| ObjectivesTo understand the status of health human resources in grassroots health institutions of Gansu; to evaluate the distribution equity of health human resources based on some dimensions such as the service population, service territory, etc; to investigation the situation on mastering the basic contents of basic public health services of professionals in grass-roots health institutions in order to reflect the service capabilities. The objective of this research is to provide a scientific basis for further optimization of health human resources project and strategy for human resource development in Gansu.MethodsTypical sampling method was applied for selecting layered samples according to characteristics of social-economic situation, traits of cultural and ethnic of population in Gansu. The first layer was to choose five counties and autonomous prefectures as sample areas including Chengguan district in Lanzhou, liangzhou district in Wuwei, Huining county in Baiyin, Kangle county in Hui Autonomous Prefecture of Linxia and Xiahe county in Tibetan Autonomous Prefecture of Gannan. According to the results of annual performance evaluation on the grassroots health institutions in 2013, three township health institutes and/or a community health service center in each of 5 counties (and districts) mentioned above were selected to collect related data of professional human resources, and a survey was conducted. Quantificational data input was finished by Excel 2007, and then the Lorenz curve and Gini coefficient were calculated by use of SPSS18.0. Data of qualitative interview were coded and analyzed with Nvivo8.0 software. The Data of questionnaire survey were input with Epidata software through double-blind approach.Results(1) Gansu faced some problems with health human resource shortage and unreasonable personnel structure in grassroots health institutions. The doctor number per one thousand persons was 0.64, technician number per a thousand persons was 1.20, nurse number was 0.35 per thousand persons and the ratio of doctor and nurse was 1:0.55, lower than the national and provincial levels. The age composition of health technical personnel presented the characteristics of young, the majority was at the age of 25 to 34 years old, accounted for 43.4%, and the personnel at the age of 35 to 44 years old was 28.0%. The academic structure of technical personnel was poor in some degree. Most of them were junior college degree and technical secondary school degree, accounted for 58.4% and 22.9% respectively. Only 16.2% had bachelor degree. The title structure showed a poor situation, primary title accounted for 53.4%, intermediate title,14.0%, and just only 0.7% of personal owned senior titles,28.3% had not any titles.(2) As for the equity of health human resource allocation, the total number of doctor and nurse showed rational allocation in some extent, while the allocation fairness of full-time public health and medical personnel was poor. The Gini coefficient on the basis of cumulative percentage of the population was 0.2563 (all worker),0.2983 (personnel establishment),0.3960 (number of practicing doctors), 0.2478 (registered nurses),0.4145 (public health professionals) and 0.4280 (technician). The Gini coefficient of doctors and nurses were below 0.3 and their configurations were relative fair. The Gini coefficient of full-time public health personnel and technician were above 0.4, higher than the fairness warning line of WHO. The Gini coefficient based on the service area of the cumulative percentage were 0.9565 (all staff),0.7962 (personnel establishment),0.6488 (professional medical doctor),0.8387 (registered nurse),0.8986 (public health professionals) and 0.8343(technician). All Gini coefficients were above 0.4. The highest Gini coefficient was total number of employees, almost close to 1.(3)The knowledge level concerning basic public health services of health technical personnel in grass-roots health institutions was not high. It reflects the lack of basic training, insufficient of service ability. Average score of basic public health services knowledge questionnaire of health technical personnel in grass-roots was 57.21. Among various sample county (district), the average score of personnel in Liangzhou district was 64.05, Huining county was 71.03, Chengguan district was 49.83, Guanghe county was 56.37and Xiahe county was 44.77. Only Liangzhou and Huining average score were above the pass level.ConclusionsHealth human resources of grass-roots health institutions in Gansu province was overall shortage and age structure,title structure and academic structure are unreasonable. The proportion of High-level personnel is not high. About health human resource in the service configuration of the total population, the allocation fairness of full-time public health personnel and technician are poorer. The fairness of total staff based on the geographical area of service coverage is the worst. The knowledge level related to basic public health services of health technical personnel in grass-roots health institutions is poor. The results indicated that we should further improve the regional health planning, especially strengthen health human resource configuration, optimize personnel structure so as to improve the allocation fairness. Furthermore, we also should further strengthen service capacity building of grassroots health personals in the field of basic public health services through enlarging the number of public health staff, perfecting personnel training plan and improving the basic medical and public health service and service quality. |
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