Has the global healthcare workforce crisis finally reached a tipping point?

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There is a global healthcare workforce crisis. That healthcare workers are underpaid, overworked and physically and emotionally stressed is widely recognised in many countries. The wider crisis across many nations is well-documented by unions and international organisations.

This week, a decision was made which promises concerted action to end the crisis. Health ministers and ministries from almost 50 countries signed up to a commitment to “address health workforce shortages by concerted action to train, retain, and improve the working conditions of health and care workers”. Governments should be taken on their words and while such a commitment is a step in the right direction, it should lead to concrete and urgent actions on the ground.

The priorities of trade unions, and health unions, are clear.

It’s time for governments to invest in the health sector and its workers

Under-funding, precarious and poorly paid but demanding work in the healthcare sector inevitably leads to staff shortages, which makes over-work and the demoralisation of staff even worse. The World Health Organization (WHO) estimates that there will be a shortfall of 10 million health workers by 2030. Over three million additional healthcare and long-term care workers are already required to improve health system resilience, says the Organisation for Economic Co-operation and Development (OECD). One in five nurses reported in 2021 that they were considering leaving the profession in Belgium, Canada, France, the United Kingdom and the United States.

Global public services union Public Services International published a devastating account of “high work demands, […] long working hours, insufficient rest for recovery between shifts, high emotional demands; high work/life conflict; […] lack of professional development; moral distress […], and with low wages and precarity contributing significantly to financial stress and insecurity in some workforces” in a report at the end of last year on mental health in the public health sector in Sweden, Australia, Canada, Brazil and Liberia. In 2021, UNI Global Union found that care workers were enduring violence, personal protective equipment shortages, poverty wages, understaffing and lack of mental health support one year after the start of the Covid-19 pandemic.

And it is not just unions that are ringing the alarm bells. The OECD’s 2023 report Health Care at a Glance found “worsening working conditions have weakened the attractiveness of healthcare professions. Across the OECD countries, 57 per cent of hospital physicians and nurses perceive staffing levels and work pace to be unsafe”.

Negotiating in good faith with unions, and saying no to austerity

Employers, whether government or private companies, need to negotiate with unions for better wages and working conditions for healthcare workers, on how to tackle staff shortages and improve recruitment and training, and work with unions to identify and implement solutions to the healthcare workforce crisis.

Governments must also refrain from new spending restrictions that would make the healthcare workforce crisis even worse. Years of under-investment left health systems under-prepared for the Covid-19 pandemic, yet there is a real risk of health systems facing post-Covid (and post-energy price crisis) financial cuts.

The OECD reported early last year that “boosting investment in health systems will be essential to deal with future shocks” and later that health systems in the OECD are under renewed financial pressure. The latest OECD Economic Outlook calls fiscal policy to reduce public debt and “stronger near-term efforts to rebuild fiscal space” which means a return to austerity.

EU member states could be forced to collectively cut their budgets by more than €100 billion next year under the Council’s plans to reintroduce austerity measures, warns the European Trade Union Confederation.

Poaching staff from poorer countries is not the answer

Richer countries facing staff shortages in the health sector often recruit staff from poorer countries – leaving those countries’ health systems even more understaffed. In the European Union this has left Bulgaria (amongst others) with a terrible shortage of doctors while African countries including Tanzania and Mozambique have reported the loss of over half of newly qualified health personnel.

In a world of global trade and travel – and global pandemics – poaching staff cannot benefit global health and simply makes global health inequalities worse.

International organisations, including the WHO, OECD and International Labour Organization, need to work together to put much greater pressure on ministers to end the health staff brain drain.

A commitment made by representatives of 40 national governments will not on its own end the global healthcare workforce crisis. But ministers and officials have made that positive commitment and we should hold them to account and work with them to achieve it. It is a chance to make the OECD’s Health Ministerial Meeting the tipping point that starts a serious and co-ordinated effort to tackle the global healthcare workforce crisis.

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