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      Forecasting imbalances in the global health labor market and devising policy responses

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          Abstract

          Background

          The High-Level Commission on Health Employment and Economic Growth released its report to the United Nations Secretary-General in September 2016. It makes important recommendations that are based on estimates of over 40 million new health sector jobs by 2030 in mostly high- and middle-income countries and a needs-based shortage of 18 million, mostly in low- and middle-income countries. This paper shows how these key findings were developed, the global policy dilemmas they raise, and relevant policy solutions.

          Methods

          Regression analysis is used to produce estimates of health worker need, demand, and supply. Projections of health worker need, demand, and supply in 2030 are made under the assumption that historical trends continue into the future.

          Results

          To deliver essential health services required for the universal health coverage target of the Sustainable Development Goal 3, there will be a need for almost 45 million health workers in 2013 which is projected to reach almost 53 million in 2030 (across 165 countries). This results in a needs-based shortage of almost 17 million in 2013. The demand-based results suggest a projected demand of 80 million health workers by 2030.

          Conclusions

          Demand-based analysis shows that high- and middle-income countries will have the economic capacity to employ tens of millions additional health workers, but they could face shortages due to supply not keeping up with demand. By contrast, low-income countries will face both low demand for and supply of health workers. This means that even if countries are able to produce additional workers to meet the need threshold, they may not be able to employ and retain these workers without considerably higher economic growth, especially in the health sector.

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          Most cited references40

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          Global Health Workforce Labor Market Projections for 2030

          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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            Global Supply of Health Professionals

            New England Journal of Medicine, 370(10), 950-957
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              Forecasting the global shortage of physicians: an economic- and needs-based approach.

              Global achievements in health may be limited by critical shortages of health-care workers. To help guide workforce policy, we estimate the future demand for, need for and supply of physicians, by WHO region, to determine where likely shortages will occur by 2015, the target date of the Millennium Development Goals. Using World Bank and WHO data on physicians per capita from 1980 to 2001 for 158 countries, we employ two modelling approaches for estimating the future global requirement for physicians. A needs-based model determines the number of physicians per capita required to achieve 80% coverage of live births by a skilled health-care attendant. In contrast, our economic model identifies the number of physicians per capita that are likely to be demanded, given each country's economic growth. These estimates are compared to the future supply of physicians projected by extrapolating the historical rate of increase in physicians per capita for each country. By 2015, the global supply of physicians appears to be in balance with projected economic demand. Because our measure of need reflects the minimum level of workforce density required to provide a basic health service that is met in all but the least developed countries, the needs-based estimates predict a global surplus of physicians. However, on a regional basis, both models predict shortages for many countries in the WHO African Region in 2015, with some countries experiencing a needs-based shortage, a demand-based shortage, or both. The type of policy intervention needed to alleviate projected shortages, such as increasing health-care training or adopting measures to discourage migration, depends on the type of shortage projected.
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                Author and article information

                Contributors
                +1 (510) 643-4100 , rscheff@berkeley.edu
                campbellj@who.int
                comettog@who.int
                Akiko.MAEDA@oecd.org
                Jenny.Liu2@ucsf.edu
                tim.bruckner@uci.edu
                danielarnold@berkeley.edu
                tgevans@worldbank.org
                Journal
                Hum Resour Health
                Hum Resour Health
                Human Resources for Health
                BioMed Central (London )
                1478-4491
                11 January 2018
                11 January 2018
                2018
                : 16
                : 5
                Affiliations
                [1 ]ISNI 0000 0001 2181 7878, GRID grid.47840.3f, School of Public Health and Goldman School of Public Policy, , University of California, Berkeley, ; Berkeley, CA United States of America
                [2 ]ISNI 0000000121633745, GRID grid.3575.4, Health Workforce Department, , World Health Organization, ; Geneva, Switzerland
                [3 ]ISNI 0000000121590079, GRID grid.36193.3e, Organisation for Economic Co-operation and Development (OECD), ; Paris, France
                [4 ]ISNI 0000 0001 2297 6811, GRID grid.266102.1, Institute for Health and Aging, Department of Social and Behavioral Sciences, , University of California, San Francisco, ; San Francisco, CA United States of America
                [5 ]ISNI 0000 0001 0668 7243, GRID grid.266093.8, School of Public Health, , University of California, Irvine, ; Irvine, CA United States of America
                [6 ]ISNI 0000 0001 2181 7878, GRID grid.47840.3f, School of Public Health, , University of California, ; Berkeley, CA United States of America
                [7 ]ISNI 0000 0004 0482 9086, GRID grid.431778.e, The World Bank, ; Washington, DC, United States of America
                Article
                264
                10.1186/s12960-017-0264-6
                5765602
                29325556
                a9d0b58a-e235-4a99-bf51-4cb5ed7cd83b
                © The Author(s). 2018

                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
                : 6 September 2017
                : 14 December 2017
                Categories
                Research
                Custom metadata
                © The Author(s) 2018

                Health & Social care
                health workforce,global health
                Health & Social care
                health workforce, global health

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