The last WHO EB meeting dedicated some of the session time to discussing issues related to health workers. Besides reporting on the implementation of the Global Strategy on Human Resources for Health, it highlighted particularly
the contribution of community health workers, who are overwhelmingly female, to primary health care and the achievement of universal health care;
the importance of integrating community health worker programs in the broader policies on health workforce and health system development; and
the need for national planning and resource allocation
Announced 2020 as the Year of Nurses
Surely, the above mentioned discussions were important as they underlined the role of community health workers in general and emphasized the importance of nurses. These are often neglected. However, given the huge problems countries are facing in terms of human resources for health and thus in achieving UHC – particularly major shortages of health workers estimated at uncountable millions of workers by 2030 globally, lack of decent working conditions in many countries, such as low salaries or none and deficiencies in occupational safety resulting even in deaths of health workers – the focus on community health workers and the acclamation of a Year of Nurses seem completely insufficient to address the issues and achieve Universal Health Coverage by 2030.
Effective health worker strategies need to focus on a more comprehensive approach that does not put the burden of shortages on the back of those who are lowest paid, or if paid at all, and receive the least amount of training and education compared to other health workers. Not only should we be aware of the resulting gender dimension of such policies but also realize that the inherent risk of these approaches is poorer services for the vulnerable, who usually use the services of community health workers, compared to the better off who can afford to access trained staff.
Quality services for primary health care can only be provided by a sufficient number of health workers at all training and educational levels and supported by decent working conditions. They should be available for all people, be they vulnerable, old, migrants or refugees or living in poor areas. Against this background, financing is key. It is useful to advice countries on the need for national planning and resource allocation. There should be no doubt that a transition from voluntary unpaid work to paid employment for community health workers is the only strategy that can be applied to achieve sustainable results.
But, how much should countries invest and where should the money come from in times of the expected global recession? We should not dream that ministers of finance will be generous, particularly as we also expect them to also react to health damaging developments such as climate change and negative impacts of social determinants of health.
It is thus important to convince governments about the need to develop solidarity in financing, through taxes and contributions to social health protection, when investing in people’s health. Further, it is important to highlight – beside the economic returns in terms of increased employment rates – the social returns of such policies which are key to achieving the Sustainable Development Goals on health, poverty, decent work and gender by 2030: They include contributing to peace, accelerating progress towards equity and leaving no one behind.