| Objectives: To analyze the total amount of human resources for health in township health centers and its change trend,the human resources for health per thousand rural population and its change trend,as well as the structural distribution and change trend in China’s township health hospitals from 2016 to 2020.At the same time,to analyze the allocation fairness from different dimensions,explore the existing problems and put forward relevant suggestions,in order to provide theoretical support for optimizing the allocation of human resources for health in township hospitals.Methods: The literature analysis method was used to sort out the related policies related to health talent development in township health centers,and the research theory of health human resource allocation was determined by literature review.The original database was established by Excel2019 software and the descriptive statistics method was used to analyze the current situation of health human resources in township health centers in China.Theil index,Lorenz curve and Gini coefficient were used to evaluate the fairness of health human resources allocation in township hospitals from population and geographical area.Based on Arc Map10.8 software,spatial analysis of health human resources in township health hospitals in 29 provinces(municipalities directly under the Central Government and autonomous regions)was carried out by using global spatial autocorrelation analysis and local spatial autocorrelation analysis.Results:(1)From 2016 to 2020,the total number of health personnel in township hospitals showed an overall upward trend,from 1320,841 in 2016 to 148,1230 in 2020,with an increase of 12.14%;the number of health technicians increased from 1,115,921 in 2016 to 1,267,426 in 2020,an increase of 11.95%;the number of licensed(assistant)physicians increased from 454,995 in 2016 to 520,116 in 2020,with an increase of12.52%;the number of registered nurses increased from 318,609 in 2016 to 408,550 in2020,an increase of 22.01%;the ratio of doctors to nurses was improved and showed a downward trend year by year,from 1.43:1 in 2016 to 1.27:1 in 2020,with a decrease of 12.17%.The number of all types of health workers per 1,000 rural population is on the rise,among which,the number of health workers per 1,000 rural population is increasing from 2.33 in 2016 to 2.94 in 2020,with an increase of 20.72%,and the number of health technicians per 1,000 rural population is increasing from 1.97 in 2016 to 2.51 in 2020,with an increase of 21.72%.The number of licensed(assistant)physicians per 1,000 rural population increased from 0.80 in 2016 to 1.03 in 2020,with an increase of 22.22%,and the number of registered nurses per 1,000 rural population increased from 0.56 in 2016 to 0.81 in 2020,with an increase of 30.66%.(2)By the end of 2020,from the perspective of each region of the country,the eastern region had the largest number of health personnel,with 509,078,accounting for34.37%,the western region has comparable numbers of health personnel per 1,000 rural population at 3.05 and 2.97 respectively.Sichuan had the largest number of health personnel,up to 115,163 people,accounting for 7.77%;the western and eastern regions had comparable numbers of health personnel per 1,000 rural population at 3.05 and2.97 respectively.Jiangsu had the highest number of health personnel per 1,000 rural population at 4.46,while Hebei had the lowest number,with only 1.98.(3)The composition of health human resources in township health centers in 2016 and 2020 was compared and analyzed.From gender composition,the overall proportion of women was predominant,but the proportion of women had decreased,while the proportion of male gradually increased.From the age composition,the ages of health technicians,other technicians and managers were all predominantly young and middleaged people aged 25 to 54,with the proportion of health technicians aged 25 to 54 in2016 and 2020 remaining basically the same,and the proportion of other technicians and managers aged 25 to 54 decreasing.From the perspective of educational composition,junior college degree was the main degree of health technicians,other technicians and managers in both 2016 and 2020,and postgraduate qualifications accounted for the smallest proportion.Compared with 2016,the proportion of bachelor’s degrees of health technicians,other technicians and managers in township health hospitals decreased in 2020,and the proportion of secondary school education and below has increased.In terms of both the composition of professional and technical qualifications and the composition of appointed technical positions,the proportion of deputy senior or above was the smallest.In 2016 and 2020,the majority of health and technical personnel and other technical personnel were at the rank of sergeant,the professional and technical qualifications of managers were mainly unknown,accounting for 44.6% and 44.9% respectively.The technical positions of appointment for managers are predominantly at the intermediate and sergeant levels,with 28.5% and40.9% respectively.(4)From the Lorenz curve and Gini coefficient,the fairness of health human resources distribution in township health centers was fine.The Lorenz curve was less curved,which was closed to the absolute fairness line.Gini coefficient showed a downward trend from 2016 to 2020,and both of them were less than 0.2,indicating that they were in the absolute fairness state.The fairness of the distribution by geographical area was worse than the population area,and the Lorenz curve was more curved and deviates from the absolute fairness line.From 2016 to 2020,the Gini coefficients of the distribution of health human resources by geographical area of township health hospitals were all greater than 0.5,and the overall trend is fluctuating and slightly decreasing,which means that it is in a highly inequitable state.(5)From Theil index,the total Theil index of health human resources in township hospitals based on population dimension was greater than geographical area dimension in the past five years,and the overall change range was small.Among them,the total Theil index based on population dimension was maintained between 0.0088 and 0.0271,with better equity for health personnel and worse equity for registered nurses;the total Thiel index based on the geographical area dimension remained in the range of 0.3507 to 0.3788,with relatively the worst equity for registered nurses.Further decomposition of Theil index showed that inequality mainly originated within regions.(6)From the global spatial autocorrelation analysis,Moran’s I > 0,|Z| value > 1.96,P < 0.05,statistically significant difference and significant positive spatial correlation per 1,000 rural population health personnel and per 1,000 rural population health technicians in 2020 only from 2016 to 2020.The difference was statistically significant with no spatial autocorrelation for |Z| values <1.96,P > 0.05 for licensed(assistant)physicians per 1,000 rural population,and spatial autocorrelation for registered nurses per 1,000 rural population except in 2019,all with Moran’s I > 0,|Z| values > 1.96,P <0.05,a statistically significant difference with significant positive spatial correlation.LISA analysis showed that high-high aggregation areas were mainly located in Fujian,Hubei,Hunan,Zhejiang and Guangdong;high-low aggregation areas were mainly in Guizhou,Jiangxi,Anhui and Henan;low-high aggregation areas were constant in Inner Mongolia and Jilin,while low-low aggregation areas were mainly located in Inner Mongolia,Tianjin,Liaoning,Heilongjiang and Jilin.Conclusions:(1)The number of health human resources in township health centers was on an overall upward trend during 2016 to 2020,but there were differences among different regions,the total amount was relatively insufficient,and the ratio of doctors to nurses still needed to be improved.(2)The personnel structure needed to be optimized,with a lack of highly educated and highly qualified personnel and a relatively reasonable age structure.(3)The fairness of population dimension was better than geographical area dimension.Intra-regional difference was the main source of inequity,with the worst fairness of registered nurses.(4)There was no spatial autocorrelation of licensed(assistant)physicians per thousand rural population,and the high-high concentration areas were mainly distributed in Fujian,Guangdong,Zhejiang and other economically developed areas. |
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