Shortfall in health workers and the SDGs

Ensuring there are more jobs in the global health workforce may not seem a significant step towards ending poverty - but it could actually prove game-changing.

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Although the health and social sector is expected to generate some 40 million new health worker jobs by 2030, this is not enough - not by a long stretch.

Health workers are a vital part of every community, both in both high and low income nations. They perform a variety of tasks, from dealing with health threats and preventing disease to providing care at the beginning and often end of each person's life.

According to the World Health Organization (WHO), predictions show there could be a deficit of up to 18 million health workers by then, something that could have detrimental effects on targets set in the 2030 Agenda for Sustainable Development.

The study Global Health Workforce Labor Market Projections for 2030 (Human Resources for Health, 2017 15:11) explains that there is a three-pronged issue with supply of health workers:

1. Availability - i.e. the concrete number of health professionals entering the jobs market

2. Distribution - getting health workers to where they are needed most

3. Performance, relating to productivity and quality of care, linked to training.

Health workers and SGD targets

According to the WHO's Global Strategy on Human Resources for Health report, the largest net shortages of health workers by 2030 are predicted to occur in south-east Asia and the Pacific, due to their relative size.

However, there are also severe challenges in Africa, particularly in the sub-Saharan region.

This causes serious problems for the Sustainable Development Goals for health and wellbeing, which lay out targets including universal health coverage to create health equity by 2030. Clearly, this cannot be achieved with such severe shortage of healthcare workers to roll out this universal care.

Said Gillian Slinger, Senior Project Manager for FIGO’s Fistula Surgery Training Initiative,

“The global shortfall in health care providers is not an abstract risk – it is immediate and life-threatening. Due to a shortage of trained, skilled fistula surgeons, only one woman in 50 has access to fistula treatment. We see these staggering inequalities in access and quality of care across so many critical areas of women’s health, from sexual health and reproductive rights to cervical cancer screening and treatment.

We’re so proud of our amazing FIGO Fellow trainee fistula surgeons, of whom more than one third are women, doing remarkable work, often in very tough circumstances to help women with fistula. Investing in the health workforce, especially in women and young people, is critical for ensuring that every woman, wherever she is in the world, achieves the highest standards of health and wellbeing.”

What is to be done?

Stakeholders and organisations including the WHO have now recognised that reforms and better development of skills are likely to be necessary if these global shortages in health workers are to be averted.

As such, they have been working towards the implementation of programmes that ensure these targets are not simply lofty ambitions, but something tangible and attainable to aim for.

In 2018, the WHO brought in its Five Year Action Plan for Health Employment and Economic Growth (2017-2021) in collaboration with the International Labour Organization and the Organization for Economic Cooperation and Development

This aims to support member states in implementing the recommendations of the High Level Commission on Health Employment and Economic Growth and was adopted at the 70th World Health Assembly.

It aspires to accelerate progress towards UHC by ensuring equitable access to health workers and investing in the expansion and transformation of the global health and social workforce.

The agenda proposes ten recommendations to this end, many of which will "require game-changing interventions and action by member states" to dismantle the belief "that investment in the health workforce is a drag on the economy".

Importantly, the report also recognises the importance of women and young people in addressing the global shortfall of health workers. It recommends that skilled jobs are created for women and youth and that women should be empowered in terms of addressing the inequity in the health education sector.

By 2020, the WHO hopes that all countries will have established accreditation mechanisms for health training institutions and by 2030, will have worked towards halving inequalities in access to a health worker.

A global response to a global threat

The world now seems to be coming around to the necessity of real action towards health-related SDGs. In November 2018, the largest-ever forum focusing on health workers and global health concluded with proposed actions to address the health worker shortfall.

The Dublin Declaration was agreed to by representatives of over 70 countries and includes actions such as setting up an international fund to support the expansion of the health workforce and strengthening the code of practice for the recruitment of health personnel.

Delegates committed to investing in transformative health workforce education and job creation, especially for women and youth, which is a huge step forward.

Director of the WHO health workforce department James Campbell said:

"The entire global community - countries, partners, global agencies - has been energized since the 2016 adoption of the WHO Global Strategy on Human Resources for Health: Workforce 2030.

However, he added: "There is more work to be done. The world must now invest in supporting the technical gaps of those countries in most need. The health-related SDGs will not be achieved unless the global shortfall ... is averted. The next phase will focus on delivering coordinated actions to support for countries to achieve these milestones."

By creating jobs for health workers, particularly youth and women, not only could significant progress be made towards SDG 3, but progress could be made to impact SDG 4 (education), SDG 5 (gender inequality) and SDG8 (work and inclusive growth).

What at first glance appeared to be only one small step towards a sustainable future could truly prove to be a giant leap for all.