Health Workforce Shortages and Surpluses: The Case of Unsalaried Workers in Kurdistan Region of Iraq

Abstract Background: The health workforce is crucial for achieving universal health coverage (UHC), yet significant inequities persist globally, particularly in the Eastern Mediterranean Region (EMR). This study examines the paradoxical surplus of unsalaried health workers (UHWs) in the Kurdistan Region of Iraq (KRI) amidst global health worker shortages. Method: We conducted an online survey of 585 UHWs in KRI. Results: the research highlights the disproportionate impact on women, who constitute 77% of respondents, and the socio-economic implications of high unemployment rates among female health workers. The study underscores the challenges posed by austerity measures post-2014, leading to a reliance on volunteer work and exacerbating interprofessional tensions. Key findings reveal that the majority of UHWs prefer public sector employment due to perceived job security and societal norms. Conclusion: The study calls for prioritising formal employment, addressing gender inequities, and implementing broader economic reforms to enhance the health workforce's resilience. The findings stress the need for collaborative efforts between regional and central governments to create equitable and sustainable employment opportunities, thereby supporting the overall health system's capacity to achieve UHC.