全球疾病负担（GBD）2019健康人力资源协作组Maitreyi Sahu团队研究了1990-2019年204个国家和地区健康人力资源的可用性及其与全民健康覆盖的相关性。相关论文发表在2022年5月23日出版的《柳叶刀》杂志上。

健康人力资源（HRH）包括一系列旨在促进或改善人类健康的职业。联合国可持续发展目标（SDG）和世界卫生组织《2030年卫生人力资源战略》提请人们注意人力资源对实现全民健康覆盖（UHC）等政策优先事项的重要性。

虽然先前的研究发现，全球在HRH方面存在巨大差异，但由于缺乏对现有劳动力可比性的跨国估计，阻碍了量化劳动力需求以实现卫生系统目标的努力。该研究旨在使用可比较和标准化的数据源来估计全球的HRH密度，并研究一组HRH骨干队伍与UHC有效覆盖绩效之间的关系。

通过国际劳工组织和全球卫生数据交换数据库，研究组确定了1404个国家-年的劳动力调查数据和69个国家-年的人口普查数据，以及与卫生有关就业的详细微观数据。从世界卫生组织国家卫生人力账户中，研究组确定了2950个国家-年的数据。

研究组将所有职业编码系统的数据映射到1988年国际标准职业分类（ISCO-88），从而可以对整个时间序列中16类卫生工作者的密度进行标准化估计。利用1990-2019年204个国家和地区中196个国家和地区的数据，涵盖7个全球疾病负担、伤害和风险因素研究（GBD）超级区域和21个地区，研究组应用时空高斯过程回归（ST-GPR）对1990-2019年所有国家和地区的HRH密度进行建模。

研究组使用随机前沿荟萃回归对SDG指标3.c.1中列举的与HRH相关的四类卫生工作者（医生、护士和助产士、牙科人员和制药人员）的UHC有效覆盖指数和密度之间的关系进行建模。他们确定了达到UHC有效覆盖率指数80/100这一特定目标所需的最低劳动力密度阈值，并量化了与这些最低阈值相关的国家短缺。

研究组估计，2019年，全球有1.04亿卫生工作者，其中包括1280万名医生、2980万名护士和助产士、460万名牙医和520万名制药人员。他们计算出全球医生密度为每10000人16.7名，护士和助产士密度为每10000人38.6名。研究组发现撒哈拉以南非洲、南亚、北非和中东的GBD超级地区的HRH密度最低。

为了达到UHC有效覆盖指数80/100人，研究组估计每10000人至少需要20.7名医生、70.6名护士和助产士、8.2名牙医和9.4名制药人员。总体来说，2019年全国卫生工作人员数量未达到这些最低标准，共缺乏640万名医生、3060万名护士和助产士、330万名牙医和290万名制药人员。

研究结果表明，为了实现高水平的UHC有效覆盖率，需要大幅扩大世界卫生人力。最大的短缺发生在低收入地区，这突出表明需要增加资金和协调，以培训、雇用和保留卫生部门的人力资源。实际的人力资源短缺可能比估计的要大，因为每个卫生工作者骨干的最低门槛是以最有效地将人力资源转化为全民健康教育的卫生系统为基准的。

附：英文原文

Title: 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

Author: Annie Haakenstad, Caleb Mackay Salpeter Irvine, Megan Knight, Corinne Bintz, Aleksandr Y Aravkin, Peng Zheng, Vin Gupta, Michael R M Abrigo, Abdelrahman I Abushouk, Oladimeji M Adebayo, Gina Agarwal, Fares Alahdab, Ziyad Al-Aly, Khurshid Alam, Turki M Alanzi, Jacqueline Elizabeth Alcalde-Rabanal, Vahid Alipour, Nelson Alvis-Guzman, Arianna Maever L Amit, Catalina Liliana Andrei, Tudorel Andrei, Carl Abelardo T Antonio, Jalal Arabloo, Olatunde Aremu, Martin Amogre Ayanore, Maciej Banach, Till Winfried Brnighausen, Celine M Barthelemy, Mohsen Bayati, Habib Benzian, Adam E Berman, Kelly Bienhoff, Ali Bijani, Boris Bikbov, Antonio Biondi, Archith Boloor, Reinhard Busse, Zahid A Butt, Luis Alberto Cámera, Ismael R Campos-Nonato, Rosario Cárdenas, Felix Carvalho, Collins Chansa, Soosanna Kumary Chattu, Vijay Kumar Chattu, Dinh-Toi Chu, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, William James Dangel, Ahmad Daryani, Jan-Walter De Neve, Meghnath Dhimal, Isaac Oluwafemi Dipeolu, Shirin Djalalinia, Hoa Thi Do, Chirag P Doshi, Leila Doshmangir, Elham Ehsani-Chimeh, Maha El Tantawi, Eduarda Fernandes, Florian Fischer, Nataliya A Foigt, Artem Alekseevich Fomenkov, Masoud Foroutan, Takeshi Fukumoto, Nancy Fullman, Mohamed M Gad, Keyghobad Ghadiri, Mansour Ghafourifard, Ahmad Ghashghaee, Thomas Glucksman, Houman Goudarzi, Rajat Das Gupta, Randah R Hamadeh, Samer Hamidi, Josep Maria Haro, Edris Hasanpoor, Simon I Hay, Mohamed I Hegazy, Behzad Heibati, Nathaniel J Henry, Michael K Hole, Naznin Hossain, Mowafa Househ, Olayinka Stephen Ilesanmi, Mohammad-Hasan Imani-Nasab, Seyed Sina Naghibi Irvani, Sheikh Mohammed Shariful Islam, Mohammad Ali Jahani, Ankur Joshi, Rohollah Kalhor, Gbenga A Kayode, Nauman Khalid, Khaled Khatab, Adnan Kisa, Sonali Kochhar, Kewal Krishan, Barthelemy Kuate Defo, Dharmesh Kumar Lal, Faris Hasan Lami, Anders O Larsson, Janet L Leasher, Kate E LeGrand, Lee-Ling Lim, Narayan B Mahotra, Azeem Majeed, Afshin Maleki, Narayana Manjunatha, Benjamin Ballard Massenburg, Tomislav Mestrovic, GK Mini, Andreea Mirica, Erkin M Mirrakhimov, Yousef Mohammad, Shafiu Mohammed, Ali H Mokdad, Shane Douglas Morrison, Mohsen Naghavi, Duduzile Edith Ndwandwe, Ionut Negoi, Ruxandra Irina Negoi, Josephine W Ngunjiri, Cuong Tat Nguyen, Yeshambel T Nigatu, Obinna E Onwujekwe, Doris V Ortega-Altamirano, Nikita Otstavnov, Stanislav S Otstavnov, Mayowa O Owolabi, Abhijit P Pakhare, Veincent Christian Filipino Pepito, Norberto Perico, Hai Quang Pham, David M Pigott, Khem Narayan Pokhrel, Mohammad Rabiee, Navid Rabiee, Vafa Rahimi-Movaghar, David Laith Rawaf, Salman Rawaf, Lal Rawal, Giuseppe Remuzzi, Andre M N Renzaho, Serge Resnikoff, Nima Rezaei, Aziz Rezapour, Jennifer Rickard, Leonardo Roever, Maitreyi Sahu

Issue&Volume: 2022-05-23

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 cross-national 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 10000 population, and a nurse and midwife density of 38·6 (30·1–48·8) per 10000 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 10000 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.

DOI: 10.1016/S0140-6736(22)00532-3

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00532-3/fulltext