World Health Systems Facts currently has sections on the US and sixteen other OECD nations. The links below lead directly to national sections on Healthcare Workers:
“We estimated that, in 2019, the world had 104.0 million (95% uncertainty interval 83.5–128.0) health workers, including 12.8 million (9.7–16.6) physicians, 29.8 million (23.3–37.7) nurses and midwives, 4.6 million (3.6–6.0) dentistry personnel, and 5.2 million (4.0–6.7) pharmaceutical personnel. We calculated a global physician density of 16.7 (12.6–21.6) per 10 000 population, and a nurse and midwife density of 38.6 (30.1–48.8) per 10,000 population. We found the GBD super-regions of sub-Saharan Africa, south Asia, and north Africa and the Middle East had the lowest HRH densities. To reach 80 out of 100 on the UHC effective coverage index, we estimated that, per 10,000 population, at least 20.7 physicians, 70.6 nurses and midwives, 8.2 dentistry personnel, and 9.4 pharmaceutical personnel would be needed. In total, the 2019 national health workforces fell short of these minimum thresholds by 6.4 million physicians, 30.6 million nurses and midwives, 3.3 million dentistry personnel, and 2.9 million pharmaceutical personnel.”
Source: GBD 2019 Human Resources for Health Collaborators. Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2022;399(10341):2129-2154. doi:10.1016/S0140-6736(22)00532-3
“Human resources for health (HRH) are crucial to health-system functioning,1, 2, 3, 4 but previous studies have found considerable differences in HRH densities across countries.5, 6, 7, 8, 9, 10 The importance of addressing workforce gaps is underscored by studies linking HRH to population-level health outcomes11, 12 and research suggesting that investing in health workforces promotes economic growth.13 The COVID-19 pandemic has also revealed the importance of health workers for an effective pandemic response.14 Health worker density and distribution is indicator 3.c.1 of the UN Sustainable Development Goals (SDGs), helping to track the “recruitment, development, training, and retention of health workforce[s]”.15 Additionally, WHO has outlined an ambitious agenda for expanding and improving the quality of health workforces by 2030.16
“Despite this attention, comprehensive national health workforce estimates based on comparable data and standard methods are not available. Numerous studies of health workforces have been done at the national, regional, and subnational levels,17, 18, 19, 20, 21, 22, 23, 24, 25 but these do not present a comprehensive assessment of all or most countries and territories. WHO’s Global Health Observatory releases workforce density data for various countries and cadres, including physicians, nurses and midwives, dentists, pharmacists, and other groupings.26 Gaps in the data and lack of standardisation across sources, however, restrict the comparability of these numbers.27, 28 The Global Health Observatory acts as a repository and WHO density numbers are based on an array of data sources that might differ in their definitions of HRH cadres across contexts. Additionally, many WHO sources are country reports, which might not capture health workers employed in the private sector and might rely on payroll lists from different providers that count the same health worker more than once.29“
Source: GBD 2019 Human Resources for Health Collaborators. Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2022;399(10341):2129-2154. doi:10.1016/S0140-6736(22)00532-3
“In 2019, the global density of physicians was 16.7 (95% UI 12.6–21.6) per 10,000 population (table 1). There was more than a ten-fold difference in median physician densities between the lowest and highest SDI quintiles (figure 1A). Across GBD super-regions, densities ranged from 2.9 (2.1–4.0) per 10,000 population in sub-Saharan Africa to 38·3 (29.0–49.3) per 10,000 population in central Europe, eastern Europe, and central Asia (table 1). Physician densities were 10.8 per 10,000 or lower in sub-Saharan Africa, south Asia, and north Africa and the Middle East, whereas the remaining four GBD super-regions had densities of 19.5 per 10,000 or higher. Sizeable differences existed not only across super-regions33 in 2019, but also within them (figure 2A). Whereas the region of east Asia had a density of 26.5 (19.5–35.1) physicians per 10,000 population, southeast Asia had a density of 7.3 (5.0–10.2) per 10,000 population and Oceania had a density of 2.3 (1.6–3.3) per 10,000 population. Additionally, although eastern Europe had a density of 50.6 (38.8–64.2) per 10,000 population, central Europe had a much lower density of 22.2 (17.2–28.1) per 10,000 population. Even starker national-level differences within regions included Cuba, with a density of 84.4 (62.8–107.6) per 10,000 population, compared to Haiti, with a density of 2.1 (1.4–2.9) per 10,000 population, as well as the United Arab Emirates, with a density of 30.4 (21.4–41.9) per 10,000 population, compared to Afghanistan, with a density of 3.8 (2.6–5.3) per 10,000 population.
“The density of physicians increased globally between 1990 and 2019, with an annualised rate of change of 2.0% (95% UI −0.9 to 5.6). From 1990 to 2019, the GBD super-region encompassing north Africa and the Middle East had the largest annualised rate of change (increasing by 2.7% [0.7 to 5.5]), whereas the high-income super-region had the smallest annualised rate of change (increasing by 1.5% [–0.8 to 2.4]; table 1).
“In comparison, the global density of nurses and midwives in 2019 was 38.6 (95% UI 30.1–48.8) per 10,000 population. A greater than ten-fold difference also existed in median nurse and midwife densities between the lowest and highest SDI quintiles (figure 1B). A large increase in this cadre was observed between the high-middle and high SDI countries. Across super-regions, densities ranged from 9.7 (7.3–12.8) per 10,000 in south Asia to 114.9 (94.7–137.7) per 10,000 population in the high-income super-region (table 1). Differences within super-regions were especially large in the high-income super-region, where a density of 152.3 (116.3–195.9) nurses and midwives per 10,000 population in the Australasia region contrasted with a density of 37.4 (30.2–46.3) per 10,000 population in southern Latin America in 2019. Notable differences at the national level existed within both well-resourced and poorly resourced regions. Japan, with a density of 119.2 (94.7–148.8) nurses and midwives per 10,000 population, contrasted with South Korea’s density of 52.6 (40.7–67.4) per 10,000 population, Botswana’s density of 46.5 (33.3–62.2) nurses and midwives per 10,000 population differed from Lesotho’s density of 32.8 (22.9–44.8) per 10,000 population, and Bhutan had a density of 28.4 (20.1–39.3) nurses and midwives per 10,000 population compared to Pakistan’s density of 8.3 (6.6–10.2) per 10,000 population.
“The density of nurses increased globally between 1990 and 2019, with an annualised rate of change of 2.1% (95% UI −0.7 to 5.5) per 10,000 population. As with physicians, the largest annualised rate of change in nurse and midwife densities at the super-region level from 1990 to 2019 was in north Africa and the Middle East (3.0% [–0.3 to 5.5] per 10,000 population) and the smallest annualised rate was in the high-income super-region (1.4% [–0.8 to 2.4] per 10,000 population).
“To achieve a UHC effective coverage of 80 out of 100 at the global level, the minimum required number of health workers per 10,000 population was 20.7 for physicians, 70.6 for nurses and midwives, 8.2 for dentistry personnel, and 9.4 for pharmaceutical personnel (table 2). By comparison, to achieve a UHC effective coverage of 90, the minimum numbers of health workers per 10,000 population was estimated to be 35.4 for physicians, 114.5 for nurses and midwives, 14.5 for dentistry personnel, and 15.8 for pharmaceutical personnel.”
Source: GBD 2019 Human Resources for Health Collaborators. Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2022;399(10341):2129-2154. doi:10.1016/S0140-6736(22)00532-3
“Globally, the needs-based shortage of health-care workers in 2013 is estimated to be about 17.4 million, of which almost 2.6 million are doctors, over 9 million are nurses and midwives, and the remainder represent all other health worker cadres. The largest needs-based shortages of health workers are in South-East Asia at 6.9 million and Africa at 4.2 million. The shortage in absolute terms is highest in South-East Asia due to the large populations of countries in this Region, but in relative terms (i.e. taking into account population size) the most severe challenges are in the African Region. The global needs-based shortage of health-care workers is projected to be still more than 14 million in 2030 (a decline of only 17%). Hence, current trends of health worker production and employment will not have sufficient impact on reducing the needs-based shortage of health-care workers by 2030, particularly in some countries: in the African Region the needs-based shortage is actually forecast to worsen between 2013 and 2030, while it will remain broadly stable in the Eastern Mediterranean Region.
“Assessing health workforce needs in relation to service requirements in countries of the Organisation for Economic Co-operation and Development (OECD)
“All countries in the OECD have a density of health workers above the SDG index threshold of 4.45 physicians, nurses and midwives per 1000 population. Their health systems, however, have a service delivery profile that goes beyond the provision of essential health services such as those to which the UHC tracer indicators refer.”
Source: World Health Organization. (2016). Global strategy on human resources for health: workforce 2030. World Health Organization.
“Despite repeated claims in the media and in public discussions of ‘growing shortages’ or ‘crisis’, the number of doctors and nurses has never been greater in OECD countries, both in absolute number and on a per capita basis. In 2013, a total of 3.6 million doctors and 10.8 million nurses were employed in OECD countries, up from 2.9 million doctors and 8.3 million nurses in 2000. The number of doctors and nurses has grown more rapidly than the overall population in nearly all countries, so the doctor-to-population and nurse-to-population ratios have increased. On average across OECD countries, there were 3.3 doctors per 1,000 population in 2013, up from 2.7 in 2000 (an increase of 20%), and 9.1 nurses per 1,000 population in 2013, up from 7.8 in 2000 (an increase of 15%).
“The growth in the number of doctors has been particularly rapid in some countries, such as Turkey, Korea and Mexico, which started with relatively low levels in 2000, thereby narrowing the gap with other OECD countries. The number of doctors has also increased strongly in the United Kingdom, by over 50% in absolute terms, so that the number of doctors per population in the United Kingdom now exceeds the number in the United States and Canada, although it still remains below the (rising) OECD average. The number of doctors has also increased in other OECD countries that already had a relatively large number of doctors in 2000 (such as Greece, Austria and Norway), albeit in some cases at a slower pace following the economic crisis that started in 2008-09 (Figure 1).”
Source: OECD (2016), Health Workforce Policies in OECD Countries: Right Jobs, Right Skills, Right Places, OECD Health Policy Studies, OECD Publishing, Paris. dx.doi.org/10.1787/9789264239517-en
“Similarly, the number of nurses has also increased in nearly all OECD countries, both in absolute number and on a per capita basis. This increase has occurred both in countries that had relatively low numbers in 2000 (such as Korea and Portugal) and in other countries that already had relatively high numbers (such as Switzerland, Norway and Denmark), although the growth rate has slowed down in some countries in the post-economic crisis period (such as Estonia, Ireland and Spain).
“The “skill mix” (or to be more precise, the occupational mix), as measured by the number of nurses per doctor, differs widely across OECD countries, reflecting different ways of organising health care delivery and the distribution of tasks among different health care providers. In half of the countries, there were between 2 to 4 nurses per doctor in 2013; yet, this ratio varied from less than one nurse per doctor in Greece to 4.5 nurses per doctor (or over) in Finland, Japan, Ireland and Denmark. Some countries (e.g., Finland, Ireland and the United States) clearly rely more on nurses to do some tasks that are still the prerogative of doctors or other health care providers in others.”
Source: OECD (2016), Health Workforce Policies in OECD Countries: Right Jobs, Right Skills, Right Places, OECD Health Policy Studies, OECD Publishing, Paris. dx.doi.org/10.1787/9789264239517-en
“Nurses tend to be the main providers of primary health care services in many countries, and therefore will have a key role to play in its expansion (1–3). A Cochrane systematic review showed nurses to be effective in the delivery of a wide range of services to address communicable and noncommunicable diseases, including clinical decision-making roles, health care education and preventive services (4). Nurses provide a wide variety of basic nursing services at the primary level, such as wound care, vaccination and health promotion, but are also effective at providing more specialized care, including through nurse-led services (5). For example, nurse-led HIV services (assessment of eligibility for antiretroviral therapy (ART); initial prescriptions for ART; and follow-up care for ART) has been significantly associated with good quality of care and increased retention of HIV patients at 12 months (6). As part of interprofessional primary care teams, nurses lead the coordination of care for patients with complex chronic diseases and work with such patients for 6–12 months to reach stabilization and self-efficacy (7).
“Nurse-led primary care services can, in certain settings and under the right circumstances, lead to similar or in some cases even better patient health outcomes and higher patient satisfaction than traditional care delivery models (4). The same systematic review found that nurses probably also have longer consultations with patients. The introduction of nurse-led heart failure clinics at the primary care level reduced heart failure-related emergency room visits, hospital admissions (by 27%), and the length of stay in the hospital (8). Nurses in Kenya, Malawi and the United Republic of Tanzania demonstrated high productivity in performing trichiasis surgery after training by an expert and with appropriate supervision (9). Increasingly, nurses have a more prominent role in the delivery of primary care: for example, over an eight-year period, the percentage of nurse practitioners in primary care practices in the United States of America rose from 17.6% to 25.2% in rural areas and from 15.9% to 23% in urban areas (10).”
Source: State of the world’s nursing 2020: investing in education, jobs and leadership. Web Annex. Nursing roles in 21st-century health systems. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.
“The LTC [Long Term Care] sector suffers from shortages of workers, and this is likely to get worse in the future. In three-quarters of OECD countries, growth in the number of LTC workers has been outpaced by the growth in numbers of elderly people between 2011 and 2016. Demand for care will likely keep going up and put more pressure on the LTC sector. The number of people aged over 80 years will climb from over 57 million in 2016 to over 1.2 billion in 2050 in 37 OECD countries. Keeping the current ratio of five LTC workers for every 100 people aged 65 and older across OECD countries would imply that the number of workers in the sector will need to increase by 13.5 million by 2040.”
Source: OECD (2020), Who Cares? Attracting and Retaining Care Workers for the Elderly, OECD Health Policy Studies, OECD Publishing, Paris. doi.org/10.1787/92c0ef68-en.
World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other nations.
Page last updated November 29, 2023 by Doug McVay, Editor.
