The Development of Human The Development of Human

Resources for Health and Resources for Health and

Challenges in ChinaChallenges in China

Junhua ZHANGHealth Human Resource Development Center,

Ministry of Health

OverviewsOverviews

Quantity and trends of HRH in China

Distribution and characteristics of HRH in

China

Structure of HRH in China

Problems and challenges of HRH in China

A. Quantity and trends of HRH in ChinaA. Quantity and trends of HRH in China

（（ As of December 2005As of December 2005 ））Health workforce in health sectors:

5.43 million

health professionals 4.46 million

among which: licensure physicians (assistant ） 1.94 million

Licensure nurses 1.35 million

Physicians and health workers in rural areas ：

0.92 million

Total 6.35 million

The trends of health workforce in The trends of health workforce in health sectors and health health sectors and health

professionals in Chinaprofessionals in China（（ 10,00010,000 ））

259

431

502543

177

145

341

446

404

150

0

100

200

300

400

500

600

1960 1965 1970 1975 1980 1985 1990 1995 2000 2004 2005

Heal th workforce

Heal th professi onal s

The trends of licensure physicians and nurses in The trends of licensure physicians and nurses in ChinaChina （（ 10,00010,000 ））

64

43 45

72

132

156

1730

111

135

0

20

40

60

80

100

120

140

160

180

1960 1965 1970 1975 1980 1985 1990 1995 2000 2004 2005

Li censurephysi ci ansLi censure nurses

B. Distribution and characteristics of B. Distribution and characteristics of

HRH in ChinaHRH in China Distribution in urban and rural

Progress of urbanization

The trends of HRH in urban and rural

Distribution by regionsEastern, Middle and Western Regions

The trends of HRH by region

Distribution by the ownership of institutions

Urbanization-the trends of Urbanization-the trends of proportion of urban proportion of urban populationpopulation （（ %% ））

In 2005, the number of migration from rural to urban was 150 million, who left rural areas at least three months.

50

20

23

44

0

10

20

30

40

50

60

1970 1980 1985 1990 1995 2000 2005 2010

Health professionals in urban and Health professionals in urban and

ruralrural（（ per 1000 populationper 1000 population ））

2.9

8.0

1.8

3.5

5.0

2.2

0

1

2

3

4

5

6

7

8

9

1980 2005

Overall Urban Rural

Distribution of licensure physicians Distribution of licensure physicians

in urban and rural in urban and rural （（ per 1000 per 1000

populationpopulation ））

1.2

3.2

0.8

1.5

2.1

1.0

0

0.5

1

1.5

2

2.5

3

3.5

1980 2005

Overall Urban Rural

Distribution of licensure nurses in Distribution of licensure nurses in

urban and ruralurban and rural （（ per 1000 populationper 1000 population ））

0.5

1.8

0.2

1.1

1.7

0.5

00.20.40.60.8

11.21.41.61.8

2

1980 2005

OverallUrbanRural

The distribution of licensure The distribution of licensure

physicians by region (pphysicians by region (per 1000 er 1000

populationpopulation ））

1.67

1.471.53

1.74

1.37 1.39

11.11.21.31.41.51.61.71.81.9

2

1990 2005

EasternMiddleWestern

The distribution of licensure nurses The distribution of licensure nurses

by region (pby region (per 1000 populationer 1000 population ））

0.99

0.83

0.74

1.28

0.960.87

0.4

0.6

0.8

1

1.2

1.4

1.6

1990 2005

EasternMiddleWestern

Distribution of beds by regionDistribution of beds by region（（ per 1000 populationper 1000 population ））

2.45

2.35

2.13

2.81

2.23 2.24

22.12.22.32.42.52.62.72.82.9

3

1990 2005

EasternMiddleWestern

Distribution of health workforce by Distribution of health workforce by the ownership of institutionthe ownership of institution

Persons Health Professiona

ls

Physicians

Assistant physicians

Overall （ million ）

5.24 4.27 1.46 0.38

Ownership of institutions (%)

State 82.3 80.6 81.6 70.6Collective 10.8 11.5 10.1 19.7Joint-venture 0.2 0.3 0.2 0.2Private 5.3 6.2 6.6 8.1Others 1.3 1.4 1.4 1.5

C. The structure of HRH in C. The structure of HRH in

ChinaChina

Health professional by gender

Health professional by age group

Health professional by education attainment

Health professional by academic title

Health professionals by gender, age Health professionals by gender, age groupgroup

Overall

Urban

Rural

East Middle

West

Gender （ % ）

M 36.2 33.2 41.8 34.9 37.3 37.2 F 63.8 66.8 58.2 65.1 62.7 62.8

Age group （ % ）

<25 10.6 10.3 11.1 11.4 10.4 9.4 25-34 40.1 39.1 41.9 40.2 40.3 39.7

35-44 26.9 27.3 26.2 25.4 27.8 28.4 45-54 19.1 19.9 17.6 19.4 18.4 19.4 55 or

above3.3 3.3 3.3 3.6 3.1 3.0

Health professional by education Health professional by education attainment and regionattainment and region

Overall Urban Rural East Middle West

Education （ % ）

Bachelor or +

14.1 18.7 5.5 16.7 12.2 12.1

Associate 26.6 28.1 23.9 24.6 30.1 25.5

Vocational

46.9 42.9 54.3 46.7 45.9 48.6

Middle school

12.4 10.3 16.3 12.0 11.8 13.8

Health professional by academic titleHealth professional by academic title

Overall Urban

Rural

East Middle

West

Title (% ）

Associate prof. or prof.

6.1 8.0 2.6 7.1 5.9 4.8

Senior lecturer

25.5 27.9 21.0 24.1 26.7 26.2

Attend./assist.

40.6 39.9 41.9 40.9 39.4 41.5

Junior 27.8 24.2 34.6 27.9 27.9 27.5

D. Problems and challenges of HRH D. Problems and challenges of HRH in China in China (1)(1)

Overall low qualification of HRH in China Majority with associate degree or vocational

education, 74% Shortage of senior health professionals ： prof.

or associate prof. 230000, only 1.1% with master and doctor degree

460,000 persons did not have formal health professional training, 12.3% of total health professionals

Low coverage of continuous education and on-service education ： 12% of physicians accept standardized attending physician training ， only 28% of physicians accept continuous education.

Regional HRH unbalance, coexistence of shortage and wastage of HRH The density of HRH is more in east than in west （ in

2004, 3.98 per 1000 population, 3.27 in the middle and 3.00 in the west ； bachelor or above in east is 16.7% ， 4.5 percentage higher than middle and west ） ， however, the utilization of HRH in west is more efficient than the middle region.

There is big gap on HRH between urban and rural (47% of population in urban area have occupied 67% of total HRH. In rural areas the health institutions have 300,000 employees, who did not have formal health professional training (65% of HRH in rural areas) 。

D. Problems and challenges of D. Problems and challenges of HRH in China HRH in China ((2)2)

Unreasonable distribution of HRH Majority of HRH in medical sectors

and hospitals 94% in medical sectors, shortage

in public health Only 52000 GPs ， community

health service is backward Inverse ratio of physicians to

nurses In hospital 1:0.97 In township health station 1:0.40

D. Problems and challenges of HRH in China D. Problems and challenges of HRH in China (3)(3)

Health management is not yet professional, the quality of management need to be improved

370000 health administrators ， 43% of them with medical and health background

85% of administrative managers (presidents, directors etc) are medical graduates ， it means that before they took administrative posts, they were medical professionals.

The leaders usually “ full time doing health professionals, part time doing management” ， lack of management knowledge and expertise

D. Problems and challenges of HRH in China D. Problems and challenges of HRH in China (4)(4)

Thank you very much!Thank you very much!