PAHO warns of critical gaps in the health labor market in nine South American countries

The availability of health personnel ranges from fewer than 40 to nearly 118 professionals per 10,000 inhabitants in the region. PAHO calls for strengthening training, retention, and working conditions.

Washington D.C. , April 29, 2026 (PAHO) - The Pan American Health Organization (PAHO) warned today that critical inequalities persist in the availability and distribution of health personnel in South America, with a marked concentration in capitals and large cities and shortages in rural and underserved areas, according to a new regional report.

The report, "Overview of the health labor market in nine South American countries," analyzes the situation in Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Paraguay, Peru, and Uruguay, and for the first time offers a comparative overview of the main inequalities affecting the functioning of health systems in the subregion.

The identified gaps directly impact the availability of specialists, the continuity of services, and the ability of health systems to respond to the needs of the population, particularly at the primary care level.

"The region will not be able to move toward more equitable health systems if gaps in availability, distribution, and working conditions of health personnel are not addressed," said Dr. Jarbas Barbosa, PAHO Director. "This report provides key evidence to guide public policy decisions in order to strengthen the capacity of health systems to respond in a timely and equitable manner," he added.

The analysis identifies common challenges in the nine countries, including an increasing number of professionals holding multiple jobs, migration of health personnel, concentration in urban areas, misalignment between educational supply and the needs of health systems, and marked differences in working conditions between sectors and territories.

Human resources for health densities vary widely between countries, from fewer than 40 professionals per 10,000 inhabitants in some contexts to nearly 118 in others, reflecting regional asymmetries.

Among the main country-specific findings, the report highlights that:

• Argentina shows a strong concentration of doctors in Buenos Aires, growing gaps in residency programs, and significant multiple jobholding.
• Bolivia concentrates 73% of health personnel in three departments and faces persistent difficulties in retaining professionals in rural areas.
• Brazil shows large inequalities between regions, with lower availability in the north and northeast, and a high proportion of multiple contracts.
• Chile reports a shortage of specialists, and difficulties filling vacancies in remote areas.
• Colombia presents marked territorial gaps, a need to strengthen primary care teams, and an educational supply concentrated in large cities.
• Ecuador faces high turnover in remote areas and concentration of personnel in Quito, Guayaquil, and Cuenca.
• Paraguay maintains unfilled vacancies in the public sector and low training in family medicine.
• Peru concentrates 85% of personnel in urban areas and has an estimated shortage of more than 54,000 health workers.
• Uruguay shows high concentration in Montevideo and wage differences between sectors.

"Countries need stronger information systems and comprehensive policies that simultaneously address the training, hiring, distribution, and retention of health personnel," said James Fitzgerald, Director of Health Systems and Services at PAHO.

PAHO urges governments in the region to invest in training and retaining health personnel, improve working conditions, and strengthen workforce planning, with special attention to primary care and areas with the greatest needs.

The report also underscores the importance of coordinating actions between the health, education, and finance sectors, as well as promoting ethical migration policies that protect both health workers and health systems.

Five years before the deadline for achieving the Sustainable Development Goals (SDGs), PAHO reaffirms that placing health personnel at the center of public policy decisions is key to advancing toward universal health coverage.