For decades, enormous health workforce shortages in many countries have undermined the objective of moving towards Universal Health Coverage (UHC). Recent ILO research points to a gap of 10.3 million health workers globally. Throughout the world, rural populations are the most concerned: Globally, 7 million health workers are missing in rural areas compared to 3 million in cities. In Africa and Asia as much as 84 per cent of the population cannot access adequate health care due to gaps in service delivery in the absence of health workers.

Not surprisingly, a clear correlation between health workforce shortages and health outcomes can be observed: Countries with lowest numbers of health workers are challenged by worldwide highest numbers of maternal deaths. Health outcomes in turn directly impact on economic development: Healthy people are more productive and able to work longer during their lives. Also, increasing health workforce employment directly contributes to a country’s GDP and generates multiplier employment effects in other sectors. Finally, creating employment in the health sector increases the tax base of countries and thus allows for additional investments to accelerate development.

However, such effects can only be achieved if certain conditions are met: ILO estimates that at least 41.1 health workers per 10,000 population are needed to guarantee the availability of health care for all. To ensure equity and service quality, health worker jobs should be equally distributed (e.g. between rural and urban areas) and embedded in a decent work environment that provides for adequate wages and occupational safety and health. Moreover, implementing inclusive legislation, establishing fair financing mechanisms based on broad risk pools and minimizing out-of-pocket payments to avoid health-related impoverishment are perquisites for equity in access.

“Making affordable quality health care available to all in need improves the health status of the population, reduces poverty and can trigger sustained and equitable economic growth. In contrast, and as the recent Ebola crisis has shown, ignoring the need for investments into a skilled national health workforce leads to extremely high social and economic costs,” says Xenia Scheil-Adlung, Health Policy Coordinator at ILO. Countries find advice on efficient and effective policies ensuring that all in need have access to at least essential health care in ILO Recommendation 202 (2012) on National Social Protection Floors. Thorsten Behrendt, Health Expert at ILO, highlights that within a broader framework of health protection and complementary socio-economic policies, investments pay off by creating employment and economic growth.

For more information:

International Labour Organization. Addressing the global health crisis - Universal health protection policies. Database on multiple dimensions of health coverage. Geneva: 2015. 

Scheil-Adlung, X. (Ed.) Global evidence on inequities in rural health protection – New data on rural deficits in health coverage for 174 countries. International Labour Organization. Geneva: 2015.