Functional health systems depend on the availability, accessibility, acceptability and quality of health workers. Improving the global health workforce is key to achieving one of the targets under the Sustainable Development Goal (SDG) agenda for health—to “substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries”—as well as several other SDGs related to employment, education and reduced inequalities.

The global maternal health workforce is comprised of care providers with different skillsets who practice in diverse contexts, including physicians, midwives, nurses, community health workers and others. The “Global strategy on human resources for health: Workforce 2030” report estimated the global health workforce shortage at roughly 17.4 million providers as of 2013, of which nine million were nurses and midwives. The authors of the report noted that most countries are not on track to reach a threshold of 4.45 physicians, nurses and midwives per 1,000 people, which will be necessary for accomplishing the health-related SDG targets by 2030. Additionally, the health workforce tends to be concentrated in cities, leaving women in rural areas with limited access to skilled care.

Shortages in the workforce can have dire consequences for maternal health outcomes. One analysis found that countries with higher densities of surgeons, anesthesiologists and obstetricians had significantly lower maternal mortality ratios. Researchers who modeled the projected effects of scaling-up midwifery predicted that a 10% increase in coverage of midwifery-led care would result in a 27% reduction in maternal mortality in low-income countries. Task-sharing and task-shifting are two strategies to manage health worker shortages. Studies from several countries have had success expanding the scope of work of mid-level providers or training community health workers to deliver a number of services such as breastfeeding and immunizations education, safe abortion care and intermittent preventive treatment for malaria. Researchers in Malawi, Mozambique and Tanzania found that medical officers were able to perform safe cesarean section surgery when properly trained. Ensuring that all health workers receive high quality education and pre-service training—and that the health system in which they work has the capacity to administer supportive supervision, opportunities for continuing education and operational management—is essential to improve maternal health.

Given that the majority of health care providers worldwide are women, acknowledging and addressing gender inequities within the health workforce is crucial. For example, in the 2016 “Midwives’ Voices’, Midwives’ Realities” report, midwives working across the globe reported being treated poorly as a result of gender inequality and discrimination, referencing experiences of sexual harassment, violence and social isolation.

An effective maternal health workforce requires not only a sufficient number of workers, but also equitable geographic distribution, diversity in skill, adequate education and training and strong, supportive health systems. All of these components are critical to ensure that health workers are willing and able to provide high quality maternal health care.

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