09363nas a2202353 4500000000100000008004100001260001600042653002100058100001700079700001500096700001300111700001200124700001500136700001200151700001200163700001500175700001600190700001500206700001400221700001400235700001300249700001100262700001400273700002300287700001400310700001900324700001300343700001400356700001300370700001600383700001400399700001200413700001500425700001300440700002100453700001800474700001300492700001400505700001400519700001500533700001300548700001300561700001300574700001300587700001200600700001200612700001500624700002100639700001600660700001500676700001300691700001400704700001400718700001000732700001000742700001400752700001400766700001400780700001400794700001400808700001300822700001500835700001700850700001000867700001300877700001700890700002000907700001700927700001600944700001400960700001300974700001600987700001501003700001501018700001401033700001101047700001401058700001901072700001701091700001601108700001501124700001301139700001501152700001301167700001201180700001601192700001101208700001401219700001401233700001301247700001201260700001401272700001301286700001601299700001801315700001501333700001401348700001401362700001201376700001301388700001401401700001301415700001301428700001101441700001401452700001401466700001701480700001101497700001201508700001501520700001501535700001501550700001001565700001501575700001301590700001301603700001701616700001801633700001601651700001101667700001301678700001901691700001501710700001501725700001401740700001601754700001401770700001601784700001201800700001301812700001601825700001401841700001401855700001701869700002501886700001601911700001701927700001501944700001501959700001501974700001301989700001202002700001402014700001502028700001302043700001302056700002202069700001302091700001202104700001202116700001402128700001602142700001602158700001302174700001502187700001402202700001302216700001102229700001202240700001502252700002502267700001902292700001302311700002102324700001902345700001402364700001302378700001402391700001202405700001302417700001402430700001202444700002102456700001202477700001902489700001402508700001402522700001702536700002502553700001402578700001002592700001602602700001502618700001402633700000902647700001202656700001302668700001302681700001202694700001402706700001302720700001102733700001502744700001302759245023002772856007503002520391803077022001406995 2022 d bElsevier BV10aGeneral Medicine1 aHaakenstad A1 aIrvine CMS1 aKnight M1 aBintz C1 aAravkin AY1 aZheng P1 aGupta V1 aAbrigo MRM1 aAbushouk AI1 aAdebayo OM1 aAgarwal G1 aAlahdab F1 aAl-Aly Z1 aAlam K1 aAlanzi TM1 aAlcalde-Rabanal JE1 aAlipour V1 aAlvis-Guzman N1 aAmit AML1 aAndrei CL1 aAndrei T1 aAntonio CAT1 aArabloo J1 aAremu O1 aAyanore MA1 aBanach M1 aBärnighausen TW1 aBarthelemy CM1 aBayati M1 aBenzian H1 aBerman AE1 aBienhoff K1 aBijani A1 aBikbov B1 aBiondi A1 aBoloor A1 aBusse R1 aButt ZA1 aCámera LA1 aCampos-Nonato IR1 aCárdenas R1 aCarvalho F1 aChansa C1 aChattu SK1 aChattu VK1 aChu D1 aDai X1 aDandona L1 aDandona R1 aDangel WJ1 aDaryani A1 aDe Neve J1 aDhimal M1 aDipeolu IO1 aDjalalinia S1 aDo HT1 aDoshi CP1 aDoshmangir L1 aEhsani-Chimeh E1 aEl Tantawi M1 aFernandes E1 aFischer F1 aFoigt NA1 aFomenkov AA1 aForoutan M1 aFukumoto T1 aFullman N1 aGad MM1 aGhadiri K1 aGhafourifard M1 aGhashghaee A1 aGlucksman T1 aGoudarzi H1 aGupta RD1 aHamadeh RR1 aHamidi S1 aHaro JM1 aHasanpoor E1 aHay SI1 aHegazy MI1 aHeibati B1 aHenry NJ1 aHole MK1 aHossain N1 aHouseh M1 aIlesanmi OS1 aImani-Nasab M1 aIrvani SSN1 aIslam SMS1 aJahani MA1 aJoshi A1 aKalhor R1 aKayode GA1 aKhalid N1 aKhatab K1 aKisa A1 aKochhar S1 aKrishan K1 aKuate Defo B1 aLal DK1 aLami FH1 aLarsson AO1 aLeasher JL1 aLeGrand KE1 aLim L1 aMahotra NB1 aMajeed A1 aMaleki A1 aManjunatha N1 aMassenburg BB1 aMestrovic T1 aMini G1 aMirica A1 aMirrakhimov EM1 aMohammad Y1 aMohammed S1 aMokdad AH1 aMorrison SD1 aNaghavi M1 aNdwandwe DE1 aNegoi I1 aNegoi RI1 aNgunjiri JW1 aNguyen CT1 aNigatu YT1 aOnwujekwe OE1 aOrtega-Altamirano DV1 aOtstavnov N1 aOtstavnov SS1 aOwolabi MO1 aPakhare AP1 aPepito VCF1 aPerico N1 aPham HQ1 aPigott DM1 aPokhrel KN1 aRabiee M1 aRabiee N1 aRahimi-Movaghar V1 aRawaf DL1 aRawaf S1 aRawal L1 aRemuzzi G1 aRenzaho AMN1 aResnikoff S1 aRezaei N1 aRezapour A1 aRickard J1 aRoever L1 aSahu M1 aSamy AM1 aSanabria J1 aSantric-Milicevic MM1 aSaraswathy SYI1 aSeedat S1 aSenthilkumaran S1 aServán-Mori E1 aShaikh MA1 aSheikh A1 aSilva DAS1 aStein C1 aStein DJ1 aTitova MV1 aTopp SM1 aTovani-Palone MR1 aUllah S1 aUnnikrishnan B1 aVacante M1 aValdez PR1 aVasankari TJ1 aVenketasubramanian N1 aVlassov V1 aVos T1 aYearwood JA1 aYonemoto N1 aYounis MZ1 aYu C1 aZadey S1 aZaman SB1 aZerfu TA1 aZhang Z1 aZiapour A1 aZodpey S1 aLim SS1 aMurray CJL1 aLozano R00aMeasuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019 uhttps://www.thelancet.com/action/showPdf?pii=S0140-6736%2822%2900532-33 a

 

Background

Human resources for health (HRH) include a range of occupations that aim to promote or improve human health. The UN Sustainable Development Goals (SDGs) and the WHO Health Workforce 2030 strategy have drawn attention to the importance of HRH for achieving policy priorities such as universal health coverage (UHC). Although previous research has found substantial global disparities in HRH, the absence of comparable cross-national estimates of existing workforces has hindered efforts to quantify workforce requirements to meet health system goals. We aimed to use comparable and standardised data sources to estimate HRH densities globally, and to examine the relationship between a subset of HRH cadres and UHC effective coverage performance.

Methods

Through the International Labour Organization and Global Health Data Exchange databases, we identified 1404 country-years of data from labour force surveys and 69 country-years of census data, with detailed microdata on health-related employment. From the WHO National Health Workforce Accounts, we identified 2950 country-years of data. We mapped data from all occupational coding systems to the International Standard Classification of Occupations 1988 (ISCO-88), allowing for standardised estimation of densities for 16 categories of health workers across the full time series. Using data from 1990 to 2019 for 196 of 204 countries and territories, covering seven Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) super-regions and 21 regions, we applied spatiotemporal Gaussian process regression (ST-GPR) to model HRH densities from 1990 to 2019 for all countries and territories. We used stochastic frontier meta-regression to model the relationship between the UHC effective coverage index and densities for the four categories of health workers enumerated in SDG indicator 3.c.1 pertaining to HRH: physicians, nurses and midwives, dentistry personnel, and pharmaceutical personnel. We identified minimum workforce density thresholds required to meet a specified target of 80 out of 100 on the UHC effective coverage index, and quantified national shortages with respect to those minimum thresholds.

Findings

We estimated that, in 2019, the world had 104·0 million (95% uncertainty interval 83·5–128·0) health workers, including 12·8 million (9·7–16·6) physicians, 29·8 million (23·3–37·7) nurses and midwives, 4·6 million (3·6–6·0) dentistry personnel, and 5·2 million (4·0–6·7) pharmaceutical personnel. We calculated a global physician density of 16·7 (12·6–21·6) per 10 000 population, and a nurse and midwife density of 38·6 (30·1–48·8) per 10 000 population. We found the GBD super-regions of sub-Saharan Africa, south Asia, and north Africa and the Middle East had the lowest HRH densities. To reach 80 out of 100 on the UHC effective coverage index, we estimated that, per 10 000 population, at least 20·7 physicians, 70·6 nurses and midwives, 8·2 dentistry personnel, and 9·4 pharmaceutical personnel would be needed. In total, the 2019 national health workforces fell short of these minimum thresholds by 6·4 million physicians, 30·6 million nurses and midwives, 3·3 million dentistry personnel, and 2·9 million pharmaceutical personnel.

Interpretation

Considerable expansion of the world's health workforce is needed to achieve high levels of UHC effective coverage. The largest shortages are in low-income settings, highlighting the need for increased financing and coordination to train, employ, and retain human resources in the health sector. Actual HRH shortages might be larger than estimated because minimum thresholds for each cadre of health workers are benchmarked on health systems that most efficiently translate human resources into UHC attainment.

 a0140-6736