Methods for Projecting the Supply of, Need for, and Demand for Health Workers | 31
is, Model 1). Regional data (n = 20) were available for only 11 years (from 2007 to 2018) for the number of physicians and nurses, categorized by nationality (Saudi or foreign), gender (male or female), and facility type (hospital or primary care setting). Furthermore, data were available only for health workers employed by the public MOH and private sectors; regional health worker data from nonMOH public sector employers, such as the Ministry of the National Guard and the Ministry of Defense, were not available. Despite these limitations, these data capture the largest portion (75 percent) of those employed in the public sector. The national proportion of non-MOH health workers out of all public sector health workers was projected (in lieu of disaggregated regional-level data for non-MOH public sector health workers) and added to the regional projections of health workers in the MOH and private sectors to obtain the total projected supply of health workers in Saudi Arabia from 2020 through 2030.
NEED-BASED PROJECTIONS Approaches to defining the need-based criterion Predicting the future need-based requirement for health workers rests on how need is defined. Several approaches for defining this requirement have been used in the past (Ansah et al. 2017; Bruckner, Liu, and Scheffler 2016; Scheffler, Cometto, et al. 2016; WHO 2006). These can be summarized by the six approaches described below. Workforce-to-population ratio is the simplest approach to determining the number of health workers required to serve a given population. The ratio is often taken from a reference country or region with a slightly more developed health care sector for use as a benchmark. Alternatively, an international standard (for example, a standard from the World Health Organization [WHO]) can be adopted. However, this approach does not consider other factors, such as utilization, and it does not take into account any country-specific details. Example: A country could adopt a target workforce-to-population ratio based on another country’s workforce density that it would like to reach. Utilization-based approaches estimate future health care workforce requirements using the current level of services used by the population as a proxy for satisfied demand. This approach assumes that the current consumption of health care services reflects the desired level of consumption of a population that will seek out and have the ability to purchase health care in the current context of the health care system. In other words, setting current utilization as the need-based criteria assumes that the status quo is acceptable. Example: A country could choose the existing utilization level ( for example, 70 percent of the population are vaccinated against influenza) and set the corresponding level of health worker density needed to achieve this utilization level as the target; future health worker numbers would then be determined solely by population growth and, by definition, no shortages would currently exist. A bottom-up need-based approach projects health workforce requirements based on the current estimated health care needs of a particular population (rather than of a different population) to deliver a specific level of health services. In essence, a fully deterministic model is built to delineate the number of full-time equivalent employees required to provide health services. Additional factors, such as burden of disease, can be taken into account and can determine
