title: Health workforce equity in urban community health service of China.
abstract: OBJECTIVE
  To reveal the equity of health workforce distribution in urban community health service (CHS), and to provide evidence for further development of community health service in China.
  
  
  METHODS
  A community-based, cross-sectional study was conducted in China from September to December 2011. In the study, 190 CHS centers were selected from 10 provinces of China via stratified multistage cluster sampling. Human resources profiles and basic characteristics of each CHS centers were collected. Lorenz curves and Gini Coefficient were used to measure the inequality in the distribution of health workforce in community health service centers by population size and geographical area. Wilcoxon rank test for paired samples was used to analyze the differences in equity between different health indicators.
  
  
  RESULTS
  On average, there were 7.37 health workers, including 3.25 doctors and 2.32 nurses per 10,000 population ratio. Significant differences were found in all indicators across the samples, while Beijing, Shandong and Zhejiang ranked the highest among these provinces. The Gini coefficients for health workers, doctors and nurses per 10,000 population ratio were 0.39, 0.44, and 0.48, respectively. The equity of doctors per 10,000 population ratio (G = 0.39) was better than that of doctors per square kilometer (G = 0.44) (P = 0.005). Among the total 6,573 health workers, 1,755(26.7%) had undergraduate degree or above, 2,722(41.4%)had junior college degree and 215(3.3%) had high school education. Significant inequity was found in the distribution of workers with undergraduate degree or above (G = 0.52), which was worse than that of health works per 10000 population (P<0.001).
  
  
  CONCLUSIONS
  Health workforce inequity was found in this study, especially in quality and geographic distribution. These findings suggest a need for more innovative policies to improve health equity in Chinese urban CHS centers.
authors.affiliation: School of General Practice and Continuing Education, Capital Medical University, Beijing, 100069, P.R. China.
authors.forename: Rui
authors.initials: R
authors.lastname: Chen
authors.affiliation: School of General Practice and Continuing Education, Capital Medical University, Beijing, 100069, P.R. China.
authors.forename: Yali
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: School of General Practice and Continuing Education, Capital Medical University, Beijing, 100069, P.R. China.
authors.forename: Juan
authors.initials: J
authors.lastname: Du
authors.affiliation: Beijing An Zhen Hospital, Capital Medical University, Beijing, P. R. China.
authors.forename: Tao
authors.initials: T
authors.lastname: Wu
authors.affiliation: School of General Practice and Continuing Education, Capital Medical University, Beijing, 100069, P.R. China.
authors.forename: Yafang
authors.initials: Y
authors.lastname: Huang
authors.affiliation: School of General Practice and Continuing Education, Capital Medical University, Beijing, 100069, P.R. China.
authors.forename: Aimin
authors.initials: A
authors.lastname: Guo
mesh_terms: D002681:China; D003151:Community Health Centers; D003153:Community Health Services; D003430:Cross-Sectional Studies; D003627:Data Interpretation, Statistical; D005843:Geography; D006282:Health Personnel; D006301:Health Services Needs and Demand; D006280:Health Workforce / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006801:Humans; D011795:Surveys and Questionnaires; D019037:Urban Health Services