Worsening Global Health Workforce Shortage: What’s Being Done?

JM: photo emailed to you. Photo is of Frances Day-Stirk, president of the International Confederation of Midwives, and David Benton, CEO of the International Council of Nurses. Photo courtesy of Marilyn DeLuca, consultant, Global Health - Health Systems  and adjunct associate professor, College of Nursing, New York University.

Frances Day-Stirk, president, International Confederation of Midwives, and David Benton, CEO of International Council of Nurses. Photo courtesy of Marilyn DeLuca.

By Shawn Kennedy, MA, RN, AJN editor-in-chief

While it might seem—based on what we see in our own country—that there is no shortage of health care workers, there is indeed a global shortage and it’s only going to get worse. We reported on the global health workforce last year; new reports are revealing just how much worse things may get. According to the World Health Organization (WHO), by 2035 there will be a shortage of 12.9 million health care workers; currently, there is a shortage of 7.2 million.*

The shortage is being exacerbated by a confluence of occurrences:

  • the aging population is living longer and with more illness
  • noncommunicable chronic illnesses like cancer, cardiovascular disease, and diabetes are increasing worldwide
  • many undeveloped countries lack educational facilities for training new professionals
  • experienced health care workers migrate to developed countries for better working conditions and pay

Discussions focused on how nations individually and together can develop and strengthen the workforce to meet Millenium Development Goals and attain the goal of universal health coverage. The result was the Recife Declaration, a call to action detailing what needed to be done to address the problem, asking nations and organizations to commit to a goal of universal health coverage for all, and committing resources to develop the workforce to provide it.

The International Council of Nurses (ICN) and the International Confederation of Midwives (ICM) were among those making a commitment to work towards universal health coverage and to “support policies that advance equity and the provision of high quality care and services that are available, accessible, and acceptable.”

A glaring irony at WHO. I can’t help wondering, though, with nurses and midwives the key providers in many underdeveloped countries—and often the only educated providers of any health care—why the WHO has yet to fill the nursing and midwifery leadership position at headquarters. (See my editorial from 2011.) The Office of Nursing and Midwifery, which coordinated the work of the Global Advisory Group on Nursing and Midwifery, has been without a director since 2009. This is the group that develops and supports nursing and midwifery training programs in WHO member countries. Seems to me it would be a good idea to fill this position if the WHO is serious about universal health care.

* The figures cited above come from a new report, A Universal Truth: No Health Without a Workforce, released at last month’s Third Global Forum on Human Resources for Health conference in Recife, Brazil. Organized by the Global Health Workforce Alliance in conjunction with the WHO, the Brazilian government, and the Pan American Health Organization, the meeting drew representatives from 85 countries—over 1,300 participants in total—to address the workforce shortage.

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2016-11-21T13:05:53+00:00 December 9th, 2013|nursing perspective|13 Comments

About the Author:

Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. Christine Rincon November 19, 2017 at 10:57 am

    Hello Mr. Kennedy,
    This is an interesting topic and it presents additional information about a problem that I did not know existed. I always wondered about how to even become a global health worker. In nursing school, it is not presented as an option for future employment. The focus is usually on jobs in the hospital. That being said, it could be possible that American organizations could do more to make young nurses aware about the opportunities they could have in global healthcare. Maybe they would choose that instead of travel nursing. I do also see how as nurses get older they would want to move to a more developed country to get better pay. It seems that where the work is truly needed, it would take a very dedicated nurse to want to continue working so hard for the time that would be needed to effect any change. Appointing a director that is aware of this problem would be a great first step.

  2. Mara July 13, 2017 at 11:00 am

    Nursing shortage is nowadays a global issue. As the blog states, the aging population is living longer as well as noncommunicable diseases are increasing worldwide. These creates a higher demand in nurses and also the need for more hospitals. As a BSN student and a RN at a busy floor, I have to say that I feel the nursing shortage. Sometimes I get to “take care” of six patients and unfortunately, I feel that I am not giving the care my patients need. I can’t imagine how Nurses in other countries feel when the nurse patient ratio is 3:1000 like in Haiti.
    Thanks for a great blog, I found it very interesting!

  3. Leslie April 18, 2017 at 9:53 pm

    Nurses shortage has always been considered a global problem for many years. It has always been said with the baby boomers getting older, people living longer and most disease being able to be managed better, the supply for nurses is limited compared to demand. When I graduated from LPN school 6 years ago, it was very difficult for me to find a job since everyone wanted experienced nurses. It took me almost 6 months to find a job and even over a year for most of my classmates. With 6 years of experience now and working in different settings, I can see that the demand for the right nurse in that particular setting can be challenging. I would witness both experienced and new nurses being trained and will leave if the job is too difficult or a better offer is made. Sometimes nurses work multiple jobs at once and really only get into the career field for the money opportunities. Although nursing won’t make you rich it can provide for a comfortable living. So many nurses come to the job just for a paycheck and the bedside nursing is lost. There really should be a standard rate of pay for level of experience with regular raises to keep the good and efficient nurses working, which in turn can provide stability for our patients.

  4. curtis April 18, 2017 at 9:39 pm

    This article is another example of how the nursing shortage is affecting the world. It provides the reader with examples that influence this shortage. As a registered nurse working in an extremely populated city (Miami), one would expect that vacancies are filled in the hospital healthcare work field. Unfortunately, units are continuing to be understaffed, causing nurses to be overworked and possibly jeopardizing patient safety. The purpose for a patient to attend a hospital is to receive adequate care and improve their health. With shortages continuing to rise, it seems like quality of care may be harder to come by. Underdeveloped countries are also struggling with this shortage. In some parts of the world, nurses take responsibility for over 10-20 patients on a unit. If you were to put yourself in a patients shoes, would you rather be taken care of by a nurse with four patients or a nurse with 20 patients. Hospitals around the globe know there is a shortage. The question is will a strategy be implemented to address the situation, or will the shortage continue to rise.

  5. Luis Rijos Padron July 12, 2016 at 12:54 am

    Nursing shortages is a reality the world faces today. Despite the growth in the health care industry, demand is outpacing supply. According to the World Health Organization, the shortfall is expected to be more than twice as large as any nurse shortage experienced globally. The primary reason for this crisis is the aging of the Baby Boomer generation and as the population ages, demand for health-care services will rise. The demand for nurses was supposed to exceed the supply by the year 2010. The question of whether we truly have a nursing shortage right now is a fair one. Neither the distribution nor supply of nurses or the demand is uniform. Some geographic areas have a shortage of nurses, whereas some urban locations are witnessing an oversupply of nurses. New graduates seeking jobs in these regions will face a very competitive job market. Also, the global economic recession is a problem. The shrinking job pool is widely believed to be a consequence of the declining world economy. Economic pressures and job losses in all industries have induced thousands of experienced but aging nurses to forego retirement and even increase their working hours to support their families. One strategy to alleviate this problem involves global awareness of the nursing shortage and joint solutions to spread the talent. Aligning wages and creating better measurement and standards across countries could help.

  6. Elizabeth Maya November 24, 2014 at 9:25 pm

    There have always been rumors of a nursing shortage; however, many of us do not recognize it because we live in major cities with better staffed hospitals, and access to resources. This is not always the case, and it’s even worse in underdeveloped countries around the world. “Others do not produce enough nurses, and they tend to make up these shortages through the recruitment of healthcare personnel from other countries, particularly low- and middle-income countries.” (Holtz, 2008, pp. 99) They don’t have adequate facilities or staff much less do they have enough resources. Health facilities are costly to maintain, and many of these countries under pay nurses and physicians making them look for better opportunities abroad. Underdeveloped countries should work harder at trying to keep their professionals maybe offering health services at lower costs for their families, aids to go back to school; and finally instead of monetary payback for school aid they can have these highly trained professionals teach the newer generations. It is hard as a healthcare professional to know that as a nurse, nurses are making way more money in other countries; sometimes these nurses are not making enough to keep their families alive. Such governments should take more responsibility in taking care of their health care professionals and find a way to give them more opportunities within their own countries.

    Holtz, C. (2008). Global Health Care: Issues and Policies. Sudbury, MA: Bartlett and Jones Publishers

  7. Jessica Delahoz November 24, 2014 at 7:54 pm

    Nursing shortages seem to be one of the most popular topics in the United States, especially amongst new graduates. Even more so in underdeveloped countries due to aging populations, increases in chronic illnesses, lack of sufficient training for new professionals and work conditions worldwide as stated in the blog. What wasn’t stated was the fact that the United States tends to hire nursing professionals from other countries to fill positions, furthering the shortage in those countries. The World Health Organization (WHO) should step in and create a plan to provide educational opportunities and/or incentives for nurses from the United States to begin their careers in underdeveloped countries. For instance, the new grads that are having a hard time finding work here in the United States should be recruited and trained to work in underdeveloped countries where they will gather much needed experience and possibly begin a revolution within their corresponding countries health care system. If small changes like this were made, shortages would surely diminish. The first change should be to fill the directors position at the Office of Nursing and Midwifery at the WHO since its vacancy in 2009.

  8. Alexandria April 16, 2014 at 6:03 am

    As stated above the health care shortage is world wide, even if in our native country it isn’t evident. According to the WHO, the shortage is going to get more profound than it already is, almost doubling in numbers by 2035. The WHO can and should create a strategy to effectively address in detail the overwhelming impending shortage. As seen in recent decades, developed countries stuggle to produce an adequate amount of health care professionals. With that thought in mind, expecting these countries to effectively produce enough qualified nurses for the under developed countries as well as incentives urging them to take the positions rather than take opportunities provided in their own countries is going to be no small task.

  9. Amanda Ventura April 15, 2014 at 11:18 pm

    As most of us have heard before, the shortage in health care workers around the world is a very big issue. Just as us Americans have health problems, so do people from low income and underdeveloped countries. Every person has the right to be treated for his or her health care issues. With the increasing shortage of health care workers, something drastic needs to be done. As the years pass, the increasing aging population and chronic illnesses are making it more difficult to get assistance in health care around the world. Although many people in the United States are attending medical and nursing school, we retain most of the health care workers. Globally, we all need to find a way to increase the amount of health care workers, especially in underdeveloped countries.

  10. Joanna Sheldon April 15, 2014 at 10:35 pm

    Regarding the noncommunicable chronic illnesses that have the possibility of been preventable, it is crucial for nurses to implement education to all patients that are at risk or already have such conditions. Education has to become part of the daily routine of nurses to make the patients feel as if each part of the nurses education is the same as taking a pill of prevention.
    Another interesting topic dealt with here is how the World Health Organization has not had a leadership position filled since 2009. If the shortage of nursing is at such risk to be exacerbated, then this position should be filled to promote and facilitate the fulfillment of nursing and midwifery positions in underdeveloped countries. If this position is to be filled, then the training programs could aid in the growth of nursing and prevent the shortage.

  11. Barbara B April 15, 2014 at 6:30 pm

    Nursing shortage continues to be a big treat to the world of medicine. Despite the amount of new nursing schools that we see opening their doors all over the United States, the thousands of nurse graduates that have entered the field of nursing or getting reading for the challenge, it we are still unable to meet the demand of our population. At this point of time, the “Baby Boomers”, which we can say are a great part of our population, are aging, requiring medical assistance and nursing care, but yet staffing in nurses continues to be poor. The lack of nurses is not only caused by a greater number of people needing care, but also by a lot of nurses quitting the profession and redirecting their career toward something else then nursing. Many nurses quit because of different factors, including the pay, workload, working circumstances, long hours, lack of support and appreciation, burnouts and many more. For these reasons, some countries like ours recruit nurses from other country offering them a brighter future, creating a shortage in these countries as well. Finally, we have a lot of work to do in order to not only encourage people to become nursing professionals but also to keep the vast numbers of nurses that we already have from quitting. “Others do not produce enough nurses, and they tend to make up these shortages through the recruitment of healthcare personnel from other countries, particularly low- and middle-income countries.” (Holtz, 2008, pp. 99)
    Holtz, C. (2008). Global Health Care: Issues and Policies. Sudbury, MA: Bartlett and Jones Publishers

  12. glondy April 15, 2014 at 4:55 pm

    Even developed countries like Canada, Australia, and United Kingdom are facing health care professionals shortage. These countries, like United States, have aging health professionals caring for a rising number of elderly people. In the case of nursing, the challenge is how to substitute the number of nurses that are expected to retire during next decades. As we all have seen through the last decades, developed countries rely in more nurses than they are capable to produce. This is been achieved by recruiting them from developing countries. Since these nurses have lower payment, worst work’s conditions, less opportunities to advance education and even the thread of violence; they leave their countries where their centrally to deliver care. While this fix the shortage in developed countries temporarily, worsens the global situation. This is a big issue that needs to be address before is too late for all countries.

  13. robert April 8, 2014 at 4:20 am

    As it is stated here global nursing shortage is a big issue, here in America of course is not so much as a big issue since, nurses and doctors from around the world migrate to work here. Take for example the incentives that the people of India have; they have in place training schools which the United States recruits from. For many Indians it is a dream to come to America due to the poverty and salaries they earn in such a demanding profession, In an article I read recently an Indian migrant states, “We will be paid $30 an hour in the US. Here the average salary for nurses is about 6,000 rupees ($120) a month.” Indian nurses working in the US are paid on par with their American counterparts, meaning they take home around $3,000 plus a month. To my knowledge the global nursing shortage will continue to grow in countries where there are no or little incentives for nurses, nursing is a demanding profession mentally and physically and it deserves to be rewarded with a compensation that one can actually support themselves and their family.

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