Can poverty reduction investments translate into more healthcare workers?

Abstract

Background: New targets for global development emphasize poverty reduction with some perceiving these priorities as de-emphasizing healthcare investments even though health and poverty are inextricably linked. This study sought to examine the relationships between key country development indicators and physician and nurse-topopulation ratios in order to explore the potential impact poverty reduction investments could have on human resources for health production. Methods: Publicly available data from international databases that collect human resources for health, political system, economic, and population demographic data comprised the data for the 184 countries included in this cross-national comparative observational study. Selected variables have known influences on healthcare systems indicators. Data were from the most recent year available. Relationships between key variables were examined using descriptive and multiple regression techniques. Missing data were imputed using the ICE technique in STATA. Analyses were also replicated in R for added rigor. IRB approval for this study was obtained through New York University. Findings: Average education levels of the population were strongly and significantly correlated with the nurse/midwife (r = .60, p=0.000) and physician (r = .72, p=0.000) to population ratios. In regression models, average years of school in a country's population, emigration rates, beds per 1,000 population, and low income country statuses were consistently statistically significant predictor variables. Regression models found that the combination of variables explained 63% of the nurse/midwife-to-population ratio (pseudo R2=.627, p = .0000) and 73% of the physician-to-population ratio (pseudo R2 = .729, p = .0000). Interpretation: Poverty reduction priorities in the next decade appear to have the potential to indirectly facilitate the production of human resources for health. The education variable in the model and its consistent significance is the best illustrator of the potential long term effects of these investments. While the study was limited by the overall quality and availability of data, the stability of the model across various analytic strategies strengthens the rigor of the results. Thus, while poverty reduction initiatives may help future generations and long term economic development, policies and investments also need to strengthen present day production systems that support the operations of health systems vital to combating health conditions related to poverty.