Models for health workforce
planning and projections
卫生人力规划与预测模型
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Models for health workforce planning and projections
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HRH planning and projections
卫生人力资源的规划与预测
The purpose of workforce planning projections is to 人力规划与预测的目的
 contribute to evidence-based, rationalize decisions in the formulation of national
HRH policies and strategies . 有助于国家制定合理的、有证据支持的卫生
人力资源政策与策略
 rationalize policy options based on a (financially) feasible picture of the future in
which the expected supply of HRH matches the requirements for staff within the
overall health service plans 基于政策的可行性合理化政策选择，在整体健
康服务计划中，根据工作人员的要求进行卫生人力资源的补充
 identify short and longer term actions for achieving longer-term objectives.为实现
长期目标，确定短期或长期行动
Making projections is a policy-making necessity, and needs regular re-evaluation
and adjustment
预测是制定政策的必要，且需要定期的再评估及调整。
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Models for health workforce planning and projections
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Uncertainties with projections
预测中的不确定因素
 Country situation changes (demographic, epidemiological, economic,
etc.)国家情况的改变（人口，流行病，经济等）
 The capacity (both current and projected) for implementing the
proposed interventions执行干预的能力（现在及未来）
 Conflicting priorities for different stakeholders 不同利益相关人优先
权的冲突
 leadership turnover 政权的更迭
 Actions of stakeholders that can impact on health systems development
影响卫生系统发展的活动
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Models for health workforce planning and projections
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Linking health workforce requirements and supply projections
卫生人力需求及补充预测
Source: Hornby 2007
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Models for health workforce planning and projections
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Factors affecting HRH Supply
影响卫生人力资源补充的因素
 Health Workers Supply 卫生人力补充
– HRH production / training capacity 卫生人力资源产出/培训能
力
– human capital stock 人力资本存量
– other resources 其他资源
– global, regional, local exit and entry forces, labor market conditions
全球性或区域性人口流动，及劳工市场的情况
 Health Workers Attrition / Loss 卫生人力的流失
– death, out-migration 死亡，移民
– career change 职业变换
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Models for health workforce planning and projections
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Methods of supply projection
补充方法预测
Trend projection 趋势预测
In- and out- moves method 人口流动法
– Stock and flow projection 存量与流量的预
测
Cohort method, based on cohort retention rates股
群法，基于同期组群保留率
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Models for health workforce planning and projections
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Trend projection趋势预测
Projection of medical doctors per 1000 population, Brazil 1970-2030
每千人医生数量预测（巴西，1970-2030）
3.5
Densidade de medicos per 1000 pop
3
2.5
2
1.5
1
médicos per capita _DATASUS
Projeção de oferta medicos per capita_datasus
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Models for health workforce planning and projections
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médicos per capita _census+PNAD
Projeção de oferta medicos per capita_census+PNAD
2030
2028
2026
2024
2022
2020
2018
2016
2014
2012
2010
2008
2006
2004
2002
2000
1998
1996
1994
1992
1990
1988
1986
1984
1982
1980
1978
1976
0
1970
0.5
In and out move method人口流动法
Inflow
人口流入
Education教育
In-migration移民
Stock of
Health Workers
卫生人力总量
人口流出
退休
Outflow
残疾/死亡
移民
Retirement
Disability/Death
Out-migration
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Models for health workforce planning and projections
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“Inflow” and “outflow” of nurses from the UK, 1993-2010
英国（1993-2010）护士的“流入”与“流出”
Buchan, J & Seccombe, I. Planning for Retirement? The
2011 UK Nursing Labour Market Review. 2011. in print.
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Models for health workforce planning and projections
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Cohort method股群法
 Estimate approximate percentage of each cohort of graduates who remain in active
workforce over time 估计每个组群长期工作的毕业生的比例
– Cohort refers to a group of persons followed through time as, for example, male doctors who
graduated during the five-year period 1980-84, or female nurses during the period, 1990-94 组
群指有共同工作年限的人，如1980-1984这五年间毕业的男医生，或1990-1994年
毕业的女护士
 Use observed or assumed cohort retention rates to project numbers of each cohort
of graduates who will be active in future years运用观察所得或假设的组群保
留率预测每个组群未来几年仍将在职的毕业生人数
– For example, 98% remain active 5 years after graduation, 96% remain active 10 years after
graduation, 92% remain active 15 years after graduation
– 例如，98%的人在毕业后五年在职，95%的人在毕业后十年内在职，92的人在毕
业后15年内在职
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Models for health workforce planning and projections
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Ageing nurses in the United States of America
美国护士的老龄化
-
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Models for health workforce planning and projections
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-
-
-
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Factors affecting HRH demand
影响卫生人力资源需求的因素
 Demand for health services:卫生服务的需求
– Population demographic characteristics: population size, age structure人口学
特征： 人口规模，年龄，结构
– Epidemiological factors: disease patterns 流行病因素：疾病的形式
– Socio-economic factors: income, education 社会经济因素：收入，教育
– Behavioral factors: utilization patterns 行为因素：利用方式
 Health service policy and resources: 卫生服务政策及资源
– Technology & service provision patterns 技术及服务提供形式
– Finance / budgets 财政/预算
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Models for health workforce planning and projections
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Requirements projections 需求预测
 Workforce to population ratio method人力与
人口比 法
 Service demands method 服务需求法
 Service targets method 服务对象法
 Health needs method 卫生服务需要法
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Models for health workforce planning and projections
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HRH per population approach
卫生人力资源与总人口
Population Growth Trends
人口增长趋势
现在的人口情况
未来的人口情况
所需卫生人力
资源
现在卫生人力
密度
期望卫生人力密度
* Regional/Global standard区域/全球标准
* Geographical comparisons地域比较
* Economic and social status经济与社会状况
* Historical trends历史趋势
* Expert opinions专家意见
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Models for health workforce planning and projections
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Population density of health care professionals
required to ensure skilled attendance at births
所需医疗专业人员的密度，以确保熟练的助产服务
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Models for health workforce planning and projections
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Source: WHR 2006
Health Worker Density in European Countries
欧洲国家卫生人员密度（每万人卫生人员数量）
Physicians
内科医生
Nurses
护士
亚美尼亚
34,5
41,7
4,1
0,5
3,9
乌克兰
30,8
78,3
5,0
4,8
4,1
欧盟
32,1
74,5
3,6
7,1
6,0
世界卫生
组织欧洲
地区办公
室
33,9
72,2
4,4
5,2
5,1
对照组
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Models for health workforce planning and projections
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Midwives Pharmacists Dentists
助产士
药剂师
牙医
Service demand approach 服务需求
Using current demand make assumptions about how that will change over time运
用当下的需求假设随时间的推移而产生的变化
Current Health
当下卫生保健的使用状
care utilization
况（调查）
(Survey)
未来人口特点
Population
characteristics
age, income, sex,
education
人口特点：年龄，
收入，性别，教育
水平
Future Population
Characteristics
Population and
socioeconomic
trends
人口及社会经济趋势
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Models for health workforce planning and projections
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未来卫生服务需求
Future health
service
requirements
人力资源生
产率
HR
Productivity
HRH
Requirements
卫生人力
资源需求
Service target approach 服务对象
决策者
•Current and projected
facilities
Policy
Makers
Future health systems
scenario and health
service requirements
•Current and projected
staffing patterns
•Vacancy and attrition
rates
*Experts
*Planners
当前及预测机构
专家
当年及预测中的人员编制
规划人员
Models for health workforce planning and projections
HR
Productivit
y
人力资源生产率
HRH
Requirements
空缺及消耗率
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未来卫生系统状况及卫生服务需求
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卫生人力
资源需求
HRH demand for ART in Mozambique (scenario 1)
8 000 starting ART by the end of year 1,
ending with 58 000 starting ART by the end of year
Source: Hagopian, A., Micek, M., Vio, F., Gimbel-Sherr, K., Montoya, P. What if we decided to take care of everyone who needed treatment?
Workforce planning in Mozambique using simulation of demand for HIV/AIDS care. Human Resources for Health 2008, 6:3
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Models for health workforce planning and projections
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Health needs approach卫生需求
当下卫生需求
Current
Health Needs
健康状况目标的具体研究
Detailed study of health
status targets
Population
characteristics
*age *income
*sex *education
人口特点：年龄，
收入，性别，教育
水平
未来人口特点
未来卫生需求
Future Pop
Characteristics
Future Health
Needs
HR
Population
and socioeconomic
trends
Productivity
人力资源生产率
人口及社会经济趋势
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Models for health workforce planning and projections
未来卫生服务需求
Future
health service
requirements
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卫生人力
HRH 资源需求
Requirements
Key problems with requirements projections
需求中主要问题的预测
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Each approach has limitations 每种方法都有局限
Problems in securing data 数据安全性的问题
Degree of precision of some variables are subjective 一些变量的精确度较主观
Private sector characteristics and projecting demand 私营部门的特点及预测需
求
Converting full-time equivalents (FTEs) into ‘persons’ 全职人力人数到“人”的
转换
Potentially wide errors regarding loss estimates关于损失估算的潜在误差
Difficulty maintaining relevant policies over time 超时维持相关政策执行的困难
Lack of data about deployment, productivity, location, costs, specialization 在人员
部署、生产力，位置、花费及专业化方面的数据缺乏
Lack of data about the ‘inactive’ supply and what policies might help bring them
back to active status非积极供应以及哪些政策能够帮助恢复活跃状态的相
关数据缺乏
Models for health workforce planning and projections |
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Special studies and applications特殊研究及应用 (1)
 Econometric analysis: a statistical techniques on market factors that
influence labour participation and health service utilization, such as
access to services and preferences of health consumers.
计量经济学分析：统计对影响劳动力的参与和卫生服务利用
的市场因素，如服务渠道和消费者偏好。
 Regression analysis: This is a technique for the modelling and
analysis of numerical data consisting of values of a dependent variable
(response variable) and of one or more independent variables
(explanatory variables).
回归分析：建模和数值数据分析，包括单个因变量的值(反
应变量)单个或多个的独立变量(解释变量)
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Models for health workforce planning and projections
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Special studies and applications (2)
特殊研究及应用
 Meta analysis: A technique to assess and reconcile potential variances in
coverage, classification and reporting of data, by means of amalgamating,
summarizing and assessing all available information on a specific dimension and
applying statistical techniques to measure outcomes on a common scale.
元分析：合并、汇总和评估所有可用的信息，基于特定维度，运用统
计技术，以共同的尺度来测量结果；以评估和调和数据的覆盖率、分
类和报告的潜在差异。
 Simple models: Specialized analysis of a given issue for consideration of other
health aspects, such as the impact of HIV on the workforce: used by aid decisionmakers to take to address HW situation to mitigate potential future scenarios
简单模型：出于健康角度对给定问题的专业分析，如艾滋病对人力的
影响；援助决策者在处理HW对未来潜在远景的转移时的决策模型
 WISN 工作量指标法测算
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Models for health workforce planning and projections
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Factors influencing choice of method (1)
影响选择方法的因素
 Magnitude of system and HRH changes sought系统的量级和卫生人力资源变化
寻求
– Nature and urgency of the HR problem (s) 人力资源问题的本质和紧迫性
• Projections <10 years permit only minor changes in the health system,
supply, or deployment 近十年的预测只允许卫生系统，供给或者部
署的微小变动
• 20+ years allow significant changes in type of health system, personnel
numbers and ratios
• 20年以上，允许卫生系统的类型，人员数量和比率的较大变动
 Number of cadres to be projected 干部数量的预测
 Data availability, especially on staffing patterns, costs, productivity, and on geographic
and functional distribution 数据可用性，特别是在人员模式、成本、生产力
以及在地理和功能分布
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Models for health workforce planning and projections |
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Factors influencing choice of method (2)
 Passive or active government health policies消极或积极的政府医疗卫生政策
– Passive: Seeks to anticipate likely future developments based on observable
and likely trends
– 消极：根据可观察到的或可能的趋势，寻求对未来可能发展的预测
– Active: Seeks to intervene to shape future developments, eg, changes in ratios,
numbers, types of health facilities, public/private sector balance, geographic
distribution, task allocations, level of performance
– 积极：通过政府干预，塑造未来发展，如通过比率、数据、卫生设
施条件变化，公共/私有部门之间的平衡，地理分布、任务配置的调
整以及政府效能的提升等等
– But, governments are never entirely passive, or active
– 但是，政府不可能完全消极或者完全积极
 Level of ‘precision’ sought寻求‘精度’等级
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Models for health workforce planning and projections |
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Developing scenarios
 The requirements models develop alternative scenarios of a future
health care system 需求模型为未来医疗系统提供了其它可能性
– Scenarios are different visions of what might take place based on
specified assumptions Scenarios 是指根据特定假设对未来可能
发生的事情做出的种种展望
– Scenarios are never wrong — they say what would result if input
estimates are valid and assumptions come true. However... Scenarios
永远不会出错——有人说只要输入估计有效，假设能够实现
的话，就会发生的事情，然而……
•
•
•
•
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Base year data estimates may be wrong
基准年数据可能是错的
Planning assumptions may be unrealistic or impossible
规划假设可能是不现实的或不可能的
Models for health workforce planning and projections
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Developing scenarios (2)
 Scenario characteristics….情景特点
– Scenarios assist planning process by showing the potential
consequences of alternative assumptions about the future
– 该情景展现了未来的其它假设的结果，有助于计划过程发展。
– Scenarios do not predict the future 情景不能预测未来
– No scenario projection model can result in a human resources plan!没有
情景预测模式会产生人力资源计划
 A plan is the result of human choices regarding the future evolution
of the health system 计划是关于健康系统的未来发展的人
类选择结果
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Models for health workforce planning and projections
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Concluding remarks结语
 Projecting requirements is much more challenging, and controversial, than supply
预测要求比预测供给更加具有挑战性和争议性。
 Supply and requirements projections are two sides of a single coin, without the
other, is of little use 供应和要求预测相互依存，缺一不可
 Match method to country needs, characteristics, and data 将乡村需求、特点和
数据与方法进行比较
 Develop array of projection options using different plausible assumptions 使用不
同合理的假设，开发一系列预测选择。
 Involve stakeholders at appropriate points and seek consensus as to key
assumptions 股东需在适当时刻参与并对关键预测达成一致
 Plan long (10-30 years), act short (3-5 years), update often (every 3-4 years) 长期
规划（10-30年） 行动快速（3-5年） 频繁更新（每3-4年一次）
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Models for health workforce planning and projections
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