decreased noticeably. However, little is known whether the decreasing trend in adolescent smoking can be seen across all socioeconomic status (SES) groups. This study aimed to examine trends in socioeconomic inequalities in smoking among Japanese adolescents between 2008 and 2016. Methods We conducted a repeated cross-sectional study using data from three surveys of high school students in Okinawa, Japan, in 2008, 2012, and 2016. The study participants consisted of 7902 students in grades 10 through 12 (15–18 years). Smoking was assessed as current cigarette use. SES indicators included familial SES (parental education and family structure) and student’s own SES (school type). To evaluate absolute and relative inequalities, prevalence differences (PDs) and ratios (PRs) between low and high SES groups were estimated. The slope index of inequality (SII) and relative index of inequality (RII) were also calculated. Results Smoking prevalence among boys and girls significantly declined from 11.5% and 6.2% in 2008 to 4.7% and 1.9% in 2016, respectively. Similar decreasing trends in smoking were found among most of the SES groups. The PDs and SII for parental education in boys and family structure in girls decreased over time while those for school type persisted among boys and girls. The PRs and RII for school type in boys increased while those for other SES indicators among both sexes remained stable over time. Conclusions Smoking among Japanese adolescents has been declining and time trends of socioeconomic inequalities in smoking varied by absolute and relative measures. Further policies and/or interventions to reduce smoking inequalities should focus on the context of schools, especially in vocational high schools.

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Size, composition and distribution of health workforce in India: why, and where to invest?

Human Resources for Health ◽

10.1186/s12960-021-00575-2 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Anup Karan ◽

Himanshu Negandhi ◽

Suhaib Hussain ◽

Tomas Zapata ◽

Dilip Mairembam ◽

...

Keyword(s):

Labor Markets ◽

Health Workforce ◽

Health Professionals ◽

Health Workers ◽

Human Resources For Health ◽

Labour Force ◽

Medical Practitioner ◽

Skewed Distribution ◽

Sample Survey ◽

Skill Mix

Abstract Background Investment in human resources for health not only strengthens the health system, but also generates employment and contributes to economic growth. India can gain from enhanced investment in health workforce in multiple ways. This study in addition to presenting updated estimates on size and composition of health workforce, identifies areas of investment in health workforce in India. Methods We analyzed two sources of data: (i) National Health Workforce Account (NHWA) 2018 and (ii) Periodic Labour Force Survey 2017–2018 of the National Sample Survey Office (NSSO). Using the two sources, we collated comparable estimates of different categories of health workers in India, density of health workforce and skill-mix at the all India and state levels. Results The study estimated (from NHWA 2018) a total stock of 5.76 million health workers which included allopathic doctors (1.16 million), nurses/midwives (2.34 million), pharmacist (1.20 million), dentists (0.27 million), and traditional medical practitioner (AYUSH 0.79 million). However, the active health workforce size estimated (NSSO 2017–2018) is much lower (3.12 million) with allopathic doctors and nurses/midwives estimated as 0.80 million and 1.40 million, respectively. Stock density of doctor and nurses/midwives are 8.8 and 17.7, respectively, per 10,000 persons as per NHWA. However, active health workers’ density (estimated from NSSO) of doctor and nurses/midwives are estimated to be 6.1 and 10.6, respectively. The numbers further drop to 5.0 and 6.0, respectively, after accounting for the adequate qualifications. All these estimates are well below the WHO threshold of 44.5 doctor, nurses and midwives per 10,000 population. The results reflected highly skewed distribution of health workforce across states, rural–urban and public–private sectors. A substantial proportion of active health worker were found not adequately qualified on the one hand and on the other more than 20% of qualified health professionals are not active in labor markets. Conclusion India needs to invest in HRH for increasing the number of active health workers and also improve the skill-mix which requires investment in professional colleges and technical education. India also needs encouraging qualified health professionals to join the labor markets and additional trainings and skill building for already working but inadequately qualified health workers.

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Advancing the Population Needs-Based Health Workforce Planning Methodology: A Simulation Tool for Country Application

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18042113 ◽

2021 ◽

Vol 18 (4) ◽

pp. 2113

Author(s):

James Asamani ◽

Christmal Christmals ◽

Gerda Reitsma

Keyword(s):

Open Access ◽

Population Health ◽

Health Workforce ◽

Health Professionals ◽

Real Life ◽

Workforce Planning ◽

Health Needs ◽

Simulation Tool ◽

Flow Process ◽

Health Workforce Planning

Although the conceptual underpinnings of needs-based health workforce planning have developed over the last two decades, lingering gaps in empirical models and lack of open access tools have partly constrained its uptake in health workforce planning processes in countries. This paper presents an advanced empirical framework for the need-based approach to health workforce planning with an open-access simulation tool in Microsoft® Excel to facilitate real-life health workforce planning in countries. Two fundamental mathematical models are used to quantify the supply of, and need for, health professionals, respectively. The supply-side model is based on a stock-and-flow process, and the need-side model extents a previously published analytical frameworks using the population health needs-based approach. We integrate the supply and need analyses by comparing them to establish the gaps in both absolute and relative terms, and then explore their cost implications for health workforce policy and strategy. To illustrate its use, the model was used to simulate a real-life example using midwives and obstetricians/gynaecologists in the context of maternal and new-born care in Ghana. Sensitivity analysis showed that if a constant level of health was assumed (as in previous works), the need for health professionals could have been underestimated in the long-term. Towards universal health coverage, the findings reveal a need to adopt the need-based approach for HWF planning and to adjust HWF supply in line with population health needs.

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Evaluation of Education for Public Health: A Practical Foundation for Solidarity

European Journal of Public Health ◽

10.1093/eurpub/ckz185.063 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

M Perkiö ◽

R Harrison ◽

M Grivna ◽

D Tao ◽

C Evashwich

Keyword(s):

Public Health ◽

Health Education ◽

Health Workforce ◽

Health Professionals ◽

Public Health Education ◽

Public Health Workforce ◽

Rigorous Evaluation ◽

The Public ◽

Public Health Professionals

Abstract Education is a key to creating solidary among the professionals who advance public health’s interdisciplinary mission. Our assumption is that if all those who work in public health shared core knowledge and the skills for interdisciplinary interaction, collaboration across disciplines, venues, and countries would be facilitated. Evaluation of education is an essential element of pedagogy to ensure quality and consistency across boundaries, as articulated by the UNESCO education standards. Our study examined the evaluation studies done by programs that educate public health professionals. We searched the peer reviewed literature published in English between 2000-2017 pertaining to the education of the public health workforce at a degree-granting level. The 2442 articles found covered ten health professions disciplines and had lead authors representing all continents. Only 86 articles focused on evaluation. The majority of the papers examined either a single course, a discipline-specific curriculum or a teaching method. No consistent methodologies could be discerned. Methods ranged from sophisticated regression analyses and trends tracked over time to descriptions of focus groups and interviews of small samples. We found that evaluations were primarily discipline-specific, lacked rigorous methodology in many instances, and that relatively few examined competencies or career expectations. The public health workforce enjoys a diversity of disciplines but must be able to come together to share diverse knowledge and skills. Evaluation is critical to achieving a workforce that is well trained in the competencies pertinent to collaboration. This study informs the pedagogical challenges that must be confronted going forward, starting with a commitment to shared core competencies and to consistent and rigorous evaluation of the education related to training public health professionals. Key messages Rigorous evaluation is not sufficiently used to enhance the quality of public health education. More frequent use of rigorous evaluation in public health education would enhance the quality of public health workforce, and enable cross-disciplinary and international collaboration for solidarity.

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