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With changing lifestyles and ageing populations, chronic diseases have become increasingly common. Bearing this in mind, it has been predicted that by the year 2030, there will be a demand for 40 million new jobs in healthcare worldwide, most of these in high-income countries. In this same period, the shortage of healthcare workers in low-income countries will have grown to 18 million. These numbers are clear and point to the same conclusion: now, more than ever, we need a global strategy to tackle this unequal distribution. Wemos is glad that the 70th World Health Assembly in Geneva in 2017 unanimously adopted the five-year plan ‘Health Employment and Economic Growth’ at (WHA 2017).
| The five-year action plan on ‘Health Employment and Inclusive Economic Growth’ that was adopted during the World Health Assembly in Geneva in 2017 provides a pathway for sustained and evidence-based investments in a strong health workforce, worldwide. Dr Ann Phoya, President of the Association of Malawian Midwives (AMAMI), and keynote speaker at the NVTG Congress on Human Resources, Research and Rights (9 November 2018) will look at the merits and possible pitfalls of this plan. Based on her experiences in Malawi, she will highlight lessons learned from previous initiatives to strengthen the health workforce. But most of all, she will call for attention to the responsibility of governments and international actors to invest in the development and deployment of a strong health workforce, based on their duty to fulfil the right to health, and the right to access a skilled, motivated and supported health worker, for everyone, everywhere. |
The response to the plan from WHO member states [] was overwhelming. New Zealand even concluded its participation in Geneva during the WHA 2017 by saying, ‘We cannot allow this plan to fail.’ This sense of urgency calls for the next necessary steps. The WHO, the International Labour Organization (ILO), and the Organization for Economic Co-operation and Development (OECD) are working together to execute the plan.
Secure sufficient funding
First, money is needed to train health personnel and then to fund jobs. Many low-income countries lack the necessary funds. While ministries of health usually have a fairly good idea of what is needed in terms of health personnel, the budget negotiations with the ministry of finance often are not successful. This is because the health workforce is seen as a recurring cost. To counter this, WHO, ILO and OECD have come up with evidence that new jobs in the health care sector stimulate economic growth. Zambia and Zimbabwe have chosen an original approach to get approval from their ministers of finance for additional health budgets: they present it as an ‘investment case’. But this is not always a formula for success.
The restricted budget and subpar working conditions are a breeding ground for the migration of health workers.
The WHO has drafted guidelines [2] to determine the required number of health workers to guarantee universal access to health services. While it takes health needs as a starting point, in its approach towards the labour market it looks at supply and demand and is guided by a country’s financial capacity to pay for the health workforce. This approach has a downside: it means that if a country has insufficient financial means, it cannot meet its health workforce demand. That is why Wemos rather advocates a human rights approach: everyone worldwide – has the right to have access to health care.
Remove restrictions
Next to sufficient national funds, international co-financing for schools and jobs is indispensable. The problem with this is that in the past the IMF and the World Bank have restricted their health financing to certain limits as a condition for their loans. Although these limits are now called ‘recommendations’, ministers of finance remain too stringent and prefer to limit their financial efforts. In Geneva at the WHA 2017, countries like Zambia, Zimbabwe and Botswana made it clear that they have shortages of fiscal and budget space. As a result, too little money is budgeted for the health workforce and recently graduated health personnel are left unemployed as there are no vacancies. Also, salaries in the public sector are (temporarily) ‘frozen’ and working conditions are far from ideal. As a reminder: we have seen this same situation in the EU member states during the latest financial and economic crisis. And since budgets are once again increasing, the number of vacancies has sky-rocketed, for example in the Netherlands.
Keep providing support
International donors who, until recently, invested in the health workforce, for instance via salaries or top-ups, now hardly do so anymore because they do not want to finance recurring costs. The underlying idea is that spending more money on the health workforce would not be a sustainable solution. Colleagues from low- and middle-income countries tell us that financial support is still lacking. This is why Wemos is encouraging high-income countries to keep providing financial support to countries that need it the most. In an interconnected world, this is not just an optional commitment: the universal right to health obliges us to do so.
Invest in education
Investments are also needed from high-income countries here. The restricted budget and subpar working conditions are a breeding ground for the outward migration of health workers, which is another factor undermining health systems. The prospect of thousands of vacancies in high-income countries is a huge red flag. To prevent a disastrous ‘pull’ effect on health personnel in low-income countries, high-income countries need to take a closer look in the mirror and invest more in health education and training. The WHO Global Code of Practice on the International Recruitment of Health Personnel [3] is definitely still relevant in this light, and that is why Wemos will continue advocating for its implementation with partner organizations.
Work intersectorally
According to the ILO, health workers should organise themselves so that they can collectively advocate for adequate working conditions. The ILO also promotes an intersectoral approach. Ministers of health must therefore talk with their colleagues in education, employment and finance to collectively reach good agreements. This is exactly what Wemos has argued for during the past years. We brought together different ministries, unions, civil society organizations, and employers in the healthcare sector to discuss financing, education and working conditions in the health sector. Encouraged by our newest insights from Geneva, we will continue doing this together with our partners in the Health Systems Advocacy Partnership.
By the year 2030, there will be a demand for 40 million new jobs in healthcare worldwide, most of these in high-income countries.
Read more about the plan in Mariëlle Bemelman’s and Mit Philips’ (MSF) blog in BMJ: https://blogs.bmj.com/bmj/2017/07/24/new-action-plan-to-address-the-global-shortage-of-health-workers-fails-to-address-economic-constraints-to-its-implementation/
This article is an adaptation of a blog which was published on the Wemos website (July 2017): www.wemos.nl/en/we-cannot-allow-this-plan-to-fail-invest-in-health-workforce/
References
- http://apps.who.int/gb/ebwha/pdf_files/WHA70/A70_18-en.pdf
- http://www.who.int/gho/health_workforce/en/
- http://www.who.int/hrh/migration/code/WHO_global_code_of_practice_EN.pdf
