Reassessing the Human Resources Crisis in Primary Health Care: A Review of Global Findings with New Evidence from 10 Sub-Saharan African Countries

This paper revisits the widely held idea of a “human resources crisis” in primary health care (PHC) across low- and middle-income countries (LMICs). First, we review micro- and macro-level evidence, finding little empirical support for generalized workforce shortages. Providers in LMICs appear to operate with substantial excess capacity, characterized by low caseloads, short consultation lengths, and modest wait times. Second, using nationally representative data from 7,915 facilities across 10 African countries, we estimate that the median provider sees 10.9 patients per day. We suggest that the perceived experience of overcrowding arises from a highly unequal distribution of caseloads, with most visits concentrated among a minority of providers. In other words, the average provider is not busy, but the average patient visits a busy provider. Third, we assess allocative inefficiencies using matched data on provider caseload and competence, documenting that caseloads are not concentrated among more competent providers. Using simulations, we show that this misallocation reduces potential aggregate service quality by 4–33 percent, depending on the country. These findings suggest that failures in PHC service delivery cannot be addressed by simply expanding human resources under existing systems arrangements—the competence, allocation, and utilization of both new and existing providers must be improved to meaningfully impact care quality.