Global health workforce triples since 1990, thanks to women

Women have driven the expansion of the global health workforce over the past three decades, but the world still faces a shortage of 34.4 million health workers to achieve moderate levels of universal health coverage, according to a new study published in The Lancet Public Health.

Researchers found that the global health workforce nearly tripled between 1990 and 2023, increasing from 40.9 million workers to 122.1 million. Women accounted for 71.4 per cent of that growth and represented 68.9 per cent of all health workers worldwide in 2023.

“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,” Institute for Health Metrics and Evaluation (IHME) researcher and study lead author Megan Knight said.

“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.”

Women dominate health’s lowest paid jobs

The study, based on Global Burden of Disease (GBD) 2023 estimates, provides sex-disaggregated assessments of 20 health worker cadres across 204 countries and territories between 1990 and 2023. It also includes the first global estimates of community health workers.

According to the findings, the global workforce in 2023 included 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 made up 80.7 per cent of nurses, 96.0 per cent of midwives and 89.5 per cent of community health workers globally. However, women accounted for less than half of doctors worldwide.

Similar trends were observed in dentistry and pharmacy, where women were more likely to work as assistants than as dentists or pharmacists.

Millions more workers needed

Despite significant workforce growth, researchers estimate that an additional 34.4 million doctors, nurses, midwives, dentists and pharmacists are needed worldwide to achieve a score of 80 out of 100 on the GBD universal health coverage effective coverage index, which represents moderate levels of universal health coverage.

The study estimates shortages of 23.9 million nurses and midwives, 7.1 million doctors, 1.8 million dentists and 1.6 million pharmacists.

The greatest workforce gaps were identified in South Asia and sub-Saharan Africa.

Researchers estimate South Asia would require an additional 2.6 million doctors and 10 million nurses and midwives to reach moderate universal health coverage.

Sub-Saharan Africa was also found to face severe shortages across major health professions. The study reported nursing density of 14.5 nurses per 10,000 population in the region, compared with 121.8 per 10,000 in high-income countries.

At the country level, nurse density was estimated at 3.2 per 10,000 population in Chad and 3.3 in Madagascar. By comparison, Belgium recorded 171.7 nurses per 10,000 people and the United States recorded 161.4 per 10,000.

“Health workers are the foundation of every health system,” said Dr Annie Haakenstad, senior author of the study and assistant professor of Health Metrics Sciences at IHME.

“These findings provide countries with minimum thresholds for planning the workforce needed to strengthen health systems and move toward universal health coverage,” she said.

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

Researchers said these benchmarks could help countries identify workforce gaps and plan future investments while also supporting progress toward Sustainable Development Goal targets related to health workforce development and universal health coverage.

The authors concluded that closing global workforce gaps will require sustained investment in health worker education, recruitment, retention and working conditions.

They also highlighted the importance of gender-responsive measures such as leadership development, workplace protections, paid parental leave and flexible work arrangements to support the predominantly female health workforce.