Health sector employment: a tracer indicator for universal health coverage in national Social Protection Floors

Abstract

Background: Health sector employment is a prerequisite for availability, accessibility, acceptability and quality (AAAQ) of health services. Thus, in this article health worker shortages are used as a tracer indicator estimating the proportion of the population lacking access to such services: The SAD (ILO Staff Access Deficit Indicator) estimates gaps towards UHC in the context of Social Protection Floors (SPFs). Further, it highlights the impact of investments in health sector employment equity and sustainable development.

Methods: The SAD is used to estimate the share of the population lacking access to health services due to gaps in the number of skilled health workers. It is based on the difference of the density of the skilled health workforce per population in a given country and a threshold indicating UHC staffing requirements. It identifies deficits, differences and developments in access at global, regional and national levels and between rural and urban areas.

Results: In 2014, the global UHC deficit in numbers of health workers is estimated at 10.3 million, with most important gaps in Asia (7.1 million) and Africa (2.8 million). Globally, 97 countries are understaffed with significantly higher gaps in rural than in urban areas. Most affected are low-income countries, where 84 per cent of the population remains excluded from access due to the lack of skilled health workers. A positive correlation of health worker employment and population health outcomes could be identified. Legislation is found to be a prerequisite for closing access as gaps.

Conclusions: Health worker shortages hamper the achievement of UHC and aggravate weaknesses of health systems. They have major impacts on socio-economic development, particularly in the world's poorest countries where they act as drivers of health inequities. Closing the gaps by establishing inclusive multi-sectoral policy approaches based on the right to health would significantly increase equity, reduce poverty due to ill health and ultimately contribute to sustainable development and social justice.

Figure 1

Indicators for UHC in the context of SPFs [ 3 ].

Figure 2

Estimated number of health workers required to close global and regional gaps for UHC (ILO threshold 41.1 health workers per 10 000 population in 2014).

Figure 3

Percentage of population globally not covered due to deficits in health workforce employment (per cent of population without access to quality health services in 2014).

Figure 4

Estimates of coverage gaps (in per cent of population) due to health workforce shortages, by income level of countries (ILO threshold 41.1 health workers per 10 000 population in 2014).

Figure 5

Rural/urban coverage gaps due to staff access deficit, by region.

Figure 6

Maternal mortality ratios and global gaps in health sector employment.

Figure 7

Legal health protection and gaps in health sector employment in low- and lower middle-income countries.