Distribution of health workers, by occupation / specialization, region, place of work and sex
The distribution or percent of health workers according to selected characteristics, notably by occupation, geographical region, place of work and sex.
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).
Where possible, geographic mapping of sites can be used to help determine coverage.
This indicator is calculated as:
(The number of health workers with a given characteristic / Total number of health workers in a designated area) x 100
This 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 (2009).
The HSS indicator for stock of health workers can be subset according to the selected characteristics (see indicator in this section Number of health workers per 10,000 population by type of health worker). Geographic locations of health facility sites using maps or computerized mapping system. 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 SARA, see WHO (2010). Data can be disaggregated by occupation (and subset within a given occupation or medical specialization), by geographical typology (e.g. urban or rural, within or outside the capital city, by province/state or district), by place of work (e.g. hospital or primary health-care facility, public or private), by main work activities (e.g., preventive, curative, rehabilitative healthcare versus teaching or research), and by sex.
This indicator provides information on the distribution of health workers by their occupations and areas of specialty and can be subset by district, sex, age and other categories to examine coverage and demographics of the health care workforce. The additional information on health workers’ demographic characteristics may be important for policy and planning, for instance, the age distribution can lend insights into the numbers of workers approaching retirement age and whether sufficient numbers of younger health workers are coming into the system. At least four main typologies for monitoring the distribution of health workers should be considered: imbalances in occupation/specialty; geographical representation; institutions and services; and demographics. The impact on the health system varies for these different types of imbalances and, consequently, there is a need to monitor and assess each of these dimensions of workforce distribution (WHO, 2010).
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 register and/or provide reports on staff and services. Private sector providers are often less accessible to low-income populations, compared with public and community- based providers making it important to disaggregate this indicator by employment sector. While this indicator measures the availability and distribution of service providers by occupations and other categories, 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.
Service access and availability, Health workforce, Human resources, Facility management
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 and distribution of well-trained health workers by occupations and specialties 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.
The Global Fund, 2009, Monitoring and Evaluation Toolkit: HIV, Tuberculosis and Malaria and Health Systems Strengthening. http://rbm.who.int/toolbox/tool_MEtoolkit.html
USAID, 2009, Measuring the Impact of Health Systems Strengthening, A Review of the Literature, Washington, DC: USAID. http://www.usaid.gov/our_work/global_health/hs/publications/impact_hss.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
