Social protection

No health workers, no health protection

The global shortage of health workers is hampering efforts to deliver essential quality health care to all in need and achieve universal health protection.

Comment | 09 July 2014
By Xenia Scheil-Adlung, Health Policy Coordinator at the ILO Social Protection Department
GENEVA – There is a shortfall of around 10.3 million health workers worldwide to ensure that all those in need receive quality health services. This is particularly a problem in low-income countries where, as a result, close to 90 per cent of the population has no access to health care.

According to the latest estimate of the ILO’s World Social Protection Report, a country should have on average 41.1 health workers per 10,000 people to be able to provide essential health care to its entire population. But in many low-income countries this is far from a reality.

For example, in countries like Haiti, Niger, Senegal and Sierra Leone, there are only five or fewer health workers available for as many as 10,000 people, compared to 269 in a high-income country such as Finland. Asia is the continent where most additional health workers are needed (7.1 million), followed by Africa (2.8 million).

Mapping the facts
Shortage of skilled health workers, by country
The good news is that government investments in health protection can help close this gap and bring benefits to those who need it, as well as to the economy as a whole. Patients who have access to health services are more productive, which in turn enhances economic growth. At the same time, increasing the number of health workers means more jobs are created, which also helps boost growth.

Social protection policies can also be used to make sure that people living in remote or underserved areas have adequate access to health care.

Why the shortage of health workers?

One of the major reasons is the low salaries that health workers earn. In Sudan, Egypt and Myanmar, for instance, health sector wages are only 1 per cent above the poverty line of US$2 a day.

The global economic crisis led many countries to introduce fiscal consolidation policies as a way of reigning in public spending. As a result, the wages of civil servants – among them health workers – were cut or capped in as many as 98 countries, including 75 developing countries. According to the World Social Protection Report, public expenditure was cut in 122 countries, among them 82 developing countries.

Inadequate wages also lead to negative consequences, such as people failing to report to work, requests for informal payments, and a brain drain of workers seeking better wages outside their home countries. This means that more and more people have to spend money out of their own pocket to receive treatment, and hence the gap to achieve universal health coverage grows bigger.

We know that there is a correlation between poverty levels and out-of-pockets payments from those needing treatment. For example, in countries where less than 2 per cent of the population is living on US$2 day, about 20 per cent of total health care expenditure comes from out-of-pocket payments, while in countries where more than 50 per cent of the population is living on US$2 a day, it amounts to around 50 per cent.

Poor working conditions for health workers also lead to unnecessary deaths, for example in the case of difficult deliveries and long waiting lists for surgery. There are also cases of nurses working in emergency care units who have to take care of four or more patients when one or two is the preferred maximum.

Closing these large gaps requires coherent social protection policies that make quality health care available and affordable for all. ILO Recommendation No 202 sets out related policies focusing on achieving universal coverage that should be enshrined in legislation, and based on the provision of at least essential health care and financial protection. Successful policies involve providing decent working conditions and wages for a sufficient number of health workers.

If we want to avoid fiscal adjustments taking priority over basic human needs, and if we want to meet the ambitious health targets of the Millennium Development Goals and of the post-2015 Development Agenda, then concrete action on improving social protection in health is urgently needed. This can only happen through strong political will.

Shortage of skilled health workers, by country

Additional skilled health workers needed to provide services to all in need, per 10,000 population
Mouse over the chart to see the values
Source: ILO calculations based on WHO data (Physicians, nursing and midwifery personnel density per 10,000 population).

The ILO estimates that at least 41.1 health workers per 10,000 population are necessary to provide services to all in need. The figure is based on calculations of median values of the density of health workers in countries where socio-economic conditions and health financing characteristics are conducive to universal coverage.