Indicator Name, Target and Goal

Indicator 3.c.1: Health worker density and distribution 

Target 3.c: Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States

Goal 3: Ensure healthy lives and promote well-being for all at all ages

Definition and Rationale

Definition:

This indicator consists of 4 sub-indicators. 

Density of physicians: The density of physicians is defined as the number of physicians, including generalists and specialist medical practitioners per 1,000 population in the given national and/or subnational area.

Density of nursing and midwifery personnel: The density of nursing and midwifery personnel is defined as the number of nursing and midwifery personnel per 1,000 population in the given national and/or subnational area.

Density of dentistry personnel: The density of dentistry personnel is defined as the number of dentists, dental technician/assistants and related occupation personnel per 1,000 population in the given national and/or subnational area.

Density of pharmaceutical personnel: The density of pharmaceutical personnel is defined as the number of pharmacists, pharmaceutical, technicians/assistants and related occupation personnel per 1,000 population in the given national and/or subnational area.

Concepts:

Physicians is the occupation classified in the ISCO-08 codes 221,2211 and 2212. 

Nursing and midwifery personnel is the occupation classified in the ISCO-08 codes 2221, 2222, 3221 and 3222. 

Dentistry personnel is the occupation classified in the ISCO-08 codes 2261, 3214 (excluding medical prosthetic related technicians) and 3251. 

Pharmaceutical personnel is the occupation classified in the ISCO-08 codes 2262 and 3213. 

Active health workers who provide services to patients and communities (practising health worker) or whose medical education is a prerequisite for the execution of the job (e.g. education, research, public administration) even if the health worker is not directly providing services (professionally active health worker). If data are not available for practising or professionally active health workers, data with the closest definition can be used, such as “health worker licensed to practice”. For more information refer to the NHWA Handbook. 

Health occupations should be reported separately. 

Rationale and Interpretation:

Health worker density, with respect to each occupation, provides a view of the level of healthcare workforce available in a given area such that efforts to increase the recruitment, development, training and retention of this workforce can be undertaken in places that need it.

Data Sources and Collection Method

The data is compiled from routine administrative information systems (including reports on staffing and payroll as well as professional training, registration and licensure), population censuses, labour force and employment surveys and health facility assessments. Most of the data from administrative sources are derived from published national health sector reviews and/or official country reports to WHO offices. 

Following the adoption of the Global strategy on human resources for health: workforce 2030 and resolution (WHA 69.19) to address human resources for health (HRH) challenges at the 69th World Health Assembly, May 2016, Member States are called on to consolidate a core set of human resources for health data with annual reporting to the Global Health Observatory, as well as progressive implementation of National Health Workforce Accounts (NHWA), to support national policy and planning and the Global Strategy’s monitoring and accountability framework. Since Its launch in November 2017, Member States are called to use the NHWA data platform to report health workforce data. For additional information, contact hrhstatistics@who.int 

To view latest available data: http://www.who.int/hrh/statistics/nhwa/en/

Method of Computation and Other Methodological Considerations

Computation Method:

Countries are encouraged to provide the number of active health workers disaggregated by occupation.

Currently, this is being reported separately – density of each health occupations is separately reported.

Health worker density  for the occupation i in the area a can be calculated using the following formula:

For a given health occupation i, in the country

where,

HWi  is the number of health workers of the occupation i; and

POP is the total population of the country. 

Comments and limitations:

Previously, this indicator was estimated using 2 measurements: density of physicians, and density of nursing and midwifery personnel. But in the context of the SDGs, the dataset has been expanded to include physicians, nursing personnel, midwifery personnel, dentistry personnel and pharmaceutical personnel. The dataset is planned to progressively move to cover all health cadres. 

Data on health workers tend to be more complete for the public sector and may underestimate the active workforce in the private, military, nongovernmental organization and faith-based health sectors. 

Depending on the nature of the original data source figures for physicians may include practising physicians only or all registered physicians. Traditional and complementary medicine professionals (ISCO 2230) is not included here. 

The figures for number of nursing and midwifery include nursing personnel and midwifery personnel, whenever available. In many countries, nurses trained with midwifery skills are counted and reported as nurses. This makes the distinction between nursing personnel and midwifery personnel difficult to draw. 

The figures for number of dentistry personnel include dentists, dental technicians/assistants and related occupations. Due to variability of data sources, the professional-level and associate-level occupations may not always be distinguishable. 

The figures for number of pharmaceutical personnel include pharmacists, pharmaceutical technicians/assistants and related occupations. Due to variability of data sources, the professional-level and associate-level occupations may not always be distinguishable. 

Due to the differences in data sources, considerable variability remains across countries in the coverage, periodicity, quality and completeness of the original data. 

Proxy, alternative and additional indicators: N/A

Data Disaggregation

This indicator can be disaggregated by occupation and geographic area.

References

Official SDG Metadata URL
https://unstats.un.org/sdgs/metadata/files/Metadata-03-0C-01.pdf  

Internationally agreed methodology and guideline URL
http://www.who.int/hrh/documents/brief_nhwa_handbook/en/  

Other references
Sixty-Ninth World Health Assembly (2016). Global strategy on human resources for health: Workforce 2030. Agenda Item 16.1. Available at: http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_R19-en.pdf

WHO (2014). Global strategy on human resources for health: Workforce 2030. Geneva. Available at: http://who.int/hrh/resources/pub_globstrathrh-2030/en/

WHO (2018). WHO Global Health Workforce Statistics. Available at: http://www.who.int/hrh/statistics/hwfstats/en

WHO (2018). Global Health Workforce Statistics. Available at: http://apps.who.int/gho/data/node.main.A1444?lang=en&showonly=HWF

WHO (2018). National Health Workforce Accounts: A Handbook, n.d. Available at: http://www.who.int/hrh/statistics/nhwa/en/

Country examples
N/A

International Organization(s) for Global Monitoring

This document was prepared bas018 on inputs from World Health Organization (WHO).

For focal point information for this indicator, please visit https://unstats.un.org/sdgs/dataContacts/

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