Where are the paediatricians? An international survey to understand the global paediatric workforce
Beth D Harper1, Waceke Nganga2, Robert Armstrong3
1Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
Global pediatrician numbers vary widely, with low-income nations facing critical shortages. This impacts child health equity, as fewer new pediatricians enter underserved regions, worsening existing disparities.
Area of Science:
- Global Health
- Pediatrics
- Health Workforce Distribution
Background:
- Significant geographic disparities exist in the global distribution of pediatric healthcare providers.
- Understanding these differences is crucial for addressing inequities in child health outcomes worldwide.
Purpose of the Study:
- To examine the global pediatric workforce, focusing on geographic variations in pediatrician numbers.
- To describe pediatric workforce expectations, the provision of preventative care for children, and the age of transition to adult care.
Main Methods:
- A global survey of identified pediatric leaders in various countries.
- Data collected on pediatrician numbers, primary care provision for children, and transition age to adult care.
Main Results:
- Paediatrician density ranged from 0.5/100,000 children in low-income countries to 72/100,000 in high-income countries.
- Africa and South-East Asia reported the lowest pediatrician density and workforce entry.
- Most countries (91%) provide pediatric preventative care, but only 64% of low-income countries do.
Conclusions:
- Paediatrician density reflects existing health inequities, with fewer entering the workforce in already underserved areas.
- Transition to adult care occurs during adolescence in some regions, impacting training and delivery.
- Heterogeneous pediatrician roles necessitate country-specific strategies to improve child health equity.
Objective:
Our primary objective was to examine the global paediatric workforce and to better understand geographic differences in the number of paediatricians globally. Secondary objectives were to describe paediatric workforce expectations, who provides children with preventative care and when children transition out of paediatric care.
Design:
Survey of identified paediatric leaders in each country.
Setting:
Paediatric association leaders worldwide.
Main Outcome Measures:
Paediatrician numbers, provision of primary care for children, age of transition to adult care.
Results:
Responses were obtained from 121 countries (73% of countries approached). The number of paediatricians per 100 000 children ranged from a median of 0.5 (IQR 0.3-1.4) in low-income countries to 72 (IQR 4-118) in high-income countries. Africa and South-East Asia reported the lowest paediatrician density (median of 0.8 paediatricians per 100 000 children, IQR 0.4-2.6 and median of 4, IQR 3-9, respectively) and fewest paediatricians entering the workforce. 82% of countries reported transition to adult care by age 18% and 39% by age 15. Most countries (91%) but only 64% of low-income countries reported provision of paediatric preventative care (p<0.001, Cochran-Armitage trend test). Systems of primary care provision varied widely. A majority of countries (63%) anticipated increases in their paediatric workforce in the next decade.
Conclusions:
Paediatrician density mirrors known inequities in health provider distribution. Fewer paediatricians are entering the workforce in areas with already low paediatrician density, which may exacerbate disparities in child health outcomes. In some regions, children transition to adult care during adolescence, with implications for healthcare training and delivery. Paediatrician roles are heterogeneous worldwide, and country-specific strategies should be used to address inequity in child health provision.
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