Across 20 health-worker cadres, the estimated global workforce increased by 81.2 million between 1990 and 2023. By 2023, it included approximately:

• 33.2 million nurses and midwives
• 15.1 million doctors
• 7.6 million community health workers
• 6.8 million pharmacists and pharmaceutical assistants
• 6.1 million dentists and dental assistants

Women’s participation was central to this growth. However, representation has not translated into equal influence across the health system. Women made up most nurses, midwives and community health workers, while fewer than half of doctors were women in the reported estimates. That pattern reflects a gendered division of labour: women are heavily represented in essential frontline and caregiving work but remain less represented in occupations and decision-making positions associated with higher pay and authority.

The distinction matters because simply counting workers can obscure who performs the work, how that work is valued and who controls workforce priorities. A health system can become larger without becoming more equal or more effective at retaining skilled professionals.

Why the estimated gap is 34.4 million workers

The GBD 2023 analysis does not define a shortage simply as the number of vacant posts. Instead, it compares workforce density with the lowest observed density in countries that reached a UHC effective-coverage score of 80 or higher. The resulting thresholds are empirical benchmarks linked to service coverage, rather than universal staffing rules for every country.

Using those benchmarks, the estimated global additions needed in 2023 were:

The largest component is nurses and midwives, whose estimated gap is more than three times the doctor shortfall. That finding reinforces why workforce planning cannot focus on producing more physicians alone. Primary care, nursing, midwifery, oral health, pharmacy and community-based services all contribute to effective coverage.

The workforce-density benchmarks have changed

An earlier GBD-based study, using 2019 data, estimated that countries needed at least the following densities per 10,000 people to reach a UHC effective-coverage score of 80:

• 20.7 physicians
• 70.6 nurses and midwives
• 8.2 dentistry personnel
• 9.4 pharmaceutical personnel

The newer analysis reports different observed thresholds—approximately 23.8 doctors, 64.5 nurses and midwives, 5.2 dentists and 5.6 pharmacists per 10,000 people.

These figures should not be read as a contradiction or as a single fixed global standard. The studies use different data vintages and estimation procedures. The newer approach is based on observed workforce densities among countries meeting the UHC threshold, while the earlier analysis produced minimum benchmark densities from its own modelling framework. Changes in data coverage, country performance and methodology can therefore change the estimated threshold and the resulting gap.

South Asia has the largest absolute gap

South Asia has the largest estimated shortfall in absolute terms: about 13.6 million additional workers across the five professional groups. The reported regional breakdown includes approximately 2.6 million doctors, 10.0 million nurses and midwives, 0.7 million dentists and 0.3 million pharmacists.

Population size is a major reason South Asia’s total gap is so large. The region’s challenge is therefore both numerical and organisational: it must expand the workforce while ensuring that workers are distributed across rural, poorer and underserved communities.

Sub-Saharan Africa presents a different but equally severe problem. It had the lowest workforce densities for nearly all major cadres in 2023, with community health workers the main exception, while high-income countries had the highest densities.

The contrast shows why a single global number can mislead. South Asia has the largest absolute requirement, whereas sub-Saharan Africa faces exceptionally low availability relative to population and need. Both regions require more workers, but the policy response must be tailored to local population growth, disease burden, training capacity and retention conditions.

Why the estimate is higher than some WHO figures

The 34.4-million estimate is not directly comparable with every figure published by WHO. WHO shortage estimates may use different years, occupational categories, definitions of need and planning horizons. For example, a WHO summary reported a needs-based shortage of 20 million workers in 2013, falling to 15 million in 2020 and projected to reach 10 million by 2030.

The GBD estimate answers a different question: how many doctors, nurses, midwives, dentists and pharmacists would be needed to reach an effective UHC coverage score of 80, using observed workforce-density thresholds from countries that meet that benchmark.

A higher GBD estimate does not automatically invalidate a lower WHO estimate. The figures become misleading only when they are presented as if they measure the same target, occupations, year and definition of shortage.

Recruitment alone will not close the gap

Training and hiring are necessary, but adding workers without improving the conditions of work can produce rapid turnover, poor distribution and migration away from underserved areas. A durable workforce strategy needs to address the entire employment pipeline:

• Education: expand training capacity while maintaining faculty, clinical placements and quality standards.
• Distribution: create incentives and support systems for workers in rural and underserved areas.
• Retention: improve pay, safety, workload management, social protection and career progression.
• Gender equity: address unequal pay, harassment, discrimination, unpaid care burdens and opaque promotion systems.
• Leadership: ensure women have meaningful representation in management, policy and professional decision-making.
• Skills mix: invest in nursing, midwifery, pharmacy, oral health, community health workers, primary care and referral systems—not only physicians.

The central lesson is a paradox: the global health workforce expanded by more than 80 million people, largely through women’s labour, yet many health systems remain far below the workforce capacity associated with even moderate UHC. Closing that gap requires more than recruitment. It requires valuing the roles already doing much of the work, distributing workers more fairly and building institutions that enable them to stay and lead.

Across 20 health-worker cadres, the estimated global workforce increased by 81.2 million between 1990 and 2023. By 2023, it included approximately:

• 33.2 million nurses and midwives
• 15.1 million doctors
• 7.6 million community health workers
• 6.8 million pharmacists and pharmaceutical assistants
• 6.1 million dentists and dental assistants

Women’s participation was central to this growth. However, representation has not translated into equal influence across the health system. Women made up most nurses, midwives and community health workers, while fewer than half of doctors were women in the reported estimates. That pattern reflects a gendered division of labour: women are heavily represented in essential frontline and caregiving work but remain less represented in occupations and decision-making positions associated with higher pay and authority.

The distinction matters because simply counting workers can obscure who performs the work, how that work is valued and who controls workforce priorities. A health system can become larger without becoming more equal or more effective at retaining skilled professionals.

Why the estimated gap is 34.4 million workers

The GBD 2023 analysis does not define a shortage simply as the number of vacant posts. Instead, it compares workforce density with the lowest observed density in countries that reached a UHC effective-coverage score of 80 or higher. The resulting thresholds are empirical benchmarks linked to service coverage, rather than universal staffing rules for every country.

Using those benchmarks, the estimated global additions needed in 2023 were:

The largest component is nurses and midwives, whose estimated gap is more than three times the doctor shortfall. That finding reinforces why workforce planning cannot focus on producing more physicians alone. Primary care, nursing, midwifery, oral health, pharmacy and community-based services all contribute to effective coverage.

The workforce-density benchmarks have changed

An earlier GBD-based study, using 2019 data, estimated that countries needed at least the following densities per 10,000 people to reach a UHC effective-coverage score of 80:

• 20.7 physicians
• 70.6 nurses and midwives
• 8.2 dentistry personnel
• 9.4 pharmaceutical personnel

The newer analysis reports different observed thresholds—approximately 23.8 doctors, 64.5 nurses and midwives, 5.2 dentists and 5.6 pharmacists per 10,000 people.

These figures should not be read as a contradiction or as a single fixed global standard. The studies use different data vintages and estimation procedures. The newer approach is based on observed workforce densities among countries meeting the UHC threshold, while the earlier analysis produced minimum benchmark densities from its own modelling framework. Changes in data coverage, country performance and methodology can therefore change the estimated threshold and the resulting gap.

South Asia has the largest absolute gap

South Asia has the largest estimated shortfall in absolute terms: about 13.6 million additional workers across the five professional groups. The reported regional breakdown includes approximately 2.6 million doctors, 10.0 million nurses and midwives, 0.7 million dentists and 0.3 million pharmacists.

Population size is a major reason South Asia’s total gap is so large. The region’s challenge is therefore both numerical and organisational: it must expand the workforce while ensuring that workers are distributed across rural, poorer and underserved communities.

Sub-Saharan Africa presents a different but equally severe problem. It had the lowest workforce densities for nearly all major cadres in 2023, with community health workers the main exception, while high-income countries had the highest densities.

The contrast shows why a single global number can mislead. South Asia has the largest absolute requirement, whereas sub-Saharan Africa faces exceptionally low availability relative to population and need. Both regions require more workers, but the policy response must be tailored to local population growth, disease burden, training capacity and retention conditions.

Why the estimate is higher than some WHO figures

The 34.4-million estimate is not directly comparable with every figure published by WHO. WHO shortage estimates may use different years, occupational categories, definitions of need and planning horizons. For example, a WHO summary reported a needs-based shortage of 20 million workers in 2013, falling to 15 million in 2020 and projected to reach 10 million by 2030.

The GBD estimate answers a different question: how many doctors, nurses, midwives, dentists and pharmacists would be needed to reach an effective UHC coverage score of 80, using observed workforce-density thresholds from countries that meet that benchmark.

A higher GBD estimate does not automatically invalidate a lower WHO estimate. The figures become misleading only when they are presented as if they measure the same target, occupations, year and definition of shortage.

Recruitment alone will not close the gap

Training and hiring are necessary, but adding workers without improving the conditions of work can produce rapid turnover, poor distribution and migration away from underserved areas. A durable workforce strategy needs to address the entire employment pipeline:

• Education: expand training capacity while maintaining faculty, clinical placements and quality standards.
• Distribution: create incentives and support systems for workers in rural and underserved areas.
• Retention: improve pay, safety, workload management, social protection and career progression.
• Gender equity: address unequal pay, harassment, discrimination, unpaid care burdens and opaque promotion systems.
• Leadership: ensure women have meaningful representation in management, policy and professional decision-making.
• Skills mix: invest in nursing, midwifery, pharmacy, oral health, community health workers, primary care and referral systems—not only physicians.

The central lesson is a paradox: the global health workforce expanded by more than 80 million people, largely through women’s labour, yet many health systems remain far below the workforce capacity associated with even moderate UHC. Closing that gap requires more than recruitment. It requires valuing the roles already doing much of the work, distributing workers more fairly and building institutions that enable them to stay and lead.