Women have been the main force behind the expansion of the global health workforce over the past three decades. Yet despite the number of health workers nearly tripling since 1990, the world remains short of more than 34 million doctors, nurses, midwives, dentists and pharmacists needed to reach moderate levels of universal health coverage.
A new study provides what researchers describe as the most comprehensive assessment of the global health workforce to date. Based on Global Burden of Disease (GBD) 2023 estimates, it maps 20 categories of health workers across 204 countries and territories between 1990 and 2023. For the first time, the analysis also provides global estimates for community health workers and breaks workforce numbers down by sex.
The findings reveal two interconnected challenges: large geographical inequalities in access to health professionals and persistent gender disparities within the workforce itself.
Women fuel global expansion
The global health workforce grew from 40.9 million people in 1990 to 122.1 million in 2023. Women accounted for 71.4 percent of that increase and represented 68.9 percent of all health workers in 2023. The workforce now includes 33.2 million nurses and 15.1 million doctors, alongside 7.6 million community health workers, 6.8 million pharmacists and pharmaceutical assistants, and 6.1 million dentists and dental assistants.
Women are particularly strongly represented in nursing, midwifery and community care. They account for 80.7 percent of nurses, 96 percent of midwives and 89.5 percent of community health workers. Yet fewer than half of the world's doctors are women. Similar differences can be seen in dentistry and pharmacy, where women are more likely to work as assistants than as dentists or pharmacists.
This means that numerical representation does not necessarily translate into equal professional opportunities. Lead author Megan Knight of the Institute for Health Metrics and Evaluation (IHME) points out that women remain concentrated in professions that generally offer lower salaries and fewer opportunities for leadership. For policymakers, workforce expansion therefore presents a dual challenge: recruiting enough professionals while ensuring that the predominantly female workforce has equitable opportunities for career development, leadership and supportive working conditions.
A shortage of 34 million workers
The scale of the remaining workforce deficit is considerable. The researchers estimate that another 34.4 million health professionals would be required worldwide to achieve a score of 80 out of 100 on the GBD universal health coverage effective coverage index. The largest shortage is among nurses and midwives, with an estimated deficit of 23.9 million. An additional 7.1 million doctors, 1.8 million dentists and 1.6 million pharmacists would also be required.
The study calculates minimum workforce densities associated with this level of healthcare coverage: 23.8 doctors and 64.5 nurses and midwives per 10,000 inhabitants, complemented by 5.2 dentists and 5.6 pharmacists. These figures are not merely a measure of staffing pressure. They provide governments with benchmarks for workforce planning and offer an indication of the scale of investment required to expand access to essential healthcare.
Geography determines access
The global totals also mask profound regional differences. South Asia faces the largest absolute shortages, requiring an estimated additional 2.6 million doctors and 10 million nurses and midwives to reach the study's benchmark for moderate universal health coverage.
Sub-Saharan Africa also faces severe shortages. The region had just 14.5 nurses per 10,000 people in 2023, compared with 121.8 in high-income countries. At country level, the contrast becomes even sharper. Chad had 3.2 nurses per 10,000 inhabitants and Madagascar 3.3. Belgium, by comparison, had 171.7, while the United States had 161.4.
Such disparities illustrate why global workforce growth alone is an incomplete measure of progress. Adding millions of health workers does not automatically improve access if that growth occurs primarily in countries and regions that already have relatively high workforce densities.
Not just a recruitment challenge
Closing the gap will require long-term investment in education, recruitment and retention. Working conditions will be equally important. With women making up almost 70 percent of the workforce, policies around workplace safety, leadership development, paid parental leave and flexible working arrangements could have a direct impact on the resilience of health systems. The findings are also relevant to the Sustainable Development Goals. SDG target 3.c.1 calls for greater recruitment, development, training and retention of health workers, while target 3.8 focuses on universal health coverage.
The study ultimately reframes healthcare staffing as a fundamental part of health infrastructure. Digitalisation, AI, new diagnostics and other medical innovations may help health systems work differently, but access to care still depends heavily on having enough trained professionals to deliver it.
The expansion since 1990 demonstrates that large-scale workforce growth is possible. At the same time, the estimated shortage of 34.4 million professionals shows how far health systems still have to go. Addressing that deficit will require more than increasing headcounts. Where workers are located, which professions they enter and whether the predominantly female workforce receives opportunities to develop and lead will be equally important to the future of global healthcare.
Robots ‘solve’ staff shortages
Last year, researchers from Johns Hopkins University and Stanford University trained surgical robots to perform complex tasks autonomously using video-based learning. The robots learned procedures such as manipulating needles, tying knots and suturing wounds by analysing recordings of surgical tasks and translating visual information into robotic movements.
The training method resembles techniques used for large language models such as ChatGPT, but instead of predicting words, the system learns the positions and movements required to perform surgical procedures. Importantly, the robots can also recognize and correct mistakes without direct human intervention.
During demonstrations, the trained systems successfully transferred their skills to new environments, performing tasks on pig and chicken tissue. The robots can additionally respond to spoken instructions, allowing users to direct their movements verbally. According to the researchers, autonomous surgical robotics could eventually help address growing shortages of surgeons.
References
The Lancet Public Health (research)
