Inequality in the distribution of ear, nose and throat specialists in 15 Latin American countries: an ecological study

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dc.contributor.authorBright, Tess
dc.contributor.authorMújica, .Oscar J.
dc.contributor.authorRamke, Jacqueline
dc.contributor.authorMoreno, Claudia M.
dc.contributor.authorDer, Carolina
dc.contributor.authorMelendez, Amarilis
dc.contributor.authorLara Ovares, Ericka
dc.contributor.authorSandoval Domingues, Edgar Ivan
dc.contributor.authorSantana Hernandez, Diego Jose
dc.contributor.authorChadha, Shelly
dc.contributor.authorSilva, Juan Carlos
dc.contributor.authorPeñaranda, Augusto
dc.date.accessioned2022-07-18T21:59:13Z
dc.date.available2022-07-18T21:59:13Z
dc.date.issued2019
dc.description.abstractObjective: To explore sociogeographical inequalities in the availability and distribution of ear, nose and throat specialists (ENTs) in 15 Latin American (LA) countries. Design: Ecological. Setting: Spanish and Portuguese-speaking countries of LA.The number of registered ENTs in 2017 was obtained from the National ENT Society in each country. Outcome measures: The ENT rate/million population was calculated at the national and subnational (eg, state) level. Three measures were calculated to assess subnational distributive inequality of ENTs: (1) absolute and (2) relative index of dissimilarity; and (3) concentration index (using the Human Development Index as the equity stratifier). Finally, the ratio of ENTs/million population in the capital area compared with the rest of the country was calculated. Results: There was more than a 30-fold difference in the number of ENTs/million population across the included countries-from 61.0 in Argentina (95% CI 58.7 to 63.4) to 2.8 in Guatemala (95% CI 2.1 to 3.8). In all countries, ENTs were more prevalent in advantaged areas and in capital areas. To attain distributive equality, Paraguay would need to redistribute the greatest proportion of its ENT workforce (67.3%; 95% CI 57.8% to 75.6%) and Brazil the least (18.5%; 95% CI 17.6% to 19.5%). Conclusions: There is high inequality in the number and distribution of ENTs between and within the 15 studied countries in LA. This evidence can be used to inform policies that improve access to ear and hearing services in the region, such as scale-up of training of ENTs and incentives to distribute specialists equally. These actions to reduce inequities, alongside addressing the social determinants of ear and hearing health, are essential to realise Universal Health Coverage.es
dc.description.versionVersión Publicadaes
dc.identifier.citationBright T, Mújica OJ, Ramke J, et al. Inequality in the distribution of ear, nose and throat specialists in 15 Latin American countries: an ecological study. BMJ Open 2019;9:e030220. doi:10.1136/ bmjopen-2019-030220es
dc.identifier.urihttp://doi.org/10.1136/bmjopen-2019-030220es
dc.identifier.urihttp://hdl.handle.net/11447/6374
dc.language.isoenes
dc.subjectHealth equityes
dc.subjectHealth policyes
dc.subjectOrganisation of health serviceses
dc.subjectOtolaryngologyes
dc.titleInequality in the distribution of ear, nose and throat specialists in 15 Latin American countries: an ecological studyes
dc.typeArticlees
dcterms.sourceBMJ Openes

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