1. 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.

2. Outline Introduction Subjects and Methods Results and Discussions Conclusions Recommendations

3. The first decade of the 21 st century is considered to be the era of health workforce. The first decade of the 21 st 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. Many countries face workforce imbalances. The problems are rooted in political, economic, cultural, and health systems. Introduction

4. After 2003, Erbil governorate faced tremendous health demand, due to rapid socio-demographic changes. 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. 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.

5. 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.

6. 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.

7. Subjects and Methods A cross-sectional study was done from 1 st Sep., 2008 to 31 st March, 2010 ( Data collection from the period 1 st Feb., to 30 th Sep., 2009. A cross-sectional study was done from 1 st Sep., 2008 to 31 st March, 2010 ( Data collection from the period 1 st Feb., to 30 th Sep., 2009. The sample included 962 doctors from: The sample included 962 doctors from: DOH-Erbil health facilities and HMU affiliated to DOH-Erbil. DOH-Erbil health facilities and HMU affiliated to DOH-Erbil.

8. Exclusion criteria: Exclusion criteria: 1.Doctors not affiliated from HMU to DOH- Erbil. 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.

9. Mergasor 62,139 PHC=5, H=1 Soran 232,938 PHC=7, H=3 Shaqlawa 147,682 PHC=7, H=3 Choman 35,922 PHC=2, H=1 DashtiHawler 128,287 Nawandi Hawler 1,192,459 PHC=21,H=8, SMC=7 Khabat 63,566 PHC=20 Koisnjaq 112,864

10. Results & Discussion

11. Distribution of doctors by gender Male: female ratio is 1.59:1 Male: female ratio is 1.59:1

12. Distribution of doctors by age Mean age ± SD is 35.10 ± 9.79 y ranging from 23 – 68 y Mean age ± SD is 35.10 ± 9.79 y ranging from 23 – 68 y

13. Distribution of doctors by marital status and geographical distribution In: Single= 80.2%, Married = 85.4%, T = 83.6%, P = 0.001 In: Single= 80.2%, Married = 85.4%, T = 83.6%, P = 0.001

14. Distribution of doctors by No. of children P = 0.001 P = 0.001

15. Distribution of doctors by type of health facility Distribution of doctors by type of health facility

16. Distribution of doctors by hospital per district

18. Relationship between workplace and birthplace

19. Born in the same district Total No.District %No. 51.2412804Nawandi Hawler 0.0016Choman 4.5122Mergasor 2.2145Shaqlawa 0.0030Dashti Hawler 0.0010Khabat 2.9135Soran 43.1415962Total

20. Distribution of doctors by job title

21. Distribution of doctors by type of health facility

22. Distribution of doctors according to job title and employer

23. Distribution of specialists by gender & specialty

24. Distribution of doctors by job titles for those working for private clinic and / or hospitals Type of private work (%) TotalBothHospitalClinicJob title 83.838.53.358.2Specialist 1.60.020.080.0General practitioner 12.412.52.5085.0Specialty practitioner 2.20.057.142.9Rural practitioner 10033.84.761.5Total

25. Factors influence employment process in rural areas Total Doctors willing to stay in current workplace Variable % NoYes % Marital status (P < 0.001) 64.115.684.4 Married 35.947.552.5 Single Opportunities to select workplace (P < 0.001) 63.69.890.2 Yes 36.457.142.9 No

26. Total Doctors willing to stay in current workplace Variable % NoYes % Working for private sector (P < 0.001) 52.76.893.2 Yes 47.332.267.8 No Place of better financial income for those working in private sector (P < 0.001) 94.44.995.1 Inside Erbil city 5.638.961.1 Outside Erbil city

27. Density of doctors per 10,000 populations

29. Doctors satisfaction with the current health system by socio-demographic characteristics and other variables

30. Doctor satisfied with the current health system %Variable Gender 56.7 Male 61.2 Female Age 56.0 < 30 61.8 30 -39 56.5 40 - 49 64.1 50 - 59 48.0 ≥ 60

31. Marital status 55.9 Single 59.8 Married Job title 53.7 House officer 58.9 Rural practitioner 62.5 General practitioner 59.6 Senior house officer 59.3 Specialty practitioner 59.6 Specialist

32. Workplace 59.6 Inside Erbil city 52.5 Outside Erbil city 58.4Total

33. Conclusions 1)Numerical imbalance : below the regional and international average. 2)Urban- rural imbalance: geographic maldistribution of specialists. 3)Institutional imbalance: hospitals versus PHCs.

34. 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. General surgery, internal medicine, pediatrics, obstetrics.Female: Obstetrics, radiology, pediatrics, dermatology. Obstetrics, radiology, pediatrics, dermatology.

35. 7)Most influential factors to determine the workplace and satisfaction are: Having private practice. Having private practice. Opportunity to choose workplace. Opportunity to choose workplace. 8) More than half of the doctors are satisfied with their work.

36. 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.

37. 3)Strengthening liaison between DOH and HMU through emphasis on primary health care and family medicine: ٍٍPostgraduate study. ٍٍPostgraduate study. Adopt family health care system. Adopt family health care system. 4)Emphasis on appointment of properly trained health managers: regular supervision of health facilities.

38. 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.

39. THANK YOU