TY - JOUR
T1 - Measuring the composition and availability of human resources for health by sex in 204 countries and territories, 1990–2023, and workforce gaps for universal health coverage
T2 - a systematic analysis for the Global Burden of Disease Study 2023
AU - [email protected] 2023 Human Resources for Health Collaborators
AU - Knight, Megan
AU - Bienhoff, Kelly
AU - A, Bhoomadevi
AU - Ababneh, Hazim S.
AU - Abbasi, Madineh
AU - Abbasi Dolatabadi, Zahra
AU - Abbasifard, Mitra
AU - Abd ElHafeez, Samar
AU - Abdalla, Ashraf Nabiel
AU - Abdel-Hameed, Reda
AU - Abdelkader, Atef
AU - Abd-Elsalam, Sherief
AU - Abdulah, Deldar Morad
AU - Abdullahi, Auwal
AU - Abebe, Meklit Girma
AU - Abebe, Tesfaye Birhanu
AU - Abebe Getahun, Habtamu
AU - Abedi, Armita
AU - Abejew, Asrat Agalu
AU - Abhilash, E. S.
AU - Abie, Alemwork
AU - Aboagye, Richard Gyan
AU - Aborode, Abdullahi Tunde
AU - Abourashed, Nagah M.
AU - Abouzid, Mohamed
AU - Abreu, Lucas Guimarães
AU - Abrigo, Michael R.M.
AU - Abtahi, Dariush
AU - Abu Lila, Amr Selim
AU - Abubakar, Bilyaminu
AU - Abu-Farha, Rana Kamal
AU - Abu-Gharbieh, Eman
AU - Abuhelwa, Ahmad Y.
AU - Abukhadijah, Hana J.
AU - Acharya, Anirudh Balakrishna
AU - Acharya, Krishna Prasad
AU - Acharya, Swetha
AU - Adabi, Maryam
AU - Adams, Lisa C.
AU - Adamu, Nuhu Lawan
AU - Addo, Isaac Yeboah
AU - Adediran, Olusegun Adetomiwa
AU - Adedokun, Kamoru Ademola
AU - Adegbile, Oluwatobi E.
AU - Adeleke, Olumide Thomas
AU - Adesina, Miracle Ayomikun
AU - Adesola, Ridwan Olamilekan
AU - Adetunji, Charles Oluwaseun
AU - Adetunji, Juliana Bunmi
AU - Shahwan, Moyad Jamal
N1 - Publisher Copyright:
© 2026 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
PY - 2026/9
Y1 - 2026/9
N2 - Background Understanding the size, gender composition, and cadre mix of the health workforce and how it has evolved across time and locations can inform policies for planning, recruitment, training, and retention of human resources for health (HRH), and improvement of access to the health-care workforce among populations. Using comparable and standardised data sources, we aim to describe the composition and density of health workers by sex among 20 cadres for 204 countries and territories over 1990–2023 and quantify workforce shortfalls relative to universal health coverage (UHC) attainment. Methods We used 1816 country-years of data from population-based surveys, 82 from censuses, 3888 from administrative sources, and 96 from scientific literature. We harmonised reported occupation in all sources with the International Standard Classification of Occupations 2008. We produced estimates for 20 cadres and the total health workforce disaggregated by sex using spatiotemporal Gaussian process regression, a standardised method in the Global Burden of Diseases, Injuries, and Risk Factors study. Finally, stochastic frontier meta-regression was used to estimate the minimum density of doctors, nurses and midwives, dentists, and pharmacists required to reach a score of 80 out of 100 on the UHC effective coverage index. Findings In 2023, there were 122·1 million (95% uncertainty interval 115·4–130·5) health workers across 20 cadres, an increase of 81·2 million (72·0–90·5) or 198·5% (161·9–245·6) relative to 1990. Of that total, there were 15·1 million (13·1–18·2) doctors, 33·2 million (30·8–36·3) nurses, 2·4 million (2·0–2·9) midwives, and 7·6 million (6·7–8·6) community health workers (CHWs). 68·9% (66·9–70·6) of all health workers in 2023 were female, and female health workers accounted for 71·4% (64·5–77·4) of net HRH workforce growth. Less than half of doctors were female (43·9%, 34·5–53·2) and most nurses (80·7%, 76·2–83·1), midwives (96·0%, 83·9–98·5), and CHWs (89·5%, 83·6–93·7) were female. Substantial differences in HRH density remained into 2023: sub-Saharan Africa had the lowest HRH densities across cadres, with the exception of CHWs, while high-income countries had the highest HRH densities. To reach 80 out of 100 on the UHC index, an additional 7·1 million (6·6–7·5) doctors, 23·9 million (21·8–26·1) nurses and midwives, 1·8 million (1·6–1·9) dentists, and 1·6 million (1·4–1·9) pharmacists are required globally. Interpretation The global health workforce has expanded substantially since 1990, largely due to women entering the formal health workforce. However, this expansion has been uneven across regions and persistent shortfalls remain in doctors, nurses and midwives, dentists, and pharmacists relative to moderate UHC attainment. Addressing these gaps will require expansion of training capacity, retention and remuneration policies for early-career workers, and gender-responsive workforce arrangements. Funding Gates Foundation.
AB - Background Understanding the size, gender composition, and cadre mix of the health workforce and how it has evolved across time and locations can inform policies for planning, recruitment, training, and retention of human resources for health (HRH), and improvement of access to the health-care workforce among populations. Using comparable and standardised data sources, we aim to describe the composition and density of health workers by sex among 20 cadres for 204 countries and territories over 1990–2023 and quantify workforce shortfalls relative to universal health coverage (UHC) attainment. Methods We used 1816 country-years of data from population-based surveys, 82 from censuses, 3888 from administrative sources, and 96 from scientific literature. We harmonised reported occupation in all sources with the International Standard Classification of Occupations 2008. We produced estimates for 20 cadres and the total health workforce disaggregated by sex using spatiotemporal Gaussian process regression, a standardised method in the Global Burden of Diseases, Injuries, and Risk Factors study. Finally, stochastic frontier meta-regression was used to estimate the minimum density of doctors, nurses and midwives, dentists, and pharmacists required to reach a score of 80 out of 100 on the UHC effective coverage index. Findings In 2023, there were 122·1 million (95% uncertainty interval 115·4–130·5) health workers across 20 cadres, an increase of 81·2 million (72·0–90·5) or 198·5% (161·9–245·6) relative to 1990. Of that total, there were 15·1 million (13·1–18·2) doctors, 33·2 million (30·8–36·3) nurses, 2·4 million (2·0–2·9) midwives, and 7·6 million (6·7–8·6) community health workers (CHWs). 68·9% (66·9–70·6) of all health workers in 2023 were female, and female health workers accounted for 71·4% (64·5–77·4) of net HRH workforce growth. Less than half of doctors were female (43·9%, 34·5–53·2) and most nurses (80·7%, 76·2–83·1), midwives (96·0%, 83·9–98·5), and CHWs (89·5%, 83·6–93·7) were female. Substantial differences in HRH density remained into 2023: sub-Saharan Africa had the lowest HRH densities across cadres, with the exception of CHWs, while high-income countries had the highest HRH densities. To reach 80 out of 100 on the UHC index, an additional 7·1 million (6·6–7·5) doctors, 23·9 million (21·8–26·1) nurses and midwives, 1·8 million (1·6–1·9) dentists, and 1·6 million (1·4–1·9) pharmacists are required globally. Interpretation The global health workforce has expanded substantially since 1990, largely due to women entering the formal health workforce. However, this expansion has been uneven across regions and persistent shortfalls remain in doctors, nurses and midwives, dentists, and pharmacists relative to moderate UHC attainment. Addressing these gaps will require expansion of training capacity, retention and remuneration policies for early-career workers, and gender-responsive workforce arrangements. Funding Gates Foundation.
UR - https://www.scopus.com/pages/publications/105047871342
U2 - 10.1016/S2468-2667(26)00145-3
DO - 10.1016/S2468-2667(26)00145-3
M3 - Article
C2 - 42612647
AN - SCOPUS:105047871342
SN - 2468-2667
VL - 11
SP - e604-e629
JO - The Lancet Public Health
JF - The Lancet Public Health
IS - 9
ER -
SDG 3 Good Health and Well-being
SDG 10 Reduced Inequalities