Critical unemployment or shortage of the health workforce in West Africa? Unravelling the health labour market puzzle in Guinea, 2024

The 2016 global strategy on health human resources highlights the health workforce as a cornerstone of sustainable and resilient health systems. Over the last decade, Guinea has launched great reforms to tackle critical health workforce challenges, including shortages and geographical imbalances. We undertook this study to understand the implications of these reforms on the availability, distribution, gender composition, and employment of the workforce in rural areas. We conducted a health labour market analysis focusing on HRH data in two regions—N’zérékoré and Kindia—using mixed-methods approach. Data were collected from private and public health facilities and training institutions, complemented by policy documents and literature published between 2018 and 2024. The analysis focused on key indicators of workforce production, availability, distribution, employment and gender equity. In 2024, the two study regions reported 9,545 skilled health workers across ten health professions, predominantly state-registered nurses (36.7%), auxiliary nurses (29.7%), and midwives (17.8%), with medical doctors constituting only 4.4%. This reflects a density of 2.0 skilled health workers per 1,000 population in the regional health system—triple the official statistics of 2022. However, 61.2% of this workforce was concentrated in urban and peri-urban areas, serving 28% of the population. Health workforce density varied widely across districts, from 3.9 per 1,000 in N’zérékoré to 0.9 in Beyla. Despite increased production, local absorption and employment outcomes remain poor. Of the 21,176 health workers trained locally since 2016, only 23.7% were absorbed by the regional health system, and 64.1% remain unemployed. The overall health worker unemployment rate reached 74.8%, with nurses, midwives, and nurse-aides most affected. Gender disparities were also notable, as women make up 64.4% of the workforce, yet men disproportionately occupy higher-paying roles such as medical doctors, pharmacists, and managers, and represent 77.4% of specialists. Guinea has made significant progress in skilled health workforce production and availability in rural regions. However, high unemployment and persistent gender inequities threaten the long-term sustainability of these gains. Addressing these challenges will require strengthening the health workforce reporting and financing systems.