Maternal and child health workforce profile and density in China since 1949: a systematic review

Background

Routine sources of information on the maternal and child health workforce in China are without clear definition and categorisation. The aim of the study was to systematically review all the evidence on China's maternal and child health workforce profile (ie, level of education, training, qualification, and professional title), and determine the density of the maternal and child health workforce.

Methods

We did a systematic review by searching six English (Embase, MEDLINE, CENTRAL, EconLit, Global Health, and Web of Science) and two Chinese (Wanfang and China National Knowledge Infrastructure) databases, from 1949 onwards, using a combination of the search terms “human resources for health”, “maternal and child health services”, and “China” with both thesaurus and free text words. We included studies either describing the profile of the maternal and child health workforce or providing data allowing us to calculate the density of the maternal and child health workforce.

Findings

We included 58 studies: 43 reporting profiles of the maternal and child health workforce, and 19 reporting density of the maternal and child health workforce, four of which covered both. 51 (88%) of the 58 studies were done after 1990. The maternal and child health workforce in China covers an array of professions, including obstetricians, gynaecologists, neonatologists, paediatricians, nurses, midwives, general physicians, specialised public health workers, vaccinators, barefoot doctors (ie, farmers who go through short-term medical training), and traditional birth attendants. Definitions of who qualifies as a maternal and child health provider are not clear (eg, the term midwife was used in six studies, and covered a range of training, including clinical medicine, maternal and child health care, nursing, and midwifery). Two studies reported that 7% (24 of 321) and 48% (650 of 1364), respectively, of the maternal and child health workforce at county-level facilities or below held no certificate for maternal and child health care. Only one study reported the density of the maternal and child health workforce at a national level, which was 0·6 health professionals per 1000 population in 2011. The density of the maternal health workforce was between 1·6 and 6·5 times higher than the child health workforce in the same population. The ratio of obstetric nurses to obstetricians ranged from 1·3:1 to 2·0:1, which was higher than the overall nurse-to-doctor ratio at a national level of 1·1:1 in 2017. The ratio of paediatric nurses to paediatricians ranged from 1·1:1 to 1·7:1, which was higher than the national ratio of 1·1:1.

Interpretation

The density of the maternal and child health workforce in China is lower than the minimum desired level of 2·3 health professionals (physicians, nurses, and midwives) per 1000 population, as recommended in the World Health Report 2006. The maternal and child health workforce in China is characterised by varied personnel with diverse training backgrounds, a larger maternal health workforce than child health workforce, and more nurses than doctors. A strength of the study is the conceptual understanding of the maternal and child health workforce over the entire period of contemporary China. A limitation of the study is that various data sources prevented us from synthesising the available evidence together.

Funding

China Medical Board.