A recent publication by The Lancet on “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 of the global burden of disease 2019” -carried out by the Institute for Health Metrics and Evaluation (IHME) and its network of collaborators- reports that in 2019 there were 104 million health workers in the world. Of them 12.7 million practiced medicine; 29.8 million nursing; 4.6 million were dentists and 5.2 million worked in pharmacies. However, despite the fact that the four occupations add up to 52.3 million, there is a deficit of 43.2 million of these four occupations to reach the effective universal health coverage index at levels of 80. In other words, a considerable expansion of the world’s health workforce to achieve one of the sustainable development goals.
To achieve the threshold of 80 Universal Effective Health Coverage (CUE) estimated by IHME in 2020, a rate of 20.7 per 10,000 inhabitants of medical personnel and 70.4 per 10,000 of nursing personnel is estimated. For the same reason, if the result observed in 2019 was 16.6 and 38.5 per 10,000 inhabitants, respectively, a global deficit of 6.4 million workers dedicated to medicine and 30.6 million dedicated to nursing is detected. In addition, the study also shows that 3.3 million dentists and 2.9 million pharmacy workers are needed. The study estimated that 132 countries had a shortage of medical personnel and 154 countries had a shortage of nursing personnel. It is evident that the observed density of human resources for health varies greatly among the 204 countries analyzed and, therefore, the excess or deficit of human resources is also very different.
For example, the study revealed a 13-fold difference in the density of medical workers between countries in Central and Eastern Europe compared to countries in Sub-Saharan Africa. However, the extreme gap is between Cuba with 86.4 per 10,000 inhabitants and Ethiopia with 0.8 per 10,000, that is, 109 times more medical personnel in Cuba than in Ethiopia. In Cuba there is a surplus of 72,301 doctors and Ethiopia with a deficit of 214,430. In the case of nursing personnel, the gap between countries is 63 times. Norway presents a rate of 211 per 10,000 and Somalia of 3.3 per 10,000 inhabitants. Norway exceeds 75,000 nurses and Somalia is short 137,000 to reach the same level in the CUE index.
In Mexico, it is estimated that for 2019 there are 26.6 medical workers and 57.7 nursing workers per 10,000 inhabitants (see table), a figure that, when compared to the rate expected to reach the CUE threshold, shows an excess in the medical staff of 73,262 and a deficit of 161,590 in the nursing staff. The table confirms that at the national level there is a slight excess of dentists and a deficit in pharmacy professionals.
The excess of personnel dedicated to medicine is not observed in Chiapas, Oaxaca and San Luis Potosí. In contrast, the nursing personnel deficit is present in all states except Baja California Sur, Coahuila, CDMX and Nuevo León. Only in CDMX there is no deficit of health personnel. The results obtained for Mexico at the national level place it in the 74th percentile of medical personnel and in the 66th percentile of nursing personnel. CDMX is located in the 90th percentile in medical personnel and in the 80th percentile in nursing. In contrast, Chiapas is located in the 61st and 50th percentiles, respectively. The possibility for someone who lives in CDMX to find a medical professional is 2.7 times higher than in Chiapas and 1.7 times higher in the case of nursing.
The results lead us to an agenda that places nursing as the priority of attention due to the deficit so great that it is detected at the national and state levels. The importance of investing in nursing has been presented in previous texts published in this journal. It should be made clear that the Universal Effective Coverage thresholds represent the minimum levels of human resources for health that are necessary to achieve one of the sustainable development goals, that is, it measures whether countries are efficient in translating human resources to achieve its international commitments. This threshold approach seeks to meet the demand for standardized benchmarks to assess the density and distribution of the health workforce. In addition, it is an external indicator to human resources, where these are essential. Using values achieved by other richer or better prepared countries offers a limited vision and also undermines the usefulness of the global goals.
*The author is a professor at the University of Washington in the Department of Health Measurement Sciences and the Institute for Health Metrics and Evaluation and the author responsible for the article analyzed.
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