What are the latest statistics on health workforce availability? Why does the latest HRH report (A Universal Truth – No health without a Workforce, 2013) use a different threshold (33.45/10’000) from the WHO 2006 report(22.8/10’000)?
The 22.8/10,000 population threshold was identified in 2006 to partly illustrate the global shortage of health workers in relation to the objective of delivering essential health services of relevance to the MDGs – primarily MDG 4 and 5. The HRH ‘crisis’ category refers to two dimensions: density of skilled health professionals less than 22.8/10,000 population and deliveries by skilled birth attendants less than 80%; so low HRH density and low service coverage together. Using this threshold the WHR 2006 identified a shortage of 4.3 million health workers.
Almost a decade later, the threshold of 34.5 skilled health professionals (midwives, nurses and physicians) per 10,000 population has emerged in the discourse on universal health coverage, based on the density of health professionals of a country (Thailand) which has attained very high coverage of a broader range of health services. This threshold comes from analysis conducted by the International Labour Organization in support of its regulation on Social Protection, the World Social Security Statistics 2010/2011. There are currently 100 countries with a density of skilled health professionals below this threshold, translating in a total shortage of about 7.2 million skilled health professionals.
Based on projections of a simple model entirely driven by population growth, this gap would increase to 12.9 million by 2035.
It is important to note that none of these thresholds are meant to be planning targets, but rather are used to illustrate the variance in HRH availability, and the magnitude of challenges that lie ahead, calling for transformative approaches to planning, education and management of the health workforce.
Thresholds identified to allow comparisons and promote dialogue at global level however have limitations in terms of their use to national policy makers. What is needed is a move towards context-specific identification of needs and opportunities, so that countries can rather set their own benchmarks, assess progress, and revise them over time as required and as they broaden the scope of health services they intend to provide to the population.