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

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Abstract

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.

Electronic supplementary material

The online version of this article (doi:10.1186/s12960-017-0190-7) contains supplementary material, which is available to authorized users.

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Most cited references 74

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Health service coverage and its evaluation.

T Tanahashi (1978)

Health service coverage is considered as a concept expressing the extent of interaction between the service and the people for whom it is intended, this interaction not being limited to a particular aspect of service provision but ranging over the whole process from resource allocation to achievement of the desired objective. For the measurement of coverage, several key stages are first identified, each of them involving the realization of an important condition for providing the service; a coverage measure is then defined for each stage, namely the ratio between the number of people for whom the condition is met and the target population, so that a set of these measures represents the interaction between the service and the target population. This definition of coverage allows for variations, which are called "specific coverage", by limiting the target population to specific subgroups differentiated by certain conditions related to service provision or by demographic or socioeconomic factors.The evaluation of coverage on the basis of these concepts enables management to identify bottlenecks in the operation of the service, to analyse the constraining factors responsible for such bottlenecks, and to select effective measures for service development.

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China's human resources for health: quantity, quality, and distribution.

Sudhir Anand, Victoria Y Fan, Junhua Zhang … (2008)

In this paper, we analyse China's current health workforce in terms of quantity, quality, and distribution. Unlike most countries, China has more doctors than nurses-in 2005, there were 1.9 million licensed doctors and 1.4 million nurses. Doctor density in urban areas was more than twice that in rural areas, with nurse density showing more than a three-fold difference. Most of China's doctors (67.2%) and nurses (97.5%) have been educated up to only junior college or secondary school level. Since 1998 there has been a massive expansion of medical education, with an excess in the production of health workers over absorption into the health workforce. Inter-county inequality in the distribution of both doctors and nurses is very high, with most of this inequality accounted for by within-province inequalities (82% or more) rather than by between-province inequalities. Urban-rural disparities in doctor and nurse density account for about a third of overall inter-county inequality. These inequalities matter greatly with respect to health outcomes across counties, provinces, and strata in China; for instance, a cross-county multiple regression analysis using data from the 2000 census shows that the density of health workers is highly significant in explaining infant mortality.

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Global Health Workforce Labor Market Projections for 2030

Jenny Liu, Yevgeniy Goryakin, Akiko Maeda … (2017)

Background In low- and middle-income countries, scaling essential health interventions to achieve health development targets is constrained by the lack of skilled health professionals to deliver services. Methods We take a labor market approach to project future health workforce demand based on an economic model based on projected economic growth, demographics, and health coverage, and using health workforce data (1990–2013) for 165 countries from the WHO Global Health Observatory. The demand projections are compared with the projected growth in health worker supply and the health worker “needs” as estimated by WHO to achieve essential health coverage. Results The model predicts that, by 2030, global demand for health workers will rise to 80 million workers, double the current (2013) stock of health workers, while the supply of health workers is expected to reach 65 million over the same period, resulting in a worldwide net shortage of 15 million health workers. Growth in the demand for health workers will be highest among upper middle-income countries, driven by economic and population growth and aging. This results in the largest predicted shortages which may fuel global competition for skilled health workers. Middle-income countries will face workforce shortages because their demand will exceed supply. By contrast, low-income countries will face low growth in both demand and supply, which are estimated to be far below what will be needed to achieve adequate coverage of essential health services. Conclusions In many low-income countries, demand may stay below projected supply, leading to the paradoxical phenomenon of unemployed (“surplus”) health workers in those countries facing acute “needs-based” shortages. Opportunities exist to bend the trajectory of the number and types of health workers that are available to meet public health goals and the growing demand for health workers. Electronic supplementary material The online version of this article (doi:10.1186/s12960-017-0187-2) contains supplementary material, which is available to authorized users.

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Author and article information

Contributors

Andrea Nove: +44 7894 261229 , andrea.nove@icsintegrare.org

Journal

Journal ID (nlm-ta): Hum Resour Health

Journal ID (iso-abbrev): Hum Resour Health

Title: Human Resources for Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1478-4491

Publication date (Electronic): 15 February 2017

Publication date PMC-release: 15 February 2017

Publication date Collection: 2017

Volume: 15

Electronic Location Identifier: 14

Affiliations

[1 ]Instituto de Cooperación Social Integrare, calle Balmes 30, 3-1, 08007 Barcelona, Spain

[2 ]ISNI 0000000121633745, GRID grid.3575.4, , Health Systems and Innovations, WHO Headquarters, ; Geneva, Switzerland

[3 ]ISNI 0000000121633745, GRID grid.3575.4, , Global Health Workforce Network, WHO Headquarters, ; Geneva, Switzerland

[4 ]ISNI 0000 0004 1936 7611, GRID grid.117476.2, School of Nursing Midwifery and Health, , University of Technology Sydney, ; Sydney, Australia

[5 ]ISNI 0000000121511713, GRID grid.10772.33, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, , Universidade Nova de Lisboa, ; Lisbon, Portugal

Article

Publisher ID: 190

DOI: 10.1186/s12960-017-0190-7

PMC ID: 5312527

PubMed ID: 28202047

SO-VID: 71e65db6-f184-488d-b1d5-c4f2eec9a7a3

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 12 February 2016

Date accepted : 9 February 2017

Funding

Funded by: U.S. Fund for UNICEF

Award ID: Countdown to 2015 for Maternal, Newborn and Child Survival Grant from the Bill and Melinda Gates Foundation

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: health workforce,health systems,metrics,countdown,data,densities,low- and middle-income countries,universal health coverage,sustainable development goals

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: health workforce, health systems, metrics, countdown, data, densities, low- and middle-income countries, universal health coverage, sustainable development goals

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

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Abstract

Background

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Conclusions

Electronic supplementary material

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UN Sustainable Development Goals

Most cited references 74

Health service coverage and its evaluation.

China's human resources for health: quantity, quality, and distribution.

Global Health Workforce Labor Market Projections for 2030

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