Researchers estimated the composition and density of 20 health worker cadres across 204 countries and territories from 1990 to 2023. The analysis included 1,816 country-years of population-based survey data, 82 country-years of census data, 3,888 country-years of administrative data, and 96 country-years of data from scientific literature. Occupations were harmonized using the International Standard Classification of Occupations 2008. The researchers used spatiotemporal Gaussian process regression to estimate workforce densities and sex shares across locations and years. 

They also used stochastic frontier meta-regression to estimate the minimum densities of physicians, nurses and midwives, dentists, and pharmacists associated with universal health coverage effective coverage index scores of at least 80. They estimated each cadre threshold separately and did not account for the skill mix required to attain universal health coverage.

An estimated 122 million health workers were active in health systems in 2023, including approximately 15 million physicians, 33 million nurses, 2 million midwives, and 8 million community health workers. Nurses represented 27% of the global workforce.

Women represented 69% of health workers in 2023 and accounted for 71% of net workforce growth from 1990 to 2023. Women comprised 44% of physicians, 81% of nurses, 96% of midwives, and 90% of community health workers.

“The global health workforce has expanded substantially since 1990, largely due to women entering the formal health workforce,” noted the Global Burden of Diseases, Injuries, and Risk Factors Study 2023 Human Resources for Health Collaborators.

Health worker densities differed substantially across regions. High-income countries had the highest densities overall, whereas sub-Saharan Africa had the lowest health worker densities across cadres except for community health workers. Using the modeled thresholds for a universal health coverage score of at least 80, the researchers estimated gaps of approximately 7 million physicians, 24 million nurses and midwives, 2 million dentists, and 2 million pharmacists globally.

The researchers cautioned that these thresholds represented minimum indicative levels rather than normative staffing targets and that the shortage estimates were aspirational and not additive. They noted that achieving all four thresholds simultaneously was neither necessary nor sufficient.

Study limitations included reliance on binary sex categorization as an approximation of gender, the concentration of available data in high-income countries and among physician and nursing cadres, variation in duties within health worker cadres globally, possible inclusion of volunteer community health workers in some tabulated sources, and potential disruption of health workforce data systems during the COVID-19 pandemic.

The Gates Foundation funded the study. Full disclosures can be found in the published study.

Source: The Lancet Public Health