Tuesday 7 April marks World Health Day, an important day in the global development calendar as well as an opportunity to celebrate health workers. Health workers play an important part in our lives – if we are lucky enough to have one within reach, that is. They are also the single most important element of any health system. In No Child out of Reach, Save the Children established that the ability of health systems to meet the needs of the population depends largely on the size, skills, distribution and commitment of its workforce.
The recent Ebola outbreak in West Africa serves as a stark reminder of health workers’ heroic role, many working tirelessly to save children’s lives and risking their own in the process. The Ebola crisis exposed one of the biggest hurdles the world faces both in terms of dealing with such extreme situations as well as in ensuring access to healthcare full stop: the health worker crisis.
Acute health worker shortage
The World Health Oganization (WHO) recommends that countries have a minimum of one health worker (a doctor, nurse or midwife) per 439 people to ensure the provision of adequate coverage of essential services. Yet, many countries fall far below that magic number. In our recent A Wake up Call report, we highlighted the chronic shortage in Guinea (one health worker per 1,597 people), Liberia (one per 3,472 people) and Sierra Leone (one per 5,319 people). Compare this to one for 88 people in the UK and you get the picture.
But Guinea, Liberia and Sierra Leone are far from being the only countries in the world to experience a health workforce shortage. Save the Children recently compiled a Health Access Index which demonstrates that the health systems of many low-income countries are massively understaffed and underfunded. In Niger the health worker gap is huge, with one health worker per 6,410 people.
The extent of the problem
Estimates on the extent of the health workforce shortfall vary widely, between 7.2 million doctors, nurses and midwives, according to the Global Health Workforce Alliance, to a staggering 10.3 million according to the latest figures from the International Labour Organization. The lack of consensus in itself is problematic, but suffice to say that we face a huge uphill battle. And projections are grimmer still, standing at 12.9 million by 2035.
There are numerous and complex reasons for the shortfall, including: poor pay and insufficient incentives; lack of political will to prioritise and invest in health; ineffective aid; ‘underproduction’ due to the lack of medical schools; poor distribution of health workforce between urban and rural areas; and migration.
So, what needs to happen?
Strategies at the local level need to focus on improving health workforce retention, especially in rural and remote areas including through increased financial and non-financial incentives and better training and working conditions.
But more must also be done at the global level to prioritise the health workforce crisis, such as ensuring that all countries abide by the rules of the WHO Global Code of Practice on the International Recruitment of Health Personnel, which aims to establish and promote voluntary principles and practices for the ethical international recruitment of health personnel.
No health without health workers
We live in a world where at least one billion people are unlikely to ever see a health worker in their lives. Predictably, it is the poorest, hardest–to-reach communities that suffer the most.
As part of the wider international discussions on universal health coverage and the SDGs, we have an unprecedented opportunity to address the chronic health workforce shortage, so that by 2030 we can have a world where health workers are appropriately skilled, supported, equipped, motivated and geographically distributed.
So, on 7 April let us give a big shout out to health workers everywhere for their extraordinary contributions and let us make sure that we keep health workers high on the policy agenda, because without them we have no chance of ending all preventable child and newborn mortality or achieving universal health coverage.