Aziz Roomi, Kapilashrami Anuj, Majdzadeh Reza
Centre for Global Health and Intersectional Equity Research, University of Essex, Colchester, UK
Centre for Global Health and Intersectional Equity Research, University of Essex, Colchester, UK.
BMJ Glob Health. 2025 Aug 14;10(8):e016795. doi: 10.1136/bmjgh-2024-016795.
Health and care workers' well-being is critical for comprehensive human resources for health (HRH) planning. However, system-wide factors such as wage disparities and career advancement barriers remain underexplored, while most existing planning frameworks focus on gender, ignoring other interactions shaping the HRH experiences.
To systematically map literature on adverse HRH experiences, underlying inequalities and the resulting impact using an intersectional equity lens.
A rigorous scoping protocol was developed which guided the search in four bibliographic databases (SCOPUS, Web of Science, PubMed and CINAHL Ultimate). Literature was screened by two reviewers independently, charted and thematically analysed.
From 21 184 records, 511 articles were included. 76% of the excluded articles were duplicates, while the rest were ineligible (non-English, grey literature, irrelevant publication type, etc). The review unpacked six types of adverse experiences (invisibilisation, disproportionate scrutiny, denial of opportunities, verbal abuse, physical abuse and sexual harassment) across 72 countries. 20 social locations, such as gender, race, ethnicity, cadre and their interactions shaped these experiences.55% of these studies were based in high-income countries and only 2% in low-income countries. 45% of articles studied these experiences across only two or more social locations, with the most common combinations being race-sex. Adverse manifestations included wage disparities, career advancement barriers, poor mental health and high turnover. The existing literature lacked an equity gaze, missing the underlying systematic drivers and rarely exploring intersecting unique positionalities of health and care workers.
Using an intersectionality lens, this scoping review identifies three key gaps: regional evidence imbalances, lack of an explicit intersectional equity focus and absence of translation of the scant intersectional evidence into HRH policy tools. These gaps restrict global HRH planning and hinder the development of inclusive, context-specific strategies-especially in low- and middle-income countries facing the most severe workforce challenges.
卫生和护理工作者的福祉对于全面的卫生人力资源规划至关重要。然而，工资差距和职业发展障碍等全系统因素仍未得到充分探索，而大多数现有的规划框架侧重于性别，忽视了塑造卫生人力资源经历的其他相互作用因素。
运用交叉公平视角，系统梳理关于不良卫生人力资源经历、潜在不平等及其影响的文献。
制定了严格的范围界定方案，指导在四个文献数据库（Scopus、科学网、PubMed和CINAHL终极版）中进行检索。文献由两名评审员独立筛选、制表并进行主题分析。
从21184条记录中，纳入了511篇文章。76%被排除的文章是重复的，其余的不符合要求（非英文、灰色文献、不相关的出版类型等）。该综述梳理了72个国家的六种不良经历类型（被忽视、过度审查、机会剥夺、言语虐待、身体虐待和性骚扰）。20种社会身份，如性别、种族、民族、干部身份及其相互作用塑造了这些经历。这些研究中有55%基于高收入国家，只有2%基于低收入国家。45%的文章仅在两个或更多社会身份层面研究了这些经历，最常见的组合是种族-性别。不良表现包括工资差距、职业发展障碍、心理健康不佳和高离职率。现有文献缺乏公平视角，未揭示潜在的系统性驱动因素，也很少探讨卫生和护理工作者交叉的独特身份地位。
运用交叉性视角，本范围界定综述确定了三个关键差距：区域证据失衡、缺乏明确的交叉公平重点以及缺乏将稀少的交叉证据转化为卫生人力资源政策工具。这些差距限制了全球卫生人力资源规划，阻碍了包容性的、因地制宜的战略发展，尤其是在面临最严峻劳动力挑战的低收入和中等收入国家。
