Health worker unemployment in countries with critical health worker shortages: a rapid synthesis of evidence from 33 countries

Abstract

Introduction: There have been increasing concerns about the overproduction of the health workforce in low- and middle-income countries, leading to unemployment, even as recent literature and country reports point to concurrent shortages based on population health needs. This paradox underscores the need for analyses that synthesise and reconcile these contrasting phenomena. Methods: This is a rapid review of evidence of unemployment for countries that are listed on the 2023 WHO list of safeguard countries, which are countries designated as having critical health workforce shortages. Searches were done in PubMed, Embase and Google for health labour market analyses, peer-reviewed literature and grey literature detailing health workforce physician, nurse or midwife, unemployment. We combined unemployment rates into a weighted estimate (except for graduates) and as trends. We also provided a narrative summary from the literature providing unemployment rate estimates. Results: Searches yielded 99 estimates from 72 sources, representing 33 of the 55 (60%) safeguard countries. 65 estimates were used for quantitative analysis. The weighted average of unemployment was 26.8% for physicians (across 13 countries), 39.7% for nurses/midwives (across 18 countries) and 26.1% in health workforce-wide estimates (across 8 countries). The unweighted average unemployment rate for new graduates is 54.2% across cadres: 58.4% for physicians across eight countries, 68.8% for nurses among six countries and 46.2% for midwives in two countries reported. Trends indicated declines in some countries but general increases in unemployment since 2020. Key findings included the contribution of education-market discoordination to unemployment, the realities of informal health care labor and shortage-unemployment paradoxes and migration and protests as a response to unemployment. Conclusion: The disconnect between health workforce unemployment and critical shortages in many countries underscores deep systemic inefficiencies and missed opportunities to strengthen health systems. Addressing this misalignment is not only urgent, but also essential for achieving universal health coverage and improving population health outcomes.