Why the workforce is important Picture of the global workforce Based on new analyses of national censuses, labour surveys and statistical sources, WHO estimates there to be a total of 59.2 million full-time paid health workers worldwide. These workers are in health enterprises whose primary role is to improve health(such as health programmes operated by government or nongovernmental organizations) plus additional health workers in non-health organizations(such as nurses staffing a company or school clinic). Health service providers constitute about two thirds of the global health workforce, while the remaining third is composed of health management and support workers. Workers are not just individuals but are integral parts of functioning health teams in which each member contributes different skills and performs different functions. Countries demonstrate enormous diversity in the skill mix of health teams. The ratio of nurses to doctors ranges from nearly 8:1 in the African Region to 1.5:1 in the Western Pacific Region. Among countries, there are approximately four nurses per doctor in Canada and the United States of America, while Chile, Peru, El Salvador and Mexico have fewer than one nurse per doctor. The spectrum of essential worker competencies is characterized by imbalances as seen, for example, in the dire(可怕的) shortage of public health specialists and health care managers in many countries. Typically, more than 70% of doctors are male while more than 70% of nurses are female a marked gender imbalance. About two thirds of the workers are in the public sector and one third in the private sector. Driving forces: past and future Workers in health systems around the world are experiencing increasing stress and insecurity as they react to a complex array of forces some old, some new. Demographic(人口统计学的)and epidemiological transitions drive changes in population-based health threats to which the workforce must respond. Financing policies, technological advances and consumer expectations can dramatically shift demands on the workforce in health systems. Workers seek opportunities and job security in dynamic health labour markets that are part of the global political economy. The spreading HIV/AIDS epidemic imposes huge work burdens, risks and threats. In many countries, health sector reform. under structural adjustment capped public sector employment and limited investment in health worker education, thus drying up the supply of young graduates. Expanding labour markets have intensified professional concentration in urban areas and accelerated international migration from the poorest to the wealthiest countries. The consequent workforce crisis in many of the poorest countries is characterized by severe shortages, inappropriate skill mixes, and gaps in service coverage. WHO has identified a threshold in workforce density below which high coverage of essential interventions, including those necessary to meet the health-related Millennium Development Goals(MDGs), is very unlikely. Based on these estimates, there are currently 57 countries with critical shortages equivalent to a global deficit of 2.@4 million doctors, nurses and midwives. The proportional shortfalls axe greatest in sub-Sabaran Africa, although numerical deficits are very large in South -East Asia because of its population size. Paradoxically, these insufficiencies often coexist in a country with large numbers of unemployed health professionals. Poverty, imperfect private labour markets, lack of public funds, bureaucratic red tape and political interference produce this paradox of shortages in the midst of underutilized talent. Skill mix and distributional imbalances compound today's problems. In many countries, the skills of limited yet expensive professionals are not well matched to the local profile of health needs. Critical skills in public h