Ballpark Estimates of Budget Space for Health Workforce Investments in the 47 Countries of the WHO African Region: A Modelling Study.

Introduction: The needs-based requirement for health workers in the 47 countries of the World Health Organization's African Region is estimated to be 11.8 million by 2030, and the supply will fail to meet the need, leaving an anticipated shortage of 6.1 million by 2030. However, several countries are also having a situation whereby trained health workers cannot be employed due to budget space constraints. This paper sought to explore the level of prioritisation of health and health workforce in government spending, estimate the budget space potential for investing in the employment of health workers using scenario analysis and estimate the budget space gap if all the trained health workers were to be employed. Method: Building on previous work using publicly available data, the study modelled 3 scenarios of health workforce investment (expenditure): (1) business as usual scenario in which it was assumed the level of prioritisation for health from the overall envelope for government spending on consumption, and the prioritisation of HWF from the health sector allocation/budget will be constant. Thus, expansion in the budget space will be a function of economic growth, (2) HWF prioritisation scenario, in which it was assumed that all parameters were held constant, but countries will prioritise at least 43% of their health budget for HWF employment - in line with the regional average and (3) health prioritisation scenario in which it is assumed that countries will prioritise at least 15% of public sector consumption (general government spending) for health - in line with the Abuja target - but maintain prevailing levels of HWF prioritisation from the health budget. A 3-step model was developed first to estimate the annual general government consumption expenditure envelope, from which the public expenditure envelope for health was estimated and then the potential expenditure envelope for the health workforce. Results: On health workforce budget space, the 'business as usual' scenario, showed an estimated expenditure envelope for HWF from all sources could increase from $20.85 billion in 2022 to $31.81 billion by 2030, driven by macroeconomic factors like GDP growth. However, this could be affected by uncertainty in overseas development assistance. In 'HWF prioritisation' scenario, prioritising at least 43% of the health budget for health workforce (HWF) employment increased the HWF envelope by 28%. In the 'health prioritisation' scenario, prioritising at least 15% of public sector consumption expenditure for health (but maintaining the prevailing levels of prioritisation for HWF) could yield $55.32 billion for health workforce employment by 2030. In 2022, there was a 43% deficit in the current spending level to employ and pay the remuneration of all trained health workers in the Region, taking into account government and private sector spending as well as overseas development assistance. This financing gap translates into unemployed health workers, estimated to be 27% (95% CI: 14%-39%) based on data from a subset of 10 countries conducting health labour market analyses. Conclusion: Better prioritising health within the overall government expenditure coupled with highly prioritising the health workforce to at least regional average levels of 43% within the health budget could make a difference in the investments needed to tackle the health workforce challenges. This should, however, be underpinned by ensuring efficient and accountable use of the resources.