A ‘pattern of inequity’ within nursing across the globe must be urgently addressed to achieve universal healthcare, a major report from the World Health Organization (WHO) has warned.
Today on International Nurses Day, the WHO has published its second State of the World’s Nursing (SOWN) report – setting out the latest data, trends and challenges within nursing across 194 countries.
It builds on the findings of the inaugural SOWN from 2020, and while it suggests some ‘global improvement’ in nursing shortages, it also warns that progress is ‘unevenly distributed’ across and within WHO regions.
The report found ‘persistent and worsening inequities’ within nursing – including in the distribution of nurses, nurse education, wages, working conditions and nurse shortages.
‘This inequity trend recurs among and within regions, across countries and within countries, and by country income classification,’ it said.
‘The impacts of the inequities affect patient care and health outcomes, health system functioning, health equity and access, [universal healthcare coverage], and economic and social development.’
And to achieve the United Nations’ Sustainable Development Goals – which include good health and wellbeing for all countries – the WHO report said these inequities in nursing ‘must be addressed and urgently’.
The global stock of nurses
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Data analysis within the report found that the global stock of nurses was 29.8 million in 2023 – reflecting some growth from the previous report which stated there were 27.9 million nurses in 2018.
However, the WHO said there had been some improved data reporting for its second SOWN and also stressed that the ‘global distribution and density of nurses in 2023 is highly inequitable and it masks a shortage of 5.8 million nurses’.
WHO analysis stated the estimated shortage of nurses reduced from 6.2 million in 2020 to 5.8 million in 2023, and is projected to decline to 4.1 million by 2030.
However, 69% of the shortages in 2030 will be in the African and the Eastern Mediterranean regions, the report said.
‘While this report demonstrates a continuing trend of aggregate increase in the global nursing stock, the average growth masks widening inequalities and persisting losses in supply of nurses (from attrition, retirement and international migration),’ the SOWN report said.
Disproportionate access to nursing services
Around 78% of the world’s nurses are found in countries representing only 49% of the world’s population, the report revealed.
And it suggested that high-income countries (HICs), which represent only 17% of the world’s population, host 46% of the world’s nursing population.
While the global density of nurses is 37.1 nurses per 10,000 people, this number is similarly skewered across different regions and nations, it said.
In fact, nurse density in the WHO European region is five times higher than in the African and Eastern Mediterranean regions, the report highlighted.
There is also a tenfold difference between the density of nurses living in HICs compared to those living in low-income countries (LICs).
‘These statistics indicate that much of the world’s population has substantially less access to nurses for services such as maternal and childcare, chronic disease management, and response to public health threats and emergencies,’ the WHO said.
The report also demonstrated significant differences in the number of nursing personnel per regional population number.
For example, in the WHO Africa region, there were 14.1 nursing personnel per 10,000 population in 2023. This contrasts with the European region, which had 76.9 nursing personnel per 10,000 population.
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Global variation in entry-level nurse wages
The report also highlighted the significant differences in the median entry-level wage of nurses by WHO region and income group in 2023.
It describes how the median wages in HICs were twice as high as those in upper middle-income countries, and three times higher than those in LICs.
When adjusted for purchasing power parity (to account for buying goods in different countries), the WHO analysis indicates that the European and Eastern Mediterranean regions have the highest median entry wages, and the WHO African and South-East Asian regions have the lowest.
‘Inequities holding back nurses’
President of the International Council of Nursing (ICN), Dr Pamela Cipriano, said the report shows how inequalities are ‘holding back the nursing profession’ and ‘acting as a barrier to realising UHC’.
‘Delivering on health for all is dependent on truly recognising the value of nurses and harnessing their power and influence to act as catalysts of positive change in our health systems’, she added.
ICN chief executive, Howard Catton, who is also a co-chair of the SOWN report, said: ‘We are used to nurses safeguarding society from catastrophic health outcomes when disaster strikes, just as airbags deploy to protect us in a collision. But without immediate action to invest in and care for our nursing workforce, we risk a perilous future where the nursing airbag will not inflate to offer vital protection to individuals’ and populations’ health.’
He added: ‘The new SOWN report offers us a compass direction, a true north to guide us to build the strong, sustainable, supported nursing workforce we need to support the world’s health and achieve Universal Health Coverage.
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‘We now need the world’s leaders to follow this compass, which depends on facing up to the challenges and taking immediate action.
‘ICN calls on governments worldwide to demonstrate the same courage and commitment that nurses show every day in serving their communities across the globe – by investing in nursing.’
A government spokesperson said: ‘We hugely value the vital work that nurses do every day, and we are supporting nursing students with a grant of £5,000 per academic year, on top of maintenance and tuition fee loans.
‘This government inherited a broken NHS where nurses have been undervalued and demoralised for years – but through our Plan for Change, we will work with staff to rebuild our health service together.’
