UHC under threat as global health worker deficit hits 34.4 million

No fewer than 34.4 million doctors, nurses, midwives, dentists, and pharmacists are needed worldwide to achieve moderate levels of universal health coverage, researchers have said.

The researchers, in a new study published in The Lancet Public Health, found that the global health workforce nearly tripled between 1990 and 2023, growing from 40.9 million to 122.1 million workers.

Despite this, the study found that substantial workforce shortages remain globally.

“Despite substantial workforce growth, researchers estimate the world would need an additional 34.4 million health workers to achieve a score of 80 out of 100 on the GBD universal health coverage effective coverage index, a benchmark representing moderate levels of universal health coverage. This includes shortages of 23.9 million nurses and midwives, 7.1 million doctors, 1.8 million dentists, and 1.6 million pharmacists.

“Workforce shortages were greatest in South Asia, which would require an additional 2.6 million doctors and 10 million nurses and midwives to reach moderate universal health coverage. Sub-Saharan Africa also faced severe shortages across major health professions, with nursing density of 14.5 per 10,000 population compared with 121.8 per 10,000 in high-income countries.

“At the country level, nurse density was as low as 3.2 per 10,000 in Chad and 3.3 in Madagascar, compared with 171.7 per 10,000 in Belgium and 161.4 in the United States,” the study found.

It added that over the past three decades, women have driven the expansion of the global health workforce, adding that women accounted for 71.4% of this growth and represented 68.9% of all health workers in 2023.

The study, based on Global Burden of Disease 2023 estimates, provides the first global, sex-disaggregated estimates of 20 health worker cadres, or groups of specially trained health personnel such as doctors, nurses, midwives, pharmacists, dentists, and community health workers, across 204 countries and territories from 1990 to 2023, including the first global estimates of community health workers.

It also offers the most comprehensive assessment of the global health workforce to date.

According to the study, women have driven global health workforce growth but remain underrepresented in many higher-paid professions.

“Between 1990 and 2023, the global health workforce expanded by more than 81 million workers, including 18.9 million nurses and 8.7 million doctors. Most regions saw substantial growth over this period, although the pace of expansion varied across countries and health professions.

“In 2023, the global health workforce included 122.1 million health workers, including 33.2 million nurses, 15.1 million doctors, 7.6 million community health workers, 6.8 million pharmacists and pharmaceutical assistants, and 6.1 million dentists and dental assistants.

“Women represented nearly seven in ten health workers worldwide, comprising 80.7% of nurses, 96.0% of midwives, and 89.5% of community health workers, while less than half of doctors were women. Similar patterns were observed across dentistry and pharmacy, where women were more likely to work as assistants than as dentists or pharmacists,” the study found.

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Reacting to the study, the lead author of the study and researcher at the Institute for Health Metrics and Evaluation, Megan Knight, said, “Women have transformed the global health workforce over the past three decades, but they continue to be concentrated in professions that generally offer lower pay and fewer opportunities for leadership.

“Building stronger health systems will require not only expanding the workforce, but also creating equitable opportunities for career advancement, leadership, and safe, supportive working environments.”

Meeting global health goals, the study found, will require sustained investments in the health workforce.

The study estimates that achieving moderate universal health coverage is associated with minimum workforce densities of 23.8 doctors and 64.5 nurses and midwives per 10,000 people, along with 5.2 dentists and 5.6 pharmacists per 10,000.

These minimum benchmarks can help countries identify workforce gaps and plan the investments needed to meet future health needs.

The estimates also provide a measure of progress toward Sustainable Development Goal target 3.c.1, which calls for substantially increasing the recruitment, development, training, and retention of the health workforce, as well as SDG target 3.8 on achieving universal health coverage.