Number of health workers per 10,000 population by type of health worker

 

The number of health workers available in a country relative to the total population subset by type of health worker.

Health workers are defined as all persons eligible to participate in the national health labor market by virtue of their training, accreditation, skills, and, where required, by age. The most complete and comparable data currently available on the health workforce globally pertain to physicians, nurses and midwives. However, the health workforce includes a wide range of other categories of service providers (e.g., dentists, pharmacists, physiotherapists, community health workers), as well as management and support workers. Information should be captured on all of these categories of human resources for health. Optimally, data on health occupations should be classified according to the latest International Standard Classification of Occupations (ISCO) revision or its national equivalent.  For guidelines on using ISCO for classification of healthcare workers, see WHO (2011).

This indicator is calculated as:

(The number of health workers at a given time in a given country or region / Total population for the same geographical area)

 

The ratio can be adjusted to per 10,000 population by multiplying the numerator and denominator by the same factor required for the denominator to equal 10,000.

This standardized indicator is selected from the list of core indicators in the WHO Health System Strengthening (HSS) Handbook.  For more background on the process and criteria used in developing the WHO handbook of indicators for HSS and for details on this and related indicators, see WHO (2010); USAID (2009); and The Global Fund (2006).


The numerator can be assessed through routine administrative records on numbers of active health workers compiled, updated and submitted regularly (e.g. quarterly) by district health officers, payroll registrars, individual health facilities (public, private, non-governmental and community-based) and/or health professional regulatory bodies. These data can be collated into a centralized human resource information system (HRIS) or database maintained by the ministry of health or other mandated agency. Information on the supply of health workers and on the total population should be periodically validated and adjusted against data from a population census and other nationally representative source. A comprehensive facility survey instrument called the Service Provision Assessment (SPA) has been developed by USAID and Macro International Inc. to be used with nationally representative samples of health facilities to provide information on the characteristics of health services, including their quality, infrastructure, utilization and availability.  The WHO service availability and readiness assessment (SARA) is specifically designed to assess, map and monitor service availability and readiness, including human resources. For more details on the SPA and SARA, see WHO (2010) and MEASURE DHS (2011).


Health facility records; HRIS; census data; facility surveys, such as the SPA and SARA


This indicator provides information on the stock of health workers relative to the population.  It can be used to monitor whether the size and specialties of the current workforce meets a given threshold that should allow the most basic levels of healthcare coverage in a country. The advantages include that it is simple to calculate, may be used for comparative analyses across countries and over time, and is easy to understand among a wide range of audiences, making it useful for policy and advocacy purposes. The primary aim of HSS is to improve access, quality, and utilization, and growing evidence shows that health systems capable of delivering services equitably, efficiently, and in a coordinated manner are essential for achieving improved health outcomes. Globally, there is increasing attention to equity in health and the pathways by which inequities arise and are perpetuated or exacerbated.  Imbalance or uneven distribution in the supply, deployment and composition of human resources for health can lead to inequities in the effective provision of health services and is an issue of social and political concern in many countries. Attaining and maintaining sufficient numbers of well-trained health workers is basic to HSS and contributes to achieving progress in the Millennium Development Goals for health #4. Reduce child mortality; #5. improve maternal health; and #6. combat HIV/AIDs.   


 

Counts of workers outside the public sector (i.e., private, non-governmental, community-based) are likely to be less accurate, particularly if these sectors are not required to regiser and/or provide reports on staff and services. While this indicator measures the availability of service providers, it does not take into account all of a health system's objectives, particularly with regard to accessibility, equity, efficiency, and quality of training and services.


access, health system strengthening (HSS), training, newborn (NB), safe motherhood (SM)

 

The Global Fund, 2006, Monitoring and Evaluation Toolkit: HIV, Tuberculosis and Malaria and Health Systems Strengtheninghttp://www.hivpolicy.org/Library/HPP000485.pdf

MEASURE DHS. 2011, Service Provision Assessments (SPA) Survey Overview, DHS Website. http://www.measuredhs.com/What-We-Do/Survey-Types/SPA.cfm

USAID, 2009, Measuring the Impact of Health Systems Strengthening, A Review of the Literature, Washington, DC: USAID.  https://www.k4health.org/sites/default/files/measuring%20reform%20hss.pdf

WHO, 2010, Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies, Geneva: WHO. http://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf

WHO, 2011, Classifying health workers: Mapping occupations to the international standard classification, Geneva: WHO. http://www.who.int/hrh/statistics/Health_workers_classification.pdf

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