DOCTORS WORKFORCE IN ERBIL GOVERNORATE: A STUDY ON

DISTRIBUTION AND TURNOVER

ByMOAYAD ABDULLAH WAHAB

M. B. Ch. B

SUPERVISOR

PROFESSOR TARIQ S. AL – HADITHIM.B.Ch.B, M.Sc., DTM & H, Ph.D.

OutlineOutline

Introduction Subjects and Methods Results and Discussions Conclusions Recommendations

The first decade of the 21The first decade of the 21stst century is century is

considered to be the era of health considered to be the era of health workforce.workforce.

Many countries face workforce imbalances. Many countries face workforce imbalances. The problems are rooted in political, The problems are rooted in political, economic, cultural, and health systems.economic, cultural, and health systems.

IntroductionIntroduction

After 2003, Erbil governorate faced After 2003, Erbil governorate faced tremendous health demand, due to rapid tremendous health demand, due to rapid socio-demographic changes.socio-demographic changes.

Many aspects of doctors workforce Many aspects of doctors workforce distribution in Erbil governorate are not distribution in Erbil governorate are not disclosed. There is few published studies disclosed. There is few published studies in this field in Kurdistan region and Iraq.in this field in Kurdistan region and Iraq.

Aim of the studyAim of the study

The aim of this study was to tackle the The aim of this study was to tackle the problem of uneven distribution of problem of uneven distribution of doctors in Erbil governorate and rapid doctors in Erbil governorate and rapid turnover of doctors in primary health turnover of doctors in primary health care centers in Erbil city. care centers in Erbil city.

ObjectivesObjectives

1.1. To find out current distribution of doctors relevant To find out current distribution of doctors relevant to age, gender, location, marital status. to age, gender, location, marital status.

2.2. To determine current ratio of doctors to population To determine current ratio of doctors to population at the governorate and district levels.at the governorate and district levels.

3.3. To identify possible causes for uneven distribution To identify possible causes for uneven distribution of doctors in Erbil governorate and their rapid of doctors in Erbil governorate and their rapid turnover at PHCs inside Erbil city.turnover at PHCs inside Erbil city.

4.4. To set up certain recommendations for health To set up certain recommendations for health policy makers to ensure proper future distribution policy makers to ensure proper future distribution of doctors.of doctors.

Subjects and MethodsSubjects and Methods

A cross-sectional study was done from A cross-sectional study was done from 11stst Sep., 2008 to 31 Sep., 2008 to 31stst March, 2010 ( Data March, 2010 ( Data collection from the period 1collection from the period 1stst Feb., to Feb., to 3030thth Sep., 2009. Sep., 2009.

The sample included 962 doctors from: The sample included 962 doctors from:

DOH-Erbil health facilities and HMU DOH-Erbil health facilities and HMU affiliated to DOH-Erbil.affiliated to DOH-Erbil.

Exclusion criteria:Exclusion criteria: 1.1. Doctors not affiliated from HMU to DOH-Doctors not affiliated from HMU to DOH-

Erbil.Erbil.

2.2. Employers other than DOH-Erbil & retired Employers other than DOH-Erbil & retired doctors.doctors.

3.3. Postgraduate students (529 doctors).Postgraduate students (529 doctors).

4.4. Long leave for >72 days (23 doctors).Long leave for >72 days (23 doctors).

5.5. Koya and Makhmour districts.Koya and Makhmour districts.

Mergasor

62,139

PHC=5, H=1

Soran

232,938

PHC=7, H=3

Shaqlawa

147,682

PHC=7, H=3

Choman

35,922

PHC=2, H=1

DashtiHawler

128,287

Nawandi Hawler

1,192,459 PHC=21 ,H=8,

SMC=7

Khabat

63,566

PHC=20

Koisnjaq

112,864

Results & DiscussionResults & Discussion

Distribution of doctors by genderDistribution of doctors by gender

Male: female ratio isMale: female ratio is 1.59:11.59:1

Male 61.4%

Female38.6%

Distribution of doctors by ageDistribution of doctors by age

36.6

29.8

21.3

8.6

3.7

39

42.9

13.8

3.50.8

0

5

10

15

20

25

30

35

40

45

50

< 30 30 -39 40 - 49 50 - 59 ≥ 60

Age group

Pe

rce

nta

ge

Male

Female

Mean age ± SD isMean age ± SD is 35.10 ± 9.7935.10 ± 9.79 yy ranging from ranging from 23 – 6823 – 68 yy

Distribution of doctors by marital status and Distribution of doctors by marital status and geographical distributiongeographical distribution

In: Single= 80.2%, Married = 85.4%, T = 83.6%In: Single= 80.2%, Married = 85.4%, T = 83.6% , , P = 0.001P = 0.001

0

10

20

30

40

50

60

70

80

90Pe

rcenta

ge

NawandiHawler

DashtiHawler

Khabat Shaqlawa Soran Mergasor Choman

Districts

SingleMarriedTotal

Distribution of doctors by No. of children Distribution of doctors by No. of children

74.2

92.6 95.2

25.8

7.4 4.8

0

10

20

30

40

50

60

70

80

90

100

< 2 2 - 3 ≥ 4

No. of children

Perc

enta

ge Inside Erbil city

Outside Erbil city

P = 0.001P = 0.001

Distribution of doctors by type of health facilityDistribution of doctors by type of health facility

Hospital 74.2%

DOH & SMC 2.5%

PHC 23.3%

Distribution of doctors by hospital per districtDistribution of doctors by hospital per district

90.1

9.9

01020304050

60708090

100

Urban hospitals District hospitals

Doctors workplace

Perc

enta

ge

Distribution of doctors by hospital per districtDistribution of doctors by hospital per district 32.4

27.2

15.9

8.4 7.63.7 2.5 1.7 0.6

0

5

10

15

20

25

30

35

Hospitals

Per

cent

age

Relationship between workplace and birthplaceRelationship between workplace and birthplace

61.1

6.2

1.8

27.7

3.2

0

10

20

30

40

50

60

70

Erbil Sulaimania Duhok Rest of Iraqigovernorates

Abroad

Birthplace

Per

cen

tag

e

RelationshipRelationship between workplace and birthplace between workplace and birthplace

DistrictTotal No. Born in the same district

No.%

Nawandi Hawler80441251.2

Choman1600.0

Mergasor2214.5

Shaqlawa4512.2

Dashti Hawler3000.0

Khabat1000.0

Soran3512.9

Total96241543.1

Distribution of doctors by job title Distribution of doctors by job title

33.5

21.2

15.212.3 11.1

6.7

0

5

10

15

20

25

30

35

40

Specialist House Officer Senior HouseOfficer

SpecialtyPractitioner

RuralPractitioner

GeneralPractitioner

Job title

Perc

enta

ge

Distribution of doctors by type of health facilityDistribution of doctors by type of health facility

28.6

03.9

35.3

1

24.120.5

0

5.9

33.540.1

7.1

05

1015

202530354045

Percentage

House officer Ruralpractitioner

Generalpractitioner

Senior houseofficer

Specialtypractitioner

Specialist

Job title

Hospital

PHC

Distribution of doctors according to job title Distribution of doctors according to job title and employer and employer

99 100 100 98 97.5

70.289.2

1 0 0 2 2.5

29.810.8

0

20

40

60

80

100

120

Job title

Perc

enta

ge DOH

HMU

Distribution of specialists by gender & specialty Distribution of specialists by gender & specialty

92.3 94.7

65.555.6

61.5

7.7 5.3

34.544.4

38.5

100

412.1 11.8 8.7 8.49

0%10%20%

30%40%50%60%70%

80%90%

100%

Surgery Medicine Pediatrics Obstetrics Radiology DermatologySpecialty

Perce

ntage

TotalFemaleMale

Distribution of doctors by job titles for those Distribution of doctors by job titles for those working for private clinic and / or hospitalsworking for private clinic and / or hospitals

Type of private work (%)

Job titleClinicHospitalBothTotal

Specialist58.23.338.583.8

General practitioner80.020.00.01.6

Specialty practitioner85.02.5012.512.4

Rural practitioner42.957.10.02.2

Total61.54.733.8100

Factors influence employmentFactors influence employment process in rural areas process in rural areas

Variable

Doctors willing to stay in current

workplaceTotal

YesNo % %%

Marital status (P < 0.001)

Married84.415.664.1

Single52.547.535.9

Opportunities to select workplace (P < 0.001)

Yes90.29.863.6

No42.957.136.4

Variable

Doctors willing to stay in current

workplaceTotal

YesNo % %%

Working for private sector (P < 0.001)

Yes93.26.852.7

No67.832.247.3

Place of better financial income for those working in private sector (P < 0.001)

Inside Erbil city95.14.994.4

Outside Erbil city61.138.95.6

Density of doctors per 10,000 populationsDensity of doctors per 10,000 populations

4.5

2.21.6

6.7

5.1

1.7

2.5

0.50.9

0.30.2

3.4

4.2

3.12.2

1.2

3.63.1

4.5

2.41.6 1.5

0

1

2

3

4

5

6

7

8

Districts

Rat

io

/ 10

,000

pop

ulat

ion

Specialist

Non-specialist

Total

2.5

4.2

6.7

0.4

22.4

0

1

2

3

4

5

6

7

8

Specialist Non-specialist Total

Job title of doctors

Rat

io

/ 10

,000

pop

ulat

ion

Iniside Erbil city

Outside Erbil city

Density of doctors per 10,000 populationsDensity of doctors per 10,000 populations

Doctors satisfaction with the current health Doctors satisfaction with the current health system by socio-demographic system by socio-demographic

characteristics and other variablescharacteristics and other variables

Doctor satisfied with the current health system

Variable%

Gender

Male56.7

Female61.2

Age

< 3056.0

30 -3961.8

40 - 4956.5

50 - 5964.1

≥ 6048.0

Marital status

Single55.9

Married59.8

Job title

House officer53.7

Rural practitioner58.9

General practitioner62.5

Senior house officer59.6

Specialty practitioner59.3

Specialist59.6

Workplace

Inside Erbil city59.6

Outside Erbil city52.5

Total58.4

ConclusionsConclusions

1)1) Numerical imbalance : below the regional Numerical imbalance : below the regional and international average.and international average.

2)2) Urban- rural imbalance: geographic Urban- rural imbalance: geographic maldistribution of specialists. maldistribution of specialists.

3)3) Institutional imbalance: hospitals versus Institutional imbalance: hospitals versus PHCs.PHCs.

4)4) The largest category is specialists and The largest category is specialists and the smallest is general practitioners.the smallest is general practitioners.

5)5) The proportion of pediatricians is The proportion of pediatricians is declining.declining.

7)7) The most common specialties: The most common specialties: Overall:Overall: General surgery, internal medicine, General surgery, internal medicine,

pediatrics, obstetrics. pediatrics, obstetrics. Female:Female: Obstetrics , radiology, pediatrics, Obstetrics , radiology, pediatrics,

dermatology.dermatology.

7)7) Most influential factors to determine the Most influential factors to determine the workplace and satisfaction are:workplace and satisfaction are:

Having private practice. Having private practice. Opportunity to choose workplace.Opportunity to choose workplace.

8)8) More than half of the doctors are More than half of the doctors are satisfied with their work.satisfied with their work.

RecommendationsRecommendations

1)1) Increase no. of doctors: next 6 y by two Increase no. of doctors: next 6 y by two fold = 10 / 10,000 populations ( Middle fold = 10 / 10,000 populations ( Middle East region level).East region level).

2)2) Make rural jobs more attractive than Make rural jobs more attractive than urban jobs: financial and non-financial urban jobs: financial and non-financial incentives.incentives.

3)3) Strengthening liaison between DOH and Strengthening liaison between DOH and HMU through emphasis on primary HMU through emphasis on primary health care and family medicine:health care and family medicine:

""""Postgraduate study. Postgraduate study. Adopt family health care system.Adopt family health care system.

4)4) Emphasis on appointment of properly Emphasis on appointment of properly trained health managers: regular trained health managers: regular supervision of health facilities. supervision of health facilities.

5)5) Make private sector synergize with the Make private sector synergize with the public sector.public sector.

6)6) Similar studies in this field are highly Similar studies in this field are highly recommended in Erbil governorate to recommended in Erbil governorate to study in more details the findings of this study in more details the findings of this study.study.

THANK YOUTHANK YOU