Nurses and midwives are central to safe and effective service delivery across the care continuum – from hospital care to community-based prevention, chronic disease management and maternal and newborn health. Evidence from evaluations of nurse staffing policy reforms shows that improving registered-nurse staffing is associated with lower patient mortality and readmissions, underscoring that workforce availability is both a capacity and a quality/safety lever (Dall’Ora et al., 2022[1]; McHugh et al., 2021[2]).
Across the LAC33, the density of nurses and midwives averages 3.9 per 1 000 population, well below the OECD average of 10.3 (Figure 8.4). Values range from around 9.7 in Antigua and Barbuda and 9.4 in Paraguay to 0.7 in Haiti and 0.7 in Honduras. Several large countries cluster around 2‑3 nurses and midwives per 1 000 (e.g. Mexico 3.0; Costa Rica 3.1; Panama 3.3), pointing to constraints on scaling team-based primary care and safe hospital staffing. As with doctors, cross-country comparability is influenced by whether countries report practising personnel or all registered/licensed nurses and midwives (see Definition and comparability box).
Midwifery personnel density averages 4.3 per 10 000 population across LAC19, broadly similar to the OECD average of 4.2, but dispersion is large (Figure 8.5). Antigua and Barbuda reports a very high value (29.5 per 10 000), which may reflect differences in how nurse‑midwives are classified and small-population effects; Chile (8.2) and Paraguay (7.8) also stand above the regional average. Several countries report very low densities (≤0.3 per 10 000 in Brazil, Trinidad and Tobago and El Salvador), and Mexico reports a near-zero value. These differences should be interpreted cautiously because midwifery is not recognised as a distinct occupation in some countries, and midwifery functions may be performed by other cadres. Where implemented, continuity of midwife‑led care is associated with lower caesarean and instrumental birth rates and more spontaneous vaginal births.
Skill-mix in LAC, proxied here by the number of nurses and midwives per doctor, is comparatively doctor-heavy in many LAC health systems, as Figure 8.6 shows by plotting the density of nurses and midwives against that of doctors. The figure also highlights overall workforce shortages in several countries. The LAC33 average is 1.6 nurses per doctor, far below the OECD average of 2.9. Several Caribbean countries exceed the OECD average (e.g. Dominica 5.8; Saint Vincent and the Grenadines 5.1; Jamaica 3.5), whereas ratios are notably low in Colombia (0.6), Cuba (0.8) and the Dominican Republic (0.8). Persistently low nurse‑to-doctor ratios typically indicate constrained capacity for prevention, follow-up and care co‑ordination in team-based models of care. The comparatively limited data available for countries like Colombia reflect the fragmentation of human resources for health information sources and inherent issues of comparability.
These indicators point to a dual agenda: (i) expanding and retaining nurses and midwives where densities remain very low, and (ii) improving skill-mix and deployment, so that workers can practise to the top of their competencies – particularly in primary care teams and maternal services. At the same time, cross-country variation in nurse‑to-doctor ratios should be interpreted with caution, as national reporting does not always distinguish consistently between nursing professionals, nursing associate professionals and nurses not further defined. WHO’s latest nursing report suggests that these classification issues remain material for international comparison, even though many observations can be reclassified ex post (WHO, 2025[3]). Evidence syntheses indicate that delegation or substitution of some primary care physician activities to nurses can maintain patient-relevant outcomes across multiple tasks and settings, supporting skill-mix reforms as a practical response to workforce constraints. (Paier-Abuzahra et al., 2024[4]).
