doctors workforce in erbil governorate: a study on distribution and turnover by moayad abdullah...
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DOCTORS WORKFORCE IN ERBIL GOVERNORATE: A STUDY ON
DISTRIBUTION AND TURNOVER
ByMOAYAD ABDULLAH WAHAB
M. B. Ch. B
SUPERVISOR
PROFESSOR TARIQ S. AL – HADITHIM.B.Ch.B, M.Sc., DTM & H, Ph.D.
OutlineOutline
Introduction Subjects and Methods Results and Discussions Conclusions Recommendations
The first decade of the 21The first decade of the 21stst century is century is
considered to be the era of health considered to be the era of health workforce.workforce.
Many countries face workforce imbalances. Many countries face workforce imbalances. The problems are rooted in political, The problems are rooted in political, economic, cultural, and health systems.economic, cultural, and health systems.
IntroductionIntroduction
After 2003, Erbil governorate faced After 2003, Erbil governorate faced tremendous health demand, due to rapid tremendous health demand, due to rapid socio-demographic changes.socio-demographic changes.
Many aspects of doctors workforce Many aspects of doctors workforce distribution in Erbil governorate are not distribution in Erbil governorate are not disclosed. There is few published studies disclosed. There is few published studies in this field in Kurdistan region and Iraq.in this field in Kurdistan region and Iraq.
Aim of the studyAim of the study
The aim of this study was to tackle the The aim of this study was to tackle the problem of uneven distribution of problem of uneven distribution of doctors in Erbil governorate and rapid doctors in Erbil governorate and rapid turnover of doctors in primary health turnover of doctors in primary health care centers in Erbil city. care centers in Erbil city.
ObjectivesObjectives
1.1. To find out current distribution of doctors relevant To find out current distribution of doctors relevant to age, gender, location, marital status. to age, gender, location, marital status.
2.2. To determine current ratio of doctors to population To determine current ratio of doctors to population at the governorate and district levels.at the governorate and district levels.
3.3. To identify possible causes for uneven distribution To identify possible causes for uneven distribution of doctors in Erbil governorate and their rapid of doctors in Erbil governorate and their rapid turnover at PHCs inside Erbil city.turnover at PHCs inside Erbil city.
4.4. To set up certain recommendations for health To set up certain recommendations for health policy makers to ensure proper future distribution policy makers to ensure proper future distribution of doctors.of doctors.
Subjects and MethodsSubjects and Methods
A cross-sectional study was done from A cross-sectional study was done from 11stst Sep., 2008 to 31 Sep., 2008 to 31stst March, 2010 ( Data March, 2010 ( Data collection from the period 1collection from the period 1stst Feb., to Feb., to 3030thth Sep., 2009. Sep., 2009.
The sample included 962 doctors from: The sample included 962 doctors from:
DOH-Erbil health facilities and HMU DOH-Erbil health facilities and HMU affiliated to DOH-Erbil.affiliated to DOH-Erbil.
Exclusion criteria:Exclusion criteria: 1.1. Doctors not affiliated from HMU to DOH-Doctors not affiliated from HMU to DOH-
Erbil.Erbil.
2.2. Employers other than DOH-Erbil & retired Employers other than DOH-Erbil & retired doctors.doctors.
3.3. Postgraduate students (529 doctors).Postgraduate students (529 doctors).
4.4. Long leave for >72 days (23 doctors).Long leave for >72 days (23 doctors).
5.5. Koya and Makhmour districts.Koya and Makhmour districts.
Mergasor
62,139
PHC=5, H=1
Soran
232,938
PHC=7, H=3
Shaqlawa
147,682
PHC=7, H=3
Choman
35,922
PHC=2, H=1
DashtiHawler
128,287
Nawandi Hawler
1,192,459 PHC=21 ,H=8,
SMC=7
Khabat
63,566
PHC=20
Koisnjaq
112,864
Results & DiscussionResults & Discussion
Distribution of doctors by genderDistribution of doctors by gender
Male: female ratio isMale: female ratio is 1.59:11.59:1
Male 61.4%
Female38.6%
Distribution of doctors by ageDistribution of doctors by age
36.6
29.8
21.3
8.6
3.7
39
42.9
13.8
3.50.8
0
5
10
15
20
25
30
35
40
45
50
< 30 30 -39 40 - 49 50 - 59 ≥ 60
Age group
Pe
rce
nta
ge
Male
Female
Mean age ± SD isMean age ± SD is 35.10 ± 9.7935.10 ± 9.79 yy ranging from ranging from 23 – 6823 – 68 yy
Distribution of doctors by marital status and Distribution of doctors by marital status and geographical distributiongeographical distribution
In: Single= 80.2%, Married = 85.4%, T = 83.6%In: Single= 80.2%, Married = 85.4%, T = 83.6% , , P = 0.001P = 0.001
0
10
20
30
40
50
60
70
80
90Pe
rcenta
ge
NawandiHawler
DashtiHawler
Khabat Shaqlawa Soran Mergasor Choman
Districts
SingleMarriedTotal
Distribution of doctors by No. of children Distribution of doctors by No. of children
74.2
92.6 95.2
25.8
7.4 4.8
0
10
20
30
40
50
60
70
80
90
100
< 2 2 - 3 ≥ 4
No. of children
Perc
enta
ge Inside Erbil city
Outside Erbil city
P = 0.001P = 0.001
Distribution of doctors by type of health facilityDistribution of doctors by type of health facility
Hospital 74.2%
DOH & SMC 2.5%
PHC 23.3%
Distribution of doctors by hospital per districtDistribution of doctors by hospital per district
90.1
9.9
01020304050
60708090
100
Urban hospitals District hospitals
Doctors workplace
Perc
enta
ge
Distribution of doctors by hospital per districtDistribution of doctors by hospital per district 32.4
27.2
15.9
8.4 7.63.7 2.5 1.7 0.6
0
5
10
15
20
25
30
35
Hospitals
Per
cent
age
Relationship between workplace and birthplaceRelationship between workplace and birthplace
61.1
6.2
1.8
27.7
3.2
0
10
20
30
40
50
60
70
Erbil Sulaimania Duhok Rest of Iraqigovernorates
Abroad
Birthplace
Per
cen
tag
e
RelationshipRelationship between workplace and birthplace between workplace and birthplace
DistrictTotal No. Born in the same district
No.%
Nawandi Hawler80441251.2
Choman1600.0
Mergasor2214.5
Shaqlawa4512.2
Dashti Hawler3000.0
Khabat1000.0
Soran3512.9
Total96241543.1
Distribution of doctors by job title Distribution of doctors by job title
33.5
21.2
15.212.3 11.1
6.7
0
5
10
15
20
25
30
35
40
Specialist House Officer Senior HouseOfficer
SpecialtyPractitioner
RuralPractitioner
GeneralPractitioner
Job title
Perc
enta
ge
Distribution of doctors by type of health facilityDistribution of doctors by type of health facility
28.6
03.9
35.3
1
24.120.5
0
5.9
33.540.1
7.1
05
1015
202530354045
Percentage
House officer Ruralpractitioner
Generalpractitioner
Senior houseofficer
Specialtypractitioner
Specialist
Job title
Hospital
PHC
Distribution of doctors according to job title Distribution of doctors according to job title and employer and employer
99 100 100 98 97.5
70.289.2
1 0 0 2 2.5
29.810.8
0
20
40
60
80
100
120
Job title
Perc
enta
ge DOH
HMU
Distribution of specialists by gender & specialty Distribution of specialists by gender & specialty
92.3 94.7
65.555.6
61.5
7.7 5.3
34.544.4
38.5
100
412.1 11.8 8.7 8.49
0%10%20%
30%40%50%60%70%
80%90%
100%
Surgery Medicine Pediatrics Obstetrics Radiology DermatologySpecialty
Perce
ntage
TotalFemaleMale
Distribution of doctors by job titles for those Distribution of doctors by job titles for those working for private clinic and / or hospitalsworking for private clinic and / or hospitals
Type of private work (%)
Job titleClinicHospitalBothTotal
Specialist58.23.338.583.8
General practitioner80.020.00.01.6
Specialty practitioner85.02.5012.512.4
Rural practitioner42.957.10.02.2
Total61.54.733.8100
Factors influence employmentFactors influence employment process in rural areas process in rural areas
Variable
Doctors willing to stay in current
workplaceTotal
YesNo % %%
Marital status (P < 0.001)
Married84.415.664.1
Single52.547.535.9
Opportunities to select workplace (P < 0.001)
Yes90.29.863.6
No42.957.136.4
Variable
Doctors willing to stay in current
workplaceTotal
YesNo % %%
Working for private sector (P < 0.001)
Yes93.26.852.7
No67.832.247.3
Place of better financial income for those working in private sector (P < 0.001)
Inside Erbil city95.14.994.4
Outside Erbil city61.138.95.6
Density of doctors per 10,000 populationsDensity of doctors per 10,000 populations
4.5
2.21.6
6.7
5.1
1.7
2.5
0.50.9
0.30.2
3.4
4.2
3.12.2
1.2
3.63.1
4.5
2.41.6 1.5
0
1
2
3
4
5
6
7
8
Districts
Rat
io
/ 10
,000
pop
ulat
ion
Specialist
Non-specialist
Total
2.5
4.2
6.7
0.4
22.4
0
1
2
3
4
5
6
7
8
Specialist Non-specialist Total
Job title of doctors
Rat
io
/ 10
,000
pop
ulat
ion
Iniside Erbil city
Outside Erbil city
Density of doctors per 10,000 populationsDensity of doctors per 10,000 populations
Doctors satisfaction with the current health Doctors satisfaction with the current health system by socio-demographic system by socio-demographic
characteristics and other variablescharacteristics and other variables
Doctor satisfied with the current health system
Variable%
Gender
Male56.7
Female61.2
Age
< 3056.0
30 -3961.8
40 - 4956.5
50 - 5964.1
≥ 6048.0
Marital status
Single55.9
Married59.8
Job title
House officer53.7
Rural practitioner58.9
General practitioner62.5
Senior house officer59.6
Specialty practitioner59.3
Specialist59.6
Workplace
Inside Erbil city59.6
Outside Erbil city52.5
Total58.4
ConclusionsConclusions
1)1) Numerical imbalance : below the regional Numerical imbalance : below the regional and international average.and international average.
2)2) Urban- rural imbalance: geographic Urban- rural imbalance: geographic maldistribution of specialists. maldistribution of specialists.
3)3) Institutional imbalance: hospitals versus Institutional imbalance: hospitals versus PHCs.PHCs.
4)4) The largest category is specialists and The largest category is specialists and the smallest is general practitioners.the smallest is general practitioners.
5)5) The proportion of pediatricians is The proportion of pediatricians is declining.declining.
7)7) The most common specialties: The most common specialties: Overall:Overall: General surgery, internal medicine, General surgery, internal medicine,
pediatrics, obstetrics. pediatrics, obstetrics. Female:Female: Obstetrics , radiology, pediatrics, Obstetrics , radiology, pediatrics,
dermatology.dermatology.
7)7) Most influential factors to determine the Most influential factors to determine the workplace and satisfaction are:workplace and satisfaction are:
Having private practice. Having private practice. Opportunity to choose workplace.Opportunity to choose workplace.
8)8) More than half of the doctors are More than half of the doctors are satisfied with their work.satisfied with their work.
RecommendationsRecommendations
1)1) Increase no. of doctors: next 6 y by two Increase no. of doctors: next 6 y by two fold = 10 / 10,000 populations ( Middle fold = 10 / 10,000 populations ( Middle East region level).East region level).
2)2) Make rural jobs more attractive than Make rural jobs more attractive than urban jobs: financial and non-financial urban jobs: financial and non-financial incentives.incentives.
3)3) Strengthening liaison between DOH and Strengthening liaison between DOH and HMU through emphasis on primary HMU through emphasis on primary health care and family medicine:health care and family medicine:
""""Postgraduate study. Postgraduate study. Adopt family health care system.Adopt family health care system.
4)4) Emphasis on appointment of properly Emphasis on appointment of properly trained health managers: regular trained health managers: regular supervision of health facilities. supervision of health facilities.
5)5) Make private sector synergize with the Make private sector synergize with the public sector.public sector.
6)6) Similar studies in this field are highly Similar studies in this field are highly recommended in Erbil governorate to recommended in Erbil governorate to study in more details the findings of this study in more details the findings of this study.study.
THANK YOUTHANK YOU