Health and Care Workforce - Time To Act

The WHO Regional Office for Europe
The World Health Organization (WHO) is a specialized

agency of the United Nations created in 1948 with the
primary responsibility for international health matters
and public health. The WHO Regional Office for Europe
is one of six regional offices throughout the world, each
Health and care

with its own programme geared to the particular health
conditions of the countries it serves.
workforce in Europe:
Member States
Albania Hungary Romania
time to act
Andorra Iceland Russian Federation
Armenia Ireland San Marino
Austria Israel Serbia
Azerbaijan Italy Slovakia
Belarus Kazakhstan Slovenia
Belgium Kyrgyzstan Spain
Bosnia and Herzegovina Latvia Sweden
Bulgaria Lithuania Switzerland
Croatia Luxembourg Tajikistan
Cyprus Malta Türkiye
Czechia Monaco Turkmenistan
Denmark Montenegro Ukraine
HEALTH AND CARE WORKFORCE IN EUROPE: TIME TO ACT

Estonia Netherlands United Kingdom
Finland North Macedonia Uzbekistan
France Norway
Georgia Poland
Germany Portugal
Greece Republic of Moldova
World Health Organization

Regional Office for Europe
UN City, Marmorvej 51,

DK-2100 Copenhagen Ø, Denmark
Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01
Email: eurocontact@who.int
Website: www.who.int/europe
Health and care
time to act
ABSTRACT
All countries of the WHO European Region currently face severe challenges related to the health and care workforce
(HCWF). This report focuses on identifying effective policy and planning responses to these HCWF challenges
across the Region. The report presents an overview of the HCWF situation in the Region (focusing on medical
doctors, nurses, midwives, dentists, pharmacists and physiotherapists, for whom data are available) and identifies
relevant policy options, their expected benefits and potential facilitators or barriers to successful implementation.
Examples of sound evidence-informed practices in countries are also provided. The aim of the report is to describe
the data, rather than to analyse. Data supplied by countries have been used, but in many cases these have been
incomplete. It is expected that data will grow progressively in future. No data on informal health workers are
included. The WHO Regional Office for Europe, working with stakeholders, will support Member States’ efforts
to strengthen their HCWF. It will continue to make the case for investment in the HCWF not only to secure health
gains, but also to achieve economic and social benefits.
Keywords
HEALTH PERSONNEL, HEALTH AND CARE WORKFORCE, WORLD HEALTH ORGANIZATION, COVID-19
ISBN: 978-92-890-5833-9
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Contents
Foreword........................................................................................................................................iv
Acknowledgements..........................................................................................................................v
Abbreviations.................................................................................................................................vii
Executive summary ....................................................................................................................... viii

Ten actions to strengthen the HCWF in the WHO European Region....................................................x
1. Why do we need this report, and why now?...................................................................................1
2. Profile of the HCWF in the WHO European Region..........................................................................5

2.1 What do the data show?............................................................................................................ 7
2.2 How countries responded to the pressures of the COVID-19 pandemic on the HCWF ......... 21
3. Responses to challenges to HCWF policy development in the Region...........................................27

3.1 Strengthening education and improving training................................................................. 29
3.2 Retention of new and existing graduates in domestic HLMs ................................................ 34
3.3 Organization of work and the performance of the HCWF...................................................... 36
3.4 Creating an attractive work environment that is protective of the health and
well-being of HCWs ................................................................................................................ 42
3.5 Governance for a strong and effective HCWF......................................................................... 46
3.6 Investing smartly in the HCWF................................................................................................ 59
4. The way forward: 10 actions to strengthen the HCWF in the European Region..............................61
4.1 Proposed actions................................................................................................................... 61
5. Conclusion..................................................................................................................................67
References.....................................................................................................................................70
Annex 1. Sources of strategic recommendations and tools..............................................................77
Annex 2. Country profiles................................................................................................................82
iii
Foreword
Every single country of the WHO European Region

owes huge gratitude to their health and care
workforce. Never was this more evident than at
the height of the COVID-19 pandemic, when health
and care professionals stood as the main defence,
striving to provide the care our populations needed,
often at great personal risk, putting their own lives
on the line.
Hans Henri P. Kluge
WHO Regional Director for Europe
Their heroic efforts came at a cost. Stress, fatigue, Europe stands with them to put in place appropriate
distress, burnout and the deadly effects of the virus measures to protect and nurture their workforce.
itself were constant companions. Thousands of
health and care workers succumbed to the impacts Health and care workers need our support as never
of some or all of these. WHO’s population-based before. That is why this report is so important.
estimate for Europe is that around 50 000 health The report is underpinned by an understanding
and care workers may have lost their lives during that all countries of the WHO European Region are
the pandemic1 due to the severe acute respiratory facing significant challenges with their health and
syndrome coronavirus-2 virus. care workforce. Personnel shortages, insufficient
recruitment and retention, migration of qualified
The pressure on the workforce, mainly constituting workers, unattractive working conditions and poor
women, remains high. The backlogs created access to continuing professional development
by postponed health interventions are placing opportunities are blighting health systems.
enormous strain on services and workers as they These are compounded by inadequate data and
try to make up for lost time, while still standing on limited analytical capacity, poor governance
the COVID-19 frontline. Combined with the normal and management, lack of strategic planning and
burdens of providing services to populations that insufficient investment in developing the workforce.
are ageing and living with chronic conditions, this
is creating huge challenges for health and care The focus of this report is on identifying effective
workers across the Region. policy and planning responses to support countries
to meet these very challenges. It recognizes,
This is happening as they try to recover from the however, that while common prerequisites for
psychological trauma and physical exhaustion efficient health and care workforce management
experienced during the pandemic. This is happening apply to all countries, there is no one-size-fits-all
as we face no less than three public health solution. Countries need to design their own path
emergencies of international concern: monkeypox, to reflect their historical, economic, social and
polio and COVID-19. political contexts.
The problems WHO Member States face existed

The Region is at a critical juncture. Strategic
before the pandemic, but have been exacerbated
planning and smart investment are crucial next
since. Countries are responding to the challenges
steps in supporting our health and care workers to
at a time of acute economic crisis, which demands
deliver on the promises of ensuring health for all,
the introduction of effective, imaginative, innovative
and leaving no one – including our health and care
and smart approaches. The WHO Regional Office for
professionals – behind. It is time to act.
1 The impact of COVID-19 on health and care workers: a closer look at deaths. Health Workforce Department – Working Paper 1.
Geneva: World Health Organization; 2021:6 (WHO/HWF/WorkingPaper/2021.1; https://apps.who.int/iris/handle/10665/345300,
accessed 14 July 2022).
iv
Acknowledgements
This report was developed under the overall Regional Office for Europe), and Giorgio Cometto
strategic and technical guidance of Natasha and Khassoum Diallo (WHO headquarters). Special
Azzopardi-Muscat (WHO Regional Office for Europe) thanks to Govin Permanand (WHO Regional Office
and Tomas Zapata (WHO Regional Office for Europe). for Europe) for thorough review of the report.
Gilles Dussault (Nova University Lisbon, Portugal) The vignette template was developed by James
was the lead editor, supported by Tomas Zapata and Buchan and Tomas Zapata. Authors of each vignette
James Buchan (WHO Regional Office for Europe). are as follows.
Belgium
Oversight and strategic development of the report
Walter Sermeus (KU Leuven Institute for
was provided by a reference group comprising
Healthcare Policy, Belgium) and Koen Van den
Natasha Azzopardi-Muscat, Matthieu Boniol (WHO
Heede (Belgian Knowledge Centre).
headquarters), Gaetan Lafortune (Organisation
for Economic Co-operation and Development),
Georgia
Katarzyna Ptak-Bufkens (European Commission),
Allison Ekberg (WHO Country Office in Georgia)
Cris Scotter (WHO Regional Office for Europe),
and Cris Scotter.
Matthias Wismar (European Observatory on Health
Systems and Policies) and Tomas Zapata.
Iceland
Ester Petra Gunnarsdóttir (Health Department,
The writing group was Gilles Dussault, Gemma
Iceland).
Williams (European Observatory on Health Systems
and Policies), Graham Willis, James Buchan,
Ireland
Tomas Zapata, Cris Scotter, Maggie Langins, Yanina
Geraldine Crowley and Abbie McCarthy (Health
Andersen and Ana Paula Cavalcante Oliveira (WHO Service Executive, Ireland).
Regional Office for Europe), listed in order of
contribution level. Israel
Shoshy Goldberg (Ministry of Health, Israel),
Data compilation, analysis and production was Rivka Hazan Hazoref (WHO Collaborating Centre
performed by Graham Willis, Olga Rigina and for Leadership and Governance in Nursing and
Cris Scotter, supported by Gaetan Lafortune and Ministry of Health, Israel), Margrieta Langins and
Matthieu Boniol. Alba Llop Girones.
Special thanks to all Member States of the WHO Kazakhstan

European Region that regularly reported data Azhar Giniyat (Ministry of Health, Kazakhstan),
through the Joint Data Collection questionnaire and Arnoldas Jurgutis (WHO European Centre
reviewed the country profiles and country vignettes. for Primary Health Care), Zhamilya Abeuova
(Enbekshikazakh Interdistrict Hospital,
The WHO Regional Office for Europe wishes to Kazakhstan), Vitalii Stetsyk (WHO Country Office
thank the external reviewers of the report, Kenneth in Kazakhstan) and Melitta Jakab (WHO European
Grech (Ministry for Health, Malta) and Eszter Centre for Primary Health Care).
Kovacs (Semmelweis University Health Services
Management Training Centre, Hungary). Kyrgyzstan
Kaija Kasekamp (WHO Barcelona Office for Health
Technical review and feedback were provided by Systems Strengthening), Joana Madureira Lima
the following WHO staff: Mafaten Chaouali, Carina (WHO Country Office in Kyrgyzstan), Triin Habicht
Ferreira-Borges, Katrine Bach Habersaat, João (WHO Regional Office for Europe) and Aigul
Breda, Melitta Jakab, Ledia Lazeri, Alba Llop-Girones, Sydykova (WHO Country Office in Kyrgyzstan) and
Satish Mishra, Cathal Morgan, Sinaia Netanyahu, Graham Willis (WHO Regional Office for Europe).
David Novillo-Ortiz and Isabel Yordi-Aguirre (WHO
v
Malta United Kingdom
Maureen Mahoney (Ministry of Health, Malta) and Gemma Williams.
Cris Scotter.
United Kingdom (England)
North Macedonia Nihar Shembavnekar, Nuha Bazeer, Elaine Kelly,
Rosamund Bryar (WHO Regional Office for Jake Beech, Anita Charlesworth, Ruth McConkey,
Europe), Mireia Sanchez Martínez (WHO Regional Rebecca Fisher (all Health Foundation, United
Office for Europe), Cris Scotter and Peter P. Kingdom) and James Buchan.
Groenewegen (Netherlands Institute for Health
Services Research). United Kingdom (Scotland)
Scottish Government.
Slovenia
Pia Vračko (National Institute of Public Health, International Association for Health
Slovenia), Vesna-Kerstin Petrič (Ministry of Health, Professions Education (AMEE)
Slovenia) and Liesbeth Borgermans (University of AMEE and Janusz Janczukowicz (Medical
Ghent, Belgium). University of Lodz, Poland).
vi
vi
Abbreviations
AMEE Association for Medical Education in Europe

ASPIRE International Recognition of Excellence in Medical Education (initiative)
CHN community care network (Ireland)
CPD continuing professional development
ECC Enhanced Community Care (programme) (Ireland)
EEA European Economic Area
EPW WHO’s European Programme of Work 2020–2025: United Action for Better Health in
Europe
EU European Union
GCNMOs government chief nursing and midwifery officers
GCNO government chief nursing officer
GDP gross domestic profit
GP general practitioner
HCWs health and care workers
HCWF health and care workforce
HLM health labour market
HRH human resources for heath
Int$ international dollars
NHS National Health Service (United Kingdom)
NIPH National Institute of Public Health (Slovenia)
NMC Nursing and Midwifery Council (United Kingdom)
OECD Organisation for Economic Co-operation and Development
P4P pay-for-performance (system)
PHC primary health care
PPP purchasing power parity
REAL Research and Economic Analysis for the Long term (Centre) (United Kingdom)
TAPIC transparency, accountability, participation, integrity, capacity (framework)
UCAT University Clinical Aptitude Test
UHC universal health coverage
vii
vii
Executive summary
The aim of this report is to present for the first time a picture of the
health and care workforce (HCWF) in the WHO European Region based
on available data provided by countries in 2022. The focus is on the main
policy options that can help countries strengthen their HCWF to meet
current and future health needs and progress towards universal health
coverage (UHC).
The report concentrates on six health professions crisis) across Europe in mid-2022 is having an
for which data of sufficient quality are available. impact on pay, attrition rates and the attractiveness
It therefore does not consider the entire breadth of working in the health and care sectors in many
of the HCWF, including informal carers, due to parts of the Region.
current challenges around access to reliable data
for these groups. European countries must now prioritize their HCWs
by investing more and investing smarter. They
The COVID-19 pandemic has demonstrated the must protect their HCWF by implementing policies
strengths and fragilities of the HCWF in the that place the interests and well-being of HCWs at
European Region the forefront. HCWs inspired everyone during the
pandemic with their commitment and it is now time
Many Member States entered the COVID-19 to place them not only at the centre of the health
emergency with insufficient numbers of health policy agenda, but also at the heart of economic and
and care workers (HCWs), suboptimal skill-mixes social recovery.
and imbalanced geographical distributions. This
posed challenges to creating surge capacity and The report identifies effective policy and
maintaining essential health services. planning responses to HCWF challenges
in the Region
HCWs have been placed under extreme pressure,
having to cope with heavy workloads and job-related The report proposes key priority policy actions
stress and frequently facing physical and mental that can help countries strengthen their HCWF to
health risks, with some experiencing violence and meet current and future health needs and progress
harassment. Yet throughout the crisis, the HCWF towards UHC. It is aimed at policy-makers at
has responded with agility and determination, European, national and subnational levels across
rapidly acquiring new skills, adapting to new service health and other relevant sectors.
requirements and responding effectively to an
increase in health needs. The European Region HCWF has never
been larger or more diverse in terms of
Health system recovery and future available skills
preparedness will fail without a strengthened
HCWF Available data (until 2020), much of which do not yet
capture the full effect of the pandemic, show that
In the absence of targeted policy action, there is a the HCWF of medical doctors, nurses and midwives
risk that the pressures of COVID-19 will exacerbate in Europe increased by 10% between 2010 and
long-standing shortcomings related to HCW 2020. The greatest increase was seen in western
shortages and difficulties in attracting and retaining Asia (36%), followed by western Europe (26%) and
HCWs. The economic climate (and cost-of-living southern Europe (15%), but there was a decline
viii
in central Asia (15%) and eastern Europe (6%). An Policy responses have involved ensuring the
overall upward trend is welcome in a context of availability of more workers by, for example,
growing prevalence of noncommunicable diseases, deploying students in care settings, bringing back
multimorbidity, disabilities and chronic conditions. retired and inactive workers, using volunteers
and fast-tracking deployment of foreign-trained
The ageing of the HCWF is a concern throughout the professionals. Reskilling and repurposing the
Region and poses a threat to the sustainability of the workforce and the accelerated use of digital
workforce due to the challenge of replacing workers technology have made a critical contribution to
when they retire, especially for medical doctors (13 creating surge capacity and meeting the specific
of the 44 countries that reported data on this issue demands of the pandemic. Urgent action has
have a workforce in which 40% of medical doctors also been taken to protect HCWs by creating safe
are aged 55 or older). While the proportion of working environments, supporting mental health
women in the medical workforce increased over the and providing financial and practical help (such as
past 10 years from 42% to 48%, women comprise the childcare) to motivate and enable HCWs to continue
majority of workers in lower-paid and lower-status working effectively.
occupations. More data and research on gender gaps
and occupational segregation in critical areas are Many of the strategies adopted during COVID-19
required to ensure a health and care system that to protect, retain and reskill HCWs are not new,
recognizes all the competencies and contributions but required rapid changes to policy, regulation,
of women. financing and ways of working to create an enabling
environment for implementation. Learning from
There is wide variability in the production of HCWs and building on these initiatives can help support
across countries. Countries with a low number of and sustain the HCWF going forward.
graduates may not be providing sufficient staff to
replace losses due to retirement and other causes. The report proposes 10 actions to strengthen
For medical doctors, the numbers of graduates as a the HCWF in the European Region
percentage of the HCWF size varies across countries
from under 1% (not sufficient to replace losses) to The report outlines policy options that can help
15%. For nurses, the percentages range from under countries strengthen their HCWF, proposing 10
1% to nearly 25%. actions to strenghten the HCWF in the European
Region. All interventions require intersectoral
Building on innovative strategies implemented collaboration, engaging different ministries and
during the COVID-19 pandemic will support and government functions and other stakeholders
sustain an effective workforce (including organizations representing HCWs and
employers). WHO will continue to support Member
Countries across the Region have had to adopt States to make policy change happen and drive
innovative strategies to meet surge capacity during improved health outcomes.
the pandemic. They must now sustain and develop
the HCWF and protect its health and well-being. This report comes at a critical moment that presents
an unprecedented opportunity to take firm action
to address persistent HCWF challenges in the WHO
European Region. It is time to act.
ix
TEN ACTIONS
to strengthen the health and care workforce
Action 1.
Align education with population needs and health service

requirements
Action 2.
Strengthen continuing professional development to equip the
workforce with new knowledge and competencies
Action 3.
Expand the use of digital tools that support the workforce
Action 4.
Develop strategies that attract and retain health workers in
rural and remote areas
Action 5.
Create working conditions that promote a healthy work–life
balance
Action 6.
Protect the health and mental well-being of the workforce
Action 7.
Build leadership capacity for workforce governance and planning
Action 8.
Strengthen health information systems for better data
collection and analysis
Action 9.
Increase public investment in workforce education, development
and protection
Action 10.
Optimize the use of funds through innovative workforce policies $
x
xi
Why do we need this report,
and why now?
All countries of the WHO European Region face severe problems

related to their health and care workforce (HCWF). These are not
new challenges, but the COVID-19 pandemic has exacerbated
the problems and created some of its own. In addition, the
economic climate (and cost-of-living crisis) across Europe in
mid-2022 is having an impact in relation to pay, attrition rates
and the attractiveness of at least some parts of the HCWF to
potential recruits. The Region is at a critical juncture in being
able to ensure a fit-for-purpose HCWF.
Irrespective of their income level, countries are, to • unattractive employment and working
varying extents, having to deal with: conditions that are demotivating, fail to
protect the physical and mental health of
• shortages of health and care workers HCWs and allow bias and gender- or ethnic-
(HCWs): despite the Region having the based discrimination to flourish, with women
highest density of HCWs of all WHO regions, clustered in lower-status jobs and being
many countries face shortages, and underrepresented in decision-making positions;
trends are concerning as the workforce is • a lack of gender-responsive policies to
ageing and efforts to replace professionals improve the gender balance across services,
finishing their careers are suboptimal; increase recruitment in underserved services
• insufficient recruitment in services and geographical areas and reduce attrition
such as primary care, long-term care, rates of women, who are particularly
rehabilitation and mental health; exposed to difficult working conditions;
• problems with retention of HCWs in • inadequate HCWF governance and
health and care services, particularly public management mechanisms, which makes it
services, as increasing numbers leave or difficult to balance supply and demand
intend to leave due to experiencing high for HCWs;
levels of workload, stress and fatigue since • lack of strategic planning informed by a sound
the beginning of the COVID-19 pandemic; analysis of the HLM, exacerbated by a lack of
• difficulties in attracting HCWs to work in data and information to plan effectively; and
underserved geographical areas (especially • insufficient investment in the development
rural, remote or poor urban zones); of the HCWF, leading to suboptimal
• increased internal and international mobility provision of health and care services.
of HCWs (rural to urban, public to private
The report offers a picture of the HCWF in the Region
sector), cross-border working and emigration as
part of a globalized health labour market (HLM); based on available data provided by countries in
2022. In many cases, these data are incomplete, which
• skills mismatches originating from poor
points to the crucial need to strengthen data sources.
alignment of basic education and lifelong
learning with practice requirements It focuses only on six groups of HCWs for whom data
to meet population health needs; are available (medical doctors, nurses, midwives,
• inefficient organization of work, with dentists, pharmacists and physiotherapists) and
narrow and poorly defined scopes of practice does not include data on informal health workers, a
for some professions, underdevelopment of category that remains poorly documented despite the
multiprofessional teamwork, underuse of digital indispensable contribution they make in all countries.
health tools and limited integration of services;
2
The report nevertheless is a significant achievement Examples of sound evidence-informed practices
as the first of its kind to describe the situation of the for Member States to consider as they design and
HCWF in the whole European Region. It represents the implement HCWF policy and planning interventions
start of a process to gain a much more comprehensive are also presented.
view of the HCWF, which will create the foundation
and provide impetus for more robust and consistent The priority of coordinated action across the Region is
data-collection and analysis to inform health workforce stressed throughout.
policies in Member States in the future.
The report is framed by WHO’s European Programme
The report focuses on identifying effective policy and of Work, 2020–2025: United Action for Better Health
planning responses to HCWF challenges in the Region. in Europe (EPW) (1). The EPW places the HCWF at the
It recognizes that an effective governance system heart of efforts to improve access to quality health
and strategic planning informed by reliable data and services. It builds on evidence-informed analyses,
information are prerequisites for effective HCWF recommendations and tools that can support Member
management, but that there is no single one-size-fits- States in responding to their HCWF needs (see Annex 1).
all solution. Each country needs to design its own path
to a stronger HCWF to reflect their historical economic, The WHO Regional Office for Europe, working with
social and political contexts. stakeholders, national authorities and partners, will
support Member States’ efforts to strengthen their
The report is presented in two main parts: HCWF. It will continue to make the case for investment
in the HCWF not only to secure health gains, but also
1. an overview of the HCWF situation in the
Region, highlighting how the COVID-19 to achieve economic and social benefits.
pandemic has affected the HCWF and how
countries are responding to its pressures; and Annex 2 presents detailed individual health
2. a focus on “What to do?”, identifying relevant workforce profiles of the 53 countries of the Region
policy options, their expected benefits and and regional and subregional aggregated data.
potential facilitators or barriers to successful
implementation, with 10 proposed actions to
strengthen the HCWF in the European Region.
3
4
5
Profile of the HCWF in the
WHO European Region
The focus of this report is medical doctors, nurses, midwives,

dentists, pharmacists and physiotherapists (see Box 1 for
data methods).
Comprehensive headcount data over time consistent data on other HCWs, including informal
are available for these professions, except carers and workers, explains the incomplete profile
physiotherapists. Data on sex and age are available presented in this report. WHO supports countries’
for medical doctors, nurses and midwives, but efforts to progressively expand the production of
are sparse for other professions. The absence of data on all components of the HCWF.
Box 1.
Data methods
Health workforce headcount data are from the National Health Workforce Accounts,
provided through data returns from Member States. These data were collected from
a large number of countries that may count their workforce in different ways. There
are gaps where some countries have not returned any data, and places where the
data are inconsistent. All countries were asked to review their draft profiles. Some
provided updated health workforce data, which have been used in the report, and
revised population data, which have not. Population data from the United Nations
Department of Economic and Social Affairs Population Division have been used across
all countries for consistency.
If the National Health Workforce Accounts data had gaps, data from the Eurostat,
Organisation for Economic Development and Co-operation (OECD) and WHO joint
data collection on non-monetary health-care statistics were used (wherever possible)
to fill them. If no data were available, the value “not available” was returned.
Inconsistencies occur because the National Health Workforce Accounts collect data
on HCWs who are practising, professionally active and are licenced to practise, but
countries do not always return the right values. For example, countries may return
the same value for all of them, return the number licenced to practise instead of the
number practising, or have the number practising greater than the number licenced
to practise. These errors have been corrected where possible. Data from the joint
data collection on non-monetary health-care statistics were helpful in this process.
The headcount therefore may not match the number given by the National Health
Workforce Accounts. Because of this, the National Health Workforce Accounts
workforce density were not used. Instead, density was calculated from the corrected
headcount and country populations from the United Nations Department of Economic
and Social Affairs Population Division.
Where a 10-year period of assessment (from 2010 to 2020) is required, gaps in the data
mean that a full 10-year period may not be available, or the 10-year period does not
span 2010 to 2020. In this case, the nearest years to 2010 and 2020 were used to get
a 10-year range if possible.
6
2.1 What do the data show?
There are few comparable data available on The planning of the HCWF also requires an
numbers in training, workforce entry and exit understanding of the health-care needs of
rates, vacancy rates, attrition rates and full-time a population, its demographic profile and
equivalents. Lack of standardized data on these geographic distribution, and demand for and
indicators in multiple countries makes projecting utilization of services.
the future supply of HCWs in the Region difficult.
Building a comprehensive and reliable HCWF
database and workforce planning system is a major
challenge for most countries of the Region.
2.1.1 Workforce densities
The most commonly used, and most available, It does not account for the actual time that
indicator is density of HCWs (the number of active occupations work to deliver services – their full-
HCWs in an occupation divided by the population). time equivalents. Neither does it account for the
For all density data cited below, the population is variations in the services delivered – the scope
per 10 000 people. of practice. For example, the scope of practice of
nurses differs widely between countries, so nurse
Workforce density is a simple measure that is useful density often does not measure the same thing.
for basic comparisons between countries and
occupations.
2.1.1.1 Health professional densities
Densities vary five-fold between countries. The total Densities for the other professions also vary. At
medical doctor-, nurse- and midwife-to-population subregional level (Table 1), central and western Asia
density ranges from 54.3 in Türkiye to over 200 for have the lowest densities and northern and western
Iceland, Norway, Monaco and Switzerland. Europe the highest.
Table 1. Countries by subregiona

Subregion Countries
Central Asia Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan
Belarus, Bulgaria, Czechia, Hungary, Poland, Republic of Moldova, Romania, Russian

Eastern Europe
Federation, Slovakia, Ukraine
Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Lithuania, Norway, Sweden, United
Northern Europe
Kingdom
Albania, Andorra, Bosnia and Herzegovina, Croatia, Greece, Italy, Malta, Montenegro, North
Southern Europe
Macedonia, Portugal, San Marino, Serbia, Slovenia, Spain
Western Asia Armenia, Azerbaijan, Cyprus, Georgia, Israel, Türkiye
Western Europe Austria, Belgium, France, Germany, Luxembourg, Monaco, Netherlands, Switzerland
Note: countries of the WHO European Region only.

a
The geographic subregions are as defined by the United Nations Statistics Division and used in all United Nations publications and
databases. This provides consistency across data sources, including United Nations population data that are used to calculate health
workforce density. The official United Nations country names are also used as these are not standard across all the data sources used. In the
case of the western Asian subregion, only those countries that are part of the WHO European Region are considered (others are part of the
WHO Eastern Mediterranean Region and are excluded as not being within the remit of this report).
Source: United Nations Department of Economic and Social Affairs Population Division (2).
7
Medical doctor density varies from 17.3 in midwives who are licenced to practise rather than
Tajikistan and 17.5 in Kyrgyzstan to 88.7 in Monaco. those actually practising. The regional average ratio
Central Asia has the lowest regional density (average in 2020 of doctors to nurses was 2.11 and 2.25 of
21.3), with western Europe (45.5) the highest. The doctors to nurses and midwives.
available data show that nurse density also shows
strong country-level variations, from 27.0 in Türkiye Dentist density varies from 1.7 in central Asia to 6.4
to 183.7 in Switzerland and 202.7 in Monaco. WHO in western Asia and 8.0 in southern and northern
European Region countries in the western Asia Europe. The lowest density is in Montenegro (0.5)
subregion have the lowest density (48.2), followed and the highest in San Marino (17.6). The lowest
by those in central Asia (48.9), southern Europe pharmacist density of 1.7 is found in central Asia
(61.7) and eastern Europe (65.3). The highest and the highest in northern and western Europe
reported ratios are in northern (108.4) and western (8.3 and 9.7 respectively). According to the data
Europe (136.0). The density of midwives varies available, physiotherapist density varies greatly
significantly by country, from 1.4 in Georgia to 21.3 across the Region. Densities range from 0.2 in central
in Ireland, although the latter figure represents Asia to 7.9 in southern Europe, 12.5 in northern
Europe and 17.9 in western Europe (Fig. 1 (a–g)).
Fig. 1. H
ealth professional densities compared to regional averages, 2020 or
latest year
a. Medical doctor, nurse and midwife total density compared to regional average of 121 per 10 000 population
350
300
Medical doctor, nurse and midwife density
250
200
150
100
50
0
Slovakia
Spain
Ireland
Sweden
Switzerland
Azerbaijan
Hungary
Italy
Belgium
France
Turkmenistan
Latvia
Andorra
Poland
Greece
Estonia
Croatia
Norway
Armenia
Serbia
United Kingdom
Malta
Slovenia
Ukraine
Kazakhstan
Romania
Czechia
Denmark
Germany
Belarus
Iceland
Montenegro
Republic of Moldova
Cyprus
Georgia
Luxembourg
Bosnia and Herzegovina
Bulgaria
Lithuania
Portugal
San Marino
Netherlands
Austria
Finland
Monaco
Kyrgyzstan
Tajikistan
Albania
Israel
Uzbekistan
North Macedonia
Russian Federation
Türkiye
Central Asia Eastern Europe Northern Europe Southern Europe

Western Asia Western Europe Regional average
8
9
Nurse density per 10 000 population Medical doctor density per 10 000 population
0
10
20
30
40
50
60
70
100
150
200
250
0
50
Türkiye Tajikistan
Greece Kyrgyzstan
Turkmenistan Albania
Kyrgyzstan Uzbekistan
Andorra Türkiye
Bulgaria Turkmenistan
Latvia Bosnia and Herzegovina
North Macedonia Poland
Armenia Serbia
Tajikistan Montenegro
Central Asia
Central Asia
Montenegro North Macedonia
Western Asia
Western Asia
Poland Kazakhstan
Israel Luxembourg
Republic of Moldova Ukraine
Azerbaijan United Kingdom
Uzbekistan Republic of Moldova
Cyprus Azerbaijan
Albania Armenia
Serbia Hungary
Slovakia Belgium
Georgia Slovenia
Russian Federation Romania
Bosnia and Herzegovina France
Eastern Europe
Eastern Europe
Italy
Western Europe
Western Europe
Latvia
Spain Estonia
Ukraine Croatia
Estonia Finland
Kazakhstan Ireland
Hungary
Israel
Croatia
Andorra
Portugal
Slovakia
San Marino
Russian Federation
Romania
Netherlands
Lithuania
Iceland
Malta
Italy
c. Nurse density compared to regional average of 80 per 10 000 population

United Kingdom
Northern Europe
Regional average
Northern Europe
Regional average
Czechia Czechia
Belarus Malta
Denmark Bulgaria
Slovenia Denmark
Cyprus
b. Medical doctor density compared to regional average of 37 per 10 000 population
Austria
Sweden Sweden
Belgium Switzerland
Netherlands Lithuania
Luxembourg Germany
France Belarus
Ireland Spain
Southern Europe
Southern Europe
Finland Norway
Germany Portugal
Iceland Austria
Norway Georgia
Switzerland San Marino
Monaco Greece
Dentist density per 10 000 population Midwife density per 10 000 population
0
2
4
6
8
10
12
14
16
18
20
0
5
10
15
20
25
Montenegro Georgia
Uzbekistan Slovenia
Turkmenistan Serbia
Tajikistan Andorra
Kyrgyzstan Romania
Serbia Republic of Moldova
Kazakhstan Turkmenistan
Bosnia and Herzegovina Spain
Russian Federation Latvia
Azerbaijan Hungary
Central Asia
Central Asia
Poland Netherlands
Western Asia
Western Asia
Switzerland Israel
Türkiye Greece
Armenia Austria
Republic of Moldova Italy
Malta Portugal
Slovakia Lithuania
United Kingdom Germany
Netherlands Bosnia and Herzegovina
Belarus Slovakia
Austria Russian Federation
Ukraine Switzerland
Georgia Kyrgyzstan
Eastern Europe
Eastern Europe
France Albania
Western Europe
Western Europe
Ireland Luxembourg
Hungary France
Finland Ukraine
Latvia Estonia
Denmark Denmark
Slovenia Cyprus
Czechia Croatia
Belgium Azerbaijan
North Macedonia Czechia
Sweden Armenia
Iceland Montenegro
Spain Uzbekistan
Northern Europe
Regional average
Northern Europe
Regional average
e. Dentist density compared to regional average of 6.7 per 10 000 population
Germany Finland
d. Midwife density compared to regional average of 4.1 per 10 000 population
Italy North Macedonia

Croatia Kazakhstan
Andorra Bulgaria
Norway Belarus
Israel United Kingdom
Romania Malta
Monaco San Marino
Luxembourg Norway
Estonia Monaco
Albania Poland
Southern Europe
Southern Europe
Bulgaria Tajikistan
Portugal Iceland
Lithuania Türkiye
Cyprus Belgium
Greece Sweden
San Marino Ireland
10
f. Pharmacist density compared to regional average of 6.9 per 10 000 population
30
25
Pharmacist density per 10 000 population
20
15
10
0
Armenia
Ukraine
Turkmenistan
Azerbaijan
Hungary
Ireland
Spain
Belarus
Republic of Moldova
Slovakia
Andorra
France
Kyrgyzstan
Georgia
Serbia
Germany
Switzerland
Sweden
Italy
Kazakhstan
Denmark
Estonia
Latvia
Norway
Greece
Tajikistan
Poland
Belgium
Malta
Uzbekistan
Montenegro
Iceland
Luxembourg
Slovenia
United Kingdom
Netherlands
North Macedonia
San Marino
Albania
Czechia
Croatia
Bulgaria
Portugal
Türkiye
Austria
Romania
Cyprus
Israel
Lithuania
Finland
Monaco
Russian Federation

g. Physiotherapist density compared to regional average of 8.0 per 10 000 population
30
25
Physiotherapist density per 10 000 population
20
15
10
0
Slovakia
Latvia
Hungary
Ireland
Spain
Turkmenistan
Azerbaijan
Greece
Croatia
France
Armenia
Italy
Malta
Sweden
Belgium
Norway
Belarus
Ukraine
Serbia
Estonia
Germany
Republic of Moldova
Kazakhstan
Montenegro
United Kingdom
Poland
Slovenia
Czechia
Iceland
Luxembourg
Tajikistan
Portugal
Cyprus
Finland
Denmark
Uzbekistan
Kyrgyzstan
Georgia
Romania
Bulgaria
Austria
Albania
San Marino
Israel
Monaco
Russian Federation
North Macedonia
Lithuania
Netherlands
Türkiye

Source: Health workforce density is estimated using the latest numbers of staff practising from the WHO National Health Workforce Accounts
Data Portal (3) supplemented with recent country submissions to the Eurostat, OECD and WHO joint data collection on non-monetary health-
care statistics. For a small number of countries where the number of practising HCWs is not available, the number professionally active
or the number licenced to practise is used. For most countries, the data are for 2019 to 2020. Population data are from the United Nations
Department of Economic and Social Affairs Population Division (2).
11
2.1.2 HCWF: profile in the European Region
2.1.2.1 HCWF growth
Overall, the HCWF in the Region grew significantly The number of nurses2 in the Region increased by
between 2010 and 2020, but there are exceptions 9.5% but wide variation was seen, increasing by
(Fig. 2). 50% in western Asia due to a large rise in numbers
in Türkiye and decreasing by 19% in central Asia,
The most recent data (from 2019 or 2020, depending mostly due to a decline in Uzbekistan. Eastern
on country) give a 10-year period of assessment. Europe also saw a reduction (–9%), while nurses in
Data from 2020, however, may reflect temporary northern Europe increased by 8%.
responses to the COVID-19 pandemic, showing an
increase in the availability of HCWs as a response The number of midwives increased by 2.1% and
to the pandemic, though it is not possible to showed a similar variation to nurses, increasing
define the extent. in northern and western Europe by 28% and 26%
respectively, and decreasing by 25% in central Asia
Overall, the HCWF of medical doctors, nurses and and 15% in eastern Europe. The number of dentists
midwives in the Region increased by 10%, while the in the Region increased by 17%. Dentist numbers
HCWF in central Asia declined by 15% and in eastern decreased by 9% in central Asia and increased by
Europe by 6%. The greatest increase of 36% was 57% in western Asia and 41% in southern Europe,
seen in western Asia, followed by western Europe driven by rises in Georgia, Israel, Italy, Spain and
with 26%, southern Europe with 15% and northern Türkiye.
Europe with 12%.
The number of pharmacists increased by
The number of medical doctors in the Region 21%. Pharmacist numbers increased in all
increased by 11%, with an increase of 14% and 28% subregions by over 26% apart from central Asia,
in all subregions other than central Asia, where which declined by 20%, and western Europe, which
there was limited growth of about 1%, and eastern had a small increase of 3%. Data on physiotherapist
Europe, with little change. numbers are too incomplete to allow subregional
comparisons.
2.1.2.2 Demand for HCWF
As a consequence of the challenges facing countries and community-based care that requires a HCWF
in ensuring their health and social systems are with the right composition of professionals and
prepared to adapt to changing health needs that skills is increasing and will continue to rise. Future
arise through ageing populations with increased improvements in data collection and analysis will
multimorbidity and chronic conditions, demand for enable projections and modelling of future health
health professionals is growing. Demand for home- workforce demand.
2.1.2.3 Ageing of the HCWF
The ageing of the HCWF is a particular concern in all Only four of the 36 countries reporting data have
Member States, but particularly so in those in which a workforce in which 40% of nurses are aged 55 or
a significant percentage of the workforce is aged 55 older (Fig. 4). The median percentage for medical
years and older and therefore face the challenge of doctors is about 30%, but for nurses it is around 18%.
replacing them when they retire. Thirteen of the 44
countries that reported data on this issue have a These statistics point to important replacement
workforce in which 40% of medical doctors are aged needs in the coming decade.
55 or older (Fig. 3). This poses a big challenge to the
sustainability of the medical workforce.
2 The interpretation of data on nurses is difficult, given important variations in their scope of practice across the 53 countries of the
European Region.
12
Fig. 2. C
hange in workforce from 2010 (or nearest year) to 2020 (or nearest year) by
subregion (percentage)
Central Asia Western Asia Eastern Europe Southern Europe Northern Europe Western Europe
70
57
60
Percentage change in workforce 2010–2020 (or nearest years)
50
50
41
37
40
35
29
29
28
28
26
26
30
22
19
17
20
14
12
11
10
10
7
6
3
1
0
–0
–10
–9
–9
–15
–20
–19
–20
–25
–30
Medical doctors Nurses Midwives Dentists Pharmacists
Source: health workforce density is estimated using the latest numbers of staff practising from the WHO National Health Workforce Accounts
care statistics. For a small number of countries where the number of practising HCWs is not available, the number of professionally active or
the number licenced to practise is used.
Fig. 3. Percentage of medical doctors aged 55 and over, 2020 or latest year
60
Percentage of medical doctors aged 55 and over
50
40
30 30.1%
20
10
0
Ireland
Azerbaijan
Hungary
Croatia
Spain
Slovakia
France
Italy
Sweden
Greece
Switzerland
Belgium
Estonia
Latvia
United Kingdom
Malta
Armenia
Norway
Slovenia
Serbia
Belarus
Luxembourg
Germany
Cyprus
Portugal
Denmark
Czechia
Albania
Finland
Montenegro
Romania
Iceland
Republic of Moldova
Tajikistan
Netherlands
Austria
Lithuania
Bulgaria
Uzbekistan
North Macedonia
Monaco
Israel
Russian Federation
Türkiye

Source: WHO (3).
13
Fig. 4. Percentage of nurses aged 55 or over, 2020 or latest year
50
45
40
Percentage of nurses aged 55 and over
35
30
25
20
18.0%
15
10
0
Slovakia
Spain
Hungary
Ireland
Greece
Croatia
Belgium
Switzerland
France
Latvia
Armenia
Slovenia
Norway
Estonia
Sweden
Cyprus
Belarus
United Kingdom
Germany
Romania
Republic of Moldova
Tajikistan
Portugal
Albania
Netherlands
Montenegro
Czechia
Iceland
Finland
Austria
Denmark
Lithuania
Bulgaria
Israel
Türkiye

Source: WHO (3).
2.1.2.4 HCWF gender characteristics
Women constitute the majority of the nursing pandemic has disproportionately affected workers
workforce in all countries, and the percentage of at the low end of the pay scale in the sector, most
female medical doctors in the Region increased from of whom are women, hitting them harder and
approximately 43% in 2010 to 48% in 2020. jeopardizing some equality gains (6).
A gender analysis of HCWF reveals that health Where pandemic control and system response
systems can replicate many existing gender biases measures have not taken an equity-focused
and social inequalities across and within health approach, a deepening of pre-existing inequalities in
occupations – both paid and unpaid. The health the HCWF has been seen. This includes interruption
sector faces lower than average earnings for of nursing and midwifery services, difficulties in
women compared to other economic sectors (4), mobilizing necessary surge capacity due to women
with a raw gender pay gap of 20% compared to an workers needing to also care for their older and
estimated 12% among all other economic sectors younger family members, increased rates of mental
(4). The largest gender pay gaps are found in top pay health issues among nurses and midwives (7–9),
categories. The largest pay penalties are for women rapid depletion of the long-term and primary care
of reproductive age and there is clear evidence in the workforce as a result of early retirement or rapid
European Region of a motherhood pay gap among turnover, problems in securing stable resources
HCWs. Men are subsequently overrepresented at top and geographical coverage of care, and overall
pay categories and women overrepresented at the difficulties in reaching and preventing the spread
bottom (4). of the virus. The pandemic also highlighted the lack
of visibility in most countries of women leadership
Existing gender inequalities have increased since in the health sector response.
the beginning of the COVID-19 pandemic (5). The
14
More data and research on gender gaps and uses all the competencies of women as well as
occupational segregation in critical areas are looking after their needs (10,11).
required to ensure a health and care system that
2.1.2.5 Subnational distribution of HCWF
It is difficult to assess the subnational distribution of is recognized in many countries of the European
HCWs due to limited data from countries. Region, and the issue of distribution needs to be
considered urgently.
Very few countries report on HCWs by urban/
rural, hospital/primary health care (PHC) and
public/private distribution. Unequal distribution
2.1.2.6 Existing vacancies by countries
Very limited data on existing vacancies are effective planning to understand the dynamics
reported by countries. Planned but unfilled posts of the HLM, in particular the distribution of HCWs
– vacancies – can be an indicator of shortage and (urban/rural) and flows in and out of the HCWF.
mismatch. Countries should progressively improve These include vacancies (unfilled vacancies may
the data available on vacancies, especially in indicate a problem in recruitment and retention),
rural areas. There is little country-level data on age (potential retirement exits), and education
vacancies, retention and attrition within the completion and participation rates (are new
different occupational groups. It is essential for graduates joining the HLM or going elsewhere?).
2.1.2.7 HCWF production across countries
There is wide variability in the production of HCWs HCWF size varies from under 1% (not sufficient to
across countries. Fig. 5 and 6 show the wide variation replace losses) to 15%, suggesting that graduates
in the number of graduates produced in the latest are seeking work outside of their country of training.
year. Countries with a low number of graduates may For nurses, the percentages range from under 1%
not be providing sufficient staff to replace losses due to nearly 25%. The figures do not appear to be
to retirement and other causes. For medical doctors, correlated by subregion.
the numbers of graduates as a percentage of the
2.1.2.8 Health professional graduates across subregions
Caution is needed when interpreting data on show that the highest increase was in western
graduates as a source of new recruits. Not all Asia. Data for central Asia were very limited as few
graduates join the domestic HLM, and those who countries reported, so the percentage changes are
do may leave it before retirement age. Tracking of not representative of the subregion.
graduates can document these phenomena, but
very few countries do so. In the European Region, several professions showed
strong growth, with the number of medical doctor
The number of health professional graduates graduates increasing by 37%, dentists by 29% and
increased between 2010 and 2020 in most nurses by 26%. Western Asia had high increases
subregions. Overall, the number of graduates has across all professions.
increased in five of the professions3 since 2010
(Fig. 7). This is due to the expansion of domestic Of note is the fall in the number of midwifery
recruitment and, in some countries, to the opening graduates in central Asia, and eastern and southern
of programmes for international students. Europe (–30%, –20% and –14% respectively).
Midwives had the lowest growth at 4%.
The numbers presented in Fig. 7 are estimates due
to gaps in the available data, but they nevertheless
3 Sufficient data on physiotherapists were not available.
15
Number of annual nursing graduates per 100 000 population Number of annual medical doctor graduates per 100 000 population
0
5
10
15
20
25
30
35
40
45
Fig. 6. N
Fig. 5. N
0
20
40
60
80
100
120
Andorra
Georgia Cyprus
Turkmenistan Montenegro
Bulgaria Turkmenistan
North Macedonia Israel
latest year
Affairs Population Division (2).

Montenegro Ukraine
Tajikistan
or latest year
Cyprus
France
Central Asia
Luxembourg
Central Asia
Western Asia
Uzbekistan
Western Asia
Czechia
Estonia
Poland
Greece
Russian Federation
Armenia
Türkiye
Norway
Italy
Azerbaijan
Republic of Moldova Georgia
Spain Iceland
Slovakia Switzerland
Lithuania Finland
Poland Bulgaria
Netherlands Germany
Hungary North Macedonia
Eastern Europe
Eastern Europe
Western Europe
Western Europe
Malta Greece
Portugal United Kingdom
Kyrgyzstan Sweden
Estonia Slovenia
Ireland Albania
Slovenia Spain
Austria
Latvia
Türkiye
Israel
Netherlands
United Kingdom
Croatia
Iceland
Hungary
Ukraine Portugal
Austria
Northern Europe
Regional average
Czechia
Northern Europe
Regional average
Kazakhstan Belgium
France Serbia
Switzerland Slovakia
Sweden Italy
Germany Lithuania
Denmark Denmark
Belgium Latvia
Serbia Ireland
Croatia Republic of Moldova
Norway Belarus
Monaco Romania
Southern Europe
Finland Kyrgyzstan
Southern Europe
umber of annual nursing graduates per 100 000 population , 2020 or

Armenia
Albania
Malta
Romania
Kazakhstan
36.6
umber of annual medical doctor graduates per 100 000 population, 2020
15.3
Source: number of graduates taken from WHO (3). Country population data taken from United Nations Department of Economic and Social
Source: number of graduates taken from WHO (3). Country population data taken from United Nations Department of Economic and Social
16
Fig. 7. C
hange in the number of graduates from 2010 (or nearest year) to 2020 (or
nearest year), by subregion (percentage)
Eastern Northern Southern Western

Central Asia Europe Europe Europe Western Asia Europe Europe
170
149
115
120
86
68
62
70
Percentage
48
46
45
44
40
37
37
29
29
28
27
26
21
21
18
17
15
15
13
12
12
12
20
9
8
6
4
2
-14
–30
-20
-30
–80
Source: number of graduates from WHO (3). Country population data from United Nations Department of Economic and
Social Affairs Population Division (2).
2.1.2.9 Foreign-trained HCWF
The proportion of foreign-trained HCWs tends to be Freedom of movement and mutual recognition of
larger in higher-income countries. Medical doctors the qualifications of some health professions (such
and nurses trained abroad form an important part of as medical doctors, dentists, nurses, midwives and
these occupational groups in a number of countries, pharmacists) facilitate intraregional mobility in the
mostly in northern and western Europe. European Union (EU). In addition, many countries
of the Region are destinations for health workers
Germany, Spain and the United Kingdom were the from other (non-EU/European Economic Area (EEA))
main countries of destination in absolute terms for countries of the Region and beyond. Most foreign-
foreign-trained doctors and nurses in 2020. The trained professionals in the European Region
number of foreign-trained medical doctors entering come from other countries of the EU. Some (such
the HLM in Ireland, Norway and Switzerland in 2019 as Belgium, Germany and Ireland) are both major
was greater than domestic graduates. This trend source and destination countries, while others,
has been apparent in a number of countries since predominantly EU Member States in the south and
2010, suggesting that international recruitment east of the Region, are source countries.
forms an increasing source of new HCWs in some
Member States. Countries monitor intentions to emigrate based
on the number of requests for certificates of
qualifications, a document that is required by
destination countries. They do not monitor
emigration itself, however, so no reliable data are
available on outflows of HCWs.
17
2.1.3 Links to health outcomes
2.1.3.1 Universal health coverage
Important variations in universal health coverage Some countries reported UHC service coverage
(UHC)4 remain in the European Region. UHC of below 70% (the lowest was 62%); 23 countries
progressed in all countries of the European Region had between 70% and 80% and 21 were above 80%
between 2000 and 2019, but the range from the (Fig. 8). These variations broadly reflect those in
lowest to the highest percentage – in the order of the density of HCWs, but this indicator is only one
25% – is important (12). of many, which also include productivity and model
of service delivery.
2.1.3.2 Country expenditure
Based on the data available, it appears that HCW Data are not available for all countries, but those
density is generally higher in countries with a higher that are available show a 10% average proportion
gross domestic product (GDP) and in those that of the total workforce employed in health and social
report better health outcomes. These factors are care activities across the European Region. This
summarized in Fig. 9. The three outliers on the right ranges from 5% in Latvia and Türkiye to over 15%
are Luxembourg, Ireland and Monaco respectively. in Denmark, Finland, the Netherlands, Norway and
Total expenditure on health as a percentage of GDP Sweden (Fig. 10).
tends to be higher in high-income countries. HCW
densities also tend to be higher.
Fig. 8. UHC service coverage index, 2019
90
85
80
UHC service coverage index
77.1%
75
70
65
60
55
50
Spain
Hungary
Slovakia
Ireland
Azerbaijan
Latvia
Armenia
Croatia
Turkmenistan
Andorra
Italy
France
Switzerland
Norway
Sweden
Serbia
Greece
Belgium
Ukraine
Malta
Poland
Estonia
Germany
United Kingdom
Montenegro
Republic of Moldova
Belarus
Kazakhstan
Czechia
Slovenia
Denmark
Luxembourg
Iceland
Albania
Tajikistan
Bulgaria
Kyrgyzstan
Romania
Portugal
Georgia
Lithuania
Cyprus
Austria
San Marino
Finland
Israel
Monaco
Uzbekistan
Netherlands
North Macedonia
Russian Federation
Türkiye

Source: WHO (12).
4 Coverage of essential health services is defined as the average coverage of essential services based on tracer interventions that include
reproductive, maternal, newborn and child health, infectious diseases, noncommunicable diseases and service capacity and access, among
the general and the most disadvantaged populations.
18
Fig. 9. GDP and HCWF density, 2019
300
Medical doctors, nurses and midwives per 10 000 population
250
200
150
100
50
0
0 50 000 100 000 150 000 200 000 250 000
GDP per capita in PPP Int$
Central Asia Western Asia Northern Europe Southern Europe Eastern Europe Western Europe
Int $: international dollars.

PPP: purchasing power parity.
Source: WHO (12).
Fig. 10. T
otal health and social employment as percentage of total civilian
employment, 2020 or latest year
25
Percentage of civillian workforce in health and care activities
20
15
10
0
Italy
Latvia
Estonia
Austria
Luxembourg
Greece
Czechia
Portugal
Belgium
Poland
Russian Federation
Lithuania
Spain
Israel
Switzerland
Netherlands
Finland
Ireland
Slovakia
Germany
Sweden
Denmark
Norway
Slovenia
Hungary
United Kingdom
Iceland
France
Türkiye

Note: based on classifications from the United Nations Department of Economic and Social Affairs Statistics Division (13).
Source: OECD (14).
19
2.1.3.3 Country life expectancy and mortality rates
The available data suggest that subregions and western Europe (Fig. 11). The central Asia
reporting lower life expectancy and higher maternal subregion also has the highest under-5 mortality
mortality, under-5 mortality and noncommunicable and maternal mortality rates and the lowest HCW
disease mortality rates tend to have lower HCWF density (Fig. 12 and 13). This may suggest that
density. Life expectancy, for instance, is lowest higher density of HCWF is among the various factors
in central Asia and highest in southern, northern that can contribute to better health outcomes.
Fig. 11. Life expectancy and health workforce density, 2020
90
85
Life expectancy (years)
80
75
70
65
0 50 100 150 200 250 300 350
Central Asia Western Asia Northern Europe

Southern Europe Eastern Europe Western Europe
Data Portal (3) supplemented with recent country submissions to the Eurostat, OECD and WHO joint data collection on non-monetary
health-care statistics.. For a small number of countries where the number of practising HCWs is not available, the number of professionally
active or the number licenced to practise is used. Life expectancy data are from the United Nations Department of Economic and Social
Fig. 12. Under-5 mortality and health workforce density, 2020

45
40
Probability of dying by age 5 per 1000 live births
35
30
25
20
15
10
0
0 50 100 150 200 250 300 350

care statistics. For a small number of countries where the number of practising HCWs is not available, the number professionally active or
the number licenced to practise is used. Under-5 mortality data are from WHO (15).
20
Fig. 13.Maternal mortality ratio and health workforce density, 2017
60
Maternal mortality ratio (per 100 000 live births)
50
40
30
20
10
0
0 50 100 150 200 250 300 350

Note: health workforce density is estimated using the latest numbers of staff practising from the WHO National Health Workforce Accounts
Data Portal (3) supplemented with recent country submissions to the Eurostat, OECD and the WHO joint data collection on non-monetary
health-care statistics. For a small number of countries where the number of practising HCWs is not available, the number of professionally
active or the number licenced to practise is used. Maternal mortality data are from WHO (16).
2.2 How countries responded to the pressures of the COVID-19

pandemic on the HCWF
COVID-19 has placed an unprecedented strain on over 80% of nurses reporting negative psychological
Member States’ HCWF. Many countries entered impacts due to the pandemic in some countries
the health emergency with insufficient numbers (19,20). Up to nine out of 10 nurses had declared an
of HCWs, suboptimal skill-mixes and imbalanced intention to quit their jobs (21).
geographical distributions. This was exacerbated
during the COVID-19 pandemic as HCWs had higher Countries across the Region have had to adopt
rates of infection than the general population (17) innovative strategies to increase surge capacity
and experienced the negative impacts of burnout to manage demand generated by the pandemic.
and stress. It has been reported that HCW absences This has involved ensuring the availability of more
increased by 62% in the first days of the pandemic workers, improving retention rates and re-skilling
(18). High levels of psychological impacts have been the existing HCWF.
reported by several countries in the Region, with
21
2.2.1 Targeting the existing HCWF
Strategies adopted by Member States that targeted Transfers and reallocations occurred between cities,
the existing workforce included asking HCWs to regions and even between Member States in an act
work longer hours or work full-time instead of part- of regional solidarity.
time, suspending exemptions to night shifts or on-
call activities, and cancelling leaves of absence. Frontline workers such as nurses and personal
support workers had to cope with heavy workloads,
Some countries eased minimum staffing high risks of stress, susceptibility to infection and
requirements in settings such as intensive care being vulnerable to burnout, leading to higher
units (22). Workers in some instances were rates of absenteeism, lower job satisfaction and
redeployed from areas with spare capacity to wards more intentions to leave employment. Levels
or health facilities experiencing high demand, such of violent incidents against HCW increased after
as emergency departments and intensive care units. the COVID-19 pandemic started (23). Maintaining
Often this was achieved at the expense of availability workforce capacity depended on protecting the
of services in other areas, including long-term and physical and mental health of workers to reduce
home care. absenteeism (24,25).
2.2.2 Boosting surge capacity
Member States primarily have relied on four sources Malta, Montenegro, North Macedonia and the
to further increase surge capacity: United Kingdom (England) adopted measures
to enable private sector workers to work in the
• graduates entering the workforce early;
public sector. In United Kingdom (England) an
• workers who at the time were inactive; agreement was brokered for the United Kingdom
• private sector workers recruited into the public Government to take over private hospitals and their
HCWF; and staff for the duration of the crisis, resulting in tens
• foreign-trained professionals. of thousands of clinical staff moving to the public
sector during 2020 (26).
Most countries allowed final-year medical and
nursing students to graduate early and join the Some countries put special measures in place to
HCWF, or to take a gap semester to support active accelerate the registration process for bringing
HCWs. Some permitted students who were not foreign-trained professionals into the workforce
in their final year of study to participate in non- (22). The European Commission issued guidance
clinical tasks such as operating COVID-19 hotlines on free movement of health professionals and
or contact-tracing (26). minimum harmonization of training in relation
to COVID-19 emergency measures (28). Belgium,
Workers not active in the HLM were brought into Czechia, Germany, Ireland, Italy, Luxembourg, Spain
the workforce in a number of Member States, and the United Kingdom adopted procedures to
either by drawing on existing medical care reserves bring foreign-trained health professionals into the
(inactive workers who can be deployed in times workforce temporarily or to speed up recognition
of emergency), as was the case in Belgium and procedures.
France, or through special campaigns to encourage
retired or otherwise inactive workers to rejoin the Overall, however, pandemic-related travel
workforce (27). restrictions were an obstacle to foreign-trained or
previously foreign-licenced health workers arriving
Registration processes for bringing inactive workers in 2020 with the intention to practise in Europe.
back included automatic renewal of licenses
for those who had left the workforce within the
past year. Countries such as Cyprus, Hungary,
22
2.2.3 Reskilling and repurposing HCWF
Reskilling and repurposing the workforce made authorized to administer vaccinations and carry out
a critical contribution to creating surge capacity. testing (30,31).
COVID-19 has driven an increase in the number
and pace of skill-mix innovations in the Region. Changes to scopes of practice were put in place
Redeployment of health workers, development of rapidly to support new ways of working. Previous
new competencies and the accelerated use of digital resistance from professional bodies was overcome
technology have proved critical to creating surge and new training programmes were developed. A
capacity and meeting the specific demands of the shift towards remote working and greater use of
pandemic (22,29). digital health tools, such as e-prescriptions and
electronic health records, were observed in all
HCWs took up new tasks like testing, contact-tracing care areas, particularly in primary care. This often
and monitoring of COVID-19 patients. France and the entailed HCWs having to learn about and adapt to
United Kingdom (England) temporarily authorized new ways of working.
community pharmacists to renew prescriptions for
specified chronic conditions or as part of ongoing It is important to ensure these actions around
care. A range of workers across the Region, such as changes to the skill-mix, task-sharing and task-
dentists (Ireland), physician assistants (Germany shifting do not remain ad hoc, but are part of
and the Netherlands), paramedics (Austria), strategic measures to build a more efficient HCWF.
pharmacists (Austria, Croatia, France, Ireland, Italy
and Portugal) and nurses (Israel and Poland), were
2.2.4 Retaining HCWs
Multifaceted efforts were made to retain HCWs Other interventions aimed to provide practical
during the pandemic. Maintaining sufficient support to ensure that HCWs could continue working
numbers of workers during the pandemic depended in the face of pandemic-related restrictions. These
on policies to scale-up supply and target retention included keeping schools and childcare facilities
(29). Measures to improve retention had to open for their children and providing alternative
encompass a range of actions in addition to those accommodation to reduce the risk of transmission
supporting mental health and well-being. to family members who might be vulnerable to
COVID-19.
Provision of financial support in addition to normal
salaries, either to compensate for lost income as Regional data on HCW retention rates during the
a result of the suspension or scaling-back of non- pandemic are scarce. Evidence from the United
urgent care or to explicitly reward health workers for Kingdom suggests that nurse retention rates in
their work, was common (27). This usually took the 2020–2021 were higher than average, as many
form of bonus payments, with countries like Latvia delayed retirement or leaving for other reasons to
and Lithuania putting salary increases in place. support the pandemic response (32). The number
Alongside these forms of financial compensation, leaving then increased in 2021–2022, with an
some countries (Denmark, France, Lithuania and important proportion citing pressures from the
Spain) recognized COVID-19 as a work-related injury, pandemic (Vignette 1).
enabling access to associated benefits.
Further efforts to improve retention will be needed
Continuing education credits were awarded for to tackle an expected increase in people leaving
work done during the pandemic. Medical doctors, the workforce due to COVID-19-related burnout, ill
dentists, nurses and pharmacists in Italy who health and general dissatisfaction. Such efforts are
continued working during the pandemic received fundamentally important to maintaining sufficient
50 continuing medical education credits for 2020. numbers of health workers to cope with increasing
backlogs due to the pandemic.
23
Vignette 1.
United Kingdom:
trends in the number and region of origin of
entrants and leavers to the permanent register of
nurses and midwives
Data from the United Kingdom Nursing and Midwifery Council (NMC) (32) show that
48 436 people joined the permanent register of nurses and midwives eligible to
practise in the United Kingdom for the first time in 2021–2022 (a full year runs from
1 April–31 March), an increase of 40.3% from the previous year. This reverses a decline
in the number of new joiners in 2020–2021 compared to the previous year, driven in
part by the COVID-19 pandemic and the fall in the number of people joining from
abroad (Fig. 14).
Fig. 14. J oiners and leavers of the United Kingdom permanent

register of nurses and midwives by country/region of
initial registration
60 000
United EU/EEA Rest of
People entering the permanent register for the first time
Kingdom world
50 000 United EU/EEA Rest of

People leaving the permanent register
Kingdom world
40 000
30 000
20 000
10 000
0
2017–2018 2018–2019 2019–2020 2020–2021 2021–2022
Note: figures capture those eligible to practise in the United Kingdom, but not all may
be working in the health sector as nurses, nursing associates or midwives; country of
initial registration captures country where first professional registration was held.
Source: author, complied from data from the Nursing and Midwifery Council (32).
The number leaving the register in 2021–2022 also rose, reversing a general downward
trend in recent years. The most common reason identified for leaving was retirement
24
Vignette 1 contd
(42.9% of respondents to the NMC leavers’ survey), with 21.7% citing personal
circumstances and 18.3% feeling too much pressure; 36.5% of leavers stated that
the COVID-19 pandemic had “some” or a “strong” influence on their decision to leave.
Almost 50% of those joining the permanent register in 2021–2022 had an initial
registration from outside the United Kingdom. The vast majority (97.2%) were
from outside the EU/EEA, with India, Nigeria and the Philippines the most common
countries for initial registration..
In terms of total stock of foreign-trained nurses, 113 579 people with an initial registration
from outside the United Kingdom/EU/EEA were on the United Kingdom register in 2022, an
increase of approximately 66% since 2017–2018. Conversely, the number on the permanent
register with an initial registration in the EU/EEA had declined by almost 18% over the same
period, dropping to 28 864 in 2021–2022.
This probably is influenced by the United Kingdom vote to leave the EU (so-called Brexit)
and suggests that nurses coming from EU/EEA countries are no longer the major source of
recruitment, with a major switch to recruiting from other regions and countries.
25
26
Responses to challenges to HCWF policy
development in the Region
How Member States can build back better their HCWF to

support improvements in the performance of their health
service systems is the focus of this chapter. More specifically,
it addresses health service backlogs generated during the
COVID-19 pandemic and reports examples of good practices
observed in the Region and elsewhere. These examples can
help policy-makers to design and implement their own country
responses to HCWF challenges.
A comprehensive approach to addressing shortages The chapter also provides recommended actions
and the imbalanced distribution of the HCWF must to help address HCWF challenges and defines the
consider how best to: support the WHO Regional Office for Europe can
offer in implementing them in the Region. The
• align the production, recruitment and
deployment of new workers; proposed actions correspond with the priorities of
the EPW (1) and are informed by analysis, evidence
• increase retention and productivity rates; and
and known good practices.
• manage international flows of HCWs.
To achieve maximum benefit from the proposed
Corrective interventions need intersectoral actions, countries should look to implement
collaboration, engaging different ministries and them all. The actions complement and support
government functions (such as labour, public each other. Opting to implement only some of the
administration and finance with health and actions will not fully produce the positive impacts a
education) and other stakeholders (including comprehensive approach would realize.
organizations representing HCWs and employers).
3.1 Strengthening education and improving training
Education and training are areas in which data are Nurses Organisation reports severe shortages of
very weak. The issue of strengthening data around faculty in nursing schools (34). Small countries often
the HCWF is addressed in section 3.5. do not have a critical mass of educators in some
specialties and would benefit from international
To transform HCW education and training, education cooperation (35).
institutions need adequately prepared personnel,
appropriate infrastructure and equipment, sufficient Education institutions need to design and
clinical training settings and appropriate funding. implement strategies to attract additional staff as
they expand their admission capacity. Professional
Many countries already have shortages of qualified fields in which demand will increase, like
educators and trainers. The problem in nursing is rehabilitation, mental health, care of older people
global and recurrent (33) – even in Norway, one of and palliative services, require specific actions to
the richest countries of the Region, the Norwegian attract and retain candidates.
28
Infrastructures should adapt to emerging challenges be put in place, as occurred in North Macedonia
and new ways of learning that increasingly take (Vignette 2).
place in small groups, making big amphitheatres
Admitting more students requires additional clinical
obsolete and placing more demands on digital
training settings and trainers in the field. This may
technology and simulation laboratories. Technical
be problematic when health services already are
capacity to support distance learning needs to
overloaded.
Vignette 2.
North Macedonia:
online training platform for primary care nurses
The Ministry of Health, in collaboration with the WHO Country Office, launched the
national PHC strategy in 2019 (36). Actions to develop the PHC workforce include
a pilot experiment that enabled nurses to deliver clinical care after completing an
online training programme, based on the Regional Office competency framework
for nurses in PHC (37).
The programme’s aim was to develop the knowledge and skills of PHC nurses and
midwives to enable them to contribute more effectively to the delivery of the new
model of PHC.
The programme included six modules: 1) Introduction; 2) Foundations of

communication and professionalism; 3) PHC nursing and COVID-19; 4) Public health;
5) Health education; and 6) Empowerment of nurses and midwives.
It was reviewed by the Nurse Facilitators’ Group, a subgroup of the National Working
Group for Moving PHC Nursing Forward that includes representatives from nursing,
midwifery, PHC, allied health, the ministries of health and education and science, and
clinical managers from the two pilot PHC health centres.
Once reviewed, the pedagogical materials were translated into Macedonian and
modules were uploaded to the Moj Termin (e-health) platform from December 2020.
They were made available to the end of 2021 and could be undertaken in any order.
Information was disseminated to PHC and other nurses by the WHO Project Manager.
The programme was evaluated via a questionnaire to participants in March 2021.

By that time, 429 nurses had accessed the modules and 70–100 had attended
workshops, including 177 doctors, two dentists, four health associates and 39 other
health practitioners.
Key findings include (WHO Country Office in North Macedonia, unpublished

data, 2021):
• wide sharing of module content with colleagues and team members;

• reports of application of learning to practice (such as COVID-19 protection and
prevention, communication skills and patient counselling); and
• support for further continuing professional development (CPD).
Online programmes allow many more nurses from a much wider geographical area
to participate. Delivery during the pandemic meant that the PHC nurses were better
prepared to contribute fully to the pilot PHC areas and the new model of PHC.
29
3.1.1 Educating the next generations of HCWs and training current HCWs differently
Future HCWs will assume roles and tasks different • address public health priorities that require
from those of today. The burden of disease is behaviour change, such as noncommunicable
changing, and rapid technological, social and disease risk factors;
organizational developments mean HCWs already • communicate effectively with their patients and
in the workforce need to acquire knowledge, skills colleagues; and
and attitudes on a continuous basis to meet future • develop sociocultural sensitivity and openness.
health service requirements.
New programmes and learning strategies
In addition to the basic cognitive and technical need to attract and select candidates with the
fundamentals of their professions, education personal traits and aptitudes to deliver person-
programmes need to equip future graduates with centred, high-quality services. Many medical
competencies to (38,39): and dental schools in the United Kingdom have
been using the University Clinical Aptitude Test
• use digital and artificial intelligence tools;
(UCAT) since 2006. UCAT assesses the verbal,
• practise in an interprofessional and intersectoral quantitative and abstract reasoning, decision-
team environment with shared decision-
making and situational judgement characteristics
making;
of candidates (40). Selection criteria can also
• think in a critical and systemic way;
include candidates’ geographical or social origins
• search and analyse information for evidence- to address the issue of underrepresentation of
informed practice; certain regions or populations, as recommended
• assess health needs and plan accordingly; by WHO (41).
• lead and manage population-level health
programmes;
Action 1.
Align education with population needs and
health service requirements
Equipping new HCWs with the right competencies is necessary to respond to the
changing health needs of individuals and populations.
The WHO Regional Office for Europe will:

• support health and education institutions in reviewing and updating health and
care education curricula and programmes; and
• support the development and strengthening of regulation and accreditation of
health and care education institutions and programmes.
30
Efforts to attract more students will benefit from Education institutions that adopt the objective
including measures to address gender issues and of producing fit-for-purpose HCWs will have to
imbalances. transform the traditional silo approach of educating
each professional group separately. They can do
Workers already active in health and care services this by creating bridges between programmes
need to adapt to changes in demand for services and through interprofessional activities and increasing
the introduction of new tasks through CPD activities. cooperation with other institutions, as is done
CPD includes formal face-to-face and distance through the ASPIRE initiative (Vignette 3).
courses, self-learning, participation in scientific
and professional meetings, and in-service training. Moving gradually from a system of lecturing to large
uniprofessional groups to one of supervising small
Some countries make CPD mandatory, placing groups of students using e-learning and developing
a requirement on practitioners to complete CPD interprofessional curricula requires buy-in from
activity as a condition of renewal of authorization to educators and students. Educators and trainers
practise (42).25 need training, support and motivation to adopt new
methods aligned with the objective of equipping
In others, CPD remains voluntary. Intercountry future HCWs and those in practice with the desired
initiatives are in place to improve the competencies.
competencies of HCWs through common training
frameworks (43–45). German-speaking (Austria, Germany and
Switzerland) and Nordic (Denmark, Finland, Iceland,
Policy-makers are challenged with assigning Norway and Sweden) countries, the Netherlands
responsibility for the delivery of CPD to, for instance, and the United Kingdom integrate the Global
education institutions, professional councils or Confederation for Interprofessional Education and
associations and private consultancy firms. They Collaborative Practice within their systems. This
also ensure its quality and alignment with health offers support and guidance to institutions engaging
priorities through accreditation of providers and in interprofessional learning (51).
programmes. Regulators and employers must create
conditions that make lifelong learning attractive to Mobilizing additional funding to cover the costs
HCWs and, above all, enable access to participation. of better educating the HCWF is the overarching
challenge. Funding should be seen as an investment
Many countries accelerated the integration of that will result in better coverage and more effective
digital competencies in CPD programmes during health services, and at the same time benefit society
the COVID-19 pandemic, including for nurses in and the economy (50).
the United Kingdom (46) and medical doctors in
Germany (47). EU countries can benefit from CPD
programmes that focus on digital skills within the
EU4Health programme (48).
5 In the EU, some countries link CPD to licencing and revalidation. Cycles of CPD vary, however, from three-
yearly (in, for example, France and Italy) to five-yearly (in Hungary, Lithuania and the Netherlands).
The cycle in Slovenia is seven-yearly.
31
Action 2.
Strengthen continuing professional
development to equip the workforce
with new knowledge and competencies
CPD activities support HCWs to adapt to changes in demand for services and the
introduction of new tasks.

• provide support in improving CPD standards and approaches for the HCWF and
promote access to CPD opportunities.
Action 3.
Expand the use of digital tools that support the
workforce
Extensive shifts towards greater use of digital health in service delivery and HCW
training and development took place during the COVID-19 pandemic. Their ongoing
and increased use will require a HCWF that is skilled in the use of digital health tools.

• support the development of guidance and frameworks to equip HCWs with digital
competencies.
32
Vignette 3.
Association for Medical Education in Europe
(AMEE): building communities of good practice
in health profession education – the ASPIRE to
Excellence programme and AMEE responses to
the COVID-19 pandemic
Health profession education and training at undergraduate, postgraduate and CPD

levels should effectively support the development and sustainability of the European
health workforce. Educational curricula must adapt to constantly changing societal
and population health needs to ensure the European population receives the required
services now and in the future.
AMEE is engaging with countries in the WHO European Region to support the
development of a community of good practice in health profession education and
add real value to the technical assistance Member States seek.
The ASPIRE (International Recognition of Excellence in Medical Education) initiative

(49), which was launched in 2012, aims to promote outstanding performance in
education institutions. ASPIRE has an international board of experts in health
profession education and is supported by AMEE and other organizations.
Nine areas currently are selected for ASPIRE awards following a holistic evaluation
of excellence in education: student assessment; student engagement; social
accountability; faculty development; simulation; curriculum development;
technology-enhanced learning; international collaboration; and inspirational
approaches to health profession education. ASPIRE provides expert support to
organizations that do not yet meet the necessary criteria but aim to do so in future.
The defined areas of excellence were emphasized during the rapid shift towards
digital education and digital health in the COVID-19 pandemic. As early as May 2020,
AMEE initiated open-access webinars supporting educators’, trainers’ and learners’
responses to COVID-19 and sharing good practice examples. This was supported by a
new online COVID-19 facility with extensive resources and toolkits (50).
The 2020 AMEE conference was delivered online using virtual-reality technology.
It managed to create a forum to further develop the health profession education
community of practice despite lockdown restrictions and teachers’ and learners’
additional workloads. The 2021 conference was also virtual and the 2022 was a hybrid
event, featuring joint Regional Office/AMEE symposia and workshops.
AMEE continues to act to ensure the highest-quality learning opportunities are

available for all and are adjusted to health professions’ diverse needs. The aim is to
leave no one behind in education.
33
3.2 Retention of new and existing graduates in domestic HLMs
Retention policies and measures are necessary EU Balkan countries to Germany, for example)
throughout HCWs’ careers, from studentship to even if they find it is more difficult to have their
established practitioner. Larger attrition rates at qualifications recognized in the destination country.
all levels of the system because of the COVID-19
pandemic emphasize the urgency of improving Some countries are both destination and source
retention. countries for HCWs. Patterns vary, with some
short (sometime daily) cross-border mobility and
Effective mentoring and support will increase longer-term migrations. Nurses based in France, for
the probability that students will complete their example, go to Switzerland and Luxembourg, or to
programmes of study. On exiting their programme, Quebec (Canada). Austrian and German doctors go
some new graduates (and active HCWs) in lower- to Switzerland, Portuguese and Spanish nurses go to
income countries of the Region may choose to the United Kingdom, and Australia and New Zealand
seek better working conditions and professional recruit nurses and doctors based in Ireland and the
development opportunities elsewhere. United Kingdom.
The free movement of persons in the EU and the The evidence base on so-called magnet institutions
directive on the mutual recognition of professional – those that improve nursing staff retention and
qualifications (52) make it relatively easy to move therefore patient care – is well established (53).
to a higher-income country. Romanian doctors Initially developed in the United States of America,
and nurses, for example, go to France, Italy and the approach is now being taken forward in a
Spain, where there is demand for their services and European context. The EU-funded Magnet4Europe
language is not a major obstacle. study (54) covers 60 hospitals in six European
countries (Belgium, Germany, Ireland, Norway,
Beyond the EU, other countries of the Region also Sweden and the United Kingdom) and focuses on
face challenges in retaining their best qualified using redesign of workplaces to improve staff health
HCWs. Many migrate to EU countries (from non- and well-being, productivity and patient safety.
3.2.1 Tackling geographical and public sector shortages
Some geographical areas face particular difficulties in underserved areas receive monthly bonuses, a
in recruiting and retaining HCWs. Most countries higher capitation rate and other financial incentives,
struggle with the problem of eliminating so- including for continuous development of staff (55).
called medical deserts, which are areas where the The WHO guideline on health workforce development,
population has insufficient access to HCWs and to attraction, recruitment and retention in rural and
health services. These tend to be in rural, remote remote areas (41) sets out further evidence-informed
or isolated areas, but they also exist in some urban options for policy interventions to help retain HCWs
settings, often in zones of poverty. in understaffed geographical areas.
Finland uses a mix of strategies to cover underserved Better data on distribution of HCWs at subnational
areas. These include adjusting the geographical level can provide impetus to policies for attracting
distribution of training admissions, delegating tasks professionals to underserved areas. EU countries
from physicians to nurses and providing incentives benefit from support under the third Health
(including salary benefits and flexibility of working Programme (56) to better diagnose and address
time) to encourage settlement in underserved areas. problems of the so-called medical deserts and
improve retention and task-shifting policies. Good
Medical universities in Latvia give priority to applicants practices from this ongoing work may be replicated
who agree to practise in a rural area on completion of in the future.
their training. General practitioners (GPs) practising
34
Policies to improve recruitment and retention and Public services in some countries lose staff who
thereby mitigate shortages are more likely to work move to the private sector to find better working
when they include a mix of interventions that are conditions. Many of the interventions proposed in
adapted to local contexts. Financial incentives alone the WHO guideline (41) can be adapted to address
are not sufficient. An overall package of incentives this issue.
should also include support for professional
development through access to mentoring and The WHO Health labour market analysis guidebook
CPD opportunities, and attractive career prospects (57) proposes an analytical approach that supports
and working conditions, including adaptation to countries to assess critical flows of staff. It provides
the needs of women with family constraints and of tools to help countries understand why individuals
older workers. choose specific education pathways or places
of work.
Action 4.
Develop strategies that attract and retain health
workers in rural and remote areas
The issue of so-called medical deserts in which populations have insufficient access
to HCWs and health services is affecting rural, remote, isolated and even some urban
settings in many countries.

• support countries and national policy dialogues in developing evidence-informed
strategies, informed by the WHO guideline on health workforce development,
attraction, recruitment and retention in rural and remote areas (41).
3.2.2 Managing international workforce flows and their impact
International flows of HCWs are a feature of Philippines (58). Countries must monitor these flows
European HLMs. These flows occur between, into to assess the implications for workforce planning
and out of countries in the Region. In the EU/EEA, and policy.
freedom of movement of persons and mutual
recognition of qualifications facilitate the mobility A key issue is the impact that such flows have on
of HCWs. HCWs’ availability and on service delivery. Some
countries are very dependent on international
Some countries have signed government-to- recruitment to fill HCWF gaps. This can have a knock-
government agreements with non-European on effect on service delivery in source countries and
countries to recruit HCWs. These include Germany create shortages. It is therefore important that all
with the Philippines and Viet Nam (nurses), international recruitment activity conforms with the
Portugal with Cuba (medical doctors and nurses), requirements of the WHO Global Code of Practice on
and the United Kingdom with Malaysia and the the International Recruitment of Health Personnel
35
(59), which all Member States have endorsed. The should be no recruitment from countries included
Code commits Member States to ethical practices in its Health Workforce Support and Safeguard
that avoid negative effects on source countries List (60).
and on individuals who migrate. WHO insists there
3.3 Organization of work and the performance of the HCWF
The performance of the HCWF is influenced by: their specific competencies and higher degrees of
work satisfaction.
• individual factors (competencies, experience
and motivation of workers);
Information and communication technologies such
• health-system factors (structure, financing
as telehealth, mobile health (m-health), electronic
modalities and funding available, and
regulation); and medical records, electronic health records, big
data and artificial intelligence are transforming
• factors related to the organization of work
(division of roles among categories of HCWs and how HCWs work. They promote interaction with
the composition of the HCWF). patients and with fellow HCWs and contribute to
service efficiency.
These three factors determine the extent to which
HCWs can produce the services needed in a more The COVID-19 pandemic stimulated and accelerated
productive manner. the use of digital tools to ensure continuity of
health care and prevention of virus transmission
Changing how work is organized to make it (46). European countries have used digital tools to
more efficient mitigates shortages by increasing remotely monitor COVID-19 patients in isolation at
productivity and improving quality. Implementing home (France and Luxembourg), for remote medical
teamwork and strengthening PHC are triage and referral (Malta and Portugal), and for
examples (Vignette 4–6). maintaining access to ambulatory care (Norway) or
to services provided by a multiprofessional team
Multiprofessional teams that share information and (Lithuania). Countries have also adopted emergency
medical records are more efficient. Coordination regulations to allow electronic digital prescriptions
between clinicians is enhanced and they are (Ireland) and sickness certifications (Malta).
better able to access complementary expertise.
Teleconsultations have become an important
Teams that have greater autonomy and the option part of the work pattern of physicians in many
of organizing their own work tend to provide more countries. In Portugal, 50% of physicians expressed
effective and more efficient services. Examples satisfaction with teleconsultations, with only 16%
of this in action in PHC include family health dissatisfied or very dissatisfied (70). The national
units in Portugal (66) and the Buurtzorg model of “Min læge” [“My doctor”] mobile application has
autonomous nursing teams that collaborate with been providing patients in Denmark with direct
physicians as required in the Netherlands and 10 access to their doctor via their mobile phones since
other countries in Europe (67–69). The Buurtzorg 2018. The app offers video consultations with GPs
approach enables patients to avoid repeated and specialists. In 2020, 46% of people in Denmark
examinations and consultations and allows them to reported having received an online or telephone
access more holistic management of their problems. medical consultation during the first 12 months of
HCWs benefit from mutual learning, recognition of the pandemic, more than the EU average of 39% (71).
36
Vignette 4.
Ireland:
the Enhanced Community Care (ECC)
programme– reducing the health service model’s
dependency on the acute hospital system
The ECC programme is the Government’s Sláintecare [health-care] policy to provide

more care in the community as close to home as possible to allow the ageing
population to maintain independence (61). It releases pressure on the hospital
system and brings enhanced community care services to towns and villages across
the country.
Ireland’s population is growing and ageing quickly. Demographic projections

suggest the over-65 population will increase by 3% per annum compared to national
population growth of 1% over the next 10 years. By 2028, there will be more people
aged over 65 than those under 14. This highlights the scale of the challenge of
responding to increasing demand for services.
The Health service capacity review 2018 (62) projected increases in demand for PHC of
46%, 39% for long-term residential care, 70% for home care and 24% for non-elective
inpatient services. Ireland needs to develop a more sustainable integrated health-care
system that can meet these growing needs.
The ECC programme aims to deliver increased levels of health care oriented towards
general practice, PHC and community-based services. The focus is on a countrywide
end-to-end pathway that prevents referrals to acute hospitals where it is safe and
appropriate to do so and enables a home-first approach. The ECC programme involves
3500 additional staff across a range of medical, health and social care professional,
nursing and support roles (budget €240 million) to increase levels of care and support
delivery of the transformation programme.
The main elements of the programme are:
• 96 community health-care networks (CHNs) serving a population of 50 000,

through which integrated care is delivered with community health-care staff
empowered at local level to drive multiprofessional integrated care delivery and
support egress in the community; and
• 30 community specialist teams for older people and 30 for those with chronic
disease, ideally co-located, servicing populations of 150 000 (equating to three
CHNs) by supporting GPs and CHN teams to respond to the specialist needs of this
population, bridging and linking care pathways between acute and community
services with a view to improving access to, and departure from, acute hospital
services.
37
Vignette 4 contd
Work undertaken by integrated care programmes for older people and chronic disease
shows that improved outcomes can be achieved particularly for older people who
are frail and those with chronic disease through a model of care that allows specialist
multiprofessional teams to engage and interact with GPs and services at CHN level
on diagnosis and ongoing care.
The ECC programme places the service user at the centre. It is changing structures
and ways of working to transform care from uniprofessional to multiprofessional
structures.
Key roles in the CHN model include: network manager, who provides multiprofessional
management; GP lead, who provides strategic oversight for GPs and engages with
colleagues to improve participation in PHC teams and clinical team meetings; key
worker, who supports integration of services for service users with complex needs;
and clinical co-ordinator(s) to facilitate multiprofessional work.
Community specialist teams are fully aligned with the acute system. Clinical
governance is provided through the relevant acute medical unit (Model 4 hospital)
or acute medical assessment unit (Model 3) but with services being delivered in
community settings. Increased direct access to radiology diagnostics supports the
community focus of the ECC programme.
Implementation is progressing at the expected pace. Reports suggest improved

integration, access and enhanced experiences for services users, improved staff
relationships, positive perceptions of local management, and good progress on
communications and clarity.
The ECC programme is focused on delivery of integrated care, staff recruitment, target-
population initiatives and activity and outcome monitoring. The infrastructure and
approach are being explored in the context of the roll-out of other transformation
and change programmes. Information on policies that are supporting these
transformations can be found on the Government of Ireland publications webpage (63).
38
Vignette 5.
Slovenia:
community health centres with multiprofessional
teams provide an effective dual-track approach
to COVID-19
The Ministry of Health and a COVID-19 advisory board, with the support of the National
Institute of Public Health (NIPH), conducted the response to the pandemic while
maintaining essential routine PHC services through a dual-track approach (64). The
approach included: providing surge capacity for testing and tracing; identifying
and responding to vulnerabilities for COVID-19 and essential health services; and
continuing to deliver health promotion and disease prevention services.
The NIPH carried out monitoring and surveillance of COVID-19 cases and traced high-
risk contacts. PHC teams participated in public health actions such as implementing
early detection and surveillance protocols. They also provided outreach services for
frail older people, those living alone and people whose clinical status could rapidly
deteriorate. Mobile teams were established for this purpose to closely follow-up
patients in their home environments.
Population health management during the pandemic was facilitated by existing

multiprofessional teams operating in community health centres. These teams
offered a comprehensive basket of services, supported by social care services and
local community organizations.
A pilot project that was already underway enabled clinical pharmacists to be mobilized
rapidly into GPs’ teams to support medication review. Existing multidisciplinary teams
enabled rapid responses to new patients’ needs, providing rehabilitation services for
patients with post-COVID conditions and rapidly deploying vaccination programmes.
The Government and the NIPH were responsible for vaccination promotion and
the supply of vaccines, while PHC services played a key role in ensuring access to
vaccination for all population groups.
The ability to adapt quickly and to effectively operate the dual-track system depended
on effective collaboration between primary care and public health. This provided
a vital shield for hospitals during the pandemic and is conducive to protecting
vulnerable and marginalized groups.
39
Vignette 6.
Kazakhstan:
multiprofessional teams to better align PHC
services with needs and expectations of the
population
Kazakhstan is transforming PHC from a biomedical and doctor-centred model to one

that is person-centred (65). More preventive, social care and mental health services
are being provided alongside strengthened delivery of clinical services. Nurses,
social workers and psychologists working with family doctors are increasing their
competencies and enjoying greater professional autonomy.
An intensive six-month retraining programme was introduced to improve family

doctors’ clinical knowledge in evidence-informed medicine and non-clinical
competencies. The programme focused on areas such as communication with patients
and within the PHC team, and assessment of patients’ medical and social needs.
Interprofessional courses provided opportunities for PHC team members from

different professions to better understand their respective roles and jointly adjust
task profiles. This resulted in better recognition and acceptance by GPs of the role of
PHC nurses, social workers and psychologists.
Kazakhstan followed international experiences in its gradual expansion of nurses’

scope of practice. The number of nurses in PHC teams tripled to up to three nurses per
family doctor. Typically, one is a patronage (community) nurse, a second is responsible
for disease management programmes and the third supports triage of patients for
doctors’ consultations.
A new regulation provided for a minimum of one social worker and one psychologist
per 10 000 population. The scope of practice of psychologists includes counselling
of patients referred to them by other PHC team members or through self-referral. In
addition to assessing the needs of referred patients, social workers now have more
proactive roles in identifying the social needs of vulnerable groups, such as people
with disabilities, older people and socially disadvantaged families with small children.
Special disease management programmes provide PHC teams with contextualized

evidence-informed clinical protocols and guidelines and supportive tools for patient
education. Initially, these focused on four priority noncommunicable diseases —
arterial hypertension, diabetes, chronic heart failure and chronic obstructive
pulmonary disease.
40
Vignette 6 contd
The integration of PHC services with specialized care was introduced through
evidence-informed clinical pathways that enable patients to get the right services from
the right specialist at the right time. This avoids care fragmentation and optimizes the
use of scarce health-care resources.
The Ministry of Health introduced a phased stepwise approach to achieving sustainable

transformation of the PHC model. It started with 17 selected good-practice centres in
every region and the bigger cities, followed by further roll-out after evaluation. The
approach applied a unique model of change management through partnerships with
the national PHC association and municipal administrations. Academic institutions
designed and implemented training for PHC professionals and managers, with
municipalities covering costs.
3.3.1 Making the division of labour more efficient
The COVID-19 health emergency has reinforced the shifting of tasks as required (see the European
recognition that over-rigid definitions of scopes of Commission empowering EU health policies on Task
practice of health professions can be an obstacle SHIfting project (72)).
to a rapid response to an emergency. Flexibility in
the division of tasks among occupational groups is Many countries in the Region have legislated over the
therefore required. last two decades to allow nurses and pharmacists
to perform tasks traditionally defined as medical.
Flexible scopes of practice and skill-mix facilitate the This frees time for doctors to see more patients and
use of the full range of competencies of all categories concentrate on more complex interventions.
of HCWs, permitting sharing, delegating and even
3.3.2 Making the composition of the HCWF more efficient
There is no benchmark for the most efficient occupational groups like feldshers (Azerbaijan,
proportions of different types of workers (sometimes Bulgaria, Kazakhstan, Kyrgyzstan, the Russian
called skill-mix) in the composition of the HCWF. Federation, Ukraine and Uzbekistan) or physician
Each country has specific needs, its own model of assistants (Germany, Ireland, Israel, the Netherlands
care delivery and division of tasks among HCWs, and and the United Kingdom) will opt for a different
different capacity to employ HCWs. combination than those that do not. A country that
has developed teleconsultations on a large scale,
The challenge is to find the combination of like Denmark, will have different needs from one
occupations that corresponds best to the needs of that has not yet done so.
the population. For example, countries that have
41
3.4 Creating an attractive work environment that is protective
of the health and well-being of the HCWF
Terms of employment and working conditions Countries in the Region launched many preventive
are key determinants of HCWs’ productivity and and supportive actions to address mental health
the quality of their work. Factors such as an open- risks. In the United Kingdom, for example, the
ended contract and access to a pension, health Government of Scotland has allocated £12 million
insurance, professional development opportunities, (approximately €14 million) to support the well-
career advancement, autonomy, supportive and being of HCWs since 2020. It has adopted measures
transparent management, recognition of merit, to support staff of its NHS staff, including:
protection against occupational risks, reasonable
• providing access to support via a national
workloads and fair remuneration all contribute to helpline;
engaging and motivating HCWs.
• developing an online national well-being hub;
and
The Netherlands has fewer shortages of nurses than,
• providing a workforce specialist service that
for instance, Switzerland or the United Kingdom
offers support in identifying the mental health
thanks to work arrangements that give nurses an needs of health and social care professionals
expanded role and more autonomy in organizing who may be reluctant to seek help or who are
and managing the delivery of their services (73). struggling to find confidential care.
Different dimensions of decent working conditions A review of the first 100 service users of the workforce
highlight the challenge of developing a fit-for- specialist service, utilization of the national well-
purpose HCWF. The list of factors goes beyond being helpline and an analysis of the national well-
financial incentives (see Vignette 7 for an example of being hub suggests they have had a positive impact
pay-for-performance), indicating that interventions on well-being (76). Vignette 8 presents an example
to create and maintain a motivating work from Belgium.
environment need to be multiple and adapted to
the specific needs of subgroups of the HCWF, such as The WHO Supporting the mental health and well-
those with family responsibilities and older workers. being of the health and care workforce document (78)
proposes that countries adopt a stepped approach
Some hospitals in Germany adopted family-friendly to supporting the mental health and general well-
measures such as providing childcare support and being of HCWs. This will ensure that workers receive
putting in place flexible working hours (74). Decent the right support at the right time. Measures should
working conditions in Slovenia are defined though range from specialized and primary care services to
the Regulation on Continuous Health Care and family and community support.
collective agreements with trade unions, including
those for physicians and dentists (74). In addition to short-term responses to adjust
working conditions to the environment created
Protection against occupational health and safety by the crisis, long-term actions by governments
risks is also a critical component of decent work. and employers are also needed to support the
WHO and the International Labour Organization sustainability of the HCWF. Well designed and
have joined forces to propose guidance that competently implemented interventions can
countries can deploy at national, subnational and prevent negative effects on the availability and
facility levels (75). The guidelines define processes quality of services due to HCWs’ coping behaviours.
that will help identify and mitigate risks and ensure Such behaviours include unjustified absence from
the well-being of HCWs. work, asking for under-the-table payments, carrying
out illegal dual practice, exiting early from the HLM
The COVID-19 pandemic highlighted the importance and emigrating.
of good working conditions to the physical and
mental health of HCWs in general, but particularly Policy-makers and employers are obliged to care
those on the frontline. Pressures and stress are those who care (75). The Global Health and Care
inherent to working in health and care services, Worker Compact captures international frameworks
but while HCWs are trained to cope with these, and instruments to support improvements in
increased workloads and the need to adapt rapidly working conditions and uphold HCWs’ rights (79).
to new roles in times of crisis can take their toll.
42
Vignette 7.
Kyrgyzstan:
pay-for-performance system in primary care
Kyrgyzstan introduced a pay-for-performance (P4P) system for PHC from October

2018 to March 2021. The aim was to attract more doctors by increasing salaries for
well performing providers. The system was accompanied by an offer for specialists
to retrain as family doctors, as 30% of family doctors in 2020 were of retirement age.
Prior to implementation, family doctors’ low salaries had the dual effect of promoting
informal payments and disincentivizing doctors from staying in the field.
The P4P system was based on 12 quality indicators covering priority areas of health
policy, among them maternal and child health, and prevention and treatment of
cardiovascular diseases and diabetes mellitus. A maximum possible score for all 12
indicators was defined and linked to a bonus payment of up to 30% in addition to
base salary.
WHO completed a qualitative and quantitative assessment of the P4P system effect
in 2022. Despite P4P only being in place for a short period, the number of specialists
who had retrained had increased, resulting in more family doctors in urban areas.
The system also had a significant impact on family doctors’ work motivation – 76% of
respondents indicated it had increased and 69% noted that P4P had a strong impact
on the quality of their work.
P4P was replaced by a higher base salary. This has noticeably reduced young
professionals’ motivation, as remuneration has dropped significantly compared to
that under the P4P system
The P4P assessment clearly indicated that the goals set by the Government of
improving the attractiveness of PHC, increasing the quality and performance of PHC
workers and boosting the motivation of providers were achieved. The Government
is now considering reintroducing the system.
43
Vignette 8.
Belgium:
implementation of a plan to increase the
attractiveness of the profession by improving the
working conditions, career prospects and social
recognition of nurses
The Belgian Federal Government agreed to invest about €1 billion in 2020 to improve
the working conditions of nurses and other staff in acute and psychiatric hospitals
and community care. The main objectives were to improve salaries (with €600 million
allocated) and create additional jobs via a special health-care staff fund (worth €402
million) started in November 2019.
With the agreement of unions and employer organizations, the Government decided
to spend €500 million on accelerated implementation (from July 2021 onwards) of a
new salary scheme for all salaried staff of the sectors involved. Functions instead of
degrees served as the basis, with salaries increasing proportionally more in the first
years of careers to attract more people into the health-care sector. New staff are hired
within the new salary scheme while current staff can choose to opt-in.
The additional €100 million was earmarked to improve working conditions via
bonuses and other measures like social leave and investments in human resource
department projects.
The largest part of the health-care staff fund targets the creation of additional jobs and
improvements to working conditions in hospitals through, for example, mentorship
programmes. Additional nursing and caring staff jobs are prioritized, though the fund
can also serve to hire support staff where it results in nurses being able to spend more
time on direct patient care.
Budget spending is approved by local committees of employee and employer
representatives and reported to the Ministry of Public Health. Part of the fund goes
to attracting individuals from other sectors to consider a career as a nurse or health-
care assistant by providing them with a salary during their education.
The new salary scheme corresponds to an average increase of 6%, but impacts at
individual level strongly depend on years of experience (with a higher increase at the
start of the career) and function. Although the salaries of the vast majority of staff have
increased, this has not been the case for all. For nurses with a specialized professional
title (such as intensive and emergency care), the advantage has been limited or non-
existent, since yearly bonuses for their professional title have been incorporated into
the new scheme. A recent study showed that 75% of nurses working in intensive care
units were not satisfied with their salary.
Although a first evaluation in 2020 demonstrated that the health-care staff fund
resulted in the additional recruitment of 4250 full-time equivalents (64.8% nurses
and health-care assistants) and 446 people starting nurse or health-care assistant
education, 69% of intensive care nurses reported problems with staffing and resource
adequacy (77). Implementation was carried out during the COVID-19 pandemic, so
occurred at a time characterized by nurses being absent or leaving the profession and
a very tight labour market.
The Federal Minister of Public Health announced in 2022 an additional budget of €45
million to finance annual bonuses for nurses with a specialized title. This rewards
their specific competencies, which were perceived to have been undervalued by the
new salary scheme.
44
Action 5.
Create working conditions that promote a
healthy work–life balance
The aim is to sustain decent work. This relates to workload and staffing levels,
remuneration and benefits, work flexibility, access to training and mental
health services, protection against occupational risks, violence and all forms of
discrimination, and attention to the needs of older HCWs and those with demanding
family responsibilities.

• support the development of legislation and regulation to guarantee optimal working
conditions for HCWs as part of comprehensive recruitment and retention strategies.
Action 6.
Protect the health and well-being of the
workforce
The benefits of taking care of the health of the HCWF are numerous. They include more
motivated and better performing HCWs, less harm and absenteeism, higher retention
rates and, most importantly, more available, accessible and effective health and care
services and higher user satisfaction.

• support identification and implementation of effective measures to ensure the
health and well-being of HCWs.
45
3.4.1 Addressing gender segregation in working environments
Meaningful improvements and solutions require should be oriented towards reducing and closing
action by ministries of health in collaboration with existing gender gaps and understanding how a
other sectors, such as departments for women’s more gender-equal HCWF can contribute to larger
issues, social protection, social affairs, education, regional goals, based on balanced economic growth,
labour, finance and employment, to address both full employment and social progress. The continued
horizontal and vertical gender segregation. This lack of sex-disaggregated data makes assessments
includes driving gender-transformative measures of gender in the age composition of different parts
in promoting better working conditions, addressing of the workforce and retention, recruitment and
issues of safety in the workplace and dealing with migration dynamics difficult.
gender-based differences in terms of burnout and
attrition. The Regional Office has been able to address some
of these issues by creating a community of practice
Family-friendly measures such as provision of on gender, PHC and the COVID-19 response by
childcare support, flexible working hours, part-time building the capacity of WHO staff and national
contracts and good annual leave arrangements for counterparts in countries, engaging with civil society
fathers and mothers have been put in place to make representing groups experiencing vulnerability
workplaces more attractive. It must be ensured, and increasing advocacy with partners in the Issue-
however, that such policies do not keep women based Coalition on Gender. The Regional Office is
in low-paid jobs with less pension benefits and do aiming to mainstream gender into the HCW and is
not dissuade men from taking paternity leave or engaged with the country-driven forum on long-
working flexible hours to support family care. term care service delivery. It is also collaborating
with the forum of government chief nursing and
In rebuilding more responsive and resilient health midwifery officers (GCNMOs) to influence policy and
and economic systems in the aftermath of the management and inspire others to commit to the
COVID-19 pandemic, countries will benefit from implementation of a new vision to achieve better
reviewing the sustainability of their workforces population health outcomes.
through an equity-focused lens. Reform efforts
3.5 Governance for a strong and effective HCWF
3.5.1 HCWF governance It is therefore critical that Member States “build the
capacity of institutions at subnational, national
There are at least three prerequisites for successfully and international levels for effective leadership
addressing the challenge of developing a HCWF and governance of actions on human resources for
that ensures UHC: an effective governance system, health” (82).
strategic planning and adequate financing.
The European Observatory on Health Systems and
Governance of the HCWF is the system and process Policies identifies five dimensions of governance of a
of designing and implementing policies, decisions country health system that serve to assess its quality
and rules that shape the HCWF (80,81). This occurs, (81). This approach applies well to governance of
for example, through regulating and accrediting the HCWF. The dimensions are known as the TAPIC
education institutions and programmes, developing framework and comprise:
policies on access to the HLM, defining the division
• transparency of decisions – who took them, and
of tasks among HCWs and setting conditions of with what justification;
employment and work.
• accountability of decision-makers;
Governance has a direct influence on the availability, • participation of those affected in the
decision process through, for example,
accessibility, acceptability and quality of the HCWF.
a consultation mechanism;
46
• integrity through clarity and fairness of There is no standard, one-size-fits-all model of
procedures and in the management of workers’ governance. The configuration of actors in the
careers; and process of governance and their respective capacity
• capacity – the availability of competent technical to influence the design and implementation of
assistance to conduct policy-making that is HCWF policies and decisions are country-specific.
informed by reliable data and valid information. Countries can use the TAPIC framework to guide
their choices in building their HCWF governance
The exercise of governance of the HCWF involves system; whatever countries choose, they will need
the choice of what should be regulated. This may the technical capacity to make it work.
include conditions of entry into the HLM, fitness to
practise, required competencies, number and type Vignette 9–11 give examples of how some countries
of jobs created, wage levels and work conditions, have improved the governance of their HCWF.
and quality of practice. Key components of the
HCWF are already highly regulated; the challenge is
not to regulate more, but to make regulation more
effective.
Action 7.
Build leadership capacity for workforce
governance and planning
This includes strengthening strategic planning capacity to inform policy- and decision-
making and ensuring more equitable representation of women in decision-making
positions. It also means more intersectoral collaboration, sharing of data and
information, and engagement of stakeholders through, for example, policy dialogues.

• support countries in strengthening HCWF governance functions through the
provision of leadership training and facilitation of action learning programmes;
• support countries in strengthening HRH units for stronger leadership, strategic
planning and management capacity;
• support countries in implementing effective HCWF planning approaches and
tools;
• support countries in conducting HLM analysis by training a critical mass of
analysts and developing national health workforce strategies; and
• support national policy dialogues on HCWF analysis and policy development.
47
Vignette 9.
Israel:
contribution of nursing leadership to the HCWF
governance system in general and during the
COVID-19 pandemic in particular
World Health Assembly resolution 74.15 calls on Member States to establish and
strengthen national and subnational senior leadership roles for nurses and midwives.
These leaders should have authority and responsibility for managing nursing and
midwifery workforces and be able to input into health decision-making, including by
appointing GCNMOs. Having GCNMOs and senior leadership programmes in place is
associated with better regulation of education and work (83).
The Government Chief Nursing Officer (GCNO) in Israel serves as Deputy to the Ministry
of Health General Manager and is a key contributor to determining policies and
leading the national health workplan. The Nursing Division oversees 11 departments,
including that for Managing the Health Workforce in Emergencies.
The GCNO led the process of rapidly mobilizing, repurposing and upskilling the
country’s health workforce to meet the requirements of the COVID-19 response during
the pandemic.
Three main challenges were faced in managing the HCWF during the pandemic:
• monitoring the incidence of the disease;

• combatting staff shortages; and
• dealing with the absence of a robust routine data-collection system on the HCWF
that provided real-time information to inform policy-making.
Policy responses led by the GCNO included creating thousands of new permanent
positions, increasing training in intensive care and extracorporeal membrane
oxygenation, and using a data-driven decision-making process to assess the utilization
of resources. The Nursing Division provided intensive care training for 2000 nurses
and 4000 newly graduated nurses and recruited 7418 nursing students from July 2020
until 2021.
Eight hundred paramedics and 700 other health workers, including social workers,
physiotherapists, nutritionists, technological assistants and laboratory workers, joined
the HCWF. New permanent positions for nurses (2550) and medical doctors (700) were
also created.
This data-driven process increased efforts to gather, synthesize and analyse data.
It enabled the Nursing Division to provide daily reports that helped identify staff
shortages in real time and target recruitment, allocation and training where it was
most needed.
The Nursing Division’s work illustrates the benefits a GCNO can bring when placed in
a position to steward, resource and monitor education and work at national scale to
rapidly adjust to demand in a pandemic.
48
Vignette 10.
Scotland (United Kingdom):
how government actors collaborated in the
production of the National Workforce Strategy for
Health and Social Care in Scotland
The National Workforce Strategy for Health and Social Care in Scotland (84) sets out
a collective vision for the HCWF, based on coordination of planning.
The strategy, which addresses the needs of over 400 000 skilled people working in the
NHS, social care and third-sector nongovernmental organizations in many different
roles, presents a long-term framework for progressively realizing the workforce vision,
underpinned by a clear ambition to deliver recovery, growth and transformation. It
acknowledges that sustained action is required to improve policy and operational
interventions across the five key pillars of the workforce lifecycle: plan, attract, train,
employ and nurture.
The strategy’s vision is based on the core values of continual improvement,

engagement, honesty, co-design and accountability. Achieving the vision will be
critical to delivering the national mission to address health inequalities through early
intervention and prevention.
Improving decision-making at all levels of the system to promote sustainability is a

strategic priority. In particular, the strategy aims to enhance integrated workforce,
service and financial planning, ensuring that workforce skills-mix and capacity:
• supports Scotland’s National Performance Framework outcomes for health and

social care; and
• responds to the changing environments in which health and care is being
delivered.
The strategy sets out over 100 actions across three time horizons. The actions will
be reviewed annually. They commit to improving planning capability, specifically
focusing on shared learning and better alignment of national and local planning using
improved data and modelling. Local services will assess changing workforce needs
through three-year workforce plans, based on an assessment of population health
and demand for health and care services.
49
Vignette 11.
Iceland:
establishing a national council of staffing and
education in health services
Iceland is an island country with a small population and its own language. Some parts
are rural and hard to access during winter, which influences the challenges in ensuring
adequate numbers and education for the HCWF.
Iceland’s policy is to provide access to quality health services to all citizens in remote,
rural and urban areas. To enable this, working groups for three health-care professions
(general nurses, practice nurses and medical doctors) submitted reports to the Minister
of Health in 2019 that presented proposals on how to improve staffing.
In May 2021, the Minister established a national council to tackle challenges in staffing
and education in the health-care system. The council acts as a consultation forum
to provide advice on HCWF education and employment priorities, including cross-
government and stakeholder involvement.
The council comprises representatives from the ministries of education and children,
and higher education, science and innovation, national health-care institutions,
PHC, universities, the Icelandic Association of Local Authorities and the Directorate
of Health. Among its key aims is improving connections between the education and
training of HCWs and the identified priorities of employment and skills required.
Main tasks include:
• building a stronger education system for HCWs, especially for specialist education
and postgraduate training programmes;
• improving task-sharing or task-shifting between health professions to build
stronger cooperation;
• placing greater emphasis on the self-sufficiency of the system;
• providing sufficient staffing in rural areas; and
• performing analytical work to profile the workforce and assess future needs.
The council meets twice monthly (one face-to-face and one virtual meeting). Other
stakeholders are invited to participate when appropriate.
Reports suggest the national council has been a significant catalyst in getting different
parties to the table to jointly define system-wide HCWF goals. It is strongly committed
to a team ethos in examining policy advice, including developing policy and action-
oriented proposals, projects and actions with relatively quick turnaround times.
The national council has been operational for little more than a year. It will continue
to focus on enabling the education system to increase the number of workers in
professions where there is a need and build up a more productive HCWF. The emphasis
is always on quality, safety and efficiency in the health-care service.
50
3.5.2 Strategic planning: an indispensable approach
Some policy decisions around the HCWF taken to draw lessons on what makes a health system
today will produce their effects only in 5–10 years’ resilient.
time, or perhaps longer. Decisions need to reflect a
plausible assessment of future needs. Objectives Analysis of the current HCWF situation is the
and a strategy that take account of optimal HCW foundation of informed planning. Reliable up-
numbers, locations and competencies need to be to-date data on the HCWF is therefore of prime
in place to support the achievement of UHC by 2030. importance (42,85). The WHO National Health
Workforce Accounts (86,87) and the OECD/
Strategic planning therefore goes beyond Eurostat/Regional Office joint questionnaire
projections. It is a starting point; effective forward- on non-monetary health-care statistics (88)
looking strategic workforce planning needs to propose standard indicators and sources of data.
be complemented by the identification of future Table 2 presents information sources and tools
competency requirements. Corresponding to this that countries can use to identify trends in health
are the required education capacity, the desired services and HCWF needs.
division of tasks, organization and conditions of
work, and the regulatory framework to ensure Good quantitative data, combined with the
HCWs’ quality of practice. consultation of experts (epidemiologists,
demographers and researchers) and key informants
The overarching challenge of strategic planning is (policy-makers and leaders of education institutions
how to coordinate actions in education and training, and professional organizations), make it possible
regulation, organizational change, employment and to envisage different scenarios of future HCWF
working conditions. requirements. The European Commission-funded
Support for the Health Workforce Planning and
Effective planning (80–82): Forecasting Expert Network (89) and The toolkit for
a sustainable health workforce in the WHO European
• covers the whole HCWF and factors-in the
complex interactions of occupational groups Region (90) present good practices and planning
involved in the delivery of health and care tools.
services;
• considers variations in HCWF needs within the Work at EU level will continue with the launch of the
country; Joint Action Heroes on health workforce planning
• requires valid, reliable, up-to-date and and forecasting in autumn 2022.
comprehensive data on the baseline HCWF
situation and on trends in the supply and Vignette 12–15 provide examples of how Kyrgyzstan,
demand for health services and for HCWs; Malta and Georgia estimate future requirements for
• has access to the technical capacity (such as medical and dental personnel, education capacity
policy analysts, demographers, statisticians and to meet need and resources required – a complex
informaticians) to collect and analyse relevant exercise in any context.
data and information;
• engages stakeholders in supporting proposed Failure to plan may mean that current HCWF
objectives and strategies to progress towards problems will persist or worsen and policy-makers
UHC;
will not be informed about the causes of, or options
• is informed by rigorous estimates of the costs to address, them. This has negative consequences
of reforms, including costs for educating and
on the health and quality of life of people now and
employing more workers and the additional
services they will generate; and in the future and will cause inefficiencies in the use
of training resources.
• is flexible and adapts strategies and
interventions when monitoring shows that
objectives are not being achieved or that Populations everywhere place high value on the
undesirable effects are being observed. ability to access quality health services. A poor
response to this expectation may cost political
The COVID-19 health emergency illustrated the capital. Planning the HCWF is not an exact science,
challenge of planning for unexpected shocks like a but with a clear vision of the health system the
pandemic, an economic crisis or a major ecological country wants to have in place in the future,
catastrophe. It presents a unique opportunity planners can propose policy options from which
decision-makers can choose to strengthen their
HCWF in an informed way.
51
Table 2. Data and information useful for informing planning
Variable Data/information needs Sources
Epidemiological Population projection: Census data; national information system

and fertility rates, life on mortality and morbidity; national
demographic expectancy, migratory health surveys; WHO Global Health
changes flows Observatory; Global Burden of Disease
Burden of disease
projections: mortality,
morbidity, risk factors, by
sex and age group
Demand and Utilization of services Administrative databases

utilization of by type of service (PHC, Demographic and health surveys
health services hospital, long-term, home
care), by sex and age
group
Unmet demand
Policies Stated goals and Public policy documents and reports:

objectives of the national health plan, public administration
government relative to: and ministry of finance policies
health priority needs,
funding of health Survey of opinion of key informants
services, decentralization/
regionalization of decision-
making and management,
contracting health workers
Models of care Stated goals and Public policy documents: national health
objectives of the plan, public administration and ministry
government relative of finance policies
to organization and
management of health Recommendations by international
services (priority to PHC, bodies (WHO, other United Nations
integration, coordination agencies, professional organizations)
of services, management
autonomy of facilities) Survey of opinion of key informants
Regulatory Stated goals and Public policy documents: national health

changes objectives of the plan, public administration policies
government relative
to: regulation of the Survey of opinion of key informants
private sector; division
of tasks among the
various categories of
health workers; quality of
professional practice
Technological Information on the Literature review

changes potentialities of existing
technological innovations Survey of opinion of key informants
and of those in the pipeline
52
Action 8.
Strengthen health information systems for
better data collection and analysis
Primarily, countries should optimize the use of available data, identify possible gaps
and take steps to fill them. Data collection should focus on indicators that are more
likely to influence policy choices, and cover behavioural and cultural barriers to,
and facilitators of, HCWF performance. It is crucial to extend data collection to all
occupations in the HCWF to attain a full picture of the HLM. Strengthening information
systems and developing National Health Workforce Accounts is critical to supporting
labour-market analysis, planning, advocacy for increased investment, and policy- and
decision-making.

• support countries in assessing their HRH information systems and in developing
plans for their improvement; and
• support the strengthening of data collection and analysis for policy decision-
making.
53
Vignette 12.
Kyrgyzstan:
applying and adapting health workforce tools to
support COVID-19 surge response
Two tools were used:
• an epidemiological model (Adaptt) (91) to project how the pandemic might

evolve; and
• a WHO HCWF estimator to highlight where problems might occur in future.
The tools used data collected by the e-health team in Kyrgyzstan on the available
national HCWF and hospitals in the Bishkek (capital) region, together with the daily
number of patients hospitalized with COVID-19 and their severity. The hours per day
required for the treatment of moderate, severe and critical COVID-19 cases were
estimated and confirmed against actual hospital statistics.
The epidemiological tool was used to show how COVID-19 case numbers might unfold
and their likely severity. The HCWF estimator tool then used these data to assess the
potential impacts on the HCWF.
Outputs showed the number of cases that could be handled by the current workforce
and identified predicted gaps by occupation and health facility in the Bishkek region.
This allowed the Ministry of Health to manage the situation by, for example, moving
staff between regions or task-sharing to reduce any deficits or surpluses.
The tools played a major role in supporting effective overall management and
planning systems and mechanisms during the pandemic and highlighted the need
to improve HCWF data. They showed the importance of contingency planning to deal
with situations where the number of patients exceeds the capacity of the health-care
system and the need for additional data to extend the analysis across other hospitals
and regions.
Work to improve data capabilities and the wider workforce-planning process is

ongoing.
54
Vignette 13.
Malta:
planning future health worker requirements
informed by data analysis and consultations with
experts and stakeholders
The Ministry for Health is responsible for national health services and provides
primary, secondary and tertiary care.
Currently, the Ministry submits a rolling three-year business and human resource plan
to central government. The plan is not evidence-informed and therefore is exposed to
being challenged. It is considered too short-term, given that most health-care students
take years to train. Service leaders only plan for the following year, and the current
process also poses a challenge with (re)deploying HCWs where they are needed most.
The COVID-19 pandemic has exposed system deficiencies and the need for a more
rigorous planning approach.
The final draft HCWF strategy goals include strategic HCWF planning, strengthening
of data management, enhancement of communication between the education and
health sectors, and improving the physical and psychological well-being of workers.
The Ministry is collaborating with WHO advisors to develop a bespoke data-driven tool
aimed at transforming HCWF planning into a more evidence-informed and longer-term
system. The tool is being tested to improve workforce decision-making in multiple
staff categories. Consultations with stakeholders and service leaders are being taken
forward to obtain a better understanding of current HCWF needs and challenges
and build stronger stakeholder relationships. Resistance to change from some
stakeholders is foreseen as the major barrier to this new approach being accepted.
The expected outcome is more accurate, evidence-informed HCWF planning processes

that take into consideration a number of factors not considered in the current system.
These include demographic, epidemiological, sociocultural, political, productivity,
technological and task-shifting trends.
More effective HRH projections are also expected. Ministry for Health advocacy for
additional resources will gain credibility with higher authorities, including central
government and the Ministry for Finance and Employment. The Ministry will also be
supported during consultations with education institutions to identify gaps between
demand and supply for specific staff categories. This will contribute to delivery of the
highest quality of care to the population.
Once finalized, the tool will be shared with heads of health entities and service leaders,
followed by a comprehensive training programme to provide the necessary skills and
competencies in use of the tool.
This system can be easily adapted to address the needs of other small countries that
do not currently have a robust HRH planning system in place.
55
Vignette 14.
Georgia:
from absence of planning to strategic planning
With the exception of rural PHC services and a handful of public hospitals, Georgia
has a highly privatized health-care system dominated by for-profit entities. Georgia
has been striving to provide UHC since 2013, but the organization of the health system
and financial incentives favour emergency and inpatient care, where funding is based
on a fee-for-service basis.
This approach also applies to the HCWF, whose supply has been left to the market.
Since deregulation of the health system began in 2004, Georgia has not undertaken
any formal HCWF planning, relying instead on the choices of students, the output of
education institutions and demands of health service providers in the market. The
Ministry has not actively influenced the supply of HCWs, and governance links between
the Ministry and key stakeholders have not been in place.
The result was a laissez-faire and unplanned approach to HCW supply, leading to
oversupply of medical doctors (mainly in narrow specialties), undersupply of nurses
and midwives, and concentration of the workforce in big cities around private health-
care networks.
The Government renewed its commitment to investing in and strengthening PHC in

December 2019. Successful reform will depend in large part on addressing supply
constraints related to human resources for PHC to achieve appropriate and sustainable
long-term numbers, composition, competencies and working conditions.
To support this renewed interest, WHO contributed to the first comprehensive HCWF
assessment in Georgia, with a particular focus on PHC. The assessment found the
following.
• PHC workforce demographics were unfavourable, with an ageing profile. A

significant number of workers were within 10 years of the retirement age (60 for
women and 65 for men) and a number were working well into retirement.
• Wages were low by comparative standards, though the Government has adjusted
the taxation requirement for HCWs to raise the real-term equivalent.
• Rural staff retention is a challenge. Practices are small, leading to professional
isolation and potential deskilling due to limited exposure to professional
development opportunities.
• CPD was being implemented in an ad hoc way. In addition to changing the
model of care, opportunities exist for a more systematic approach to CPD for
PHC services to continually improve the quality of care and enhance patient
experience.
56
Vignette 14 contd
The assessment findings will support the creation of the country’s first HCWF
development strategy, beginning in June 2022. Successful implementation of the
strategy relies on attracting additional professionals to PHC in a sustainable way. Key
recommendations include:
• establishing and investing in an HRH planning and governance unit;

• substantially increasing investment in human resources for PHC;
• providing support to improve quality though CPD;
• developing formal HRH reporting mechanisms and review of the HRH information
system;
• improving the regulatory environment, including revalidation of accreditation;
and
• developing a new approach to recruitment and retention.
WHO is committed to supporting Georgia’s capacity development through

participation in the ongoing Workforce Planning Leadership Development programme
(89). This includes providing technical assistance to support the drafting of a HCWF
development strategy and facilitating a policy dialogue with key stakeholders on the
implementation of recommendations and reforms to establish the structures and
capacity to shape the HCWF.
Vignette 15.
England (United Kingdom):
addressing shortages in general practice
PHC services in England, based on general practices, have consistently faced workforce
pressures. These have been exacerbated by the COVID-19 pandemic.
Concerns about current and future workforce supply–demand gaps were a major
driver for the REAL Centre (Research and Economic Analysis for the Long term) of
the Health Foundation to undertake independent analysis of long-term supply and
demand in the NHS in England to 2030–2031 (92). The analysis focuses on patient-care
staff in general practice (fully qualified, permanently employed GPs, general practice
nurses and other patient-care staff).
The REAL Centre’s projections were informed by analysis of publicly available data
from multiple sources, with underlying assumptions developed in consultation with
key stakeholders in government, the professions, regulation and employers.
57
Vignette 15 contd
The GP supply projections explored future changes in qualified permanent GP supply

through alternative supply channels:
• GP retention: retention of GPs currently practising in England (captured by

changes in GP leaver rates);
• shifts in workforce composition: the extent to which significant increases in
recruitment in other patient-care roles in general practice could alleviate GP
workload pressures;
• domestic training: changes in the number of GP specialty trainees, the GP trainee
attrition rate and workforce joiner rates; and
• international recruitment: recruitment of GPs with a primary medical
qualification from outside the United Kingdom.
The analysis considers how policy choices might affect recruitment and retention of
these staff groups under alternative scenarios:
• current policy scenario: continuation of historical trends and existing policies;

• optimistic scenario: further policy intervention that achieves increased
recruitment and retention; and
• pessimistic scenario: negative impacts to future supply arising largely from
incomplete realization of existing policy potential, a lack of longer-term planning
and COVID-19.
The results highlighted that in all three scenarios, the supply of GPs and general
practice nurses is projected to fall short of demand.Under current policy, the NHS
faces a shortfall of around one in four GP and general practice nurse posts by 2030–
2031. This increases to around one in two GP and nurse posts in the pessimistic
scenario, raising concerns about patient safety, quality of care and equity of access.
In the optimistic scenario, the GP shortfall can be substantially mitigated by 2030–

2031, with a lower projected GP shortfall of around 1200 full-time equivalents (around
3% of projected GP posts), but this assumes substantial improvements in GP retention
and more effective integration of new direct patient care roles helping to lower GP
demand by 9% by 2030–2031.
The REAL Centre stressed that policy choices around staff recruitment, retention,
training, funding and equity in general practice have a vital role to play in addressing
workforce pressures in general practice in the medium term. It recognizes that:
• addressing general practice workforce shortages requires comprehensive long-

term planning and acknowledgement that improvement will take many years;
• top-down targets are unlikely to be effective in addressing workforce
supply–demand shortfalls, meaning policy-makers should account for
geographic and sector variation in supply and demand;
• policies need to be fully costed and funded to be implemented effectively;
• joined-up policy-making needs to be underpinned by substantive research on the
drivers of workforce supply and demand and rigorous projections analysis; and
• substantial gaps in accessible data about the NHS workforce should be
acknowledged and mitigated.
58
3.6 Investing smartly in the HCWF
The HCWF in all countries requires financial support Funding such investments depends on the capacity
to take on new responsibilities and face challenges of the country to create fiscal space to spend more
over the short and longer terms. on the HCWF. Classic examples of how a government
can raise more revenue to strengthen the HCWF
The absence of adequate funding leads to unrealistic
include:
options and spurious projections, while funding
without planning risks producing inefficiencies • reallocating funds within current health sector
and waste. Funding needs to be smart (targeted) expenditure without spending more by, for
example, improving allocative efficiency;
to achieve best results. This can include greater
investment in skill-mix innovations, improved • improving organizational efficiency in health
working conditions for HCWs, incentives to attract through making savings by, for instance,
reducing the inappropriate utilization of
new talent (including through increased investment hospital services, eliminating wastage, making
in training and education) and policies to retain procurement more cost–efficient or simplifying
HCWs. All of these are key ingredients of successful decision-making and bureaucratic procedures;
HCWF strategies (93). • reallocating funds from other government
budget areas;
Expenditure on training and employment of HCWs
is variable among countries of the Region, as is • generating additional revenue from taxation,
including from contributions of users of services;
their capacity to spend more. During the COVID-19
pandemic, however, many Member States managed • borrowing on the financial markets or, if this is
not possible, applying for external aid; and
to mobilize additional resources to strengthen their
response to the crisis. • using a mix of these options.
The potential to use these policy options depends
Among them, EU countries had access to grants
principally on the political context. All require
and loans from the Recovery and Resilience Facility
collaboration from many stakeholders whose
to support the health sector, including the HCWF,
interests and objectives may be affected.
though more resources went on infrastructure. Non-
EU countries also spent more on their HCWF. Türkiye, Action 9. capacity to invest in education or
Private sector
for example, recruited an additional 44 000 HCWs
services depends on users’ willingness to pay more
in 2020 (94). Others, like Albania, Armenia, Belarus,
for its services through higher fees for studies, higher
Bosnia and Herzegovina, Kyrgyzstan, Montenegro
insurance premiums and out-of-pocket payments.
and the Russian Federation, paid bonuses to HCWs
or increased their remuneration (95).
The development of a fit-for-purpose and resilient
Immediate challenges require urgent responses. HCWF comes at a cost, but it brings a huge return.
Looking to the longer term, additional investments The High-level Commission on Health Employment
should be part of the strategic planning process of and Economic Growth showed convincingly that
the HCWF to, for example: spending more on HCWs, if done well, is a productive
social and economic investment (96). Failure to
• determine where investment should be made
invest has a higher cost in the form of unmet needs,
in educating and training HCWs (more students,
more and better qualified educators and poor-quality health services and loss of workers to
trainers, better infrastructure, and promoting other sectors or countries.
the attractiveness of joining the professions by
improving working conditions and increasing Expenditure on training and employment of HCWs
the compensation/wage bill), or in research is variable among countries of the Region, as is
to produce the data and knowledge to inform
their capacity to spend more. During the COVID-19
policy development;
pandemic, many countries managed to mobilize
• define the expected results in the short, medium
additional resources to strengthen their response
and long terms and how to monitor them;
to the crisis. Looking to the longer term, additional
• estimate how much additional financial investments should be part of the strategic planning
resources are needed in the short, medium and
process for the HCWF.
long terms and how to access them; and
• build the technical capacity required to ensure
the investment is effective.
59
Action 9.
Increase public investment in workforce
education, development and protection
Ministries of health and health sector stakeholders need to make the case to other
ministries and potential funders for increased and targeted investment in the HCWF.
Addressing backlogs of services post-COVID-19 and the economic and employment
returns from such investment are powerful advocacy arguments. Public and private
investment should be mobilized.

• support countries in making the investment case to ministries of finance for
increased financing of the HCWF; and
• support countries in making the case to education and labour ministries for
increased and targeted investment in the HCWF.
Action 10.
$ Optimize the use of funds through innovative
workforce policies
Countries will benefit from investing in innovative ways to increase the availability,
accessibility and productivity of HCWs. Prioritizing investments in the PHC workforce
is the best strategy to improve the performance of health services.

• support countries in developing investment strategies to: improve HCWF
optimization by defining new roles and introducing multiprofessional teams;
improve digital health skills; introduce more flexible working arrangements; and
improve working conditions; and
• support countries in strengthening their PHC workforce.
60
The way forward: 10 actions to strengthen
the HCWF in the European Region
This chapter brings together the recommended actions to help

address HCWF challenges across the Region set out in Chapter 3.
There is no implied hierarchy in the listing of the actions – they
each carry equal significance.
4.1 Proposed actions
Action 1.
Align education with population needs and
health service requirements
Equipping new HCWs with the right competencies is necessary to respond to the
changing health needs of individuals and populations.

• support health and education institutions in reviewing and updating health and
care education curricula and programmes; and
• support the development and strengthening of regulation and accreditation of
health and care education institutions and programmes.
Action 2.
Strengthen continuing professional
development to equip the workforce
with new knowledge and competencies
CPD activities support HCWs to adapt to changes in demand for services and the
introduction of new tasks.

• provide support in improving CPD standards and approaches for the HCWF and
promote access to CPD opportunities.
62
Action 3.
Expand the use of digital tools that support the
workforce
Extensive shifts towards greater use of digital health in service delivery and HCW
training and development took place during the COVID-19 pandemic. Their ongoing
and increased use will require a HCWF that is skilled in the use of digital health tools.

• support the development of guidance and frameworks to equip HCWs with digital
competencies.
Action 4.
Develop strategies that attract and retain health
workers in rural and remote areas
The issue of so-called medical deserts in which populations have insufficient access
to HCWs and health services is affecting rural, remote, isolated and even some urban
settings in many countries.

• support countries and national policy dialogues in developing evidence-informed
strategies, informed by the WHO guideline on health workforce development,
attraction, recruitment and retention in rural and remote areas (41).
63
Action 5.
Create working conditions that promote a
healthy work-life balance
The aim is to sustain decent work. This relates to workload and staffing levels,
remuneration and benefits, work flexibility, access to training and mental
health services, protection against occupational risks, violence and all forms of
discrimination, and attention to the needs of older HCWs and those with demanding
family responsibilities.

• support the development of legislation and regulation to guarantee optimal working
conditions for HCWs as part of comprehensive recruitment and retention strategies.
Action 6.
Protect the health and mental well-being of the
workforce
The benefits of taking care of the health of the HCWF are numerous. They include more
motivated and better performing HCWs, less harm and absenteeism, higher retention
rates and, most importantly, more available, accessible and effective health and care
services and higher user satisfaction.

• support identification and implementation of effective measures to ensure the
health and well-being of HCWs.
64
Action 7.
Build leadership capacity for workforce
governance and planning
This includes strengthening strategic planning capacity to inform policy- and decision-
making and ensuring more equitable representation of women in decision-making
positions. It also means more intersectoral collaboration, sharing of data and
information, and engagement of stakeholders through, for example, policy dialogues.

• support countries in strengthening HCWF governance functions through the
provision of leadership training and facilitation of action learning programmes;
• support countries in strengthening HRH units for stronger leadership, strategic
planning and management capacity;
• support countries in implementing effective HCWF planning approaches and
tools;
• support countries in conducting HLM analysis by training a critical mass of
analysts and developing national health workforce strategies; and
• support national policy dialogues on HCWF analysis and policy development.
Action 8.
Strengthen health information systems for
better data collection and analysis
Primarily, countries should optimize the use of available data, identify possible gaps
and take steps to fill them. Data collection should focus on indicators that are more
likely to influence policy choices, and cover behavioural and cultural barriers to,
and facilitators of, HCWF performance. It is crucial to extend data collection to all
occupations in the HCWF to attain a full picture of the HLM. Strengthening information
systems and developing National Health Workforce Accounts is critical to supporting
labour-market analysis, planning, advocacy for increased investment, and policy- and
decision-making.

• support countries in assessing their HRH information systems and in developing
plans for their improvement; and
• support the strengthening of data collection and analysis for policy decision-
making.
65
Action 9.
Increase public investment in workforce
education, development and protection
Ministries of health and health sector stakeholders need to make the case to other
ministries and potential funders for increased and targeted investment in the HCWF.
Addressing backlogs of services post-COVID-19 and the economic and employment
returns from such investment are powerful advocacy arguments. Public and private
investment should be mobilized.

• support countries in making the investment case to ministries of finance for
increased financing of the HCWF; and
• support countries in making the case to education and labour ministries for
increased and targeted investment in the HCWF.
Action 10.
$ Optimize the use of funds through innovative
workforce policies
Countries will benefit from investing in innovative ways to increase the availability,
accessibility and productivity of HCWs. Prioritizing investments in the PHC workforce
is the best strategy to improve the performance of health services.

• support countries in developing investment strategies to: improve HCWF
optimization by defining new roles and introducing multiprofessional teams;
improve digital health skills; introduce more flexible working arrangements; and
improve working conditions; and
• support countries in strengthening their PHC workforce.
66
Conclusion
The need to strengthen HCWF policies in the European Region

has been highlighted by experiences during the COVID-19
pandemic.
HCWs have been critical not only to countries’ It nevertheless is plain that the COVID-19 pandemic
response to the pandemic, but also to maintaining offers an unprecedented opportunity to address
essential health services. HCWs quickly acquired HCWF challenges. Central to this will be maintaining
new skills, adapted to new service requirements and growing some of the successful policy
and responded to surges in health needs. Often, interventions implemented by countries during the
doing so meant they had to put themselves at risk pandemic, particularly in relation to digital delivery
of contracting the virus and cope with much heavier- of health services and education.
than-normal workloads.
At stake is the capacity of health systems to respond
All of this was happening at a time when HCWs to current and future health and care needs, to be
were also having to contend with the same dread of more resilient, and to optimize the investment
COVID-19 as the rest of the population. They feared countries make in the health and care sector.
most of all that their high exposure to the virus in European countries must prioritize their HCWs by
health and care settings might lead to them passing investing more and investing smarter. They must
it on to loved ones and family members. Yet they still protect their HCWF by developing and implementing
took their places in the frontline and delivered for policies that place the interests and well-being of
the communities they serve. HCWs at the forefront.
HCW shortages, difficulties in attracting and This report offers a range of policy options that can
retaining HCWs, increased international mobility, strengthen countries’ HCWF. WHO will continue
skill-mix mismatches, inefficient organization to support Member States to make policy change
of work, unattractive working conditions, lack happen and drive improved health outcomes.
of gender-responsive policies, inadequate HRH
governance and management, lack of strategic HCWs inspired everyone during the pandemic. It is
HCWF planning and insufficient investment – all time to place them at the centre of the health policy
these existed before the pandemic. There is no agenda and prioritize investment in the HCWF. It is
doubt, however, that the pandemic has exacerbated time to act.
the impacts of each.
68
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76
Annex 1. Sources of strategic
recommendations and tools
Sources of strategic recommendations
• European Programme of Work 2020–2025: United Action for Better Health (2021) (1)
• Pan-European Commission on Health and Sustainable Development (2022) (2)
• European Observatory studies and policy briefs (3)
• Global Strategy on Human Resources for Health: Workforce 2030 (2016) (4)
• Final report of the expert group to the High-Level Commission on Health Employment and Economic
Growth (2016) (5)
• Five-year Action Plan for Health Employment and Inclusive Economic Growth (2017–2021) (2018) (6)
• Health employment and economic growth: an evidence base (2017) (7)
• Building the primary health care workforce of the 21st century (2018) (8)
• Building better together. Roadmap to guide implementation of the global strategi directions for nursing
and midwifery in the WHO European Region (2021) (9)
• Global strategic directions for nursing and midwifery 2021–2025 (2021) (10)
• Horizon scanning future health and care demand for workforce skills in England, UK: noncommunicable
disease and future skills implications (2017) (11)
• How can structured cooperation between countries address health workforce challenges related to
highly specialized health care? (2016) (12)
• International migration of doctors and nurses to OECD countries: recent trends an policy implications
(2017) (13)
• Noncommunicable diseases and human resources for health: a workforce fit for purpose (2018) (14)
• Organisation for Economic Co-operation and Development (OECD) policy and research papers (15)
• Recruitment and retention of health professionals across Europe: a literature review and multiple case
study research (2015) (16)
• The International Labour Organization Decent Work agenda (17)
• The WHO Global Code of Practice on the International Recruitment of Health Personnel (2010) (18)
• Towards a sustainable health workforce in the WHO European Region: framework for action (2017) (19)
• Transforming and scaling up health professionals’ education and training (2013) (20)
• Working for Health (2022) (21)
• Working for health and growth: investing in the health workforce (2016) (22)
• Global health and care worker compact (2022) (23)
Tools to support health and care worker policies
• Health labour market analysis guidebook (2021) (24)

• Health Workforce Estimator (HWFE) (25)
• Health workforce policy and management in the context of the COVID-19 pandemic response: interim
guidance (2020) (26)
• Health system performance assessment: a framework for policy analysis (2022) (27)
• Eurostat/OECD/WHO Regional Office for Europe joint questionnaire (2022) (28)
• The toolkit for a sustainable health workforce in the WHO European Region (2018) (29)
• WHO guideline on health workforce development, attraction, recruitment and retention in rural and
remote areas (2021) (30)
77
• WHO minimum data set for health workforce registry (2015) (31)
• WHO National Health Workforce Accounts (2022) (32,33)
• Joint Action Health Workforce Planning and Forecasting (2015) (34)
• Workload indicators of staffing need (revised 2014) (35)
• Adaptt surge planning support tool (2022) (36)
• National workforce capacity to implement the essential public health functions including a focus on
emergency preparedness and response (2022) (37)
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int/iris/handle/10665/326411). the health workforce. Report of the High-
Level Commission on Health Employment
14. Dussault G, Buchan J. Noncommunicable and Economic Growth. Geneva: World Health
diseases and human resources for health: Organization; 2016 (https://apps.who.int/iris/
a workforce fit for purpose. In: Jakab M, handle/10665/250047).
Farrington J, Borgermans L, Mantingh F, editors.
Health systems respond to noncommunicable 23. Global health and care worker compact:
diseases: time for ambition. Copenhagen: WHO technical guidance compilation. Geneva: World
Regional Office for Europe; 2018:182–99 (https:// Health Organization; 2022 (https://www.who.
apps.who.int/iris/handle/10665/342223). int/publications/m/item/carecompact).
15. OECD: better policies for better lives [website]. 24. Health labour market analysis guidebook.
Paris: Organisation for Economic Co-operation Geneva: World Health Organization;
and Development; 2022 (https://www.oecd. 2021 (https://apps.who.int/iris/
org/). handle/10665/348069).
16. Kroezen M, Dussault G, Craveiro I, Dieleman M, 25. Health workforce estimator (HWFE). In:
Jansen C, Buchan J et al. Recruitment and WHO Regional Office for Europe [website].
retention of health professionals across Europe: Copenhagen: WHO Regional Office for Europe;
a literature review and multiple case study 2022 (https://www.who.int/europe/tools-and-
research. Health Policy. 2015;119(12):1517–28. toolkits/strengthening-the-health-system-
doi:10.1016/j.healthpol.2015.08.003. response-to-covid-19/Surge-planning-tools/
health-workforce-estimator-(hwfe)).
17. Decent Work. In: International Labour
Organization [website]. Geneva: International 26. Health workforce policy and management in
Labour Organization; 2022 (https://www.ilo. the context of the COVID-19 pandemic response:
org/global/topics/decent-work/lang--en/index. interim guidance 3 December 2020. Geneva:
htm). World Health Organization; 2020. (https://apps.
who.int/iris/handle/10665/337333).
79
27. World Health Organization, European 33. National health workforce accounts (NHWA).
Observatory on Health Systems and Policies, In: WHO Regional Office for Europe [website].
Papanicolas I, Rajan D, Karanikolos M, Copenhagen: WHO Regional Office for Europe;
Soucat A et al. Health system performance 2022 (https://www.who.int/europe/news-room/
assessment: a framework for policy analysis. questions-and-answers/item/what-is-the-
Health policy series 57. Geneva: World Health national-health-workforce-accounts-(nhwa)).
handle/10665/352686). 34. Joint Action Health Workforce planning
and forecasting (2013–2016). In: European
28. OECD health data questionnaire 2022: Commission [website]. Brussels: European
guidelines for completing the questionnaire. Commission; 2022 (https://health.ec.europa.
Paris: Organisation for Economic Co-operation eu/health-workforce/overview_en#joint-
and Development; 2022 (https://www.oecd.org/ action-health-workforce-planning-and-
statistics/data-collection/Guidelines_OECD_ forecasting-2013--2016).
Health_Data%202022_Questionnaire.pdf).
35. Workload indicators of staffing need (WISN):
29. The toolkit for a sustainable health workforce in user’s manual. Geneva: World Health
the WHO European Region. Copenhagen: WHO Organization; 2010 (revised 2014) (https://apps.
Regional Office for Europe; 2018 (https://apps. who.int/iris/handle/10665/44414).
who.int/iris/handle/10665/345687).
36. Adaptt surge planning support tool. In:
30. WHO guideline on health workforce WHO Regional Office for Europe [website].
development, attraction, recruitment and Copenhagen: WHO Regional Office for Europe;
retention in rural and remote areas. Geneva: 2022 (https://www.who.int/europe/tools-and-
World Health Organization; 2021 (https://apps. toolkits/strengthening-the-health-system-
who.int/iris/handle/10665/341139). response-to-covid-19/Surge-planning-tools/
adaptt-surge-planning-support-tool).
31. Human resources for health information
system: minimum data set for health 37. National workforce capacity to implement the
workforce registry. Geneva: World Health essential public health functions including
Organization; 2015 (https://apps.who.int/iris/ a focus on emergency preparedness and
handle/10665/330091). response: roadmap for aligning WHO and
partner contributions. Geneva: World Health
32. National health workforce accounts data portal. Organization; 2022 (https://apps.who.int/iris/
In: World Health Organization [website]. Geneva: handle/10665/354384).
who.int/nhwaportal/).
80
Annex 2. Country profiles
The following 53 country profiles provide health workforce data

across key areas to support individual countries in their policy
and planning responses.
The data used in the country profiles are, wherever The latest published data are used. Other useful
possible, from the National Health Workforce sources of data are Eurostat health care resources
Accounts Data Portal, the WHO Global Observatory and the Organisation for Economic Co-operation
for Health, the WHO Global Health Expenditure and Development (OECD) health database, which
database and the United Nations Department of may have more recent or easier-to-access data.
Economic and Social Affairs Population Division.
Data sources
Population, median age and life expectancy data Graduates per year per 1000 practitioners are
for 2022 are from the United Nations Department of from the WHO National Health Workforce Accounts
Economic and Social Affairs Population Division (1). data portal (3) supplemented with recent country
submissions to the Eurostat, OECD and WHO joint
Universal health coverage (UHC) service coverage data collection on non-monetary health-care
index data are from the WHO Global Health statistics.
Observatory for Health (2).
Data for charts showing Health workforce
Health workforce density is calculated using distribution by age group, Health workforce
population data from the United Nations distribution by gender, Percentage of workforce
Department of Economic and Social Affairs aged over 65, Country of training and Country of
Population Division (1). birth are from the WHO National Health Workforce
Accounts Data Portal (3).
Data for charts showing Trends in health workforce
density, Percentage of professional health
Data on Annual intake from other countries are
workforce, Health workforce trends (headcount),
from the Eurostat data explorer (4).
Graduates per year per 100 000 population and
Technical notes
The UHC coverage index is defined as (2): a unitless scale of 0 to 100, which is computed as
the geometric mean of 14 tracer indicators of health
coverage of essential health services (defined as the service coverage. The tracer indicators are as follows,
average coverage of essential services based on tracer organized by four components of service coverage: 1.
interventions that include reproductive, maternal, Reproductive, maternal, newborn and child health 2.
newborn and child health, infectious diseases, non- Infectious diseases 3. Noncommunicable diseases 4.
communicable diseases and service capacity and Service capacity and access.
access, among the general and the most disadvantaged
population). The indicator is an index reported on
82
The share of foreign-born health and care workers In charts showing Percentage of professional
(HCWs) is calculated as: health workforce, the focus is on medical doctors,
nurses, midwives, dentists, pharmacists and
• stock of foreign-born/(stock of foreign-born +
stock of national-born). physiotherapists, as these are the professions for
which quality data are available. These are also the
The share of foreign-trained HCWs is calculated professions covered in the report.
as:
For charts showing Trends in health workforce
• stock of foreign-trained/(stock of foreign-trained
+ stock of national-trained + stock of unknown density, Percentage of professional health
place of training). workforce, Health workforce trends (headcount)
and Graduates per year per 1000 practitioners,
The annual intake of HCWs from another country where the number of practising HCWs is not available
is reported based on the country of training. for certain years, the number of professionally active
or the number licenced to practise is used.
References8
1. World Population prospects, 2022. In: 3. National Health Workforce Accounts data
United Nations Department of Economic portal [online database]. Geneva: World
and Social Affairs Population Division Health Organization; 2022 (https://apps.
[website]. New York (NY): United Nations who.int/nhwaportal/).
Department of Economic and Social
Affairs Population Division; 2022 (https:// 4. Health workforce migration. In: Eurostat
population.un.org/wpp/). [online database]. Brussels: Eurostat;
2022 (http://appsso.eurostat.ec.europa.
2. The Global Health Observatory [online eu/nui/show.do?dataset=hlth_rs_
database]. Geneva: World Health wkmg&lang=en).
Organization; 2022 (https://www.who.int/
data/gho).
8 All references accessed 16 August 2022.
83
84
Albania
Human resources for health profile
See pages 82–83 for data sources and technical notes
DOCTORS, NURSES
LIFE EXPECTANCY MEDIAN AGE AND MIDWIVES PER UHC SERVICE
POPULATION AT BIRTH (YEARS) (YEARS) 10 000 POPULATION COVERAGE INDEX
Country 2 866 849 77.0 36.9 77.1 62

at a glance
Health workforce density per 10 000 population

Health workforce
No data available
density
Health Health workforce trends (total number)

workforce
availability
Medical doctors Nurses Midwives
6000 20 000 1500

15 000
4000 1000
Total number
Total number
Total number
10 000
2000 500
5000
0 0 0
Physiotherapists Dentists Pharmacists
2000 4000 3000

Total number
Total number
Total number
1500 3000
2000
1000 2000
500 1000
1000
0 0 0
Composition by six professional

categories covered in the report, Ratio of nurses and midwives to medical doctors
percentage (latest year)
Medical doctors Nurses

Ratio
Midwives
18.6 54.0 3.5
Dentists Pharmacists Physiotherapists

10.2 8.4 5.3 Country Subregional average Regional average
85
Health workforce distribution Health workforce distribution
by age group, percentage by sex, percentage
0 10 20 30 40 (%)
dical doctor Nurses Midwives

0.2
Me

17.7
Medical 26.3
s
33.4

doctors <25
17.5
(2020) 4.9 25–34
3.6 35–44
31.1
19.5 45–54
27.5
Nurses 18.2
55–64
0.1
(2020)
Health ≥65 55.9% 44.1% 83.3% 16.7% 99.8% 0.20%
2.6
workforce 22.0
29.6
(2020) (2020) (2020)
distribution 19.8
Midwives 25.6
0.4
(2020) Female Male
Percentage of workforce aged >55
Pharmacists No data available
Dentists No data available
Midwives
Nurses
Medical doctors
(%)
Annual
Graduates per year per Graduates per year per
Professions graduates
100 000 population 1000 practitioners
(total number)
397
Medical doctors (2019)
2348
Graduates
Graduates
Nurses (2019)
273
Midwives (2019)
Health
240
Dentists (2019)
workforce
HEALTH
domestic 274
WORKFORCE
and Pharmacists (2019)
PRODUCTION
international
supply
Country of training, Country of birth, Annual intake from other
percentage percentage countries
NO DATA AVAILABLE NO DATA AVAILABLE NO DATA AVAILABLE
86
Andorra
DOCTORS, NURSES
Country 77 700 79.0 42.1 79.1 77

at a glance
50
41.3
40.5
36.2
36.0
40
31.3
31.1
30.9
30.4
29.8
28.7
28.1
Health workforce
25.4
30
density
20
10.6
9.7
9.5
9.4
9.0
6.9
6.5
5.9
5.8
5.7
10
1.6
1.5
1.4
1.1
0.8
0
2000 2002 2004 2006 2009 2015

workforce
availability
300 400 15
300
200 10
Total number
Total number
Total number
200
100 5
100
0 0 0
2016
2018
2020
2010
2012
2014
2000
2012
2014
2016
2018
2020
2002
2004
2006
2008
2000
2002
2004
2006
2008
2010
2020
2014
2016
2018
2008
2010
2012
2000
2002
2004
2006
1 80 100
0,8 80
Total number
Total number
Total number
60
0,6 60
40
0,4 40
0,2 20 20
0 0 0
2006
2008
2000
2002
2004
2010
2012
2014
2016
2018
2020
2012
2014
2016
2018
2020
2006
2008
2010
2012
2014
2016
2000
2002
2004
2018
2020
2000
2002
2004
2006
2008
2010


Ratio
Midwives
36.6 41.7 1.7

9.0 11.0 – Country Subregional average Regional average
87
0 10 20 30 40 50 (%)

Me

No data available
Medical

doctors <25
25–34
35–44
No data available 45–54

Nurses 55–64
Health ≥65 No data available No data available No data available
workforce (2020) (2020) (2020)

No data available
distribution
Midwives
Female Male
Midwives No data available
Nurses No data available
Medical doctors No data available
(%)
Annual
(total number)
2
No data available
No data available
No data available
Graduates
Graduates
No data available
Nurses
2
Midwives (2009)
Health
1
Dentists (2007)
workforce
HEALTH
domestic 1
WORKFORCE
PRODUCTION
international
supply
88
Armenia
DOCTORS, NURSES
Country 2 805 608 72.2 34.1 79.4 69

at a glance

Health workforce
No data available
density

workforce
availability
10 000 20 000 2000

8000 15 000 1500
Total number
Total number
Total number
6000 1000
10 000
4000
5000 500
2000
0 0 0
150 1500 200

Total number
Total number
Total number
150
100 1000
100
50 500
50
0 0 0
2016
2018
2020
2012
2014
2006
2008
2010
2000
2002
2004
2016
2018
2020
2010
2012
2014
2000
2002
2004
2006
2008


Ratio
37.0 52.6 4.8

89
0 10 20 30 40 (%)

3.0
Me

26.5
26.8
Medical
s
21.5

doctors 17.9 <25
4.4
(2011) 25–34
8.5 35–44
19.9
24.2
29.6 45–54
Nurses 17.0
0.7 55–64
(2011)
Health ≥65 69% 31% 98% 2% No data available
workforce (2015) (2011)

No data available
distribution
Midwives
Female Male
Nurses
Medical doctors
(%)
Annual
(total number)
839
491
Graduates
Graduates
Nurses (2019)
145
Midwives (2019)
Health
145
Dentists (2019)
workforce
HEALTH
domestic 276
WORKFORCE
PRODUCTION
international
supply
92.9
90.9
Percentage
NO DATA AVAILABLE NO DATA AVAILABLE

9.1
7.1
Born in the Born outside

country the country
Medical doctors (2011) Nurses (2011) Midwives
90
Austria
DOCTORS, NURSES
Country 8 907 777 81.5 42.6 161.3 82

at a glance

Health workforce
density

workforce
availability
60 000 100 000 3000
80 000
40 000 60 000 2000
Total number
Total number
Total number
20 000 40 000 1000

20 000
0 0 0
5000 6000 8000

4000
Total number
Total number
Total number
6000
3000 4000
4000
2000
2000
1000 2000
0 0 0


Ratio
Midwives
29.9 58.7 1.6

91
0 10 20 30 40 (%)
Nurses wives
dical doctor Mid

19.3
17.7 26.1 Me
Medical 22.4
s
25.8 <25

doctors 6.5
(2020) 25–34
2.1
19.1 35–44
21.2
33.2 45–54
24.4
Nurses 55–64
(2016)
Health ≥65 48.5 51.5 93% 7% No data available
workforce (2020) (2016)

No data available
distribution
Midwives
Female Male
Nurses
Medical doctors
(%)
Annual
(total number)
1242
2949
Graduates
Graduates
Nurses (2019)
141
Midwives (2019)
Health
243
Dentists (2019)
workforce
HEALTH
domestic 319
WORKFORCE
PRODUCTION
international
supply
100
95.2
93.6
661
86.3
83.8
Annual intake
Percentage
Percentage
257
16.2
13.7
4.8
6.4
Trained in the Trained outside Training Born in the Born outside

country the country unknown country the country
Medical doctors (2019) Nurses (2011) Midwives (2020) Medical doctors (2017) Nurses (2011) Midwives (2020) (2019) (2019)
92
Azerbaijan
DOCTORS, NURSES
Country 10 284 951 66.9 31.0 88.1 65

at a glance

Health workforce
density

workforce
availability
40 000 80 000 15 000
30 000 60 000
10 000
Total number
Total number
Total number
20 000 40 000
5000
10 000 20 000
0 0 0

400 4000 2500
300 2000
Total number
Total number
Total number
3000
1500
200 2000
1000
100 1000 500
0 0 0
2018
2020
2012
2014
2016
2006
2008
2010
2000
2002
2004


Ratio
Midwives
33.1 57.0 4.2

93
0 10 20 30 40 (%)
9.5

Me

26.1
33.2
Medical
s
23.9

doctors 4.9 <25
2.4
(2013) 25–34
35–44

Nurses 55–64
Health 9.6 ≥65 65% 35% No data available 94% 6%

26.7
workforce 34.4 (2013) (2013)
23.3
distribution 4.0
Midwives 2.0
(2013) Female Male
Midwives
Medical doctors
(%)
Annual
(total number)
1141
No data available
No data available
No data available
Graduates
Graduates
Nurses
362
Midwives (2014)
Health
179
Dentists (2014)
workforce
HEALTH
domestic 274
WORKFORCE
PRODUCTION
international
supply
94
Belarus
DOCTORS, NURSES
Country 9 633 740 72.5 40.0 149.9 74

at a glance

Health workforce
density

workforce
availability
50 000 150 000 8000
40 000 6000
100 000
Total number
Total number
Total number
30 000
4000
20 000 50 000
10 000 2000
0 0 0
2000
2003
2006
2009
2012
2015
2018
2018
2003
2009
2012
2015
2000
2006

500 6000 5000
400 4000
Total number
Total number
Total number
4000
300 3000
200 2000 2000
100 1000
0 0 0
2012
2015
2018
2000
2003
2006
2009
2000
2003
2006
2009
2012
2015
2018
2018
2020
2014
2016
2010
2012
2006
2008
2000
2002
2004


Ratio
Midwives
27.9 62.6 3.0

95
0 10 20 30 40 (%)

Me

37.7
18.9
Medical
s
22.9

doctors 20.5 <25
(2015) 25–34
9.6 35–44
26.5
30.7
23.4 45–54
Nurses 8.8
1.1 55–64
(2009)
Health ≥65 72.5% 27.5% 99.4% 0.6% No data available
workforce (2015) (2009)

No data available
distribution
Midwives
Female Male
Nurses
Medical doctors
(%)
Annual
(total number)
2480
Medical doctors (2021) No data available
No data available
Graduates
Graduates
No data available
Nurses
271
Midwives (1998)
Health
104
Dentists (2021)
workforce
HEALTH
domestic 210
WORKFORCE
PRODUCTION
international
supply
89.5
Percentage

10.5

country the country
Medical doctors (N/A) Nurses (2009) Midwives (N/A)
96
Belgium
DOCTORS, NURSES
Country 11 561 717 80.8 40.8 149.9 85

at a glance

Health workforce
density

workforce
availability
40 000 150 000 10 000
30 000 8000
100 000
Total number
Total number
Total number
6000
20 000
4000
50 000
10 000 2000
0 0 0

25000 10 000 20 000
20000 8000 15 000
Total number
Total number
Total number
15000 6000
10 000
10000 4000
5000 2000 5000
0 0 0


Ratio
Midwives
16.9 57.7 3.8

97
0 10 20 30 40 (%)

Me
11.9

21.5
Medical
s
22.5

doctors 24.6 <25
(2019) 19.4
25–34
4.1 35–44
26.8
27.2 45–54
27.8
Nurses 13.4 55–64
(2016) 0.6
workforce (2019) (2016)

No data available
distribution
Midwives
Female Male
Nurses
Medical doctors
(%)
Annual
(total number)
1917
5194
Graduates
Graduates
Nurses (2020)
648
Midwives (2020)
Health
270
Dentists (2020)
workforce
HEALTH
domestic 599
WORKFORCE
PRODUCTION
international
supply
98.4
95.9
87.3
85.4
83.3
75.3
Annual intake
Percentage
Percentage
24.7
16.7
14.6
11.5
3.8
0.3

98
DOCTORS, NURSES
Country 3 318 407 76.2 41.5 87.1 65

at a glance

Health workforce
density

workforce
availability
10 000 25 000 1500

8000 20 000
1000
Total number
Total number
Total number
6000 15 000
4000 10 000 500
2000 5000
0 0 0

800 1000 500
600 800 400
Total number
Total number
Total number
600 300
400
400 200
200 200 100
0 0 0
2020
2014
2016
2018
2010
2012
2006
2008
2000
2002
2004
2014
2016
2018
2020
2008
2010
2012
2000
2002
2004
2006


Ratio
24.9 65.3 3.4

99
0 20 40 60 80 (%)

Me

53.7
Medical
s
46.3

doctors <25
(2015) 25–34
35–44
23.0
30.4 45–54
Nurses 25.8
20.8 55–64
(2018)
workforce (2015) (2018)

No data available
distribution
Midwives
Female Male
Nurses
(%)
Annual
(total number)
360
Graduates
432
Graduates
No data available
No data available
Nurses (2018)
No data available
Midwives
Health
94
Dentists (2019)
workforce
HEALTH
domestic 324
WORKFORCE
PRODUCTION
international
supply
100
Bulgaria
DOCTORS, NURSES
Country 6 979 175 73.6 44.3 88.9 70

at a glance

Health workforce
density

workforce
availability
40 000 40 000 5000

30 000 30 000 4000
Total number
Total number
Total number
3000
20 000 20 000
2000
10 000 10 000 1000
0 0 0

2000 8000 8000
1500 6000 6000
Total number
Total number
Total number
1000 4000 4000

500 2000 2000
0 0 0


Ratio
Midwives
38.4 37.8 4.2

101
0 10 20 30 40 (%)

Me

10.1
12.8
s
32.6
Medical

31.2 <25
doctors 13.3
25–34
(2015)
0.8
6.2 35–44
19.3
33.8 45–54
Nurses 32.2
7.8 55–64
(2018)
Health ≥65 55.1% 44.9% 99.4% 0.6% 99.7% 0.3%
workforce (2015) (2018) (2014)
No data available
distribution
Midwives
Female Male
Nurses
Medical doctors
(%)
Annual
(total number)
837
494
Graduates
Graduates
Nurses (2018)
175
Midwives (2015)
Health
296
Dentists (2015)
workforce
HEALTH
domestic 414
WORKFORCE
PRODUCTION
international
supply
100
100
99.8
99.8
Annual intake
Percentage
Percentage
0.2

(2020) (2020)
Medical doctors Nurses (2018) Midwives Medical doctors Nurses (2018) Midwives
102
Croatia
DOCTORS, NURSES
Country 4 096 869 78.0 43.5 107.2 73

at a glance

Health workforce
density

workforce
availability
20 000 30 000 2000
15 000 1500
20 000
Total number
Total number
Total number
10 000 1000
10 000
5000 500
0 0 0

4000 4000 4000
3000 3000 3000
Total number
Total number
Total number
2000 2000 2000

1000 1000 1000
0 0 0


Ratio
Midwives
26.5 52.3 2.9

103
0 10 20 30 40 50 (%)

Me

14.2
45.6
Medical
s
13.8

doctors 24.6 <25
(2016) 1.8
25–34
10.2 35–44
33.9
23.6 45–54
Nurses 20.7
55–64
11.6
(2016)
workforce (2016) (2016)

No data available
distribution
Midwives
(2020) Female Male
Nurses
Medical doctors
(%)
Annual
(total number)
627
2439
Graduates
Graduates
Nurses (2018)
82
Midwives (2018)
Health
160
Dentists (2018)
workforce
HEALTH
domestic 130
WORKFORCE
PRODUCTION
international
supply
100
100
94.7
Percentage

5.3
Trained in the Trained outside Training

country the country unknown

104
Cyprus
DOCTORS, NURSES
Country 1 237 537 81.4 37.1 100.9 79

at a glance

Health workforce
No data available
density

workforce
availability
4000 6000 400
3000 300
4000
Total number
Total number
Total number
2000 200
1000 2000 100
0 0 0
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
1500 1500 1000
800
Total number
Total number
Total number
1000 1000 600

500 500 400
200
0 0 0


Ratio
Midwives
32.1 40.7 2.9

105
0 20 40 60 (%)

3.3
Me

19.2
Medical
s
20.2
32.2

doctors <25
13.3
(2016) 11.7 25–34
7.0 35–44
50.9
26.2 45–54
13.9
Nurses 2.0
55–64
(2016)
Health ≥65 44.7% 53.3% 80.3% 19.7% 98.8% 1.2%
workforce 26.5
27.0 (2016) (2016) (2019)
distribution 34.9
Midwives 11.6
(2016) Female Male
Midwives
Nurses
Medical doctors
(%)
Annual
(total number)
45
No data available
No data available
No data available
No data available
122
Graduates
Graduates
Nurses (2019)
No data available
Midwives
No data available
Health Dentists
workforce
HEALTH
domestic 104
WORKFORCE
PRODUCTION
international
supply
100
100
100
309
81.4
Annual intake
Percentage
Percentage
18.6

country the country Medical doctors Nurses
(2019)
Medical doctors (2017) Nurses Midwives Medical doctors (2017) Nurses Midwives
106
Czechia
DOCTORS, NURSES
Country 10 530 953 78.6 42.2 131.8 78

at a glance

Health workforce
No data available
density

workforce
availability
60 000 100 000 6000
80 000
40 000 60 000 4000
Total number
Total number
Total number
40 000
20 000 2000
20 000
0 0 0
2018
2000
2003
2006
2009
2012
2015
2009
2012
2015
2018
2000
2003
2006
2009
2012
2015
2018
2003
2006
2000
10000 10 000 10 000

8000 8000 8000
Total number
Total number
Total number
6000 6000 6000

4000 4000 4000
2000 2000 2000
0 0 0
2000
2003
2006
2009
2012
2015
2018
2009
2012
2015
2018
2000
2003
2006
2012
2015
2018
2000
2003
2006
2009


Ratio
Midwives
26.5 55.9 2.5

107
0 10 20 30 40 (%)

Me
21.0

22.0
Medical
s
21.0

18.0 <25
doctors 18.0
(2020) 25–34
1.0
13.0 35–44
26.0
34.0 45–54
21.0
Nurses 5.0
55–64
(2020)
Health 3.0 ≥65 57% 43% 98% 2% 100%
26.0
workforce 25.0
23.0 (2020) (2020) (2020)
distribution 17.0
Midwives 6.0
(2020) Female Male
Pharmacists
Dentists
Midwives
Nurses
Medical doctors
(%)
Annual
(total number)
1718
1400
Graduates
Graduates
Nurses (2019)
171
Midwives (2019)
Health
293
Dentists (2019)
workforce
HEALTH
domestic 284
WORKFORCE
PRODUCTION
international
supply
100
100
97
92.5
96
148
83
Annual intake
Percentage
Percentage
17
7.5
4
3

(2020)
Medical doctors (2020) Nurses Midwives Medical doctors (2020) Nurses (2020) Midwives (2020)
108
Denmark
DOCTORS, NURSES
Country 5 825 641 81.5 41.2 148.0 85

at a glance

Health workforce
No data available
density

workforce
availability
30 000 80 000 2500
60 000 2000
20 000 1500
Total number
Total number
Total number
40 000
10 000 1000
20 000 500
0 0 0
15000 5000 4000

4000 3000
Total number
Total number
Total number
10000 3000
2000
2000
5000
1000 1000
0 0 0


Ratio
Midwives
24.0 57.3 2.1

109
0 10 20 30 40 (%)

22.7
Me

27.8
Medical
s
19.2

19.8 <25
doctors 10.5
(2018) 25–34
1.0
20.8 35–44
24.2
26.6 45–54
24.3
Nurses 3.0 55–64
(2017)
Health 1.2 ≥65 52.9% 47.1% 95.7% 4.3% 98.8% 0.2%
32.2
workforce 27.9 (2018) (2017) (2018)
20.6
distribution 15.6
Midwives 2.4
(2018) Female Male
Midwives
Nurses
Medical doctors
(%)
Annual
(total number)
1335
2587
Graduates
Graduates
Nurses (2018)
335
Midwives (2019)
Health
127
Dentists (2018)
workforce
HEALTH
domestic 238
WORKFORCE
PRODUCTION
international
supply
98.1
100
90.6
Annual intake
Percentage
NO DATA AVAILABLE
9.4
0.9

country the country unknown Medical doctors Nurses
(2018) (2018)
110
Estonia
DOCTORS, NURSES
Country 1 329 444 78.3 41.4 102.2 78

at a glance

Health workforce
density

workforce
availability
5000 10 000 600

4000 8000
400
Total number
Total number
Total number
3000 6000
2000 4000 200
1000 2000
0 0 0
2018
2020
2006
2008
2010
2012
2014
2016
2000
2002
2004

600 1500 1500
Total number
Total number
Total number
400 1000 1000
200 500 500
0 0 0
2016
2018
2020
2012
2014
2006
2008
2010
2000
2002
2004


Ratio
Midwives
28.1 51.5 2.9

111
0 10 20 30 40 (%)

0.2
Me

21.0
15.2
Medical
s
17.5

doctors 25.5 <25
20.7
(2020) 25–34
2.5
21.5 35–44
21.4
27.3 45–54
18.7
Nurses 8.5 55–64
(2020)
Health 2.5 ≥65 73.2% 26.8% 96.8% 3.2% 100%
29.2
workforce 20.3 (2020) (2020) (2020)
25.5
distribution 16.8
Midwives 5.8
(2020) Female Male
Dentists
Midwives
Nurses
Medical doctors
(%)
Annual
(total number)
138
367
Graduates
Graduates
Nurses (2020)
30
Midwives (2020)
Health
33
Dentists (2020)
workforce
HEALTH
domestic 87
WORKFORCE
PRODUCTION
international
supply
99.8
100
95.9
Annual intake
Percentage
NO DATA AVAILABLE
4.1
0.2

(2020) (2020)
112
Finland
DOCTORS, NURSES
Country 5 529 468 81.9 42.2 174.7 83

at a glance

Health workforce
No data available
No data available
density

workforce
availability
25 000 100 000 2500
20 000 80 000 2000
15 000 60 000 1500
Total number
Total number
Total number
10 000 40 000 1000
5000 20 000 500
0 0 0
2015
2018
2000
2003
2006
2009
2012
2018
2000
2003
2006
2009
2012
2015
2009
2015
2018
2000
2003
2006
2012

10000 5000 8000
8000 4000 6000
Total number
Total number
Total number
6000 3000
4000
4000 2000
2000 1000 2000
0 0 0
2012
2015
2018
2015
2018
2000
2003
2006
2009
2015
2018
2000
2003
2006
2009
2012
2000
2003
2006
2009
2012


Ratio
Midwives
16.6 64.9 2.0

113
0 10 20 30 40 (%)

Me

32.0
Medical
s
25.6
19.8

doctors <25
16.1
(2016) 6.5 25–34
3.2 35–44
24.7
27.1 45–54
24.8
Nurses 19.5
55–64
0,7
(2017)
Health ≥65 56.6% 43.4% 92.3% 7.7% 99.8% 0.2%
2.0
workforce 31.6
33.2 (2016) (2017) (2014)
distribution 18.1
Midwives 14.6
0.4
(2014) Female Male
Midwives
Nurses
Medical doctors
(%)
Annual
(total number)
657
4519
Graduates
Graduates
Nurses (2019)
217
Midwives (2019)
Health
188
Dentists (2019)
workforce
HEALTH
domestic 372
WORKFORCE
PRODUCTION
international
supply
98.2
96.8
97.8
99
91.8
Annual intake
54.6
Percentage
Percentage
40.4
8.2
3.2
2.2
0.8
0.1
0.1
5

country the country unknown country the country Medical doctors Nurses
(2012)
Medical doctors (2015) Nurses (2015) Midwives (2015) Medical doctors (2014) Nurses (2014) Midwives (2014)
114
France
DOCTORS, NURSES
Country 64 480 053 82.2 41.4 155.4 84

at a glance

Health workforce
density
3.2
3.4
3.5
3.6
3.6
workforce
availability
250 000 1000 000 25 000

200 000 800 000 20 000
Total number
Total number
Total number
150 000 600 000 15 000
100 000 400 000 10 000
50 000 200 000 5000
0 0 0
2000
2003
2006
2015
2018
2009
2012
2000
2003
2006
2009
2012
2015
2018
2015
2009
2012
2000
2003
2006
2018
100000 50 000 80 000

80000 40 000
Total number
Total number
Total number
60 000
60000 30 000
40 000
40000 20 000
20000 10 000 20 000
0 0 0
2000
2000
2003
2003
2006
2006
2009
2009
2012
2012
2015
2015
2018
2018
2012
2015
2018
2006
2009
2000
2003


Ratio
Midwives
17.8 63.4 1.9

115
0 10 20 30 40 (%)

15.6
Me

20.3
Medical 19.9
s
29.8

doctors <25
14.5
(2019) 25–34
2.5
25.8 35–44
24.2
26.9 45–54
20.7
Nurses 0.1 55–64
(2016)
Health 6.1 ≥65 46.1% 53.9% 87.6% 12.4% 97.1% 2.9%
36.4
workforce 25.4
21.5 (2019) (2016) (2014)
distribution 10.0
Midwives 0.5
(2014) Female Male
Pharmacists
Dentists
Midwives
Nurses
Medical doctors
(%)
Annual
(total number)
6387
27 076
Graduates
Graduates
Nurses (2018)
864
Midwives (2019)
Health
1168
Dentists (2018)
workforce
HEALTH
domestic 2612
WORKFORCE
PRODUCTION
international
supply
100
92.2
97
88.4
93
79.8
Percentage
Percentage
Annual intake
20.2
11.6
7.8
7
3

(2019) (2019)
Medical doctors (2019) Nurses (2019) Midwives (N/A) Medical doctors (2011) Nurses (2011) Midwives (2011)
116
Georgia
DOCTORS, NURSES
Country 3 765 912 72.8 36.3 114.3 65

at a glance

Health workforce
density
2.4
1.7
1.6
1.3
1.4
1.3

workforce
availability
30 000 25 000 2000
20 000 1500
20 000 15 000
Total number
Total number
Total number
1000
10 000 10 000
5000 500
0 0 0

250 4000 600
200 3000
Total number
Total number
Total number
150 400
2000
100
1000 200
50
0 0 0
2018
2020
2014
2016
2008
2010
2012
2004
2006
2000
2002
2016
2018
2020
2012
2014
2000
2002
2004
2006
2008
2010


Ratio
Midwives
44.3 48.1 1.2

117
0 10 20 30 40 (%)

Me

Medical
s
No data available

doctors <25
25–34
35–44
No data available
45–54
Nurses 55–64
No data available No data available No data available
Health ≥65
workforce No data available

distribution
Midwives
Female Male
(%)
Annual
(total number)
420
9
Graduates
Graduates
Nurses (2015)
7
Midwives (2013)
Health
342
Dentists (2015)
workforce
HEALTH
domestic 488
WORKFORCE
PRODUCTION
international
supply
118
Germany
DOCTORS, NURSES
Country 83 328 988 81.1 45.0 187.2 86

at a glance

Health workforce
density
2.6
2.7
2.8
3.0
3.1
2.8

workforce
availability
400 000 1500 000 30 000
300 000
1000 000 20 000
Total number
Total number
Total number
200 000
500 000 10 000
100 000
0 0 0
2015
2018
2000
2003
2006
2009
2012
2018
2009
2012
2015
2003
2006
2015
2018
2000
2009
2012
2000
2003
2006
250000 80 000 60 000

Total number
Total number
Total number
200000 60 000
150000 40 000
40 000
100000
20 000
50000 20 000
0 0 0
2018
2006
2009
2012
2015
2000
2003
2018
2009
2012
2015
2000
2003
2006
2015
2018
2009
2012
2000
2003
2006


Ratio
Midwives
19.8 61.8 1.4

119
0 10 20 30 40 (%)

Me

20.1
13.0
Medical
s
22.1

doctors 38.0 <25
6.8
(2019) 25–34
9.0
20.3 35–44
22.2
24.9 45–54
18.8
Nurses 4.8 55–64
(2019)
Health ≥65 47.6% 52.4% 84% 16% No data available
workforce No data available (2019)

distribution
Midwives
Female Male
Nurses
Medical doctors
(%)
Annual
(total number)
10 234
36 498
Graduates
Graduates
Nurses (2019)
648
Midwives (2019)
Health
2463
Dentists (2019)
workforce
HEALTH
domestic 2304
WORKFORCE
PRODUCTION
international
supply
100
100
94.2
91.1
7014
88.1
83.1
Annual intake
Percentage
Percentage
16.9
11.9
1349
8.9
5.8

Medical doctors (2017) Nurses (2019) Midwives Medical doctors (2017) Nurses (2018) Midwives (2017) (2019) (2019)
120
Greece
DOCTORS, NURSES
Country 10 512 232 80.9 44.4 99.5 78

at a glance

Health workforce
No data available
density
2.7
2.3
2.4
2.5
2.4
2.7
workforce
availability
80 000 50 000 3000

60 000 40 000
2000
Total number
Total number
Total number
30 000
40 000
20 000 1000
20 000 10 000
0 0 0
10000 20 000 15 000

8000 15 000
Total number
Total number
Total number
10 000
6000
10 000
4000 5000
2000 5000
0 0 0


Ratio
Midwives
47.9 26.3 2.1

121
0 20 40 60 (%)

15.7
Me

25.7
Medical
s
28.3

21.6 <25
doctors 8.6
(2019) 25–34
1.1
15.8 35–44
48.6
31.4 45–54
3.1
Nurses 55–64
(2019)
Health 5.0
≥65 42.9% 57.1% 82.3% 17.7% 93.7% 6.3%
29.5
workforce 32.4 (2019) (2016) (2011)
distribution 6.7
25.9
Midwives 0.4
(2011) Female Male
Pharmacists
Dentists
Midwives
Nurses
Medical doctors
(%)
Annual
(total number)
1344
1519
Graduates
Graduates
Nurses (2018)
196
Midwives (2018)
Health
296
Dentists (2018)
workforce
HEALTH
domestic 330
WORKFORCE
PRODUCTION
international
supply
100
97.5
92.1
88.9
88.1
79.3
Annual intake
Percentage
Percentage
19.7
11.1
11.9
7.9
2.5
Trained in the Trained outside Training Born in the Born outside Medical doctors Nurses
country the country unknown country the country (2017) (2015)
Medical doctors (2017) Nurses (2015) Midwives Medical doctors (2011) Nurses (2011) Midwives (2011)
122
Hungary
DOCTORS, NURSES
Country 9 750 573 75.7 42.5 99.6 73

at a glance

Health workforce
density

workforce
availability
40 000 80 000 3000

30 000 60 000
2000
Total number
Total number
Total number
20 000 40 000
1000
10 000 20 000
0 0 0
6000 8000 10 000

6000 8000
Total number
Total number
Total number
4000 6000
4000
4000
2000
2000 2000
0 0 0


Ratio
Midwives
26.2 55.0 2.0

123
0 10 20 30 40 (%)

21.4
Me

16.0
Medical
s
17.6

22.7 <25
doctors 22.3
(2019) 25–34
3.8
35–44
13.2
28.3
38.0 45–54
Nurses 15.8
0.9 55–64
(2019)
Health ≥65 56.1% 43.9% 91.0%
91% 9.0%
9% 99.6% 0.4%
3.1
workforce 20.5
28.0 (2019) (2019) (2019)
distribution 29.1
Midwives 18.2
(2019) 1.2 Female Male
Midwives 19.4
Nurses 16.7
Medical doctors 45.0
(%)
Annual
(total number)
1540
2437
Graduates
Graduates
Nurses (2019)
116
Midwives (2019)
Health
320
Dentists (2019)
workforce
HEALTH
domestic 318
WORKFORCE
PRODUCTION
international
supply
98.5
100
95.4
92.4
92
87.2
Annual intake
Percentage
Percentage
12.8
7.6
4.6
1.5
8

124
Iceland
DOCTORS, NURSES
Country 366 669 82.6 35.6 87 200

at a glance
156.2
153.2
153.5
151.5
142.1
146.6
145.3
Health workforce
density
35.9
35.6
36.4
38.5
38.9
38.9
4.9
8.0
7.9
8.2
8.4
8.0
8.4
9.4
7.9
8.3
7.9
5.4
4.7
8.1
8.2
6.9
7.9
4.9
5.7
5.2
4.6

workforce
availability
1500 8000 400
6000 300
1000
Total number
Total number
Total number
4000 200
500 100
2000
0 0 0
2020
2014
2016
2018
2008
2010
2012
2000
2002
2004
2006

800 400 250
600 300 200
Total number
Total number
Total number
150
400 200
100
200 100 50
0 0 0
2020
2014
2016
2018
2008
2010
2012
2000
2002
2004
2006
2020
2014
2016
2018
2020
2008
2010
2012
2014
2016
2018
2000
2008
2010
2012
2002
2004
2006
2000
2002
2004
2006

5,0
4,0
Ratio
3,0
16.5 67.4 3.0 2,0
1,0
0,0
2012
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2013
2014
2015
2016
2017
2018
2019
2020

3.4 2.4 7.2 Subregional average Regional average
125
0 10 20 30 40 (%)

18.4
Me

19.2
Medical 22.6
s
24.8

doctors <25
15.0
(2019) 25–34
1.4
14.9 35–44
19.3
21.9 45–54
28.7
Nurses 13.9
55–64
(2019)
Health ≥65 40.6% 59.4% 97.1% 2.9% 99.8% 0.2%
6.9
workforce 22.4
19.2 (2019) (2019) (2019)
distribution 31.4
Midwives 20.1
(2009) Female Male
Midwives
Nurses
Medical doctors
(%)
Annual
(total number)
41
117
Graduates
Graduates
Nurses (2019)
10
Midwives (2019)
Health
7
Dentists (2019)
workforce
HEALTH
domestic 26
WORKFORCE
PRODUCTION
international
supply
100
100
97.2
95.2
91.2
84.2
Annual intake
Percentage
Percentage
15.8
6.3
4.8
2.5
2.8

(2020) (2020)
Medical doctors (2017) Nurses (2018) Midwives (2017) Medical doctors (2017) Nurses (2018) Midwives (2017)
126
Ireland
DOCTORS, NURSES
Country 4 946 119 82.5 37.3 190.3 83

at a glance

Health workforce
density

workforce
availability
20 000 80 000 15 000

15 000 60 000
10 000
Total number
Total number
Total number
10 000 40 000
5000 5000
20 000
0 0 0
6000 4000 8000

3000 6000
Total number
Total number
Total number
4000
2000 4000
2000
1000 2000
0 0 0


Ratio
Midwives
16.2 61.6 9.9

127
0 10 20 30 40 (%)

Me

34.2
25.0
Medical
s
22.5

doctors 15.3 <25
7.1
(2020) 25–34
35–44
3.4
18.7
30.7 45–54
Nurses 30.0
55–64
16.6
(2018) 0.7
workforce (2020) (2018)

distribution No data available
Midwives
Female Male
Pharmacists
Dentists
Nurses
Medical doctors
(%)
Annual
(total number)
1225
Graduates
1427
Graduates
Nurses (2019)
121
Midwives (2019)
Health
95
Dentists (2019)
workforce
HEALTH
domestic 170
WORKFORCE
PRODUCTION
international
supply
100
2301
75.2
72.1
59.1
59.8
61
Annual intake
Percentage
Percentage
40.9
40.2
39
1017
27.9
24.8

128
Israel
DOCTORS, NURSES
Country 8 757 489 82.4 29.0 88.9 84

at a glance

Health workforce
density

workforce
availability
35 000 50 000 2500
30 000
40 000 2000
25 000
Total number
Total number
Total number
20 000 30 000 1500

15 000 20 000 1000
10 000
10 000 500
5000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
8000 10 000 10 000
7000
8000 8000
6000
Total number
Total number
Total number
5000 6000 6000

4000
3000 4000 4000
2000
2000 2000
1000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
30.3 44.6 2.3

129
0 10 20 30 40 (%)

Me

16.2
19.6
Medical
s
16.3

doctors 19.3 <25
(2020) 28.6
25–34
1.8 35–44
18.2
19.4
20.8 45–54
17.1
Nurses 22.7 55–64
(2019)
workforce (2020) (2019)

Midwives
Female Male
Nurses
Medical doctors
(%)
Annual
(total number)
654
2680
Graduates
Graduates
Nurses (2020)
147
Midwives (2020)
Health
91
Dentists (2019)
workforce
HEALTH
domestic 116
WORKFORCE
PRODUCTION
international
supply
100
88.7
54.5
57.8
Percentage
Percentage
45.5
42.1
NO DATA AVAILABLE
10.6

Medical doctors (2020) Nurses (2020) Midwives Medical doctors Nurses (2018) Midwives
130
Italy
DOCTORS, NURSES
Country 59 500 579 82.4 46.4 103.8 83

at a glance

Health workforce
density

workforce
availability
300 000 400 000 20 000
250 000 350 000
300 000 15 000
200 000
Total number
Total number
Total number
250 000
150 000 200 000 10 000
100 000 150 000
100 000 5000
50 000 50 000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
70000 60 000 80 000
60000 50 000 70 000
50000 60 000
40 000
Total number
Total number
Total number
50 000
40000
30 000 40 000
30000
20 000 30 000
20000 20 000
10000 10 000 10 000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
29.7 45.1 2.1

131
0 10 20 30 40 (%)

Me

8.6
17.7
Medical
s
17.4

doctors 33.2 33.2 <25
(2020) 23.2
25–34
35–44
45–54
No data available
Nurses 55–64
(2019)
Health ≥65 44.1% 55.9% No data available No data available
workforce (2020)
Midwives
Female Male
Medical doctors
(%)
Annual
(total number)
10 488
10 964
Graduates
Graduates
Nurses (2019)
658
Midwives (2019)
Health
919
Dentists (2019)
workforce
HEALTH
domestic 3112
WORKFORCE
PRODUCTION
international
supply
99.5
98.9
100
94.7
Annual intake
63
Percentage
Percentage
31.7
5.3
1.1
0.5
5

(2020) (2020)
Medical doctors (2020) Nurses (2020) Midwives Medical doctors (2017) Nurses (2017) Midwives
132
Kazakhstan
DOCTORS, NURSES
Country 18 979 243 70.0 29.5 99.2 76

at a glance

Health workforce
density

workforce
availability
70 000 140 000 12 000
60 000 120 000 10 000
50 000 100 000 8000
Total number
Total number
Total number
40 000 80 000
6000
30 000 60 000
4000
20 000 40 000
10 000 20 000 2000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
1000 8000 20 000
7000
800
6000 15 000
Total number
Total number
Total number
600 5000
4000 10 000
400 3000
200 2000 5000
1000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
28.3 61.8 4.1

133
0 5 10 15 20 25 (%)

Me

Medical
s
No data available

doctors <25
25–34
35–44

Nurses 55–64
Health ≥65
workforce
Midwives
Female Male
(%)
Annual
(total number)
7909
6662
Graduates
Graduates
Nurses (2020)
605
Midwives (2020)
Health
791
Dentists (2020)
workforce
HEALTH
domestic 242
WORKFORCE
PRODUCTION
international
supply
134
Kyrgyzstan
DOCTORS, NURSES
Country 6 424 874 69.6 23.6 61.8 70

at a glance

Health workforce
density

workforce
availability
12 000 40 000 3500
10 000 35 000 3000
30 000 2500
8000
Total number
Total number
Total number
25 000
2000
6000 20 000
1500
4000 15 000
10 000 1000
2000 5000 500
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
200 1400 350
1200 300
150 1000 250
Total number
Total number
Total number
800 200
100
600 150
50 400 100
200 50
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
27.4 63.5 5.6

135
0 10 20 30 (%)

Me

Medical
s
No data available

doctors <25
25–34
35–44

Nurses 55–64
Health ≥65 64.5% 35.5% No data available 99.4% 0.6%

13.8
workforce 28.5 (2013) (2013)
23.0
distribution 21.5
Midwives 8.8
(2013) 4.4 Female Male
Midwives
(%)
Annual
(total number)
1687
1753
Graduates
Graduates
Nurses (2019)
1162
Midwives (2019)
Health
364
Dentists (2014)
workforce
HEALTH
domestic 59
WORKFORCE
PRODUCTION
international
supply
136
Latvia
DOCTORS, NURSES
Country 1 897 052 75.5 43.4 77.5 72

at a glance

Health workforce
density

workforce
availability
8000 14 000 600
7000 12 000 500
6000 10 000 400
Total number
Total number
Total number
5000
8000
4000 300
6000
3000 200
2000 4000
1000 2000 100
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
800 1600 2000
700 1400
600 1200 1500
Total number
Total number
Total number
500 1000
400 800 1000
300 600
200 400 500
100 200
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
34.4 43.1 2.1

137
0 20 40 60 (%)

Me

21.7
10.7
s
Medical 20.2

doctors 29.8 <25
(2019) 17.6
25–34
35–44
15.0
50.6
45–54
Nurses 34.3
55–64
(2018)
workforce (2019) (2018)

No data available
distribution
Midwives
Female Male
Nurses
Medical doctors
(%)
Annual
(total number)
454
Graduates
557
Graduates
Nurses (2020)
42
Midwives (2020)
Health
60
Dentists (2020)
workforce
HEALTH
domestic 43
WORKFORCE
PRODUCTION
international
supply
97.4
97.2
94.1
Percentage
Annual intake
NO DATA AVAILABLE
5.9
2.6
2.8

Medical doctors (2020) Nurses (2020) Midwives (2020) (2012)
138
Lithuania
DOCTORS, NURSES
Country 2 820 267 75.1 43.5 124.9 70

at a glance

Health workforce
density

workforce
availability
14 000 30 000 1600
12 000 25 000 1400
10 000 1200
20 000
Total number
Total number
Total number
1000
8000
15 000 800
6000
10 000 600
4000 400
2000 5000 200
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
4000 3500 3500
3500 3000 3000
3000 2500 2500
Total number
Total number
Total number
2500
2000 2000
2000
1500 1500 1500
1000 1000 1000
500 500 500
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
27.9 48.5 1.9

139
0 10 20 30 40 (%)

Me

s
Medical 26.2

14.8 <25
doctors 19.2
(2019) 25.4 25–34
14.4
35–44
0.5
9.2 45–54
23.1
Nurses 32.5
55–64
30.6
(2016) 4.1
workforce (2019) (2016)

No data available
distribution
Midwives
Female Male
Nurses
Medical doctors
(%)
Annual
(total number)
570
614
Graduates
Graduates
Nurses (2019)
34
Midwives (2019)
Health
142
Dentists (2019)
workforce
HEALTH
domestic 130
WORKFORCE
PRODUCTION
international
supply
99.1
99.3
99.8
100
100
100
Percentage
Percentage
Annual intake
0.9
0.7

140
Luxembourg
DOCTORS, NURSES
Country 630 399 81.4 38.6 150.7 86

at a glance

Health workforce
No data available
No data available
No data available
density

workforce
availability
2000 8000 250
7000
200
1500 6000
Total number
Total number
Total number
5000 150
1000 4000
3000 100
500 2000
50
1000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
1400 700 500
1200 600
400
1000 500
Total number
Total number
Total number
800 400 300

600 300 200
400 200
100
200 100
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
15.9 62.5 1.9

141
0 10 20 30 40 (%)

Me

4.8
Medical 23.2
s
28.6

doctors <25
31.4
(2017) 12.0 25–34
35–44

Nurses 55–64
workforce (2017) (2016)

No data available
distribution
Midwives
Female Male
Medical doctors
(%)
Annual
(total number)
No data available
Medical doctors
No data available
No data available
No data available
No data available
No data available
No data available
Graduates
66
Graduates
Nurses (2019)
5
Midwives (2019)
No data available
Health Dentists
workforce
HEALTH
domestic No data available
WORKFORCE
and Pharmacists
PRODUCTION
international
supply
142
Malta
DOCTORS, NURSES
Country 515 358 83.4 39.0 127.0 81

at a glance

Health workforce
density

workforce
availability
2500 5000 300
2000 4000 250

200
Total number
Total number
Total number
1500 3000
150
1000 2000
100
500 1000 50
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
700 300 800
600 250 700
500 600
200 500
Total number
Total number
Total number
400
150 400
300
100 300
200 200
100 50 100
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
26.6 51.0 3.1

143
0 10 20 30 40 50 (%)

Me

43.8
18.0
Medical
s
20.4

doctors 12.5 <25
5.2
(2015) 25–34
35–44

Nurses 55–64
Health ≥65 60% 40% No data available No data available
workforce (2015)
No data available
distribution
Midwives
Female Male
Medical doctors
(%)
Annual
(total number)
164
132
Graduates
Graduates
Nurses (2018)
12
Midwives (2018)
Health
7
Dentists (2018)
workforce
HEALTH
domestic 14
WORKFORCE
PRODUCTION
international
supply
93.4
93.4
90
90
78.6
66.1
Annual intake
Percentage
Percentage
29.4
No data available
21.4
10
10
6.6
6.6
4.5

Medical doctors (2017) Nurses (2017) Midwives (2017) Medical doctors (2017) Nurses (2017) Midwives (2017) Medical doctors Nurses
(2019)
144
Monaco
DOCTORS, NURSES
Country 36 922 86.5 54.5 297.0 85

at a glance

Health workforce
No data available
No data available
density

workforce
availability
350 800 25
300 700
20
250 600
Total number
Total number
Total number
500 15
200
400
150 10
300
100 200
5
50 100
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
200 40 120
35 100
150 30
25 80
Total number
Total number
Total number
100 20 60
15 40
50 10
5 20
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
25.4 56.7 1.5

145
0 10 20 30 40 50 (%)

Me

0.9
s
Medical 27.8

doctors 40.2 <25
(2014) 31.2
25–34
35–44

Nurses 55–64
workforce (2014)
No data available
distribution
Midwives
Female Male
Medical doctors
(%)
Annual
(total number)
No data available
Medical doctors
No data available
No data available
No data available
No data available
No data available
No data available
No data available
No data available
29
Graduates
Graduates
Nurses (2014)
No data available
Midwives
No data available
Health Dentists
workforce
HEALTH
WORKFORCE
and Pharmacists
PRODUCTION
international
supply
100
100
100
Percentage


146
Montenegro
DOCTORS, NURSES
Country 629 048 76.3 37.9 81.0 67

at a glance

Health workforce
density

workforce
availability
2000 3500 300
3000 250
1500 2500 200
Total number
Total number
Total number
2000
1000 150
1500
100
500 1000
500 50
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
160 50 160
140 140
40
120 120
100 30 100
Total number
Total number
Total number
80 80
60 20 60
40 40
10
20 20
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
31.8 57.6 4.7

147
0 10 20 30 40 (%)

Me

18.7
34.4
s
Medical 21.0

doctors 26.9 <25
(2020) 25–34
29.4 35–44
24.4
22.1 45–54
24.2
Nurses 55–64
(2020)
63.6% 36.4% 83.7% 16.3% 100%
Health ≥65
29.3
workforce 30.5 (2020) (2020) (2020)
23.0
distribution 17.2
Midwives
(2020) Female Male
Pharmacists
Dentists
Midwives
Nurses
Medical doctors
(%)
Annual
(total number)
32
61
Graduates
Graduates
No data available
No data available
Nurses (2019)
No data available
Midwives
Health
19
Dentists (2019)
workforce
HEALTH
domestic 28
WORKFORCE
PRODUCTION
international
supply
148
Netherlands
DOCTORS, NURSES
Country 17 434 557 81.6 41.7 151.7 86

at a glance

Health workforce
density

workforce
availability
80 000 250 000 5000
70 000
200 000 4000
60 000
Total number
Total number
Total number
50 000 150 000 3000

40 000
30 000 100 000 2000
20 000
50 000 1000
10 000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
40000 12 000 4000
35000 10 000 3500
30000 3000
25000 8000 2500
Total number
Total number
Total number
20000 6000 2000

15000 1500
4000
10000 1000
5000 2000 500
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
21.4 61.9 1.4

149
0 10 20 30 40 (%)

Me

31.7
s
Medical 25.0

18.8 <25
doctors 18.9
(2019) 5.6 25–34
6.0 35–44
26.9
19.0 45–54
25.8
Nurses 21.3
55–64
0.9
(2016)
56.4% 43.6% 84.6% 15.4% No data available
Health ≥65
workforce No data available (2019) (2016)

distribution
Midwives
Female Male
Nurses
Medical doctors
(%)
Annual
(total number)
2620
Graduates
Graduates
4290
Nurses (2019)
150
Midwives (2019)
Health
230
Dentists (2019)
workforce
HEALTH
domestic 230
WORKFORCE
PRODUCTION
international
supply
98.7
100
96.8
Annual intake
Percentage
NO DATA AVAILABLE

country the country unknown Nurses
Medical doctors
(2018) (2018)
150
North Macedonia
DOCTORS, NURSES
Country 2 111 072 75.2 38.0 78.0 68

at a glance

Health workforce
density

workforce
availability
7000 10 000 1600
6000 1400
8000
5000 1200
Total number
Total number
Total number
6000 1000
4000
800
3000 4000 600
2000 400
2000
1000 200
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
500 2000 1200
400 1000
1500
800
300
Total number
Total number
Total number
1000 600
200
400
100 500
200
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
31.9 47.3 4.6

151
0 10 20 30 40 (%)

Me

s
Medical 18.3
22.8

doctors <25
28.9
(2013) 30.0
25–34
35–44
Nurses 55–64
60.3% 39.7% No data available No data available
Health ≥65

distribution
Midwives
Female Male
Medical doctors
(%)
Annual
(total number)
261
203
Graduates
Graduates
Nurses (2010)
14
Midwives (2012)
Health
143
Dentists (2012)
workforce
HEALTH
domestic 96
WORKFORCE
PRODUCTION
international
supply
152
Norway
DOCTORS, NURSES
Country 5 379 839 83.2 39.0 236.5 86

at a glance

Health workforce
density

workforce
availability
30 000 120 000 3500
25 000 100 000 3000
20 000 80 000 2500

Total number
Total number
Total number
2000
15 000 60 000
1500
10 000 40 000
1000
5000 20 000 500
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
16000 6000 5000
14000 5000
12000 4000
10000 4000
3000
Total number
Total number
Total number
8000 3000
6000 2000
2000
4000
1000 1000
2000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
18.2 64.5 2.0

153
0 10 20 30 40 (%)

Me

25.5
s
30.3
Medical 20.3

doctors <25
15.0
(2020) 8.9
25–34
5.7 35–44
23.0
27.3
22.6 45–54
Nurses 18.3
3.1 55–64
(2016)
51.7% 48.3% 89.1% 10.9% No data available
Health ≥65

distribution
Midwives
Female Male
Nurses
Medical doctors
(%)
Annual
(total number)
587
4069
Graduates
Graduates
Nurses (2020)
145
Midwives (2020)
Health
114
Dentists (2020)
workforce
HEALTH
domestic 115
WORKFORCE
PRODUCTION
international
supply
89.4
1236
83.2
87
85
74.9
50.4
Percentage
Percentage
Annual intake
28.8
25.1
1114
20.8
15
12.3
13
6.1
4.5
4.5

Trained in the Trained outside Training country the country
154
Poland
DOCTORS, NURSES
Country 38 428 366 76.9 40.5 79.6 74

at a glance

Health workforce
No data available
No data available
density

workforce
availability
100 000 250 000 25 000
80 000 200 000 20 000

Total number
Total number
Total number
60 000 150 000 15 000
40 000 100 000 10 000
20 000 50 000 5000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
30000 16 000 40 000
25000 14 000 35 000
12 000 30 000
20000 10 000 25 000
Total number
Total number
Total number
15000 8000 20 000

10000 6000 15 000
4000 10 000
5000
2000 5000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
23.6 50.6 5.9

155
0 10 20 30 40 (%)

Me

Medical
s
No data available

doctors <25
25–34
35–44
No data available
45–54
Nurses 55–64
Health ≥65 56.4% 43.6% 97.7% 2.3% 99.8% 0.2%

workforce No data available (2017) (2018) (2018)
distribution
Midwives
Female Male
(%)
Annual
(total number)
4006
9070
Graduates
Graduates
Nurses (2018)
1471
Midwives (2018)
Health
1058
Dentists (2018)
workforce
HEALTH
domestic 1039
WORKFORCE
PRODUCTION
international
supply
98.1
100
100
Percentage
Annual intake
NO DATA AVAILABLE

(2020) (2019)
Medical doctors (2017) Nurses (2017) Midwives (2017)
156
Portugal
DOCTORS, NURSES
Country 10 298 192 81.1 44.7 126.8 84

at a glance

Health workforce
No data available
density

workforce
availability
60 000 80 000 3500
50 000 70 000 3000
60 000 2500
40 000
Total number
Total number
Total number
50 000
2000
30 000 40 000
1500
20 000 30 000
20 000 1000
10 000 10 000 500
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
30000 12 000 12 000
25000 10 000 10 000
20000 8000 8000
Total number
Total number
Total number
15000 6000 6000

10000 4000 4000
5000 2000 2000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
30.8 41.0 1.7

157
0 10 20 30 40 (%)

Me

0.1
38.9
s
Medical 21.3

doctors 11.1 <25
22.2
(2019) 6.4 25–34
2.7 35–44
24.6
34.7 45–54
24.9
Nurses 12.7 55–64
(2019) 0.4

distribution
Midwives
Female Male
Nurses
Medical doctors
(%)
Annual
(total number)
1629
No data available
2732 No data available

Graduates
Graduates
Nurses (2019)
No data available
Midwives
Health
769
Dentists (2019)
workforce
HEALTH
domestic 871
WORKFORCE
PRODUCTION
international
supply
Country of birth,
pecentage (latest year)
98.2
100
93.6
87.8
357
100.0
87.3
80.0
Annual intake
Percentage
Percentage
60.0
No data available
40.0
12.7
12.2
20.0
6.3
1.8
0.0
Trained in the Trained outside Training Born
Born in the
in the Born outside
Born outside
country the country
158
Republic of Moldova
DOCTORS, NURSES
Country 3 084 847 70.2 35.8 84.0 67

at a glance

Health workforce
No data available
density

workforce
availability
12 000 25 000 1600
10 000 1400
20 000
1200
8000
Total number
Total number
Total number
15 000 1000
6000 800
10 000 600
4000
400
2000 5000
200
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
Physiotherapists Dentists 2020 Pharmacists
140 2000 2000
120
100 1500 1500
80
Total number
Total number
Total number
1000 1000
60
40 500 500
20
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
32.5 55.4 1.7

159
0 10 20 30 40 (%)
2.0

Me
9.4

21.3
Medical
s
24.2

doctors 25.6 <25
17.6
(2022) 25–34
3.4 35–44
24.7
13.4 45–54
24.9
Nurses 22.3
55–64
22.3
(2022)
Health ≥65 64.6% 35.4% 94.4% 5.6% 98.7% 1.3%
0.9
20.0
workforce 15.2 (2022) (2022) (2022)
distribution 24.4
Midwives 26.9
26.9
(2022) Female Male
Midwives
Nurses
Medical doctors
(%)
Annual
(total number)
783
655
Graduates
Graduates
Nurses (2022)
16
Midwives (2022)
Health
172
Dentists (2022)
workforce
HEALTH
domestic 65
WORKFORCE
PRODUCTION
international
supply
98.2
97.8
96.4
Annual intake
Percentage
NO DATA AVAILABLE
No data available
3.6
2.2
1.8

country the country
Medical doctors (2022) Nurses (2022) Midwives (2022) (2022)
160
Romania
DOCTORS, NURSES
Country 19 442 038 75.3 41.6 111.1 71

at a glance

Health workforce
density

workforce
availability
70 000 160 000 8000
60 000 140 000 7000
50 000 120 000 6000
Total number
Total number
Total number
100 000 5000

40 000
80 000 4000
30 000
60 000 3000
20 000 40 000 2000
10 000 20 000 1000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2500 20 000 20 000
2000
15 000 15 000
1500
Total number
Total number
Total number
10 000 10 000
1000
500 5000 5000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
25.2 58.4 1.3

161
0 10 20 30 40 50 (%)

Me
1.3

20.5
s
Medical 27.3

24.0 <25
doctors 25.4
(2016) 1.5 25–34
3.3 35–44
19.3
42.8 45–54
24.5
Nurses 9.7 55–64
0.4
(2016)
Health ≥65 66.9% 33.1% 89.4% 10.6% 85.5% 14.5%
1.8
workforce 38.2
36.4 (2016) (2016) (2011)
distribution 14.5
Midwives 9.1
(2011) Female Male
Pharmacists
Dentists
Midwives
Nurses
Medical doctors
(%)
Annual
(total number)
5076
18 664
Graduates
Graduates
Nurses (2018)
50
Midwives (2014)
Health
2077
Dentists (2018)
workforce
HEALTH
domestic 1662
WORKFORCE
PRODUCTION
international
supply
96.9
99.9
98.6
100
100
100
Annual intake
Percentage
Percentage
1.4
3.1
Trained in the Trained outside Training Born in the Born outside Medical doctors Nurses
country the country unknown country the country (2019) (2018)
162
Russian Federation
DOCTORS, NURSES
Country 145 617 329 71.3 38.6 100.7 75

at a glance

Health workforce
density

workforce
availability
700 000 2000 000 80 000
600 000 70 000
500 000 1500 000 60 000
Total number
Total number
Total number
50 000
400 000
1000 000 40 000
300 000
30 000
200 000 500 000 20 000
100 000 10 000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
7000 50 000 10 000
6000
40 000 8000
5000
4000 30 000 6000
Total number
Total number
Total number
3000 20 000 4000

2000
10 000 2000
1000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
36.7 56.7 3.2

163
0 10 20 30 40 (%)

Me

Medical 33.0
s
23.5

doctors <25
29.5
(2015) 14.0
25–34
35–44
No data available
45–54
Nurses 55–64

distribution
Midwives
Female Male
Medical doctors
(%)
Annual
(total number)
15 410
No data available
No data available
Graduates
No data available
Graduates
Nurses
2326
Midwives (2004)
Health
2567
Dentists (2004)
workforce
HEALTH
domestic 2657
WORKFORCE
PRODUCTION
international
supply
164
San Marino
DOCTORS, NURSES
Country 34 007 79.6 45.7 141.1 82

at a glance

Health workforce
No data available
No data available
No data available
No data available
density

workforce
availability
250 300 20
200 250
15
200
Total number
Total number
Total number
150
150 10
100
100
5
50 50
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
Physiotherapists Dentists Pharmacists 2020
25 70 25
60
20 20
50
15 40 15
Total number
Total number
Total number
10 30 10
20
5 5
10
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
35.1 44.2 3.0

165
0 10 20 30 40 (%)

Me

Medical
s
No data available

doctors <25
25–34
35–44

Nurses 55–64
Health ≥65

distribution
Midwives
(%)
Annual
(total number)
No data available
Medical doctors
No data available
Nurses

Midwives
No data available
Health Dentists
workforce
HEALTH
WORKFORCE
and Pharmacists
PRODUCTION
international
supply
166
Serbia
DOCTORS, NURSES
Country 7 358 005 75.4 42.8 86.3 71

at a glance

Health workforce
No data available
density

workforce
availability
25 000 50 000 3000
20 000 40 000 2500

2000
Total number
Total number
Total number
15 000 30 000
1500
10 000 20 000
1000
5000 10 000 500
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
3000 4000 3000
2500 3500 2500
3000
2000 2500 2000
Total number
Total number
Total number
1500 2000 1500

1000 1500 1000
1000
500 500
500
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
28.7 61.6 1.6

167
0 10 20 30 40 (%)

Me

0.1
10.9
Medical
s
25.6

doctors 32.4 <25
28.5
(2016) 2.4 25–34
35–44
Nurses 55–64

distribution
Midwives
Female Male
Pharmacists
Dentists
Medical doctors
(%)
Annual
(total number)
1231
4057
Graduates
Graduates
Nurses (2018)
251
Midwives (2018)
Health
443
Dentists (2018)
workforce
HEALTH
domestic 729
WORKFORCE
PRODUCTION
international
supply
98.6
100
100
Annual intake
Percentage
No data available
NO DATA AVAILABLE
1.4

(2010)
Medical doctors (2019) Nurses Midwives
168
Slovakia
DOCTORS, NURSES
Country 5 456 681 77.0 40.2 97.9 77

at a glance

Health workforce
density

workforce
availability
25 000 50 000 2000
20 000 40 000
1500
Total number
Total number
Total number
15 000 30 000
1000
10 000 20 000
500
5000 10 000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2500 3500 5000
3000
2000 4000
2500
1500 2000 3000
Total number
Total number
Total number
1000 1500 2000

1000
500 1000
500
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
31.8 50.2 2.8

169
0 10 20 30 40 (%)

Me

22.6
19.6
s
Medical 23.0

doctors 19.3 <25
15.5
(2019) 25–34
17.0 35–44
39.8
33.3 45–54
7.0
Nurses 3.0 55–64
(2016)
Health ≥65 58% 42.% 85.3% 14.7% No data available

distribution
Midwives
Female Male
Nurses
Medical doctors
(%)
Annual
(total number)
938
1185
Graduates
Graduates
Nurses (2019)
44
Midwives (2019)
Health
160
Dentists (2019)
workforce
HEALTH
domestic 264
WORKFORCE
PRODUCTION
international
supply
100
100
97
Percentage

3

Medical doctors (2011) Nurses Midwives

170
Slovenia
DOCTORS, NURSES
Country 2 117 641 80.4 42.9 138.1 80

at a glance

Health workforce
density

workforce
availability
8000 25 000 350
7000 300
20 000
6000 250
Total number
Total number
Total number
5000 15 000 200

4000
10 000 150
3000
2000 100
5000
1000 50
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
Physiotherapists Dentists Pharmacists 2020
2000 2000 2000
1500 1500 1500

Total number
Total number
Total number
1000 1000 1000
500 500 500
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020


Ratio
Midwives
20.5 64.8 0.9

171
0 10 20 30 40 (%)

Me

24.7
26.4
Medical
s
20.1

doctors 20.7 <25
8.2
(2019) 25–34
37.9 35–44
27.5
14.3 45–54
20.2
Nurses 0.2 55–64
(2018)

distribution
Midwives
Female Male
Nurses
Medical doctors
(%)
Annual
(total number)
288
611
Graduates
Graduates
Nurses (2018)
37
Midwives (2018)
Health
52
Dentists (2019)
workforce
HEALTH
domestic 146
WORKFORCE
PRODUCTION
international
supply
97.8
97.5
93.2
97
83.7
84
Annual intake
Percentage
Percentage
No data available
16.3
16
6.8
2.5
2.2
3
1

Medical doctors (2020) Nurses (2019) Midwives (2017) Medical doctors (2017) Nurses (2017) Midwives (2017) (2020)
172
Spain
DOCTORS, NURSES
Country 47 363 807 82.3 43.5 108.8 86

at a glance

Trends in health workforce density per 10 000 population
70
61.0
58.9
58.7
55.2
52.5
51.5
51.5
60
45.8
44.0
Health workforce
50
40.2
38.2
38.2
38.0
37.6
density
40
30
13.2
12.3
12.1
11.9
11.7
20
10.5
9.2
8.4
8.1
8.2
7.7
7.2
6.7
6.0
10
1.9
2.0
2.0
2.0
1.7
1.8
1.6
0
2010 2012 2014 2016 2018 2019 2020

Midwives Dentists
Dentists Pharmacists
Pharmacists
Health
workforce Health workforce trends (total number)
availability

250 000 350 000 12 000
300 000 10 000
200 000
250 000 8000
Total number
Total number
Total number
150 000 200 000

6000
100 000 150 000
4000
100 000
50 000 2000
50 000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
60000 50 000 70 000
50000 60 000
40 000
40000 50 000
30 000 40 000
Total number
Total number
Total number
30000
20 000 30 000
20000
20 000
10000 10 000
10 000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020

Ratio of nurses and midwives to medical doctors
3.0
2.5
2.0
Ratio
Midwives
1.5
32.4 43.2 1.4 1.0
0.5
0.0
2011
2012
2009
2010
2007
2008
2005
2006
2019
2020
2000
2001
2002
2003
2004
2013
2017
2018
2014
2015
2016

173
0 10 20 30 40 (%)
ica l docto Nurses Midwives

ed r

21.6 M
s
24.4

22.0
Medical <25
26.7
doctors 5.3
(2019) <25–34
5.1 <35–44
26.9
26.2 45–54
20.9
Nurses 20.6 55–64
(2016) 0.3 56.4% 43.6% 83.6% 16.4% No data available
Health >64
(2019) (2016)
distribution
Midwives
Female Male
Percentage of workforce aged 55+
Dentists No data available 20.9
Nurses 20.9
Medical doctors 32.0-
(%)
Annual Graduates per year per Graduates per year per

100 000per
Graduates population
year per 1000
Graduates perpractitioners
year per
(total number)
100 000 population thousand practitioners (latest
(latest year) year)
42
6574 25 45
39
22
38
35
40
20
30
35
30
14
Graduates
Graduates
10 250 15 25
Nurses (2019) 10 20
Graduates
Graduates
15
6
5 10
3
360 5
1
Midwives (2020) 0 0
Medical doctors
Nurses (2019)
Midwives (2020)
Dentists (2019)
Pharmacists (2019)
Nurses (2019)
Medical doctors
Midwives (2020)
Dentists (2019)
Pharmacists (2019)
1565
(2019)
(2019)
Dentists (2019)
Health
workforce 2645
HEALTH
domestic Pharmacists (2019)
WORKFORCE
and
PRODUCTION
international Country of training, Country of birth, Annual intake from other
supply percentage percentage
Country of training, percentage
countries
Annual
Annual
intake
intake (total
from
from
othernumber)
other
countries
countries
(latest year)
(latest
(latest
year)
year)
97.9
100
4,036
4,036
90.6
100.0
4036
90.0 4500
4500
80.0 4000
4000
70.0 3500
3500
3000
3000
Annual intake
60.0
2500
2500
Percentage
50.0 NO DATA AVAILABLE

40.0 2000
2000
30.0 1500
1500
617
617
1000
1000
617
20.0
9.4
10.0 500500
2.1
0.0 0 0
Medical doctors
doctors
Nurses (2020)
Nurses (2020)
Trained in the
Trained Trainedoutside
Trained outside Training unknown
Training Medical doctors Nurses
country
country the
thecountry
country unknown (2020) (2020)
(2020)
(2020)

Medical Nurses
doctors (2018)
(2011) Midwives
Nurses (2018)
(2011)
Medical
174
Sweden
DOCTORS, NURSES
Country 10 368 969 82.4 39.5 159.3 87

at a glance

108.8
108.9
109.0
108.7
108.5
120
Health workforce
100
density
80
No data available
60
43.2
42.9
42.2
40.9
39.5
38.1
40
20
8.1
8.2
8.1
8.1
7.7
7.7
8.1
7.9
7.7
7.8
7.9
7.5
7.6
7.5
7.4
7.6
7.5
7.6
0
2010 2012 2014 2016 2018 2019 2020

Health
availability
50 000 120 000 10 000
40 000 100 000 8000

80 000
Total number
Total number
Total number
30 000 6000
60 000
20 000 4000
40 000
10 000 20 000 2000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
16000 10 000 10 000
14000
8000 8000
12000
10000 6000 6000
Total number
Total number
Total number
8000
6000 4000 4000
4000
2000 2000
2000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020

Ratio of nurses and midwives to medical doctors
4.0
3.0
Ratio
Midwives
2.0
22.9 57.4 4.1 1.0
0.0
2011
2012
2009
2010
2007
2008
2005
2006
2019
2020
2000
2001
2002
2003
2004
2013
2017
2018
2014
2015
2016

175
0 10 20 30 40 (%)

21.1
Medical Me

27.7
doctors 21.3
s
18.8 <25

(2018) 11.1
25–34
2.2
21.5 35–44
22.5
Nurses 24.8 45–54
23.3
(2017) 5.7 55–64
Health 11.3
≥65 49.6% 50.4% 88.4% 11.6% 99.7% 0.3%
workforce 25.1
25.6 (2018) (2017) (2017)
Midwives
distribution (2017) 8.5
29.5
Female Male

Percentage of workforce aged over 55
Midwives 37.9
Nurses 29.0
0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 (%)
Annual
graduates
Professions
(total number) Graduates
Graduates
perper
year
year
perper Graduates
Graduatesperper
year
year
perper
100100
000000population
population thousand
thousandpractitioners
practitioners
(latest
(latest
year)
year) (latest
(latest
year)
year)
1385
43
43
57
57
45 45 60 60
Medical doctors (2019) 40 40
45
45
50 50
40
40
35 35
33
33
30 30 40 40
4443
31
31
Graduates
Graduates
25 25
Nurses (2019) 20 20 30 30
13
13
15 15 20 20
10 10 10 10
4
4
354
3
3
3
3
5 5
Midwives (2019) 0 0 0 0
Medical doctors
doctors
Nurses (2019)
Nurses (2019)
Midwives (2019)
Midwives (2019)
Pharmacists
Pharmacists
Nurses (2019)
Nurses (2019)
Midwives (2019)
Midwives (2019)
Dentists (2019)
Dentists (2019)
Medical doctors
doctors
Pharmacists
Pharmacists
Dentists (2019)
Dentists (2019)
(2019)
(2019)
(2019)
(2019)
266
(2019)
(2019)
(2019)
(2019)
Medical
Medical
Dentists (2019)
Health
workforce 462
HEALTH
WORKFORCE
and
PRODUCTION
international
supply Country of training, Country of birth, Annual intakefrom
Annual intake from other
other
percentage
Country of training, percentage Countrypercentage
of birth, pecentage (latest countries
countries (latest year)
(latest year) year)
93.5
92.5
96.7
723
100.0 800
100.0
90.0
90.0 700
73.3
80.0 80.0
75
66.6
70.0 600
70.0
Annual intake
60.0 60.0 500

Percentage
Percentage
50.0 50.0 400

40.0 40.0
28.7
26.7
300
185
21.6
30.0 30.0
20.0 20.0 200
7.5
6.5
4.8
100
3.3
10.0
3.2
10.0
1
0.0 0.0 0
Trained in
Trained inthe
the Trained outside
Trained Training
Training Born
Born in theincountry
the Born outside
Born outside the Medical doctors Nurses
Nurses (2018)
Medical doctors

country outside the unknown country (2018) (2018)
(2018)
Medical doctors (2018) country

Nurses (2018) Midwives (2018) Medical doctors (2018) Nurses (2018) Midwives (2018)
Medical doctors (2018) Nurses (2018)
Medical doctors (2018) Nurses (2018) Midwives (2018) 176
Midwives (2018)
Switzerland
DOCTORS, NURSES
Country 8 638 613 83.1 41.7 231.0 87

at a glance

183.7
179.6
175.9
170.2
200
161.6
155.8
146.5
Health workforce
150
density
100
43.4
43.5
43.9
42.5
41.3
39.2
38.1
50
6.4
6.7
6.5
7.0
6.9
6.7
5.3
5.2
5.1
5.0
5.1
4.1
3.4
2.9
3.1
3.0
3.2
3.3
3.4
0
2010 2012 2014 2016 2018 2019 2020

Health
availability

40 000 200 000 3500
35 000 3000
30 000 150 000 2500
Total number
Total number
Total number
25 000
2000
20 000 100 000
1500
15 000
10 000 50 000 1000
5000 500
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
1 5000 7000
6000
0,8 4000
5000
0,6 3000 4000
Total number
Total number
Total number
NO DATA AVAILABLE 3000

0,4 2000
2000
0,2 1000
1000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020

5.0
4.0
Ratio
Midwives 3.0
18.2 76.0 1.4 2.0

1.0
0.0
2011
2012
2009
2010
2007
2008
2005
2006
2019
2020
2000
2001
2002
2003
2004
2013
2017
2018
2014
2015
2016

1.7 2.8 NO DATA AVAILABLE Country Subregional average Regional average
177
0 10 20 30 40 (%)
12.1
dical doctor Nurses Mid
wives

Medical 23.5
27.1 Me
s
doctors 25.6 <25

(2020) 11.7
25–34
7.7
Female
29.8 35–44
23.3
21.3
45–54
Nurses 1.9
16.0
(2020) 55–64
workforce NO DATA AVAILABLE (2020) (2016)

distribution Midwives
(2016)
Female Male

Nurses 17.9
0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 (%)
Annual
graduates
Professions
100 000 population
Graduates
Graduates
perper
year
year
perper 1000
Graduates
Graduates practitioners
perper
year
year
perper
(total number)
100
100
000000population
population thousand
thousand practitioners
practitioners
(latest
(latest
year)
year) (latest
(latest
year)
year)
1017
43
43
45 45 70 70
59
59
Medical doctors (2019) 40 40 60 60
35 35 50 50
40
40
30 30
38
38
3682 25 25 40 40
Graduates
Graduates
27
27
23
23
20 20 30 30
12
12
Nurses (2019)
15 15 20 20
10 10
10 10
3
3
5 5
2
2
2
2
173 0 0 0 0
Midwives (2019)
Midwives (20 19)
Midwives (20 19)
Midwives (20 19)

Midwives (20 19)
Nurses (2019)
Nurses (2019)
Dentists (2019)
Dentists (2019)
Nurses (2019)
Nurses (2019)
Dentists (2019)
Dentists (2019)
Medical doctors
doctors
Pharmacis ts
(20 19) ts
Medical doctors
doctors
Pharmacis ts
(20 19) ts
Pharmacis
Pharmacis
(20 19)
(20 19)
(20 19)
(20 19)
(20 19)
(20 19)
133
Medical
Medical
Dentists (2019)
Health
workforce 228
HEALTH
WORKFORCE
and
PRODUCTION
international Country of training, Country of birth, Annual intake from other
supply Country of training,
100.0
2,367
2367
2500
1,910
1910
80.0
63.3
62.6
63
2000
Annual intake
60.0
Percentage
1500
37.4
40.0
25.9
1000
26
NO DATA AVAILABLE
11.2
10.7
20.0 500
0.0 0
Medical doctors
Nurses (2020)
Trained inthe
Trained in the Trained
Trained outside
outside Training
Training
country the country unknown (2020) (2020)
(2020)
Medical
doctors Nurses
(2020) (2019) (2019)
Nurses Midwives (2016)
Midwives (2016) 178

Tajikistan
DOCTORS, NURSES
Country 9 543 207 68.0 21.3 71.0 66

at a glance
47.5
46.5
46.4
44.1
50
41.7
Health workforce
38.0
33.7
40
density
30
17.3
17.3
17.1
17.1
17.1
17.1
16.8
20
6.3
5.9
5.5
5.4
5.6
5.7
5.3
10
2.5
2.5
2.6
2.6
2.2
1.6
1.9
1.6
1.6
1.6
1.6
1.5
1.5
0
2010 2012 2014 2016 2018 2019 2020

Health
availability

20 000 50 000 7000
6000
40 000
15 000 5000
Total number
Total number
Total number
30 000 4000
10 000
20 000 3000
5000 2000
10 000
1000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
200 2000 3000
2500
150 1500
2000
Total number
Total number
Total number
100 1000 1500

1000
50 500
500
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020

3.5
3.0
2.5
Ratio
2.0
22.9 62.9 8.3 1.5
1.0
0.5
0.0
2011
2012
2008
2009
2010
2020
2004
2005
2006
2007
2018
2019
2000
2001
2002
2003
2013
2014
2015
2016
2017

179
0 10 20 30 40 (%)
dical doctor Nurses Mid

wives

29.4
Medical 27.5 Me
s
doctors 26.1
<25

17.1
(2014)
25–34
19.6 Female
31.9 35–44
22.8
18.0 45–54
Nurses 7.0
(2018) 0.6 55–64
Health ≥65 39.2% 60.8% 84% 16.0% No data available
workforce NO DATA AVAILABLE (2014) (2018)

Female Male

Nurses 7.6
0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 (%)
Annual
graduates
Professions
100 000 population
Graduates per year per 1000 practitioners
(total number)
100 000 population Graduates per year per
(latest year) thousand practitioners
(latest year)
893 140
116

244
100 250
11 056
Graduates
80
Graduates
200
Nurses (2018) 60 150
40
71
100
68
54
20
26
50
9
422
4
0 0
Midwives (2014)
Medical doctors
Nurses (2018)
Midwives (2014)
Dentists (2014)
Pharmacists (2014)
Medical doctors
Nurses (2018)
Midwives (2014)
Dentists (2014)
Pharmacists (2014)
(2014)
(2014)
105
Dentists (2014)
Health
workforce 66
HEALTH
WORKFORCE
and
PRODUCTION
international
supply
180
Türkiye
DOCTORS, NURSES
Country 84 135 428 75.9 30.6 54.4 79

at a glance
27.0
30
23.7
23.0
25
20.4
19.3
Health workforce
18.9
18.5
18.2
17.9
17.9
17.4
17.2
16.9
20
15.7
density
15
10
7.1
7.0
6.9
6.8
6.8
6.7
6.5
4.1
4.2
4.1
3.9
3.9
3.7
3.6
3.5
3.5
3.4
3.3
2.9
2.9
2.8
0
2010 2012 2014 2016 2018 2019 2020
Health
availability

200 000 250 000 70 000
60 000
200 000
150 000 50 000
Total number
Total number
Total number
150 000 40 000

100 000
100 000 30 000
50 000 20 000
50 000
10 000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
7000 40 000 40 000
6000 35 000 35 000
5000 30 000 30 000
25 000 25 000
4000
Total number
Total number
Total number
20 000 20 000
3000
15 000 15 000
2000 10 000 10 000
1000 5000 5000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020

3.00
2.50
2.00
Ratio
Midwives 1.50
32.1 42.6 11.1 1.00
0.50
0.00
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020

181
0 10 20 30 40 (%)

0.2

Me
20.7

Medical 31.9
s
doctors 29.6
<25

(2019) 13.1
4.5
25–34
15.5
40.0 35–44
31.3
45–54
Nurses 1.8
11.3
(2019) 0.1 55–64
Health 2.2 ≥65 38.3% 61.7% 84.3% 15.7% 100% 0.0%

32.8
workforce 33.6 (2019) (2019) (2019)
28.1
distribution Midwives 3.0
(2019) 0.2
Female Male
Dentists 15.1
Midwives 3.2
Nurses 1.9

0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 (%)
Annual
(total number)
111
18
20 120
11 909 18
14

70
14 80 66
Graduates
Graduates
59
59
12
15 041 10
8
60
Nurses (2020) 40
5
6
4
4
2
20
2
0
3499 0
Pharmacists (2020)
Nurses (2020)
Midwives (2020)
Pharmacists (2020)
Nurses (2020)
Midwives (2020)
Midwives (2020)
3859
Dentists (2020)
Health
workforce 2082
HEALTH
WORKFORCE
and
PRODUCTION
international
supply Country of training, Country of birth, Annual intake from other
Countrypercentage
of training, percentage percentage countries
(latest year)
99.8
99.7
100
100.0
57
80.0 60
50
60.0
Annual intake
Percentage
NO DATA AVAILABLE 40
40.0
No data available
30
20.0
20
0.2
0.3
0.0 10
Trained
Trained in thein Trained
Trained
outside Training
Training
country the country unknown 0
the country outside the unknown Medical doctors Nurses
Medical doctors
Nurses (2015)
(2015) (2015)
Medical doctors (2020) country
Nurses (2020) Midwives
(2015)
Nurses (2015)
182
Midwives (#N/A)
Turkmenistan
DOCTORS, NURSES
Country 6 250 438 68.7 25.6 61.7 73

at a glance

41.6
41.5
40.8
40.3
45
39.5
38.8
37.9
40
35
Health workforce
30
22.0
21.8
21.6
21.6
21.6
21.5
21.2
density
25
20
15
10
2.0
2.0
2.0
2.0
2.0
1.9
2.0
1.8
1.8
1.8
1.7
5
1.6
1.6
1.7
1.4
1.3
1.3
1.1
1.1
1.1
1.2
0
2010 2012 2014 2016 2018 2019 2020
Health
availability

16 000 40 000 4000
14 000 35 000 3500
12 000 30 000 3000
Total number
Total number
Total number
10 000 25 000 2500

8000 20 000 2000
6000 15 000 1500
4000 10 000 1000
2000 5000 500
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
160 1200 1600
140 1000 1400
120 1200
100 800 1000
Total number
Total number
Total number
80 600 800
60 600
400
40 400
20 200 200
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020

4.00
3.00
Ratio
Midwives 2.00
33.5 58.4 3.0 1.00
0.00
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020

183
0 10 20 30 40 (%)

Medical Me
doctors
s
<25

25–34
Female Female
35–44
NO DATA AVAILABLE
45–54
Nurses
55–64
workforce (2014)
Female Male
Physiotherapists No data available
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 (%)

0.01 0.02 0.03 0.04 0.05 0.06 0.07 0.0
Annual
graduates
Professions
(total number)
8 40
455
7
33
32
7 35
6
25
5 25
378 4
Graduates
Graduates
18
20
16
3 15
Nurses (2021)
2 10
1
1
5
0
0
40 0 0
Dentists (2021)
Pharmacists (2021)
Midwives (2021)
Nurses (2021)
Dentists (2021)
Pharmacists (2021)
Midwives (2021)
Nurses (2021)
Midwives (2021)
Health
15
Dentists (2021)
workforce
HEALTH
domestic 27
WORKFORCE
PRODUCTION
international
184
Ukraine
DOCTORS, NURSES
Country 43 909 666 72.6 40.5 96.5 73

at a glance

70.5
70.9
80
62.9
70
60
Health workforce
50
density
34.9
34.9
29.9
40
No data available
No data available
No data available
No data available
30
20
6.8
6.6
6.0
4.4
4.3
3.6
10
0.4
0.4
0.3
0
2010 2012 2014 2016 2018 2019 2020
Health
availability
200 000 350 000 25 000
300 000
20 000
150 000 250 000
Total number
Total number
Total number
200 000 15 000

100 000
150 000 10 000
50 000 100 000
5000
50 000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
25000 35 000 2000
30 000
20000
25 000 1500
15000 20 000
Total number
Total number
Total number
1000
10000 15 000
10 000 500
5000
5000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020

3.00
2.50
2.00
Ratio
Midwives 1.50
28.2 59.4 3.4 1.00
0.50
0.00
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020

185
0 10 20 30 40 (%)

Medical Me
doctors
s
<25

25–34
Female Female
35–44
NO DATA AVAILABLE
45–54
Nurses
55–64
workforce (2014)
Female Male
Physiotherapists No data available
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 (%)

0.01 0.02 0.03 0.04 0.05 0.06 0.07 0.0
Annual
Graduates per year per
Professions graduates Graduates per year per
1000 practitioners
(total number) 100 000 population
4026
3787
33
35 4500
3500
25 3000
Graduates
Graduates
14 526 20 2500
14
15 2000
Nurses (2014) 1500
10
9
1000
4
5
3
500
93
61
51
28
1515 0 0
Midwives (2014)
Medical doctors
Medical doctors
Dentists (2014)
Pharmacists (2014)
Dentists (2014)
Midwives (2014)
Nurses (2014)
Midwives (2014)
Nurses (2014)
(2014)
(2014)
1637
Dentists (2014)
Health
HEALTH
workforce 6124
WORKFORCE
PRODUCTION
and
international
supply
186
United Kingdom
DOCTORS, NURSES
Country 67 059 474 80.4 39.5 120 88

at a glance
84.7
84.1
82.1
90
80.6
79.3
79.2
78.8
80
70
Health workforce
60
density
50
40
30.4
29.5
28.4
27.8
27.4
26.9
26.5
30
20
8.6
8.6
8.7
8.5
8.2
7.8
6.5
5.3
5.3
5.3
5.4
5.1
5.2
5.3
4.8
4.8
4.8
4.8
4.8
4.8
4.9
10
0
2010 2012 2014 2016 2018 2019 2020
Health
availability
250 000 600 000 35 000
500 000 30 000
200 000
400 000 25 000
Total number
Total number
Total number
150 000 20 000

300 000
100 000 15 000
200 000
10 000
50 000 100 000 5000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
35000 40 000 70 000
30000 35 000 60 000
25000 30 000 50 000
25 000
20000 40 000
Total number
Total number
Total number
20 000
15000 30 000
15 000
10000 10 000 20 000
5000 5000 10 000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020

5.00
4.00

Nurses
Ratio
Midwives
21.9 61.1 3.5 2.00
1.00
0.00
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020

187
0 10 20 30 40 (%)

33.8
Me

Medical 29.0
doctors 22.9
s
12.2 <25

(2020) 2.1
25–34
3.2 No data available
22.2 35–44
22.5
28.6 45–54
Nurses 20.8
(2019) 2.6
55–64
Health 5.9 ≥65 49% 51% 88,6% 11.4% 99.7% 0.3%

27.1
workforce 25.0
23.8 (2020) (2018) (2018)
1.3
(2019)
Female Male
Midwives 18.2
Nurses 23.4
(%)
Annual
graduates
Professions
(total number)
8730 35 70
31
64
58
30 60
25 50
43
Graduates
Graduates
20 524
36
20 40
33
13
15 30
Nurses (2018)
10 20
5
5 10
3
2094 0 0
Dentists (2019)
Pharmacists (2019)
Midwives (2018)
Nurses (2018)
Dentists (2019)
Pharmacists (2019)
Midwives (2018)
Nurses (2018)
Midwives (2018)
Health
1200
Dentists (2019)
workforce
HEALTH
domestic 3330
WORKFORCE
PRODUCTION
international
100
100.
83.1
11 020
90.0
80.0 12 000
63.4
Annual intake
70.0 10 000
6925
60.0
Percentage
8000
50.0 NO DATA AVAILABLE
6000
30.7
40.0
30.0 4000
16.1
20.0 2000
5.9
10.0
0
1
0. Medical doctors Nurses

Trained in the Trained outside Training (2019) (2019)

188
Uzbekistan
DOCTORS, NURSES
Country 33 526 656 70.3 26.4 77.9 71

at a glance
120 105.2
104.6
104.5
100
Health workforce
80
density
53.5
52.9
50.9
60
40
25.3
24.4
23.7
20.4
20.3
19.8
19.3
20
8.8
8.6
8.2
4.2
4.3
4.1
1.6
1.6
1.5
1.1
0.4
0.5
0.4
0.4
0
2010 2012 2014 2016 2018 2019 2020
Medical doctors Medical doctors

Nurses Nurses Midwives
Midwives DentistsDentists
Pharmacists Pharmacists

workforce
availability
80 000 350 000 30 000
70 000 300 000 25 000
60 000 250 000 20 000
Total number
Total number
Total number
50 000
200 000
40 000 15 000
150 000
30 000 10 000
20 000 100 000
10 000 50 000 5000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
600 6000 2000
500 5000
1500
400 4000
Total number
Total number
Total number
300 3000 1000

200 2000
500
100 1000
0 0 0
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020

5.00
4.00
Ratio
Midwives 3.00
25.5 67.2 5.1 2.00
1.00
0.00
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020

189
0 10 20 30 40 (%)

17.9
Me

Medical 27.8
35.1
s
doctors 19.3 <25

(2014)
25–34
No data available
35–44
No data available
45–54
Nurses
55–64
Health 12.2 ≥65 52.7% 47.3% No data available 100% 0%

28.6
workforce 21.4
28.6
(2014) (2013)
3.1
(2013)
Female Male
Midwives 9.2
0.05 .0 10.0 15.0 20.0 (%)
Annual
(total number) 100 000 population 1000 practitioners
157
180
3452 160 350 293
120 250
185
Graduates
Graduates
100
52 602 80
200
150
Nurses (2013) 60
68
40 100 63
51
10
20 50
8
2540 0 0
Medical doctors
Pharmacists (2014)
Dentists (2014)
Midwives (2005)
Medical doctors
Pharmacists (2014)
Nurses (2013)
Dentists (2014)
Midwives (2005)
Nurses (2013)
Midwives (2005)
(2014)
(2014)
Health
230
Dentists (2014)
workforce
HEALTH
domestic 117
WORKFORCE
PRODUCTION
international
supply
190
The WHO Regional Office for Europe
The World Health Organization (WHO) is a specialized

agency of the United Nations created in 1948 with the
primary responsibility for international health matters
and public health. The WHO Regional Office for Europe
is one of six regional offices throughout the world, each
Health and care

with its own programme geared to the particular health
conditions of the countries it serves.
Member States
Albania Hungary Romania
time to act
Andorra Iceland Russian Federation
Armenia Ireland San Marino
Austria Israel Serbia
Azerbaijan Italy Slovakia
Belarus Kazakhstan Slovenia
Belgium Kyrgyzstan Spain
Bosnia and Herzegovina Latvia Sweden
Bulgaria Lithuania Switzerland
Croatia Luxembourg Tajikistan
Cyprus Malta Türkiye
Czechia Monaco Turkmenistan
Denmark Montenegro Ukraine
HEALTH AND CARE WORKFORCE IN EUROPE: TIME TO ACT

Estonia Netherlands United Kingdom
Finland North Macedonia Uzbekistan
France Norway
Georgia Poland
Germany Portugal
Greece Republic of Moldova
World Health Organization

Regional Office for Europe
UN City, Marmorvej 51,

DK-2100 Copenhagen Ø, Denmark
Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01
Email: eurocontact@who.int
Website: www.who.int/europe

Health and Care Workforce - Time To Act

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Health and Care Workforce - Time To Act

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The WHO Regional Office for Europe

The World Health Organization (WHO) is a specialized

Health and care

Albania Hungary Romania

HEALTH AND CARE WORKFORCE IN EUROPE: TIME TO ACT

World Health Organization

UN City, Marmorvej 51,

Executive summary ....................................................................................................................... viii

1. Why do we need this report, and why now?...................................................................................1

2. Profile of the HCWF in the WHO European Region..........................................................................5

3. Responses to challenges to HCWF policy development in the Region...........................................27

Annex 1. Sources of strategic recommendations and tools..............................................................77

Annex 2. Country profiles................................................................................................................82

Every single country of the WHO European Region

The problems WHO Member States face existed

Special thanks to all Member States of the WHO Kazakhstan

AMEE Association for Medical Education in Europe

Align education with population needs and health service

Expand the use of digital tools that support the workforce

Protect the health and mental well-being of the workforce

Build leadership capacity for workforce governance and planning

Optimize the use of funds through innovative workforce policies $

All countries of the WHO European Region face severe problems

The focus of this report is medical doctors, nurses, midwives,

2.1.1 Workforce densities

2.1.1.1 Health professional densities

Table 1. Countries by subregiona

Central Asia Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan

Belarus, Bulgaria, Czechia, Hungary, Poland, Republic of Moldova, Romania, Russian

Western Asia Armenia, Azerbaijan, Cyprus, Georgia, Israel, Türkiye

Note: countries of the WHO European Region only.

Central Asia Eastern Europe Northern Europe Southern Europe

c. Nurse density compared to regional average of 80 per 10 000 population

Italy North Macedonia

Bosnia and Herzegovina

Central Asia Eastern Europe Northern Europe Southern Europe

g. Physiotherapist density compared to regional average of 8.0 per 10 000 population

Central Asia Eastern Europe Northern Europe Southern Europe

2.1.2.1 HCWF growth

2.1.2.2 Demand for HCWF

2.1.2.3 Ageing of the HCWF

Medical doctors Nurses Midwives Dentists Pharmacists

Central Asia Eastern Europe Northern Europe Southern Europe

Source: WHO (3).

Bosnia and Herzegovina

Central Asia Eastern Europe Northern Europe Southern Europe

Source: WHO (3).

2.1.2.4 HCWF gender characteristics

2.1.2.5 Subnational distribution of HCWF

2.1.2.6 Existing vacancies by countries

2.1.2.7 HCWF production across countries

2.1.2.8 Health professional graduates across subregions

Affairs Population Division (2).

 umber of annual nursing graduates per 100 000 population , 2020 or

Eastern Northern Southern Western

Medical doctors Nurses Midwives Dentists Pharmacists

2.1.2.9 Foreign-trained HCWF

2.1.3.1 Universal health coverage

2.1.3.2 Country expenditure

Fig. 8. UHC service coverage index, 2019

Central Asia Eastern Europe Northern Europe Southern Europe

Source: WHO (12).

Medical doctors, nurses and midwives per 10 000 population

umber of annual nursing graduates per 100 000 population , 2020 or

2.2 How countries responded to the pressures of the COVID-19

Fig. 14. J oiners and leavers of the United Kingdom permanent