A letter to The Lancet from Ms Gabriela Cueva and Dr Justin...
Strong and resilient health systems depend on health workers. Even prior to the COVID-19 pandemic, the capacity to deliver essential health services in many countries was limited due to persistent health workforce shortages and a projected global shortfall of 18 million health workers by 2030.
The pandemic further exposed the impact of these shortages on health systems, while also leading to new ways to rapidly hire and train health workers. It has reinforced the vital importance of leveraging long-term sustainable investments in the health workforce to ensure there are enough health workers attracted, deployed and retained, where they are needed, and with the skills and equipment to do their jobs safely. Over a year into the pandemic, what are the major lessons that we have learned about its impact on health workers? and how can we best mobilize the health workforce to respond to priorities and shortages during emergencies?
1. In many countries the crisis magnified pre-existing workforce shortages
Many countries faced the COVID-19 health emergency with health workforce shortages in key occupational categories and/or imbalanced regional distributions of health workers, leading to disruptions of other essential health services, as many existing health workers were redeployed. In addition, during 2020, further strains were put on the health workforce by COVID-19 infections among health workers, increased workloads in difficult working conditions, and the impact of the crisis on health workers’ mental health. In many countries women, who make up the majority of health workers, have been disproportionally affected. Many health workers had to quarantine, became sick, died, or were absent. This had a negative impact both on individual health workers and on the ability of health systems to respond to COVID-19 and sustain other essential services. WHO guidelines, tools and increase availability of PPE have been useful to countries to decrease infection rates among health workers.
2. Health workforce planning is a crucial element of emergency response
Workforce surge planning during ‘peacetime’ and during the early phases of a crisis can support a more effective response. This requires timely information on the health workforce by occupational profile and distribution across a country. This information is useful to plan workforce needs by phase of implementation strategy for crisis response, occupational categories (specialists, general doctors, nurses, therapists, auxiliary nurses, etc.) and for different levels of health facility (e.g. intensive and intermediate care units). Existing tools had to be modified to account for the percentage of HW infected or in quarantine, while some countries broadened workforce planning to include, for example, graduates and retirees.
3. Countries applied several measures to maintain or increase the health workforce to face the COVID-19 emergency
Many countries found ways of contracting health workers to fill critical needs and shortages, and regulations and policies to facilitate recruitment and deployment of additional staff, and re-deployment of existing staff. Identifying and understanding the mechanisms used by countries (such as recruitment processes, type of redeployment, incentives) will provide evidence on best ways to invest and address shortages during future emergencies. These may include: creating faster recruitment tracks or allowing more freelance contracts, often underpinned by emergency legislation; reorganizing shifts, ‘task shifting’ (i.e. introducing flexibility for different occupational categories to undertake specific tasks) and reassigning staff within facilities or between regions; new hiring of prioritized occupational profiles, mobilizing retirees and pensioned health workers (including from military or police services), and flexibility in authorization and recognition of qualifications, including drawing on students nearing the end of their training. As well as addressing immediate shortages, providing job security and social security for health personnel remains a longer-term challenge.
4. Invest in skills and new delivery models: existing and new competencies for a new disease
COVID-19 demanded training in new competencies to provide the right interventions to the people infected by the COVID-19 virus or using the telemedicine to provide the health services to the population when they cannot come into the facilities. Telehealth and telemedicine are valuable options to improve access of people's care and contribute to the reduction of infections. Many countries issued administrative acts to accelerate and facilitate these options. It is likely there will remain a need to guarantee training and updating of knowledge, and to create guidance on use of innovations such as telehealth beyond the pandemic.
5. Protect health workers, who protect us all
Health worker infections affect not only the well-being of health workers but also the health system, since they increase workforce shortages and decrease response capacity. COVID-19 is highly transmissible and can lead to severe disease. As many countries faced a shortage of personal protective equipment (PPE), health workers were exposed to both the risk of infection and increased stress related to potential risks to themselves and to their families. The pandemic has highlighted that protecting health workers is key to ensuring a functioning health system and a functioning society. The prevention of COVID-19 infection in health workers needs responsive strategies that integrate technical guidance, training and provision of PPE, access to routine testing and (when needed) recognition of COVID-19 as an occupational disease. For the same reason it is crucial that health workers are now prioritized as countries role out COVID-19 vaccination.
6. Invest in learning and evidence for the future
Countries and the international community have found they need more and better information to monitor the impact on the health workforce of COVID-19 and policy response. This is especially timely in 2021, the Year of Health and Care Workers, and is vital to react promptly to the ever-evolving crisis and better prepare for future emergencies. It includes identifying data to collect and methods to assess impact on the health workforce, and specific investments, policies and regulations to facilitate adequate numbers and distributions of suitably skilled and equipped health workers.
The Global Health Workforce Network’s Health Labour Market Hub is developing around 30 Country Case Studies from Africa and Latin America to assess the effect of COVID-19 on health workers, and the policy responses that have been introduced. If you are interested in this topic please join the Health Labour Market hub.
About the author
Juana Paola Bustamante Izquierdo is a Labour Economist who works at WHO, Global Health Workforce Network - Labour Market Hub
This blog from the Global Health Workforce Health Labour Market Hub is part of a curated blog series from the UHC2030 Health Systems Related Initiatives. The UHC2030 Related Initiatives promote collective action for stronger health systems that protect everyone. Find out more.
Photo credit: Covid19 Italy © WHO / Lindsay Mackenzie