The following data were gathered from the professional bodies, but there is no information about whether these numbers refer to public or private sector. We assume that these numbers refer to both private and public sectors.

References:

Conselho Federal de Medicina. (2020). Demografia Médica no Brasil. https://www.fm.usp.br/fmusp/conteudo/DemografiaMedica2020_9DEZ.pdf

Conselho Federal de Enfermagem. (2019). Enfermagem em Números Conselho Federal de Enfermagem—Brasil. http://www.cofen.gov.br/enfermagem-em-numeros

In 2019, Hong Kong has 196 doctors, 2 geriatricians, 2 neurologists, 99 Chinese medicine practitioners, 568 registered nurses, and 190 enrolled nurses per 100,000 population (Department of Health, 2019b; The Medical Council of Hong Kong, 2017).

References:

Department of Health. (2019b). Health Facts of Hong Kong 2019 Edition.  Retrieved from https://www.dh.gov.hk/english/statistics/statistics_hs/files/Health_Statistics_pamphlet_E.pdf.

The Medical Council of Hong Kong. (2017). Annual Report 2017. Retrieved from Hong Kong: https://www.mchk.org.hk/files/annual/files/2017/MCAR_2017_e.pdf

Exact figures of the human resources for health in India are not available. Estimates suggest there are 7.35 medical doctors (World Health Organization (WHO), 2020) and 17.48 nursing and midwifery (WHO,2020), for every 10,000 population in India. The health workforce is more concentrated in the private sector and urban areas (KPMG, 2017).

In 2015, it was reported that 3,812 neurologists were associated with the professional associations for neurologists in India, which is about approximately 70% of the total number of neurologists in the country (Ganapathy, 2015). We modelled this information to estimate that India could be having just about 4.3 neurologists for every 100,000 populations, and the distribution being heavily concentrated in the main cities. We do not have an estimate on the number of geriatricians in the country, but there are likely to be fewer than neurologists. There is a skewed distribution of health personnel across India and the local personnel-population ratio could be significantly different from the national averages (Karan et al., 2019).

There is not much emphasis on geriatrics in the curriculum for undergraduate medicine or nursing education. The National Medical Commission (erstwhile Medical Council of India; the regulatory authority for medical education in India) does not mandate the available theory classes offered in some of the universities. In the 11th Five-year plan under the NPHCE, it was proposed to start training for postgraduate’s medical students in geriatric medicine in seven regional institutes along with in-service training of health professionals from district hospitals (including 100 doctors participating in the training). The scheme has been revised and includes more institutes; however, only one institute has started with the implementation. There are only four medical schools that provide postgraduate geriatric programmes. With respect to nurses, The Indian Nursing Council (the national regulatory body for nurses in India) has developed a one year postgraduate diploma course in geriatrics for nurses (Indian Nursing Council, n.d).

References:

Ganapathy, K. (2015). Distribution of neurologists and neurosurgeons in India and its relevance to the adoption of telemedicine. Neurology India, 63(2), 142. https://doi.org/10.4103/0028-3886.156274

Indian Nursing Council (n.d). PB Diploma in Gerontological Nursing. Available from: https://indiannursingcouncil.org/uploads/pdf/15993067779181124165f537c1986349.pdf

Karan, A., Negandhi, H., Nair, R., Sharma, A., Tiwari, R., & Zodpey, S. (2019). Size, composition, and distribution of human resource for health in India: new estimates using National Sample Survey and Registry data. BMJ Open, 9(4), e025979. https://doi.org/10.1136/bmjopen-2018-025979

KPMG (2017). Human resources and skill requirements in the health sector. Ministry of Skill Development And Entrepreneurship and National Skill Development Corporation. Available from: https://skillsip.nsdcindia.org/sites/default/files/kps-document/Healthcare.pdf

World Health Organization (2020). Global Health Workforce Statistics database. World Health Organization. Available from: https://www.who.int/data/gho/data/themes/topics/health-workforce

The WHO, in collaboration with PAHO (2013), conducted a study across 16 Caribbean nations which revealed that there is a total of 43 practicing psychologists for more than 17.2 million people. The numbers were described as inadequate and have serious implications for PLWD in the Caribbean, but specifically Jamaica where it has been highlighted that there is a shortage of health care professionals.

According to World Bank Data (2017), Jamaica has a ratio of 1.3 physicians to every 1,000 persons (as compared with, for example, Trinidad and Tobago which has 2.7 physicians per 1,000 persons or Cuba, which has 8.2 physicians to every 1,000 persons).

On March 24, 2020, Jamaica received 150 specialist nurses and doctors from Cuba to assist in meeting the healthcare demand to fight against COVID-19.

References:

The World Bank. (2017). Physicians (per 1,000 people) – Jamaica, Cuba, Trinidad and Tobago. Available from: https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?locations=JM-CU-TT

World Health Organization, & PAHO. (2013). WHO-AIMS: Report on Mental Health Systems in Latin America and the Caribbean. Pan American Health Organization. https://www.mhinnovation.net/sites/default/files/downloads/innovation/reports/WHO-AIMS-REPORT-on-mental-health-systems-in-latin-american-and-the-caribbean.pdf

With the steady population growth in Kenya, a greater health workforce is required in order to efficiently cater for people. Kenya has 20.7 doctors and 159.3 nurses (enrolled and nursing officers) per 100,000 (Republic of Kenya, 2014a). This is considerably lower than the minimum threshold (average of 21.7 doctors and 228 nurses per 100,000 people) recommended by the World Health Organization.

References:

Republic of Kenya. (2014a). Kenya Health Policy 2014-2030. Nairobi, Kenya. http://publications.universalhealth2030.org/uploads/kenya_health_policy_2014_to_2030.pdf

The supply of health workers in Mexico has increased over the past decade, but remains low by OECD standards, in particular the number of nurses. The lack of health workforce puts a lot of pressure on the healthcare system and it endangers its potential to provide quality services. In addition, scarce data is published in Mexico about the state of medical specialists in order to inform the design of policies for training and management of human resources for health.

The only official statistics available show a rate of 2.4 medical doctors and 2.9 nurses per 1 000 inhabitants in Mexico for the year 2017 (DGIS, 2017). These figures are similar to those reported by the OECD (OECD Health Statistics, n.d., accessed 22 June 2019).

In 2017, it was estimated that there was a total of 147,910 specialist physicians in Mexico, for a total population of 123.5 million, a rate of 119 specialist per 100 000 population. Of this total, 69% had current specialty certification and showed a highly unequal distribution among the country with 54% of the total concentrated in Mexico City and in the States of Mexico, Jalisco, and Nuevo León. On average, there were 1.7 male specialists per female specialist physicians (Heinze-Martin et al., 2018). On the other hand, there were 16,895 family physicians^[1] or 14 per 100,000 population in 2017 (Heinze-Martin et al., 2018) and 36,184 general practitioners in 2015 or 29 per 100,000 population (DGIS, 2017).

Regarding specialities more relevant to all forms of dementia, there were 422 Geriatricians, 1,345 Neurologists (adult and paediatric), 2992 Cardiologists (adult and paediatric) and 4,429 Psychiatrists in the whole country in 2017. It was estimated that there were 3.25 Geriatricians per 100,000 individuals aged 60 years and older, 3.4 Psychiatrists and 2.2 Cardiologists per 100,000 individuals (Heinze-Martin et al., 2018).

While the General Direction of Health Information, DGIS (Dirección General de Información en Salud) at the Ministry of Health reports data on other professional personnel in their official statistics on human resources, these only cover chemists, biologists, pharmacologists, nutritionists, psychologists, and social workers. Other professions such as occupational therapists and community health workers are not defined currently as part of the public and social security health care institutions’ professional health workers.

[1] Family medicine is also a specialisation in Mexico obtained after the general physician/practitioner diploma.

References:

DGIS. (2017). Recursos en salud.

Heinze-Martin, G., Olmedo-Canchola, V. H., Bazán-Miranda, G., Bernard-Fuentes, N. A., & Guízar-Sánchez, D. P. (2018). Medical specialists in Mexico. Gaceta Medica de Mexico, 154(3), 342–351. https://doi.org/10.24875/GMM.18003770

OECD. (n.d.). Health Statistics. https://www.oecd.org/health/health-statistics.htm

The most recent Medical Council of New Zealand (MCNZ) statistics from 2018 (Table 26) (Medical Council of New Zealand, 2018) showed that NZ had 333 doctors per 100,000 people. There is a reliance on international medical graduates (IMG) who account for 40% of the medical workforce. Available data report 33 neurologists in the public sector in 2015 (Ranta et al., 2015) and 72 Geriatricians in 2012 (New Zealand Parliament, n.d.). The proportion of medical doctors of Māori and Pacific ethnicity remains low relative to the proportion of these ethnicities in the NZ population (table 27) (Medical Council of New Zealand, 2018).

Doctors: 

Table 26: Number of medical doctors, neurologists, and geriatricians in NZ

Table 27: proportion of medical doctors by ethnicity and relative to the total population

Nurses:

Nursing council workforce statistics for 2018/19 counted over 50,000 registered nurses, equating to ~1,000 nurses per 100,000 population (Table 28) (Nursing Council of New Zealand, n.d.). This compares with 1160 per 100,000 in Australia, 990 per 100,000 in Canada, and 790 per 100,000 in the UK based on the most recent OECD data. Registered nurses practice independently and in collaboration with other health professionals, perform general nursing functions, and delegate to and direct enrolled nurses, health care assistants and others. Nurse practitioners have advanced education, clinical training and the demonstrated competence and legal authority to practice beyond the level of a registered nurse. Enrolled nurses practice under the direction and delegation of a registered nurse or nurse practitioner to deliver nursing care and health education across the life span to health consumers in community, residential or hospital settings.

As with the medical workforce, Māori (7.6%) and Pacific people (4%) are underrepresented when compared against their proportions of the total NZ population (table 29) (Nursing Council of New Zealand, n.d.).

Table 28: NZ nursing workforce (Nursing Council of New Zealand, n.d.)

Table 29: proportion of registered nurses by ethnicity (Nursing Council of New Zealand, n.d.)

Social workers:

New Zealand has 8,742 social workers registered in NZ as of August 2020 (Social Workers Registration Board website).

References:

Medical Council of New Zealand. (2018). The New Zealand Medical Workforce in 2018. Wellington Medical Council of New Zealand. Available from: https://www.mcnz.org.nz/assets/Publications/Workforce-Survey/434ee633ba/Workforce-Survey-Report-2018.pdf

New Zealand Parliament. (n.d.). Indicator 34: Specially trained physicians. Available from: https://oag.parliament.nz/2013/ageing/our-ageing-population-indicators/indicator-34.

Nursing Council of New Zealand. (n.d.). Tatauranga Ohu Mahi, Workforce Statistics. Available from: https://www.nursingcouncil.org.nz/Public/Publications/Workforce_Statistics/NCNZ/publications-section/Workforce_statistics.aspx?hkey=3f3f39c4-c909-4d1d-b87f-e6270b531145.

Ranta, A., Tiwari, P., Mottershead, J., Abernethy, D., Simpson, M., Brickell, K., et al. (2015). New Zealand’s neurologist workforce: a pragmatic analysis of demand, supply, and future projections. NZ Med J. 128(1419):35-44. Available from: https://pubmed.ncbi.nlm.nih.gov/26365844/.

Social Workers Registration Board website. Available from: https://swrb.govt.nz/.

South Africa is one of five top ranking countries in Africa regarding density of physicians and nurses per 1000 population. However, the country still experiences staff shortages especially in rural areas (Rispel & Padarath, 2018).

The urban-bias in skilled health professionals leaves 44% of the country’s rural population with 19% of the country’s physicians and 12% of its nurses (Rawat, 2012).

Available sources describe South Africa’s health workforce are as follows (DOH, 2011):

Table 11: Total public and private clinical professions in South Africa, 2010

Table 12: Practitioners in public sector for uninsured population

Source: (Docrat, Besada, Cleary, Daviaud & Lund, 2019).

Other sources such as published research articles in South Africa note the following for other medical categories below:

• Psychiatrists 0.1 per 100 000 people (Kalula & Petros, 2011);
• Less than 5 specialists in old-age psychiatry (Kalula & Petros, 2011);
• In 2010, 8 geriatricians were registered for a population of 4 million people of 60 years and older (Lloyd-Sherlock, 2019a).

There was no information found on the number of neurologists registered in South Africa as specialist categories are composite under the category “medical specialists” in the Department of Health and categorised broadly under “medical practitioner” with the Health Professions Council of South Africa (HPCSA).

Gerontology was removed by the South African Nursing Council (SANC) from its specialist training curriculum (Lloyd-Sherlock, 2019a), and despite being urged by the South African Human Rights Commission (SAHRC) to reconsider (SAHRC, 2015), it has not been restored to nursing curriculums.

Officials estimate that approximately 64.7% of the South African population live in rural areas (Mahlathi & Dlamini, 2015) and are served by 12% of doctors and 19% of nurses practicing in the country (DOH, 2011). There are 2.12 medical practitioners per 1000 population that comprise of 0.92 general practitioners and 0.83 specialists (per 1000) in the private sector (Competition Commission SA, 2018). It is estimated that 79% of physicians (Rawat, 2012) and 41.4% of nurses work in the private sector (DOH, 2011). Medical practitioners (i.e., general practitioners) in South Africa are found mostly in the private sector (3.76/10 000 population) compared to the public sector (3.66/10 000 population), with more noticeable imbalances in the Western Cape and Gauteng provinces with 7.64 and 7.32 per 10 0000 population found in the private sector, respectively (DOH, 2011).

References:

Competition Commission SA. (2018). Health market injuiry. Available from:  http://www.compcom.co.za/wp-content/uploads/2018/07/Executive-Summary.pdf

Docrat, S., Besada, D., Cleary, S., Daviaud, E. & Lund, C. (2019). Mental Health system costs, resources and constraints in South Africa: a national survey. Health Policy and Planning, 34, 706-719. https://doi.org/10.1093/heapol/czz085

DOH. (2011). HUMAN RESOURCES FOR HEALTH SOUTH AFRICA (HRH) Department of Health. Available from: http://www.hst.org.za/publications/NonHST Publications/hrh_strategy-2.pdf

Kalula, S. Z., & Petros, G. (2011). Responses to Dementia in Less Developed Countries with a focus on South Africa. Global Aging, 7(1), 31–40.

Lloyd-Sherlock, P. (2019a). Long-term Care for Older People in South Africa: The Enduring Legacies of Apartheid and HIV/AIDS. Journal of Social Policy, 48(1), 147–167. https://doi.org/10.1017/S0047279418000326

Mahlathi, P., & Dlamini, J. (2015). MINIMUM DATA SETS FOR HUMAN RESOURCES FOR HEALTH AND THE SURGICAL WORKFORCE IN SOUTH AFRICA’S HEALTH SYSTEM: A rapid analysis of stock and migration. Available from: http://www.prographic.com/wp-content/uploads/2016/07/0316-south-africa-case-studies-web.pdf

Rawat, A. (2012). Gaps and shortages in South Africa’s health workforce. Backgrounder, 31(June), 1–8. https://doi.org/10.13140/RG.2.1.4424.0805

Rispel, L. ., & Padarath, A. (2018). South African Health Review 2018. Available from: http://www.hst.org.za/publications/South African Health Reviews/SAHR 2018.pdf

SAHRC. (2015). Investigative Hearing Report: Investigating hearing into systemic complaints relating to the treatment of Older Persons. Available from: http://www.sahrc.org.za/construction-site/home/21/files/SAHRC Investigative hearing report.pdf