How to rebuild robust health workforces: An evidence-based approach

Warnings over an impending crisis in the global healthcare workforce have sounded for many years. They’ve been driven by a diminishing workforce beset with burnout and low morale, against ever-increasing demands. The COVID-19 pandemic heightened vulnerabilities within health systems and amplified these workforce issues, pushing many healthcare workers to their breaking point.

Some positive progress has been made, with a significant increase in the global health workforce reported in The Sustainable Development Goals (SDG) Report 2023: Special Edition, released by the United Nations in July. The report cited that the projected global workforce shortage of 18 million workers by 2030 has been reduced by 8 million. But despite this, it highlights that serious challenges still exist. Regions with the highest disease burden continue to have the lowest proportion of health workers. Even countries with seemingly adequate numbers of health workers are experiencing disparities in their distribution, with rural and hard-to-reach areas not as well served as urban areas.

The Partnership for Health System Sustainability and Resilience (PHSSR) is a non-profit, global, cross-sector collaboration, with a unified goal to improve global health by building more sustainable and resilient health systems. The partnership has commissioned global research that follows a comprehensive framework, developed by the London School of Economics, to assess seven core domains affecting health system sustainability and resilience. The domains are workforce, governance, financing, medicines and technology, health service delivery, population health, and environmental sustainability.

The research findings have identified key challenges for each domain and informed policy experts in the development of evidence-based and actionable recommendations to address them – which can be found in the recent 2023 PHSSR Summary Report that emphasizes the interplay between domains and the essential role of the healthcare workforce in strengthening health systems.

The PHSSR research findings reflect those of the SDG Progress Report Special Edition, finding a shortage and imbalanced distribution of healthcare workers that undermines equity of service provision, disproportionately affecting vulnerable and socio-economically deprived populations. Staff shortages also place increased pressure on those within the workforce, eroding their well-being.

Underinvestment and inadequate workforce development planning, insufficient attention to staff well-being, and policies that have not adequately addressed evolving healthcare needs, have together culminated into the current crisis.

So how can this be achieved? The PHSSR’s evidence-based workforce recommendations lay out a potential roadmap for policymakers, with real-world examples of solutions that are being implemented in the countries studied.

Track workforce changes against population needs with improved data infrastructure to allow more quantitative monitoring. This will support improved workforce planning – something that is high on the agenda of many countries, with Brazil, India and Ireland having reported increasing numbers of health professionals in recent years.

Realize the full value of the healthcare workforce, reframing it from being a “cost” to an “asset”. The workforce’s critical role in supporting healthy populations helps to create healthier economies, making it worthy of investment.

Provide adequate and sustained investment that takes a long-term approach to address the root cause of challenges, avoiding short-term fixes that do not create sustainable change. For example, lengthy training periods for healthcare professionals mean investment is needed now to pay dividends in the future. To do this, commitment needs to be secured from all key stakeholders, lasting beyond shorter-term planning or political cycles to ensure changes are maintained. This philosophy is clearly understood in Belgium, where they are investing in training programmes for nurses and caregivers, with income protection during training and employment.

Improve working conditions to build morale by providing mental health and well-being support, and improving career progression and remuneration, to avoid high turnover and attrition of staff. Switzerland has recently approved several initiatives to address this, looking to improve working conditions for nursing staff through a referendum, while Belgium and the Netherlands have proposed measures to incentivize staff retention.

Build a workforce fit for the future by delivering education and training for existing and new roles, and upskilling workers in health technology and digital health solutions to improve efficiency. The latter approach is being adopted in Belgium and the Netherlands, with proposed measures to take advantage of the potential for digital health technologies to alleviate workloads.

Maximize the impact of the existing workforce by making sure health workers are distributed in alignment with population needs, in terms of location and specialty services, to address inequities in access. Policies and incentives to encourage healthcare workers to pursue careers in underserved areas can help address this. An adaptable workforce that can flex to changing needs is also important and requires policy and regulatory changes to enable task-shifting and expanded scopes of practice for healthcare professionals. Countries such as Belgium, Canada, Greece and Japan reported that rigid professional competences and a 'siloed' approach to healthcare are a barrier to achieving this. Training nurses with cross-specialty skills could empower them to deliver coordinated and high-quality care for an expanding ageing population with higher rates of multiple chronic conditions.

The healthcare workforce is an essential piece of the puzzle to building sustainable and resilient health systems and active economies. Enough evidence has been amassed on the challenges of staff shortages and well-being issues that it faces. Now, armed with research informed recommendations, it is time to make meaningful changes.

Action is urgently needed, but sustained, long-term commitment will be critical to success and to the future well-being of the health workforce and the population as a whole.

The PHSSR Summary Report is available here.