Cameroon public health sector: shortage and inequalities in geographic distribution of health personnel.

INTRODUCTION: Cameroon is classified by the World Health Organization (WHO) as having a critical shortage of health personnel. This is further complicated by the geographic distributional inequalities of the national health workforce. This shortfall impedes Cameroons' progress of improving the human resources for health (HRH) to meet up with the Millennium Development Goals (MDGs) by 2015. However, it is unknown whether the health workforce of Cameroon is distributed equally across geographic regions. Additionally, indicators other than population levels have not been used to measure health care needs. This study aimed to assess the adequacy, evenness of distribution and challenges faced by the health workforce across the different regions of Cameroon. METHODS: National health personnel availability and distribution were assessed by use of end-of-year census data for 2011 obtained from the MoPH data base. The inequalities and distribution of the workforce were estimated using Gini coefficient and Lorenz curve and linear regression was used to determine the relation between health personnel density and selected health outcomes. Alternative indicators to determine health care needs were illustrated using concentration curves. RESULTS: Significant geographic inequalities in the availability of health workforce exist in Cameroon. Some regions have a higher number of physicians (per person) than others leading to poor health outcomes across the regions. 70 % of regions have a density of health personnel-to-population per 1,000 that is less than 1.5, implying acute shortage of health personnel. Poor working and living conditions, coupled with limited opportunities for career progress accounted for some documented 232 physicians and 205 nurses that migrated from the public sector. Significant distributional inequality was noticed when under-five infant mortality and malaria prevalence rate were used as indicators to measure health care needs. CONCLUSION: Our results show an absolute shortage of public health personnel in Cameroon that is further complicated by the geographic distributional inequalities across the regions of the nation. Cameroon aims to achieve universal health coverage by 2035; to realize this objective, policies targeting training, recruitment, retention and effective deployment of motivated and supported health workforce as well as the development and improvement of health infrastructures remain the major challenge.

Impact of change in job status on mortality for newly onset type II diabetes patients: 7 years follow-up using cohort data of National Health Insurance, Korea.

OBJECTIVE: This study investigates the relationship between change in job status and mortality of newly diagnosed type II diabetes patients by gender. METHODS: Newly onset of individuals diagnosed with type II diabetes in the years 2003 and 2004, had 7 years follow-up using National Health Insurance Corporation (NHIC) sample cohort data. The individuals diagnosed with type II diabetes within this period were 14,861. After adjusting for age, initial income group, insulin treatment and medical service utilization, hazard ratio was analyzed using Cox's proportional hazard model. RESULTS: Mortality hazard ratio of continuously unemployed individuals is 3.78 times higher in males and 9.78 times higher in females than in those who keep their jobs. Also, individuals with a change in job status (e.g. from industrial worker to unemployed or self-employed), the mortality hazard ratio is 2.24 times higher in males and 5.23 times higher in females than in those who keep their jobs. The impact of change in job status change is largest for the middle class males. The middle class males has the higher mortality hazard ratio, 6.14 times in maintain unemployed and 4.12 times in change his job (industrial worker to unemployed or self-employer) than maintain one's job. CONCLUSIONS: The continuous unemployment and the loss of job are related to risk of death in diabetic patients. The impact of unemployed is stronger than job change (loss or change). The impact of job status change is largest for the middle class man.