Health workers count, but are we counting them?

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Nurse handing out drugs to mothers at the Paediatric Ward of the Mchinji District Hospital, Malawi.

The WHO Global Health Observatory reports health workforce data for 186 countries and was most recently updated in July 2013. This data is used to monitor national-level progress – for example by Countdown to 2015 – and to report against global commitments such as the one made by the G8 in 2008.

However, human resource information systems are often very weak. Few countries have a comprehensive and valid information base on health workers. Many countries do not collect data on midwives, nurses and physicians on a regular basis. Other important categories of health workers, such as community health workers, are often completely uncounted.

Despite a ‘decade of action’ on HRH there has been a reduction in the reported data since 2004 (the year WHO led a focused effort to capture data on HRH for the 2006 world health report). A number of key countries have reported no new data from the past five years.

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Data that is collected is mostly for public sector workers, hiding information about health workers employed by the private sector, non-governmental organisations and the military – either exclusively, or in addition to working for the public sector. From the available data, it is not possible to determine which health workers are actually practicing or which are registered but not currently employed.

These limitations all pose considerable challenges for both policymakers and those actors interested in holding decision-makers to account. Despite recognising the critical importance of health workers, we can’t say with certainty how many there are, where they are and how many more are needed. It is therefore crucial that national governments and the international community work together to ensure that all health workers are counted on a regular basis.