Bridging health systems and sustainable development goals: the role of health workforce, international health regulations, and universal health coverage

Achieving Sustainable Development Goals (SDGs), particularly those related to health, requires integrated strategies that reinforce health systems. This study investigates the pathway through which health workforce availability, international health regulations (IHR) compliance, and universal health coverage (UHC) interact to influence SDG performance. We hypothesize that health professional density contributes to SDG achievement through sequential effects on IHR implementation and UHC expansion. We conducted a cross-sectional analysis using publicly available data from 194 countries. Four indicators were analyzed: health professional density per 10,000 population, IHR compliance scores, UHC Service Coverage Index, and two SDG indices—the overall SDG Index representing comprehensive national performance across all SDGs, and the SDG Goal 3. Serial mediation models were applied using SPSS PROCESS macro to assess whether IHR and UHC mediate the relationship between workforce density and SDG performance. Health professional density was positively associated with IHR compliance (β = 0.465, p < 0.001), UHC service coverage (β = 0.506, p < 0.001), and SDG Index scores (β = 0.710, p < 0.001). Mediation analysis confirmed a significant indirect effect of HPD on SDG performance through IHR and UHC (indirect effect = 0.018, 95% CI: 0.008–0.029). UHC had the strongest direct effect on SDG outcomes. Country case comparisons between Korea and the Philippines illustrated the model’s applicability. Health professional density enhances SDG performance through its influence on health security and service coverage. These findings support integrated policy approaches that align workforce development, IHR strengthening, and UHC advancement as mutually reinforcing pillars of sustainable health systems. What is already known on this topic • Health workforce shortages limit progress in both UHC and pandemic preparedness. • IHR compliance is essential for national health security. • The connections among HPD, IHR, UHC, and SDG outcomes have not been jointly quantified. What this study adds • This study is the first to apply a global serial mediation model linking HPD to SDGs through IHR and UHC. • It reveals that the relationship between health workforce and the SDGs is primarily mediated by UHC, which has the strongest direct effect, while IHR acts as an essential upstream enabler for expanding coverage. How this study might affect research, practice or policy • Encourages integrated strategies to invest in health workforce, strengthen IHR capacities, and scale up UHC. • Supports alignment of global monitoring frameworks across HPD, IHR, and UHC metrics.