This year, all member states at the World Health Assembly, including Australia, approved the first Global Strategy on Human Resources for Health: Workforce 2030, responding to what has been widely characterised as a global “health workforce crisis”. In summary, the Global Strategy sets out five main objectives to improve health workforce performance, effectiveness and capacity.
The overall goal is to improve health, social and economic development outcomes through adequate investments to strengthen health systems, and the sustained implementation of effective health workforce policies.
- To optimize performance quality and impact of the health workforce through evidence-informed policies on human resources for health.
- To align investment in human resources for health with the current and future needs of the population and of health systems taking account of labour market dynamics and education policies.
- To address shortages and improve distribution of health workers so as to enable maximum improvements in health outcomes social welfare employment creation and economic growth.
- To build the capacity of institutions at sub-national, national regional and global levels for effective public policy stewardship leadership and governance of actions on human resources for health.
- To strengthen data on human resources for health for monitoring and ensuring accountability for the implementation of national and regional strategies and the Global Strategy itself.
Often oversimplified as a numerical shortage of health workers, the crisis also has management, quality, location and performance dimensions which have been recognised before (hence the much used phrase “right staff, right place, right time, right skills”) but rarely addressed effectively. The Global Strategy emphasizes the importance of a health labour market perspective and an inclusive approach, including broad engagement of consumers and other stakeholders such as professional associations, regulators and critical government functions (e.g. education, finance, health, immigration, labour, and treasury ).
The scale of the global Human Resources for Health or HRH challenge is daunting. New data projections conducted to inform the Global Strategy point to the creation of approximately 40 million new health and social care jobs worldwide by 2030, and to the need for 18 million additional health workers, primarily in low-resource settings, to attain high and effective coverage of the broad range of health services necessary to ensure healthy lives for all.
Whilst many of these health workforce challenges impact most obviously and deeply in the low income countries, high income countries, including Australia have not escaped, and will have to be part of this global approach to problem solving and solution finding. The health sector in many high income countries, including Australia, faces a demographic “double whammy”.
An ageing population generating more demand for health care, is being cared for by an ageing health workforce, with growing concerns about future levels of supply of health professionals.
And it is not just about workforce numbers. Health workforce sustainability is often undermined by under-investment in education and training of health workers in some countries, and by the mismatch between education strategies and health systems and population needs, which result in continuous shortages. These are compounded by difficulties in deploying health workers to rural, remote and underserved areas, an issue always on the policy agenda in Australia.
Shortages and distribution challenges contribute to cross border labour mobility and the international recruitment of health workers from low-resource settings, which can have negative impacts on care delivery. Many high income countries, including Australia, are reliant on international health professionals. About one in three of Australia’s physicians are foreign trained- twice the average for OECD countries, and about 16% of nurses, also twice the OECD average. The Global Strategy has also endorsed the WHO Global Code of Practice on the International Recruitment of Health Personnel, which calls upon countries to strive to use their own HRH to meet their needs, to collaborate towards more ethical and fair international recruitment practices, and to respect the rights of migrant health workers.
The critical role of investment in health, and in the health workforce, is given greater weight and momentum by the recent publication of the report of the UN High-Level Commission on Health Employment and Economic Growth (“the Commission”), chaired by the Presidents of France and South Africa. The Commission identifies the health sector as a leading employment sector and a driver of inclusive economic growth, with increasing evidence on the broader socioeconomic benefits resulting from health workforce investments. Health-care employment has a significant growth-inducing effect on other sectors: this, together with the expected growth in health labour markets, means that investing in health-care education and employment will increasingly represent a strategy for countries at all levels of socioeconomic development to create qualified jobs, particularly for women and youth, in the formal sector. The ten key recommendations of the High Level Commission are summarized below.
Recommendations of the High level Commission
Recommendations to transform the workforce
1. JOB CREATION
Stimulate investments in creating decent health sector jobs, particularly for women and youth.
2. GENDER AND WOMEN’S RIGHTS
Maximize women’s economic participation and foster their empowerment through institutionalizing their leadership.
3. EDUCATION, TRAINING AND SKILLS
Scale up transformative, high-quality education and lifelong learning so that all health workers have skills that match the health needs of populations and can work to their full potential.
4. HEALTH SERVICE DELIVERY AND ORGANIZATION
Focus on prevention and on the efficient provision of high-quality, affordable, integrated, community-based, people-centred primary and ambulatory care, paying special attention to underserved areas.
Harness the power of cost-effective information and communication technologies to enhance health education, people-centred health services and health information systems.
6. CRISES AND HUMANITARIAN SETTINGS
Ensure investment in the International Health Regulations core capacities. Ensure the protection and security of all health workers and health facilities in all settings.
Recommendations to enable change
7. FINANCING AND FISCAL SPACE
Raise adequate funding from domestic and international source to invest in the right skills, decent working conditions and an appropriate number of health workers.
8. PARTNERSHIP AND COOPERATION
Promote intersectoral collaboration at national, regional and international levels; engage civil society, unions and other health workers’ organizations and the private sector; and align international cooperation to support investments in the health workforce, as part of national health and education strategies and plans.
9. INTERNATIONAL MIGRATION
Advance international recognition of health workers’ qualifications to optimize skills use, increase the benefits from and reduce the negative effects of health worker migration, and safeguard migrants’ rights.
10. DATA, INFORMATION AND ACCOUNTABILITY
Undertake robust research and analysis of health labour markets, using harmonized metrics and methodologies, to strengthen evidence, accountability and action.
Health care is labour intensive because it can only be effectively delivered at multiple points of access, by skilled workers, who are enabled to do their job properly by effective planning and management. Whilst many of the HRH challenges will have to be met primarily at national level, there is also a global imperative for shared responsibility and collective response which is set out in the new Global Strategy.