From the absolute number point of view, compared to the China, Eastern China, Mid-China and Western China regions, the AAGR of beds and doctors per 1,000 rural population was the highest. Furthermore, from 2016 to 2019, the number of health resources per 1,000 rural population in Guangxi is higher than that of China, Eastern China, Mid-China and Western China regions. Illustrating that the health service capacity in rural Guangxi has been improved from 2016 to 2019. However, the ratio of doctors and nurses in rural Guangxi was decreased from 0.91 in 2016 to 0.82 in 2019. This may be partially due to the fact that China has attaches great importance to the training of doctors, while neglecting the nurses . Furthermore, from 2016 to 2019, the primary health investment in Guangxi was mainly used for the infrastructure construction of primary medical institutions, while ignoring the introduction and training of health workers in rural health centers to some extent, which was consistent with the findings of other study . In terms of the structure of health workers in rural Guangxi, the proportion of Junior college degree (44.72%) was the largest, while the Postgraduate degree was the least (0.06%). Furthermore, the proportion of No titles/unknown was the largest (40.87%), while the proportion of High professional title was the least (0.04%). In rural areas in China, health workers are badly qualified, due to the lack of the training opportunities, which was consistent with the findings of Zhu and Xiao .
Studies in China also found that the quality health resources tend to be concentrated in the general hospitals [28, 29]. On account of the "Siphon effect", the majority of the health resources are concentrated in Nanning, the most developed city in Guangxi, while the underdeveloped rural areas are lack of health resources, this observation was in line with other studies [8, 19, 30]. Low wages and restricted career development have often been blamed for the loss of health workers in rural health centers . Meanwhile, general hospitals developed far more rapidly than rural health centers . It may impose a risk of further enlarging the health service capacity gap between developed areas and remote poor regions, which is against the governmental effort to strengthen primary health service capacity in the new health reform. Although the government has invested heavily in PHC, the health service capacity of rural health centers still lags behind the hospital sector .
From 2016 to 2019, G of population size (0.068–0.217) was lower than that of geographic size (0.080–0.367). Moreover, the trends of Theil index and Gini coefficient were similar from 2016 to 2019. The Chinese government were based on the number of population to allocating health resource, while ignoring the different geographical factors of each region . Correspondingly, the fairness of health resource allocation by population size was much better than geographic size, which was consistent with the findings of other researches [33, 34]. By GDP and geographical size, the contribution rate were: Tbetween>Twithin. It suggests that the regional economic differences might be the main reason for the unfairness of health resources in rural Guangxi, which was in line with the other study .
Furthermore, Baise, Hechi, Chongzuo and Laibin are the cities inhabited by ethnic minorities in Guangxi, where the population of ethnic minorities accounts for more than 75% of the total . In 2019, the health resources per Km2 in the ethnic minorities region in Guangxi was higher than the average level of Guangxi. In recent years, the government has formulated documents and increased investment for PHC to promote the development of health services in ethnic minorities regions. Currently, the health workers working in rural health centers have several encouragements: short-term centralism training, more wages and welfare, and cash bonuses. Furthermore, "Internet + medical" model was implemented in remote poor ethnic regions to promote the sharing of health resources, and encouraged the hospitals in the developed cities in Guangxi such as Nanning and Liuzhou, to provide health support for poor and remote ethnic minority regions, including technological resources, health manpower and financing.
Based on our analysis, several policy implications to improve the overall equity of health resources allocation in rural Guangxi was as follows. First of all, the government guidance should be strengthened and increase the financial support to further reducing the gap between the urban and rural areas. Secondly, the geographic of health resource allocation in vast and sparsely populated areas need to be addressed. Moreover, the health institutions are supposed to introduce adequate health workers in remote and economically underdeveloped areas by giving extra subsidies and other preferential policies to ameliorate the inequity status. Last but not least, health workers determined the prosperity and decline of rural health centers to some extent. The salary and welfare of health workers in rural areas should be improved gradually. In order to reduce the inequity of health resources allocation in Guangxi, stakeholders, including policymakers, governments, health workers and patients, should strive to cooperate jointly in order to ameliorate the situation. In addition, investments for PHC needs to be increased significantly in underdeveloped regions.