Infectious disease epidemics may erode the healthcare workforce most severely in countries already struggling with staffing shortages, “further aggravating the global inequity in the health workforce,” suggests a new study published in PLOS Medicine. The study analyzed three decades of data across 194 countries and territories.
Researchers led by a team from the Chinese Academy of Medical Sciences in Beijing estimated that epidemics could account for an average annual shortfall of 17,500 health workers worldwide, with disproportionately large losses relative to workforce size in low- and lower-middle–income countries (though that estimate assumes cause and effect, which the study could not establish).
The analysis spanned 1990 through 2019, so it does not capture healthcare worker losses during the COVID-19 pandemic, during which an estimated 115,500 healthcare workers died globally.
Largest losses in sub-Saharan Africa
For the study, the researchers analyzed data from the International Emergency Events Database and the Global Burden of Disease study and identified 1,185 epidemic events in 132 countries (62 countries had no records).
To qualify, events had to meet at least one of the following conditions: they had to cause 10 or more deaths, affect at least 100 people, and trigger a state-of-emergency declaration or a formal request for international assistance.
After adjusting for geographic and sociodemographic factors, the researchers found that epidemic outbreaks in a country were followed by a fall in healthcare worker density the following year. Assuming a causal relationship, they estimated an average annual workforce shortfall of 17,549—though the confidence interval was wide, suggesting uncertainty—or 2.57 workers per 10,000.
Estimated annual losses amounted to about 15.9 workers per 10,000 health workers in low-income countries and 12.8 per 10,000 in lower-middle–income countries, compared with 1.0 per 10,000 in upper-middle–income countries and 0.1 per 10,000 in high-income countries.
Countries in sub-Saharan Africa had the highest estimated losses relative to workforce size: Niger (57.1 per 10,000), Somalia (44.2), and Ethiopia (37.1).
Epidemics threaten already scarce staffing
Illness and death may not be the only reasons for healthcare workforce declines, note the authors. Some workers may leave the profession or migrate to other countries, and some may be redeployed within the health sector. The study could not distinguish among these different pathways of attrition.
Our analysis demonstrates that epidemics occurring globally over the past three decades are associated with profound and sustained reductions of [healthcare worker] density.
Still, the findings suggest that protecting and retaining healthcare workers deserves greater attention in epidemic preparedness, particularly in areas where staffing is already scarce.
“Our analysis demonstrates that epidemics occurring globally over the past three decades are associated with profound and sustained reductions of [healthcare worker] density,” write the researchers. “Without immediate and targeted policy interventions to strengthen [healthcare worker] development, future disaster events could be associated with even more severe and lasting damage.”