Gender inequality in the health workforce in the midst of achieving universal health coverage in Mexico

BACKGROUND: The third Sustainable Development Goal aims to ensure healthy lives and to promote well-being for all at all ages. The health system plays a key role in achieving these goals and must have sufficient human resources in order to provide care to the population according to their needs and expectations. METHODS: This paper explores the issues of unemployment, underemployment, and labor wastage in physicians and nurses in Mexico, all of which serve as barriers to achieving universal health coverage. We conducted a descriptive, observational, and longitudinal study to analyze the rates of employment, underemployment, unemployment, and labor wastage during the period 2005–2017 by gender. We used data from the National Occupation and Employment Survey. Calculating the average annual rates (AAR) for the period, we describe trends of the calculated rates. In addition, for 2017, we calculated health workforce densities for each of the 32 Mexican states and estimated the gaps with respect to the threshold of 4.45 health workers per 1000 inhabitants, as proposed in the Global Strategy on Human Resources for Health. RESULTS: The AAR of employed female physicians was lower than men, and the AARs of qualitative underemployment, unemployment, and labor wastage for female physicians are higher than those of men. Female nurses, however, had a higher AAR in employment than male nurses and a lower AAR of qualitative underemployment and unemployment rates. Both female physicians and nurses showed a higher AAR in labor wastage rates than men. The density of health workers per 1000 inhabitants employed in the health sector was 4.20, and the estimated deficit of workers needed to match the threshold proposed in the Global Strategy is 70 161 workers distributed among the 16 states that do not reach the threshold. CONCLUSIONS: We provide evidence of the existence of gender gaps among physicians and nurses in the labor market with evident disadvantages for female physicians, particularly in labor wastage. In addition, our results suggest that the lack of physicians and nurses working in the health sector contributes to the inability to reach the health worker density threshold proposed by the Global Strategy.