Nguyen Mai Phuong, Mirzoev Tolib, Le Thi Minh
Vietnam Ministry of Health, 138A Giang Vo street, Ba Dinh district, Hanoi, Vietnam.
Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, LS2 9LJ, United Kingdom.
Hum Resour Health. 2016 Nov 16;14(1):68. doi: 10.1186/s12960-016-0165-0.
In Vietnam, a lower-middle income country, while the overall skill- and knowledge-based quality of health workforce is improving, health workers are disproportionately distributed across different economic regions. A similar trend appears to be in relation to health outcomes between those regions. It is unclear, however, whether there is any relationship between the distribution of health workers and the achievement of health outcomes in the context of Vietnam. This study examines the statistical relationship between the availability of health workers and health outcomes across the different economic regions in Vietnam.
We constructed a panel data of six economic regions covering 8 years (2006-2013) and used principal components analysis regressions to estimate the impact of health workforce on health outcomes. The dependent variables representing the outcomes included life expectancy at birth, infant mortality, and under-five mortality rates. Besides the health workforce as our target explanatory variable, we also controlled for key demographic factors including regional income per capita, poverty rate, illiteracy rate, and population density.
The numbers of doctors, nurses, midwives, and pharmacists have been rising in the country over the last decade. However, there are notable differences across the different categories. For example, while the numbers of nurses increased considerably between 2006 and 2013, the number of pharmacists slightly decreased between 2011 and 2013. We found statistically significant evidence of the impact of density of doctors, nurses, midwives, and pharmacists on improvement to life expectancy and reduction of infant and under-five mortality rates.
Availability of different categories of health workforce can positively contribute to improvements in health outcomes and ultimately extend the life expectancy of populations. Therefore, increasing investment into more equitable distribution of four main categories of health workforce (doctors, nurses, midwives, and pharmacists) can be an important strategy for improving health outcomes in Vietnam and other similar contexts. Future interventions will also need to consider an integrated approach, building on the link between the health and the development.
在越南这个中低收入国家，尽管以技能和知识为基础的卫生人力总体素质在提高，但卫生工作者在不同经济区域的分布不均衡。这些区域之间的健康结果似乎也呈现出类似趋势。然而，在越南的背景下，卫生工作者的分布与健康结果的实现之间是否存在任何关系尚不清楚。本研究考察了越南不同经济区域卫生工作者的可及性与健康结果之间的统计关系。
我们构建了涵盖6个经济区域、8年（2006 - 2013年）的面板数据，并使用主成分分析回归来估计卫生人力对健康结果的影响。代表结果的因变量包括出生时预期寿命、婴儿死亡率和五岁以下儿童死亡率。除了将卫生人力作为我们的目标解释变量外，我们还控制了关键人口因素，包括区域人均收入、贫困率、文盲率和人口密度。
在过去十年中，该国医生、护士、助产士和药剂师的数量一直在增加。然而，不同类别之间存在显著差异。例如，2006年至2013年期间护士数量大幅增加，而2011年至2013年期间药剂师数量略有下降。我们发现，医生、护士、助产士和药剂师的密度对提高预期寿命以及降低婴儿和五岁以下儿童死亡率有统计学上的显著影响。
不同类别的卫生人力可及性能够对改善健康结果产生积极作用，并最终延长人口预期寿命。因此，增加对四类主要卫生人力（医生、护士、助产士和药剂师）更公平分布的投资，可能是改善越南及其他类似背景下健康结果的一项重要战略。未来的干预措施还需要考虑一种综合方法，基于健康与发展之间的联系。
