Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019

Annie Haakenstad; Caleb Mackay Salpeter Irvine; Megan Knight; Corinne Bintz; Aleksandr Y. Aravkin; Peng Zheng; Vin Gupta; Michael R. M. Abrigo; Abdelrahman Abushouk; Oladimeji M. Adebayo; Gina Agarwal; Fares Alahdab; Ziyad Al-Aly; Khurshid Alam; Turki M. Alanzi; Jacqueline Elizabeth Alcalde-Rabanal; Vahid Alipour; Nelson Alvis-Guzman; Arianna Maever L. Amit; Catalina Liliana Andrei; Tudorel Andrei; Carl Abelardo T. Antonio; Jalal Arabloo; Olatunde Aremu; Martin Amogre Ayanore; Maciej Banach; Till Winfried Barnighausen; Celine M. Barthelemy; Mohsen Bayati; Habib Benzian; Adam E. Berman; Kelly Bienhoff; Ali Bijani; Boris Bikbov; Antonio Biondi; Archith Boloor; Reinhard Busse; Zahid A. Butt; Luis Alberto Camera; Ismael R. Campos-Nonato; Rosario Cardenas; Felix Carvalho; Collins Chansa; Soosanna Kumary Chattu; Vijay Kumar Chattu; Dinh-Toi Chu; Xiaochen Dai; Lalit Dandona; Rakhi Dandona; William James Dangel; Ahmad Daryani; Jan-Walter De Neve; Meghnath Dhimal; Isaac Oluwafemi Dipeolu; Shirin Djalalinia; Hoa Thi Do; Chirag P. Doshi; Leila Doshmangir; Elham Ehsani-Chimeh; Maha El Tantawi; Eduarda Fernandes; Florian Fischer; Nataliya A. Foigt; Artem Alekseevich Fomenkov; Masoud Foroutan; Takeshi Fukumoto; Nancy Fullman; Mohamed M. Gad; Keyghobad Ghadiri; Mansour Ghafourifard; Ahmad Ghashghaee; Thomas Glucksman; Houman Goudarzi; Rajat Das Gupta; Randah R. Hamadeh; Samer Hamidi; Josep Maria Haro; Edris Hasanpoor; Simon Hay; Mohamed Hegazy; Behzad Heibati; Nathaniel J. Henry; Michael K. Hole; Naznin Hossain; Mowafa Househ; Olayinka Stephen Ilesanmi; Mohammad-Hasan Imani-Nasab; Seyed Sina Naghibi Irvani; Sheikh Mohammed Shariful Islam; Mohammad Ali Jahani; Ankur Joshi; Rohollah Kalhor; Gbenga A. Kayode; Nauman Khalid; Khaled Khatab; Adnan Kisa; Sonali Kochhar; Kewal Krishan; Barthelemy Kuate Defo; Dharmesh Kumar Lal; Faris Hasan Lami; Anders O. Larsson; Janet L. Leasher; Kate E. LeGrand; Lee-Ling Lim; Narayan B. Mahotra; Azeem Majeed; Afshin Maleki; Narayana Manjunatha; Benjamin Ballard Massenburg; Tomislav Mestrovic; G. K. Mini; Andreea Mirica; Erkin M. Mirrakhimov; Yousef Mohammad; Shafiu Mohammed; Ali H. Mokdad; Shane Douglas Morrison; Mohsen Naghavi; Duduzile Edith Ndwandwe; Ionut Negoi; Ruxandra Irina Negoi; Josephine W. Ngunjiri; Cuong Tat Nguyen; Yeshambel T. Nigatu; Obinna E. Onwujekwe; Doris Ortega-Altamirano; Nikita Otstavnov; Stanislav S. Otstavnov; Mayowa O. Owolabi; Abhijit P. Pakhare; Veincent Christian Filipino Pepito; Norberto Perico; Hai Quang Pham; David M. Pigott; Khem Narayan Pokhrel; Mohammad Rabiee; Navid Rabiee; Vafa Rahimi-Movaghar; David Laith Rawaf; Salman Rawaf; Lal Rawal; Giuseppe Remuzzi; Andre M. N. Renzaho; Serge Resnikoff; Nima Rezaei; Aziz Rezapour; Jennifer Rickard; Leonardo Roever; Maitreyi Sahu; Abdallah M. Samy; Juan Sanabria; Milena M. Santric-Milicevic; Sivan Yegnanarayana Iyer Saraswathy; Soraya Seedat; Subramanian Senthilkumaran; Edson Servan-Mori; Masood Ali Shaikh; Aziz Sheikh; Diego Augusto Santos Silva; Caroline Stein; Dan J. Stein; Mariya Vladimirovna Titova; Stephanie M. Topp; Marcos Roberto Tovani-Palone; Saif Ullah; Bhaskaran Unnikrishnan; Marco Vacante; Pascual R. Valdez; Tommi Juhani Vasankari; Narayanaswamy Venketasubramanian; Vasily Vlassov; Theo Vos; Jamal Akeem Yearwood; Naohiro Yonemoto; Mustafa Z. Younis; Chuanhua Yu; Siddhesh Zadey; Sojib Bin Zaman; Taddese Alemu Zerfu; Zhi-Jiang Zhang; Arash Ziapour; Sanjay Zodpey; Stephen S. Lim; Christopher J. L. Murray; Rafael Lozano; GBD 2019 Human Resources for Health Collaborators

doi:10.1016/S0140-6736(22)00532-3

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Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019

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Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019

Annie Haakenstad, Caleb Mackay Salpeter Irvine, Megan Knight, Corinne Bintz, Aleksandr Y. Aravkin, Peng Zheng, Vin Gupta, Michael R. M. Abrigo, Abdelrahman Abushouk, Oladimeji M. Adebayo, …

The Lancet (British edition), Vol.399(10341), pp.2129-2154

04/06/2022

DOI: https://doi.org/10.1016/S0140-6736(22)00532-3

PMID: 35617980

Abstract

General & Internal Medicine

Life Sciences & Biomedicine

Medicine, General & Internal

Science & Technology

Background Human resources for health (HRH) include a range of occupations that aim to promote or improve human health. The UN Sustainable Development Goals (SDGs) and the WHO Health Workforce 2030 strategy have drawn attention to the importance of HRH for achieving policy priorities such as universal health coverage (UHC). Although previous research has found substantial global disparities in HRH, the absence of comparable crossnational estimates of existing workforces has hindered efforts to quantify workforce requirements to meet health system goals. We aimed to use comparable and standardised data sources to estimate HRH densities globally, and to examine the relationship between a subset of HRH cadres and UHC effective coverage performance. Methods Through the International Labour Organization and Global Health Data Exchange databases, we identified 1404 country-years of data from labour force surveys and 69 country-years of census data, with detailed microdata on health-related employment. From the WHO National Health Workforce Accounts, we identified 2950 country-years of data. We mapped data from all occupational coding systems to the International Standard Classification of Occupations 1988 (ISCO-88), allowing for standardised estimation of densities for 16 categories of health workers across the full time series. Using data from 1990 to 2019 for 196 of 204 countries and territories, covering seven Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) super-regions and 21 regions, we applied spatiotemporal Gaussian process regression (ST- GPR) to model HRH densities from 1990 to 2019 for all countries and territories. We used stochastic frontier meta-regression to model the relationship between the UHC effective coverage index and densities for the four categories of health workers enumerated in SDG indicator 3.c. 1 pertaining to HRH: physicians, nurses and midwives, dentistry personnel, and pharmaceutical personnel. We identified minimum workforce density thresholds required to meet a specified target of 80 out of 100 on the UHC effective coverage index, and quantified national shortages with respect to those minimum thresholds. Findings We estimated that, in 2019, the world had 104.0 million (95% uncertainty interval 83.5-128.0) health workers, including 12.8 million (9.7-16.6) physicians, 29.8 million (23.3-37.7) nurses and midwives, 4.6 million (3.6-6.0) dentistry personnel, and 5.2 million (4.0-6.7) pharmaceutical personnel. We calculated a global physician density of 16.7 (12.6-21.6) per 10 000 population, and a nurse and midwife density of 38.6 (30.1-48.8) per 10 000 population. We found the GBD super-regions of sub-Saharan Africa, south Asia, and north Africa and the Middle East had the lowest HRH densities. To reach 80 out of 100 on the UHC effective coverage index, we estimated that, per 10 000 population, at least 20.7 physicians, 70.6 nurses and midwives, 8.2 dentistry personnel, and 9.4 pharmaceutical personnel would be needed. In total, the 2019 national health workforces fell short of these minimum thresholds by 6.4 million physicians, 30.6 million nurses and midwives, 3.3 million dentistry personnel, and 2.9 million pharmaceutical personnel. Interpretation Considerable expansion of the world's health workforce is needed to achieve high levels of UHC effective coverage. The largest shortages are in low-income settings, highlighting the need for increased financing and coordination to train, employ, and retain human resources in the health sector. Actual HRH shortages might be larger than estimated because minimum thresholds for each cadre of health workers are benchmarked on health systems that most efficiently translate human resources into UHC attainment. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.

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Title: Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019
Creators - without role: Annie Haakenstad - University of Washington
Caleb Mackay Salpeter Irvine - University of Washington
Megan Knight - University of Washington
Corinne Bintz - University of Washington
Aleksandr Y. Aravkin - University of Washington
Peng Zheng - University of Washington
Vin Gupta - University of Washington
Michael R. M. Abrigo - Philippine Inst Dev Studies, Dept Res, Quezon City, Philippines
Abdelrahman Abushouk - Harvard University
Oladimeji M. Adebayo - College Station Medical Center
Gina Agarwal - McMaster University
Fares Alahdab - Evidence
Ziyad Al-Aly - College Station Medical Center
Khurshid Alam - Murdoch University
Turki M. Alanzi - Imam Abdulrahman Bin Faisal University
Jacqueline Elizabeth Alcalde-Rabanal - Natl Inst Publ Hlth, Ctr Hlth Syst Res, Cuernavaca, Morelos, Mexico
Vahid Alipour - College Station Medical Center
Nelson Alvis-Guzman - University of the Coast
Arianna Maever L. Amit - Supreme Council Of Health
Catalina Liliana Andrei - College Station Medical Center
Tudorel Andrei - Bucharest Univ Econ Studies, Dept Stat & Econometr, Bucharest, Romania
Carl Abelardo T. Antonio - University of the Philippines Manila
Jalal Arabloo - College Station Medical Center
Olatunde Aremu - Birmingham City University
Martin Amogre Ayanore - Univ Hlth & Allied Sci, Dept Hlth Policy Planning & Management, Ho, Ghana
Maciej Banach - College Station Medical Center
Till Winfried Barnighausen - Harvard University
Celine M. Barthelemy - University of Washington
Mohsen Bayati - Shiraz University
Habib Benzian - NYU, Dept Epidemiol & Hlth Promot, New York, NY USA
Adam E. Berman - Augusta University
Kelly Bienhoff - University of Washington
Ali Bijani - College Station Medical Center
Boris Bikbov - Mario Negri Inst Pharmacol Res, Ranica, Italy
Antonio Biondi - University of Catania
Archith Boloor - College Station Medical Center
Reinhard Busse - Tech Univ Berlin, Dept Hlth Care Management, Berlin, Germany
Zahid A. Butt - University of Waterloo
Luis Alberto Camera - College Station Medical Center
Ismael R. Campos-Nonato - Natl Inst Publ Hlth, Hlth & Nutr Res Ctr, Cuernavaca, Morelos, Mexico
Rosario Cardenas - Metropolitan Autonomous Univ, Dept Hlth Care, Mexico City, DF, Mexico
Felix Carvalho - Universidade do Porto
Collins Chansa - Heidelberg Univ, Heidelberg Inst Global Hlth HIGH, Heidelberg, Germany
Soosanna Kumary Chattu - Texila Amer Univ, Dept Publ Hlth, Georgetown, Guyana
Vijay Kumar Chattu - College Station Medical Center
Dinh-Toi Chu - Supreme Council Of Health
Xiaochen Dai - University of Washington
Lalit Dandona - University of Washington
Rakhi Dandona - University of Washington
William James Dangel - University of Washington
Ahmad Daryani - College Station Medical Center
Jan-Walter De Neve - Heidelberg Univ, Heidelberg Inst Global Hlth HIGH, Heidelberg, Germany
Meghnath Dhimal - Nepal Hlth Res Council, Hlth Res Sect, Kathmandu, Nepal
Isaac Oluwafemi Dipeolu - University of Ibadan
Shirin Djalalinia - College Station Medical Center
Hoa Thi Do - Inst Hlth Econ & Technol, Hanoi, Vietnam
Chirag P. Doshi - Supreme Council Of Health
Leila Doshmangir - College Station Medical Center
Elham Ehsani-Chimeh - Natl Inst Hlth Res, Tehran, Iran
Maha El Tantawi - Alexandria University
Eduarda Fernandes - Universidade do Porto
Florian Fischer - Charité - Universitätsmedizin Berlin
Nataliya A. Foigt - College Station Medical Center
Artem Alekseevich Fomenkov - Plant
Masoud Foroutan - College Station Medical Center
Takeshi Fukumoto - Kobe University
Nancy Fullman - University of Washington
Mohamed M. Gad - College Station Medical Center
Keyghobad Ghadiri - College Station Medical Center
Mansour Ghafourifard - College Station Medical Center
Ahmad Ghashghaee - Supreme Council Of Health
Thomas Glucksman - University of Washington
Houman Goudarzi - Hokkaido University
Rajat Das Gupta - University of South Carolina
Randah R. Hamadeh - Arabian Gulf University
Samer Hamidi - Hamdan Bin Mohammed Smart University
Josep Maria Haro - Universitat de Barcelona
Edris Hasanpoor - College Station Medical Center
Simon Hay - University of Washington
Mohamed Hegazy - Cairo University
Behzad Heibati - University of Oulu
Nathaniel J. Henry - University of Oxford
Michael K. Hole - Univ Texas Austin, Dept Pediat, Austin, TX USA
Naznin Hossain - Bangladesh Ind Gases, Dept Pharmacol, Tangail, Bangladesh
Mowafa Househ - Hamad bin Khalifa University
Olayinka Stephen Ilesanmi - College Station Medical Center
Mohammad-Hasan Imani-Nasab - Lorestan University
Seyed Sina Naghibi Irvani
Sheikh Mohammed Shariful Islam - Deakin University
Mohammad Ali Jahani - College Station Medical Center
Ankur Joshi - College Station Medical Center
Rohollah Kalhor - College Station Medical Center
Gbenga A. Kayode - Int Res Ctr Excellence, Inst Human Virol Nigeria, Abuja, Nigeria
Nauman Khalid - Supreme Council Of Health
Khaled Khatab - Sheffield Hallam University
Adnan Kisa - Supreme Council Of Health
Sonali Kochhar - University of Washington
Kewal Krishan - Panjab University
Barthelemy Kuate Defo - Univ Montreal, Dept Demog, Montreal, PQ, Canada
Dharmesh Kumar Lal - Publ Hlth Fdn India, Gurugram, India
Faris Hasan Lami - University of Baghdad
Anders O. Larsson - Uppsala University
Janet L. Leasher - Nova Southeastern University
Kate E. LeGrand - University of Washington
Lee-Ling Lim - Univ Malaya, Dept Med, Kuala Lumpur, Malaysia
Narayan B. Mahotra - Tribhuvan University
Azeem Majeed - Imperial Coll London, Dept Primary Care & Publ Hlth, London, England
Afshin Maleki - University of Tehran
Narayana Manjunatha - Natl Inst Mental Hlth & Neurosci, Dept Psychiat, Bengalore, India
Benjamin Ballard Massenburg - University of Washington
Tomislav Mestrovic - University of Washington
G. K. Mini - Ananthapuri Hosp & Res Inst, Global Inst Publ Hlth, Trivandrum, Kerala, India
Andreea Mirica - Bucharest Univ Econ Studies, Dept Stat & Econometr, Bucharest, Romania
Erkin M. Mirrakhimov - College Station Medical Center
Yousef Mohammad - King Saud University
Shafiu Mohammed - Tech Univ Berlin, Dept Hlth Care Management, Berlin, Germany
Ali H. Mokdad - University of Washington
Shane Douglas Morrison - University of Washington
Mohsen Naghavi - University of Washington
Duduzile Edith Ndwandwe - South African Med Res Council, Cochrane South Africa, Cape Town, South Africa
Ionut Negoi - College Station Medical Center
Ruxandra Irina Negoi - College Station Medical Center
Josephine W. Ngunjiri - University of Embu
Cuong Tat Nguyen - Duy Tan University
Yeshambel T. Nigatu - Ctr Addict & Mental Hlth, Inst Mental Hlth & Policy, Toronto, ON, Canada
Obinna E. Onwujekwe - University of Nigeria
Doris Ortega-Altamirano - Natl Inst Publ Hlth, Hlth Syst Res Ctr, Cuernavaca, Morelos, Mexico
Nikita Otstavnov - Moscow Inst Phys & Technol, Lab Publ Hlth Indicators Anal & Hlth Digitalizat, Dolgoprudnyi, Russia
Stanislav S. Otstavnov - Moscow Inst Phys & Technol, Lab Publ Hlth Indicators Anal & Hlth Digitalizat, Dolgoprudnyi, Russia
Mayowa O. Owolabi - College Station Medical Center
Abhijit P. Pakhare - College Station Medical Center
Veincent Christian Filipino Pepito - Ateneo de Manila University
Norberto Perico - Mario Negri Inst Pharmacol Res, Bergamo, Italy
Hai Quang Pham - Trường ĐH Nguyễn Tất Thành
David M. Pigott - University of Washington
Khem Narayan Pokhrel - Integrated Dev Fdn Nepal, HIV & Mental Hlth Dept, Kathmandu, Nepal
Mohammad Rabiee - Amirkabir University of Technology
Navid Rabiee - Macquarie University
Vafa Rahimi-Movaghar - University of Tehran
David Laith Rawaf - Imperial Coll London, WHO Collaborating Ctr Publ Hlth Educ & Training, London, England
Salman Rawaf - Imperial Coll London, Dept Primary Care & Publ Hlth, London, England
Lal Rawal - Supreme Council Of Health
Giuseppe Remuzzi - Mario Negri Inst Pharmacol Res, Bergamo, Italy
Andre M. N. Renzaho - Western Sydney University
Serge Resnikoff - UNSW Sydney
Nima Rezaei - University of Tehran
Aziz Rezapour - College Station Medical Center
Jennifer Rickard - Universal Sci Educ & Res Network, Tehran, Iran
Leonardo Roever - Univ Teaching Hosp Kigali, Dept Surg, Kigali, Rwanda
Maitreyi Sahu - University of Washington
Abdallah M. Samy - Ain Shams University
Juan Sanabria - Federal Reserve
Milena M. Santric-Milicevic - University of Belgrade
Sivan Yegnanarayana Iyer Saraswathy
Soraya Seedat - Stellenbosch University
Subramanian Senthilkumaran - College Station Medical Center
Edson Servan-Mori - Natl Inst Publ Hlth, Ctr Hlth Syst Res, Cuernavaca, Morelos, Mexico
Masood Ali Shaikh
Aziz Sheikh - Harvard University
Diego Augusto Santos Silva - Univ Fed Santa Catarina, Dept Phys Educ, Florianopolis, SC, Brazil
Caroline Stein - University of Washington
Dan J. Stein - College Station Medical Center
Mariya Vladimirovna Titova - Plant
Stephanie M. Topp - James Cook University
Marcos Roberto Tovani-Palone - College Station Medical Center
Saif Ullah - Univ Agr Faisalabad, Inst Soil & Environm Sci, Faisalabad, Pakistan
Bhaskaran Unnikrishnan - College Station Medical Center
Marco Vacante - University of Catania
Pascual R. Valdez - College Station Medical Center
Tommi Juhani Vasankari - UKK Inst, Tampere, Finland
Narayanaswamy Venketasubramanian - Raffles Hosp, Raffles Neurosci Ctr, Singapore, Singapore
Vasily Vlassov - Supreme Council Of Health
Theo Vos - University of Washington
Jamal Akeem Yearwood - Gates
Naohiro Yonemoto - Natl Ctr Neurol & Psychiat, Dept Neuropsychopharmacol, Kodaira, Tokyo, Japan
Mustafa Z. Younis - Jackson State University
Chuanhua Yu - Wuhan University
Siddhesh Zadey - Duke University
Sojib Bin Zaman - Monash University
Taddese Alemu Zerfu - University of Edinburgh
Zhi-Jiang Zhang - Wuhan University
Arash Ziapour - College Station Medical Center
Sanjay Zodpey - Publ Hlth Fdn India, Indian Inst Publ Hlth, Gurugram, India
Stephen S. Lim - University of Washington
Christopher J. L. Murray - University of Washington
Rafael Lozano - University of Washington
GBD 2019 Human Resources for Health Collaborators
Publication Details: The Lancet (British edition), Vol.399(10341), pp.2129-2154
Publisher: Elsevier
Number of pages: 26
Grant note: Bill & Melinda Gates Foundation; CGIAR
Identifiers: 9915495408331
Academic Unit: Imam Abdulrahman Bin Faisal University; King Saud University
Language: English
Resource Type: Journal article