Human resources for health
- Number of physicians (per 10 000 population)
- Number of nursing and midwifery personnel (per 10 000 population)
- Number of dentistry personnel (per 10 000 population)
- Number of pharmaceutical personnel (per 10 000 population)
- Number of environmental and public health workers(per 10 000 population)
- Number of community and traditional health workers (per 10 000 population)
- Number of laboratory health workers (per 10 000 population)
- Number of other health service providers (per 10 000 population)
- Ratio of nurses and midwives to physicians
- Ratio of health management and support workers to health service providers
Rationale for use
Preparing the health workforce to work towards the attainment of a country's health objectives represents one of the most important challenges for its health system. Methodologically, there are no gold standards for assessing the sufficiency of the health workforce to address the health care needs of a given population. It has been estimated, however, that countries with fewer than 25 health care professionals (counting only physicians, nurses and midwives) per 10 000 population failed to achieve adequate coverage rates for selected primary health care interventions as prioritized by the Millennium Development Goals framework (WHO 2006). In addition, for every physician, nurse and midwife there are on average about another 1.8 health service providers of different cadres, such as pharmacists, laboratory technicians and community health workers. It is also estimated that about one third of the global health workforce is composed of health management and support workers, who do not provide services directly but are essential to the performance of health systems. Measuring the skills mix of the health workforce offers a means of assessing the combination of categories of personnel at a specific time and identifying possible imbalances related to a disparity in the numbers of the various health professions. Statistics on skills mix can help inform strategies to ensure the most appropriate and cost-effective combination of roles and staff.
Definition
Estimates of the stock (absolute numbers), density (per 10 000 population) and skills mix of the health workforce are available here for 193 WHO Member States. National-level data refer to the active health workforce, that is, all people currently participating in the health labour market. Various permutations and combinations of what constitutes the health workforce potentially exist, depending on each country's situation and the means of measurement. The present selection of indicators reflects a framework for harmonizing the boundaries and constituency of the health workforce across contexts.
Physicians: includes generalists and specialists.
Nursing and midwifery personnel: includes professional nurses, professional midwives, auxiliary nurses, auxiliary midwives, enrolled nurses, enrolled midwives and other personnel, such as dental nurses and primary care nurses. Traditional birth attendants included here but as community/traditional health workers (see below).
Dentistry personnel: includes dentists, dental assistants and dental technicians.
Pharmaceutical personnel: includes pharmacists, pharmaceutical assistants, pharmaceutical technicians and related occupations.
Environment and public health workers: includes environmental and public health officers, environmental and public health technicians, sanitarians, hygienists, district health officers, public health inspectors, food inspectors, malaria inspectors and similar professions.
Community and traditional health workers: includes community health officers, community health education workers, community health aides, family health workers, lady health visitors, health extension package workers, traditional and complementary medicine practitioners, community midwives, traditional birth attendants and associated occupations.
Laboratory health workers: includes laboratory scientists, laboratory assistants, laboratory technicians, radiographers and related occupations.
Other health service providers: includes a large range of other cadres of health service provider such as medical assistants, dieticians and nutritionists, occupational therapists, operators of medical and dentistry equipment, optometrists and opticians, physiotherapists, podiatrists, personal care workers, psychologists, respiratory therapists, speech pathologists, and medical trainees and interns.
Health management and support workers: includes other categories of health systems personnel, such as managers of health and personal care services, health economists, health statisticians, health policy lawyers, medical records and health information technicians, ambulance drivers, building maintenance staff, and other general management and support staff.
Associated terms
The classification of health workers given above is based on criteria for vocational education and training, regulation of health professions, and the activities and tasks involved in carrying out a job, i.e. a framework for categorizing key workforce variables according to shared characteristics. The WHO framework draws on the latest revisions to the internationally standardized classification systems of the International Labour Organization (International Standard Classification of Occupations), the United Nations Educational, Scientific and Cultural Organization (International Standard Classification of Education) and the United Nations Statistics Division (International Standard Industrial Classification of All Economic Activities).
Data sources
The information needed to describe the characteristics of the health workforce and monitor its development over time can be generated from a multitude of statistical sources and cover many areas (such as occupation, vocational education and training, and industry of employment). The data presented here were compiled from four major sources: national population censuses, labour force and employment surveys, health facility assessments and routine administrative information systems (including registries on public expenditure, staffing and payroll as well as professional training, registration and licensure). Most of the data from administrative sources are derived from official country reports to WHO regional offices or WHO headquarters.
While much effort has been made to harmonize the data to enhance cross-national comparability, the diversity of sources means that considerable variability remains across countries in the coverage, quality and reference year of the original data. In particular, for some countries the available information from official sources does not make it clear whether both the public and private sectors are included. Data derived from population censuses, and on physicians and nursing and midwifery personnel, are generally the most complete and comparable information on human resources in health systems; data on health management and support workers tend to be the least complete.
Methods of estimation
The methods of estimation for stock and density of the health workforce depend on the nature of the original data source. Enumeration of health workers from census data is a simple count of the number of people with a health-related occupation and/or working in the health services industry. A similar method is used for counting health workers from labour force survey data, with the additional application of a sampling weight to calibrate for national representation. Data from health facility assessments and routine information sources may be based on head counts of employees, duty rosters, staffing records, payroll records, registries of health professional regulatory bodies, or tallies from other types of administrative and professional records.
In general, the denominator data for health workforce density (i.e. national population estimates) were obtained from the United Nations Population Division's "World population prospects" database. In some cases the official report provided only workforce density indicators, from which estimates of the stock were then calculated.
Disaggregation
Data disaggregated for up to 18 occupational categories are not included here but can be accessed for some countries from the WHO Global Atlas of the Health Workforce. Data disaggregated by age, sex and urban/rural are also available from this source for some countries.
References
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The world health report 2006 – working together for health.
Geneva, World Health Organization, 2006 -
The world health report 2006 papers. Follow-up to The world health report 2006
Geneva, World Health Organization, 2006
Database
Comments
Some figures may be underestimated or overestimated when it is not possible to distinguish whether the data include health workers in the private sector, double counts of health workers holding two or more jobs at different locations, health service providers working outside the health care sector (e.g. nurses working in a school or large private company), workers who are unpaid or unregulated but performing health care tasks (e.g. volunteer community health workers) or people with health vocational training who are not currently engaged in the national health labour market (e.g. unemployed, migrated, retired or withdrawn from the labour force for personal reasons).