If there is one thing that every health system needs, without exception, it is its health professionals. Ensuring an investment in their training, employment, deployment, retention, performance and protection is a fundamental key to the resilience of health systems, their ability to respond even in the worst crises and the scope of universal health coverage.
Table of contents:
The challenges faced by health systems with their health care personnel
Lack of health personnel, especially in low-income countries
It is estimated that there are approximately 65 million health professionals in the world and that there are some 15 million more (including 2.7 million physicians and more than 7 million nurses) to be able to move towards at least an 80% of universal access to health services.
Of course, the problem is greater in low-income countries, where the density of health personnel is almost 7 times lower than in high-income countries. Although globally many countries (especially middle- and high-income countries) are making progress in reducing the shortage of professionals, the estimated 10 million shortfall by 2030 will be concentrated in the African region, where the number of health workers is barely growing while the population is growing.
The problem of the shortage of health care personnel is not easy to address
The causes of this shortage are many. These include the chronic lack of investment in training, the financial inability of the public sector to absorb the available personnel, the difficulties in attracting and retaining professionals in rural areas, poor and remote areas (resulting in inadequate distribution), lack of oversight, poorly regulated public-private dual practices, limited productivity and performance, and of course migration to rich countries, increasing asymmetry and inequality.
Overcoming these problems requires a thorough analysis of the education sector and the labor market and the factors that determine it, as well as proper planning. In addition, a set of public policies that go beyond "training more people" is needed. These policies must take into account all the dynamics related to the generation of more talent by existing academic institutions (and the alignment of training programs with health priorities and needs), staff entry and exit flows (largely determined by employment conditions), and the causes of inefficiency and low productivity, as well as the regulation of the private sector and its relationship with the public sector.
Challenges with healthcare workers in humanitarian crises
In humanitarian contexts the problem is even more severe and complex, as conflicts, massive forced displacement of the population and the inability of local authorities to respond overlap with the structural weakness of existing health systems.
In complex humanitarian emergencies, health workers are often the target of attacks.
The violence, insecurity and, at times, direct attacks on health professionals cause them to leave their jobs and migrate to more stable and safer areas. Those who stay, generally with less experience and ability to seek options outside that location, are left working in very harsh conditions. They are forced to face enormous stress and workload, with hardly any economic and institutional support, with scarce material resources, medicines and equipment, performing tasks for which they have no preparation simply because there is no one else who can do them, without supervision or accompaniment from more experienced professionals, with enormous limitations in referring patients to higher levels of care, and without social support.
After the acute emergency, the problems with health personnel continue
In protracted humanitarian crises, the public sector is still unable to recover health personnel who had left the country or to serve in the armed forces. In addition, the impact of the crisis on the mental health of staff or the distortions introduced into the system by humanitarian actors who have recruited health personnel have yet to be addressed.
The effects of the interruption of training of new healthcare personnel during the crisis can be long-lasting. Moreover, during the crisis period, in the absence of accreditation systems and standards, much of the healthcare personnel who did stay have received little in the way of continuing education or supervision.
Other problems are the weak governance of a health system under strong political, economic and military pressure, the possible intensification of corruption, the lack of data about the situation and needs to support decision making, or the unequal concentration of resources in areas that have already recovered better or are safer, to the detriment of the most affected areas.
International cooperation to support health personnel
In an acute emergency, and if local authorities are unable to sustain their health personnel, humanitarian aid is key to ensuring the continuity of essential health services. In addition, humanitarian agencies and NGOs can recruit locally or bring in additional staff from abroad to deploy mobile and emergency teams to ensure access to services where the damaged local health system cannot reach. These actions are critical to help stabilize the initial situation before a transition to recovery.
Resources and support for the management of healthcare workers
Along with support to ensure essential healthcare services, technical and financial support for talent and workforce management systems enables an effective early post-crisis recovery to begin as soon as possible. This includes financial and non-financial incentives (such as recognition, participation in decision-making, benefits packages, work-life balance possibilities, career development opportunities), supportive supervision, mentoring and tutoring programs, in-service training and performance appraisal, not to mention psychosocial support.
All this also requires support and training for management and coordination staff who have to perform these tasks under difficult conditions. Often, priority is given to direct support for clinical staff and those who directly provide healthcare services, without taking into account that these people need the support of managers with skills in management, problem solving, strategic planning, risk and safety management, financial management, human resources management and leadership. Quality management, with appropriate incentives, clearly established roles in well-developed job descriptions, and proper organization of work at all levels, is essential to ensure the proper performance of staff.
Coordination with authorities, accreditation systems, and public policies
It is important that efforts to support healthcare personnel in terms of supervision, training, mentoring and performance evaluation be carried out in coordination with public authorities, with regulated curricula and training guides and, if possible, based on a sustainable system of certification and accreditation, which facilitates talent management.
Finally, for adequate coordination and governance of the system, which is key to its post-crisis reconstruction and recovery, new policies for the development of human resources in health may be necessary, even on a provisional or temporary basis. These must take into account the changes that have occurred in the context and the new needs or priorities that now exist.
New policies can help to convene new recruitment processes or update their internal procedures, include new topics (such as gender-based violence or psychosocial support) in training curricula and the competencies of new positions, determine professional categories with their roles and functions, standardize educational and continuing education programs for health personnel for their integration into the system, redistribute health personnel equitably in the different geographical areas, establish certification systems for professionals who during the crisis have developed professionally with humanitarian actors or have received unregulated training, or create mechanisms for evaluation and accreditation of health units, as they recover their functionality and capacity, where new professionals can be incorporated.
Health systems
External links
- Sheffel, 2024. Human resource challenges in health systems: evidence from 10 African countries.
- WHO, 2023. Global health and care worker compact: technical guidance compilation.
- Onvlee, 2023. Human resources for health in conflict affected settings: a scoping review of primary peer reviewed publications 2016-2022.
- Boniol, 2022. The global health workforce stock and distribution in 2020 and 2030: a threat to equity and ‘universal’ health coverage?
- WHO, 2022. Working for health 2022-2030 Action Plan.
- WHO, 2021. Health labour market analysis guidebook.
- WHO, 2016. Global strategy on human resources for health: workforce 2030.
- Roome, 2014. Human resource management in post-conflict health systems: review of research and knowledge gaps.
- Sousa, 2013. A comprehensive health labour market framework for universal health coverage.
- Mowafi, 2012. Facing the challenges in human resources for humanitarian health.
- WHO, 2005. Guide to health workforce development in post-conflict environments.
English 
Español