Key Points

• Women account for nearly 70% of the global health workforce, according to a new Global Burden of Disease study.
• Despite their dominance, women remain concentrated in lower-paid health professions and have fewer opportunities to reach leadership positions.
• The global health workforce nearly tripled between 1990 and 2023.
• The world still needs an estimated 34.4 million additional health workers to achieve moderate universal health coverage.
• Sub-Saharan Africa and South Asia face some of the largest workforce shortages.
• Researchers are calling for gender-responsive policies, better pay, leadership development, parental leave and safer, more flexible workplaces.

Main Story

Women now account for almost seven in every 10 health workers globally, yet their overwhelming presence in the sector has not translated into equal pay, professional advancement or representation in leadership, a new global study has found.

The study, published in The Lancet and conducted by researchers at the Institute for Health Metrics and Evaluation (IHME), provides the first global sex-disaggregated estimates covering 20 categories of health workers across 204 countries and territories between 1990 and 2023.

The findings expose a paradox at the heart of the global healthcare system: women form the backbone of healthcare delivery, but remain disproportionately represented in occupations and positions that attract lower pay and less decision-making power.

Researchers found that the global health workforce almost tripled during the period under review. However, the increase has not been enough to eliminate major shortages, particularly in developing regions.

The study estimates that the world will require an additional 34.4 million doctors, nurses, midwives, dentists and pharmacists to achieve moderate universal health coverage, with some of the most severe shortages concentrated in South Asia and sub-Saharan Africa.

Women dominate healthcare — but not the top

The gender imbalance identified by the study goes beyond the number of women working in healthcare.

Although women make up nearly 70 per cent of the workforce, they remain disproportionately concentrated in professions traditionally associated with lower remuneration and fewer opportunities for advancement.

Nursing and midwifery, for example, have historically relied heavily on female workers, while men remain more strongly represented in some of the higher-paid and more senior areas of medicine and health administration.

This means that simply counting the number of women in healthcare can obscure another problem: who earns more, who makes decisions and who occupies the top positions.

The study found that women continue to face barriers to leadership despite their enormous contribution to healthcare delivery.

In effect, women have become indispensable to the health system without achieving equivalent influence within it.

Africa faces a double challenge

For sub-Saharan Africa, the findings are particularly significant.

The region is already facing some of the world’s largest shortages of trained health professionals, while many countries struggle to recruit and retain doctors, nurses, midwives and other skilled personnel.

Health workers are also unevenly distributed, with professionals more likely to be concentrated in urban centres while rural and underserved communities experience severe shortages.

This creates a double challenge.

African countries must not only train and recruit substantially more health workers; they must also create working conditions that encourage professionals to remain in the system and serve communities where they are most needed.

For women, this means tackling workplace barriers that can push experienced professionals out of the workforce or prevent them from progressing into senior positions.

Why the shortage matters

A shortage of health workers has consequences far beyond hospitals and clinics.

When there are too few doctors, nurses, midwives and other professionals, patients may face longer waiting times, reduced access to essential services and greater pressure on already overstretched healthcare workers.

The shortage can also undermine efforts to improve maternal and child health, manage infectious diseases, provide preventive care and respond to public health emergencies.

For countries pursuing universal health coverage, the study’s projected requirement for 34.4 million additional professionals demonstrates the enormous scale of the challenge.

It also suggests that simply building hospitals or purchasing medical equipment will not be enough.

Without people to operate health facilities and provide care, physical infrastructure cannot deliver its full value.

The leadership problem

The researchers argue that increasing the number of women entering healthcare should therefore be accompanied by deliberate efforts to ensure they can stay, progress and lead.

That means addressing issues such as workplace discrimination, unequal opportunities, inadequate maternity support and working conditions that make it difficult for women to combine demanding healthcare careers with family responsibilities.

The study recommends gender-responsive workforce policies, including leadership development programmes, workplace protections, paid parental leave and flexible working arrangements.

Such measures, researchers argue, could help prevent women from leaving the health workforce prematurely while creating clearer pathways into management and senior professional roles.

What this means for Nigeria and Africa

For Nigeria and other African countries, the findings carry particular relevance because the continent simultaneously faces health-worker shortages, uneven distribution of professionals and limited resources for training and retention.

The challenge is not simply producing more graduates.

Governments must also consider where health workers are needed, what skills they require, how they are remunerated and what conditions will persuade them to remain in the profession.

A doctor or nurse trained at considerable public expense can still be lost to another country or another sector if working conditions, remuneration and career opportunities remain unattractive.

The same applies to women who may leave healthcare because of inadequate childcare support, inflexible working arrangements, unsafe workplaces or limited opportunities for advancement.

What the study recommends

The researchers call for sustained investment in:

• Health worker education and training;
• Recruitment and retention;
• Better distribution of professionals;
• Leadership opportunities for women;
• Workplace safety and protection;
• Paid parental leave;
• Flexible working arrangements; and
• Gender-responsive health workforce planning.

They also provide workforce-density benchmarks that countries can use to determine whether they have enough professionals to meet the healthcare needs of their populations.

The data can help governments identify where shortages are greatest and which categories of health workers require urgent investment.

The Bigger Picture

The study essentially reframes the global health workforce debate.

The challenge is no longer simply “How many health workers do we have?”

It is also “Who are they, where are they, what are they paid, who leads them, and what conditions allow them to remain in the profession?”

For women, the numbers tell a compelling story. They have become the majority of the global health workforce, yet the professional and economic structures surrounding healthcare have not fully caught up with that reality.

For Africa, meanwhile, the challenge is even more urgent: the continent needs significantly more trained professionals while also creating systems capable of retaining the workers it already has.

Bottom Line

The finding that women make up nearly 70% of the global health workforce demonstrates their central role in delivering healthcare worldwide.

But their numerical dominance has not produced equal professional power.

As countries race to close an estimated 34.4-million-worker global health gap, researchers argue that governments must pursue two goals simultaneously: train more health professionals and build fairer systems that allow women to earn, advance and lead on equal terms.