Trends and inequalities of Human Resources for Health across 15 states/territories in Malaysia during 2010–2022

Abstract

Background: The density and distribution of Human Resources for Health (HRH) are critical to achieving universal health coverage. We aimed to study temporal trends in HRH density and state-wise inequalities in Malaysia, 2010–2022. Methods: We obtained state-wise data on HRH (doctors, dentists, pharmacists, nurses, and assistant medical officers) from the Ministry of Health (MOH), and estimates of mid-year population, the human development index (HDI), and Gross National Income (GNI) from the Department of Statistics Malaysia. We estimated trends in HRH density per 10,000 population. Inequalities in HRH density were measured using absolute and relative gaps, and slope index inequality (SII) and concentration index (CI) across the states are ranked high, middle, and low. For geographic inequalities, we estimated absolute and relative dissimilarity indices and the Theil index. Results: HRH density increased from 43.77 to 77.65 at an annual rate of change (ARC) of 4.89%. In absolute terms (SII), HRH density in states ranked by HDI and GNI was higher for doctors (9.77) and nurses (7.44), and in relative terms (CI), however, pharmacists (9.62), doctors (8.48), and dentists (6.30) had higher inequalities between the states, indicating higher concentration in higher-ranked states. To attain distributive equality across the states, about 13% of current doctors, nurses, and dentists, and 11% of pharmacists need to be redistributed. Conclusion: HRH numbers and density increased across the states. Inequalities analyses showed that HRH are concentrated in higher-ranked states. Our report provides leads and directions for policymakers to achieve an equitable distribution of HRH, essential for achieving Universal Health Coverage.