Progress on HRH: Availability

Progress on HRH- Availability_ Kenya 1

Community Health Worker Maryan talks through a lesson on reproductive health with pregnant mother Raha Hassan in Abacore, Kenya.
Credit: Colin Crowley/Save the Children

The availability dimension of human resources for health (HRH) looks at whether there is a sufficient number of health workers, with the relevant competencies and skill-mix to meet the health needs of the population.

Availability is influenced by a country’s capacity to educate, graduate and incentivise young people (particularly girls) with the appropriate knowledge and skills to enter health professional education programmes, and later the health labour market, and to retain them.

In 2006, the World Health Report estimated a global shortage of 4.3 million doctors, midwives, nurses and support workers – or 3.5 million in the 49 poorest countries. Due to limitations with HRH data , the exact scale of the global health workforce shortage is unknown.

The majority of the countries with available data are reporting increases in the numbers of midwives, nurses and physicians: in some of these, however, the net gains in stock are not commensurate with population growth so health worker density may not increase. The Universal Health Coverage (UHC) process of expanding coverage to a larger proportion of the population therefore requires countries to pay more explicit attention to demographic dynamics in HRH planning and forecasting exercises.

In recent years, a lot of emphasis has been placed on measuring HRH density – the number of health workers compared to the total population. As part of setting a new HRH agenda linked to UHC, the Global Health Workforce Alliance has proposed three different thresholds to highlight how many additional health workers may be required to achieve different goals.

Threshold 1 – 22.8 skilled health professionals per 10,000 people is the estimated minimum for a country to achieve relatively high coverage of essential health interventions, including 80% of all births assisted by a skilled birth attendant.

Threshold 2 – 34.5 skilled health professionals per 10,000 people has been recommended by the International Labour Office as the minimum workforce needs to address deficits in population coverage of an expanded health benefits package.

Threshold 3 – 59.4 skilled health professionals per 10,000 people has been introduced to estimate workforce requirements for ending preventable maternal deaths by 2035 (or reducing maternal deaths to a rate of 50 per 100,000 live births as has been achieved by Mexico). Maternal (and neonatal) mortality is proposed as a potential tracer indicator for UHC.

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Based on the latest available data, it is clear that many countries have a long way to go to reach even the lowest of these thresholds. Two-thirds of countries – particularly low and middle-income countries – will face considerable challenges in addressing HRH deficits and scaling up to the level needed to end preventable maternal deaths. HRH density in the richest 20% of countries is 10 times higher than poorest 20% of countries. The poorest countries will therefore continue to require external assistance in order to scale up their health workforces.

Visit the Country Profiles page  to see how the health workforce-to-population ratio varies between countries

The availability of health workers is also determined by mobility. A number of richer countries remain dependent  on foreign workers to avoid health worker shortages. Further efforts required to accelerate implementation of the Global Code of Practice on the International Recruitment of Health Personnel . In 2013, only 36 out of 53 EU Members States, and one African country reported on any activity to implement the Code.