NEW DELHI: Women have driven the expansion of the global health workforce over the past three decades, yet substantial workforce shortages, especially in South Asia, remain, according to a global study.
Published in The Lancet Public Health, the study estimates that an additional 34.4 million doctors, nurses, midwives, dentists, and pharmacists are needed globally to achieve moderate levels of universal health coverage, where people can access essential health services without financial hardship.
The report said that India has a ratio of about 73 health workers per 10,000 population - 10.5 doctors per 10,000 population, 10.8 nurses per 10,000 population, 8.1 pharmacists and pharmaceutical assistants per 10,000 population and 1.2 midwifery personnel per 10,000 population.
It also estimated China to have a ratio of about 130 health workers per 10,000 population - over 30 doctors per 10,000 population and about 45 nurses per 10,000 population.
The study said that 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.
However, there is some good news.
The global health workforce nearly tripled between 1990 and 2023, growing from 40.9 million to 122.1 million workers, and women accounted for 71.4% of this growth and represented 68.9% of all health workers in 2023.
But they work in professions that generally offer lower pay and fewer opportunities for leadership.
“Despite this progress, substantial shortages persist across many regions, particularly South Asia and sub-Saharan Africa, where health systems continue to face some of the world’s lowest workforce densities,” said researchers from the Institute for Health Metrics and Evaluation at the University of Washington, US.
Based on Global Burden of Disease (GBD) 2023 estimates, the study 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.
Women have driven global health workforce growth but remain underrepresented in many higher-paid professions, it said.
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.
“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,” said Megan Knight, lead author of the study and researcher at the IHME.
“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.”
The study highlighted that millions of health workers will be needed to achieve universal health coverage.
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.
After South Asia, Sub-Saharan Africa faced severe shortages across major health professions, with a 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 US.
“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.
“Although the global workforce has expanded dramatically, millions more doctors, nurses, midwives, dentists, and pharmacists will be needed to ensure people everywhere can access essential health services. These findings provide countries with minimum thresholds for planning the workforce needed to strengthen health systems and move toward universal health coverage.”
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.
Closing global workforce gaps will require sustained investments in health worker education, recruitment, retention, and working conditions.
The study said building a well-supported health workforce will be essential to expanding access to care and ensuring health systems are equipped to meet future health challenges.
