Uses of population census data for monitoring geographical imbalance in the health workforce: snapshots from three developing countries

BACKGROUND: Imbalance in the distribution of human resources for health (HRH), eventually leading to inequities in health services delivery and population health outcomes, is an issue of social and political concern in many countries. However, the empirical evidence to support decision-making is often fragmented, and many standard data sources that can potentially produce statistics relevant to the issue remain underused, especially in developing countries. This study investigated the uses of demographic census data for monitoring geographical imbalance in the health workforce for three developing countries, as a basis for formulation of evidence-based health policy options. METHODS: Population-based indicators of geographical variations among HRH were extracted from census microdata samples for Kenya, Mexico and Viet Nam. Health workforce statistics were matched against international standards of occupational classification to control for cross-national comparability. Summary measures of inequality were calculated to monitor the distribution of health workers across spatial units and by occupational group. RESULTS: Strong inequalities were found in the geographical distribution of the health workforce in all three countries, with the highest densities of HRH tending to be found in the capital areas. Cross-national differences were found in the magnitude of distributional inequality according to occupational group, with health professionals most susceptible to inequitable distribution in Kenya and Viet Nam but less so in Mexico compared to their associate professional counterparts. Some discrepancies were suggested between mappings of occupational information from the raw data with the international system, especially for nursing and midwifery specializations. CONCLUSIONS: The problem of geographical imbalance among HRH across countries in the developing world holds important implications at the local, national and international levels, in terms of constraints for the effective deployment, management and retention of HRH, and ultimately for the equitable delivery of health services. A number of advantages were revealed of using census data in health research, notably the potential for producing detailed statistics on health workforce characteristics at the sub-national level. However, lack of consistency in the compilation and processing of occupational information over time and across countries continues to hamper comparative analyses for HRH policy monitoring and evaluation

The 'feminisation of poverty' in Costa Rica: to what extent a conundrum?

Quantitative data from Costa Rica suggest that poverty is 'feminising', especially in respect of female-headed households, who, since the early 1990s, have constituted a progressively greater share of the population classified as poor. This presents something of a conundrum given significant attempts on the part of the state to promote gender equality and to direct public expenditure to low-income women. Some light on this apparent paradox is shed by qualitative fieldwork undertaken in Guanacaste province where female headship seems to have become a more viable, and sometimes, preferred, option among women on account of its role in enhancing well-being. This is largely on account of social and legal changes that have contributed to making women less inclined to tolerate gender inequalities at the domestic level. The findings underline the importance of embracing gendered subjectivities in analyses of the 'feminisation of poverty' and invite caution about the latter being a unilaterally negative phenomenon

The 'feminisation of poverty' and the 'feminisation' of anti-poverty programmes: room for revision?

The construct of the 'feminisation of poverty' has helped to give gender an increasingly prominent place within international discourses on poverty and poverty reduction. Yet the way in which gender has been incorporated pragmatically�-�predominantly through the 'feminisation' of anti-poverty programmes�-�has rarely relieved women of the onus of coping with poverty in their households, and has sometimes exacerbated their burdens. In order to explore how and why this is the case, as well as to sharpen the methodological and conceptual parameters of the 'feminisation of poverty' thesis, this paper examines four main questions. First, what are the common understandings of the 'feminisation of poverty'? Second, what purposes have been served by the popularisation and adoption of this term? Third, what problems are there with the 'feminisation of poverty' analytically, and in respect of how the construct has been taken up and responded to in policy circles? Fourth, how do we make the 'feminisation of poverty' more relevant to women's lives�-�and empowerment�-�at the grassroots? Foremost among my conclusions is that since the main indications of feminisation relate to women's mounting responsibilities and obligations in household survival we need to re-orient the 'feminisation of poverty' thesis so that it better reflects inputs as well as incomes, and emphasises not only women's level or share of poverty but the burden of dealing with it. Another, related, conclusion is that just as much as women are often recruited into rank-and-file labour in anti-poverty programmes, 'co-responsibility' should not be a one-way process. This requires, inter alia, the more active support of men, employers and public institutions in domestic labour and unpaid care work.