A conference of health leaders outlines the challenges and strategies for addressing shortages of health care workers around the world.
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| Mary A. Pittman | Per-Gunnar Svensson |
The rapidly increasing demand for health care in both developed and developing countries has created an international health care workforce crisis. While the problem of health worker shortages, migration and retention is shared by all of us, solutions must also be shared—they cannot be segmented by stage of economic development or national population size.
Innovations in planning, programming and technology promise increased global health workforce capacity, address the maldistribution of workers, and ensure the rights of patients and caregivers. The challenges of reaching this promise were explored during “A Call to Action: Ensuring Global Human Resources for Health,” an international gathering of researchers, policy-makers, educators, organization leaders and front-line health care workers from more than 40 countries. The conference was supported by a grant from the Bill & Melinda Gates Foundation.
The Challenges
The current worldwide shortage of health workers is estimated to be more than 4 million. In the industrialized world, the World Health Organization (WHO) projects that the need for health care workers will increase by 20 percent over the next 20 years, due to the demands of aging populations. Maintaining present levels of care will require an extra 8.5 million health care workers by 2025. By 2010—two years from now—the United States itself will not have enough health care workers to meet demand.
Developing countries face far more serious shortages. National health care issues and inequities among national health systems spur the migration of health workers from nations where demand for services is high to nations with less acute needs. Health professionals around the globe share a knowledge base, which also facilitates migration. As developed nations attract and assimilate migrant health workers into their health care workforce, developing nations struggle with retention and the costs of educating workers who do not stay in their home countries.
Systems-Based Strategies and Solutions
A Call to Action participants presented new research and identified areas requiring further investigation and investment. One area of focus was the changing work models and skill sets needed by future workers and the impact of those models in the training and mix of caregivers. One of the new models proposes using teams and technology to expand the skilled workforce. Another focus area was the central role hospitals can play in partnership with professional organizations and governmental agencies to create and implement effective plans. Recommendations and current initiatives included:
Creating an adequate, available, competent and motivated health care workforce, thereby strengthening each nation’s health system. Positive Practice Environments is a campaign that brings together organizations representing all health care professions to build better attitudes toward careers in health care and to create more opportunities and better environments for health care workers. This campaign will promote examples of what “resource-limited” environments can do, as well as build trust and hope into the health care systems for both patients and providers. It is led by the World Medical Association in partnership with WHO, the International Labour Organisation, the Global Health Workforce Alliance, the International Organization for Migration, the International Council of Nurses, the International Hospital Federation and other nongovernmental organizations.
Educating the health care workforce to meet the needs of the populations where that workforce is needed. Botswana’s Ministry of Health created a framework for integrated, comprehensive health systems planning. With planning that is responsive rather than reactive, the government can better guide its own human resources development efforts as well as donors’ efforts. In Hong Kong, improved planning will help its universities meet the nation’s need for nurses within the next two years. Meanwhile, the Hong Kong Health Authority has implemented strategies to meet a projected shortfall of 200 nurses per year, including employing nursing students during summer breaks while permanent staff take leaves, and recruiting Australian nurses trained in Hong Kong to provide short-term training and permanent placement.
Providing detailed educational and training plans, and exploiting technology to deliver education and training in different ways. The Hong Kong Authority’s One Nurse, One Plan initiative creates career development plans and personal curricula for 19,800 nurses; the authority also reviews career paths and progression for front-line doctors. The International Council of Nurses (ICN) has developed Leadership for Change, which creates leaders who can work effectively in times of change, and Leadership in Negotiation, which builds negotiation and management skills for nurses and associations.
Examining crossover roles for different health workers. The American Organization of Nurse Executives (AONE) projects that the future work of nurses will change, though the core values of caring and knowledge will remain the same. Future nurses will need the skills to be partners with their patient, coordinators of interdisciplinary teams and managers of care across a highly complex health delivery environment. This new framing of the nursing field may attract a broader set of workers.
Obtaining agreement from funding agencies and developing countries to use a significant part of new funding for health education, training and employment of health workers. Organizations like the Norwegian Agency for Development Cooperation (Norad) are dedicated to mobilizing better national health systems. With other donors, Norad provides grants that are increasingly channeled through state coffers in cooperating countries and through sector basket funds. This nationalization of projects challenges the governments of developing nations to take ownership of processes that can lead to better health for all.
Developing an evidence base that will show how to develop and scale up health professional education and training in practice. The Global Health Workforce Alliance has helped implement successful national strategies to increase the number of health workers and has developed an information base of successful strategies and best methods for planning and implementing them. It also promotes political visibility through advocacy and cooperation. The African Health Workforce Observatory includes a learning site program, a community health workforce program, a component to track accountability, a program that builds leadership and management capacity, and a component that brokers knowledge.
Setting policies to encourage the ethical recruitment of health workers internationally. The Commonwealth Code of Practice for the International Recruitment of Health Workers offers guidelines for fair recruitment practices and suggests the goal of achieving self-sufficiency for developed countries. For developing countries, the code outlines obligations for respecting the rights of the individual migrant worker and developing strategies to improve recruitment and retention.
As Mary Robinson, founder of Realizing Rights: The Ethical Globalization Initiative, said, “The issue of health worker migration … poignantly illustrates our global connectedness and dependence on each other. It clearly points to the fact that sending and receiving countries must talk constructively and creatively about these issues, which are projected to be with us for decades to come.”
Building Bridges
Today the climate is right for tackling the health worker agenda. Building partnerships, networks and alliances—locally, nationally, internationally and across sectors—is critical to strengthening health systems and attracting and retaining competent and dedicated health care workers. Collaborative efforts to understand and address the workforce gaps will be beneficial to all nations.
Mary A. Pittman, Dr. P.H., is president and CEO of the Public Health Institute in Oakland, Calif., and former president of the Health Research & Educational Trust. Per-Gunnar Svensson, Ph.D., is director general of the International Hospital Federation in Ferney Voltaire, France.
A complete report from the conference can be accessed at www.hret.org.
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