Women drove 71% of global health workforce growth since 1990 – study

Women accounted for 71.4 per cent of global health workforce growth between 1990 and 2023, according to a study covering 204 countries and territories.

The global workforce almost tripled over the period, rising from 40.9m to 122.1m workers.

Women represented 68.9 per cent of all health workers in 2023, but remained concentrated in professions that generally offer lower pay and fewer leadership opportunities.

The study analysed 20 groups of specially trained health personnel, including doctors, nurses, midwives, pharmacists, dentists and community health workers.

Between 1990 and 2023, the workforce grew by more than 81m people, including an additional 18.9m nurses and 8.7m doctors.

In 2023, there were 33.2m nurses, 15.1m doctors, 7.6m community health workers, 6.8m pharmacists and pharmaceutical assistants, and 6.1m dentists and dental assistants worldwide.

Women made up 80.7 per cent of nurses, 96 per cent of midwives and 89.5 per cent of community health workers, while fewer than half of doctors were women.

A similar pattern was seen in dentistry and pharmacy, where women were more likely to work as assistants than as dentists or pharmacists.

Megan Knight, lead author of the study and researcher at the Institute for Health Metrics and Evaluation, said: “Women have transformed the global health workforce over the past three decades, but they continue to be concentrated in professions that generally offer lower pay and fewer opportunities for leadership.

“Building stronger health systems will require not only expanding the workforce, but also creating equitable opportunities for career advancement, leadership, and safe, supportive working environments.”

Despite the growth, researchers estimated that an additional 34.4m doctors, nurses, midwives, dentists and pharmacists would be needed to achieve moderate levels of universal health coverage.

Universal health coverage means people can access essential health services without experiencing financial hardship.

The estimated global shortage includes 23.9m nurses and midwives, 7.1m doctors, 1.8m dentists and 1.6m pharmacists.

South Asia had the largest estimated shortages, requiring an additional 2.6m doctors and 10m nurses and midwives to reach the study’s benchmark for moderate universal health coverage.

Sub-Saharan Africa also had substantial shortages. Nursing density was estimated at 14.5 nurses per 10,000 people, compared with 121.8 per 10,000 in high-income countries.

At country level, there were 3.2 nurses per 10,000 people in Chad and 3.3 in Madagascar, compared with 171.7 in Belgium and 161.4 in the US.

Dr Annie Haakenstad, senior author of the study and assistant professor of health metrics sciences at the Institute for Health Metrics and Evaluation, said: “Health workers are the foundation of every health system.

“Although the global workforce has expanded dramatically, millions more doctors, nurses, midwives, dentists, and pharmacists will be needed to ensure people everywhere can access essential health services.

“These findings provide countries with minimum thresholds for planning the workforce needed to strengthen health systems and move toward universal health coverage.”

The study estimated that moderate universal health coverage was associated with minimum workforce densities of 23.8 doctors and 64.5 nurses and midwives per 10,000 people, alongside 5.2 dentists and 5.6 pharmacists per 10,000.

Researchers said closing workforce gaps would require continued investment in education, recruitment, retention and working conditions.

They also highlighted gender-responsive policies, including leadership development, workplace protections, paid parental leave and flexible work arrangements, as measures that could support a predominantly female workforce.