Where are the paediatricians? An international survey to understand the global paediatric workforce

Beth D. Harper, Waceke Nganga, Robert Armstrong, Kevin D. Forsyth, Hazen P. Ham, William J. Keenan, Christiana M. Russ

Research output: Contribution to journalReview articlepeer-review

15 Citations (Scopus)
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Objective Our primary objective was to examine the global paediatric workforce and to better understand geographic differences in the number of paediatricians globally. Secondary objectives were to describe paediatric workforce expectations, who provides children with preventative care and when children transition out of paediatric care. Design Survey of identified paediatric leaders in each country. Setting Paediatric association leaders worldwide. Main outcome measures Paediatrician numbers, provision of primary care for children, age of transition to adult care. Results Responses were obtained from 121 countries (73% of countries approached). The number of paediatricians per 100 000 children ranged from a median of 0.5 (IQR 0.3-1.4) in low-income countries to 72 (IQR 4-118) in high-income countries. Africa and South-East Asia reported the lowest paediatrician density (median of 0.8 paediatricians per 100 000 children, IQR 0.4-2.6 and median of 4, IQR 3-9, respectively) and fewest paediatricians entering the workforce. 82% of countries reported transition to adult care by age 18% and 39% by age 15. Most countries (91%) but only 64% of low-income countries reported provision of paediatric preventative care (p<0.001, Cochran-Armitage trend test). Systems of primary care provision varied widely. A majority of countries (63%) anticipated increases in their paediatric workforce in the next decade. Conclusions Paediatrician density mirrors known inequities in health provider distribution. Fewer paediatricians are entering the workforce in areas with already low paediatrician density, which may exacerbate disparities in child health outcomes. In some regions, children transition to adult care during adolescence, with implications for healthcare training and delivery. Paediatrician roles are heterogeneous worldwide, and country-specific strategies should be used to address inequity in child health provision.

Original languageEnglish
Article numbere000397
Number of pages9
JournalBMJ Paediatrics Open
Issue number1
Publication statusPublished - 31 Jan 2019

Bibliographical note

© Author(s) (or their employer(s)) 2019. Open access. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/


  • health service
  • paediatric staffing
  • international survey
  • global paediatric workforce


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