Imbalance in the health workforce is a major concern in both developed and developing countries. It is a complex issue that encompasses a wide range of possible situations. This paper aims to contribute not only to a better understanding of the issues related to imbalance through a critical review of its definition and nature, but also to the development of an analytical framework. The framework emphasizes the number and types of factors affecting health workforce imbalances, and facilitates the development of policy tools and their assessment. Moreover, to facilitate comparisons between health workforce imbalances, a typology of imbalances is proposed that differentiates between profession/specialty imbalances, geographical imbalances, institutional and services imbalances and gender imbalances.
Pascal Zurn*, Mario R Dal Poz, Barbara Stilwell and Orvill Adams
Address: Department of Human Resources for Health, World Health Organization, Geneva, Switzerland
Email: Pascal Zurn* - zurnp@who.int; Mario R Dal Poz - dalpozm@who.int; Barbara Stilwell - stilwellb@who.int;
Orvill Adams - adamso@who.int
* Corresponding author
Abstract
Imbalance in the health workforce is a major concern in both developed and developing countries.
It is a complex issue that encompasses a wide range of possible situations. This paper aims to
contribute not only to a better understanding of the issues related to imbalance through a critical
review of its definition and nature, but also to the development of an analytical framework. The
framework emphasizes the number and types of factors affecting health workforce imbalances, and
facilitates the development of policy tools and their assessment. Moreover, to facilitate
comparisons between health workforce imbalances, a typology of imbalances is proposed that
differentiates between profession/specialty imbalances, geographical imbalances, institutional and
services imbalances and gender imbalances.
Introduction
Imbalance in the health workforce is a major challenge for
health policy-makers, since human resources – the different
kinds of clinical and non-clinical staff who make each
individual and public health intervention happen – are
the most important of the health system's inputs [1].
Imbalance is not a new issue, as nursing shortages were
reported in hospitals in the United States of America as
early as 1915 [2]. It remains a major concern to this day,
reported in both developed and developing countries and
for most of the health care professions.
Although imbalance in the health workforce is an important
issue for policy-makers, various elements contribute
to obscuring policy development. First, many reports of
shortages are not borne out by the evidence. Rosenfeld
and Moses [3] show that an overwhelming majority of
newspapers, journals and newsletter articles describing
the nursing situation in the United States presume the
existence of a shortage. They found that even in those
areas where concrete evidence of a shortage was not available,
the term "nursing shortage" still appeared. Second,
the notion of shortage is a relative one: what is considered
a nursing shortage in Europe would probably be viewed
differently from an African perspective. Finally, imbalances
are of different types and their impact on the health
care system varies. In consequence, there is a general need
to critically review the imbalance issue.
The objective of this paper is to contribute to a better
understanding of the issues related to imbalance through
a critical review of its definition and nature and the development
of an analytical framework.
Definition
There are various approaches to defining imbalances [4].
From an economic perspective, a skill imbalance (shortage/
surplus) occurs when the quantity of a given skill supplied
by the workforce and the quantity demanded by
employers diverge at the existing market conditions [5].
Published: 17 September 2004
Human Resources for Health
Received: 18 August 2004
Accepted: 17 September 2004
This article is available from: http://www.human-resources-health.com/content/2/1/13
© 2004 Zurn et al; licensee BioMed Central Ltd.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.2004, 2:13 doi:10.1186/1478-4491-2-13