A shortage of health workers is pervasive across most countries – and the most worrying aspect is that this gap is increasing. Aggravating the issue is the unmet need for upskilling and reskilling that new disease patterns and emerging technology in healthcare continuously demand.
This shortfall is captured by the following statistics:
• A Global Burden of Disease Study (2017) estimates that only half of all countries have the requisite health workforce required to deliver quality healthcare services, critical to achieving Universal Health Coverage (UHC). For instance, the US requires 1 million nurses and Japan 2.5 million by 2020 and 2025 respectively, and India faces a shortage of over 3.9 million doctors and nurses.
• The global health workforce is unevenly and inequitably distributed. The WHO region of the Americas, with 10% of the global burden of disease, has 37% of the world’s health workforce, whereas the African region, with a 24% disease burden, has only 3% (see graphic below).
Add to this the rising incidence of non-communicable diseases (NCDs) and growing geriatric population – these will generate a demand for 40 million additional health workers globally by 2030. This would require doubling our current global health workforce.
This is a formidable target, unless steps to correct the situation are implemented with a sense of urgency. Without timely action, a shortfall of 18 million workers is predicted by 2030, along with a resultant annual cost to healthcare of $500 billion, due to health workforce inefficiency.
It is therefore imperative to address the shortage of healthcare workforce across the gamut – doctors, nurses, allied health professionals, community outreach workers. We must be on a war footing if we are to meet the UHC targets within set timelines.
There is no alternative to investing in human resources for health; sustainable funding models have to be a critical part of the strategy. A report by the High-Level Commission on Health Employment and Economic Growth reveals return on investment in health at a ratio of 9:1. A further one extra year of average life expectancy has been shown to raise GDP per capita by about 4%.
Addressing the global health workforce shortage has to be a key priority area in national development agendas. Useful steps in a multi-stakeholder participation would include:
1. Strengthening governance grameworks
Setting up strong governance frameworks to guide medical education, health employment, international exchange of medical services, migration of health workers, and innovative partnership models is crucial. Fostering sustainable PPPs would require strengthening of institutional models with high-quality and accessible cross-sectoral inputs, such as finance, education, training, among others.
2. Harnessing technology
The healthcare industry is fast-tracking use of e-health and e-learning techniques, AI, VR simulation and the internet of things to train, upskill and empower health workers. From personalized wearable devices for home-based care, to point of care, drone technology and telemedicine strategies for outreach remote healthcare, all are revolutionizing healthcare delivery. The scaling-up is rapid, based on big data and analytics, and these emerging technologies are also generating more demand for new skills, increasing the potential to employ more in digital healthcare delivery.
A clear roadmap to align technology and the workforce is critical. In India, for instance, the thinktank NITI Aayog, in the National Strategy for Artificial Intelligence and Strategy for New India @75, has already set out plans to bring technology and innovation at the core of healthcare & related policy formations, a crucial step for augmenting healthcare resources.
3. Rebalancing healthcare tasks
As per an OECD global survey, 79% of nurses and 76% of doctors were found to be performing tasks for which they were over-qualified. Given the global evidence for the poor distribution of skills, we must rationally re-organize our workforce for effective management of high-burden diseases, particularly NCDs, which are responsible for 71% of the global mortality and, unless addressed, could cost the world $30 trillion by 2030.
Nurses and GPs can be trained with the essential skill set that enables them to perform select live-saving procedures, recognize acute conditions in time, and make referrals to relevant specialists. This will not only reduce high dependency on limited specialists available worldwide, but also reduce cost and time needed to scale up additional workforce.
4. Developing new care models
Health systems designed around hospitals and clinics need to shift focus towards preventive care, and encourage a holistic health approach encompassing all socio-economic determinants of health. New care models should be created, with a “hub and spoke” arrangement of assets, and workforce trained to provide high-quality, community-based, integrated healthcare, focused on disease surveillance, prevention & ambulatory care. This will not just help avoid unnecessary in-patient and emergency room visits, but will also result in better health outcomes for the community at large.
5. Creating a sustainable and gender-balanced workforce
Evidence points towards gender imbalance and disparities in health employment and the medical education system. According to the WHO, globally only 30% of doctors are females and more than 70% of nurses are females. A similar trend is seen in India, where the majority of the nursing workforce is comprised of women, but only 16.8% of allopathic doctors are females. As per ILO data, gender wage gaps are also a cause for concern. We need pro-active steps to create a balanced healthcare workforce that addresses the issue of gender inequity and ensure equal pay for work of equal value, a favorable working environment, and targets investments towards training the female workforce.
Globally, too there needs to be better mapping of healthcare resources to facilitate collaborations in medical education and exchange programs between countries. For instance, several countries have similar course curriculums for nursing; however, cultural aspects sometimes pose problems. For instance, Sweden and India have a similar nursing curriculum, and there is great potential to encourage exchange of nurses, but the potential for exchange is restricted due to linguistic barriers. This can be easily overcome, and more conducive arrangements put in place to facilitate exchange of healthcare workers.
It is time for all stakeholders in healthcare, be it in the domains of policy, medical education, training or financing, to align with each other on specific issues and targets, and implement steps to augment healthcare workforce productivity towards creating a population-centric workforce.