This study uses longitudinal data from 2016 to 2020, divides regions according to regional economic levels, and explores the allocation and equity of health human resources in maternal and child health care institutions in mainland China. The results of the analysis can reveal the remaining problems in the current development, help rationally allocate the human resources for MCH, provide more equitable and accessible MCH services, and promote the high-quality development of the cause of MCH. To the best of our knowledge, this is the first study on the allocation of MCH human resources using nationwide longitudinal data after the adjustment of the new fertility policy.
In terms of allocation level, the allocation level of MCH human resources in mainland China has been continuously improved. From 2016 to 2020, the number of health technicians, licensed (assistant) physicians, and registered nurses in maternal and child health care institutions showed an increasing trend year by year. By the end of 2020, health technicians have accounted for 83.31% of the total number of health personnel, and the ratio of medical care to nurses has reached 1:1.28, which has completed the "China Medical and Health Service System Planning Outline (2015–2020)." The staff ratio is not less than 80% of the total number and the mission target of a medical-to-care ratio of 1:1.25 [31]. This shows that the Chinese government's efforts to improve the MCH service system are very effective.
However, there are differences in the level of MCH staffing in regions with different economic development levels. In 2020, the HRDI value of Guangdong health technicians and registered nurses will be about 52 times and 75 times that of Tibet, respectively, while the HRDI value of Beijing licensed (assistant) physicians will be about 65 times that of Tibet. In the five-year comparison, the HRDI values in the Q4 regions were the highest, followed by the Q3 regions, and the lowest in the Q2 regions and the Q1 regions. Analyzing the reasons, on the one hand, may be related to the level of economic development and population density between regions. The more developed the regional economy and the higher the population density, the greater the investment in MCH resources. On the other hand, regions with better economic development are more attractive to health professionals and have more development opportunities [32]. Therefore, in the future, government health investment should focus on balancing regional differences, and appropriately tilt towards regions with lower levels of economic development. At the same time, a talent incentive policy was formulated to encourage health personnel to go to poor areas with relatively scarce health resources [33].
We found that when analyzing the allocation of health human resources, few studies have explored the quality structure of allocation. This study adds to this section. The results show that health technicians and registered nurses in maternal and child health care institutions in mainland China are mainly college graduates while licensed (assistant) physicians are mainly college graduates, which is similar to the findings of Ren Z et al. [34]. A previous study found that in 2005, 67.2% of licensed (assistant) physicians and 97.5% of registered nurses in China had only junior college or technical secondary education [35]. Compared with the national average, the education level of MCH personnel has been greatly improved, and they can provide higher quality MCH services. In addition, the professional titles of health technicians and licensed (assistant) physicians are mainly at the division level/assistant level, and registered nurses are concentrated at the doctoral level. The WHO has recommended that the ratio of professional titles for health personnel should be 1:3:1 in the ratio of senior, intermediate, and junior [36]. At present, there is still a gap in this standard. It is suggested to improve the continuing education mechanism of MCH personnel, reasonably standardize the scale and structure of personnel training, and continuously improve their knowledge.
In terms of allocation equity, this study shows that the allocation of MCH technicians, licensed (assistant) physicians, and registered nurses in mainland China is equitable by population, but not by geographical area. This conclusion is consistent with previous research results [27, 37, 38]. The reason may be that government health departments usually use the number of health resources per 1,000 population as the standard for regional planning and allocation, and pay less attention to the geographic availability of health resources [39]. However, the fairness of the allocation of health resources by geographical area is very critical to the utilization rate of health resources. Therefore, it is suggested that in the formulation of MCH plans in the new era, the two factors of the service population and geographical area should be comprehensively considered, to improve the geographical accessibility of MCH services and meet the needs of residents for MCH services.
The T was also decomposed in this study. The results show that the inequity in the allocation of MCH human resources is mainly caused by differences within regions, which is consistent with the results of previous studies [14, 40, 41]. The contribution rate of different economic regions to the national total T is further analyzed. The study found that if allocated by population, the main reasons for the inequity in the allocation of MCH human resources were the Q2 regions and the Q1 regions. It is worth noting that if the allocation is based on geographical area, the Q4 regions are the main reason for the unfair allocation. It is not difficult to understand that Tibet, Xinjiang, and other places are sparsely populated and have a large service radius, while Beijing, Shanghai, and other places are on the contrary, and the economic development levels of the two are also far from each other. At this time, the allocation of MCH resources according to the population is Obviously in favor of the latter, geographically in favor of the former. Therefore, it is suggested that policymakers need to fully understand the impact of intra-regional differences on the allocation of MCH human resources, increase financial support for regions with medium and low GDP per capita, introduce corresponding employment guidance policies, and attract more outstanding health professionals.
This study has some limitations. First, the research subjects were only included in the 31 provinces, municipalities, and autonomous regions in mainland China, excluding Hong Kong, Macau, and Taiwan. The medical and health systems in these regions are somewhat different from those in mainland China. In the future, we can further explore their impact on the fairness of China's overall MCH human resources allocation. Secondly, the research objects are divided into regions based on the level of economic development, and the contribution rates of differences between groups and within groups to the total T are analyzed to reflect the overall fair impact of economic and non-economic factors. However, the specific impact of economic and non-economic factors on the equity of MCH staffing has not been studied. Finally, this study only discusses the fairness of allocation and ignores the efficiency of allocation. In the future, evaluation can be made on this basis, so that the allocation of MCH human resources can take into account both fairness and efficiency.