Workforce unemployment and underemployment: defining and scaling an overlooked problem in global health systems
1
Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):A3483
ABSTRACT
BACKGROUND:
Health systems globally report critical shortages of health workforce, alongside growing concerns about burnout, retention, and sustainability. At the same time, reports from both high-income and low- and middle-income countries (LMICs) suggests that unemployment and underemployment among trained health professionals persistent. This apparent paradox remains poorly understood, particularly in relation to how unemployment and underemployment are defined and measured.
METHODS:
We conducted a series of systematic and document reviews covering 2000-2024, including (1) the academic literature in high-income countries and LMIC; (2) reports from international organisations such as the World Health Organisation, International Labour Organisation, and the World Bank. Evidence was extracted and synthesised iteratively to examine definitions used, reported prevalence, and data quality.
RESULTS:
We identified 42 academic studies (22 from high-income countries, and 20 from LMICs), and 30 policy reports. Across sources, unemployment and underemployment among doctors and nurses were reported but with marked inconsistency in definitions, indicators, and data sources. Unemployment was variably defined as health workers seeking work or registered at unemployment centres, graduates unable to access internship, and workers reliant on temporary contracts. Underemployment was reported less frequently and referred to constrained working hours, skills mismatch, or insecure employment contracts. Reported scale varied widely depending on the definitions and data sources. Most academic studies were small-scale, specialty or training institution-based, reported low unemployment but noting delayed labour entry. In contrast, more nationally representative WHO-led Health Labour Market Analyses in LMICs reported substantially higher levels, including estimates of 56.7% and 47.6% in Zambia and Uganda respectively (in 2023), with variation by cadre.
CONCLUSIONS:
Unemployment and underemployment among health workers are inconsistently defined and unevenly measured, leading to wide variations in reported scale across settings. We argue for clearer, aligned definitions, and improved use of regulatory and labour market data to strengthen workforce monitoring and planning.
Health systems globally report critical shortages of health workforce, alongside growing concerns about burnout, retention, and sustainability. At the same time, reports from both high-income and low- and middle-income countries (LMICs) suggests that unemployment and underemployment among trained health professionals persistent. This apparent paradox remains poorly understood, particularly in relation to how unemployment and underemployment are defined and measured.
METHODS:
We conducted a series of systematic and document reviews covering 2000-2024, including (1) the academic literature in high-income countries and LMIC; (2) reports from international organisations such as the World Health Organisation, International Labour Organisation, and the World Bank. Evidence was extracted and synthesised iteratively to examine definitions used, reported prevalence, and data quality.
RESULTS:
We identified 42 academic studies (22 from high-income countries, and 20 from LMICs), and 30 policy reports. Across sources, unemployment and underemployment among doctors and nurses were reported but with marked inconsistency in definitions, indicators, and data sources. Unemployment was variably defined as health workers seeking work or registered at unemployment centres, graduates unable to access internship, and workers reliant on temporary contracts. Underemployment was reported less frequently and referred to constrained working hours, skills mismatch, or insecure employment contracts. Reported scale varied widely depending on the definitions and data sources. Most academic studies were small-scale, specialty or training institution-based, reported low unemployment but noting delayed labour entry. In contrast, more nationally representative WHO-led Health Labour Market Analyses in LMICs reported substantially higher levels, including estimates of 56.7% and 47.6% in Zambia and Uganda respectively (in 2023), with variation by cadre.
CONCLUSIONS:
Unemployment and underemployment among health workers are inconsistently defined and unevenly measured, leading to wide variations in reported scale across settings. We argue for clearer, aligned definitions, and improved use of regulatory and labour market data to strengthen workforce monitoring and planning.
| eISSN: | 2654-1459 |
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