24 Jul Catalyzing Economic Growth and Social Change through the Health and Social Workforce
There is no question that a fit-for-purpose, fit-to-practice health workforce is a critical component in meeting global health goals. From volunteer community health workers in remote rural villages to doctors and health managers in urban hospitals, the health workforce is the primary link to the health system for individuals, families, and communities. If we are to meet the goals of ending preventable maternal and child deaths, Family Planning 2020, controlling the HIV/AIDS epidemic, and protecting communities from infectious diseases, we must ensure that people everywhere have access to a quality health workforce that meets their specific health needs.
On April 19, 2017 a multisectoral group of representatives from USAID, USAID implementing partners, the International Labour Organization (ILO), and the World Health Organization (WHO) gathered at Chemonics in Washington, D.C. to discuss the expansion and transformation of the health and social workforce. The recent recommendations of the High-Level Commission on Health Employment and Economic Growth served as the foundation. These recommendations propose actions to guide the creation of health and social sector jobs as a means for advancing inclusive economic growth.
Specifically, the goals of the meeting were to:
- Promote awareness of the commission’s recommendations
- Brainstorm ideas for greater focus on commission principles and identify areas for collaboration across existing cross-sector portfolios
Commission Recommendations to Enable Change
In her introductory remarks, Ariella Camera, Public Health Advisor for Human Resources for Health (HRH) at USAID, pointed to the agency’s commitment to addressing key HRH challenges through its work in health, education, and economic growth to foster innovation and partnerships.
Continuing with the theme of partnerships, ILO’s Stephen Pursey and WHO’s Tana Wuliji introduced the work of the commission, emphasizing the challenges and opportunities that investing in the global health and social workforce creates for sustainable development and the need to work across sectors to enact change.
Although improvements over the past decade in the health workforce in sub-Saharan Africa have been commensurate with population increases, Wuliji explained, “They haven’t fundamentally led to a new level of workforce capacity in many countries. We cannot keep going the way we have been,” she added, pointing to opportunities to work across sectors. “We need a shift in trajectory.”
The global economy will produce 40 million new health worker jobs by the year 2030, according to the World Bank. But, demand for those positions will come mainly from middle- and high-income countries. Experts project a shortfall of 18 million health workers, largely in low and lower-middle income countries, needed to achieve and sustain a basic level of health care by 2030.
“The shortfall [in low and lower-middle income countries] far outnumbers the demand … When we talk about demand, we’re not talking about population demand. We’re talking about it in the economic sense. So, the ability of the economy to create [health worker] jobs … That means that even if we invest in the supply of health workers in low-income countries — in particular, to train more health workers — the economies will not be able to create the jobs to employ them. Unless we can employ them in the work, we are not going to get the kind of impact in health and also in the broader economy that we would like to have,” Wuliji explained. Ultimately, efforts to advance global health are at threat unless the health and social workforce mismatch can be addressed.
The quality of the jobs needed is also critical. New jobs must be decent jobs, in better conditions of work, with improved occupational safety and health, and recognition of workers’ rights, said Pursey. In the absence of decent jobs, workers will migrate to areas where they can find work, and that can mean leaving their home country. Furthermore, some wealthier countries may not be able to sustain the health workforce they need, mainly as a result of a decline in the working age population. They may have to rely on foreign workers.
“But how do you do that without undermining others’ ability to provide health services,” Wuliji asked. Understanding the dynamics of the labor market is an opportunity for transformative strategies and investments. We can’t just count health workers. We have to study this interdependency. We need to understand the pipeline, where the inefficiencies are, and where labor market and public failures are, she explained. “[There is] no way that the health sector can do it alone.”
The opportunity to achieve multiple goals across the 2030 Agenda for Sustainable Development beyond health (SDG 3) is also critical to highlight. Pursey and Wuliji emphasized the potential impact of health and social workforce investments and action on quality education (SDG 4), gender equality (SDG 5) and decent work and inclusive growth (SDG 8). Women comprise 71 percent of the health and social workforce, yet half of women’s contribution to global wealth is in unpaid care roles. Investments in this workforce has the gender-transformative power to accelerate women’s economic empowerment and participation.
Resource mobilization to stimulate job creation in low- and lower-middle income countries, particularly, is a necessity. “You’ve got to move your fiscal space out at the same pace that you’re moving your health services,” said Pursey. For example, the International Monetary Fund emphasizes expansion of the tax base, which is low in many countries. We also need to take a new look at international investments. “A lot of the international investments in health workforce mainly concentrate on the existing supply — not so much in expanding the supply … We’ve got to look at that again.” In doing so, there is an opportunity to address the health workforce demand and supply mismatch to better position countries to achieve health goals and create decent jobs, particularly for youth and women.
Following the presentations by Pursey and Wuliji, the group engaged in discussion, raising several questions and sharing current activities that further the work outlined by the commission.
Attendees agreed on the need for more accurate health data and analysis of that data. WHO led the development of the National Health Workforce Accounts (NHWAs), a system of standardized health labor market indicators applicable to all health and social workforce occupations. The health sector often overlooks labor force data/surveys, which could be useful for capturing private sector and unregulated occupations. Within the public sector, reliable data doesn’t exist, or it is kept in disparate systems that do not “talk” to one another. In Jordan, for example, the Civil Service Bureau (CSB) keeps health workforce data, but the CSB doesn’t necessarily communicate with the Ministry of Health. Another challenge is data harmonization and ensuring that stakeholders are working with the same health worker definitions. For example, does the description of “community health worker” in Mozambique mirror the definition in Indonesia?
Reliable data can shed light on many of the “mysteries” of HRH — informing policies and planning. In another example from Jordan, research carried out by HRH2030 showed that the country did not, in fact, have severe worker retention issues. Data collection and analysis dispelled this false perception. Data can also help to ensure that the right type of health workers are in the right places at the right times based upon the population’s health needs and epidemiological transitions. HRH2030 is also working in this area.
Labor market and fiscal space analyses have become increasingly important as countries strive to achieve the 90-90-90 targets. Greater shared responsibility for HRH requires greater evidence and analysis to make the business case for increased country HRH investment. HRH2030 is currently carrying out health labor market analyses in several countries in Southern Africa. In South Africa, for example, the program is focused on factors influencing migration of specific cadres between the public and private sectors.
Labor market analyses and implementation of NHWAs can aid in building the evidence base for HRH; however, stakeholders must be equipped to make sound economic arguments for HRH investments. Wuliji proposed development of a playbook that ministries of health could use to negotiate for resources with ministries of finance. Ministries of labor could be potential allies in this cause, Wuliji said, adding that they tend to be better positioned to have these discussions than ministries of health. In line with strengthening the economic argument for HRH, HRH2030 is developing a research methodology to assess potential health, social, and economic gains of HRH investments. The program welcomes contributions from others interested in this topic. HRH2030 recently conducted a literature review, which showed that while there is some evidence for the value of HRH investment, many studies were conducted in high-income countries and evidence for social cohesion, in particular, was scant.
The global health community must also recognize that HRH is not just a health or economic issue; it is also a political issue. In some cases, decision-makers may prefer to put their health investments into equipment, infrastructure, or medicines — something perceived to be more tangible with a more rapid return than HRH (e.g., a new hospital). One argument HRH advocates could use to appeal to leaders in elected positions is the benefit of gainfully employing constituents, particularly youth and women. They can leverage the demands of people wanting decent work.
Finally, when arguing for resources, HRH advocates have to demonstrate efficiency without sacrificing quality or value. As Wuliji pointed out, we need to “instill the sea change in service delivery reforms.” Others noted that stakeholders should explore ways to improve processes — look at how workers are spending their time and how they are distributed. They should also take into account the social workforce. These workers have been trained to work alongside health services. How can health systems better use them to realize system efficiencies and better outcomes?
The challenge for governments and societies going forward will be determining where to place their priorities. As HRH2030 partner Open Development’s Sarah Scheening summarized, “I think recognizing these political forces is important. Recognizing that there is this tremendous deficiency in funding is also really important, and I think being really rigorous in our ROI [is important] … We need to bring clarity to the conversation and not muddy the waters.”
In May 2017, the World Health Assembly adopted Working for Health: Five year action plan for health employment and inclusive economic growth. Through this program, ILO, the Organisation for Economic Co-operation and Development, and WHO are working jointly to catalyze and stimulate the expansion and transformation of the health and social workforce by supporting implementation of the high-level commission’s recommendations in line with the WHO Global Strategy on Human Resources for Health: Workforce 2030.
Organizations participating in the roundtable discussion are listed below. If you are interested in learning more or connecting with any of these groups, please email email@example.com. HRH2030 looks forward to exploring opportunities for future collaboration among USAID implementing partners and other stakeholders in the health and social workforce.
- Abt Associates
- FHI 360
- Global Social Service Workforce Alliance
- International Labour Organization
- Open Development, LLC
- Pan American Health Organization
- World Health Organization