Background

Human resources for health (HRH) include a range of occupations that aim to promote or improve human health. The UN Sustainable Development Goals (SDGs) and the WHO Health Workforce 2030 strategy have drawn attention to the importance of HRH for achieving policy priorities such as universal health coverage (UHC). Although previous research has found substantial global disparities in HRH, the absence of comparable cross-national estimates of existing workforces has hindered efforts to quantify workforce requirements to meet health system goals. We aimed to use comparable and standardised data sources to estimate HRH densities globally, and to examine the relationship between a subset of HRH cadres and UHC effective coverage performance.

Methods

Through the International Labour Organization and Global Health Data Exchange databases, we identified 1404 country-years of data from labour force surveys and 69 country-years of census data, with detailed microdata on health-related employment. From the WHO National Health Workforce Accounts, we identified 2950 country-years of data. We mapped data from all occupational coding systems to the International Standard Classification of Occupations 1988 (ISCO-88), allowing for standardised estimation of densities for 16 categories of health workers across the full time series. Using data from 1990 to 2019 for 196 of 204 countries and territories, covering seven Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) super-regions and 21 regions, we applied spatiotemporal Gaussian process regression (ST-GPR) to model HRH densities from 1990 to 2019 for all countries and territories. We used stochastic frontier meta-regression to model the relationship between the UHC effective coverage index and densities for the four categories of health workers enumerated in SDG indicator 3.c.1 pertaining to HRH: physicians, nurses and midwives, dentistry personnel, and pharmaceutical personnel. We identified minimum workforce density thresholds required to meet a specified target of 80 out of 100 on the UHC effective coverage index, and quantified national shortages with respect to those minimum thresholds.

Findings

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.

Interpretation

Considerable expansion of the world's health workforce is needed to achieve high levels of UHC effective coverage. The largest shortages are in low-income settings, highlighting the need for increased financing and coordination to train, employ, and retain human resources in the health sector. Actual HRH shortages might be larger than estimated because minimum thresholds for each cadre of health workers are benchmarked on health systems that most efficiently translate human resources into UHC attainment.

Funding

Bill & Melinda Gates Foundation.

中文翻译：

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衡量 1990 年至 2019 年 204 个国家和地区的卫生人力资源可用性及其与全民健康覆盖的关系：对 2019 年全球疾病负担研究的系统分析

背景

卫生人力资源（HRH）包括一系列旨在促进或改善人类健康的职业。联合国可持续发展目标 (SDG) 和世卫组织 2030 年卫生人力战略已引起人们对 HRH 对实现全民健康覆盖 (UHC) 等政策重点的重要性的关注。尽管之前的研究发现全球卫生人力资源存在巨大差异，但缺乏对现有劳动力的可比跨国估计阻碍了量化劳动力需求以实现卫生系统目标的努力。我们旨在使用可比和标准化的数据源来估计全球 HRH 密度，并检查一部分 HRH 干部与 UHC 有效覆盖绩效之间的关系。

方法

通过国际劳工组织和全球健康数据交换数据库，我们确定了来自劳动力调查的 1404 个国家年数据和 69 个国家年的人口普查数据，以及与健康相关的就业的详细微观数据。从世卫组织国家卫生人力账户中，我们确定了 2950 个国家年的数据。我们将来自所有职业编码系统的数据映射到 1988 年国际职业标准分类 (ISCO-88)，以便对整个时间序列中 16 类卫生工作者的密度进行标准化估计。使用 1990 年至 2019 年 204 个国家和地区中的 196 个国家和地区的数据，涵盖 7 个全球疾病负担、伤害和风险因素研究 (GBD) 超级区域和 21 个区域，我们应用时空高斯过程回归 (ST-GPR) 来模拟所有国家和地区从 1990 年到 2019 年的 HRH 密度。我们使用随机前沿元回归来模拟 UHC 有效覆盖指数与与 HRH 相关的 SDG 指标 3.c.1 中列举的四类卫生工作者的密度之间的关系：医生、护士和助产士、牙科人员和制药人员。我们确定了满足 UHC 有效覆盖指数中 100 人中有 80 人的特定目标所需的最低劳动力密度阈值，并量化了与这些最低阈值相关的国家短缺情况。我们使用随机前沿元回归来模拟 UHC 有效覆盖指数与与 HRH 相关的 SDG 指标 3.c.1 中列举的四类卫生工作者的密度之间的关系：医生、护士和助产士、牙科人员和制药人员。我们确定了满足 UHC 有效覆盖指数中 100 人中有 80 人的特定目标所需的最低劳动力密度阈值，并量化了与这些最低阈值相关的国家短缺情况。我们使用随机前沿元回归来模拟 UHC 有效覆盖指数与与 HRH 相关的 SDG 指标 3.c.1 中列举的四类卫生工作者的密度之间的关系：医生、护士和助产士、牙科人员和制药人员。我们确定了满足 UHC 有效覆盖指数中 100 人中有 80 人的特定目标所需的最低劳动力密度阈值，并量化了与这些最低阈值相关的国家短缺情况。

发现

我们估计，在 2019 年，全球有 104·0 百万（95% 不确定区间 83·5–128·0）卫生工作者，其中包括 12·8 百万（9·7–16·6）医生，29·8 百万(23·3–37·7) 护士和助产士、4·6 百万 (3·6–6·0) 牙科人员和 5·2 百万 (4·0–6·7) 制药人员。我们计算出全球医生密度为每 10 000 人 16·7 (12·6–21·6)，护士和助产士密度为每 10 000 人 38·6 (30·1–48·8)。我们发现撒哈拉以南非洲、南亚、北非和中东的 GBD 超级区域的 HRH 密度最低。为了在 UHC 有效覆盖指数上达到 100 人中的 80 人，我们估计，每 10 000 人口中，至少有 20·7 名医生、70·6 名护士和助产士、8·2 名牙科人员和 9·4 名制药人员需要。总共，

解释

要实现高水平的全民健康覆盖有效覆盖，需要大幅扩大世界卫生人力。最大的短缺出现在低收入环境中，这突出表明需要增加融资和协调以培训、雇用和留住卫生部门的人力资源。实际的 HRH 短缺可能比估计的要大，因为每个卫生工作者干部的最低阈值是以最有效地将人力资源转化为 UHC 成就的卫生系统为基准的。

资金

比尔和梅琳达盖茨基金会。