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My hospital is staffed on average 5/5 doctors (people with university education) and on most days, there is 2+ doctors treating 1 patient.
I agree there must be something dragging me down. None of my other republics have had this problem. Though they were on easy/normal/custom difficulty. That is the only thing that I can think of that matters. Some of my republics, their birth rate was positive even without a hospital.
How is the life expectancy of your people?
Life expectancy varies between 60 years and 70 years, depending on day.
For testing purposes, I started a new republic, but this time I made the Coal Plant run with as minimal production as possible as far away from apartments as possible. It fixed deaths/births rate very well, 80 births for 20 deaths now.
Lesson for everyone with the same problem!
I had already spent most of my money building all sorts of things, making a new power plant would not have been financially possible.
New city has power plant further away from people, lifespan is very well above 75, sometimes close to 80.
I tried the bus thing once, but it didn't seem to work out so well, bus stop was next to houses, another bus stop was next to power plant, but nobody never went there. Was just an empty bus driving between the stops.
Do you know if planting lots of trees has an effect on reducing pollution? And if having a school/grocery store in the polluted zone, where people to daily, have an effect?