43 million health workers required to achieve universal health coverage

universal health coverage
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A new peer-reviewed study has stated that more than 43 million additional health workers are needed globally to meet universal health coverage targets.

An investigation by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine has highlighted significant workforce gaps in universal health coverage – which the World Health Organization (WHO) characterises as all individuals and communities receiving adequate health services without suffering financial hardship.

The study, which is published in The Lancet, identified that the most significant gaps in universal health coverage were in sub-Saharan Africa, North Africa, South Asia, and the Middle East.

Dr Rafael Lozano, Director of Health Systems at IHME, commented: “These are the most comprehensive estimates to date of the global health care workforce. Health care workers are essential to the functioning of health systems, and it’s very important to have these data available so that countries can make informed decisions and plan for the future.”

Shortages in the global health workforce

To determine the universal health coverage landscape, the investigators analysed health worker shortages in four categories: physicians, dental personnel, nurses and midwives, and pharmaceutical workers. They discovered that in 2019, over 130 countries did not have a sufficient number of physicians, and more than 150 had shortages of nurses and midwives.

The researchers compared the current volume of health care workers to the minimum needed to achieve a target score of 80 on the universal health coverage (UHC) effective service coverage index, which staggeringly revealed a shortage of over 43 million health care professionals, which includes 30.6 million nurses and midwives and 6.4 million physicians.

Dr Annie Haakenstad, the lead author of the study and an Assistant Professor of Health Metrics Sciences at IHME, said: “We found that the density of health care workers is strongly related to a nation’s level of social and economic development. There are different strategies and policy approaches that may help with addressing worker shortages, and these should be tailored to the individual situation in each country. We hope that these estimates can be used to help prioritise policy interventions and inform future planning.”

The results illuminated a 10-fold difference in the density of health care workers across different parts of the world in 2019, ranging from 2.9 physicians per 10,000 of the population in sub-Saharan Africa to 38.3 per 10,000 in Central Europe, Eastern Europe, and Central Asia. The disparities in density were vast in some regions, with Cuba having 84.4 physicians per 10,000 compared to 2.1 per 10,000 in Haiti.

Coverage of nurses and midwives also demonstrated significant inequalities; for example, Australasia has a density of 152.3 per 10,000, whereas Southern Latin America only has 37.4 per 10,000. Consistent progress has been made in bolstering the health care workforce over the last two decades, but there is still work to do as considerable gaps still exist.

Optimising universal health coverage

The team explained that contributing factors to gaps in universal health coverage include an out-migration of health workers, war and political unrest, violence against health workers, and limited incentives for training and retention. They explained that high-income countries should implement WHO guidelines on responsible recruitment of health personnel, which will help to mitigate contributing to further gaps in lower-income countries.

The study highlighted how poorly equipped the world was for the COVID-19 pandemic, which decimated health systems that were already lacking essential workers. The researchers explained that their findings would help inform policymakers and medical facilities on enhancing recruitment and training to be better prepared for future pandemics.

They also noted that there are still many aspects of health care affected by the pandemic that requires further study, such as how it impacted gender dynamics in human resources for health (HRH) and how women who departed from formal employment for care duties influenced the health workforce.

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