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Measuring 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

journal contribution
submitted on 2024-04-02, 09:25 and posted on 2024-05-05, 06:48 authored by Annie Haakenstad, Caleb Mackay Salpeter Irvine, Megan Knight, Corinne Bintz, Aleksandr Y Aravkin, Peng Zheng, Vin Gupta, Michael R M Abrigo, Abdelrahman I Abushouk, Oladimeji M Adebayo, Gina Agarwal, Fares Alahdab, Ziyad Al-Aly, Khurshid Alam, Turki M Alanzi, Jacqueline Elizabeth Alcalde-Rabanal, Vahid Alipour, Nelson Alvis-Guzman, Arianna Maever L Amit, Catalina Liliana Andrei, Tudorel Andrei, Carl Abelardo T Antonio, Jalal Arabloo, Olatunde Aremu, Martin Amogre Ayanore, Maciej Banach, Till Winfried Bärnighausen, Celine M Barthelemy, Mohsen Bayati, Habib Benzian, Adam E Berman, Kelly Bienhoff, Ali Bijani, Boris Bikbov, Antonio Biondi, Archith Boloor, Reinhard Busse, Zahid A Butt, Luis Alberto Cámera, Ismael R Campos-Nonato, Rosario Cárdenas, Felix Carvalho, Collins Chansa, Soosanna Kumary Chattu, Vijay Kumar Chattu, Dinh-Toi Chu, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, William James Dangel, Ahmad Daryani, Jan-Walter De Neve, Meghnath Dhimal, Isaac Oluwafemi Dipeolu, Shirin Djalalinia, Hoa Thi Do, Chirag P Doshi, Leila Doshmangir, Elham Ehsani-Chimeh, Maha El Tantawi, Eduarda Fernandes, Florian Fischer, Nataliya A Foigt, Artem Alekseevich Fomenkov, Masoud Foroutan, Takeshi Fukumoto, Nancy Fullman, Mohamed M Gad, Keyghobad Ghadiri, Mansour Ghafourifard, Ahmad Ghashghaee, Thomas Glucksman, Houman Goudarzi, Rajat Das Gupta, Randah R Hamadeh, Samer Hamidi, Josep Maria Haro, Edris Hasanpoor, Simon I Hay, Mohamed I Hegazy, Behzad Heibati, Nathaniel J Henry, Michael K Hole, Naznin Hossain, Mowafa Househ, Olayinka Stephen Ilesanmi, Mohammad-Hasan Imani-Nasab, Seyed Sina Naghibi Irvani, Sheikh Mohammed Shariful Islam, Mohammad Ali Jahani, Ankur Joshi, Rohollah Kalhor, Gbenga A Kayode, Nauman Khalid, Khaled Khatab, Adnan Kisa, Sonali Kochhar, Kewal Krishan, Barthelemy Kuate Defo, Dharmesh Kumar Lal, Faris Hasan Lami, Anders O Larsson, Janet L Leasher, Kate E LeGrand, Lee-Ling Lim, Narayan B Mahotra, Azeem Majeed, Afshin Maleki, Narayana Manjunatha, Benjamin Ballard Massenburg, Tomislav Mestrovic, GK Mini, Andreea Mirica, Erkin M Mirrakhimov, Yousef Mohammad, Shafiu Mohammed, Ali H Mokdad, Shane Douglas Morrison, Mohsen Naghavi, Duduzile Edith Ndwandwe, Ionut Negoi, Ruxandra Irina Negoi, Josephine W Ngunjiri, Cuong Tat Nguyen, Yeshambel T Nigatu, Obinna E Onwujekwe, Doris V Ortega-Altamirano, Nikita Otstavnov, Stanislav S Otstavnov, Mayowa O Owolabi, Abhijit P Pakhare, Veincent Christian Filipino Pepito, Norberto Perico, Hai Quang Pham, David M Pigott, Khem Narayan Pokhrel, Mohammad Rabiee, Navid Rabiee, Vafa Rahimi-Movaghar, David Laith Rawaf, Salman Rawaf, Lal Rawal, Giuseppe Remuzzi, Andre M N Renzaho, Serge Resnikoff, Nima Rezaei, Aziz Rezapour, Jennifer Rickard, Leonardo Roever, Maitreyi Sahu, Abdallah M Samy, Juan Sanabria, Milena M Santric-Milicevic, Sivan Yegnanarayana Iyer Saraswathy, Soraya Seedat, Subramanian Senthilkumaran, Edson Serván-Mori, Masood Ali Shaikh, Aziz Sheikh, Diego Augusto Santos Silva, Caroline Stein, Dan J Stein, Mariya Vladimirovna Titova, Stephanie M Topp, Marcos Roberto Tovani-Palone, Saif Ullah, Bhaskaran Unnikrishnan, Marco Vacante, Pascual R Valdez, Tommi Juhani Vasankari, Narayanaswamy Venketasubramanian, Vasily Vlassov, Theo Vos, Jamal Akeem Yearwood, Naohiro Yonemoto, Mustafa Z Younis, Chuanhua Yu, Siddhesh Zadey, Sojib Bin Zaman, Taddese Alemu Zerfu, Zhi-Jiang Zhang, Arash Ziapour, Sanjay Zodpey, Stephen S Lim, Christopher J L Murray, Rafael Lozano

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.

Other Information

Published in: The Lancet
License: http://creativecommons.org/licenses/by/4.0/
See article on publisher's website: https://dx.doi.org/10.1016/s0140-6736(22)00532-3

Funding

Bill & Melinda Gates Foundation.

History

Language

  • English

Publisher

Elsevier

Publication Year

  • 2022

License statement

This Item is licensed under the Creative Commons Attribution 4.0 International License.

Institution affiliated with

  • Hamad Bin Khalifa University
  • College of Science and Engineering - HBKU