Inequalities in the distribution of the nursing workforce in the Kingdom of Saudi Arabia: a regional analysis.

Background: The global nursing shortage is a growing concern, particularly in regions experiencing rapid population growth and healthcare transformation. This study examines trends and regional inequalities in Saudi Arabia's nursing workforce distribution from 2019 to 2023 within the context of Saudi Vision 2030 and the Health Sector Transformation Program.

Methods: Data from the Ministry of Health's 2023 Statistical Yearbook were used for this study. Nurse-to-1 000 population ratios were calculated across 20 health regions. Inequality in the nursing distribution was assessed using Gini coefficients and Lorenz curves, disaggregated by sector (Ministry of Health vs. private health sector) and nationality (Saudi vs. non-Saudi).

Results: The national nursing workforce increased by 9% from 2019 to 2023, reaching 213 110 nurses. However, nurse-to-population ratios varied significantly across regions, ranging from 3.13 to 9.89 per 1 000 people. The overall Gini coefficient was 0.48, indicating a relatively unequal distribution of nurses across regions. Inequalities were more pronounced in the private health sector (Gini coefficient = 0.69) and among non-Saudi nurses (Gini coefficient = 0.59). While Saudization efforts led to a modest increase-Saudi nationals comprised 44.22% of the nursing workforce in 2023-localization remained uneven across regions and healthcare sectors.

Conclusion: Despite workforce growth and increased localization, Saudi Arabia continues to face considerable regional inequalities in nursing distribution. These disparities require targeted workforce policy interventions, including expanding nursing education opportunities, optimizing working conditions, and implementing strategic workforce plans to distribute nursing resources more equitably. Additionally, offering incentives for deployment in underserved regions will be critical.