The Global Health Observatory
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The WHO Global Strategy on Human Resources for Health: Workforce 2030 sets out the policy agenda to ensure a workforce that is fit for purpose to attain the targets of the Sustainable Development Goals (SDGs). One of its objectives is primarily linked to strengthening data on human resources for health.
Health worker density, with respect to each occupation, provides a view of the level of healthcare workforce available in a given area such that efforts to increase the recruitment, development, training and retention of this workforce can be undertaken in places that need it.
The attainment of an adequate, effective, and sustainable health workforce is essential to achieving Immunization Agenda 2030, Primary Health Care, and Universal Health Coverage goals. This indicator will show whether disparities between countries and regions remain fixed over the course of the decade, or whether efforts to shore up the health workforce, particularly in light of pandemic-related strain, will reduce disparities. While this indicator does not display trend data, the likely negative effect of the COVID pandemic on the health workforce is of concern and efforts to expand and maintain an effective workforce is critical.
• Numerator: Number of physicians, nurses and midwives*, defined in headcounts, multiplied by 10,000
• Denominator: Total estimated population size
*Depending on the original data source, this may include personnel who are active only, or all personnel registered in the relevant health occupations.
• Baseline year: 2020
Physicians: Individuals with the following occupations: generalists, specialist medical practitioners and medical doctors. The International Standard Classification of Occupations 8th revision (ISCO-08) from the International Labour Organization (ILO) unit group codes included in this category are 221, 2211, 2212.
Nursing and midwifery personnel: Individuals with the following occupations: nursing professionals, nursing associate professionals, midwifery professionals, midwifery associate professionals and related occupations. The ISCO-08 unit group codes included in this category are 2221, 2222, 3221 and 3222.
Population estimates: Civil registration and vital statistics (CRVS) systems, population censuses or registers, population registers, household surveys
• For detailed metadata and definitions, refer to the National Health Workforce Accounts (NHWA) Handbook
Step 2: Sum the total number of medical doctors, nursing personnel, and midwifery personnel for each WHO Member State.
• Prevent “double counting” health personnel listed for certain Member States by removing midwifery counts from this sum for Member States where midwives are already included in the density of nursing personnel due to changes in classification.
Step 3: Extract the latest national population estimates from the most recent revision of United Nations Population Division’s World Population Prospects (UNPD WPP) database.
• In general, the denominator data for workforce density (i.e., national population estimates) are obtained from the United Nations Population Division's World Population Prospects database. In cases where the official health workforce report provides density indicators instead of counts, estimates of the stock were then calculated using the population estimated from the United Nations Population Division's World population prospects database (2017).
Steps 4 and 5 are only for computing regional or global averages
Step 4: Calculate a population-weighted average of density for each Member State by multiplying the density (per 10,000 population) of specified health personnel by the latest UNPD WPP estimate of national population size
• Additional information on data sources for each country and methodology to calculate WPP estimates can be found on the UNPD WPP website here. Estimates are based on all available data sources on population size and composition and levels of fertility, mortality and international migration, which are evaluated and adjusted as needed. In countries where no or minimal data is available for trends in population change, demographic and statistical models are employed.
Step 5: To calculate global and regional aggregate densities, divide the sum of UNPD WPP population estimates for all Member States in a particular area (global or regional) by the sum of population-weighted densities (density per 10,000 population multiplied by estimated population size) of all Member States in the same area.
Averages for a geographic area are computed by pooling all available national densities plus estimated values for countries with missing values for the previous five years, based on neighboring comparable countries.
• Data on health workers tend to be more complete for the public health sector and may underestimate the active workforce in the private, military, nongovernmental organization and faith-based health sectors. In many cases, information maintained at the national regulatory bodies and professional councils is not updated.
• As data is not always published annually for each country, the latest available data has been used. Due to the differences in data sources, considerable variability remains across countries in the coverage, periodicity, quality and completeness of the original data. Densities are calculated using national population estimates from the United Nations Population Division's World Population Prospects database and may vary from densities produced by the country.
• Continuous data quality improvement processes and country data updates may result in observed differences across versions of data published on the NHWA data portal.
Limitations on population estimates can be found on the WPP website, and include:
• Variability in reliability and timeliness of demographic data (e.g., if a recent census is not available for a country, estimates are projected using historical data)