Neyazi Narges, Yaghmaei Nima, Ahmadzai Mirwais, Kleipool Elisabeth, Naumann Nadine, Wassenaar Myrte, Omar Muhammad Haider, Gedik Fethiye Gülin, Alba Sandra, Dieleman Marjolein, Ibrahimi Abdul Ghani, AbouZeid Alaa
World Health Organization Country Office, Kabul, Afghanistan.
KIT Royal Tropical Institute, Amsterdam, Netherlands.
Confl Health. 2025 Apr 17;19(1):25. doi: 10.1186/s13031-025-00663-3.
Universal health coverage (UHC) is a key component of Afghanistan's health plan, but the country faces challenges due to decades of conflict and instability. Concurrently, healthcare successes have been achieved despite significant shortages in the health workforce. A fit-for-purpose health workforce is crucial for achieving UHC, and requires decision-making by policy-makers driven by sufficient evidence. This study presents a comprehensive situational analysis of Afghanistan's health workforce in 2023, focusing on distribution by geography, gender, facility type, as well as trends in health worker production.
A multi-stage assessment of the active health workforce was conducted through a national census-style count using active registries and facility-level verification through sampled facilities visits. Health worker production was estimated through an analysis of enrollment and graduation figures from public and private institutions from 2019 to 2023.
We estimated 63,632 health workers in Afghanistan in 2023, with 73% in the public sector and 27% in the private sector. Key health workers (physicians, nurses and midwives) total 10.3 per 10,000 population, falling significantly short of the aspirational UHC threshold (44.5 key health workers per 10,000). Substantial geographic disparity exists between provinces, with remote provinces reporting far fewer key health workers compared to the national average and Kabul representing approximately 50% of the country's specialized physicians. Significant gender imbalances exist as only 18% of specialized physicians and 29% of nurses are female. Health workforce production is largely dependent on the private sector, and has declined for certain cadres due to restrictions on female education, which are increasing in severity. Majority female cadres, such as Obstetrics/Gynecology, are anticipating significant declines in active staff, jeopardizing aspirations of UHC.
Afghanistan faces critical health workforce challenges, including shortages, gender imbalances and unequal geographic distribution. These findings provide essential insights for policymakers to guide human resources policies aimed at achieving UHC.
全民健康覆盖是阿富汗卫生计划的关键组成部分，但由于数十年的冲突和不稳定，该国面临诸多挑战。与此同时，尽管卫生人力严重短缺，但仍取得了一些医疗保健成就。一支符合目标的卫生人力队伍对于实现全民健康覆盖至关重要，这需要政策制定者在充分证据的驱动下做出决策。本研究对2023年阿富汗的卫生人力进行了全面的态势分析，重点关注地理分布、性别、机构类型以及卫生工作者培养趋势。
通过全国人口普查式计数，利用活跃登记册并通过抽样设施访问进行机构层面核查，对在职卫生人力进行了多阶段评估。通过分析2019年至2023年公立和私立机构的招生和毕业数据来估计卫生工作者的培养情况。
我们估计2023年阿富汗有63632名卫生工作者，其中73%在公共部门，27%在私营部门。关键卫生工作者（医生、护士和助产士）每10000人口共有10.3人，远低于理想的全民健康覆盖阈值（每10000人44.5名关键卫生工作者）。各省之间存在巨大的地理差异，偏远省份的关键卫生工作者数量远低于全国平均水平，而喀布尔的专科医生约占全国的50%。存在显著的性别失衡，因为只有18%的专科医生和29%的护士为女性。卫生人力培养在很大程度上依赖私营部门，并且由于女性教育限制（这些限制正在加剧），某些干部的数量有所下降。大多数女性干部，如妇产科医生，预计在职人员将大幅减少，这危及全民健康覆盖的目标。
阿富汗面临关键的卫生人力挑战，包括短缺、性别失衡和地理分布不均。这些发现为政策制定者指导旨在实现全民健康覆盖的人力资源政策提供了重要见解。
