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      Health workforce demography: a framework to improve understanding of the health workforce and support achievement of the Sustainable Development Goals

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          Abstract

          The ambition of universal health coverage entails estimation of the number, type and distribution of health workers required to meet the population need for health services. The demography of the population, including anticipated or estimated changes, is a factor in determining the ‘universal’ needs for health and well-being. Demography is concerned with the size, breakdown, age and gender structure and dynamics of a population. The same science, and its robust methodologies, is equally applicable to the demography of the health workforce itself. For example, a large percentage of the workforce close to retirement will impact availability, a geographically mobile workforce has implications for health coverage, and gender distribution in occupations may have implications for workforce acceptability and equity of opportunity. In a world with an overall shortage of health workers, and the expectation of increasing need as a result of both population growth in the global south and population ageing in the global north, studying and understanding demographic characteristics of the workforce can help with future planning. This paper discusses the dimensions of health worker demography and considers how demographic tools and techniques can be applied to the analysis of the health labour market. A conceptual framework is introduced as a step towards the application of demographic principles and techniques to health workforce analysis and planning exercises as countries work towards universal health coverage, the reduction of inequities and national development targets. Some illustrative data from Nepal and Finland are shown to illustrate the potential of this framework as a simple and effective contribution to health workforce planning.

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          Most cited references 12

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          Social inequalities in facing old-age dependency: a bi-generational perspective

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            Nurses, community health workers, and home carers: gendered human resources compensating for skewed health systems.

             Ben A George (2007)
            This review examines the experiences of nurses, community health workers, and home carers in health systems from a gender analysis. With respect to nursing, current discussions around delegation take place over layers of historical struggle that mark the evolution of nursing as a profession. Female community health workers also struggle to be recognized as skilled workers, in addition to defending at a personal level the legitimacy of their work, as it transgresses traditional norms proscribing morality and the place of women in society, at times with violent consequences. The review concludes by exploring the characteristics of, and challenges faced by, home carers, who fail to be recognized as workers at all. A key finding is that these mainly female frontline health workers compensate for the shortcomings of health systems through individual adjustments, at times to the detriment of their own health and livelihoods. So long as these shortcomings remain as private, individual concerns of women, rather than the collective responsibility of gender, requiring public acknowledgement and resolution, health systems will continue to function in a skewed manner, serving to replicate inequalities in the health labour force and in society more broadly.
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              Workplace violence and gender discrimination in Rwanda's health workforce: Increasing safety and gender equality

              Background Workplace violence has been documented in all sectors, but female-dominated sectors such as health and social services are at particular risk. In 2007-2008, IntraHealth International assisted the Rwanda Ministries of Public Service and Labor and Health to study workplace violence in Rwanda's health sector. This article reexamines a set of study findings that directly relate to the influence of gender on workplace violence, synthesizes these findings with other research from Rwanda, and examines the subsequent impact of the study on Rwanda's policy environment. Methods Fifteen out of 30 districts were selected at random. Forty-four facilities at all levels were randomly selected in these districts. From these facilities, 297 health workers were selected at random, of whom 205 were women and 92 were men. Researchers used a utilization-focused approach and administered health worker survey, facility audits, key informant and health facility manager interviews and focus groups to collect data in 2007. After the study was disseminated in 2008, stakeholder recommendations were documented and three versions of the labor law were reviewed to assess study impact. Results Thirty-nine percent of health workers had experienced some form of workplace violence in year prior to the study. The study identified gender-related patterns of perpetration, victimization and reactions to violence. Negative stereotypes of women, discrimination based on pregnancy, maternity and family responsibilities and the 'glass ceiling' affected female health workers' experiences and career paths and contributed to a context of violence. Gender equality lowered the odds of health workers experiencing violence. Rwandan stakeholders used study results to formulate recommendations to address workplace violence gender discrimination through policy reform and programs. Conclusions Gender inequality influences workplace violence. Addressing gender discrimination and violence simultaneously should be a priority in workplace violence research, workforce policies, strategies, laws and human resources management training. This will go a long way in making workplaces safer and fairer for the health workforce. This is likely to improve workforce productivity and retention and the enjoyment of human rights at work. Finally, studies that involve stakeholders throughout the research process are likely to improve the utilization of results and policy impact.
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                Author and article information

                Contributors
                sylviaszabo@ait.asia
                andrea@novametrics.org
                zoe.matthews@soton.ac.uk
                abajracharya@popcouncil.org
                dhilloni@who.int
                dsingh3797@gmail.com
                saaresa@who.int
                campbellj@who.int
                Journal
                Hum Resour Health
                Hum Resour Health
                Human Resources for Health
                BioMed Central (London )
                1478-4491
                29 January 2020
                29 January 2020
                2020
                : 18
                Affiliations
                [1 ]ISNI 0000 0000 8861 2220, GRID grid.418142.a, Asian Institute of Technology, ; 58 Moo 9, Km. 42, Paholyothin Highway, Klong Luang, Pathum Thani, 12120 Thailand
                [2 ]Novametrics Ltd., 4 Cornhill Close, Duffield, Derbyshire DE56 4HQ UK
                [3 ]ISNI 0000 0004 1936 9297, GRID grid.5491.9, Department of Social Statistics and Demography, , University of Southampton, ; Highfield, Southampton, SO17 1BJ UK
                [4 ]Population Council, Phnom Penh Center, Building B, 1st Floor, Rm 136, Street Sothearos, Khan Chamkar Morn, Phnom Penh, Cambodia
                [5 ]ISNI 0000000121633745, GRID grid.3575.4, World Health Organization, ; Avenue Appia 20, 1211 Geneva, Switzerland
                [6 ]ISNI 0000 0000 9021 3093, GRID grid.444739.9, Asian College for Advanced Studies, , Purbanchal University, ; Satdobatdo, Lalitpur, Kathmandu, Nepal
                Article
                445
                10.1186/s12960-020-0445-6
                6990468
                31996212
                © The Author(s). 2020

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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