Health workforce

Report of the High-Level Commission on Health Employment and Economic Growth

Working for health and growth: investing in the health workforce

The High-Level Commission on Health Employment and Economic Growth was established by United Nations Secretary-General Ban Ki-moon in March 2016. Its task: to make recommendations to stimulate and guide the creation of at least 40 million new jobs in the health and social sectors, and to reduce the projected shortfall of 18 million health workers, primarily in low- and lower-middle-income countries, by 2030. Six months of intensive work and productive discussions, first among the Expert Group and then among the Commissioners, facilitated by ILO, OECD and WHO, have led to this report, which presents the case for more and better investment in the health workforce.


Recommendations of the Commission

The Commission makes ten recommendations that should be read in the context of efforts to strengthen health and social protection systems as well as broader initiatives to implement the 2030 Agenda for Sustainable Development and to meet the targets of the SDGs.

Recommendations to transform the health workforce for the SDGs

Job creation

Stimulate investments in creating decent health sector jobs, particularly for women and youth, with the right skills, in the right numbers and in the right places.

Gender equality and rights

Maximize women’s economic participation and foster their empowerment through institutionalizing their leadership, addressing gender biases and inequities in education and the health labour market, and tackling gender concerns in health reform processes.

Educations, training and competencies

Scale up transformative, high-quality education and lifelong learning so that all health workers have skills that match the health needs of populations and can work to their full potential

Health service delivery and organization

Reform service models concentrated on hospital care and focus instead on prevention and on the efficient provision of high-quality, affordable, integrated, community-based, people-centred primary and ambulatory care, paying special attention to underserved areas

Technology

Harness the power of cost-effective information and communication technologies to enhance health education, people-centred health services and health information systems.

Crises and humanitarian settings

Ensure investment in the International Health Regulations core capacities, including skills development of national and international health workers in humanitarian settings and public health emergencies, both acute and protracted. Ensure the protection and security of all health workers and health facilities in all settings.

Recommendations to enable change

Financing and fiscal space

Raise adequate funding from domestic and international sources, public and private where appropriate, and consider broad-based health financing reform where needed, to invest in the right skills, decent working conditions and an appropriate number of health workers.

Partnership and cooperation

Promote intersectoral collaboration at national, regional and international levels; engage civil society, unions and other health workers' organizations and the private sector; and align international cooperation to support investments in the health workforce, as part of national health and education strategies and plans.

International Migration

Advance international recognition of health workers' qualifications to optimize skills use, increase the benefits from and reduce the negative effects of health worker migration, and safeguard migrants' rights.

Data, Information and Accountability

Undertake robust research and analysis of health labour markets, using harmonized metrics and methodologies, to strengthen evidence, accountability and action.

The Commission calls for urgent action to develop labour market policies to foster the demand for a sustainable health workforce. Government policies are needed to address the systemic issues that result in significant health labour market and public failures.

As the health sector is a growing employer of women, it can greatly contribute to gender equality. Today women are the main providers of care, including in humanitarian crises and conflict settings. Yet gender biases, physical and sexual violence and harassment remain important challenges for health workers.

All countries can do more to prioritize investments in education. Education models should shift away from narrow specializations to focus on lifelong building of locally relevant competencies. Generally, there is a need to relax unnecessary barriers to entry. Addressing geographical inequities is a priority and demographic transitions present opportunities to strengthen youth education for employment in the health sector. Evidence reinforces the effectiveness of community-based health workers, including health professionals as well as other cadres.

Health systems organized around clinical specialities and hospitals will need to shift towards prevention and primary care. There is no prescription for a perfect mix of public and private health-care provision. Governments should adopt policies that cover the performance of the whole sector. Social business models are emerging as a private-sector, socially oriented solution to serve the unserved. Public policies and regulatory bodies must protect the interests of the public and ensure that professional interests do not dominate.

Rapidly changing technologies are already changing the nature of health services. New cadres of health workers are emerging, enabled by information and communication technologies. Digital technologies also provide opportunities to enhance people's access to health services, improve the responsiveness of health systems to the needs of individuals and communities, and improve the delivery of a wide range of health services.

Each country should build the capacity of its health workforce and health systems to detect and respond to public health risks and emergencies. In fragile and conflict settings, public health crises also exacerbate countries’ existing shortcomings for providing basic health and social care to their citizens. Furthermore, health workers and facilities have become deliberate targets in conflict settings.

Most countries can secure sustainable health financing, assuming continuing growth in public revenue, with necessary priority to the health workforce. Societal dialogue and political commitment are critical to drive appropriate macroeconomic reforms and health financing policies. Public policies can also attract co-investments by the private sector. But there is likely to be insufficient market demand to create jobs to achieve the SDGs in low-income and fragile countries. The Commission believes collective action on financing should be taken in those countries.

Achieving a fit-for-purpose health workforce requires actions across all sectors involved with the health labour market. These intersectoral processes must engage public and private sectors, civil society, trade unions, health worker associations, nongovernmental organizations, regulatory bodies and training institutions. The Commission believes the role of official development assistance can help operationalize the SDGs and supports national and international accountability mechanisms.

Demand in high- and middle-income countries is likely to continue to drive health worker migration in the years ahead. The Commission recognizes that the international mobility of health workers may bring numerous benefits to source and destination nations and health workers themselves. However, the adverse effects of migration must be mitigated. An updated broader international agreement on health workforce should include provisions to maximize mutuality of benefit.

Institutional capacity to analyse data is needed for labour market analysis and research. The strength of the data architecture depends on the active engagement of communities, health workers, employers, training institutions, and professional and regulatory bodies. ILO, OECD and WHO have a key role to play in establishing a set of harmonized metrics to transparently monitor trends of the health labour market.