No UHC without health workers

This week two thousand people gathered in Recife, Brazil for the 3rd Global Forum on Human Resources for Health. As well as looking back on progress made over the past decade, the Forum also looked ahead to the role of health workers in achieving Universal Health Coverage (UHC).

The overarching message from the Forum is that UHC depends on health workers. However, new data published at the Forum warns that we face a current shortage of more than 7.2 million doctors, nurses and midwives, not to mention those uncounted community health workers who are often the only healthcare providers available to the poorest people. This global health worker shortage is set to grow to 12.9 million by 2035 unless urgent action is taken.

A new report by the Global Health Workforce Alliance, which you can explore through a new website produced by Save the Children, backs up the argument that strong health workforces are central to UHC and suggests three guiding questions for decision-makers:

  1. What kind of health workforce is required to ensure effective coverage of an agreed health benefits package?
  2. What kind of health workforce is required to progressively expand coverage over time?
  3. How does a country produce, deploy and sustain a health workforce that is both fit for purpose and fit to practice in support of UHC?

In answering these questions all countries will have to overcome a number of challenges. They must assess what kind of health workforce is required to ensure that all people – rich and poor – can access, utilise and most importantly obtain the quality health services that they need without facing financial hardship. People with policy formulation and implementation skills are also essential for building effective and sustainable systems for UHC.

Removing financial barriers to healthcare may stimulate demand for services that the existing health workforce is insufficiently prepared for. UHC policies that don’t take health workforce considerations into account may result in reduced patient time with their health provider, lower the quality of care, reduce patient satisfaction and potentially lead to worse health outcomes.

Four critical dimensions of human resources for health are at the core of the concept of effective coverage and the right to health: availability, accessibility, acceptability and quality:

Without sufficient availability, accessibility to health workers cannot be guaranteed; and even if availability and accessibility are adequate, without acceptability, the population may not use health services. Finally, when quality of health workers is inadequate, the effects on services in terms of improving health outcomes will be sub-optimal.

The majority of countries with available data are reporting increases in the numbers of doctors, nurses and midwives. However, these gains are often not commensurate with population growth. By 2035, an additional 1.9 billion people will be seeking access to high-quality health care. The UHC process of expanding coverage to a larger proportion of the population therefore requires countries to pay more explicit attention to demographic dynamics in human resources for health planning and forecasting exercises.

Using a simple projection model, the Global Health Workforce Alliance estimates that 107 countries will not have sufficient numbers of health workers required to achieve UHC. As well as increasing the number of health workers, countries also need to take steps to ensure that all health workers are well trained, fairly paid and supported to provide the best possible care.

It is clear that we cannot reach the goal of UHC, or end preventable deaths, without sufficient numbers of skilled and motivated health workers in the places where they are needed most. As countries move towards UHC, they must take into account health workforce requirements and the potential impact of policies on health workers themselves. The international community has a role to play in supporting countries to develop, fund and implement coherent UHC policies that guarantee universal access to skilled health workers and equitable coverage of quality healthcare for all.

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