Health – Addressing the health workforce crisis in Africa and in Europe
- The Africa-Europe Foundation
‘The data for this story is based on the report “Scope for a Future of Health Workforce Initiative” developed in partnership with Management Sciences for Health.’
Health workforce shortages are a global crisis
Health systems can only function and universal health coverage is only possible with health workers. Achieving health service coverage and realizing the right to the enjoyment of the highest attainable standard of health is dependent on their availability, accessibility, acceptability, and quality.
In 2016, the experts estimated a shortage of 18 million health workers globally. While this number was reduced to 15 million in 2020 the ravages of the COVID-19 Pandemic have not only highlighted the need for a competent, supported, and motivated workforce but slowed global progress toward existing shortfalls. It remains that in 2030, there will still be a shortage of health workers.
Since 2006, European and African entities have been documenting the health workforce crisis and strategies needed to address the issue, the problem is worsening. In 2016, the WHO adopted the Global Strategy on Human Resources for Health: Workforce 2030
The Impact of the COVID-19 pandemic on the health workforce
The COVID-19 pandemic has had a grave and substantive impact on the health and care workforce. It not only put a stop on progress achieved in heath workforce development, but it also accelerated the crisis leading to growing staff shortages. The pandemic has and continues to erode health gains of the past two decades.
The crisis has amplified the need to have a real time understanding of the relationship between the health and care workers and addressing the global pandemic, while continuing to provide routine health services.
WHO estimates that up to 180,000 health and care workers could have died from COVID-19 in the period between January and May 2021.
At least a quarter of European health and care workers report symptoms of burnout, anxiety, and depression. Health worker absences in the region increased by 62% in March 2020.
The International Council of Nurses (ICN) reports that the pandemic has exacerbated the existing nurse supply shortfall and has forced rapid and “emergency” policy responses in all countries. It reports that if 4% of the global nursing workforce were to leave as a result of pandemic impact, this would push the global nurse shortage by 7 million.
WHO has documented that COVID-19 has caused major disruptions and backlogs in health care over the course of the pandemic. As part of the organization’s Global Pulse Survey in 2021, respondents cited health workforce challenges as the main barrier for COVID-19 diagnostics and testing (for 56% respondents), COVID-19 therapeutics availability (for 64%) and COVID-19 vaccination (for 35%).
While Africa and Europe are both impacted by the health workforce crisis, Africa bears the brunt of the issue
The unequal distribution of workforces between Africa and Europe
There are great disparities regarding the distribution of health workforce cadres between Europe and Africa.
Africa carries 24% of the global disease burden with only 3% of the world’s Health Workforce (HWF) and less than 1% of the world’s financial resources available for health.
According to WHO, the European region has 3.4 million medical doctors and 7.4 million nurses for 749 million inhabitants. Comparatively, the African region had around 300 000 doctors and 1.2 million nurses for 1.4 billion inhabitants.
There is an average of 37 doctors per 10,000 population in Europe against 3 in Africa. The average for nurses and midwives is 83 per 10,000 population in Europe against 13 in Africa.
At country level, Belgium has an average of 189 midwives per 10,000 population against 6 in Burundi.
Of the global disease burden is carried by Africa
With only 3% of the world’s Health Workforce and less than 1% of the world’s financial resources available for health.
Million medical doctors and 7.4 million nurses for 749 million inhabitants within the European region.
In comparison to the African region with 300, 000 doctors and 1.2 million nurses for 1.4 billion inhabitants.
37 doctors per 10,000 population in Europe against 3 in Africa
The average for nurses and midwives is 83 per 10,000 population in Europe against 13 in Africa.
Midwives per 10,000 population in Belgium against 6 in Burundi.
Nursing is the largest occupational group in the health sector, accounting for about 59% of the total health workforce. From an equity perspective:
- Around 81% of the world’s nurses are found in the American, European, and Western Pacific regions which account for 51% of the world’s population
- Individual countries experiencing low densities of nurses are mostly in the African, South-East Asia, and Eastern Mediterranean regions, and parts of Latin America.
- Global inequalities in availability of nursing personnel are largely income driven, with a density of 9.1 nurses per 10,000 population in low-income countries compared to 107.7 per 10,000 population in high-income economies.
Nurses per 10,000 population in low-income countries
Compared to 107.7 per 10,000 population in high-income economies.
In Europe, the challenges of an ageing health and care workforce
According to WHO Regional Office for Europe (WHO/Europe) in September 2022, 40% of medical doctors are close to retirement age in one-third of countries in the ‘WHO European Region’
In Europe, the age and gender structure of the health workforce is changing. Physicians are getting older and nearly one out of three physicians are more than 55 years old.
This is an increase of 6% over the past 7 years. The proportion of female physicians has increased and 52% of physicians today are female, an increase of 4% over the past 10 years. This has important implications, as women tend to work shorter hours and have slightly shorter careers.
There is an estimated shortage of 1 million health workers in Europe.
In Africa, the challenges of competing priorities and limited funding for the health and care workforce
The shortage and maldistribution of health workers in the WHO African Region is a big challenge towards the attainment of universal access to health services.
The African region has a ratio of 1.55 health workers (physicians, nurses, and midwives) per 1000 people. This is below the WHO threshold density of 4.45 health workers per 1000 people needed to deliver essential health services and achieve universal health coverage.
Only four countries (Mauritius, Namibia, Seychelles, and South Africa) have surpassed the WHO health worker-to-population ratio.
There are only 168 medical schools in Africa, with 11 countries having no medical school and 24 only one medical school.
The region’s health workforce is also unevenly distributed by country, ranging from 0.25 health workers per 1000 people in Niger (the region’s lowest) to 9.15 health workers per 1000 people in the Seychelles – the highest in the region.
Africa’s health worker shortage comes from inadequate training capacity, rapid population growth, brain drain, career changes as well as poor retention of health personnel.
Projections state that the shortage of health workers will reach 6.1 million by 2030.
Health workers per 1000 people.
WHO threshold density of health workers per 1000 people needed to deliver essential health services.
Only Mauritius, Namibia, Seychelles, and South Africa have surpassed the WHO health worker-to-population ratio.
Medical schools in Africa, with 11 countries having no medical school
Health workforces represent a good investment
Heath workers are crucial for functional health systems. They play an essential role in delivering routine services, educating communities, combatting misinformation, building vaccine confidence, and encouraging behaviour change to support better health outcomes.
Health employment not only provides better health (SDG 3) but also decent work and economic growth (SDG 8).
The health workforce is a worthwhile investment that guarantees a massive return on investment at a ratio of 1:10 but it remains with chronic underinvestment.
A study led in 20 countries in East and Southern Africa found that small increments in government health expenditure and increased prioritisation of health workforce in funding in tandem with 57% global average could increase the fiscal space for health workforces by at least 32% in 11 countries.
Meeting health workforce needs must go through investments in the 10 following pathways: job creation, gender and women’s rights, education, training and skills, health service delivery and organization, technology, crises and humanitarian settings, financing and fiscal space, partnership and cooperation, international migration and data, information, and accountability.
Often misconstrued by policymakers and financers as a cost, health employment is an investment for our future.
Digital is an enabler for health workforces to deliver high quality healthcare
The COVID-19 pandemic induced a great acceleration in the uptake of digital health tools in healthcare delivery and public health.
The potential benefits for digital technologies to enhance care and support health workforces in their practice are numerous. By ensuring that the right information is delivered to the right person at the right time, digital tools in health can improve care. They ensure health workers are better informed in their practice, thus bringing down the unnecessary harm caused to 10% patients during care.
Digital is an enabler for health workforces to manage changes in response to dynamic, evolving circumstances, in the areas of supply, demand, gender, migration, technology, and health service delivery.
While the benefits of digital technologies in health are clearly recognised by health workforces, their successful uptake will need to go through changes in attitudes, advancing skills and adapting the organisation of health service delivery and related legal and financial frameworks. This will only be possible through collaboration between health, education, and training institutions.
An AEF Future health workforce initiative to support Africa and Europe in developing the health workforce that they both need
The Africa-Europe Foundation’s Future Health Workforce Initiative aims to convene stakeholders around the goal of advocating for health workforce expertise to be at the heart of health policy and planning. Working with stakeholders to support the African and European regions to have a resilient and adaptive health workforce able to meet the health workforce challenges of the future.
The vision for this initiative is that Africa and Europe have the health workforce required to deliver quality public health functions and emergency preparedness, meeting country universal health coverage (UHC) goals now and into the future.
This initiative would aim to advocate for the immediate progress of the health workforce development agenda with high level stakeholders and decision makers. It would seek to connect state, regional, and country stakeholders, across sectors and constituencies to cross pollinate experience, learning and solutions to accelerate the pace of change. It would ensure that digitization is an enabler for health workforces to deliver high quality and efficient health services. Finally, it would support analysis and use of health workforce data to ensure data informed decisions for the management and planning of the current and future health workforce issues and the future.