title: Contribution of health workforce to health outcomes: empirical evidence from Vietnam.
abstract: In Vietnam, a lower-middle income country, while the overall skill- and knowledge-based quality of health workforce is improving, health workers are disproportionately distributed across different economic regions. A similar trend appears to be in relation to health outcomes between those regions. It is unclear, however, whether there is any relationship between the distribution of health workers and the achievement of health outcomes in the context of Vietnam. This study examines the statistical relationship between the availability of health workers and health outcomes across the different economic regions in Vietnam.
  
  
  
  We constructed a panel data of six economic regions covering 8 years (2006-2013) and used principal components analysis regressions to estimate the impact of health workforce on health outcomes. The dependent variables representing the outcomes included life expectancy at birth, infant mortality, and under-five mortality rates. Besides the health workforce as our target explanatory variable, we also controlled for key demographic factors including regional income per capita, poverty rate, illiteracy rate, and population density.
  
  
  
  The numbers of doctors, nurses, midwives, and pharmacists have been rising in the country over the last decade. However, there are notable differences across the different categories. For example, while the numbers of nurses increased considerably between 2006 and 2013, the number of pharmacists slightly decreased between 2011 and 2013. We found statistically significant evidence of the impact of density of doctors, nurses, midwives, and pharmacists on improvement to life expectancy and reduction of infant and under-five mortality rates.
  
  
  
  Availability of different categories of health workforce can positively contribute to improvements in health outcomes and ultimately extend the life expectancy of populations. Therefore, increasing investment into more equitable distribution of four main categories of health workforce (doctors, nurses, midwives, and pharmacists) can be an important strategy for improving health outcomes in Vietnam and other similar contexts. Future interventions will also need to consider an integrated approach, building on the link between the health and the development.
authors.affiliation: Vietnam Ministry of Health, 138A Giang Vo street, Ba Dinh district, Hanoi, Vietnam. maipn@brandeis.edu.
authors.forename: Mai Phuong
authors.initials: MP
authors.lastname: Nguyen
authors.affiliation: Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, LS2 9LJ, United Kingdom.
authors.forename: Tolib
authors.initials: T
authors.lastname: Mirzoev
authors.affiliation: Hanoi University of Public Health, 1A Duc Thang, Duc Thang ward, Bac Tu Liem district, Hanoi, Vietnam.
authors.forename: Thi Minh
authors.initials: TM
authors.lastname: Le
mesh_terms: D002648:Child; D046688:Child Mortality; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D008017:Life Expectancy; D009721:Nurse Midwives / Q000600:supply & distribution; D009726:Nurses / Q000600:supply & distribution*; D010595:Pharmacists / Q000600:supply & distribution*; D010820:Physicians / Q000600:supply & distribution*; D025341:Principal Component Analysis; D011787:Quality of Health Care; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D014744:Vietnam / Q000453:epidemiology
keywords: Asia; Health outcomes; Health workforce; Human resources for health; Infant mortality; Life expectancy; Under-five mortality; Vietnam