ORIGINAL ARTICLE
Y Zhang Z Lu R Cheng L liu
Authors’ affiliations: Y Zhang, Z Lu, R Cheng, L liu, The school of stomatology, China Medical University, Shenyang City, Liaoning Province, China Correspondence to: Y. Zhang Department of Preventive Dentistry, School of Stomatology, China Medical University No. 117, Nanjing North Street Heping District Shenyang City Liaoning Province China Tel.: +86 2012225015 Fax.: +86 24 22892450 E-mail: [email protected]
Current state of allocation of oral health human resources in northern China and future needs Abstract: Objective: The aim of the present investigation was to describe the distribution, structure and allocation of oral health services personnel, evaluate oral health service capacity and predict the needs for oral health services in northern China over the coming 10 years. Methods: The questionnaires were sent to all the dental medical institutions included in this study directly from the Sanitation Bureau and the Health Supervision Station. All the institutions and dental personnel were asked to fill out the questionnaires, and then, the questionnaires were collected through postal service and email. Results: In Liaoning Province, which is in northern China, there are a total of 5617 dentists in total, 87.8% of whom are located in urban areas. Dentists in rural areas were found to be less educated and specialized. The ratio of dentists to nurses to technicians was about 6:2:1, and the ratio of dentists to total population was 1:7682. It was predicted that, in 2020, the number of dentists could reach 13 207. This would meet the area’s needs for oral health services. Conclusion: Currently, in northern China, the oral health infrastructure suffers from an insufficient number of dental professionals, disproportionate distribution and inappropriate structure. To improve social equity, it is necessary to adjust the distribution of dental personnel capable of performing for oral health services. Key words: dentist; human resource; oral health; prediction
Introduction
Dates: Accepted 4 December 2014 To cite this article: Int J Dent Hygiene 13, 2015; 268–272 DOI: 10.1111/idh.12126 Zhang Y, Lu Z, Cheng R, Liu L. Current state of allocation of oral health human resources in northern China and future needs © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
268
| Int J Dent Hygiene 13, 2015; 268--272
Oral disease is a major public health problem. It is highly prevalent, especially in developing countries. As of China’s third national oral health survey: the prevalence of caries in 5 year old was 66%, and about 97% of these were left untreated (1), For adults aged 35–44 and 65–74, the prevalence of caries was 61% and 75%, and about 79% and 92% of carious teeth were left untreated. With China’s recent economic development, the need for proper dental services has increased quickly. However, the difficulty of visiting dentists and paying for medication without insurance has remained a serious problem limiting many people’s ability to access dental service. In 1986, a survey was conducted on all dentists in north China (2). Results showed that all 697 dentists worked at public medical institutions, and the ratio of dentist to population was 1:51 248. This made it highly impractical to deliver the oral health services to communities. Liaoning Province, which is in northern China, has a population of 43.15 million (Fig. 1). It has 14 cities, both urban and rural area, and its gross domestic product (GDP) in 2010 was 11th among China’s 30
Zhang et al. Dental workforce in China
Fig. 1. The geographic location of Liaoning Province in China.
provinces. Its prevalence of oral disease is close to China’s mean level (3). In recent years, as standards of living have increased, the number of dentists and of oral health education institutions has grown rapidly. However, the shortage of dental workforce and its inequitable distribution still threaten the resident’s oral health in China. The aim of this investigation was to provide the information on the dental workforce and its inequities distribution between the urban and rural area in Liaoning Province, to evaluate the oral health service capacity and to predict needs for oral health services over the coming 10 years (2020).
Ethical considerations
To protect the rights of participants, the questionnaires were completed anonymously. All the personal and institutional data indicate status as of 30 December 2009.
Data analysis
To predict the need for dental personnel over the next 10 years, each professional’s number of years of work experience of dentists and the ratio of the number of dental professionals to total population were recorded.
Study population and methodology Study population
Prediction based on working time of dentists
Data were collected on all dental facilities registered in Liaoning Province. Public dental facilities and their dental personnel were obtained from the Sanitation Bureau of 14 cities (including surrounding rural areas). Non-public dental facilities and data related to their dental personnel came from the Health Supervision Stations of 14 cities.
The formula used to calculate this was as follow (4): M = P 9 I9 N 9 T/S (M is the number of dentists needed; P is the size of the population during the target year; I is the number of cases of oral disease per person per year; N is the average number of clinic visit per person per year; T is the average duration of each service; S is the total amount of time worked by each dentist per year).
Investigation methods
The questionnaires were sent directly to all dental facilities from the Sanitation Bureau and the Health Supervision Station. All dental professionals were asked to fill in a questionnaire regarding data such as their gender, age, professional title, education, work experience. For dental facilities, the contents included classification of institutions, number of dentists, nurses and technicians.
Prediction based on ratio of number of dental professionals to population
The formula used to calculate predicted manpower based on ratio of manpower in oral health to population was as follows (5): Future need for manpower in oral health = Population in the target year 9 ratio of the size of the oral health workforce to population. Int J Dent Hygiene 13, 2015; 268--272 |
269
Zhang et al. Dental workforce in China
The SPSS (SPSS Inc, Chicago, IL, USA)13.0 software package was used for data analysis. The v2 test was performed for group comparison of dental facilities and allocation of personnel. Values of P < 0.05 were considered indicative of statistical significance.
Prediction of the need for dental personnel over the next 10 years Assessment based on needs for dental service
The number of clinical dentists needed was estimated using residential needs for dental services.
Results The survey was conducted from January to October 2010. A total of 2395 questionnaires regarding dental facilities were distributed, and 2155 were collected, giving a response rate of 90%. All employees in the 2155 dental facilities filled out personal questionnaires, and 8611 personal questionnaires were collected. Data from the dental facilities and employee questionnaires were collected. Inconsistencies among the data were addressed through telephone interviews made to the institutions to verify that all information sent to us were accurate and credible.
Assessment based on amount of time worked by dentists
According to a prediction made by population experts, in 2020, the total population of Liaoning Province will be 43 million (4). Assuming that, on average, each person suffers from oral disease once and visits dental clinic once per year, with an average service time of 0.5 h, and each dentist works average of 2000 h per year (five work days per week, 8 h per work day), then M = 43 million 9 1 9 1 9 0.5/2000 = 10 750 dentists.
Conditions of oral health institutions and dental workforce Assessment based on ratio of dentists to population
In Liaoning Province, there were a total of 2155 dental facilities, 5617 dentists, 2038 nurses, 956 technicians. The ratio of dentists to nurses to technicians was about 6:2:1 (Table 1). As shown in Table 2, in urban areas 45.3% of dentists were senior or intermediate professionals. However, the number was only 20.6% in rural areas. In rural areas, 26.2% of dentists had no professional title which means they were operating illegally. With respect to level of education, in urban areas, 40.5% of dentists had bachelor’s degrees or higher, and in rural areas, 63.2% of dentists had only a secondary level of education. There were significant differences in the professional level and education of dentists in urban and rural areas (P < 0.001).
The total population in 2020 may reach 43 million (5). According to World Health Organization recommendations, the ratio of the number of dentists to total population in developing countries should be 1:4000. Using this formula, in 2020, Liaoning Province will need 10 750 dentists: (43 000 000 9 1/4000). Our survey showed a total of 5617 dentists in Liaoning Province. On average, each dentist provided service to 7682 residents. According to the predicted need for dentists, in 2020, the number of dentists in Liaoning Province will need to be doubled. Over the next 5 years, 3795 students will graduate from dental school and assuming posts. Based on current enrolment, in 10 years, there will be 3795 9 2 = 7580 newly graduated dentists in Liaoning Province. Including the existing 5617 dentists, there will be a total of 13 207 dentists. On average, each dentist will provide service to about 3256 people. This can well meet the needs for dental medical service adequately.
Ratio of dentists to population
The ratio of number of dentists to population was 1:7682. In urban areas, each dentist provided service to an average of 5254 people. In rural areas, each dentist provided service to an average of 25 190 people (Table 3).
Discussion Education
Oral diseases have become a major health threat to Chinese residents. The results of the present survey showed that as of the end of 2009, there were a total of 8611 dental personnel in Liaoning Province, including 5617 dentists, the ratio of dentists to population was 1:7682, far lower than 1:5000 as
In Liaoning Province, there were a total of five dental colleges and universities that recruited students for training future dentists. From 2005 to 2009, a total of 3795 students were recruited (Table 4).
Table 1. Oral health institutions and size of the dental workforce by urban and rural locations Oral health institutions
Dental human resources Dentists
Urban Rural Total
270
Nurses
Dental technicians
N
%
N
%
N
%
N
%
1734 421 2155
80.5 19.5 100
4933 684 5617
87.8 12.2 100
1967 71 2038
96.5 3.5 100
762 194 956
79.7 20.3 100
| Int J Dent Hygiene 13, 2015; 268--272
Zhang et al. Dental workforce in China
Table 2. Characteristics of dentists identified within the oral health institutions in Liaoning Province Dentists
Professional level Senior professional Intermediate professional Junior professional Dental assistant No professional title Education Master’s degree or above Bachelor’s degree College graduate High school graduate
Urban area, n (%)
Rural areas, n (%)
Total, n (%)
P-value
569 1669 1517 684 494
11.5 33.8 30.8 13.8 10.0
15 2.2 126 18.4 206 30.1 158 23.1 179 26.2
584 1795 1723 842 673
10.4 31.9 30.7 15.0 11.9
Y Zhang Z Lu R Cheng L liu
Authors’ affiliations: Y Zhang, Z Lu, R Cheng, L liu, The school of stomatology, China Medical University, Shenyang City, Liaoning Province, China Correspondence to: Y. Zhang Department of Preventive Dentistry, School of Stomatology, China Medical University No. 117, Nanjing North Street Heping District Shenyang City Liaoning Province China Tel.: +86 2012225015 Fax.: +86 24 22892450 E-mail: [email protected]
Current state of allocation of oral health human resources in northern China and future needs Abstract: Objective: The aim of the present investigation was to describe the distribution, structure and allocation of oral health services personnel, evaluate oral health service capacity and predict the needs for oral health services in northern China over the coming 10 years. Methods: The questionnaires were sent to all the dental medical institutions included in this study directly from the Sanitation Bureau and the Health Supervision Station. All the institutions and dental personnel were asked to fill out the questionnaires, and then, the questionnaires were collected through postal service and email. Results: In Liaoning Province, which is in northern China, there are a total of 5617 dentists in total, 87.8% of whom are located in urban areas. Dentists in rural areas were found to be less educated and specialized. The ratio of dentists to nurses to technicians was about 6:2:1, and the ratio of dentists to total population was 1:7682. It was predicted that, in 2020, the number of dentists could reach 13 207. This would meet the area’s needs for oral health services. Conclusion: Currently, in northern China, the oral health infrastructure suffers from an insufficient number of dental professionals, disproportionate distribution and inappropriate structure. To improve social equity, it is necessary to adjust the distribution of dental personnel capable of performing for oral health services. Key words: dentist; human resource; oral health; prediction
Introduction
Dates: Accepted 4 December 2014 To cite this article: Int J Dent Hygiene 13, 2015; 268–272 DOI: 10.1111/idh.12126 Zhang Y, Lu Z, Cheng R, Liu L. Current state of allocation of oral health human resources in northern China and future needs © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
268
| Int J Dent Hygiene 13, 2015; 268--272
Oral disease is a major public health problem. It is highly prevalent, especially in developing countries. As of China’s third national oral health survey: the prevalence of caries in 5 year old was 66%, and about 97% of these were left untreated (1), For adults aged 35–44 and 65–74, the prevalence of caries was 61% and 75%, and about 79% and 92% of carious teeth were left untreated. With China’s recent economic development, the need for proper dental services has increased quickly. However, the difficulty of visiting dentists and paying for medication without insurance has remained a serious problem limiting many people’s ability to access dental service. In 1986, a survey was conducted on all dentists in north China (2). Results showed that all 697 dentists worked at public medical institutions, and the ratio of dentist to population was 1:51 248. This made it highly impractical to deliver the oral health services to communities. Liaoning Province, which is in northern China, has a population of 43.15 million (Fig. 1). It has 14 cities, both urban and rural area, and its gross domestic product (GDP) in 2010 was 11th among China’s 30
Zhang et al. Dental workforce in China
Fig. 1. The geographic location of Liaoning Province in China.
provinces. Its prevalence of oral disease is close to China’s mean level (3). In recent years, as standards of living have increased, the number of dentists and of oral health education institutions has grown rapidly. However, the shortage of dental workforce and its inequitable distribution still threaten the resident’s oral health in China. The aim of this investigation was to provide the information on the dental workforce and its inequities distribution between the urban and rural area in Liaoning Province, to evaluate the oral health service capacity and to predict needs for oral health services over the coming 10 years (2020).
Ethical considerations
To protect the rights of participants, the questionnaires were completed anonymously. All the personal and institutional data indicate status as of 30 December 2009.
Data analysis
To predict the need for dental personnel over the next 10 years, each professional’s number of years of work experience of dentists and the ratio of the number of dental professionals to total population were recorded.
Study population and methodology Study population
Prediction based on working time of dentists
Data were collected on all dental facilities registered in Liaoning Province. Public dental facilities and their dental personnel were obtained from the Sanitation Bureau of 14 cities (including surrounding rural areas). Non-public dental facilities and data related to their dental personnel came from the Health Supervision Stations of 14 cities.
The formula used to calculate this was as follow (4): M = P 9 I9 N 9 T/S (M is the number of dentists needed; P is the size of the population during the target year; I is the number of cases of oral disease per person per year; N is the average number of clinic visit per person per year; T is the average duration of each service; S is the total amount of time worked by each dentist per year).
Investigation methods
The questionnaires were sent directly to all dental facilities from the Sanitation Bureau and the Health Supervision Station. All dental professionals were asked to fill in a questionnaire regarding data such as their gender, age, professional title, education, work experience. For dental facilities, the contents included classification of institutions, number of dentists, nurses and technicians.
Prediction based on ratio of number of dental professionals to population
The formula used to calculate predicted manpower based on ratio of manpower in oral health to population was as follows (5): Future need for manpower in oral health = Population in the target year 9 ratio of the size of the oral health workforce to population. Int J Dent Hygiene 13, 2015; 268--272 |
269
Zhang et al. Dental workforce in China
The SPSS (SPSS Inc, Chicago, IL, USA)13.0 software package was used for data analysis. The v2 test was performed for group comparison of dental facilities and allocation of personnel. Values of P < 0.05 were considered indicative of statistical significance.
Prediction of the need for dental personnel over the next 10 years Assessment based on needs for dental service
The number of clinical dentists needed was estimated using residential needs for dental services.
Results The survey was conducted from January to October 2010. A total of 2395 questionnaires regarding dental facilities were distributed, and 2155 were collected, giving a response rate of 90%. All employees in the 2155 dental facilities filled out personal questionnaires, and 8611 personal questionnaires were collected. Data from the dental facilities and employee questionnaires were collected. Inconsistencies among the data were addressed through telephone interviews made to the institutions to verify that all information sent to us were accurate and credible.
Assessment based on amount of time worked by dentists
According to a prediction made by population experts, in 2020, the total population of Liaoning Province will be 43 million (4). Assuming that, on average, each person suffers from oral disease once and visits dental clinic once per year, with an average service time of 0.5 h, and each dentist works average of 2000 h per year (five work days per week, 8 h per work day), then M = 43 million 9 1 9 1 9 0.5/2000 = 10 750 dentists.
Conditions of oral health institutions and dental workforce Assessment based on ratio of dentists to population
In Liaoning Province, there were a total of 2155 dental facilities, 5617 dentists, 2038 nurses, 956 technicians. The ratio of dentists to nurses to technicians was about 6:2:1 (Table 1). As shown in Table 2, in urban areas 45.3% of dentists were senior or intermediate professionals. However, the number was only 20.6% in rural areas. In rural areas, 26.2% of dentists had no professional title which means they were operating illegally. With respect to level of education, in urban areas, 40.5% of dentists had bachelor’s degrees or higher, and in rural areas, 63.2% of dentists had only a secondary level of education. There were significant differences in the professional level and education of dentists in urban and rural areas (P < 0.001).
The total population in 2020 may reach 43 million (5). According to World Health Organization recommendations, the ratio of the number of dentists to total population in developing countries should be 1:4000. Using this formula, in 2020, Liaoning Province will need 10 750 dentists: (43 000 000 9 1/4000). Our survey showed a total of 5617 dentists in Liaoning Province. On average, each dentist provided service to 7682 residents. According to the predicted need for dentists, in 2020, the number of dentists in Liaoning Province will need to be doubled. Over the next 5 years, 3795 students will graduate from dental school and assuming posts. Based on current enrolment, in 10 years, there will be 3795 9 2 = 7580 newly graduated dentists in Liaoning Province. Including the existing 5617 dentists, there will be a total of 13 207 dentists. On average, each dentist will provide service to about 3256 people. This can well meet the needs for dental medical service adequately.
Ratio of dentists to population
The ratio of number of dentists to population was 1:7682. In urban areas, each dentist provided service to an average of 5254 people. In rural areas, each dentist provided service to an average of 25 190 people (Table 3).
Discussion Education
Oral diseases have become a major health threat to Chinese residents. The results of the present survey showed that as of the end of 2009, there were a total of 8611 dental personnel in Liaoning Province, including 5617 dentists, the ratio of dentists to population was 1:7682, far lower than 1:5000 as
In Liaoning Province, there were a total of five dental colleges and universities that recruited students for training future dentists. From 2005 to 2009, a total of 3795 students were recruited (Table 4).
Table 1. Oral health institutions and size of the dental workforce by urban and rural locations Oral health institutions
Dental human resources Dentists
Urban Rural Total
270
Nurses
Dental technicians
N
%
N
%
N
%
N
%
1734 421 2155
80.5 19.5 100
4933 684 5617
87.8 12.2 100
1967 71 2038
96.5 3.5 100
762 194 956
79.7 20.3 100
| Int J Dent Hygiene 13, 2015; 268--272
Zhang et al. Dental workforce in China
Table 2. Characteristics of dentists identified within the oral health institutions in Liaoning Province Dentists
Professional level Senior professional Intermediate professional Junior professional Dental assistant No professional title Education Master’s degree or above Bachelor’s degree College graduate High school graduate
Urban area, n (%)
Rural areas, n (%)
Total, n (%)
P-value
569 1669 1517 684 494
11.5 33.8 30.8 13.8 10.0
15 2.2 126 18.4 206 30.1 158 23.1 179 26.2
584 1795 1723 842 673
10.4 31.9 30.7 15.0 11.9
