Recife,Brazil--The world will be short of 12.9 million health-care workers by 2035; today, that figure stands at 7.2 million. A World Health Organization (WHO) report released this month warns that the findings – if not addressed now – will have serious implications for the health of billions of people across all regions of the world.
The report, "A universal truth: No health without a workforce", identifies several key causes. They include an ageing health workforce with staff retiring or leaving for better paid jobs without being replaced, while inversely, not enough young people are entering the profession or being adequately trained. Increasing demands are also being put on the sector from a growing world population with risks of noncommunicable diseases (e.g. cancer, heart disease, stroke etc.) increasing. Internal and international migration of health workers is also exacerbating regional imbalances.
The findings were released at the Third Global Forum on Human Resources for Health together with recommendations on actions to address workforce shortages in the era of universal health coverage. The main recommended actions include:
Increased political and technical leadership in countries to support long-term human resource development efforts.
Collection of reliable data and strengthening human resource for health databases.
Maximizing the role of mid-level and community health workers to make frontline health services more accessible and acceptable.
Retention of health workers in countries where the deficits are most acute and greater balancing of the distribution of health workers geographically.
Providing mechanisms for the voice, rights and responsibilities of health workers in the development and implementation of policies and strategies towards universal health coverage.
“The foundations for a strong and effective health workforce for the future are being corroded in front of our very eyes by failing to match today’s supply of professionals with the demands of tomorrow’s populations,” says Dr. Marie-Paule Kieny, WHO Assistant Director-General for Health Systems and Innovation. “To prevent this happening, we must rethink and improve how we teach, train, deploy and pay health workers so that their impact can widen.”
While the report highlights some encouraging developments, for example, more countries have increased their health workforce, progressing towards the basic threshold of 23 skilled health professionals per 10 000 people, there are still 83 countries below this basic threshold. But it is the future projections that raise the loudest alarms. In a stark assessment, the report says the current rate of training of new health professionals is falling well below current and projected demand. The result will be that in the future, the sick will find it even harder to get the essential services they need and preventive services will suffer.
Whilst the largest shortages in numerical terms are expected to be in parts of Asia, it is in sub-Saharan Africa where the shortages will be especially acute. On education and training, for example, in the 47 countries of sub-Saharan Africa, just 168 medical schools exist. Of those countries, 11 have no medical schools, and 24 countries have only one medical school.
“One of the challenges for achieving universal health coverage is ensuring that everyone – especially people in vulnerable communities and remote areas – has access to well-trained, culturally-sensitive and competent health staff,” says Dr. Carissa Etienne, WHO Regional Director for the Americas. “The best strategy for achieving this is by strengthening multidisciplinary teams at the primary health care level.”
Universal health coverage aims to ensure that all people obtain the health services they need without suffering financial hardship when paying for them. In the Americas, 70% of countries have enough health care workers to carry out basic health interventions, but those countries still face significant challenges linked to the distribution of professionals, their migration and appropriate training and skills mix.
“Training of health professionals must be aligned with the health needs of the country,” adds Dr. Etienne.
All countries are urged to heed the signals of shortages. For example, in developed countries, 40% of nurses will leave health employment in the next decade. With demanding work and relatively low pay, the reality is that many young health workers receive too few incentives to stay in the profession.
The publication also identifies maternal and child health as an urgent health workers’ action area. Around 90% of all maternal deaths and 80% of all still births occur in 58 countries, largely because those countries lack trained midwives. Also, of the 6.6 million under-five year olds who died in 2012, most deaths were from treatable and preventable diseases. Again, more health workers would prevent most of those unnecessary young deaths.
The Third Global Forum for Human Resources for Health is the largest event ever held on human resources for health, with more than 1300 participants from 85 countries, including 40 ministers of health.