Inequality in Human Resources for Health: Measurement Issues

This article discusses options to allow comparative analysis of inequalities in the distribution of health workers (HWs) across and within countries using a single summary measure of the distribution. Income inequality generally is measured across individuals, but inequalities in the dispersion of HWs must use geographical areas or population groupings as units of analysis. The article first shows how this change of observational unit creates a resolution problem for various inequality indices and then tests how sensitive a simple ratio measure of the distribution of HWs is to changes in resolution. This ratio of inequality is illustrated first with the global distribution of HWs and then with its distributions within Indonesia. The resolution problem is not solved through this new approach, and indicators of inequalities of access to HWs or health services more generally appear not to be comparable across countries. Investigating geographical inequalities over time in one setting is possible but only if the units of analysis remain the same over time.