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 comprises care providers with different skillsets who practice in diverse contexts, including physicians, midwives, nurses, community health workers and others. The 2013 “Global strategy on human resources for health: Workforce 2030” report estimated the global health workforce shortage at roughly 17.4 million providers, of which nine million were nurses and midwives. More recent estimates suggest that this shortage will reach about 15 million. The authors of the Workforce 2030 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 Sierra Leone 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.
- Conducting a Sexual, Reproductive, Maternal, Newborn and Adolescent Health Workforce Assessment: A Handbook | United Nations Population Fund, World Health Organization
- Midwifery Series | The Lancet
- Human Resources for Sexual and Reproductive Health Care Series | Reproductive Health Matters
- Systematic review on human resources for health interventions to improve maternal health outcomes: Evidence from low- and middle-income countries
Human Resources for Health | March 2016
- The state of the world’s midwifery 2014
United Nations Population Fund | 2014
- Current and future availability of and need for human resources for sexual, reproductive, maternal and newborn health in 41 countries in Sub-Saharan Africa
International Journal for Equity in Health | May 2017
- Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: A systematic review
BMC Public Health | September 2013
- Midwives’ voices, midwives’ realities
World Health Organization | 2016
- Human resources for health in the low-resource world: Collaborative practice and task shifting in maternal and neonatal care
International Journal of Gynecology & Obstetrics | January 2009
- What prevents quality midwifery care? A systematic mapping of barriers in low and middle income countries from the provider perspective
PLOS One | May 2016
Documents & Reports
The Role of the MHTF
- Addressing Maternal Health Disparities in India
- Inclusion of Respectful Maternity Care in professional Standards for Frontline Maternity Care Providers
- Maternal Health Innovations Fund
- Strengthening the Maternal Health Care System in Ethiopia
- Young Champions of Maternal Health
Meetings & Events
As part of the Advancing Dialogue on Maternal Health Series, the MHTF hosted several events at the Woodrow Wilson Center related to the global maternal health workforce.
- Midwives’ Voices, Midwives’ Realities: Results From the Largest Global Midwifery Survey
- Engaging Health Workers in the Global Movement to End Female Genital Mutilation
- Call the Midwife: A Conversation About the Rising Global Midwifery Movement
- Innovative Training of Birth Attendants
- Human Resources for Maternal Health: Midwives, TBAs and Task-Shifting
Blog series: Global Maternal Health Workforce