The global health workforce stock and distribution in 2020 and 2030: a threat to equity and 'universal' health coverage?

OBJECTIVE: The 2016 Global Strategy on Human Resources for Health: Workforce 2030 projected a global shortage of 18 million health workers by 2030. This article provides an assessment of the health workforce stock in 2020 and presents a revised estimate of the projected shortage by 2030. METHODS: Latest data reported through WHO's National Health Workforce Accounts (NHWA) were extracted to assess health workforce stock for 2020. Using a stock and flow model, projections were computed for the year 2030. The global health workforce shortage estimation was revised. RESULTS: In 2020, the global workforce stock was 29.1 million nurses, 12.7 million medical doctors, 3.7 million pharmacists, 2.5 million dentists, 2.2 million midwives and 14.9 million additional occupations, tallying to 65.1 million health workers. It was not equitably distributed with a 6.5-fold difference in density between high-income and low-income countries. The projected health workforce size by 2030 is 84 million health workers. This represents an average growth of 29% from 2020 to 2030 which is faster than the population growth rate (9.7%). This reassessment presents a revised global health workforce shortage of 15 million health workers in 2020 decreasing to 10 million health workers by 2030 (a 33% decrease globally). WHO African and Eastern Mediterranean regions' shortages are projected to decrease by only 7% and 15%, respectively. CONCLUSIONS: The latest NHWA data show progress in the increasing size of the health workforce globally as more jobs are and will continue to be created in the health economy. It however masks considerable inequities, particularly in WHO African and Eastern Mediterranean regions, and alarmingly among the 47 countries on the WHO Support and Safeguards List. Progress should be acknowledged with caution considering the immeasurable impact of COVID-19 pandemic on health workers globally.

Multi-country case studies on planning RMNCH services using WISN methodology: Bangladesh, Ghana, Kenya, Sultanate of Oman and Papua New Guinea.

BACKGROUND: Globally, many countries are adopting evidence-based workforce planning that facilitates progress towards achieving sustainable development goals for reproductive, maternal newborn and child health. We reviewed case studies on workforce planning for reproductive maternal newborn child health services at primary care level facilities using workload indicators of staffing need in five countries. METHOD: Using available workload indicators for staffing need reports from Bangladesh, Ghana, Kenya, Sultanate of Oman and Papua New Guinea, we generated descriptive statistics to explore comparable workload components and activity standards, health service delivery models with an emphasis on the primary care levels and the specific health occupations offering interventions associated with reproductive maternal, newborn and child health services. RESULTS: The health services delivery models vary from one country to another. The results showed variability in the countries, in the workload components and activity standards of each regardless of facility level or occupational groups involved. All the countries have decentralized health services with emphasis on comprehensive primary care. Reproductive, maternal and new-born child health care services include antenatal, postnatal, immunization, family planning, baby wellness clinics, delivery and management of integrated minor childhood illnesses. Only Sultanate of Oman offers fertility services at primary care. Kenya has expanded interventions in the households and communities. CONCLUSION: Since the health care services models, health services delivery contexts and the health care worker teams vary from one country to another, the study therefore concludes that activity standards cannot be adopted or adapted from one country to another despite having similar workload components. Evidence based workforce planning must be context-specific, and therefore requires that each country develop its own workload components and activity standards aligned to their local contexts.

Ear and Hearing Care Workforce: Current Status and its Implications.

OBJECTIVE: This study aimed to provide comprehensive global evidence on the availability of ear and hearing care (EHC) professionals and real-life examples that showcase the impact of workforce shortages on the workload faced by existing professionals. METHODS: Six sources of data were used to estimate availability of EHC workforce: a scoping literature review, World Health Organization (WHO) National Health Workforce Accounts platform, WHO Member States survey and regional consultations, hearing care organizations survey, and official government statistics. EHC professionals' workload undertaking common interventions was estimated through the WHO workload indicators of staffing need human resource management tool. RESULTS: With data on otolaryngologists from 138, audiologists from 102, speech and language therapists from 124, and teachers of the deaf from 86 countries, this study revealed large gaps in availability of EHC cadres. The majority of countries in the African region had less than one professional in each cadre per million in comparison with most European countries having up to 50 times higher densities. Workload indicators of staffing need calculations revealed the challenging workload faced by existing EHC professionals, with ratios between existing and required staff of 0.01-0.86. CONCLUSION: There is an enormous shortage of EHC professionals and urgent actions are needed to ensure sufficient and equitable access to services. Task sharing, a novel approach for improving access to hearing care alongside the development of new cadres, can be a vital strategy in overcoming the shortage of highly qualified providers in many settings, even in well-resourced health systems, to facilitate equitable access to required EHC services.

Surgical Human Resources According to Types of Health Care Facility: An Assessment in Low- and Middle-Income Countries.

BACKGROUND: A robust health care system providing safe surgical care to a population can only be achieved in conjunction with access to competent surgical personnel. It has been reported that 5 billion people do not have access to safe, affordable surgical and anaesthesia care when needed. This study aims to fill the existing gap in evidence by quantifying shortfalls in trained personnel delivering safe surgical and anaesthetic care in low- and middle-income countries (LMICs) according to the type of health care facility. METHODS: We conducted secondary analysis of 1323 health facilities, in 35 low- and middle-income countries using facility-based cross-sectional data from the World Health Organization Situational Analysis Tool to Assess Emergency and Essential Surgical Care. RESULTS: The majority of surgical and anaesthetic care in LMICs was provided by general doctors (range 13.8-41.1%; mean 27.1%). Non-physicians made up a significant proportion of the surgical workforce in LMICs. 26.76% of the surgical and anaesthetic workforce was provided by clinical medical officers and nurses. Private/NGO/mission hospitals, large, well-resourced institutions had the highest proportion of surgeons compared to any other type of health care facility at 27.92%. This compares to figures of 18.2 and 19.96% of surgeons at health centres and subdistrict/community hospitals, respectively, representing the lowest level of health facility. CONCLUSIONS: We highlight the significant proportion of non-physicians delivering surgical and anaesthetic care in LMICs and illustrate wide variations according to the type of health care facility.

Health workforce metrics pre- and post-2015: a stimulus to public policy and planning.

BACKGROUND: Evidence-based health workforce policies are essential to ensure the provision of high-quality health services and to support the attainment of universal health coverage (UHC). This paper describes the main characteristics of available health workforce data for 74 of the 75 countries identified under the 'Countdown to 2015' initiative as accounting for more than 95% of the world's maternal, newborn and child deaths. It also discusses best practices in the development of health workforce metrics post-2015. METHODS: Using available health workforce data from the Global Health Workforce Statistics database from the Global Health Observatory, we generated descriptive statistics to explore the current status, recent trends in the number of skilled health professionals (SHPs: physicians, nurses, midwives) per 10 000 population, and future requirements to achieve adequate levels of health care in the 74 countries. A rapid literature review was conducted to obtain an overview of the types of methods and the types of data sources used in human resources for health (HRH) studies. RESULTS: There are large intercountry and interregional differences in the density of SHPs to progress towards UHC in Countdown countries: a median of 10.2 per 10 000 population with range 1.6 to 142 per 10 000. Substantial efforts have been made in some countries to increase the availability of SHPs as shown by a positive average exponential growth rate (AEGR) in SHPs in 51% of Countdown countries for which there are data. Many of these countries will require large investments to achieve levels of workforce availability commensurate with UHC and the health-related sustainable development goals (SDGs). The availability, quality and comparability of global health workforce metrics remain limited. Most published workforce studies are descriptive, but more sophisticated needs-based workforce planning methods are being developed. CONCLUSIONS: There is a need for high-quality, comprehensive, interoperable sources of HRH data to support all policies towards UHC and the health-related SDGs. The recent WHO-led initiative of supporting countries in the development of National Health Workforce Accounts is a very promising move towards purposive health workforce metrics post-2015. Such data will allow more countries to apply the latest methods for health workforce planning.