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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

The Lancet(2022)

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Abstract
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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要点】:本研究通过系统分析1990至2019年204个国家和地区的卫生人力资源(HRH)数据,评估了全球卫生人力资源密度,并探讨了其与全民健康覆盖(UHC)之间的关系,发现全球卫生人力资源严重短缺,特别是在低收入国家。

方法】:研究利用国际劳工组织和全球卫生数据交换数据库中的劳动力调查和人口普查数据,以及世界卫生组织国家卫生人力资源账户的数据,通过国际标准职业分类系统(ISCO-88)对数据进行标准化处理,并使用时空高斯过程回归(ST-GPR)模型估计各国卫生人力资源密度,再通过随机前沿元回归模型分析卫生人力资源密度与UHC有效覆盖率之间的关系。

实验】:研究使用1990至2019年196个国家和地区的卫生人力资源数据,覆盖了全球疾病负担研究的七个超级区域和21个区域,确定了达到UHC有效覆盖率80/100的最低卫生人力资源密度阈值,并计算出2019年全球卫生人力资源短缺情况。