Healthcare Workforce Trends in Changing Socioeconomic Context: Implications for Planning

Introduction: A key international issue in the health policy is the capability of the healthcare system to maintain and improve population health given the contextual challenges, including health workforce problems. Considering the possibility of the replication of strategically relevant contextual changes in transitional countries, it seemed important to ensure future health workforce planning is built on past successes and to avoid repeating mistakes. Objective: The study aimed at assessing the impact of key social and economic events on the development of the healthcare workforce by use of Joinpoint Regression Programme to analyse the main healthcare workforce (physicians and nurses) trends in Serbia between 1961 and 2007, and to yield recommendations for a more socially accountable approach to healthcare workforce planning. Methods: A literature search was done to identify the key social and economic changes in Serbia between 1961 and 2007. To capture the impact of key socioeconomic events on the development of healthcare workforce the joinpoint regression analyses was conducted to assess changes of healthcare workforce density rates per 100,000 of population (1961-2007) in the public sector. Estimates of jointpoint regression models included the annual per cent change and the average annual per cent change with the respective 95% confidence interval. Results: The joinpoint regression analysis demonstrated a significantly diverse trend over time in the ratio of general practitioners, medical specialists, and nurses to population (p<0.05). The average annual per cent change of specialist and nurse density was higher (4.6% and 3.6%, respectively), while the growth of general practitioner density was much more limited (1%). In Serbia, the main drivers for healthcare workforce policy changes include shifts from decentralisation to centralisation and private practice development, social and financial crises, and economic and constitutional reforms. The following policy implications were based on the evidence of some compatibility in the projections of observed density rates with links to socioeconomic events: a higher growth of workforce density rates occurred with decentralisation (general practitioner's by 33%, specialist's by 169% and nurse's by 221%), while a lower growth of workforce density rates was observed in centralisation and their decrease with a stronger financial control (general practitioner's by -6%, specialist's by 29% and nurse's by 24%). Conclusion: Making socially accountable policies in transitional countries requires capacity building for integrative workforce planning and management among health managers at all levels in the system. This study has highlighted several key lessons learned and policy implications, built on efforts, success and mistakes in health workforce policy making, local and global.