Health workforce metrics pre- and post-2015: a stimulus to public policy and planning

Abstract

Background: Evidence-based health workforce policies are essential to ensure the provision of high-quality health services and to support the attainment of universal health coverage (UHC). This paper describes the main characteristics of available health workforce data for 74 of the 75 countries identified under the 'Countdown to 2015' initiative as accounting for more than 95% of the world's maternal, newborn and child deaths. It also discusses best practices in the development of health workforce metrics post-2015.

Methods: Using available health workforce data from the Global Health Workforce Statistics database from the Global Health Observatory, we generated descriptive statistics to explore the current status, recent trends in the number of skilled health professionals (SHPs: physicians, nurses, midwives) per 10 000 population, and future requirements to achieve adequate levels of health care in the 74 countries. A rapid literature review was conducted to obtain an overview of the types of methods and the types of data sources used in human resources for health (HRH) studies.

Results: There are large intercountry and interregional differences in the density of SHPs to progress towards UHC in Countdown countries: a median of 10.2 per 10 000 population with range 1.6 to 142 per 10 000. Substantial efforts have been made in some countries to increase the availability of SHPs as shown by a positive average exponential growth rate (AEGR) in SHPs in 51% of Countdown countries for which there are data. Many of these countries will require large investments to achieve levels of workforce availability commensurate with UHC and the health-related sustainable development goals (SDGs). The availability, quality and comparability of global health workforce metrics remain limited. Most published workforce studies are descriptive, but more sophisticated needs-based workforce planning methods are being developed.

Conclusions: There is a need for high-quality, comprehensive, interoperable sources of HRH data to support all policies towards UHC and the health-related SDGs. The recent WHO-led initiative of supporting countries in the development of National Health Workforce Accounts is a very promising move towards purposive health workforce metrics post-2015. Such data will allow more countries to apply the latest methods for health workforce planning.

Keywords: Countdown; Data; Densities; Health systems; Health workforce; Low- and middle-income countries; Metrics; Sustainable development goals; Universal health coverage.

Fig. 1

Mapping of 74 countries based on the established SHP density thresholds, most recent available year (list of countries in the Additional file 1)

Fig. 2

Number of physicians, nurses and midwives per 10 000 population in 74 countries, by UNICEF region

Fig. 3

Number of physicians, nurses and midwives per 10 000 population in 74 countries, by World Bank income group

Fig. 4

Median maternal mortality ratio (MMR), by quintiles of number of physicians, nurses and midwives per 10 000 population

Fig. 5

Median stillbirth, neonatal mortality and under-5 mortality rates, by quintiles of number of physicians, nurses and midwives per 10 000 population

Fig. 6

Median postnatal care coverage/median skilled birth attendance coverage/median antenatal care coverage by quintile of number of physicians, nurses and midwives per 10 000 population

Fig. 7

Average exponential growth rate (AEGR) in number of physicians, nurses and midwives per 10 000 population for 53 Countdown countries with more than one data point between 2004 and the latest available year

Fig. 8

Average exponential growth rate (AEGR) in the number of physicians, nurses and midwives per 10 000 population for 53 Countdown countries with more than one data point between 2004 and the latest available year, by UNICEF region

Fig. 9

Average exponential growth rate (AEGR) in the number of physicians, nurses and midwives in 32 Countdown countries with positive change between 2004 and the latest available year, by UNICEF region

Fig. 10

Average exponential growth rate (AEGR) in the number of (a) nurses and midwives and (b) physicians for 52 Countdown countries with positive change between 2004 and the latest available year, and data disaggregated by cadre

Fig. 11

Average exponential growth rate (AEGR) in the number of physicians, nurses and midwives required to reach 44.5 per 10 000 population by 2030 for the 63 Countdown countries currently below this threshold, by UNICEF region