Invest in the Health Workforce: That is how we keep the UHC promise

The New York High-Level Meeting on Universal Health Coverage held in September 2019 confirmed the commitments and a political declaration achieve UHC by the year 2030. At country level, the debate continues on what these commitments mean and, specifically, what actions countries must take to keep their promise of providing UHC and realize all people’s right to health. 

On Universal Health Coverage day, it is pertinent we move beyond debates on financing models and discussions of the health system as a money-consuming sector where efficiency revolves around ensuring products such as drugs and equipment. We need to talk about the health workers, the nurses, the doctors, the midwives, the clinical officers and many others that will actually deliver UHC.

No stable health systems without a stable health workforce 

Currently we face an 18 million shortage of health professionals worldwide. The most pressing shortages are in those countries with the highest disease burdens, especially in Sub Saharan Africa. With globally aging populations, increasing and changing disease patterns, and fragmented health systems in countries experiencing civil strife, the demand for health workers can only skyrocket. An estimated 40 million more health workers will be needed by the year 2030 with nearly one in four jobs being in the healthcare sector if countries are to deliver UHC to all people.

International migration of health workers is increasing, and projections do not show any expectation of this slowing down. Patterns of health worker mobility are complex. There is substantial movement from the Global South to the Global North but increasingly we learn of significant intra-regional, South-South, and North-South mobility and migration. However, data on the migration numbers is not readily available for many countries and awareness as well as implementation of WHO Global Code of Practice on the International Recruitment of Health Personnel is limited. Coupled with commercial and other interests which heavily influence human capital flows worldwide, the stability of the health workforce is threatened. Yet, healthcare systems can only be stable and resilient with a stable health workforce.

Keep the practical promise: absorb and retain health workers

Some countries have increased their investments in health workforce training, resulting in several thousands of newly qualified doctors, nurses and midwives every year. Other countries have decreased their training investments to rely mostly on filling their gaps with migrant health workers. However, without a dedicated effort to ensure absorption and retention of health workers, including through decent working conditions, neither of these strategies will lead to a larger, more stable health workforce. 

 “Invest in the health workforce component of the healthcare system.” This is the well-known chorus and commitment heard at many health conferences and fora worldwide. However, this commitment is not as strong as the political commitment to achieve UHC. So: what does keeping the UHC promise mean as far as health workforce is concerned? It actually means a practical action to absorb trained and qualified health workforce into the healthcare system and retaining them to ensure everyone, everywhere has access to a skilled, motivated and supported health worker.

There is no universal health coverage without health workers. Health workers must be trained, absorbed and retained to acquire the skills and competencies necessary to respond to the world’s disease burden. They are the key investment. 

Political leaders must keep the UHC promise by showing action on how they organize and treat and invest in the health workforce, not by the number of speeches and declarations reminding citizens of how committed they are to achieving UHC.

Dr. Ouma Oluga is a Physician and Co-Chair of Health Workers For All Coalition.