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

Annie Haakenstad(University of Washington), Caleb Mackay Salpeter Irvine(University of Washington), Megan Knight(University of Washington), Corinne Bintz(University of Washington), Aleksandr Y. Aravkin(University of Washington), Peng Zheng(University of Washington), Vin Gupta(University of Washington), Michael R.M. Abrigo(University of Washington), Abdelrahman Ibrahim Abushouk(University of Washington), Oladimeji Adebayo(University of Washington), Gina Agarwal(University of Washington), Fares Alahdab(University of Washington), Ziyad Al‐Aly(University of Washington), Khurshid Alam(University of Washington), Turki M Alanzi(University of Washington), Jacqueline Elizabeth Alcalde‐Rabanal(University of Washington), Vahid Alipour(University of Washington), Nelson Alvis‐Guzmán(University of Washington), Arianna Maever L. Amit(University of Washington), Cătălina Liliana Andrei(University of Washington), Tudorel Andrei(University of Washington), Carl Abelardo T Antonio(University of Washington), Jalal Arabloo(University of Washington), Olatunde Aremu(University of Washington), Martin Amogre Ayanore(University of Washington), Maciej Banach(University of Washington), Till Bärnighausen(University of Washington), Celine M Barthelemy(University of Washington), Mohsen Bayati(University of Washington), Habib Benzian(University of Washington), Adam E. Berman(University of Washington), Kelly Bienhoff(University of Washington), Ali Bijani(University of Washington), Boris Bikbov(University of Washington), Antonio Biondi(University of Washington), Archith Boloor(University of Washington), Reinhard Busse(University of Washington), Zahid A Butt(University of Washington), Luis Alberto Cámera(University of Washington), Ismael Campos‐Nonato(University of Washington), Rosario Cárdenas(University of Washington), Félix Carvalho(University of Washington), Collins Chansa(University of Washington), Soosanna Kumary Chattu(University of Washington), Vijay Kumar Chattu(University of Washington), Dinh‐Toi Chu(University of Washington), Xiaochen Dai(University of Washington), Lalit Dandona(University of Washington), Rakhi Dandona(University of Washington), William James Dangel(University of Washington), Ahmad Daryani(University of Washington), Jan‐Walter De Neve(University of Washington), Meghnath Dhimal(University of Washington), Isaac Oluwafemi Dipeolu(University of Washington), Shirin Djalalinia(University of Washington), Hoa Do(University of Washington), Chirag Doshi(University of Washington), Leila Doshmangir(University of Washington), Elham Ehsani‐Chimeh(University of Washington), Maha El Tantawi(University of Washington), Eduarda Fernandes(University of Washington), Florian Fischer(University of Washington), Nataliya A Foigt(University of Washington), Artem Alekseevich Fomenkov(University of Washington), Masoud Foroutan(University of Washington), Takeshi Fukumoto(University of Washington), Nancy Fullman(University of Washington), Mohamed Gad(University of Washington), Keyghobad Ghadiri(University of Washington), Mansour Ghafourifard(University of Washington), Ahmad Ghashghaee(University of Washington), Thomas Glucksman(University of Washington), Houman Goudarzi(University of Washington), Rajat Das Gupta(University of Washington), Randah R Hamadeh(University of Washington), Samer Hamidi(University of Washington), Josep María Haro(University of Washington), Edris Hasanpoor(University of Washington), Simon I Hay(University of Washington), Mohamed Hegazy(University of Washington), Behzad Heibati(University of Washington), Nathaniel J Henry(University of Washington), Michael K. Hole(University of Washington), Naznin Hossain(University of Washington), Mowafa Househ(University of Washington), Olayinka Stephen Ilesanmi(University of Washington), Mohammad Hasan Imani-Nasab(University of Washington), Seyed Sina Naghibi Irvani(University of Washington), Sheikh Mohammed Shariful Islam(University of Washington), Mohammad Ali Jahani(University of Washington), Ankur Joshi(University of Washington), Rohollah Kalhor(University of Washington), Gbenga A Kayode(University of Washington), Nauman Khalid(University of Washington), Khaled Khatab(University of Washington), Adnan Kısa(University of Washington), Sonali Kochhar(University of Washington), Kewal Krishan(University of Washington), Barthélémy Kuate Defo(University of Washington), Dharmesh Kumar Lal(University of Washington), Faris Lami(University of Washington), Anders Larsson(University of Washington), Janet L Leasher(University of Washington), Kate E LeGrand(University of Washington), Lee‐Ling Lim(University of Washington), Narayan Bahadur Mahotra(University of Washington), Azeem Majeed(University of Washington), Afshin Maleki(University of Washington), Narayana Manjunatha(University of Washington), Benjamin B. Massenburg(University of Washington), Tomislav Meštrović(University of Washington), GK Mini(University of Washington), Andreea Mirică(University of Washington), Erkin М Мirrakhimov(University of Washington), Yousef Mohammad(University of Washington), Shafiu Mohammed(University of Washington), Ali H. Mokdad(University of Washington), Shane D. Morrison(University of Washington), Mohsen Naghavi(University of Washington), Duduzile Ndwandwe(University of Washington), Ionuţ Negoi(University of Washington), Ruxandra Irina Negoi(University of Washington), Josephine W Ngunjiri, Cuong Tat Nguyen(University of Washington), Yeshambel T. Nigatu(University of Washington), Obinna Onwujekwe(University of Washington), Doris V Ortega-Altamirano(University of Washington), Nikita Otstavnov(University of Washington), Stanislav S Otstavnov(University of Washington), Mayowa Owolabi(University of Washington), Abhijit Pakhare(University of Washington), Veincent Christian Filipino Pepito(University of Washington), Norberto Perico(University of Washington), Hai Quang Pham(University of Washington), David M. Pigott(University of Washington), Khem Narayan Pokhrel(University of Washington), Mohammad Rabiee(University of Washington), Navid Rabiee(University of Washington), Vafa Rahimi‐Movaghar(University of Washington), David Laith Rawaf(University of Washington), Salman Rawaf(University of Washington), Lal Rawal(University of Washington), Giuseppe Remuzzi(University of Washington), André M. N. Renzaho(University of Washington), Serge Resnikoff(University of Washington), Nima Rezaei(University of Washington), Aziz Rezapour(University of Washington), Jennifer Rickard(University of Washington), Leonardo Roever(University of Washington), Maitreyi Sahu(University of Washington), Abdallah M Samy(University of Washington), Juan Sanabria(University of Washington), Milena M Santric-Milicevic(University of Washington), Sivan Yegnanarayana Iyer Saraswathy(University of Washington), Soraya Seedat(University of Washington), Subramanian Senthilkumaran(University of Washington), Edson Serván‐Mori(University of Washington), Masood Ali Shaikh(University of Washington), Aziz Sheikh(University of Washington), Diego Augusto Santos Silva(University of Washington), Caroline Stein(University of Washington), Dan J. Stein(University of Washington), М. В. Титова(University of Washington), Stephanie M. Topp(University of Washington), Marcos Roberto Tovani‐Palone(University of Washington), Saif Ullah(University of Washington), Bhaskaran Unnikrishnan(University of Washington), Marco Vacante(University of Washington), Pascual Valdéz(University of Washington), Tommi Vasankari(University of Washington), Narayanaswamy Venketasubramanian(University of Washington), Vasily Vlassov(University of Washington), Theo Vos(University of Washington), Jamal A Yearwood(University of Washington), Naohiro Yonemoto(University of Washington), Mustafa Z Younis(University of Washington), Chuanhua Yu(University of Washington), Siddhesh Zadey(University of Washington), Sojib Bin Zaman(University of Washington), Taddese Alemu Zerfu(University of Washington), Zhi-Jiang Zhang(University of Washington), Arash Ziapour(University of Washington), Sanjay Zodpey(University of Washington), Stephen S Lim(University of Washington), Christopher J L Murray(University of Washington), Rafael Lozano(University of Washington)
The Lancet
May 23, 2022
10.1016/s0140-6736(22)00532-3
Cited by 416Open Access
Full Text

Abstract

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. FUNDING: Bill & Melinda Gates Foundation.

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