WHO estimates global shortfall of 5.9M nurses as world battles COVID-19

MANILA — Nurses play a vital role on the front lines of the novel coronavirus pandemic. But a shortage of these essential health care workers could pose challenges in countries dealing with a growing number of COVID-19 cases.

“One of the lessons I hope the world learns from COVID-19 is that we must invest in nurses and midwives,” said World Health Organization Director-General Tedros Adhanom Ghebreyesus during a speech Tuesday in celebration of World Health Day, which recognized the vital work of nurses and midwives worldwide.

The WHO chief said nurses around the globe are providing care for critically ill and isolated COVID-19 patients, at the risk of their own lives.

This is not the first time their importance has been highlighted in international emergencies. Nurses were also on the front lines of the Ebola outbreaks in the Democratic Republic of the Congo and West Africa. In Liberia, they were the most affected by the outbreak among health care workers.

WHO’s new “State of the World’s Nursing 2020” report has identified a global shortage of 5.9 million nurses. Many of those gaps are found in Africa, Southeast Asia, the Eastern Mediterranean, and parts of Latin America.

Among regions of the world, the Americas have the highest density of nurses at 83.4 per 10,000 people, followed by Europe with 79.3 nurses per 10,000 people. In contrast, there are 8.7 nurses per 10,000 people in Africa, 15.6 nurses per 10,000 people in the Eastern Mediterranean region, 16.5 nurses per 10,000 people in Southeast Asia, and 36 nurses per 10,000 people in the Western Pacific.

But there are stark differences within regions. In the Americas, for example, countries such as Brazil, Canada, Chile, and the U.S. have a higher density of nurses at close to or over 100 per 10,000 people, distorting the regional average. Many of the neighboring countries in the region have less than 50 nurses per 10,000 people. In Haiti, there are only 3.8 nurses per 10,000 people.

Data on the distribution of the nursing workforce within countries — which is only available for a handful of nations in Africa and Latin America — also shows imbalances.

While regional aggregates and national estimates are helpful, limited data on the geographic distribution of nurses within countries can make effective policy solutions elusive for governments, said Dr. Giorgio Cometto, WHO coordinator on human resources for health policies and standards.

National density numbers only provide a partial picture of the situation in countries, Cometto said. Not knowing where nurses work or where they are employed “represents a huge limitation in terms of how best to manage them or whether inequitable distribution exists,” he told Devex. “More often than not, it does [exist], but knowing exactly its patterns, its extent — that's essential for driving policy decisions.”

If the vast majority of a country’s health workers are concentrated in urban or other affluent areas, “then of course there's still a major issue with the shortages, especially in some parts of the country,” he added.

The challenge and potential solution

Countries’ economic capacities and health allocations drive the disparity in nursing numbers.

When broken down by country income, data in the report shows an unsurprising trend: The higher the income, the higher the nursing density. In low-income countries, the average density of nurses is 9.1 per 10,000 people, while the figure for high-income countries is 107.7 per 10,000 people.

But training more nurses won’t solve the problem, Cometto said.

“We wish that were true, but unfortunately it's not. Training more is not enough, because ... if the country lacks the economic capacity to employ them or to create economic opportunities for them to work as nurses … training more nurses can just go into the direction of exacerbating labor market imbalances, resulting in unemployment among nurses. And that's a huge wastage of human capital as well as financial resources,” Cometto said.

The key is balancing training with the creation of employment opportunities in rural areas where there are known health worker shortages.

That may be easier said than done, especially among countries that are suffering from chronic or complex emergencies, in active conflict, or struggling in the wake of conflict. But in these settings, the international aid community can align its assistance with national priorities and covering recurrent costs, such as salaries, within a specified period of time, Cometto said.

He said a lot of aid money is funneled into the training of health personnel — particularly short-term, disease-specific, in-service training. But this has known drawbacks, including absenteeism of health workers from their positions.

“If that money, or at least a large part of that money, can be instead channeled up through national systems to increase the pool of health workers instead of competing for the time of the limited number of health workers, I think that will go a long way in terms of improving efficiency of aid as well as creating the jobs that are required to actually grow the workforce of some of these low-income countries that cannot meet domestic needs through domestic financial resources,” Cometto said.

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