The world had 122 million health workers in 2023, and women drove most of the growth

Every health system runs on people before it runs on anything else, and yet the global health workforce has been among the harder things to count consistently — spread across dozens of job titles, recorded differently in every country, and rarely disaggregated by sex. A new Global Burden of Disease analysis takes that count on, estimating the size, composition and gender of the health workforce across 204 countries from 1990 to 2023, and then asking how far it falls short of what universal health coverage would require [s1].

The topline is one of growth. In 2023 there were 122.1 million health workers across 20 cadres, an increase of 81.2 million, or 198.5%, relative to 1990 [s1]. The workforce has, in round terms, nearly tripled in a generation. Within that total were 15.1 million doctors, 33.2 million nurses, 2.4 million midwives and 7.6 million community health workers [s1].

A workforce built by women

The most consequential finding is about who did the growing. In 2023, 68.9% of all health workers were female, and female health workers accounted for 71.4% of net workforce growth since 1990 [s1]. The expansion of the world's health workforce has, in other words, been largely the story of women entering formal health employment.

That headline hides a sharp division of labour. Fewer than half of doctors were female, at 43.9%, while most nurses, at 80.7%, most midwives, at 96.0%, and most community health workers, at 89.5%, were women [s1]. The gradient is hard to miss: the higher-paid, higher-status cadre remains close to evenly split, while the caring and community roles are overwhelmingly female. A workforce that grew on women's labour did not distribute that labour evenly across its ranks.

The gaps that did not close

Growth is not the same as sufficiency, and the analysis is built to show the difference. Substantial differences in workforce density remained into 2023: sub-Saharan Africa had the lowest densities across cadres, with the exception of community health workers, while high-income countries had the highest [s1]. Tripling the global total did not move the workers to where the need is greatest.

The authors then convert that density gap into a concrete target, using a stochastic frontier model to estimate the minimum staffing required to reach a score of 80 out of 100 on the universal health coverage effective coverage index [s1]. The shortfalls are large. To hit that mark, the world needs an additional 7.1 million doctors, 23.9 million nurses and midwives, 1.8 million dentists and 1.6 million pharmacists [s1]. Nursing and midwifery — already the most female cadres — carry by far the largest gap.

Why universal coverage is the benchmark

The choice of the UHC index as the yardstick connects the workforce numbers to a goal the world has formally adopted and is quietly missing. The WHO's universal-health-coverage fact sheet records that the UHC service coverage index rose from 54 to 71 between 2000 and 2023, but that progress since 2015 dropped to one-third of the earlier annualised rate [s2]. About 4.6 billion people were not fully covered by essential health services in 2023 [s2].

A workforce shortfall is one of the concrete reasons a coverage index stalls. Clinics without staff cannot deliver services regardless of how the financing is arranged, and the cadres with the biggest gaps in this analysis — nurses, midwives, doctors [s1] — are precisely the ones who deliver the primary care that the coverage index measures. The staffing estimate is, in effect, a price tag in people for a goal usually discussed in money.

What the authors conclude

The interpretation is balanced between the achievement and the gap. The global health workforce has expanded substantially since 1990, largely due to women entering the formal workforce, but the expansion has been uneven across regions and persistent shortfalls remain [s1]. Closing them, the authors argue, will require expansion of training capacity, retention and remuneration policies for early-career workers, and gender-responsive workforce arrangements [s1].

That last phrase is where the two findings meet. A workforce that is 68.9% female [s1] and still growing on women's labour cannot be planned as though gender were incidental to it — the conditions that retain or drive out early-career nurses and midwives are, demographically, conditions that act mostly on women.

What to watch

The number to track is whether the density gap narrows in the next GBD cycle, not just whether the global total keeps rising. A workforce that grows in high-income countries while sub-Saharan Africa stays lowest [s1] would widen the coverage gap even as the headcount climbs — growth on paper, shortage where it counts.

Sources

• Measuring the composition and availability of human resources for health by sex in 204 countries and territories, 1990–2023, and workforce gaps for universal health coverage: a systematic analysis for the Global Burden of Disease Study 2023, The Lancet Public Health, 18 August 2026
• Universal health coverage (UHC) (fact sheet), World Health Organization