the development of human resources for health and challenges in china junhua zhang health human...
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The Development of Human The Development of Human
Resources for Health and Resources for Health and
Challenges in ChinaChallenges in China
Junhua ZHANGHealth Human Resource Development Center,
Ministry of Health
OverviewsOverviews
Quantity and trends of HRH in China
Distribution and characteristics of HRH in
China
Structure of HRH in China
Problems and challenges of HRH in China
A. Quantity and trends of HRH in ChinaA. Quantity and trends of HRH in China
(( As of December 2005As of December 2005 ))Health workforce in health sectors:
5.43 million
health professionals 4.46 million
among which: licensure physicians (assistant ) 1.94 million
Licensure nurses 1.35 million
Physicians and health workers in rural areas :
0.92 million
Total 6.35 million
The trends of health workforce in The trends of health workforce in health sectors and health health sectors and health
professionals in Chinaprofessionals in China(( 10,00010,000 ))
259
431
502543
177
145
341
446
404
150
0
100
200
300
400
500
600
1960 1965 1970 1975 1980 1985 1990 1995 2000 2004 2005
Heal th workforce
Heal th professi onal s
The trends of licensure physicians and nurses in The trends of licensure physicians and nurses in ChinaChina (( 10,00010,000 ))
64
43 45
72
132
156
1730
111
135
0
20
40
60
80
100
120
140
160
180
1960 1965 1970 1975 1980 1985 1990 1995 2000 2004 2005
Li censurephysi ci ansLi censure nurses
B. Distribution and characteristics of B. Distribution and characteristics of
HRH in ChinaHRH in China Distribution in urban and rural
Progress of urbanization
The trends of HRH in urban and rural
Distribution by regionsEastern, Middle and Western Regions
The trends of HRH by region
Distribution by the ownership of institutions
Urbanization-the trends of Urbanization-the trends of proportion of urban proportion of urban populationpopulation (( %% ))
In 2005, the number of migration from rural to urban was 150 million, who left rural areas at least three months.
50
20
23
44
0
10
20
30
40
50
60
1970 1980 1985 1990 1995 2000 2005 2010
Health professionals in urban and Health professionals in urban and
ruralrural(( per 1000 populationper 1000 population ))
2.9
8.0
1.8
3.5
5.0
2.2
0
1
2
3
4
5
6
7
8
9
1980 2005
Overall Urban Rural
Distribution of licensure physicians Distribution of licensure physicians
in urban and rural in urban and rural (( per 1000 per 1000
populationpopulation ))
1.2
3.2
0.8
1.5
2.1
1.0
0
0.5
1
1.5
2
2.5
3
3.5
1980 2005
Overall Urban Rural
Distribution of licensure nurses in Distribution of licensure nurses in
urban and ruralurban and rural (( per 1000 populationper 1000 population ))
0.5
1.8
0.2
1.1
1.7
0.5
00.20.40.60.8
11.21.41.61.8
2
1980 2005
OverallUrbanRural
The distribution of licensure The distribution of licensure
physicians by region (pphysicians by region (per 1000 er 1000
populationpopulation ))
1.67
1.471.53
1.74
1.37 1.39
11.11.21.31.41.51.61.71.81.9
2
1990 2005
EasternMiddleWestern
The distribution of licensure nurses The distribution of licensure nurses
by region (pby region (per 1000 populationer 1000 population ))
0.99
0.83
0.74
1.28
0.960.87
0.4
0.6
0.8
1
1.2
1.4
1.6
1990 2005
EasternMiddleWestern
Distribution of beds by regionDistribution of beds by region(( per 1000 populationper 1000 population ))
2.45
2.35
2.13
2.81
2.23 2.24
22.12.22.32.42.52.62.72.82.9
3
1990 2005
EasternMiddleWestern
Distribution of health workforce by Distribution of health workforce by the ownership of institutionthe ownership of institution
Persons Health Professiona
ls
Physicians
Assistant physicians
Overall ( million )
5.24 4.27 1.46 0.38
Ownership of institutions (%)
State 82.3 80.6 81.6 70.6Collective 10.8 11.5 10.1 19.7Joint-venture 0.2 0.3 0.2 0.2Private 5.3 6.2 6.6 8.1Others 1.3 1.4 1.4 1.5
C. The structure of HRH in C. The structure of HRH in
ChinaChina
Health professional by gender
Health professional by age group
Health professional by education attainment
Health professional by academic title
Health professionals by gender, age Health professionals by gender, age groupgroup
Overall
Urban
Rural
East Middle
West
Gender ( % )
M 36.2 33.2 41.8 34.9 37.3 37.2 F 63.8 66.8 58.2 65.1 62.7 62.8
Age group ( % )
<25 10.6 10.3 11.1 11.4 10.4 9.4 25-34 40.1 39.1 41.9 40.2 40.3 39.7
35-44 26.9 27.3 26.2 25.4 27.8 28.4 45-54 19.1 19.9 17.6 19.4 18.4 19.4 55 or
above3.3 3.3 3.3 3.6 3.1 3.0
Health professional by education Health professional by education attainment and regionattainment and region
Overall Urban Rural East Middle West
Education ( % )
Bachelor or +
14.1 18.7 5.5 16.7 12.2 12.1
Associate 26.6 28.1 23.9 24.6 30.1 25.5
Vocational
46.9 42.9 54.3 46.7 45.9 48.6
Middle school
12.4 10.3 16.3 12.0 11.8 13.8
Health professional by academic titleHealth professional by academic title
Overall Urban
Rural
East Middle
West
Title (% )
Associate prof. or prof.
6.1 8.0 2.6 7.1 5.9 4.8
Senior lecturer
25.5 27.9 21.0 24.1 26.7 26.2
Attend./assist.
40.6 39.9 41.9 40.9 39.4 41.5
Junior 27.8 24.2 34.6 27.9 27.9 27.5
D. Problems and challenges of HRH D. Problems and challenges of HRH in China in China (1)(1)
Overall low qualification of HRH in China Majority with associate degree or vocational
education, 74% Shortage of senior health professionals : prof.
or associate prof. 230000, only 1.1% with master and doctor degree
460,000 persons did not have formal health professional training, 12.3% of total health professionals
Low coverage of continuous education and on-service education : 12% of physicians accept standardized attending physician training , only 28% of physicians accept continuous education.
Regional HRH unbalance, coexistence of shortage and wastage of HRH The density of HRH is more in east than in west ( in
2004, 3.98 per 1000 population, 3.27 in the middle and 3.00 in the west ; bachelor or above in east is 16.7% , 4.5 percentage higher than middle and west ) , however, the utilization of HRH in west is more efficient than the middle region.
There is big gap on HRH between urban and rural (47% of population in urban area have occupied 67% of total HRH. In rural areas the health institutions have 300,000 employees, who did not have formal health professional training (65% of HRH in rural areas) 。
D. Problems and challenges of D. Problems and challenges of HRH in China HRH in China ((2)2)
Unreasonable distribution of HRH Majority of HRH in medical sectors
and hospitals 94% in medical sectors, shortage
in public health Only 52000 GPs , community
health service is backward Inverse ratio of physicians to
nurses In hospital 1:0.97 In township health station 1:0.40
D. Problems and challenges of HRH in China D. Problems and challenges of HRH in China (3)(3)
Health management is not yet professional, the quality of management need to be improved
370000 health administrators , 43% of them with medical and health background
85% of administrative managers (presidents, directors etc) are medical graduates , it means that before they took administrative posts, they were medical professionals.
The leaders usually “ full time doing health professionals, part time doing management” , lack of management knowledge and expertise
D. Problems and challenges of HRH in China D. Problems and challenges of HRH in China (4)(4)
Thank you very much!Thank you very much!