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The global distribution of physicians and nurses
1Post-graduate Division of Nursing Studies, The Medical School, University of Nottingham, England.
Journal of Advanced Nursing
|July 15, 1999
Summary
Global physician and nurse distribution is strongly linked to economic status (Gross National Product per capita). While nurse numbers often mirror physician numbers, the poorest nations show limited substitution, impacting health workforce planning.
Area of Science:
- Global Health
- Health Economics
- Health Workforce Studies
Background:
- Physician and nurse distribution varies globally, impacting healthcare access.
- Understanding economic influences on health workforce distribution is crucial for policy.
- The World Development Report 1993 highlighted health workforce substitution, necessitating further investigation.
Purpose of the Study:
- To compare the international distribution of physicians and nurses.
- To examine the influence of Gross National Product (GNP) per capita on health workforce distribution.
- To explore implications for health workforce substitution and future global health labor studies.
Main Methods:
- Compiled a database from United Nations sources for 147 countries.
- Employed general linear regression to model log GNP per capita against physician and nurse distribution.
- Utilized standardized residuals to analyze the relationship between physician and nurse distribution and identify outliers.
Main Results:
- Physician-to-population ratios ranged from 0.02 to 4.4 per 1000; nurse ratios ranged from 0.03 to 16.4 per 1000.
- A significant positive correlation (r=0.84) exists between physician and nurse distribution.
- GNP per capita explained 49% of physician and 40% of nurse distribution variations.
Conclusions:
- Physician distribution explains 70% of global nurse distribution; GNP per capita has a substantial influence.
- Evidence for nurse substitution for physicians is limited to a minority of the poorest countries.
- Standardization by GNP suggests countries can aim for optimal health personnel levels within economic constraints, though health reform modifications may be challenging.