Health workforce planning should be strategy or policy-driven: From linear forecasts to normative futures

Health workforce planning (HWP) remains persistently ineffective, a weakness that was starkly exposed during the pandemic and amplified in today's ongoing health permacrisis. Despite the development of increasingly sophisticated workforce models and planning techniques, outcomes continue to fall short. We argue that a central reason lies in how the HWP problem is framed: the dominant reliance on linear, forward-looking forecasting methods constrains both the scope of planning and the relevance of its outputs. We propose reframing HWP through the use of normative futures methods, which begin with a desired future and then work backwards to identify the steps needed to reach it. Such approaches are well established in other complex policy domains and are particularly suited to HWP's long-term horizon, multi-stakeholder setting, and inherent uncertainties. By aligning workforce planning with the strategic directions already articulated in national health strategies, normative backcasting offers three key advantages: (1) improved integration of drivers of change into workforce modelling, (2) more meaningful stakeholder engagement and ownership, and (3) stronger governance through clearer milestones, responsibilities, and monitoring. As a result, HWP is more likely to deliver actionable, timely, and resource-efficient plans. We therefore call on policymakers and planners to shift from linear forecasting toward normative futures approaches to enable more reliable decisions and achieve the health workforce needed for resilient health systems.