DOCTORS WORKFORCE IN ERBIL
GOVERNORATE: A STUDY ON
DISTRIBUTION AND TURNOVER
By
MOAYAD ABDULLAH WAHAB
M. B. Ch. B
SUPERVISOR
PROFESSOR TARIQ S. AL – HADITHI
M.B.Ch.B, M.Sc., DTM & H, Ph.D.
Outline





Introduction
Subjects and Methods
Results and Discussions
Conclusions
Recommendations
Introduction
 The first decade of the 21st century is
considered to be the era of health
workforce.
 Many countries face workforce imbalances.
The problems are rooted in political,
economic, cultural, and health systems.
 After 2003, Erbil governorate faced
tremendous health demand, due to rapid
socio-demographic changes.
 Many aspects of doctors workforce
distribution in Erbil governorate are not
disclosed. There is few published studies
in this field in Kurdistan region and Iraq.
Aim of the study
The aim of this study was to tackle the
problem of uneven distribution of
doctors in Erbil governorate and rapid
turnover of doctors in primary health
care centers in Erbil city.
Objectives
1.
To find out current distribution of doctors relevant
to age, gender, location, marital status.
2.
To determine current ratio of doctors to population
at the governorate and district levels.
3.
To identify possible causes for uneven distribution
of doctors in Erbil governorate and their rapid
turnover at PHCs inside Erbil city.
4.
To set up certain recommendations for health
policy makers to ensure proper future distribution
of doctors.
Subjects and Methods
 A cross-sectional study was done from
1st Sep., 2008 to 31st March, 2010 ( Data
collection from the period 1st Feb., to
30th Sep., 2009.
 The sample included 962 doctors from:
DOH-Erbil health facilities and HMU
affiliated to DOH-Erbil.
 Exclusion criteria:
1. Doctors not affiliated from HMU to DOHErbil.
2. Employers other than DOH-Erbil & retired
doctors.
3. Postgraduate students (529 doctors).
4. Long leave for >72 days (23 doctors).
5. Koya and Makhmour districts.
Mergasor
62,139
Soran
PHC=5, H=1
232,938
PHC=7, H=3
Choman
35,922
PHC=2, H=1
Shaqlawa
147,682
Khabat
Nawandi Hawler
63,566
1,192,459 PHC=21
,H=8, SMC=7
PHC=20
PHC=7, H=3
DashtiHawler
128,287
Koisnjaq
112,864
Results & Discussion
Distribution of doctors by gender
Fe m ale
38.6%
M ale
61.4%
 Male: female ratio is 1.59:1
Distribution of doctors by age
50
45
40
42.9
39
36.6
Percentage
35
29.8
30
25
Male
21.3
Female
20
13.8
15
8.6
10
3.5
5
3.7
0.8
0
< 30
30 -39
40 - 49
50 - 59
≥ 60
Age group
 Mean age ± SD is 35.10 ± 9.79 y ranging from 23 – 68 y
Percentage
Distribution of doctors by marital status and
geographical distribution
90
80
70
60
50
40
30
20
10
0
Nawandi
Hawler
Dashti
Hawler
Khabat Shaqlawa
Districts
Soran
Mergasor Choman
Single
Married
Total
 In: Single= 80.2%, Married = 85.4%, T = 83.6% , P = 0.001
Distribution of doctors by No. of children
100
Percentage
90
80
95.2
92.6
74.2
70
60
50
Inside Erbil city
Outside Erbil city
40
30
25.8
20
10
7.4
4.8
0
<2
2-3
No. of children
 P = 0.001
≥4
Distribution of doctors by type of health facility
DOH & SMC
2.5%
PHC
23.3%
Hospital
74.2%
Percentage
Distribution of doctors by hospital per district
100
90
80
70
60
50
40
30
20
10
0
90.1
9.9
Urban hospitals
District hospitals
Doctors workplace
ed
liz
Hospitals
e
H
.
H.
l
2.5
Pr
iv
at
y
sp
ita
H.
3.7
nc
ho
al
y
.
H.
H
H.
5
Em
er
ge
ca
l
an
ak
nc
y
in
al
.
8.4
Su
rg
i
N
m
er
ge
ap
ar
ol
og
ic
R
ec
Er
bi
lH
10
ec
ia
gy
n
aw
le
rE
&
.
20
H
et
ric
s
ar
iH
30
Sp
bs
t
iz
g
35
O
R
Percentage
Distribution of doctors by hospital per district
32.4
27.2
25
15.9
15
7.6
1.7
0.6
0
Relationship between workplace and birthplace
70
61.1
60
Percentage
50
40
27.7
30
20
10
6.2
3.2
1.8
0
Erbil
Sulaimania
Duhok
Birthplace
Rest of Iraqi
governorates
Abroad
Relationship between workplace and birthplace
District
Total No.
Born in the same district
No.
%
Nawandi Hawler
804
412
51.2
Choman
16
0
0.0
Mergasor
22
1
4.5
Shaqlawa
45
1
2.2
Dashti Hawler
30
0
0.0
Khabat
10
0
0.0
Soran
35
1
2.9
Total
962
415
43.1
Distribution of doctors by job title
40
Percentage
35
33.5
30
25
21.2
20
15.2
12.3
15
11.1
10
6.7
5
0
Specialist
House Officer Senior House Specialty
Officer
Practitioner
Job title
Rural
Practitioner
General
Practitioner
Distribution of doctors by type of health facility
45
40
35
30
25
Percentage
20
15
10
5
0
40.1
35.3
33.5
28.6
24.1
20.5
5.9
3.9
0
House officer
1
7.1
0
Rural
General Senior house Specialty Specialist
practitioner practitioner officer practitioner
Job title
Hospital
PHC
100
99
100
98
97.5
89.2
70.2
DOH
29.8
HMU
10.8
Job title
2.5
l
2
To
ta
0
Sp
ec
ial
ist
0
Ru
ra
lp
ra
ct
iti
Ge
on
ne
er
ra
lp
ra
ct
iti
Se
on
ni
er
or
ho
us
eo
Sp
ffi
ec
ce
ial
r
ty
pr
ac
tit
io
ne
r
1
of
fic
er
120
100
80
60
40
20
0
Ho
us
e
Percentage
Distribution of doctors according to job title
and employer
Percentage
Distribution of specialists by gender & specialty
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
12.1
7.7
11.8
9
8.7
Medicine
44.4
38.5
100
94.7
65.5
Surgery
4
5.3
34.5
92.3
8.4
55.6
61.5
Pediatrics Obstetrics Radiology Dermatology
Specialty
Total
Female
Male
Distribution of doctors by job titles for those
working for private clinic and / or hospitals
Type of private work (%)
Job title
Clinic
Hospital
Both
Total
Specialist
58.2
3.3
38.5
83.8
General practitioner
80.0
20.0
0.0
1.6
Specialty practitioner
85.0
2.50
12.5
12.4
Rural practitioner
42.9
57.1
0.0
2.2
Total
61.5
4.7
33.8
100
Factors influence employment
process in rural areas
Variable
Doctors willing to
stay in current
workplace
Total
Yes
No
%
%
%
Marital status (P < 0.001)
Married
84.4
15.6
64.1
Single
52.5
47.5
35.9
Opportunities to select workplace (P < 0.001)
Yes
90.2
9.8
63.6
No
42.9
57.1
36.4
Variable
Doctors willing to
stay in current
workplace
Total
Yes
No
%
%
%
Working for private sector (P < 0.001)
Yes
93.2
6.8
52.7
No
67.8
32.2
47.3
Place of better financial income for those working in
private sector (P < 0.001)
Inside Erbil city
95.1
4.9
94.4
Outside Erbil city
61.1
38.9
5.6
Density of doctors per 10,000 populations
Ratio / 10,000 population
8
6.7
7
6
5.1
5
4.5 4.5
4.2
3.6
4
3.1
3 2.5
3.4
3.1
2.2
2.2 2.4
1.5 1.7
1.2
0.3
1.6 1.6
2
0.9
0.5
1
0.2
l
To
ta
So
ra
n
ba
t
Ha
w
ht
i
Sh
a
Kh
a
le
r
a
w
r
er
ga
so
M
an
Ch
om
ql
a
Da
s
Na
w
an
di
Ha
w
le
r
0
Specialist
Non-specialist
Districts
Total
Density of doctors per 10,000 populations
8
6.7
Ratio / 10,000 population
7
6
5
4.2
Iniside Erbil city
4
3
Outside Erbil city
2.5
2.4
2
2
1
0.4
0
Specialist
Non-specialist
Job title of doctors
Total
Doctors satisfaction with the current health
system by socio-demographic
characteristics and other variables
Doctor satisfied with the
current health system
Variable
%
Gender
Male
56.7
Female
61.2
Age
< 30
56.0
30 -39
61.8
40 - 49
56.5
50 - 59
64.1
≥ 60
48.0
Marital status
Single
55.9
Married
59.8
Job title
House officer
53.7
Rural practitioner
58.9
General practitioner
62.5
Senior house officer
59.6
Specialty practitioner
59.3
Specialist
59.6
Workplace
Inside Erbil city
59.6
Outside Erbil city
52.5
Total
58.4
Conclusions
1) Numerical imbalance : below the regional
and international average.
2) Urban- rural imbalance: geographic
maldistribution of specialists.
3) Institutional imbalance: hospitals versus
PHCs.
4) The largest category is specialists and
the smallest is general practitioners.
5) The proportion of pediatricians is
declining.
6) The most common specialties:
Overall:
General surgery, internal medicine,
pediatrics, obstetrics.
Female:
Obstetrics , radiology, pediatrics,
dermatology.
7) Most influential factors to determine the
workplace and satisfaction are:
 Having private practice.
 Opportunity to choose workplace.
8) More than half of the doctors are
satisfied with their work.
Recommendations
1) Increase no. of doctors: next 6 y by two
fold = 10 / 10,000 populations ( Middle
East region level).
2) Make rural jobs more attractive than
urban jobs: financial and non-financial
incentives.
3) Strengthening liaison between DOH and
HMU through emphasis on primary
health care and family medicine:
 ٍٍPostgraduate study.
 Adopt family health care system.
4) Emphasis on appointment of properly
trained health managers: regular
supervision of health facilities.
5) Make private sector synergize with the
public sector.
6) Similar studies in this field are highly
recommended in Erbil governorate to
study in more details the findings of this
study.
THANK YOU