Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce
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BioMed Central
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Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce Gilles Dussault*1 and Maria Cristina Franceschini2 Address: 1Human Development Department, World Bank Institute, Washington, DC, USA and 2Consultant, Pan American Health Organization, Washington, DC, USA Email: Gilles Dussault* - [email protected]; Maria Cristina Franceschini - [email protected] * Corresponding author
Published: 27 May 2006 Human Resources for Health 2006, 4:12
doi:10.1186/1478-4491-4-12
Received: 29 March 2005 Accepted: 27 May 2006
This article is available from: http://www.human-resources-health.com/content/4/1/12 © 2006 Dussault and Franceschini; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Access to good-quality health services is crucial for the improvement of many health outcomes, such as those targeted by the Millennium Development Goals (MDGs) adopted by the international community in 2000. The health-related MDGs cannot be achieved if vulnerable populations do not have access to skilled personnel and to other necessary inputs. This paper focuses on the geographical dimension of access and on one of its critical determinants: the availability of qualified personnel. The objective of this paper is to offer a better understanding of the determinants of geographical imbalances in the distribution of health personnel, and to identify and assess the strategies developed to correct them. It reviews the recent literature on determinants, barriers and the effects of strategies that attempted to correct geographical imbalances, with a focus on empirical studies from developing and developed countries. An analysis of determinants of success and failures of strategies implemented, and a summary of lessons learnt, is included.
Introduction Access to good-quality health services is crucial for the improvement of health outcomes, such as those targeted by the Millennium Development Goals (MDGs) adopted by the international community in 2000. For example, the reduction of maternal mortality by 75% in 2015 depends on access to skilled care at birth and during the pregnancy [1,2]. But often, services are not available at a reasonable distance; or they are available, but people cannot afford them. Or, they are not accessible for some organizational reason, such as limited hours of presence of staff, unfriendly behaviour towards users, cultural barriers, and so on. Accessibility of health services is a multidimensional concept [3] that refers to geographical, economic (affordability), organizational and cultural (acceptability) factors that can facilitate or hinder use of services.
This article will focus on the geographical dimension of access and on one of its critical determinants: t
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