Taking advantage of the 2010 population census round to strengthen the global evidence base on the health workforce

Abstract

There is an increasing body of evidence of a strong correlation between the density of trained health workers in a country and improved population health outcomes. Yet many countries lack sufficient numbers and equitable distribution of skilled health workers to deliver essential health interventions, such as immunization and skilled attendance at delivery. The World Health Organization estimates that there are 57 countries, mostly located in sub-Saharan Africa, with crisislevel shortages of doctors, nurses, midwives and other health workers (WHO, 2006). An increasing number of stakeholders – including international and national agencies, non-governmental organizations and the general public – have become sensitive to the importance of planning, developing and strengthening the health workforce in order to meet national and global health and development goals, including the healthrelated Millennium Development Goals. With only five years left until the 2015 deadline to achieve the Millennium Development Goals, 2010 presents a critical opportunity for action to increase investment and support to countries to strengthen their health systems, including their health workforce, to deliver primary health services. Despite the undoubted importance of monitoring the health workforce and impacts on population health outcomes, the empirical evidence to support policy formulation is often fragmented. Many sources can potentially produce information relevant to this issue but remain underused in health research, especially among lowand middleincome countries. Falling into this category are national population censuses. Population censuses with questions on labour force activity and occupation can be a key source for statistics describing the health workforce, providing a comprehensive snapshot of the stock and distribution of health workers in a country (GUPTA et al., 2003; LAVALLEE, et al., 2009). However there are few (if any) documented experiences of health sector planners, managers and policy-makers capitalizing on this resource to inform decision making. In most cases, ministries of health rely exclusively on administrative data sources such as facility staffing records and registries of professional regulatory bodies. While these sources offer many advantages compared to populationbased sources, including being locally available and generally easy to use among non-specialist audiences, having and using a range of data from different sources can help present a fuller picture and minimize the risk of making decisions based on statistics that are incomplete or biased (ABOUZAHR et al., 2007). In Brazil, like many other countries, population censuses are conducted about once every ten years. The last census for which data are currently available, conducted in the year 2000, included questions on occupation among household members of age of economic activity. The coding of responses, as mapped to the national classification of occupations, allowed for statistical delineation and analysis of those with a health-related occupation, such as medical doctors, nutritionists and nursing auxiliaries. As in many other countries, the national classification holds as reference the International Standard Classification of Occupations (ISCO).